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It's possible to educate the public not to take antibiotics unnecessarily. Taking these drugs when you have a viral infection rather than the bacterial infection to which they're suited creates resistant pathogens and reduces the efficacy of antibiotics over the long term.
Doctors at the Ha'emek Medical Center in Afula, the Technion's Rappaport Medical School and Clalit Health Services report in the January issue of the Israel Medical Association Journal (IMAJ) that counselling their patients reduced unnecessary antibiotics use by about a fifth.
The team, headed by Prof. Raul Raz and Prof. Hava Tabenkin, conducted a monthly educational campaign in selected Clalit clinics to promote diagnosis of common infectious diseases and prudent antibiotics use. At other clinics, they launched a massive educational campaign that included leaflets and talks with doctors and nurses to promote the judicious use of antibiotics for respiratory infections. The whole intervention took place over four winter seasons.
The total use of antibiotics was reduced in both groups, with higher success among the patients who received more intensive counselling. Parents whose children suffered ear infections were advised not to give antibiotics unless the pain was significant; in the past, giving antibiotic syrup to such children was automatic, even though in most cases the body's immune system fights it alone, and the infection passes without treatment.
The unnecessary use of broad-spectrum antibiotics to kill ordinary bacteria was also reduced among both groups; this can gradually reduce the inability of more powerful antibacterial drugs to wipe out stronger bacteria.
PAUSE IN PERIODS?
When birth control pills first hit the market in the 1960s, women generally took three weeks of active pills followed by one week of placebos or no pills.
"The thinking was that women would find this more acceptable, that they would feel like they were having their normal menses," says Dr. Susan Ernst, chief of gynecology services at the University of Michigan. Now, many gynecologists believe that the week without contraception - during which women experience a "withdrawal bleed" that mimics the normal menstrual cycle - isn't necessary. And while some debate surrounds the issue, numerous women are opting to take hormonal contraceptive products continually as a way of stopping the cycle entirely or for several months at a time. Until the 20th century, most women rarely had periods, as they were either pregnant or nursing and then died in their 50s or 60s.
Some women now use products such as Seasonale or Seasonique - pills that result in four periods a year; others take birth control pills that have been around for years, but without the week of placebos or no pills.
An implantable device was approved during the summer for use in the US, and injections, patches and vaginal rings are other ways of suppressing menses.
Ernst points out that suppressing one's menstrual cycle is not very different from taking the three-weeks-on, one-week-off cycle ofl pills, which women have been doing for decades. "When a woman chooses to use hormonal contraceptives, she's giving her body estrogen and progesterone and that suppresses her own hormonal fluctuations," Ernst says. "So she's already controlling her cycle by taking those hormonal contraceptives and can further control her cycle by eliminating the pill-free interval or placebo pills." She notes that the practice of prescribing contraceptives to stop women's menstrual cycles is not new. "Gynecologists have been doing this for years," she says, "using hormonal contraception for treating women with painful, heavy or irregular periods, or painful premenstrual symptoms."
Menstrual suppression has also been used by women with endometriosis - a painful condition in which tissue that normally lines the inside of the uterus grows outside it; patients with disabilities who cannot maintain menstrual hygiene; and women athletes who have a difficult time with their periods when competing.
One downside experienced by some women is "breakthrough bleeding," or unplanned days of spotting that can occur when not having monthly menses. Shedding menses three to four months after beginning menstrual suppression can help stop or prevent breakthrough bleeding, Ernst says. "If you shed the lining of the uterus every three to four months, there tends to be less breakthrough bleeding than if you try to go completely menses-free for a year," she says. Ernst also notes that there are risks related to hormonal contraception, including blood clots, hypertension, stroke and heart attack, especially among women who smoke. Additionally, long-term use of progesterone injections can lead to a decrease in bone density and even osteoporosis. "A woman has to take those risks into account when thinking about using hormonal contraception for menstrual suppression," Ernst says. Women should discuss the risks and benefits with their doctors before deciding to suppress their cycles, she says.
Critics contend that too much remains unknown about the effects of menstrual suppression. Some say it prevents women from ridding their bodies of excess iron; that it is unnatural; and that more needs to be known about the effects on bone health, heart health and cancer risks. A recent survey by the Association of Reproductive Health Professionals found that 71% of women don't like getting their period each month, but that only 36% of clinicians think the monthly period is something women have to deal with. A 2003 Gallup Organization survey, conducted for The American College of Obstetricians and Gynecologists, found that 69% of female obstetrician-gynecologists believe long-term menstrual suppression is safe, and 30% say it is safe if used occasionally. One percent said it is unsafe.
DON'T VISIT MOM
If you're thinking of visiting a new mother soon after delivery, forget it - at least according to a poll of women at the "Hadassah Baby" recuperation hotel who were polled. Ninety-three percent declared they didn't want to see "anybody" in the days after giving birth. Sixty-five percent said they weren't interested in dieting to shed some of the kilos they took on during pregnancy.
The survey involved 500 women who gave birth at Hadassah University Medical Center in Jerusalem's Ein Kerem and paid extra to rest at the new boutique hotel.
More than half said they don't care how they looked after giving birth, while the remaining 43% said they cared but preferred to recuperate before doing something about their appearance. Eighty-one percent said they didn't care at that point whether they were attractive to their husbands. More than two-thirds said they depended on their own mothers to take care of them, compared to only 10% who said so about their husbands. Sixty-eight percent said they prefer to convalesce at a hotel, while only 28% preferred to go home and 4% wanted to be with their mothers.
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