Preventive and health promotion in men over 40 years

Currently in our country and, in general, in the Western world, the most important causes of death in quantitative terms are cancer and cardiovascular diseases, including those affecting the heart and brain. Among the three constitute approximately 50% of all deaths annually, ie, one in two people die because of some of them.

It has been shown repeatedly that the abandonment of snuff is a huge health benefit.

In males, the most common cancers that cause death, are the trachea, bronchus and lung in the first place, followed by cancer of the stomach and the prostate .

Today, with the knowledge we have we can say without mistaken fear that many of these deaths could be prevented if measures were put in place health promotion and prevention of cardiovascular disease, which have been shown to be effective.

In man the leading cause of cancer death in our country is the bronchial cancer and lung cancer, with mortality rates of 54 per 100,000 inhabitants. One of the measures to be taken to dramatically reduce mortality from lung cancer is smoking cessation . It has been shown repeatedly that the abandonment of snuff is a huge benefit.

Preventive Actions

Currently the implementation of systematic prevention activities in the field of Primary Health Care is based on the realization of a periodic health examination. This is the application of various measures of health promotion and disease prevention with appropriate intervals to age and sex of those whom they are addressed.

Traditionally, and until well into the decade of 70, the preventive screenings, also called checks, were performed with a fixed frequency, usually annually. As the epidemiological and clinical studies provided more accurate data about the natural history of disease, became known periods of vulnerability (susceptibility to suffer a particular disease) and was opting for periodic reviews of health. In some cases the application of a preventive measure may be indicated on an annual basis and in others can be performed with longer intervals. Sometimes, however, the variables age and sex alone can not justify taking a preventative measure, so it is necessary to identify groups that share a number of features that increase the likelihood of developing a certain disease. It is in this way does the concept of risk.

The high-risk groups may be determined for reasons as diverse as genetic conditions, the presence of preexisting conditions, personal habits or behavior or simply belonging to a population with a large frequency of the disease.

In this article we will address the following activities of health promotion and disease prevention that can benefit men older than 40 years:

• Detection of smoking and smoking cessation advice.
  
  
• Detection of hypertension or high blood pressure.
  
  
• Screening for cholesterol or high blood cholesterol.
  
  
• Other activities.
  
  

Smoking

is estimated that in US smokes about one in three people, and among the population over 40 years smoke one in two people. We also know people who smoke more than upper middle class (about 45%) and those living in big cities.

Today it is indisputable that smoking is the most common preventable cause of premature death in developed countries. In europe die each year some 40,000 people from diseases directly related to snuff, among which ischemic heart disease by obstruction of the coronary arteries that are supplying the heart muscle, lung cancer, chronic obstructive pulmonary disease of the bronchi and blood vessel disease of the brain.

It has been shown that the degree of awareness of people about the harmful effects of snuff is low. For this reason the physician should undertake the following tasks on their patients:

• Question all patients about their smoking
  
  
• Advise all smokers to quit
  
  
• Helping those who want to quit to get
  
  
• Agree monitoring visits.
  
  

Quitting smoking is therefore one of the main activities for the prevention of cardiovascular diseases, which cause, as mentioned, a large number of deaths in Spain.

Detection of hypertension or high blood pressure

Hypertension is defined as a sustained elevation of blood pressure levels above those considered normal and, at this time, because of the evidence accumulated by numerous scientific studies over in recent years, is set at 140/90 mmHg (or millimeters of mercury).

We know for a fact that this disease is a risk factor of prime importance for the heart and blood vessels. Currently one in three adults have this disease.

The benefits of treatment have been clearly established and proven in numerous medical studies. At present it is recommended to measure and record blood pressure of blood every two years in men older than 40 years. In cases in which blood pressure is kept high so many records, often require treatment and medical follow-up long term.

Cholesterol or high blood cholesterol

Numerous scientific studies have taught us that the numbers of blood cholesterol are associated with disease and death caused by heart problems and blood vessels. The risk of any of these health problems increases progressively as they rise in cholesterol levels in the blood, so they pose a predictor or announcer of all deaths in men aged 40 to 60 years. In this group of people are much more common traditional cardiovascular risk factors like high blood pressure, use of snuff and a sedentary lifestyle or lack of exercise, among others.

At present the treatment of hypercholesterolemia in primary prevention , ie before the disease appears, requires classifying patients according to individual risk assessment, and medications only treat the cases where it is most likely that the benefits outweigh the risks.

The situation changes when we secondary prevention, ie when the patient has the disease in its early stages, not yet clearly manifest. In these cases, medications to treat high blood cholesterol have proved their usefulness in different medical studies.

In general, it is recommended to men aged between 35 and 40 years to 65 years a determination of total blood cholesterol every 5 years and opportunistically, ie, use of other reasons for medical consultation.

talk about high levels of cholesterol in the blood when the patient has a higher level of 250 mg / dl; discuss borderline high cholesterol with cholesterol levels between 200 and 250 mg / dl, and those figures desirable cholesterol below 200 mg / dl.

When a patient has already had a cardiovascular disease such as angina pectoris, a myocardial infarction or stroke, diagnosis of hypercholesterolemia (high cholesterol) is set as a fraction of cholesterol called LDL (English acronym for the so-called low-density lipoprotein or low density lipoprotein). We speak in these cases of hypercholesterolemia when the number of LDL cholesterol (or "bad" cholesterol) is greater than 130 mg / dL cholesterol to the upper limit when the LDL cholesterol is between 100 and 130 mg / dl, and when it is desirable cholesterol below 100 mg / dl.

Treatment of cardiovascular diseases

in the treatment of these health problems always pass the initial steps by changes in lifestyle, such as monitoring of a diet low in animal fats (reducing the consumption of fatty meats, sausages, whole milk, eggs, fatty pastries, etc..), the practice of regular physical exercise and avoiding overweight and high alcohol consumption. In some cases when these measures fail and require the use of specific drugs.

Activities or measures for the prevention of cardiovascular disease

or activities The following measures have proved effective in promoting health and preventing disease:

• Physical exercise on a regular basis, tailored to the individual characteristics of each person.
  
  
• Prevent overweight and obesity, controlling the power.
  
  
• Follow a diet low in animal fats and rich in fruits, vegetables, legumes, fish, etc.. (So-called Mediterranean diet). Determine the level of blood cholesterol at least every 5 years.
  
  
• Prevent abuse of Alcohol .
  
  
• Do not smoke or quit if you smoke.
  
  
• Measure and record your blood pressure regularly, at least every 2 years. See your doctor if you have persistently high numbers of blood pressure.
  
  
• Vaccinated against tetanus every 10 years and the flu every year, especially if you belong to any of the groups most at risk.
  
  
• Avoid sun exposure too.
  
  
• Early detection of some cancers such as colon, in patients with a family history of disease or risk factors.
  
  
• Early detection and treatment of patients with high risk factors for coronary artery disease, so common in men over 40 years.

Breast Prostheses

What are they and what are they used?

breast prostheses are devices that are implanted in the breast or breasts of women mainly for two reasons: as an aesthetic breast augmentation for women who want to have larger breasts (80 % of cases), and to reconstruct the breast in those women who have had a breast removed for breast cancer suffer.

Some prostheses to adjust the volume of the filler material after the operation.

Types of prostheses

There are 3 basic types of breast implants: prosthesis filled with saline , prosthesis filled with silicone gel -filled and other alternative substances such as soybean oil .

Breast implants vary in shell surface (smooth or rough), shape (round or other shapes), the profile (which protrudes), volume (or size) and the thickness of the envelope.

The fundamental parts of a breast prosthesis are:

• it wrap the outer casing
  
  
• the filler
  
  
• a patch covering the hole manufacturing.
  
  

Concerning the design of the wrapper, most prostheses have a single outer layer (shell itself), some have a double shell prosthesis (one inside the other). Regarding the filling material, some prostheses are manufactured with a fixed volume of filler material, others are filled during surgery and other to adjust the volume of the filler material after the operation.

In the prosthesis filled with silicone gel The term silicone refers to a family of organic silicon compounds related chemically derived from silica. In medicine, the silicone has been used extensively as small amounts of this substance can be found in prosthetic joints (knee, hip, etc..) Artificial heart valves and even the bottle nipples for babies. However, the medical use of the compound more liquid, polydimethyl siloxane, is done with breast implants that were developed for over 40 years.

What is the surgery?

The surgery, though it can be done with local anesthesia and sedation, it is preferable under anesthesia general. An incision is made ​​at the lower end of the nipple-areola, or in the groove under the breast or in the crease of the armpit and the prosthesis is inserted to place, well below the mammary gland itself or under the muscle the chest which is in turn under the gland. The choice of technique depends on the plastic surgeon's discretion. The hospital stay is usually 24 to 36 hours.

What complications can arise?

It is important to bear in mind that most women who have surgery of breast implants may experience local complications such as pain, capsular contracture (scar tissue formation around the prosthesis that tightens or squeezes) or the prosthesis rupture or deflation. In many cases require nonsurgical or surgical reinterventions to treat these complications.

Local complications of surgery for breast implants are therefore common and are the primary concern regarding the safety of the intervention. In addition, complications accumulate over the life of the prosthesis should also know, do not last a lifetime. Finally, the women received information on possible local complications of this surgery is essential to make the final decision to operate or not.

There is a long list of local complications of this type of intervention:

• asymmetry of the breasts
  
  
• pain of the same
  
  
• Breast tissue atrophy
  
  
• calcification or calcium deposits on the breasts
  
  
• capsular contracture
  
  
• chest wall deformity
  
  
• delayed wound healing or keloid formation or large scars
  
  
• extrusion of the prosthesis or output
  
  
• galactorrhea or secretion of milk from the nipple
  
  
• hematoma, granuloma or wound complication
  
  
• infections
  
  
• inflammation or irritation
  
  
• malposition or displacement of the prosthesis
  
  
• necrosis or tissue death
  
  
• sensory changes in the breast or nipple
  
  
• rupture of the prosthesis, or it will deflate or deflate
  
  
• seroma
  
  
• wrinkles or ripples in the skin
  
  
• unsatisfactory aesthetic results by size or style, etc..
  
  

Of these, the most important because of their frequency and consequences are breast pain, capsular contracture referred to above, changes in sensation in the breast or nipple and rupture of the prosthesis or deflate or deflate it.

Some of these local complications require reoperation, and in some cases, removal of the prosthesis, with subsequent complications aesthetic (dimples and wrinkles or ripples in the skin, loosening or falling of the chest, etc.).. The frequency of these complications aesthetic stands at 12-14% at 5 years when the intervention is to increase breast size and 28-30% at 5 years when it's for breast reconstruction, with the average time to remove the prosthesis of 11.5 years.

Women should be subjected to multiple reoperations to improve the appearance of the breasts, remove the deflated prosthesis or repair broken or other local complications may end the process with a clearly unsatisfactory cosmetic result, with all that entails.

It has been found that one in four women with breast implants had local complications that required a reoperation during the first 5 years after implantation. Just as we saw that one of every 3 women who received breast implants to reconstruct her breasts needed to be reoperated within the next 5 years and 1 in 8 women who were operated for breast augmentation had to be reoperated within 5 years.

Are there any health risks caused by the prosthesis?

Some women living with breast implants have developed health problems that they think are related to the prosthesis, but the majority of medical and scientific studies have failed to demonstrate such an association. Most health concerns related to breast implants are believed caused by a reaction of the organism against foreign material such as silicone.

Of the various diseases that have tried to link with breast implants are two: the cancer breast and a rheumatological disease called connective tissue disease includes diseases such as rheumatoid arthritis , lupus erythematosus or scleroderma among others, or disorders (signs or symptoms) related.

Today we know that breast cancer is more common in women with breast implants compared with those who do not carry. Multiple scientific studies have confirmed so.

What seems clear is that breast implants may interfere with early detection of breast cancer in making and interpreting a mammogram . Compression of the breast during this test may cause rupture of the prosthesis or deflate it. The best test to detect this problem in silicone prosthesis is the nuclear magnetic resonance .

Several scientific studies have been unable to establish a clear cause-effect relationship between breast implants and connective tissue disease, so currently can not mention that breast implants cause these diseases.

Considerations before getting a breast prosthesis

• Most women who get breast implants will experience some local complications that may require further medical or surgical treatment (reoperation or removal of the prosthesis). Breast implants do not last a lifetime. Often require long term monitoring and reoperations for treatment of complications.
  
  
• To be considered a cosmetic treatment, not within the Social Security benefits in Spain so that intervention is not funded. Even many private insurers cover it. In case of need for reconstruction after breast cancer surgery is considered medical treatment and is funded by Social Security.
  
  
• It is important to know the real possibilities of the outcome. No surgeon will provide absolute guarantees that the result will be similar to other women who have obtained a great success. The results of your particular case will depend on many individual factors such as general health (including age), the structure of the thorax, the shape and position of the breast and nipple, skin texture, healing capacity (which may be delayed in case of previous radiotherapy or chemotherapy, alcohol, snuff, drugs, etc..) tendency to bleed, prior breast surgery, skills and experience of the surgical team, the type of surgery and the type and size of the prostheses.
  
  
• Many of the changes that occur in the breast following implantation of the prosthesis can be aesthetically undesirable and irreversible. With the subsequent removal of the prosthesis may appear dimples, wrinkles or loosening of the breasts, loss of breast tissue or other undesirable cosmetic changes.
  
  
• Women with implants should follow the same program for early detection of breast cancer by mammography. There is a certain risk of breast implant rupture or deflate during this test.
  
  
• Other risks targets are delayed detection of breast cancer and pain or discomfort that may be after surgery.
  
  

Despite the controversy, there is no scientific evidence linking silicone breast implants with various diseases like breast cancer or connective tissue.

Check male urological

Prostate cancer

The prostate cancer clinically detectable is the most common cancer in men over 50 years of age in the U.S., and the second leading cause of cancer death in men. Approximately 30% of men over 50 have asymptomatic foci of prostate cancer recognizable in the autopsy series. However, it is estimated that the risk of a man of 50 years to develop a clinically relevant prostate cancer has been estimated at about 10%, while the risk of dying from prostate cancer is approximately 3%.

The right candidate for a urological check is a male between 50 and 70 years of age with good health and a life expectancy of at least 10-15 years.

The implementation of programs for early detection of prostate cancer is very controversial, in Spain, the number of potential tax men of this program over five million. Several screening programs, and including the American Cancer Society , have shown that between 85% and 93% of cancers detected with current methods are important clinically, ie, they are likely to progress and cause damage to individual. In addition, tumors detected from the use of PSA (prostate specific antigen) are more likely to be confined to the organ. When used in screening programs, patients with prostate cancer detected at an earlier stage than when they are symptomatic.

Benign prostatic hyperplasia

Moreover, it should be noted that benign prostatic hyperplasia (BPH) is the most common benign tumor in men over 50 years, and the second cause of admission for surgery. It is therefore advisable to assess clinically, albeit brief, in this age group. In fact, 70% of patients over age 70 develop BPH, of whom between 35 and 40% suffer with prostate clinic due to cervico-urethral process.

Who recommends a prostate check?

The right candidate is a male between 50 and 70 years of age with good health and a life expectancy of at least 10-15 years. In cases of family history of prostate cancer suggests starting as an option at 40 years of age. Although it has been said that the prevalence of prostate cancer increases with advancing age, after 70 years of life expectancy decreases to less than ten years and the risk of death from other causes increases. Thus, although each case must be taken individually, do not recommend routine screening of men over 70 years without symptoms, except that the detection or treatment of prostate cancer affecting the quality of life of patients.

Of course The urologist should include an assessment visit in the prostate of any man with urinary symptoms.

What tests are performed on a prostate check?

Medical history

was prompted by urinary frequency, by the existence of complaints or problems associated with it, hematuria (blood in urine) and so on. May also be given the IPSS ( International Prostatic Syptoms Score ), a scale of urinary symptoms and quality of life validated by WHO, which gives us an impression of the man's clinical situation quickly.

Physical examination

The application of digital rectal examination as part of routine screening is well established. However, some patients feel aversion for the exam and the lack of sensitivity and specificity of the test are the two limitations. Used alone, it has not succeeded in detecting prostate cancer at an early stage, potentially curable, but in combination with PSA has unquestionable value.

Analysis

• Urinary sediment analysis: to distinguish urinary tract infections that can cause irritative symptoms similar to prostate patients and to identify the hematuria (blood in urine).
  
  
• Determination of plasma creatinine (allows an assessment of renal function), so this determination as the above are part of routine health checks, so it is common for patients to bring in the time of the visit to the urologist.
  
  
• The PSA is a protein produced by prostate epithelial cells and, among other circumstances, blood level increases with the presence of prostate cancer cells. The routine use of PSA in male patients older than 50 years has been recommended by the American Society of Cancer , the American Urological Association , among others, and the FDA also has approved it as a tool for early detection of prostate cancer. Although the standard reference values ​​are between 0 and 4 ng / ml (Tandem E assay), have also been proposed age-specific levels, but have not enjoyed wide acceptance. The problem is that in any case, there is an overlap between the values ​​of PSA in cancer patients and patients with benign prostatic hyperplasia. That is, it is not uncommon for patients with elevated (usually moderate, between 4 and 10 ng / ml) of this index is to make appropriate diagnostic tests and are not cancer cells, and conversely, not what is that other men have figures within the normal range and who suffer from prostate cancer. Therefore, it has been suggested the use of other tests (free PSA, PSA density, PSA velocity, etc.) to avoid this uncertainty, but this exceeds the purpose of a urological check and must be determined in subsequent visits if required .
  
  

Urological ultrasound (vesico-prostatic renewable)

is a test not required, but it is certainly a useful tool if there are significant micturition or other clinical circumstances so warrant. The measurement of waste (volume of urine left in the bladder after urination) may be sufficient in the context of a urological check. Although transrectal ultrasound is useful in the diagnosis of prostate cancer is not recommended as part of a routine by the lack of specificity and relative discomfort.

Flowmetry

is a test easy to perform, devoid of hassles and reproducible. Its purpose is to obtain objective and quantifiable data on the patient's lower urinary tract, that does not always correlate with symptoms and the degree of obstruction. It consists of making urination in the flow meter device that measures the amount of urine output per unit of time and transforms it into a signal that can be digitized and sent to a polygraph.

In general, organizations that promote urological checkups recommend an evaluation combined, most often based on physical examination and PSA, although, as we have seen, may include other tests based on clinical findings.

Why do people get hiccups

Why get the hiccups, why you hiccup? The most common cause of hiccups is to give us indigestion, because, after taking too strong and abundant food, it accelerates the production of acids that trigger sound annoying and contractions of the diaphragm. Another cause is eating too fast and dry food without water. Also, sometimes the cold causes hiccups. To avoid hiccups: • Drink a glass of water before eating very dry and do not eat fast. • In the event that either by cold, seek shelter. Note: • If hiccups occur too often, there might be a more serious stomach order, a condition in the intestines or hepatitis.