Lung Diseases and Conditions

Many steps are involved in breathing. If injury, disease, or other factors affect any of the steps, you may have trouble breathing.
For example, the fine hairs (cilia) that line your upper airways may not trap all of the germs you breathe in. These germs can cause an infection in your bronchial tubes (bronchitis) or deep in your lungs (pneumonia). These infections cause a buildup of mucus and/or fluid that narrows the airways and limits airflow in and out of your lungs.
If you have asthma, breathing in certain substances that you're sensitive to can trigger your airways to narrow. This makes it hard for air to flow in and out of your lungs.
Over a long period, breathing in cigarette smoke or air pollutants can damage the airways and the air sacs. This can lead to a condition called COPD (chronic obstructive pulmonary disease). COPD prevents proper airflow in and out of your lungs and can hinder gas exchange in the air sacs.
An important step to breathing is the movement of your diaphragm and other muscles in your chest, neck, and abdomen. This movement lets you inhale and exhale. Nerves that run from your brain to these muscles control their movement. Damage to these nerves in your upper spinal cord can cause breathing to stop, unless a machine is used to help you breathe. (This machine is called a ventilator or a respirator.)
A steady flow of blood in the small blood vessels that surround your air sacs is vital for gas exchange. Long periods of inactivity or surgery can cause a blood clot called a pulmonary embolism (PE) to block a lung artery. A PE can reduce or block the flow of blood in the small blood vessels and hinder gas exchange.

Getting fit before pregnancy

Get ready for pregnancy

• Having a healthy baby someday starts well before pregnancy.
• You and your partner should start making healthy choices now.
• Eating right and getting fit are some ways to get healthy.

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• In depth

 

 

 

 

 

 

 

 

Getting fit before pregnancy

If you're thinking about pregnancy, or if you're just interested in leading a healthier lifestyle, it's important to include physical activity in your daily routine. Many women know that regular physically activity is very important for keeping good health and maintaining a healthy weight. Now, more research is showing that the healthier a woman is before pregnancy, the better her chances are to have a healthy baby someday.
For example, a woman who is at a healthy weight before pregnancy is less likely to have serious complications during pregnancy, like high blood pressure or diabetes, or during childbirth. Her baby is also less likely to be born preterm, have birth defects, or face childhood obesity, which is a growing problem in the United States.
Benefits of physical activity
Physical activity is any form of exercise or movement of the body that uses energy. Having an active lifestyle can help all women be healthy. Regular physical activity can lower your risk of:

• Heart disease
• Stroke
• High blood pressure
• Breast or colon cancer
• Type 2 diabetes (often related to being overweight)
• Osteoarthritis (most common form of arthritis)
• Osteoporosis (weakens bones and affects many women)

Physical activity can also:

• Improve a person's mood
• Reduce feelings of mild or moderate depression
• Help with managing stress
• Help with managing weight
• Help with quitting smoking
• Help with sleeping better
• Increase energy throughout the day

Know your body
Physical activity, along with a well-balanced diet, can also help an overweight person to lose weight. To find out if you are overweight, you'll need to know your height and weight. You then can calculate your body mass index (BMI). BMI helps to determine if your weight is appropriate for your height.
Not only is lowering your body fat important to your health, but it also matters where you carry the fat on your body. Women with a "pear" shape tend to store fat in their hips and buttocks. Women with an "apple" shape tend to store fat around their waists.
Women with an "apple" shape are more likely to develop health problems related to being overweight than women with a "pear" shape. For women, a waist size of more than 35 inches increases the risk of heart disease.
Kinds of physical activity
Aerobic activities
There are two kinds of aerobic activities: moderate and vigorous. Moderate activities increase your heart rate, but you can continue doing them while carrying on a conversation with little trouble. Moderate activities include:

• Walking briskly 
• Biking slowly or on a flat surface
• Doing water aerobics
• Dancing (ballroom or line)
• Playing sports in which you catch and throw a ball (baseball, softball, volleyball)

Vigorous activities also increase your heart rate, but it's harder to carry on a conversation while doing them because you're breathing heavier. Vigorous activities include:

• Jogging or running
• Biking faster than 10 miles per hour or uphill
• Fast swimming or lap swimming
• Aerobic or fast dancing
• Sports with a lot of running (basketball, hockey, soccer)

Strength-training activities: Strength-training activities help build muscles by improving their strength and ability. These activities include:

• Push-ups
• Sit-ups
• Weight lifting
• Working with weight machines
• Working with resistance bands (giant rubber bands made especially for exercising)

Stretching activities: To improve flexibility and movement in your everyday life, stretching can be a big help. Moving more freely makes it easier to reach down and tie your shoes or look over your shoulder when driving your car in reverse.
Stretch after your muscles are warmed up (for example, after strength training). Stretching your muscles before they are warmed up may cause injury. Stretching activities include:

• Yoga
• Pilates
• Basic body stretches (reaching up above your head or reaching down to touch your toes)

Amount of physical activity
Aerobics: In 2008, the Department of Health and Human Services updated its guidelines for physical activity. It recommends that all adults get at least 2 ½ hours each week of aerobic physical activity. This activity should be at least moderately intense.
You can break up the 2 ½ hours up however you like. But it’s best if you do this type of activity for at least 10 minutes at a time.
For example, you can do 30 minutes of moderate physical activity 5 or more days a week. Another option is to do 50 minutes of moderate activity on 3 or more days a week.
You can also replace some or all of your moderate activity with vigorous activity. In general, 15 minutes of vigorous activity provides the same benefits as 30 minutes of moderate activity. So vigorous activity gets you similar health benefits in half the time that moderate activities take.
Strengthening: In addition, all adults should do strengthening activities at least 2 days a week. You can do these exercises on the days between your aerobic workouts. Focus on strengthening the muscles in your legs, hips, back, chest, stomach, shoulders and arms.
In each strength-training session, aim for 8 to 10 different activities that will work out the different muscle groups in your body. Repeat exercises for each muscle group 8-12 times per session.
Cost
You don't need to spend a lot of money to get the physical activity you need. For aerobic activity, take a walk or jog around your neighborhood. If you need to be indoors because of weather conditions or safety concerns, try exercising to a workout video. You can also contact your local recreation center or house of worship to see if they have indoor activity programs that you can join.
For strength training, try using things around the house. Homemade weights, like plastic soft-drink bottles filled with water or sand, or a couple of soup cans, can help you strengthen your muscles. You can also use your own body weight by doing activities such as push-ups, pull-ups or sit-ups.
Special challenges
If you've never been active or haven't been in a long time, it's important to start slowly. Begin your physical activity program with short sessions of 5 to 10 minutes and build up to your goal.
If you're a larger woman, don’t be afraid to get started. You may face special challenges in trying to be physically active, but you can work hard to overcome them. You may not be able to bend or move in the same way as others. You may even feel a little self-conscious. But don’t give up. Try doing activities such as swimming or exercising while seated. They put less stress on your joints because your legs are not supporting the whole weight of your body. Ask your health provider for help in coming up with a physical activity plan that is right for you.
If you have a disability, it may be harder to stay active, but don't let that stop you. In most cases, people with disabilities can improve their flexibility, mobility and coordination by becoming physically active. Being active can help you stay independent. It can help prevent illnesses, such as heart disease, that can make it hard for you to care for yourself. Work with your health provider to develop a physical activity plan that is right for you.
Talk to your health provider
You should talk to your health provider before you begin any physical activity program if you:

• Are pregnant
• Have heart disease or are at high risk of developing this illness
• Have diabetes or are at high risk for this disease
• Are obese (BMI of 30 or greater)
• Have an injury or disability
• Have a bleeding or detached retina
• Had recent eye surgery or laser treatment on your eye
• Had recent hip surgery
• Had a stroke or are at high risk of developing this condition

Physical activity tips

• Pick activities that you like to do.
• Mix it up. Try different activities so you don't get bored or lose motivation.
• Spread aerobic activity out over at least 3 days a week.
• Team up with your partner or a friend to help keep you motivated.
• Track your time and progress to help you stay on course.
• Once you’ve gotten into a groove, replace some moderate aerobic activities with vigorous activities. Try jogging for 15 minutes instead of walking for 30 minutes.

Sneak in mini-workouts whenever you can

• If you have kids, make time to play with them outside.
• Take the stairs instead of the elevator.
• Park your car further away from the office and walk. Get off the bus or train a couple of stops earlier and walk.
• Go dancing with your partner or friends.
• If you're going on vacation, take a walking tour or do your site-seeing on foot.

Stay safe while active

• Warm up before doing any activity. Try jogging in place for a few minutes to loosen muscles.
• Go at your own pace. Start slowly and work your way up to longer and more challenging workouts.
• Learn about the types and amounts of activity that are appropriate for your fitness level.
• Use the right safety gear and sports equipment.
• Choose a safe place to do your activity.
• Stop physical activity if you feel faint, dizzy, nauseous, pain in your chest or have trouble breathing. Talk to a health care provider to make sure you’re in good health.

Preconception Care Questions and Answers: General Public

1. What is preconception health?
2. What is preconception health care?
3. Why are there new recommendations on preconception health and health care now?
4. Does preconception health apply to women who do not plan to get pregnant?
5. How long before becoming pregnant should a woman start preparing for pregnancy? What are the five most important things she should do before pregnancy for her and her baby’s health?
6. The new recommendations say that everyone should have a reproductive life plan. What does this really mean?
7. What can men do to support the preconception health of their female partners and their future babies?
8. What is the role of community groups in promoting preconception health?
9. What should my health care provider be doing about preconception care at my regular visits?

1. What is preconception health?
Preconception health is a woman’s health before she becomes pregnant. It focuses on the conditions and risk factors that could affect a woman if she becomes pregnant. Preconception health applies to women who have never been pregnant, and also to women who could become pregnant again. Preconception health looks at factors that can affect a fetus or infant. These include factors such as taking prescription drugs or drinking alcohol. The key to promoting preconception health is to combine the best medical care, healthy behaviors, strong support, and safe environments at home and at work.


2. What is preconception health care?
Preconception health care is care given to a woman before pregnancy to manage conditions and behaviors which could be a risk to her or her baby. There are many topics covered under preconception care.

• Folic acid supplements to prevent neural tube defects.
  
• Rubella vaccinations to prevent Congenital Rubella Syndrome.
  
• Detecting and treating existing health conditions to prevent complications in the mother, and reduce the risk of birth defects:
  
  • Diabetes
    
  • Hypothyroidism
    
  • HIV/AIDS
    
  • Hepatitis B
    
  • PKU
    
  • Hypertension
    
  • Blood diseases
    
  • Eating disorders
    
• Reviewing medications that can affect the fetus or the mother, such as epilepsy medicine, blood thinners, and some medicines used to treat acne, such as Accutane.
  
• Reviewing a woman’s pregnancy history – has she lost a baby before?
  
• Stopping smoking to reduce the risk of low birth weight
  
• Eliminating alcohol consumption to prevent Fetal Alcohol Syndrome, and other complications.
  
• Family planning counseling to avoid unplanned pregnancies.
  
• Counseling to promote healthy behaviors such as appropriate weight, nutrition, exercise, oral health. Counseling can help a woman avoid substance abuse and toxic substances. It can help women and couples understand genetic risks, mental health issues (such as depression), and intimate partner domestic violence.
  

Good preconception health care is about managing current health conditions. By taking action on health issues BEFORE pregnancy, future problems for the mother and baby can be prevented. Preconception health care must be tailored to each individual woman. It means helping women and their partners reduce risks and get ongoing care. Men and other family members are also very important in supporting the goals of preconception health.


3. Why are there new recommendations on preconception health and health care now?

There have been important advances in medicine and prenatal care in recent years. Despite these advances, birth outcomes are worse in the United States than in other developed countries. Many babies are born prematurely or have low birthweight. In some groups of people, the problems are actually getting worse.
Experts agree that women need to be healthier before becoming pregnant. While this is not a new idea, there has not been an organized effort to promote preconception health and health care until now. The recommendations shown here have been developed by local, state, and federal government agencies, with help from national medical organizations and groups such as the March of Dimes. They offer guidance to individuals and their families, health care providers, planners, and policy makers. The goal is to improve the health of women so that babies can be born healthier in the future.

4. Does preconception health apply to women who do not plan to get pregnant?

Absolutely. Every woman should be thinking about her health, whether or not she wants to get pregnant. Some of the basic recommendations for preconception health include healthy weight and nutrition, and identifying and managing existing conditions and infections. All women should quit smoking and avoid other harmful substances. These are important health goals for everyone, not just women planning to get pregnant.
Since over half of all pregnancies in the United States are unplanned, women who might be sexually active with male partners should consider their health. As they might not know they are pregnant, women need to avoid risks, such as using medications that could harm a fetus, whenever possible.
CDC recommends that men and women think about a reproductive life plan. This means deciding the ideal time and conditions for having children and learning how to achieve these goals. This can include effective contraception. (See Question 6 below) Women’s lives are rich and complex, and the possibility of pregnancy is only one factor affecting women’s health choices. The more that women know about the health care relevant to their own circumstances, the more empowered they are to make the right choices for their lives.


5. How long before becoming pregnant should a woman start preparing for pregnancy? What are the five most important things she should do before pregnancy for her and her baby’s health?

Every man and woman should prepare for pregnancy before becoming sexually active, or at least three months before conception. Women should begin some of the recommendations even sooner – such as quitting smoking, reaching healthy weight, and adjusting medications. Planning for pregnancy is also a good time to talk about other concerns. Issues such as intimate partner domestic violence, mental health, and previous pregnancy problems need to be discussed. Although men and women can do much on their own, a health care provider is necessary for finding and treating existing health problems. They can also help a woman improve her health before pregnancy.
The five most important things a woman can do for preconception health are:

1. Take 400 mcg of folic acid a day for at least 3 months before becoming pregnancy to reduce the risk of birth defects.
   
2. Stop smoking and drinking alcohol.
   
3. If you currently have a medical condition, be sure these conditions are under control. Conditions include but are not limited to asthma, diabetes, oral health, obesity, or epilepsy. Be sure that your vaccinations are up to date.
   
4. Talk to your doctor and pharmacist about any over the counter and prescription medicines you are taking, including vitamins, and dietary or herbal supplements, you are taking.
   
5. Avoid exposures to toxic substances or potentially infectious materials at work or at home, such as chemicals, or cat and rodent feces.
   

6. The new recommendations say that everyone should have a reproductive life plan. What does this really mean?

A reproductive life plan is a set of personal goals about having (or not having) children. It also states how to achieve those goals. Everyone needs to make a reproductive plan based on personal values and resources. Here are some examples:

• “I’m not ready to have children now. I’ll make sure I don’t get pregnant. Either I won’t have heterosexual sex, or I’ll correctly use effective contraception.”
  
• “I’ll want to have children when my relationship feels secure and I’ve saved enough money. I won’t become pregnant until then. After that, I’ll visit my doctor to discuss preconception health. I’ll try to get pregnant when I’m in good health.”
  
• “I’d like to be a father after I finish school and have a job to support a family. While I work toward those goals, I’ll talk to my wife about her goals for starting a family. I’ll make sure we correctly use an effective method of contraception every time we have sex until we’re ready to have a baby.”
  
• “I’d like to have two children, and space my pregnancies by at least two years. I’ll visit my certified nurse midwife to discuss preconception health now. I’ll start trying to get pregnant as soon as I’m healthy. Once I have a baby, I’ll get advice from a health professional on birth control. I don’t want to have a second baby before I’m ready.”
  
• “I will let pregnancy happen whenever it happens. Because I don’t know when that will be, I’ll make sure I’m in optimal health for pregnancy at all times.”
  

There are many kinds of reproductive life plans. What’s important is that you think about when and under what conditions you want to become pregnant. Then make sure your actions support these goals. Health care providers and counselors can help you understand the clinical and lifestyle options that are best for you.


7. What can men do to support the preconception health of their female partners and their future babies?

Men can make a big difference in promoting good preconception health. As boyfriends, husbands, fathers-to-be, partners, and family members, they can learn how their loved ones can achieve optimal preconception health. They can encourage and support women in every aspect of preparing for pregnancy.
There are other ways men can help. Men who work with chemicals or other toxins need to be careful that they don’t expose women to them. For example, men who use fertilizers or pesticides in agricultural jobs should change out of dirty work clothes before coming near their female partners. They should handle and wash soiled clothes separately.
The family health histories of men are also important when planning a pregnancy. Understanding genetic risks from both sides enables providers to give more accurate advice. Screening for and treating STIs (sexually transmitted infections) in men can help make sure that the infections are not passed to female partners. Men can improve their own reproductive health by reducing stress, eating right, avoiding excessive alcohol use, not smoking, and talking to their health care providers about their own medications. It is also important for men who smoke to stop smoking around their partners, to avoid the harmful effects of second-hand smoke.

8. What is the role of community groups in promoting preconception health?

Since preconception health affects so many women, community groups can help ensure that no one gets left out. They can learn about preconception health and make sure their members know. Also, because community groups are often trusted sources of support, they can be effective in encouraging healthy choices.
[Return to questions]

9. What should my health care provider be doing about preconception care at my regular visits?

Health care providers have a lot to cover during an appointment, so it’s always a good idea to make a list and bring up any issues on your mind. Do this even if the health care provider doesn’t ask about them. The first thing to discuss is your plan for pregnancy. If you tell your provider that you might become pregnant in the near future, there will be a number of things to discuss. You may need to schedule another visit to make sure everything gets covered.
Your health care provider should:

• Review your family’s medical history. This includes your previous experiences with pregnancy, fertility, birth, and use of birth control methods.
  
• Ask about your lifestyle, behaviors, and social support concerns that affect your health. Do you smoke, drink alcohol, use drugs, or have psychological problems, including depression? Do you have nutrition and diet issues? Concerns about health conditions in your or your partner’s family? Are there issues around intimate partner domestic violence? What are the medications you are taking? Are there chemicals, solvents, radiation, or other potential risks at your workplace or home that could harm you or your baby?
  
• Schedule health screening tests – Pap smear, urinalysis, blood tests. Your provider needs to know your blood type, Rh factor, and whether you have diabetes, hypertension, sexually transmitted infections, or other conditions.
  
• Review your immunization status and update them if needed.
  
• Perform a physical exam, including a pelvic exam and a blood pressure check.
  

Based on your individual health, your health care provider will suggest a course of treatment or follow up care as needed.

CDC Report Finds Gay, Lesbian and Bisexual Students At Greater Risk for Unhealthy, Unsafe Behaviors

CDC Report Finds Gay, Lesbian and Bisexual Students At Greater Risk for Unhealthy, Unsafe Behaviors

Students who report being gay, lesbian or bisexual and students who report having sexual contact only with persons of the same sex or both sexes are more likely than heterosexual students and students who report having sexual contact only with the opposite sex to engage in unhealthy risk behaviors such as tobacco use, alcohol and other drug use, sexual risk behaviors, suicidal behaviors, and violence, according to a study by the Centers for Disease Control and Prevention.
"This report should be a wake-up call for families, schools and communities that we need to do a much better job of supporting these young people. Any effort to promote adolescent health and safety must take into account the additional stressors these youth experience because of their sexual orientation, such as stigma, discrimination, and victimization," said Howell Wechsler, Ed.D, M.P.H, director of CDC's Division of Adolescent and School Health (DASH). "We are very concerned that these students face such dramatic disparities for so many different health risks."
This report represents the first time that the federal government has conducted an analysis of this magnitude across a wide array of states, large urban school districts, and risk behaviors.
Researchers analyzed data from Youth Risk Behavior Surveys conducted during 2001–2009 in seven states—Connecticut, Delaware, Maine, Massachusetts, Rhode Island, Vermont, and Wisconsin—and six large urban school districts—Boston, Chicago, Milwaukee, New York City, San Diego, and San Francisco. These sites collected data on high school students' sexual identity (heterosexual, gay or lesbian, bisexual, or unsure), sex of sexual contacts (sexual contact with the opposite sex only, with the same sex only, or with both sexes), or both.
The study, "Sexual Identity, Sex of Sexual Contacts, and Health Risk Behaviors Among Students in Grades 9–12 in Selected Sites—Youth Risk Behavior Surveillance, United States, 2001–2009," was published as a Morbidity and Mortality Weekly Report Surveillance Summary. Findings across 76 health risks in the following 10 categories are highlighted:

• Behaviors that contribute to unintentional injuries (e.g., rarely or never wore a seat belt)
• Behaviors that contribute to violence (e.g., did not go to school because of safety concerns)
• Behaviors related to attempted suicide (e.g., made a suicide plan)
• Tobacco use (e.g., ever smoked cigarettes)
• Alcohol use (e.g., binge drinking)
• Other drug use (e.g., current marijuana use)
• Sexual behaviors (e.g., condom use)
• Dietary behaviors (e.g., ate vegetables 3 or more times per day)
• Physical activity and sedentary behaviors (e.g., physically active at least 60 minutes per day for 7 days)
• Weight management (e.g., did not eat for 24 hours or more to lose weight or to keep from gaining weight)

Across the sites that assessed sexual identity, gay or lesbian students had higher prevalence rates for 49 percent to 90 percent of all health risks measured. Specifically, gay or lesbian students had higher rates for seven of the 10 health risk categories (behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, and weight management).
Similarly, bisexual students had higher prevalence rates for 57 percent to 86 percent of all health risks measured. They also had higher rates for eight of the 10 health risk categories (behaviors that contribute to unintentional injuries, behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, and weight management).
"For youth to thrive in their schools and communities, they need to feel socially, emotionally, and physically safe and supported," said Laura Kann, Ph.D., chief, Surveillance and Evaluation Research Branch, DASH. "Schools and communities should take concrete steps to promote healthy environments for all students, such as prohibiting violence and bullying, creating safe spaces where young people can receive support from caring adults, and improving health education and health services to meet the needs of lesbian, gay, and bisexual youth."
National, state, and local YRBSs are conducted every two years among high school students throughout the United States. These surveys monitor health risk behaviors, including unintentional injuries and violence; tobacco, alcohol, and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, including HIV infection; unhealthy dietary behaviors; and physical inactivity. These surveys also monitor the prevalence of obesity and asthma. Interested states and large urban school districts may add questions to measure sexual identity and the sex of sexual contacts.

Health Risks Among Sexual Minority Youth

Sexual minority youth—those who identify as gay, lesbian, or bisexual or who have sexual contact with persons of the same or both sexes—are part of every community and come from all walks of life. They are diverse, representing all races, ethnicities, socioeconomic statuses, and parts of the country.
While many sexual minority youth cope with the transition from childhood to adulthood successfully and become healthy and productive adults, others struggle as a result of challenges such as stigma, discrimination, family disapproval, social rejection, and violence. Sexual minority youth are also at increased risk for certain negative health outcomes. For example, young gay and bisexual males have disproportionately high rates of HIV, syphilis, and other sexually transmitted diseases (STDs), and adolescent lesbian and bisexual females are more likely to have ever been pregnant than their heterosexual peers.

A New CDC Report

Related Resources

• Report (PDF)  [pdf 3M] Report (HTML)
• Backgrounder  [pdf 138K]
• HIV and Young Men Who Have Sex With Men  [pdf 521K]

To understand more about behaviors that can contribute to negative health outcomes among sexual minority students, CDC analyzed data from the Youth Risk Behavior Surveillance System (YRBSS). The findings of this analysis are described in a new CDC Morbidity and Mortality Weekly Report, “Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors Among Students in Grades 9–12 in Selected Sites—Youth Risk Behavior Surveillance, United States, 2001–2009.” The report documents the disproportionate rates at which sexual minority students reported many health risks, including tobacco, alcohol, and other drug use; sexual risk behaviors; and violence.
For this report, CDC analyzed data from Youth Risk Behavior Surveys conducted during 2001–2009 in seven states—Connecticut, Delaware, Maine, Massachusetts, Rhode Island, Vermont, and Wisconsin—and six large urban school districts—Boston, Chicago, Milwaukee, New York City, San Diego, and San Francisco—that collected data on high school students’ sexual identity (heterosexual, gay, lesbian, bisexual, or unsure), sex of sexual contacts (sexual contact with the opposite sex only, with the same sex only, or with both sexes), or both.
Sexual minority students were defined as those who identified themselves as gay, lesbian, or bisexual; who had had sexual contact only with persons of the same sex; or who had had sexual contact with persons of both sexes. Collecting information about students’ sexual identity and about the sex of their sexual contacts is necessary because some students identify themselves as heterosexual but report having sexual contact only with persons of the same sex, whereas some students who identify themselves as gay, lesbian or bisexual have not had sexual contact. Therefore, questions about sexual identity and sex of sexual contacts can help identify a broader range of individuals as sexual minority students.

What this Report Shows

The findings from this report show the disproportionate rates at which sexual minority students experience many health risks, compared with non-sexual minority students. This disproportionate risk is most apparent among students who identify themselves as gay, lesbian, or bisexual and who have had sexual contact with both sexes.
This report represents the first time that the federal government has conducted an analysis of this magnitude across such a wide array of states, large urban school districts, and risk behaviors. Specifically, the report summarizes results by sexual minority status across 13 sites and 76 health risks in the following 10 categories:

Behaviors that contribute to violence (e.g., did not go to school because of safety concerns) Behaviors related to attempted suicide (e.g., made a suicide plan) Behaviors that contribute to unintentional injuries (e.g., rarely or never wore a seat belt) Tobacco use (e.g., ever smoked cigarettes) Alcohol use (e.g., binge drinking)

Other drug use (e.g., current marijuana use) Sexual behaviors (e.g., condom use) Dietary behaviors (e.g., ate vegetables 3 or more times per day) Physical activity and sedentary behaviors (e.g., physically active at least 60 minutes per day for 7 days) Weight management (e.g., did not eat for 24 or more hours to lose weight or to keep from gaining weight)

Risks by sexual identity

Nine states and large urban school districts assessed sexual identity. Across these locations, the percentage of all health risks for which the prevalence was higher for gay or lesbian students than it was for heterosexual students ranged from 49% to 90%. Gay and lesbian students had higher prevalence rates than heterosexual students for health risks in seven of the 10 health risk categories (behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, and weight management).

For example—

• The prevalence of current cigarette use ranged from 8% to 19% among heterosexual students but ranged from 20% to 48% among gay and lesbian students.

Similarly, the percentage of all health risks for which the prevalence was higher for bisexual students than it was for heterosexual students ranged from 57% to 86% across the nine locations. Bisexual students had higher prevalence rates than heterosexual students for health risks in eight of the 10 health risk categories (behaviors that contribute to unintentional injuries, behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, and weight management).

For example—

• The prevalence of students who did not go to school because of safety concerns on at least 1 day during the 30 days before the survey ranged from 4% to 11% among heterosexual students but ranged from 11% to 25% among bisexual students.

Risks by sex of sexual contacts

Twelve states and large urban school districts assessed sex of sexual contacts. Across these locations, the percentage of all health risks for which the prevalence was higher for students who had sexual contact with both sexes than it was for students who only had sexual contact with the opposite sex ranged from 32% to 86%. Students who had sexual contact with both sexes had higher prevalence rates than those who only had sexual contact with the opposite sex for health risks in six of the 10 health risk categories (behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, and weight management).

For example—

• The prevalence of binge drinking ranged from 16% to 44% among students who only had sexual contact with the opposite sex, but from 33% to 63% among students who had sexual contact with both sexes.

Recommendations from this Report

Policies and Practices

• Public health and school health policies and practices should be developed to support the establishment of safe and supportive environments for sexual minority students.
  • By addressing the challenges sexual minority students face, such as stigma, discrimination, family disapproval, social rejection, and violence, schools can help to improve health outcomes and reduce the prevalence of health-risk behaviors.

Professional Development

• Professional development should be provided for school staff and others who work with sexual minority youth, and effective programs should be implemented.
  • School staff members and others can benefit from training to help them understand the needs of sexual minority students and implement effective programs and services to reduce health risks among these young people.

Future Surveys

• The results of this report highlight the disproportionate impact of negative health outcomes on sexual minority students and indicate a need to include questions on sexual identity and the sex of sexual contacts when monitoring health risks and selected health outcomes among high school students.
  • In 2009, 10 states and 7 large urban school districts added questions to their YRBS questionnaire about sexual identity, sex of sexual contacts, or both.

Going to the ER

Almost everyone who lives with pain has been to the emergency room at some time.
You may have gone because your pain was out of control and you could not reach your own health care team.  You may have gone because you feared that your pain was a sign of a new medical problem.   You may have gone because you have no insurance. Or your own doctor may have sent you there.
A randomized survey conducted by the ACPA and the American College of Emergency Medicine Physicians found these reason and more among the 500 people with recurring or chronic pain who visited the emergency department (ED) once or more in the last two years. To see the full survey results, click here.
While most of the people surveyed were satisfied with their treatment in the ED, there were important gaps between what people expected from their visit and what they experienced.  This site can help you know what to expect in case you need to go to the ED in the future. When you are prepared, you are likely to have a more positive experience.

Clostridium difficile infection rate has risen among hospitalized children since late 1990s

Child/Adolescent Health

Clostridium difficile infection rate has risen among hospitalized children since late 1990s The number of cases of Clostridium difficile infection (CDI) among hospitalized children in the United States more than doubled over a 10-year period, according to a new study. A bacterium that can colonize the gastrointestinal tract, C. difficile can cause symptoms ranging from nothing to severe diarrhea, inflammation of the colon, bowel perforation, and even death. The researchers found that the incidence of CDI in hospitalized children increased from 3,565 cases in 1997 to 7,779 cases in 2006. Children with CDI had a 20 percent greater risk of death and a 36 percent higher risk of requiring surgery to remove part of or the entire colon. In addition, children diagnosed with CDI were four times more likely to have an extended hospital stay and twice as likely to have higher hospital costs than hospitalized children not infected by C. difficile. The researchers found no trend in the severity of CDI over time, despite the disease's increased incidence. However, patients with inflammatory bowel disease were 11.4 times as likely to have CDI compared with childlren without this condition. Solid-organ transplants, HIV infection, and transplantation of blood-forming stem cells—all requiring or resulting in immune suppression—increased the odds of CDI 3.3- to 4.5-fold in adjusted multivariable analysis. The researchers used data from the AHRQ-funded Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP-KID) for 1997, 2000, 2003, and 2006. HCUP-KID is a stratified random sample of 5.8 million inpatient discharges for children from 22 to 38 States (depending on the year). For 2006, it represented an estimated 89 percent of all pediatric hospital discharges in the United States. The study was funded in part by the Agency for Healthcare Research and Quality (HS016957). More details are in "Clostridium difficile infection in hospitalized children in the United States," by Cade M. Nylund, M.D., Anthony Goudie, Ph.D., Jose M. Garza, M.D., and others in the May 2011 Archives of Pediatrics and Adolescent Medicine 165(5), pp. 451-457.

No greater risk or mortality observed for endoscopic vein harvesting for coronary bypass surgery

Patient Safety and Quality

No greater risk or mortality observed for endoscopic vein harvesting for coronary bypass surgery During coronary artery bypass surgery, a vein is taken from the leg to replace blocked arteries in the heart. Today, the majority of vein harvesting is done endoscopically rather than using an open surgical procedure. By using this minimally invasive approach, the surgeon can reduce pain and infection. Recently, some experts have questioned whether this approach to leg vein harvesting may expose patients to the risk of vein-graft failure, death, heart attack, and repeated blockages after surgery. A new study that compared the two techniques over a 4-year period found no increase in harm to patients who underwent endoscopic vein harvesting. Between 2001 and 2004, 8,542 patients underwent coronary artery bypass grafting procedures in northern New England. More than half (52.5 percent) had endoscopic vein harvesting. Over the study period, endoscopic vein harvesting grew in popularity, from 34 percent in 2001 to 75 percent in 2004. Patients receiving endoscopic vein harvesting were more likely to be male, have vascular disease, and have two-vessel disease. They were less likely to have a history of a heart attack or congestive heart failure. In terms of hospital outcomes, open surgical harvesting was associated with an increase in postoperative leg wound infections. On the other hand, endoscopic harvesting resulted in an increase in patients being returned to the operating room to correct postoperative bleeding. With respect to long-term outcomes, there was a significant reduction in long-term mortality with endoscopic harvesting. The relatively small increased risk of repeat revascularization over four years with endoscopic harvesting was non-significant. The study was supported in part by the Agency for Healthcare Research and Quality (HS15663). See "Long-term outcomes of endoscopic vein harvesting after coronary artery bypass grafting," by Lawrence J. Dacey, M.D., John H., Braxton, Jr., M.D., Robert S. Kramer, M.D., and others in the January 18, 2011, Circulation 123(2), pp. 147-153.

Lung Diseases and Conditions

Many steps are involved in breathing. If injury, disease, or other factors affect any of the steps, you may have trouble breathing.
For example, the fine hairs (cilia) that line your upper airways may not trap all of the germs you breathe in. These germs can cause an infection in your bronchial tubes (bronchitis) or deep in your lungs (pneumonia). These infections cause a buildup of mucus and/or fluid that narrows the airways and limits airflow in and out of your lungs.
If you have asthma, breathing in certain substances that you're sensitive to can trigger your airways to narrow. This makes it hard for air to flow in and out of your lungs.
Over a long period, breathing in cigarette smoke or air pollutants can damage the airways and the air sacs. This can lead to a condition called COPD (chronic obstructive pulmonary disease). COPD prevents proper airflow in and out of your lungs and can hinder gas exchange in the air sacs.
An important step to breathing is the movement of your diaphragm and other muscles in your chest, neck, and abdomen. This movement lets you inhale and exhale. Nerves that run from your brain to these muscles control their movement. Damage to these nerves in your upper spinal cord can cause breathing to stop, unless a machine is used to help you breathe. (This machine is called a ventilator or a respirator.)
A steady flow of blood in the small blood vessels that surround your air sacs is vital for gas exchange. Long periods of inactivity or surgery can cause a blood clot called a pulmonary embolism (PE) to block a lung artery. A PE can reduce or block the flow of blood in the small blood vessels and hinder gas exchange.

Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they’re widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don’t directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You’ll learn about treatments and tests you may receive, and the benefits and risks they may pose. You’ll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you’ll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to your disease or condition, talk with your doctor.

Antidepressants Might Raise Fall Risk in Nursing Homes

Residents with dementia taking so-called SSRIs seem to be at higher risk of injury, study suggests.

By Robert Preidt

Wednesday, January 18, 2012

WEDNESDAY, Jan. 18 (HealthDay News) -- Antidepressants called selective serotonin reuptake inhibitors (SSRIs) are associated with an increased risk of falls in nursing home residents with dementia, a new study finds.
Researchers in the Netherlands analyzed data about daily prescription medicine use and falls among 248 nursing home residents with dementia. The dataset collected between Jan. 1, 2006 and Jan. 1, 2008 included 85,074 person-days.
Antidepressants were used on 13,729 days (16 percent), with SSRIs used on 11,105 of these days, the investigators found.
A total of 683 falls were experienced by 152 (61.5 percent) of the 248 nursing home residents, which works out to fall incidence of 2.9 falls per person-year. Thirty-eight residents had one fall but 114 had frequent falls.
Injury or death resulted from 220 of the falls: 10 were hip fractures, 11 were other types of fractures, and 198 were injuries such as sprains, bruises, swelling and open wounds. One person died after falling, according to the results.
The researchers found that the risk of having an injury-causing fall was three times higher for residents taking SSRIs than for those who didn't take the antidepressants. For example, the absolute daily risk of a fall was 0.28 percent for an 80-year-old woman taking a daily dose of an SSRI, compared with 0.09 percent for a woman the same age who didn't take an SSRI.
Similar increases in risk were found for both women and men of different ages, according to the study published Jan. 19 in the British Journal of Clinical Pharmacology.
"Our study also discovered that the risk of an injurious fall increased even more if the residents were also given hypnotic or sedative drugs as sleeping pills," lead author Carolyn Shanty Sterke, who works in the section of geriatric medicine at Erasmus University Medical Center in Rotterdam, said in a journal news release.
Falls are a major issue for nursing home residents with dementia, and one-third of falls among nursing home residents result in an injury, the study authors noted.
"Staff in residential homes are always concerned about reducing the chance of people falling and I think we should consider developing new treatment protocols that take into account the increased risk of falling that occurs when you give people SSRIs," Sterke said in the news release.
While the study uncovered an association between injury-causing falls and SSRI use, it did not prove a cause-and-effect relationship.

SOURCE: British Journal of Clinical Pharmacology, news release, Jan. 18, 2012