Thursday, April 30, 2009

Influenza: Treatment & Medication

Author: Hakan Leblebicioglu, MD, Chairman, Professor, Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Turkey
Coauthor(s): Itzhak Brook, MD, MSc, Professor, Department of Pediatrics, Georgetown University School of Medicine
Contributor Information and Disclosures

Updated: Apr 27, 2009

Medical Care
Influenza symptoms may last longer than 1 week. Caregivers can relieve and soothe children's aches and pains with basic supportive care.

Acetaminophen (paracetamol/panadol) may be administered for fever and relief of other symptomatology.
Caution: In children <16 y who have symptoms of influenza infection or colds, aspirin is not recommended because of an association with Reye syndrome.
Use cough suppressants and expectorants to treat the cough. Steam inhalations may also be useful. If dehydration occurs, administration of oral or intravenous fluids is indicated.

No special diet is indicated for influenza.

Adequate rest is recommended.

The following 4 antiviral agents are approved for preventing or treating influenza: amantadine, rimantadine, zanamivir, and oseltamivir.

Amantadine and rimantadine are effective against type A influenza virus only. They are approved by the US Food and Drug Administration (FDA) for influenza type A prophylaxis in patients older than 1 year. Amantadine is also FDA-approved for treatment in children.
Since the 2005-2006 influenza season, amantadine and rimantadine are no longer recommended by the CDC because of resistance. Laboratory testing by the CDC on the predominant strain of influenza (H3N2) currently circulating in the United States shows that it is resistant to these drugs.

Zanamivir and oseltamivir (Tamiflu) are members of a new class of drugs termed neuraminidase inhibitors and are active against both influenza virus type A and type B.
Zanamivir is provided as a dry powder that is administered by inhalation. It is approved for the treatment of uncomplicated acute influenza A or B in persons aged 7 years and older who have been symptomatic for no more than 2 days.
Oseltamivir is approved for oral administration in persons older than 1 year with influenza A or B who have been symptomatic for no more than 2 days.

Neither zanamivir nor oseltamivir is approved for prophylaxis of influenza infection.

Oseltamivir (Tamiflu) resistance has emerged in the United States during the 2008-2009 influenza season. The CDC has issued revised interim recommendations for antiviral treatment and prophylaxis of influenza.
Preliminary data from a limited number of states indicate a high prevalence of influenza A (H1N1) virus strains resistant to oseltamivir (Tamiflu). Because of this, zanamivir (Relenza) is recommended as the initial choice for antiviral prophylaxis or treatment when influenza A infection or exposure is suspected. A second-line alternative is a combination of oseltamivir plus rimantadine, rather than oseltamivir alone. Local influenza surveillance data and laboratory testing can assist the physician regarding antiviral agent choice.

Influenza A viruses, including two subtypes (H1N1) and (H3N2), and influenza B viruses currently circulate worldwide, but the prevalence of each can vary among communities and within a single community over the course of an influenza season.

In the United States, 4 prescription antiviral medications (oseltamivir, zanamivir, amantadine, rimantadine) are approved for treatment and chemoprophylaxis of influenza.
Since January 2006, the neuraminidase inhibitors (oseltamivir, zanamivir) have been the only recommended influenza antiviral drugs because of widespread resistance to the adamantanes (amantadine, rimantadine) among influenza A (H3N2) virus strains. The neuraminidase inhibitors have activity against influenza A and B viruses, whereas the adamantanes have activity against only influenza A viruses.

In 2007-2008, a significant increase in the prevalence of oseltamivir resistance was reported among influenza A (H1N1) viruses worldwide. During the 2007-2008 influenza season, 10.9% of H1N1 viruses tested in the United States were resistant to oseltamivir. Complete recommendations are available from the CDC.

Treatment of influenza A virus illness should be started as soon as possible, preferably within 24-48 hours after onset of signs and symptoms, and should be continued for 24-48 hours after the disappearance of signs and symptoms.

Antiviral agents
Use of influenza-specific antiviral drugs for chemoprophylaxis or treatment of influenza is an important adjunct to vaccine, particularly for controlling outbreaks in closed populations.

Sunday, April 26, 2009

How to Deal with Difficult Employees

By: Yvonne Bleakley

Most managers will do almost anything to avoid having a "difficult conversation" with an staff member, because they simply don't know how to do them!
Why? Well, most good managers were promoted into management because they almost always did the right thing - without being told. They had initiative. They produced results.

Every manager in their career stumbles across a challenging who frustrates them and takes a lot of their energy to manage such as:-
-Someone with an "attitude"
-Doesn't work well with other members on the team
-Challenges everything
-Fail to meet expectations
-Great at some things and weak in others
-Attendance issues
-Fail to follow procedures

As anyone who has had to put up with difficult behaviour knows, it is not funny when a employee causes problems in the office, and the effects can ripple out, having a negative effect on relationships, productivity, and general employee welfare.

Managers fear that if they speak with employee they may react defensively or the issue seems minor and mentioning it could de-motivate the employee. The stress brought about by difficult behaviour at work can be serious. Many people lead pressured lives anyway, without the unnecessary stress of having to cope with the behaviour of someone who sapps our energy and enthusiasm.

The cost of disputes at work goes far beyond the direct impact on those involved. The trouble isn't necessarily the fact that conflict exists. It's the damage that it causes when conflicts aren't resolved. The impact of an ongoing dispute at work can be catastrophic to those in the dispute, but also to their colleagues and the business as a whole.

Difficult people exist in every organization and although your natural instinct maybe to ignore and avoid them, you do so at your peril. As a Manager you're not only responsible for your own success and job satisfaction but also that of your team.

Challenging people should be a top management priority as they can adversely affect self-esteem, workplace happiness, business success and team member retention.
1. Create some notes around the behaviour or performance issue you find disturbing or challenging. This helps keep your focus especially if the employee gets defensive.
2. Sit down with the employee and find out how they feel about their job and do they have any concerns or issues they want to discuss.. Don't rush into your agenda, but rather be open to what they have to say. This open conversation can potentially eliminate a lot of stress for both of you.
3. State clearly the behaviour or performance issue you want to address with them and provide no more than three examples to support your concern. If they become defensive, listen to them for a while to see if there you can gather information to further understand how to support the employee. If they are rambling, bring them gently back to the issues and ask them what they think they need to do to correct the situation. Help them come up a suitable solution.
4. Follow Up! No matter what the outcome of the meeting, always follow up with the employee. If you need to provide further clarity for the employee, then do so. If the staff member has solved their problem, then acknowledge them. Let them know that you are available to help them with any of their concerns, your role as their manager is to support them.

Yvonne Bleakley is the manager's mentor, director of and creator of The Silent Motivator System, the proven step-by-step programme to maximise staff and gain true respect and commitment. Download your free e-book "How to Maximise your Staff and Gain Respect" at

Saturday, April 25, 2009

Breastfeeding Reduce Cardiovascular Risks

Breast Is Best: New WHI Data Extend CV Benefits of Breast-Feeding to Mom
by Lisa Nainggolan
April 23, 2009 (Pittsburgh, Pennsylvania)From Heartwire

Women who breast-fed for a year or more were less likely to develop hypertension, diabetes, hyperlipidemia, and cardiovascular disease when postmenopausal than women who were pregnant but never breast-fed, a new analysis of the Women's Health Initiative (WHI) has found. Dr Eleanor Bimla Schwarz (University of Pittsburgh Center for Research on Healthcare, PA) and colleagues report their findings in the May 2009 issue of Obstetrics & Gynecology.

"We were able to show that benefits were visible in anyone with six or more months' lifetime duration of breast-feeding," Schwarz told heartwire , with those who reported a lifetime history of more than 12 months' lactation being 10% to 15% less likely to have hypertension, diabetes, hyperlipidemia, and CVD than those who never breast-fed.

She says the findings--from a large data set and one of the first studies to report an effect on vascular events--build on a growing body of literature that demonstrates lactation has beneficial cardiovascular effects, as well as reducing the risk of breast and ovarian cancer. "We've known for years that breast-feeding is important for babies' health; we now know that it is important for mothers' health as well," she notes.

It is imperative that healthcare providers and our society support and educate women concerning the maternal benefits of prolonged breastfeeding.
In an accompanying editorial, ob-gyn Dr Edward R Newton (East Carolina University, Greenville, NC) says: "The findings are dramatic and persuasive." Although he notes some possible limitations of this study, he says, "A strong benefit of prolonged breast-feeding is still observed. It is imperative that healthcare providers and our society support and educate women concerning the maternal benefits of prolonged breast-feeding as well as the well-documented benefits of breast-feeding for the child."

Cardiologist Dr C Noel Bairey Merz (Cedars Sinai Healthcare Center, Los Angeles, CA) told heartwire this is "very nice work, controlled for a number of confounders such as education."

The Risks of Not Breast-Feeding

The study examined 139 681 women enrolled in both observational and clinical-trial cohorts of WHI who had had at least one live birth. The dose-response relationship between the cumulative months women lactated and postmenopausal risk factors for CVD were examined; the average age of the women was 63 years. Lifetime duration of breast-feeding was based on patient recollection, and Schwarz admitted this could have been subject to recall bias, a point that Newton also makes in his editorial.

In fully adjusted models, those who reported a lifetime history of more than 12 months of lactation were less likely to have hypertension (odds ratio 0.88; p<0.001), diabetes (OR 0.80; p<0.001), hyperlipidemia (OR 0.81; p<0.001), and CVD (OR 0.91; p=0.008) than women who never breast-fed, but they were not less likely to be obese. In models adjusted for all of the above variables and body-mass index (BMI), similar relationships were seen.

And women who breast-fed for seven to 12 months were also significantly less likely to develop CVD (hazard ratio 0.72) than those who never breast-fed.

Schwarz said: "We saw significant trends; the longer someone had breast-fed, the better." In his editorial, Newton says that prior analyses from the Nurses' Health Study show that women who breast-fed for a lifetime total of two years or more significantly reduced a major predictor for CVD--insulin-resistant diabetes--by 14% to 15% and had a 23% lower risk of incident MI.

We can talk about the benefits of breast-feeding but perhaps it is better framed as the risks of not breast-feeding.

Schwarz stressed an important point to heartwire . "It's not that you are better off if you have a baby and breast-feed than someone who's never been pregnant, it's that you are better off than someone who becomes pregnant and does not breast-feed. A woman who becomes pregnant and does not breast-feed is actually putting herself at risk. So we can talk about the benefits of breast-feeding but perhaps it is better framed as the risks of not breast--feeding."

Bairey Merz agrees. "We assume the pathway is that breast-feeding protects, but the association could go in the opposite direction--eg, inability to breast-feed may be a marker of early vascular dysfunction," she suggests.

"Women put themselves at risk by becoming pregnant and not fulfilling the cycle that nature has intended," Schwarz says. "In my mind, the cycle really ends with breast-feeding. During pregnancy, the body stores up a bunch of nutrients with the plan that it's going to release much of this in the form of breast milk, a very calorific food. If this doesn't happen, what we see is that the woman's body pays the price. Breast-feeding really helps bring you back to your baseline, and it helps women recover from the stress test that pregnancy entails."

Study of Physiology During Lactation May Help Tackle CVD in Women

In their discussion, Schwarz et al say their finding that women who breast-fed had lower rates of CVD even after adjustment for BMI "indicates that lactation does more than simply reduce a woman's fat stores. Hormonal effects, such as those of oxytocin, may have significant effects on cardiovascular profiles," they note.

Newton says: "The physiologic reasons for these important observations are largely speculative," but "the antistress, probonding effects of oxytocin and intense skin-to-skin contact found with prolonged breast-feeding certainly contribute to the protective effects," he notes.

Although Bairey Merz acknowledges the findings were adjusted for BMI, she says it is well known from many studies "that women who breast-feed lose the pregnancy weight gain better than those that do not--and this likely contributes to their lower CVD risk. What we do not know is whether breast-feeding preferentially impacts the visceral fat deposits, which would be of specific benefit and should be the focus of research."

"A more intense and focused study of maternal physiology during lactation may give us critical information to limit the scourge of CVD in women," Newton concludes.

Thursday, April 23, 2009

Exercise Program Reduces Migraine

Allison Gandey
From Medscape Medical News

April 15, 2009 — An exercise program has shown promise in decreasing the frequency of migraine and improving quality of life, report researchers. Even though physical activity can trigger migraine in some, new study results suggest the aerobic intervention can be well tolerated and even improve outcomes.

"While the optimal amount of exercise for patients with migraine remains unknown, our evaluated program can now be tested further and compared with pharmacological and nonpharmacological treatments to see if exercise can prevent migraine," lead author Emma Varkey, PhD, from the Cephalea Headache Center, in Gothenburg, Sweden, said in a news release.

The study is published in the April issue of Headache.

Significant Improvement in Quality of Life

Researchers studied 26 patients from the Swedish headache clinic. The exercise program, based on indoor cycling, was performed 3 times a week for 12 weeks. The program was developed to improve maximum oxygen uptake in untrained patients with migraine.

The research team evaluated migraine status, oxygen uptake, adverse effects, and quality of life. They found there was no deterioration in migraine status, and in fact, during the last month of treatment, there was a significant decrease in the number of migraine attacks, the number of days with migraine per month, mean headache intensity, and amount of headache medication used compared with baseline.

Investigators also found that after the exercise program, maximum oxygen uptake increased from 32.9 mL/kg/minute to 36.2 mL/kg/minute (P = .044). None of the patients reported adverse effects. But a patient experienced a migraine with aura that started immediately after training on 1 occasion.

As measured by the Migraine-Specific Quality-of-Life questionnaire, researchers report a significant improvement in patients completing the exercise program.

Results Encouraging, but Inconclusive

Individuals with headache and migraine typically are less physically active than those without headache, the investigators point out. Patients with migraine often avoid exercise, resulting in less aerobic endurance and flexibility.

"The positive results reported in migraine status and quality of life are encouraging but inconclusive, since this was not a blinded study and there was no control group," the researchers write. "Well-designed studies of exercise in patients with migraine are imperative."

The researchers have disclosed no relevant financial relationships.

Headache. 2009;49:563-570. Abstract

Thursday, April 9, 2009

Postnatal Confinement Home Kuching

Havilah Confinement Home

I am pleased to inform you that I have a license from the Ministry of Health to run a confinement home.

A semidetached house has been renovated to cater for seven mums and newborn up to 60 days post natal. Mothers who prefer to stay at home may leave the babies with us for care for part or full time. Only well mothers and babies will be housed.

Nursing and trained aides will be on duty 24/7 to attend to mum and baby with a pediatrician on call. They will be referred to their doctor of choice should problems arise.

Phototherapy units are available.
During the stay mums will be helped to establish breast feeding.

Where bottle feeding is preferred, hygienic techniques will be taught.

Parents will be taught baby massage, parenting skills and child health using the book “Congratulations, You’re a Mum and Dad - Caring for your baby from day one”.

We aim to help parents become more knowledgeable and confident caregivers.

Mums will have options for massage, hair, face and nail care.

There is phone, TV, Astro, satellite and internet access in all rooms, a library and board games. The kitchen is fully furnished for self catering. Meals may be catered if desired. Infant formula may be provided at cost.

The house is secured with alarm and CCTV.

Visitors will be screened and limited to ensure privacy and reduce infection risks.

Visiting hours are restricted except for husband.

Tel +06 082 366452 + 016 85 20 200 for booking