text:
You might get the best sleep of your life in this house—if you can afford it
Troon Pacific builds "ultra-performance homes" that come fully equipped with everything you need to relax and get some shut-eye. Will it propel the real estate industry forward?
[Photo: Mikiko Kikuyama]
Over 35% of American adults don't get enough sleep, while 44% say their snooze got worse in the past five years. Is it any wonder our society has fetishized rest? The national "sleep epidemic" has inspired legacy brands and startups alike to hawk gadgets, tonics, trackers, "coaches," and smart mattresses. The U.S. sleep aid market is expected to grow to over $100 billion by 2023.
Sleep, much like other health and wellness categories, has become something of a status symbol, a signifier of wealth, something that you spend money on to fix (as compared to the rest of us, for whom it just means what happens when you collapse out of exhaustion after a long day at work or taking care of children).
So it's no surprise that the ever-elusive slumber has been embraced by entrepreneurs, including real estate developers. It makes sense: If you spend a third of your time sleeping at home, shouldn't it be fully optimized for snooze?
Troon Pacific, a San Francisco-based development and investment management company, is leading the trend by designing luxury sleep-enhanced homes. It takes into account all construction, design, and materials to give clients a solid sleep—from insulating walls to reducing noises like humming and vibrating, filtering the air, and keeping temperatures consistent throughout the night.
The company is now going all in on over-the-top health amenities: it recently listed a $29.8 million "wellness focused" mansion in the Bay Area. The high-priced, 8,350 square-foot estate boasts four bedrooms, two guest suites, and seven bathrooms. Dubbed "Residence 2646," the property features biophilic design throughout and an entire floor dedicated to health and fitness—i.e. a gym, yoga deck, massage room, sauna, and steam shower. (The home, of course, also comes equipped with a Tesla car charger.)
Troon Pacific is one of several players in the home wellness sector, which includes $800 million startup Delos, known for selling "Well" building certifications to developers. It's expected to be a rapidly growing consumer market: According to a recent survey commissioned by home wellness subscription service Second Nature, 99% of Americans desire a healthy home but 62% admitted they don't do a good enough job achieving it.
"The greatest luxury in life is your health," says Troon Pacific CEO and founder Gregory Malin, "and so wellness became our focus."
Twenty years ago, Troon was more associated with sustainability, known for building a number of LEED Platinum-certified residences. The company even built the most sustainable home in America in 2008. It still practices sustainable building, but that specialty morphed into other environmentally friendly issues, such as air and water quality.
Once Troon Pacific started working on how to best mitigate the use of carcinogens and chemicals in building materials, the company started to think about how else it could impact health. "We realized there's lots we could do in the course of construction that helps with sleep," says Malin.
To start, there's an emphasis on enforcing quiet. Troon Pacific insulates areas that typically aren't insulated. A lot goes into acoustic reduction, including the use of sound-reducing drywall over plumbing lines and walls, bathrooms, and sleeping areas.
Even the smallest buzz gets hammered out: Plumbing or drain lines don't touch wood in order to minimize vibration; empty cavities are filled with green insulation; while magnetic transformers are swapped for LEED drivers or electronic transformers that don't make humming sounds. Troon Pacific uses natural insulation materials—such as cellulose, mineral wool, cork, or agrifiber—to cut down on chemical exposure.
(For those who want a bit of sound? The master bedrooms, bathrooms, and showers boast built-in speakers with calming music, guided meditation, or white noise.)
Many of these adjustments are invisible to the naked eye. For example, Troon installs an air barrier beneath the concrete slab of a house foundation. Under the barrier lies an active ventilation system that prevents pollution and other toxins from permeating the house.
Air pollution might affect sleep quality, which is why Troon Pacific homes' Merv 13 filtered air systems go through 9-12 air changes per day, along with a heat exchanger that maintains consistent air temperature throughout the night. It's fresh air—no matter whether the windows are open or closed—and produced in an energy efficient manner.
"We're trying to invest in ways that people don't typically expect, and in a way to help enhance lives," says Malin.
To minimize exposure to electromagnetic fields, which can impede the production of melatonin and affect the body's circadian rhythm, all bedroom walls include shielded cables no less than 10 feet from where beds will be placed. Troon Pacific also plugs a Wi-Fi system onto POE (Power Over Ethernet) switches, which is then controlled by a home system. The idea is that when you turn the lights off for the evening, it also turns off the Wi-Fi signals.
"We don't need Wi-Fi on when we're sleeping. Why have that going through our heads?" says Malin. "These are little things that we could think of that may help [one's health]."
Dream (friendly) design
Buyers don't have to go the spa to relax. A Troon Pacific home features a designated "wellness area" meant to induce pre-snooze calm. This includes a number of concepts, such as an oversize outdoor bath, yoga deck, detoxifying sauna, massage room, or meditation area.
"We want this to be an escape from urban living," stresses Malin.
One major component of each home is integrated nature. A typical indoor space—like a TV den—is built completely outdoors, or an al fresco theatre might boast hanging plants and outdoor fire pits. Some light fixtures are composed of organic materials like coral. And there's always an element of water, specifically the soothing sounds of a fountain.
Of course, homes are prewired for automated and motorized shades that transform harsh light into soft, relaxing light. But Troon Pacific also goes so far as to obsess over indoor light. The design team rarely ever incorporates anything that might have a shiny surface, instead opting for both matte hardware and wall paint.
"It just absorbs light differently, it's less reflective and therefore disarming and meditative," explains Malin. The company usually relies on natural stone and wood, as well as visible grains. "We're really sensitive about how design comes together in a way to maximize light."
Some of these tweaks—such as filling your home with more plants or installing a house water filter—can obviously be adopted by all homeowners, not just those considering a luxe Troon Pacific property, notes Marlin. But the company's homes include many other, more unique features.
Related: Utopic Wellness Communities Are A Multibillion-Dollar Real Estate Trend
Troon Pacific has only built six sleep-enabled homes to date but intends to add more inventory as demand grows. There's an increasing awareness among consumers as to how one's home environment impacts sleep, especially in markets like China or India where issues like air quality are common. Others specifically seek out homes made for better living.
"We've had homebuyers buy the home even though it wasn't a perfect home for their lifestyle because their child was going through wellness treatments for some [other health] issue," notes Malin. "We've been a solution for people."
But for the most part, Troon Pacific sees itself leading the industry. It's still early for the sleep-enhanced real estate sector, although consumers seem eager for anything and everything that promises more shut-eye. As Malin says, "I would say for the most part, we're educating the market."
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text:
The Mane Post
Grace Preparatory Academy, Arlington, TX
Entertainment/Review
Dream pop duo Beach House returns to Dallas
Beach House performs at the Bomb Factory in Dallas last month. This was a setting for a show as spacey as their signature sound.
By Jacob Shipley 5 years ago
Beach House is somewhat of an anomaly. The Baltimore-based duo, comprised of vocalist/keyboardist Victoria Legrand and guitarist Alex Scally, is still virtually unknown outside their core group of fans, despite being one of the most respected indie acts currently touring and the forerunners of the atmospheric "dream pop" genre.
The band released two albums in 2015, the spacey Depression Cherry, and the more stripped down Thank Your Lucky Stars. On April 9th, the duo played their first show in Dallas since 2012, nearly filling the 4,300-capacity Bomb Factory, twice the size of the venue they played on their last visit.
Backed with minimal lighting and accompanied by a drummer and additional keyboardist, Beach House took the stage, Legrand sporting an oversized Dallas Cowboys jersey, and started with Depression Cherry cut, "Beyond Love." The setlist, influenced by a voting feature on the band's website, fairly equally represented both 2015 albums, as well as 2012's Bloom and 2010's Teen Dream.
The stage, backed by three massive, translucent drapes hanging from the ceiling, shifted colors to match the mood of each song, occasionally making drastic lighting changes to accompany beat switches in the songs. As the show continued, fans cheered at any sign of what song might be played next, from favorites like "Wishes" and "PPP" to the electronic-tinged "All Your Yeahs," the closest thing Beach House has made to a dance song.
While in their recordings, Beach House sounds somewhat quiet and reserved, nothing could be farther from the truth when it comes to their live shows. Songs like "10 Mile Stereo" and "Sparks" show the band, known for being generally reserved and calm, at their loudest and most wild, as Legrand sings to unreal levels and the stage lights flash at an almost epileptic pace.
But it was Scally's guitar work that brought itself to the forefront on tracks like the hypnotizing "Myth" and dreamy "Silver Soul," the latter of which was popularized after being sampled on Kendrick Lamar's "Money Trees." Uncharacteristic of most guitarists, Scally opted to sit down for the majority of the show, allowing him to focus more on playing his instrument, which was only marred on two occasions due to a feedback issue with the sound.
The finale, "Elegy to the Void," completely captivated the audience as Scally's distorted guitar and Legrand's voice filled the room in the best performance of the night. In fact, one of Beach House's best qualities is their ability to translate their calm and melodic recordings into grandiose live displays that make you wonder how you are fortunate enough to be in the same room as them.
Depression Cherry and Thank Your Lucky Stars are both streaming in full on YouTube.
Written by: Jacob Shipley on 18 May, 2016.
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redpajama_set_name: RedPajamaCommonCrawl


text:
Collinsworth: 49ers a legitimate contender, Dennis Allen deserves another year
Field of Links: Curry's popularity continues to rise, a Kuiper-wich, and a Superman double backflip
Field of Links: Warriors fan wins free groceries for a year, Rudolph's baseball-reference page, drunken elf arrested
Field of Links: Nobody does holiday videos quite like the Sharks
Here are the many different A's stadium renderings through the years
A horse named Harbaugh
Case of the Mondays: Davis hits the wall, See the A's field of dreams, NFL tantrums
TBT: Giants take on outfielder Michael Morse and his epic '80s walk-up song
Andre Iguodala surprises a Warriors fan at work with season tickets
Ahmed Fareed makes a sweet trade with Billy Beane
49ers fans plan to buy a billboard ad near CenturyLink Field
Field of Links: Active Winter Meetings, Curry is clutch, Rangers draft Russell Wilson
Jerry Blevins' hilarious reaction to getting traded
Seahawks fans enraged over new commercial featuring Kaepernick
Field of Links: Gore says 49ers are 'still the big dogs in the division'
Football could be an Olympic sport by 2024
Dec 16, 2013, 1:52 PM PST
A horse is a horse, of course, of course, but this horse is named after the 49ers' head coach.
While Jim Harbaugh and the 49ers defeated the Tampa Bay Buccaneers on Sunday, a horse bearing his name galloped to win a race by two lengths at Hollywood Park Racetrack.
Harbaugh (the horse) won the fifth race of the day with ease. He shot out of the gate and held onto the lead for the entire race.
The 49ers' coach is a race fan, so he might appreciate the effort. He is the co-owner of Panther racing, which is an IndyCar series team, but he has no official affiliation with the horse.
Their only really connection — besides the name — is that Harbaugh was foaled (horse lingo for born) in 2011, the same year Jim was named head coach of the 49ers. The horse's previous owners, Kretz Racing, were huge 49ers fans, which explains the name. After Harbaugh's second career race, he was claimed by new owners, though.
Harbaugh has amassed $40,250 in career earnings while winning two of his four career races. Meanwhile, the human Harbaugh is on the third year of his five-year, $25 million contract, and is likely to get an extension in the offseason.
The 49ers' coach is much slower, but currently has the horse beat in popularity and earnings, of course.
« Newer Here are the many different A's stadium renderings through the years
Older » Case of the Mondays: Davis hits the wall, See the A's field of dreams, NFL tantrums


Johannesburg – Hacking a website used to be a fairly complex and specialist business. H@xx0rs (I'm sure most hackers still refer to themselves that way) were not only excellent software and operating system engineers, but also resourceful in an age where access to fast Internet and useful information was difficult to find.
It's hard to answer why they do it. For some it's about showing off, for others it's a genuine interest in the data but, in a strange way, most do it simply because they can and it gives them a thrill to pull it off. The onus on the developers of these platforms – to ensure data security and up-time for platforms – has never been more important. A quick look through our weblogs shows that the wp-admin login page on the WordPress sites that we are managing are receiving, on average, a login authentication script for automating attempted logins once every minute. This is almost 10 times what they were this time last year.
It's unfortunate to say – but also realistic – that nothing is ever truly secure. Nor will it ever be. However, hacking is a risk that can largely be mitigated and most issues and concerns are preventable.


Do you have a question about placing a new order or an existing one?
You can also call direct at 856-439-9500. Your call will be placed in our queue and a customer service representative will call you back as soon as possible.


text:
Snežne verige so dodatna oprema, nameščena na pnevmatikah vozil in zagotavlja maksimalnen oprijem na zasneženih ter poledenelih površinah.

Zimske pnevmatike velikokrat ne predstavljajo zadostne zimske opreme, predvsem med močnim sneženjem, saj je njihov oprijem z asfaltom oziroma cestiščem bistveno slabši. Vožnja z verigami tako pripomore k povečanju vlečne sile in lažjemu zaviranju na zasneženih ali ledenih površinah. Ob uporabi verig je potrebno upoštevati hitrostne omejitve, ustrezno velikost pnevmatik na vozilu. V primeru suhe podlage njihova uporaba ni primerna, saj se lahko poškodujejo ali uničijo, prav tako pa lahko pride do poškodb na samem cestišču. Če imate le en par verig, jih je potrebno namestiti na isto os. Pri vozilih s preklopljiivim štirikolesnim pogonom jih namestitimo na par, ki je ves čas v pogonu.

Obstaja več vrst snežnih verig: verige iz vrvi, verige iz jeklenih členov, tekstilne snežne verige, hitro montažni sistemi. Prednost jeklenih verig je, da ponujajo odločno več oprijema v snegu, saj se zarežejo mnogo globlje.

Postopek namestitve verig: Z vozilom se postavite na ravno površino, ter verigo razprostrete za pnevmatiko. Nato dvignete oba dela verige na vrh pnevmatike in ju vzpnete na tekalni površini. Pritrdite verigo čez sredino platišča in poravnajte verigo po tekalni površini. Na koncu samo še verige zategnite, in pazite da ni nikjer razrahljana. Premaknete vozilo za približno 100m ter ponovno zategnite, v kolikor je potrebno.

Prometna varnost

redpajama_set_name: RedPajamaWikipedia


These unique pieces hand cut, hand poked and polished by hand. The dark coat usually traditionally used is muted in this collections, therefore achieving a cleaner, modern look. This Tin Art collection is handmade by artisans in Southern Mexico. Each item is crafted individually; slight variation in color or finish can occur.


Impact Statement: Literacy is an essential skill in today's world. At Frontier College, we believe it's a fundamental right. Frontier College is Canada's original literacy organization. Through a network of thousands of volunteers, Frontier College is helping people realize their potential and seize the opportunities that come their way.
Description: The SCAWR Homework Club is a homework program run by Frontier College in partnership with the Somali Canadian Association of Waterloo Region (SCAWR). This evening homework club was developed to address the needs of newcomers and refugees from East Africa. The program serves all new immigrants in Waterloo Region. The focus of the program is to provide academic support to students in grades 1 - 12. Volunteers work one-on-one helping students with math, science, reading, and writing.
This volunteer position is currently accepting applications for our spring session running from May 14-June 20, 2019.
Training Details: Required 3-hour volunteer tutor training to be held in Waterloo from 6:00pm-9:00pm on Wed. May 8.
Time Detail: The program runs 6:15pm to 8:15pm Tuesday and Thursday evenings. Volunteers may pick one day only.


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Every quarter, I like to visit Grace Cathedral for a little self-check-in time. I call it my quarterly "pilgrimage," when, for a few hours, I get away from work, stay off the internet, and allow for reflection. On my pilgrimage earlier this week, I began to consider why I enjoyed performing this ritual so much. What was it that I gained that made the trek so worthwhile? Craning my neck up towards the high ceilings of the church, I recognized within myself a sensation that can only be described as awe. Awe is what brings me back to Grace, what entices me back to these more silent moments of thought. Truth is, I long for awe in my life.
Some might say that inner peace or clarity of mind is what is sought after in self-reflection. For me, these are actually the results of starting from a place of awe. Awe involves an encounter with something that is beyond myself. There is an element of befuddlement and wonder - a recognition that something is so big, vast, profound, complex or beyond knowing that I am left gaping or sighing without much to say. At face value, it might seem that the natural response to this is fear. If something is so unfathomable, it would make sense that people would steer clear of it. I think much of consumer culture is a series of attempts at turning away from that which would hold us in awe.
Many religious folk might say that when we are in awe, we are re-connecting with the divine love of God. Moments of awe are really moments of beholding God. And the fact that God Almighty, who is perhaps the most fearful being in the universe, would deign to let us ponder God Almighty is seen as a definition of grace. An awesome thought, indeed. And not necessarily one I disagree with.
But something that has bothered me about that line of thought is how packaged the whole thing comes out. Clearly defining the experience of awe with such unabashed certitude seems to... well, de-awe the whole thing. The emotional responses of love, hope and even fear seem to be what comes after awe. But what I wanted to know, sitting in the Cathedral as groups of tourists snapped photo after photo of the building's grandeur, was why was I drawn to awe itself? I recognize my need for love and hope, but those aren't the reasons why I go to Grace. I enjoy being in awe - but why?
Grace's latest environmental art installment. Isn't it awe-some?
The best answer I could find for myself that day was perspective. Awe is a moment of perspective revision. When I gaze upon the Cathedral, when I take in a view of the Grand Canyon, when I ponder God and existence, the common thread is that my perspective is shattered. Something that doesn't seem possible is, or something that once seemed so simple is inconceivable. In any case, awe occurs when my grasp on reality is disturbed. In the cases of nature or art, that disturbance is often delightfully surprising. But awe isn't always so kind. Awe can yield paralyzing fear and horror. But my point is that any awesome encounter, regardless of the emotional result, brings a new or wider perspective (even if it means a disorienting one). And as someone who loves the idea of continual growth and evolution through life, this perspective shift is what draws me to awe again and again.
Now let's get real. Am I always in this happy, fuzzy state where awe is always welcome? Of course not. I love mental distractions and simple thinking as much as any other person who watches Sailor Moon fanatically... Nor am I saying we should always be in awe, because quite frankly I don't think anything would get done in the world if we were in a constant state of getting our mind blown ("Double rainbow...What does it mean...?"). But every now and again, I think creating space for that awe to well up in me does me a great amount of good, keeping my perspective in check and reminding me of my size in the scheme of things. It's kinda awesome.
Posted on July 10, 2014 by Min Kahng and filed under Thought and tagged Grace Cathedral.


text:
Карло Бацці (; 1875, Турин, Італія — 1947, Мілан, Італія) — італійський художник-пейзажист та художник-реаліст.

Біографія
Карло Бацці народився в Турині. Він вивчав живопис у Академії образотворчих мистецтв Бере [Джузеппе Бертіні] і Vespasiano Bignami. У Мілан Тисячоліття 1897, який забезпечує вивчення всередині. З цього часу він присвятив себе під впливом свого друга художника Стефано Берсані, з яким він часто обійшовся озеро Комо, особливо ландшафт, включаючи гори та погляди флот. Учитель Карло Бацці був художником Арріго Парнісарі.

У 1906 він відкрив художню скляну майстерню в Мілані з художником Сальваторе Корвайя..

Його мальовничі твори з'являються у збірці Banca Commerciale Italiana, потім об'єднані з зображенням Banca Intesa.

Виставки
 Національна виставка Мілана, 1984
 Триєнале 1900 року, з його найважливішою роботою під назвою «Піднімання сонця у Сплюзі» (Levata del sole allo Spluga), 1900<ref>Accademia di Brera, Quarta esposizione triennale: 1900 ; catalogo ufficiale ; Milano, (Palazzo di Brera), 1900 </ref>
 Національна художня виставка Брера з роботою "Verso sera", 1922

 Музеї
 Сучасна художня галерея (Мілан), живопис
 Палац Банк Італії (Banca d'Italia), Мілан, художнє вітражне скло
 Colleccioni d'Arte della Fondazione Cariplo, Milan, живопис
 Бібліотека Амброзія, Мілан, художнє вітраж
 Амброзіана Пінакотека, Мілан, художнє вітраж
 Церква Святого Йосипа в поліклініці [Милан], художнє вітраж
 Вілла делла Рейна (Маргерита ді Савойя) Бордіґера, художнє вітраж
 Società e Artisti Patriottica Мілан, живопис
 Аукціони Raccolte dell'Ospedale Maggiore, Milan, Живопис
 Pinacoteca Verbanese, Magazzeno Storico Verbanese, Вербания, Intra, Живопис

 Примітки

 Література
 Agostino Mario Comanducci, Pittori Italiani dell'Ottocento, Milano, 1934
 Agostino Mario Comanducci, Dizionario illustratori pittori e incisori italiani moderni, II ediz. Milano, 1945
 Agostino Mario Comanducci, Dizionario illustratori pittori e incisori italiani moderni, III ediz. Milano, 1962
 H. Vollmer, Kunslerlex, 1953
 Guido Cesura, Il Lago Maggiore in un secolo di pittura 1840/1940, Istituto Geografico De Agostini, Novara, 1978
 Raffaele De Grada, Il Novocento a Palazzo Isimbardi, Palazzo Isimbardi (Milan, Italy), Vita Firenza, 1988
 Paola Slavich, Ospedale maggiore/Cà granda: Ritratti moderni, 1987
 Vincenzo Vicario, Giuseppe Bertini: il grande maestro dell'Ottocento a Brera nel primo centenario della morte : 11 dicembre 1825-24 novembre 1898'', Grafica GM, 1997
 L'Illustrazione italiana, Edizioni 1-15, Editore Garzanti, 1938
 Le industrie artistiche italiane, Volumi 1-3, Italy. Ministero di agricoltura, industria e commercio, 1909
 La Chimica e l'industria, Volume 6, Società di chimica industriale, Milan, Società chimica italiana, Associazione italiana di chimica, Rome, Federazione nazionale fascista degli industriali dei prodotti chimici, 1924 (Medaglia d'oro di secondo grado)
 Il Laboratorio dei Bragaglia 1911/1932, Loggetta Lombardesca (Ravenna, Italy), Essegi, 1986
 Rosa Barovier Mentasti, Tra creatività e progettazione: il vetro italiano a Milano 1906-1968, Electa, 1998
 Fulvio Roiter, Guido Lopez, Art nouveau in Milan, Edizioni CELIP, 1993
 Carlo Carrà, L'arte decorativa contemporanea alla prima biennale internazionale di Monza, Alpes, 1923

Див. також

 Реалізм

Примітки

Реалізм
Італійські художники
Померли в Мілані
Художники, чиї твори перебувають у суспільному надбанні


text:
<?php

namespace Creios\Creiwork\Framework\Result;

use Creios\Creiwork\Framework\Result\Util\Result;

/**
 * Class RedirectResult
 * @package Creios\Creiwork\Util\Results
 */
class RedirectResult extends Result
{

    /**
     * @var string
     */
    protected $url;

    /**
     * RedirectResult constructor.
     * @param string|null $url
     */
    public function __construct($url = null)
    {
        $this->url = $url;
    }

    /**
     * @return string
     */
    public function getUrl()
    {
        return $this->url;
    }

}

redpajama_set_name: RedPajamaGithub


text:
Q: Summing in json data with nodejs I am using nodejs. I get the json data with the code below.
I want to get the sum of "element.debt". How can I do that ?
so I want to get the sum of "element.debt" in json

            var sonuc = 0;
            result.forEach(element => {
                sonuc = element.debt
            });
            console.log(sonuc)

{
    "message": "customer debst",
    "result": [
        {
            "id": 3,
            "user_id": 15,
            "debt": "100.00",
            "received_amount": "150.00",
            "business_code": "123456",
            "debt_description": "description here"
        },
        {
            "id": 2,
            "user_id": 15,
            "debt": "110.00",
            "received_amount": "150.00",
            "business_code": "123456",
            "debt_description": "description here"
        }
    ]
}

A: Here is a basic way to sum the debt using reducer and keeping the decimals
const reducer = (accumulator, currentValue) => (parseFloat(accumulator.debt) + parseFloat(currentValue.debt)).toFixed(2);

console.log(result.reduce(reducer));

redpajama_set_name: RedPajamaStackExchange


text:
Paulo Jorge Nogueira
Institute of Preventive Medicine and Public Health. Faculty of Medicine. University of Lisbon. Lisbon. Laboratory of Biomathematics. Faculty of Medicine. University of Lisbon. Lisbon. Institute for Evidence Based Health. Faculty of Medicine. University of Lisbon. Lisbon. Institute for Environmental Health. Faculty of Medicine. University of Lisbon. Lisbon.
DGS + Faculdade de medicina da Universidade de Lisboa - Chefe de Divisão de Estatísticas de Saúde - Direção-Geral da Saúde - Professor Auxiliar Convidado da Faculdade de Medicina de Lisboa
Miguel De Araújo Nobre
Institute for Evidence Based Health. Faculty of Medicine. University of Lisbon. Lisbon. Stomatological University Clinic. Faculty of Medicine. University of Lisbon. Lisbon. Epidemiology Unit. Institute of Preventive Medicine and Public Health. Faculty of Medicine. University of Lisbon. Lisbon.
Paulo Jorge Nicola
Institute for Evidence Based Health. Faculty of Medicine. University of Lisbon. Lisbon. Institute for Environmental Health. Faculty of Medicine. University of Lisbon. Lisbon. Epidemiology Unit. Institute of Preventive Medicine and Public Health. Faculty of Medicine. University of Lisbon. Lisbon.
Cristina Furtado
Institute of Preventive Medicine and Public Health. Faculty of Medicine. University of Lisbon. Lisbon. Institute for Environmental Health. Faculty of Medicine. University of Lisbon. Lisbon. Epidemiology Unit. Institute of Preventive Medicine and Public Health. Faculty of Medicine. University of Lisbon. Lisbon. National Institute of Health Dr. Ricardo Jorge. Lisbon.
António Vaz Carneiro
Institute of Preventive Medicine and Public Health. Faculty of Medicine. University of Lisbon. Lisbon. Institute for Evidence Based Health. Faculty of Medicine. University of Lisbon. Lisbon. Cochrane Portugal. Lisbon.
Home > Vol 33, No 9 (2020) >	Nogueira
Reply to a Comment Published on Acta Med Port 2020; May 25; doi:10.20344/amp.14155 about the Article Published on Acta Med Port 2020; Apr 27; doi:10.20344/amp.13928
Paulo Jorge Nogueira, Miguel De Araújo Nobre, Paulo Jorge Nicola, Cristina Furtado, António Vaz Carneiro
Coronavirus; Coronavirus Infections; COVID-19; Disease Outbreaks; Mortality; Pandemics; Portugal


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text:
FISHERMEN AND WOMEN FROM MARÉ ISLAND/BAHIA DENOUNCE THE CRIMINAL DESTRUCTION OF MANGROVES
The community of Maré Island publically denounces the destruction of the mangroves located within their traditional territories. About a week ago, with chainsaws in hand, approximately 50 unidentified men devastated the biome. In the assessment of Marizélha Lopes, one of the local leaders and a representative of the Movement of Artisanal Fishermen and Women (Movimento de Pescadores e Pescadoras Artesanais: MPP), this will have a severe impact on the environmental diversity and means of subsistence of the fishermen and women, and shellfish pickers in the region.
The focus of the devastation is situated within the River Aratu, between the company Dow Química and the Ford company port. "We don't know who it is, we are just in agony. I am devastated to see this situation, the chainsaws; the herons that usually lived in there, in the mangroves, which are now on the ground," said Marizélha with concern.
The area is authorized for vegetation suppression and dredging, with licensing authorized to the Bahia Terminais port enterprise. The space has become another port in the region, disregarding its capacity to support the environment and the ecosystem, as well as social and economic impacts, particularly on artisanal fishing.
However, the community asserts that no consultation was undertaken, nor was previous warning provided of the destruction of the mangroves, which are essential for both environmental balance and the existence of these fishing peoples.
"This population is treated as inexistent", states Pedro Diamantino, teacher and researcher from the Federal University of Feira de Santana (Universidade Federal de Feira de Santana: UEFS), portraying yet another facet of racism that has taken over the world's media in recent weeks. Environmental racism, instigated in this region, is made manifest in the death of the programme for traditional black peoples who live in territories with precarious access to their basic rights, or, as in this case, residents in regions of economic interest. "Now, in the middle of the pandemic, when we are concerned with our health, they are destroying the remains of the mangroves. If they do this, fishing will disappear. Several families live off this river, both fishermen and women from Maré island, such as those from Caboto, Boca do Rio (a community within Aratu Port), the community of Aratu (on São João island), and Mapele" notes the leader, reinforcing the need for the local authorities to inspect and prevent the destruction of local flora and the fishermen and women's and shellfish pickers' means of survival in the region.
History of rights violations
Since the 1950s, significant industrialization has taken place in the region, which was already inhabited by quilombola communities, with the installation of petrochemical industries. The effects were quickly felt by local residents and today have been documented in research.
The Aratu Port is the main outlet of products from Bahia's Petrochemical Complex, located in the city of Camaçari (Bahia).
For years, the irresponsible disposal of products has contaminated the waters and brought sickness to the population of Maré Island. Several studies have provided evidence of the impact of this contamination on the health of the fishermen and women in the area. One of the most serious cases resulted from an accident involving the Golden Miller tanker. On 17 December 2013, this ship from the Bahamas leaked oil into All Saints Bay.
A study conducted by Neuza Miranda, from the Federal University of Bahia (Universidade Federal da Bahia: UFBA), shows that the pollution of the waters has led to an accumulation of heavy metals across the region's entire food chain. Since fish form an essential part of the residents' diet, these metals are continually being ingested.


text:
Tag: Pap test
Ailmemts & Remedies Pediatric
No Comments on Torticollis
Alternative Names : Wry neck; Loxia
Torticollis is a twisted neck in which the head is tipped to one side, while the chin is turned to the other.It is a stiff neck associated with muscle spasm, classically causing lateral flexion contracture of the cervical spine musculature. The muscles affected are principally those supplied by the spinal accessory nerve.
•Limited range of motion of the head
•Headache
•Head tremor
•Neck pain
•Shoulder is higher on one side of the body
•Stiffness of neck muscles
•Swelling of the neck muscles (possibly present at birth)
Types of Torticollis:
Temporary Torticollis: This type of wry neck usually disappears after one or two days. It can be caused by:
*swollen lymph nodes
*an ear infection
*a cold
*an injury to the head and neck that causes swelling
Fixed Torticollis: Fixed torticollis is also called acute torticollis or permanent torticollis. It is usually due to a problem with muscle or bone structure.
Muscular Torticollis:
This is the most common type of fixed torticollis. It is caused by scarring or tight muscles on one side of the neck
Klippel-Feil Syndrome:
This is a congenital form of wry neck. It occurs when the bones in an infant's neck have formed incorrectly. Children born with this condition may have difficulty with hearing and vision.
Cervical Dystonia:
This rare disorder is sometimes referred to as spasmodic torticollis. It causes neck muscles to contract in spasms. If you have cervical dystonia, your head twists or turns painfully to one side. It may also tilt forward or backward. Cervical dystonia sometimes goes away without treatment. However, there is a risk of recurrence.
This type of wry neck or Torticollis can happen to anyone. However, it is most commonly diagnosed in middle age. It affects more women than men.
CAUSES:
Torticollis can be inherited. It can also develop in the womb. This may happen if the fetus' head is in the wrong position. It can also be caused by damage to the muscles or blood supply to the neck.
Anyone can develop wry neck after a muscle or nervous system injury. However, most of the time, the cause of wry neck is not known. This is called idiopathic torticollis.
Evaluation of a child with torticollis begins with history taking to determine circumstances surrounding birth and any possibility of trauma or associated symptoms. Physical examination reveals decreased rotation and bending to the side opposite from the affected muscle. Some say that congenital cases more often involve the right side, but there is not complete agreement about this in published studies. Evaluation should include a thorough neurologic examination, and the possibility of associated conditions such as developmental dysplasia of the hip and clubfoot should be examined. Radiographs of the cervical spine should be obtained to rule out obvious bony abnormality, and MRI should be considered if there is concern about structural problems or other conditions.
Evaluation by an ophthalmologist should be considered in children to ensure that the torticollis is not caused by vision problems (IV cranial nerve palsy, nystagmus-associated "null position," etc.). Most cases in infants respond well to physical therapy. Other causes should be treated as noted above.
Common treatments might involve a multi-phase process:
1.Low-impact exercise to increase strong form neck stability
2.Manipulation of the neck by a chiropractor, physical therapist, or D.O.†
3.Extended heat application.
4.Repetitive shiatsu massage.
†An Osteopathic Physician (D.O.) may choose to use Cranial techniques to properly position the occipital condyles – thereby relieving compression of cranial nerve XI in children with Torticollis. This is an example of Osteopathic Manipulative Treatment.
Acquired torticollis:
Acquired torticollis occurs because of another problem and usually presents in previously normal children and adults…..
*A self-limiting spontaneously occurring form of torticollis with one or more painful neck muscles is by far the most common ('stiff neck') and will pass spontaneously in 1–4 weeks. Usually the sternocleidomastoid muscle or the trapezius muscle is involved. Sometimes draughts, colds or unusual postures are implicated; however in many cases no clear cause is found. These episodes are rarely seen by doctors other than a family physician.
*Trauma to the neck can cause atlantoaxial rotatory subluxation, in which the two vertebrae closest to the skull slide with respect to each other, tearing stabilizing ligaments; this condition is treated with traction to reduce the subluxation, followed by bracing or casting until the ligamentous injury heals.
*Tumors of the skull base (posterior fossa tumors) can compress the nerve supply to the neck and cause torticollis, and these problems must be treated surgically.
*Infections in the posterior pharynx can irritate the nerves supplying the neck muscles and cause torticollis, and these infections may be treated with antibiotics if they are not too severe, but could require surgical debridement in intractable cases.
*Ear infections and surgical removal of the adenoids can cause an entity known as Grisel's syndrome, a subluxation of the upper cervical joints, mostly the atlantoaxial joint, due to inflammatory laxity of the ligaments caused by an infection. This bridge must either be broken through manipulation of the neck, or surgically resected.
*The use of certain drugs, such as antipsychotics, can cause torticollis.
*Antiemetics – Neuroleptic Class – Phenothiazines
There are many other rare causes of torticollis.
Spasmodic torticollis:
Torticollis with recurrent but transient contraction of the muscles of the neck and esp. of the sternocleidomastoid. "intermittent torticollis . "cervical dystonia"
TREATMENT: Botulinum toxin has been used to inhibit the spastic contractions of the affected muscles.
In animals:….CLICK & SEE
The condition can also occur in animals, usually as a result of an inner ear infection but sometimes as a result of an injury. It is seen largely in domestic rodents and rabbits, but may also appear in dogs and other different animals.
Possible ComplicationsComplications may include:
•Muscle swelling due to constant tension
•Neurological symptoms due to compressed nerve roots
The condition may be easier to correct in infants and children. If the condition becomes chronic, numbness and tingling may develop as nerve roots become compressed in the neck.
The muscle itself may become large (hypertrophic) due to constant stimulation and exercise.
Botulinum toxin injections often provide substantial relief.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose
http://en.wikipedia.org/wiki/Torticollis
http://www.nlm.nih.gov/medlineplus/ency/article/000749.htm
http://www.umm.edu/imagepages/19090.htm
http://commons.wikimedia.org/wiki/File:Sternocleidomastoideus.png
http://www.healthline.com/health/torticollis#Causes2
Bodyquirk of the Month: Torticollis (bodyquirks.wordpress.com)
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Torticollis (kylealina.wordpress.com)
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The Body Remembers – Childhood Origins of Adult Musculoskeletal Issues – Part I (hofholistichealingcenters.wordpress.com)
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Some Health Quaries & Answers (findmeacure.com)
Is torticollis painful? (zocdoc.com)
Is my child dragging his foot because of torticollis? (zocdoc.com)
Tags Avian influenza, Cancer, Centers for Disease Control and Prevention, Cervical cancer, Chicken, Chief Veterinary Officer (United Kingdom), CNN, Conditions and Diseases, Daddy Potts, Dr. John, Emera, Health, Human papillomavirus, Iowa, Movement Disorders, Muscle, Musculoskeletal Disorders, Neurological Disorders, Pap test, Plea, Prison, Respiratory disease, The Million Women Study, Torticollis, Tumor, United States, United States Department of Agriculture
Ailmemts & Remedies
1 Comment on Human Papilloma Virus (HPV)
HPV, short for Human Papillomavirus, is a group of over 100 different kinds of viruses, some of which cause warts on the hands and feet and others which cause genital warts and cervical cancer. This health guide is about the sexually transmitted types of HPV. If you are sexually active, or thinking about becoming sexually active, your best protection is to learn the facts about how HPV is spread and how to prevent getting it.
Click to see the picture
HPV (Human Papillomavirus) is one of the most common sexually transmitted diseases. There are many different types of HPV and more than 30 are sexually transmitted. Researchers keep track of the different types of HPV by identifying them with numbers, such as 6, 11, 16, and 18.
Some sexually transmitted HPV types may cause genital warts. Persistent infection with "high-risk" HPV types—different from the ones that cause skin warts—may progress to precancerous lesions and invasive cancer. HPV infection is a cause of nearly all cases of cervical cancer. However, most infections with these types do not cause disease.
Some types (such as 6 and 11) cause genital warts, others (such as 16 and 18) cause pre-cancerous changes on the cervix that can later lead to cancer of the cervix. In rare cases, the virus can cause other types of cancers to the vulva, vagina, and anus in girls and the anus and penis in guys.
HPV is passed on through genital contact, usually during vaginal and anal sex, as well as during oral sex. People with weakened immune systems, such as those on chemotherapy or people with HIV are more susceptible to HPV infection.
At least 1 in every 2 sexually active young women has had a genital HPV infection. Any sexually active person—no matter what color, race, gender, or sexual orientation—can get HPV. HPV is mainly spread by sexual contact. Very rarely, a mother who is infected with the HPV virus can infect her newborn baby during the delivery.
It's estimated that by the age of 27, most sexually active people have been exposed to some strain of HPV, usually without them knowing, and very rarely do doctors know which strain.
Most people with HPV don't develop symptoms or further health problems, as in around 90 per cent of cases the body's immune system has naturally cleared it within two years.
However, certain types of HPV (most commonly strains 6, 11, 16 and 18) can cause genital warts in men and women, while other HPV strains (especially 16, 18 and 39) can cause cellular changes that lead to cancer of the cervix and possibly other less common but serious cancers including:
•vulval cancer
•cancer of the vagina
•cancer of the penis
•anal cancer
•head and neck (tongue, tonsils and throat) cancers
It's possible to have HPV present years after sexual contact with an infected person, and it's also possible to be exposed to more than one strain of HPV.
There is currently no easy way to spot which people affected by HPV exposure will go on to develop cancer or other serious health problems.
Very rarely, a pregnant woman can pass HPV to her baby during birth and the child can develop recurrent respiratory papillomatosis – a chronic lung condition where growths block the airways.
*The infected area of your body remains totally normal (called latent or inactive infection). You may never know about it, but you may give the infection to others. Your body then usually clears the infection.
*Bumps, called genital warts, can be seen in your genital area. They almost never lead to cancer.
*Changes in the cells of your cervix can result in an abnormal Pap test. Most of the time, if you are a teenager, your body will clear the HPV and the Pap test will become normal again over several years. However, sometimes the HPV infection persists in your cervix which can lead to cervical cancer. This is why your doctor will want to see you for follow-up visits if you have had an abnormal Pap test.
*You had sexual contact at an early age.
*Either you or your sexual partners have had many different sexual partners at any time.
*You or any of your sexual partners have had a history of sexually transmitted diseases.
*Any of your sexual partners did not wear a condom.
HPV and cancer risks:
We don't fully understand the way in which HPV affects cells. Both high-risk and low-risk strains of HPV can cause the growth of abnormal cells, but only the high-risk types of HPV appear to lead to cancer.
Several types of cancer (up to five per cent worldwide), while linked to other risk factors, are now also associated with HPV exposure:
•cervical cancer (the most common HPV-associated cancer)
•vulval and vaginal cancer (40 to 70 per cent linked to HPV)
•penile cancer (possibly 40 per cent linked)
•anal cancer (around 85 per cent linked)
•cancers of the head and neck (although most are linked to tobacco and alcohol use, it's now thought about 25 per cent of mouth and 35 per cent of throat cancers may be linked to HPV exposure (in particular HPV strain 16)
Sometimes it's hard to know if you have HPV. Although genital warts are usually seen on, around, or inside your vagina or anus, they may be small and hard to see. And you may not have any symptoms such as pain or bleeding.
In March 2003, the U.S. Food and Drug Administration (FDA) approved a test manufactured by Qiagen, which is a "hybrid-capture" test, as the primary screening tool for detecting HPV cervical infection as an adjunct to Pap testing. The test may be performed during a routine Pap smear. It can detect the DNA of the 18 HPV types that most commonly affect the cervix and distinguish between "low" and "high-risk" HPV types, but it cannot determine the specific HPV types.
According to the National Cancer Institute, "testing samples of cervical cells is an effective way to identify high-risk types of HPV that may be present. The FDA has approved an HPV test as a follow-up for women who have an ambiguous Pap test and, for women over the age of 30, for general cervical cancer screening. This HPV test can identify at least 13 of the high-risk types of HPV associated with the development of cervical cancer. The test can detect high-risk types of HPV even before there are any conclusive visible changes to the cervical cells."
The recent outcomes in the identification of molecular pathways involved in cervical cancer provide helpful information about novel bio- or oncogenic markers that allow monitoring of these essential molecular events in cytological smears, histological or cytological specimens. These bio- or onco- markers are likely to improve the detection of lesions that have a high risk of progression in both primary screening and triage settings. E6 and E7 mRNA detection PreTect HPV-Proofer, (HPV OncoTect) or p16 cell-cycle protein levels are examples of these new molecular markers. According to published results these markers, which are highly sensitive and specific, allow to identify cells going through malignant transformation.
Other testing:
Although it is possible to test for HPV DNA in other kinds of infections, there are no FDA-approved tests for general screening in the United States or tests approved by the Canadian government, since the testing is inconclusive and considered medically unnecessary.
Genital warts are the only visible sign of low-risk genital HPV, and can be identified with a visual check. These visible growths, however, are the result of non-carcinogenic HPV types. 5% acetic acid (vinegar) is used to identify both warts and squamous intraepithelial neoplasia (SIL) lesions with limited success by causing abnormal tissue to appear white, but most doctors have found this technique helpful only in moist areas, such as the female genital tract. At this time, HPV test for males are only used in research.
There is currently no specific treatment for HPV infection. However, the viral infection, more often than not, clears by itself. According to the Centers for Disease Control and Prevention, the body's immune system clears HPV naturally within two years for 90% of cases. However, experts do not agree on whether the virus is completely eliminated or reduced to undetectable levels, and it is difficult to know when it is contagious.
Health management is based on prevention, by advising condom use and vaccination.
There is treatment for some of the diseases that HPV can cause, including:
•Genital warts, which can be cauterised or treated chemically.
•Abnormal cervical cells, which can be removed by various techniques.
Treatments for genital warts range from acid medicines, to creams, to laser therapy. The treatment will remove visible warts and unwanted symptoms such as itchiness. The type of treatment your doctor recommends will depend on the number, location and size of the warts and the cost and side effects of the different treatments. It's important to talk with your health care provider about treatment choices and what type of follow-up you will need. Tell your health care provider if you think you are pregnant so that the right therapy is chosen.
Do NOT use over-the-counter "wart medicine" on genital warts. (These medicines are not meant for the very sensitive skin around your genital area).
Condoms offer some protection against genital infection, but any exposed skin can transmit the virus. In short, condoms are not 100% effective in preventing HPV. Genital HPV infection is the most frequent sexually transmitted disease in the world.
Vaccines:
Two vaccines are available to prevent infection by some HPV types: Gardasil, marketed by Merck, and Cervarix, marketed by GlaxoSmithKline. Both protect against initial infection with HPV types 16 and 18, which cause most of the HPV associated cancer cases. Gardasil also protects against HPV types 6 and 11, which cause 90% of genital warts.
The vaccines provide little benefit to women who have already been infected with HPV types 16 and 18—which includes most sexually active females. For this reason the vaccine is recommended primarily for those women who have not yet been exposed to HPV during sex. The World Health Organization position paper on HPV vaccination clearly outlines appropriate, cost-effective strategies for using HPV vaccine in public sector programs.
Both vaccines are delivered in three shots over six months. In most countries they are approved only for female use, but are approved for male use in countries like USA and UK. The vaccine does not have any therapeutic effect on existing HPV infections or cervical lesions.
Women should continue to seek cervical screening, such as Pap smear testing, even after receiving the vaccine. Cervical cancer screening recommendations have not changed for females who receive HPV vaccine. Without continued screening, the number of cervical cancers preventable by vaccination alone is less than the number of cervical cancers prevented by regular screening alone.
Both men and women are carriers of HPV. Possible benefits and efficacy of vaccinating men are being studied. According to a study by Harvard University Medical School, to vaccinate boys may not be cost effective, especially if a widespread vaccination of girls continues.
No efficacy trials for children under 15 have been performed. Duration of vaccine efficacy is not yet answered by rigorous methodologic trials. Cervarix efficacy is proven for 7.4 years with published data through 6.4 years while Gardasil efficacy is proven for 5 years. Age of vaccination is less important than the duration of efficacy.
Condoms:–
The Centers for Disease Control and Prevention says that male "condom use may reduce the risk for genital human papillomavirus (HPV) infection" but provides a lesser degree of protection compared with other sexual transmitted diseases "because HPV also may be transmitted by exposure to areas (e.g., infected skin or mucosal surfaces) that are not covered or protected by the condom."
Studies have suggested that regular condom use can effectively limit the ongoing persistence and spread of HPV to additional genital sites in individuals who are already infected. Thus, condom use reduces the risk that already infected individuals will progress to cervical cancer or develop genital warts.
Microbicides:–
Ongoing research has suggested that several inexpensive chemicals might serve to block HPV transmission if applied to the genitals prior to sexual contact. These candidate agents, known as topical microbicides, are currently undergoing clinical efficacy testing. A recent study indicates that some sexual lubricant brands that use a gelling agent called carrageenan prevent papillomavirus infection in animal model systems. Clinical trial results announced at the 2010 International Papillomavirus Conference indicate that a carrageenan-based personal lubricant called Carraguard is effective for preventing HPV infection in women. The results suggest that use of carrageenan-based personal lubricant products, such as Divine No 9, Bioglide and Oceanus Carrageenan may likewise be effective for preventing HPV infection.
Oral infection:
A review of scientific studies in healthy subjects has found carcinogenic HPV in 3.5% of the studies subjects and HPV16 in 1.3%. Men have higher prevalence of oral HPV than women.
Oral HPV infection is associated with HPV-positive oropharyngeal cancer. Odds of oral HPV infection increases with the number of recent oral sex partners or open-mouthed kissing partners. Nonsexual oral infection through salivary or cross transmission is also plausible
http://www.bbc.co.uk/health/physical_health/conditions/hpv.shtml
http://www.youngwomenshealth.org/hpv.html
http://en.wikipedia.org/wiki/Human_papillomavirus
http://www.hivandhepatitis.com/recent/2009/060909_d.html
http://www.magazine.ayurvediccure.com/what-are-the-health-consequences-of-hpv/
http://w-cancer.com/anal-cancer/
http://e-cervicalcancer.com/human-papilloma-virus-cervical-cancer/
Should boys be vaccinated against the human papilloma virus (HPV)? (guardian.co.uk)
How is an HPV cancer screening performed? (zocdoc.com)
HPV: Symptoms & Treatment in At Risk Men (connectwithwellness.wordpress.com)
Does HPV cause genital warts? (zocdoc.com)
How do genital warts and molluscum differ? (zocdoc.com)
Advice on Human Papilloma Virus Vaccine (drppanda.wordpress.com)
Do I need a pain medicine injection before my first PAP smear? (zocdoc.com)
Study shows the HPV vaccine Gardasil doesn't increase disease activity in SLE patients (medicalxpress.com)
How do you choose the best vaccination against cervical cancer? (guardian.co.uk)
Cancer does not define me, but how I live and fight with cancer DOES define me." (applesaucedelight.wordpress.com)
http://bryanking.net/human-papilloma-virus-hpv/
Tags Cancer, Cervical cancer, Genital wart, Human papillomavirus, Pap test, Sex organ, Sexually transmitted disease, Wart
No Comments on Cancer Prevention
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Cancer conjures up images of mutilating surgery, chemotherapy, radiation, years with doctors and in hospitals, and — most terrible — death. It comes in many avatars and can attack any part of the body. The risk factors for the ailment are many. It has been found to have associations with infections, lifestyle, genetic factors and heredity. If an injection is available to prevent cancer, it is hard to imagine anyone opting not to take it!
Viruses have long been known to cause infections that can progress to cancer. Previously, the association was suspected but not proven. Today, with electron microscopes, DNA sequencing and other advanced techniques, the association between certain viral infections and cancer has been conclusively proven. Of these, two types of cancer — of the cervix and some cancers of the liver — can be prevented with timely immunisation.a
The statistics speak for themselves. Cervical cancer (or cancer of the neck of the uterus) accounts for 25 per cent of all cancers in women. It is commoner than breast cancer (14 per cent). Around 1,30,000 cases are detected annually in India and half of these women eventually succumb to the disease.
Cervical cancer has long been associated with certain risk factors. It is more likely to occur if the woman smokes, does not have a healthy diet with plenty of fruits and vegetables, is exposed to multiple male sexual partners, has her first sexual contact before the age of 17 years, or has multiple pregnancies. A higher incidence is also noted if the woman has other sexually transmitted infections like Chlamydia or infection with HIV.
Recently, the association between infection with HPV (Human Papilloma Virus) and cervical cancer has been conclusively established. More than 95 per cent of the women with cervical cancer have evidence of HPV infection. Although 75 per cent of normal women have evidence of HPV infection, the virus persists and goes on to cause cancer in 5-10 per cent.
There are 130 identified types of HPV. Some cause infection but produce no symptoms like fever or pain, and are harmless. The patient may remain totally unaware of the infection. Other subtypes of HPV may cause warts on the skin. Around 30-40 types of the virus is transmitted through sexual contact. They may produce no symptoms when the infection first occurs. The virus can persist in the surface mucosa of the moist ano-genital areas. It can produce disfiguring warts in these areas. It can extend into the vaginal areas and cervix. Cancerous changes occur 20-30 years after the initial infection, when the woman is in her 40s and 50s.The progression depends on the type of virus and is more likely to occur if the infection occurred with the subtypes 15-20.
Once the association between cervical cancer and HPV was established, the scientific community got to work and produced a vaccine. It has been extensively studied and is now marketed in India by two companies under the trade names "Gardasil" and "Cervarix". This is a major scientific breakthrough and cervical cancer can now be prevented in future generations of women.
The dosage schedule advised for HPV vaccine is as follows. The first dose is given between nine and 11 years of age. The second dose is administered two months later, and the third six months after that. No booster doses are advised at present. Women who have not been immunised can have the first dose at any time up to the age of 26 years. If they have already been exposed to HPV, the vaccine will only protect them against the strains to which they have not been exposed. Immunisation is not advised in pregnancy but can be given to breast-feeding mothers. Side effects are rare and include fever and rash.
For those of us who are older and have not had access to the vaccine, a screening test called "pap smear" (Papanicolaou test) can be done to detect cervical cancer in its early stages. The test is widely used and is effective. Screening should ideally be done three years after sexual activity has started and then continued every three years after that. Many Indian women do not have access to this test or are unaware of it.
Liver cancer and chronic liver disease can occur in people who develop hepatitis B infection. This too is a viral disease which is spread by contact with infected body fluids (blood transfusions, sexual intercourse). Infection can be prevented by three doses of hepatitis B vaccine. The second dose is given a month after the first and the third six months later.
Men and women should receive immunisation against Hepatitis B. At present, HPV vaccine is advised only for girls. Perhaps we have forgotten that women get the infection from their infected male partners, making a case for non-gender specific universal immunisation of all children.
Source: The Telegraph (Kolkata, India)
Tags Cancer, Cervical cancer, Diseases & Conditions, Gardasil, Health, Human papillomavirus, Pap test, Sexually transmitted disease
Diagnonistic Test
Testing for Vaginitis (Yeast Infections, Trichomonas, and Gardnerella)
No Comments on Testing for Vaginitis (Yeast Infections, Trichomonas, and Gardnerella)
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What is the test?
Vaginitis is inflammation or an infection of the vagina; symptoms usually include itchiness or irritation, abnormal discharge, and an unpleasant odor. Diagnosing the cause of vaginitis involves a simple examination of the vaginal fluid under a microscope or sending the sample to a laboratory for a culture….CLICK & SEE
How do you prepare for the test?
Because douches or vaginal creams can make it hard for the doctor to interpret test results, don't use these products before the test. No other preparation is necessary.
What happens when the test is performed?
You'll have a pelvic examination. The doctor uses a cotton swab to collect a sample of the fluid that moistens the lining of the vagina. This swab is rubbed against two glass slides, and a small drop of fluid is placed on each slide to mix with the vaginal fluid. If your doctor is testing for infection with gonorrhea or chlamydia, he or she might use a second cotton swab to take a sample of mucus from the middle of the cervix.
Your doctor or a technician examines the slides under a microscope for signs of infection with yeast, a tiny parasite called Trichomonas, or a bacterium called Gardnerella (which causes an infection called bacterial vaginosis). If a second cotton swab was used, the doctor sends it to a laboratory for gonorrhea or chlamydia testing.
A pelvic examination assesses the health of your vagina, uterus, fallopian tubes, and ovaries. This exam may be done in conjunction with a diagnostic or screening test. You lie on your back on an examining table with your knees bent and your feet in footrests. The doctor or the doctor's assistant asks you to spread your knees apart. The exam has two parts: a speculum examination and a bimanual examination. The speculum examination allows the doctor to see inside you, and the bimanual examination allows him or her to feel inside you.
During the first part of the examination, the doctor inserts a speculum, a device used to separate the walls of your vagina (normally the walls are touching each other) so that he or she can see inside. You will feel some pressure when the doctor inserts the speculum. As it is inserted, the doctor also shines a light inside you, and can see the walls of your vagina as well as the cervix-the outermost part of your uterus. If you have a vaginal infection, an abnormal discharge may be visible in the vagina. The doctor can take a sample of that discharge and study it under a microscope to diagnose what kind of infection you have.
In the center of the cervix is a channel called the cervical os that leads to the interior of your uterus. If there is bleeding in the uterus, bloody material may be seen coming out through the cervical os. If there is an infection in the uterus, pus can be seen coming out through the os. With certain infections, the outer surface of the cervix can appear irritated, or may have tiny areas of bleeding.
Even if everything looks normal, the doctor may do a routine screening test such as a Pap smear or a diagnostic test such as an endometrial biopsy or colposcopy. These techniques identify various diseases or conditions that cannot be seen with the naked eye.
During the bimanual examination, the doctor determines the size and shape of your uterus. He or she presses inside your vagina with one or two fingers while pressing on your lower abdomen with the other hand. In this way, the uterus is lifted up toward your abdominal wall, making it easier to feel between the two hands. The doctor can feel if the uterus is enlarged, or whether it is lumpy from fibroids (very common but benign growths on or in the wall of the uterus). The doctor also sometimes can feel the ovaries and any masses in the fallopian tubes (the tubes that carry eggs from the ovaries into the uterus). Sometimes he or she will insert another finger into your rectum, to better feel the area between the uterus and rectum. That finger can also feel for any lumps in the wall of the rectum, and can obtain a sample of stool to be tested for any sign of bleeding.
What risks are there from the test?
There are no risks from this test.
Must you do anything special after the test is over?
How long is it before the result of the test is known?
Your doctor can tell you what he or she saw under the microscope right away. Testing for gonorrhea and chlamydia usually requires a few days. Yeast infections are the most common type of vaginal infection, affecting three out of four women at one point or another in their lives.Although a number of over-the-counter medications are available to treat yeast infections, it is best to consult a doctor before treating yourself-especially if you have never had a yeast infection before.
Source: https://www.health.harvard.edu/fhg/diagnostics/testing-for-vaginitis.shtml
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No Comments on Cervical Dysplasia
Alternative Names: Cervical intraepithelial neoplasia (CIN); Precancerous changes of the cervix
Definition:Cervical dysplasia is the abnormal growth of cells on the surface of the cervix. Although this is not cancer, this is considered a pre-cancerous condition. Depending on the extent of changes, the condition is further categorized as:
CIN I — mild dysplasia (a few cells are abnormal)
CIN II — moderate to marked dysplasia
CIN III — severe dysplasia to carcinoma-in-situ (cancer confined to the surface layer of the cervix)
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In some women, the cells of the cervix gradually change from normal to a cancerous state. The condition between these two extremes, when the cells are abnormal with the potential to become cancerous, is known as cervical dysplasia. There are three grades of dysplasia: mild, moderate, and severe. mild dysplasia may return to a normal state, but severe dysplasia may progress to cancer of the cervix if not treated.
Many developed countries, including the US, have established screening programs to check for cervical dysplasia using the pap test. Regular testing, which helps ensure that cervical dysplasia is diagnosed and treated at an early stage before the abnormal cells become cancerous, has led to a dramatic fall in the total number of cases of cancer of the cervix.
Causes: The exact cause of cervical dysplasia is not known, but a number of different risk factors have been identified. for
example, the risk of developing cervical dysplasia appears to be slightly higher after exposure to those types of human
papilloma virus that cause genital warts. other risk factors for the development of cervical dysplasia include unprotected
sex at an early age, and becoming pregnant before age 20. however, exactly how these risk factors are connected to cervical
dysplasia is unknown. smoking also increases the risk of developing cervical dysplasia.
Less than 5% of all Pap smear test results find cervical dysplasia. While the cause is unknown, a number of risk factors have
been identified. Most cases occur in women aged 25 to 35.
Other risk factors include:
Starting sexual activity before age 18
Having children before age 16
DES exposure
Having had sexually transmitted diseases, especially HPV (genital warts) or HIV infection .
Symptoms: There are usually no symptoms.
Diagnosis: Cervical dysplasia does not produce symptoms. the condition is only normally diagnosed after a pap test, during which a sample of cells is taken from the cervix and sent for examination under a microscope. If you are found to have abnormal cells, your doctor may arrange for you to have a colposcopy, so that the cervix can be seen through an instrument and examined for abnormal-looking areas. A small sample of tissue may also be removed from the cervix and examined under the microscope for abnormalities.
Exams and Tests:
A pelvic examination is usually normal.
The following tests may indicate cervical dysplasia:
Pap smear showing mild, moderate, marked, or severe dyspepsias.
Colposcopy revealing "white epithelium." These are mosaic-like patterns on the surface of the cervix, caused by changes in the surface blood vessels.
Colposcopy-directed biopsy to confirm dyspepsias and the extent of cervical involvement.
Endocervical curettage to rule out involvement of the cervical canal.
Cone biopsy may be necessary to rule out invasive cancer.
Treatment:If you are diagnosed with cervical dysplasia, the treatment depends on the degree of abnormality cells revert to normal in up to 4 in 10 cases. however, the disorder will be monitored by pap tests every 6 months. If cervical dysplasia persists or worsens, treatment to destroy or remove the abnormal cells will be needed. after treatment you may have a bloodstained discharge for a few weeks.
The treatment depends on the degree of dysplasia. Mild dysplasia, which may go away on its own, usually involves careful observation with repeat Pap smears every 3 to 6 months. Other forms may require methods to destroy the abnormal tissue, including electrocauterization, cryosurgery, laser vaporization, or surgical removal.
Consistent follow-up, every 3 to 6 months or as prescribed, is essential.
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Prognosis: In many cases of cervical dysplasia, the cells of the cervix will return to normal after treatment. However, your condition will be monitored for the next few years to ensure that no further abnormalities develop. about 3 months after treatment, you will have a pap test and colposcopy, followed by regular pap tests every 6 months. The risk of developing cancer of the cervix is higher in cases of severe cervical dysplasia.
Nearly all cervical dysplasia can be cured with early identification, proper evaluation and treatment, and careful, consistent follow-up.
Without treatment, 30-50% cases of cervical dysplasia may progress to invasive cancer. The risk of cancer is higher for severe dysplasia (CIN III) that is not treated.
When to Contact your Medical Professional :
Call for an appointment with your health care provider if you are a woman who is sexually active or aged 20 or older, and you have never had a pelvic examination and Pap smear.
Call for an appointment with your health care provider if you have not had regular Pap smears at these intervals:
Every year initially
For women up to age 35 or 40: every 2-3 years after having three negative, consecutive annual Pap smear tests and a single sexual partner or no sexual partner
*Every year for women over age 35 or 40
*Every year for women who have had multiple sexual partners
*Every year for women who are taking oral contraceptives (birth control pills)
*Every 6 months for women who have a history of HPV (genital warts)
*Every year for DES daughters (women whose mothers took DES during the pregnancy)
The frequency recommended by your health care provider after an abnormal Pap smear or prior dysplasia
Prevention :
To reduce the chance of developing cervical dysplasia:
Wait until you are 18 or older before becoming sexually active
Practice monogamy and use condoms during intercourse
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
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