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December 21, 2010
Most forms of DIMS fall into one or another of the categories I’ve just described; occasionally, however, I will run across cases that fit none of them. There is no doubt that the patients suffer from insomnia – they sleep less than they feel is right for them.
But when I examine them I am unable to discern any physical or psychological abnormality. Even the results of a sleep lab study may demonstrate no objective findings, by any of the usual clinical measurements, to indicate that sleep was disturbed, yet the patients insist that sleep was somehow unsatisfactory. Such patients are known as “short sleepers,” meaning that their sleep lasts less than 75 percent of the time considered average for their age group. Any symptoms they experience as a result of their sleep patterns are not directly related to their perceived insomnia. Rather, problems arise from their basic concern that they are somehow “abnormal,” that they should be sleeping differently from how they are. Sometimes these patients express the belief that there is a certain amount of sleep they “should” be getting—what I call the eight-hour myth. They may also feel lonely because they are awake during the early hours of the morning, or because there is relatively little support from our culture for people who do not fit the normal pattern of rest and waking. One short-sleeper acquaintance told me she would wake up hours before she had to be at work and do nothing except worry about her job. By the time she got there she was a nervous wreck. However, her life and her work improved tremendously when she began an early-morning hobby: writing. She is now writing a sequel to her first, unpublished spy novel.
Often a patient’s description of a sleep problem may initially suggest a disorder in initiating or maintaining sleep. As I’ve mentioned, however, careful attention to the patient’s sleep patterns, drug use, and medical history may help further differentiate the true nature of the disorder. Sometimes reassessment is mandated when the initial approach to therapy is insufficient or completely unsuccessful.
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December 13, 2010
Occupational rhinitis refers to nasal symptoms caused or triggered by exposure to an agent in the workplace. This takes two forms:
Office Rhinitis: Symptoms occur in a particular office, or office building.
Non-office Rhinitis: Symptoms occur only in a special work situation.
Occupational rhinitis can affect a broad range of workers: the president of the company, the secretarial staff, the janitorial service, security, the gardener, as well as beauticians, photographers, and veterinarians.
There are only a few scientific studies that have determined the frequency with which workers in offices and office buildings suffer various symptoms. These studies suggest that from 15 to 35 percent of office workers have work related symptoms. There are many studies that have examined the frequency of development with which workers in non-office environments develop work-related symptoms. The focus of studies on the non-office occupations rather than office occupations stems from the interest in the unique agents to which these workers are exposed while on the job. These non-office occupation studies have shown that 20 to 30 percent of animal-laboratory workers become allergic to the animals with which they work, 10 percent of bakers become allergic to flour, and 30 percent of workers exposed to platinum salts will become allergic to these chemicals.
General Symptoms of Occupational Rhinitis
Congestion Runny nose
Sneezing Itchy nose, throat, palate
Burning or stinging Headache
of the nose Drainage and cough
Dry throat
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December 8, 2010
In the mid-1980s, a problem began to emerge that may have long-term effects on babies born to women who use cocaine. Because cocaine rapidly crosses the placenta (as virtually all drugs do), the fetus is vulnerable when a pregnant woman snorts, freebases, or shoots up. It is estimated that between 2.4 and 3.5 percent of pregnant women between the ages of 12 and 34 abuse cocaine. It is difficult to gauge how many newborns have been exposed to cocaine because pregnant women who are users are often reluctant to discuss their drug habit with health care providers for fear of prosecution. The most threatening problem during pregnancy is the increased risk of a miscarriage.
Fetuses exposed to cocaine or crack in the womb are more likely to suffer a small head, premature delivery, reduced birth-weight, increased irritability, and subtle learning and cognitive deficits. It was once thought that babies who had been exposed to crack or cocaine as fetuses could suffer a number of physical and emotional problems, including permanent malformation of the brain, strokes, sudden in death syndrome (SIDS), permanent learning disabilities, and behavioral disorders. However, recent research has refuted some of these findings and suggests that a significant number of these children develop problems with learning and language skills that require remedial attention. It is critical these children are identified early and receive immediate intervention. For both financial and humane reasons, developing prenatal care and education programs for mothers at risk should be a priority for state and local government.
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