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For better or worse, your parents’ health history can predict your own: If your mom or dad has a serious condition like obesity, heart disease or cancer, your own risk is, of course, higher.

But how much higher? The truth is, what it means to have a family history can vary a lot depending on the disease. That’s why it’s important to not only know your medical background, but also to tease out how much hereditary factors influence your individual risk so you can identify the precautions to take to protect yourself while you’re still healthy.

“Knowing your family history might save your life,” says Theresa Frezzo, M.S., a genetic counselor and research coordinator at the Center for Genetic Medicine at Northwestern University in Chicago. “If you know that you have a family history of a particular disease, you can report that information to your health-care provider and take steps to modify your risk. With most adult-onset illnesses, your heritage is not your destiny. There are preventive measures you can take that can reduce your risk of following in your family member’s footsteps.”

But it’s up to you to be proactive about your health care: A recent study led by Frezzo found that approximately 20 percent of patients in an internal-medicine clinic were at increased risk for diseases with genetic links–though this was not noted in their charts. (These family histories came to light because either the patients were asked for the information in a separate questionnaire or they were interviewed by a genetic-counseling intern.)

You may think you already know the signs of diabetes: You’re thirsty all the time, you feel exhausted 24/7 and/or you’re constantly running to the bathroom. Yet a surprising number of Americans–including young and seemingly healthy women–have abnormally high blood-sugar (glucose) levels but don’t know it. The signs can be so subtle–or altogether absent–that the problem goes undetected, yet it increases the risk for heart disease and other serious health problems. As more and more of us pack on extra pounds, the incidence of diabetes and its recently defined precursor, pre-diabetes, is soaring in the United States. In fact, new research from the Centers for Disease Control and Prevention suggests that more than one in three girls born in the year 2000 will develop diabetes during their lifetime.

Approximately 18 million Americans have diabetes, either type 1–in which the pancreas doesn’t produce enough insulin (a hormone that helps regulate blood sugar)–or type 2, a far more common condition that develops over time in which the body cannot use insulin effectively to maintain normal blood-sugar levels. Unfortunately, about 5 million of these diabetics are unaware they have the condition, according to the American Diabetes Association (ADA).

What’s even more worrisome is that more than 24 million additional Americans have pre-diabetes, in which a person’s blood-sugar levels are higher than normal, but not quite high enough to be classified as diabetic. Research has found that the majority of people with pre-diabetes develop type 2 diabetes within 10 years, notes Francine Kaufman, M.D., immediate past president of the ADA and an endocrinologist at Childrens Hospital Los Angeles. More alarming, pre-diabetes, by itself, carries a 50 percent increased risk of cardiovascular disease. Yet, because it doesn’t cause symptoms, most people who have it are blissfully unaware of the danger.

Six simple steps

The good news is that there is a lot you can do now to lower your risk of developing both pre-diabetes and type 2 diabetes. The latest research suggests that more than half of new cases of diabetes could be prevented through lifestyle changes. Here are six steps that can greatly reduce your odds.

Are you in your 20-something years and find yourself avoiding the treadmill in your home? Do you hide it with those unhung pieces of clothing?

Do you take the longer route to your house just to bypass the neighborhood gym you once belonged to? Do you tell yourself you’re going to rejoin? Well, you might want to rethink your exercise routine now to escape health problems in the future.

People who stay in shape in their 20s by leading an active lifestyle are more likely to decrease their high risk of developing high blood pressure, diabetes and other heart attack risk factors by their 30s and 40s, according to a study in which people were given treadmill tests for their fitness.

The lesson: “People can’t wait until they are middle age to try to protect themselves,” said lead author Mercedes Carnethon, an assistant professor of preventive medicine at Northwestern University in Chicago.

The study, published in the Journal of the American Medical Association (JAMA), involved about 4,400 men and women who were given a treadmill test when they were aged 18 to 30. Most of them were followed for 15 years after that.

Those who did not do well on the treadmill test faced double the risk of developing high blood pressure, diabetes or a condition called metabolic syndrome when compared with highly fit participants.

Metabolic syndrome is a cluster of symptoms that includes high blood sugar, poor cholesterol levels, elevated blood pressure and a fat belly.

Some of the participants underwent a second treadmill test, seven years after the first one. Those who became more fit during those intervening years reduced their risk of diabetes and metabolic syndrome by 50 percent.

The findings “confirm what common sense has always told us-lack of fitness in youth is not a good thing for later life,” said Dr. Teri Manolio, director of epidemiology at the National Heart, Lung and Blood Institute, which funded the research. “It doesn’t take that long for risk factors to develop and disease to develop.”

Fitness levels were determined by how long participants could walk on a treadmill without becoming fatigued and short of breath.

About 60 percent of the female test subjects and 50 percent of the male subjects had low or moderate fitness levels. They were said to be twice as likely to develop heart-disease factors as those who were highly fit.

MALARIA is killing between one and two million people each year, 90 per cent of them in Africa and more than half of them young children. And visceral leishmaniasis will kill half a million in the developing world if they don’t receive treatment: These are neglected, seriously disabling or life-threatening diseases that mainly affect people in the poor world, and for which treatment options are inadequate or do not exist. In their own right, they don’t constitute a valuable enough ‘market’ to stimulate adequate research and development for new medicines by the pharmaceutical industry.

Take sleeping sickness. Civil war and the mass movement of civilians fleeing conflict has led to an epidemic of the disease through Uganda, DR Congo, Angola, Congo Brazzaville and Sudan. Sixty million Africans are at risk from catching this often-fatal disease. Although 45,000 cases of sleeping sickness were reported in 1999, the World Health Organization estimates that the number of people actually affected is 10 times greater. Yet it’s a disease that most people living in industrialized countries haven’t heard of. And because it poses no threat to rich-world consumers, there is little incentive to research effective drugs to treat it.

So until very recently the only drug available to patients infected with sleeping sickness was an archaic treatment first made 50 years ago that has a 1-in-20 chance of killing them. This drug — melarsoprol — is a derivative of arsenic. When injected it burns the patient. It can also cause a swelling in the brain leading to convulsions, coma and death. It has placed doctors in an invidious position — they knew the risks of injecting their patients with this caustic poison, yet they had no other option.

Then, in the late 1990s, a new drug emerged which could treat sleeping sickness with none of the painful side-effects. The new drug — eflornithine — has been dubbed the ‘resurrection drug’ because of its ability to revive even comatose patients. But it did not make it into Africa’s hospitals: despite its potential to save thousands of lives, eflornithine was pulled off the shelves in 1999 because its production was considered unprofitable. Finally, in 2001, the drug made it to Africa. Why? Because a new use for it was discovered late last year: it suppresses the enzymes that cause facial hair to grow. Now — in a facial-hair cream costing $54 a tube — it is again deemed worthy of manufacture.

Persons who have close relatives with certain diseases (e.g., heart disease, diabetes, and osteoporosis) are more likely to develop those diseases themselves (i). Family health history is an important risk factor that reflects inherited genetic susceptibility, shared environment, and common behaviors. Although clinicians are trained to collect family histories, substantial barriers exist to obtaining this information in primary care practice (e.g., lack of time or lack of reimbursement) (2). To promote the use of family history as a screening tool for disease prevention and health promotion, several initiatives have called for new self-administered family history collection tools and educational programs to help clinicians interpret and apply family history information to patient care (3,4). To assess attitudes, knowledge, and practices of U.S. residents regarding their family health histories, CDC analyzed data from the 2004 HealthStyles Survey. This report summarizes the results of that analysis, which indicated that although 96.3% of survey respondents believe their family history is important for their own health, few have actively collected health information from their relatives to develop a family history. Targeted public health efforts are needed to 1) help persons collect family history information to share with their health-care providers and 2) educate and assist providers to interpret and apply this information effectively.

HealthStyles is an annual mail survey of the U.S. population aged [greater than or equal to] 18 years that examines health-related attitudes and behaviors (5). The survey is designed and conducted by Porter Novelli (Washington, DC), with technical assistance from health organizations, including CDC. In July and August 2004, a stratified random sample of 6,175 respondents was selected from approximately 600,000 households previously recruited to participate in a consumer marketing survey. In return for their participation, respondents were given small gifts (e.g., a 20-minute calling card) and entered into a sweepstakes drawing. Of the 6,175 households contacted by mail, 4,345 (70.4%) returned the survey. Survey data were weighted to match the 2003 Current Population Survey estimates relative to age, race/ethnicity, sex, income, and household size.

Whether leading his team on the gridiron or offering pro football commentary on ESPN, Joe Theismann’s play-calling has always commanded respect. Today, the legendary “number 7″ is lending his voice and support to educating men about enlarged prostate (EP), a condition that affects more than 50 percent of American men over 50 years of age and 80 percent of men over age 80, according to the American Urological Association.

“Over the last three years, I found myself getting up in the middle of the night to go to the bathroom,” Theismann told the Post. “After a while, I began to accept that going to the bathroom so frequently was simply part of aging after hitting 50.”

The nightly ritual, however, exacted a physical toll on the busy businessman and sportscaster, who suspected after investigation that his symptoms were similar to those of EP.

“During a routine physical, I asked my doctor about the signs indicating an enlarged prostate,” recalls Theismann. “He explained the symptoms, which basically matched what I was experiencing. During my checkup, he found that I did indeed have an enlarged prostate.”

Theismann’s physician suggested medication, and over time, the symptoms eased.

“Now, I sleep well throughout the night,” Theismann reports. “I don’t go to the bathroom as often as I did before. I used to go to the bathroom at 2:30 and 4:30 before finally getting up for good at 6:00 a.m. My sleep was interrupted. Now, I feel refreshed throughout the day. And when I plan a trip, I don’t have to figure out rest stops. I resumed my normal life.”

The prostate is a walnut-sized gland of the male reproductive system that is located beneath the bladder and in front of the rectum. The urethra, which transports urine and sperm out of the body, passes through the prostate to the bladder neck. Surrounded by a capsule of fibrous tissue that is called the prostate capsule, the gland can begin to enlarge in two ways–cells multiply around the urethra, squeezing it; or cells grow into the urethra and bladder outlet area, a condition that typical] requires surgery. As cells proliferate, the prostate gets bigger, pressing on the urethra and causing the flow of urine to become slower and less forceful.

IT’S called “the sneak thief of sight,” and it strikes African-Americans at a higher rate than any other race. In fact, a staggering I in every 13 Blacks has glaucoma–a total of about 1.5 million persons of all ages and conditions. Because of a prevalence of other risk factors, Blacks are four to six times more likely to develop the disease than Whites. Not only that, Blacks develop it on average 10 years earlier than Whites and are about 10 times more likely to go blind from it.

The disease, which has not received the attention and publicity of diseases like diabetes, heart disease, and hypertension, has taken the vision of some 120,000 people now living in the United States.

One of the major problems is that many people think glaucoma automatically leads to blindness. Although it is true that there is no cure and that vision impaired by the disease cannot be restored, the progression of the disease, if caught early and properly treated, can usually be halted and sight preserved for a lifetime. The New York-based Glaucoma Foundation, which is leading a national campaign for a greater understanding of the disease, says 90 percent of the people who are blind as a result of glaucoma lost their sight needlessly.

Dr. Kevin C. Greenidge, chairman of the Department of Ophthalmology at the SUNY Health Science Center at Brooklyn and a board member of the Glaucoma Foundation, says that there have been many advances in recent years in treating the disease. “We’re finding that glaucoma may be a different disease in people of African descent requiring more aggressive therapies” he says. “Our main aim is to lower the pressure buildup within the eye to slow progression of the disease and save sight.”

Anyone, at any age, can develop glaucoma. Infants can be born with the disease, and it can develop in small children. The Glaucoma Foundation says 6 percent of the population over 65 has glaucoma. The more significant risk factors a person has the greater the likelihood that the disease will set in at an earlier age.

Dr. Greenidge says “diabetes is a risk factor, and hypertension is a risk factor, and being African-American is a risk factor–and if you have those three–there is a significant chance that you may develop glaucoma and you need to be checked on a regular basis. And if you add to that a family history of glaucoma, you probably have a 50-50 chance of getting glaucoma, if not greater.”

The incorporation of patient-reported health-related quality of life (HRQL) measures to better assess clinical outcomes has been an important goal of evidence-based medicine (Guyatt et al. 1997). The Medical Outcomes Study Short-Form 36-Item Health Survey, or SF-36, is the most widely used HRQL instrument in the world (Brazier, Harper, and Jones 1992). Designed as a generic instrument capable of measuring the HRQL of individuals with different diseases or health conditions, the SF-36 yields scale scores for eight domains: Physical Functioning, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role Emotional, and Mental Health. Recently, this instrument was revised to reflect improved wording and response options, and Version 2 is now available for patient reported measurement of HRQL outcomes (Ware, Kosinski, and Dewey 2000).

Other HRQL measures, primarily disease-specific instruments designed to measure particular health conditions, have established standards for determining clinically important differences (CIDs) using various approaches for interpreting important changes over time (Guyatt et al. 2002). Many consumers seek such standards or thresholds for interpreting and evaluating change on these important outcomes (Symonds et al. 2002). These consumers include not only patients, clinicians, and clinical researchers but also pharmaceutical and medical device manufacturers who must demonstrate the usefulness of their products, and government regulators who, along with insurance payers, must evaluate the usefulness and consequences of each product seeking endorsement or coverage. Without established standards for interpreting the change in HRQL measures attributed to treatments or interventions, these consumers must often resort to statistical evaluations that rely on the variation in a sample(s) and the number of enrollees or power to detect a statistically significant difference (p< .05) between two groups, such as treatment versus placebo. Statistically significant differences, however, do not imply that a meaningful or relevant difference has been demonstrated for the individuals enrolled in such trials (Sloan et al. 2002).

ONE is the No. 1 single cause of death to Blacks in the United States. The other is No. 3. Together, the twin assassins of heart disease and stroke kill 9,000 Blacks every month–more deaths to African-Americans than all other diseases combined.

But as devastating as cardiovascular disease is, research has shown that Blacks are actually more afraid of cancer and AIDS than heart disease. And most Black women believe that breast cancer (which kills 1 in 25 women) is their greatest health risk, although heart disease and stroke claim 1 in every 2 women.

In fact, the disparities in heart disease are widest for African-American women, who have a 69 percent higher death rate than White women. The reasons for the disparities include a higher prevalence of hypertension, diabetes and obesity among Black women.

But there is good news. Doctors say the risk of having a heart attack–even in people who already have coronary heart disease or have had a previous heart attack–can be reduced by preventing or controlling certain risk factors.

One of the greatest risks is smoking. Cigarettes greatly increase the risk of fatal and nonfatal heart attacks in both men and women. Smoking also increases the risk of a second heart attack among survivors. Women who smoke and use oral contraceptives have an even greater risk than smoking alone.

The good news is that quitting smoking greatly reduces the risk of heart attack. One year after quitting, the risk of having a heart attack drops to about one-half that of current smokers and gradually returns to normal in people without heart disease. Even among people with heart disease, the risk also drops sharply one year after quitting smoking and it continues to decline.

Another factor that increases the risk of heart attack is high blood pressure. Also called hypertension, high blood pressure makes the heart work harder than it should. Although it has no symptoms, hypertension is the most common form of cardiovascular disease. Two out of every three Blacks will develop hypertension by the time they are 60. Those who have high blood pressure have an 80 percent higher stroke mortality rate, a 50 percent higher heart disease mortality rate and a 320 percent greater rate of kidney disease than in the general population.

During May 1997-November 2000, eight (3%) of 265 kidney transplant recipients at a hospital in California developed an unusual skin condition posttransplant (Figure 1). On clinical examination, the patients had fibrotic skin lesions histologically resembling scleromyxedema on their distal extremities and trunk, resulting in severe contractions and limited mobility. However, the usual IgG lambda paraprotein associated with scleromyxedema was not observed in these patients. Personnel in the dermatopathology section at the University of California, San Francisco, reviewed the biopsies and concluded that this skin disorder had not been described previously. As a result, health-care providers at the hospital where the index patient was treated asked the California Department of Health Services (CD HS) and CDC to assist in the investigation. This report summarizes preliminary findings from the investigation.

A case was defined as large areas of hardened skin with slightly raised plaques or papules, with or without pigment alteration, in a patient with a skin biopsy indicating increased dermal fibroblasts and mucin and an abnormal dermal collagen bundle pattern. Additional patients were identified by responses to a publication describing the condition (1), by colleague referral, and by contacting members of the American Society of Dermatopathology, who were asked to alert other clinicians about the condition and to refer potential patients to CDHS. As of January 2002, 49 patients have been identified throughout the United States and Europe. Although having renal disease is not a part of the case definition, all patients have had underlying renal disease; approximately half have had renal transplantation. No consistently effective treatment exists; however, several patients have improved.