*INTRODUCTION
*WHAT IS?- Fever
*HEALTH NEWS - The latest news in health
*FEATURE ARTICLE - Ronald Cox,
Ph.D. discusses the FITT Principle (the stuff you
always wanted to know about exercise)
*HEALTH RESEARCH - Current research you
should be aware of
*HOW TO CONTACT US
INTRODUCTION
Welcome to the fourth issue of Health-E-Newsletter, a
weekly newsletter for those interested in a wide variety of up-to-date
health news. Our mission is to provide informative, useful, and
current health news for the betterment of our community. This
information was found online and in peer-reviewed health and medical
journals and is not intended to be a replacement for professional health
care. Please forward this to friends, family, discussion groups
and others so that they may benefit as well. If you have
questions, comments, suggestions for future articles, or to
subscribe/unsubscribe, please let us know at: Essence
of Wellness
Yours in health,
Dean L. Smith, D.C., M.Sc.
Jane Palmer Smith, D.C.
We look forward to serving you.
_________________________________
WHAT IS?
*This is our newest section. In
this column, we will try to explain common health terms and concepts
that sometimes are misunderstood. Along with providing the
importance of these concepts to human health, we will briefly describe
them and try to correct any common misconceptions surrounding these
terms. This week we describe what a fever is as well as some
interesting developments in this highly misunderstood phenomenon.
"Fever is Nature's engine which
she brings into the field to remove her enemy." Hippocrates
What is a fever?
Normothermia ("normal
temperature") is typically thought to be a body temperature of 98.6
degreesF (36degC) and is the result of the balance between heat gain and
heat loss that allows the body to maintain a constant core temperature.
Mean body temperature exhibits a diurnal (twice per day) variation with
a peak in the early evening (~6pm) and a low in the early morning
(~6am). With fever the central thermostat of the body increases to
a new "set point" and heat loss and heat gain again balance at
this higher temperature. Fever is not a disease but a nonspecific
sign/symptom of some underlying condition or process that involves
inflammation. Although there is no consensus regarding the exact
temperature that denotes fever, it is generally accepted that a rectal
temperature of at least 100.4 degreesF (38degC) represents a fever.
There is also a lack of clear-cut treatment guidelines among
professionals that may contribute to patient misconceptions.
What is fever phobia?
Fever is extremely common in childhood,
and parents have been shown to have unrealistic fears in this regard,
resulting in vigorous and unnecessary treatment (1). They are
unable to define a fever accurately, overestimate its dangers, and make
inappropriate telephone calls and unnecessary office visits, leading to
exessive utilization of health-care services (1-2). It has
generally been accepted that this "fever phobia" might be
diminished by physician education of parents (1-2). Such
suggestions assume that doctors have a good understanding of fever and
its consequences, yet it is recognized that doctors tend to treat fever
vigorously and without a documented rationale (3-4). "Perhaps
by attempting to relieve parents' concern, physicians may, in fact, be
accentuating their anxiety." (5)
Several recent medical journal articles discuss the
benefits and misconceptions of fever. A study in the journal Clinical
Pediatrics polled Physicians' attitudes toward the diagnosis and
management of fever in children 3 months to 2 years of age (5).
Although many doctors have an appropriate knowledge of fever in children
aged 3 months to 2 years, a significant number still have exaggerated
concerns. Below I quote from the discussion of this article.
"...there is little uniformity in the teaching and management of
the febrile child, which often results in the vigorous and often
inappropriate administration of antipyretics by physicians without
documented rationale. This attitude exists in the face of good
data which suggest that fever is not harmful and may in fact, be
beneficial to the host, although contrary opinions still prevail.
Furthermore, the benign outcome of typical febrile seizures has now also
been well documented."
"It is surprising that a significant number of the
physicians in this study still consider febrile seizures a significant
danger to the child's health, since there is no evidence to suggest that
death or permanent motor disability, deficits in school performance, or
significant behavioral differences exist between children with a history
of typical febrile convulsions and the rest of the population. It
has also not been proven that antipyretics or sponging can decrease or
prevent febrile seizures or their recurrence, yet one fifth of
physicians indicated that this was the main purpose of antipyretic
treatment." (5)
An interesting study published in the Annals of
Tropical Pediatrics (6) asked parents, medical students and nurses
from Saudi Arabia about their understanding of fever. "All
the parents and 80-90% of the students, nurses and doctors believed that
fever is harmful...As shown, 37.5% of the parents believed that fever
caused brain damage, while 42.7% believed that it was a sign of serious
disease. It was obvious that the main concern of the medical staff
was convulsions. However, none of the medical students and doctors
and only 2% of the nurses were concerned about brain damage. When
questioned on the usefulness of fever, 86% of the parents, 37.5% of the
doctors, 23% of the medical students and 33% of the nurses did not know
or believe that fever could be useful."
Are there benefits of Fever?
A recent article from the journal Infectious
Disease Clinics of North America concludes the following.
"Overall we believe there is overwhelming evidence in favor of
fever being an adaptive response to infection that has persisted
throughout the animal kingdom for hundreds of millions of years.
As such, it is probable that the use of
antipyretic/anti-inflammatory/analgesic drugs, when they lead to
suppression of fever, results in the increased morbidity and mortality
during most infections. The reason is that this increased
morbidity and mortality may not be readily apparent to most healthcare
workers is that we are armed with dozens of host defense repsonses, with
fever being just only one of them. Furthermore, most infections
are not life-threatening and subtle changes in morbidity are not easily
detected, particularly, in "experiments" that are not
carefully controlled." (7)
Are all fevers beneficial?
Clearly not. Because fever is a non-specific
defense response, these responses are highly stereotypical. In
other words, infection by a wide range of different organisms will
produce similar responses characterized by loss of appetite, lethargy,
increased sleep, fever, and synthesis of a wide array of proteins geared
for inflammation. This is why it is recommended you consult a
health care practitioner to examine the cost-benefit ratio of a specific
fever response if there is question.
If fever is overall beneficial then why
do we not maintain fever continually even when not infected?
Firstly, there is the metabolic (energy)
cost of fever. Fevers cost considerable energy. It has also
been theorized that maintaining a body temperature below optimal
temperature for immune defenses may be a mechanism to reduce the
"contribution of the immune system to aging." This lower
"normal" temperature also would produce less free radicals.
How does a fever kill the
"invading microorganisms" inside us
Most living organisms have had to adapt
their structural and biochemical characteristics to a given temperature
to function at the lowest possible "thermodynamic" (energy)
cost. Invading microorganisms acclimated to a given ambient
temperature may encounter unfavorable conditions if the temperature of
the host changes rapidly either upward or downwards. The invading
microbe is proposed to suffer "thermic shock", which might
contribute to reduced growth. Also, our own bodily reactions speed
up, which also aid in the defense.
References:
1. Schmitt BD. Fever phobia. Am J Dis Child
1980;134:176-81.
2. Kramer MS, Naimark L, Leduc DG. Parental
fever phobia and its correlates. Pediatrics 1985;75:1110-1113.
3. Weiss J, Herskowitz L. House officer
management of the febrile child. Clin Pediatr 1983;22:766-769.
4. Isaacs SN, Axelrod PI, Corber B.
Anti-pyretic orders in a university hospital. Am J Med
1990;88:31-35.
5. Ipp M, Jaffe D. Physicians' attitudes toward the
diagnosis and management of fever in children 3 months to 2 years of
age. Clin
Pediatr 1993;33:66-70.
6. Abdulla MA et al. Fever in children:diagnosis
and management by nurses, medical students, doctors and parents.
Ann Trop
Paed 1987;7:194-99.
7. Kluger MJ et al. The adaptive value of fever.
Infectious Dis Clin North America 1996;10;1-20.
HEALTH NEWS
Eat around your plate for good bone health because
researchers say that eating too much animal protein compared to
vegetable protein can cause more rapid bone loss and fracture in
postmenopausal women.
Scoliosis is defined as "any lateral deviation of
the spine from the mid-sagittal plane."1 While there are
many causes for scoliosis, children and adolescents with scoliosis who
present to chiropractors usually fall into three categories. Successful
treatment is dependent upon differentiating the underlying cause of the
spinal curvature. In most children, the scoliotic spine is not
symptomatic; the spinal curvature is first noticed either by a parent
who becomes concerned about a child's posture, or during a screening
examination, usually at school. The importance of a good evaluation and
early treatment is to prevent progression and worsening of the
curvature.
Babies
whose mothers participated in an intensive breast-feeding program had
significantly fewer intestinal infections and eczema. Other studies have
linked breast-feeding with similar benefits and a host of others,
including fewer earaches, colds and asthma. But most, if not all, of
those studies were after-the-fact research: Doctors looked at data on
babies whose mothers had or had not breast-fed them. For this study,
published in the Journal of the American Medical Association,
hospitals were assigned at random to institute a breast-feeding program.
Researchers have been reluctant to do a randomized breast-feeding study
because of concerns about the ethics of withholding a treatment or
practice that is widely thought to be beneficial, such as
breast-feeding.
Note:
You can get the full-text of this article free by following the above
link.
Everyone agrees with the public health messages that call
for regular, moderate exercise. However, the best way for the average
couch potato to exercise is as clear as mud. Now results from a small
study suggest that ideally, daily exercise should come in one steady
dose, instead of 10 minutes here and there. In a study of 30 middle-aged
women, researchers found that walking briskly for 30 minutes straight
burned more calories compared with taking three 10-minute walks
throughout the day. The calorie difference could amount to losing
roughly 5 pounds per year, the authors report in the January issue of
Medicine & Science in Sports & Exercise.
________________________________
FEATURE ARTICLE
* A special thanks to Dr. Cox for this
excellent article on some "how to's" of exercise. This
information is extremely valuable and will empower you with knowledge
for healthy activity. This is the first of a two-part series on the FITT
Principle. This week Dr. Cox discusses the basics of the
principle. Next week, he will discuss the application of this
principle. Enjoy!
By: Ronald Cox, Ph.D., Associate Professor, Department of
Physical Education, Health and Sports Studies, Miami University
The FITT Principle
One of the duties of a fitness
professional is to write exercise prescriptions. There are many aspects
to an exercise prescription, but they can be simplified and summarized
by the FITT principle. Because one goal of this column and education in
general is to make people independent, FITT is described here.
FITT stands for:
Frequency:
how often one exercises; this is usually expressed as days per week. For
example jogging 5 days per week or weight training 3 days per week.
Intensity:
how hard you are working; generally expressed as a percentage of maximal
effort. For example lifting 80% of your 1 repetition max for 8 reps or
jogging at 50-85% of your heart rate reserve. This will be described
more fully below.
Time:
the duration of your exercise session. For example, using the stair
stepper for 30 min.
Type:
the mode of exercise; for aerobic exercise this might be walking,
jogging, cycling, swimming or stepping.
Three of the four facets of exercise are
simple enough. However the Intensity one can be a little
complicated especially if we try to get scientific about it. Let’s
make it simple and then we can examine the more elaborate ways to
quantify your intensity. If you are new to exercise and are performing
aerobic types of activity and can still carry on a conversation (you are
not gasping for breath) you are in an appropriate range. The more
elaborate description of Intensity involves the concept of maximal
volume of oxygen that can be consumed (VO2max). [Let’s
digress for a moment.
The energy we use during endurance
activities (biking, running etc) comes from the combustion of food.
Combustion of course requires oxygen (O2). In most cases we
have plenty of fuel (food) but are limited in how much O2 we
can deliver to the cells "furnace". This of course limits how
much energy we can generate and thus how hard we can exercise. During
strenuous exercise it may feel like the lungs aren’t giving you enough
air (and thus O2) but in reality the primary culprit is the
inability of the heart to deliver O2.]
The ACSM recommends intensity be set at
50-85% 0f VO2max. Luckily we can estimate that because there
is a close relationship between oxygen consumption and the difference
between maximum and resting heart rate. This difference is known as
heart rate reserve (HRR). Thus if you are exercising at 50% of HRR we
can assume you are at 50% of VO2max. This holds for most
people, but for low fit individuals this can be inaccurate.
To calculate your HRR estimate your
maximum heart rate by subtracting your age from 220 and then subtracting
your resting pulse from your maximum. For example a 50 year old male
with a resting pulse of 60 would be:
220-50 = 170 beats is the heart rate
maximum, thus the HRR is 170 – 60 = 110 beats per minute (bpm)
To find the target heart rate (the heart
rate during your exercise session) for 60% of the HRR we multiply .6 x
110 = 66 bpm and add it to resting heart rate or 60 in this case and it
equals 126 bpm (66 bpm + 60 = 126).
In equation form: Target Heart rate = (HRR
fraction)(HRmax-HR rest) + HR rest
Remember you are aiming for an intensity
between 50 and 80%.
_______________________________
HEALTH RESEARCH
Although a relation
between exposure to estrogen and the risk of breast cancer has been
identified in specific groups of women, we cannot accurately predict
the risk in an individual woman. Clinical markers of exposure to
estrogen, such as serum estrogen concentrations, breast density on
mammography, and bone mineral density, may prove to be useful tools
for assessing a woman's risk of breast cancer. Composite
determinations of risk based on these as well as other risk factors,
such as family and reproductive histories, may lead not only to a more
accurate assessment of risk in individual women but also to a better
understanding of the role of estrogen in the pathogenesis of breast
cancer.
The glitz of President George W Bush’s
inauguration ceremony owed a considerable debt to the US
pharmaceutical industry, which paid $1.7m (£1.1m) towards the
estimated $17m bill for the occasion.
Reducing the amount of time that primary
school children spend watching television and playing video games can
make them less aggressive towards their peers, a new study has
reported.
An official inquiry has been set up into
allegations that the drug manufacturer Pfizer did not obtain official
approval before testing a new drug on children during a
meningitis epidemic in Nigeria five years ago.
The Nigerian doctor who supervised the clinical trial has said that
his office backdated an approval letter and this may have been
written a year after the study had taken place.
HOW TO CONTACT
US
Essence of Wellness
Chiropractic Center
Dean Smith, D.C., M.Sc.
Jane Palmer Smith, D.C.
890 South Barron St.
Eaton, Ohio 45320
(937) 456-4555
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