The Proper Attitude

The place to begin is with one’s basic attitude toward dieting and good health. We live in a society in which we are conditioned to expect instant results. Over-the-counter remedies are available for almost every ache and pain. For a headache, an upset stomach, or a runny nose, we simply take a pill. If we are overweight, our response is no different. Where’s that magic solution—the pill that promises to dissolve our unwanted bulges while we sleep? Clearly, the dollars we shell out for such overnight cures would be far better spent on whole, nutritious foods and a pair of walking shoes.

            You cannot keep pounds off your body permanently until you realize that the foods you eat on your “weight-loss program” must be similar to the foods you will choose for the rest of your life. A diet is not temporary; it is a way of living that you maintain on a regular basis. The emphasis needs to be changed from short-term deprivation to long-term change.

            It is necessary to retrain your mind to focus on “eating for life” those foods that cause you to feel good, alive, energetic, young, and positive about yourself. It is an attitude of “what is good for my wonderful body” rather than “what do I have to give up so I can lose ten pounds by Saturday night.”

WEIGHT CONTROL

WEIGHT CONTROL

The sad thing is that too many people ignore the basics in the search for the esoteric.

(COVERT BAILEY)

If we are not careful, middle-age spread can creep up on any of us. After thirty, the body start to change metabolically; muscle tissue decreases, and the body’s basal metabolic rate (BMR), the rate at which we burn calories in sustaining basic life functions, slows down. By some estimates, the BMR decreases about 2 percent each decade, which means by age eighty, we need to take in two hundred fewer calories each day  then we do at midlife. For most women, this will not be enough of a reduction. Because their activity level has also lessened, maintaining the same weight requires further reduction in food intake. There is no way around it: To maintain our weight, we must alter our eating habits and remain physically active.

                Obviously, monitoring your weight throughout your life is better than discovering at menopause that you have a serious problem. Menopause brings enough issues to contend with; you don’t need to compound the situation by having to diet as well. Sometimes I think the best way to maintain your figure is to vow never to buy a larger size in clothes. You may not be eating more than normally do, but your body will tell you the time has come to make adjustments.

                A bathroom scale is not an accurate indicator of fitness or optimum weight. In fact, I suggest you throw out your scale. It does not tell you how your body should look or how healthy you are. Worst of all, it can become a constant source of anxiety and guilt.

                How important is keeping our weight down after fifty? Certainly, a few additional pounds won’t harm most women, but I think the operative word here is few. Studies show that the pounds you put on in midlife may be more harmful than any extra weight you carried in your early years. Women who gain weight later in life are at a higher risk for heart disease than those who have carried the weight all their lives. Being overweight to the point of obesity is extremely high risk and is associated with heart disease, high blood pressure, adult-onset diabetes, and certain types of cancer (notably breast, endometrial, and colon cancers).

Home and everyday life hygiene

Home and everyday life hygiene

Home hygiene pertains to the hygiene practices that prevent or minimize disease and the spreading of disease in home (domestic) and in everyday life settings such as social settings, public transport, the work place, public places etc.

Hygiene in home and everyday life settings plays an important part in preventing spread of infectious disease. It includes procedures used in a variety of domestic situations such as hand hygiene, respiratory hygiene, food and water hygiene, general home hygiene (hygiene of environmental sites and surfaces), care of domestic animals, and healthcare (the care of those who are at greater risk of infection).

At present, these components of hygiene tend to be regarded as separate issues, although all are based on the same underlying microbiological principles. Preventing the spread of infectious diseases means breaking the chain of infection transmission. The simple principle is that, if the chain of infection is broken, infection cannot spread. In response to the need for effective codes of hygiene in home and everyday life setting the International Scientific Forum on Home Hygiene has developed a risk-based approach (based on Hazard Analysis Critical Control Point  (HACCP), which has come to be known as ‘targeted hygiene’. Targeted hygiene is based on identifying the routes of spread of pathogens in the home, and applying hygiene procedures at critical points at appropriate times to break the chain of infection.

The main sources of infection in the home are people (who are carriers or are infected), foods (particularly raw foods) and water, and domestic animals (in western countries more than 50% of homes have one or more pets). Additionally, sites that accumulate stagnant water—such as sinks, toilets, waste pipes, cleaning tools, face cloths—readily support microbial growth, and can become secondary reservoirs of infection, though species are mostly those that threaten “at risk” groups. Germs (potentially infectious bacteria, viruses etc.) are constantly shed from these sources via mucous, faeces, vomit, skin scales, etc. Thus, when circumstances combine, people become exposed, either directly or via food or water, and can develop an infection. The main “highways” for spread of germs in the home are the hands, hand and food contact surfaces, and cleaning cloths and utensils. Germs can also spread via clothing and household linens such as towels. Utilities such as toilets and wash basins, for example, were invented for dealing safely with human waste, but still have risks associated with them, which may become critical at certain times, e.g., when someone has sickness or diarrhea. Safe disposal of human waste is a fundamental need; poor sanitation is a primary cause of diarrheal disease in low income communities. Respiratory viruses and fungal spores are also spread via the air.

Good home hygiene means targeting hygiene procedures at critical points, at appropriate times, to break the chain of infection i.e. to eliminate germs before they can spread further. Because the “infectious dose” for some pathogens can be very small (10-100 viable units, or even less for some viruses), and infection can result from direct transfer from surfaces via hands or food to the mouth, nasal mucosa or the eye, 'hygienic cleaning' procedures should be sufficient to eliminate pathogens from critical surfaces. Hygienic cleaning can be done by:

• Mechanical removal (i.e. cleaning) using a soap or detergent. To be effective as a hygiene measure, this process must be followed by thorough rinsing under running water to remove germs from the surface.
• Using a process or product that inactivates the pathogens in situ. Germ kill is achieved using a “micro-biocidal” product i.e. a disinfectant or antibacterial product or waterless hand sanitizer, or by application of heat.
• In some cases combined germ removal with kill is used, e.g. laundering of clothing and household linens such as towels and bedlinen.

FOOD SAFETY

Ten point plan for safer cooked meat production
Preparation
1. Clean and disinfect the raw meat preparation area before you start. This area must be separate from any area in which cooked meat is handled.
A detergent solution should be used to clean surfaces before they are disinfected. It is important to use the correct disinfectant for surfaces and equipment which will not adversely affect the food, and to use it at the appropriate concentration for the minimum specified time. For guidance on the use of disinfectants see point 9.
Wash your hands before and after handling the raw meat.
Cooking
2. To cook meat safely so that E.coli 0157, Salmonella and Listeria are killed, the centre of the meat must reach a core temperature of at least 70°c for 2 minutes or the equivalent temperature/time combination see 10). It is important that the juices run clear.
3. Make sure your cooking equipment can achieve this consistently.
4. The cooking process must be monitored. You should record the core temperature of at least one item for every cook using a probe thermometer. Wash and disinfect the probe thermometer after each use. Remember to check the accuracy of the thermometer regularly.
Cooling
5. The cooked product should be cooled as quickly as possible in order to prevent the growth of food poisoning bacteria and then kept under refrigeration. Remember the smaller the joint the quicker it cools.
Handling after cooking
6. Clean and disinfect the cooked product handling area, which must be separate from any area in which raw products are handled.
7. Always wash your hands before handling cooked products.
All equipment must be thoroughly cleaned and disinfected before and after use on cooked foods.
8. NEVER allow raw foods or any other product, used utensil or tool, or surface likely to cause contamination to come into contact with cooked foods.
REMEMBER THAT FOOD POINSONING FROM COOKED FOODS OFTEN OCCURS AS A RESULT OF CROSS-CONTAMINATION FROM RAW FOODS (DIRECTLY OR INDIRECTLY).
Help available
9. Your Trade Associations or Environmental Health Officer will be only too pleased to help you if you need any advice on the safe handling of foods, and on disinfectants. For safe and effective use of disinfectants always follow the manufacturers instructions very carefully.
10. EQUIVALENT CORE COOKING TIME/TEMPERATURE
Temperature Time
60°c 45 minutes
65°c 10 minutes
70°c 2 minutes
75°c 30 seconds
80°c 6 seconds

GENERAL PATHOLOGY

GENERAL PATHOLOGY

General pathology is the study of the functional and structural changes that occur in cells and tissues as a result of direct damage by, or reactions to, a wide range of unfavourable circumstances. At any given time our knowledge of these circumscribed by the techniques available to study these processes. Despite this reservation, it is probably true to say that the number of responses of the mammalian cell is finite. These responses represent, on the whole, either an increase or a reduction or loss in some of the components of a large, but not infinite, number of normal cell processes.

            This general principle holds good only so long as so change has taken place in the genome of the target cell or in the transcription of its genetic information. If such changes have occurred, them a new range of phenotypic characteristics and new responses, not characteristics of this cell (at least in its adult or fully differentiated form), may be acquired. The words “adult or fully differentiated” should be stressed because the acquisition of apparently new functions (such as the secretion of fetal antigens by the cells of the tumours) may be the expression of functions that were normal and appropriate at an earlier stage of the organism’s embryological development.

Morphological Change Can Occur Without Significant Functional Disturbance

Morphological Change Can Occur Without Significant Functional Disturbance

In other situations a considerable degree of morphological alteration may be present as, for instance, in some large benigh neoplasms, but functional disturbance may be slight or absent. 

Severe Functional Disturbances Need Not be Accompanied by Significant Structural Changes

Severe Functional Disturbances Need Not be Accompanied by Significant Structural Changes

A direct relationship between disordered function and disordered structure is not always present and there may be very severe functional disturbances without any significant structural changes being present. A striking example of this has been of the worst scourges of humankind, yet it is caused by an organism, Vibrio cholera, that cannot either destroy the lining cells of the gut wall or even penetrate between them. There is no microscopic evidence that the organism damages any tissue. However, if untreated, more than half of the infected people will die from the dehydration and electrolyte disturbances that are V.Cholerae causes. This diarrhea occurs because the epithelial lining cells of the intestine respond to a toxin, secreted by the organism, which behaves in the same way as a normal hormonal regulatory signal. When food is delivered to the small intestine, a peptide binds to a receptor site on the luminal membrane of the small intestinal epithelial cell and stimulates the adenylate cyclase system, with the result that about 2 litres of alkaline fluid are pumped into the small intestine.

THE CONCEPT OF DISEASE

THE CONCEPT OF DISEASE

What is disease? Some have defined it as the condition in which the normal function of some part or organ of the body is disturbed. Others have maintained that disease does not exist except as a reaction to injury. These definitions are both valid and in no way mutually exclusive. Any individual disease can usefully be regarded, in terms of simple set theory, as the common set of a number of sets, most notably type of injury, type of reaction and the location of injury. One can expand this simple concept to cover situations in which cells, tissue or organs are acted upon unfavourably either by injurious agents or by inborn errors acting alone or in conjunction of events that follows may be dominated by the direct effects of the injurious agent on the cell (as in certain chemical injuries), or may be a combination of these direct effects, and the local and general cell and tissue reactions that may be elicited.

            The functional disturbances produced by injury to cells are often mirrored by structural changes (a lesion), just as, in turn, structural damage may be followed by loss or alteration of some normal function. The sum of these effects finds its expression in the symptoms experienced by the patient and the signs observed by the physician.

OBESITY AND HEALTH

OBESITY AND HEALTH

The relationship between obesity cardiovascular risk factors and cardiovascular disease (CVD) has been documented by numerous studies. The following are the major issued that remain unresolved:

1.    Whether there is a threshold level of obesity and increase in prevalence of cardiovascular risk factors.

2.    Whether the increase in risk factors primarily is a function of weight gain over time or the extent of overweight / obesity at a specific age, and

3.    Whether weight gain between different ages has similar effects on cardiovascular risk factors?

Weight gain is associated with increased cardiovascular risk factors. Are the changes in risk factors with weight gain a function of increased caloric intake, decreased energy expenditure, or changes in specific types of calories and nutrients, namely fat, saturated fat, salt intake, or dietary cholesterol? Is the relationship between measures of obesity and risk of CVD linear, or is there a threshold effect? Is there a relationship between the distribution of body fat and risk of CVD, independent of the level of obesity? Is the association of measures of obesity and distribution of body fatness and subsequent risk of CVD age dependent? What are the possible pathophysiological processes that relate obesity and distribution of body fat to the risk of CVD?

            There is solid evidence that weight loss is associated with a decrease in cardiovascular risk factors [such as blood pressure, low density lipoprotein cholesterol (LDLC), and blood glucose levels]. Evidence that weight reduction is associated with a decrease in morbidity and mortality caused by CVD is weaker, and the magnitude of the effect is still unknown.

WOMEN WITH LOW RISK PREGNANCIES SHOULD BE ABLE TO CHOOSE WHERE THEY GIVE BIRTH

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WOMEN WITH LOW RISK PREGNANCIES SHOULD BE ABLE TO CHOOSE WHERE THEY GIVE BIRTH
Research: Perinatal and maternal outcomes by planned place of birth for women with low risk pregnancies: The Birthplace in England national prospective cohort study.

Women with low risk pregnancies should be able to choose where they give birth, concludes a study published on bmj.com today.Although it shows that first-time mums who opt for a home birth are at a higher risk of adverse outcomes, the overall risk is low in all birth settings.The researchers say their results "support a policy of offering women with low risk pregnancies a choice of birth setting" and will enable women and their partners to have informed discussions with health professionals about planned place of birth. Perinatal refers to the period just before, during or shortly after birth. So a team led by Professor Peter Brocklehurst from the University of Oxford for the Birthplace in England Collaborative Group set out to compare perinatal outcomes and interventions in labour by planned place of birth across all NHS trust in England. Planned place of birth included home, freestanding midwifery units, midwife-led units on a hospital site with obstetric service, and obstetric units. Serious adverse outcomes included stillbirth after start of care in labour, early neonatal death, brain injury (encephalophaty), faeces in the lungs (meconium aspiration syndrome), and injuries to the upper arm or shoulder during birth. A total of 64,538 single, full term infants born to women with low risk pregnancies were involced in the study. Factors, such as maternal age, ethnic group, body mass index and deprivation score were taken into account. Overall, the rate of adverse outcomes was low in all birth settings (4.3 per 1,000 births) and there were no significant differences in the odds of an adverse outcome for any of the non-obstetric unit settings compared with obstetric units.For women giving birth for the first time (nulliparous women), the risk of an adverse outcome was higher (9.3 per 1,000 births) for planned home births compared with obstetric units, but not for either midwifery unit settings. In contrast, for women who had given birth before (multiparous women), there were no significant differences in the rate of adverse outcomes between birth settings. the results also show that interventions during labour, such as epidural, forceps delivery or caesarean section, were substantially lower in all non-obstetric unit settings. Transfer from non-obstetric unit settings were also much higher (up to 45%) for nulliparous women than for multiparous women (up to 13%). "These results will enable women and their partners to have informed discussions with health professionals in relation to clinical outcomes and planned place of birth," say the authors. "For policy makers, the results are important to inform decisions about service provision and commissioning." They add that a cost effectiveness analysis of the different birth settings is currently being carried out, and they suggest that further research on this issue is needed, particularly into the effect of staffing and service configuration on outcomes, and more detailed analysis of transfer from non-obstetric settings.