Артрит – Arthritis

It’s not that skeptical scientists don’t believe that hundreds of thousands of people will be celebrating their 100th birthdays in the years to come. But the buck pretty much stops there, they say.

«It’s true that we’re living about 30 years longer than we did at the beginning of the century,» says Dr. Olshansky. «But if you look at the data, those advances are due to how much we’ve been able to lower infant and child mortality. Now that we’re trying to extend life expectancy on the back end of life, those improvements have slowed dramatically.»

In 1993, there was actually a small dip in life expectancy, followed by a stagnant period in 1994. Since then, we’ve made some gains. Life expectancy is expected to pick up some steam again, but the U.S. Census Bureau has conservative estimates. By 2050, they predict, the average man will add about 7 years to his life, living to about 79-7 years. If they’re right, plenty of men would reach the century mark, but not much longer than that.

«Though people like to talk about how much we understand the aging process, that doesn’t mean that we’ll be able to do anything about it,» says Dr. Siegfried Hekimi of McGill University. «We can mutate certain genes in worms so that they live five times longer, but that’s by slowing them down metabolically so that they live five times slower. You have to stop living to stop aging, and I doubt that people want to do that.»

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An infection will raise the amount of inflammation in your body because of the toxins that bacteria and viruses produce, and because of the chemicals our immune cells produce in response to an infection. People suffering with an infection usually have higher levels of C-reactive protein (CRP) in their body, which is a major risk factor for heart disease. A study published in the New England Journal of Medicine analyzed 40 000 medical records and found that some respiratory tract infections and urinary tract infections can trigger a heart attack or stroke. Cystitis and pneumonia were the infections studied, and it was found that in susceptible people the chance of having a heart attack or stroke was much higher in the three days after having a respiratory tract infection.

If you have an elevated level of CRP and you don’t know why, it is quite possible you have a hidden infection in your body. Bacteria, viruses and other infectious agents can produce toxins that cause irritation and injury to the walls of your arteries. This sets the stage for the development of atherosclerosis. Various imaging techniques have allowed doctors to detect microorganisms in the fatty plaques of arteries. Bacterial toxins, cytokines and other chemicals secreted by white blood cells during infections are detected in high amounts in many patients who have recently had a heart attack or stroke.

The bugs suspected of being able to promote heart disease include Helicobacter pylori, the bacterium linked to stomach ulcers; Chlamydia pneumoniae, which can cause pneumonia and bronchitis; Herpes Simplex type 1, the virus that causes cold sores; various bacteria that can cause gum disease; and cytomegalovirus, a very common viral infection that usually produces no symptoms at all.

It is very important to have a strong functioning immune system, as this will help to protect you against infections. It is often chronic, long standing infections that do the most harm.

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A discussion of snoring would be incomplete without acknowledging the fact that snoring in children can be as socially disruptive and as medically demanding as that of adults. One of the problems arising from any discussion of children is the tendency to make generalizations about a group which undergoes complex changes from infancy to adolescence. Size of airways, breathing rate and shape of the chest wall are just some of the variables which change significantly in the first few years of life, highlighting the need to specify the age group in question. Another problem relating to the investigation of young children is the inability of parents to give an adequate description of the child’s symptoms. Difficult breathing during sleep, whether it be described as wheezing, coughing or choking can be symptomatic of any number of disorders, the doctor’s task being made all the more challenging if these symptoms only occur at night.

The first priority is to identify these nocturnal events either by having the child observed during a hospital admission or by making a sound recording of the events on a portable tape recorder. Any abnormal breathing associated with sleep should be investigated but for the purpose of this discussion it will be assumed that nocturnal snoring has been confirmed. Data on the incidence of snoring in healthy children is unreliable, ranging between 10% and 25%, a variation possibly arising from different age groups and populations selected from one study to another. It is therefore not an uncommon occurrence and parents should not be alarmed by the observation of occasional snoring.

The common factor in both adult and childhood snoring is a comparatively narrow upper airway compromised by a lack of muscle tone during sleep. Whilst accepting that obstructed airways of different age groups have something in common, there are differences in the incidence of underlying causes. Enlarged tonsils and adenoids remains one of the most common findings in snoring children and, although there has been some reticence in recent years to remove tonsils and/or adenoids, surgery is certainly warranted in cases of persistent heavy snoring which is accompanied by complete and repetitive airway closure. Upper respiratory tract infections and nasal congestion are more likely to cause problems in newborns and young children, given the narrow diameter of their airways and susceptibility to collapse. In the absence of other predisposing factors, a return to normal breathing would follow the successful treatment of such infections or allergies.

Children born with structural abnormalities of the head and face (or craniofacial abnormalities) will be prone to snore if the structure results in compression or narrowing of the upper airway. There are several well described syndromes, each with characteristic facial and anatomic features which interfere with normal breathing. Children with Down’s Syndrome, for example, with the characteristic flattened face and nose, short neck, small jaw and mouth, and general lack of muscle tone, may have symptoms of obstructive sleep apnoea (OSA) depending on the severity of the syndrome. Other anatomical factors common to both young and older snorers include a large or poorly positioned tongue, abnormal jaw alignment, an excessively fleshy soft palate and obesity.

As with adults, the differentiation between mild snoring and OSA in children ultimately depends on the results of overnight studies in hospital. However, a clue to the need for further investigation is provided by the observation of certain behavioural changes. Snoring accompanied by laboured breathing and frequent arousals is suggestive of OSA. Sleep disruption then manifests itself as lethargy, sleepiness, irritability and possible learning difficulties and behavioural problems at home and at school. The weight and stature of these children often falls behind that of their peers, commonly referred to as a «failure to thrive».

Hospital or sleep unit admission screens for the same physiological changes seen in adults with OSA, with blood oxygen saturation being the most important measure of airway obstruction. The options available for treatment of heavy snoring or OSA in children are not as diverse as those available for adults. Middle-aged, overweight adults with the problem show considerable improvement with weight loss and alcohol avoidance, conditions which may be difficult to enforce or which simply do not apply to young children. Continuous Positive Airway Pressure (CPAP) applied through a nose mask has been used successfully on infants and older children, but in general cooperation by younger people who are unaware of its benefits remains a problem.

In summary, snoring in children is fairly common. Parents should not be alarmed by mild snoring but should consult their doctor if sleep disruption or difficult breathing becomes a regular feature at night.

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However we define health, illness and prevention, it has to be said that health and disease are very unevenly spread throughout society. Put bluntly, people lower down the socio-economic scale have more disease and illness, and die younger, than those higher up. Analyses show that since 1910 those at the top of the social scale have consistently lived longer and are healthier, both mentally and physically. Not every disease is less common or causes less mortality among those better-off in socio-economic terms but this is generally so.

One of the best illustrations of health differences between socioeconomic groups is the infant mortality rate. In 1975-7 the infant mortality rate in the world was 99 per thousand live babies, ranging from 11-20 per thousand in advanced countries to 100-200 per thousand in less developed countries. Within advanced countries, though, the variation between the figures for different socio-economic groups is remarkable, with those lower down the scale having three times the infant mortality of those higher up. Whilst British and US statistics show a consistent overall fall in infant mortality the differences according to position on the socio-economic scale

still persist.

In the US socio-economic group is clearly related to racial composition since a large proportion of the non-white population lives in poverty. This is less true of the UK but there are close parallels. Infant mortality rates amongst the US black population are still double those amongst the white population-in fact the gap has widened over the last thirty

The crucial questions when thinking about prevention are to do with trying to understand why these discrepancies occur. Factors such as the mother’s age, nutrition, literacy and use of the health services greatly influence the risks for her baby. ‘High-risk’ mothers are more likely to be at the extremes of reproductive age, to be unmarried, to have had several babies, and to have had miscarriages and still-births. There is also a higher incidence of prematurity and low-birth-weight babies in the less advantaged socio-economic groups. These two conditions carry an increased risk of infant mortality and of physical and intellectual handicap in the baby. Women from these groups also have two behavioural factors that act against the best interests of their babies – they are more likely to smoke, and to have below-normal weight-gain during pregnancy.

I have used infant mortality as an example, but there are many other sets of statistics that show how much more commonly diseases occur in the jess advantaged sections of society. Infectious diseases are more common, possibly because the poor may be living in conditions which make infections more likely and lower their resistance to them. As recently as 1972 the mortality rate for ÒÂ among British men was ten times as great lower down the social scale as it was at the top. Better environmental conditions do not always act in favour of the rich though. People living in poor sanitary conditions acquire antibodies against poliomyelitis and hepatitis A virus early in life, whereas those living in clean conditions are vulnerable unless they are immunized.

When we look at chronic illnesses such as heart disease and cancer-the two biggest killers in the western world-the story is more confusing. The relationship between socioeconomic group and heart disease, for example, has changed with time. A position towards the bottom of the scale seemed to ‘protect’ men from heart attacks in 1960 but today this advantage has largely disappeared. One UK study found that the direct relationship between socio-economic status and heart disease (those at the top of the scale having more heart disease) disappeared when each category was analyzed for physical activity. Once, the kind of work a person did was what determined his or her level of physical activity, but with the coming of jogging, squash and other leisure-time sports this is no longer so.

There is also a relationship between socio-economic group and psychological well-being, whether one is rating subjective happiness, psychiatric symptoms, or first admissions to mental hospital. Studies show that certain neurotic conditions are commoner among those lower down the socio-economic scale. These groups are less likely to feel well in themselves, physically and psychologically. In a major US survey, groups lower down the socioeconomic scale (mostly members of racial minorities) were consistently (60 per cent) more likely than those higher up the scale to report their health to be ‘fair’ or ‘poor’. Reports of ‘excellent’ health increased with income-and people in the highest income group were more than twice as likely as those with the lowest incomes to report ‘excellent’ health. The factors influencing these differences are very complex and far from completely understood. It is clear, though, that the influences determining an individual’s health are many and varied, and are not always within his or her own control.

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If you’re prone to bingeing, don’t worry. You can stop it and take control of your eating habits. But first you must understand why it happens. What sorts of things cause you to overeat? For some people, the cause is stress, loneliness, anger, or sadness. For others, it’s dining out with friends or having a good time at a party.

Reading your food diary can help you recognize and anticipate the emotions or situations that lead to your binges. As you become more aware of what’s setting you off, you can avoid those situations and find other, nonfood sources of comfort. ©

If you feel that you are heading for a binge or if you catch your- ^ self in the middle of one, you can still stop it. Simply walk away— <s-leave everything where it is and get out of the house. A brisk walk «* around the block can give you time to think about what’s making <5 you want to eat. Once you get back home, you’ll have a new perspective on the situation, and you may realize that you’re not interested in eating after all.

There may be times when you’re nursing a craving—say, for chocolate mocha almond ice cream—that you have no choice but to go ahead and help yourself. Not to a huge bowl, mind you. And definitely not to the whole carton. Scoop out a single serving and put the rest back in the freezer. Then really that ice cream. Let each spoonful melt in your mouth and wash over all of your tastebuds.

When worse comes to worst and you indulge in an all-night bingefest, don’t berate yourself afterward. You have to accept what happened and move on. There’s no point in kicking yourself because you messed up. Just be sure to add a half-hour to your next workout, and be extra careful about what you eat for the next few days.

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