"Netiquette" and married couples

From the study:

Men are more associated with activities that have been associated with internet addiction. Men usually take more risks in their online activity.

Women are more likely to have lower computer self-efficacy and less positive internet attitudes. Women are more aware of privacy and economic risks in online transactions.

6% of married internet users have met their partner online.

In 30% of the couples at least one person checked their partner’s emails or read their partner’s SMS messages without them knowing. In 20% of the couples at least one the partners had checked their spouse’s browser history.

Helsper, E., & Whitty, M. (2010). Netiquette within married couples: Agreement about acceptable online behavior and surveillance between partners Computers in Human Behavior DOI: 10.1016/j.chb.2010.02.006

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"The Clinic" at Walmart – Operated by "Family Medicine Specialists"

Medical clinics debut at Walmart stores and the photos from one Chicago location are included in this blog post (click to enlarge the images to see the details such as pricing, etc.).

Walmart has been adding health clinics to its stores during the last 3 years as part of its drive for "one-stop shopping." There were 100 in-store clinics in 21 states in 2010.

The clinics are staffed by nurse practitioners. Does that fit the description of "Family Medicine Specialists"?

Services include $14 for a pregnancy test, $29 for a flu vaccine, and $49 for treatment of a sinus infection or physical examination. The most expensive services cost $75, for treatment of bladder infections and ear wax removal.

CVS Pharmacy is not too far behind with their own model for in-store clinics called the "Minute Clinic".

References:

Medical clinic debuts at city's Walmart store

Comments from Twitter:

@langdon: False advertising. That would actually be sanctioned here in Ontario as per recent guidance about specialty titles from our College.

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Can a Happy Relationship Predict a Happy Life? Apparently, Yes

The association between overall life satisfaction (LS) and relationship satisfaction (RS) was investigated longitudinally among 67,000 mothers in Norway.

Data were collected twice during pregnancy, and at 6 and 36 months postpartum:

- Satisfaction increased during pregnancy.
- However, relationship satisfaction decreased immediately following birth.
- Life satisfaction showed an initial increase followed by a decrease postpartum.

Relationship satisfaction predicted change in life satisfaction. Having a satisfying romantic relationship was important for retaining and increasing future life satisfaction.


References:

Can a Happy Relationship Predict a Happy Life? A Population-Based Study of Maternal Well-Being During the Life Transition of Pregnancy, Infancy, and Toddlerhood, Journal of Happiness Studies, Volume 11, 663-793, Number 6 / December 2010.

Image source: OpenClipArt.org, public domain.

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Exercises to Avoid with Osteoarthritis of the Knee or Hip

Exercises to Avoid with Osteoarthritis of the Knee or Hip include:

- Running and jogging. The difference between how much force goes through your joints jogging or running, as opposed to with walking, is sometimes more than 10-fold your whole body weight

- Jumping rope
- High-impact aerobics
- Any activity where, at any time, you have both feet off the ground at once, however briefly (basketball, jumping)

Fortunately, that leaves a lot of activities that are OK for people with knee and hip osteoarthritis and that can help keep you mobile - see the list at WebMD.

References:

Image source: OpenClipart.org, public domain.

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Porphyrias

From a Lancet review:

Hereditary porphyrias represent a group of 8 metabolic disorders of the haem biosynthesis. They are characterised by acute neurovisceral symptoms, skin lesions, or both.

Every porphyria is caused by abnormal function of a separate enzymatic step, resulting in a specific accumulation of haem precursors:

- 7 porphyrias are the result of a partial enzyme deficiency
- a gain of function mechanism is present in one new porphyria

Acute porphyrias present with acute attacks - severe abdominal pain, nausea, constipation, confusion, and seizure - and can be life-threatening.

Cutaneous porphyrias present with painful photosensitivity, skin fragility and blisters.

Porphyrias are still underdiagnosed. Screening of families to identify presymptomatic carriers and avoidance of precipitants is important.

References:

Porphyrias. The Lancet, Volume 375, Issue 9718, Pages 924 - 937, 13 March 2010.

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Hepatitis C: Teenager Jazzy’s Story

NHS Choices: Teenager Jazzy was born with hepatitis C. This is her video diary about living with the condition.

Comments from Twitter:
@napernurse: Fortunate to live in UK where extensive med/psych prescriptions for HepatitisC covered by NHS. If liver transplant needed, that is covered too!

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Hepatitis delta virus

From a recent review in The Lancet:

Hepatitis delta virus (HDV) is a small, defective RNA virus that can infect only individuals who have hepatitis B virus (HBV). More than 15 million people are co-infected worldwide.

There are 8 genotypes of HDV. The hepatitis D virion is composed of a coat of HBV envelope proteins surrounding the nucleocapsid.

The nucleocapsid consists of:

- a single-stranded, circular RNA genome
- delta antigen, viral protein

HDV suppresses HBV replication but also causes severe liver disease with rapid progression to cirrhosis and hepatic decompensation (liver failure).

The range of clinical presentation is wide, varying from mild disease to fulminant liver failure.

Treatment of HDV is with pegylated interferon alfa; however, response rates are poor.

Better understanding of the molecular structure of HDV may lead to new therapeutic targets for this most severe form of chronic viral hepatitis.

References:

Hepatitis delta virus. Sarah A Hughes MBBCh, Heiner Wedemeyer MD, Dr Phillip M Harrison MD. The Lancet, Volume 378, Issue 9785, Pages 73 - 85, 2 July 2011.

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Worldwide number of new TB cases is higher than any other time in history

From the 2011 Lancet review:

The worldwide number of new TB cases is more than 9 million - higher than at any other time in history.

22 low-income and middle-income countries account for more than 80% of the active cases in the world.

Due to the devastating effect of HIV on susceptibility to TB, sub-Saharan Africa has been disproportionately affected and accounts for 4 of every 5 cases of HIV-associated tuberculosis.

Management problems include:

- In highly endemic areas, TB diagnosis continues to rely on century-old sputum microscopy

- No vaccine with adequate effectiveness (although BCG works to some extent). According to a recent report, BCG vaccination not only protects against tuberculosis but the number needed to treat (NNT) is 11.

- TB treatment regimens are protracted and have a risk of toxic effects

- Increasing rates of drug-resistant tuberculosis in eastern Europe, Asia, and sub-Saharan Africa

Promising progress includes improved tuberculosis diagnostics with biomarkers of disease activity. New and improved drugs, biomarkers, and vaccines need to be developed.
Diagnosing tuberculosis with cytokines IL-15, IL-10 and MCP-1, in addition to interferon-gamma
A pattern of two cytokines, called MCP-1 and IL-15, was reasonably good at differentiating between persons sick with TB and persons infected but not sick.
Monocyte chemotactic protein-1 (MCP-1) is a small cytokine belonging to the CC chemokine family. According to the new nomenclature, MCP-1 is called chemokine (C-C motif) ligand 2 (CCL2).

A third cytokine called IP-10 also showed promise at differentiating between people who are infected and those who are not.
Interferon gamma-induced protein 10 kDa (IP-10) is also known as C-X-C motif chemokine 10 (CXCL10). It belongs to the CXC chemokine family.

These 3 cytokines could form the basis of a new test to quickly detect whether tuberculosis is dormant or active and infectious.



52 chemokines from 4 families have been described. They interact with 20 receptors (click here for a larger image).

References:

Tuberculosis. Stephen D Lawn MRCP, Prof Alimuddin I Zumla FRCP. The Lancet, Volume 378, Issue 9785, Pages 57 - 72, 2 July 2011.

Xpert MTB/RIF is a rapid diagnostic test for tuberculosis with high sensitivity (90%) and specificity (99%). Lancet, 2011.
Image source: PPD, CDC, public domain.
Comments from Twitter:
@sdietrich17: How discouraging. We just keep going backwards with so many infectious diseases...

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Social media tips for employees of Dartmouth-Hitchcock medical center: What you write is forever

From Dartmouth Hitchcock YouTube channel:

Social media is everywhere... and what you write is forever.

A simple rule of thumb: if you wouldn't say something in a loud voice in the crowded cafeteria, you shouldn't say it on Facebook, Twitter, or other social media sites.

When can I use social media? Even if you have your own phone and you're just sending a quick tweet, you may only use social media for personal reasons on your own time, such as during scheduled breaks or meals.

What's not allowed?

- Posting protected health information or patient identifiable information

- Using information created by or for Dartmouth-Hitchcock - such as logos, pictures, and videos - without the approval of Public Affairs and Marketing department. It's copyrighted content.

- Creating social media sites that are branded as Dartmouth-Hitchcock without the approval of Public Affairs and Marketing.

I assembled a short list of suggestion for medical bloggers several years ago. Here it is:

Tips for Medical Bloggers

- Write as if your boss and your patients are reading your blog every day

- Comply with HIPAA

- Do not blog anonymously. List your name and contact information.

- If your blog is work-related, it is better to let your employer know.

- Inquire if there are any employee social media guidelines. If there are, comply with them strictly.

- Use a disclaimer, e.g. "All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice."

- Get your blog accredited by the Heath on the Net Foundation

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Beyond "Good Job": How to Give Effective Feedback to Residents

Although too often used interchangeably, encouragement, evaluation, and feedback are quite distinct:

- Encouragement (eg, "good job!") is supportive but does nothing to improve the learner's skills

- Evaluation is summative and is the final judgment of the learner's performance

- Feedback is designed to improve future performance

References:

Getting Beyond "Good Job": How to Give Effective Feedback. PEDIATRICS Vol. 127 No. 2 February 2011, pp. 205-207 (doi:10.1542/peds.2010-3351).
Image source: OpenClipArt.org, public domain.

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Post-splenectomy and hyposplenism – Lancet review

The spleen links innate and adaptive immunity.

The impairment of splenic function is defined as hyposplenism. The term asplenia refers to the absence of the spleen, a condition that is rarely congenital and mostly post-surgical.


Spleen. Image source: National Cancer Institute and Wikipedia, public domain.

Complications of hyposplenism and asplenia
Hyposplenism and asplenia might predispose individuals to thromboembolic events. However, infectious complications are the most widely recognised consequences of these states.

Splenectomy and hyposplenism are associated with infections by encapsulated bacteria with high mortality, fulminant course, and refractoriness to common treatment.

Prevention through vaccination and antibiotic prophylaxis is the basis of management.

References:
Post-splenectomy and hyposplenic states. Antonio Di Sabatino MD, Rita Carsetti MD, Prof Gino Roberto Corazza MD. The Lancet, Volume 378, Issue 9785, Pages 86 - 97, 2 July 2011.

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Mayo Clinic on procedure competency: "140 colonoscopies is not cool. You know what’s cool, 275 colonoscopies"

Mayo Clinic: GI professional organizations have traditionally recommended that gastroenterology (GI) fellows perform 140 colonoscopies before assessing competency. Robert E. Sedlack, M.D., of the Department of Gastroenterology and Hepatology at Mayo Clinic, discusses findings that suggest it takes an average of 275 procedures to acquire the skills needed to perform safe and effective exams.

The quote is from here:

"The Social Network" tells the story of how Facebook went from a college startup to essentially the only way that old friends keep in touch. Napster founder-turned-Facebook president Sean Parker gives site creator Mark Zuckerberg, some shrewd financial advice. "A million dollars isn't cool. You know what's cool? A billion dollars," he says.

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100-year-old doctor still practicing at UCSF, shares unconventional longevity secrets

Even though he recently turned 100, Dr. Ephraim Engleman still sees arthritis patients regularly at the University of California San Francisco (UCSF). He has some rather unconventional longevity secrets to share:

"I think exercise is mostly overrated. And the use of vitamins, forget it. And I don't encourage a lot of doctors.

Fall in love and get married. Sex is to be encouraged. Children are a priority."

His two sons are physicians. His daugher, a lawyer, is a married to a doctor, and their son is a physician.

From NBC’s Nightly News:

Visit msnbc.com for breaking news, world news, and news about the economy

The extended 17-minute version of the report is embedded below:

Visit msnbc.com for breaking news, world news, and news about the economy

Comments from Twitter:

@theRealAnubis: Hum...If he was right, 1/2 of the world population would reach 100 yrs.... For what I see about his case, money is the biggest ally..

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Redefining age 65 – when your job description is "rockstar"

Deep Purple and Orchestra - Maybe I'm a Leo, Mainz, Germany, July 2011:

Ian Gillan, 65, is best known as the lead singer and lyricist for Deep Purple. Roger Glover, 65, is the bassist and songwriter for the group. Ian Paice, 63, is the drummer. He is the only founding member of the band who never stopped performing with the group, and the only member to appear on every album the band has released during the last 43 years (Deep Purple was founded in 1968).

This is the same group almost 40 years ago, in 1972:
I have attended two concerts of Deep Purple, the last one was in June 2011 and it was quite impressive. The audience age ranged from 5 to 75 and everyone rose to their feet to the sound of Smoke on the Water.
Related:
Videos from Deep Purple at Ravinia Festival 2011, 3 part series.

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What happens when you ask for medical advice on Twitter – CNN’s Anderson Cooper knows from experience

What happens when you ask for medical advice on Twitter and you are CNN's host Anderson Cooper with 1.5 million followers:

andersoncooper Anderson Cooper

Ok, thanks for all the great info! I'm pretty sure I have it. Uh oh.
andersoncooper Anderson Cooper

How do you know if you have bronchitis? Anyone know?


Replies:

@thehighsign I generally just go with the opinion of a million and a half strangers.

@SashaTalebi Crazy times we're living in when @andersoncooper can crowdsource his bronchitis diagnosis via Twitter. Get well soon.

@JPLondon72 When a doctor says "You have bronchitis". Usually. Not always.

@emokidsloveme I feel like @andersoncooper has health insurance. Call me crazy, but I think he could afford to pay out of pocket too. #TwitterER

@Technikohler But why don't you just hit up good ole Gupta and ask him ?

@SadaoTurner hey @sanjayguptaCNN, do u know this guy @andersoncooper

@sherrybutlerpr Tight breathing, Burning in chest, fever. B careful, walking pneumonia

@LizaLizzieHalim i knew when i had troubled breathing&it makes sounds.Then i get the doctor checked&was diagnosed with it. Still have it now.

@lynngosselin I've had bronchitis many times so yes I know...but maybe a Dr. will pick up your post

@feathersong Two words - doctor, antibiotics. Make that three words - stat. Feel better soon, you've got a show to do!

@EldinaV And use a mist vaporizer in your dream and lots of OJ

@teresac8 fever, cough, wheezing and irritated breathing but to be sure see a doctor.

@cheeki3 well you want to the homeopathic route. Oregano oil (diluted in juice) will knock it right out.#justsaying

@sherrybutlerpr Also coughing up phlegm. Get on meds. U don't slow down, so will need that or will really go down. Take good care.

Acute bronchitis: Many patients expect to be treated with antibiotics and cough meds but this differs from guidelines


Mind map of differential diagnosis of cough. See more Allergy and Immunology mind maps here.

Cough is the most common symptom bringing patients to the primary care physician's office. The most common diagnosis in these patients is acute bronchitis, according to a recent review in the official journal of AFP, American Family Physician.
Acute bronchitis should be differentiated from other common causes of cough such as pneumonia and asthma - because the therapies are clearly different.
Symptoms of acute bronchitis typically last 3 weeks. As we already know, the presence of colored (e.g., yellow or green) sputum does not reliably differentiate between bacterial and viral lower respiratory tract infections.
Viruses cause more than 90% of acute bronchitis, and therefore, antibiotics are generally not indicated. They should be used only if pertussis is suspected to reduce transmission or if the patient is at increased risk of developing pneumonia (e.g., patients 65 years or older).
The typical therapies that have been traditionally used for managing acute bronchitis symptoms have been shown to be ineffective. The U.S. Food and Drug Administration recommends against using cough and cold preparations in children younger than 6 years.
The supplement pelargonium may help reduce symptom severity in adults.
Many patients expect to be treated with antibiotics and cough medications but this differs from evidence-based recommendations.
References:
Diagnosis and treatment of acute bronchitis. Albert RH. Am Fam Physician. 2010 Dec 1;82(11):1345-50.

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How to apply sunscreen

NHSChoices: An expert explains why it is important to protect your skin from sunburn to help avoid skin cancer. She also gives advice on how to apply sunscreen correctly and what to look out for when buying sunscreen.

You get exposed to both UVA and UVB light:
- UVB light is the light that Burns (causes sunburn)
- UVA light as the light that Ages the skin (wrinkles, etc.)
There is 8-10% increase in sun exposure for every 1,000 feet of elevation. In the summertime, you can get anywhere from 40-50% greater sun intensity than at sea level

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Medicine’s first Nobel laureate

Medicine's first Nobel laureate was Emil von Behring (1854-1917). He was the discoverer of diphtheria antitoxin in 1890 and attained a great reputation in his lifetime but also was a subject of controversy:

Behring’s unabashed pursuit of financial rewards for his efforts — unusual in that era—drew much criticism. One of the first modern medical entrepreneurs, he aggressively sought to patent his discoveries, and profited handsomely from their applications. This conflicted with the more genteel notions that prevailed at the time, which venerated physicians as selfless servants of mankind.

For all his accomplishments, Behring was a deeply troubled man. He suffered from frequent bouts of profound depression, and was institutionalised several times.

The great discoverer of serum therapy died of pneumonia in Marburg on March 31, 1917.

References:
Emil von Behring (1854-1917): Medicine's first Nobel laureate. Singapore Med J. 2011 Jan;52(1):1-2 (free full text PDF).

Image source: Emil Adolf von Behring, Wikipedia, public domain.

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Cyclist who survived: Use your head. Use your helmet

James Cracknell, OBE (born 5 May 1972) is a British rowing champion and double Olympic gold medalist.

From Official JCracknell: On 20th July it's exactly one year since James Cracknell was seriously injured in a cycling accident in America. His helmet saved him. James has made a short film to encourage others to wear cycle helmets. To show your support, pass the film to your friends and most importantly, when you're out cycling, use your head. Use your helmet.

More about the cycling Accident from Wikipedia:

On 20 July 2010, Cracknell was hit from behind by a truck whilst attempting to cycle, row, run and swim from Los Angeles to New York within 16 days. The accident happened at around 5.30 am on a quiet stretch of road outside Winslow, Arizona. It has been reported that his bicycle helmet saved his life but he suffered a contre-coup injury to the frontal lobes of his brain. He is now back at home with his family, although recovery is expected to be still some time away.

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Neighborhood Determinants of Quality of Life – street lighting, sidewalks, trees, absence of air or noise pollution

This paper analyzed quality of life in Uruguay. Differences in overall happiness can be explained by access to public goods.

Neighborhood Determinants of Quality of Life included:

- access to electricity, running water, sewage system, drainage, waste disposal system
- street lighting
- sidewalks in good condition
- trees in the street - "forest bathing" (exposure to parks and forests) may increase immunity

- absence of air or noise pollution

Based on research, Mike Cadogan summarized happiness in just 4 ideas - repeat every morning: "I'm happy, I'm hopeful about the future, I enjoy life, and I feel I'm just as good as other people."

References:

Neighborhood Determinants of Quality of Life. Néstor Gandelman, Giorgina Piani and Zuleika Ferre. Journal of Happiness Studies, 2011.
Image source: OpenClipArt.org, public domain.

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