Prevention of Specific Infectious Diseases

Description:
Mycobacterium tuberculosis is a rod-shaped bacterium that can cause disseminated disease but is most frequently associated with chronic pneumonia. Transmission occurs when a contagious patient coughs, spreading the bacilli through the airborne route to a person sharing the same air space. The exposed person may acquire latent infection (sometimes abbreviated LTBI) or, depending on host factors, tuberculosis disease. Both conditions can usually be treated successfully with medications (1).

Multi-drug resistant or MDR-TB is TB resistant to at least two of the most effective drugs, isoniazid and rifampin (also called first-line drugs). XDR-TB is resistant to at least these two drugs and three of the six second-line drugs used to treat MDR-TB.



Occurrence

In many other countries, tuberculosis is much more common than in the United States, and it is an increasingly serious public health problem (2). Although MDR-TB occurs globally, it appears to be rare compared to drug-sensitive TB. XDR-TB is of particular concern among HIV-infected or other immunocompromised persons (see Maps 4-13, 4-14).
Risk for Travelers

To become infected, a person usually has to spend a relatively long time in a closed environment where the air was contaminated by a person with untreated tuberculosis who was coughing and who had numerous M. tuberculosis organisms (or tubercle bacilli) in secretions from the lungs or larynx. Infection is generally transmitted through the air; therefore, there is virtually no danger of its being spread by dishes, linens, and other items that are touched, or by most food products. However, it can be transmitted through unpasteurized milk or milk products (e.g., some cheeses) obtained from infected cattle (1). Documented sites of XDR-TB include crowded hospitals, prisons, homeless shelters, and other settings where susceptible persons come in contact with infected persons with TB disease.

Travelers who anticipate possible prolonged exposure to tuberculosis (e.g., those who could be expected to come in contact routinely with hospital, prison, or homeless shelter populations) should be advised to have a tuberculin skin test or QuantiFERON TB-Gold test (QFT-G) before leaving the United States (1,3). If the result is negative, they should have a repeat test approximately 8-10 weeks after returning (4,5). Because persons with HIV infection are more likely to have an impaired response to the test, travelers should be advised to inform their physicians about their HIV status. Except for travelers with impaired immunity, travelers who have already been infected are unlikely to be reinfected (1).

Travelers who anticipate repeated travel with possible prolonged exposure or an extended stay over a period of years in an endemic country should be advised to have a baseline two-step tuberculin test or a single-step QFT-G (4). If the baseline test is negative, annual screening would identify recent infection, which should prompt medical evaluation to exclude disease and treatment for latent infection.

CDC and state and local health departments have published the results of six investigations of possible tuberculosis transmission on commercial aircraft. In these six instances, a passenger or a member of a flight crew traveled on commercial airplanes while contagious with tuberculosis. In all six instances, the airlines were unaware that the passengers or crew members had tuberculosis. In two of the instances, CDC concluded that tuberculosis was probably transmitted to others on the airplane. The findings suggested that the risk of tuberculosis transmission from an infectious person to others on an airplane was greater on long flights (8 hours or more). The risk of exposure to tuberculosis was higher for passengers and flight crew members sitting or working near an infectious person because they were more likely to inhale droplets containing M. tuberculosis bacteria (6).

Based on these studies and findings, WHO issued recommendations to prevent the transmission of tuberculosis in aircraft and to guide potential investigations. The risk of tuberculosis transmission on an airplane does not appear to be greater than in any other enclosed space. To prevent the possibility of exposure to tuberculosis on airplanes, CDC and WHO recommend that persons known to have infectious tuberculosis travel by private transportation (that is, not by commercial airplanes or other commercial carriers), if travel is required. CDC and WHO have issued guidelines for notifying passengers who might have been exposed to tuberculosis aboard airplanes (6). Passengers concerned about possible exposure to tuberculosis should be advised to see their primary health-care provider for evaluation.


read more http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx

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The Power of Positive Reinforcement

When you're faced with a challenge, a little positive self-talk goes a long way. Learn how to find your own success mantra.

Studies back up the benefits of positive self-talk: Research suggests that consistently replacing negative thoughts with optimistic ones may improve your outlook, reduce stress and lift your self-esteem. Here's how to come up with a motivating personal mantra you can rely on again and again:

1. First, envision your ideal life, then come up with an encouraging phrase that makes it sound as if what you desire is already a reality. Instead of "I hope tomorrow is better," try "I believe that tomorrow will be a better day."

2. Repeat your mantra whenever you start to badmouth yourself ("I'm such a loser!"). You'll retrain your brain to focus on the positive, not the negative. Share your successful mantras on our Happiness forum.

3. Can't think of a mantra that doesn't make you feel silly? Try one of these:

"I choose to love and appreciate myself and others."
"I am grateful for the good and wonder in my life."
"I can make healthy choices and be the architect of my future."
"I forgive my flaws and celebrate my strengths."

Source: http://health.yahoo.com/

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Treatment of Tuberculosis

The recommendations in this document are intended to guide the treatment of tuberculosis in settings where mycobacterial cultures, drug susceptibility testing, radiographic facilities, and second-line drugs are routinely available. In areas where these resources are not available, the recommendations provided by the World Health Organization, the International Union against Tuberculosis, or national tuberculosis control programs should be followed.

What's New In This Document

* The responsibility for successful treatment is clearly assigned to the public health program or private provider, not to the patient.
* It is strongly recommended that the initial treatment strategy utilize patient-centered case management with an adherence plan that emphasizes direct observation of therapy.
* Recommended treatment regimens are rated according to the strength of the evidence supporting their use. Where possible, other interventions are also rated.
* Emphasis is placed on the importance of obtaining sputum cultures at the time of completion of the initial phase of treatment in order to identify patients at increased risk of relapse.
* Extended treatment is recommended for patients with drug-susceptible pulmonary tuberculosis who have cavitation noted on the initial chest film and who have positive sputum cultures at the time 2 months of treatment is completed.
* The roles of rifabutin, rifapentine, and the fluoroquinolones are discussed and a regimen with rifapentine in a once-a-week continuation phase for selected patients is described.
* Practical aspects of therapy, including drug administration, use of fixed-dose combination preparations, monitoring and management of adverse effects, and drug interactions are discussed.
* Treatment completion is defined by number of doses ingested, as well as the duration of treatment administration.
* Special treatment situations, including human immunodeficiency virus infection, tuberculosis in children, extrapulmonary tuberculosis, culture-negative tuberculosis, pregnancy and breastfeeding, hepatic disease and renal disease are discussed in detail.
* The management of tuberculosis caused by drug-resistant organisms is updated.
* These recommendations are compared with those of the WHO and the IUATLD and the DOTS strategy is described.
* The current status of research to improve treatment is reviewed.

read more http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm

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Bloggerwave is aiming to be Europes biggest advertsing media on blogs and you can help us grow so more and more jobs will come. This is not free, you will be paid for each review you post on your blog.


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Lessons in Home Cooking

The most healthful meal is the one you cook at home. But for those of us skilled at the art of takeout, the idea of cooking in our kitchens is daunting. Who has time after a busy day to shop, chop, prepare and cook?

The Times’s food writer Mark Bittman always makes cooking look easy as author of the weekly Minimalist column and his new blog Bitten. He’s also the author of several cookbooks, including “How to Cook Everything: Simple Recipes for Great Food.'’ I recently spoke with Mark about the how-to’s of home cooking, his favorite ingredients and a lot about beans.

Why do you think so many people find it tough to cook regularly at home?

I think there are a couple of lost generations. In the years after the war it became less and less popular to cook and more and more common to do things conveniently. Especially people born after 1960 or after, when reentering the workforce and using canned and frozen microwave stuff — they just didn’t see their mothers cooking.

For those of us who want to cook more, what’s your advice for getting started?

I would say start with a decent cookbook. Pick something you really like, and make the effort to be successful; you want positive reinforcement. Read the recipe carefully, set aside the time and make sure you’ve got the ingredients and the equipment and really walk yourself through it. What takes you two hours the first time may only take 15 minutes the third time.

What supplies should I always have in my kitchen? Are there any special pots or pans I need?

In “How To Cook Everything,” there are lists of what you need for your pantry and a list of the equipment. You can start with three or four pans, a couple different utensils. And you can start with 10 or 15 ingredients. The list includes pasta and rice, canned beans and tomatoes, spices, olive oil, eggs and butter, long-keeping vegetables like onions, potatoes and garlic and canned stock. You have to start with the right ingredients, and you have to invest a little money and a fair amount of time.

But that is usually the problem for most people. They say they don’t have time to cook. I know I often don’t.

Well, whatever it takes to get food on the table, you have to do something. I’m not saying calling the Chinese takeout guy is harder than cooking. But all things considered, it’s not that much different. Yesterday morning I woke up and cooked beans while getting ready to come to work. I got home really late, like at 7:45 p.m. I reheated the beans, washed some lettuce and broiled a piece of fish. I had stuff on the table in 15 minutes. People say, “I have no time.” It’s like exercise: you have to want to do it.

For me the worst part of cooking is shopping for groceries and figuring what ingredients I need for a meal.

These days I cook a lot of things that are already in the house. I eat a lot of eggs, vegetables, beans and pasta. A lot of people think cooking is complicated. But this is the thing. Once you learn what you’re doing you realize it’s not. As I said, I woke up yesterday and made beans. Even if you take a can of beans and throw it in a pot with cherry tomatoes (you don’t even have to cut them up), some garlic and olive oil — there’s nothing wrong with that. Broil a piece of fish, wash some lettuce, and you have a fine meal. If your kids don’t like fish, then use shrimp or a piece of meat. I’ve gotten so used to cooking simply I almost never do anything else. Even when people come over for dinner — they get the same things I cook for myself. If I made what I just described to you and you were coming over for dinner, you’d probably think, “He cooked. How nice.'’ People worry about this too much.

How many different types of meals should we know how to make? Is variety important?

Whatever makes you happy. If you know how to broil a piece of fish or meat, if you know how to make a stir-fry and a couple pasta dishes and maybe a rice dish, and if you know how to deal with beans and make a salad, at that point you are well on your way.

When you are cooking, do you ask yourself whether it’s healthy, or do you just want it to taste good?

I always thought if you were aware of what you were putting in your mouth you’re not going to eat badly. Nobody can cook what they cook in fast-food joints and restaurants, in general, because you just don’t have the same ingredients. But if you looked at what it means to put a half a cup of butter in a dish, you would just look and say, “I’m going to use less.'’ When you cook yourself, you just don’t put the same kind of crappy things in there that people put in food that is prepared for you.

Do you have a favorite ingredient?

I go through an awful lot of olive oil, a stunning amount. I’m eating a lot of legumes.

You’ve talked a lot about beans. How do you cook them? Don’t you have to soak them?

You don’t have to soak them, but it makes it faster if you do. If you soak small dried beans overnight, I wager you could get them most of the way cooked by the time you and your daughter got out of the house in the morning. There’s a lot of stuff you can start and stop in the morning, especially beans and grains.

I have to confess, I’m not much of a bean eater. Maybe I need to start. Why are you such a fan?

It’s the flavor, the satisfaction, the non-meatness, the high-fiberness. When you get into cooking you start to see the subtle differences among things. At first I didn’t know anything about fish, then I learned 50 species, and then it mattered if it was bay scallops or sea scallops or pink scallops. That’s where I’m at these days with vegetables and legumes. I didn’t pay much attention to cooking them for most of my adult life, and now I’m starting to understand the subtle differences.

Okay, so what beans should we all be trying?

Chickpeas are the best. Now I’m into these huge beans called gigantes. You eat three of them and it’s like you had a small potato. But you can take a pound of chickpeas, cook them on a Saturday and stick them in the refrigerator tossed with olive oil, and you can eat them all week long.

Do you have a particular food indulgence?

I have a lot of friends in the food business, so I get my share of treats. At home it’s almost like I’m happy with pretty much everything I cook. It’s not that it’s so great. It’s the knowledge that I put something together, it’s simple and I put something on the table and there we are, sitting and eating it. It’s something I’ve loved doing for a long time, and I’m still into it.

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Pizza for Breakfast? Yes!

I know what you're thinking: pizza? For breakfast? But the truth is that you can crack open last night's leftovers in the a.m. if you want to.

I know lots of women who skip breakfast, and they have a ton of different excuses for doing it. Some say they don't have time, others think they're "saving" calories by eliminating a meal, still others just don't like breakfast food.

But the bottom line is, eating in the morning is crucial when you're trying to trim down. "Eating just about anything in the range of 300 to 400 calories would be better than nothing at all," says SELF contributor Katherine Brooking, R.D., who developed the super-easy eating plan for this year's SELF Challenge. And even pizza can be healthy if it's thin-crust, loaded with veggies, and you stick to one slice.

Breakfast is one meal I never miss (my favorite morning combo includes Fage nonfat yogurt topped with fresh fruit and low-carb granola, yum!), and the same goes for most weight loss success stories.

Research shows that eating breakfast revs up your metabolism, keeps you from overeating later in the day and may even help sleekify your abs. Researchers at the University of Southern California at Los Angeles found that breakfast skippers have bigger tummies than those who regularly have a morning meal.

So eat something in the morning, anything. I know plenty of pals who end up forgoing it altogether to have just coffee or cola. I say, try heating up last night's leftovers-it may sound crazy, but if it works for you, do it!

Bonus: I find if I tell myself, "You can always eat it tomorrow," I put away the leftovers instead of eating more that night. Try it...you may save yourself some prebedtime calories. And watch your body reap the fat-burning benefits. What are your favorite breakfast foods?

Source: http://health.yahoo.com

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The Easiest Diet Secret

Produce, especially the veggie variety, is a dieter’s best friend. When people eat veggies with a meal, they consume a full 20 percent fewer calories overall — and still feel satisfied afterward, a study in The American Journal of Clinical Nutrition reveals.

I know that all that chopping and cooking feels like a drag, but it’s easier than you think to work in five cups of the fresh stuff a day.

At breakfast, have a fruit “smush” made with a medley of fresh berries and yogurt (the lean protein fills me up). Then, at lunch, have a great big salad with cucumbers, tomatoes, peppers, peas or whatever your favorite veggies are. Add grilled chicken or another lean protein to hold off afternoon hunger.

Start dinner with a veggie-packed soup, like minestrone, and make a side dish that you love (I’m a big fan of steamed spinach with a little salt). I also love ratatouille (especially in summer), but if you don’t have time for that, heat up some frozen veggies and sprinkle them with Parmesan or lemon juice for an easy, delicious, healthy side. My favorite brand of frozen veggies is from Cascadian Farm.

Source: health.yahoo.com

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