The authors concluded that glucosamine is substantially absorbed and rapidly eliminated following multiple-dose oral adminis- tration of glucosamine alone and combination in humans whereas no change in basal plasma chondroitin sulfate concentration can be detected with similar administration of chondroitin sulfate alone or in combination cheap biaxin online amex eosinophilic gastritis diet. The amount of sulfate made available to cells is an important factor in the degree of proteoglycan sulfation (132 generic biaxin 500mg without prescription gastritis yahoo,133) buy line biaxin gastritis diet india. Additionally, sulfate pools in humans are among the smallest of all species (136), making them especially susceptible to physiologically relevant small changes. In humans, sulfate balance is poorly understood and may vary on dietary factors or on dietary supplements. One study measured human urinary sulfate excretion after ingestion of methionine or chondroitin sulfate supplements in the setting of high- or low-protein diets. The authors observed that more sulfate was excreted in the urine in those with a background of high-protein diets compared with those on low-protein diets. This suggests that in the low-protein state, the body increased sulfate retention from supplements (137). These observations raise the possibility that sulfate supplementation may have a beneficial role in cartilage health. A recent study measured serum levels of sulphate during 3 hours of fasting or glucose ingestion after overnight fasts to determine how much sulphate lowering may occur during this period. Continuation of overnight fasting for 3 hours resulted in a near-linear 3-hour decrease in levels for all 14 patients ranging from 3 to 20% with a mean drop of 9. Efcacy for Pain and Function Glucosamine and chondroitin sulfate had been the subject of numerous clinical trials in Europe and Asia, all of which (until recently) had demonstrated favorable effects (139 153). In the subset of trials that tested the Rotta preparation of glucosamine sulfate (N=10), a surprisingly large effect on pain was seen (1. They also estimated that the evident publication bias in this review could lead to a relative error of 30% (159). Thus, these authors found no robust evidence for an effect of chondroitin on pain. The body of evidence concerning the efficacy of glucosamine and chondroitin has been altered by the publication of recent independently funded clinical trials, some of which had completely null results (161164). They found no difference in pain outcomes between the two groups after either 30 or 60 days of treatment. The design was a 6-month, randomized, placebo-controlled glucosamine discontinu- ation trial in which enrollees were randomly assigned to placebo or to the treatment, where participants continued taking glucosamine sulfate. In the multi- variate regression analysis, time-to-disease flare was not significantly different between the glucosamine and the placebo group (hazard ratio of flare = 0. No differ- ences were found in severity of disease flare or other secondary outcomes between placebo and patients taking glucosamine. The effect of glucosamine sulfate was significant on all parameters, for example, Lequesne difference 1. Acetaminophen had more responders than placebo, but it failed to reach a significant difference on the Lequesne (p = 0. The primary outcome in this study was treatment response, defined as a 20% improvement in knee pain. The difference between combination treatment and placebo was reported as near statistically significant (p = 0. In this analysis, the combination treatment was significantly different from placebo (p = 0. The authors concluded that glucosamine and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group. The study was limited by an attrition rate of at least 20% in each group, as well as unusually high response rates in the placebo group. Also, although not explicitly stated, the subgroup analysis looking at those with higher baseline pain scores appeared to be a post-hoc analysis where the placebo response rate was slightly lower and the combination treatment response rate was slightly higher. The primary outcome in each trial was based on joint-space measurements obtained from conventional, extended-view, standing anteroposterior knee radiographs, a recom- mended radiographic approach at that time. Both trials showed quantitatively similar benefits in the glucosamine-treatment arms, with respect to the rate of loss of joint- space width and symptoms. Precise measurement of this variable is contingent on highly reproducible radio-anatomic positioning of the joint, and may be biased by the presence of pain. If those in the glucosamine group had less pain at their follow-up X-ray, they may have stood with the knee more fully extended, a nonphysiological position that may be associated with the femur riding up on the tibial edge, giving the appearance of a better preserved joint space. What appeared to have been a slower rate of joint space loss may have reflected between-group differences in the degree of knee extension at the follow-up radiograph. The primary outcome was joint-space loss over 2 years as assessed by a posteroanterior radiograph of the knee in mild flexion, a better validated technique (172). The participants in the placebo arm exhibited significant joint-space loss with a mean cumulative joint-space loss of 0. In contrast, the differences in the symptom outcomes between the groups were trivial and nonsignificant. However, chondroitin was well tolerated, with no significant differences in rates of adverse events between the two groups. Of note, the lack of symptomatic improvement of chondroitin sulfate in this moderate to large intervention trial further highlights the likely overestimation of effect sizes of symptoms as an outcome reported in the two meta-analyses of this treatment. The results of this study have been presented in abstract form at the time of this publication (173). Diacerein Diacerein is metabolized to rhein, which has analgesic and anti-inflammatory properties (174). With regards to radiographic progression, the mean decrease in joint-space width was similar in all treatment arms (0. Although a modest short-term benefit on pain has been noted, long-term studies on the potential of diacerein as a disease-modifying agent are lacking. Omega-3 is found in fish and canola oils, as well as in flaxseeds, soybean, and walnuts. The n-6- derived eicosanoids tend to be proinflammatory, whereas the n-3-derived eicosanoids tend to be anti-inflammatory. A dietary intervention study in rats showed that low intake of n-6 induced cartilage surface irregularities and localized proteoglycan depletion (195). Participants were assessed at 4-week intervals for joint pain/inflammation and disability. There was no significant benefit for the patients taking cod liver oil compared with placebo (195). Piascledine (Pharmascience, Inc), composed of one-third avocado and two-thirds soybean unsaponifiables (183), is the most frequently investigated lipid combination. In sheep with lateral meniscectomy, 900 mg once a day for 6 months reduced the loss of toluidine blue stain in cartilage and prevented subchondral sclerosis in the inner zone of the lateral tibial plateau but not focal cartilage lesions (186).
The types of roles that women play in the delivery Department of Health and Human Services buy cheap biaxin gastritis dieta, National Cancer Institute cheap biaxin 500 mg with amex gastritis symptoms vs gallbladder. This trend is likely to 20 Women in the Health Professions continue as women currently make up approximately professional specialty occupations were the group with half of medical student classes compared to only 11% the highest self-assessment of general health status in in 1970 generic 250mg biaxin fast delivery gastritis diet indian. The fact that a majority of women physicians are However, as described by Stellman and Lucas younger and are primary care providers has important (2000), there are a variety of basic socioeconomic fac- implications in the delivery of preventative care services tors that affect all women workers. These factors are rel- as well as on patient satisfaction and communication evant to women health care professionals as well, and issues. Age and gender of physician significantly impact represent potential barriers to successful employment likelihood of adherence with evidence-based guidelines by women in health care fields. As is the case for gested that women health care providers have communi- women workers in general, women health profession- cation styles that enhance patient satisfaction and the als tend to be overrepresented in a relatively small providerpatient relationship (Clancy, 2000). Women number of health occupations, particularly nursing and physicians spend more time in interactive communica- health support/health aid capacities (U. Department tion and listen more closely to patient concerns (Clancy, of Labor, 1997). These traditionally female occupa- 2000), and in situations where personal violence or tions have tended in the past to be less well paid than sexual abuse has occurred, patients are more likely to many traditionally male occupations (Stellman & reveal this information to their women physicians Lucas, 2000). Women in academic medicine are most likely to still rarely occupy positions of leadership in profes- hold lower level ranking such as instructor or assistant sional medical organizations. This, women physicians in primary care practice work part along with a developing focus on womens health time (McMurray et al. This is often in response issues, a more informed consumer base, and a frequent to other personal commitments such as parenting/child preference by women patients for women health care care. A growing issue in the United States is elder care providers, all create growing opportunities for women where women, usually employed daughters, care for in the health care professions. In general women con- remuneration, and personal empowerment are all sistently perform significantly more unpaid hours of potential benefits for successful women health care home/family-related work compared to men with fewer providers. Department of Health paid hours of work outside the home (Stellman & and Human Services (1989) found that women in Lucas, 2000). However, variability exists in or with less seniority may be more likely to suffer layoffs opportunities and growth among the health care spe- or employment termination in times of economic hard- cialties. This is most likely to experiencing staff shortages of crisis proportions (Ross, affect women who are entering a health occupation only 2002). Managed care and reduction in hospital-based will affect health care practice and service delivery. The history of rience multiple social and occupational roles offer nursing goes back many centuries, with the earliest women more choices and potential for overall better groups having minimal training and typically associated physical and mental health (Barnett & Baruch, 1987), the with religious orders. Later, during the Crusades, presence of multiple, conflicting obligations may lead to knights took part in nursing care of the wounded. Modern nursing began in (Messing, 2000) in addition to their occupations as health earnest during the mid-19th century. For example, nurses who work full time Nightingale, a British nurse, is credited with making and have young children report more fatigue than those nursing a desirable and respected profession. She was without children, particularly in circumstances where a major force in securing a critical and valued role for domestic tasks are not shared (Tierney, Romito, & nurses in health care. Nurses are the largest group of professional and women in leadership positions may make these health care workers and have one of the largest per- skills difficult to acquire for young women just entering centages of women in an occupation. Most commonly they become harassment and discrimination against women may licensed practical or registered nurses. Work locations occur in all the health professions, most particularly in cover a broad spectrum from hospitals to nursing areas that have been traditionally male dominated. Furthermore, nurses Palepu and Herbert (2002) recently reported that three- have a wide range of specialties to choose from, includ- quarters of U. Some feel that nurses 22 Women in the Health Professions endure more than other female professionals because represented a different decade and it was hoped that their occupation is more stressful. Examples of current this would shed some light on the perceptions of the stressors in the nursing profession include a severe field. Letvak (2001) recently tions have long been applied to traditional housewife suggested that women nurses may be able to improve and mother roles as well. In contrast to the commonly their job satisfaction through united effort and by perceived central role of physicians for curing, nurses obtaining flexible work schedules, thus leading to may receive little credit for their important role in illness better attendance at work and fewer nurses leaving treatment and recovery. This is that the female domination of nursing has been one of an important issue on many frontswith regard to the reasons this fields development has been ham- nurse employees, nursing management, and health pered; specifically, that nursing has been socialized to care administrators. In addition to the destructive be a female career and in a way is considered an effects on the victim, sexual harassment can lower staff extension of work at home. Sexual harassment feminist movement, society in general has been quick is illegal and the employer can be held liable if it hap- to criticize women who have a family and work for not pens while a nurse is at work. Others point out that the ideal Bowman, 1994) found that 72% of women nurses nursing traits of compassion, sensitivity, and compli- experienced sexual harassment while at work. Twenty- ance are not useful in career successwhere autonomy five percent of the perpetrators were physicians, and competitiveness are valued (Castledine, 1983). This is true in general of female- this behavior, although fewer nurses did this if the dominated professions, such as nursing and social perpetrator was a physician or a coworker. It is felt that work, which have traditionally been identified with this may be secondary to the power differential at play a housewife role. The feminist movement has at times in a hospital setting where physicians and male nurses ignored women nurses, as the strongest emphasis has traditionally have had more power than female nurses. Because of this, some nursing of self-blame as is common for many female victims groups feel that their field is devalued by the feminist of sexual harassment. Some have observed responsibility for providing a safe work environment that men and women have different approaches and ensure that sexual harassment does not occur toward morality. A study by Magnussen (1998) abuse appears to be fairly common, it is not often evaluated career perceptions of nurses who entered openly addressed. Each woman verbal abuse at some time from peers, physicians, or 23 Women in the Health Professions patients (Bruder, 2001). This type of abuse can lead to It has been noted that male nurses gravitate to decreased self-esteem and job dissatisfaction. On the male nurses are at much lower risk of verbal abuse other hand, female nurses tend to work in pediatrics, than are female nurses. A recent report emphasized the midwifery, and geriatrics, which are specialty areas importance of open communication regarding this considered more traditionally female. The study found that career aspirations are influenced Nurses are considered to be at relatively high risk by perceived gender role and motivation, but not by job of substance use, possibly because of the high stress commitment (Muldoon & Kremer, 1995). Early women doctors marijuana, 16% had used opiates, and almost 3% had learned through apprenticeships and cared primarily for used hallucinogens. In the 1770s, Frances Coomes 1% had used marijuana and almost 2% had used may have been the first American woman physician. Prescribed drugs were also included in this She practiced in Kentucky and, although she was study; lifetime use of tranquilizers was 20% and known as Mrs. It was noted that the rate of pre- a man who was thereafter known as a practicing scription drug use was comparable to that of male and physician. During the Civil War, Mary Walker served as female physicians and this may relate to the fact that a doctor, while disguised as a man (Dickstein, 1996).
This is followed by an scribe amphetamines for a variety of conditions biaxin 500 mg with amex gastritis diet шинэ, rang- elevation of mood and energy generic 500mg biaxin with visa gastritis symptoms and remedies, and a subsequent steep ing from asthma and narcolepsy to attention deficit decline generic biaxin 500 mg fast delivery gastritis symptoms h. pylori. Pregnant drug users: Combating short-acting, the euphoric effects of methampheta- stereotypes and stigma. Methamphetamine addicts are sometimes called tweakers because of their compul- sive and paranoid behavior. Curanderos During colonial Spain, curanderos Methamphetamine appeals to poor and working emerged as spiritual and physical healers. The drug curandero comes from the Spanish word curar, which promises to fill the gap between the multiple expecta- means to heal. With roots throughout Latin work and household tasks, losing weight, and combat- America, curanderos have significantly shaped the role of ing depression. However, abuse and/or dependence medicine in countries with large Hispanic populations. Yet, curan- phetamine with intravenous injection and heightened deros are most notable for limpiadas, which are sexual activity raises the risk of acquiring sexually cleansings for an individuals spirit. Since methampheta- Through prayers and rituals, a curandero deciphers the mine use can produce confusion, impair judgment, and cause of an individuals unclean spirit. Usually, curan- heighten aggressiveness, it may also contribute to sex- deros discover that the patients illness was triggered by ual victimization. After the limpiada, the evil spirits leave and the ment efforts or a lessening of the societal pressures individual is healed. Despite their popularity, curanderos maintain low pro- files and restrain from publicizing their services. Addictions: A compre- insurance so that cost-conscious patients are more likely hensive guidebook. Second, curanderos can be more 203 Curie, Marie accessible than medical doctors because curanderos are Roentgen had made a photographic image of the bones more prevalent in suburbs and rural communities. A colleague of the Curanderos have been healing people from sick- Curies, Professor Henri Becquerel, began a search for ness and evil spirits for centuries; thus, the level of con- the source of the rays and discovered that uranium salts fidence Hispanics have in curanderos has not wavered. Although not all Hispanics believe in curanderismo, a Marie used a piezo-quartz electrometer to test min- large majority of the Hispanic community considers eral samples, and quickly discovered that the strength curanderos as their only source of healing from sickness of the rays was directly related to the amount of ura- and evil spirits. She also found that another ele- be passed down from generation to generation, influ- ment, thorium, produced rays similar to those produced encing healing and medicine. They hypothesized that Suggested Resources pitchblende must have another component that was responsible for the increased radioactivity. The Curies chose to focus their efforts on extract- ing radium and studying its properties. Because radium Curie, Marie Marie Curie lived from 1867 to 1934 is a very small component of pitchblende, the couple and made enormous contributions to science. She won spent a great deal of time in physically intensive labor two Nobel Prizes (in 1903 for physics and in 1911 for refining and purifying pitchblende to yield radium. In November 1903, the Curies along with class and later studied in the Floating University, an out- Henri Becquerel were awarded the Nobel Prize for lawed night school. Sorbonne and was given funds to hire three assistants In Paris, Marie enrolled in the Sorbonne and was for his laboratory. Marie became a laboratory chief, thus the first woman to earn a degree in physics in 1893. Also in 1894, The Curies had a second daughter in December she met Pierre Curie, a French physicist whom she mar- 1904, whom they named Eve. Eve Curie later wrote in her biography Toward the end of 1897, Marie began work on her of her mother that Marie became a pitiful and incur- doctoral thesis, with the goal of earning her PhD. Refusing and Pierre had become intrigued by the discovery of a pension, she later assumed the chair given to Pierre x-rays by Wilhelm Roentgen; the rays were called x rays with the title of Assistant Professor, becoming the first since it was not understood where they came from. She conceived of radio- logical cars as portable x-ray units; these were nick- named les Petites Curie, or the little Curies. Center-based care offers children an oppor- tunity to meet and play with other children, and offers parents reliability and reassurance that more than one adult is involved in the care of the child. Home-based Day Care Day care is the care, on a continuing day care offers a comfortable environment and a basis, of a child by someone other than the childs par- smaller number of children. Day care can come in many forms, and it is not vide day care allows the caregiver to focus on the indi- limited to daytime. Different day care providers have different nights often need day care for children at night. Some day care Center-based day care is provided in a place that is providers offer structured learning opportunities for built or made to suit the purposes of caring for many the children, while others may offer less structured children. The regulations can require qualifications for Finding good day care can require some work. Center-based identify center-based and home-based day care ser- day care can be run by a not-for-profit group or by vices. The state licensing agency may be a good place someone who is working to make a profit. Asking other parents profit centers are often associated with religious groups may be the best way to get information about the qual- and they may share space. Our national constitution requires Home-based day care is an alternative to center- people to be treated equally and laws that treat men based day care. Home-based day care may also require and women differently must have a valid reason for state licensing by the state, depending on the number doing so. Child care is one of those areas where the his- home-based day care is the provision of care for a child torical separation of roles by gender may have an or children by a relative, friend, or someone employed influence. But women who work outside the not regulated, with the exception of laws that apply to home may be considered less typical and this may be employing and paying people. The irreducible needs of chil- Beauvoir wrote a farewell tribute to her lifelong com- dren: What every child must have to grow, learn, and flourish. She graduated Scholars hope that her diary will shed some light on her from the Sorbonne in 1929. It was at the Sorbonne that Simone met Jean-Paul Suggested Reading Sartre, the famous French existentialist. Beauvoirs writings were reflections on either Sartre or Merriam-Webster Dictionary (1st ed. Other writings by de Beauvoir that echo existentialist theories are All Men are Mortal (1946), The Blood of Others (1946), and The Mandarins (1955). The cost of the dementia Sex that de Beauvoir proclaimed women in a patriarchal syndromes to the United States has been estimated at society to be the other and that one is not born a up to $140 billion per year in caregiving costs, lost pro- woman, but rather becomes one. Because book to be an application of Sartrean existentialism to the risk of dementia increases with age, and as the pro- the situation of women. The dementia 207 Dementia syndrome refers to a group of symptoms related to a vascular dementia, it is more common to see a stepwise sustained decrease in intellectual function from previ- decline. Memory decline is always a part of this syn- diovascular disease can sometimes halt the progression drome along with combinations of other impairments of the illness but will usually not reverse symptoms. Personality change can also occur time with a stroke and the onset of sustained memory as a component.
G. Sugut. Greenwich University.