: Health,Psychology,Sağlık Blog-: Nisan 2009
30 04 2009

How to Get Your Way With Body Language

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Did you know that the way you stand can make you more persuasive? And how you hold your arms can be a tip off that you’re tense? Send out the best possible message with this quick primer.
Be a copycatMirroring someone else’s body language is a great way to show that the two of you are in sync. In fact, when you talk to a close friend, you may find yourself matching her posture—she leans forward, you lean forward; she takes a sip of her latte, you take a sip.
“You’re saying, ‘I feel comfortable and at ease,’” says Patti Wood, MA, a body language expert in Atlanta. “And when someone mirrors you, it calms you.” This move can also show empathy. When listening to your child, a friend, or even a client describe a problem, matching their posture and tone of voice shows them that you truly understand what they’re going through.

Take up spaceDo you keep your arms close to your sides or folded in front of you? This makes your body more compact, which sends out the signal that you’re not only closed but subordinate. “When you take up less space, you appear and feel less power-ful, and people may treat you that way,” Wood notes.
If you want to command respect, whether it’s from a co-worker or a family member, take up a little more space. Remember to stand up straight and relaxed, with your feet 6 to 7 inches apart.
Hold your head upThere’s a good reason why “jump for joy” is a cliché. When you feel happy and confident, your body automatically lifts up, Wood says. You may raise your head, shoulders, and/or chest, and momentarily push up on the balls of your feet. Feeling down? Hold up your head, bring your shoulders back, sit up, and smile. “It can change your mood in less than a fraction of a second,” Wood says. Believe it or not, our body movements actually change our feelings.
Watch your armsThough anything from stress to an overly air-conditioned room may prompt you to cross your arms, people assume you’re trying to keep something inside or someone out when you get in this stance. You might unconsciously do it at a party to keep others at bay or at work as a way of holding back your real opinion. To appear more approachable, leave arms by your sides or gesture with them.
Open upIf you’re physically attracted to a date (or your husband on date night), you might reach out with open palms or push your hair behind your ear with your palm facing out. “That’s a signal to his brain that you’re open to seduction,” Wood says. Similarly, turning the upper part of your chest—what Wood calls “the heart window”—toward a person and pointing your toes toward him show a desire to connect, whether it’s a romantic interest or a potential new friend.

Cholesterol:Your Risk for High Cholesterol

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Each year more than 750,000 Americans suffer a stroke. Strokes are often caused by unhealthy cholesterol levels. Cholesterol is a waxy substance that circulates, but does not dissolve, in the blood. If a person has too much low-density lipoprotein (LDL), also known as bad cholesterol, it can slowly build up in the wall of the arteries. Eventually this buildup forms a thick, hard plaque that narrows the arteries. If one of these plaques ruptures, it causes a blot clot to form, which can block normal blood flow to the brain and lead to a stroke.

A stroke is a sudden disruption in blood flow to the brain caused by a blockage or bleeding of a blood vessel. Areas of the brain that are affected by the blockage or bleeding can become damaged within minutes.
The effects of a stroke may be mild or severe and temporary or permanent, depending on which brain cells are damaged, how much of the brain is involved, and how quickly the blood supply is restored to the area.
Symptoms of a stroke are sudden and may include:
Numbness, weakness, or lack of movement (paralysis) in the face, an arm, or a leg, especially on only one side of the body.
Trouble seeing in one or both eyes.
Confusion and difficulty speaking.
Dizziness and a loss of balance or coordination.
Vomiting.
A sudden, severe headache.
A person with stroke symptoms needs immediate medical attention to help limit potential damage.

Öksürük deyip geçmeyin

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Türk Akciğer Kanseri Derneği Başkanı Prof. Dr. Nezih Özdemir, Türkiye'de akciğer kanseri sorununun, sigara tüketiminin çoğalmasıyla her yıl daha da arttığına dikkat çekti.
Türkiye için ciddi boyutlarda olan akciğer kanserini daha iyi tanımak amacıyla yarın Adana Hilton Oteli'nde "Erkek evre küçük hücreli dışı akciğer kanseri tedavisini ne kadar biliyoruz" sempozyumu düzenlenecek.
Sempozyum öncesinde açıklama yapan Özdemir, sempozyumda akciğer kanseriyle ilgili yeni bilgi ve tekniklerin gözden geçirilip, Türkiye'de yapılan yeni çalışmaların tartışılacağını kaydetti.
Türkiye'de her yıl yeni 15 bin akciğer kanseri tanısı konulduğunu aktaran Prof. Özdemir, son yıllarda akciğer kanseri tedavisiyle ilgili önemli gelişmeler kaydedildiğini söyledi.
Akciğer kanseri belirtilerinin başında öksürük geldiğini hatırlatan Prof. Dr. Özdemir, "Öksürük çok önemli bir uyarıcı olmasına karşın, insanlar tarafından kolaylıkla ihmal edilebilmekte. Bunun sebebi de bu hastalığa yakalanan insanların yüzde 90'ı sigara içmekte, güne öksürükle başladıkları için öksürük artsa da karakter değiştirse de doktora gitmemekteler. Şikayetler başladığında hemen hekime başvurdukları takdirde, erken evrede hastalık tanısı mümkün olmaktadır ve hastalıktan kurtulma ihtimali çok yüksektir. Bu yüzden halkımızın bu konuda bilinçlendirilmesi gerekmektedir." diye konuştu.Günümüzde kanserin ölüm nedenleri arasında kalp hastalıklarından sonra ikinci sırada geldiğini hatırlatan Özdemir, akciğer kanserine yakalanma oranının erkeklerde yüzde 8 kadınlarda yüzde 6 olduğunu belirtti.
Akciğer kanserinin Türkiye'de erkeklerde yüzde 35 ile en sık görülen kadınlarda yüzde 6 oranı ile beşinci sırada yer alan bir hastalık olduğunu vurgulayan Prof. Dr. Özdemir, "Ölümlere baktığımızda akciğer kanseri erkeklerde yüzde 40'la ilk sırada, kadınlarda ise yüzde 6'le 4. sırada yer almaktadır. Bu kanserin en büyük nedeni yüzde 85-90 oranları ile sigara ve tütün alışkanlığıdır." dedi.

Domuz Gribi

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Dünya Sağlık Örgütü domuz katliamına karşı önlem alıyor30.04.2009 21:24
Dünya Sağlık Örgütü (WHO) ''domuz gribi'' teriminin kullanımını domuzları korumak için durduracağını bildirdi.WHO Sözcüsü Dick Thompson, isim değişikliği kararının, tarım söktörü ve BM gıda örgütünün ''domuz gribi'' teriminin tüketicileri yanıltacağı ve ülkelerin gereksiz yere domuzların itlaf edilmesi talimatı vereceği kaygısını açıklamasından sonra alındığını söyledi.WHO'nun İsviçre'nin Cenevre kentindeki genel merkezinde gazetecilere açıklama yapan Thompson, bundan sonra domuz gribinin bilimsel teknik ismi olan "H1N1 grip A"yı kullanacaklarını kaydetti.

Botox ve Uygulama Alanları

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Yüz çizgilerini ortadan kaldırmak amacıyla kozmetik alanda kullanıldığından beri medyada sık sık adı geçen Botox’un diğer uygulama alanlarının öneminin vurgulanması gerekir. Botulinum Toksini (Botox), halk arasında yılan zehiri olarak bilinmesine rağmen aslında tıp dilinde « Clostridium Botulinum » adıyla anılan bakterinin salgıladığı bir toksindir. Bu bakterinin yol açtığı zehirlenme tablosuna « botulizm » denir. Varlığı 19. yüzyılın sonlarından beri bilinmektedir. Botulizm ilk kez literatüre o tarihlerde geçmiştir. Botulizm hijyenik koşulların düzelmesiyle, evde yapılan konserve geleneğinin giderek azalmasıyla, günümüzde daha az görülen bir zehirlenmesi tablosudur. Botulizme yol açan Botox bilinen en güçlü nörotoksindir. 1980'lerin başindan itibaren medikal alanda uygulanmaya başlanan Botox’un ilk kullanım alanı şaşılıktı. Daha sonra hızla nörolojinin kullanım alanına girdi. Distonilerin (vücutta yüz dahil birçok bölgesinde istemsiz hareketlere yol açan hastalıklar gurubu) tedavisinde, özellikle de fokal distonilerin tedavisinde başarıyla kullanılmaktadır. Medikal tedavinin de söz konusu olduğu bu hastalıklarda artık Botox’un ilk tercih edilen tedavi yaklaşımı olduğunu vurgulamak gerek. Kas içine enjekte edilerek olarak kullanılan bu ajan başlıca aşırı kasılan kasta geçici güçsüzlük yaparak etkisini göstermekte, bu etki de 3-4 ay sürmektedir. Botox’un nörolojide kullanıldığı alanlar giderek genişledi ; serebral palsi (CP), multiple skleroz (MS) inme gibi hastaliklarda ortaya çikan spastisiteyi ortadan kaldirmak amacıyla, hastaya fonksiyonel açıdan katkıda bulunacak kas gruplarının enjeksiyonu başarılı sonuçlar vermektedir. Botox ayrıca üroloji, gastroentroloji, plastik cerrahi, dermatoloji alanlarında uygulandığı gibi, kullanım alanları giderek genişlemektedir. Aslında uzun süredir- 25 yıldır- tıbbın hizmetinde olan Botox hekimlerin gayet iyi bildiği etkili bir tedavi yöntemidir. Yüz çizgilerini ortadan kaldırmak amacıyla kozmetik alanda kullanıldığından beri medyada sık olarak ismi geçmeye başladı. Yukarıda da vurgulandığı gibi, Botox ile büyük bir hasta ve hastalıklar grubunun sağaltımı sağlandığında daha geniş bir yelpazeyi içeren diğer kullanım alanlarının öneminin vurgulanması gerektiğini düşünmekteyiz. Botox’un etki mekanizması nedir?Botox kas içine enjekte edildiğinde o kas veya kas gruplarının sinirlerini geçici olarak devre dışı bırakıp istemsiz hareketleri ve aşırı kasılmayı ortadan kaldırır. Sözü edilen geçici etki 3-4 ay kadar sürer ve bu süre sonunda kasılmalar tekrar başlayabilir. Bu nedenle enjeksiyonları tekrarlamak gereklidir. Bazı uygulama alanlarında etki daha uzun sürebilir [örneğin kozmetik amaçlı uygulamalar ve hiperhidroziste (aşırı terleme) ]. Botox nin uygulama alanlarından aşağıda söz edilecektir.UYGULAMA ALANLARI :1. Distoni Distoni istemsiz , süregen, bükücü, döndürücü nitelikte kas kasılmalarıyla karakterize, tekrarlayan istem dışı hareketlere neden olan, geçici ya da kalıcı anormal postürlere yol açan hareket bozukluğudur. Hareket sisteminin hastalığıdır, beynin daha çok derin yapılarını tutan hastalıklarda görülür. Bazı hastalıklara eşlik edebileceği gibi (örn. Parkinson Hastalığı), tek başına bir hastalık olarak da ortaya çıkabilir. Her yaşta görülebilir. Özellikle ilk dekadlarda ve 40 yaşın üstünde daha sık görülür. Distoni özellikle hastalığın başlangıcında, tutulan vücut bölgesi istemli olarak kullanıldığında ortaya çıkar veya belirgin hale gelir. Diğer bir vücut bölgesinin istemli hareketleri esnasında da distonik bölge daha çok kasılır. Ayrı ayrı vücut bölgelerini tutabileceği gibi (örn. yüz, boyun) tüm vücutta yaygın olarak da görülebilir. İlaçla tedavi mümkün olduğu gibi, daha nadir olarak da cerrahi yöntemlere de başvurulabilir. Günümüzde en etkili tedavi yöntemi Botox iledir. Özellikle vücudun belli bölgelerini tuttuğunda (örneğin yüz ve boyun) uygulanması gereken ilk tedavi yöntemi olmalıdır. İstemsiz olarak kasılan kas veya kas gruplarına enjekte edilir. Bilinen distoniler içinde spazmodik tortikolis (boyun kaslarının istemsiz kasılması) , blefarospazm (göz çevresinde yer alan kasın aşırı kasılması), yazıcı krampı (yazı yazarken ortaya çıkan parmak ve kol kaslarında aşırı kasılma), oromandibüler distoni (çene kaslarının kasılması), sayılabilir.2. Spastisite Spastisite bir semptomdur (belirtidir). Beyinde ve omurilikte hareketle ilgili merkezlerin hastalandığı durumlarda spastisite ortaya çıkabilir. Kaslarda ve kas gruplarında sertleşme ve kasılmayla kendini gösterir, istemli hareketin yapılmasını güçleştirir. Spastisiteye yol açan hastalıkların başında beyin damarlarının tıkanması ya da beyin kanaması sonucunda ortaya çıkan inme (felç) durumları gelmektedir. İnme dünyada 2. ölüm nedenidir. Bu durumdan başka, beyin ve omurilik travmaları, multiple skleroz (MS) gibi sinir sistemini hasara uğratan hastalıklar da sayılabilir. Botox uygulamasına iyi bir fizyoterapi programının da eklenmesi tedaviyi daha etkili kılmaktadır. Spastisitenin birçok tedavi yöntemi vardır. Öncelikle ilaçla tedavi denenebilir, gerekli, durumlarda cerrahi tedaviye de başvurulabilir. Son yıllarda özellikle öne çıkan tedavi yöntemi Botox ile olan tedavi aşırı kasılan ve sertleşen kas ve kas gruplarının gevşemesine neden olmaktadır. Bu tedavi yöntemi fizyoterapi ile birlikte uygulandığında yüz güldürücü sonuçlar alınmakta , bu sorunu olan hastaların günlük yaşamlarında daha aktif olması mümkün olabilmektedir. Fonksiyonel kapasiteyi arttırmak, kontraktür gelişimini önlemek, cerrahi girişimi geciktirmek amaçlanan hedeflerden bazılarıdır.3. Hemifasyal spazm:Hemifasyal spazm (HFS), yüz siniri tarafından uyarılan yüzün mimik kaslarının aralıklı olarak kasılmasıdır. Genellikle erişkinlerde görülür. Önce tek taraflı olarak göz çevresinde başlar, daha sonra zamanla aynı taraf yüz kaslarına yayılır. Yayıldığı kaslar arasında başlıca yanak kasları, ağız çevresi kasları ve nadir olarak da boyun kasları sayılabilir. Nörolojik muayene sözü edilen kasılmalar dışında normaldir. Nöroradyolojik inceleme yöntemleri geliştikçe, HFS’ın yüz sinirin damar basısına uğramasına bağlı olarak ortaya çıktığı görülmüştür. HFS’lı olguların 2/3’de beyin manyetik rezonans (MR) incelemesinde söz konusu görüntüye rastlanmaktadır. Bu durumda cerrahi yöntemler uygulanabilir. Hastalar genellikle bu invaziv yöntemden çok semptomatik tedaviyi, Botox ile tedaviyi tercih etmektedirler. Botox, bugün için dünyada HFS tedavisinde ilk seçenek olarak kabul edilmektedir. Botox göz çevresindeki kaslara ve spazmın görüldüğü yüz kaslarına uygulanır. Tedavi hastaların %80-90’ da olumlu sonuç verir. HFS’lı hastalarda Botox uygulaması sonrasında yüz çizgilerinin de ortadan kalktığı gözlenmiş ve Botox’un kozmetik alanda kullanılmaya başlaması bu sayede olmuştur.Hiperhidrozis (Aşırı Terleme):Ter bezlerinin aşırı çalışmasıyla ortaya çıkan bu durum, kozmetik açıdan rahatsız edici bir tabloya yol açmaktadır. Özellikle koltuk altı, avuç içi ve ayak tabanı aşırı olarak terler. Yüzde de aşırı terleme görülebilir. Botox aşırı terlemede diğer uygulamalarda olduğu gibi kas içine değil, terlemeyi düzenleyen sinir uçları derinin üst tabakasında yer aldığı için deri içine veya altına enjekte edilir. Bu uygulamada Botox’un etkisi 6 ay kadar sürmektedir. Bu yakınmayla gelen hastalara Botox uygulaması giderek artmaktadır. Uygulamanın ağrılı olmaması için lokal anestezikler kullanılır.Yan Etkiler:Botox, 25 yıldır tıbbın hizmetinde, birçok hastalığın sağaltımında kullanılmaktadır. Oldukça emniyetli bir ilaçtır. Belirgin yan etkiye yol açmaz, açsa da bu etkinin geçici olduğunu bilmekteyiz. En sık görülen yan etki Botox’un hedeflenmeyen kaslara da yayılarak geçici zaaf yapmasıdır. Bu nedenle, yüz bölgesindeki kaslar daha küçük olduğu için, özellikle yüze uygulanan dozlar çok önemlidir. Bu tedavi yaklaşımı, Botox uygulamasını yapmak için gerekli eğitimi almış hekimlerin elinde oldukça yüz güldürücü sonuçlar vermektedir.

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Sağlıklı yaşamın vazgeçilmeziABD'de elma kabuğundaki 'triterpenoids' adlı maddenin, laboratuvar ortamında kanser hücrelerinin çoğalmasını engellediği veya öldürdüğünün tespit edildiği bildirildi.Gökbel, elmanın sağlıklı yaşam için vazgeçilmez meyvelerden olduğunu, ülkemizin hemen hemen her yerinde bol miktarda yetişen elmanın düzenli olarak tüketilmesinin, sağlık açısından yarar sağlayacağını ifade etti.Çalışmalar sürüyor...Prof. Dr. Gökbel, elmanın, sağlık açısından bugüne kadar bilinmeyen yararlarının öğrenilmesi ve özellikle çağın neredeyse en önemli sağlık sorunu haline gelen kanserle mücadelede kullanılabilirliğinin tespit edilmesi için gelişmiş ülkelerde çalışmalarının sürdüğünü anlattı.Gökbel, ABD'nin saygın üniversitelerinden Cornell Üniversitesi araştırmacılarının, elma kabuğundaki 'triterpenoids' adlı maddenin, laboratuvar ortamında kanser hücrelerinin çoğalmasını engellediği veya öldürdüğünü tespit ettiğini vurguladı.






Çay Sağlıklı mı Zararlı mı?

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Yeşil çay ve siyah çay arasında ne fark var? Çayın besin değeri var mı? Çay uyku kaçırır mı?
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Sabah kahvaltısında demleme çay, benim için güne iyi başlamanın önemli bir parçası. Şekersiz içtiğim için çok koyu tercih etmiyorum ama sabahları çay içmeyi çok seviyorum. Çayın yanına sabahları ekmek, peynir ve zeytin; öğleden sonraları ise kuru meyve ekliyorum. Bir de akşam yemeğinden sonra keyif yaparken yeşil çay ve kuru yaban mersini harika bir ikili oluyor. Yeşil çay ve siyah çay arasında ne fark var? Çayın besin değeri var mı? Çay uyku kaçırır mı? gibi sorularla zaman zaman karşılaşıyorum bu sebeple bugün bu konulara değinmek istedim.

Çay yapraklarından, siyah ve yeşil olmak üzere iki tip çay elde edilir son yıllarda yeşil çay tüketimi artsa da ülkemizde en çok tüketilen tip, siyah çaydır. Siyah çay polifenollerin enzimatik oksidasyonuyla elde edilir. Yeşil çayda ise çaydaki enzimler etkisizleştirilerek, polifenollerin oksidasyonu önlenir.

Siyah çay: Siyah çay, paketlenmiş kuru çayın sıcak suda demlenmesiyle hazırlanır. Demlenme sırasında kafein, organik asitler, polifenol türevleri ve minerallerin bir kısmı suya geçer. Demlenme süresi uzadıkça, bu öğelerin suya geçen miktarları da artar. Böylece çayın rengi koyulaşır ve tadı acır. Çayın tadı polifenol türevleri ve kafeinden kaynaklanır.

Yeşil çay: Yeşil çay, Çin ve Japonya gibi ülkelerde yaygın olarak kullanılır. Yeşil çayın aminoasit içeriği siyah çaydan yüksek, polifenol içeriği ise düşüktür. Yeşil çayın kafein içeriği de siyah çaydan düşüktür. Yeşil çay da siyah çay gibi demlenerek hazırlanır. Çay yapraklarının suda çözünür bölümlerinin ayrılmasıyla toz halinde “poşet çay” hazırlanır. Poşet çayın kafein içeriği, normal siyah çaydan biraz daha düşüktür.

Kısa Sürede 4 kilo veri

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Metabolizmanızın hızını arttırmak ve hedefiniz doğrultusunda emin adımlarla ilerlemek için bu tavsiyeleri deneyin.

Metabolizma hızınızı biliyor musunuz?

Az kilolu olduğunuzda, gün boyunca daha az kalori kullanırız. Çünkü az kilo ile daha rahat hareket edebiliriz. Ayrıca, çabucak kilo kaybetmediğinizde, ilginizin dağılması ve fazla yemek yemeğe başlamanız çok kolaydır.

Metabolizmanızın hızını arttırmak ve hedefiniz doğrultusunda emin adımlarla ilerlemek için bu tavsiyeleri deneyin.

1- Egzersize daha çok zaman ayırın. Toplam her gün en azından 60 dakika egzersiz ve enerjik aktiviteler yapmayı hedefleyin.

2- Daha çok egzersiz yapın. Yürüyüşlerinize tepeleri ekleyin, adımlarınızı hızlandırın, bisikletin pedallarını daha hızlı çevirin veya günlük yürüyüşlerinize 1 veya 2 dakika koşma periyotları ekleyin. Ne kadar çok egzersiz yaparsanız o kadar çok kalori yakarsınız.

3- Haftalık egzersiz rutininize ağırlık kaldırma antrenmanını ekleyin. Ağırlık kaldırmak, kalorileri yakarken kaslarınızda arttırır. Ne kadar çok kasınız varsa vücudunuz gün boyunca o kadar çok kaloriye ihtiyaç duyar.

4- Yiyecek porsiyonlarınızı ölçün. Her gün 200 veya 300 ekstra kalori almanıza neden olan porsiyonlarınızın büyüklüğünü abartmanız ve sadece “ bir ısırık daha “diyerek yemeye devam etmeniz çok kolaydır. En iyi sonuca ulaşmak için yemeye başlamadan önce yiyeceklerinizi tartın.

Egzersiz olmadan diyet bir işe yaramıyor

Parmaklar Kişiliğin Göstergesi

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Parmaklarınız ve siz...

Bir süre önce İngiltere’de piyasaya çıkan ‘The Finger Book’ (Parmak Kitabı) adlı kitapta, birçok özelliğimizin parmak yapısına ve parmak uzunluğuna bağlı olduğu ifade ediliyor.
İşte kitapta yer alan ifadelerden bazıları;

Yüzük parmağı, işaret parmağından uzun olan;

- Hassas ve dışa dönük biridir.
- Risk almaktan korkmaz.
- Normal bir insana göre daha agresif olur.
- Müzisyenlik kabiliyetine sahip olur.
- Genelde solak olur.
- Futbol, Basketbol ve uzun koşu gibi spor dallarında başarılı olur.
- Hiperaktif ve anti sosyal olma ihtimali yüksek olur.

Ruh durumları analiz ister...

Domuz Gribi

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81 kişinin ölümüne neden olan domuz gribi Meksika sınırını aştı, tüm ülkeler Meksika'dan gelen yolcularını dikkatle izliyor.

Dünya Sağlık Örgütü: Salgın daha çok yayılabilir

Meksika’nın başkenti Meksiko’da başlayan ve 13 Nisan’dan beri 81 kişinin ölümüne neden olan domuz gribi salgınının ülke sınırlarını aşıp farklı ülkelere yayılmasından korkuluyor. Meksika Sağlık Bakanı Jose Angel Cordova, ülkede 1324 kişinin domuz gribi şüphesiyle gözetim altında olduğunu söylerken endişeler dünden beri ABD, Kolombiya, Yeni Zelanda ve İspanya’ya sıçradı.
Cordova, 81 kişiden 20’sinin domuz gribinden öldüğünün doğrulandığını açıklarken Meksiko’da kapatılan okulların 6 Mayıs’ta, müze, kütüphane ve tiyatrolarınsa bir hafta sonra açılacağını söyledi.

Hastalığın yayılmasını engellemek için bir süre kapalı ya da açık alanlarda gösteri düzenlenmemesini isteyen Cordova, ölenlerin büyük bölümünün 20 ile 45 yaşlarındaki kişiler olduğunu kaydetti. Dün kiliseler hastalığın yayılmasını engellemek için pazar ayinleri yapmadı.

Tüm dünya alarm halinde

Dünya Sağlık Örgütü Başkanı Margaret Chan salgının daha çok yayılabileceğini söyledi. Chan, salgının hayvanlarda görülen H1N1 virüsü içerdiğini belirtti. DSÖ, Meksika ve ABD’de salgının başlamasından sonra tüm ülkelere salgınları takip etme tavsiyesinde bulundu.

ABD’nin Meksika’ya yakın Teksas ve Kaliforniya eyaletlerinde hastalığın sekiz kişiye bulaştığı iddia edilirken, New York’ta özel bir lisede 75 öğrencinin aynı anda gribe yakalandığı bilgisi geldi.

75 öğrencinin aynı şikâyetlerle hastalandığını belirten yetkililer, öğrencilerin öksürük, ateş, ağrı, boğaz yanması şikâyetlerinin grip vakalarındaki şikâyetler olduğunu belirterek öğrencilere test uyguladıklarını söyledi.

Kolombiya’da da Meksika’dan gelip grip belirtileri görülen beş yolcu gözlem altına alındı. Ekvador’da da gribe rastlanan ABD ve Meksika’dan gelenler için önlem alınıyor. Yeni Zelanda’da Meksika’dan dönen 25 kişi karantinaya alındı.

Japonya’nın uluslararası havaalanında kontroller artırılırken, Filipinler Meksika’dan gelen ve ateşi olan yolcuları karantinaya alabileceğini bildirdi. Tayland ve Hong Kong’taki yetkililer de durumu izliyor. İspanya’da üç kişi domuz gribi şüphesiyle gözetim altında.

Domuz gribi virüsü nedir?

* Domuz gribi, normalde domuzlarda görülen A tipi grip virüsünün yol açtığı ve hızla yayılan bir solunum hastalığı olarak biliniyor.
* Grip domuzdan insana ve insandan insana bulaşabiliyor. Virüse karşı insanın doğal bağışıklığı bulunmuyor.
* Virüs, domuz eti yenmesiyle bulaşmıyor. Solunum yoluyla bulaşıyor.
* İnsanlardaki grip virüsü gibi, domuz gribi virüsü de domuzlarda sürekli değişim gösteriyor. Domuzların solunum yollarında domuz, insan ve kuş gribi virüslerine duyarlı alıcılar var. Domuzlar, virüslerin eş zamanlı bulaşmasıyla yeni virüslerin çıkma ihtimalini artırıyor.
* DSÖ’ye göre, ölümlere neden olan virüs A/H1N1. Bu virüs insandan insana bulaşabiliyor ve insan, domuz, kuş gribi virüslerinin karışımından oluşuyor.
* Domuzlara yapılan aşı var, ancak insan için aşı yok.

Türkiye domuz gribine karşı ne yapmalı?

Prof. Şadi Yenen, hızla yayılan domuz gribi virüsünün Türkiye'de görülmediğini ancak Meksika ve ABD'den gelen yolcuların havaalanında solunum enfeksiyonu kontrolünden geçirilmesi gerektiğini söyledi.

Prof. Yenen şu bilgileri verdi:

"Domuz gribi virüsü, insanoğlunun bilmediği bir virüs değil aslında ancak yeni dönemde kazandığı özellikler nedeniyle insanlık için sorun olabilir.

Meksika'daki salgının hızla yayılıyor olması haklı olarak Dünya Sağlık Örgütü'nü alarma geçirdi. Bu tip alarm durumlarında epidemi 6 ayrı evrede değerlendirilir. Dünya Sağlık Örgütü, üçüncü devre olarak alarm düzeyi vermiş durumda. Bu da şu demek, insanlara da geçiyor ve insandan insana da bulaşıyor. Ama henüz kalıcı salgınların olup olmayacağı belli değil ve vakalar inceleniyor.

Türkiye'nin bulunduğu coğrafyada henüz grip tespit edilmedi ancak günümüzdeki hızlı ulaşım teknolojisi nedeniyle virüsün gelme olasılığı yüksek. Özellikle Meksika ve ABD'den gelen yolcuların havaalanında solunum yolu enfeksiyonu yönünden denetlenmesi gerekiyor. Zaten birçok ülke bu konuda önlem almış durumda.

Eldeki aşıların virüse karşı etkili olup olmayacağı belli değil. Kaldı ki salgının ne kadar yayılacağı da belli değil.

Benzer bir domuz gribi olayı ABD'de 1976 yılında ortaya çıkmıştı, büyük bir panik oldu, aşı geliştirildi, 40 milyon ABD'li aşılandı ancak salgın hiç de beklendiği gibi büyük bir etki yapmadı ve bir süre sonra kendiliğinden söndü."

29 04 2009

What is cancer of the lung?

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Cancer of the lung, like all cancers, results from an abnormality in the body's basic unit of life, the cell. Normally, the body maintains a system of checks and balances on cell growth so that cells divide to produce new cells only when needed. Disruption of this system of checks and balances on cell growth results in an uncontrolled division and proliferation of cells that eventually forms a mass known as a tumor.

Tumors can be benign or malignant; when we speak of "cancer," we refer to those tumors that are considered malignant. Benign tumors can usually be removed and do not spread to other parts of the body. Malignant tumors, on the other hand, grow aggressively and invade other tissues of the body, allowing entry of tumor cells into the bloodstream or lymphatic system and then to other sites in the body. This process of spread is termed metastasis; the areas of tumor growth at these distant sites are called metastases. Since lung cancer tends to spread or metastasize very early in its course, it is a very life-threatening cancer and one of the most difficult cancers to treat. While lung cancer can spread to any organ in the body, certain organs -- particularly the adrenal glands, liver, brain, and bone -- are the most common sites for lung-cancer metastasis.

The lung is also a very common site for metastasis from tumors in other parts of the body. Tumor metastases are made up of the same type of cells as the original, or primary, tumor. For example, if prostate cancer spreads via the bloodstream to the lungs, it is metastatic prostate cancer in the lung and is not lung cancer.

28 04 2009

Should all males be circumcised?

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The day your wife gives birth to a baby boy, the kind, bespectacled face of Marvin L. Wang, M.D., is one that you want to see coming through the recovery-room door. Co-director of newborn nurseries at Massachusetts General Hospital in Boston, Dr. Wang has a perky, conversational bedside manner that puts everyone at ease.

I have to hustle to keep up with him as he strides energetically between hospital rooms. Right now he's congratulating a pair of new parents. Larry is standing on wobbly legs, looking both ecstatic and shell-shocked, while Joy sits serenely, holding their newborn son to her breast.

Dr. Wang jokes with the new parents a bit and then says, "I understand you may want to have a circumcision for your baby."

You May Need to Think Twice About Those Silver Fillings

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Silver-colored fillings, officially known as amalgam fillings, contain mercury and have been used by dentists for over a hundred years to treat cavities in teeth, but the FDA is now saying they may have toxic effects on the unborn fetus and young children. In the past, regulators have warned pregnant women against eating certain fish that contain high levels of mercury, but now the FDA has also agreed to post warnings on the danger mercury in fillings may cause to a developing human's brain, in response to a lawsuit filed on behalf of various groups.

As a result of the lawsuit, the groups agreed on a settlement where the FDA is conducting a review of the mercury contained in fillings that has to be completed mid-year 2009. Depending on the findings, the process may require that warnings be provided, through prescribing information, to dentists and patients to warn of nervous system dangers to fetuses and young children, said Pepper Long, the FDA's spokesperson.

The American Dental Association doesn't feel the settlement was very significant, because the FDA is not limiting the use of mercury fillings. The dental group has said that they feel the amalgam fillings remain safe for dental patients based on many studies and scientific reviews conducted by both government and independent agencies.

Amalgam fillings contain half mercury and half a combination of other metals, and are used by dentists to patch cavities in teeth. Millions of Americans have these silver fillings and the FDA isn't recommending replacement. The FDA wasn't able to answer whether pregnant women and young children should avoid the fillings based on the most recent information gathered by the advisory panel. Hopefully, they will have a better recommendation in 2009.

Mercury is a metal that is found naturally in the environment and in water. Fish absorb mercury through the water. It has been shown to effect brain growth and result in cognitive and motor-skill development problems according to the Environmental Protection Agency. As a result, the FDA and EPA already recommend that women who plan to become pregnant, pregnant women, nursing mothers, and young children avoid eating shark, swordfish, king mackerel, white tuna or tilefish, because of their high quantities of mercury. Now they may begin limiting silver fillings usage or at least require strict warnings.

Amalgam fillings, as well as fish, have their advantages. Silver fillings seem to be stronger and therefore last longer, and are less expensive. They have been used for many years, but have become less common and only used about 30 percent of the time with patients opting for the tooth-colored composite fillings for cosmetic reasons. Fish and shellfish can contribute to a healthy heart and children's growth and development and may be essential to one's daily diet; however, depending on age and health, the quantity of fish eaten with mercury and the usage of mercury fillings may need to be monitored more closely. One may still opt to have silver fillings and feel confident with their decision, but doctors may be required in the near future to inform patients of the dangers due to their mercury content.

HealthNews Dozen: Top 12 Fitness Trends for the New Year

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Health and fitness are part of any plan for life improvement. And there is no better time to dedicate oneself to a healthier lifestyle than upon the start of a new year. It is typically the number one resolution of people in America: to get healthy, which may include a more appropriate diet, more daily exercise, and/or a gym routine.

But New Year’s resolutions may last only a few weeks. That is why health professionals take many more factors into considerations when predicting the actual trends for the new year. Not only do they look at the past and current years and the course of health and fitness throughout, but they are familiar enough with where the industry is going as 2008 comes to an end to predict what 2009 may hold.

For the third year running, the American College of Sports Medicine (ACSM) has conducted its annual survey of 1,540 certified health and fitness professionals across six continents to predict what the industry may seen in the coming year. The survey provided 35 choices of possible trends to choose from, and the most popular were ranked and published in the November/December issue of ACSM’s Health and Fitness Journal. The report was authored by the survey’s lead author, Walter Thompson, PhD, FACSM, FAACVPR, and Regent’s Professor at Georgia State University.

For the second straight year, it was voted that the health and fitness industry will see more educated and experienced fitness professionals. As the field becomes more competitive and the public grows more concerned over the credentials of those who hold their health in their hands, not to mention stricter regulations being put into place, more professionals are working toward certification and accreditation. Not only should that be more comforting to those seeking health and fitness guidance, but it heightens the level of education among those who want to train and teach.

Also for the second year in a row, obesity rates with regard to children came in as the runner-up, signifying a growing concern among professionals the general public alike that youngsters are not eating properly and getting enough exercise. Over the past decade, children have become more sedentary, as video games, computers, cell phones, and the like involve little to no physical activity. By stressing fitness in schools and encouraging children to play outdoor games, become involved in sports, and even exercise in formal classes or at a gym, it might reverse the trend of the next generation as more obese than any in history.

Personal training ranked third, again for a second year, which shows that people seem to be taking fitness more seriously than ever. Instead of people relying on self-discipline or self-education about health issues, hiring someone to motivate, teach, and encourage exercise and positive eating habits is becoming more common.

Other items that made it into the top twenty were, in order from 13th to 20th, were wellness coaching for health-related behavioral changes, worker incentive programs, outcome measurements to monitor progress, spinning or indoor cycling, physician referrals to health and fitness facilities, exercise for weight loss, group personal training, and reaching new markets, such as people who have never participated in the health and fitness community before.

Author Thompson noted, “When predictions become consistent, we view it as an opportunity for education and action. These developing themes will help health and fitness professionals give the best possible service to the public, and also help the public understand the quality of service they should be receiving as clients.”

While the reported trends should not have a tremendous effect on one’s personal goals for 2009, they do show which way the industry is going and what be more readily available--like personal training--than in the past. Whatever one’s New Year’s resolutions may be, if health and fitness are on the list in some fashion, that desire to make it happen is all anyone in the industry can ask for.

Medical Marijuana Requests Higher Since Obama Term Began

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The rise in requests for medical marijuana has been dramatic of late. In various states where laws allow, dispensary owners recently admitted to an increase in 2009 requests for the pain reducer that ranges from 50 percent to as much as 300 percent. The high numbers seem to be implicitly linked to the stance of the Obama administration on the subject; the federal government will not interfere with state laws and patients who abide by them.

While some analysts insist the rise in medical marijuana requests pertains to the economic recession and subsequent growing number of Americans without health insurance, as they may turn to alternative and less expensive treatments for pain and disease, treatments like medical marijuana. However, most dispensary owners attribute the increase to the word from U.S. Attorney General Eric Holder that the Obama administration would not involve itself in state matters regarding medical marijuana.

The word first hit the medical marijuana community when the Obama for America campaign acknowledged its opposition to the Bush policy on the matter. A response letter to those inquiring on the subject read, in part: “Many states have laws that condone medical marijuana, but the Bush Administration is using federal drug enforcement agents to raid these facilities and arrest seriously ill people. Focusing scarce law enforcement resources on these patients who pose no threat while many violent and highly dangerous drug traffickers are at large makes no sense. Senator Obama will not continue the Bush policy when he is president.”

Though Holder has not always held the same view, he has changed course since his appointment as the Attorney General. And despite Drug Enforcement Administration raids that happened as Obama took office in late 2008 as a continuation of the Bush policy, which stated that federal law overrode that of the states, those have since been ordered to an end. Holder stated in February of 2009, “What the president said during the campaign, you’ll be surprised to know, will be consistent with what we’ll be doing in law enforcement… What he said during the campaign is now American policy.”

According to Colorado clinic numbers, applications for medical marijuana have risen significantly. As December 2008 came to a close, there were 4,720 applications on file, as compared to the 6,796 by February 28, 2009. While this certainly does not indicate that doctors are willing to authorize all of the new patients for marijuana use, the requests are difficult to ignore. And to accommodate, some dispensaries are paying doctors to be on staff and provide the oversight to patients whose own doctors are unwilling to sign off on the applications.

And more states are looking to provide the medical marijuana service for their residents, as a growing number of studies show that the drug is a safe and highly effective alternative to prescription medicines like morphine, in addition to being a form of miracle drug for cancer patients dealing with the effects of chemotherapy. New Hampshire and North Carolina are two states in the process of debating laws that would add them to the thirteen-state list of states already supportive of the medicinal qualities of marijuana. Those states are Alaska, California, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont, and Washington.

With that said, some states are still involved in complicated and expensive court battles due to the Bush administration’s crackdown and blurring of the lines between federal and state laws. California, the first state to legalize medical marijuana 13 years ago, has lost every court battle with the federal government thus far but seeks to avenge those losses in a current appeals process.

Americans for Safe Access, an organization promoting the safe and legal access to marijuana for therapeutic use and research, recently sued the federal government on the basis that law prohibits the government from disseminating inaccurate information, such as that about the actual benefits of marijuana. In its most recent hearing in the U.S. 9th Circuit Court of Appeals, lawyers for Safe Access argued that the government must update its data and rely on current information.

Director of Safe Access Steph Sherer told the Los Angeles Times, “The science to support medical marijuana is overwhelming. It’s time for the federal government to acknowledge the efficacy of medical marijuana and stop holding science hostage to politics.”

If the Obama administration has anything to say about it, science will prevail over politics, as evidenced by President Obama’s strong stand on stem cell research. But it may take some time for the medical marijuana advocacy organizations to make their case on a federal level. In the meantime, the absence of federal government intervention in state laws regarding marijuana is a start. Patients who can find some peace in the face of chronic and overwhelming medical conditions may be able to rest or recover a bit easier without the fear of federal agents appearing at their local dispensary or their own front doors.

Physicians Could Spot Melanoma Earlier in Men

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In today’s society, there is much more to skin care than just clear skin and a glowing tan. For older men, it is very important to visit their physicians regularly to check for melanoma because they are less likely to find it themselves in time to be treated. Many men over the age of 40 are not fully aware of their skin cancer risks, or the need for regular exams to help check for early signs of skin cancer, when it is the easiest treat.

Dr. Susan Swetterr from the Stanford University Medical Center in California and her colleagues stated that trained physicians are far more likely to spot dangerous skin cancers in the earliest stages. The researchers stated, “For men 40 years or older, who constitute more than half of all melanoma deaths in the United States, we have identified at least two key variables (physician exams and education) as major targets for new interventions to promote earlier melanoma detection.”

Melanoma, which is considered to be the rarest and deadliest form of skin cancer, is becoming more and more common and the death rates are climbing, especially among me over the age of 50.

Swetter and her colleagues surveyed approximately 227 patients with melanoma age 40 and above between the years of 2004 and 2006 within three months of being diagnosed. Fewer than 20 percent of the men were actually aware of the melanoma warning signs and fewer than half of the men practiced self-examinations. A quarter of the men diagnosed had the thick, harder-to-treat tumors. The men who had the smaller tumors were much more treatable and were more likely to have been aware of the risks of skin cancer and the importance of exams for skin cancer by their physicians.

Alan Geller, from Harvard, also analyzed the data and found that more than half of the patients whose melanomas were detected by a physician and were age 65 or above. American that over the age of 65 usually have health coverage under Medicare, which is the federal insurance program for the elderly, and tend to make more frequent visits to their physician.

Most of the melanomas were found on the patient’s backs, and Geller and his colleagues said that the findings suggest the need for “Watch your back” education campaigns that stress the need for physician screening programs that are particularly useful for this high-risk group.

Melanoma cancers account for less than 5 percent of the skin cancer cases but causes the most number of deaths linked to skin cancer. The American Cancer Society estimates that approximately 62,480 new cases of melanoma were diagnosed in the United States during they year 2008 alone.

23 04 2009

Health insurance

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Health insurance is insurance that pays for medical expenses. It is sometimes used more broadly to include insurance covering disability or long-term nursing or custodial care needs. It may be provided through a government-sponsored social insurance program, or from private insurance companies. It may be purchased on a group basis (e.g., by a firm to cover its employees) or purchased by individual consumers. In each case, the covered groups or individuals pay premiums or taxes to help protect themselves from high or unexpected healthcare expenses. Similar benefits paying for medical expenses may also be provided through social welfare programs funded by the government.

By estimating the overall risk of healthcare expenses, a routine finance structure (such as a monthly premium or annual tax) can be developed, ensuring that money is available to pay for the healthcare benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity. [1]
Contents
[hide]

* 1 History and evolution
* 2 How it works
o 2.1 Health plan vs. health insurance
o 2.2 Comprehensive vs. scheduled
o 2.3 Inherent problems with multiple insurance funds and optional insurance
+ 2.3.1 Adverse selection
+ 2.3.2 Moral hazard
o 2.4 Other factors affecting insurance prices
* 3 Comparison
o 3.1 Australia
o 3.2 Canada
o 3.3 France
o 3.4 Netherlands
o 3.5 United Kingdom
o 3.6 United States
* 4 See also
* 5 Notes and references

[edit] History and evolution
Main article: History of insurance

The concept of health insurance was proposed in 1694 by Hugh the Elder Chamberlen from the Peter Chamberlen family. In the late 19th century, "accident insurance" began to be available, which operated much like modern disability insurance.[2].This payment model continued until the start of the 20th century in some jurisdictions (like California), where all laws regulating health insurance actually referred to disability insurance.[3]

Accident insurance was first offered in the United States by the Franklin Health Assurance Company of Massachusetts. This firm, founded in 1850, offered insurance against injuries arising from railroad and steamboat accidents. Sixty organizations were offering accident insurance in the US by 1866, but the industry consolidated rapidly soon thereafter. While there were earlier experiments, the origins of sickness coverage in the US effectively date from 1890. The first employer-sponsored group disability policy was issued in 1911.[4]

Before the development of medical expense insurance, patients were expected to pay all other health care costs out of their own pockets, under what is known as the fee-for-service business model. During the middle to late 20th century, traditional disability insurance evolved into modern health insurance programs. Today, most comprehensive private health insurance programs cover the cost of routine, preventive, and emergency health care procedures, and also most prescription drugs, but this was not always the case.

Hospital and medical expense policies were introduced during the first half of the 20th century. During the 1920s, individual hospitals began offering services to individuals on a pre-paid basis, eventually leading to the development of Blue Cross organizations.[4] The predecessors of today's Health Maintenance Organizations (HMOs) originated beginning in 1929, through the 1930s and on during World War II.[5][6]

[edit] How it works

A health insurance policy is a contract between an insurance company and an individual or his sponsor (e.g. an employer). The contract can be renewable annually or monthly. The type and amount of health care costs that will be covered by the health insurance company are specified in advance, in the member contract or "Evidence of Coverage" booklet. The individual insurered person's obligations may take several forms[7]:

* Premium: The amount the policy-holder or his sponsor (e.g. an employer) pays to the health plan each month to purchase health coverage.
* Deductible: The amount that the insured must pay out-of-pocket before the health insurer pays its share. For example, a policy-holder might have to pay a $500 deductible per year, before any of their health care is covered by the health insurer. It may take several doctor's visits or prescription refills before the insured person reaches the deductible and the insurance company starts to pay for care.
* Copayment: The amount that the insured person must pay out of pocket before the health insurer pays for a particular visit or service. For example, an insured person might pay a $45 copayment for a doctor's visit, or to obtain a prescription. A copayment must be paid each time a particular service is obtained.
* Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a copayment), the co-insurance is a percentage of the total cost that insured person may also pay. For example, the member might have to pay 20% of the cost of a surgery over and above a co-payment, while the insurance company pays the other 80%. If there is an upper limit on coinsurance, the policy-holder could end up owing very little, or a great deal, depending on the actual costs of the services they obtain.
* Exclusions: Not all services are covered. The insured person is generally expected to pay the full cost of non-covered services out of their own pocket.
* Coverage limits: Some health insurance policies only pay for health care up to a certain dollar amount. The insured person may be expected to pay any charges in excess of the health plan's maximum payment for a specific service. In addition, some insurance company schemes have annual or lifetime coverage maximums. In these cases, the health plan will stop payment when they reach the benefit maximum, and the policy-holder must pay all remaining costs.
* Out-of-pocket maximums: Similar to coverage limits, except that in this case, the insured person's payment obligation ends when they reach the out-of-pocket maximum, and the health company pays all further covered costs. Out-of-pocket maximums can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.
* Capitation: An amount paid by an insurer to a health care provider, for which the provider agrees to treat all members of the insurer.
* In-Network Provider: (U.S. term) A health care provider on a list of providers preselected by the insurer. The insurer will offer discounted coinsurance or copayments, or additional benefits, to a plan member to see an in-network provider. Generally, providers in network are providers who have a contract with the insurer to accept rates further discounted from the "usual and customary" charges the insurer pays to out-of-network providers.
* Prior Authorization: A certification or authorization that an insurer provides prior to medical service occurring. Obtaining an authorization means that the insurer is obligated to pay for the service, assume it matches what was authorized. Many smaller, routine services do not require authorization[8]
* Explanation of Benefits: A document sent by an insurer to a patient explaining what was covered for a medical service, and how they arrived at the payment amount and patient responsibility amount[9]

Prescription drug plans are a form of insurance offered through some employer benefit plans in the US, where the patient pays a copayment and the prescription drug insurance part or all of the balance for drugs covered in the formulary of the plan.

Some, if not most, health care providers in the United States will agree to bill the insurance company if patients are willing to sign an agreement that they will be responsible for the amount that the insurance company doesn't pay. The insurance company pays out of network providers according to "reasonable and customary" charges, which may be less than the provider's usual fee. The provider may also have a separate contract with the insurer to accept what amounts to a discounted rate or capitation to the provider's standard charges. It generally costs the patient less to use an in-network provider.

[edit] Health plan vs. health insurance

Historically, HMOs tended to use the term "health plan", while commercial insurance companies used the term "health insurance". A health plan can also refer to a subscription-based medical care arrangement offered through HMOs, preferred provider organizations, or point of service plans. These plans are similar to pre-paid dental, pre-paid legal, and pre-paid vision plans. Pre-paid health plans typically pay for a fixed number of services (for instance, $300 in preventive care, a certain number of days of hospice care or care in a skilled nursing facility, a fixed number of home health visits, a fixed number of spinal manipulation charges, etc.) The services offered are usually at the discretion of a utilization review nurse who is often contracted through the managed care entity providing the subscription health plan. This determination may be made either prior to or after hospital admission (concurrent utilization review).

[edit] Comprehensive vs. scheduled

Comprehensive health insurance pays a percentage of the cost of hospital and physician charges after a deductible (usually applies to hospital charges) or a co-pay (usually applies to physician charges, but may apply to some hospital services) is met by the insured. These plans are generally expensive because of the high potential benefit payout — $1,000,000 to 5,000,000 is common — and because of the vast array of covered benefits.[10]

Scheduled health insurance plans are not meant to replace a traditional comprehensive health insurance plans and are more of a basic policy providing access to day-to-day health care such as going to the doctor or getting a prescription drug. In recent years, these plans have taken the name mini-med plans or association plans. These plans may provide benefits for hospitalization and surgical, but these benefits will be limited. Scheduled plans are not meant to be effective for catastrophic events. These plans cost much less than comprehensive health insurance. They generally pay limited benefits amounts directly to the service provider, and payments are based upon the plan's "schedule of benefits". Annual benefits maximums for a typical scheduled health insurance plan may range from $1,000 to $25,000.[11]

[edit] Inherent problems with multiple insurance funds and optional insurance

The basic concept of insurance is population solidarity. There are inherent risks in a population but the population absorbs the cost of risks to an individual by spreading the impact of incurred costs amongst the insured population. However, if the population is split into insured and uninsured groups, or into selectively groups (as with private insurance with pre-insurance selection either by the insurance company or the insured) the concept of population solidarity breaks down. Insurance systems must then typically deal with two inherent challenges: adverse selection and ex-post moral hazard.

Some national systems with compulsory insurance utilize systems such as risk equalization and community rating to overcome these inherent problems. Proponents of single-payer health care in the United States aim to provide the population of the country with health care from a single fund and thus avoid problems and costs associated with adverse selection, moral hazard, and private profiteering from insurance.

[edit] Adverse selection

Insurance companies use the term "adverse selection" to describe the tendency for only those who will benefit from insurance to buy it. Specifically when talking about health insurance, unhealthy people are more likely to purchase health insurance because they anticipate large medical bills. On the other side, people who consider themselves to be reasonably healthy may decide that medical insurance is an unnecessary expense; if they see the doctor once a year and it costs $250, that's much better than making monthly insurance payments of $40. (example figures).

The fundamental concept of insurance is that it balances costs across a large, random sample of individuals (see risk pool). For instance, an insurance company has a pool of 1000 randomly selected subscribers, each paying $100 per month. One person becomes very ill while the others stay healthy, allowing the insurance company to use the money paid by the healthy people to pay for the treatment costs of the sick person. However, when the pool is self-selecting rather than random, as is the case with individuals seeking to purchase health insurance directly, adverse selection is a greater concern.[12] A disproportionate share of health care spending is attributable to individuals with high health care costs. In the US the 1% of the population with the highest spending accounted for 27% of aggregate health care spending in 1996. The highest-spending 5% of the population accounted for more than half of all spending. These patterns were stable through the 1970s and 1980s, and some data suggest that they may have been typical of the mid-to-early 20th century as well.[13][14] A few individuals have extremely high medical expenses, in extreme cases totaling a half million dollars or more.[15] Adverse selection could leave an insurance company with primarily sick subscribers and no way to balance out the cost of their medical expenses with a large number of healthy subscribers.

Because of adverse selection, insurance companies employ medical underwriting, using a patient's medical history to screen out those whose pre-existing medical conditions pose too great a risk for the risk pool. Before buying health insurance, a person typically fills out a comprehensive medical history form that asks whether the person smokes, how much the person weighs, whether the person has been treated for any of a long list of diseases and so on. In general, those who present large financial burdens are denied coverage or charged high premiums to compensate.[16] One large US industry survey found that roughly 13 percent of applicants for comprehensive, individually purchased health insurance who went through the medical underwriting in 2004 were denied coverage. Declination rates increased significantly with age, rising from 5 percent for individuals 18 and under to just under a third for individuals aged 60 to 64.[17] Among those who were offered coverage, the study found that 76% received offers at standard premium rates, and 22% were offered higher rates.[18] On the other side, applicants can get discounts if they do not smoke and are healthy.[19]

[edit] Moral hazard
Main article: Moral hazard

Moral hazard occurs when an insurer and a consumer enter into a contract under symmetric information, but one party takes action, not taken into account in the contract, which changes the value of the insurance. A common example of moral hazard is third-party payment—when the parties involved in making a decision are not responsible for bearing costs arising from the decision. An example is where doctors and insured patients agree to extra tests which may or may not be necessary. Doctors benefit by avoiding possible malpractice suits, and patients benefit by gaining increased certainty of their medical condition. The cost of these extra tests is borne by the insurance company, which may have had little say in the decision. Co-payments, deductibles, and less generous insurance for services with more elastic demand attempt to combat moral hazard, as they hold the consumer responsible.

[edit] Other factors affecting insurance prices

A recent study by PriceWaterhouseCoopers examining the drivers of rising health care costs in the US pointed to increased utilization created by increased consumer demand, new treatments, and more intensive diagnostic testing, as the most significant driver.[20] People in developed countries are living longer. The population of those countries is aging, and a larger group of senior citizens requires more intensive medical care than a young healthier population. Advances in medicine and medical technology can also increase the cost of medical treatment. Lifestyle-related factors can increase utilization and therefore insurance prices, such as: increases in obesity caused by insufficient exercise and unhealthy food choices; excessive alcohol use, smoking, and use of street drugs. Other factors noted by the PWC study included the movement to broader-access plans, higher-priced technologies, and cost-shifting from Medicaid and the uninsured to private payers.[20]

[edit] Comparison
See also: Health care systems

The Commonwealth Fund, in its annual survey, "Mirror, Mirror on the Wall", compares the performance of the health care systems in Australia, New Zealand, the United Kingdom, Germany, Canada and the U.S. Its 2007 study found that, although the U.S. system is the most expensive, it consistently under-performs compared to the other countries.[21] One difference between the U.S. and the other countries in the study is that the U.S. is the only country without universal health insurance coverage.

[edit] Australia
Main article: Health care in Australia

The public health system is called Medicare. It ensures free universal access to hospital treatment and subsidised out-of-hospital medical treatment. It is funded by a 1.5% tax levy.

The private health system is funded by a number of private health insurance organisations. The largest of these is Medibank Private, which is government-owned, but operates as a government business enterprise under the same regulatory regime as all other registered private health funds. The Coalition Howard government had announced that Medibank would be privatised if it won the 2007 election, however they were defeated by the Australian Labor Party under Kevin Rudd which had already pledged that it would remain in government ownership.

Some private health insurers are 'for profit' enterprises, and some are non-profit organizations such as HCF Health Insurance and GMHBA Health Insurance. Some have membership restricted to particular groups, but the majority have open membership.

Most aspects of private health insurance in Australia are regulated by the Private Health Insurance Act 2007.

The private health system in Australia operates on a "community rating" basis, whereby premiums do not vary solely because of a person's previous medical history, current state of health, or (generally speaking) their age (but see Lifetime Health Cover below). Balancing this are waiting periods, in particular for pre-existing conditions (usually referred to within the industry as PEA, which stands for "pre-existing ailment"). Funds are entitled to impose a waiting period of up to 12 months on benefits for any medical condition the signs and symptoms of which existed during the six months ending on the day the person first took out insurance. They are also entitled to impose a 12-month waiting period for benefits for treatment relating to an obstetric condition, and a 2-month waiting period for all other benefits when a person first takes out private insurance. Funds have the discretion to reduce or remove such waiting periods in individual cases. They are also free not to impose them to begin with, but this would place such a fund at risk of "adverse selection", attracting a disproportionate number of members from other funds, or from the pool of intending members who might otherwise have joined other funds. It would also attract people with existing medical conditions, who might not otherwise have taken out insurance at all because of the denial of benefits for 12 months due to the PEA Rule. The benefits paid out for these conditions would create pressure on premiums for all the fund's members, causing some to drop their membership, which would lead to further rises, and a vicious cycle would ensue.

There are a number of other matters about which funds are not permitted to discriminate between members in terms of premiums, benefits or membership - these include racial origin, religion, sex, sexual orientation, nature of employment, and leisure activities. Premiums for a fund's product that is sold in more than one state can vary from state to state, but not within the same state.

The Australian government has introduced a number of incentives to encourage adults to take out private hospital insurance. These include:

* Lifetime Health Cover: If a person has not taken out private hospital cover by the 1st July after their 30th birthday, then when (and if) they do so after this time, their premiums must include a loading of 2% per annum. Thus, a person taking out private cover for the first time at age 40 will pay a 20 per cent loading. The loading continues for 10 years. The loading applies only to premiums for hospital cover, not to ancillary (extras) cover.

* Medicare Levy Surcharge: People whose taxable income is greater than a specified amount (currently $70,000 for singles and $140,000 for couples) and who do not have an adequate level of private hospital cover must pay a 1% surcharge on top of the standard 1.5% Medicare Levy. The rationale is that if the people in this income group are forced to pay more money one way or another, most would choose to purchase hospital insurance with it, with the possibility of a benefit in the event that they need private hospital treatment - rather than pay it in the form of extra tax as well as having to meet their own private hospital costs.
o The Australian government announced in May 2008 that it proposes to increase the thresholds, to $100,000 for singles and $150,000 for families. These changes require legislative approval. A bill to change the law has been introduced but was not passed by the Senate.[22] A changed version was passed on 16 October 2008. There have been criticisms that the changes will cause many people to drop their private health insurance, causing a further burden on the public hospital system, and a rise in premiums for those who stay with the private system. Other commentators believe the effect will be minimal.[23]

* Private Health Insurance Rebate: The government subsidises the premiums for all private health insurance cover, including hospital and ancillary (extras), by 30%, 35% or 40%.

[edit] Canada
Main article: Health care in Canada

Most health insurance in Canada is administered by each province, under the Canada Health Act, which requires all people to have free access to basic health services. Collectively, the public provincial health insurance systems in Canada are frequently referred to as Medicare. Private health insurance is allowed, but the provincial governments allow it only for services that the public health plans do not cover; for example, semi-private or private rooms in hospitals and prescription drug plans. Canadians are free to use private insurance for elective medical services such as laser vision correction surgery, cosmetic surgery, and other non-basic medical procedures. Some 65% of Canadians have some form of supplementary private health insurance; many of them receive it through their employers.[24] Private-sector services not paid for by the government account for nearly 30 percent of total health care spending.[25]

In 2005, the Supreme Court of Quebec ruled, in Chaoulli v. Quebec, that the province's prohibition on private insurance for health care already insured by the provincial plan could constitute an infringement of the right to life and security if there were long wait times for treatment as happened in this case. Certain other provinces have legislation which financially discourages but does not forbid private health insurance in areas covered by the public plans. The ruling has not changed the overall pattern of health insurance across Canada but has spurred on attempts to tackle the core issues of supply and demand and the impact of wait times.[26]

[edit] France
Main article: Health care in France

The French model of health insurance has been ranked by the World Health Organization as the best in the world, because it permits a high quality of care and nearly total patient freedom. The national system of health insurance was instituted in 1945, just after the end of the Second World War. It was a compromise between Gaullist and Communist representatives in the French parliament. The Conservative Gaullists were opposed to a state-run healthcare system, while the Communists were supportive of a complete nationalisation of health care along a British Beveridge model.

The resulting programme was profession-based : all people working were required to pay a portion of their income to a health insurance fund, which mutualised the risk of illness, and which reimbursed medical expenses at varying rates. Children and spouses of insured people were eligible for benefits, as well. Each fund was free to manage its own budget and reimburse medical expenses at the rate it saw fit.

The government has two responsibilities in this system.

* The first government responsibility is the fixing of the rate at which medical expenses should be negotiated, and it does this in two ways: The Ministry of Health directly negotiates prices of medicine with the manufacturers, based on the average price of sale observed in neighboring countries. A board of doctors and experts decides if the medicine provides a valuable enough medical benefit to be reimbursed (note that most medicine is reimbursed, including homeopathy). In parallel, the government fixes the reimbursment rate for medical services : this means that a doctor is free to charge the fee that he wishes for a consultation or an examination, but the social security system will only reimburse it at a pre-set rate. These tariffs are set annually through negotiation with doctors' representative organisations.
* The second government responsibility is oversight of the health-insurance funds, to ensure that they are correctly managing the sums they receive, and to ensure oversight of the public hospital network.

Today, this system is more-or-less intact. All citizens and legal foreign residents of France are covered by one of these mandatory programs, which continue to be funded by worker participation. However, since 1945, a number of major changes have been introduced. Firstly, the different health-care funds (there are five : General, Independent, Agricultural, Student, Public Servants) now all reimburse at the same rate. Secondly, since 2000, the government now provides health care to those who are not covered by a mandatory regime (those who have never worked and who are not students, meaning the very rich or the very poor). This regime, unlike the worker-financed ones, is financed via general taxation and reimburses at a higher rate than the profession-based system for those who cannot afford to make up the difference. Finally, to counter the rise in health-care costs, the government has installed two plans, (in 2004 and 2006), which require insured people to declare a referring doctor in order to be fully reimbursed for specalist visits, and which installed a mandatory co-pay of 1 € (about $1.45) for a doctor visit, 0,50 € (about 80 ¢) for each box of medicine prescribed, and a fee of 16-18 € (20-25 $) per day for hospital stays and for expensive procedures.

An important element of the French insurance system is solidarity : the more ill a person becomes, the less they pay. This means that for people with serious or chronic illnesses, the insurance system reimburses them 100 % of expenses, and waives their co-pay charges.

Finally, for fees that the mandatory system does not cover, there is a large range of private complementary insurance plans available. The market for these programs is very competitive, and often subsidised by the employer, which means that premiums are usually modest. 85% of French people benefit from complementary private health insurance.

[27][28]

[edit] Netherlands
Main article: Health care in the Netherlands

In 2006, a new system of health insurance came into force in the Netherlands. This new system avoids the two pitfalls of adverse selection and moral hazard associated with traditional forms of health insurance by using a combination of regulation and an insurance equalization pool. Moral hazard is avoided by mandating that insurance companies provide at least one policy which meets a government set minimum standard level of coverage, and all adult residents are obliged by law to purchase this coverage from an insurance company of their choice. All insurance companies receive funds from the equalization pool to help cover the cost of this government-mandated coverage. This pool is run by a regulator which collects salary-based contributions from employers, which make up about 50% of all health care funding, and funding from the government to cover people who cannot afford health care, which makes up an additional 5%.

The remaining 45% of health care funding comes from insurance premiums paid by the public, for which companies compete on price, though the variation between the various competing insurers is only about 5%. However, insurance companies are free to sell additional policies to provide coverage beyond the national minimum. These policies do not receive funding from the equalization pool, but cover additional treatments, such as dental procedures and physiotherapy, which are not paid for by the mandatory policy.

Funding from the equalization pool is distributed to insurance companies for each person they insure under the required policy. However, high-risk individuals get more from the pool, and low-income persons and children under 18 have their insurance paid for entirely. Because of this, insurance companies no longer find insuring high risk individuals an unappealing proposition, avoiding the potential problem of adverse selection.

Insurance companies are not allowed to have co-payments, caps, or deductibles, or to deny coverage to any person applying for a policy, or to charge anything other than their nationally set and published standard premiums. Therefore, every person buying insurance will pay the same price as everyone else buying the same policy, and every person will get at least the minimum level of coverage.

[edit] United Kingdom
Main article: National Health Service

The UK's National Health Service (NHS) is a publicly funded healthcare system that provides coverage to everyone normally resident in the UK. It is not strictly an insurance system because (a) there are no premiums collected, (b) costs are not charged at the patient level and (c) costs are not pre-paid from a pool. However, it does achieve the main aim of insurance which is to spread financial risk arising from ill-health. The costs of running the NHS (est. £104 billion in 2007-8)[29] are met directly from general taxation. The NHS provides the majority of health care in the UK, including primary care, in-patient care, long-term health care, ophthalmology and dentistry.

Private health care has continued parallel to the NHS, paid for largely by private insurance, but it is used by less than 8% of the population, and generally as a top-up to NHS services. There are many treatments that the private sector does not provide. For example, health insurance on pregnancy is generally not covered or covered with restricting clauses.[30] One of the major insurers, BUPA, excludes many forms of treatment and care that most people will need during their lifetime or specialist care most of which are freely available from the NHS. These include:-

ageing, menopause and puberty; AIDS/HIV; allergies or allergic disorders; birth control, conception, sexual problems and sex changes; chronic conditions; complications from excluded or restricted conditions/ treatment; convalescence, rehabilitation and general nursing care ; cosmetic, reconstructive or weight loss treatment; deafness; dental/oral treatment (such as fillings, gum disease, jaw shrinkage, etc); dialysis; drugs and dressings for out-patient or take-home use† ; experimental drugs and treatment; eyesight; HRT and bone densitometry; learning difficulties, behavioural and developmental problems; overseas treatment and repatriation; physical aids and devices; pre-existing or special conditions; pregnancy and childbirth; screening and preventive treatment; sleep problems and disorders; speech disorders; temporary relief of symptoms[31] († = except in exceptional circumstances)

BUPA's competitors include, among others, AXA, Aviva, Groupama Healthcare and Pru Health.

Recently the private sector has been used to increase NHS capacity despite a large proportion of the British public opposing such involvement.[32]. According to the World Health Organization, government funding covered 86% of overall health care expenditures in the UK as of 2004, with private expenditures covering the remaining 14%.[33]

[edit] United States
Main articles: Health insurance in the United States and Health care in the United States

The US market-based health care system relies heavily on private and not-for-profit health insurance, which is the primary source of coverage for most Americans. According to the United States Census Bureau, approximately 84% of Americans have health insurance; some 60% obtain it through an employer, while about 9% purchase it directly. Various government agencies provide coverage to about 27% of Americans (there is some overlap in these figures).[34]

Public programs provide the primary source of coverage for most seniors and for low-income children and families who meet certain eligibility requirements. The primary public programs are Medicare, a federal social insurance program for seniors and certain disabled individuals, Medicaid, funded jointly by the federal government and states but administered at the state level, which covers certain very low income children and their families, and SCHIP, also a federal-state partnership that serves certain children and families who do not qualify for Medicaid but who cannot afford private coverage. Other public programs include military health benefits provided through TRICARE and the Veterans Health Administration and benefits provided through the Indian Health Service. Some states have additional programs for low-income individuals.[35]

In 2006, there were 47 million people in the United States (16% of the population) who were without health insurance for at least part of that year.[34] About 37% of the uninsured live in households with an income over $50,000.[34]

In 2004, US health insurers directly employed almost 470,000 people at an average salary of $61,409.[36] (As of the fourth quarter of 2007, the total US labor force stood at 153.6 million, of whom 146.3 million were employed. Employment related to all forms of insurance totaled 2.3 million.[37] Mean annual earnings for full-time civilian workers as of June 2006 were $41,231; median earnings were $33,634.)[38] The insurance industry also represents a significant lobbying group in the US. For 2008 insurance was the 8th among industries in political contributions to members of Congress, giving $28,654,121, of which 51% was given to Democrats and 49% to Republicans, with the top recipient of insurance industry contributions being Senator John McCain (R-AZ).[39] The leading contributor from the insurance industry — as measured by total political contributions — was AFLAC, Inc., which contributed $907,150 in 2007.[40].

[edit] See also

* Injury cover
* Economic capital
* Health economics
* Health maintenance organization
* Healthcare reform
* Self-funded health care
* List of insurance topics
* Public health
* Social health insurance
* Social security
* Social welfare
* Health care
* Health care politics
* Philosophy of Healthcare
* Single-payer health care

Biomedical engineering

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Biomedical engineering (BME) is the application of engineering principles and techniques to the medical field. It combines the design and problem solving skills of engineering with medical and biological sciences to improve healthcare diagnosis and treatment.

Biomedical engineering has only recently emerged as its own discipline, compared to many other engineering fields; such an evolution is common as a new field transitions from being an interdisciplinary specialization among already-established fields, to being considered a field in itself.

Much of the work in biomedical engineering consists of research and development, spanning a broad array of subfields (see below). Prominent biomedical engineering applications include the development of biocompatible prostheses, various diagnostic and therapeutic medical devices ranging from clinical equipment to micro-implants, common imaging equipment such as MRIs and EEGs, biotechnologies such as regenerative tissue growth, and pharmaceutical drugs & biopharmaceuticals.

Subdisciplines within biomedical engineering
Biomedical engineering is a highly interdisciplinary field, influenced by (and overlapping with) various other engineering and medical fields. This often happens with newer disciplines, as they gradually emerge in their own right after evolving from special applications of extant disciplines. Due to this diversity, it is typical for a biomedical engineer to focus on a particular subfield or group of related subfields. There are many different taxonomic breakdowns within BME, as well as varying views about how best to organize them and manage any internal overlap; the main U.S. organization devoted to BME divides the major specialty areas as follows:[1]

Bioinstrumentation
Biomaterials
Biomechanics
Cellular, Tissue, and Genetic Engineering
Clinical Engineering
Medical Imaging
Orthopaedic Bioengineering
Rehabilitation Engineering
Systems Physiology
Sometimes, disciplines within BME are classified by their association(s) with other, more established engineering fields, which can include:

Chemical engineering - often associated with biochemical, cellular, molecular and tissue engineering, biomaterials, and biotransport.
Electrical engineering - often associated with bioelectrical and neural engineering, bioinstrumentation, biomedical imaging, and medical devices. This also tends to encompass Optics and Optical engineering - biomedical optics, imaging and related medical devices.
Mechanical engineering - often associated with biomechanics, biotransport, medical devices, and modeling of biological systems.

[edit] Biotechnology and Pharmaceuticals
Biotechnology can be a somewhat ambiguous term -- in its broadest form occasionally encompassing all of BME; however, it more typically denotes specific products which utilize "biological systems, living organisms, or derivatives thereof." [2] Even some complex "medical devices" (see below) can reasonably be deemed "biotechnology" depending on the degree to which such elements are central to their principal of operation. Biologics/Biopharmaceuticals (e.g., vaccines, stored blood product), genetic engineering, and various agricultural applications are some major classes of biotechnology.

Pharmaceuticals are related to biotechnology in two indirect ways: 1) certain major types (e.g. biologics) fall under both categories, and 2) together they essentially comprise the "non-medical-device" set of BME applications. (The "Device - Bio/Chemical" spectrum is an imperfect dichotomy, but one regulators often use, at least as a starting point.)


[edit] Tissue engineering
Main article: Tissue engineering
Tissue Engineering is a major segment of Biotechnology.

One of the goals of tissue engineering is to create artificial organs (via biological material) for patients that need organ transplants. Biomedical engineers are currently researching methods of creating such organs. In one case bladders have been grown in lab and transplanted successfully into patients.[2] Bioartificial organs, which utilize both synthetic and biological components, are also a focus area in research, such as with hepatic assist devices that utilize liver cells within an artificial bioreactor construct.[3]


Micromass cultures of C3H-10T1/2 cells at varied oxygen tensions stained with Alcian blue.
[edit] Genetic engineering
Genetic engineering, recombinant DNA technology, genetic modification/manipulation (GM) and gene splicing are terms that apply to the direct manipulation of an organism's genes.[1] Genetic engineering is different from traditional breeding, where the organism's genes are manipulated indirectly. Genetic engineering uses the techniques of molecular cloning and transformation to alter the structure and characteristics of genes directly. Genetic engineering techniques have found some successes in numerous applications. Some examples are in improving crop technology, the manufacture of synthetic human insulin through the use of modified bacteria, the manufacture of erythropoietin in hamster ovary cells, and the production of new types of experimental mice such as the oncomouse (cancer mouse) for research.


[edit] Pharmaceutical engineering
Pharmaceutical Engineering is sometimes regarded as a branch of biomedical engineering, and sometimes a branch of chemical engineering; in practice, it is very much a hybrid sub-discipline (as many BME fields are). Aside from those pharmaceutical products directly incorporating biological agents or materials, even developing chemical drugs is considered to require substantial BME knowledge due to the physiological interactions inherent to such products' usage.


[edit] Medical devices
Main articles: Medical devices and medical equipment
This is an extremely broad category -- essentially covering all healthcare products that do not achieve their intended results through predominantly chemical (e.g., pharmaceuticals) or biological (e.g., vaccines) means, and do not involve metabolism.

A medical device is intended for use in:

the diagnosis of disease or other conditions, or
in the cure, mitigation, treatment, or prevention of disease,

A pump for continuous subcutaneous insulin infusion, an example of a biomedical engineering application of electrical engineering to medical equipment.Some examples include pacemakers, infusion pumps, the heart-lung machine, dialysis machines, artificial organs, implants, artificial limbs, corrective lenses, cochlear implants, ocular prosthetics, facial prosthetics, somato prosthetics, and dental implants.


Biomedical instrumentation amplifier schematic used in monitoring low voltage biological signals, an example of a biomedical engineering application of electronic engineering to electrophysiology.Stereolithography is a practical example of medical modeling being used to create physical objects. Beyond modeling organs and the human body, emerging engineering techniques are also currently used in the research and development of new devices for innovative therapies, treatments, patient monitoring, and early diagnosis of complex diseases.

Medical devices are regulated and classified (in the US) as follows (see also Regulation):

Class I devices present minimal potential for harm to the user and are often simpler in design than Class II or Class III devices. Devices in this category include tongue depressors, bedpans, elastic bandages, examination gloves, and hand-held surgical instruments and other similar types of common equipment.
Class II devices are subject to special controls in addition to the general controls of Class I devices. Special controls may include special labeling requirements, mandatory performance standards, and postmarket surveillance. Devices in this class are typically non-invasive and include x-ray machines, PACS, powered wheelchairs, infusion pumps, and surgical drapes.
Class III devices generally require premarket approval, a scientific review to ensure the device's safety and effectiveness, in addition to the general controls of Class I. Examples include replacement heart valves, silicone gel-filled breast implants, implanted cerebellar stimulators, implantable pacemaker pulse generators and endosseous (intra-bone) implants.

[edit] Medical imaging
Main article: Medical imaging
Medical/Biomedical Imaging is a major segment of Medical Devices. This area deals with enabling clinicians to directly or indirectly "view" things not visible in plain sight (such as due to their size, and/or location). This can involve utilizing ultrasound, magnetism, UV, other radiology, and other means.


An MRI scan of a human head, an example of a biomedical engineering application of electrical engineering to diagnostic imaging. Click here to view an animated sequence of slices.Imaging technologies are often essential to medical diagnosis, and are typically the most complex equipment found in a hospital including:

Fluoroscopy
Magnetic resonance imaging (MRI)
Nuclear Medicine
Positron Emission Tomography (PET) PET scansPET-CT scans
Projection Radiography such as X-rays and CT scans
Tomography
Ultrasound
Electron Microscopy

[edit] Implants
An implant is a kind of medical device made to replace and act as a missing biological structure (as compared with a transplant, which indicates transplanted biomedical tissue). The surface of implants that contact the body might be made of a biomedical material such as titanium, silicone or apatite depending on what is the most functional. In some cases implants contain electronics e.g. artificial pacemaker and cochlear implants. Some implants are bioactive, such as subcutaneous drug delivery devices in the form of implantable pills or drug-eluting stents.


Artificial limbs: The right arm is an example of a prosthesis, and the left arm is an example of myoelectric control.
A prosthetic eye, an example of a biomedical engineering application of mechanical engineering and biocompatible materials to ophthalmology.
[edit] Clinical engineering
Main article: Clinical engineering
Clinical engineering is the branch of biomedical engineering dealing with the actual implementation of medical equipment and technologies in hospitals or other clinical settings. Major roles of clinical engineers include training and supervising biomedical equipment technicians (BMETs), selecting technological products/services and logistically managing their implementation, working with governmental regulators on inspections/audits, and serving as technological consultants for other hospital staff (e.g. physicians, administrators, I.T., etc). Clinical engineers also advise and collaborate with medical device producers regarding prospective design improvements based on clinical experiences, as well as monitor the progression of the state-of-the-art so as to redirect procurement patterns accordingly.

Their inherent focus on practical implementation of technology has tended to keep them oriented more towards incremental-level redesigns and reconfigurations, as opposed to revolutionary research & development or ideas that would be many years from clinical adoption; however, there is a growing effort to expand this time-horizon over which clinical engineers can influence the trajectory of biomedical innovation. In their various roles, they form a "bridge" between the primary designers and the end-users, by combining the perspectives of being both 1) close to the point-of-use, while 2) trained in product and process engineering. Clinical Engineering departments will sometimes hire not just biomedical engineers, but also industrial/systems engineers to help address operations research/optimization, human factors, cost analysss, etc. Also see safety engineering for a discussion of the procedures used to design safe systems.


Schematic representation of a normal ECG trace showing sinus rhythm; an example of widely-used clinical medical equipment (operates by applying electronic engineering to electrophysiology and medical diagnosis.)
[edit] Regulatory issues
Regulatory issues are of particular concern to a biomedical engineer; it is among the most heavily-regulated fields of engineering, and practicing biomedical engineers must routinely consult and cooperate with regulatory law attorneys and other experts. The Food and Drug Administration (FDA) is the principal healthcare regulatory authority in the United States, having jurisdiction over medical devices, drugs, biologics, and combination products. The paramount objectives driving policy decisions by the FDA are safety and efficacy of healthcare products.

In addition, because biomedical engineers often develop devices and technologies for "consumer" use, such as physical therapy devices (which are also "medical" devices), these may also be governed in some respects by the Consumer Product Safety Commission. The greatest hurdles tend to be 510K "clearance" (typically for Class 2 devices) or pre-market "approval" (typically for drugs and class 3 devices).


Implants, such as artificial hip joints, are generally extensively regulated due to the invasive nature of such devices.Most countries have their own particular mechanisms for regulation, with varying formulations and degrees of restrictiveness. In most European countries, more discretion rests with the prescribing doctor, while the regulations chiefly assure that the product operates as expected. In European Union nations, the national governments license certifying agencies, which are for-profit companies. Technical committees of engineers write recommendations which incorporate public comments, and these can be adopted as regulations by the European Union. These recommendations vary by the type of device, and specify tests for safety and efficacy. Once a prototype has passed the tests at a certification lab, and that model is being constructed under the control of a certified quality system, the device is entitled to bear a CE mark, indicating that the device is believed to be safe and reliable when used as directed.

The different regulatory arrangements sometimes result in particular technologies being developed first for either the U.S. or in Europe depending on the more favorable form of regulation. While nations often strive for substantive harmony to facilitate cross-national distribution, philosophical differences about the optimal extent of regulation can be a hindrance; more restrictive regulations seem appealing on an intuitive level, but critics decry the tradeoff cost in terms of slowing access to life-saving developments.


[edit] Training and Certification

[edit] Education
Biomedical engineers require considerable knowledge of both engineering and biology, and typically have a Masters (M.S., M.S.E., or M.Eng.) or a Doctoral (Ph.D.) degree in BME or another branch of engineering with considerable potential for BME overlap. As interest in BME is increasing, many engineering colleges now do have a Biomedical Engineering Department or Program, with offerings ranging from the undergraduate (B.S. or B.S.E.) to the doctoral levels. As noted above, biomedical engineering has only recently been emerging as its own discipline rather than a cross-disciplinary hybrid specialization of other disciplines; now, BME programs of study at all levels are becoming more widespread, including the Bachelor of Science in Biomedical Engineering which actually includes so much biological science content that many students use it as a "pre-med" major in preparation for medical school. The number of biomedical engineers is expected to rise as both a cause and effect of improvements in medical technology.[4]

In the U.S., an increasing number of undergraduate programs are also becoming recognized by ABET as accredited bioengineering/biomedical engineering programs. Over 40 programs are currently accredited by ABET.[5][6]

As with many degrees, the reputation and ranking of a program may factor into the desirability of a degree holder for either employment or graduate admission. The reputation of many undergraduate degrees are also linked to the institution's graduate or research programs, which have some tangible factors for rating, such as research funding and volume, publications and citations. With BME specifically, the ranking of a university's hospital and medical school can also be a significant factor in the perceived prestige of its BME department/program.

Graduate education is a particularly important aspect in BME. While many engineering fields (such as mechanical or electrical engineering) do not need graduate-level training to obtain an entry-level job in their field, most BME positions do prefer or even require them.[7] Since most BME-related professions involve scientific research, such as in pharmaceutical and medical device development, graduate education is highly desirable (as undergraduate degrees typically do not involve sufficient research training and experience). This can be either a Masters or Doctoral level degree; while in certain specialties a Ph.D. is notably more common than in others, it is hardly ever the majority (except in academia). In fact, the perceived need for some kind of graduate credential is so strong that some undergraduate BME programs will actively discourage students from majoring in BME without an expressed intention to also obtain a masters degree or apply to medical school afterwards.

Graduate programs in BME, like in other scientific fields, are highly varied, and particular programs may emphasize certain aspects within the field. They may also feature extensive collaborative efforts with programs in other fields (such as the University's Medical School or other engineering divisions), owing again to the interdisciplinary nature of BME. M.S. and Ph.D. programs will typically require applicants to have an undergraduate degree in BME, or another engineering discipline (plus certain life science coursework), or life science (plus certain engineering coursework).

Education in BME also varies greatly around the world. By virtue of its extensive biotechnology sector, its numerous major universities, and relatively few internal barriers, the U.S. has progressed a great deal in its development of BME education and training opportunities. Europe, which also has a large biotechnology sector and an impressive education system, has encountered trouble in creating uniform standards as the European community attempts to supplant some of the national jurisdictional barriers that still exist. Recently, initiatives such as BIOMEDEA have sprung up to develop BME-related education and professional standards.[8] Other countries, such as Australia, are recognizing and moving to correct deficiencies in their BME education.[9] Also, as high technology endeavors are usually marks of developed nations, some areas of the world are prone to slower development in education, including in BME.


[edit] Licensure/Certification
See also: Professional engineer
Engineering licensure in the US is largely optional, and rarely specified by branch/discipline. As with other learned professions, each state has certain (fairly similar) requirements for becoming licensed as a registered professional engineer ("PE"), but in practice such a license is not required to practice in the majority of situations (thanks to an "exception" known as the private industry exemption -- which effectively applies to the vast majority of American engineers). This is notably not the case in many other countries, where a license is as legally necessary to practice engineering as it is for law or medicine.

Biomedical engineering is regulated in some countries, such as Australia, but registration is typically only recommended and not required.[10]

In the UK, mechanical engineers working in the areas of Medical Engineering, Bioengineering or Biomedical engineering can gain Chartered Engineering status through the Institution of Mechanical Engineers. The intuition also runs the Medical Engineering Division.[11]

The Fundamentals of Engineering exam -- the first (and more general) of two licensure examinations for most U.S. jurisdictions -- does now cover biology (although technically not BME). For the second exam, called "Part 2" or the "Professional Engineering" exam, candidates may select a particular engineering discipline's content to be tested on; there is currently not an option for BME with this, meaning that any biomedical engineers seeking a license must prepare to take this examination in another category (which does not affect the actual license, since most jurisdictions do not recognize discipline specialties anyway). However, the Biomedical Engineering Society (BMES) is, as of 2009, exploring the possibility of seeking to implement a BME-specific version of this exam to facilitate biomedical engineers' pursuing licensure.

Beyond governmental registration, certain private-sector professional/industrial organizations also offer certifications with varying degrees of prominence. One such example is the Certified Clinical Engineer (CCE) certification for Clinical engineers.


[edit] Founding figures
Leslie Geddes - Professor Emeritus at Purdue University, electrical engineer, inventor and educator of over 2000 biomedical engineers, received a National Medal of Technology in 2006 from President George Bush[12] for his more than 50 years of contributions that have spawned innovations ranging from burn treatments to miniature defibrillators, ligament repair to tiny blood pressure monitors for premature infants, as well as a new method for performing cardiopulmonary resuscitation (CPR).
Y. C. Fung - professor emeritus at the University of California, San Diego, considered by many to be the founder of modern Biomechanics[13]
Robert Langer - Institute Professor at MIT, runs the largest BME laboratory in the world, pioneer in drug delivery and tissue engineering[14]
Nicholas A. Peppas - Chaired Professor in Engineering, University of Texas at Austin, pioneer in drug delivery, biomaterials, hydrogels and nanobiotechnology.
Otto Schmitt (deceased) - biophysicist with significant contributions to BME, working with biomimetics
Ascher Shapiro (deceased) - Institute Professor at MIT, contributed to the development of the BME field, medical devices (e.g. intra-aortic balloons)
John G. Webster - Professor Emeritus at the University of Wisconsin-Madison, a pioneer in the field of instrumentation amplifiers for the recording of electrophysiological signals
U. A. Whitaker (deceased) - provider of The Whitaker Foundation, which supported research and education in BME by providing over $700 million to various universities, helping to create 30 BME programs and helping finance the construction of 13 buildings[15]
Alfred E. Mann - Physicist, entrepreneur and philanthropist.[16] A pioneer in the field of Biomedical Engineering.[17]

 

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