Wednesday, May 27, 2015

HOW MUCH WATER DO YOU REALLY NEED?

Every year it seems that water recommendations are increasing. But did you know that you consume quite a bit of water from solid foods? That is right! Juicy fruits and vegetables such as lettuce, watermelon, apples, oranges, broccoli, etc. contribute to your daily intake of water.

High-water foods are also low in calories. What does that mean? You can feel full with fewer of calories. So aim for at least six to eight glasses of water daily and don't forget to use fruits and vegetables as a source.

HYDRATING TIPS IF YOU DON'T LIKE WATER

If you find that drinking the recommended 8 glasses of water a day (more if you're exercising!) is a challenge, there are other choices you can make to get your body the fluids it needs. And hydrating your body is, after all, the bottom line.
  • Skim milk. A small glass has about 80 calories, along with respectable amounts of protein and calcium. And, of course, no fat.
  • Decaffeinated iced tea. Go without sugar and you've got a drink that's as calorie-free as water.
  • Soups and broths. There are plenty of low-calorie products on the market. However, they can be very high in sodium, so be sure to check the nutrition label for salt content. (You shouldn't have more than 2400 mg of sodium daily.)
  • Juice-water mix. You can get the flavor of juice with less sugar and calories by mixing a half glass with water and ice.

HOW TO REBOUND AFTER FALLING OFF THE DIET WAGON

Too many of us expect absolute perfection when we embark on a new fitness or weight-loss program. Perhaps the more logical approach is to acknowledge that we probably will fall short of the ideal at some point -- and to have tactics in place for getting back on track.

For example, if you've over-indulged in food over the weekend, you might regain dietary balance during the week with strategies like these:
  • Eat only fruits and raw vegetables for between-meal snacks.
  • If you eat dessert after lunch or dinner, make fruit that dessert. If you need to make it interesting, use a low-fat yogurt dip or make a baked-fruit dessert with apples or pears.
  • Be sure to drink your 8 glasses of water (more if you're exercising that day). Water may help you feel less hungry.
  • DON'T skip meals as a way of compensating for a weekend's calorie overload. If you eat too little, your metabolism will slow down.

Normal body temperature

Is there a normal body temperature?

Most people think of 'normal' body temperature as 37C (98.6F), measured using a thermometer in the mouth.
However, the concept of there being a normal body temperature is somewhat misleading. In fact normal body temperature can vary according to a wide range of factors including a person's age, the time of day and whether someone is active or not.
The 'normal' benchmark for body temperature was established by a 19th century German physician called Dr Carl Wunderlich. He is credited with taking temperature readings from thousands of patients, which led him to propose that 37C was normal body temperature.

So, what is normal body temperature?

Some studies have disputed Dr Wunderlich's findings. For instance, a 1992 evaluation of his work in the US, and based on 148 participants, found that 36.8C was a more accurate figure.
Normal body temperature also depends on where the temperature reading is taken. For instance, a reading from the armpit will be about 0.5C lower than the body's core temperature.
Research from Winthrop University in the US published in 2006 found that older people have lower temperatures and that, even when ill, their bodies may never reach temperatures that would be regarded as fever.
The NHS says that a normal temperature is around 37C (98.6F), although it depends on:
  • The person
  • Their age
  • What they've been doing
  • The time of day
  • Which part of the body you take the temperature from
It is generally accepted that normal body temperature ranges between 36.1C (97F) to 37.2C (99F).

Labor epidural analgesia and the incidence of instrumental assisted delivery

Objective

To assess the influence of labor epidural analgesia on the course of labor and to determine its association with instrumental assisted delivery rate.

Materials and methods

A retrospective case–control study was performed during 2007–2011 aiming to identify the relation between epidural analgesia (EA) and instrumental assisted delivery (IAD) rate. All patients in whom instrumental assistance for delivery was applied were allocated into either case (parturients who received EA and had IAD) or control (parturients who did not receive EA but had IAD) groups. Maternal demographic data, pregnancy and delivery characteristics as well as neonatal short-term outcome were studied.

Results

A total of 7675 vaginal deliveries occurred during the study period and 187 (2.43%) patients had IAD. Vacuum extraction was applied to 67 (2.16%) parturients who received EA, and to 120 (2.61%) who did not. The median duration of the first stage of labor was 510 min in the EA group as compared to 390 min in the control group (P = 0.001). The median duration of the second stage of labor among cases and controls was 60 and 40 min, respectively (P < 0.0005). Cases more often had their labor induced by oxytocin 80.3% as compared to 58.3% among controls (P = 0.003). There was no significant association between the use of EA and increased IAD rate (OR = 0.81; 95% CI, 0.60–1.09).

Conclusions

Labor EA did not increase the incidence of IAD and the risk of adverse neonatal outcomes, but was associated with prolonged first and second stages of labor.

Keywords

  • Epidural analgesia
  • Instrumental assisted delivery
  • Vacuum extraction

1. Introduction

Labor epidural analgesia (EA) is an increasingly used technique for pain relief of a parturient. In a recent Cochrane database review regarding pain management for women in labor, EA was acknowledged as the most effective pain management technique as compared with inhaled analgesia, systemic opioid and nonopioid analgesics, and nonpharmacologic interventions [1]. It enables to achieve high maternal satisfaction rates with regard to pain management, sense of control in labor, and overall childbirth experience [1] and [2]. In addition to analgesic efficacy, physiological benefits of EA for the mother and fetus are well-documented: it improves maternal cardiovascular and pulmonary physiology, uteroplacental perfusion and acid–base status of the fetus [3][4][5] and [6]. Since EA was introduced for labor pain relief, the controversy about the relation between EA and instrumental deliveries, cesarean section, as well as prolonged labor has originated. Further studies, however, found no EA association with increased cesarean section rate, but discussions regarding its influence on instrumental assisted delivery (IAD) rate and duration of labor persist [7][8][9][10][11][12][13][14][15][16][17][18][19][20] and [21].

2. Materials and methods

The study was performed in the maternal unit of a tertiary perinatology center. All the patients in whom instrumental assistance for delivery was applied from January 1, 2007, until November 24, 2011, were studied. All computer registry data and medical records were analyzed. Study patients were allocated into two groups: the epidural analgesia group (cases) comprised parturients who received EA and had vacuum extraction, and the control group (controls) consisted of parturients who did not receive EA, but had vacuum extraction. Epidural catheters for analgesia were placed at the L2–L3, L3–L4 or L4–L5 interspace, when patients had cervical dilation of ≥3 cm. A 3-mL epidural test dose of lidocaine (15 mg/mL) with epinephrine (5 μg/mL) was given to all patients. Parturients were subsequently administered an initial epidural bolus of 10–15 mL bupivacaine (1 mg/mL) with fentanyl (2.5 μg/mL), which was followed by a continuous infusion of bupivacaine (1 mg/mL) with fentanyl (2 μg/mL) at a rate of 7–10 mL/h. Maternal demographic data, pregnancy and delivery characteristics, use of oxytocin and duration of delivery stages were studied. Neonatal outcomes of interest were birth weight, height, neonatal arterial pH, and Apgar scores at the first and fifth minutes. We performed our statistical analysis using SPSS for Windows (version 15). Demographic variables were assessed using descriptive statistics. Odds ratio with 95% confidence interval for IAD was estimated. Statistical analysis was performed using Student t test, Mann–Whitney Utest and χ2 test where appropriate. All data are presented as mean ± standard deviation (SD) unless indicated otherwise. A P value of less than 0.05 was considered statistically significant.

3. Results

A total of 7675 vaginal deliveries occurred in our maternal unit during the study period and 187 (2.43%) women had vacuum extraction. EA was given to 3093 (40.3%) parturients whereas 4582 (59.7%) received systemic opioid, inhalation analgesia or no analgesia at all. Instrumental assistance for delivery was applied to 67 (2.16%) women in labor who received EA and to 120 (2.61%) who did not. Three entries (1 case and 2 controls) were not studied due to lack of medical records (Fig. 1).
Full-size image (34 K)
Fig. 1. 
Flow chart of the study. EA, epidural analgesia; IAD, instrumental assisted delivery.
Patient demographics such as maternal age, height, weight, weight gain, and gestational age were comparable between groups. The mean age of study patients was 26 years with a mean gestational age of 38 weeks. Nulliparas requested EA significantly more often than multiparas: 54 and 12, respectively (P = 0.041) ( Table 1). The median duration of the first stage of labor was 510 min in the EA group as compared with 390 min in the control group (P = 0.001). The median duration of the second stage of labor among cases and controls was 60 and 40 min, respectively (P < 0.0005). As presented in Table 2, the first stage of labor was statistically significantly prolonged in primiparas with EA, but not in multiparas. However, the second stage of labor was significantly longer in primiparas and multiparas with EA (P < 0.05) ( Table 2). There was no significant association between the use of EA and increased IAD rate (OR = 0.81; 95% CI, 0.60–1.09).
Table 1.
Maternal and pregnancy characteristics in study groups.
VariableEA group (Cases) (n = 66)Control group (Controls) (n = 118)P value
Maternal characteristics
Age, years26.5 ± 5.526.4 ± 6.20.846
Height, cm166.7 ± 5.5166.1 ± 5.70.505
Weight, kg76.5 ± 12.076.0 ± 13.40.781
Weight gain, kg15.5 ± 4.915.2 ± 5.20.62

Pregnancy characteristics, n (%)
Nulliparous54 (81.8)72 (61.0)0.003
Multiparous12 (18.2)46 (39.0)0.003
Gestational age, weeks38.7 ± 5.138.4 ± 5.50.73
Data are expressed as mean ± standard deviation unless otherwise indicated.
Table 2.
Duration of the first and second stages of labor with regard to the use of EA in nulliparas and multiparas.
VariableEA group n = 66Control group n = 118P value
Nulliparas1st stage of labor, min540 (330)435 (154)<0.05
2nd stage of labor, min56.5 (76)42 (35)<0.05
Multiparas1st stage of labor, min435 (266)300 (283)>0.05
2nd stage of labor, min67.5 (49)30 (38)<0.05
Data are expressed as median (interquartile range).
The patients who requested for EA had labor induced by oxytocin significantly more often: 80.3% vs. 58.3% among cases and controls, respectively (P = 0.003). As presented in Table 3, there were no significant differences between study groups with regard to neonatal weight, height, Apgar score, and neonatal arterial pH.
Table 3.
Neonatal characteristics in study groups.
VariableEA group (Cases) (n = 66)Control group (Controls) (n = 118)P value
Apgar at 1 min7.15 ± 1.927.05 ± 1.940.79
Apgar at 5 min8.35 ± 1.027.36 ± 1.130.875
Neonatal arterial pH7.20 ± 0.107.20 ± 0.110.891
Weight, g3393 ± 5163338 ± 4800.483
Height, cm51.1 ± 2.350.8 ± 2.10.385
Data are expressed as mean ± standard deviation.

4. Discussion

Epidural analgesia is an increasingly popular labor pain management technique with well documented favorable efficacy and safety profile. However, controversial opinion about relation between EA and cesarean section, instrumental deliveries, prolonged labor still exists. According to our study results, labor EA did not increase the incidence of IAD, which is in accordance with findings of previous reports [11][14],[18][22][23][24][25][26] and [27]. In contrast to our findings, a retrospective case-control study performed in 2012 by Junichi et al. [28] demonstrated increased IAD rate (vacuum extraction 6.5% vs. 2.9%, P < 0.001) in parturients who received EA as compared with those who did not. Neonatal variables did not differ significantly between cases and controls even when subjects were stratified by the mode of delivery (spontaneous delivery, cesarean section, vacuum extraction) in that study, which corresponds to our results. However, it should be noticed that parturient age differed significantly between studies, as our study enrolled younger women (26.5 ± 5.5 vs. 32.2 ± 6.3). Maternal age may be a potential factor influencing the outcome of labor.
A systemic review performed in 2011 by Anim-Somuah et al. [19] involved 23 randomized controlled trials with 7935 women comparing labor EA vs. nonpharmacologic interventions or no analgesia at all. They reported an increased risk of IAD associated with EA (RR = 1.42; 95% CI, 1.28–1.57). However, limitations of this review should be noticed as analyzed trials varied with regard to characteristics of participants, labor management protocols and epidural regimens. Moreover, studies using high and low concentrations of local anesthetics for EA as well as studies maintaining the block during the second stage of labor and those discontinuing it, were enrolled into the same analysis. These factors might have influenced the findings regarding the course of labor, pain relief requirements, outcomes and, particularly, the duration of labor and IAD rates.
Interestingly, a retrospective study by Toledo et al. [29] with 2072 parturients found that women who experienced breakthrough pain during the first stage of labor were more likely to undergo IAD. This finding suggesting that early-onset severe pain and higher labor analgesia requirements increase the risk of abnormal labor and surgical delivery might explain the association between EA and surgical delivery [30].
Previous trials have demonstrated that EA slows the progress of labor [7][27][28] and [31] and significantly prolongs the duration of the second stage of labor [7][11] and [19]. However, data regarding the effect of EA on the first stage of labor remains conflicting. The duration of labor stages was analyzed in our study as well. Our results showed that the first and second stages were significantly prolonged in patients who received EA, and are in accordance with similar findings of many studies [7][10][27][28],[31] and [32]. In contrast, Ohel et al. [14] reported that the first stage of labor was not prolonged or even was shorter in parturients who received early EA in their study. However, the definition of first stage of labor differed between studies; therefore its duration could have been interpreted differently.
We have to note that EA was used more often if labor was induced by oxytocin. Presumably, pharmacologically induced labor is more painful.
We have found no significant differences in neonatal Apgar scores between study groups as demonstrated in previous studies and systematic reviews [16][19][28] and [33]. Furthermore, there were no significant differences in neonatal arterial pH, which is in conflict with results of other studies [34] and [35]. This mismatch might be explained by the heterogeneity of our control group, as it consisted of women who received systematic opioid, inhalation analgesia or no analgesia at all.
We have to face several limitations of our study. Firstly, a retrospective study is inevitably associated with selection bias as women with long painful labors and with increased risk of intervention are more likely to request EA, and those women deemed at high risk are actually recommended or encouraged to have an epidural. Furthermore, the use of oxytocin during labor was not documented in women who received EA. As oxytocin stimulates uterine contractions, it could have influenced the mode of delivery. Secondly, the majority of our parturients who received EA were nulliparous (81.8% vs. 18.2%). This might have affected the total duration of labor as well as the duration of distinct labor stages. Subgroup analysis of primiparous vs. multiparous parturients with EA showed significantly prolonged first stage of labor among primiparas, whereas among multiparas this was not significant.

5. Conclusions

According to our study, labor EA did not increase the incidence of instrumental assisted delivery and the risk of adverse neonatal outcomes. EA was associated with prolonged first and second stages of labor. The rate of labor induction with oxytocin was statistically significantly higher in the group of parturients who had requested EA. There are many variables influencing parturient physiology and overall course of labor, therefore the choice of labor EA should be based not only on anesthesiologist's clinical decision but on patient values and preferences as well.

13 Ways To Lower Blood Pressure Naturally

Natural ways to lower blood pressure

While medication can lower blood pressure, it may cause side effects such as leg cramps, dizziness, and insomnia. Fortunately, most people can bring down their blood pressure naturally without medication. First, get to a healthy weight. Then try these strategies to reduce the risk of heart disease.
1. Go for power walks
Hypertensive patients who went for fitness walks at a brisk pace lowered pressure by almost 8 mmhg over 6 mmhg. Exercise helps the heart use oxygen more efficiently, so it doesn't work as hard to pump blood. Get a vigorous cardio workout of at least 30 minutes on most days of the week. Try increasing speed or distance so you keep challenging your ticker.
MORE: 14 Best Walking Workouts 
2. Breathe deeply
Slow breathing and meditative practices such as qigong, yoga, and tai chi decrease stress hormones, which elevate renin, a kidney enzyme that raises blood pressure. Try 5 minutes in the morning and at night. Inhale deeply and expand your belly. Exhale and release all of your tension. (Trythese stress-busting yoga poses to relieve tension.)
3. Pick potatoes

Loading up on potassium-rich fruits and vegetables is an important part of any blood pressure-lowering program, says Linda Van Horn, PhD, RD, professor of preventive medicine at Northwestern University Feinberg School of Medical. Aim for potassium levels of 2,000 to 4,000 mg a day, she says. Top sources of potassium-rich produce include sweet potatoes, tomatoes, orange juice, potatoes, bananas, kidney beans, peas, cantaloupe, honeydew melon, and dried fruits such as prunes and raisins.
Are you at risk for the #1 cause of heart-related death?
4. Be salt smart
Certain groups of people—the elderly, African Americans, and those with a family history of high blood pressure—are more likely than others to have blood pressure that's particularly salt (or sodium) sensitive. But because there's no way to tell whether any one individual is sodium sensitive, everyone should lower his sodium intake, says Eva Obarzanek, PhD, a research nutritionist at the National Heart, Lung, and Blood Institute. How far? To 1,500 mg daily, about half the average American intake, she says. (Half a teaspoon of salt contains about 1,200 mg of sodium.) Cutting sodium means more than going easy on the saltshaker, which contributes just 15% of the sodium in the typical American diet. Watch for sodium in processed foods, Obarzanek warns. That’s where most of the sodium in your diet comes from, she says. Season foods with spices, herbs, lemon, and salt-free seasoning blends. (For more ways to reduce your sodium, see 6 simple ways to lower your salt intake.)
5. Indulge in dark chocolate
Dark chocolate varieties contain flavanols that make blood vessels more elastic. In one study, 18% of patients who ate it every day saw blood pressure decrease. Have ½ ounce daily (make sure it contains at least 70% cocoa).
6. Take a supplement
In a review of 12 studies, researchers found that coenzyme Q10 reduced blood pressure by up to 17 mmhg over 10 mmhg. The antioxidant, required for energy production, dilates blood vessels. Ask your doctor about taking a 60 to 100 mg supplement up to 3 times a day.
MORE: The Best Supplements For Women
7. Drink (a little) alcohol

According to a review of 15 studies, the less you drink, the lower your blood pressure will drop—to a point. A study of women at Boston's Brigham and Women's Hospital, for example, found that light drinking (defined as one-quarter to one-half a drink per day for a woman) may actually reduce blood pressure more than no drinks per day. One "drink" is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of spirits. Other studies have also found that moderate drinking—up to one drink a day for a woman, two for a man—can lower risks of heart disease. "High levels of alcohol are clearly detrimental," says Obarzanek. "But moderate alcohol is protective of the heart. If you are going to drink, drink moderately."
MORE: Sneaky Signs You Drink Too Much
8. Switch to decaf coffee
Scientists have long debated the effects of caffeine on blood pressure. Some studies have shown no effect, but one from Duke University Medical Center found that caffeine consumption of 500 mg—roughly three 8-ounce cups of coffee—increased blood pressure by 4 mmhg, and that effect lasted until bedtime. For reference, 8 ounces of drip coffee contain 100 to 125 mg; the same amount of tea, 50 mg; an equal quantity of cola, about 40 mg. Caffeine can raise blood pressure by tightening blood vessels and by magnifying the effects of stress, says Jim Lane, PhD, associate research professor at Duke and the lead author of the study. "When you're under stress, your heart starts pumping a lot more blood, boosting blood pressure," he says. "And caffeine exaggerates that effect." If you drink a lot of joe, pour more decaf to protect your ticker.
9. Take up tea
Lowering high blood pressure is as easy as one, two, tea: Study participants who sipped 3 cups of a hibiscus tea daily lowered systolic blood pressure by 7 points in 6 weeks on average, say researchers from Tufts University—results on par with many prescription medications. Those who received a placebo drink improved their reading by only 1 point. The phytochemicals in hibiscus are probably responsible for the large reduction in high blood pressure, say the study authors. Many herbal teas contain hibiscus; look for blends that list it near the top of the chart of ingredients—this often indicates a higher concentration per serving. (Try your own DIY tea with these easy healing herbal tea recipes.)
10. Work (a bit) less
Putting in more than 41 hours per week at the office raises your risk ofhypertension by 15%, according to a University of California, Irvine, study of 24,205 California residents. Overtime makes it hard to exercise and eat healthy, says Haiou Yang, PhD, the lead researcher. It may be difficult to clock out super early in today’s tough economic times, but try to leave at a decent hour—so you can go to the gym or cook a healthy meal—as often as possible. Set an end-of-day message on your computer as a reminder to turn it off and go home. Follow these tips to make your weekends stress-free.
11. Relax with music

Need to bring down your blood pressure a bit more than medication or lifestyle changes can do alone? The right tunes can help, according to researchers at the University of Florence in Italy. They asked 28 adults who were already taking hypertension pills to listen to soothing classical, Celtic, or Indian music for 30 minutes daily while breathing slowly. After a week, the listeners had lowered their average systolic reading by 3.2 points; a month later, readings were down 4.4 points.
12. Seek help for snoring
It's time to heed your partner's complaints and get that snoring checked out. Loud, incessant snores are one of the main symptoms of obstructivesleep apnea (OSA). University of Alabama researchers found that manysleep apnea sufferers also had high levels of aldosterone, a hormone that can boost blood pressure. In fact, it's estimated that half of all people with sleep apnea have high blood pressure. If you have sleep apnea, you may experience many brief yet potentially life-threatening interruptions in your breathing while you sleep. In addition to loud snoring, excessive daytime tiredness and early morning headaches are also good clues. If you have high blood pressure, ask your doctor if OSA could be behind it; treating sleep apnea may lower aldosterone levels and improve BP.
MORE: What Your Sleep Habits Say About Your Health
13. Jump for soy
A study from Circulation: Journal of the American Heart Associationfound for the first time that replacing some of the refined carbohydrates in your diet with foods high in soy or milk protein, such as low-fat dairy, can bring down systolic blood pressure if you have hypertension or prehypertension.