Vegetable-Rich Diet Keeps You Away From The Hospital.

Individuals who consume a diet rich in vegetables are significantly less likely to develop acute pancreatitis, say researchers.

The study, published online in the journal Gut, examined 80,000 adults in Sweden in order to determine if an imbalance in antioxidant levels, associated with dietary factors, increased the risk of acute pancreatitis.

Pancreatitis refers to inflammation of the pancreas. The pancreas releases hormones as well as digestive enzymes to break down food. However, these enzymes can sometimes activate inside the pancreas, and start to digest the gland itself. Symptoms of acute pancreatitis can be severe and potentially life threatening.

Earlier studies have associated acute pancreatitis with excessive production of free radicals. In addition, levels of antioxidant enzymes, which remove free radicals, are increased during an attack.

In the study, the researchers found that participants consumed on average 2.5 services of vegetables per day and 2 servings of fruit. In general, men, smokers, and those with lower levels of education ate the fewest daily servings of vegetables. 
A similar profile was observed for fruit consumption, although these participants were more likely to have diabetes or to consume alcohol.



 320 study participants developed acute pancreatitis that was not associated with the complications of gallstones.

Although consuming more vegetables appeared to reduce the risk of acute pancreatitis, consuming more fruit did not. 

According to the researchers, individuals who consumed more than 4 servings of vegetables per day were 44% less likely to develop acute pancreatitis than people who ate 1 serving per day. 

Participants who were overweight or drank more than 1 alcoholic beverage per day seemed to benefit the most from consuming a diet rich in vegetable. The team found that the risk of developing acute pancreatic decreased by 71% among drinkers and by 51% among those who were overweight.

The researchers note that the protective effect of vegetables is most likely due to the high levels of antioxidants they contain. However, why fruit does not appear to reduce the risk of developing acute pancreatitis may be due to its fructose content, which might counter the effects of antioxidants. Earlier studies have associated fructose with free radical production.

If further studies verify these findings, the researchers suggest that consuming more vegetables may reduce the risk of developing acute pancreatitis that is not associated to gallstones.

How much do you know about allergies?

Allergy

Date of last update: 25 July 2012

Allergy refers to an adverse reaction of the body to a particular substance in the environment. Many substances that cause allergies are not harmful and have no effect on those people who are not allergic. Any substance that triggers an allergic reaction is called an allergen. Some of the most common allergens include pollen, dust mites, mold and pets.

What are allergies?

Allergy means an adverse reaction of the body to a particular substance in the environment. Many substances that cause allergies are not harmful and have no effect on those who are not allergic. Any substance that triggers an allergic reaction is called an allergen. Some of the most common allergens include pollen, dust mites, mold and pets. Few other common allergens include nuts, fruits and latex. An allergy develops when the body's immune system reacts to an allergen, as if it were a threat, an infection, by producing antibodies to fight it. This process is called immune response. The next time the person comes into contact with the allergen, the body "remembers" previous exposure and produces more antibodies. This causes the release of chemicals in the body leading to an allergic reaction. The most common disorders caused byallergy include asthma, eczema and hay fever. Symptoms may include:

• Sneezing
• Wheezing
• Cough
• Rash

Symptoms depend on how a person came into contact with the allergen. For example, you may have respiratory problems if inhaled pollen.

What are the symptoms of allergies?

Allergic reactions do not occur the first time you come into contact with the allergen, but after being exposed to. This is because the immune system must develop a sensitivity to the allergens before they become allergic. Typical reactions include irritation and allergic inflammation.

Symptoms may include:

• Sneezing
• Wheezing
• Sinus pain (feelings of pressure and pain in the upper nose, around the eyes and the front of the skull)
• Runny nose
• Cough
• Skin rashes
• Swelling
• Itchy eyes, lips, throat and palate

It is important to remember that these symptoms may be caused by other diseases, so it is best to consult your doctor. Rarely, an allergy can lead to a severe allergic reaction called anaphylactic shock (or anaphylaxis), which can be fatal. Most allergic reactions are produced locally in specific tissues of a body part, such as nose, eyes or skin. In anaphylactic shock (or anaphylaxis), an allergic reaction does not involve the entire body and usually occurs in a few minutes after contact with a particular allergen. Symptoms of anaphylactic shock (or anaphylaxis) may include:

• Swelling of the throat and mouth
• Difficulty swallowing or speaking
• Shortness of breath
• Rashes
• The redness and itching
• Stomach cramps, nausea and vomiting
• Sudden feeling of weakness due to the drop in blood pressure
• Collapse
• Loss of consciousness

If you have an anaphylactic shock (or anaphylaxis), you need emergency treatment, usually an injection of adrenaline.

Who is affected by allergy?

The reason that triggers an allergic response is not clear. Some experts believe it may be associated with pollution. Another theory is that allergies are caused by living in an environment that is too clean and free of germs, which would reduce the number of germs that the immune system is able to cope with. This can cause an overreaction when you come into contact with harmless substances. Some people are more likely to develop the hereditary allergy. If this possibility exists, it is called atopic allergy or suffering from atopy. Atopic individuals are more likely to develop allergies because their body produces more IgE antibody than normal. Environmental factors also play a role in the development of allergic disorders. The exact role of the environment is unknown, but studies have shown that a number of factors appear to increase the chance that a child will develop an atopy, such as:

• Exposure to secondhand smoke
• Exposure to dust mites
• Exposure to pets
• The use of antibiotics

Boys are much more likely to develop an atopy than girls. They are also more prone to be born with a weight below normal. The reasons for this are also unclear.

What are the causes of allergy?

An allergy develops when the immune system reacts to allergens, and they are considered to be harmful, as if they were an infection. There is a type of antibody (protein that fights viruses and infections) called immunoglobulin E (IgE), that fights the allergen. When the body comes into contact with the allergen, IgE antibodies are released causing a chemical production. Together, all these things cause the symptoms of allergic reaction. One of the chemicals involved in an allergic reaction is histamine, which causes:

• The contraction of muscles, including respiratory
• Increased production of nasal secretions, which causes itching and burning

An allergen is any substance that causes a stronger reaction of the immune system by producing antibodies against them. There are thousands of allergens, but the most common are the following:

• Dust mites
• Pollen
• Pet hair or small flakes of dead skin
• The spores of fungi or mildew
• Food (especially milk, eggs, flour, soy, fish, fruits and nuts)
• Stings of wasps and bees
• Some medications such as penicillin and aspirin
• Latex
• Household chemicals

How to treat allergies?

Where possible, the best way to defend against an allergy is to avoid contact with the allergen causing the reaction.

Drugs

Medications cannot cure allergies, but can be used to treat common symptoms such as a runny nose, itching and sneezing. Many treatments are available as OTC drugs, but before buying them, you should always seek the advice from your doctor or pharmacist.

Antihistamines

Antihistamines treat allergies by blocking the action of histamine, the hormone that body releases when it thinks an allergen has attacked the body. Antihistamines are in the form of pills, creams or liquids or eye drops and nasal spray. The nasal spray may be used to reduce swelling and irritation of the nose and eye drops are used to help relieve pain and itching of the eyes. Spray drops and eye drops are only available for adults, so you should always consult your doctor before buying drugs, especially if children are involved.

Decongestants

Decongestants help bring relief for a blocked nose, which is often caused by hay fever, an allergy to dust mites or an allergy to pets. Decongestants are available in different forms such as tablets, capsules, nasal spray or liquid.

Leukotriene antagonists

The tablets are leukotriene antagonists that block the effects of leukotrienes, a chemical released during an allergic reaction that causes inflammation (swelling) of the respiratory tract. Leukotriene antagonists are used to treat asthma when other treatments have failed.

Hyposensitization (immunotherapy)

Another form of treatment for allergies is the hyposensitization, also known as immunotherapy. The hyposensitization acts gradually introducing increasing amounts of allergen into the body to make it less sensitive to it. Allergens are usually given by injection at intervals of one week or less and the doses of the allergen are going to increase. Upon reaching the maintenance dose, a dose that is effective in reducing the usual allergic reaction, continue with injections every few weeks for at least two years. The hyposensitization is usually recommended for the treatment of various allergies (hay fever or allergy to pets), that have not had improvements with other treatments and for specific allergies , such as the stings of wasps and bees. This treatment should only be administered under the supervision of a physician because there is a risk involved of severe allergic reactions.

The treatment of anaphylaxis

If someone had an anaphylactic shock (or anaphylaxis) that required medical emergency treatment with adrenaline injection, that person is a subject to the possibility of triggering an anaphylactic shock again, then he or she must have a self-injection kit of adrenaline. It is an easy-to-use syringe that you should always carry.

Being cured of HIV is 'wonderful,' US man says

The only person believed to have been cured of HIV infection through a bone marrow transplant says he feels wonderful and is launching a new foundation to boost research toward a cure.  

Timothy Ray Brown, 47, an American from Seattle Washington, rose to fame as the so-called "Berlin patient" after doctors tried a novel technique to use an HIV-resistant donor for a stem cell transplant to treat Brown's leukemia.

Since 2007, he has had two high-risk bone marrow transplants and continues to test negative for HIV, stunning researchers and offering new pathways for research into how gene therapy may lead to a more widely acceptable approach.

"I am living proof that there could be a cure for AIDS," Brown told AFP in an interview. "It's very wonderful, being cured of HIV."

Brown looked frail as he spoke to reporters in Washington where the 19th International AIDS Conference, the world's largest meeting of scientific experts, policymakers and advocates is taking place.

The bone marrow transplant he received carried significant risks and may be fatal to one in five patients who undergo it. But he said his only complaint these days is the occasional headache.

He also said he was aware that his condition has generated some controversy, but disputed the claims of some scientists who believe he may still have traces of HIV in his body and may remain infectious to others.

"Yes, I am cured," he said. "I am HIV negative."

Brown said he fully supports more aggressive efforts toward finding a universal cure, and has met with a number of top scientists in recent days who have treated him "like a rock star."

He said he hopes to harness some of that fame to encourage donors to fund more research, and noted that Europe and China spend far more on cure research than the United States.

"There are thousands of very able researchers who cannot get funded for research, so I want to change that. And there are a lot of researchers who are willing to work to find a cure for HIV."

Brown was a student in Berlin, Germany, when he tested positive for HIV in 1995 and was told he probably had about two years to live.

But combination antiretroviral therapy emerged on the global market a year later, and eventually transformed HIV from a death sentence into a manageable condition for millions of people worldwide.

Brown tolerated the medications well but due to persistent fatigue he visited a doctor in 2006 and was diagnosed with leukemia. He underwent chemotherapy, which led to pneumonia and sepsis, nearly killing him.

His doctor, Gero Huetter, had the idea of trying a bone marrow transplant using a donor who had a CCR5 receptor mutation.

People without that receptor appear to be resistant to HIV because they lack the gateway through which the virus can enter the cells. But such people are rare, and are believed to consist of one percent of the northern European population.

It would be an attempt to cure cancer and HIV at the same time.

Brown's leukemia returned in 2007, and he underwent a bone marrow transplant using stem cells from a CCR5 mutation donor, whom he has never met in person. He stopped taking antiretrovirals at the same time.

He soon had no HIV detectable in his system. His leukemia returned though, and he underwent a second bone marrow transplant in 2008, using stem cells from the same donor.

Brown said his recovery from the second operation was more complicated and left him with some neurological problems, but he continues to be free of leukemia and HIV.

Asked if he feels like his cure was a miracle, Brown was hesitant to answer.

"It's hard to say. It depends on your religious belief, if you want to believe it's just medical science or it was a divine intervention," he told AFP. "I would say it's a little bit of both."

The World’s 1st artificial trachea (Synthetic Organ)

This artificial trachea was created from stem cells in 2011, then transplanted on Andemariam Beyene who was suffering from tracheal cancer. Now Beyene is in a very good condition after the transplantation surgery which took place at Karolinska University Hospital - Sweden.

Why People Smoke?

Smoking is a complex behavior that is initiated and maintained for different reasons. External factors such as the influence of peers, parents, and the media appear to be most important in the initiation of smoking. Adolescents whose parents and friends smoke are more likely to begin smoking. Once the smoking habit is established, it is sustained by both biologic and psychosocial factors.

Nicotine is the constituent of tobacco smoke that is responsible for causing physiological dependence on cigarettes. Chronic nicotine exposure produces changes in the brain, such as the upregulation of nicotinic acetylcholine receptors, which lead to tolerance and a craving for cigarettes when smoking stops. Smokers smoke to maintain a constant level of nicotine to avert the nicotine withdrawal syndrome, symptoms of which include restlessness, irritability, impatience, difficulty concentrating, an anxious or depressed mood, and an increased appetite. Nicotine withdrawal symptoms begin within a few hours of smoking cessation, peak 48 to 72 hours later, and gradually wane over weeks. The duration and the severity of nicotine withdrawal are highly variable, representing different degrees of nicotine addiction among smokers. No biochemical test can measure nicotine addiction, but heavily addicted smokers tend to have their first cigarette shortly after arising (i.e., within 30 minutes), smoke more cigarettes per day, and have difficulty when forced to abstain from cigarettes for even a few hours. This model of pharmacologic dependence can explain the initial difficulties that smokers have when they stop smoking but cannot alone explain why smokers have difficulty remaining abstinent after the first few weeks.

Cigarette smoking is also a habit, a learned behavior that continues because it is rewarding to the smoker. Certain repeated situations, such as finishing a meal, become strongly associated with smoking and trigger the urge to smoke. Cravings for cigarettes, which are produced by a combination of learned associations and physical changes in the brain, last longer than nicotine withdrawal symptoms and can trigger both early and late relapses in smokers who stop smoking. Smokers also use cigarettes to handle environmental stress and regulate emotions, especially strong negative emotions like anger or frustration. There is a strong epidemiologic association between depression and smoking. Smokers are much more likely than nonsmokers to have a current or past history of depression. Nicotine withdrawal symptoms are more intense in smokers with comorbid depression or depressive symptoms, and stopping smoking can trigger or worsen depressive symptoms in smokers with a depression history. This may explain the observation that smokers with depression are less likely to succeed at quitting.

Things you need to know about Alcohol.

Alcoholism is an inexact but popular term, encompassing two distinct conditions: alcohol abuse and alcohol dependence. Alcohol use in excess of “drinking in moderation” is epidemiologically associated with excess morbidity and mortality. 


The rates of abuse and dependence in persons 18 to 29 years of age are twice those for the nation as a whole. The overall estimated societal costs of alcohol-related health problems, lost productivity, crime, accidental deaths, and fires are staggering (>$185 billion). The estimated direct cost of treatment for alcohol problems and medical consequences approaches $26 billion, with more than $18 billion for medical care alone.

Drinking in Moderation

The behavioral hallmark of moderate drinking is that it is under easy voluntary control. With the caveat that a given dose of alcohol affects different people differently, drinking in moderation may be defined quantitatively as on average two or fewer drinks per day for men and one or fewer for women and the elderly. Furthermore, for drinking to be “moderate,” no single episode of drinking should exceed four drinks for men or three drinks for women, where a standard drink contains roughly 12 g, 15 mL, or 0.5 oz of alcohol (which is the approximate content of 12 oz of beer, 5 oz of wine, or 1.5 oz of liquor, respectively)

Alcohol Dependence

Alcohol dependence is defined as a maladaptive pattern of use, resulting in substantial distress or dysfunction, characterized by at least three of seven symptoms that include tolerance, withdrawal, unsuccessful attempts at cutting down, and preoccupation with and recurrent use of alcohol despite adverse consequences in important areas of life. Patients drink more than they intend and may give up important activities because of drinking. Most problem drinkers are employed, employable, or in families, indicating that the scope of the problem extends far beyond those who meet formal diagnostic criteria.

Causes and Risk Factors

The causes of alcohol abuse and dependence are incompletely understood, but the etiology is clearly multifactorial. Biogenetic, sociocultural, psychological, and behavioral influences have been identified. No single factor accounts for all manifestations, but attention to each contributes to a better understanding the problem.

Medical Complications

The risk of organ damage is related in part to the dose and duration of alcohol exposure, with some conditions (e.g., alcoholic cardiomyopathy, fatty liver, alcoholic hepatitis, or anemia) manifesting reversibility with abstinence, and others (e.g., cirrhosis or neuropathy) seeming to progress inexorably once organ damage has occurred. Predicting the risk of irreversible organ damage is imperfect; occasionally, resilience is afforded by abstinence and good nutrition. Risk appears to be a function of genetic predisposition, alcohol dose, and chronicity of exposure.

Increases in the risks of breast cancer and osteoporosis are associated with drinking on average more than two standard drinks daily. (Moderate drinking is associated with a modest reduction in breast cancer mortality.) Fetal alcohol syndrome occurs in infants born to mothers who drink heavily during pregnancy. 

Alcoholic hepatitis, pancreatitis, and gastritis may follow binge drinking. Fatty liver and esophagitis ensue from chronic use. Late-stage complications includecirrhosis and oral cancers.

Cerebellar degenerative disease, peripheral neuropathy, Wernicke’s encephalopathy, and Korsakoff’s dementia are among the serious neurologic consequences of alcohol excess.

Conclusion: Too much of alcohol is dangerous to your health.

Effectiveness of peer education interventions for HIV prevention & adolescent pregnancy

Peer education remains a popular strategy for health promotion and prevention, but evidence of its effectiveness is still limited. This article presents a systematic review of peer education interventions in the European Union that were published between January 1999 and May 2010. The objective of the review is to determine the effectiveness of peer education programs for human immunodeficiency virus (HIV) prevention, adolescent pregnancy prevention and promotion of sexual health among young people. Standardized methods of searching and data extraction were utilized and five studies were identified. Although a few statistically significant and non-significant changes were observed in the studies, it is concluded that, overall, when compared to standard practice or no intervention, there is no clear evidence of the effectiveness of peer education concerning HIV prevention, adolescent pregnancy prevention and sexual health promotion for young people in the member countries of the European Union. Further research is needed to determine factors that contribute to program effectiveness.

Light-powered bionic eye invented to help restore sight

A retinal implant - or bionic eye - which is powered by light has been invented by scientists at Stanford University in California.

Implants currently used in patients need to be powered by a battery.

The new device, described in the journal Photonics, uses a special pair of glasses to beam near infrared light into the eye.

This powers the implant and sends the information which could help a patient see.

Diseases such as age-related macular degeneration and retinal pigmentosa result in the death of cells which can detect light in the eye.

Eventually this leads to blindness.

Wiring eliminated

Retinal implants stimulate the nerves in the back of the eye, which has helped some patients to see.

Early results of a trial in the UK mean two men have gone from being totally blind to being able to perceive light and even some shapes.

However, as well as a fitting a chip behind the retina, a battery needs to be fitted behind the ear and a cable needs to join the two together.

Prof Robert MacLaren from Oxford Eye Hospital explains how a bionic eye implant works

The Stanford researchers say their method could be a step forward by "eliminating the need for complex electronics and wiring".

A retinal implant, which works in a similar way to a solar panel, is fitted in the back of the eye.

A pair of glasses fitted with a video camera records what is happening before a patient's eyes and fires beams of near infrared light on to the retinal chip.

The creates an electrical signal which is passed on to nerves.

Natural light is 1,000 times too weak to power the implant.

The researchers said: "Because the photovoltaic implant is thin and wireless, the surgical procedure is much simpler than in other retinal prosthetic approaches.

"Such a fully integrated wireless implant promises the restoration of useful vision to patients blinded by degenerative retinal diseases."

The implant has not been tested in people, but has been shown to work in rats.

Exercise Reduces Breast And Colon Cancer Death Rates

A study in the May 8 edition of the Journal of the National Cancer Institute reveals that physical activity is linked to lower rates of breast and colon cancer deaths. However, there is not enough evidence to link physical activity to other types of 


Cancer survivors are able to enjoy a longer life due to improved cancer therapies and screenings and they frequently study information on how life factors, such as exercise, can affect their prognosis. Various observational studies and randomized control trials (RCTs) have evaluated the potential impact of physical activity on cancer survivors.

Rachel Ballard-Barbash, M.D., of the Applied Research Program in the Division of Cancer Control and Population Sciences at the National Cancer Institute and her team reviewed 45 articles of observational studies and randomized controlled trials (RCTs), published between January 1950 and August 2011, that examined the relationship between physical activity and cancer mortality and/or cancer biomarkers amongst those who survived the disease. They discovered that the RCTs with biomarker endpoints indicate that exercise is potentially beneficial in terms of the survivors' insulin levels and also reduces inflammation and may improve immunity.

The strongest evidence was found in those who survived breast cancer, followed by those who survived colorectal cancer. Most studies displayed a statistically considerably decreased risk of breast cancer and all-cause mortality related to exercise.

The researchers highlight the fact that due to the diversity of the various studies, specific recommendations in terms of exercise types or timing cannot be made, however, they do confirm that exercise contributes to the cancer survivors' overall safety and to their physical and mental benefits. 

They continue saying that future RCTs should examine various types of exercise, including how obesity, weight loss and cancer treatments may impact the effects of exercise on biomarkers, as well as how exercise may influence comorbidities in cancer survivors.

Edward L. Giovannucci, M.D., ScD, of the Department of Nutrition at the Harvard School of Public Health writes in a linked article that physical activity may prolong cancer survivor's life span and their quality of life, writing:

"Even though direct effects of physical activity on cancer are not definitely proven, given that physical activity is generally safe, improves quality of life for cancer patients, and has numerous other health benefits, adequate physical activity should be a standard part of cancer care."

Children with cerebral palsy may benefit from playing video games

According to a study published online in the Archives of Physical Medicine and Rehabilitation, children with cerebral palsy (CP) may benefit from playing active video games (AVG), such as Nintendo's Wii. 

The researchers found that not only did children enjoy playing AVGs, the games can also help children attain moderate levels of physical activity and could potentially be used in rehabilitation therapy.

Lead researcher Elaine Biddiss, Ph.D., of Toronto's Bloorview Research Institute at Holland Bloorview Kids Rehabilitation Hospital, and the University of Toronto, Canada, explained:

"Active video games (AVG) provide a low-cost, commercially available system that can be strategically selected to address specific therapeutic goals.

While our results did not show that AVG game play can be regarded as a replacement for more vigorous physical activity or muscle strengthening, we found that some games may provide targeted therapy focused on specific joints or movements."

The researchers examined 17 children with CP whilst they played four AVGs: Wii Boxing, Tennis, Bowling, and Dance Dance Revolution (DDR). The team recorded data on energy, muscle activity and motion. Study participants were given a survey in order to mark their level of enjoyment playing the games.

In addition, the team assessed the therapeutic potential of AVG play, the intensity of the physical activity, as well as the practical considerations surrounding the of active video games to promote physical activity. 

The researchers found that although the games were not vigorous enough to build endurance or strength, children with mild CP were able to attain moderate levels of physical activity with games such as Wii Boxing and DDR that require full body movements. 

According to the researchers, AVG play could promote neuroplastic change as they encourage repetitive movements and provide feedback to the player via on-screen game scores and avatars. The children rated enjoyment levels of AVG game play as high, which also improves neuroplasticity.

Wii Boxing may be a good choice for encouraging and training faster wrist movements, the researchers note, which is vital, as children with GP often have difficulty extending their wrists. 

Furthermore, the team found that children with hemiplegia (a form of CP that affects the limbs on one side of the body) who played Wii Boxing or DDR engaged both upper limbs when playing.

Dr. Biddiss said:

"Wii boxing, or similar games, may be an effective motivational environment for encouraging increased movement speed of the hemiplegic limb, in addition to the bilateral use of the limbs, because in-game success is strongly linked to these two metrics."

According to the researchers, the range of motion of the dominant limb was well within the typical norms associated with upper limb movements in able-bodied individuals.

Although further studies regarding safety are required, this study indicates that AVG should be a fairly low impact activity for children with the disorder.

The team found significant differences in the strategies used by the children to succeed in the game. They discovered that children may adapt a movement that reduces physical effort in order to maximize in-game rewards. In a therapeutic setting, it may be necessary to train and provide rewards for appropriate movement styles.

Dr. Biddiss concludes:

"While not a replacement for structured exercise and physical therapy, AVGs may encourage children with CP to be physically active and to practice complex motor activities.

There are many opportunities for further research. Further development and optimization of AVG technologies may usher in a new age in physical rehabilitation where virtual environments provide an arena for neuroplastic change in the comfort of one's home."

Here is an Interesting Book By Dr. S. Kansagra.

This is a book that, every medical student needs to read. In this book SUJAY KANSAGRA M.D  wrote about everything he learned while in medical school. This book has been a great article since it was published. for more information on how to get this book, please visit Amazon http://www.amazon.com/gp/aw/d/1451587619?qid=1321187081&sr=8-2
Please follow him on twitter @medschooladvice

Here are some clues on How to Be an Active Patient.

People who are actively involved in their medical care stay healthier, recover quicker when they're ill and live longer, healthier lives, says the Agency for Healthcare Research and Quality.

Active patients participate as partners in their health care with their doctors and other providers. They don't make health care decisions on their own, but they're in charge of the process because they schedule appropriate visits to their health care providers, plan ahead to get the most out of those visits, learn about their conditions and medications, and follow through on treatments and lifestyle changes as agreed upon by them and their doctors.

Being informed about any health conditions you have can keep you from passively agreeing to tests and treatments.

Decide what you want to get out of an appointment before you walk into the office. Write down any questions you have and any issues you want to discuss beforehand. Bring your notes and refer to them.

Other ideas:

• Bring a list of all the prescribed and over-the-counter drugs, herbs, and supplements you take and note your dosages.
• Bring a list of any medicines to which you are allergic.
• Keep a health diary. If you have a chronic condition or specific health concern, make a dated log of your general health, taking special note of symptoms or changes. This will remind you to discuss certain things with your health care provider and also will help him or her chart any change in your symptoms over time.
• If you're seeing a new health care provider or a specialist for the first time, bring copies of your medical history and information on diseases, conditions, and cause of death of family members. This will help build your medical profile and put your current state of health into perspective. Write or call your previous health care provider and request that copies of your records and lab and X-ray reports be given to you or sent directly to the new provider.

Schedule and keep appropriate medical appointments.

Answer your health care provider's questions completely and truthfully. For example, if you're worried you'll have difficulty with a suggested treatment, say so.

Avoid saying what you believe your provider wants to hear. If you don't think your treatment is helping you, speak up. Share your fears and concerns about your condition. Ask what to expect while you're getting better and how long your provider thinks it will take before your illness is cured or your symptoms are under control. It's essential to speak openly about symptoms because your doctor uses the information you provide to make a diagnosis and determine a treatment plan. Plus, a problem will remain untreated if you don't discuss it.

Other ideas:

• Follow your provider's instructions. For example, be sure to take any medicine prescribed, as scheduled, and follow any other physical and dietary regimens he or she recommends. If you feel worse or you don't believe the treatment is working, call your doctor immediately. This feedback will help the two of you work together to adjust your treatment and find therapies that work best for you.
• Listen closely. Listening carefully to what your provider says about your condition is as important as giving him or her an accurate assessment of your health. Take notes during your visit if you think you may forget part of your treatment regimen.
• Be ready to answer specific questions. Your provider needs to know your specific symptoms, when they started, and if they appear at certain times of the day or after certain activities, such as eating.
• Advise your health care provider if you're pregnant. This will affect the treatment a physician recommends.
• Take all medications as directed. Follow drug dosages precisely. Taking more of a medication could be dangerous; taking less could delay your recovery.
• Make positive lifestyle changes to reinforce your medical treatment. Stop smoking, limit your alcohol intake, improve your diet, get enough rest, and exercise regularly; these can improve your immunity and your body's ability to heal itself.

Understanding your condition can help you manage and control chronic illnesses, such as asthma or heart disease.

Ask your health care provider to recommend additional sources of information if you want to know more about your condition. Libraries, valid Internet sites, support groups, and associations can be helpful. Be aware that advice given on some health-related Web sites and chat rooms may be hearsay.

If you have a serious condition, ask if there are other treatment options besides the one your doctor recommends.

You have a right to get the information you need to make decisions about your care.

This information may include:

• Explanations of the purpose of tests and procedures that may be costly, painful, or risky
• Explanations of the purpose and expected effectiveness, and side effects of treatments
• Clarification on any medical advice or words you don't understand

One of your doctor's primary roles is to prescribe and monitor your medication use. Your responsibility is to take the right amount at the right time.

Be sure you know the following before taking a prescription or OTC medication, herb, or supplement:

• The medicine's name and what it's supposed to do
• How often you should take it
• Any medicines, foods or beverages to avoid when taking it
• Its possible side effects
• What you should do if you forget a dose

Depressed Kids Need Help

A new label on some antidepressants, a so-called black box warning, cautions that they may make kids feel more suicidal. But that warning shouldn't stop parents from considering their use for depressed teens, psychiatrists say.

In short, teen depression is a serious illness. The benefits of getting help, including taking medications if needed, far outweigh the potential risks.

A specific group of antidepressants called selective serotonin reuptake inhibitors (SSRIs) has been shown to help children and teens with depression, according to the National Institute of Mental Health (NIMH). The black box warning applies to these SSRIs and the U.S. Food and Drug Administration (FDA) says that suicidal thoughts or behavior are more likely in the first four weeks of use or when dosages are changed. Psychiatrists say the warning was meant, in part, to alert other doctors and parents to the need for closer monitoring.

The FDA says that children and teens who begin taking SSRIs should be closely watched for any worsening of depression, suicidal thoughts or behavior, or any unusual changes in behavior, including sleeplessness, agitation or withdrawal from social situations.

Antidepressants don't work in every case. Prozac, for example, helps only about two-thirds of those who take it, the FDA says, and some children experience side effects such as agitation.

Suicidal thoughts are very common in adolescents. Fortunately, few succeed. Usually, they don't tell anybody about it.

Studies involving about 4,400 depressed kids led to the new warning. Those who took antidepressants were twice as likely to express suicidal thoughts as those who took placebos (sugar pills). The numbers were small—4 percent for those on the drugs versus 2 percent on placebos. There were no actual suicides.

If you think your child might have depression, don't worry about trying to define what it is, just get it checked out. See a mental health professional and get a comprehensive evaluation. The good news is that if it is depression, most kids can be helped.

Here are some suggestions from the NIMH:

• Realize that depression in your child or teen is a serious condition that should be treated and monitored.
• Your child should be thoroughly evaluated by a health care provider to determine if medication is appropriate. If an SSRI is prescribed, the child should be closely monitored, particularly during the first four weeks. And if suicidal thoughts or agitation develop, notify your provider at once.
• Medications are not the only treatment for depression, but are usually required if the depression is more than mild. Many times psychotherapy is given as the first treatment for mild forms of depression. For more severe forms, medication may be given in combination with psychotherapy.
• If your child expresses suicidal thoughts or behavior or even intimates these, or has nervousness, agitation, irritability, sleeplessness or easily changeable moods, have him/her evaluated without delay.
• If your child is already taking an SSRI, he/she should not stop taking the medication without discussing it with a health care provider. The child also should continue to be monitored to see that the medication is helping.
• Realize that any medication may have side effects. Talk to your health care provider if you have concerns about side effects.