tag:blogger.com,1999:blog-60289531535712018182024-02-18T20:01:27.360-08:00Importance Of NatueA blog about allama iqbal ashar 2013 new ashar of allama iqbal &Allama iqbal sms allama iqbal asha sms 2013 @2014Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.comBlogger36125tag:blogger.com,1999:blog-6028953153571201818.post-34506941524669406252013-11-02T19:13:00.002-07:002013-11-02T19:13:26.810-07:00Bridging the care transition gap: how healthcare reform is drivng better care management transitions.<h1 id="article_title" style="background-color: white; font-family: Arial; font-size: 1.8em; font-weight: normal; margin: 0px; padding: 15px 0px 0px;">
Bridging the care transition gap: how healthcare reform is driving better care management transitions.</h1>
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Will 2012 be the year of better care transitions? Many of the pieces are in place to make that happen, although there is still much work to be done to remedy this persistent--and multi-faceted--problem. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">A conference hosted by </span>Kaiser Permanente<span style="background-color: white; font-family: Arial; font-size: 13px;"> in Washington, D.C., last October demonstrated the complexity of the care transitions problem. The meeting identified key areas of focus, including the discharge process, medication reconciliation, information flow, and patient and </span>caregiver<span style="background-color: white; font-family: Arial; font-size: 13px;"> interaction. At the conference, Farzad Mostashari, M.D., national coordinator for health IT, urged the participants to embrace technology as a facilitator for improving care transitions, and he made a business case, as fee-for-service payment models are replaced by new models of payment. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">MULTI-FACETED PROBLEM </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Harry Greenspun, M.D., senior adviser for healthcare transformation and technology at the Deloitte Center for Health Solutions in Washington, D.C., notes that care management transitions are an area in which "the application of IT can improve quality, improve safety, and as a result can likely reduce costs." </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Good patient care requires an enormous amount of information to be conveyed, both within care teams and from setting to setting. Greenspun says. IT collaboration tools, can help coordinate teams, make clear where responsibilities lie, and help make sure that things don't get dropped and are not duplicated, </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">[ILLUSTRATION OMITTED] </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">He has observed increasing appreciation among provider organizations that transitions are actually a dangerous time for patients, which is being reflected in the changing nature of discharge summaries. "In the past, discharge summaries were focused on what happened, as opposed to here are the goals, here is what needs to be done and this is what has been done so far, and what information needs to be handed off to make the transition successful," he says. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Greenspun notes that there is no single solution to optimizing care transitions. The ability to pull information together from different sources and make sense of it is important. One problem in the industry has been that there are a lot of technology solutions directed at a narrow piece of the puzzle, but they haven't been incorporated well into what Greenspun calls the "people-process-technology triad. You can solve one problem" he says, "like a great care coordination application. But if the data isn't there, or people can't access it, or it's not easy for the </span>clinician<span style="background-color: white; font-family: Arial; font-size: 13px;"> to use it as part of their daily routine, it's not a real advance." </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Erica Drazen, managing director at the Global Institute for Emerging Healthcare Practices at </span>Falls Church<span style="background-color: white; font-family: Arial; font-size: 13px;">, Va.-based </span>CSC<span style="background-color: white; font-family: Arial; font-size: 13px;">, notes that most provider organizations did not choose care transitions as part of their Stage 1 meaningful use </span>attestation<span style="background-color: white; font-family: Arial; font-size: 13px;">. She says care management transitions will become a front-burner issue with the emergence of countable care and incentives to reduce readmissions. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Where should hospitals initially focus their attention? Drazen says the smart money would focus on diagnoses. "The most costly patients, from a hospitals perspective, are more likely to need coordinated care, since they tend to go back into the hospital," she says. Medication lists also rank high: "If you have a medication list, at least you know what a patient s likely problem looks like," she says, adding that medication lists are a small, but a key, part of the continuity of care document. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">A TIME FOR </span>TEAMWORK<span style="background-color: white; font-family: Arial; font-size: 13px;"> </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Pat </span>Rutherford<span style="background-color: white; font-family: Arial; font-size: 13px;">, R.N., vice president of the Institute for Healthcare Improvement, Cambridge, Mass., says there is a new awareness of the importance of care transitions compared to just five years ago, although there is still plenty of work to do in filling the patient engagement gap. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">She sees a need for better partnerships between IT solution vendors and quality improvement experts, to create system-wide solutions in an infrastructure that is often </span>fragmented<span style="background-color: white; font-family: Arial; font-size: 13px;">. Vendors need to sit down with clinicians who actually use the products, she says. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Hospitals are in a position to assess a patient's comprehensive needs, but handoffs of patient information need to be designed to be useful for the end users, and not necessarily written from the hospitals perspective, she says. Some of the information that skilled nursing facilities, home healthcare agencies, and primary physician offices maintain may be the same, but other information may be different, she says. We will get better compliance on what patients need to do to care for themselves if we do a better job of conveying information in a simple, clear way," she says. She describes the hospitals role as a "pay it forward" dynamic of providing the information that the next provider of care needs, and what it can do to make that transfer of information successful. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">For that to happen, each caregiver needs information that is tailored to his or needs to make the best decision, Rutherford says. What s needed by each caregiver is a one-page summary of information that is relevant to their caregiving role. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Rutherford believes that changes taking place under healthcare reform can improve care transitions by providing care that is customized to the patients' needs and preferences in every site of care, and then build connections to the whole continuum of care. "We need to be more patient-centered, and we need to think about care experiences over time,</span></div>
Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-78138086290496023342013-11-02T19:07:00.001-07:002013-11-02T19:07:19.368-07:00Nurse-led interventions to reduce cardiac risk factors in adults.<h1 id="article_title" style="background-color: white; font-family: Arial; font-size: 1.8em; font-weight: normal; margin: 0px; padding: 15px 0px 0px;">
Nurse-led interventions to reduce cardiac risk factors in adults.</h1>
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<span style="background-color: white; font-family: Arial; font-size: 13px;">* Nurse-led clinics may reduce cardiac risk factors in healthy adults, as well as those with established heart disease or known cardiac risk factors. (Grade A) </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">* The use of nurse-led clinics is particularly supported in relation to blood pressure management, cholesterol reduction, dietary modification and increasing physical activity. (Grade A) </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">* Long-term benefits of nurse interventions can be seen for some outcomes such as dietary modification and cholesterol levels, whereas others such as </span>smoking cessation<span style="background-color: white; font-family: Arial; font-size: 13px;"> were inconclusive. Research needs to be undertaken to determine how best to support the nurse-led clinic with the aim of improve sustained improvement of health measures. (Grade A) </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">* The cost-effectiveness of nurse interventions in relation to those provided by general practitioners or hospitals need to be established for each healthcare system. (Grade A) </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Information Source </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">This Best Practice information sheet updates and supersedes the Joanna Briggs Institute (</span>JBI<span style="background-color: white; font-family: Arial; font-size: 13px;">) information sheet published in 20 05 (2) which is based upon a systematic review of 6</span>randomised<span style="background-color: white; font-family: Arial; font-size: 13px;"> clinical trials. (3) Additional information has been derived from a systematic review published in 2007. (4) In total, this information is derived from 22 randomised controlled trials. Original references can be sourced from the systematic reviews. (3,4) </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Background </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">In recent years there has been a general shift of focus in the management of chronic disease from the hospital to the community. An emerging area in community healthcare is the nurse-led clinic. Nurse-led clinics are seen to focus on health promotion and education, rather than treatment of illness and are well received by patients. There are also benefits for the practice nurse, as nurse-led clinics provide an opportunity for increased development of </span>professional autonomy<span style="background-color: white; font-family: Arial; font-size: 13px;"> amongst nurse practitioners, particularly in areas of chronic disease, such as cancer therapies,</span>continence<span style="background-color: white; font-family: Arial; font-size: 13px;"> management, wound care, smoking cessation and </span>Coronary Heart Disease<span style="background-color: white; font-family: Arial; font-size: 13px;"> (</span><a class="tip" href="http://medical-dictionary.thefreedictionary.com/CHD" style="color: black; font-family: Arial; font-size: 13px;">CHD</a><span style="background-color: white; font-family: Arial; font-size: 13px;">). </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Coronary Heart Disease is the major cause of illness and death in Western countries, an effect which is likely to increase as the population ages. Many of the included studies were conducted in the United Kingdom, where there is a high incidence of CHD; however, the care processes are no different to other Westernised countries and the outcomes are considered comparable. Individuals with established CHD are at the highest risk of experiencing further coronary events. Establishing and maintaining a healthy lifestyle may contribute significantly in reducing cardiovascular mortality in these individuals. In the current economic and political climate, optimising the management of the chronically sick is a prime concern. Providing nurse-led services to divert patients from busy hospital and general practice settings has been suggested as one way of maintaining quality care of patients with chronic illness, such as CHD. Conceptually, practice nurses have the potential to contribute to risk factor reduction as a result of their familiarity with the patient, availability for sustained consultation and the potential to apply interventions when patients are ready to initiate change rather than during a period of acute crisis. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Definitions </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">For the purposes of this information sheet the following definitions are used: </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">General practice nurse--a registered or enrolled nurse who provides nursing care in a general practice environment, under some degree of supervision from their employing </span>general practitioner<span style="background-color: white; font-family: Arial; font-size: 13px;">. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Coronary heart disease (CHD)--a term that covers a wide array of disorders, including diseases of the</span><a class="tip" href="http://medical-dictionary.thefreedictionary.com/cardiac+muscle" style="color: black; font-family: Arial; font-size: 13px;">cardiac muscle</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> and the vascular system supplying the heart, brain, and other vital organs. The most common manifestations are </span>ischemic heart disease<span style="background-color: white; font-family: Arial; font-size: 13px;">, </span>congestive heart failure<span style="background-color: white; font-family: Arial; font-size: 13px;">, and stroke. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Cardiac risks factors--health or lifestyle influences that increase the chances of CHD. Known risk factors include being overweight, smoking, elevated cholesterol levels, sedentary lifestyle and having a high intake of alcohol. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Objective </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">The purpose of this information sheet is to present the best available evidence for nurse-led clinic interventions that reduce cardiac risk factors in healthy adults as well as those with known</span>cardiovascular disease<span style="background-color: white; font-family: Arial; font-size: 13px;">. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Quality of the research </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">These reviews consist of Level A evidence in the form of 22 randomised controlled trials (RCTs). This information sheet represents a synthesis of the results of these trials. It should be noted though that several trials were limited by the presence of small sample sizes and relatively short follow-up periods. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Types of Intervention </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">The interventions of interest were those related to the broad area of practice, incorporated within nurse-led clinics for patients at risk of CHD. They included a range of strategies such as individualised health assessment, lifestyle counselling and advice giving, health education, follow-up, referral and motivational interviewing. More specific areas of focus were smoking cessation, reduction of alcohol consumption and weight loss programs. The effects of nurse interventions were most commonly compared with "usual care" however this was not always fully detailed. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Outcome measures </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Primary outcomes of interest were; blood pressure, alcohol intake, cholesterol levels, diet, amount of physical activity undertaken, smoking status, body mass. Results of these outcomes are reported below. Secondary outcomes of interest included anxiety, depression and satisfaction with treatment. There is some evidence to suggest that patients with known CHD showed a significant reduction in self-reported symptoms of anxiety and depression following nurse-led education sessions and motivational interviews, compared with usual care. (2) </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Blood pressure </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Participants who received nurse-led guidance in the form of motivational interviews, consultations and an educational manual had reduced </span>systolic<span style="background-color: white; font-family: Arial; font-size: 13px;"> and </span>diastolic blood pressure<span style="background-color: white; font-family: Arial; font-size: 13px;"> after 18 weeks, regardless of their initial health status. Five trials (3 clinical and 2 in the general community) found significant reduction in blood pressure either between the intervention and control groups or from baseline to the 12-month follow-up. Prescription of </span>antihypertensive drugs<span style="background-color: white; font-family: Arial; font-size: 13px;"> also decreased substantially during this time. Follow-up data at 18 months was provided by two studies which revealed no significant difference between mean systolic or diastolic blood pressure for the intervention groups compared with controls. These findings imply that the nurse interventions are effective over a 12 month period; however this benefit is no longer seen at 18 months. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Alcohol intake </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">The effect of nurse-led education sessions on alcohol intake was assessed in two studies and both found that participants--either with or without known cardiac risk factors- decreased their alcohol intake in response to nurse- led information sessions. This result was significant at 18 weeks but was not sustained at 12 months, 18 months or 4 years. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Body Mass </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Studies that examined the body mass of overweight individuals reported a decrease in percentage body weight or body mass index (</span>BMI<span style="background-color: white; font-family: Arial; font-size: 13px;">), over a third of participants lost up to 5% (</span>Counterweight<span style="background-color: white; font-family: Arial; font-size: 13px;"> study, 2005). It was unclear in most studies was about whether the weight loss was sustained long-term. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Cholesterol </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Three studies demonstrated significant improvements in mean cholesterol levels at 3 months, 12 months and 4 years. One study noted that those with higher initial cholesterol levels showed larger decreases than those with lower starting levels. Potentially, this reflects the capacity for change in contributing factors such as dietary intake in this group. One study highlighted that a practice nurse-led group showed significant reductions in total cholesterol, high and </span>low density lipoprotein<span style="background-color: white; font-family: Arial; font-size: 13px;"> concentrations compared to baseline at the end of a 6-month trial. Another study compared practice nurse advice to usual care. 80% compliance was achieved at the 12-month follow-up with the intervention group indicating mean reduction in serum cholesterol compared to the control group. This was accompanied by a fall in the percentage of food energy from both total and saturated fat. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Diet </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Four studies using either a self-report questionnaire, fat score or saturated fat intake showed general improvement in diet following nurse-led intervention. Two CHD-oriented studies reported significant improvements in diet. The Change of Heart study (2005) demonstrated greater decrease in fat intake of the intervention group compared to the control group. Two studies reported significantly lower saturated fat intake by the intervention group at 1 and 4 years, suggesting sustainable lifestyle changes. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Physical activity </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Studies that examined the impact of nurse intervention on the level of physical activity revealed a general increase in the amount of self-reported physical activity being undertaken by participants. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Counselling combined with nurse education and an education booklet led to an increase in walking distance covered. A high or low level of patient-nurse interactions had no effect on physical activity. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Smoking </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">The effectiveness of nurse-led interventions on smoking cessation is unclear and is complicated by self-reporting methods. One study reported a significant decline in cigarettes smoked per day in the nurse intervention group after 4 months (Change of Heart study). A decrease in the number of cigarettes smoked per day was maintained in the intervention group at one year, however it was no longer significantly different from controls. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">There were discrepancies between self-reported smoking status and laboratory results, i.e. participants in control and intervention groups continued to smoke despite claiming to have stopped. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Conclusions </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">More recent research does not alter the recommendations published in 2005. The importance of nurse interventions in the management of coronary heart disease and risk factor reduction is recognised in terms of improved health outcomes for patients. However, the variation in outcome measures and inconsistent findings between some studies makes it difficult to draw firm conclusions. Improvement was demonstrated in the outcomes of anxiety and depression, quality of life, general health and lifestyle including dietary intake and physical activity. Beneficial effects attributable to nurse- led clinics were also identified for reduction in severity of angina, blood pressure, cholesterol levels, adherence to medication schedules, and lifestyle changes. Of these, only blood pressure, body mass and cholesterol levels were measured on the patient. All other outcomes were self-reported and should be interpreted with caution. It should be noted that reductions in blood pressure were reported at 12 but not 18 months, indicating that interventions are effective in the short and medium term. This trend of early and medium term success is also observed with reduction in body mass. Additional methods may need to be employed for there to be long term changes. Improvements in diet and cholesterol levels were observed up to 4 years after the intervention, showing that nurse-interventions can have long- term benefits on health care outcomes. The effectiveness of nurse-intervention on smoking cessation is unclear, there is some evidence to suggest that the number of cigarettes smoked decreased during the short term, however this was a small reduction which was not sustained past 12 months.</span></div>
Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-84033853623588114152013-11-02T19:04:00.001-07:002013-11-02T19:10:53.603-07:00Educational interventions to raise men's awareness of bladder and bowel health.<h1 id="article_title" style="background-color: white; font-family: Arial; font-size: 1.8em; font-weight: normal; margin: 0px; padding: 15px 0px 0px;">
Educational interventions to raise men's awareness of bladder and bowel health.</h1>
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Urinary incontinence (UI) is an objectively demonstrable condition in which the involuntary loss of urine is a social or hygienic problem. Urinary incontinence is a common health problem that carries with it significant medical, psychosocial and economic burdens.(2) </span>Faecal<span style="background-color: white; font-family: Arial; font-size: 13px;"> incontinence has been defined as the involuntary or inappropriate passing of liquid or solid stool and can also include the incontinence of </span>flatus<span style="background-color: white; font-family: Arial; font-size: 13px;">. Studies suggest that twice as many men suffer from faecal incontinence compared to urinary incontinence whilst more than three times as many women suffer from urinary incontinence compared to faecal incontinence.(2) The general consensus in the literature is that barriers exist for seeking help for those with incontinence, especially men. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Objectives </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">The purpose of this Best Practice Information Sheet is to present the best available evidence identified from a review assessing the effectiveness of educational interventions at raising men's awareness of bladder and bowel health, with the idea that raising awareness will lead to an increase in help-seeking behaviour. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Types of Intervention </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">The review considered any intervention, program or action that provided information, or attempted to raise awareness of men's bladder and bowel health. None of the included studies evaluated interventions to improve men's knowledge or management of bowel health, or to improve men's attendance at promotional events. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Quality of the research </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">The review identified 12 randomized and two quasi experimental studies and overall the quality of the included studies was moderate. Only two RCTs described their method of </span>randomization<span style="background-color: white; font-family: Arial; font-size: 13px;"> and no trials reported using blinding. Two studies did not provide the measures of dispersion (no standard deviation), one study provided graphical data only and one presented no data whatsoever. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Results </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Pelvic floor muscle exercises (PFME) for prostatic cancer </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Nine randomized controlled trials (RCTs) and two controlled trials examined the effectiveness of pelvic PFME on improving urinary incontinence in males ([greater than or equal to] 65 years) who have undergone prostatectomy. For participants with </span>stress urinary incontinence<span style="background-color: white; font-family: Arial; font-size: 13px;">, PFME may train the person to exert a well-timed, fast and strong voluntary pelvic floor muscle contraction just prior to an exertion. This contraction may clamp the </span>urethra<span style="background-color: white; font-family: Arial; font-size: 13px;"> to increase intraurethral pressure and prevent urine leakage. For participants with urge urinary incontinence, it has been suggested PFME, conditions a</span>reflex inhibition<span style="background-color: white; font-family: Arial; font-size: 13px;"> of </span>detrusor<span style="background-color: white; font-family: Arial; font-size: 13px;"> contraction, thus preventing involuntary contractions and urine leakage. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Random effects meta analysis was performed with two RCTs with similar populations (men after prostatectomy), interventions (pelvic floor muscle training) and outcomes (urinary </span>continence<span style="background-color: white; font-family: Arial; font-size: 13px;"> at 1, 3, 6 and 12 months). This analysis revealed that treatment with PFME resulted in statistically significant reductions in the number of </span>incontinent<span style="background-color: white; font-family: Arial; font-size: 13px;"> participants at 3 months (RR= 0.35, 95%CI 0.25, 0.49), 6 months (RR= 0.313, 95%CI 0.06, 0.25), and 12 months (RR= 0.15, 95%CI 0.05, 0.42), of PFME when compared with controls who did not practice PFME. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">These findings were echoed in a </span>RCT<span style="background-color: white; font-family: Arial; font-size: 13px;"> of older males ([greater than] 66 years, N= 58). The PFME group showed significantly more participants attaining continence compared with the no PFME group at week 1, 2 and 3 of treatment, but not at 4 weeks. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Two RCTs examined the effectiveness of PFME in combination with biofeedback in men who had undergone radical prostatectomy and neither study reported any significant improvement in the number of incontinent episodes per 24 hours, or at reducing the number of grams of urine loss in a 24 hour period, when compared with the control groups. One RCT (n=24) </span>randomised<span style="background-color: white; font-family: Arial; font-size: 13px;"> the subjects to either a biofeedback with pelvic floor muscle exercises group (45 minute sessions at 6, 7, 9, 11, and 16 weeks post-op) or a "no instruction" control group. PFME plus biofeedback was no more effective than the control in these patients for reducing the number of incontinent episodes per 24 hours, or at reducing the number of grams of urine loss in a 24 hour period. In the second RCT, (n=42) males after</span>radical retropubic prostatectomy<span style="background-color: white; font-family: Arial; font-size: 13px;"> for localised prostate cancer were randomized to receive either pelvic floor muscle exercises with biofeedback or to PFME with verbal feedback only. Results showed that although urine loss (measured by 1 hour pad tests) reduced significantly from baseline to 1, 2, 3 and 6 months for both groups, there was no significant difference between the two groups. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">In a RCT, 63 males four or more weeks after radical retropubic prostatectomy (mean age [greater than] 65 years) were randomised to either pelvic floor muscle exercises with intensive physiotherapy, PFME with electrical stimulation (ES), or PFME only provided by simple written and verbal instruction. While all groups showed significant reductions in urine loss (using the 24 hour pad test) at 12, 16 and 24 weeks compared to baseline, no significant differences were found between any group at any time point. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">In a similar RCT, 139 older males (mean age 65 years) who had undergone radical prostatectomy were randomized to one of three treatment groups: </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">1 Pelvic floor muscle exercises plus intensive physiotherapy </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">2 PFME plus electrical stimulation </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">3 PFME plus ES plus biofeedback </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Again, significant improvements in the number of continent participants were seen at each time point for each treatment group, however, no significant differences were found between any of the treatment groups at any time point. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">In a RCT of 36 males with urinary incontinence after radical prostatectomy (mean age [greater than] 66 years) were randomized to treatment consisting of PFME or functional pelvic floor electrical stimulation (FES), or </span>extracorporeal<span style="background-color: white; font-family: Arial; font-size: 13px;"> magnetic stimulation (ExMI) and followed up for 6 months. Using a 24 hour pad leakage test, there was little difference in the comparative effectiveness between the three treatment arms. There was significant reduction in the amount of urine leakage over time compared to the baseline (catheter removal) beginning at one month post-removal of the catheter. By 6 months urinary leakage was less than 10 grams in a 24 hour period compared with [greater than] 660grams 24 hours after catheter removal. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Finally, in a quasi experimental study of 24 male prostatectomy patients (mean age 70.2 years) introduction of PFME resulted in 16 of 24 (67%) participants exhibiting at least a 50% improvement in the number of incontinence episodes. At 1 to 17 months follow-up, 11 participants who had initially shown improvement reported no change to their condition or further improvement. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Post-micturition dribble </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Two RCTs attempted to address the use of educational interventions at reducing the symptoms of post-micturition dribble. In the first RCT, 44 men were randomized to receive either: </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">a) counselling, </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">b) training on </span>urethral<span style="background-color: white; font-family: Arial; font-size: 13px;"> milking, or </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">c) training in performing PFME. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">The authors found that both milking and </span>pelvic muscle exercises<span style="background-color: white; font-family: Arial; font-size: 13px;"> were significantly more effective at reducing the amount of urine lost post-micturition than counselling. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">In the second RCT, 55 men with erectile dysfunction and post-micturition dribble were randomized to receive either advice on lifestyle changes (control) or PFME combined with biofeedback and lifestyle change advice (treatment). The results showed that after 3 months nearly all treatment recipients were free of post-micturition dribble (19 of 21) while only one third of control subjects were free (5 of 15) with a risk of having post-micturition dribble less than 20% of that of the control group (RR 0.14, 95% CI 0.04, 0.56). At 6 months however, both treatments were equally successful with no-one in the treatment and only 2 men in the control group still suffering post-micturition dribble. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Lower urinary tract symptoms </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">An RCT evaluated the effectiveness of lifestyle and behavioural education sessions on men suffering from uncomplicated lower urinary tract symptoms (</span>LUTS<span style="background-color: white; font-family: Arial; font-size: 13px;">). The primary outcome was the number of treatment failures defined as evidence of urinary retention, a rise of 3 points or more on the</span>international prostate symptom score<span style="background-color: white; font-family: Arial; font-size: 13px;">, the need for drugs or a surgical intervention to control LUTS. When compared with a standard care control group, participants provided with education had significantly fewer treatment failures at every time point (3, 6 and 12 months) with a reduced risk of failure of over 60% (RR 0.38, 95%CI 0.24, 0.58 at 12 months). A decrease in the number of treatment failures were reported over time for each group. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Evidence based guidelines for management of urinary and/or faecal incontinence </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">One quasi experimental study examined the effectiveness of consensus guidelines designed for the management of continence by primary health care teams placed in an urban general practice. A random sample of patients of this general practice were mailed a questionnaire to determine their continence status (N=1503). Those that were identified as incontinent and agreed to follow-up (174 patients, 42 males) were encouraged to attend the practice where GP's could institute best practice treatment according to the guidelines. Only 4 males actually sought help and 3 or 4 (number unclear from the text) still considered their incontinence to be a problem after the intervention. Therefore, a conclusion as to the effectiveness of these guidelines in males cannot be ascertained, due to lack of detail in the study report. </span><br />
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Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-28126043795922748852013-11-02T19:00:00.001-07:002013-11-02T19:10:16.954-07:00Music interventions for dental anxiety in paediatric and adult patients.<h1 id="article_title" style="background-color: white; font-family: Arial; font-size: 1.8em; font-weight: normal; margin: 0px; padding: 15px 0px 0px;">
Music interventions for dental anxiety in paediatric and adult patients.</h1>
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Dental anxiety has been identified as a significant and common problem in both children and adults and is considered an obstacle in the provision of quality dental care by dental care providers. It is reported that one in six adults suffer from some form of dental anxiety and in children the prevalence ranges between 5.7% and 19.5%. (2) Dental anxiety denotes a state of apprehension that something dreadful is going to happen in relation to dental treatment and it is coupled with a sense of losing control. (2) Patients with dental anxiety tend to neglect dental care which poses a problem for both dentists and patients. A dentist-patient relationship dominated by severe patient anxiety may lead to</span>misdiagnosis<span style="background-color: white; font-family: Arial; font-size: 13px;"> and inappropriate treatment. (2) Treatment of dental anxiety and choosing the right method of managing this disorder is not always easy. Effective treatment options may include; an explanation of the treatment procedure, pharmacological strategies involving the use of benzodiazepines and antidepressants, </span>biofeedback<span style="background-color: white; font-family: Arial; font-size: 13px;">, hypnosis and behavioural interventions. (2) Music offers an </span>alternate treatment<span style="background-color: white; font-family: Arial; font-size: 13px;"> option which has been used in different medical fields to meet physiological, psychological, and spiritual needs of patients. The </span>anxiolytic<span style="background-color: white; font-family: Arial; font-size: 13px;"> effects of music have been studied in a variety of medical patients, including surgical, cardiac, and oncology patients. (2) People of any age may benefit from a music therapy programme regardless of musical skill or background. Several measures and scales have been developed to classify dentally anxious patients and to assess their level of anxiety for prevalence, </span><a class="tip" href="http://medical-dictionary.thefreedictionary.com/aetiology" style="color: black; font-family: Arial; font-size: 13px;">aetiology</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> and treatment studies. (2) Music is believed to reduce dental anxiety by either having a relaxing or distracting effect (or both) that in turn reduces the activity of the neuro-endocrine and sympathetic nervous systems. (2) </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Definitions </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">For the purposes of this information sheet the following definitions were used (2): </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Dental anxiety is defined as an abnormal fear or dread of visiting the dentist for preventive care or therapy and unwarranted anxiety over dental procedures. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Active music therapy is the planned and creative use of music by a music therapist to attain and maintain health and wellbeing. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Passive music listening is the passive listening to pre-recorded music offered by healthcare professionals without the involvement of music therapist. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Objectives </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">The purpose of this Best Practice Information Sheet is to present the best available evidence on the effectiveness of music interventions on dental anxiety in </span>paediatric<span style="background-color: white; font-family: Arial; font-size: 13px;"> and adult patients. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Types of Intervention </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">The interventions of interest were active music therapy and passive music listening throughout the dental procedure. The former involves a music therapist and interactive communication; the latter involves listening to music or passive listening to pre-recorded music offered by dental personnel. The type of music may vary (e.g., folk, contemporary, classical, lullaby). Studies including a combination of interventions where the direct effect of the music intervention cannot be determined (for e.g. relaxation therapy combined with music or pharmacological therapy with music) were excluded. Comparators included talking, placebo (headphones without music), relaxation techniques (such as progressive muscular relaxation, paced breathing etc) and pharmacological techniques (such as sedation with </span>nitrous oxide<span style="background-color: white; font-family: Arial; font-size: 13px;"> and other anxiolytic drugs like </span>diazepam<span style="background-color: white; font-family: Arial; font-size: 13px;">, midazolam etc). </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Quality of the research </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Seven studies were included in the review, two </span>RCT<span style="background-color: white; font-family: Arial; font-size: 13px;">, four quasi-randomised, and one quasi-experimental study. (2) Four studies that claimed to be </span>randomised<span style="background-color: white; font-family: Arial; font-size: 13px;"> failed to report the method of random allocation, hence these studies were considered as quasi-randomised studies. The approaches used by studies reporting method of randomisation were: random number table used for block random assignment and electronic spread sheet of random numbers. Only two studies attempted to determine sample size by using power analysis. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Results </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Paediatric patients </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Upbeat music distraction vs relaxing music distraction vs no music control </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">A quasi experimental study investigated the effects of music distraction on anxiety and behavior in 45 patients 4 to 6 years of age Columbus, Ohio (USA). Patients were divided into three equal groups: upbeat music distraction, relaxing music distraction and no music control. The upbeat music consisted of age-appropriate folk music songs (A Child's Celebration of Folk Music by various artists, 1996). The relaxing music was slow, </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">lulling instrumental music (In the </span>Enchanted<span style="background-color: white; font-family: Arial; font-size: 13px;"> Garden by Kevin Kern, 1996). Behaviour management techniques of tell-show-do and voice control were used, if necessary, in a conventional manner. There was no significant difference in Corah anxiety scores at either visit 1 or visit 2 among the three groups. Visit 1 was a baseline session with no music distraction or headphones used. Visit 2 was scheduled 1-2 weeks after visit 1. Children in the two music groups wore headphones whilst the control group wore headphone without music played. Measurements showed that there was no significant difference in self-reported anxiety among the three groups at visit 1 or visit 2. In addition, there was no statistically significant difference between pre- and post-operative scores in any of the groups. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Instrumental music vs nursery rhymes vs control </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">A quasi randomised controlled trial investigated the effect of music distraction in managing anxious paediatric patients and in addition compared two different types of music to ascertain the type of music most helpful for reduction of anxiety. Forty children aged between 4 and 8 years with no previous dental experience were included in the study conducted in India. Children were randomly divided into two groups initially: control group (group A) and music group. Music group was further equally divided into two groups: instrumental music group (group B) and nursery rhymes music group (group C). Patients chose their music type and listened to the music through headphones throughout the treatment during all the visits. There was statistically significant difference between the anxiety ratings among instrumental music group and nursery rhyme group, with anxiety being more in the later group. The control group showed higher mean </span>pulse rate<span style="background-color: white; font-family: Arial; font-size: 13px;"> compared to both the music groups; however the differences were not statistically significant. There was a statistically significant difference between the mean pulse rate of the instrumental music group and nursery rhyme group, with anxiety being more in the later. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Adult patients </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Relaxation vs music vs music with volume control vs control </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Eighty college students (40 males) who required a minimum of class II amalgam restorations were recruited for a quasi randomised controlled trial. The setting was a dental emergency school clinic in the USA. All patients were randomly assigned to one of the four groups. The groups included relaxation, music, music with volume control (second music group) and control group (treatment not specified). Relaxation involved presentation of tape-recorded relaxation instructions through ear phones worn by the patient. Music intervention included recorded music through earphones throughout the dental procedure and patient had a choice of eight musical programs ranging from classical to popular. Patients had the option to set the volume in the third group (second music group). There was a significant difference in level of anxiety between the visits for control and relaxation groups when each group was tested individually. The decrease in anxiety was not significant for both the music groups. In the group-by anxiety-by-visit analysis, the results indicated that only the high-anxiety control group and the high-anxiety relaxation group showed statistically significant decreases in rated discomfort to the second visit. A repeated measures analysis of relaxation and distraction measures by groups showed that there were significant differences in the relaxation group and the second music group. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Music vs </span>nitrous<span style="background-color: white; font-family: Arial; font-size: 13px;"> oxide/oxygen </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">A quasi randomised controlled trial investigated the effects of music on reducing patient's fear and anxiety. Eighty male and female patients (between 18 and 65 years of age), from Utah (USA) were randomly assigned in one of eight categories. Patients in the music group had a choice of five different types of music (classical, Broadway hits, new age, country and western, and light contemporary hits). A statistically significant reduction in the level of stress in female patients was observed with music listening alone, in contrast to male patients where there was no statistically significant difference. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Music (favourite songs from a music list) vs control </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">A quasi randomised controlled trial evaluated the efficacy of musical intervention to decrease anxiety and change of vital signs in participants who underwent surgical extraction of an impacted </span>mandibular third molar<span style="background-color: white; font-family: Arial; font-size: 13px;"> (</span>IMTM<span style="background-color: white; font-family: Arial; font-size: 13px;">) at the Seoul National University Dental Hospital (Korea). Participants were randomly assigned to a music treated group and a control group. Patients in the music group were asked to select at least 10 of their favourite songs from a prepared music list that included classical music, pop songs, folk songs, hymns and Korean style country songs. Throughout the dental procedure, patients in the music group had the option of controlling the volume of the music using a remote control. Patient vital signs were measured upon arrival in the </span>operating room<span style="background-color: white; font-family: Arial; font-size: 13px;"> (baseline) and throughout the surgical procedure (beginning from local anesthetic injection to completion and suturing). Baseline vital sign measurements were similar in both the groups. The mean </span>systolic blood pressure<span style="background-color: white; font-family: Arial; font-size: 13px;"> and </span>diastolic blood pressure<span style="background-color: white; font-family: Arial; font-size: 13px;"> varied significantly with surgical stage for both groups. There were significant differences between music treatment group and control group with respect to heart rate and respiratory rate changes from baseline. The study showed that patients in the music treatment group had significantly lower levels of intra-operative anxiety than patients in the control group. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Music (soothing piano music) vs control </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">One randomised controlled trial investigated the effect of music on anxiety during </span>root canal treatment<span style="background-color: white; font-family: Arial; font-size: 13px;">. Forty four subjects between 20 and 65 years of age were randomised to music and control group. Participants in the music group were exposed to a variety of soothing piano music through headphones with adjusted volume. Participants in the control group underwent the same procedure without the evaluation of music preference and a CD of silence played during the procedure. There was a statistically significant difference in state anxiety scores between the music group and control group, anxiety levels being higher in the later group. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Brief relaxation vs music distraction vs control </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 13px;">A </span>randomized controlled trial<span style="background-color: white; font-family: Arial; font-size: 13px;"> tested the hypothesis that brief relaxation (BR) was effective and superior to music distraction (MD) for the treatment of dental anxiety. Adult participants from a rural area in Germany were randomised to the BR, MD or control groups. Participants in control group did not receive any treatment for dental anxiety. There was a statistically significant decrease in anxiety after dental treatment in all the three groups, with the greatest decrease in the BR group. There was a relatively small decrease in anxiety after dental treatment in the control group whilst the MD group presented a statistically significant reduction in state anxiety compared to the control group. The reduction in anxiety following BR was greater than that in the control and MD groups. Stratification of anxiety levels revealed that BR was effective in alleviating state anxiety throughout all levels of dental anxiety, demonstrating the largest effect in highly anxious participants. Participants in the MD group showed reduced anxiety in the moderately anxious subgroup. </span><br />
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Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-6526090882444536832013-11-02T18:58:00.002-07:002013-11-02T18:58:59.177-07:00Adolescent care standards and state CHIP efforts.<h1 id="article_title" style="background-color: white; font-family: Arial; font-size: 1.8em; font-weight: normal; margin: 0px; padding: 15px 0px 0px;">
Adolescent care standards and state CHIP efforts.</h1>
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<span style="background-color: white; font-family: Arial; font-size: 13px;">Although widely thought of as a health insurance program for younger children, the State </span><a class="tip" href="http://medical-dictionary.thefreedictionary.com/Children's+Health" style="color: black; font-family: Arial; font-size: 13px;">Children's Health</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> Insurance Program (CHIP) also has enormous potential to expand insurance coverage, including coverage of </span><a class="tip" href="http://encyclopedia.thefreedictionary.com/Reproductive+health" rel="nofollow" style="color: black; font-family: Arial; font-size: 13px;">reproductive health</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> guidance and services, to millions of uninsured teenagers. The extent to which CHIP meets this potential will largely be determined by the individual states, which have considerable discretion in designing their own efforts and benefit packages. For guidance in making critical coverage decisions, states can look to several comprehensive guidelines for adolescent health care, including reproductive health services, developed in recent years. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Congress established the State Children's Health Insurance Program (CHIP) in 1997 in response to data indicating that there were over 10 million uninsured children in the </span><a class="tip" href="http://encyclopedia2.thefreedictionary.com/United+States" style="color: black; font-family: Arial; font-size: 13px;">United States</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> that year--including 2.7 million teenagers between the ages of 13 and 18 (1.3 million females and 1.4 million males). With nearly $40 billion in </span><a class="tip" href="http://financial-dictionary.thefreedictionary.com/federal+funds" style="color: black; font-family: Arial; font-size: 13px;">federal funds</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> available to them over 10 </span><a class="tip" href="http://encyclopedia2.thefreedictionary.com/Years%2c+The" style="color: black; font-family: Arial; font-size: 13px;">years, the</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> states are charged with establishing CHIP programs, which may enroll children under age 19 in families with incomes up to 200% of the federal poverty level. The </span><a class="tip" href="http://medical-dictionary.thefreedictionary.com/Health+Care+Financing+Administration" style="color: black; font-family: Arial; font-size: 13px;">Health Care Financing Administration</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> (</span><a class="tip" href="http://medical-dictionary.thefreedictionary.com/HCFA" style="color: black; font-family: Arial; font-size: 13px;">HCFA</a><span style="background-color: white; font-family: Arial; font-size: 13px;">), the federal agency that administers CHIP, reports that two million children were enrolled nationwide as of September 30, 1999. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><a class="tip" href="http://www.thefreedictionary.com/according+to" style="color: black; font-family: Arial; font-size: 13px;">According to</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> the federal CHIP statute, a state may design its CHIP program in one of three ways: by expanding its Medicaid program, by creating or expanding a state-designed program not based on Medicaid or by using a combination of the two approaches. A 1999 review by The </span><a class="tip" href="http://encyclopedia.thefreedictionary.com/Alan+Guttmacher" rel="nofollow" style="color: black; font-family: Arial; font-size: 13px;">Alan Guttmacher</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> Institute (</span><a class="tip" href="http://encyclopedia2.thefreedictionary.com/AGI" style="color: black; font-family: Arial; font-size: 13px;">AGI</a><span style="background-color: white; font-family: Arial; font-size: 13px;">) of the initial state plans submitted to HCFA found that 21 states and the</span><a class="tip" href="http://encyclopedia2.thefreedictionary.com/District+of+Columbia" style="color: black; font-family: Arial; font-size: 13px;">District of Columbia</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> had opted to expand their Medicaid program, 16 states were developing an entirely separate program, and 13 states intended to take a combination approach. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">In the states choosing to expand their Medicaid program, CHIP enrollees are regular Medicaid enrollees; as such, they are entitled to the full range of Medicaid-covered services, including routine</span><a class="tip" href="http://medical-dictionary.thefreedictionary.com/gynecologic" style="color: black; font-family: Arial; font-size: 13px;">gynecologic</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> examinations, Pap tests, diagnosis and treatment of </span><a class="tip" href="http://encyclopedia2.thefreedictionary.com/Sexually+transmitted+diseases" style="color: black; font-family: Arial; font-size: 13px;">sexually transmitted diseases</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> (STDs) as well as </span><a class="tip" href="http://encyclopedia2.thefreedictionary.com/family+planning" style="color: black; font-family: Arial; font-size: 13px;">family planning</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> services and supplies. (The federal Medicaid statute specifically mandates coverage of family planning services for "minors who can be considered to be sexually active.") </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">In contrast, the states choosing to design programs of their own have wide latitude in crafting a benefit package. The CHIP statute itself requires coverage of only such </span><a class="tip" href="http://medical-dictionary.thefreedictionary.com/basic+services" style="color: black; font-family: Arial; font-size: 13px;">basic services</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> as physician and hospital care, laboratory and X-ray services, well-child care and immunizations. According to the AGI review, of the 29 approved state plans that had some state-designed component, 16 specifically indicated that family planning services and supplies would be covered, while most of the remaining plans indicated that the general category "</span><a class="tip" href="http://medical-dictionary.thefreedictionary.com/prenatal+care" style="color: black; font-family: Arial; font-size: 13px;">prenatal care</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> and pre-pregnancy family planning services" would be covered. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Teens' Reproductive Health Needs </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Teens need a range of educational and medical services related to reproductive health. Half of all U.S. teens are sexually experienced. While sexual activity is rare among younger teens, it is common in the later teenage years; by age 19, over three-fourths of females and 85% of males have had intercourse. Yet, teens are less likely than older women to report consistent use of effective contraceptive methods. In addition, sexually active teens younger than 18 are less likely to use any method of contraception, compared with older women. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Contraceptive use is critical for sexually active teens to avoid unintended pregnancy and to protect themselves against STDs. A sexually active teenager who does not practice contraception has a 90% chance of becoming pregnant within one year. In fact, every year, some 900,000 American teens between the ages of 15 and 19 become pregnant, giving the United States one of the highest</span><a class="tip" href="http://medical-dictionary.thefreedictionary.com/teenage+pregnancy" style="color: black; font-family: Arial; font-size: 13px;">teenage pregnancy</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> rates in the developed world. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">The United States also has among the highest teen </span><a class="tip" href="http://encyclopedia2.thefreedictionary.com/STD" style="color: black; font-family: Arial; font-size: 13px;">STD</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> rates in the developed world. Each year, three million teens--about one in four sexually experienced teens--acquire an STD, which can compromise their ability to have children later in life or lead to life-threatening health problems, such as cancer or </span><a class="tip" href="http://encyclopedia2.thefreedictionary.com/HIV" style="color: black; font-family: Arial; font-size: 13px;">HIV</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> infection. For example, recent studies indicate that up to 1030% of sexually active teenage women tested for STDs are infected with </span><a class="tip" href="http://encyclopedia2.thefreedictionary.com/chlamydia" style="color: black; font-family: Arial; font-size: 13px;">chlamydia</a><span style="background-color: white; font-family: Arial; font-size: 13px;">, which, if left untreated, can lead to</span><a class="tip" href="http://encyclopedia2.thefreedictionary.com/pelvic+inflammatory+disease" style="color: black; font-family: Arial; font-size: 13px;">pelvic inflammatory disease</a><span style="background-color: white; font-family: Arial; font-size: 13px;">, </span><a class="tip" href="http://encyclopedia2.thefreedictionary.com/ectopic+pregnancy" style="color: black; font-family: Arial; font-size: 13px;">ectopic pregnancy</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> and infertility. Additionally, teens have higher rates of</span><a class="tip" href="http://encyclopedia2.thefreedictionary.com/gonorrhea" style="color: black; font-family: Arial; font-size: 13px;">gonorrhea</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> than women older than 20, and some studies have found that up to 15% of sexually active teenage women are infected with </span><a class="tip" href="http://encyclopedia2.thefreedictionary.com/human+papillomavirus" style="color: black; font-family: Arial; font-size: 13px;">human papillomavirus</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> (</span><a class="tip" href="http://medical-dictionary.thefreedictionary.com/HPV" style="color: black; font-family: Arial; font-size: 13px;">HPV</a><span style="background-color: white; font-family: Arial; font-size: 13px;">), many with a strain of the virus linked to </span><a class="tip" href="http://medical-dictionary.thefreedictionary.com/Cervical+Cancer" style="color: black; font-family: Arial; font-size: 13px;">cervical cancer</a><span style="background-color: white; font-family: Arial; font-size: 13px;">. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Nonetheless, there are some disturbing indications that teenagers may not always be getting the full range of reproductive health care services they need. According to a study in the July 1999 issue of Pediatrics, only half of all physicians reported that they provided any counseling or education in their encounters with adolescents; fewer than 3% reported providing counseling or education on STDs or HIV. According to the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls, only 15% of adolescent boys and 26% of adolescent girls reported that their provider had discussed pregnancy prevention with them. Similarly, only 24% of boys and 28% of girls reported that their doctor had discussed how to prevent STDs or HIV. And a study in the December 15, 1999, issue of the </span><a class="tip" href="http://encyclopedia.thefreedictionary.com/Journal+of+the+American+Medical+Association" rel="nofollow" style="color: black; font-family: Arial; font-size: 13px;">Journal of the American Medical Association</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> reported that adolescents who are sexually active are more likely than other teens to forgo important health care, such as an annual physical exam. The study found that 25% of sexually active teens had forgone care, compared with only 15% of teens who are not sexually active. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Care Guidelines Remarkably Consistent </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">For guidance in making important decisions about the coverage for adolescents in their CHIP program, state policymakers may look to several widely accepted guidelines of care for preventive services to teens that have been developed by major health organizations. The three most comprehensive efforts are Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, which was sponsored by the </span><a class="tip" href="http://www.thefreedictionary.com/Department+of+Health+and+Human+Services" style="color: black; font-family: Arial; font-size: 13px;">Department of Health and Human Services</a><span style="background-color: white; font-family: Arial; font-size: 13px;">; Guidelines for Adolescent Preventive Services (GAPS), which was developed by the </span><a class="tip" href="http://encyclopedia2.thefreedictionary.com/American+Medical+Association" style="color: black; font-family: Arial; font-size: 13px;">American Medical Association</a><span style="background-color: white; font-family: Arial; font-size: 13px;">; and Primary and Preventive Health Care for Female Adolescents, which was published by the</span><a class="tip" href="http://encyclopedia.thefreedictionary.com/American+College+of+Obstetricians+and+Gynecologists" rel="nofollow" style="color: black; font-family: Arial; font-size: 13px;">American College of Obstetricians and Gynecologists</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> (</span><a class="tip" href="http://medical-dictionary.thefreedictionary.com/ACOG" style="color: black; font-family: Arial; font-size: 13px;">ACOG</a><span style="background-color: white; font-family: Arial; font-size: 13px;">). These national guidelines strongly emphasize that comprehensive reproductive health services for teens, including both health guidance and medical care, are an integral component of preventive </span><a class="tip" href="http://medical-dictionary.thefreedictionary.com/health+services" style="color: black; font-family: Arial; font-size: 13px;">health services</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> for this population. In fact, despite subtle differences, these recommendations, which are summarized below, are remarkably consistent (see chart). </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">* Routine, preventive service visits </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Routine visits are the mainstay of comprehensive and coordinated </span><a class="tip" href="http://encyclopedia.thefreedictionary.com/Preventive+care" rel="nofollow" style="color: black; font-family: Arial; font-size: 13px;">preventive care</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> for teens. Health Care for Female Adolescents recommends that the initial visit for health guidance, screening and preventive care take place between the ages of 13 and 15. This initial visit should be followed by annual preventive health visits. The American Medical Association's GAPS recommends that all teens between the ages of 11 and 21 receive annual, routine visits, including three complete physical examinations--one each during early (11-14), middle (15-17) and late (18-21) adolescence. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">All three sets of guidelines stress the importance of integrating medical care with education and counseling on responsible sexual decision-making. Annual preventive visits that promote routine and predictable screening, counseling and intervention are vital to this integrated approach. Since participation in risky behaviors can begin at any age, regular visits provide the opportunity to identify teens who have recently initiated, or are considering engaging in, such behaviors. They also offer an opportunity to identify teens who have recently become sexually active and to provide them with information concerning unintended pregnancy and STD prevention. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">The various guidelines recommend that all teens should be screened during routine, preventive visits to determine their sexual history and practices. A comprehensive sexual history can be used to identify risk and evaluate the need for services as well as additional counseling and education. GAPS recommends that sexually active teens be asked about "their use and motivation to use condoms and contraceptive methods, their </span><a class="tip" href="http://medical-dictionary.thefreedictionary.com/sexual+orientation" style="color: black; font-family: Arial; font-size: 13px;">sexual orientation</a><span style="background-color: white; font-family: Arial; font-size: 13px;">, the number of sexual partners they have had in the past six months, if they exchanged sex for money or drugs, and their history of prior pregnancy or STDs. Adolescents at risk for pregnancy, STDs (including HIV), or sexual exploitation should be counseled on how to reduce this risk." GAPS adds that both teens and their parents and other adult caregivers should receive guidance on the use of "tobacco products, alcohol and other drugs" in conjunction with sexual activity. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">* Cancer screening </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">The guidelines all recommend that sexually active female teens receive a Pap test annually to screen for cervical cancer. In addition, GAPS and Health Care for Female Adolescents recommend that females 18 or older receive annual Pap tests, regardless of whether they are sexually active. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Bright Futures also recommends that instruction in breast and </span><a class="tip" href="http://medical-dictionary.thefreedictionary.com/Testicular+Self-Examination" style="color: black; font-family: Arial; font-size: 13px;">testicular self-examination</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> be a part of routine physical examinations; the other </span><a class="tip" href="http://medical-dictionary.thefreedictionary.com/practice+guidelines" style="color: black; font-family: Arial; font-size: 13px;">practice guidelines</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> do not address the issue. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">* STD/HIV screening </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">The various guidelines also recommend that all sexually active teens be screened for gonorrhea and chlamydia. Health Care for Female Adolescents and Bright Futures recommend that these tests be performed annually, while GAPS suggests that the frequency of the screening should depend on the individual's sexual history. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">For teens at risk for HIV, the guidelines recommend that testing be confidential and that it occur only after the teen gives informed consent and in conjunction with pre-test and </span><a class="tip" href="http://www.thefreedictionary.com/posttest" style="color: black; font-family: Arial; font-size: 13px;">posttest</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> counseling. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">GAPS makes additional recommendations regarding follow-up for positive STD tests: Positive results should be followed by additional tests, as appropriate to make a definitive diagnosis, and a treatment plan should be instituted and the use of condoms encouraged. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">* Health guidance on sexual development </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">The guidelines all recommend that as a part of routine health visits, teens receive health guidance--information, counseling and anticipatory guidance--about puberty and sexual development. In the context of health guidance on sexual development, Bright Futures suggests that health professionals ask young adolescents such questions as "Has anyone talked with you about what to expect as your body develops? Do you think you are developing pretty much like the rest of your friends? Have you started your period? Is it regular?" Health professionals can use the answers to these queries to provide information and counseling about sexual development appropriate to the individual patient. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Both Health Care for Female Adolescents and GAPS additionally recommend that parents or other adult caregivers be given periodic guidance regarding sexual development. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">* Health guidance on responsible </span><a class="tip" href="http://medical-dictionary.thefreedictionary.com/sexual+behavior" style="color: black; font-family: Arial; font-size: 13px;">sexual behavior</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> and decision-making The various guidelines recommend that all teens receive information and counseling--as part of routine, preventive service visits--about sexual decision-making, including information about abstinence, contraceptive methods, and STD transmission and prevention. According to all the major guidelines, teens should be given information on the importance of pregnancy and STD prevention, the role of abstinence as an effective way to prevent unintended pregnancy and STDs, ways to prevent HIV transmission and basic facts about protection from sexual exploitation. Adolescents should also be given counseling to reinforce responsible sexual behavior, both among those who are not currently sexually active and among those using birth control and condoms effectively. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Health Care for Female Adolescents specifically urges that teens be informed that the most effective protection against unintended pregnancy and STDs, other than abstinence, is a combination of latex condoms and hormonal methods of contraception. GAPS recommends that all adolescents should receive annual counseling on responsible sexual behaviors, including abstinence. "Latex condoms to prevent STDs, including HIV infection, and appropriate methods of birth control should be made available, as should instructions on how to use them effectively." </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Health Care for Female Adolescents specifically recommends that teens be counseled about</span><a class="tip" href="http://medical-dictionary.thefreedictionary.com/Emergency+contraception" style="color: black; font-family: Arial; font-size: 13px;">emergency contraception</a><span style="background-color: white; font-family: Arial; font-size: 13px;">. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Bright Futures suggests that health professionals question teens about the information they have learned from their family, friends, school and other sources, and supplement that information in the course of responding to their specific questions, problems or concerns. Bright Futures also suggests that the handouts that health professionals give adolescents to review at home should include, among other things, statements such as "Recognize that </span><a class="tip" href="http://medical-dictionary.thefreedictionary.com/sexual+feelings" style="color: black; font-family: Arial; font-size: 13px;">sexual feelings</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> are normal, but having sex should be a well-thought-out decision. Delay having sex until you are mature enough to assume responsibility for </span><a class="tip" href="http://www.thefreedictionary.com/sexual+relations" style="color: black; font-family: Arial; font-size: 13px;">sexual relations</a><span style="background-color: white; font-family: Arial; font-size: 13px;">. If you are sexually active, discuss contraceptive methods and STD prevention with the health professional and your partner. Learn about and practice safer sex." </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">The Critical Role of Confidentiality </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">While routine guidance and care may play a vital role in preventing myriad serious health and social consequences, teens face substantial barriers to accessing care, including, among other things, deep-seated concerns about confidentiality. These concerns may prevent teens from seeking care in a timely fashion, or at all. As a result, the various guidelines stress the importance of confidentiality as a basic underpinning of the relationship between teenage patients and their health care providers. For some longstanding patients, this can mean recasting an ongoing relationship that had included parents as equal partners. For newer patients, it may mean developing a relationship that is built from the start on the premise of confidentiality. According to the various guidelines, health professionals should establish office policies regarding confidential care for teenagers, and both teens and their parents should be informed of these policies from the outset. According to Health Care for Female Adolescents, confidentiality is frequently identified as a major obstacle to the delivery of care to teens. As a result, the guidelines recommend that rather than wait until a problem arises, physicians should initiate discussion of the subject with both the teenager and her parents, and at the same time stress the importance of open communication among all parties. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Serving Teens </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Major Guidelines for Reproductive Health Services to Teenagers </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents was developed by a special commission and a set of expert panels sponsored by the </span><a class="tip" href="http://encyclopedia.thefreedictionary.com/Health+Resources+and+Services+Administration" rel="nofollow" style="color: black; font-family: Arial; font-size: 13px;">Health Resources and Services Administration</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> and the Health Care Financing Administration of the Department of Health and Human Services. The second edition of the report, released in 2000, includes recommendations for preventive services from infancy through adolescence. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Guidelines for Adolescent Preventive Services (GAPS) was de the American Medical Association and released in 1992. GAPS was written with the assistance of a national scientific advisory board, which consisted of experts in medicine, social and </span><a class="tip" href="http://www.thefreedictionary.com/behavioral+science" style="color: black; font-family: Arial; font-size: 13px;">behavioral science</a><span style="background-color: white; font-family: Arial; font-size: 13px;"> and health insurance. </span><br style="font-family: Arial; font-size: 13px;" /><br style="font-family: Arial; font-size: 13px;" /><span style="background-color: white; font-family: Arial; font-size: 13px;">Primary and Preventive Health Care for Female Adolescents by the American College of Obstetricians and Gynecologists (ACOG) in November 1999. The guidelines were developed under the direction of the Committee on Adolescent Health Care and were based in part on the American Medical Association's GAPS, which itself was developed with representation from ACOG.</span><pre style="font-size: 13px;"> Bright Futures: Guidelines for
Guidelines for Adolescent
Health Preventive
Supervision of Services
Infants, Children, (GAPS)
and Adolescents
Developed by Department of American
Health and Medical
Human Services Association
Target Ages 11-21 years 11-21 years
Periodicity of Annual Annual
Visits
Suggested Components of Health Guidance
Sexual X X
Development
Breast/Testicular X
Self-Exam
Unintended X X
Pregnancy
Prevention
STD Prevention X X
Screening/Tests
Pap Test Sexually active Sexually active
teens, annually or age 18,
annually
STD Screening
Gonorrhea Sexually active Sexually active
teens, annually teens *
Chlamydia Sexually active Sexually active
teens, annually teens *
Syphilis High-risk teens High-risk
teens
Human Sexually active Sexually active
Papillomavirus teens, annually teens *
HIV High-risk teens High-risk
teens
Primary and
Preventive Health
Care for Female
Adolescents
Developed by American College
of Obstetricians
and
Gynecologists
Target Ages 13-20 years
Periodicity of Annual
Visits
Suggested Components of Health Guidance
Sexual X
Development
Breast/Testicular
Self-Exam
Unintended X
Pregnancy
Prevention
STD Prevention X
Screening/Tests
Pap Test Sexually active
teens or age 18,
annually
STD Screening
Gonorrhea Sexually active
teens, annually
Chlamydia Sexually active
teens, annually
Syphilis High-risk teens
Human Sexually active
Papillomavirus teens, annually
HIV High-risk teens
* Frequency of screening depends on the individual's sexual practices
and history of STDs.
Note: High risk is generally defined as a history of STDs, multiple
sexual partners, having had a sexual partner who is at risk of STDs,
history of having sex in exchange for money or drugs. Most of the
standards also include living in a geographic area with a high
incidence of syphilis as a risk factor for syphilis and a history of
intravenous drug use or having had a blood transfusion before 1985 as
a risk factor for HIV.</pre>
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Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-89298235874789488562013-10-30T18:36:00.002-07:002013-10-30T18:36:59.776-07:00Diseases caused by bacteria<h2>
<span style="color: blue; font-family: times, serif; font-size: 32px; text-align: -webkit-center;"><span style="font-weight: normal;"> </span><u style="font-style: italic; font-weight: bold;">Diseases caused by bacteria</u></span></h2>
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<span style="color: blue; font-family: times, serif; font-size: 32px; text-align: -webkit-center;"><u style="font-style: italic; font-weight: bold;"><br /></u></span></div>
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<span style="color: blue; font-family: times, serif; font-size: 32px; text-align: -webkit-center;"><u style="font-style: italic; font-weight: bold;"><br /></u></span></div>
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<div align="center">
with special reference to antibiotic resistance</div>
<a href="http://www.biotopics.co.uk/g11/bacterial_problems.html#" style="color: navy; text-decoration: none;"></a><div align="center">
<b><i>Staphylococcus aureus</i> ... <i>Streptococcus pneumoniae</i> ... <i>Klebsiella pneumoniae</i> ... <i>Escherichia coli (E. coli)</i> ...<br /><i>Enterococcus</i> spp. .. <i>Pseudomonas aeruginosa</i> .. <i>Clostridium difficile</i> ...</b></div>
<br /><i>For each organism, I have presented some information about its microscopic appearance and its characteristics in culture, together with background information - emphasising that even pathogenic bacteria have another side to them, some details of the diseases caused by these bacteria, and the modern problems caused as a result of the development of resistance to antibiotics.</i><br /><br /><a href="" name="Staphaureus"></a><h2 style="color: green; font-family: times, serif; font-size: 27px; margin: 0.5em 0px;">
<i>Staphylococcus aureus</i></h2>
- sometimes called <span style="color: green;" title="This is because it forms yellowish colonies when grown on agar (aureus means golden)
And don't be confused by the colour in the image below!
It shows purple in the Gram stain used for normal light microscopy">golden staph</span> <table align="left" border="0" cellspacing="10"><tbody>
<tr valign="top"><td width="400"><a href="http://www.biotopics.co.uk/g11/Staphaureus11153_lores.jpg" style="color: navy; text-decoration: none;"><img align="left" border="0" height="271" src="http://www.biotopics.co.uk/g11/Staphaureus11153_lores.jpg" title="Staphylococcus aureus false colour scanning electron micrograph
Click for a larger picture
Use browser 'back' arrow to return" width="350" /></a><br clear="all" /><div align="center">
<i>Image courtesy CDC/ Matthew J. Arduino, DRPH</i></div>
<br clear="all" /><br />This is a false colour scanning electron micrograph. Some of the cells can be seen to be preparing to divide. Staphylococci tend to cling together after dividing in different directions and so resemble a bunch of grapes.</td><td>To a bacteriologist,<i>Staphylococcus aureus</i> is a<span style="color: green;" title="It can turn from aerobic (using oxygen for respiration) to anaerobic in the absence of oxygen - inside the body">facultatively anaerobic</span> <span style="color: green;" title="It has a certain cell wall structure that stains purple with the Gram stain">Gram-positive</span> <span style="color: green;" title="This means it has spherical cells">coccus</span>.<br /><br />When cultured on blood agar it exhibits <span style="color: green;" title="It can break down red blood cells (in agar or in the body) releasing their contents for nutrients - especially iron in haemoglobin">haemolysis</span> and it tests<span style="color: green;" title="It can produce the enzyme coagulase which converts fibrinogen to fibrin in the blood plasma, perhaps preventing phagocyte action">coagulase-positive</span> and <span style="color: green;" title="It can produce the enzyme catalase which converts hydrogen peroxide (H2O2) to water and oxygen">catalase-positive</span>.</td><td><img border="0" hspace="20" name="Stapha" src="http://www.biotopics.co.uk/g11/staphbetadelta[1].jpg" title="Staphylococcus aureus on blood agar showing (beta) haemolysis" width="300" /><br clear="all" /><div align="center">
<i>Image courtesy The Royal Veterinary and Agricultural University of Copenhagen</i></div>
<br clear="all" />On this blood agar plate <i>Staphylococcus aureus</i>colonies show whitish grey and glistening.<br /><br /><i>Mouseover to see zones of <span style="color: green;" title="This is beta haemolysis - caused by rupture of the red blood cells, which shows as a halo on the culture plate">haemolysis</span>, visible when lit from below.</i></td></tr>
</tbody></table>
<br clear="all" /><h3 style="color: navy; font-family: times, serif; font-size: 22px; margin: 1em 0px 0.5em;">
Background information</h3>
<i>Staphylococcus aureus</i> is part of normal skin flora (possibly including nasal passages) in a large proportion of the human population, without causing problems to the carrier.<br /><br />It may be passed from person to person by direct contact or via surfaces, including door handles. It has been shown to persist on hospital privacy curtains. This underlines the importance of hand-washing and hygiene.<br /><br />It may cause disease if it enters an open wound and it can become a major problem for people with damaged or depressed immune systems, either from chronic disease, such as HIV, or in those undergoing chemotherapy, which represses the activity of the immune system.<br /><br />The related species <i>Staphylococcus <span style="color: green;" title="meaning of the epidermis - the outer layer of the skin">epidermidis</span></i> (used to be known as <i>S. <span style="color: green;" title="meaning white - the colonies are whitish on an agar plate">albus</span></i>) also exists on skin and may play a protective role against <i>S. aureus</i> in normal conditions.<h3 style="color: navy; font-family: times, serif; font-size: 22px; margin: 1em 0px 0.5em;">
Causes (disease):</h3>
<table border="0" summary=""><tbody>
<tr valign="top"><td><i>Staphylococcus aureus</i> may cause minor skin infections such as pimples and boils, but these may become deep-seated, causing abscesses etc.<br /><br />If it enters the blood it can cause a number of problems in the body: <span style="color: green;" title="invasion of the bloodstream by bacteria">bacteremia</span> and <span style="color: green;" title="sometimes known as blood poisoning">sepsis</span>, <span style="color: green;" title="caused by bacterial toxin, sometimes associated with tampons">toxic shock syndrome (TSS)</span>, <span style="color: green;" title="infection of the lung">pneumonia</span>, <span style="color: green;" title="inflammation of the meninges (protective membranes covering the brain and spinal cord)">meningitis</span>, <span style="color: green;" title="bone infection">osteomyelitis</span>, <span style="color: green;" title="inflammation of the endocardium (inner layer of the heart) usually involving the heart valves">endocarditis</span>.<br /><br />Some strains produce (entero)toxins which can cause food poisoning.<br /><br /><i>Staphylococcus aureus</i> is likely to cause problems in hospital patients:<ul>
<li>pressure sores due to inactivity in bed</li>
<li>surgical wounds after operations such as hip replacements or heart surgery</li>
<li>being treated with intravenous drips or urinary catheters</li>
</ul>
All of these offer opportunities for bacteria to enter the body from the skin surface and cause infection.</td><td width="250"><div align="center">
<img border="0" hspace="10" src="http://www.biotopics.co.uk/g11/Saureusabscess7826_lores.jpg" title="Skin abscess caused by Staphylococcus aureus" width="300" /></div>
<div align="center">
<i>Image courtesy CDC/ Bruno Coignard, M.D.; Jeff Hageman, M.H.S.</i></div>
This is a cutaneous (skin) abscess on the hip of a prison inmate, spontaneously releasing its contents as pus.</td></tr>
</tbody></table>
<h3 style="color: navy; font-family: times, serif; font-size: 22px; margin: 1em 0px 0.5em;">
Resistance Problems</h3>
<img align="left" border="0" height="157" hspace="10" src="http://www.biotopics.co.uk/g11/flemingplate.jpg" title="This is a photo of Alexander Fleming's original plate in which he accidentally discovered that a substance produced by the mould Penicillin will kill bacteria" width="151" />Before antibiotics were discovered, <i>Staphylococcus aureus</i> infections were frequently fatal. Originally <i>Staphylococcus aureus</i> bacteria were easily killed by penicillin, as shown by the zone of inhibition on this Petri dish from Alexander Fleming in 1928.<br /><br />Some bacteria <b title="The gene originally started due to a mutation, but was easily spread sideways to other bacteria as well as to offspring"><span style="color: green;">by chance</span></b> acquired the ability to break down and inactivate penicillin, using the enzyme <span style="color: green;" title="also known as ß-lactamase">penicillinase</span>, which breaks open the beta lactam ring. Since these penicillin-resistant strains were not killed by it, they reproduced and replaced the original (penicillin sensitive) strains of <i>Staphylococcus aureus</i>. These are not necessarily more aggressive pathogens, but more difficult to control.<br /><br />By the end of the 1950's penicillin resistance was a major problem,and spreading round the world. Several derivative compounds were developed for medicinal use, and categorised as beta lactamase sensitive or insensitive, depending on bacterial resistance to them.<br /><br />Methicillin was developed in the early 1960's, and fell into the beta lactamase insensitive category. It is no longer produced - having been displaced by flucloxacillin, and dicloxacillin - but it gives its name (or at least its initial) to one of the most well known "superbugs".<br /><br />The main current cause for concern is <b>MRSA</b>, a methicillin-resistant form of <i>Staphylococcus aureus</i>.<br /><br />There is some variation in abundance and <span style="color: green;" title="PVL MRSA (which produces a toxin that kills white blood cells) appears to spread easily and is community-related">virulence</span> of MRSA from country to country, as well as between community and hospital strains.<br /><br />It is also likely to be resistant to basic penicillin and more recently developed forms.<br /><br />Other antibiotics, e.g. <span style="color: green;" title="Already VRSA, or vancomycin-resistant S. aureus has emerged">vancomycin</span>, teicoplanin or linezolid, may be used to treat MRSA, but they need to be (a) injected, either directly into a vein or fed into the blood stream via a drip rather than by mouth and (b) given at quite a high dose. Treatment is likely to involve several weeks in hospital.<br /><br /><a href="" name="Streppneumoniae"></a><h2 style="color: green; font-family: times, serif; font-size: 27px; margin: 0.5em 0px;">
<i>Streptococcus pneumoniae</i></h2>
<table align="left" border="0" cellspacing="10"><tbody>
<tr valign="top"><td width="400"><div align="center">
<a href="http://www.biotopics.co.uk/g11/Streptococcus%20pneumoniae_2896_lores.jpg" style="color: navy; text-decoration: none;" title="Click for a larger image
Use browser 'back' arrow to return"><img border="0" src="http://www.biotopics.co.uk/g11/Streptococcus%20pneumoniae_2896_lores.jpg" width="350" /></a></div>
<br clear="all" /><div align="center">
<i>Image courtesy CDC/Dr. Mike Miller</i></div>
<br /><br />This is a photomicrograph of <i>Streptococcus pneumoniae</i>bacteria, grown in a liquid medium containing blood. It is a gram-stained preparation, seen using a light microscope. The bacteria can be seen as purple dots in short rows, and the pinkish strands are fibres of fibrin in the clotted blood.</td><td>Initially this organism was known as <i>Pneumococcus</i>, then renamed <i>Diplococcus pneumoniae</i> because it was commonly seen as pairs of cells in sputum from people infected with pneumonia. When grown in liquid media in the lab it forms chains so it is now known as<i>Streptococcus pneumoniae</i>.<br /><br />It was first isolated and described on 1881, by two pioneers of bacteriology working independently of one another: Louis Pasteur in France and George Miller Sternberg in America.<br /><br /><div align="left" title="This is a classical bit of the history of Biology which underpins molecular biology and genetics">
This organism was used to show the significance of DNA as the carrier of genetic information when the 'transforming principle' passed from a virulent but killed strain of bacteria (a 'smooth' form, with a capsule) to a non-virulent strain (a 'rough' form, with no capsule), as shown by experiments on mice. This transformation, discovered by Frederick Griffith in 1928, was proved in 1944 by Oswald Avery, Colin MacLeod, and Maclyn McCarty to be caused by DNA not protein.</div>
</td><td><div align="center">
<img border="0" height="200" src="http://www.biotopics.co.uk/g11/alphahaem[1].jpg" title="Streptococcus pneumoniae on blood agar plate showing alpha-haemolysis" width="201" /></div>
<br clear="all" /><br /><i>Streptococcus pneumoniae</i> is a gram-positive, catalase-negative coccus. It is said to be an aerotolerant anaerobe. When grown on agar containing blood it shows <span style="color: green;" title="This shows as a greenish colour under the colonies, caused by hydrogen peroxide produced by the bacterium reacting with haemoglobin to form a green compound">alpha haemolysis</span>.</td></tr>
</tbody></table>
<br /><br /><br clear="left" /><h3 style="color: navy; font-family: times, serif; font-size: 22px; margin: 1em 0px 0.5em;">
Background information</h3>
<i>Streptococcus pneumoniae</i> is very common and may be found in the back of the nose and throat, or the upper respiratory tract. Up to 40% of healthy adults and children show no adverse effects.<h3 style="color: navy; font-family: times, serif; font-size: 22px; margin: 1em 0px 0.5em;">
Causes (disease):</h3>
<i>Streptococcus pneumoniae</i> can be one cause of <span style="color: green;" title="Here it forms a hard mass within one or more lobes of the lung, away from the bronchioles">lobar pneumonia</span> (infection of the lung), especially in young adults. It is estimated that 25% of all community-acquired pneumonia is due to this species.<br /><br />Other forms of pneumonia may be caused by different bacteria including <i>Staphylococcus, Pseudomonas, Haemophilus, Chlamydia</i> and <i>Mycoplasma</i>, or by certain viruses, fungi or protozoans.<br /><br /><i>Streptococcus pneumoniae</i> may also cause infections of the <span style="color: green;" title="paranasal sinusitis">sinuses</span> or <span style="color: green;" title="otitis media">ears</span>. As a result, it may go on to cause bacterial <span style="color: green;" title="inflammation of the membranes covering the brain and spinal cord">meningitis</span>. It may also infect <span style="color: green;" title="osteomyelitis">bones</span> and<span style="color: green;" title="septic arthritis">joints</span> as well as <span style="color: green;" title="endocarditis, peritonitis, cellulitis and brain abscesses">internal organs</span>, especially in children and elderly people.<br /><br />It has quite a complex cell wall which tends to become attached to human cells, and produces several toxins which perforate cell membranes and cause tissue damage. There are many possible proteins in the bacterial cell wall and membrane, and abot 90 different strains or serotypes can be identified, allowing the monitoring of outbreaks but a mixed vaccine must be developed to deal with the most likely strains.<br /><br />Some strains have a capsule which makes them more virulent, and some have pili (hair-like structures that extend from the surface) which assist in the colonization of the upper respiratory tract. They also increase the formation of cytokines - signalling compounds produced by the immune system, and this causes tissue breakdown and allows invasive infection.<h3 style="color: navy; font-family: times, serif; font-size: 22px; margin: 1em 0px 0.5em;">
Resistance Problems</h3>
<i>S. pneumoniae</i> has a natural transformation system as a mechanism for genetic exchange (horizontal gene transfer) with related and unrelated species. It has been shown that genes coding for alterations in penicillin binding proteins have been passed in this way so that resistance to beta lactam antibiotics has quickly spread in the last 20 years.<br /><br />As it grows in numbers quite fast and achieves large populations when it causes infections, it achieves conditions which quickly lead to random mutations, the most advantageous of which are selected for and consequently get to dominate the population.<br /><br />Multiple antibiotic resistance now covers the globe and has rapidly increased since 1995.<br /><br /><a href="" name="Klebsiella"></a><h2 style="color: green; font-family: times, serif; font-size: 27px; margin: 0.5em 0px;">
<i>Klebsiella pneumoniae</i></h2>
<table align="left" border="0" cellpadding="10"><tbody>
<tr valign="top"><td><div align="center">
<img border="0" src="http://www.biotopics.co.uk/g11/Klebsiella.jpg" title="Klebsiella pneumoniae - Gram stained" width="350" /></div>
<br clear="all" /><div align="center">
<i>Klebsiella spp.</i> as seen under the light microscope</div>
</td><td><span style="color: green;" title="Not just K. pneumoniae"><i>Klebsiella</i> species</span> are <span style="color: green;" title="This means they do not actively move by swimming using flagella, for example">nonmotile</span>, <span style="color: green;" title="This shape - more of a dash than a (fishing?) rod - is called a bacillus - not a coccus which looks like a dot">rod-shaped</span>,<span style="color: green;" title="They do not retain the purple stain and stay pinkish">gram-negative</span>, catalase-positive, <span style="color: green;" title="does not contain cytochrome c oxidase and therefore either cannot utilize oxygen for energy production">oxidase-negative,</span> <span style="color: green;" title="meaning they can use lactose as a carbon source which is more available in the gut">lactose fermenting</span>, <span style="color: green;" title="meaning they can survive in the absence of oxygen">facultatively anaerobic</span> bacteria with a prominent polysaccharide <span style="color: green;" title="This provides defence against the body's defence mechanisms: mostly phagocytes, white cells that engulf and destroy foreign organisms">capsule</span>.<br /><br />The genus <i>Klebsiella</i> is named after Theodor Albrecht Edwin Klebs, a German-Swiss pathologist and microbiologist who identified the <span style="color: green;" title="Corynebacterium diphtheriae">bacterium causing diphtheria</span>.</td><td><div align="center">
<img border="0" height="288" src="http://www.biotopics.co.uk/g11/Klebsiellaplate.jpg" title="Klebsiella pneumoniae streaked on McConkey agar" width="288" /></div>
<br clear="all" /><i>Klebsiella pneumoniae</i> <span style="color: green;" title="Producing acid which reacts with neutral red in the agar">ferments lactose</span> and produces pink colonies on McConkey agar. The shiny (mucoid) colonies indicate the presence of the capsule.</td></tr>
</tbody></table>
<br clear="all" /><h3 style="color: navy; font-family: times, serif; font-size: 22px; margin: 1em 0px 0.5em;">
Background</h3>
<i>K. pneumoniae</i> is part of normal skin, mouth and gut flora - no problem to most healthy people.<h3 style="color: navy; font-family: times, serif; font-size: 22px; margin: 1em 0px 0.5em;">
Causes (disease)</h3>
When <i>K. pneumoniae</i> colonises the respiratory system it can cause <b>bronchopneumonia</b> or bronchial pneumonia - as distinct from lobar pneumonia (<i>see above</i>). This results in the acute inflammation of the walls of the bronchioles (small air passages leading from the windpipe and bronchi towards the alveoli: the terminal air sacs) and consequent congestion with pus. Usually there are several sites of infection, on both lungs.<br /><br />Endotracheal intubation (insertion of a tube into the windpipe to assist breathing) sometimes results in this infection.<br /><br />Bronchopneumonia may also be caused by <i>Staphylococcus aureus</i>, <i>E. coli</i>, and <i>Pseudomonas</i>.<br /><br /><i>Klebsiella pneumoniae</i> can also cause urinary tract infections often associated with catheters (UTIs) as well as infecting surgical wound sites.<h3 style="color: navy; font-family: times, serif; font-size: 22px; margin: 1em 0px 0.5em;">
Resistance problems</h3>
In healthcare settings, <i>Klebsiella</i> infections commonly occur among sick patients who are receiving treatment for other conditions, especially those with a weakened immune system or on long courses of certain antibiotics. Patients on ventilators (breathing machines) or intravenous (vein) catheters, and urinary catheters are most at risk for <i>Klebsiella</i> infections.<br /><br />Some <i>Klebsiella</i> strains have become highly resistant to antibiotics, especially carbapenems which are the last line of defence against Gram-negative infections</div>
<div>
<br /><a href="" name="Ecoli"></a><h2 style="color: green; font-family: times, serif; font-size: 27px; margin: 0.5em 0px;">
<i>Escherichia coli (E. coli)</i></h2>
<table border="0" summary=""><tbody>
<tr valign="top"><td width="50%"><div align="center">
<img border="0" src="http://www.biotopics.co.uk/g11/10068_loresEcolio157.jpg" title="Escherichia coli (E. coli)
Enteropathogenic strain (colourized scanning electron micrograph)" width="350" /><br clear="all" /><br /><i>Image courtesy CDC/ National Escherichia, Shigella, Vibrio Reference Unit at CDC</i></div>
<br />This is a colourized scanning electron micrograph (SEM) depicting a number of Gram-negative <i>Escherichia coli</i> bacteria of the strain O157:H7.<br /></td><td><div align="center">
<img border="0" height="268" src="http://www.biotopics.co.uk/g11/EcoliGram.jpg" title="Gram stain of an E. coli smear" width="375" /><br clear="all" /><br /><i>Escherichia coli</i> as seen under the light microscope</div>
</td></tr>
</tbody></table>
<i>Escherichia coli</i> is widely known as <i>E. coli</i>, although scientific names should not be abbreviated until they have been stated once in full.<br />In the past it has been called <i>Bacterium coli</i> and <i>Bacillus coli</i>, but it was (re-)named after Theodor Escherich, a leading German bacteriologist in the field of paediatrics, who first described it in 1886. The specific part of the binomial name "coli" means " of the colon" - the large intestine (also known as the bowel).<br /><br />It has been widely used in laboratories for over 60 years because it is easy to grow and offers little danger of infection, and it has been extensively used in virology and recombinant DNA work.<br /><br />As it leaves the body in faeces and can survive for some time afterwards, it serves as an indicator of faecal contamination of the environment and foods. A number of microbiological test procedures have been developed for this purpose. It lends itself to tests involving selective media based on recreating conditions within the colon.<br /><br />It is a Gram-negative, <span style="color: green;" title="It can turn from aerobic (using oxygen for respiration) to anaerobic in the absence of oxygen - inside the body">facultatively anaerobic</span>, <span style="color: green;" title="This shape is called a bacillus">rod-shaped</span> bacterium. It is non-sporulating i.e. it does not produce spores.<br /><br /><div align="left" title="Not that I could find any pictures of them!">
Some strains are motile i.e they possess flagella, which are described as peritrichous i.e. projecting outwards all round the surface of the cell wall.</div>
<h3 style="color: navy; font-family: times, serif; font-size: 22px; margin: 1em 0px 0.5em;">
Background information</h3>
There are many strains of <i>E. coli</i>.<br /><br />The harmless strains are part of the normal flora of the gut. It is said that they are beneficial in that they produce vitamin K2, and that they prevent the establishment of pathogenic bacteria within the intestine - an effect that may be counteracted if antibiotics are used for treating other bacterial conditions. <br /><br />Interestingly,<i> E. coli </i>is one of the first bacteria to colonise the gut of new-born children, but not those born by Caesarean section.<h3 style="color: navy; font-family: times, serif; font-size: 22px; margin: 1em 0px 0.5em;">
Disease caused by <i>E. coli</i></h3>
<span style="color: green;" title="Enteropathogenic means causing disease of the gut">Enteropathogenic</span> forms of <i>E.coli</i> have recently become more well known than the "ordinary" forms. These cause severe stomach cramps, diarrhoea (often bloody), and vomiting and perhaps slight fever. They produce a toxin that can attack the body in several areas: the gut (causing bloody diarrhoea), the kidneys (causing kidney failure), and sometimes the nervous system.<br /><br />One strain in particular (known as O157, O157 H7, <span style="color: green;" title="Shiga toxin-producing” E. coli">STEC</span>, <span style="color: green;" title="verocytotoxic E. coli">VTEC</span> or <span style="color: green;" title="enterohemorrhagic E. coli">EHEC</span>) has been responsible for most problems i.e outbreaks of “<i>E. coli</i>” infections around the world, first noted in 1982. In addition, other kinds of <i>E. coli</i> (called serogroups) can cause disease of varying seriousness. These serotypes are based on <span style="color: green;" title="a chemical component - often a protein - that cause the production of different antibodies">antigens</span>associated with various components: (O: outer <span style="color: green;" title="lipopolysaccharide">cell wall</span> layer, H: flagellin, K: capsule).<br /><br />A recent outbreak in Germany was caused by a strain now known as O104:H4 from contaminated seed sprouts.<br /><br />The faecal-oral transmission route is the main way in which pathogenic strains of the bacterium cause disease.<br /><br />Many incidences of holiday diarrhoea have been attributed to it, especially after consuming food which has been contaminated with faeces, either in preparation following poor lavatory hygiene or as a result of the application of (animal or other) manure to land on which crops are grown. Salads are especially suspect in this respect. Unpasteurized (raw) milk, soft cheeses made from raw milk and undercooked beefburgers are common sources of infection, as well as swallowing lake water while swimming, visiting petting zoos and other animal exhibits.<h3 style="color: navy; font-family: times, serif; font-size: 22px; margin: 1em 0px 0.5em;">
Resistance problems</h3>
Digestive system infections are not treated with antibiotics; recent strains e.g O104:H4 are resistant to most antibiotics. This is likely to be due to previous "environmental" exposure to them.<br /><br />Infections within other areas of the body can cause a variety of problems:<ul>
<li>urinary tract infections (UTIs), which may lead to:</li>
<li>bacteremia (presence of bacteria in the blood - not quite the same as "blood poisoning")</li>
<br />- this may lead to:<br />
<li><i>E. coli</i> pneumonia (bronchopneumonia of the lower lobes) - especially in patients weakened by other conditions e.g. diabetes mellitus, alcoholism, chronic obstructive pulmonary disease</li>
<li>cholecystitis - inflammation of the gallbladder</li>
<li>acute bacterial meningitis in newborn children (may also be caused by group B streptococcal infections)</li>
</ul>
Urinary tract infections by <i>E. coli</i> are more common in females than in males because the ureter is shorter and nearer to the anus and is associated with pregnancy and childbirth.<br /><br />Some strains possess P fimbriae (many short proteinaceous appendages) that are used to adhere to human body cells, especially epithelial cells of the urinary tract.<br /><br />Trimethoprim is the drug of first choice for the treatment of uncomplicated urinary tract infections although 10-20% of <i>E. coli</i> infections will be resistant to it. Other antibiotics which may be used as first-line agents if a patient is allergic to trimethoprim include nitrofurantoin and cefalexin. Amoxicillin is not used routinely as 50% of organisms will be resistant to it.<br /><a href="" name="Entero"></a><h2 style="color: green; font-family: times, serif; font-size: 27px; margin: 0.5em 0px;">
<i>Enterococcus spp.</i></h2>
<table border="0" summary=""><tbody>
<tr valign="top"><td><div align="center">
<img border="0" src="http://www.biotopics.co.uk/g11/Enterococci209_lores.jpg" width="350" /></div>
<div align="center">
<i>Image courtesy CDC/ Janice Haney Carr</i><br />This is a monochrome (uncoloured) scanning electromicrograph.</div>
</td><td>Enterococci are facultatively anaerobic Gram-positive cocci. In culture media they do not show haemolysis. The most clinically relevant of these bacteria are <i>E. faecalis</i> and <i>E. faecium</i>.<br /><br />The term enterococci may be used in a general sense to mean round-shaped bacteria (cocci) found in the gut, but if used as a Genus (<i>Enterococcus spp.</i>), it should be italicised.<br /><br />They were previously categorised as "Group D" <i>Streptococcus</i> organisms.</td></tr>
</tbody></table>
<h3 style="color: navy; font-family: times, serif; font-size: 22px; margin: 1em 0px 0.5em;">
Background information</h3>
<i>Enterococcus</i> spp. are said to be commensal, inhabiting the gastrointestinal tracts of humans. As such, they are not a problem unless complications arise following surgery or deterioration in health.<h3 style="color: navy; font-family: times, serif; font-size: 22px; margin: 1em 0px 0.5em;">
Disease caused by <i>Enterococcus</i> spp.</h3>
<i>Enterococcus</i> spp. from a patient's intestine can spread to other parts of the body, often causing urinary tract infection, infection within the abdomen, and infection of operational wound sites. From here it can spread and cause infections in a number of areas such as endocarditis.<h3 style="color: navy; font-family: times, serif; font-size: 22px; margin: 1em 0px 0.5em;">
Antibiotic Resistance problems</h3>
Enterococci from the gut are commonly found to have resistance to a variety of antibiotics and thus treatment of supplementary infections in the hospital setting presents a challenge.<br /><br />The current focus of attention is on vancomycin-resistant Enterococci (VRE).<br /><br />A number of resistance genes are known; these are carried on plasmids or transposons.<br /><br /><a href="" name="Psaer"></a><h2 style="color: green; font-family: times, serif; font-size: 27px; margin: 0.5em 0px;">
<i>Pseudomonas aeruginosa</i></h2>
<table border="0" summary=""><tbody>
<tr valign="top"><td><a href="http://www.biotopics.co.uk/g11/Ps_aeruginosa10043_lores[1].jpg" style="color: navy; text-decoration: none;" title="Click for a larger image
Use browser 'back' arrow to return"><img alt="Pseudomonas aeruginosa" border="0" src="http://www.biotopics.co.uk/g11/Ps_aeruginosa10043_lores[1].jpg" title="Click for a larger image
Use browser 'back' arrow to return" width="350" /></a><br /><div align="center">
<i>Image courtesy CDC/ Janice Haney Carr</i></div>
This is another false colour scanning electron micrograph.</td><td><i>Pseudomonas aeruginosa</i> - also known as <i>Pseudomonas pyocyanea</i> - is a <span style="color: green;" title="It goes a pink colour when Gram stained">Gram-negative</span>, <span style="color: green;" title="It normally respires using oxygen">aerobic</span> or<span style="color: green;" title="It can survive in conditions of partial or total oxygen depletion">facultatively anaerobic</span>, <span style="color: green;" title="i.e a bacillus">rod-shaped bacterium</span>. It is <span style="color: green;" title="This means it can move, using a single flagellum at one end of the cell (polar flagellation)">motile</span>. When grown on certain types of agar in the laboratory, it produces <span style="color: green;" title="Pyo means pus and cyan is a blue-green colour which explains the pigment pyocyanin">green pigments</span>.<br /><br />The genus name <i>Pseudomonas</i> means 'false unit', although it might be an attempt to distinguish it from another organism living in water, probably a protoctistan. The species name <i>aeruginosa</i> refers to the blue-green pigment produced in culture.</td></tr>
</tbody></table>
<h3 style="color: navy; font-family: times, serif; font-size: 22px; margin: 1em 0px 0.5em;">
Background information</h3>
<i>Pseudomonas aeruginosa</i> is widely distributed in the environment - in soil and water, especially stagnant water. It may be found on the surface of human skin and may be said to be part of the normal skin flora for some people.<br /><br />Because it is quite flexible in its nutrition and respiration, it can colonise many areas around the home and hospital, and (non-sterile areas) inside the human body. This is seen as less of a problem than growth of <i>P. aeruginosa</i> in normally sterile areas.<h3 style="color: navy; font-family: times, serif; font-size: 22px; margin: 1em 0px 0.5em;">
Disease caused by <i>Pseudomonas aeruginosa</i></h3>
Under some circumstances <i>Pseudomonas aeruginosa</i> may cause infections in the body. It may be considered as an opportunistic, nosocomial pathogen of immunocompromised individuals, including premature and newly-born babies.<br />These infections commonly involve the pulmonary tract, <span style="color: green;" title="Especially complications following catheterisation">urinary tract infections</span>, burns, wounds, and other blood infections<br /><br />It also commonly affects those with the condition <b>cystic fibrosis</b>, in which thick mucus in the lungs restricts diffusion of oxygen, providing conditions which favour its growth.<br /><br /><i>P. aeruginosa</i> may also cause Hot tub folliculitis - a skin rash caused by bacterial growth in hair follicles, when hygiene falls due to inadequate treatment of water in these environments, and it has also been implicated in osteomyelitis due to puncture wounds of the foot, resulting in direct inoculation with <i>P. aeruginosa</i> via the foam padding found in tennis shoes.<h3 style="color: navy; font-family: times, serif; font-size: 22px; margin: 1em 0px 0.5em;">
Antibiotic resistance problems</h3>
<i>Pseudomonas aeruginosa</i> is not easily controlled by antibiotics, because it is Gram-negative and has a fairly impermeable outer layer (envelope) and it can also turn on <span style="color: green;" title="The MexXY-OprM multidrug efflux system">"pumps"</span> that remove antibiotics from the cell.<br /><br />Additionally, it may benefit both physically and geneticaly from the formation of biofilms within the body.<br /><br /><i>P. aeruginosa</i> is generally controllable by the use of certain antibiotics, although the classically-used examples are ineffective.<br /><br />The Health Protection Agency suggests the use of third generation cephalosporins (ceftazidime), carbapenems (imipenem and meropenem), aminoglycosides (gentamicin and tobramycin) and colistin. For serious infections, broad-spectrum penicillins are recommended in combination with an aminoglycoside.<br /><br /><a href="" name="Cdiff"></a><h2 style="color: green; font-family: times, serif; font-size: 27px; margin: 0.5em 0px;">
<i>Clostridium difficile</i></h2>
<table border="0" cellspacing="10"><tbody>
<tr valign="top"><td><div align="center">
<img alt="Clostridium difficile" border="0" height="271" src="http://www.biotopics.co.uk/g11/Cdiff6252_lores[1].jpg" width="400" /></div>
<br /><div align="center">
<i>Image courtesy CDC/ Lois S. Wiggs & Janice Carr</i></div>
</td><td><i>Clostridium difficile</i> is a <span style="color: green;" title="It stays a purple colour when Gram stained">Gram-positive</span>, <span style="color: green;" title="it can respire in the absence of oxygen">anaerobic</span> <span style="color: green;" title="In its cytoplasm it can form endospores which withstand heat and chemicals">spore-forming</span> <span style="color: green;" title="This shape is called a bacillus, although anaerobic bacteria are put into the genus Clostridium">rod-shaped bacterium</span>.<br /><br /><div align="left" title="Originally it meant difficult to grow in the laboratory (it requires absence of oxygen), but it is now known to be also difficult to control in a clinical setting">
Its specific name (<i>difficile</i>) - meaning difficult - may be pronounced in a number of ways, depending on different styles of Latin or even French.</div>
<br /><div align="left">
Being anaerobic spore-formers, <i>Clostridium</i> species are in a category of their own. They also produce toxins which have adverse effects on the human body. Other members of the genus<i>Clostridium</i> cause <span style="color: green;" title="This produces a neurotoxin which causes muscle spasm - it can cause death by failure of respiratory muscles">tetanus (jockjaw)</span>, <span style="color: green;" title="This is an aggressive form of food poisoning, leading to muscle paralysis resulting from bacterial toxins">botulism</span>, and <span style="color: green;" title="This is a form of necrosis - progressive muscle death caused by bacterial toxins">gangrene</span>.<br /><br />Most bacteria form only <span style="color: green;" title="This means they simply grow in number but do not become specialised in any way.">vegetative cells</span>, and although they grow quickly and can cause different sorts of problems inside the body, outside the body they are easily killed by exposure to reasonably high temperature, dry conditions, and certain sorts of chemicals - antiseptics and disinfectants.<br /><br />The spores formed by <i>Clostridium</i> species are extremely resistant to these conditions, and remain viable for months or years. In fact these spores can withstand exposure to high temperatures and strong disinfectant chemicals.<br /><br />As anaerobic organisms, they can cause problems within the body as they can respire, function and reproduce in parts of the body that are not well supplied with oxygen, such as in the gut or deep within muscles.</div>
</td></tr>
</tbody></table>
<h3 style="color: navy; font-family: times, serif; font-size: 22px; margin: 1em 0px 0.5em;">
Background information</h3>
<i>Clostridium difficile</i> bacteria are naturally found in the gut of some people, probably kept under control by the activities of other harmless bacteria there - it may be called <span style="color: green;" title="This means sharing the same table - i.e. living alongside others">commensal</span>. Some cells of <i>Clostridium difficile</i> are transformed into spores, which will leave the body in faeces and on underclothes and bedclothes, but presumably these do not cause any further problems for these people. The spores of <i>C. difficile</i> can survive in the environment in a state of suspended animation for months or years.<h3 style="color: navy; font-family: times, serif; font-size: 22px; margin: 1em 0px 0.5em;">
Disease caused by <i>Clostridium difficile</i></h3>
In the hospital or other healthcare environment spores may be spread from one patient to another, perhaps when bedclothes are changed. Spores of <i>Clostridium difficile</i> entering the body can germinate and the resulting vegetative bacterial cells can grow in number. This may cause flu-like symptoms or (mild?) colitis.<br /><br /><div align="left" title="This is not an issue of antibiotic resistance">
However, if antibiotics are administered, they may eliminate other competing micro-organisms in the gut, causing unchecked growth of <i>C. difficile</i>. In this context cephalosporins and in particular quinolones and clindamycin are considered to be high risk antibiotics.<br /><br />Growth of <i>C. difficile</i> may cause more severe diarrhoea - the condition being known as antibiotic-associated diarrhoea (AAD). Toxins from <i>C. difficile</i> can cause severe inflammation of the colon - pseudomembranous colitis may result. This may be treated using completely different antibiotics.</div>
<h3 style="color: navy; font-family: times, serif; font-size: 22px; margin: 1em 0px 0.5em;">
Antibiotic Resistance problems</h3>
<i>Clostridium difficile</i> strains resistant to clindamycin and to fluoroquinolone antibiotics (ciprofloxacin and levofloxacin) have been reported in the USA. </div>
<div>
<span style="color: blue; font-family: times, serif; font-size: 32px; font-weight: bold; text-align: -webkit-center;"><i><u><br /></u></i></span></div>
<div>
<span style="color: blue; font-family: times, serif; font-size: 32px; font-weight: bold; text-align: -webkit-center;"><i><u><br /></u></i></span></div>
Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-1541541950685595262013-10-23T04:55:00.000-07:002013-10-23T04:55:04.910-07:00Bottle feeding linked to stomach obstruction in infants<strong>New research says that bottle feeding appears to increase the
risk of babies developing hypertrophic pyloric stenosis, a form of
stomach obstruction characterized by severe and frequent projectile
vomiting and most common among infants in their first 2 months of life. </strong><br />
Surgery, called pyloromyotomy, may be needed to clear the hypertrophic
pyloric stenosis (HPS), which occurs when the smooth muscle layer of the
pylorus (the "gateway" between the stomach and small intestines)
thickens.
<br />
Dr. Jarod P. McAteer from Seattle Children's Hospital and colleagues say
in the study that although this is a fairly common condition - it
occurs in approximately 2 in 1,000 births - the cause remains unknown.
<br />
This study, published in <em>JAMA Pediatrics</em>, sets out to establish
if bottle feeding during early infancy increases the risk of developing
HPS, and if so, how the risk is modified by other factors.
<br />
<h2>
Largest study to date</h2>
The study reports that breastfeeding became a target of interest in the
1980s, as researchers noted that an upsurge in the breastfeeding rates
coincided with a decrease in the number of cases of HPS.
<br />
The doctors claim that this study analyzes the largest group of HPS patients with data on infant feeding practices yet studied.
<br />
The researchers collected data from Washington State birth certificates
and hospital discharge data between January 1, 2003, and December 31,
2009.
<br />
<strong></strong><strong>
Participants in the study had to be singleton babies under 6 months old
who had been both diagnosed with HPS and undergone corrective surgery. </strong>
<br />
During the time period selected, researchers identified 714 such infants
and matched them to "control" babies - ones without HPS.
<br />
The researchers do note that as the study is observational, all
associations should be interpreted "with caution." They also point out
the data of how a baby was fed is based on information provided when the
mother and baby were discharged from the hospital.
<br />
Some babies who were breastfed initially could have switched to bottle
feeding (or vice versa) prior to developing HPS, the researchers say.
<br />
There are many reasons why mothers stop breastfeeding their babies,
including cracked and sore nipples or mastitis. A report, published by UNICEF, reports that 60% of women did not manage to breastfeed for as long as they would have wanted. <br />
Another potential pitfall in this research is that babies bottle-fed
expressed milk are coded as bottle-fed in the data, so interpretations
regarding formula milk versus breast milk may also be skewed.
<br />
<h2>
Bottle feeding 'may play a role in HPS'</h2>
The researchers found that the incidence of HPS decreased from 14 per
10,000 births in 2003 to 9 per 10,000 births in 2009. They note that the
popularity of breastfeeding also increased during that time from 80%
in 2003 to 94% in 2009.
<br />
The study revealed that bottle-fed infants were more likely to develop
HPS, compared with controls (19.5% vs. 9.1%). The odds of an infant
developing HPS also increased if they were male, and when mothers were
35 years and older and multiparous (having given birth more than once
before.).
<br />
The study concludes:
<br />
<blockquote>
"These data suggest that bottle feeding may play a role in HPS etiology,
and further investigations may help to elucidate the mechanisms
underlying the observed effect modification by age and parity."
</blockquote>
In an accompanying editorial, Dr. Douglas C. Barnhart from the Primary Children's Hospital, Salt Lake City, writes:
<br />
<strong>
"While the data seem convincing that bottle feeding increases the risk, the reason is not clear."
</strong><br />
"Further understanding of the pathogenesis of hypertrophic pyloric
stenosis will come from both basic research and more detailed
epidemiologic studies," Barnhart concludes.
<br />
Dr. McAteer and his colleagues agree, adding:
<br />
"Further studies are warranted to validate these findings and to look
more closely at the speculative mechanisms, including possible hormonal
effects, underlying the bottle feeding-HPS association."
<br />
Written by Abdul Samad Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-72569117316734721662013-10-23T04:52:00.000-07:002013-10-23T04:52:05.153-07:00Lack of sleep may increase Alzheimer's risk
<strong>A new study suggests that reduced sleep and poor sleep quality
may be linked to increased build-up of beta-amyloid plaques in the
brains of older adults - a sign of Alzheimer's disease. This is
according to a study published in the journal <em>JAMA Neurology</em>.</strong>
<br />
<br />
Researchers from The Johns Hopkins Bloomberg School of Health say that
previous research has linked disturbed sleep to cognitive impairment in
older individuals.
<br />
They note that those with Alzheimer's disease
(AD) have been shown to spend more time awake and have higher levels of
fragmented sleep, compared with those who do not have the disorder.
<br />
Sleep patterns have previously been linked to beta-amyloid plaques.
Research has indicated that changes in beta-amyloid levels may be
regulated by sleep-wake patterns, the researchers say.
<br />
Therefore, they wanted to determine whether there is a link between
beta-amyloid deposition and sleep variables within community-dwelling
older adults.
<br />
The research team analyzed data from 70 adults with a mean age of 76
years, taken from the Baltimore Longitudinal Study of Aging. All
participants were free of any form of dementia.
<br />
The participants were required to self-report their sleep patterns,
disclosing the mean hours of sleep they had each night, how often they
woke throughout the night, whether they had trouble falling asleep and
whether they woke earlier than planned.
<br />
Their beta-amyloid deposition in the brain was measured using various brain imaging techniques.<br />
<h2>
Lack of sleep 'increases beta-amyloid deposition'</h2>
The participants reported sleep duration ranging from no more than 5 hours, to more than 7 hours each night.
<br />
<strong>When comparing sleep duration with brain imaging showing the
participant's beta-amyloid deposition, it was found that shorter overall
nights' sleep duration and poor sleep quality were linked to increased
beta-amyloid build-up.</strong>
<br />
However, the researchers note that the number of times a person woke
during the night was not linked to an increase in beta-amyloid build-up.
<br />
The study authors say:<br />
<blockquote>
"Our results are consistent with those from animal
research in which sleep deprivation increased interstitial fluid
beta-amyloid levels.
<br />
These studies raise the possibility that poor sleep may promote
beta-amyloid deposition, but they also raise questions about the
mechanisms linking sleep/wake patterns and beta-amyloid burden."</blockquote>
<h2>
Promoting healthy sleep 'may offset AD risk'</h2>
The researchers add that these findings could have significant public
health implications, noting that AD is the most common form of dementia
and almost half of older adults with the disorder report insomnia-based
symptoms.
<br />
<strong>"Because late-life sleep disturbance can be treated,
interventions to improve sleep or maintain healthy sleep among older
adults may help prevent or slow AD to the extent that poor sleep
promotes AD onset and progression," the study authors say.</strong>
<br />
"This result would have a substantial effect on the independence and
quality of life of older adults and their families and on the
significant health care costs associated with AD."
<br />
The researchers conclude that intervention trials are warranted in order
to determine whether longer sleep duration and better sleep quality may
prevent or slow the progression of Alzheimer's disease.
<br />
Research into beta-amyloid deposition in the brain continues. <em>Medical News Today</em> reported earlier this month that researchers from the University of Rochester have suggested sleep "detoxes" the brain by flushing out the waste products of neural activity.
Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-87567368911199334662013-10-23T04:49:00.002-07:002013-10-23T04:49:57.536-07:00Insufficient vitamin D may raise anemia risk in childrenThe researchers report their study, the first to comprehensively explore the link between low vitamin D and anemia
in children, in a recent online issue of the <em>Journal of Pediatrics</em>.<br />
They say the results highlight the complex relationship between vitamin D and hemoglobin, the protein
that holds oxygen in red blood cells.<br />
They suggest that low vitamin D might be linked to anemia via several
mechanisms, for example, the link might be the way the vitamin affects
the production of red blood cells in bone
marrow. Or it could be vitamin D's role in regulating immune inflammation, which is known to trigger anemia.<br />
<strong>Anemia, a condition where the body does not have enough oxygen-carrying red blood cells, is thought to affect around
20% of children at some point in their lives.</strong><br />
And several large studies estimate that nearly 7 out of 10 American children do not have enough vitamin D, with
around 1 in 10 suffering from severe deficiency.<br />
<h2>
'Double the anemia risk'</h2>
For their study, the team looked for links between vitamin and hemoglobin in the blood samples of over 10,400
children and adolescents (aged between 1 and 21 years) who took part in the 2001-2006 National Health and Nutrition
Examination Survey (NHANES).<br />
<strong>They found children with low hemoglobin levels consistently
had lower levels of vitamin D, compared with children who had normal
hemoglobin levels.</strong><br />
Children whose vitamin D levels were below 30 nanograms per milliliter (ng/ml), defined as mild vitamin D
deficiency, had nearly double the risk of anemia than counterparts with normal vitamin D levels.<br />
When they examined the results by race, they found black children had higher rates of anemia compared with white
children, and much lower vitamin D levels overall, but their risk of anemia did not increase until their vitamin D
levels were much lower than those of white children.<br />
Lead investigator Dr. Meredith Atkinson, a pediatric kidney specialist at the Johns Hopkins Children's Center,
says:<br />
<h3>
"The clear racial variance we saw in our study should serve as a
reminder that what we may consider a pathologically
low level in some may be perfectly adequate in others, which raises some
interesting questions about our current one-size-fits-all approach to
treatment and supplementation."</h3>
It is important to treat chronic anemia and vitamin D deficiency as they can lead to a range of health consequences,
including organ damage, bone deformities and frequent fractures, as well as early development of osteoporosis later on
in life.<br />
The authors note that as well as being important for healthy bones, there is also evidence that vitamin D plays
other roles - recent studies have found low levels of the vitamin are linked to cancer, heart disease and suppressed
immunity.<br />
<h3>
</h3>
Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-35602419831342939302013-10-23T04:47:00.001-07:002013-10-23T04:47:25.763-07:00Baldness cure a step closer with promising new treatmentThe team, from Columbia University Medical Center in the US and Durham University in the UK, says their technique
generates new human hair growth, rather than simply redistributing hair follicles from one part of the scalp to
another.<br />
In a study they report online this week in the <em>Proceedings of the National Academy of Sciences (PNAS)</em>, they
describe how they tested their new approach on mice - by growing hairs on human skin grafted onto the animals.<br />
Current hair transplant treatments relocate hair follicles from one part of the head to another, usually from the
back to the front. This redistributes rather than increases hair follicles and is a lengthy process that can take all
day in the clinic and leaves a large scar.<br />
The new approach would actually increase the number of hair cells able to produce hair. It would take fewer hair
cells (leaving a much smaller scar), grow them in a lab culture, then transplant the multiplied cells back into the
bald or thinning parts of the patient's scalp.<br />
If it leads to clinical success, the technique could benefit not only men in early stages of baldness, but also
women with hair loss, who are mostly unable to use current transplant treatments because of insufficient donor
hair.<br />
Co-lead author Angela M. Christiano, the Richard and Mildred Rhodebeck Professor of Dermatology and professor of
genetics & development at Columbia, explains:<br />
<blockquote>
"This method offers the possibility of inducing large numbers of hair follicles or rejuvenating existing hair
follicles, starting with cells grown from just a few hundred donor hairs. It could make hair transplantation available
to individuals with a limited number of follicles, including those with female-pattern hair loss, scarring alopecia,
and hair loss due to burns."</blockquote>
<h2>
New hair growth in mice</h2>
The idea of cloning hair follicles has been around for decades. Scientists already know that dermal papilla cells,
that are found inside the hair follicles, can give rise to new follicles.<br />
<div class="photobox_right" style="max-width: 350px;">
<img alt="Man going bald" height="265" src="http://www.medicalnewstoday.com/images/articles/267732-baldness.jpg" width="400" /><br />
<i>A new technique that involves cloning dermal papillae and
transplanting them in tissue culture has resulted in the successful
growth of new human hair, results which could transform hair-loss
treatment.</i>
</div>
But attempts to make this happen tend to hit
brick walls, as co-lead author Colin Jahoda, professor of stem cell sciences at Durham and co-director of North East
England Stem Cell Institute, explains:<br />
"However, once the dermal papilla cells are put into conventional, two-dimensional tissue culture, they revert to
basic skin cells and lose their ability to produce hair follicles. So we were faced with a catch-22: how to expand a
sufficiently large number of cells for hair regeneration while retaining their inductive properties."<br />
They found their way out of the catch-22 when they observed how hair grows on mice and other rodents. Prof. Jahoda,
one of the early founders of stem cell sciences, has been working on methods of harvesting, expanding and successfully
transplanting rodent skin cells back into their skin for years.<br />
From observing this process over the years, the researchers developed a hunch that one reason rodent hair
transplants easily is because once they are in culture, rodent skin papillae tend to spontaneously aggregate, unlike
human papillae.<br />
<strong>They reasoned that the clumps of rodent skin papillae were somehow creating their own environment, allowing them to
interact and send signals in a way that reprogrammed the recipient skin to grow new follicles.</strong><br />
So they tested their idea by harvesting dermal papillae from seven human donors and cloned them in tissue culture -
without adding any additional growth factors.<br />
Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-30765257983853296432013-10-23T04:45:00.001-07:002013-10-23T04:45:17.111-07:00Importance of Oatmeal<b>Oatmeal</b> is meal made from rolled or ground oats, or porridge made
from ground or rolled oats. In the United Kingdom and the Republic of
Ireland, the term "porridge" or "porridge oats" are common terms for the
breakfast cereal that is usually cooked.<br /><br />
Interest in oatmeal has increased considerably over the last twenty years because of its health benefits.<br /><br />
Studies have shown that if you eat a bowl of oatmeal everyday your blood
cholesterol levels, especially if they are too high, will drop, because
of the cereal's soluble fiber content. When findings were published in
the 1980s, an <i>"oat bran craze"</i> spread across the USA and Western Europe. The oats craze dropped off in the 1990s.<br /><br />
In 1997, the FDA (Food and Drug Administration) agreed that foods with
high levels of rolled oats or oat bran could include data on their
labels about their cardiovascular heart benefits if accompanied with a
low-fat diet. This was followed by another surge in oatmeal popularity.<br /><br />
Oats is rich in complex carbohydrates, as well as water-soluble fiber,
which slow digestion down and stabilize levels of blood-glucose.<br /><br />
Oatmeal porridge is very rich in B vitamins, omega-3 fatty acids, folate, and potassium.<br /><br />
<img alt="Oatmeal" src="http://upload.wikimedia.org/wikipedia/commons/thumb/3/39/Oatmeal.jpg/512px-Oatmeal.jpg" width="512" /><br />
<i>Coarse or steel-cut oats contain more fiber than instant varieties.</i>Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-27656008293705342602013-10-23T04:44:00.001-07:002013-10-23T04:44:16.058-07:00Importance of AvocadosMany people avoid <b>avocados</b> because of its high fat content; they believe that avoiding all fats leads to better health and easier-to-control body weight - this is a myth. Approximately 75% of the calories in an avocado come from fat; mostly monosaturated fat.<br /><br />
<img alt="Alpukat" src="http://upload.wikimedia.org/wikipedia/commons/thumb/f/f4/Alpukat.jpg/512px-Alpukat.jpg" width="512" /><br />
<i>Weight-for-weight, avocadoes have 35% more potassium than bananas.</i><br /><br />
Avocados are also very rich in B vitamins, as well as vitamin K and vitamin E.<br /><br />
Avocados also have a very high fiber content of 25% soluble and 75% insoluble fiber.<br /><br />
Studies have shown that regular avocado consumption lowers blood cholesterol levels. <br /><br />
Avocado extracts are currently being studied in the laboratory to see whether they might be useful for treating diabetes or hypertension.<br /><br />
Researchers from Ohio State University found that nutrients taken from avocados were able to stop oral cancer cells, and even destroy some of the pre-cancerous cells.<br /><br />
An article on avocados and oral cancer prevention:<br />
<i>"Avocados May Help Prevent Oral Cancer, OSU Study Shows"</i>)
Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-69677529286912136562013-10-23T04:42:00.002-07:002013-10-23T04:42:42.146-07:00ALLAMA IQBAL HISTORY<div class="dablink">
For other people named Muhammad Iqbal, see Muhammad Iqbal (disambiguation).</div>
<table cellspacing="3" class="infobox vcard" style="border-spacing: 3px; width: 22em;">
<caption class="fn">Muhammad Iqbal<br />
<span class="Nastaliq" style="font-family: 'Jameel Noori Nastaleeq', 'Urdu Typesetting', IranNastaliq, 'Nafees Nastaleeq', 'Nafees Nastaleeq v1.01', Nafees, 'Pak Nastaleeq', 'PDMS_Jauhar', 'Alvi Lahori Nastaleeq'; font-size: 125%;" title="Nastaliq">محمد اقبال</span></caption>
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<td colspan="2" style="text-align: center;"><img alt="Iqbal.jpg" height="291" src="http://upload.wikimedia.org/wikipedia/commons/thumb/8/8a/Iqbal.jpg/220px-Iqbal.jpg" width="220" /></td>
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<tr>
<th scope="row" style="text-align: left;">Born</th>
<td>9 November 1877<br />
Sialkot, Punjab, British India</td>
</tr>
<tr>
<th scope="row" style="text-align: left;">Died</th>
<td>21 April 1938 (aged 60)<br />
Lahore, Punjab, British India</td>
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<th scope="row" style="text-align: left;">Era</th>
<td>20th century philosophy</td>
</tr>
<tr>
<th scope="row" style="text-align: left;">Region</th>
<td>British India</td>
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<tr>
<th scope="row" style="text-align: left;">Main interests</th>
<td>Urdu poetry, Persian poetry</td>
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<tr>
<th scope="row" style="text-align: left;">Notable ideas</th>
<td>Two-Nation Theory, Conception of Pakistan</td>
</tr>
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Influenced by[show]</div>
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<div class="NavHead" style="background: transparent; font-size: 105%; text-align: left;">
Influenced[show]</div>
</div>
</td>
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<th scope="row" style="text-align: left;">Website</th>
<td>Importance of Nature</td>
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</tbody></table>
<b>Sir Muhammad Iqbal</b> (Urdu: <span dir="rtl" lang="ur" style="font-family: sans-serif;"><span class="Nastaliq" style="font-family: 'Jameel Noori Nastaleeq', 'Urdu Typesetting', IranNastaliq, 'Nafees Nastaleeq', 'Nafees Nastaleeq v1.01', Nafees, 'Pak Nastaleeq', 'PDMS_Jauhar', 'Alvi Lahori Nastaleeq'; font-size: 125%;" title="Nastaliq">محمد اقبال</span></span>) (November 9, 1877 – April 21, 1938), also known as <b>Allama Iqbal</b> (<span lang="ur" style="font-family: sans-serif;"><span class="Nastaliq" style="font-family: 'Jameel Noori Nastaleeq', 'Urdu Typesetting', IranNastaliq, 'Nafees Nastaleeq', 'Nafees Nastaleeq v1.01', Nafees, 'Pak Nastaleeq', 'PDMS_Jauhar', 'Alvi Lahori Nastaleeq'; font-size: 125%;" title="Nastaliq">علامہ اقبال</span></span>), was a philosopher, poet and politician in British India who is widely regarded as having inspired the Pakistan Movement. He is considered one of the most important figures in Urdu literature, with literary work in both the Urdu and Persian languages.<br />
Iqbal is admired as a prominent classical poet by Pakistani, Indian, Iranian, and other international scholars of literature. Though Iqbal is best known as an eminent poet, he is also a highly acclaimed "Muslim philosophical thinker of modern times".His first poetry book, <i>Asrar-e-Khudi</i>, appeared in the Persian language in 1915, and other books of poetry include <i>Rumuz-i-Bekhudi</i>, <i>Payam-i-Mashriq</i> and <i>Zabur-i-Ajam</i>. Amongst these his best known Urdu works are <i>Bang-i-Dara</i>, <i>Bal-i-Jibril</i>, <i>Zarb-i Kalim</i> and a part of <i>Armughan-e-Hijaz</i>. In Iran and Afghanistan, he is famous as <i>Iqbāl-e Lāhorī</i> (<span dir="rtl" lang="fa" style="font-family: sans-serif;">اقبال لاهوری</span>) (Iqbal of Lahore), and he is most appreciated for his Persian work.
Along with his Urdu and Persian poetry, his various Urdu and English
lectures and letters have been very influential in cultural, social,
religious and political disputes over the years.<br />
In 1922, he was knighted by King George V, giving him the title "Sir".<br />
While studying law and philosophy in England, Iqbal became a member of the London branch of the All India Muslim League.
Later, in one of his most famous speeches, Iqbal pushed for the
creation of a Muslim state in Northwest India. This took place in his
presidential speech in the League's December 1930 session. He was very close to the founder of Pakistan, Mohammad Ali Jinnah.<br />
In much of Southern Asia and Urdu speaking world, Iqbal is regarded as the <i>Shair-e-Mashriq</i> (<span lang="ur" style="font-family: sans-serif;">شاعر مشرق</span>, "Poet of the East"). He is also called <i>Muffakir-e-Pakistan</i> (<span lang="ur" style="font-family: sans-serif;">مفکر پاکستان</span>, "The Thinker of Pakistan") and <i>Hakeem-ul-Ummat</i> (<span lang="ur" style="font-family: sans-serif;">حکیم الامت</span>, "The Sage of the Ummah"). The Pakistan government officially named him a "national poet". His birthday <i>Yōm-e Welādat-e Muḥammad Iqbāl</i> (<span lang="ur" style="font-family: sans-serif;">یوم ولادت محمد اقبال</span>) or (Iqbal Day) is a public holiday in Pakistan. In India he is also remembered as the author of the popular song Saare Jahaan Se Achcha.<br />
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<div id="toctitle">
<h2>
</h2>
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<h2>
<span class="mw-headline" id="Personal_life">Personal life</span></h2>
<h3>
<span class="mw-headline" id="Background">Background</span></h3>
Iqbal was born in Sialkot on 9 November 1877 within the Punjab Province of British India (now in Pakistan). His grandparents were Kashmiri Pandits, the Brahmins of the Sapru clan from Kashmir who converted to Islam. In the 19th century, when Sikhs
were taking over rule of Kashmir, his grandfather's family migrated to
Punjab. Iqbal often mentioned and commemorated about his Kashmiri Pandit
Brahmin lineage in his writings.<br />
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Allama Iqbal with his son Javed Iqbal in 1930</div>
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Mother of Allama Muhammad Iqbal who passed in November 9, 1914.Iqbal expressed his feeling of pathos in a poetic form on death</div>
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Iqbal's father, Sheikh Noor Muhammad, was a tailor, not formally educated but a religious man.<sup class="reference" id="cite_ref-Mustansir_Mir_15-0"></sup>
Iqbal's mother Imam Bibi was a polite and humble woman who helped the
poor and solved the problems of neighbours. She died on 9 November 1914
in Sialkot.<sup class="reference" id="cite_ref-allamaiqbal_a_person_7-1"></sup> Iqbal loved his mother, and on her death he expressed his feelings of pathos in a poetic form elegy.<sup class="reference" id="cite_ref-books.google.co.uk_6-3"></sup><br />
<blockquote class="templatequote">
Who would wait for me anxiously in my native place?<br />
Who would display restlessness if my letter fails to arrive?<br />
I will visit thy grave with this complaint:<br />
Who will now think of me in midnight prayers?<br />
All thy life thy love served me with devotion—<br />
When I became fit to serve thee, thou hast departed.<sup class="reference" id="cite_ref-books.google.co.uk_6-4"></sup></blockquote>
Iqbal was four years old when he was admitted to the mosque for learning the Qur'an, he learned the Arabic language from his teacher Syed Mir Hassan, the head of the madrassa and professor of Arabic language at Scotch Mission College in Sialkot, where Iqbal completed matriculation in 1893. He received Intermediate with the Faculty of Arts diploma from Murray College Sialkot in 1895.<sup class="reference" id="cite_ref-allamaiqbal_a_person_7-2"></sup><sup class="reference" id="cite_ref-pktoday73_10-3"></sup><sup class="reference" id="cite_ref-Taneja_and_Taneja_16-0"><a href="http://en.wikipedia.org/wiki/Muhammad_Iqbal#cite_note-Taneja_and_Taneja-16"></a></sup> The same year he qualified for Bachelor of Arts in philosophy, English literature and Arabic as his subjects from Government College Lahore in 1897, and won the Khan Bahadurddin F.S. Jalaluddin medal as he took higher numbers in Arabic class.<sup class="reference" id="cite_ref-allamaiqbal_a_person_7-3"></sup> In 1899, he received Masters of Arts degree from the same college and had the first place in Punjab University, Lahore.<sup class="reference" id="cite_ref-allamaiqbal_a_person_7-4"></sup><sup class="reference" id="cite_ref-Taneja_and_Taneja_16-1"><a href="http://en.wikipedia.org/wiki/Muhammad_Iqbal#cite_note-Taneja_and_Taneja-16"></a></sup><br />
Iqbal had married three times, in 1895 while studying Bachelor of Arts he had his first marriage with Karim Bibi, the daughter of a Gujarati
physician Khan Bahadur Ata Muhammad Khan, through an arranged marriage.
They had daughter Miraj Begum and son Aftab Iqbal. Later Iqbal's second
marriage was with Sardar Begum mother of Javid Iqbal and third marriage with Mukhtar Begum in December 1914.<sup class="reference" id="cite_ref-allamaiqbal_a_person_7-5"></sup><sup class="reference" id="cite_ref-Abida_9-1"><a href="http://en.wikipedia.org/wiki/Muhammad_Iqbal#cite_note-Abida-9"></a></sup><br />
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Iqbal in Spain, 1933</div>
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<h3>
<span class="mw-headline" id="Higher_education_in_Europe">Higher education in Europe</span></h3>
Iqbal was influenced by the teachings of Sir Thomas Arnold, his philosophy teacher at Government college Lahore, Arnold's teachings determined Iqbal to pursue higher education in the West. In 1905, he traveled to England for his higher education. Iqbal qualified for a scholarship from Trinity College in Cambridge and obtained Bachelor of Arts in 1906, and in the same year he was called to the bar as a barrister from Lincoln's Inn. In 1907, Iqbal moved to Germany to study doctorate and earned PhD degree from the Ludwig Maximilian University, Munich in 1908. Working under the guidance of Friedrich Hommel, Iqbal published his doctoral thesis in 1908 entitled: <i>The Development of Metaphysics in Persia</i>.<sup class="reference" id="cite_ref-pktoday73_10-5"><a href="http://en.wikipedia.org/wiki/Muhammad_Iqbal#cite_note-pktoday73-10"></a></sup><sup class="reference" id="cite_ref-Roy_Jackson_19-0"><a href="http://en.wikipedia.org/wiki/Muhammad_Iqbal#cite_note-Roy_Jackson-19"></a></sup><br />
During Iqbal's stay in Heidelberg, Germany in 1907 his German teacher Emma Wegenast taught him about Goethe's Faust, Heine and Nietzsche.<sup class="reference" id="cite_ref-A_Spiritual_Bridge_between_East_and_West_20-0"></sup> During his study in Europe,
Iqbal began to write poetry in Persian. He prioritized it because he
believed he had found an easy way to express his thoughts. He would
write continuously in Persian throughout his life.<sup class="reference" id="cite_ref-pktoday73_10-6"></sup><br />
<h3>
<span class="mw-headline" id="Academic">Academic</span></h3>
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Allama Iqbal as Youth in 1899</div>
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Iqbal, after completing his Master of Arts degree in 1899, initiated his career as a reader of Arabic at Oriental College
and shortly was selected as a junior professor of philosophy at
Government College Lahore, where he had also been a student, Iqbal
worked there until he left for England in 1905. In 1908, Iqbal returned
from England and joined again the same college as a professor of
philosophy and English literature.<sup class="reference" id="cite_ref-Brill_21-0"></sup>
At the same period Iqbal began practicing law at Chief Court Lahore,
but soon Iqbal quit law practice, and devoted himself in literary works
and became an active member of <i>Anjuman-e-Himayat-e-Islam</i>.<sup class="reference" id="cite_ref-allamaiqbal_a_person_7-6"></sup>
In 1919, he became the general secretary of the same organisation.
Iqbal's thoughts in his work primarily focus on the spiritual direction
and development of human society, centered around experiences from his
travels and stays in Western Europe and the Middle East. He was
profoundly influenced by Western philosophers such as Friedrich Nietzsche, Henri Bergson and Goethe.<sup class="reference" id="cite_ref-books.google.co.uk_6-5"></sup><sup class="reference" id="cite_ref-A_Spiritual_Bridge_between_East_and_West_20-1"></sup><br />
The poetry and philosophy of Mawlana Rumi
bore the deepest influence on Iqbal's mind. Deeply grounded in religion
since childhood, Iqbal began intensely concentrating on the study of
Islam, the culture and history of Islamic civilization and its political
future, while embracing Rumi as "his guide".<sup class="reference" id="cite_ref-books.google.co.uk_6-6"></sup>
Iqbal would feature Rumi in the role of guide in many of his poems.
Iqbal's works focus on reminding his readers of the past glories of
Islamic civilization, and delivering the message of a pure, spiritual
focus on Islam as a source for sociopolitical liberation and greatness.
Iqbal denounced political divisions within and amongst Muslim nations,
and frequently alluded to and spoke in terms of the global Muslim
community or the Ummah.<sup class="reference" id="cite_ref-books.google.co.uk_6-7"></sup><sup class="reference" id="cite_ref-bio-iqbalsworks_22-0"></sup><br />
Iqbal poetry has been translated into many European languages, at the
time when his work was famous during the early part of the 20th
century.<sup class="reference" id="cite_ref-Iqbal_Academy_Pakistan_4-5"></sup> Iqbal’s Asrar-i-Khudi and Javed Nama were translated into English by R A Nicholson and A J Arberry respectively.<sup class="reference" id="cite_ref-Iqbal_Academy_Pakistan_4-6"></sup><sup class="reference" id="cite_ref-dailytimes_11-1"></sup><br />
<h3>
<span class="mw-headline" id="Final_years_and_death">Final years and death</span></h3>
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The tomb of Muhammad Iqbal at the entrance of the Badshahi Mosque in Lahore.</div>
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In 1933, after returning from a trip to Spain and Afghanistan, Iqbal had suffered from a mysterious throat illness.<sup class="reference" id="cite_ref-23"></sup> He spent his final years helping Chaudhry Niaz Ali Khan to establish the Dar ul Islam Trust Institute at Jamalpur estate near Pathankot,<sup class="reference" id="cite_ref-24"></sup><sup class="reference" id="cite_ref-25"></sup>
where studies in classical Islam and contemporary social science were
plan to be subsidised, and Iqbal also advocated the demand for an
independent Muslim state.<br />
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Iqbal as a Barrister-at-Law.</div>
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Iqbal ceased practising law in 1934 and was granted pension by the Nawab of Bhopal. In his final years he frequently visited the Dargah of famous Sufi Hazrat Ali Hujwiri in Lahore for spiritual guidance. After suffering for months from his illness, Iqbal died in Lahore on 21 April 1938.<sup class="reference" id="cite_ref-allamaiqbal.com_5-5"></sup><sup class="reference" id="cite_ref-pktoday73_10-7"></sup> His tomb is located in Hazuri Bagh, the enclosed garden between the entrance of the Badshahi Mosque and the Lahore Fort, and official guards are provided by the Government of Pakistan.<br />
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A night view of the tomb.</div>
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Iqbal is commemorated widely in Pakistan, where he is regarded as the ideological founder of the state. His <i>Tarana-e-Hind</i>
is a song that is widely used in India as a patriotic song speaking of
communal harmony. His birthday is annually commemorated in Pakistan as Iqbal Day, a national holiday. Iqbal is the namesake of many public institutions, including the Allama Iqbal Campus Punjab University in Lahore, the Allama Iqbal Medical College in Lahore, Iqbal Stadium in Faisalabad, Allama Iqbal Open University in Pakistan, the Allama Iqbal International Airport in Lahore, the Allama Iqbal hall in Nishtar Medical College in Multan and Gulshan-e-Iqbal Town in Karachi and Allama Iqbal Hall at AMU, India.<br />
The government and public organizations have sponsored the
establishment of educational institutions, colleges and schools
dedicated to Iqbal, and have established the Iqbal Academy
to research, teach and preserve the works, literature and philosophy of
Iqbal. Allama Iqbal Stamps Society established for the promotion of
Iqbaliyat in philately and in other hobbies. His son Javid Iqbal has served as a justice on the Supreme Court of Pakistan. Javaid Manzil was the last residence of Allama Iqbal.<sup class="reference" id="cite_ref-26"></sup><br />
<h2>
<span class="mw-headline" id="Efforts_and_influences">Efforts and influences</span></h2>
<h2>
<u><i><span class="mw-headline" id="Political">Political</span></i></u></h2>
<div class="rellink boilerplate further">
Further information: Pakistan Movement</div>
While dividing his time between law practice and poetry, Iqbal had
remained active in the Muslim League. He did not support Indian
involvement in World War I and remained in close touch with Muslim political leaders such as Maulana Mohammad Ali and Muhammad Ali Jinnah. He was a critic of the mainstream Indian National Congress, which he regarded as dominated by Hindus
and was disappointed with the League when during the 1920s, it was
absorbed in factional divides between the pro-British group led by Sir Muhammad Shafi and the centrist group led by Jinnah.<sup class="reference" id="cite_ref-brightpk.com_27-0"></sup><sup class="noprint Inline-Template" style="white-space: nowrap;"><i><span title="The material near this tag may rely on an unreliable source. (May 2012)"></span></i></sup><sup class="Template-Fact" style="white-space: nowrap;"><i><span title="This claim needs references to reliable sources. (May 2012)"><br /></span></i></sup><br />
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Iqbal with Muslim politicians.<br />
(L to R): M. Iqbal (third), Syed Zafarul Hasan (sixth) at Aligarh Muslim University.</div>
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In November 1926, with the encouragement of friends and supporters, Iqbal contested for a seat in the Punjab Legislative Assembly from the Muslim district of Lahore, and defeated his opponent by a margin of 3,177 votes.<sup class="reference" id="cite_ref-bio-politics_28-0"></sup> He supported the constitutional proposals
presented by Jinnah with the aim of guaranteeing Muslim political
rights and influence in a coalition with the Congress, and worked with
the Aga Khan and other Muslim leaders to mend the factional divisions and achieve unity in the Muslim League.<sup class="reference" id="cite_ref-brightpk.com_27-1"></sup><sup class="noprint Inline-Template" style="white-space: nowrap;"><i><span title="The material near this tag may rely on an unreliable source. (May 2012)"></span></i></sup><sup class="Template-Fact" style="white-space: nowrap;"><i><span title="This claim needs references to reliable sources. (May 2012)"><br /></span></i></sup><br />
<h2>
<u><i><span class="mw-headline" id="Iqbal.2C_Jinnah_and_concept_of_Pakistan">Iqbal, Jinnah and concept of Pakistan</span></i></u></h2>
Ideologically separated from Congress Muslim leaders, Iqbal had also
been disillusioned with the politicians of the Muslim League owing to
the factional conflict that plagued the League in the 1920s. Discontent
with factional leaders like Sir Muhammad Shafi and Sir Fazl-ur-Rahman,
Iqbal came to believe that only Muhammad Ali Jinnah was a political
leader capable of preserving this unity and fulfilling the League's
objectives on Muslim political empowerment. Building a strong, personal
correspondence with Jinnah, Iqbal was an influential force in convincing
Jinnah to end his self-imposed exile in London,
return to India and take charge of the League. Iqbal firmly believed
that Jinnah was the only leader capable of drawing Indian Muslims to the
League and maintaining party unity before the British and the Congress:<br />
<blockquote>
"I know you are a busy man but I do hope you won't mind my writing to
you often, as you are the only Muslim in India today to whom the
community has right to look up for safe guidance through the storm which
is coming to North-West India and, perhaps, to the whole of India."<sup class="reference" id="cite_ref-igbalandpakmovement_29-0"></sup></blockquote>
While Iqbal espoused the idea of Muslim-majority provinces in 1930,
Jinnah would continue to hold talks with the Congress through the decade
and only officially embraced the goal of Pakistan in 1940. Some
historians postulate that Jinnah always remained hopeful for an
agreement with the Congress and never fully desired the partition of
India.<sup class="reference" id="cite_ref-jalal14_30-0"></sup>
Iqbal's close correspondence with Jinnah is speculated by some
historians as having been responsible for Jinnah's embrace of the idea
of Pakistan. Iqbal elucidated to Jinnah his vision of a separate Muslim
state in a letter sent on 21 June 1937:<br />
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Allama Iqbal in Allahabad with other Muslim leaders</div>
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<blockquote>
"A separate federation of Muslim Provinces, reformed on the lines I
have suggested above, is the only course by which we can secure a
peaceful India and save Muslims from the domination of Non-Muslims. Why
should not the Muslims of North-West India and Bengal be considered as nations entitled to self-determination just as other nations in India and outside India are."<sup class="reference" id="cite_ref-bio-politics_28-1"></sup></blockquote>
Iqbal, serving as president of the Punjab Muslim League, criticised
Jinnah's political actions, including a political agreement with Punjabi
leader Sir Sikandar Hyat Khan,
whom Iqbal saw as a representative of feudal classes and not committed
to Islam as the core political philosophy. Nevertheless, Iqbal worked
constantly to encourage Muslim leaders and masses to support Jinnah and
the League. Speaking about the political future of Muslims in India,
Iqbal said:<br />
<blockquote>
"There is only one way out. Muslims should strengthen Jinnah's hands.
They should join the Muslim League. Indian question, as is now being
solved, can be countered by our united front against both the Hindus and
the English. Without it, our demands are not going to be accepted.
People say our demands smack of communalism. This is sheer propaganda.
These demands relate to the defense of our national existence.... The
united front can be formed under the leadership of the Muslim League.
And the Muslim League can succeed only on account of Jinnah. Now none
but Jinnah is capable of leading the Muslims.<sup class="reference" id="cite_ref-igbalandpakmovement_29-1">"</sup></blockquote>
<h2>
<u><i><span class="mw-headline" id="Revival_of_Islamic_polity">Revival of Islamic polity</span></i></u></h2>
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Iqbal with Choudhary Rahmat Ali and other Muslim leaders</div>
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Iqbal's six English lectures were published first from Lahore in 1930 and then by Oxford University press in 1934 in a book titled The Reconstruction of Religious Thought in Islam. Which were read at Madras, Hyderabad and Aligarh.<sup class="reference" id="cite_ref-bio-iqbalsworks_22-1"></sup> These lectures dwell on the role of Islam as a religion as well as a political and legal philosophy in the modern age.<sup class="reference" id="cite_ref-bio-iqbalsworks_22-2"></sup>
In these lectures Iqbal firmly rejects the political attitudes and
conduct of Muslim politicians, whom he saw as morally misguided,
attached to power and without any standing with Muslim masses.<br />
Iqbal expressed fears that not only would secularism weaken the
spiritual foundations of Islam and Muslim society, but that India's Hindu-majority population would crowd out Muslim heritage, culture and political influence. In his travels to Egypt, Afghanistan, Iran and Turkey, he promoted ideas of greater Islamic political co-operation and unity, calling for the shedding of nationalist differences.<sup class="reference" id="cite_ref-books.google.co.uk_6-8"></sup> He also speculated on different political arrangements to guarantee Muslim political power; in a dialogue with Dr. B. R. Ambedkar,
Iqbal expressed his desire to see Indian provinces as autonomous units
under the direct control of the British government and with no central
Indian government. He envisaged autonomous Muslim provinces in India.
Under one Indian union he feared for Muslims, who would suffer in many
respects especially with regard to their existentially separate entity
as Muslims.<sup class="reference" id="cite_ref-bio-politics_28-2"></sup><br />
Sir Muhammad Iqbal was elected president of the Muslim League in 1930 at its session in Allahabad, in the United Provinces
as well as for the session in Lahore in 1932. In his presidential
address on 29 December 1930, Iqbal outlined a vision of an independent
state for Muslim-majority provinces in northwestern India:<sup class="reference" id="cite_ref-allamaiqbal.com_5-6"></sup><br />
<blockquote>
"I would like to see the Punjab, North-West Frontier Province, Sindh and Baluchistan amalgamated into a single state. Self-government within the British Empire,
or without the British Empire, the formation of a consolidated
Northwest Indian Muslim state appears to me to be the final destiny of
the Muslims, at least of Northwest India.<sup class="reference" id="cite_ref-allamaiqbal.com_5-7"></sup></blockquote>
In his speech, Iqbal emphasised that unlike Christianity,
Islam came with "legal concepts" with "civic significance," with its
"religious ideals" considered as inseparable from social order:
"therefore, the construction of a policy on national lines, if it means a
displacement of the Islamic principle of solidarity, is simply
unthinkable to a Muslim."<sup class="reference" id="cite_ref-Naipaul_31-0"></sup>
Iqbal thus stressed not only the need for the political unity of Muslim
communities, but the undesirability of blending the Muslim population
into a wider society not based on Islamic principles.<br />
He thus became the first politician to articulate what would become known as the <i>Two-Nation Theory</i>—that
Muslims are a distinct nation and thus deserve political independence
from other regions and communities of India. However, he would not
elucidate or specify if his ideal Islamic state would construe a theocracy,
even as he rejected secularism and nationalism. The latter part of
Iqbal's life was concentrated on political activity. He would travel
across Europe and West Asia to garner political and financial support
for the League, and he reiterated his ideas in his 1932 address, and
during the Third round-Table Conference,
he opposed the Congress and proposals for transfer of power without
considerable autonomy or independence for Muslim provinces.<br />
He would serve as president of the Punjab Muslim League, and would
deliver speeches and publish articles in an attempt to rally Muslims
across India as a single political entity. Iqbal consistently criticised
feudal classes in Punjab as well as Muslim politicians averse to the
League. Many unnoticed account of Iqbal's frustration toward Congress
leadership were also pivotal of visioning the two nation theory.<br />
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Copy of the first journal of <i>Tolu-e-Islam</i>.</div>
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<h2>
<u><i><span class="mw-headline" id="Patron_of_The_Journal_Tolu-e-Islam">Patron of The Journal Tolu-e-Islam</span></i></u></h2>
Iqbal was the first patron of the historical, political, religious,
cultural journal of Muslims of British India. This journal played an
important part in the Pakistan movement. The name of this journal is The Journal Tolu-e-Islam. In 1935, according to his instructions, Syed Nazeer Niazi initiated and edited, a journal Tolu-e-Islam<sup class="reference" id="cite_ref-32"></sup> named after the famous poem of Iqbal, <i>Tulu'i Islam</i>.
He also dedicated the first edition of this journal to Iqbal. For a
long time Iqbal wanted a journal to propagate his ideas and the aims and
objective of Muslim league. It was Syed Nazeer Niazi, a close friend of his and a regular visitor to him during his last two years, who started this journal.<sup class="reference" id="cite_ref-brightpk.com_27-2"></sup> He also made Urdu translation of The Reconstruction of Religious Thought in Islam, by Sir Muhammad Iqbal.<sup class="reference" id="cite_ref-brightpk.com_27-3"></sup><sup class="noprint Inline-Template" style="white-space: nowrap;"><i><span title="The material near this tag may rely on an unreliable source. (May 2012)"></span></i></sup><sup class="Template-Fact" style="white-space: nowrap;"><i><span title="This claim needs references to reliable sources. (May 2012)"><br /></span></i></sup><br />
In the first monthly journal of Oct. 1935, an article <i>Millat Islamia Hind</i> The Muslim nation of India was published. In this article Syed Nazeer Niazi
described the political conditions of British India and the aims and
objectives of the Muslim community. He also discussed the basic
principles of Islam which were aims and objective of Iqbal's concept of
an Islamic State.<sup class="reference" id="cite_ref-brightpk.com_27-4"></sup><sup class="noprint Inline-Template" style="white-space: nowrap;"><i><span title="The material near this tag may rely on an unreliable source. (May 2012)"></span></i></sup><sup class="Template-Fact" style="white-space: nowrap;"><i><span title="This claim needs references to reliable sources. (May 2012)"><br /></span></i></sup><br />
The early contributors to this journal were eminent Muslim scholars like Maulana Aslam Jairajpuri, Ghulam Ahmed Pervez,
Dr. Zakir Hussain Khan, Syed Naseer Ahmed, Raja Hassan Akhtar, Maulvi
Ghulam Yezdani, Ragheb Ahsan, Sheikh Suraj ul Haq, Rafee ud din Peer,
Prof. Fazal ud din Qureshi, Agha Muhammad Safdar, Asad Multani, Dr.
Tasadaq Hussain, Prof. Yusuf Saleem Chisti.<sup class="reference" id="cite_ref-brightpk.com_27-5"></sup><sup class="noprint Inline-Template" style="white-space: nowrap;"><i><span title="The material near this tag may rely on an unreliable source. (May 2012)"></span></i></sup><sup class="Template-Fact" style="white-space: nowrap;"><i><span title="This claim needs references to reliable sources. (May 2012)"></span></i></sup><br />
Later on, this journal was continued<sup class="reference" id="cite_ref-33"></sup> by Ghulam Ahmed Pervez, who had already contributed many articles in the early editions of this journal. After the emergence of Pakistan, the mission of the journal Tolu-e-Islam
was to propagate the implementation of the principle which had inspired
the demand for separate Muslim State according to the Quran. This
journal is still published by Idara Tolu-e-Islam, Lahore<sup class="reference" id="cite_ref-brightpk.com_27-6">.</sup><sup class="noprint Inline-Template" style="white-space: nowrap;"><i><span title="The material near this tag may rely on an unreliable source. (May 2012)"></span></i></sup><sup class="Template-Fact" style="white-space: nowrap;"><i><span title="This claim needs references to reliable sources. (May 2012)"> </span></i></sup><br />
<h2 style="font-weight: normal;">
<u><i><span class="mw-headline" id="Literary_work">Literary work</span></i></u></h2>
<h2>
<u><i><span class="mw-headline" id="Persian">Persian</span></i></u></h2>
Iqbal's poetic works are written primarily in Persian rather than Urdu.
Among his 12,000 verses of poetry, about 7,000 verses are in Persian.
In 1915, he published his first collection of poetry, the <i>Asrar-e-Khudi</i> (<i>Secrets of the Self</i>)
in Persian. The poems emphasise the spirit and self from a religious,
spiritual perspective. Many critics have called this Iqbal's finest
poetic work<sup class="reference" id="cite_ref-34"></sup> In <i>Asrar-e-Khudi</i>, Iqbal explains his philosophy of "Khudi," or "Self."<sup class="reference" id="cite_ref-allamaiqbal.com_5-8"></sup><sup class="reference" id="cite_ref-books.google.co.uk_6-9"></sup>Iqbal's use of the term "Khudi" is synonymous with the word "Rooh"
mentioned in the Quran. "Rooh" is that divine spark which is present in
every human being, and was present in Adam, for which God ordered all
of the angels to prostrate in front of Adam. One has to make a great
journey of transformation to realise that divine spark which Iqbal calls
"Khudi".<sup class="reference" id="cite_ref-allamaiqbal.com_5-9"></sup><br />
The same concept was used by Farid ud Din Attar in his
"Mantaq-ul-Tair". He proves by various means that the whole universe
obeys the will of the "Self." Iqbal condemns self-destruction. For him,
the aim of life is self-realization and self-knowledge. He charts the
stages through which the "Self" has to pass before finally arriving at
its point of perfection, enabling the knower of the "Self" to become a
vice-regent of God.<sup class="reference" id="cite_ref-bio-iqbalsworks_22-3"></sup><br />
In his <i>Rumuz-e-Bekhudi</i> (<i>Hints of Selflessness</i>),
Iqbal seeks to prove the Islamic way of life is the best code of
conduct for a nation's viability. A person must keep his individual
characteristics intact, but once this is achieved he should sacrifice
his personal ambitions for the needs of the nation. Man cannot realise
the "Self" outside of society. Also in Persian and published in 1917,
this group of poems has as its main themes the ideal community,<sup class="reference" id="cite_ref-bio-iqbalsworks_22-4"></sup>
Islamic ethical and social principles, and the relationship between the
individual and society. Although he is true throughout to Islam, Iqbal
also recognises the positive analogous aspects of other religions. The <i>Rumuz-e-Bekhudi</i> complements the emphasis on the self in the Asrar-e-Khudi and the two collections are often put in the same volume under the title <i>Asrar-e-Rumuz</i> (<i>Hinting Secrets</i>). It is addressed to the world's Muslims.<sup class="reference" id="cite_ref-bio-iqbalsworks_22-5"></sup><br />
Iqbal's 1924 publication, the <i>Payam-e-Mashriq</i> (<i>The Message of the East</i>) is closely connected to the <i>West-östlicher Diwan</i> by the famous German poet Goethe.
Goethe bemoans the West having become too materialistic in outlook, and
expects the East will provide a message of hope to resuscitate
spiritual values. Iqbal styles his work as a reminder to the West of the
importance of morality, religion and civilisation by underlining the
need for cultivating feeling, ardour and dynamism. He explains that an
individual can never aspire to higher dimensions unless he learns of the
nature of spirituality.<sup class="reference" id="cite_ref-bio-iqbalsworks_22-6"></sup> In his first visit to Afghanistan, he presented his book "Payam-e Mashreq" to King Amanullah Khan in which he admired the liberal movements of Afghanistan against the British Empire. In 1933, he was officially invited to Afghanistan to join the meetings regarding the establishment of Kabul University.<sup class="reference" id="cite_ref-A_Spiritual_Bridge_between_East_and_West_20-2"></sup><br />
The <i>Zabur-e-Ajam</i> (<i>Persian Psalms</i>), published in 1927, includes the poems <i>Gulshan-e-Raz-e-Jadeed</i> (<i>Garden of New Secrets</i>) and <i>Bandagi Nama</i> (<i>Book of Slavery</i>). In <i>Gulshan-e-Raz-e-Jadeed</i>,
Iqbal first poses questions, then answers them with the help of ancient
and modern insight, showing how it affects and concerns the world of
action. <i>Bandagi Nama</i> denounces slavery by attempting to explain
the spirit behind the fine arts of enslaved societies. Here as in other
books, Iqbal insists on remembering the past, doing well in the present
and preparing for the future, while emphasising love, enthusiasm and
energy to fulfill the ideal life.<sup class="reference" id="cite_ref-bio-iqbalsworks_22-7"></sup><br />
Iqbal's 1932 work, the <i>Javed Nama</i> (<i>Book of Javed</i>) is named after and in a manner addressed to his son, who is featured in the poems. It follows the examples of the works of Ibn Arabi and Dante's <i>The Divine Comedy</i>, through mystical and exaggerated depictions across time. Iqbal depicts himself as <i>Zinda Rud</i>
("A stream full of life") guided by Rumi, "the master," through various
heavens and spheres, and has the honour of approaching divinity and
coming in contact with divine illuminations. In a passage re-living a
historical period, Iqbal condemns the Muslim who were instrumental in
the defeat and death of Nawab Siraj-ud-Daula of Bengal and Tipu Sultan of Mysore respectively by betraying them for the benefit of the British colonists,
and thus delivering their country to the shackles of slavery. At the
end, by addressing his son Javid, he speaks to the young people at
large, and provides guidance to the "new generation."<sup class="reference" id="cite_ref-bio-iqbalsworks_22-8"></sup><br />
His love of the Persian language is evident in his works and poetry. He says in one of his poems:<sup class="reference" id="cite_ref-35"></sup><br />
<blockquote class="templatequote">
<span class="Nastaliq" style="font-family: 'Jameel Noori Nastaleeq', 'Urdu Typesetting', IranNastaliq, 'Nafees Nastaleeq', 'Nafees Nastaleeq v1.01', Nafees, 'Pak Nastaleeq', 'PDMS_Jauhar', 'Alvi Lahori Nastaleeq'; font-size: 125%;" title="Nastaliq">گرچہ اردو در عذوبت شکر است</span><br />
<i>garche Urdū dar uzūbat <u>sh</u>ekkar ast</i><br />
<span class="Nastaliq" style="font-family: 'Jameel Noori Nastaleeq', 'Urdu Typesetting', IranNastaliq, 'Nafees Nastaleeq', 'Nafees Nastaleeq v1.01', Nafees, 'Pak Nastaleeq', 'PDMS_Jauhar', 'Alvi Lahori Nastaleeq'; font-size: 125%;" title="Nastaliq">طرز گفتار دري شيرين تر است</span><br />
<i>tarz-e goftar-e Dari <u>sh</u>irin tar ast</i></blockquote>
Translation: <i>Even though in sweetness Urdu* is sugar</i> – <i>(but) speech method in Dari (Persian) is sweeter *</i><br />
<h2>
<u><i><span class="mw-headline" id="Urdu">Urdu</span></i></u></h2>
Iqbal's <i>Bang-e-Dara</i>
(The Call of the Marching Bell),the first collection of Urdu poetry was
published in 1924. It was written in three distinct phases of his life.<sup class="reference" id="cite_ref-bio-iqbalsworks_22-9"></sup> The poems he wrote up to 1905—(the year Iqbal left for England) reflects patriotism and imagery of nature, that includes the <i>Tarana-e-Hind</i> (The song of India),<sup class="reference" id="cite_ref-A_Spiritual_Bridge_between_East_and_West_20-3">[2</sup> and another poem <i>Tarana-e-Milli</i> (The song of the Community). The second set of poems from 1905—1908; when Iqbal studied in Europe and dwell upon the nature of European society
about whom he emphasised had lost spiritual and religious values, these
inspired Iqbal to write poems on the historical and cultural heritage
of Islam and Muslim community, with the global perspective. Iqbal urges
the entire Muslim community, addressed as the <i>Ummah</i> to define personal, social and political existence by the values and teachings of Islam.<sup class="reference" id="cite_ref-bio-iqbalsworks_22-10"></sup><br />
Iqbal work mainly in Persian for a predominant period of his career
and after 1930, his works were mainly in Urdu. The works of this period
were often specifically directed at the Muslim masses of India, with an
even stronger emphasis on Islam and Muslim spiritual and political
reawakening. Published in 1935, the <i>Bal-e-Jibril</i> (Wings of Gabriel) is considered by many critics as the finest of Iqbal's Urdu poetry, and was inspired by his visit to Spain, where he visited the monuments and legacy of the kingdom of the Moors. It consists of ghazals, poems, quatrains, epigrams and carries a strong sense of religious passion.<sup class="reference" id="cite_ref-bio-iqbalsworks_22-11"></sup><br />
The <i>Pas Cheh Bayed Kard ai Aqwam-e-Sharq</i> (<i>What are we to do, O Nations of the East?</i>) includes the poem <i>Musafir</i> (<i>Traveler</i>). Again, Iqbal depicts Rumi as a character and an exposition of the mysteries of Islamic laws and Sufi perceptions is given. Iqbal laments the dissension and disunity among the Indian Muslims as well as Muslim nations. <i>Musafir</i> is an account of one of Iqbal's journeys to Afghanistan, in which the Pashtun people are counselled to learn the "secret of Islam" and to "build up the self" within themselves.<sup class="reference" id="cite_ref-bio-iqbalsworks_22-12"></sup> Iqbal's final work was the <i>Armughan-e-Hijaz</i> (<i>The Gift of Hijaz</i>), published posthumously in 1938. The first part contains quatrains in Persian, and the second part contains some poems and epigrams in Urdu. The Persian quatrains convey the impression as though the poet is travelling through the Hijaz in his imagination. Profundity of ideas and intensity of passion are the salient features of these short poems.<sup class="reference" id="cite_ref-bio-iqbalsworks_22-13"></sup><br />
<div class="thumb tright">
<div class="thumbinner" style="width: 222px;">
<img alt="" class="thumbimage" height="315" src="http://upload.wikimedia.org/wikipedia/en/thumb/d/da/Miqbal4.jpg/220px-Miqbal4.jpg" width="220" />
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<a class="internal" href="http://en.wikipedia.org/wiki/File:Miqbal4.jpg" title="Enlarge"><img alt="" height="11" src="http://bits.wikimedia.org/static-1.22wmf21/skins/common/images/magnify-clip.png" width="15" /></a></div>
Sir M. Iqbal wearing Bow tie.</div>
</div>
</div>
Iqbal's vision of mystical experience is clear in one of his Urdu
ghazals which was written in London during his days of studying there.
Some verses of that ghazal are:<br />
<blockquote class="templatequote">
At last the silent tongue of Hijaz has<br />
announced to the ardent ear the tiding<br />
That the covenant which had been given to the<br />
desert-dwelles is going to be renewed<br />
vigorously:<br />
The lion who had emerged from the desert and<br />
had toppled the Roman Empire is<br />
As I am told by the angels, about to get up<br />
again (from his slumbers.)<br />
You the dwelles of the West, should know that<br />
the world of God is not a shop (of yours).<br />
Your imagined pure gold is about to lose it<br />
standard value (as fixed by you).<br />
Your civilization will commit suicide with its<br />
own daggers.</blockquote>
Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-59815583910187558462013-10-23T04:38:00.003-07:002013-10-23T04:38:55.210-07:00Importance of Sweet Potatoes<b>Sweet potatoes</b> are rich in dietary fiber, beta carotene, complex carbohydrates, vitamin C, vitamin B<sub>6</sub>, as well as carotene (the pink, yellow ones).<br /><br />
The Center for Science in the Public Interest, USA, compared the
nutritional value of sweet potatoes to other vegetables. The sweet
potato ranked number one, when vitamins A and C, iron, calcium, protein
and complex carbohydrates were considered.<br /><br />
<img alt="Ipomoea batatas 006" src="http://upload.wikimedia.org/wikipedia/commons/thumb/5/58/Ipomoea_batatas_006.JPG/512px-Ipomoea_batatas_006.JPG" width="512" /><br />
<i>Sweet potato roots are rich in fiber and several important nutrients</i>Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-65187267646945476722013-10-20T19:06:00.000-07:002013-10-20T19:16:55.890-07:00Importance of Leafy green vegetables<h2 class="blue_sea_paddingtop">
<u><i>Leafy green vegetables</i></u></h2>
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</h2>
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Studies have shown that a high intake of <b>dark-leafy vegetables, such as spinach or cabbage</b>
may significantly lower a person's risk of developing diabetes type 2.
Researchers from Leicester University, England, said that the impact of
dark green vegetables on human health should be investigated further,
after they gathered data from six studies.<br /><br />
Spinach, for example, is very rich in antioxidants, especially when
uncooked, steamed or very lightly boiled. It is a good source of
vitamins A, B<sub>6</sub>, C, E and K, as well as selenium, niacin, zinc, phosphorus, copper, <a class="keywords" href="http://www.medicalnewstoday.com/articles/219853.php" title="What Is Folic Acid? What Is Vitamin B9?">folic acid</a>, potassium, calcium, manganese, betaine, and iron.<br /><br />
<img alt="Spinach" src="http://upload.wikimedia.org/wikipedia/commons/thumb/2/22/Spinach.JPG/512px-Spinach.JPG" width="512" /><br />
<i>Boiling spinach can significantly reduce its levels of good nutrients.</i></h2>
Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-57852737831842969012013-10-20T19:04:00.003-07:002013-10-20T19:07:08.282-07:00Importance of Oily fish<h2 class="blue_sea_paddingtop">
<u><i>Oily fish </i></u></h2>
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<u><i><br /></i></u></h2>
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Examples of <b>oily fish</b> include salmon, trout, mackerel, herring,
sardines and anchovies. These types of fish have oil in their tissues
and around the gut. Their lean fillets contain up to 30% oil,
specifically, omega-3
fatty acids. These oils are known to provide benefits for the heart, as
well as the nervous system. Oily fish are also known to provide
benefits for patients with inflammatory conditions, such as arthritis.<br /><br />
Oily fish also contain vitamins A and D.<br /><br />
Scientists at UCLA's Jonsson Comprehensive Cancer Center found that prostate cancer progression was significantly slowed when patients went on a low-fat diet with fish oil supplements. (Link to article)<br /><br />
<img alt="Sardin from sardegna 1" src="http://upload.wikimedia.org/wikipedia/commons/thumb/4/48/Sardin_from_sardegna_1.jpg/512px-Sardin_from_sardegna_1.jpg" width="512" /><br />
<i>Oily fish are rich in omega-3 fatty acids</i><br /><br />
The following <b>benefits linked to fish oils or fish oil supplements</b> have been reported online in <i>Medical News Today</i>:
</h2>
<ul>
<li><i>"Fish Oil Aids Bi-Polar Behavior In Mice, Hinders Alcohol Cravings"</i></li>
<br />
<li><i>"Fish Oil May Prevent Muscle Loss In Breast Cancer Survivors"</i> </li>
<br />
<li><i>"Fish Oil Boosts Responses To Breast Cancer Drug Tamoxifen"</i> </li>
<br />
<li><i>"Fish Oil Omegas Now Fight Women's Vision Loss"</i> </li>
<br />
<li><i>"Fish Oil And Omega-3s, Helping Chemo Patients Gain Weight"</i></li>
</ul>
Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-56163080057548296922013-10-20T19:02:00.001-07:002013-10-20T19:02:17.368-07:00Bahoo Shanasi<h2>
<u><i>Bahoo Shanasi</i></u></h2>
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Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-79544462581520165422013-10-20T09:06:00.002-07:002013-10-20T19:15:16.193-07:00Importance of Blueberries<h2 class="blue_sea_paddingtop">
<u><i>Blueberries</i></u></h2>
<h2 class="blue_sea_paddingtop">
</h2>
<h2 class="blue_sea_paddingtop">
<b>Blueberries</b> are rich in fiber, antioxidants and phytonutrients.
Phytonutrients are natural chemicals found in plants. Unlike minerals
and vitamins that are also found in plant foods, phytonutrients are not
essential for keeping us alive. However, they may help prevent disease
and keep the body working properly.<br /><br />
According to a study carried out at Harvard Medical School, elderly people who eat plenty of blueberries (and strawberries) are less likely to suffer from cognitive decline, compared to other people of their age who do not.<br /><br />
Blueberries were found in another study carried out by scientists at Texas Woman's University, to help in curbing obesity. Plant polyphenols, which are abundant in blueberries, have been shown to reduce the development of fat cells (adipogenesis), while inducing the breakdown of lipids and fat (lipolysis).<br /><br />
<img alt="Blueberries-Littleisland" src="http://upload.wikimedia.org/wikipedia/commons/thumb/2/26/Blueberries-Littleisland.jpg/512px-Blueberries-Littleisland.jpg" width="512" /><br />
<i>Blueberries may help in controlling body weight</i><br /><br />
Regular blueberry consumption can reduce the risk of suffering from hypertension (high blood pressure)
by 10%, because of the berry's bioactive compounds, anthocyanins,
scientists from East Anglia University, England, and Harvard University,
USA reported in the <i>American Journal of Nutrition</i>. (Link to article)<br /><br />
Blueberry consumption has also been associated with a lower risk of
artery hardening, and/or intestinal diseases. The fruit has also been
linked to stronger bones in animal studies.</h2>
Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-39466360388861812102013-10-20T09:04:00.005-07:002013-10-20T19:15:59.686-07:00Importance of Broccoli<h2 class="blue_sea_paddingtop">
<u><i>Broccoli</i></u></h2>
<h2 class="blue_sea_paddingtop">
<b>Broccoli</b> is rich in fiber, calcium, potassium, folate and
phytonutrients. Phytonutrients are compounds which reduce the risk of
developing heart disease, diabetes and some cancers. Broccoli also contains vitamin C, as well as beta-carotene, an antioxidant.<br /><br />
<img alt="Broccoli and cross section edit" src="http://upload.wikimedia.org/wikipedia/commons/thumb/0/03/Broccoli_and_cross_section_edit.jpg/512px-Broccoli_and_cross_section_edit.jpg" width="512" /><br />
<i>Boiling broccoli for too long can destroy much of its vital nutrients</i><br /><br />
<b>Overcooking can destroy myrosinase</b> - if the enzyme myrosinase is
not destroyed during cooking, broccoli can also reduce the risk of
developing cancer. The best way to cook broccoli and to preserve the
myrosinase is to steam the vegetable lightly - if it is overcooked, the
vegetable's beneficial effects can be seriously undermined, researchers
from the University of Illinois wrote in the peer-reviewed journal <i>Nutrition and Cancer</i>.<br /><br />
Myrosinase converts some of the sulfur-based chemicals found in broccoli
(called glucosinolates) into isothiocyanates (other sulfur-containing
chemicals), which are known to have anticancer properties.
The researchers said that adding broccoli to a meal can often double its
cancer protection properties.<br /><br />
Another ingredient, sulforphane, which exists in broccoli, is also said
to have anti-cancer as well as anti-inflammatory qualities. However,
overcooking can destroy most of the benefits.<br /><br />
Broccoli powder does not contain myrosinase.<br /><br />
A recent article on the <b>health benefits of broccoli</b>:<br />
<i>"Lightly Steamed Broccoli Has Powerful Anticancer Enzyme Myrosinase"</i></h2>
Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-27377637738723607912013-10-20T09:03:00.001-07:002013-10-20T19:16:08.888-07:00Importance of Almonds<h2>
<u><i><span style="font-weight: normal;"> Almonds</span></i></u></h2>
<h2>
</h2>
<h2>
<b>Almonds</b> are rich in nutrients, including magnesium, vitamin E, iron, calcium, fiber, and riboflavin. A scientific review published in <i>Nutrition Reviews</i> last year found that almonds as a food may help maintain healthy cholesterol levels.<br /><br />
The authors wrote:</h2>
<blockquote>
"The message that almonds, in and of themselves, are a heart-healthy
snack should be emphasized to consumers. Moreover, when almonds are
incorporated into a healthy, balanced diet, the benefits are even
greater."</blockquote>
<br />
Almonds have more fiber than any other tree nut.<br />
<br />
The fatty acid profile of almonds, which is made up of 91-94%
unsaturated fatty acids, may partly explain why it helps maintain
healthy cholesterol levels.<br />
<br />
<img alt="Sa almonds" src="http://upload.wikimedia.org/wikipedia/commons/thumb/7/78/Sa_almonds.jpg/512px-Sa_almonds.jpg" width="512" /><br />
<i>Almonds are rich in fiber, vitamins, iron and other vital nutrients</i><br />
<br />
A recent article on the <b>health benefits of almonds</b>:<br />
<i>"Research Review Suggests Almonds Contain Nutrients That Provide Cardioprotective Effects"</i>Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-42821617510502436322013-10-20T09:00:00.003-07:002013-10-20T19:16:40.797-07:00Importance of Apple<h2>
<u><i>What Are The Top 10 Healthy Foods?</i></u></h2>
<h2>
</h2>
<h2 class="blue_sea_paddingtop">
1) Apples</h2>
<h2 class="blue_sea_paddingtop">
<b>Apples</b> are an excellent source of antioxidants, which combat free
radicals. Free radicals are damaging substances generated in the body
that cause undesirable changes and are involved in the aging process and
some diseases.<br /><br />
Some animal studies have found that an antioxidant found in apples
(polyphenols) might extend lifespans. Tests on fruit flies found that
polyphenols also help them to preserve their ability to walk, climb and
move about.<br /><br />
Another study found that adult females who regularly ate apples had a 13% to 22% lower risk of developing heart disease.<div class="separator" style="clear: both; text-align: center;">
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<i style="font-weight: normal;">"An Apple A Day Keeps The Grim Reaper Away"</i><span style="font-weight: normal;"></span></div>
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Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-34846514621505519242013-10-20T08:53:00.002-07:002013-10-20T08:53:25.318-07:00Mirza Galib Pics<h2>
<u><i>Mirza Galib Pics</i></u></h2>
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Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-33390314565710163332013-10-20T08:40:00.002-07:002013-10-20T08:49:21.793-07:00Allama Iqbal Picx<div class="separator" style="clear: both; text-align: center;">
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<br />Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-69756595610381020472013-10-19T23:03:00.002-07:002013-10-19T23:03:36.400-07:00Allama Iqbal's Biography<h2>
Allama Iqbal's Biography</h2>
<h2>
<br /></h2>
<h2>
<span align="justify" style="font-family: verdana,arial,helvatica; font-size: x-small;"><b><span style="color: white;">Birth</span></b><br />
<br /><br />
Iqbal was born in the Punjab on 9<sup>th</sup>Nov,1877.
His ancestors, who were Kashmiri Brahmins, had
embraced Islam two hundred years earlier.
Iqbal’s own father was a devout Muslim with
Sufistic bent of mind.
<br />
<b><span style="color: white;"> Education</span></b>
<br />
He received his early education in Sialkot. After
passing the entrance examination, he joined
Intermediary College. Mir Hassan, a great oriental
scholar, had a special aptitude for islamic Studies.
<br />
Passing on to the Government College of Lahore, Iqbal
did his graduation with English Literature,
Philosophy and Arabic as his subjects. At the college
he met Prof. Arnold and Sir Abdul Qadir.During this
Period he wrote different Poems which gave him much
recognition.
<br />
In the mean time he had done his MA in Philosophy and
was appointed as a Lecturer in History, Philosophy
and Political science at Oriental College, Lahore. He
then moved to Government College to teach Philosophy
and English Literature.Wherever Iqbal worked or thought
his versatility and scholarship made a deep impression
on those around him.
<br />
<b>
<span style="color: white;"> Higher Studies </span></b><br />
Iqbal proceeded to Europe for higher studies in 1905
and stayed there for three years. He took the Honors
Degree in Philosophy and taught Arabic at the Cambridge
University in the absence of Prof. Arnold. From England,
he went to Germany to do his doctorate in Philosophy
from Munich and then returned to London to qualify for
the bar.
<br />
<br />
<b>
<span style="color: white;">Back in India</span></b><br /><br />
Iqbal returned to India in 1908. The poet had won all
these academic laurels by the time he was 32 or 33. He
practiced as a lawyer from 1908 to 1934, when ill health
compelled him to give up his practice. In fact, his heart
was not in it and he devoted more time to philosophy
and literature than to legal profession.He attended the
meetings of Anjuman Himayat-I-Islam regularly at Lahore.
<br />
<b>
<span style="color: white;"> Iqbal in Cordova </span></b><br />
While in England, Iqbal accepted the hospitality of Spain.
He also went to Cordoba and had the distinction of being
the first Muslim to offer prayers at its historical mosque
after the exile of Moors. Memories of the past glory of Arabs
and their 800-year rule over Spain were revived in his mind
and his emotions were aroused by what he saw.Meeting with
Mussolini In Italy Iqbal was received by Mussolini who had
read some of his works and was aquatinted with his philosophy.
<br />
<b>
<span style="color: white;"> Iqbal as Politician </span></b><br />
In 1927 the poet was elected to the Punjab Legislative assembly.
In 1930, he was elected to preside over at the annual session
of Muslim League. In his presidential address at Allahabad,
Iqbal for the first time introduced the idea of Pakistan. In
1930-31, he attended the Round Table conference, which met
in London to frame a constitution for India.
<br />
<b>
<span style="color: white;"> Iqbal’Death </span></b><br />
<span align="justify" style="font-family: verdana,arial,helvatica; font-size: x-small;"><b><span style="color: white;">Iq </span></b></span>
The last phase of Iqbal’s life was embittered with constant
illness. But as regards his creative activities this product
was most productive. He kept in touch with every question of
the day and continued composing beautiful verses.
A few minutes before his death he recited these touching lines:<br />
<br />
<br />
<br />
<center>
The departed melody may return or not!<br />
The zephyr from Hijaz may blow again or not!<br />
The days of this Faqir has come to an end,<br />
Another seer may come or not!<br />
</center>
<br />
Although Iqbal’s was long and protracted the end was sudden
and verypeaceful. He breathed his last in the early hours
of April 21, 1938, in the arms of his old and devoted servant,
leaving behind a host of mourners all over the Islamic world.
There was a faint smile playing on his lips, which irresistibly
reminded one of the last criterions, which he laid down for a
truthful Muslim.I tell you the sign of a Mumin
When death comes there is smile on his lips.
</span></h2>
Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0tag:blogger.com,1999:blog-6028953153571201818.post-75748812308073410712013-10-19T22:58:00.002-07:002013-10-19T22:59:59.542-07:00Browse Contemporary Long Term Care by date<h2>
</h2>
<h2>
Browse Contemporary Long Term Care by date</h2>
<h2>
</h2>
<h3>
Bad news abounded for SNFs that bill for frequent blood glucose tests in the 2007 Medicare Physician Fee Schedule (MPFS) final rule.
Effective January 1, under the rule, physicians must certify the medical
necessity of each blood glucose test furnished to SNF residents--if the
SNF submits that finger-stick test for payment under the Medicare Part B
clinical laboratory fee schedule. In addition, CMS clarified that a
physician's standing order isn't sufficient to order a series
of blood glucose tests. The 2007 MPFS is available at
www.cms.hhs.gov/PhysicianFeeSched/PFSFRN/list.asp.
</h3>
Anonymoushttp://www.blogger.com/profile/11989130622437599747noreply@blogger.com0