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Lana

Top Parenting Concerns New Parents Face

Parenting is a journey filled with challenges, especially for new parents. Here’s a comprehensive summary of the top struggles they face:

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PSYCHOLOGICAL CONSEQUENCES OF CHILD MARRIAGE IN GAMBIA

ABSTRACT

The Gambia has a high rate of under-18 marriage for girls and as recent as 2016, the legal age of marriage for girls was increased to 18. This ethnographic study of the urban Muslim in The Gambia explores the causes behind and meanings of early marriage in this country. It also discusses the likelihood of the recent legislative changes to have effect on actual practice among the poor in the towns and cities of this country.  It also puts into consideration the possible long-term solutions to the issue of early marriage. This research paper also outlines the major psychological effects early marriage has on the young girls involved.

INTRODUCTION

Early marriage is a growing concern in the world today, especially in Africa. The Gambia is one of the countries that practice this act. In this part of the world parents encourage the marriage of their daughters at a very young age. This is done mostly in the hopes that the marriage will benefit them both financially and socially. Child marriage is actually a violation of human right, the right to a ‘free and full’ consent to a marriage which is recognized in the Universal Declaration of Human Rights. Although early child marriage is not considered directly in the Convention on the Rights of the Child, child marriage is linked to other rights – such as the right to express their views freely, the right to protection from all forms of abuse, and the right to be protected from harmful traditional practices. The Pan-African Forum against the Sexual Exploitation of Children as a type of commercial sexual exploitation of children.

There are numerous reasons most cultures see absolutely nothing wrong with getting a child married early. This report will enumerate some of those reasons and also explore the steps the government took and other possible solutions to this problem. The issue of early marriage has a lot of psychological strains on the young girl. These girls are usually subjected to physical and emotional abuse that affects them greatly in the future.

Methodology

Data and valid information regarding the subject matter to which this research is based was gotten empirically and theoretically.

Empirical information was collected by interviews conducted. A total of 20 persons were interviewed, where they were asked about their opinion on the subject matter. Most of them were against the idea of child marriage and attributed it to cultural beliefs and lack of knowledge. Some statements made by the interviewees will be outlines in the main content of the report.

Also, looking at the outcome of the interviews, none of the persons interviewed -even victims and uneducated ones- were in support of child marriage in the Gambia and they expressed their sincere concerns as well.

Theoretical data was gotten from books and internet sources. I also used some past materials on researches conducted by persons on the same subject matter in different African countries. As a result, it came to my attention that The Gambia is not the only nation dealing with the issue of child marriage.

Discussion/analysis

Getting most of the interviewees to speak was not exactly an easy task but most questions regarding this topic will be answered in this section. Reasons behind early marriage, its effects on the young girls, the role of the government and other possible solutions to early marriage will be discussed.

Why Early Marriage?

·       Culture

 Many of the individuals (both male and female) that were interviewed referred to “culture” as the reason for child marriage. Early marriage is a traditional practice that in many places happens simply because it has happened for generations. For some of those girls, when they begin their menstruation, they become women in the eyes of the community. Marriage is therefore the next step towards giving a girl her status as a wife and mother. These cultural practices often go unquestioned because they have been part of a community’s life and identity for a very long time. But as Graça Machel, widow of Nelson Mandela, says, traditions are made by people – and people can unmake them.

·       Poverty

More than half of girls from the poorest families in the developing world are married as children. Where poverty is acute, families and sometimes girls themselves believe that marriage will be a solution to secure their future. Most of the girls interviewed were from poor backgrounds. A particular one attributed to this as a cause of her getting married in her teenage years. According to her it “took the stress off her family’s pocket”.

Giving a daughter in marriage allows parents to reduce family expenses by ensuring they have one less person to feed, clothe and educate. Families may also see investing in their son’s education as more worthwhile investment. In some cases marriage of a daughter is a way to repay debts, manage disputes, or settle social, economic and political alliances.

Also, in communities where a dowry or ‘bride price’ is paid, it is often welcome income for poor families; in those where the bride’s family pays the groom a dowry, they often have to pay less money if the bride is young and uneducated.

·       Insecurity

In areas where girls are at high risk of harassment and physical or sexual assault, most parents marry their daughters young because they feel it is in her best interest, often to ensure her safety.

Child marriage can increase in humanitarian crises, such as in conflict or after a natural disaster. When families face even greater hardship, they may see child marriage as a coping mechanism in the face of poverty and violence. Nine out of the ten countries with the highest child marriage rates are considered fragile states.


                             Effects Of Early Marriage On Young Girls

The loss of adolescence, the forced sexual relations, and the denial of freedom and personal development attendant to early marriage have profound psychosocial and emotional consequences. Here are some effects:

1.  Isolation

Most girls are unhappy in an imposed marriage hence they become very isolated. They have nobody to talk to as they are surrounded by people who endorse their situation. The elders usually show lack of interest in the traumas suffered by young girls in this regard. They believe that with time they will get used to their situation. When these girls run home to their parents, they are beaten and sent back to their husbands. Thus, distress is generally endured in silence.

In some other cases, the girls run away from their husbands’ houses and do not go back to their parents. Instead, the run to other towns or cities where mostly end up engaging in prostitution to survive. This does not solve any problem as it is simply resulting to another issue. A young lady I spoke to said she ran away from home at the age of 15 because her parents wanted to get her marries to a man in his fifties and she wouldn’t have it. Instead she came to the city and has settled for a life with white older men for money. According to her, she is comfortable, lives a well, eats good food, is free and can do whatever she wants. She also stated that she has no interest in getting married ever because there was no point accepting the bondage she ran away from. She is 27 now and her family does not know of her whereabouts. According to her, she is fine with it because she has her freedom.

2.  Illiteracy

The majority of the child wives have never gone to school, of left school before completing a full course of primary education, making them entirely dependent on their husbands in practical aspects of everyday life. These girls are denied of personal development and education as it is expected that the husband provides for the girl. Early marriage inevitably denies children of school age their right to the education they need for their personal development, their preparation for adulthood, and their effective contribution to the future well-being of their family and society. The married girls who would like to continue schooling may be both practically and legally excluded from doing so. In some cases, some girls are withdrawn from school to enter into a marriage.

3.  Adolescent Health and Reproduction

They are prone to HIV/AIDS and other sexually transmitted diseases (STD). The over-riding desire to be a good wife in the eyes of family and husband prevents the child wife from negotiating for safer sex practices; thus exposing her to risk of acquiring HIV/AIDS and other sexually transmitted diseases. In the case of girls married before puberty, the normal understanding between families is that there will be no sexual intercourse until first menstruation. There are many cases of forced intercourse by much older, and physically fully developed husbands with wives as young as eight reported in West Africa. Pain and trauma are enhanced where girls have undergone some form of Female Genital mutilation, especially where this has been undertaken recently, and especially in the case of infibulations which is designed to make penetration difficult. Their health is put at great risk and some of them even die. Most of these girls have under-developed pelvises which makes child bearing very dangerous for them and when brought to the hospitals, their husbands refuse to let them have it safer by surgeries, which could leave these girls for dead.

4.  Abuse

Physical, sexual and emotional abuse is a very paramount part of being married off early. Out of fear of her parents and the social stigma as well as the poverty associated with being single; many child wives are compelled to remain in a loveless and violent marriage. These girls are denied of their right to grow up as most of them that have kids have to become responsible for them, and we are left with a case where children have children and children raise children. This messes up the emotions of the girl as she might see her mates at school or playing and she cannot get involved because of the fear of being either sexually or physically abused. The trauma of living in fear is very dreadful. A beautiful young married girl I spoke to also lives with this predicament but she refuses to admit it. While speaking to her, although reluctant, she kept hammering on the fact that she couldn’t be seen talking to strangers as it would land her in big trouble.


                             The Role Of The Government

The government of the Gambia has indeed put in place certain laws to this effect. In 2016, The Gambia’s president at that time, President Yahya Jammeh announced that child marriage below 18 years will be illegal in the country. Making Gambia the latest country to decisively outlaw child marriage

The President declared that the penalty for child marriage would be up to 20 years imprisonment for both the husband and the parents of the girl being married.  This was a very encouraging move for the country which should have been done a while back. Indeed, the Gambian government’s decision in the mobilization of the political will needed to end child marriage for good is a critical step. The leaders must ensure the law leads to real social change.

 
              Possible Long-Term Solutions

1.  Empower girls with information, skills and good support networks

In many countries where child marriage is widespread, girls are often seen as economic burdens. Girls in households where boys are favored often have low self-esteem and little confidence. An empowerment program for young girls is key to preventing early marriages by improving their self-efficacy. This can be achieved by informing girls of their basic human rights, their legal right to refuse a marriage, and education programs on health and sex education. Also, they can be offered opportunities to gain skills and education, providing support networks and creating ‘safe spaces’ where girls can gather and meet outside the home, can help them to assert their right to choose when they marry.

2.  Female education

According to valid studies it is more likely that a girl who marries as a child will come from a society where education for girls is not valued. She will probably be illiterate and will have little to no understanding of her human rights. Girls having access to both primary and secondary education will improve their chances of access to employment and a means of sustaining themselves and then in turn their families. It is important to reach out to societies and help challenge traditional and discriminatory views on access to education. For instance, Tostan, a woman’s human rights non-profit based in Senegal, is an inspirational example of an organization that has outreach programs which educate community elders and lawmakers about the importance of educating young girls. Female education should be the priority of the government.

3.  Educate and rally parents and members of the community

Some parents from very traditional communities believe that child marriage is a way of protecting their female child that is, providing for her economically so she will be taken care of, shielding her from harassment and sexual violence before she reaches adolescence, and preventing premarital sex which is still taboo in many countries. Unfortunately, families often do not know the detrimental effects of early child marriages. Pregnancy at a very tender age can lead to many complications as a girl’s body will not be ready for childbirth. Education will benefit such parents on the very harmful effects of forced early childhood marriage. Meetings, public campaigns or public announcements can be put in place to this effect.

4.  Provide economic support to the girls and their families

Poverty that is inter-generational is often the most common reason given for forcing girls into early marriage. Parents may know about the harmful effects of child marriage, but may be compelled to marry off their daughters. Some believe that the dowry payment from the marriage of an older sister might be essential in ensuring the survival of younger children and the whole family. Providing economic support to families may be a way of assisting parents who do not want their daughters to get married early. Prong a girl or her family with an incentive, such as a loan, or an opportunity to learn an income generating skill can yield immediate economic relief for struggling families. Daughters with skills can earn for their family and save their family from poverty even when avoiding marriage.

5.  Encourage supportive laws and policies

One of the most powerful tools that anti-child marriage organizations and women’s rights advocates have been campaigning for is to make child marriage illegal by raising the legal age of marriage. These laws have been put in place here in The Gambia. It is now our duty to support this legislation passed by participating in community campaigning activities such as petitions and demonstrations. In cases where the legislation is already in place but still facing trouble gaining traction over entrenched traditions, you can help prevent child marriage by notifying the relevant authorities or agencies about any child marriages being facilitated.

 
Conclusion

This research indicates that not all girls have equal access to schooling due to hidden costs in children’s education such as extra fees, transportation costs, uniforms and books. For those girls whose parents can afford to send them to school and in some cases for girls who do well in school, education is perceived among interviewees to delay marriage. However, the hidden costs of schooling are understood to be an indirect cause of early marriage when poor families cannot pay for a daughter’s continued education and see no other alternatives for her subsistence.

Also, some girls go ahead to marry early to alleviate financial burdens on their parents, especially if the husband has resources that can benefit the bride's family.    Another major conclusion we draw is that adolescent girls in the areas we studied are increasingly  sexually active which  is a  new problem:  what can parents  do with this cohort of girls whom the law says cannot be married but who risk pregnancy outside marriage, causing increased financial burdens for parents in poverty? As Muslims, parents are seen to be responsible for their children's behavior in the eyes of God and therefore may feel that a girl engaging in premarital sex should be wed. In The Gambia, going back to school later after childbirth is difficult because of childcare responsibilities and/the need to earn income. 

As long as girls and their families see the most available option for a girl's economic support to be early marriage with boys or men whose earning opportunities are greater than women's, the practice of early marriage is unlikely to decline among the urban poor.

Finally, I believe that marriage should be a thing of choice and support. A girl should be allowed to chose who she wants to marry, when she wants to marry and should also receive support from her family members. If this can become a norm, we can be one step closer to making the world a better place.


REFERENCES

1· https://www.icrw.org/wp-content/uploads/2016/10/19967_ICRW-Solutions001-pdf.pdf

2·  CAUSES AND EFFECTS OF EARLY MARRIAGE ON THE GIRL-CHILD IN SUBA SUB - COUNTY, WESTERN KENYA MONICA ANYANGO REUBEN

3·  https://www.girlsnotbrides.org/why-does-it-happen/

4·  https://www.globalcitizen.org/en/content/gambia-bans-child-marriage-gender-equality/ Gambia outlaws child marriage ‘as from today’, Global Citizen, july 2016

5·  Causes and Motives of Early Marriage in The Gambia and Tanzania Is New Legislation Enough? (PDF      Download Available). Available from:                https://www.researchgate.net/publication/321723696_Causes_and_Motives_of_Early_Marriage_in_The_Gambia_and_Tanzania_Is_New_Legislation_Enough [accessed Mar 25 2018].

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Lana

Hepatitis

OVERVIEW
Hepatitis is an inflammation of the liver. It may be caused by drugs, alcohol use, or certain medical conditions. But in most cases, it's caused by a virus. This is known as viral hepatitis. The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer. Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepatitis.

                             TYPES OF HEPATITIS

VIRAL HEPATITIS
There are 5 main hepatitis viruses, referred to as types A, B, C, D and E. The most common forms are the types A, B, C. These 5 types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread.

Hepatitis A:
Hepatitis A is highly contagious and can spread from person to person in many different settings. It typically causes only a mild illness, and many people who are infected may never realize they're sick at all. The virus almost always goes away on its own and does not cause long-term liver damage.
Hepatitis A usually passes within a few months, although it can occasionally be severe and even life-threatening. There's no specific treatment for it, other than to relieve symptoms such as pain, nausea and itching.

Treatments for hepatitis A
There's currently no cure for hepatitis A, but it will normally pass on its own within a couple of months. You can usually look after yourself at home.

Hepatitis B
Hepatitis B is caused by the hepatitis B virus, which is spread in the blood of an infected person. It is transmitted through exposure to infective blood, semen, and other body fluids. HBV can be transmitted from infected mothers to infants at the time of birth or from family member to infant in early childhood. Transmission may also occur through transfusions of HBV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use.

Many adults who get hepatitis B have mild symptoms for a short time and then get better on their own. But some people are not able to clear the virus from the body, which causes a long-term infection. Nearly 90% of infants who get the virus will carry it for life. Over time, hepatitis B can lead to serious problems, such as liver damage, liver failure, and liver cancer.

Symptoms of hepatitis B
Many people with hepatitis B won't experience any symptoms and may fight off the virus without realizing they had it. If symptoms do develop, they tend to occur two or three months after exposure to the hepatitis B virus.

Symptoms of hepatitis B include:
flu-like symptoms, including tiredness, a fever, and general aches and pains
loss of appetite
feeling and being sick
diarrhea
tummy (abdominal) pain
yellowing of the skin and eyes (jaundice)
Treatments for hepatitis B

Treatment for hepatitis B depends on how long you've been infected for:
If you've been exposed to the virus in the past few days, emergency treatment can help stop you becoming infected.
If you've only had the infection for a few weeks or months (acute hepatitis B), you may only need treatment to relieve your symptoms while your body fights off the infection.
If you've had the infection for more than six months (chronic hepatitis B), you may be offered treatment with medicines that can keep the virus under control and reduce the risk of liver damage.
Chronic hepatitis B often requires long-term or lifelong treatment and regular monitoring to check for any further liver problems.

Hepatitis C
Hepatitis C is caused by the hepatitis C virus and is usually spread through blood-to-blood contact with an infected person. Hepatitis C often causes no noticeable symptoms, or only flu-like symptoms, so many people are unaware they're infected.
Around one in four people will fight off the infection and be free of the virus. In the remaining cases, it will stay in the body for many years. This is known as chronic hepatitis C and can cause cirrhosis and liver failure.
Chronic hepatitis C can be treated with very effective antiviral medications, but there's currently no vaccine available.

Hepatitis D
Hepatitis D is caused by the hepatitis D virus. It only affects people who are already infected with hepatitis B, as it needs the hepatitis B virus to be able to survive in the body.
Hepatitis D is usually spread through blood-to-blood contact or sexual contact. It's uncommon in the UK, but is more widespread in other parts of Europe, the Middle East, Africa and South America. Long-term infection with hepatitis D and hepatitis B can increase your risk of developing serious problems, such as cirrhosis and liver cancer.
There's no vaccine specifically for hepatitis D, but the hepatitis B vaccine can help protect you from it.

Hepatitis E
Hepatitis E is caused by the hepatitis E virus. is mostly transmitted through consumption of contaminated water or food. HEV is a common cause of hepatitis outbreaks in developing parts of the world and is increasingly recognized as an important cause of disease in developed countries.
Hepatitis E is generally a mild and short-term infection that doesn't require any treatment, but it can be serious in some people, such as those who have a weakened immune system.
There's no vaccine for hepatitis E. When travelling to parts of the world with poor sanitation, where epidemic hepatitis E may be common, you can reduce your risk by practicing good food and water hygiene measures.

Parasitic hepatitis
Parasites can also infect the liver and activate the immune response, resulting in symptoms of acute hepatitis with increased serum IgE (though chronic hepatitis is possible with chronic infections). Protozoans such as  Trypanosoma cruzi, Leishmania species, and the malaria-causing Plasmodium species all can cause liver inflammation. Entamoeba histolytica, causes hepatitis with distinct liver abscesses.
 Echinococcus granulosus(dog tapeworm), infects the liver and forms characteristic hepatic hydatid cysts.The liver flukes Fasciola hepatica and Clonorchis sinensis live in the bile ducts and cause progressive hepatitis and liver fibrosis.

Fulminant hepatitis
Fulminant hepatitis or massive hepatic cell death is a rare and life-threatening complication of acute hepatitis that can occur in cases of hepatitis B, D, and E, in addition to drug-induced and autoimmune hepatitis.

Bacterial hepatitis
Bacterial infection of the liver commonly results in pyogenic liver abscesses, acute hepatitis, or granulomatous (or chronic) liver disease. This involves enteric bacteria such as Escherichia coli and Klebsiella pneumonia. Acute hepatitis is caused by Neisseria meningitidis, Neisseria gonorrhea, Bartonella henselae, Borrelia burgdorferi, salmonella species, brucella species and campylobacter species. Chronic or granulomatous hepatitis is seen with infection from mycobacteria species, Tropheryma whipplei, Treponema pallidum, Coxiella burnetii, and rickettsia species.

Metabolic
This form of Hepatitis includes:

Alcoholic hepatitis
Excessive alcohol consumption is a significant cause of hepatitis and is the most common cause of cirrhosis in the U.S. Alcoholic hepatitis is within the spectrum of alcoholic liver disease. This ranges in order of severity and reversibility from alcoholic steatosis, alcoholic hepatitis, cirrhosis, and liver cancer (most severe, least reversible). Hepatitis usually develops over years-long exposure to alcohol, occurring in 10 to 20% of alcoholics. Long-term alcohol intake (in excess of 80 grams of alcohol a day in men and 40 grams a day in women) is associated with development of alcoholic hepatitis.

Toxic and drug-induced hepatitis
Many chemical agents, including medications, industrial toxins, and herbal and dietary supplements, can cause hepatitis. Toxins and medications can cause liver injury through a variety of mechanisms, including direct cell damage, disruption of cell metabolism, and causing structural changes.  Some drugs such as paracetamol exhibit predictable dose-dependent liver damage while others such as isoniazid cause idiosyncratic and unpredictable reactions that vary among individuals.
Exposure to other hepatotoxins can occur accidentally or intentionally through ingestion, inhalation, and skin absorption. Examples of such toxins are carbon tetrachloride and the wild mushroom Amanita phalloides.

Non-alcoholic fatty liver disease
Non-alcoholic liver disease occurs in people with little or no history of alcohol use, and is instead strongly associated with metabolic syndrome, obesity, insulin resistance and diabetes, and hypertriglyceridemia. Over time, non-alcoholic fatty liver disease can progress to non-alcoholic steatohepatitis, which additionally involves liver cell death, liver inflammation and possible fibrosis.

Autoimmune Hepatitis
Autoimmune hepatitis is a rare cause of long-term hepatitis in which the immune system attacks and damages the liver. The liver can get so damaged that it stops working properly. As in other autoimmune diseases, circulating auto-antibodies may be present and are helpful in diagnosis. Treatment for autoimmune hepatitis involves very effective medicines that suppress the immune system and reduce inflammation. The causes of autoimmune hepatitis are still unclear and it's not known whether anything can be done to prevent it.

Other forms include:
Genetic hepatitis.
Ischemic hepatitis
Neonatal hepatitis


                             DIAGNOSIS OF HEPATITIS
Diagnosis of hepatitis is made on the basis of some or all of the following:
*a patient's signs and symptoms
* medical history including sexual and substance use history.
* Blood tests, imaging, and liver biopsy.
 In general, for viral hepatitis and other acute causes of hepatitis, the patient's blood tests and clinical picture are sufficient for diagnosis but in chronic hepatitis, blood tests may not be useful, instead, liver biopsy is used for establishing the diagnosis as histopathology analysis is able to reveal the precise extent and pattern of inflammation and fibrosis.

                                           PROGNOSIS OF HEPATITIS

Acute hepatitis
Nearly all patients with hepatitis A infections recover completely without complications if they were healthy prior to the infection. Similarly, acute hepatitis B infections have a favorable course towards complete recovery in 95–99% of patients.[14] However, certain factors may portend a poorer outcome, such as co-morbid medical conditions or initial presenting symptoms of ascites, edema, or encephalopathy.[14] Overall, the mortality rate for acute hepatitis is low:
In contrast to hepatitis A & B, hepatitis C carries a much higher risk of progressing to chronic hepatitis, approaching 85–90%.[105] Cirrhosis has been reported to develop in 20–50% of patients with chronic hepatitis C. Rare complications of acute hepatitis include pancreatitis, aplastic anemia, peripheral neuropathy, and myocarditis.

Fulminant hepatitis
Fulminant hepatitis represents a rare but feared complication. Mortality rates in cases of fulminant hepatitis rise over 80%, but those patients that do survive often make a complete recovery. Liver transplantation can be life-saving in patients with fulminant liver failure. Hepatitis D infections can transform benign cases of hepatitis B into severe, progressive hepatitis, (superinfection).

Chronic hepatitis
Overall, the 5-year survival rate for chronic hepatitis B ranges from 97% in mild cases to 55% in severe cases with cirrhosis. Most patients who acquire hepatitis D at the same time as hepatitis B (co-infection) recover without developing a chronic infection; however, in people with hepatitis B who later acquire hepatitis D (superinfection), chronic infection is much more common at 80-90%, and liver disease progression is accelerated.
Chronic hepatitis C progresses towards cirrhosis, with estimates of cirrhosis prevalence of 16% at 20 years after infection. While the major causes of mortality in hepatitis C is end stage liver disease, hepatocellular carcinoma is an important additional long term complication and cause of death in chronic hepatitis.

 

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Lana

A Talk About Female Genital Mutilation

What is female genital mutilation?

In simple words Fgm is the partial or total removal of the female external genitalia and it is also called female circumcision due to the fact that it involves the removal of the skin cover of the genitalia. It is also called female circumcision. It is mostly done at an early age or in childhood. The removal of the external genitalia in female usually results to lots of impairement and difficulties, that are just not physical, but are sexual, psychological, emotional and medical. Female genitalia mutilation has been proven to be as a result of cultural beliefs and tradition of people from different societies. The reasons according to the beliefs are to prevent promiscuity and waywardness of girls or women in their society, protect family honor and reputation from being crushed, protect virginity and sexual beauty of their daughters. To ensure social and cultural control of women’s sexuality in that society, secure the marital future of their daughters, promote male attraction rate and sexual pleasure. All these are misconception mostly due to ignorance that must be addressed if fgm is to be eradicated. Estimated 150 million women living today have undergone this ritual (2-3 million girls per year), widely practiced in Africa. Which is alarming.

Fgm is performed mostly in local villages, where the instruments used are are not sterilized. Infant and mortality rates are generally higher in those communities. FGM has no health benefits but many side effects like excessive bleeding, urinary infection, septicemia, tetanus, acute urinary retention, HIV, and other sexually transmitted diseases. These diseases are transmitted due to the fact that the instruments used in performing the procedure are not sterilized. It has been noted that the risks and complications of FGM are adverse to an extent of high death rate, infertility and so many long term effects.

     The short term effects or immediate complications are , Severe pain which can lead to shock during and after procedure, loss of blood, inflammation of tissues beneath the skin can occur, Infections on the wounds can lead to tetanus, Urinary dysfunction, damage of adjoining organs can occur as a result of the use of blunt tools by amateur operators.

      On the long run, Painful intercourse as a result of tight vaginal opening, Impaired sexual response , Inability to undergo pelvic examinations, Psychological and psychosexual sequelae ranging from anxiety to severe depression and psychosomatic illnesses, painful and blocked menstruation, Increased risk of maternal and child morbidity and mortality due to obstructed labor. However, Women who have undergone FGM are twice as likely to die during childbirth and are more likely to give birth to a stillborn child than other women. Obstructed labor can also cause brain damage to the infant and complications for the mother (including fistula formation, an abnormal opening between the vagina and the bladder or the vagina and the rectum, which can lead to incontinence).

        Finally, It has been observed that women who have undergone female genitalia mutilation have psychosocial problems, emotional issues and impairment in sexual behavior, they lack sexual enjoyment as a result of certain physical complications. They tend to have difficult or impossible penetration and painful intercourse due to lacerations and loss of skin elasticity.

     there is possible solution to suppress fgm, and I will like to take this opportunity to ask everyone of you here present to contribute to the fight.

  Governmental and non governmental agencies, which I am willing to work with have in various ways been trying to suppress the practice of female genitalia mutilations done in different places and parts of the world.  Community leadership is the key to decreasing the prevalence of FGM, However, provision of education in the remote areas where there is lack of civilization can also be a method to suppress the practice of female genitalia mutilation as suggested by the World Health Organization.

     Sensitization must be done in those communities on the complications, the disadvantages or the risks involved in the practice of female genitalia mutilation and this especially should not exclude the men because it has also been observed that the men of such tradition and custom want their wives and children to be victims or partakers of FGM. The essence of sensitizing the men also is to ensure the change of their mentality towards female circumcision. Moreover, the heads of those communities, customs and culture should be prioritized during the sensitization process in order to ensure that ‘when the head is cut off, the rest of the body dies as well. The government should pass a law against the practice of FGM which will guarantee the fear of community heads and leaders who engage in the practice not to get into trouble with the government and get punished. Campaign road sign against female genital mutilation. It’s a cost effective yet efficient method of sensitizing communities.

   In conclusion, Female genitalia mutilation is one that has so many effects on the girls and women that has gone through the process. It tends to change their personality and mindset about many issues of life and it creates a vague image of life in their mind presenting them the wrong ideas to believe it is a norm that should continue generations upon generations.

This practice is not medically related and has no medical benefits as a support to its barbarism other than custom, culture and tradition which is the reason it needs to be discouraged and eradicated to ensure the freedom of these girls and women who think it be a practice of pride in ignorance. Hence, enlightening the victims of female genitalia mutilation is one of the steps to achieving their freedom from such callous act of ungodliness rather than remaining silent and this procedure continues to spread building firm roots and mobilizing generations or more people to its support which will make it extremely difficult to suppress if its backup becomes hard and unyielding.  

  Ladies and gentlemen, talk about this topic with your friends and family, in order to spread the message and point out that urgent action must be taken. Lets join hands and eradicate this barbaric act.Thank you.

 

 

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Lana

THE INFLUENCES OF GENES ON BEHAVIOUR

INTRODUCTION
Scientists have studied twins for many years to understand how genes and environments influence differences among individuals, spanning conditions such as cancer and mental health to characteristics such as intelligence and political beliefs.

Although the twin method is well-established, findings from twin studies are often controversial. Critics of twin research question the value of establishing that characteristics, such as health behaviours, have a strong genetic basis. A primary concern is that these types of findings will result in complacency or fatalism, effectively undermining motivation to change lifestyle. But there is very little evidence to support these fears.

Genetic influence on human characteristics is often misinterpreted. It is wrongly assumed that a behaviour that has strong genetic influence (highly heritable) must be biologically hardwired. However, genes are not destiny. Genes are often dependent on environmental exposure, such that genes can have a stronger effect, or no effect, depending on the environment.

For example, people with a genetic predisposition to lung cancer are unlikely to develop the disease unless they smoke. The same is true of behaviour. Behaviour is only elicited in response to environmental cues. Establishing that a behaviour has an important genetic basis does not imply that this behaviour cannot be changed through environmental means.

The influence of genes on behavior has been well established in the scientific community. To a large extent, who we are and how we behave is a result of our genetic makeup. While genes do not determine behavior, they play a huge role in what we do and why we do it.

Behavioral genetics studies heritability of behavioral traits, and it overlaps with genetics, psychology, and ethology (the scientific study of human and animal behavior). Genetics plays a large role in when and how learning, growing, and development occur. For example, although environment has an effect on the walking behavior of infants and toddlers, children are unable to walk at all before an age that is predetermined by their genome. However, while the genetic makeup of a child determines the age range for when he or she will begin walking, environmental influences determine how early or late within that range the event will actually occur.

The field was originally focused on testing whether genetic influences were important in human behavior (e.g., do genes influence human behavior). It has evolved to address more complex questions such as: how important are genetic and/or environmental influences on various human behavioral traits; to what extent do the same genetic and/or environmental influences impact the overlap between human behavioral traits; how do genetic and/or environmental influences on behavior change across development; and what environmental factors moderate the importance of genetic effects on human behavior (gene-environment interaction). ‪

Most recently, the field has moved into the area of statistical genetics, with many behavioral geneticists also involved in efforts to identify the specific genes involved in human behavior, and to understand how the effects associated with these genes changes across time, and in conjunction with the environment.

(Encyclopedia Britannica, Behavior Genetics by Robert Plomin, 4-11-2011)

GENETICS
Genetics is the study of heredity. Heredity is a biological process where a parent passes certain genes onto their children or offspring. Every child inherits genes from both of their biological parents and these genes in turn express specific traits. Some of these traits may be physical for example hair and eye color and skin color etc. On the other hand some genes may also carry the risk of certain diseases and disorders that may pass on from parents to their offspring.

Previously it had been difficult to link particular chromosome with psychiatric illness. However in a number of studies over years such an association has been made. E.g., schizophrenia, mood disorders, neuropsychiatric disorders, personality disorders, alcoholism, and personality traits.

Specific chromosomes have been associated with other disorders with behavior symptoms. Example:

 1.    Schizophrenia has been associated with markers on chromosome 1, 6, 7, 8, 13, 21 and 22.
 2.    Bipolar disorder and major depressive disorder have been associated with markers on chromosome            3, particularly 3p21.1.

TYPES OF STUDIES USED IN GENETIC RESEARCH

·       Twin studies 
a.  Used in genetic research to study the correlation between genetic inheritance and behaviour due to           the common genetics shared by twins.
b. Monozygotic twins (MZT) identical - share 100% genetic material.
c. Dizygotic twins (DZT) fraternal - share 50% genetic material. 
d. It is usually further explored, by studying the twins either separated or together to make a correlation        of their behaviour. 

·       Adoption studies 
a.  Allow researchers to study the comparison between genetic and environmental influence on behaviour.
b.  Adopted children share no genes with their adoptive parents but 50% of genes with their biological             parents. 

·       Family studies 
a.  Study behaviour between family members who have similar genetics to different degrees. 
 
·      Outline intelligence 
a.  Intelligence is an aspect of behaviour that has been studied in relation to genetics.
b.   It was questioned whether intelligence was attributed to genetic or environmental factors. Intelligence        difficult to define
c.  IQ tests have been developed by a French person called Binet to measure of intelligence and are used       in much psychological research. 

CONCLUSION
Identifying a chromosomal abnormality in a patient with mental disorder is of profound importance to the individual and their family. Diagnosis of a chromosomal abnormality can alter medical management and affect prognosis with respect to known associated conditions, and has important genetic counseling implications. In addition, receiving a genetic diagnosis may relieve parents of guilt or inappropriate blame for causing behavioral manifestations of the condition.


REFERENCES
1.     Boundless. “The Influence of Genes on Behavior.” Boundless Psychology. Boundless, 26 May. 2016.
2.     Dick, Danielle; Rose, Richard (2002). "Behavior Genetics: What's New? What's Next". Current                    Directions in Psychological Science (11): 70–74.
3.     Encyclopedia Britannica, Behavior Genetics by Robert Plomin, 4-11-2011
4.     http://theconversation.com/why-it-is-useful-to-understand-the-role-of-genetics-in-behaviour-67502 
5.     Wikipedia, Human Behavior Genetics

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Lana

Measles Infection And Challenges

INTRODUCTION

Measles virus, a paramyxovirus is one of the main causes of death in children in developing countries and responsible for some deaths in industrialized nations. Infection resorts to immunosuppression, making the host more susceptible to secondary infections with a range of viral and bacterial pathogens and causing most measles associated (Carter et al, 2007).

Measles is an acute highly viral infectious disease. Before vaccines, infection was nearly universal during childhood. It has no known animal reservoir and no asymptomatic carrier state has been recorded (Roy P et al, 2015).

Measles is still a common and fatal disease especially in developing countries. It is primarily transmitted through large respiratory droplets. It is highly infectious, with greater than 90% secondary attack rates among susceptible persons (CDC, 2015). It infects nearly 30 million children per year worldwide. Complications related to pneumonia, diarrhea and malnutrition usually cause death (Orenstein et al, 2004).

WHO estimates that of the approximately two- thirds of the global burden of death due to measles, almost 1,36,000 (range: 98,000 to 1,80,000) occurred in the South East Asian Region in 2007, with most of in India. India had 47% of estimated global measles mortality in 2010 (Simon et al, 2012).


THE MEASLES DISEASE

Pathogenesis:

Infection is very contagious and usually through aerosol route. Initially, the Virus replicates in the respiratory tract, then spreads to lymphoid tissues. Viremia and spread to a variety of epithelial sites follows. About 1-2 weeks after infection disease symptoms develop.

(Hunt M, 2009).
  
 
Figure 1: The pathogenesis of measles.  


Diagnosis:

i.Clinical picture
History of exposure and upper respiratory tract symptoms, Koplik's spots and rash.

ii.Confirmatory tests
Disease is confirmed with RT-PCR serodiagnosis, isolation. Serology diagnosis by IgG is simpler than isolation but two samples are needed (one 10-21 days post rash) so it takes longer. An IgM test is now available.

Epidemiology:

Almost all individuals infected are symptomatic. Only one serotype exists. A single natural infection gives life-long protection. Inhalation is the main route of infection. It is highly contagious – the maximum period of contagiousness is 2-3 days before the onset of rash (Hunt M, 2009).

PROBLEMS ASSOCIATED WITH MEASLES INFECTION

A high fever is usually the first sign of infection with measles, which begins after incubation period which is about 10 to 12 days after exposure to the virus, and lasts for about 4 to 7 days. A runny nose with cough, conjunctivitis, and koplik can develop in the initial stage. After several days, a rash appears, often on the face and upper neck, averagely, the rash occurs 14 days after infection (in a range of 7 to 18 days). Over about 3 days, the rash spreads; it eventually gets to the hands and feet. It lasts for 5 to 6 days, and then fades (Roy P et al, 2015).

Most measles-related deaths are as a resort of associated complications. Complications are more common in children under the age of 5, or adults over the age of 20. The severe complications are blindness, severe diarrhea and resulting dehydration, ear infections, and severe respiratory infections such as pneumonia. Measles could be severe among poorly nourished young children, especially those with insufficient vitamin A, or the immune-compromised (WHO measles factsheet, 2015).

In a very small proportion, the virus establishes in the brain and, after a long period of incubation, causes a degenerative pattern of changes in brain function, this includes loss of higher brain activity, death is inevitable. Two related but different diseases result from neural infection, Measles Inclusion Body Encephalitis (MIBE) and Sub-acute Sclerosing Pan Encephalitis (SSPE).

MIBE occurs in approximately 1 in 2000 cases of infection, a chronic progressive encephalitis which occurs in young adults and children and is associated with a persistent measles virus infection. MIBE can be fatal with the survival time after diagnosis being an average of 3 years. It is usually a seen in immunocompromised patients and is associated with early primary infection usually before two years of age.

SSPE a slowly progressive neurological degenerative disease, occurs in approximately 1 in 100,000 cases. It is associated with a long term persistent measles virus infection that leads to death many years after the first infection (Dimmock et al, 2015).

AVAILABLE CONTROL MEASURES

A live attenuated virus vaccine (grown in chicken embryo fibroblast culture) is currently recommended to be given to children at twelve to fifteen months, Younger children do not show a strong immune response to the vaccine.

A Second dose is given at about four to six years of age. Thus, reducing the number of persons who are susceptible due to failure of primary vaccine. Vaccination gives long term immunity and the vaccine does not spread the virus.

Immune serum globulin can be used for at risk patients (less than 1 year old, or with impaired cellular immunity) during an outbreak (Hunt M, 2009).

Measles virus has not changed over its known history of about fifty years, the same level of protection is still reached by the original vaccines. The polio and measles viruses are stable when compared with HIV-1 and the influenza virus (Dimmock et al, 2007).

Although the vaccine can cause fatal giant cell pneumonia  in those with severely compromised cell-mediated immunity (Hunt M., 2009).

CHALLENGES FACED WITH GLOBAL AMBITION OF COMPLETELY ELIMINATING MEASLES

The feasibility of measles eradication has been proven by the Region of the Americas, where elimination of measles and interruption of transmission has been achieved and sustained since 2002 (WHO Global Eradication of Measles, 2015). Despite the success in global measles control, the progress in reduction of the numbers of measles cases and deaths became stagnant between 2008 and 2010. This is was mostly due to prolonged measles outbreaks in Africa and Europe and the high burden of the disease in India. The number of measles cases in western European countries, rose from 7,499 in 2009 to over 30,000 in 2010 and 2011, this contributed to an increase the number of reported cases globally. During the same period, twenty-eight countries in sub-Saharan Africa were affected in a widespread resurgence (CDC, Eliminating measles, Rubella and CRS worldwide, 2015).

The eradication of measles is faced with so many challenges, some of the key challenges include:

(1)  Maternal antibody Fast rate of waning
A large number of children are left unprotected before the first dose because of the fast rate of waning of these maternal antibodies (Adu, 2008).

(2)  Injectable nature of vaccine
There are problems with vaccine administration. Unlike the polio vaccine, the measles vaccine is administered with the injection, so it is not easy to administer. A large number of workforce are to be trained for vaccine administration. A very good solution to this problem would be the may be use of aerosol technique which, this can also be used by field workers. The acceptability of the vaccine may be improved through this method, since it would not require the use of injections (Roy P et al, 2015).

(3)  Adverse reaction and reversion to virulent strain
The chances of adverse reactions to the live vaccine need to be addressed. Maintaining proper cold chain during storage and transportation of vaccine should also be considered (Roy P et al, 2015).

(4)  Other competing priorities
The availability of qualified staff and funds are affected by competition from other health programs.There are competing priorities like streamlining of newer vaccines, polio eradication and other health initiatives (Roy P et al, 2015).

(5)  Population displacement and Migration
Population displacement and migration are challenges a measles eradication initiative would also face. Presently, there are large displaced populations in urban areas. Current eradication programs may face greater challenges than earlier programs as a result of exponential increase in trans- migration (United Nations Population Fund, 2015).

(6)  Political instability
In several countries particularly Somalia and Afghanistan, Sierra Leone, part of Pakistan, Congo, Sudan, Ethiopia and Liberia political instability and armed conflicts cause vaccination to be logistically unpredictable and difficult. In addition, Nigerian internal politics in the boycott of the 2003 immunization, were ramifications from the arena of international politics (Okonko et al, 2009).

(7)  Terrorism and War
The main measles- endemic countries are at war, and the world spends more on arms than ever before. Both real and perceived terrorism makes the situation more complex. As a resort, reaching high rates of vaccination coverage in areas affected by conflict will be very dangerous and difficult (Roy P et al, 2015).

(8)  Low vaccination rates and Surveillance
It is essential to maintain excellent vaccination coverage with high quality surveillance. Overcoming this, will be critical in dealing with importations of measles virus, so long as the measles virus is still endemic in other parts of the world (Andrus, 2011).

(9)  Poor maintenance of high population immunity
Maintaining a high population immunity with excellent coverage and laboratory networking that is efficient for high- quality surveillance would deal with the problem of the importation of measles virus into countries where it has been eliminated (Ministry of Health and Family Welfare, 2004).

(10) The changing epidemiology of measles
The increased transmission of measles among adolescents and adults as a result of the changing epidemiology of measles should also be considered (Roy P et al, 2015).

CONCLUSION

To eradicate measles, research has shown the need to have homogeneous population immunity of ≥93% (WHO Global Immunization Vision and Strategy, 2005). Elimination of measles requires immunization coverage of at least 96% of children aged less than one year and also the prevention of accumulation in the immunity gap (Roy P et al, 2015).

Three criteria are biologically important for the feasibility of the eradication of a disease, measles meets all:

(a) humans are the only reservoir;

(b) existence of accurate diagnostic tests

(c) an practical and effective intervention is available at an affordable cost.

It can be concluded, that measles eradication is a very challenging but feasible target. Exponential increase in commitment and resources is an essential requirements, if the measles eradication initiative should be pursued. To achieve measles eradication, all the regions and countries of the world will have to work together.

REFERENCES

1. Adu FD (2008). That Our Children Will Not Die. An Inaugural Lecture delivered at the
University of Ibadan, on Thursday 11th December. Ibadan University Press p. .34

2. Andrus JK, de Quadros CA, Solórzano CC, Periago MR, Henderson DA. Measles and
rubella eradication in the Americas. Vaccine 2011; 29(S4): 91-6.

3. Carter JB, Saunders VA. Virology Principles and Applications. 2007.

4. Centers for Disease Control and Prevention. Measles: Pink Book. Available at:
http://www.cdc.gov/vaccines/pubs/pinkbook/ downloads/meas.pdf. Last accessed on: 9 Feb, 2019.

5. Dimmock NJ, Easton AJ, Leppard KN. Introduction to Modern Virology. Sixth edition 2007.

6. Global eradication of measles. Report by the Secretariat. Sixty third World Health Assembly.
March 2010. Available at: http://apps.who.int/gb/ebwha/pdf_files/wha6 3/a63_18-en.pdf. Last accessed on: 9 Feb, 2019.

7. Hunt Margaret. Measles (Rubeola), Mumps, Rubella (German Measles) and Human
parvovirus B19. Medical Microbiology, PAMB 650/720. 2009.

8. Ministry of Health and Family Welfare, Government of India. Measles Mortality Reduction
India Strategic Plan 2005-2010, New Delhi.

9. Okonko IO, Nkang AO, Udeze AO, Adedeji AO, Ejembi J, Onoja BA, Ogun AA, Garba KN.
Global Eradication of measles: A highly contagious disease – what went wrong in Africa? JCAB 2009: 3(8) 119-140.

10. Orenstein WA, Perry RT, Halsey NA. The Clinical Significance of Measles: A Review. J
Infect Dis 2004; 189(Suppl 1): 4-16.

11. Roy P, Priyanka, Geol MK, Rasania SK. Measles Eradication: Issues, strategies and
challenges. JCD 2015: Article 10.

12. World Health Organization. GIVS: Global Immunization Vision and Strategy: 2006- 2015.
Geneva: WHO, 2005. Document WHO/IVB/05.05.p. 8.

13. World Health Organisation. Measles Factsheet. Available at http://www.who.int/mediacentre/factsheets/fs286/en/ . Accessed on 9 Feb, 2019.

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Lana

MEASUREMENT AND SCIENTIFIC METHODOLOGY, THE MEDICAL RELEVANCES

SCIENTIFIC METHODOLOGY

The scientific method is a process for experimentation that is used to explore observations and answer questions. Scientists use the scientific method to search for cause and effect relationships in nature. In other words, they design an experiment so that changes to one item cause something else to vary in a predictable way.

Just as it does for a professional scientist, the scientific method will help you to focus your science fair project question, construct a hypothesis, design, execute, and evaluate your experiment.

Steps of the Scientific Method
 
Ask a Question: The scientific method starts when you ask a question about something that you observe: How, What, When, Who, Which, Why, or Where?

And, in order for the scientific method to answer the question it must be about something that you can measure, preferably with a number.
 
Do Background Research: Rather than starting from scratch in putting together a plan for answering your question, you want to be a savvy scientist using library and Internet research to help you find the best way to do things and insure that you don't repeat mistakes from the past.

Construct a Hypothesis: A hypothesis is an educated guess about how things work:
"If _____[I do this] _____, then _____[this]_____ will happen."

You must state your hypothesis in a way that you can easily measure, and of course, your hypothesis should be constructed in a way to help you answer your original question.
 
Test Your Hypothesis by Doing an Experiment: Your experiment tests whether your hypothesis is supported or not. It is important for your experiment to be a fair test. You conduct a fair test by making sure that you change only one factor at a time while keeping all other conditions the same.

You should also repeat your experiments several times to make sure that the first results weren't just an accident.
 
Analyze Your Data and Draw a Conclusion: Once your experiment is complete, you collect your measurements and analyze them to see if they support your hypothesis or not.

Scientists often find that their hypothesis was not supported, and in such cases they will construct a new hypothesis based on the information they learned during their experiment. This starts the entire process of the scientific method over again. Even if they find that their hypothesis was supported, they may want to test it again in a new way.
 
Communicate Your Results: To complete your science project you will communicate your results to others in a final report and/or a display board. Professional scientists do almost exactly the same thing by publishing their final report in a scientific journal or by presenting their results on a poster at a scientific meeting. In a science fair, judges are interested in your findings regardless of whether or not they support your original hypothesis.
 
Even though we show the scientific method as a series of steps, keep in mind that new information or thinking might cause a scientist to back up and repeat steps at any point during the process.

 

 
MEASUREMENT

Measurement is an integral part of modern science as well as of engineering, commerce, and daily life. Measurement is often considered a hallmark of the scientific enterprise and a privileged source of knowledge relative to qualitative modes of inquiry.[1] Despite its ubiquity and importance, there is little consensus among philosophers as to how to define measurement, what sorts of things are measurable, or which conditions make measurement possible. Most (but not all) contemporary authors agree that measurement is an activity that involves interaction with a concrete system with the aim of representing aspects of that system in abstract terms (e.g., in terms of classes, numbers, vectors etc.) But this characterization also fits various kinds of perceptual and linguistic activities that are not usually considered measurements, and is therefore too broad to count as a definition of measurement. Moreover, if “concrete” implies “real”, this characterization is also too narrow, as measurement often involves the representation of ideal systems such as the average household or an electron at complete rest.

Philosophers have written on a variety of conceptual, metaphysical, semantic and epistemological issues related to measurement. This entry will survey the central philosophical standpoints on the nature of measurement, the notion of measurable quantity and related epistemological issues. It will refrain from elaborating on the many discipline-specific problems associated with measurement and focus on issues that have a general character.



BLOOD SUGAR TESTS

Fasting Blood Sugar (FBS or Fasting Glucose)
This is a test that measures blood sugar levels. Elevated levels are associated with diabetes and insulin resistance, in which the body cannot properly handle sugar (e.g. obesity).

Goal values:
Less than 100 mg/dL = normal

Between 110–125 mg/dL = impaired fasting glucose (i.e., prediabetes)

Greater than 126 mg/dL on two or more samples = diabetes

Preparation
This test requires a 12-hour fast. You should wait to eat and/or take a hypoglycemic agent (insulin or oral medication) until after test has been drawn, unless told otherwise.

Eating and digesting foods called carbohydrates forms glucose (blood sugar). Glucose is needed by your body to provide energy to carry out your normal activities. Insulin is needed by the body to allow glucose to go into the cells and be used as energy. Without insulin, the levels of glucose in the blood will rise. Diabetes is a disease that occurs when either the pancreas (an organ in your body) is not able to produce insulin or the pancreas makes insulin, but it does not work as it should. Fasting blood sugar is a part of diabetic evaluation and management. An FBS greater than 126 mg/dL on more than one occasion usually indicates diabetes.

 CALCIUM SCORE SCREENING HEART SCAN
A test used to detect calcium deposits found in atherosclerotic plaque in the coronary arteries. State-of-the-art computerized tomography (CT) methods, such as this one, are the most sensitive approaches to detecting coronary calcification from atherosclerosis, before symptoms develop. More coronary calcium means more coronary atherosclerosis, suggesting a greater likelihood of significant narrowing somewhere in the coronary system and a higher risk of future cardiovascular events.

Your doctor uses the calcium-score screening heart scan to evaluate risk for future coronary artery disease. Those at increased risk include individuals with the following traits:

1.  Family or personal history of coronary artery disease
2.  Male over 45 years of age, female over 55 years of age
3.  Past or present smoker
4.  History of high cholesterol, diabetes or high blood pressure
5.  Overweight
6.  Inactive lifestyle

Because there are certain forms of coronary disease -- such as "soft plaque" atherosclerosis – that escape detection during this CT scan, it is important to remember that this test is not absolute predicting your risk for a life-threatening event, such as a Institutes & Services.

ELECTROLYTES
Electrolyte levels are useful in detecting kidney, heart and liver disease, and the effects of certain medications (such as diuretics or some heart pills).

ENZYME AND PROTEIN BLOOD TESTS
A series of blood tests that measure enzyme that is released into the bloodstream when cells are damaged.

LIPID BLOOD TESTS
Blood tests that provide information about the amount of cholesterol levels in your blood.

COMMON MEASUREMENT EQUIPMENTS IN THE CLINIC



BMI (BODY MASS INDEX)
The Body Mass Index (BMI) is a guide to whether someone is underweight, normal weight or overweight. It can be measured manually as it can be measured automatically in some clinics and hospitals.

The formula for calculating the Body Mass Index of individuals is:
BMI = Mass in KG/ height in m2
For example, the BMI of an individual with a height of 1.7 m with a body mass of 60kg will be:
60/1.72 = 60/ 2.89 = 20.8

BMI is really important in medicine because it helps us to know whether we are eating healthily or not and can help us with ways to improve our lifestyles.



IMPLICATIONS OF UNDERWEIGHT AND OVERWEIGHT

Your body weight may correlate to overall wellness. Excessively high or low body weight can trigger complications, such as infertility, bone problems and lethargy (weakness characterized by lack of energy). Often, your weight can be improved and managed through healthy lifestyle changes. Medical conditions or psychological disorders can also trigger weight changes.

FERTILITY ISSUES:
Overweight and underweight individuals are at risk of infertility. Excess body weight is associated with reduced fertility in men. Women with polycystic ovary syndrome--- a condition associated with obesity and insulin resistance--- may cause infertility. An unhealthy diet, a common contributor to excessive weight gain and loss, can negatively affect men and women’s ability to procreate.

In particular, diets deficient in vitamin C, folate (a b vitamin) and minerals selenium and zinc are associated with reduced fertility. Diets low in fruits, vegetables and whole grains and low-calorie, restricted diets may lack these nutrients. Low body weight can also cause a woman to stop menstruating, a condition known as amenorrhea. Reduced fertility is a common complication of amenorrhea.

BONE HEALTH:
Maintaining low body weight can derail nutrient intake and absorption. A restrictive diet, particularly one low in calcium and vitamin D, increase a person’s risk of osteoporosis substantially. Osteoporosis often leads to stopped posture and serious bone fractures in later life. These conditions are serious risk factors of eating disorders that involve low body weight, such as anorexia.

Overweight and obesity can also hinder bone health. Young women with high body fat exhibited to 8 to 9 percent weaker bone density than those with normal amount of body fats. Obese people’s bodies do not make sufficient amounts of bone mass for the amount of muscle and weight they carry. Thus, poor body weight density, osteoporosis and bone fractures may occur.

ENERGY LEVEL:
Body weight often affects energy levels. People who regularly eat too much or too little are likely to experience fatigue. Since the body depends upon nutrient intake, severe calorie restriction and malabsorption of nutrients can leave too little fuel for the body needs. As a result, people with illnesses characterized by weight loss, such as Crohn’s disease, anorexia and certain types of cancer, and people who diet compulsively may experience fatigue.

Various factors and conditions contribute to fatigue, a number of which are associated with excess body weight. Such conditions include obesity, sleep apnea (a sleep disorder associated with obesity), type 2 diabetes and sedentary lifestyle.

IMPLICATIONS OF HYPOTHERMIA AND HYPERTHERMIA

Hypothermia is a potentially dangerous drop in body temperature, usually caused by prolonged exposure to cold temperatures. The risk of cold exposure increases as the winter months arrive. But if you're exposed to cold temperatures on a spring hike or capsized on a summer sail, you can also be at risk of hypothermia.

Normal body temperature averages 98.6 degrees. With hypothermia, core temperature drops below 95 degrees. In severe hypothermia, core body temperature can drop to 82 degrees or lower.

WHAT CAUSES HYPOTHERMIA?

 1.  Cold exposure
  2. Much milder environments can also lead to hypothermia,
  3. Other causes: medical conditions such as diabetes etc.

COLD EXPOSURE:
When the balance between the body's heat production and heat loss tips toward heat loss for a prolonged period, hypothermia can occur. Accidental hypothermia usually happens after cold temperature exposure without enough warm, dry clothing for protection. Mountain climbers on Mount Everest avoid hypothermia by wearing specialized, high-tech gear designed for that windy, icy environment.

MUCH MILDER ENVIRONMENT:
However, much milder environments can also lead to hypothermia, depending on a person's age, body mass, body fat, overall health, and length of time exposed to cold temperatures. A frail, older adult in a 60-degree house after a power outage can develop mild hypothermia overnight. Infants and babies sleeping in cold bedrooms are also at risk.

OTHER CAUSES:
Certain medical conditions such as diabetes and thyroid conditions, some medications, severe trauma, or using drugs or alcohol all increase the risk of hypothermia.

HO DOES COLD EXPOSURE CAUSE HYPOTHERMIA?

During exposure to cold temperatures, most heat loss -- up to 90% -- escapes through your skin; the rest, you exhale from your lungs. Heat loss through the skin happens primarily through radiation and speeds up when skin is exposed to wind or moisture. If cold exposure is due to being immersed in cold water, heat loss can occur 25 times faster than it would if exposed to the same air temperature.

The hypothalamus, the brain's temperature-control center, works to raise body temperature by triggering processes that heat and cool the body. During cold temperature exposure, shivering is a protective response to produce heat through muscle activity. In another heat-preserving response -- called vasoconstriction -- blood vessels temporarily narrow.

Normally, the activity of the heart and liver produce most of your body heat. But as core body temperature cools, these organs produce less heat, in essence causing a protective "shut down" to preserve heat and protect the brain. Low body temperature can slow brain activity, breathing, and heart rate.

Confusion and fatigue can set in; hampering a person's ability to understand what's happening and to make intelligent choices to get to safety.

WHAT ARE THE SYMPTOMS OF HYPOTHERMIA?

Hypothermia symptoms for adults include:

1.  Shivering, which may stop as hypothermia progresses (shivering is actually a good sign that a person's heat regulation systems are still active. )
2.  Slow, shallow breathing
3.  Confusion and memory loss
4.  Drowsiness or exhaustion
5.  Slurred or mumbled speech
6.  Loss of coordination, fumbling hands, stumbling steps
7.  A slow, weak pulse
8.  In severe hypothermia, a person may be unconscious without obvious signs of breathing or a pulse
 
WHAT ARE THE RISK FACTORS OF HYPOTHERMIA?

People at increased risk for hypothermia include:

1.  The elderly, infants, and children without adequate heating, clothing, or food
2.  People with mental illness
3.  People who are outdoors for extended periods
4.  People in cold weather whose judgment is impaired by alcohol or drugs

HYPERTHERMIA
Hyperthermia is elevated body temperature due to failed thermoregulation that occurs when a body produces or absorbs more heat than it dissipates/removes. Extreme temperature elevation then becomes a medical emergency requiring immediate treatment to prevent disability or death.

The most common causes include heat stroke and adverse reactions to drugs. Heat stroke is an acute temperature elevation caused by exposure to excessive heat, or combination of heat and humidity, that overwhelms the heat-regulating mechanisms. Adverse reaction to drugs means relatively rare side effect of many drugs, particularly those that affect the central nervous system. Malignant hyperthermia is a rare complication of some types of general anesthesia.

Hyperthermia differs from fever in that the body's temperature set point remains unchanged. The opposite is hypothermia, which occurs when the temperature drops below that required for maintaining normal metabolism.


TEMPERATURE CLASSIFICATION



Note:
Hyperpyrexia is extremely high fever (especially in children)
The difference between fever and hyperthermia is the underlying mechanism.

Different sources have different cut-offs for fever, hyperthermia and hyperpyrexia.In humans, hyperthermia is defined as a temperature greater than 37.5–38.3 °C (99.5–100.9 °F), depending on the reference used, that occurs without a change in the body's temperature set point.

The normal human body temperature can be as high as 37.7 °C (99.9 °F) in the late afternoon. Hyperthermia requires an elevation from the temperature that would otherwise be expected. Such elevations range from mild to extreme; body temperatures above 40 °C (104 °F) can be life-threatening.

SIGNS AND SYMPTOMS
An early stage of hyperthermia can be "heat exhaustion" (or "heat prostration" or "heat stress"),whosesymptoms include heavy sweating, rapid breathing and a fast, weak pulse. If the condition progresses to heat stroke, then hot, dry, skin is typicalas blood vessels dilate in an attempt to increase heat loss. An inability to cool the body through perspiration may cause the skin to feel dry.

Other signs and symptoms vary. Accompanying dehydration can produce nausea, vomiting, headaches, and low blood pressure and the latter can lead to fainting or dizziness, especially if the standing position is assumed quickly.

In severe heat stroke, the individual may be confused, hostile, or have a seemingly intoxicated behavior. Heart rate and respiration rate will increase (tachycardia and tachypnea) as blood pressure drops and the heart attempts to maintain adequate circulation. The decrease in blood pressure can then cause blood vessels to contract reflexly, resulting in a pale or bluish skin color in advanced cases. Young children, in particular, may have seizures. Eventually, organ failure, unconsciousness and death will result.

CAUSES
Heat stroke occurs when thermoregulation is overwhelmed by a combination of excessive metabolic production of heat (exertion), excessive environmental heat, and insufficient or impaired heat loss, resulting in an abnormally high body temperature. In severe cases, temperatures can exceed 40 °C (104 °F). Heat stroke may be non-exertional (classic) or exertional.

EXERTIONAL
Significant physical exertion in hot conditions can generate heat beyond the ability to cool, because, in addition to the heat, humidity of the environment may reduce the efficiency of the body's normal cooling mechanisms. Human heat-loss mechanisms are limited primarily to sweating (which dissipates heat by evaporation, assuming sufficiently low humidity) and vasodilation of skin vessels (which dissipates heat by convection proportional to the temperature difference between the body and its surroundings, according to Newton's law of cooling). Other factors, such as insufficient water intake, consuming alcohol, or lack of air conditioning, can worsen the problem.

The increase in body temperature that results from a breakdown in thermoregulation affects the body biochemically. Enzymes involved in metabolic pathways within the body such as cellular respiration fail to work effectively at higher temperatures, and further increases can lead them to denature, reducing their ability to catalyse essential chemical reactions. This loss of enzymatic control affects the functioning of major organs with high energy demands such as the heart and brain.


SITUATIONAL
Situational heat stroke occurs in the absence of exertion. It mostly affects the young and elderly. In the elderly in particular, it can be precipitated by medications that reduce vasodilation and sweating, such as anticholinergic drugs, antihistamines, and diuretics. In this situation, the body's tolerance for high environmental temperature may be insufficient, even at rest.

Heat waves are often followed by a rise in the death rate, and these 'classical hyperthermia' deaths typically involve the elderly and infirm. This is partly because thermoregulation involves cardiovascular, respiratory and renal systems which may be inadequate for the additional stress because of the existing burden of aging and disease, further compromised by medications. During the July 1995 heat wave in Chicago, there were at least 700 heat-related deaths. The strongest risk factors were being confined to bed, and living alone, while the risk was reduced for those with working air conditioners and those with access to transportation. Even then, reported deaths may be underestimates as diagnosis can be misclassified as stroke or heart attack.

DRUGS
Some drugs cause excessive internal heat production. The rate of drug-induced hyperthermia is higher where use of these drugs is higher.

Many psychotropic medications, such as selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), and tricyclic antidepressants, can cause hyperthermia. Serotonin syndrome is a rare adverse reaction to overdose of these medications or the use of several simultaneously. Similarly, neuroleptic malignant syndrome is an uncommon reaction to neuroleptic agents. These syndromes are differentiated by other associated symptoms, such as tremor in serotonin syndrome and "lead-pipe" muscle rigidity in neuroleptic malignant syndrome.

Various stimulant drugs, including amphetamines, cocaine, PCP, LSD, and MDMA can produce hyperthermia as an adverse effect.

Malignant hyperthermia is a rare reaction to common anesthetic agents (such as halothane) or the paralytic agent succinylcholine. Those who have this reaction, which is potentially fatal, have a genetic predisposition.

The use of anticholinergics, more specifically muscarinic antagonists are thought to cause mild hyper thermic episodes due to its Para sympatholytic effects. The sympathetic nervous system a.k.a. the "Fight or Flight Response" dominates by raising catecholamine levels by the blocked action of the Rest and Digest System.

Drugs that decouple oxidative phosphorylation may also cause hyperthermia. From this group of drugs the most well-known is 2, 4-Dinitrophenol which was used as a weight loss drug until dangers from its use became apparent.

PERSONAL PROTECTIVE CLOTHING OR EQUIPMENT

Those working in industry, in the military, or as first responders may be required to wear personal protective equipment (PPE) against hazards such as chemical agents, gases, fire, small arms and even Improvised Explosive Devices (IEDs). PPE includes a range of hazmat suits, firefighting turnout gear, body armor and bomb suits, among others. Depending on design, the wearer may be encapsulated in a microclimate,] due to an increase in thermal resistance and decrease in vapor permeability. As physical work is performed, the body’s natural thermoregulation (i.e., sweating) becomes ineffective. This is compounded by increased work rates, high ambient temperature and humidity levels, and direct exposure to the sun. The net effect is that desired protection from some environmental threats inadvertently increases the threat of heat stress.

The effect of PPE on hyperthermia has been noted in fighting the 2014 Ebola virus epidemic in Western Africa. Doctors and healthcare workers were only able to work 40 minutes at a stretch in their protective suits, fearing heat strokes.

OTHERS
Other rare causes of hyperthermia include thyrotoxicosis and an adrenal gland tumor, called pheochromocytoma, both of which can cause increased heat production. Damage to the central nervous system, from brain hemorrhage, status epilepticus, and other kinds of injury to the hypothalamus can also cause hyperthermia.

DIAGNOSIS

Hyperthermia is generally diagnosed by the combination of unexpectedly high body temperature and a history that supports hyperthermia instead of a fever. Most commonly this means that the elevated temperature has occurred in a hot, humid environment (heat stroke) or in someone taking a drug for which hyperthermia is a known side effect (drug-induced hyperthermia). The presence of signs and symptoms related to hyperthermia syndromes, such as extrapyramidal symptoms characteristic of neuroleptic malignant syndrome, and the absence of signs and symptoms more commonly related to infection-related fevers, are also considered in making the diagnosis.

If fever-reducing drugs lower the body temperature, even if the temperature does not return entirely to normal, then hyperthermia is excluded.

PREVENTION

When ambient temperature is excessive, humans and many animals cool themselves below ambient by evaporative cooling of sweat (or other aqueous liquid; saliva in dogs, for example); this helps prevent potentially fatal hyperthermia. The effectiveness of evaporative cooling depends upon humidity. Wet-bulb temperature, which takes humidity into account, or more complex calculated quantities such as wet-bulb globe temperature (WBGT), which also takes solar radiation into account, give useful indications of the degree of heat stress and are used by several agencies as the basis for heat-stress prevention guidelines. (Wet-bulb temperature is essentially the lowest skin temperature attainable by evaporative cooling at a given ambient temperature and humidity.)

A sustained wet-bulb temperature exceeding 35 °C is likely to be fatal even to fit and healthy people unclothed in the shade next to a fan; at this temperature, environmental heat gain instead of loss occurs. As of 2012, wet-bulb temperatures only very rarely exceeded 30 °C anywhere, although significant global warming may change this.
 
In cases of heat stress caused by physical exertion, hot environments, or protective equipment, prevention or mitigation by frequent rest breaks, careful hydration, and monitoring body temperature should be attempted. However, in situations demanding one is exposed to a hot environment for a prolonged period or must wear protective equipment, a personal cooling system is required as a matter of health and safety. There is a variety of active or passive personal cooling systems; these can be categorized by their power sources and whether they are person- or - vehicle-mounted.

Because of the broad variety of operating conditions, these devices must meet specific requirements concerning their rate and duration of cooling, their power source, and their adherence to health and safety regulations. Among other criteria are the user's need for physical mobility and autonomy. For example, active-liquid systems operate by chilling water and circulating it through a garment; the skin surface area is thereby cooled through conduction. This type of system has proven successful in certain military, law enforcement, and industrial applications. Bomb-disposal technicians wearing special suits to protect against improvised explosive devices (IEDs) use a small, ice-based chiller unit that is strapped to one leg; a liquid-circulating garment, usually a vest, is worn over the torso to maintain a safe core body temperature. By contrast, soldiers traveling in combat vehicles can face microclimate temperatures in excess of 65 °C and require a multiple-user, vehicle-powered cooling system with rapid connection capabilities. Requirements for hazmat teams, the medical community, and workers in heavy industry vary further.

TREATMENT

Mild hyperthermia caused by exertion on a hot day may be adequately treated through self-care measures, such as increased water consumption and resting in a cool place. Hyperthermia that results from drug exposure requires prompt cessation of that drug, and occasionally the use of other drugs as counter measures. Antipyretics (e.g., acetaminophen, aspirin, and other nonsteroidal anti-inflammatory drugs) have no role in the treatment of heatstroke because antipyretics interrupt the change in the hypothalamic set point caused by pyrogens; they are not expected to work on a healthy hypothalamus that has been overloaded, as in the case of heatstroke. In this situation, antipyretics actually may be harmful in patients who develop hepatic, hematologic, and renal complications because they may aggravate bleeding tendencies.

When body temperature is significantly elevated, mechanical cooling methods are used to remove heat and to restore the body's ability to regulate its own temperatures. Passive cooling techniques, such as resting in a cool, shady area and removing clothing can be applied immediately. Active cooling methods, such as sponging the head, neck, and trunk with cool water, remove heat from the body and thereby speed the body's return to normal temperatures. Drinking water and turning a fan or dehumidifying air conditioning unit on the affected person may improve the effectiveness of the body's evaporative cooling mechanisms (sweating).

Sitting in a bathtub of tepid or cool water (immersion method) can remove a significant amount of heat in a relatively short period of time. It was once thought that immersion in very cold water is counterproductive, as it causes vasoconstriction in the skin and thereby prevents heat from escaping the body core. However, a British analysis of various studies stated: "this has never been proven experimentally. Indeed, a recent study using normal volunteers has shown that cooling rates were fastest when the coldest water was used."[21] The analysis concluded that cool water immersion is the most-effective cooling technique for exertional heat stroke.[21] No superior cooling method has been found for non-exertional heat stroke.[22] Thus, aggressive ice-water immersion remains the gold standard for life-threatening heat stroke.[23][24]

When the body temperature reaches about 40 °C, or if the affected person is unconscious or showing signs of confusion, hyperthermia is considered a medical emergency that requires treatment in a proper medical facility. In a hospital, more aggressive cooling measures are available, including intravenous hydration, gastric lavage with iced saline, and even hemodialysis to cool the blood.

 
EPIDEMIOLOGY
The frequency of environmental hyperthermia can vary significantly from year to year depending on factors such as heat waves. Statistically, outdoor workers, including agricultural workers, are at increased risk of experiencing heat stress and the resulting negative health effects. Between 1992 and 2006 in the United States, 68 crop workers died from heat stroke, representing a rate 20 times that of US civilian workers overall.

In India, hundreds die every year from summer heat waves, including more than 2,500 in the year 2015. Later that same summer, the 2015 Pakistani heat wave killed about 2,000 people. An extreme 2003 European heat wave caused tens of thousands of deaths.

RESEARCH
Hyperthermia can also be deliberately induced using drugs or medical devices and is being studied as a treatment of some kinds of cancer.

Posttraumatic hypothermia reduced myeloperoxidase activity in the injured and non-injured cortical and subcortical segments compared to norm thermic values (P < 0.05). In contrast, posttraumatic hyperthermia significantly elevated myeloperoxidase activity in the posterior cortical region compared to norm thermic values at both 3 hours and 3 days (473.5 ± 258.4 and 100.11 ± 27.58 U/g of wet tissue, respectively, P < 0.05 versus controls). These results indicate that posttraumatic hypothermia decreases early and more prolonged myeloperoxidase activation whereas hyperthermia increases myeloperoxidase activity. Temperature-dependent alterations in PMNL accumulation appear to be a potential mechanism by which posttraumatic temperature manipulations may influence traumatic outcome.

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Lana

LABOUR AND DELIVERY

Introduction
It takes nine months to grow a baby, and only a matter of hours (though they may seem like very long hours) to bring one into the world. Yet it is those hours that seem to occupy the minds of expectant women (and their partners) most. More questions and concerns revolve around the process of labour and delivery than around any other aspect of pregnancy; when will labour start? More important when will it end? Will I be able to tolerate the pain? Will I need an episiotomy? What if I don’t make any progress?

Answers to questions and reassurances for concerns will be found in this compilation.

PRELABOUR, FALSE LABOUR, REAL LABOUR
It always seems simple on T.V. Somewhere around 3A.M, the pregnant woman sits up in bed, puts a knowing hand on her belly and reaches over to rouse her sleeping husband with a calm, almost serene, ´´It´s time , honey.´´

How, one wonders, does this woman know it´s time? How does she recognise labour with such cool, clinical confidence when she´s never been in labour before.

One, on the other side of the screen (with no script in hand), is more likely to be with complete uncertainty. Are these really labour pains, or just more Braxton Hicks? Should I wake up my spouse and start heading for the hospital? If I do and it isn´t time, will I turn out to be a pregnant woman who cried ´´labour´´ once too often, and will anybody take me seriously when it´s for real? Will I leave for the hospital too late, may be giving birth in the back of the taxi? The questions multiply faster than the contractions.

The fact is that most women worry and end up misjudging the onset of their labour. The vast majority, thanks to instinct, luck or those with no doubt about the killer contractions, show up at the hospital neither too early nor too late, but just about the right time. Still there is no reason for one to leave her deliberations up to chance.  Becoming familiar in advance with pre-labour, false labour and real labour will help tp allay the concerns and clear up the confusion when those contractions begin.

No one knows exactly what triggers labour (and women are concerned with ´´when´´ than ´´why´´) but it is believed that a combination of fetal, placental and maternal factors are involved. This very intricate process begins with the fetus, whose brain sets off a relay of chemical messages (which probably translates into something like, ´´Mom, let me out of here! ´´) that kick off a chain reaction of hormones in the mother. These hormonal changes in turn pave the way for the work of prostaglandins and oxytocin, substances that trigger contractions when all labour systems are ´´go.´´

PRELABOUR SYMPTOMS
The physical changes of pre-labour can precede real labour by a full month or more- or by only an hour or so. Pre-labour is characterized by the beginning of cervical effacement and dilatation, which a practitioner can confirm on examination, as well as by a wide variety of related signs that a patient may notice herself.

a.  LIGHTENING AND ENGAGEMENT. Usually somewhere between two and four weeks before the onset of labour in the first-time mothers, the fetus begins to descend into the pelvis. This milestone is rarely reached in second or later births until labour is about to commence.

b.  SENSATION OF INCEASING PRESSURE IN THE PELVIS AND RECTUM. Crampiness (similar to menstrual cramps) and groin pain are particularly common in second and later pregnancies. Persistent low backache may also be present.

c.  LOSS OF WEIGHT OR CESSATION OD WEIGHT GAIN. Weight gain might slow down in the ninth month; as labour approaches, some women even lose a bit of weight, up to two or three pounds.

d.  A CHANGE IN ENERGY LEVELS. Some women at nine months find out that they are increasingly fatigued. Others experience energy spurts. An uncontrollable urge to scrub floors and clean out the closets has been related to the ´´nesting instinct, ´´ in which the female of the species prepares the nest for the impending arrival.

e. A CHANGE IN VAGINAL DISCHARGE. One may find that her discharge increases and thickens.

f.  PINK OR BLOODY SHOW. As the cervix effaces and dilates, capillaries frequently rupture, tinting the mucus pink or streaking it with blood. This ´´show´´ usually means labour will start within twenty-four hours- but could be as much as several days.

g.  LOSS OF THE MUCOUS PLUG. As the cervix begins to thin and open, the ´´cork´´ of mucous that seals the opening of the uterus becomes dislodged. This gelatinous chunk of mucus can be passed through the vagina a week or two before the first real contractions or just as labour begins.

h.  INTENSIFICATION OF BRAXTON HICKS CONTRACTIONS. These practice contractions may become more frequent and stronger, even painful.

i.  DIARRHOEA. Some women experience loose bowel movements just prior to the onset of  labour.


FALSE LABOUR SYMPTOMS
Real labour has not begun if:
1.  Contractions are not at all regular and don´t increase in frequency or severity.
2.  Contractions subside if one walks around or changes positions
3.  Show, if any, is brownish. (This kind of discharge is often the result of an internal exam or intercourse within the past forty-eight hours.)
4.  Fetal movements intensify briefly with contractions. (The practitioner has to be alerted immediately if activity becomes frantic.)


REAL LABOUR SYMPTOMS
When contractions of the pre-labour are replaced by stronger, more painful, and more frequent ones, the question arises: ´´Is this the real thing or the false labour?´´ It is probably real if:
1.  The contractions intensify, rather than ease up, with activity and aren´t relieved by a change in position.
2.  Contractions become progressively more frequent and painful and generally (but not always) more regular. However, not every contraction will necessarily be more painful or longer (they usually last about thirty to seventy seconds) than the previous one, but the intensity does build up as real labour progresses. Nor does frequency always increase in regular, perfectly even intervals- but it does increase.
3.  Contractions may feel like gastrointestinal upset and be accompanied by diarrhoea. Early labour contractions can also feel like heavy menstrual cramps. Pain may be just in the lower abdomen or it may also radiate to the legs (particularly the upper thighs). Location, however, is not as reliable an indication, because false labour contractions may also be felt in these places.
4.  Show is present and pinkish or bloody-streaked
5.  Membranes rupture, though in 15 percent of labours, the waters break. In a gush or a trickle- before labour begins and in many others, membranes do not rupture spontaneously and are ruptured artificially by the practitioner.  

CONCERNS & RECOMMENDATIONS
DARKENED AMNIOTIC FLUID (MECONIUM STAINING). The amniotic fluid of a pregnant woman may be probably stained with meconium, a greenish brown substance that comes from the baby´s digestive tract. Ordinarily meconium is passed after birth as the baby´s first stool. Sometimes – particularly when the fetus has been under stress in the womb and very often when it has passed it´s due date- the meconium is passed prior to birth into the amniotic fluid.

The practitioner should be notified immediately as it could also indicate an increased risk of infection around the time of delivery and should the patient should be watched more carefully.

INADEQUATE AMNIOTIC FLUID. Usually the mother´s nature keeps the uterus well stocked with a self-replenishing supply of amniotic fluid.
However, when levels run low during labour, the natural source should be supplemented with a saline (salt) solution pumped directly into the amniotic sac through a catheter into the uterus. This procedure is called amnioinfusion, may also be used when there is moderate or very thick meconium staining the amniotic fluid. This procedure can also significantly reduce the possibility of surgical delivery.

RUPTURE OF MEMBRANES. Normally most women whose membranes rupture expect to feel that first contraction within twelve hours; most others within twenty-four hours. So it´s likely that labour is on the way- and soon.

However, in some it takes a little longer to get going. In such situations as the risk of infection to baby and/ or mother through the ruptured amniotic sac increases, it is recommended by most physicians to induce labour within twenty- four hours of a rupture if a woman is at o near her due date.

The first thing one should do after experiencing a flow of fluid from her vagina( besides grab a towel and pads) is to call the attention of her doctor o nurse-midwife. In the meantime, the vaginal area should be kept clean to avoid infection. No sexual intercourse and always wipe from front to back after usin the toilet.

LABOUR INDUCTION. There are variety of medical situations in which it is probably wise-or even necessary- to deliver a baby before nature appears ready, willing and able to do so. In some cases caesarean section is the best way to accomplish this. In other cases, when there´s no immediate risk to baby (due to distress, for instance), both baby and mother are deemed able to tolerate labour and the practitioner may have a reason to believe that a vaginal delivery is possible, induction is usually the first choice. For example:

1. When fetus isn´t thriving- because of inadequate nourishment, postmaturity (being in the uterus ten days to two weeks beyond the estimated due date), low levels of amniotic fluid, or any reason- and is mature enough to do well outside the uterus.
2. When tests suggest that the placenta is no longer functioning optimally and the uterus is no longer a healthy home for the fetus.
3. When the membranes rupture ina term pregnancy and labour doesn´t begin within twenty-four hours thereafter (though some practitioners will induce much sooner)
4.When the amniotic fluid is infected.
5. When a pregnancy has gone two or more weeks past a due date that is considered accurate.
6. When the mother has diabetes and the placenta is deteriorating prematurely, or when it´s feared will be very large- and thus difficult to deliver-if carried to full term.
7. When the mother has preeclampsia (toxaemia) that cannot be controlled with bed rest and medication and delivery is necessary for her sake and/or her baby´s.
8. When the mother has a chronic or acute illness, such as high blood pressure or kidney disease, that threatens her well-being or that of her baby if the pregnancy continues.
9. When the fetus is afflicted with severe Rh disease that necessitates early delivery.

The first and most important step in ensuring a successful induction is ripening the cervix- making it soft and ready for labour. Ripening the cervix is usually accomplished by administering a hormonal substance such as prostaglandin E-2 in the form of vaginal gel (or a vaginal suppository in tablet form).

The next step some practitioners take is to artificially rupture the membrane (the ´´ bag of waters, ´´ also known as the amniotic sac) that surround the fetus.

Sometimes a woman goes into labour on her own, but for one reason or another, her contraction are either not effectively dilating the cervix or are too sluggish for labour to progress as it should. Often the physician will administer oxytocin to stimulate stronger and more effective contractions that will get the labour back on track.

LABOUR POSITIONS. The best labour position is the one that´s best for the patient. With the exception of lying flat on your back- which cannot only slow down labour but also compress major blood vessels, possibly interfering with blood flow to the fetus- almost any position or combination of positions can end up working well. Particular efficient are upright positions that employ the forces of gravity, speeding dilation and baby´s descent; studies show that they can actually shorten labour. These include standing, sitting (in bed, in the escorts arms), squatting or half kneeling, half squatting (on the floor or on the bed).

CONCLUSION
It is understood that labour coincides with delivery, hence i deem it important to elaborate on the stages and phases of childbirth.

Childbirth is divided (more loosely by nature, more formally by obstetrical science) into three stages. The first stage is labour, divided into three phases. Early (or latent), active and transitional, ending with full dilation (opening) of the cervix; the second stage is delivery, culminating in the birth of the baby and the third stage is the delivery of the placenta, or afterbirth.

The whole process averages about fourteen hours for first-time mothers, about eight hours for women who have already had children-but the range is enormous, from a few hours to a few days.

Unless labour is cut short by the need for a caesarean, all women who carry to term go through all three phases of the first stage. Some, however, may not recognize that they are in labour until the second, or even the third phase, because their initial contractions are mild or painless. The third phase is complete once the cervix has dilated to a full 10 centimetres.

If labour doesn´t seem to be progressing along the typical course, some doctors will augment mother nature´s efforts by administering oxytocin and if that fails, will pre-empt her entirely with a caesarean. Others may allow more time before taking such action, as long as both mother and baby are doing well.

An episiotomy, which is a minor surgical procedure (during which an incision is made in the perineum to enlarge the vaginal opening just before the emergence of the baby´s head) may be indicated when a baby is large and needs a roomier exit route. When forceps or vacuum delivery need to be performed, or for the relief of shoulder dystocia (in which a shoulder gets stuck in the birth canal during delivery).

There are two basic types of episiotomy: the median and the mediolatera . the median incision, is made directly back toward the rectum. In spite of its advantages (it´s provides more exit space per inch of incision, heals well and is easier to repair, causes less blood loss and results in less postpartum discomfort or infection), it is less frequently practiced because it has a greater risk of tearing completely through the rectum. To avoid this tearing, most gynaecologists prefer the mediolateral incision, which slants away from the rectum, especially in first births.

To reduce the possibility of an episiotomy and to ease delivery without one, it´s a good idea for the pregnant woman to do kegel exercises and perineal massage for six to eight weeks before her due date.

After a successful delivery, the first test done on the baby is the Apgar score. This is to enable medical personnel to quickly evaluate the condition of a newborn. At one minute after birth, a nurse or doctor checks the infants: Appearance (colour), Pulse (heartbeat), Grimace (reflex), Activity (muscle tone) and Respiration. Hence the acronym ´´APGAR.´´ Babies who score above 6 are fine. Those who score between 4 and 6 often need resuscitation, which generally includes suctioning their airways and administering oxygen. Those who score under 4 require more dramatic lifesaving techniques.

The APGAR test is administered once again at five minutes after birth. If thescore is 7 or better at this point, the outlook for the infant is very good. It it´s lower, it means the baby need some careful watching, but still is very likely to turn out fine.

Other test like taking the babies weight should also be performed on the newborn.

 

APGAR TABLE