Sexual Health and Safety

People commonly equate sexual health with reproductive health. However, sexual health is much broader. According to WHO definition of health has therefore been adapted to define sexual health as:

A state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence (World Association for Sexual Health, 2007)

Sexual safety is important it protects against unwanted pregnancy and STIs. Sexual health is broader than reproductive health and includes sexual freedom, sexual pleasure, and sexual safety. Sexual problems are remarkably common, with the majority of adult women and men reporting at least one sexual problem in the previous year. A substantial minority of women and men have experienced sexual coercion or abuse. This is associated with poor psychological and physical wellbeing, increased health anxiety, increased health service use, and more health-compromising behaviors.

Chronic Pelvic Pain may arise from dysfunction in several different organ systems. Because its underlying causes may be difficult to determine, it may not be possible to give patients the accurate diagnosis or effective treatment they are seeking. Sexual risks include unwanted pregnancies and contracting STIs, both of which can be avoided by practicing safer sex.

Many people feel embarrassed talking about sexual behavior and sexual problems. Let patients know that you are comfortable talking about these issues in a non-judgmental way. When prescribing oral contraception, ensure that patients are aware that non-barrier methods offer no protection against STIs. Encourage individuals and their sexual partner to be tested (and treated) for STIs.

People are more likely to use condoms if you address their attitudes and beliefs. However, it is also important to help people develop the skills needed to negotiate condom use with sexual partners.

Read More

Six-step Approach in Giving Bad News

One of the hardest task in medicine is to give bad news to patients or relatives. This can range from diagnosing a chronic illness to giving news about a death or disability. However, any news that brings with it some restriction or potential loss can be sad or bad news.

Reviews of research in this area have identified three important factors.

1. People appreciate it if the clinician is kind, confident, sensitive, and caring. People also prefer clinicians to show concern and distress rather than being aloof and detached.
2. People appreciate it more if the news is given clearly, using simple terms, and if they have time to talk about it with the clinician and ask questions.
3. People appreciate a quiet and private setting.

Here are the six-step approach whose principle guidelines overlap a good deal

1.	Setting up	Prepare thoroughly for the interview. Make sure you have all the relevant information. Locate the interview somewhere private, where you will not be interrupted. Allow yourself the time to give the news and then deal with people’s responses and questions.
2.	Patient’s perception	Start by checking how much the person already knows and understands so you can tailor the bad news appropriately. Use an open questions here such as ‘What have you been told so far?’
3.	Information needed	Ask the person how much they want to know about the diagnosis, prognosis, and treatment. This helps tailor the type and amount of information you give in this session to what the person wants and is able to cope with.
4.	Knowledge given	Impart knowledge of the bad news. It can help to pre-warn the person by saying something like, ‘It’s not the good news we hoped for’ and then pausing. This allows the person short time to prepare for the bad news. Give the bad news clearly and in simple language. Ambiguous statement should be avoided Give the information in small, manageable chunks.
5.	Emotional response	A range of emotional response may arise when giving bad news including shock, disbelief, fear, anxiety, distress, grief, and anger. The best way to deal with emotional responses is to recognize them and empathize. With very bad news there is little you can do but offer empathy and support. Evidence suggests that people will appreciate this.
6.	Summarizing and strategy	Towards the end of the interview the clinician should summarize the main points or outcomes of the interview and consider or agree a future strategy such as curative or palliative treatment. This helps focus the person on the next steps, gives some certainty, provides a known support structure, and where possible may provide hope.

Read More

How to deal with anxious and fearful patient

Anxiety and fear are a normal response to the perceived threat of illness or injury and thus are common in health-care settings. Anxiety makes people hyper-vigilant for signs of threat. Consequently, they are likely to react strongly to unexpected events, symptoms, or negative news. Anxiety also makes people less flexible in their coping strategies, so specific strategies become more rigidly applied. Anxious people may need to know exactly what will happen next so that the additional threat of unexpected events is reduced. Mere reassurance does not often work with anxious people - in fact it can backfire because they may feel that you do not understand. In dealing with an anxious patient the following may help.

Use your body language and speech	Characteristics of speech and non-verbal communication can help someone calm down. Adopt a relaxed and open body posture (non-threatening), lower the tone of your voice slightly, and slow your speech down.
Acknowledge the anxiety	As with anger, recognize the person’s anxiety
Find out the main source of anxiety	Anxiety can become generalized, so asking someone why they are anxious may elicit only a general or defensive response.
Empathize	As with anger, empathy and understanding can be very helpful responses to strong emotion. In cases of terminal illness, where the threat of death is inevitable, empathy is crucial. In these case we cannot ‘fix’ anxiety or any other strong emotion - we can only empathize and provide support.
Minimize the threat	Anxiety is based on a perceived threat. Therefore, one way to lower anxiety is to reduce or remove that threat. This is best done by providing information as opposed to mere reassurance. For example; a pregnant woman might be anxious about her baby dying. In this instance, finding out why she believes this will happen and giving her information about the actual risk of it happening in planning screening or treatment so that the risk of adverse consequences is minimized.
Increase feelings of safety	A related technique is to increase feelings of safety through information. For example, you might tell patients about monitoring or other procedures that can prevent complications developing.

Read More

Chapati pie.

Chapati pie recipe

Ingredients:

• Flour
• Salt
• Water
• Cooking oil/fat,
• Tomatoes
• Onions
• Minced meat
• Blanched carrots
• Peas
• Spices of your choice.

Method of preparation

Fry onions after drying your minced meat and throw in your tomatoes and salt to taste. Put in your desired spices then the carrots and peas. Let it cook for about 7 minutes and remove it. Let it cool off as you prepare your chapati dough. When you are done making your dough roll them thin put your meat on one side, fold and press it closed with a fork and cook it on medium heat.

Read More

Using Motivation as the Key to Good Health

Motivation is essentially a drive to act. People are motivated to do (or, indeed, not do) things in their life by a wide range of factors. Motivational interviewing rests on the principle of not judging or imposing our own views.

Clearly, motivation is relevant to health and health-care at large. Understanding social motivation can help us comprehend our own behavior and what motivates us to work as health-care professionals. It can also help us deal with other people’s behavior that we might not understand. Knowing more about another person’s motives means we can address the situation more constructively. Interventions such as motivational interviewing have been developed to treat disorders with a strong motivational component, such as addiction. Changing a habitual behavior such as alcohol consumption is difficult, particularly when it is longstanding and associated with social functioning. This is also used to encourage changes such as smoking cessation, exercise, and diet.

Understanding motivation can help us treat abnormal extremes of biological drives such as obesity, eating disorders, smoking, addiction, risky sexual behavior, and insomnia. If you ask people about perceived negative behaviors like smoking or alcohol intake they will often report them as less than they are. Educating people about the negative effects of these behaviors can trigger them to try to change. However, imposing our views and making people feel judged will not help them as much as assisting them to harness their own motivation. Try to understand why they behave in this way and empathize with their situation. Then support them to change their behavior. Help them believe that they can change.

Read More

Emotions and Health - Emotions disorder

Emotion include affect, moods, and impulses. Positive emotions are associated with good health and negative emotions, such as anger and depression, are associated with certain illness. However, the mechanisms or causes underlying this association are not clear. Emotional dispositions of optimism and neuroticism are positively and negatively associated (respectively) with psychological health as well as with some measures of physical health.

Five main personality traits 

Openness to new experience	Intellect and interest in culture, Includes characteristics such as artistic, curious, imaginative, insightful, having wide interests, and being unconventional.
Conscientiousness	Dependable with the will to achieve. Includes characteristics such as self-disciplined, efficient, organized, reliable, responsible, dutiful, and thorough.
Extroversion	Outgoing. Includes characteristics such as talkative, gregarious, enthusiastic, seeking excitement, assertive, and active.
Agreeableness	Loving, friendly, and compliant. Includes characteristics such as sympathetic, appreciative, trusting, kind, forgiving, generous, and a altruistic.
Neuroticism	Tendency to experience negative emotions. Includes characteristics such as anxious, tense, self-pitying, worrying, self-conscious, hostile, and vulnerable.

Research into emotional disorder is double-sided: Expressing emotions such as hostility is bad for physical health, yet expressing other emotions, such as those attached to traumatic events, is good for health. Emotional disorder cost society billions every year and mental illness is responsible for 40 per cent of disability. How people respond to illness is initially determined by how they appraise it. Helping people appraise things more positively can reduce negative emotions and help people cope. Humor and smiling (even when feeling low) have the potential to lift people’s mood and may also have an indirect influence on health. Negative emotions such as anxiety, anger, and depression are associated with chronic illness such as heart disease. Treating people with these dispositions early could prevent later illness. Encourage optimism could help people if they are facing an essentially controllable or modifiable illness. Getting people to write about stressful or traumatic events has the potential to improve their health.

Read More

Remedy for Sleep Disorder - Chronic Snoring

Sleep disorder occurs when the supply of oxygen needed by the body is restricted due to snoring.

Do you suffer from snoring?

Can the allergy present in the bedroom or in the pillow cause snoring? 

Do you remember when was the last time you removed the dirt on the ceiling fan? 

What about changing the pillows?

Dust on the pillows, can cause allergies which in turn could lead to snoring. Also, animals like pets, sleep in the same bed with you brings a serious allergy that can lead to snoring.

There are many things you can do yourself, so that you can stop snoring, here are some tips:

Tips	Explanation
When sleeping the head should be in a higher position.	The position of your head should be a few inches higher than the body, this can allow you to breathe, and pushing the tongue and lower jaw forward. Thus, the use of a pillow during sleep is very important.
Sleep sideways	Avoid sleeping on your back, because it will make it easier for the mouth to open and the tongue to close the respiratory tract that would impede the flow of incoming air, and finally make you snore.
Make sure the nose is not blocked when you sleep.	Nasal congestion can make the process of inhaling air be more difficult that will force one to breathe through the throat which can cause one to snore. To overcome this the user can inhale the scent of eucalyptus oil or other therapies that can make the nose not to clog.
Keep your bedroom in a moist state.	Keep your bedroom in a moist state, you can use a humidifier (humidifier). Dry air can irritate the membranes in the nose and throat, which will increase your chances of snoring.
Set a regular sleep pattern.	Adjust your bedtime, and make sure you get to sleep well and enough quality sleep. If the quality of your sleep is well, it can reduce the risk of snoring.
Avoid alcohol, sleeping pills if possible and tranquilizers before going to bed.	Alcohol, sleeping pills, and tranquilizers can relax the muscles in the throat, breathing becomes disturbed. Especially for those who really need sleeping pills and tranquilizers, further consult your doctor. This is because there are many types of sleeping pills or tranquilizers can make snoring worse.
Lose weight	Lose weight, although only slightly reduce the fat tissue in the back of the throat so as to reduce snoring and even allows you to stop snoring. You can use a diet or exercise plan to do so.
Exercise daily	In addition to weight loss, exercise will form part of the body, such as arms, legs and stomach to produce positive benefits, but also help tighten the muscles of your throat will eventually overcome your snoring problem.
Quit smoking if possible	If you are a smoker, the higher your chance of snoring. Smoking can cause breathing airways to become narrower, because the membranes in the nose and throat irritation. Therefore, it should immediately quit smoking to eliminate habitual snoring

Read More

Creamy Fudge

Three minutes and three ingredients is all you need to make this creamy.

Creamy Fudge Recipe

Ingredients

1 cup Sweetened condensed milk

2 cups chocolate chips

1 table spoon vanilla extract or any other flavor you prefer 

Method of Preparation

Place your condensed milk and choc chips in a large bowl (microwave safe)

Heat for 1 min on high in the microwave.

Then stir and stir. If needed heat for additional time at 30 seconds intervals until smooth or chips are completely melted.

Stir in the vanilla extract then pour in a prepared pan (I like lining mine with parchment paper)

Let the fudge cool completely before cutting into 1 inch squares (you can place in the refrigerator for 1 hr. to speed the process)

Store in an airtight container. Fudge does not need to be refrigerated.

It's one of my best comfort foods :-) Enjoy :-)

Read More

What you should know about tuberculosis

• Tuberculosis is an infectious disease which is transmitted from the person to another by coughing.
• The patient may have infected several other people with whom he lives in close contact. The patient should, therefore, encourage such people to have themselves checked for tuberculosis when they become ill.
• Tuberculosis drugs are available, free of charge, at any Government health facility and in most mission hospitals.
• Once treatment with these drugs is begun symptoms of tuberculosis disease will disappear quickly, but the drugs still need to be continued daily until the end of the prescribed treatment period. Failure to comply with this treatment requirement may cause the disease to start again, with great risks for the health of the patient.
• The type of regimen and the exact number and type of tablets that the patients will take.
• How long the intensive phase and the continuation phase will take and where and when the drugs will be administered.
• To stop taking Thiazina and report to the COLS if he notices a generalized itchy rash on his skin. He will then be given other drugs.
• A sputum-smear examination is required at certain intervals to monitor the progress towards cure. Explain to the patient when the examination will be required.

After start of treatment; patients are requested to inform the staff at the clinic when they intend to travel. An adequate supply of drugs can then be given to cater for the period of traveling.

Patients are also requested to inform the staff at the clinic when they intend to move to another area. The clinic staff will then write a transfer letter and give advice as to where they can continue treatment.

At the end of treatment; Tuberculosis disease may occur again. The patient should therefore report immediately to the COLS, when he notices similar symptoms, to be examined for replanse.

Read More

Care for insensitive feet

• To wear protective footwear throughout the day to avoid injury.
• To avoid too much walking because this is the most common cause of a sole wound in an insensitive foot. So, ride a bicycle when you can; send others in your place; if you must go, stop often, rest your feet, watch where you step.
• To learn from any earlier wounds to his feet so that he does not make similar mistakes again.
• To avoid heat. To sit with his feet protected, when he sits close to a fire.
• To avoid sitting on his lower legs when he sits on the ground because this may cause pressure ulcers.

Daily foot inspection

• To inspect insensitive parts of his feet and legs and also to look for signs of injury, dryness, cracks, and swellings. A small mirror is useful for inspecting the sole of his feet.
• To feel for warm spots which may warn of injury, and to press for tenderness caused by infection in the deeper layers of the sole of the foot.

Care of dry feet.

• To soak for 20 minutes twice daily in salty water, then to rub oil into the skin. This helps to keep the skin of his feet moist and prevents cracks.
• To trim and to rub off any callus.
• Care of wounds at home
• To remove the cause, e.g. a nail or small stone in a shoe.
• To soak the wound in soapy or salty water for 20 minutes, at least once a day, or more frequently when the wound is discharging. To remove dirt gently.
• To cover the wound with a bandage. This can be made of old clean cloth.
• To rest the foot.

Read More

The factors that complicate the management of leprosy

Leprosy is a complicated disease even for health staff unless they have received some specialized training in the subject. So it is even more difficult for the lay patient to understand the disease and the possible harmful consequences of ignoring medical advice (non-compliance). These are some of the factors that complicate the management of leprosy:

• People with the disease are still stigmatized.
• The patches in paucibacillary patients only disappear some years after MDT has been stooped and the patient is told that he is cured.
• Leprosy reactions with complications such as paresis, paralysis or blindness disabilities are often irreversible if patients report very late. They may have expected their disabilities to be “cured”, therefore this leads to disappointment and may influence their compliance with treatment.
• Even with MDT the treatment period is still quite long (6 months to 2 years) and this causes problems with the regular intake

In these circumstances, it is clear that education of leprosy patients must be a painstaking task which requires patience and understanding of the patient’s way of thinking and his individual circumstances.

What a diagnosed leprosy patient should know

• Leprosy is an infectious disease caused by bacilli (bacteria) not by a curse, witchcraft, or anything similar.
• The patient may have infected several other people with whom he lives in close contact. He should therefore encourage such people to have themselves checked for leprosy when they develop patches.
• Leprosy bacilli are killed by MDT if the drugs are taken regularly for the recommended period.
• Much of the damage that had been done to nerves and tissues before the patient was started on MDT cannot be reversed.
• During (and after) MDT, patients are no longer infectious and are therefore no danger at all for the family or the community.
• In PB patients patches will still be present when the MDT course is already finished. The patches will disappear slowly over a period of 1-3 years.
• Tablets need to be taken daily, as prescribed, and preferably at the same time each day.
• Drugs have to be collected from the clinic every four weeks. On the clinic day the patient takes rifampicin and clofazimine under supervision, and collects dapsone and clofazimine to be self-administered at home. Keep the drugs out of reach of children.

Read More

Spicy sweet mixed rice and beef recipe

The recipe has been passed on to me, so I can still enjoy the sweet-spicy flavors of this stew up to date.

Ingredients:

• 3 cloves garlic
• 2 tomatoes meat
• soy sauce rice
• 1 large onion 
• curry powder
• cayenne pepper
• mixed spices
• tomato sauce

Steps in preparation

Boil the meat together with the mixed spices.

After the meat is cooked add some oil, onions and garlic. Let them cook.

Add tomatoes curry powder, tomato sauce and very little cayenne pepper - it's a very strong pepper - put like a drop, not even a quarter of a teaspoon.

Add soy sauce after the tomatoes cook. Add rice, water and salt. Let it boil.

Final dish

Read More

Rules of successful chemotherapy

The success of tuberculosis chemotherapy depends on the strict application of the following rules:

• Follow NLTP regimens.
• Use the correct drug dosages.
• Ensure that the initial phase of chemotherapy is given under strict supervision.
• Ensure regular patient attendance for the full duration of the continuation phase.
• Trace defaulters promptly.
• Keep accurate records of patients’ information and clinic attendance.
• Ensure an adequate supply of drugs.

Read More

How to collect a sputum specimen

• Ask the patient to cough deeply (demonstration is usually more effective than words).
• Ensure that no one is standing in front of a patient producing sputum.
• Avoid contaminating the outside of the sputum containers with sputum. If the outside is contaminated, discard the container and repeat the collection with a fresh one.
• If the specimen is not suitable (e.g. if the quantity is insufficient or if it contains saliva), ask the patient to repeat the coughing until a sufficient amount of sputum has been obtained (3 to 5 ml). 

After collecting the sputum specimen.

• Place the lid on the container and close it firmly.
• Wash your hands with soap and water.
• Preferably store the sputum specimens in a cool and dark place, such as a cupboard or refrigerator, that can be locked and which is used solely for this purpose.
• Send the specimen to the laboratory as soon as possible (in any case, the specimen should arrive at the laboratory within 5 days of collection).
• Accompany each specimen with a properly completed laboratory request form.

Read More

Complications of tuberculosis

Pulmonary tuberculosis

Hemoptysis (Coughing up of blood)

In all severe cases, i.e. coughing up a small cup of blood or more, the patient should rest, be sedated and be referred to the nearest hospital.

Spontaneous pneumothorax (Collapse of the lung through damage caused by tuberculosis).

The patient has dyspnea and must be referred to a Medical Officer for further management (expansion of the lung with underwater seal drainage tube).

Pleural effusion.

If the amount of fluid is not too great, the clinical condition will improve after treatment with streptomycin and Thiazine. If there is too much fluid in the thorax (as judged on a chest X-rays) or pus, drainage or aspiration may be necessary.

Cardio-pulmonary insufficiency (heart-lung disease resulting in corpulmonate)

The patient has severe dyspnea. A Medical Officer should be consulted.

Bronchiectasis, fibrosis of the lungs.

These are sequelae of extensive tuberculosis disease and only symptomatic therapy is possible.

Lung abscess.

May occur in a patient with extensive damage to the lungs after tuberculosis. Antibiotic treatment is given in the light of the results of a culture-sensitivity test

.

Extra-pulmonary tuberculosis

Complications depends on the organs involved. A Medical Officer needs to be consulted in individual cases.

Read More

Tuberculosis in children

The diagnosis of tuberculosis in children is difficult, because children seldom produce sputum. Diagnosis should be made primarily on history, clinical signs and symptoms, and the result of a tuberculin test. A score chart may help in making the diagnosis.

Pediatric tuberculosis score chart

(Circle box and write in the right-hand column)

Feature	0	1	3	Score
Duration of illness	Less than 2 weeks	2-4 weeks	More than 4 weeks
Nutritional status (weight for age)	More than 80%	Between 60-80%	Less than 60%
Family history of tuberculosis	No family history	Reported by family history	Sputum +ve and family history

	Score
Positive sputum smear.
Tuberculin test result 10mm or more
Enlargement painless lymph nodes, sinus present.
Night sweats, unexplained fever
Malnutrition not improved after 4 weeks treatment.
Angle deformity of spine.
Firm, non-fluid, non-traumatic swelling or ascites
Unexplained abdominal swelling or ascites.
Change the temperament, fits or coma (send to hospital if possible)

When score is 7 or more treat as tuberculosis.

Tuberculosis pneumonia

If a child with pneumonia does not classify for tuberculosis, using the score chart, then treat it with a course of regular antibiotics that are effective against pneumonia. If response is poor then give a second course with a different antibiotic. If there is no improvement on this treatment then consider the child as suffering from tuberculosis pneumonia and start anti-tuberculosis pneumonia and start anti-tuberculosis treatment. 

Read More

Wound Healing

Wound healing is a dynamic process initiated at the time of the insult to the skin. It does not complete itself for many months. It is a natural, predictable process, but it can be affected by a number of outside factors. All wounds are contaminated no matter how clean they may appear. The most important negative influence on wound healing is wound infection. The phases of wound healing are overlapping and they include:

• Immediate response phase (occurs seconds to hours).
• Inflammatory phase (occurs hours to days).
• Epithelialization phase (occurs hours to weeks).
• Neovascularization phase (occurs days to weeks).
• Collagen synthesis phase (occurs days to months).

How to manage wounded people

People with wounds are usually anxious and frightened about their impeding treatment and are in some degree of pain. They perceive their wounds as real emergencies, no matter how minor the injury, and dislike waiting for treatment. They often are concerned about the cosmetic appearance of the wound. Many wounds result from assault, fights, robberies, animal bites, or careless mistakes or accidents. Wounded people always carry the stresses from these events.

The initial management of wounded person is aimed at reducing anxiety, relieving pain, and moving the person through the emergency care system. The exception to this goal is the intoxicated patient, who initially may be impossible to assess. In such a case, after initial examination for life-or limb threatening injuries, it is best to wait until the effect of alcohol or drugs is reduced to the point where the wounded person can be evaluated and treated properly. However, the time since injury must be monitored because that may impact treatment options.

The examination of a wound includes the following observations:

• Measurement or estimation of wound length, width, and depth.
• Identification of all skin layers involved.
• Degree of contamination and presence of foreign bodies.
• Assessment of vascularity and amount and type of bleeding.
• Identification of maceration or necrosis of tissues.
• If the wound is in a cosmetically important area, its anatomic position in relation to skin tension lines is important in predicting whether the scar will widen as it matures. This is valuable to discuss with the patient at the time of initial repair.
• Anatomic position of the wound in reference to joints, capsules, and skin creases. This is valuable to discuss with the patient at the time of initial repair.

   Reference

Trott A: Wounds and Lacerations: Emergency Care and Closure, 2^nd ed. St. Louis, Mosby 1997

Read More

Crazy Meal: Omena With Chapati

-Boil water and soak them for 5 minutes then drain.
- on a heated pan add oil enough to just cover the base and let it heat up. Add the omenas and expect a sizzle. Cook stirring until they dry up completely then transfer to a plate.
-on the same pan add oil and onions, cook till they turn translucent then add garlic. Cook stirring for about 2 minutes then add your chopped bell peppers (I used red, yellow and green bell peppers chopped julienne style).
- fry these for a minute then add your preferred spices and chilly powder for some heat. Add a tablespoon of tomato paste and mix.
- Now add your omenas and combine well then add a cup of natural yogurt (you can use less or more). Lower the heat and let this simmer for about 4 minutes. Stir and taste. Adjust the seasoning if need be then add your chopped coriander. Add a dash of lime juice ,mix and serve. Enjoy!

Read More

What Must Be Done To Stabilize the Patient?

Stabilizing a patient may require the direct intervention in a life-threatening process or an intervention that anticipates a critical problem developing. In a patient with chest pain, a cardiac monitor and an intravenous line are placed in anticipation of a dysrhythmia and the need for medications or volume repletion. These steps demonstrate the emergency physician’s awareness of the potential hazards of the pathologic processes associated with the presenting symptoms, not the diagnosis. They represent actions performed to monitor the course of the process while preparations are made to intervene quickly if necessary.

One of the most difficult aspects of emergency medicine is becoming comfortable with uncertainty regarding an exact diagnosis before important decisions are made. It also applies throughout the steps of care in the emergency department, especially during disposition decisions. Knowing when to stop an assessment or treatment is as important as knowing when to persist. Many common complaints such as chest or abdominal pain remain undiagnosed at the time the patient leaves the emergency department.

Other serious problems may require early disposition to sites outside of the department without a precise diagnosis being made (e.g. obvious penetrating trauma to the abdomen).

Read More

BAKED MASHED POTATOES WITH MINCED MEAT AND PINE NUTS

BAKED MASHED POTATOES WITH MINCED MEAT AND PINE NUTS

Ingredients;

Minced meat 

Pine nuts(optional) 

Onions 

Pepper 

Salt to taste. 

Potatoes 

Margarine/butter 

Milk(optional) 

Eggs 

Bread crumbs 

Steps of preparation.

Cook the minced meat,add pine nuts(optional),lots of onion ,white pepper and salt (set aside 2 cool).

Peel and boil potatoes in salty water until it's soft.

Mash the potatoes and add some butter/margarine and powder milk(optional)

Spread some butter as shown in the plate like you do while baking and put 1/2 of the potatoes and spread nicely.

Add pre-cooked minced meat on your layer.

Make the 2nd layer from your other half of potatoes(you can dip your hands in filtered water to avoid stickiness).

Beat an egg and spread generously.

Inventing bread crumbs😜

Spread bread crumbs evenly.

How the layers should look like from the side.

Ready for baking/freezing. Put some butter on top at least in the corners and middle(solid not melted).

Bake in a preheated oven until ready(check if it resembles cake design). Should have a nice golden color. Serve with salad. My choice is( cucumber yogurt salad😊). Mine was for freezing.

Enjoy!

Read More

Health Instant Coffee Preparation Guide

The majority of people drink ‘instant’ coffee. Instant coffee is convenient because it can be made into individual cups by adding water to the coffee and stirring. After the seal is broken on the container of instant, or soluble, coffee it should be stored in an airtight container and kept in a cool place. The flavor of instant coffee is improved if it is made in a pot using approximately one heaped teaspoon for each cup, and according to taste. Fresh water that is below boiling point should be added.

Rules for making coffee
Use good coffee that is freshly roasted and ground.
Use ground or vacuum-packed coffee within ten days or the quality will deteriorate. Sure in airtight containers in a cool place.
Use freshly drawn, freshly boiled water cooled to 92-96°C (198-205°F) (to preserve the flavor and aroma of the coffee). Do not use boiling water.
Measure the quantity of coffee carefully: 300-360g per 5 litres.
After the coffee has been made it should be strained off, otherwise it will acquire a bitter taste if kept hot for more than 30 minutes. Do not reheat brewed coffee.
Milk, if served with coffee, should be hot but not boiled.
All coffee-making equipment must be kept scrupulously clean, washed thoroughly after each use and rinsed with clean hot water (never use soda).
Making coffee in pots that have been thoroughly dried and warned.

Read More

Home Safety

We like to think our homes are places where we can be safe. However, within the confines of the home, dormitory, or apartment many potential hazards exist. By conducting a personal survey and remaining alert to these dangers, you can minimize many risks. Discuss the rules for safe living with your house-mates to help ensure each person’s safety. Here are some suggestions for safe living in one’s home. This list is not all-inclusive, but it includes items for which you need to take responsibility.

Home Safety Measures
Install smoke detectors and make sure they are in working order.
If you are going to live above the fifth floor, make sure your fire department has the equipment necessary to reach above that level.
Properly maintain all electrical and heating equipment.
Plan and practice escape in case of an emergency.
Plan alternative methods of escape in case your first-choice plan fails.
Know how to get emergency help. Most areas of the country have 911 service, but many universities have special telephone numbers other than 911. Know your number.
Never smoke in bed or leave lighted cigarettes unattended.
Inspect living areas for surfaces, objects, or room design that can lead to slipping or tripping.
Make sure all rugs have skid-proof backing.
Never overload electrical outlets.
Do not place extensions cords under rugs or where people walk.
Never use a portable heater in an unvented area or near flammable materials.
Keep outside doors locked at all times. Install chain locks on all doors.
Check carefully before allowing anyone to enter.
Look through the peephole or ask who is there before opening the door.
Require people who claim to be maintenance workers to show identification before you allow them to enter.
Place metal poles in the tracks of sliding doors so that they cannot be opened unless you remove the poles.
Be especially careful in parking garages, laundry rooms, and hallways, and when entering and leaving living quarters.
Always tell someone where you are going, and whenever possible have a friend accompany you.

Read More

Responsible Drinking Guidelines for College Students

Many colleges and universities have begun programs that emphasize responsible, rather than total, abstinence. Guidelines for reducing the risk associated with heavy drinking are:

• Pace your drinking - Allow time between drinks and sip the drink.
• Do not drink every day - Tolerance is developed and a person must increase the amount of alcohol consumed before effects are noticed. BAC is still rising even though effects are unnoticed.
• You decide when to drink - Do not allow others or situations to determine your drinking. Drink on your terms.
• Consider alternating nonalcoholic drinks with containing alcohol - Drink a soft drink without alcohol every other drink or drink plain orange juice every other drink.
• Don’t drink on an empty stomach - Food with fats and/or protein slow the absorption of the alcohol.
• Measure the alcohol - Pay attention to the size of containers. Do not provide kegs of beer or use larger sized wine, beer, or shot glasses. No contests or other drinking games.
• Don’t drink for more than one hour - Decide what nonalcoholic drink you are going to drink after the hour.
• Learn how to calculate your BAC - Know how many drinks are allowed within your hour period.
• If you are a female, drink less - Women become more intoxicated than men after drinking the same amount of alcohol even when differences in body weight are take into account. Women have proportionately less water in their bodies than men, thus they become more highly concentrated in BAC.
• Avoid taking over-the-counter or prescription medications - More than 100 medications interact with alcohol. If you are taking any over-the-counter or prescribed drugs, ask your doctor or pharmacist whether you can safely drink alcoholic beverages.

Fortunately, most college students moderate their drinking after their college years. However, about 12 percent are unable to control their drinking and continue to abuse alcohol. You should weigh carefully the potential harmful consequences of alcohol use and abuse before partaking in heavy drinking. Is it worth the price?

Read More

Foods with Unique Health Benefits

Foods that provide a specific health benefits above and beyond their inherent nutritional value are termed as functional foods. Functional food as a term in new but in the strict sense of its definition has been around a long time.

Decades ago the food industry recognized the potential value (and profits) in adding nutrients to various foods. Milk is fortified with vitamin D, cereals are enriched with vitamins and minerals, salt is fortified with iodine, and iron is added to many breads. In a technical sense these foods meet the definition of functional foods. More recent additions to the supermarket shelves include orange juice with added calcium, grain products fortified with folate, pasta enriched with soluble fiber, eggs fortified with omega - 3 fatty acids, and juices with added antioxidants.

The growing interest In functional foods has been sparked by the publicized health benefits of phytochemicals, soy, for example, contains isoflavones that may protect against heart disease; tea contains antioxidants that may reduce the risk of cancer; cranberry juice is made up of substances that may help prevent urinary tract infections. When foods such as these are consumed primarily for their purported medicinal value, they are considered functional.

Today’s supermarket are full of functional foods and give the illusion that the grocery store almost looks like a drugstore. In some cases the benefits of functional foods are welcome. Non-milk drinkers will likely benefit from orange juice fortified with calcium. In other cases, problems may occur. Experts don’t know if juices fortified with the herb Echinacea are safe or might interact adversely with other medications. The problem with functional foods, as summarized by the editor of a leading health newsletter, arises when functional foods have not been adequately tested to make sure they are safe; when the health claims are based on little or no evidence; when only a trivial amount of a beneficial ingredient is added; or when people replace healthy foods with fortified candy bars, chips and sodas.

Eating a variety is the cornerstone of a healthy diet. The only sure way to realize the benefits of various nutrients is to eat a variety of foods. No single nutrients or food can supply all of the essential nutrients in the right proportions needed by the body. Variety is the essence of a healthy diet and may be the only practical way of making sure you’re getting the full healthful effects of various nutrients.

Read More

Progressive Muscle Relaxation

There are numerous progressive muscle relaxation activities. The exercises are frequently structured by a facilitator. Some exercise begin with the feet, hands, or face, but because of space constraints, only the relaxing of the face will be described here. You can add the other parts of the body by recording the entire process on audiotape and listening to the tape as often as desired-usually once a day or two to three times a week. Take your time (3 to 4 minutes) for each area of the body.

Assume a comfortable position and concentrate on the instructions. You may find it beneficial to lie down or sit in a comfortable chair.

Close your eyes.

Allow all your muscles to relax and feel loose and heavy. Take several deep breaths.

Wrinkle your forehead and hold for seconds.

Notice the feelings.
       Relax; allow the forehead to become smooth.
       Notice the feelings of relaxation.
Frown with your eyes, forehead, and scalp and hold for 6 seconds.
        Experience the sensation of tension.
        Relax the muscles.
        Notice the feelings of relaxation.
Keeping your eyes closed, clench your jaw and push your teeth together.
        Hold for 6 seconds.
        Notice the tension.
        Relax your jaw and allow your lips to part slightly.
Now press your tongue against the roof of your mouth and feel the tension.
       Hold for 6 seconds.
       Allow your tongue to return to its normal position experiencing the sensation of relaxation.
Now press your lips together as tightly as possible.
       Hold for 6 seconds.
       Relax and notice the feelings of relaxation over your lips.

Using the same principles, gradually move through the body from the shoulders to the arms, hands, fingers, back, chest, abdomen, hips, legs, ankles, feet, and toes.

Read More

Dealing with stress

All events in life precipitate a reaction. How people react or respond to situations differs. Coping is the attempt to manage or deal with stress. Coping is independent of outcome - it does not necessarily result in success.

Dealing successfully with stress may require using a variety of techniques. Because stress-related responses are based primarily on mental perceptions, coping strategies that achieve desirable results may need to originate in a change in attitude or outlook.

The following are guidelines for effectively dealing with potential harmful stress:

Schedule time effectively. Practice good time management techniques by using time wisely. This means taking out for yourself every day and scheduling work when you are usually at your peak ability.

Set priorities. Know what is important to you. Do not attempt to work on four or five projects simultaneously. Keep your effort focused on one or two major items.

Establish realistic goals. Goals must be achievable. Do not establish impossible expectations and then become frustrated when they are not accomplished as quickly as you would like. Write down long-range goals then establish checks for keeping yourself on track and monitoring progress. Short-term goals help you see how you are moving towards your goal and provide rewards as you advance towards success.

See yourself as achieving the goals. Visualize yourself as being successful. Go over in your mind what it will look and feel like to accomplish a goal.

Give yourself a break. Take time every day to exercise and relax.

Read More

Complications resulting from diabetes

Several serious complications can result from diabetes. Most of the following complications are caused by blood vessel damage.

Coronary heart disease: People with diabetes have two to four more risk of dying from coronary heart disease than do people without diabetes.

Nerve damage: Between 60 and 70 percent of people with diabetes have some form of nerve damage.

Foot problems: Because of peripheral nerve damage, foot problems can go unnoticed. Proper treatment for conditions such as athlete’s foot, blisters, and calluses is extremely important. Any sign of infection should be treated immediately to avert the need for amputation.

Kidney damage: Thirty to 40 percent of people with type 1 diabetes and 20 percent of those with type 2 diabetes eventually develop kidney disease, which can lead to kidney failure.

Peripheral vascular disease: Diabetes and smoking can double or triple the risk of peripheral vascular disease (atherosclerosis) in the arteries of the legs, which increases the risk of foot and leg problems, including the possibility of amputation.

Skin problems: People with diabetes are at increased risk for skin infections.

Stroke: People with diabetes have a two to four time’s greater risk of stroke.

Vision loss: Diabetic retinopathy (retina disease) is the leading cause of blindness. People with diabetes are also at increased risk for glaucoma cataracts.

Read More

Recreational and Outdoor Safety

As you prepare to engage in outdoor or recreational activities, be familiar with the safety rules of your endeavor, have safe and appropriate equipment for the activity, and maintain an attitude of alertness to potentially dangerous situations. Although not all inclusive, the following rules will help keep you safe in a variety of recreational settings:

• Seek training and instruction from certified or respected instructors.
• Purchase appropriate safety equipment for the activity. Make sure your eyes and head are properly protected.
• Make sure all equipment is in proper operating order.
• Obey the laws related to your recreational pursuit.
• Begin any activity slowly and do not attempt advanced skills or actions until you are experienced enough to meet the necessary skill level.
• Stay aware of weather conditions. Always prepare for the worst possible weather.
• Never use alcohol when engaged in a dangerous recreational endeavor or during extremely hot or cold conditions. Alcohol increases the likelihood of emergency situations.
• Take a first-aid course that will prepare you to deal with a variety of unexpected situations

Recreational Injuries and Conditions.

Injury	Signs and Symptoms	Prevention	Treatment
Blisters	Fluid under skin	Wear shoes that fit and gloves on your hands.	Avoid breaking them; if painful, clean area, puncture, squeeze, leave skin, cover with sterile dressing.
Contusions(bruises)	Swelling, pain, discoloration.	Wear protective equipment.	Rest; apply cold compression; bandage.
Sprains	Pain, tearing sensation, tenderness, loss of function, swelling	Warm up before activity; strengthen your muscles.	Apply RICE—Rest, Ice, Compression, Elevation.
Muscle cramps	Painful muscle contractions (legs most often affected)	Condition for the activity; warm up before the activity; strengthen your muscles.	Stretch affected muscles.
Nosebleeds	Bleeding from nostrils	Protect your face; moisten your nose linings in dry air or high altitude.	Pinch your nose with your fingers for 5 minutes; apply ice.
Wounds (skin)	Cut, bleeding skin	Wear protective equipment and clothing; inspect equipment before use.	Apply direct pressure, elevate, clean with soap and water, and apply a sterile dressing.
Sunburns	Redness, pain, chills, blisters	Use sunscreen with a protection factor of at least 15; avoid sun exposure during peak hours.	Apply cool compresses; after pain has stopped, use a cream to keep skin moist; don’t treat with oil-based products.

Read More

Can stress and depression cause heart attack.

Stress is difficult to define and quantify. Authorities agree that distress, or chronic stress, produces a complex array of physiological changes in the body. Together, these physiological events are called the fight or flight response.

Depression (prolonged sadness beyond a reasonable length of time) also stimulates the production of stress hormones. Depression that occurs later in life increases the risk of coronary heart disease in two ways:

• By reducing blood flow to the heart in those whose blood vessels are narrowed.
• By causing heart rhythm disturbances.

Scientists have much to learn about the relationship between the heart and mind. Physicians are beginning to acknowledge that depression is a significant factor in producing cardiovascular complications for those who already have heart disease. The good news is that depression is treatable. Mild depression responds to regular exercise and voluntary relaxation techniques, both of which reduce the production of stress hormones. On the other hand, severe depression requires psychological counseling and medication plus regular exercise and relaxation training. 80 percent of people with severe depression respond to treatment.

Regular exercise promotes relaxation, reduces the response to stress, enhances emotional well-being, and lowers cardiac reactivity (high heart rate, blood pressure, and resistance to blood flow). Cardiac reactivity occurs when modest stressors produce physiological responses by the heart and circulatory system that are out of proportion to the stressors. If these occur frequently, the development of atherosclerosis may well be the result.

Exercise acts as a safety valve that enables people to “let off steam” in a constructive way. Jogging, swimming, cycling, weight training, racquetball, and other physical activities focus our energies in worthwhile pursuits that rid the body of stress products that have accumulated. Exercise training, a physiological stressor, helps build tolerance to psychological and emotional stressors. In other words, the “physiological toughness” developed through exercise training enables us to cope more effectively with other types of stressors.

Do stress and depression cause heart attack? The answer is a qualified “yes.” 

Read More

Men should observe these guidelines to avoid committing rape

• Know your sexual desires and limits. Be aware of the effects of social pressure. It’s okay not to “score.”
• Being turned down when you ask for sex is not a rejection of you personally. If someone says “no” to sex with you it does not mean you are being rejected personally; what is being expressed is the desire not to engage in a single sex act. Personal actions are within your control.
• Accept the woman’s or your partner’s decision. Don’t read other meanings into the situation; “no” means exactly that!
• Don’t assume that the way a woman dresses or flirts indicates she wants to have sexual intercourse.
• Don’t assume that previous permission for sexual contact applies to the current situation.
• Avoid excessive use of alcohol and drugs. Alcohol and drugs interfere with clear thinking, perception, and effective communication.

Read More

Health Benefits of a Vegetarian Diet

Fruit and vegetables are key parts of a nutritious diet. To promote health, at least two serving of fruits and three servings of vegetables provide essential vitamins and minerals, fiber, phytochemicals, antioxidants, and other substances good for health. They are naturally low in fat and calories are filling. Some are high in fiber, and many are quick to prepare and easy to eat.

In choosing fruits and vegetables aim for variety. Try many colors and kinds. Choose any form: fresh, frozen, canned, dried, juices. All forms provide vitamins and minerals, and all provide fiber except for most juices.

As a group, vegetarians have lower morbidity and mortality rates from several chronic degenerative diseases than do non-vegetarians. Typically, vegetarian diets are lower in fat and saturated fat and have higher concentration of nutrients (vitamins, minerals, and phytochemicals) associated with health benefits.

Here are some of the benefits of a vegetarian’s diet over a non-vegetarian diet:

• Lower cholesterol level.
• Lower level of low-density lipoproteins
• Lower incidence of hypertension
• Fewer complications and lower mortality from type 2 diabetes mellitus.
• Reduced incidence of lung, colorectal, and breast cancer.
• Improved kidney function.
• Reduction of coronary artery disease.

Types of vegetarians.

Type	What is excluded from diet	What is included in diet
Vegans	All animal products	Fruits, vegetables, grains, legumes, nuts, and seeds
Lactovegetarians	Eggs, fish, poultry, and meat	Milk products and fruits, vegetables, grains, legumes, nuts, and seeds
Ovolactovegetarians	Fish, poultry, and meat	Eggs(ova), milk products(lacto), fruits, vegetables, grains, legumes, nuts, and seeds
Pescovegetarians	Poultry and meat	Fish(pesco), eggs, milk products, fruits, vegetables, grains, legumes, nuts, and seeds
Pollovegetarians	Red meat	Poultry(pollo), fish, eggs, milk products, fruits, vegetables, grains, legumes, nuts, and seeds

Read More

Tips to stay motivated to exercise

Warming up prepares the body for physical action. The process involves physical activities that gradually heat the muscles and elevate the heart rate. A brisk walk, slow jog, jogging or hopping in place, rope jumping, and selected calisthenics will raise the heart rate and increase muscle temperature. A person should break out in a sweat during the warm-up. This indicates that heart rate and body temperature have increased to some extent and the person is ready for more vigorous activity.

The warm-up should last 5 to 10 minutes.

Follow these tips to stay motivated to exercise:

• Exercise with a friend. Make sure both of you have compatible goals and are similar in fitness level. Friends can help each other sustain a program, particularly during busy times when the temptation is high to push exercise out of an already crowded schedule.
• Exercise with group. Exchange ideas and literature about exercise with group members.
• Elicit the support of friends and family. Their support is a powerful source of reinforcement.
• Associate with other exercise. They represent an enthusiastic, positive, and informative group-and their values are contagious.
• Join an exercise class or a fitness club. This gives you a place to go and meet people who want to exercise.
• Keep a progress chart. This will give you an objective account of your improvement.
• Exercise to music. Music makes the effort appear easier.
• Set a definite time and place to exercise. This is particularly important during the early days of the program. Schedule exercise as you would any other activity of importance and then commit to the schedule.
• Participate in a variety of activity. Cross-training is excellent for the person who exercise for health or recreation.
• Do not become obsessive about exercise. Skipping exercise is not a good practice normally, but skipping is appropriate at times. Do not exercise when you are sick or overtired. Do not feel guilty about missing exercise for a day or two. Resume exercise as soon as you can.

Read More

Women should observe these guidelines to avoid being raped

Know your sexual desires and limits. Believe in your right to set limits.

Communicate your limits clearly. If you are offended, say so in a firm manner and do so immediately. Say “no” when you mean no.

Be assertive. Men sometimes interpret passivity as permission. Be direct and firm with anyone pressuring you sexually.

Be aware that your nonverbal actions send a message.  If you dress in a sexy manner and flirt, men sometimes assume you want to have sex. You should be able to dress as you please and flirt without it meaning anything. However, be aware of the possibility for someone to misunderstand and misinterpret your actions.

Pay attention to your surroundings. Do not put yourself in vulnerable situations.

Trust your intuitions. If you feel you are being pressured, you are!

Avoid excessive use of alcohol and drugs. Alcohol and drugs interfere with clear thinking, perception, and effective communication.

Read More

Conditions that can cause disorders of male sexual function

• Hypertension
• Sickle cell disease.
• Vascular disease (for example, Leriche syndrome)
• Diabetes.
• Neurological disease (for example, multiple sclerosis)
• Endocrine disease (for example, deficiencies of testosterone gonadotrophins, hypothyroidism, and prolactinoma)
• Alcoholism and substance abuse.
• Liver and kidney diseases.
• Adverse effects of drugs (for example, antihypertensive and antidepressant medication)
• After prostate and abdominal surgery.

Sexually transmitted infections rarely interfere directly with sexual functions, although concerns about STIs or HIV often are expressed by patients with dysfunction. Loss of libido and erectile dysfunction are reported commonly by men infected with HIV and may be exacerbated by antiviral treatment.

Once an individual has experienced sexual dysfunction, performance anxiety readily develops, which exacerbates the problem. Reducing performance anxiety is a key aim of psychological therapies.

Erectile dysfunction

Patients complain of failure to achieve or maintain an erection. Psychological factors can be identified by careful history taking. If the patient does not experience spontaneous erections on waking and cannot masturbate to orgasm, an organic disease is more likely.

Premature ejaculation

An organic cause is unlikely to be found. Therapy is usually behavioral and involves training the patient to delay ejaculation by using a variety of graduated stop-start exercises first, alone, using masturbatory exercises, and then with a partner.

Read More