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The Facts and Figures on Substance Abuse in the United States

Substance abuse is a serious issue all over the world. In the United States, an estimated 23.5 million people are either affected or involved in substance misuse. ......
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Polycystic Ovary Syndrome: Causes, Symptoms, and Home Remedies

Polycystic ovary syndrome (PCOS) is one of the most common causes of woman's infertility. It is a problem results from an imbalance of female sex hormones. It may cause irregular menstruation, difficulties in getting pregnant, and cysts in the ovaries. If it's not treated, overtime it can lead to diabetes and several other troubling health conditions.

According to womenshealth.gov, as many as 5 million U.S. women may be affected by PCOS. More shockingly, today between 1 in 10 and 1 in 20 women of reproductive age has this endocrine disorder. And not only that, it can affect girls as young as 11 years old.

So, if you're suspecting you have probably developed PCOS, read on to know about what are the causes and symptoms of PCOS and what lifestyle approaches can help cope your PCOS.

Causes of Polycystic Ovary Syndrome

The exact cause of PCOS remains a mystery. But based on a number study results, researchers believe several factors could play a big role. These include:

Heredity. It is thought to be one of the important factors behind PCOS, as many studies concluded a genetic linking with it. (1) If your mother or sister has PCOS, there is a strong possibility that you might also develop it.

Low-grade inflammation. In response to inflammation, our body's white blood cells produce substances that can defend and fight against infection. However, for women who are very likely to have PCOS, eating certain foods can trigger an inflammatory response inappropriately. When this happens, substances produced by the white blood cells cause the immune system to react on its own tissues and cells.

Many researchers believe this abnormal inflammatory response can lead to insulin resistance and cardiovascular disease like atherosclerosis, a disease in which cholesterol is accumulated in blood vessels. (2) In addition, researchers in a study published, October 2006, in the European Journal of Clinical Investigation reported that they found presence of low-grade inflammation in young women with PCOS. (3)

Insulin resistance. Insulin is an essential hormone for human body. It is produced in the pancreas of your body and helps the cells to convert sugar (glucose), starches, and other food into energy. Researchers believe most women with PCOS develop insulin resistance in their body. This means that the ability to use insulin effectively is impaired, so these women need to produce more insulin to make glucose available to cells. Studies suggest that excess insulin may cause the ovaries to make more male hormones, androgens. (4) In addition, excess insulin in the body is also associated with obesity, another important reason for developing PCOS.

Hormone imbalance. As stated above, PCOS results from an imbalance of female hormones. Women with PCOS tend to make more androgens than normal. Androgens are male sex hormones that females also make. However, why these hormonal changes happen in these women is still unknown. Researchers think this imbalance may start in the ovary itself, in glands responsible for producing these hormones, or part of the nervous system that regulates their production. The resistance to insulin is also identified as a possible cause for the hormone imbalance. (5)

High levels of insulin and androgen production affect the normal development of follicles in the ovaries. As a result, many follicles likely to develop but often fail to mature properly. This interferes with the release of eggs during ovulation - hence, irregular menstruation and reduced fertility occurs.
image of normal ovary and polycystic ovary
Normal ovary and polycystic ovary. Source: womenshealth.gov, public domain

Symptoms at a Glance

The signs and symptoms of PCOS can vary from person to person. Common symptoms that may become apparent include:
  • Menstrual abnormality -- irregular periods or no periods
  • Infertility (problems in getting pregnant)
  • Increased hair growth on the chest, belly, face, and around the nipples
  • Weight gain
  • Thinning of the hair on the head
  • Oily skin or acne

Lifestyle Approaches that can Help Treat PCOS

Lifestyle modification is the key approach in treating PCOS. Physicians mostly recommend weight loss, healthy diet, and regular exercise to help restore a normal period.

Weight loss. Overweight or obesity is a common issue in women with PCOS. If you're having extra weight, losing weight can help treat your hormone imbalances and health conditions, including high blood pressure, high cholesterol, or diabetes.

According to MedlinePlus Medical Encyclopedia, losing just about 5% of your body weight can help get your hormones in balance and regulate your menstrual cycle. So, make it your first priority that you need to lose weight in order to manage PCOS.

Healthy diet. Physicians often recommend a heart-healthy diet for women with POCS. So, if you have PCOS, consider a low-carbohydrate diet. But this doesn't mean you need to severely restrict carbohydrates. Instead, to get the maximum benefit, choose complex carbohydrates that are high in fiber.

As high-fiber foods are more slowly digested in the stomach, eating a diet rich in fiber will provide you with numerous benefits. This means you will have less hunger than usual, so ultimately it will also help restrict your blood sugar levels.

In general, a diet with high-fiber carbohydrates should include more whole-grain products, vegetables, fruits, nuts, rice, beans, and lean meats. Limit consuming foods with added sugars and foods that are high in saturated fat, including soda, candy, ice cream, pies, processed fruit juice, cake, cookies, red meats, cheeses, and fried foods. Overall, you need to have an anti-inflammatory/alkaline approach in your diet. (6) For more suggestion, consult with a dietician who can offer specific diet advice for you.

Regular exercise. This is a key step in managing PCOS. Exercise helps lower blood glucose and cholesterol and reduces the risk of more than hundreds of diseases. If you have PCOS, increase your regular physical activity or participate in a regular exercise program. This can not only help you keep your weight under control but may treat or even prevent insulin resistance.

Quit smoking. If you smoke, consider quitting it as early as possible. Smoking triggers an inflammatory response in the heart and lungs. Smokers are at higher risk for diseases that affect the heart, lungs, and blood vessels. Smoking is also a contributing factor for PCOS symptoms, as women who smoke have higher androgen levels. (7)

The above lifestyle approaches are highly recommended approaches for women with PCOS. But these are not all. If you have developed PCOS, you need to make more lifestyle changes to help get your hormones in balance and regulate your menstrual cycle. Consider consulting with your GP for more suggestions.
Polycystic ovary
Transvaginal ultrasound scan of polycystic ovary

References

  1. Ehrmann D.A. (2005). Polycystic Ovary Syndrome, New England Journal of Medicine, 352 (12) 1223-1236. DOI: 10.1056/NEJMra041536.
  2. Samy N., Hashim M., Sayed M. and Said M. (2009). Clinical Significance of Inflammatory Markers in Polycystic Ovary Syndrome: Their Relationship to Insulin Resistance and Body Mass Index, Disease Markers, 26 (4) 163-170. DOI: 10.1155/2009/465203.
  3. Diamanti-Kandarakis E., Alexandraki K., Piperi C., Protogerou A., Katsikis I., Paterakis T., Lekakis J. & Panidis D. (2006). Inflammatory and endothelial markers in women with polycystic ovary syndrome, European Journal of Clinical Investigation, 36 (10) 691-697. DOI:10.1111/j.1365-2362.2006.01712.x.
  4. González F. (2012). Inflammation in Polycystic Ovary Syndrome: Underpinning of insulin resistance and ovarian dysfunction, Steroids, 77 (4) 300-305. DOI:10.1016/j.steroids.2011.12.003.
  5. Saikumar P. (2013). Anti Mullerian Hormone: A Potential Marker for Recruited Non Growing Follicle of Ovarian Pool in Women with Polycystic Ovarian Syndrome, JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, DOI: 10.7860/JCDR/2013/5530.3337.
  6. Marsh K.A., Steinbeck K.S., Atkinson F.S., Petocz P. & Brand-Miller J.C. (2010). Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome, American Journal of Clinical Nutrition, 92 (1) 83-92. DOI: 10.3945/ajcn.2010.29261.
  7. Pau CT, Keefe CC, & Welt CK (2013). Cigarette smoking, nicotine levels and increased risk for metabolic syndrome in women with polycystic ovary syndrome. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 29 (6), 551-5 PMID: 23656383

A Confession for Writing This Article

Well, I think I need to confess a bit for writing this article. I know many of you would have a question that why I, being a pharmacist, have written a post on Polycystic Ovary Syndrome, as it doesn't fall under my core expertise. Yes, I agree! I'm not an expert on PCOS. And, honestly, I do appreciate your thought: a gynecologist could have written a more better post than this one!

But, I've some reasonable skills in my back for writing this article! First of all, I'm a pharmacist and pharmacology is the subject where my primary expertise lies in. Secondly, it's part of our responsibility to have an adequate knowledge over different diseases and conditions, though clinical diagnosis isn't part of our concern. Thirdly, I'm also a professional medical writer. If you've read a few of my previous posts, I'm sure you already know I don't write medical articles from my thoughts -- they're based on either respected journals and scientific magazines or authority websites.
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Freckles: Why They Occur and Ways of Concealing Them

What are Freckles?

Freckle Freckles are benign (non-cancerous) skin lesions, the old standard type of hyperpigmentation, that many people think cannot be helped.

Genetic predisposition is often a reason behind freckle formation, but these skin spots can occur naturally or develop because of overexposure to sun. It is often assumed that there’s no stopping these brown or red spots from forming.

However, as freckles are essentially just small regions of heavier pigmentation - much likes other types of hyperpigmentation - they can easily be removed or reduced using the right techniques. Remember, the triggers for the freckles may be different. For one person it may be sun exposure, for another person it might be purely genetic.

Whatever the underlying cause is, many of these brown spots share something in common with other forms of hyperpigmentation- they all are deposits of the body’s melanin. As a result, it doesn’t matter whether you are coping with freckles or liver spots; you will find easy treatment options that you can use to get rid of these brown spots.

Why Do Freckles Form?

As mentioned earlier, freckles maybe the darkening of an area of skin. However, why is it that these regions of skin become noticeably darker to begin with? Well, it is all about the way the body uses melanin.

A cute girl with freckles
Freckles | Source: Loren Kerns, CC-BY-2.0, via Flickr
We all have melanin coursing through our systems. However, when an injury occurs (or possibly a health problem, like vitiligo) the body adds or removes melanin from the affected area.

Let’s say that you've had a serious acne outbreak. After some time when the pimples are cleared, you notice some lingering brown spots where the acne had once been. You've these dark spots since your body added extra melanin to the area that was once impacted by acne. In cases of vitiligo, the opposite can happen. Melanin is actually moved from certain areas of skin.

There are lots of complex things that go on behind the scenes, but for now it's enough to know that injuries, outbreaks or any other health conditions can cause an excessive amount of melanin to deposit in a particular area of skin. All sorts of freckles are indicative of hyperpigmentation.

Some Home Remedies and Treatment Options to Deal with Freckles

The Oatmeal Mask

If you are like millions of people, I believe you eat oatmeal at least one time a week for breakfast. It’s healthy for you and very affordable. However, you can make some more use of these standard oats by using them as skin mask. It is super easy to do, and is highly effective at reducing the appearance of freckles on your skin.

Milk and Honey

Milk and honey have been renowned for their nutritional and curative properties for centuries. One of the greatest uses for a milk/honey combination is reducing the appearance of freckles and other kind of pigmentation on the skin.

E vitamin

If you pay attention to what health gurus and nutritional experts say, you most likely know that Vitamin E is recognized for being a great nutrient for overall skin health. If you buy the soft gel E vitamin tablets, you can puncture them and massage the E vitamin directly into your skin. In the event that sounds like too much of an inconvenience, most supermarkets and nutrition stores also sell E vitamin oil that you can use.

Baking Soda

Mix one part of baking soda to two parts purified water. Use the mixture on your brown spots. Leave the paste on your face for 10-20 minutes. Rinse the paste off the face with plenty of warm water. Do that every day for a month, and you will see your freckles disappearing in no time.

Creams and Lotions

The market is currently flooded with a large number of creams, lotions along with other home bleaching products. These items are all designed to remove brown spots from your skin. These products are made out of healthy ingredients that are safe for use. Some of these products are especially designed to be used as makeup. This makeup will help conceal any freckles.

Laser treatments

facial laser rejuvenation
Image courtesy of Cosmos Clinic
Laser treatments are the skin lightening treatments used by some high-end salons and doctors to get rid of the signs of freckles and other pigmentation. Laser treatments are used in cases of chronic pigmentation and have long-term effects.

Professional Skin Bleaching

Some salons and dermatologists offer bleaching treatments. After doing plenty of research on these treatments, I have found these to be very mild and easy on the skin. The experts that do these treatments know just what is required for your skin.

Although some people don’t mind their freckles, others are extremely bothered and require professional help in order to decrease their visibility. Should this be your case, remember to speak to your doctor first. This way you will be able to make sure that your skin pigmentation is not an indication of a more serious, underlying condition. Knowing what you’re up against, you will have the ability to formulate the right strategy to deal with your skin issues.

A Guest Post by
Author Bio: Lana Wilde is a passionate animal lover with a keen interest in healthy living. In her free time, she prepares vegetarian food for her family and occasionally blogs about the topics that she takes interest in. This article was inspired by Cosmos Clinic.
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Pros and Cons of Online Doctor Consultations

Doctors stethoscopeIn these days of Dr. Google, it's not surprising that scores of sites often invite you to ask unseen medical professionals a question, though little is known about what occurs on these sites.

I don't know whether you've used these services yet or not, but today many patients are seeking advice online from doctors they have never met. However, many are still out there who strongly believe these services are jam-packed with scam activities. So, the questions you may ask:
  • Are these online consultation services worth your time and money?
  • Are these doctors providing helpful advice?
To help you in getting the best possible answers, in this post, I would like to discuss the pros and cons of online medical consultations.

Some of the Pros of Online Health Consultation

Seeking online health advice isn't illegal, it's an effective means of getting professional medical advice. Although I believe strict regulatory guidance and administration is required to help patients avoid online frauds, but there are some clear advantages of online doctor consultations. These include:
  • No Location Boundaries. I believe this is the most important advantage of these services. You can gain access to reputed doctors that otherwise would not be available to you. Not only that, you can also get medical advice in places where it's not possible. Therefore, I think these services could provide remarkable benefits to you, if you're homebound, in rural areas, or in other settings that limit your access to conventional treatment options.
  • Better than Self-Diagnosis. How many times you've used Dr. Google to search symptoms of diseases or conditions? Maybe, countless times! But, believe me or not, relying on health and medical information provided by medical sites to self-diagnose your condition is as dangerous as misleading.

    Reading health and medical articles using the internet can give you some ideas about your current health condition, but it can never be a substitute for consulting a doctor. Because, without an expert advice (and a proper diagnosis), you won't be able to identify what underlying causes are behind your condition.

    Moreover, today thousands of online sites provide information on health and medical issues. And, chances are high that the information could be scams or dodgy.
  • Cost Effective. In these days of hefty medical bills, the appeal for low-cost healthcare is strong among patients. While an average doctor visit costs around $120 - $150 without insurance, online medical consultations range from $25 to $80 without insurance.
  • Secured Privacy. I'm not sure this point really fits in here or not, but there is a certain reason for putting it here. Unlike many, some people seek online contact with doctors they have never met because they value the confidentiality for sensitive medical topics or conditions.
  • Slightly Better than Telemedicine Services. Online doctor consultations have a slight advantage than telemedicine. You can take your time to write a detailed description of your condition. Also, you can submit your previous and current medical reports.
  • 24/7 Health Support. Most online health service providers offer twenty-four-hour access to doctor consultation and the convenience of receiving care at home.

Cons of Online Medical Consultations

A recent study, published this year in the Clinical Orthopaedics and Related Research, concluded that the quality of the information and cost-effectiveness of online doctor consultation are uncertain and need to be evaluated carefully. Briefly, the study noted that although these online services might answer your request for advice, and the potential for multiple answers from different physicians creates the likelihood for better balance and breadth of opinions, but the quality of the medical care by these providers are still unclear.
Despite the service has a number of pros, but it also has some cons. As more and more scammers and spammers are occupying internet, online consultation between patient and doctor also brings some potential risks. These include:
  • Lack of Confidentiality. As I've mentioned above, some patients choose online health advice from an unknown medical professional so that they can talk about sensitive health issues. But privacy violation is a very common issue in cyber space: Even big companies like facebook, google, and yahoo are reported to violate consumers privacy.
  • A New Door for Drug Abusers. There is no doubt that online medical consultation can diminish the location boundaries. But it also opens a new door for selling prescription drugs unethically. For this reason, still many people think the service is a totally fraud or illegal business. They also believe this consultation service is provided for abusers who are willing to risk it all and try to get away with getting medications online.

    However, they are not wrong at all. Thousands of con websites are out there that indeed perform scam operations targeting on selling cheap prescription medications online.
  • Limited Options to Evaluate the Quality. Unlike the traditional doctor consultation, the online service provides limited options for patients to evaluate the quality of care and professional associations of providers.

    During an online session, patients can only select doctors in person, practice context. In addition, reputation of the site offers some negligible guideposts to evaluate the quality. So, I believe there are some transparency issues with the service, as you need to seek health advice without even the basic signs of the doctor's degree on the wall, the office space, or face-to-face contact. Finally, the secrecy of doctors on many sites also challenges liability and continuity of the online medical care.
  • Confined Doctor Advice. I believe this is one of the important disadvantages of online health advice. Today patients' physical appearance is less important than their diagnostic reports and doctors evaluate patients' condition primarily based on those reports. Also, it doesn't matter what the qualification of the online doctor is. Because, if you need an advice in serious condition, he/she couldn't be able to suggest anything definitely without your current diagnostic reports.

    Moreover, when reputed doctors are consulting with patients online, they can never give suggestions as openly as they can in their official settings. So, no doubt, if you ask an advice, your online doctor would only give you some ideas about your present health condition. In addition, if the doctor is a qualified one, he/she must advice you to have a visit with your regular GP and perform some diagnosis.

    Not surprisingly, in the end of an online session, you might even feel that you've just wasted your money or you could have saved the money for a regular doctor visit.
Finally, I want to thank you for having patience in reading this article. I've written the above pros and cons of online medical consultation based on my personal thoughts and a review published in the Health Affairs, which I've cited below as a reference of this article.

online doctor consultation

Some Online Doctor Sites You can try

Here is a list of five online health consultation sites that you can use in your quest for medical information and understanding. However, I need to mention I've listed these sites based on their reputation, alexa traffic rank, and google page rank. But, definitely, there is a possibility that I might be wrong in evaluating them. So, I'm requesting you to make a comment in my comment section if I've misjudged any of the sites below.
  1. Justanswer
    Google Page Rank: 06
    Alexa Traffic Rank: 1,865
    Reputation by McAfee SiteAdvisor and Norton Safeweb: Safe
  2. My.Clevelandclinic.org
    Google Page Rank: 07
    Alexa Traffic Rank: 14,974
    Reputation by McAfee SiteAdvisor and Norton Safeweb: Safe
  3. Healthcaremagic
    Google Page Rank: 04
    Alexa Traffic Rank: 18,311
    Reputation by McAfee SiteAdvisor and Norton Safeweb: Safe
  4. Consult A Doctor
    Google Page Rank: 04
    Alexa Traffic Rank: 683,433
    Reputation by McAfee SiteAdvisor and Norton Safeweb: Safe

Medical References

Miller TE, & Derse AR (2002). Between strangers: the practice of medicine online. Health affairs (Project Hope), 21 (4), 168-79 PMID: 12117127

Briet JP, Hageman MG, Blok R, & Ring D (2014). When Do Patients With Hand Illness Seek Online Health Consultations and What Do They Ask? Clinical orthopaedics and related research PMID: 24442841
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Open Letter: A Confession with You

open letter iconDear Guest,

It's an honor to have you here. I know many of you already visited this blog, but I think I need to reintroduce it and myself with you. My name is Imtiaz Ibne Alam, and I'm the guy who is behind this medical blog. Learn more about me »

I founded Medical-Reference.net back in 2011 with a simple objective to create an informational, educational blog. But as time passed, it just converted into a magazine type blog, not a blog written from my personal opinion or experience.

I believe that's because of the topic I chose to write on, though sometimes it feels like I've filled this blog with rubbish contents. However, that is not the reason for my confession here.

Over the last three years, I've written and published posts mainly related to health or medical niches, including some general question & answer type posts (for example, visit my Anatomy or Disease & Condition Page). But there are some exceptions too. I couldn't limit my niches neighboring to only medical, health care, or heath. So, please don't get upset. Definitely, you'll find some posts that aren't relating to my key niches.

I know you may ask why I -- being a pharmacist -- am writing general posts on nonprofessional topics. Well, that's because I want to cover a wide range of lifestyle and wellness issues as well. So, I hope you would appreciate those posts of mine that aren't strictly focusing in medical/health niches.

I also need to mention that some of my posts, which I've published at the startup of this blog, aren't well researched, proofread, and written. I hope you would forgive me for those poorly written posts.

It's not that I'm not trying to update those contents, but the problem I'm still encountering is time management. Hope you would understand.

Open Letter

Here are some posts that might stumble you:

Kind Regards,

Imtiaz Ibne Alam
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How to Figure Out How Much Life Insurance You Need to Buy

How Much Life Insurance You Really Need for Your Family Life insurance is a necessary expense if your family -- or someone you care -- depends on you financially. Although the reason we need life insurance is something no one likes to think about, but an insurance policy can be invaluable in protecting the financial security for your family despite your absence.

However, for many families, the urgency of keeping balance with everyday expenses pushes one solid tool for doing that -- buying life insurance -- to the bottom of the to-do list. To avoid doing so, the solution is to purchase only the policy you need at the cheapest available price.

Factors you need to consider when buying your life insurance are:
  • Your age - as the risk of death increases with age, premium rates are higher the older you are. If you're young and want to get a policy, choosing term life insurance would be a cost-effective approach to cover your risk and have your future options open.
  • Age of spouse and children - this will help you determine how much income replacement your dependents will need to maintain their standard of living if you die prematurely.
  • Mortgage and other debts - your financial portfolio should be well balanced and need-based. If you have any existing loans, mortgages, or other debts, wrap those into your life insurance planning.
  • Education expenses - estimate future education costs for the dependents. This calculation can be tricky because you need to consider the tuition and fees of college at the time your dependents enroll. Costs for four-year colleges have been rising by up to 5.2% a year.
  • Funeral expenses - on average, a funeral, burial and related expenses tend to cost between $9,000 and $15,000. Don't stick your loved ones with the final bill. Use $12,000 as a ballpark number.
  • Income replacement - once you cover debts, college funds, and funeral expenses, your dependents might not need to replace 100% of your income. Many insurance advisers therefore recommend 50% replacement of current pretax earnings as a starting point.
  • Income uncertainty - since life by its very nature is all about change, it would be wise to estimate what it would cost to keep your family running if your annual income suddenly drop. Consider whether you can decrease the expanse of insurance you need, or even exclude it completely.
[Read: Four Life Insurance Policies You Should Never Buy]

Life Insurance Rules of Thumb

When it comes to getting a life insurance, there are some broad rules of thumb to help you estimate how much you need. However, the key is buying the right policy for your dependents -- not some generic unit.

To address customer's concern, financial planners and insurers have developed methods to help you zero in on this perpetually moving target. While rule of thumb can suggest a good starting point for further analysis, they shouldn't be followed blindly. Here are three common approaches that most insurance advisers use.
  1. Multiple of income: Many financial advisers recommend that you should buy life insurance policy -- for the death benefit or payout amount -- equal to five to seven times your annual income.
    "So if you're earning $70,000 annually, anywhere between $350,000 and $449,000 would be the standard life insurance amount to allow your family members to pay the bills and live their lives as planned despite your absence," says Lisa Harrison, an executive general manager of customer division at Suncorp Life, Australia.
  2. Income generator: Some customers prefer to build up a large life insurance investment that would generate income to give a beneficiary with annual returns. For instance, if you leave your dependent $1 million of life insurance using a conservative average annual yield of 4%, that could produces about $40,000 of annual income for the rest of your loved one's life.
  3. Shortfall calculation: This approach runs backward from the yearly earnings you would like to leave your financial dependents for X number of years. Decide your target amount. You then need to subtract all other sources of yearly earnings that will be available to your dependents, including your pension, savings, retirement accounts, and Social Security. The outcome of the calculation is the shortfall that you'll like to replace with life insurance.

Online Tools to Calculate Your Life Insurance Cost

Some online tools that can help you get more customized answers are (useful for residence of United States only):
  • Bankrate.com | life insurance calculator - This tool may help you determine your life insurance expenses depending on several factors, including your age, the ages of your dependents, education expenses for your children and/or spouse, your mortgage and other debts, your funeral expenses, and your income.
  • MassMutual.com | lifetime economic value tool - this tool measures all of the financial investments you'll contribute to your family -- or dependents -- over the course of your career. Using a simple algorithm -- requiring only your current age and annual income -- it generates a broad life insurance estimate.
  • LifeHappens.org | life insurance calculator - This tool estimates your needs in a similar manner like the Bankrate's tool. It measures all the important factors against your current investments, savings, and retirement funds to estimate the expense.
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EU's PM2.5 Limit Festering: New Study Linked PM with Heart Attack

Air-pollutionAir pollution is a significant determinant of human health. Over the past decades, studies conducted in various parts of the world documented a number of hazardous effects of ambient air pollution on health.

The adverse effects of particulate matter (PM) on health are especially well documented. However, while there is no evident and appropriate safe level of exposure, the PM issue has been seriously underestimated in most of the developing countries, particularly countries in Middle East and South Asia. But it was hard for me to believe that the EU limit for PM 2.5 is still more than twice that recommended by the World Health Organization (WHO).

Moreover, a new study published January 21, 2014 by the British Medical Journal suggested that long-term exposure to particulate matter increases the risk of heart attack. Shockingly, the study also reported that PM exposure was observed in levels below the current specified European limit values.

For the study, scientists evaluated data from more than 100,000 participants in Europe. At enrollment, these individuals were found with no history of cardiovascular diseases. They were followed for an average of 11.5 years. During the follow-up period, a total of 5,157 individuals had coronary events such as heart attack or angina. The study found that an increase of annual exposure to PM 2.5 air pollutants of just 5µg/m3 was associated with a 13 percent increased risk of coronary events, even taking into account other risk factors such as smoking or high blood pressure.

However, the EU clean air standard isn't challenged for the first time. Last year, many researchers urged it when a new WHO scientific report on PM 2.5 published on January 31, 2013.

The Ambient Air Quality Directive of EU is still more than twice as high as the 2005 AQGs of WHO. As a result, today more than 80% Europeans are standing above the WHO standards for particulate matter. In addition, on average, this exposure to PM deprives each resident of 8.6 months of life.

In 2008, the EU directive established an annual average PM 2.5 threshold level of 25 micrograms per cubic meter (µg/m3), to be met by 2015 and suggested another threshold level of 20 µg/m3 from 2020. On the other hand, the 2005 AQGs of WHO established that the annual average threshold level for PM2.5 should be 10 µg/m3.
According to the WHO report, long-term exposure to airborne particulate (PM 2.5) are associated with both cardiovascular mortality and morbidity and can trigger several detrimental consequences for health, including atherosclerosis, adverse birth results and childhood respiratory illness.

The report also noted possible links between PM 2.5 and chronic health conditions, including neurodevelopment disorders, poor cognitive function, diabetes, and respiratory diseases. Besides suggesting lower PM2.5 level, the WHO report recommended a new Air Quality Guidelines (AQGs) for vehicle engines, power generation, and nitrogen dioxide (NO2). In addition, the report suggested AQGs for long-term average ozone (O3) concentrations, as well.

There is no doubt that the EU limit for PM2.5 is not enough to reduce health risks, though the WHO report came as a shock and stirred the policy makers of EU. Yet, the European Commission has decided to revamp and tighten its policies, where needed.

However, I'm really in doubt about the release of a new review from EU. The EU was expected to revamp its PM 2.5 limit before the end of 2013. But, still, there is no sign of changes in the EU policies on air pollution. Experts believe the change can't be implemented ahead of EU elections.
Haze in Kuala Lumpur
Description: Smog from motorized vehicles is one of the common environmental problems in large cities of Asia and Southeast Asia (Haze in Kuala Lumpur, Malaysia).

Journal Reference

Cesaroni G, Forastiere F, Stafoggia M, Andersen ZJ, Badaloni C, Beelen R, Caracciolo B, de Faire U, Erbel R, Eriksen KT, Fratiglioni L, Galassi C, Hampel R, Heier M, Hennig F, Hilding A, Hoffmann B, Houthuijs D, Jöckel KH, Korek M, Lanki T, Leander K, Magnusson PK, Migliore E, Ostenson CG, Overvad K, Pedersen NL, J JP, Penell J, Pershagen G, Pyko A, Raaschou-Nielsen O, Ranzi A, Ricceri F, Sacerdote C, Salomaa V, Swart W, Turunen AW, Vineis P, Weinmayr G, Wolf K, de Hoogh K, Hoek G, Brunekreef B, & Peters A (2014). Long term exposure to ambient air pollution and incidence of acute coronary events: prospective cohort study and meta-analysis in 11 European cohorts from the ESCAPE Project. BMJ (Clinical research ed.), 348 PMID: 24452269
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How to Recognize, Prevent, and Treat the Pain that is Carpal Tunnel

Carpal Tunnel Syndrome: Symptoms and Treatments

Carpal Tunnel Syndrome In the age of endless keyboards, buttons and touchpads, the pain and inconvenience of carpal tunnel syndrome has become an increasingly widespread problem. Recognizing it for what it is and making the effort to address the problem is more than most people do, which keeps them in pain longer, and once the pain finally goes away most people don’t bother figuring out how to keep it from coming back. You can be different by finding out how to recognize, treat, and prevent the pain that is carpal tunnel below.

Carpal Tunnel vs. Other Wrist and Upper Arm Injuries

Carpal-Tunnel
Description: Transverse section at the wrist (Gray's anatomy diagram).

It’s important to determine whether you have carpal tunnel syndrome or some other injury, so that you don’t try to cure the pain with carpal tunnel exercises that can hurt your wrists rather than helping them if carpal tunnel isn’t the real problem. Other potential problems your wrist pain could be caused by include:
  • Muscle, Ligament or Tendon Injuries – Injuries to the soft tissues, such as strains, sprains, contusions and tendonitis, can happen for a variety of reasons. Falling and catching yourself awkwardly, twisting your arm muscles at an odd angle (either while awake or during sleep), or receiving a blow during sports or other activities can result in pain very similar to that of carpal tunnel. Stretching regularly can help improve flexibility and decrease your likelihood of sustaining these types of injuries.
  • Pinched Nerves – A pinched nerve occurs when a nerve is compressed by surrounding tissue, causing the nerve to become inflamed and disrupting its functionality. Pinched nerves can have a variety of causes, including poor posture, arthritis, obesity, and—you guessed it—carpal tunnel syndrome. If a nerve remains pinched for an extended period of time, chronic pain and nerve damage can result.
  • Arthritis – Joint strain, auto-immune disease and genetics are all potential factors in determining whether you will get arthritis. There are over 100 types of arthritis, but a common symptom is a painful stiffness and swollenness of the joints that can feel similar to carpal tunnel syndrome. It is most common in people age 55 and over, though it can happen (sometimes temporarily, due to allergies or infections) to younger individuals as well.
  • Bone Dislocation/Fracture – Bone dislocations or fractures should be treated as emergency injuries. It is possible not to realize a bone is broken or dislocated at the time or breaking or dislocation due to distractions, extreme temperatures and even to shock. A broken bone will usually be highly painful to touch, and carpal tunnel exercises would be virtually impossible to perform. Contact a doctor immediately if you think you might have a broken or dislocated bone in your wrist.
Your wrists and hands are some of the most valuable instruments on your body, so it’s important to take special care when attempting to treat injuries in the wrist and upper arm area. If none of the above causes seem likely to you, check out the section below to find out the potential causes of carpal tunnel syndrome and exactly why it hurts the way it does.

Looking Inside the Wrist – What Happens During Carpal Tunnel Syndrome

Untreated Carpal Tunnel SyndromeCarpal tunnel syndrome results when the median nerve within your carpal tunnel, which is a tunnel about the width of your thumb that runs up along the palm side of your upper arm, becomes pinched. The median nerve controls your hand and the 9 tendons that give you the ability to bend your fingers. Pinching generally occurs due to combined genetic and environmental factors, including muscle strain associated with awkward, difficult or repetitive movements, obesity, diabetes, pregnancy, and possibly the practice of sleeping on your side.

Once a nerve is pinched, it becomes inflamed and painful. The following symptoms are known to be associated with carpal tunnel syndrome:
  • Painful numbness
  • Outward-radiating pain that can be either sharp, aching or burning
  • "Pins and needles" painful tingling, similar to the sensation of a hand that has "fallen asleep"
  • Muscle weakness that can cause you to drop things or be unable to grip things with the affected hand
  • Unusual dryness of the skin on the hand due to reduced sweating
Chronic pain and permanent nerve damage can occur when carpal tunnel syndrome is left untreated. To alleviate the uncomfortable symptoms associated with carpal tunnel, try the exercises in the following section.

Toughening Up the Tendons – Exercises to Alleviate and Prevent Carpal Tunnel Syndrome Symptoms

The symptoms of carpal tunnel syndrome can sometimes be alleviated in mild to moderate cases through a series of simple "nerve-gliding" and "tendon-gliding" hand exercises that you can learn to do yourself (preferably with your doctor’s approval, so you can be sure it will not make the situation worse). If doing any of these exercises makes your hand feel noticeably worse, discontinue the exercise immediately.
  • "Nerve Gliding" – This type of exercise can potentially worsen your hand’s condition if the nerve is already pinched, so be sure to consult with your doctor before trying it and use it only sparingly. For this exercise, hold your wrist in a neutral (non-flexed) position. Make a fist, then extend your thumb and fingers straight out. Tilt your hand backwards, and then turn your hand palm-side-up and use your other hand to gently tug your thumb.
  • "Tendon-Gliding" – To try tendon-gliding, first hold your hand vertically with fingers extended. Bend your fingers at the second knuckle with your thumb still extended, and then bend your fingers at the first knuckle with your thumb still extended to form a fist. Extend fingers out horizontally from your knuckles, return them to the fist position, and repeat.
  • Compensate for Repetitive Motions – Compensate for repetitive motions with hand motions that move your muscles in different ways. For example, typing requires outstretched hands and bent fingers, so you can compensate for the repetitive typing motions by alternately clenching your hands tightly and stretching your fingers out straight several times.
Though surgery is sometimes a necessity in dealing with a pinched carpal tunnel nerve, exercises can potentially be of help, particularly in combination with other measures such as splinting the affected arm and applying corticosteroids. Keeping your muscles flexible and strong through regular arm exercises can help you to prevent future instances of carpal tunnel syndrome, but you may also want to consider occasionally calling rather than constantly texting once in a while—just in case.
This post is co-authored by Ryan Rivera
Ryan Rivera is an anxiety specialist and has dealt with numerous medical conditions in the past. He writes about anxiety at www.calmclinic.com.
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