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An in-depth report on the causes, diagnosis, treatment, and prevention of high blood pressure.
Blood Pressure Measurements
Blood pressure is measured in millimeters of mercury (mm Hg). The higher number is the systolic blood pressure, the pressure in your arteries while your heart is pumping blood. The lower number is the diastolic blood pressure, the pressure when your heart is relaxing and refilling with blood between beats. For adults:
Home Blood Pressure Monitoring
Most people with high blood pressure will benefit from monitoring their blood pressure at home on a regular basis. Home monitoring can help show if blood pressure medications are working or if they need to be adjusted.
Lifestyle Changes and High Blood Pressure
Lifestyle changes are important for preventing and treating high blood pressure. They include:
The DASH diet is a plan proven to improve blood pressure.
Medications for High Blood Pressure
Drug treatment for high blood pressure is tailored to the individual. There are many different types of blood pressure medications. Although some people need only one drug to control blood pressure, most patients require at least two medications.
Blood pressure measurements can fluctuate throughout the day and in different environments. The decision to start or increase blood pressure medications should not be based on a single blood pressure reading.
To obtain the most accurate estimate of your true blood pressure, your doctor will use an average of multiple readings. These may include repeated readings made in the doctor's office as well as blood pressure measurements you performed at home.
High blood pressure, also called hypertension, is elevated pressure of the blood in the arteries. Hypertension results from two major factors that can occur independently or together:
Blood pressure is the force applied against the walls of the arteries as the heart pumps blood through the body. The pressure is determined by the force and amount of blood pumped and the size and flexibility of the arteries.
High blood pressure makes the body's heart work harder, which over time can lead to damage in blood vessels throughout the body. Damaged blood vessels affect function in the heart, kidneys, brain, and eyes.
Two numbers are used to describe a blood pressure reading:
A third number, pulse pressure, is the difference between the systolic and the diastolic readings. It indicates stiffness and inflammation in blood vessel walls. The greater the difference between systolic and diastolic numbers, the greater the risk to health.
Hypertension Categories
There are a number of ways to categorize or describe hypertension.
Doctors may also categorize hypertension based on what portion of the blood pressure reading is abnormal:
Blood Pressure Guidelines
Blood pressure is measured in millimeters of mercury (mm Hg). Blood pressure is categorized as:
Blood Pressure Category
Ranges for Most Adults (systolic/diastolic)
Normal Blood Pressure (systolic/diastolic)
Systolic below 120 mm Hg
Diastolic below 80 mm Hg
Systolic 120 to 139 mm Hg
Diastolic 80 to 89 mm Hg
(NOTE: 139/89 or below should be the minimum goal for everyone. African-Americans or people with certain types of heart disease or chronic kidney disease may benefit from lower target goals. The American Diabetes Association recommends a blood pressure goal of less than 140/80 for people who have diabetes and hypertension; a lower systolic target of 130 mm Hg may be appropriate for younger patients.)
Mild Hypertension (Stage 1)
Systolic 140 to 159 mm Hg
Diastolic 90 to 99 mm Hg
Moderate-to-Severe Hypertension (Stage 2)
Systolic over 160 mm Hg or
Diastolic over 100 mm Hg
NOTE: If one of the measurements is in a higher category than the other, the higher measurement is usually used to determine the stage. For example, if systolic pressure is 165 (Stage 2) and diastolic is 92 (Stage 1), the person would still be diagnosed with Stage 2 hypertension. A high systolic pressure compared to a normal or low diastolic pressure should be a major focus of concern in most adults.
Blood Pressure in Older Patients
Blood pressure treatment target goals for patients ages 60 years and older are a matter of debate:
These numbers indicate both when drug therapy should be started, and the target to reach. For example:
Many doctors are concerned about not treating patients whose blood pressure exceeds 140/90, and are following the stricter ACC/AHA recommendations. However, doctors do agree that medication side effects need to be considered, especially when treating elderly patients.
Blood pressure medications can increase the risk for falls and cause other side effects. At the same time, poorly controlled blood pressure can increase the risk for stroke and heart complications. The advantages and disadvantages of aggressively treating blood pressure need to be carefully considered for each individual patient.
Blood Pressure in Children
For children, blood pressure readings are based on percentile ranges for a child's body size. Hypertension in children is defined as average systolic and diastolic readings that are greater than the 95th percentile for gender, age, and height on at least three occasions.
Prehypertension in children is diagnosed when average systolic or diastolic blood pressure levels are at least in the 90th percentile, but less than the 95th percentile. For adolescents as with adults, blood pressure readings greater than 120/80 are considered prehypertensive.
Increasing rates of childhood obesity have led to higher rates of hypertension and prehypertension among children and adolescents. However, according to the United States Preventive Services Task Force (USPSTF), it is not clear if blood pressure screening is helpful for children who do not show signs or symptoms of hypertension. It is also not certain if screening accurately identifies children at risk for heart disease. The USPSTF recommends pediatricians make a decision to evaluate blood pressure based on specific clinical situations (for example, when a child is overweight).
Causes of Primary Hypertension
Hypertension is referred to as primary (essential) when the doctor is unable to identify a specific cause. It is by far the most common type of high blood pressure. Primary hypertension may be due to a combination of genetic, environmental, and other factors.
Genetic factors. A number of genetic factors or interactions between genes play a major role in primary hypertension. Genes under investigation include:
Causes of Secondary Hypertension
Secondary hypertension is caused by an underlying medical condition or other factor (such as medications) that elevates blood pressure. Many different medical conditions are associated with secondary hypertension. These conditions can also make high blood pressure more difficult to control.
Diabetes. Hypertension is strongly associated with diabetes, both types 1 and 2. Kidney damage (diabetic nephropathy) is generally the cause of high blood pressure in people with diabetes.
Kidney disease. Kidney disease is the most common cause of secondary hypertension, particularly in older people. In addition to diabetic nephropathy, many other types of kidney diseases can cause hypertension. Renal artery stenosis involves the narrowing of the renal artery and is usually caused by atherosclerosis. Other types of kidney disease associated with hypertension are polycystic kidney disease and renal parenchymal disease.
Coarctation of the aorta. This is a birth defect that causes narrowing of the aorta, the main artery leading out of the heart that brings blood to the rest of the body.
Endocrine disorders. Adrenal tumors (pheochromocytoma, aldosteronism), thyroid disorders, and Cushing syndrome can all cause secondary hypertension.
Medications. Many different prescription and over-the-counter drugs can temporarily raise blood pressure or worsen existing high blood pressure, including:
In the United States, about 1 in 3 adults has high blood pressure. Many people with high blood pressure don't know they have it.
About 30% of American adults have prehypertension (blood pressure ranges from 120 to 139/80 to 89 mm Hg). People who are diagnosed with prehypertension are at increased risk of developing high blood pressure.
Age and Gender
Age is the major risk factor of hypertension. Men over age 45 and women over age 55 are at increased risk for high blood pressure. Over half of Americans over age 60 have hypertension. After age 65, high blood pressure affects more women than men. Hypertension is also becoming more common in children and teenagers. Among younger people, boys are at higher risk for high blood pressure than girls.
Race and Ethnicity
Compared to Caucasians and other ethnic groups, African-Americans are more likely to have high blood pressure. More than 40% of African-American men and women have hypertension. (African-American women have a higher risk than African-American men.) High blood pressure tends to start at a younger age among African-Americans, is often more severe, and causes greater risks for premature death from heart attack, stroke, heart failure, and kidney failure.
Family History
People with parents or other close relatives who have high blood pressure have an increased risk of developing it themselves.
About a third of people with high blood pressure are overweight. Even moderately obese adults have double the risk of hypertension than people with normal weights. Children and adolescents who are obese are at increased risk for high blood pressure when they reach adulthood.
Obstructive Sleep Apnea
Obstructive sleep apnea, a disorder in which breathing halts briefly but repeatedly during sleep, is present in many people with hypertension. The relationship between sleep apnea and hypertension has been thought to be largely due to obesity. But studies are finding a higher rate of hypertension in people with sleep apnea regardless of their weight.
Lifestyle Factors
Smoking. Cigarette smoking is a major risk factor for high blood pressure.
Sodium (salt) and potassium. Eating too much sodium (salt) can increase the risk for developing high blood pressure. Similarly, a diet that is too low in potassium can make the body accumulate too much sodium. Sodium and potassium are important regulators of fluid balance in cells.
Alcohol. Chronic heavy alcohol use can increase blood pressure. Women may be more sensitive than men to the blood pressure effects of alcohol.
Physical inactivity. A sedentary lifestyle and lack of physical activity can increase the risk of becoming overweight.
Stress. Mental and emotional stress can cause a temporary increase in blood pressure. Chronic stress can lead to engaging in unhealthy behaviors (overeating, smoking, alcohol use, lack of exercise) that contribute to high blood pressure.
High blood pressure, also called hypertension, is a disorder characterized by chronically high blood pressure. It must be monitored, treated, and controlled by medication, lifestyle changes, or a combination of both.
High blood pressure places stress on several organs (called target organs), including the kidneys, eyes, and heart. The stress causes them to deteriorate over time.
High blood pressure contributes to 75% of all strokes and heart attacks. It is particularly deadly in African-Americans.
Combined with significantly high blood pressure, other risk factors can increase the likelihood of complications. These risk factors include:
Heart Complications
High blood pressure is a major risk factor for hypertensive heart disease, the leading cause of illness and death from high blood pressure. Hypertensive heart disease is a group of complications that include:
About two-thirds of people who suffer a first stroke have moderately elevated blood pressure (160/95 mm Hg or above). Hypertensive people have up to 10 times the normal risk of stroke, depending on the severity of the blood pressure in the presence of other risk factors. Hypertension is also an important cause of silent cerebral infarcts, which are blockages in the blood vessels in the brain (mini-strokes) that may predict major stroke or progress to dementia over time.
Diabetes and Kidney Disease
Diabetes. High blood pressure, and some of the medications used to treat it, can increase the risk for developing type 2 diabetes. There are strong biologic links between insulin resistance (with or without diabetes) and hypertension. It is unclear if one condition causes the other.
In general, people with diabetes and hypertension should strive for blood pressure levels of less than 140/90 mm Hg (systolic/diastolic). The American Diabetes Association recommends a target goal of 140/80. For some people, especially younger people, a systolic blood pressure goal of less than 130 mm Hg may be appropriate. People with diabetes and high blood pressure need an individualized approach to drug treatment, based on their particular health profile.
The United States Preventive Services Task Force recommends screening for type 2 diabetes in all people with blood pressure higher than 135/80 mm Hg.
End-stage kidney disease. High blood pressure causes about 30% of all cases of end-stage kidney disease (referred to as end-stage renal disease, or ESRD). Only diabetes leads to more cases of kidney failure. People with diabetes and hypertension need to be monitored very closely for the development of kidney disease.
Isolated systolic hypertension may pose a particular risk for dementia, or memory loss.
Eye Damage
High blood pressure can injure the blood vessels in the eye's retina, causing a condition called retinopathy.
Sexual Dysfunction
Sexual dysfunction is more common and more severe in smokers and men with hypertension than it is in the general population. Although older drugs used to treat hypertension caused erectile dysfunction as a side effect, the disease process that causes hypertension is itself a major cause of erectile dysfunction.
Oral phosphodiesterase type 5 (PDE5) inhibitors -- such as sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra) -- do not appear to pose a risk for most men who have both high blood pressure and erectile dysfunction. But men who have uncontrolled or unstable hypertension should not take these medications.
Men who take nitrate medications for heart disease cannot take erectile dysfunction pills.
Pregnancy and High Blood Pressure
Many women who are likely to develop hypertension when they are older have their first elevated blood pressure readings during pregnancy. Elevated blood pressure readings generally show up early in pregnancy, before 16 to 20 weeks. These women often require antihypertensive medications during pregnancy and closer monitoring of themselves and the fetus. Continued hypertension after the pregnancy is also not uncommon.
Severe and sudden high blood pressure in pregnant women is one component of a condition called preeclampsia (also called toxemia) that can be very serious for both mother and child. Preeclampsia occurs in up to 10% of all pregnancies, usually in the third trimester of a first pregnancy, and resolves immediately after delivery. Other symptoms and signs of preeclampsia include protein in the urine, severe headaches, and swollen ankles.
The reduced supply of blood to the placenta can cause low birth weight and eye or brain damage in the fetus. Severe cases of preeclampsia can cause kidney damage, convulsions (seizures), and coma in the mother and can be lethal to both mother and child. Women at risk for preeclampsia (particularly those with existing hypertension) are monitored carefully for its presence. Both mother and fetus are monitored closely after a diagnosis. Blood pressure medications may be required.
Delivery is the main cure for preeclampsia. In severe cases, the obstetrician will need to induce pre-term birth.
High blood pressure increases slowly over the years. It is often called the "silent killer" because it usually produces no symptoms until vital organs are damaged, like the heart, brain, and kidneys.
Everyone, 18 years and older, should have their blood pressure measured on a regular basis. It is particularly important for anyone with risk factors to have their blood pressure checked regularly and to make appropriate lifestyle changes. Such recommendations are especially important for people who:
Malignant hypertension is very high blood pressure that comes on suddenly and quickly. The lower (diastolic) blood pressure reading, which is normally around 80 mm Hg, is often above 130 mm Hg. This rare disorder affects about 1% of people with high blood pressure, including both children and adults. It is more common in younger adults, especially African-American men.
Malignant hypertension is a life-threatening condition and must be treated immediately. People with uncontrolled hypertension or a history of heart failure are at increased risk for this crisis.
People should call a doctor immediately if these symptoms occur:
Most physical exams at the doctor's office include a blood pressure reading. People should not smoke, exercise, or drink caffeinated beverages within 30 minutes before their blood pressure measurement.
The standard instrument used to measure blood pressure is called a sphygmomanometer, more often referred to as a blood pressure cuff. Measurements are given as units of mercury, which was used to fill the central column in standard sphygmomanometers for many years. Modern devices do not use mercury.
Decisions on starting or increasing medications should be based on multiple blood pressure readings, taken at both the doctor's office and even at home.
Although this test has been used for more than 90 years, it is not completely accurate or sensitive. The following factors can cause a falsely low pressure reading:
Falsely high pressure readings can result from:
Blood pressure readings taken by a doctor are more likely to be higher than readings measured at home. This can be due to "white coat hypertension," which is blood pressure that is only elevated during a doctor's office visit. People with white coat hypertension have:
These people may require additional blood pressure monitoring.
Doctors may ask some people to use a special ambulatory monitoring device for a 24-hour period. The device checks blood pressure about every 15 to 30 minutes during the day and night and provides a read-out of blood pressure measurements for the doctor. Ambulatory monitoring may be used for people who have borderline high blood pressure or for those who have had difficulty keeping their blood pressure under control. It can also help distinguish between true and white coat hypertension and it can detect masked hypertension (readings that are normal in a doctor's office but high during daily life). Ambulatory monitoring can also be helpful for diagnosing children with suspected high blood pressure.
The American Heart Association (AHA) recommends that all people with high blood pressure monitor their blood pressure at home on a regular basis. In addition to other benefits, home monitoring can help show if blood pressure medications are working.
The AHA recommends:
Blood pressure variations at home. In general, everyone's blood pressure varies throughout the day. In monitoring at home, it is important to note that blood pressure is usually highest from morning to mid-afternoon. Upon waking, blood pressure in most people typically increases suddenly. Early morning is the highest risk period for heart attack and stroke.
Blood pressure normally dips to its lowest level during sleep, although some people (particularly postmenopausal women) have a condition called non-dipper hypertension, in which blood pressure does not fall at night.
Physical Examination for Complications of Hypertension
If your blood pressure is elevated, the doctor will:
Medical History
If hypertension is suspected, your doctor may ask about:
If a physical examination indicates hypertension, additional tests may help determine whether organ damage is present.
Blood tests and urinalysis. These tests are performed to check for a number of factors, including:
Measuring blood levels of the protein creatinine, for example, is important for all hypertensive people in order to determine kidney damage.
Tests to evaluate the heart. These tests include:
Tests to evaluate the kidneys. These tests include:
General treatment goals for hypertension aim to reduce blood pressure to below 140/90. Specific blood pressure goals may differ depending on a patient's individual health profile and risk factors.
Lifestyle changes are the first step for reducing blood pressure, and are an essential accompaniment to drug treatment.
Drug treatment for blood pressure control must be individualized. The doctor needs to consider a patient's risk factors, such as age, diabetes, or other heart disease conditions.
In some people, a single-drug regimen can control Stage 1 hypertension (systolic 140 to 159 or diastolic 90 to 99) if lifestyle changes (diet, exercise, weight control) are not enough. For people with Stage 2 hypertension (systolic above 160 or diastolic above 100), guidelines recommend two or more medications.
Drug Treatment
Medications for initial treatment of high blood pressure fall into the following 4 categories:
Each drug has specific benefits. But their effects may vary depending on the individual. A doctor will prescribe a medication based on factors that consider a patient's:
Side effects and problems with compliance. Side effects can be a problem with blood pressure medications. Some people find that the treatment may make them feel worse than the disease, which usually has no symptoms. Whatever the difficulties, compliance with a drug and lifestyle program is essential. It is very important to discuss any medication concerns with your doctor. If your current blood pressure drugs are causing uncomfortable side effects, your doctor may switch your drug, or adjust your dosages or combinations.
Withdrawal from anti-hypertensive medications. Some people whose blood pressure has been well-controlled and who are able to maintain a healthy lifestyle may be able to withdraw from medications. These are generally people with mild-to-moderate (Stage 1) hypertension who have been treated with a single medication. They should withdraw in a step-down manner (gradual reduction) and be monitored regularly. Stopping too quickly can have adverse effects, including serious effects on the heart.
Some people are unable to meet target blood pressure goals despite consistently following a treatment plan that includes three or more medications. Factors that contribute to treatment resistant hypertension include:
Treating any underlying medical condition is important for helping control blood pressure. People should be sure to adhere to healthy lifestyle changes and may require modifications to their drug regimens. Those with severe resistant hypertension should consult with a doctor who specializes in treating high blood pressure.
Older adults should have their blood pressure monitored on a regular basis. High blood pressure is very common in older adults and can be challenging to control. In general, older adults usually have an elevated systolic blood pressure and a normal or low diastolic blood pressure, a condition known as isolated systolic hypertension.
Blood pressure drugs prescribed for older people are generally started at the lowest dose and then gradually increased as necessary. As with all people with high blood pressure, lifestyle changes are an essential component of treatment.
Medication side effects are an important concern for older people. In particular, antihypertensive drugs can increase the risk for falls. In treating elderly people, blood pressure targets need to be balanced against drug side effects.
Blood pressure goals in older people are a matter of controversy. Recent guidelines from the Eighth Joint National Committee recommend a looser target treatment goal of below 150/90 for adults over age 60. The American Society of Hypertension recommends below 150/90 for adults ages 80 and older. However, the American College of Cardiology and the American Heart Association continue to recommend a goal of below 140/90 for all adults with hypertension, regardless of age. (See Introduction section.)
Children and adolescents with even mild hypertension should be monitored and evaluated for any signs of early organ damage. Secondary hypertension (high blood pressure due to another disease or drug) is more common in children than adults.
Children with high blood pressure should first be treated with lifestyle changes, including:
If blood pressure is not controlled with lifestyle changes, drug treatment may be required.
Healthy lifestyle changes are an important first step for lowering blood pressure. Current guidelines recommend that people should:
In general, everyone should restrict their sodium intake to no more than 2,400 mg a day (less than 1 teaspoon of salt). This is particularly important for people over age 50, all African-Americans, and everyone with high blood pressure. The American Heart Association recommends that people with heart disease risk factors limit sodium intake to no more than 1,500 mg a day (about ½ teaspoon). Sodium restriction lowers blood pressure and also helps protect against heart failure and heart disease.
Some people are salt sensitive. This means their blood pressure responds much more to salt than other people. People with salt sensitivity have a higher than average risk of developing high blood pressure, as well as other heart problems. Sodium restriction is particularly important for people with salt sensitivity, which includes:
Salt substitutes such as Nu-Salt and Mrs. Dash are available. But they can be risky for people with kidney disease or those who take blood pressure medications that can cause potassium retention.
Some tips for lowering your salt and sodium intake include:
A potassium-rich diet may help reduce blood pressure. Potassium-rich foods include:
The recommended daily intake of potassium is 3,500 mg a day for people without risk factors for excess potassium levels.
Some people may need to take potassium supplements. However, people who already have kidney problems or who take medications that limit the kidney's ability to excrete potassium, such as ACE inhibitors, digoxin, or potassium-sparing diuretics, should not take potassium supplements and should be aware of excess potassium in their diet.
The salt-restrictive DASH diet (Dietary Approaches to Stop Hypertension) is proven to help lower blood pressure, and may have additional benefits for preventing heart disease and stroke. Effects on blood pressure are sometimes seen within a few weeks. This diet is not only rich in important nutrients and fiber but also includes foods that contain far more potassium (4,700 mg/day), calcium (1,250 mg/day), and magnesium (500 mg/day), and much less sodium (salt) than the typical American diet.
DASH diet recommendations include:
Fiber. Increasing fiber in the diet may help reduce blood pressure levels.
Fish oil and omega-3 fatty acids. The omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaneoic acids (EPA) are found in oily fish. Studies indicate that omega-3s from diet may have benefits for many medical conditions, including heart disease and hypertension. They help keep blood vessels flexible and may help protect the nervous system. Omega-3 fatty acids are also available in supplement form. But eating fish protects the heart more than taking fish oil supplements.
Calcium. Hypertension increases calcium loss from the body. Calcium regulates the tone of the smooth muscles lining blood vessels. Studies have found that people who consume adequate dietary calcium on a daily basis have lower blood pressure than those who do not.
Consuming too much dietary calcium may have a negative effect: Some studies indicate that excess calcium intake (from dietary or supplement sources) may increase blood pressure and other heart disease risk factors.
Weight Loss
Even modest weight loss in overweight people, particularly in the abdominal area, can immediately lower blood pressure. When accompanied by salt restriction, weight loss may allow people with mild hypertension to safely reduce or go off medications. The benefits of weight loss on blood pressure are long-lasting.
Regular exercise helps keep arteries elastic, even in older people. This ensures blood flow and normal blood pressure. Doctors recommend at least 30 minutes of aerobic physical activity on most days. Even brisk walking can be beneficial.
High-intensity exercise may not lower blood pressure as effectively as moderate intensity exercise and may be dangerous in people with hypertension. Older people and those with uncontrolled hypertension or other serious medical conditions should check with their doctors before starting an exercise program.
Quit Smoking
Everyone should quit smoking, especially people with high blood pressure and other heart disease risk factors.
Certain sleep disorders, especially obstructive sleep apnea, are associated with hypertension. Even chronic, insufficient sleep may raise blood pressure in people with hypertension, placing them at increased risk of heart disease and death. Stress hormone levels increase with sleeplessness, which can activate the sympathetic nervous system, a strong player in hypertension.
People who have chronic insomnia or other severe sleep disturbances may want to consult a doctor who specializes in sleep disorders. People with hypertension who are habitually poor sleepers should discuss with their doctors which blood pressure medications may help counteract the increase in blood pressure that occurs in the early morning hours.
Stress reduction may help blood pressure control. Yoga, Tai chi, biofeedback, device-guided breathing, and relaxation techniques such as meditation may provide modest benefits for some people.
Several classes of drugs are used to treat hypertension.
Diuretics help the kidneys get rid of excess salt and water. Thiazide diuretics are the mainstays of anti-hypertensive therapy and are usually the first type of drug selected for most people with hypertension. Thiazide diuretics are especially helpful for treating older people (over age 60) and African-Americans. (African-Americans are more likely to be salt-sensitive, so they respond well to these drugs.) Diuretics are often used in combination with other antihypertensive drugs.
There is strong evidence that diuretics work just as well as newer drugs in lowering blood pressure and are more effective in preventing heart failure, heart attack, and stroke.
The 3 main types of diuretics include:
Common diuretic side effect symptoms include:
Thiazide and loop diuretics reduce the body's supply of potassium (hypokalemia), which, if left untreated, increases the risk for arrhythmias. Arrhythmias are heart rhythm disturbances that can lead to cardiac arrest, although they rarely do. If you experience reduced potassium, your doctor will prescribe a lower dose of your current diuretic, recommend potassium supplements, or switch to a potassium-sparing diuretic either alone or in combination with a thiazide.
Potassium-sparing drugs have their own risks, which include dangerously high levels of potassium in people with existing elevated levels of potassium or in those with damaged kidneys. However, all diuretics are generally more beneficial than harmful.
Other health concerns associated with thiazide diuretics include:
ACE Inhibitors
Angiotensin-converting enzyme inhibitors (ACEIs) widen blood vessels and decrease the workload of the heart. They treat high blood pressure and can also help protect the heart and kidneys.
An ACE inhibitor may be used as an initial blood pressure medication for non-black patients younger than age 60 years. ACEIs are also often used in combination with other anti-hypertensive medications.
Brands. ACE inhibitors include captopril (Capoten, generic), enalapril (Vasotec, generic), quinapril (Accupril, generic), benazepril (Lotensin, generic), ramipril (Altace, generic), perindopril (Aceon, generic), and lisinopril (Prinivil, Zestril, generic).
Common side effect symptoms of ACE inhibitors include:
Uncommon Side Effects of ACE Inhibitors.
People who have difficulty tolerating ACE inhibitor side effects are usually switched to an angiotensin-receptor blocker (ARB).
ARBs, also known as angiotensin II receptor antagonists, are similar to ACE inhibitors in their ability to widen blood vessels and lower blood pressure. They may have fewer or less-severe side effects than ACE inhibitors, especially coughing, and are sometimes prescribed as an alternative to ACE inhibitors. In general they are prescribed to people who cannot tolerate or did not respond to ACE inhibitors.
Brands. Losartan (Cozaar, Hyzaar, generic), olmesartan (Benicar) candesartan (Atacand), telmisartan (Micardis), eprosartan (Teveten), irbesartan (Avapro), valsartan (Diovan), and azilsartan (Edarbi).
A combination medication containing candesartan and the diuretic hydrochlorothiazide (Diovan HCT, Atacand HCT) is also available. Exforge HCT is a triple-combination medication that combines in one pill valsartan along with the calcium-channel blocker amlodipine and the diuretic hydrochlorothiazide. Tribenzor combines in one pill olmesartan, amlodipine, and hydrochlorothiazide.
Side Effects. Common side effects of ARBs may include:
NOTE: ARBs should not be used during pregnancy.
Calcium-Channel Blockers (CCBs)
Calcium-channel blockers (CCBs), also known as calcium antagonists, help relax blood vessels. Along with thiazide diuretics, CCBs appear to work better than other drug classes for lowering blood pressure in African-Americans.
Brands. Diltiazem (Cardizem, Dilacor), amlodipine (Norvasc), felodipine (Plendil), isradipine (DynaCirc), verapamil (Calan, Isoptin, Verelan), nisoldipine (Sular), nicardipine (Cardene), and nifedipine (Adalat, Procardia).
All these prescription medications are available as generics. For people who have both high blood pressure and high cholesterol, Caduet combines in one pill amlodipine and the statin drug atorvastatin.
Side Effects. Side effects of CCBs may include:
Beta Blockers. Beta blockers help slow your heart rate and lower blood pressure. They are usually prescribed for people who have hypertension and coronary artery disease or heart failure. Brands include acebutolol (Sectral, generic), metoprolol (Lopressor, generic), and carvedilol (Coreg, generic). These drugs can have serious side effects and must be used carefully. Most important, suddenly stopping a beta blocker drug can potentially cause a heart attack. Your doctor will need to slowly decrease your dose before you can stop taking this medication.
Alpha Blockers. Alpha blockers such as doxazosin (Cardura, generic), prazosin (Minipress, generic), and terazosin (Hytrin, generic) help widen small blood vessels. They are generally not used as first-line drugs for high blood pressure, but are prescribed if other drugs do not work or as add-on medication.
Vasodilators. Vasodilators help open blood vessels by relaxing muscles in the blood vessel walls. These drugs are usually used in combination with a diuretic or a beta blocker. They are rarely used by themselves. Brands include hydralazine (Apresoline, generic), clonidine (Catapres, generic), and Minoxidil (Loniten, generic). Some of these drugs should be used with caution or not at all in people who have angina or who have had a heart attack.
Aliskiren (Tekturna). Aliskiren (Tekturna, Amturnide) is a new kind of antihypertensive drug called a direct renin inhibitor. It blocks renin, a kidney enzyme associated with high blood pressure. Aliskiren is also available in the 2-in-1 combination pills Tekturna HCT (aliskiren and the diuretic hydrochlorothiazide) and Tekamlo (aliskiren and the calcium channel blocker amlodipine). Aliskiren is prescribed either alone or in combination with other blood pressure medications. However, people with diabetes or kidney impairment should not take aliskiren along with ACE inhibitors or ARBs because of increased risk for kidney damage and other problems. Aliskiren should not be used during pregnancy as it can cause injury or death to the fetus.
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Go AS, Bauman MA, Coleman King SM, et al. An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. J Am Coll Cardiol. 2014;63(12):1230-1238.
James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520.
Moyer VA; U.S. Preventive Services Task Force. Screening for primary hypertension in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159(9):613-619.
Peterson ED, Gaziano JM, Greenland P. Recommendations for treating hypertension: what are the right goals and purposes? JAMA. 2014;311(5):474-476.
Selassie A, Wagner CS, Laken ML, et al. Progression is accelerated from prehypertension to hypertension in blacks. Hypertension. 2011;58(4):579-587.
Shen L, Shah BR, Reyes EM, et al. Role of diuretics, ß blockers, and statins in increasing the risk of diabetes in patients with impaired glucose tolerance: reanalysis of data from the NAVIGATOR study. BMJ. 2013;347:f6745.
Tinetti ME, Han L, Lee DS, et al. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med. 2014;174(4):588-595.
Whelton PK, Appel LJ, Sacco RL, et al. Sodium, blood pressure, and cardiovascular disease: further evidence supporting the American Heart Association sodium reduction recommendations. Circulation. 2012;126(24):2880-2889.
Weber MA, Schiffrin EL, White WB, et al. Clinical practice guidelines for the management of hypertension in the community:a statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hypertens (Greenwich). 2014;16(1):14-26.
Wright Jr JT, Fine LJ, Lackland DT, Ogedegbe G, Dennison Himmelfarb CR. Evidence supporting a systolic blood pressure goal of less than 150 mm Hg in patients aged 60 years or older: the minority view. Ann Intern Med. 2014;160(7):499-503.
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text:
Effects of Alogliptin on Pancreatic Beta Cell Function
Recruitment status was: Recruiting
- Full Text View
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- No Study Results Posted
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- How to Read a Study Record
It is reported that pancreatic beta cell function is already declined at pre-diabetic stage, impaired glucose tolerance (IGT). It has not been clarified whether inhibitors of the dipeptidyl peptidase IV enzyme (DPP-IV inhibitors) improve beta cell function on human pancreas, however, if efficacy is ensured, they may become the first medicine to be chosen for treatments of type 2 diabetes and IGT.
In this trial, a DPP-IV inhibitor, Alogliptin, or Metformin are given to diabetic patients whose HbA1c level is below 7.9%. Oral glucose tolerance test (OGTT) will be conducted before, a year after, and two years after the beginning of the trial and beta cell function will be evaluated.
|Diabetes Mellitus, Type 2
|Drug: Alogliptin Drug: Metformin 750 mg
|Study Type:
|Study Design:
|Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
|Official Title:
|Multicenter Trial on Effects of Alogliptin on Pancreatic Beta Cell Function
- beta cell function evaluated from 75 g OGTT [ Time Frame: 2 years ]
75 g OGTT: glucose level, blood insulin level, c-peptide immunoreactivity (pre-test, 30 mins, 60 mins, 120 mins), fasting blood proinsulin
Oral glucose tolerance test ( OGTT ) will be conducted before, a year after, and two years after the beginning of the trial.
- 1,5-AG level [ Time Frame: 2 years ]Secondary end points include HbA1c level.
|Estimated Enrollment:
|Study Start Date:
|February 2011
|Estimated Study Completion Date:
|December 2014
|Estimated Primary Completion Date:
|December 2013 (Final data collection date for primary outcome measure)
|Assigned Interventions
Experimental: Alogliptin
Alogliptin 25 mg
Drug: Alogliptin
Alogliptin 25 mg, tablets, orally, once daily : two years
Other Name: Nothing
Active Comparator: Metformin
Metformin 750 mg
Drug: Metformin 750 mg
Metformin 750 mg, tablets, orally, thrice daily: two years
The dose increase is possible up to its maximum, 2250 mg, so that HbA1c is maintained below 6.9 %.
Other Name: Nothing
Detailed Description:
Patients will be randomly allocated to two groups. They will receive either Alogliptin or Metformin.
Alogliptin: The investigators will start with 25 mg QD and the dose will be maintained.
Metformin: The investigators will start with 250 mg QD and the dose will be slowly increased to 750 mg TID. The dose increase is possible up to its maximum, 2250 mg, so that HbA1c is maintained below 6.9%. However, increase in dose with elder patients requires careful consideration.
Participants taking part in this study will receive dietary and exercise coaching. Participation in this study is expected to last up to 2 years.
Patients will terminate from the trial when their HbA1c exceeds 8.4% for more than three months.
The investigators will evaluate beta cell function by conducting 75 g OGTT before, a year after, and two years after the beginning of the trial. Alogliptin or Metformin will be stopped three days before the OGTT. The investigators will make sure that urine ketone is negative before an oral glucose load.
|Ages Eligible for Study:
|20 Years to 75 Years (Adult, Senior)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion Criteria:
- Patients who are diagnosed as type 2 diabetes with HbA1c level below 7.9% and haven't received oral hypoglycemic agents or insulin treatments for the past three months.
Exclusion Criteria:
- Patients whose 75 g OGTT 30-minutes insulin secretion exceeds 100 μU/ml
- Patients with renal failure with serum creatinine level ≧ 1.2
- Patients with hepatocirrhosis
- Patients with proliferative diabetic retinopathy or worse
- Patients with acute infectious disease
- Patients who are treated with steroids
- Patients with cancer
- Pregnant patients
- Patients with malfunction of the heart (NYHA classification III-IV)
- Patients who are decided to be inappropriate subjects by study physicians
Please refer to this study by its ClinicalTrials.gov identifier: NCT01303055
|Contact: Takahiro Tosaki, MD, PhD
|Dept. of Intern. Med., School of Dentistry, Aichi Gakuin University
|Nagoya, Aichi, Japan, 464-8650
|Contact: Takahiro Tosaki, MD, PhD +81-52-759-2111 firstname.lastname@example.com
|Principal Investigator: Takahiro Tosaki, MD, PhD
|Sub-Investigator: Keiko Naruse, MD, PhD
|Tosaki Clinic for Diabetes and Endocrinology
|Not yet recruiting
|Nagoya, Aichi, Japan, 468-0009
|Contact: Takahiro Tosaki, MD, PhD email@example.com
|Principal Investigator: Takahiro Tosaki, MD, PhD
|Diabetes Clinic, Okazaki East Hospital
|Okazaki, Aichi, Japan, 444-0008
|Contact: Takahiro Tosaki, MD, PhD +81-564-22-6616 firstname.lastname@example.com
|Sub-Investigator: Chizuko Suzuki, MD, PhD
|Sub-Investigator: Maiko Mizutani, MD, PhD
|Principal Investigator: Takahiro Tosaki, MD, PhD
|Diabetes Center, Yokkaichi Social Insurance Hospital
|Yokkaichi, Mie, Japan, 510-0016
|Contact: Takahiro Tosaki, MD, PhD +81-59-331-2000 firstname.lastname@example.com
|Sub-Investigator: Miho Miyoshi, MD
|Sub-Investigator: Tomoki Majima, MD
|Principal Investigator: Takahiro Tosaki, MD, PhD
|Study Chair:
|Takahiro Tosaki, MD, PhD
|Aichi Gakuin University
|Responsible Party:
|Takahiro Tosaki, Aichi Gakuin University
|ClinicalTrials.gov Identifier:
|NCT01303055 History of Changes
|Other Study ID Numbers:
|Study First Received:
|February 23, 2011
|Last Updated:
|February 23, 2011
Keywords provided by Aichi Gakuin University:
Pancreatic beta Cell
Diabetes Mellitus, Type 2
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases
Hypoglycemic Agents
Physiological Effects of Drugs
Pharmacologic Actions
hemoglobin A1c protein, human
Oral Glucose Tolerance Test
Additional relevant MeSH terms:
Diabetes Mellitus
Diabetes Mellitus, Type 2
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases
Hypoglycemic Agents
Physiological Effects of Drugs
Hormones, Hormone Substitutes, and Hormone Antagonists
Dipeptidyl-Peptidase IV Inhibitors
Protease Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
ClinicalTrials.gov processed this record on September 19, 2017

subset: commoncrawl


text:
Posted 5 years ago
(476 items)
British pre WW11 "experimental" steel helmet , similar to one posted earlier, a different type of test chin strap fixing using WW1 split rivets. No markings on the helmet, and the manufacturer name on the liner has been machined out to hide the identity of the factory/maker. This helmet still has an original folded document under the liner, mentions the Midland Bank, ( I have not had the courage to try and get it out, may be instructions on helmet usage or copy patent? I dont know). The S on the front normally means Salvage, for example the recovery of scrap metal/aircraft etc. However, may also be for Security, with the document inside relating to the Midland Bank, obviously cash still had to be transported to banks and so may relate to this.


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MOUNT WASHINGTON - A late recruiting push from Campbellsville University suited Bullitt East senior Lindey Young just fine and the 6-2 center recently accepted the scholarship offer from Lady Tiger head coach Ginger Colvin.
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Are you the kind of person who loves engineering?
Do you want to make contributions across the technological disciplines in fields like polymers, nanoparticles, photovoltaic devices, amorphous semiconductors, optics, low energy nuclear physics, cheminformatics, ad hoc networks, spatio-temporal geostatistics, and nonlinear PDEs? If so, then a program in applied science may be for you.
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This game was classified by the community with the following category scores - Violence=0/3, Sex=0/3, Mature Content=0/3. Set sail aboard the legendary Old Spice clipper ship to the 4 FRESHEST destinations on earth! From coolest to warmest you will sail by Matterhorn, Denali, Fiji and Cyprus. A Fresh, Fast Paced Card Game where the object is to be the last player still holding an Old Spice Fresh Destination Deodorant, making you the FRESHERSHIST!
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Category: Honor Warren
There are some celebrity kids' names that are immediately embraced by other parents and become instant hits. Take Kingston, for example, the name chosen for personal reasons relating to the city in Jamaica by Gwen Stefani and Gavin Rossdale: it had all the ingredients to make it a success– accessibility, likeability, a strong, familiar sound with regal overtones, plus extremely high-profile parents.
Another name with similar qualities is Maddox, the first son of Angelina Jolie, which first entered the popularity lists in 2003 and has been steadily climbing ever since. A few recent names—Honor (Warren), Clementine (Hawkes), Seraphina (Affleck), and Harlow (Madden) spring to mind—were direct hits, and seem sure to spread.
On the other side of the coin are those that were just as instantly rejected as too weird for everyday consumption: the Ikhyds, Banjos, Bandits, Pumas, Pirates and Peanuts.


text:
Topic: UK NICE Guidelines - SIRT for ICC.
Selective internal radiation therapy for primary intrahepatic cholangiocarcinoma.
http://publications.nice.org.uk/selecti … oma-ipg459
cholangiocarcinoma.org :: Cholangiocarcinoma Foundation Discussion Board
a resource for patients, friends, caregivers and loved ones.
You are not logged in. Please login or register.
|La fundación de colangiocarcinoma (CCF) ahora ofrece servicios de traducción en Español.
Por favor publique sus preguntas en Español y un intérprete le va responder.
Join our new Mentoring Program
A new discussion board experience is coming this September!
After 10 years, we're upgrading our discussion board to a new modern system. The new forum will be easier to use, mobile-friendly and loaded with new features! We'll be taking all of the existing posts and users over to the new board, you won't have to do anything. If you have any questions, we've started a thread here to discuss.
Selective internal radiation therapy for primary intrahepatic cholangiocarcinoma.
http://publications.nice.org.uk/selecti … oma-ipg459
Hi, Gavin,
They do not say which SIRT(selective internal radiation treatment); I presume it will be radioembolization.
With regard to radioembo, I still have doubt on its effectiveness,side effects and its subsequent influence on the decision making process of both the oncologists and surgeons when the tumor recur.
Gavin, be sure to say hi to your mum for me; sorry I have forget to mention her in recent messages as I always do due to the changing of my own situation, please forgive me.
God bless.
Thanks for that Percy. I too assumed it would be radioembolization. And you have absolutely nothing to apologise about what so ever!
The second link describes the procedure as
"Tiny radioactive 'beads' are injected into branches of the artery that supplies blood to the liver"
so definitely talking about radioembolization.
Percy: My wife is being treated at Stanford, and radioembolization seems to be a likely treatment path. I share some of your concerns. I would be grateful if you could elaborate on this concern you have "its subsequent influence on the decision making process of both the oncologists and surgeons when the tumor recur."
What types of future procedures are impacted by radioembolization?
Hi, Scott,
Stanford is one of the hospital that do radioembo a lot because either they push for it to learn more or they thought it may be one of the tools they want to used at par with Northwestern university which spent lot of time on this procedure.
When this procedure came out three years ago and patients on this board mentioned they had it done.(at least 6-8of them, check out 2000miles entries by just clicking his ID after you sign on. There will be more details.) I am very interested since they can , in theory, taking care of the cancer that cannot removed by surgery or it is too big for RFA (>3-4cm and more than 3-4 tumors and in tight spot.) .it sounds like an excellent choice. I personally communicated to at least three of them,most of them over 60 years old, and may had comobidities ( other health issues). All of them passed away within or around a 6-8 months period . This was why I raised the safety issue of radioembo issue and ask 2000 milers to help me for the stats just from our members.
The reason, as far as I am concern, is that , I am not sure how the beads or resin , which will stay inside the liver for a long time( 2-3days) will affects the outcome of recurrence; I am really not sure, even they report the radiation of the beads will affect both the tumor and healthy tissues , and at the most the radiation will only be radiated about 3mm beyond the tumor site, that means the maximum effects that will affect the health tissue that surround the tumor is 3mm at the most . but I did read a report that the range of the radiation may be more like 3-12mm. I think it is depended on the beads size and where the beads end up with in the liver. I know the resin type can go deeper, but what if the different size of the beads go into the tumor not as planed (ie: a few of the big beads goes in first and block the subsequent little beads to go deeper on the same intended to treat site. If so, the readioembo is not completely effective. Furthermore, if the above range of 3-12mm radiation zone is true, that means the procedure can affect and kill relatively more a portion of the heavy cells which are not intended . Unlike RFA the burn off is around 4-5cm for a 3cm size tumor and over time they will fill up the hoe with regenerated cells, I don't know what the patients' own body will do with such a large dead tumor tissue inside the liver without surgically remove the tumor later in the radio embo procedure and if the liver regenerated the same size of what the radioembo left, how does the body keeping or reabsorb such big dead mass in the body?
The really concern to sum this up is the total radiation the patient will have over the ENTIRE treatment period from diagnosis to each recurrence and beyond. .
I also knew one of the well known oncologist shares the concern about the effectiveness of radioembolization just of short of disapproval of the whole procedure.
Besides, about the lung shunt, even if my is= to 6 and the acceptable is < 20.
I don't want to take that chance to get pneumonitis .
Scott, please remember, I am a patient only and not a doctor, I know Dr. Tse and his department is good at what they do, but it is all up to you to discern what the radioembo really means to your wife.
The most concern for me with regard to radioembo,along with every 3 month CTscan and PET scan and the future diagnosis and treatment like RFA, microwave, IRE, and chemoembolization(TACE) are all guided by Ct scan for the procedure and thus we, as patients ,should account for ALL of these accumulative radiation too.
The liver is a very sensitive organ, you try to buy a fresh pig liver and put it in the microwave oven for 1,3,5 and 10 min; low,medium, and high. And you will see how sensitive the liver are . And radioembo usually applied to a relatively large part of the liver( the entire left or right lobe) and therefore a lot of radiation will deliver to the liver.
I am lucky in a way that I can use RFA for the small sizes of my tumors and therefore I used RFA instead of sectional radioembo for the 2.5x3cm area.
But I still will not rule out radioembo as my last resort .
God bless.
Many thanks Percy. You have given me a lot to consider.
Selective internal radiation therapy
for primary intrahepatic
http://www.nice.org.uk/nicemedia/live/1 … /64613.pdf
The information expressed is not medical advice. The discussion boards are not intended to replace the services of a trained health professional or to be a substitute for the medical advice of physicians or other healthcare providers. Read the full disclaimer.


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Gabriela Cowperthwaite joins MSNBC's Alex Witt to discuss her documentary, "Blackfish." Her documentary raises critical questions about whether whales should be held in theme parks and the scope of trauma they suffer from being kept in captivity.
Two fishermen off the coast of Virginia saw a whale tangled in fishing rope, so they jumped into action and freed the endangered creature.
It survived countless storms and Confederate raids during the Civil War while taking crews across unchartered oceans in search of whales whose oil lit the world. Full story
What looked to be a peaceful encounter between a whale and a surfer took a violent turn when the whale hit the surfer with its massive tail.
Florida teen takes a ride on the back of a 50,000 pound whale shark. WBBH's Jim Spiewak reports.
A dead fin whale measuring 68 feet in length was found beached along the Washington State coast. Researchers think a ship may have hit the animal. KING's Mitch Pittman reports.
Talk about a fish story: One angler has a killer whale of a tale to tell after an orca whale snatched a halibut right off his line for a meal, as captured on video.
A mother pygmy sperm whale and her calf washed ashore in Jupiter, Florida, where rescue teams and NOAA officials were unsuccessful at saving the pair. NBCNews.com's Dara Brown reports.
Whale of a time - A humpback whale jumps to the surface of the Pacific Ocean off Colombia, South America, on July 16.
Tillikum, a killer whale at SeaWorld amusement park, performs during the show "Believe" in Orlando in this September 3, 2009 file photo. The "Blackfish" documentary was originally conceived without a point of view as Gabriela Cowperthwaite set out to answer the question of why a top trainer at SeaWo
A Humpback whale jumps to the surface of the Pacific Ocean at the Uramba Bahia Malaga natural park in Colombia, on July 16, 2013. Humpback whales migrate annually from the Antarctic Peninsula to peek into the Colombian Pacific Ocean coast, with an approximate distance of 8,500 km, to give birth and
A beached humpback whale lies on the shore of Santa Rosa fishing town, 17.6 km west of Chiclayo, July 10, 2013. Government scientists will collect samples from the cetacean, that weighs approximately 6 tonnes and stretches around 15 metres long, on Thursday to determine the cause that led it to be


text:
From the Allergic Living Archives. First published in the magazine in 2008.
If you have a child with peanut allergies, other parents will say to you: "Nobody was allergic to peanut butter when I was a kid." If a cat swishing through a room starts you wheezing, you'll get asked: "How come so many people have asthma?" Both are reasonable questions, variants on the broader million-dollar one: "Why do so many people have allergies today?"
If you want an easy answer, allergy experts will simply say they don't know. But what they mean is – they don't know entirely. The fact is that scientists understand a lot more about allergic disease than they did a decade ago. There are still gaping holes in their knowledge, but as they continue to fill in the pieces to the puzzle, what they are finding is fascinating and often surprising. In the following investigation, Allergic Living examines what science knows so far about why allergies occur.
In the Beginning
When a baby is born, its immune system is a work in progress. "You're born with a naïve, allergic-skewed immune system," explains Dr. Michael Cyr, an allergist and immunologist at McMaster University in Hamilton, Ontario. This is what scientists call the Th2 mode.
During the first days, weeks and months of life, as the baby comes into contact with various germs, bacteria, viruses and infection, the system is supposed to start learning to distinguish between what is harmful and what is benign.
Some allergists liken the emerging immune system to a toggle switch or a reset button: we're all born in that Th2 mode and then that first bout of sniffles at eight weeks or the ear infection at four months begins to "switch" the immune system over from Th2 to Th1 mode or fighting bacterial infection mode.
But in the person with a genetic inclination to allergy, something misfires and the switchover doesn't happen properly. Cyr, who's a researcher with AllerGen (the Allergy, Genes and Environment Network), says that why this process happens easily for some people but not for others remains unclear, and may depend on a confluence of factors.
The young child who doesn't get switched over is now atopic – predisposed to developing an allergic response to a trigger such as cat dander or ragweed pollen or peanuts. After breathing in or consuming one of those, the child's immune system creates allergy antibodies – specifically Immunoglobulin E or IgE antibodies – to guard against the offending trigger. The next time the immune system encounters it, the IgE will go on the defensive, setting off a cascade of allergic symptoms.
Though genetics are a large contributing factor to whether a person becomes allergic, scientists haven't found one specific allergy gene. "It's becoming clear that it's not a gene, it's a whole series of genes," says Cyr. Something has changed to increase the number of us who are developing allergies, says Dr. Dennis Ownby, a professor of pediatrics and the head of allergy and immunology at the Medical College of Georgia in Augusta.
"What seems to have happened over the last three decades, at least in developed countries, is that genetic ability [to be allergic] has become more prominent," he says.
Just how much have allergies and asthma grown? Figures from the World Allergy Organization reveal the global prevalence of asthma has increased by an astounding 50 per cent every decade for the past 40 years. In North America today, leading allergy organizations estimate that about 24 million Americans and three million Canadians have asthma.
In the past decade alone, the prevalence of food allergy, once an uncommon condition, has skyrocketed. The Food Allergy & Anaphylaxis Network*, the U.S. education group, estimates that about 12 million Americans – 4 per cent of the population – now contend with the disease. The Canadian rate of food allergy is estimated to be comparable. Peanut allergy alone has doubled in young American kids.
In our modern world, allergy has spread like wildfire. Scientists are certain that genes alone can't be the whole reason why. "The genetic pool does not dramatically change over decades," notes Cyr. "So it's obvious there's something else going on." And that something appears to be our environment.
Getting to the Dirt
While references to asthma date back to ancient Chinese medical texts, the real story of our modern understanding of allergy begins in earnest in 1989. It was a heady year, with the fall of Berlin Wall and the beginning of the opening up of the former East bloc. A team of German scientists decided this presented a great opportunity to compare the prevalence of asthma in Leipzig (former East Germany) and Munich (former West Germany).
Here were two highly similar gene pools of people who had been living in very different societies and conditions. "At that stage, everyone, including us, believed that air pollution was causing asthma and allergies," says Dr. Erika von Mutius, who was then a young pediatrician and team leader, and who today is a professor and head of the asthma and allergy department of Munich University's Children's Hospital.
When the findings began coming back showing that there was considerably more asthma in modern, Western, hygienic Munich than among the study group living in Leipzig with its billowing factory smokestacks, the researchers were incredulous.
"It was so opposite what we'd anticipated," recalls von Mutius on the phone from Munich. "We didn't believe it, so we thought it was a mistake in data entry and re-entered all the data." But the data were right, and the results were published in 1992.
*Update: The organization FAAN has been renamed FARE.


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The expansive area that is Santa Fe County District 1 covers both the northeastern corner of the city of Santa Fe and a southeastern smidgen of Española, plus all the pueblos and hamlets in between. The Democratic race to replace outgoing County Commissioner Harry Montoya remains packed, though the field has narrowed slightly. A fifth declared candidate, Sef Valdez, tells SFR he dropped out of the race April 6 for personal reasons. The remaining four candidates for the June 1 primary were subjected to SFR's election-season staple, the Pop Quiz. The rules: We make an appointment, they answer our questions, we print the answers verbatim. No Googling, no hints, no phone-a-friend callbacks.
1. How many road miles is Santa Fe County responsible for maintaining?
2. Explain Santa Fe County's new Renewable Energy Financing District.
3. To cut down on drunk driving, the county's CADDy program subsidizes the cost of a cab ride on weekend nights. What is the CADDy fare?
4. Think like a survivalist: If society collapsed, where in District 1 would you bunker down?
5. What's the biggest problem in District 1 your opponents aren't talking about?
6. The Santa Fe County Healthcare Assistance Program, formerly known as the Indigent Fund, pays certain hospital bills for people who can't afford them. Eligibility is limited to those whose gross household incomes fall within 80 percent of the area's average median income as defined by the US Department of Housing and Urban Development. What is 80 percent of Santa Fe's median family income?
7. The National Indian Gaming Commission licenses tribal gambling operations. According to the NIGC, how many licensed gaming operations are there on Pojoaque Pueblo?
8. Approximately 14,000 cubic yards of soil at the new courthouse site in downtown Santa Fe are contaminated. With what pollutant is the site contaminated?
Daniel "Danny" Mayfield, 42, former chief of staff for the New Mexico Public Regulation Commission
1. Corey, they're responsible for maintaining many of the miles of roads; I don't know the exact number.
2. The Renewable Energy Finance District is an option for residents, and the way it was set up was that the residents and commercial property owners who wish to develop renewable energy on their property can do that, and there's some benefits to the contractors and the residents so they don't have to come up with up-front cash; and there are some tax credits involved.
3. I don't know what the cost is. I would assume it would be a reduced rate because we have an epidemic problem with drunk driving, and we don't have mass transit in our county or our state. I would hope that it would be free, and that we could subsidize that program.
4. I would hope society would never collapse, and I would do everything to make sure that society was safe. And I would bunker down in my local parish.
5. My belief is the biggest problem facing District 1 is finances. It's facing Santa Fe County as a whole, and it's facing the nation. There's significant and huge water issues, as a whole. Finances are a huge issue. Property taxes are a huge issue. And it boils down to the spending level. We need to be prudent; we need to be responsible; and we need to maintain responsibility.
6. I believe the median family income in Santa Fe County is approximately $30,000.
7. How many licensed operations are there on Pojoaque Pueblo?
There's at least three different casinos that I know of on Pojoaque Pueblo: There's one at the gas station on 66, where you can go and play slots; there's the Buffalo Thunder resorts; and there's the Cities of Gold. I would say there's three.
8. They found gasoline in that soil from an old station, and that's what I believe the major contaminant is. There might be a lot of nitrates in there.
Jon Paul Romero, 42, "civil engineer [with] my own consulting firm"
1. A lot of 'em. The Public Works Department is responsible for a lot of them, I can't tell you the exact mileage. I'm going to take what I call a wild guess, and I think it's about 12,700 miles.
2. Well, the way I understand it, the way the new Renewable Energy Finance District works is that they're going to help with tax credits through the property tax base for individuals who want to do renewable energy projects for their home.
3. I should know this down to the T because I sit on the DWI Planning Council. I have not had to use the CADDy program. I think it's 2 bucks.
4. In District 1, huh? That'd be easy. I live in Cuyamungue. Right behind the hills we have a land grant. I'd just go set up a little shop down there. It's over 6,000 acres of undeveloped land. There's a lot of hills, bluffs and mountains back there.
5. [Sigh] I think the biggest problem we face in District 1—everybody's talking about different issues—is building relationships.
District 1 is the most diverse of all the districts. We're encompassed by north Santa Fe County, the City of Santa Fe, five pueblos, Española, and building relationships with all the entities within those boundaries.
6. I believe the median income for a couple is $44,500, so 80 percent of that is gonna be about $35,600. They break it down for a single person, a couple, a family of three, four, five.
7. I believe there's three. 8. That'd be petroleum gas.
Leonard J Roybal, "70 years young," Santa Fe High School boy's basketball coach
1. Wow. Road miles, huh? Uh, probably about 1,800 square miles, maybe. But I don't know how many road miles that would make. That's a hard question. Probably about 50,000.
2. The renewable energy? I believe there's a Senate Bill 200 that the Sierra Club—the chapter, what is it called, the Rio Grande?— put through the Legislature. The renewable energy plan says that they want everybody to—not everybody, but government buildings, schools and things of that nature—want them to insulate and become more energy efficient with toilets and water fountains, insulation, electricity—they're trying to make them more reasonable and lower their bills by 30 percent. I think I had that question the other night on a forum. New buildings, I believe, have to meet certain standards. The old buildings have to come up with some standards, but you know what they say, when you remodel it's more expensive than building new. The old buildings, they have to do what is reasonable rather than forcing them to do things.
3. I think it's free. I don't know about the DWI stuff, but I know to ride that county bus, you need to give them 24-hour notice, and they'll give you a ride to get your groceries or whatever. I would say it's free.
4. I would bunker down right here where I'm at because I have an acre of land that I can farm, and I also have a couple of cows in my backyard and buffaloes next door, and I also have irrigation rights. So, I'm home. SFR: Where's your place? It's in Cuarteles, C-u-a-r-t-e-l-e-s, between Santa Cruz and La Puebla. One side is Rio Arriba; the other is Santa Fe.
5. Well, I would say that my district, probably the quality of
life, safety of roads and highways. Sewage has to be dealt with because
we have a lot of wells here in our area, and everybody has a septic
tank. And also our acequias; they need a lot of work over here in my
area. We're the orphans of Santa Fe County. We don't get any services.
Once you vote for a county commissioner, they never come this way again.
That's why everybody needs to vote for me: Because I live here.
6. How much money does a person—probably whoever's making minimum wage right now. Close to $100 a day, maybe less. That'd be $400 a month—I mean $400 a week. So about $25,000, $35,000 a year. About $25,000.
7. On Pojoaque Pueblo? I would say there's probably—licenses? I would say there's at least three or four, if they require a license for each place that has that. If they license all the areas in Pojoaque, it'd just be one. But I say three or four.
8. I believe it's oil and gas.
Paul White, 57, "glass artist, small business owner, community advocate"
1. [Long pause] 200,000.
2. That has to do with a lien on your property tax that is ongoing with the sale of the house. The new owner would continue the lien if it's not been paid off by the previous owner.
don't know.
4. [Long pause] I'd stay at home right on my property where I have agricultural uses, a river, water, neighbors, friends and family.
5. [Long pause then a sigh] The lack of water security. The issue of transferring water rights from unsecure sources that will be used for large river diversions. These water rights are subject to drought, priority protection issues, priority calls, as well as concerns about the extent of these river diversions in energy costs, ongoing operations and maintenance charges, fees and taxes that the entire county is going to have to pay through property taxes. Rampant development, based on an insecure water source, and other development issues that are tied to a water resource that is based only on a 40-year horizon, which can deplete the aquifer and lessen our water security for the future.
6. [Long pause] $30,000.
7. Two. Three with the bar, the sports bar.
8. Gasoline.
Answer Key
1. According to the Santa Fe County Road Maintenance Division's website: "Within the boundaries of the County, there are approximately 2,900 road miles including state highways, city streets, private roads and county roads. Of the total mileage, Santa Fe County has maintenance responsibilities for approximately 573.81 miles."
2. The Renewable Energy Financing District is intended to help property owners defray the high up-front costs of installing solar panels, wind turbines or geothermal systems. Participating property owners will be able to repay a loan from the county through an additional charge on their property taxes. The concept was enabled by two bills supported by the Rio Grande Chapter of the Sierra Club and passed in 2009 by the state Legislature: SB 647 and HB 572. Though the county and City of Santa Fe each passed ordinances establishing the district, the program has yet to be fully implemented. To get your name on the applicant list, email Santa Fe County Economic Development Director Duncan Sill: firstname.lastname@example.com.
3. The cost is $5 for one or two passengers, or $10 for three or more; the cab's meter will start running once you leave Santa Fe city limits. Call 995-9528 for a CADDy ride on Friday and Saturday nights.
6. According to HUD, the Santa Fe area median income for a "base" family of four is $65,500. So 80 percent of that, the limit for health care assistance, would be $52,400. For a family of three, the eligibility limit would be $47,160; for a family of two, $41,920; and for a single person, $36,680.
7. According to the NIGC's March 2 report, there are five: Buffalo Thunder, Cities of Gold Casino, Cities of Gold Sports Bar, Kicks 66 and the Towa Golf Course Gaming Slots.
8. Petroleum


text:
Rally asks for Jasper County schools chief to quit
Mon, 09 Sep 2013 10:05:04 GMT —
HARDEEVILLE, S.C. (AP) -- About 50 people gathered for a rally in Hardeeville asking the Jasper County school superintendent to resign.
The Island Packet of Hilton Head reports that Saturday's rally was the second one in the past five weeks calling for Superintendent Vashti Washington to quit.
Jasper County schools have received F's on federal accountability standards in each of the past two years. Parents say the schools are filled with broken computers, lack textbooks and allow bullying to go on unchecked.
Washington has been superintendent for two years. She has dismissed the failing grades, saying the scores have no meaning and come from bad data. The Jasper County Board of Education sided with her last week.


text:
MOTHERS-TO-BE in Winchester and Eastleigh can now attend free workshops to help them stay calm and in control during labour.
Confident Birthing workshops organised by Hampshire Hospitals NHS Foundation Trust will help prenatal mothers develop relaxation skills and psychological techniques.
The bi-monthly workshops, part-funded by a lottery grant, are designed to complement routine prenatal classes.
Caroline Brunt, of Hampshire Hospitals, said: "During the sessions, the practitioners will help women understand the importance of their thought processes during labour and birth. They will explain how feelings of stress and fear can affect labour and help women to work with their body in a way that leaves them calm and in control, ready to welcome their baby into the world."
The classes take place every other month at the Carroll Centre, Stanmore, and Wells Place Centre, Eastleigh. To book a course visit hampshirehospitals.nhs.uk/confidentbirthing or call 01420 543365.


text:
Knightly LoveLogic puzzles require you to think. You will have to be logical in your reasoning.
A poor, young knight wants to marry a beautiful princess and she wants to marry him. But the king doesn't want the marriage. He offers the knight a choice. He can draw one of two slips of paper out of a golden urn. One will say "marriage" and one will say "death". The princess is able to whisper to the knight that both slips of paper really say "death". The knight and the princess end up being wed. How does the knight accomplish this?
AnswerThe knight picks a slip of paper and immediately tears it up. He then takes out the other slip and hands it to the king. Since the untorn slip of paper says "death", the knight says that obviously the one he tore up said "marriage".
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text:
how can I stored the value within an a href tag for example my php page does this
echo "
".$row['title']."
";
which prints this code on my ajax page
What is the difference between Archiving and Trashing an Article?
. I want to save the value within href so that I can use it later. Please note its ajax so location.href doesn't work.
if I can store the entire link tag that wouldn't be an issue either. In fact that may be preferred.
Is that link intended to be saved as a bookmarklet? If not then get the JavaScript out of there and into a click event where it belongs.. The href should be used for where you want people without JavaScript to go when they click the link.
Once you get the script out of the HTML and into a separate JavaScript file you will be able to more easily change it to work the way you want.
Yes i want to use that link as a bookmark but when u click on it because it is ajax i dont see that in the address bar so i need a next way to save that value
Virtually all web browsers prevent links from automatically saving as a bookmark, so the standard practice now is to instruct the user to drag the link to their bookmarks/favorites location.
For an example, see http://delicious.com/help/bookmarklets
Ok well I am not really trying to save this to the browser per say but to localStorage so that when the user visits this page again on there mobile phone the links deh favor can be accessed in its own bookmark section within the web app. Is that still not a preferred practice as I see no other way to save the users favorite articles. The drag and drop will not be favorable for all phones hence why I am asking this.
Local storage can be used, but it's available only with HTML5. What you could do is to check if local storage is available, and if it's not you could use cookies instead to store the info.
Since your links contain javascript, you should serialize the data first, before saving it to either local storage or a cookie.
I dont know what serialize means. Also even if i used cookies I still don't know how to save the link itself as it doesn't appear in the address bar since its ajax am using so i dont know how to access the link after i click on it
There might be quite a lot for you to learn here, but we'll give it a go.
To serialize, means to create a text-string version of the code. That might not strictly be necessary, but it can be a useful safety measure.The JSON library provides a nice and useful way to serialize data.
What you can do us to attach an onclick event to the section in which the link is contained. That way any click event will bubble up to where the onclick event is captured, so that you can then work with the link that was clicked.
ok will read up on the JSON it looks a lil more complicated than i thought however on the onclick what function can I use to capture the  tag that the onclick came from? As i said I think once I can get the link I would be much better of in storing that data
That all depends on how your page is structured.
As a simple example, imagine that we have a content section in to which is placed the links.

Part 1
Part 2
With JavaScript you can monitor all onclick events that occur within the content element.
document.getElementById('content').onclick = clickHandlerForLinks;
and that clickHandlerForLinks function can obtain the link that was clicked on, with which you can do what you like with it.
function clickHandlerForLinks(evt) {
evt = evt || window.event;
var targ = evt.target || evt.srcElement;
if (targ.nodeType === 3) {
targ = targ.parentNode;
if (targ.nodeType === 1 && targ.nodeName === 'A') {
// we have a link, do what you will with it.
return false;
The evt line get the event in a cross-browser compatible way, since Internet Explorer likes to do things differently from most other web browsers.
The targ line obtains information from the event about what was clicked. Once again, Internet Explorer is the odd one out using srcElement whereas most other web browsers use target instead.
Checking that the nodeType equals 3, is to deal with an Opera bug of setting the target to a text node, so taht we can get the target back to an element node instead.
The if statement checks that we have an element node (nodeType of 1) and that the element node has a nodeName of "A".
ok that was a bit confusing am a beginner so bear with me I am to assume that the tag will be stored in the targ variable correct also m going to attach my code to this post to see if it makes sense to you. So my new_articles.html calls new_articles.php toobtain the list of articles new_articles.php echos the urls with  tags and all. When the user now click on the link it calls article_desc.php to display the article. so basically i want to save the url that calls article_desc.php when a user clicks a button to make it a favorite.Sorry if the code is scrappy but I haven't gotten around to cleaning it up yet
I will certainly help where I can to help you understand what you need to know in order to achieve what you want to do, but I'm afraid that I won't do the actual work for you.
I have to head off now, but if I have time later on I'll take a look over your code and see if there's anything helpful that I can come up with.
No no am not trying to do that am trying to see how the code you send will fit in in my instance your code you put earlier made reference to some html code and javascript but I don't understand it and where it applies. So i cannot begin to even tweek it to suit my needs. The reason i sent the code was to speak about it in my case not to make you my resident coder.
The first thing that I see is that you're using Joomla for your framework. Very few of us here know much about Joomla, so I would get on to the Joomla forums to find out if Joomla contains anything that can help you to achieve what you require in a much easier way.
Failing that, we can fall back on to some old-school JavaScript programming.
While I am using Joomla it is only the db so the Joomla framework will not help in this instance. Everything i built was from scratch. I tried the code you sent before and it pulls the link fine however I get an error when trying to use the link the Error is
Forbidden You don't have permission to access /Weblog 5/JavaScript:article('39') on this server. Which is very strange. Now going to read up on JSON


text:
Green onion markets are still historically strong, though there were signs of softening as volumes increase in mid-February.
Typically green onion markets moderate by February, said Don Hobson, vice president of sales for Oxnard, Calif.-based Boskovich Farms Inc. But with abnormally warm weather in Mexico's desert growing regions followed by abnormally cold weather, that hasn't been the case this year.
In fact, Hobson said he can't remember a season like this.
"We've been shipping green onions a long time, and I've never seen (a strong market) last this long."
Steve Timsak, salesman for Salinas, Calif.-based Ippolito International LP, agreed.
"I've been doing this for 30 years, and I've never seen them this high," he said. "I'm very happy for the growers. They've taken a beating the last two years."
By the first week of March, weekly volumes should be back to levels that will bring prices closer to normal levels for this time of year, Hobson said.
But Timsak said Feb. 19 that two more cold fronts forecast for February could keep volumes below seasonal averages. He did say, however, that prices the week of Feb. 18 were down $4-5 per box from the week before.
The market in mid-February was close to a two-tiered one, with small sizes, which were more ample, in the $18-per-box range and scarcer medium sizes in the $24 range, Hobson said.
Boskovich was sourcing from the San Luis region of Mexico in February, where it would likely stay until early to mid-June, when the deal switches back to Ojos Negros, Mexico, Hobson said.
After a long stretch of scant supplies, volumes should pick up in the second half of February, said Mark McBride, salesman for Salinas-based Coastline Produce.
But the crop isn't in any rush.
"We thought we'd get some more last week, but then we had more cold weather," McBride said Feb. 18. "One of these days we'll start seeing more, but it's been difficult to forecast. We've had a long light spot."
When the higher weekly volumes do start hitting, long-high f.o.b.s should start to return to more normal seasonal levels, McBride said.
Quality was very good in February, though sizing was on the small side as growers were impatient to harvest to take advantage of strong markets, McBride said.
"There are a greater percentage of smalls and mediums," he said.
Coastline is sourcing green onions from the Mexicali region of Mexico, where it expects to stay until late spring or early summer, McBride said.


text: 11/23/16 2/14/13 POPSUGAR Fashion Marc Jacobs Marc Jacobs Review | Fashion Week Fall 2013 Marc Jacobs Fall 2013 February 14, 2013 by Melissa Liebling-Goldberg 0 Shares Chat with us on Facebook Messenger. Learn what's trending across POPSUGAR. View On One Page Photo 13 of 56 ADVERTISEMENT () Start Slideshow Share This Link Copy What's Your Reaction? Thanks for your reaction Don't forget to share this with your friends! ← Use Arrows Keys → 13 0 previous images 25 more images Previous Next Start Slideshow Marc Jacobs Fall 2013Fall 2013New York Fashion WeekMarc JacobsFashion Week


text:
LAKE COUNTY -- The Lake County Public Works Department reported several weather-related road closures Friday morning.
Bell Hill Road (Kelseyville area) is closed at the Adobe Creek low-water crossing.
Holdenreid Road at Hill Creek (Kelseyville area) is closed to all traffic because of a bridge closure. Drivers should use alternative routes.
Anderson Springs Road (Middletown area) is closed because of downed power lines.


text:
Re: New to the Site
Hi, Sandy,
If the time line was correct, that is from June 24 started to use FUDR pump and alternate with GEMOX and get 70% reduction on the Oct follow-up CT scan; that was a good progress in just 3 mnoths.
Then from Oct to about 3 weeks ago (middle of Nov.);In about just a month's time,development like you described,--"She was beyond shocked to have found a second NEW tumor of good size in the liver and a lesion on the bone on his lowest left rib. She prescribed a PET Scan next week, and an appointment with a Radiologist December 18th to begin Radiation treatment." It looks like the oncologist pretty much thought that the chemotherapy will no longer works, and depends of the PET scan result, they will use radiation like IMRT or SBRT for continuing treatment. If so, can you also ask them to provide a 2nd opinion on interventional radiologist (IR) for consult for chemoembo or radioembo possibilities.
Please mention to your oncologist if possible for her to prescribe targeted therapy agents like Tarceva or sorafenib .even though the tumor is unresectable.
Ask or insist the oncologist to recommend you for a clinical trial in your area . NCCN actually encourage patients to go through clinical trial for unresectable cholangiocarcinoma.
I know there are a few at Mass general and Sloan-kettering .
If your husband still have night sweat, tell the doctor too.
God bless.


text:
MAMMA MIA! Stars Form 'Broadway Fosters For Sandy'
Broadway's MAMMA MIA! stars Judy McLane and Stacia Fernandez have taken the initiative to form a new grassroots organization called BROADWAY FOSTERS FOR SANDY to round up foster parents to give these innocent animals a place to call home until their families can get resettled.
Representing Charles Henderson Animal Rescue at http://www.charleshendersonanimalrescue.org/, the Broadway Dynamos are reaching out to the theater community and beyond looking for people willing to make at least a three week commitment to open their hearts and homes to these displaced pets.
If you are an experienced pet owner and think Fostering is something you can do, please contact them at firstname.lastname@example.com or contact Judy or Stacia via private message on Face book.
Charles Henderson Animal Rescue is also taking donations, and is a registered 501c3 organization and therefore tax deductible.
For tickets, schedule and information about MAMMA MIA! : www.mammamianorthamerica.com/


text:
Keep kids learning
Worried your kid forgets everything they've learnt when not at school? Here's how to keep their brain sharp. more
Susan would have to take a day off work almost every month because of painful periods. She also had recurring diarrhoea. Then in her 30s she found it difficult to get pregnant.
"I'd been diagnosed with irritable bowel syndrome and told I was one of the unlucky girls who had painful periods," Susan, now 43, says. "Finally after struggling to get pregnant, I was given a laparoscopy and all was revealed – I had what my doctor said was 'stage 4' endometriosis which is pretty severe."
Susan, who went on to conceive two babies but not without difficulty, is one of the 10 percent of women who have endometriosis, a common gynaecological condition, often linked with pain and infertility.
Endometriosis occurs when tissue from the inner lining of the uterus, called endometrium, grows outside the uterus – usually in areas like the ovaries, fallopian tubes, and ligaments that support the uterus as well as sometimes on organs including the bladder, bowel, vagina, and cervix.
This misplaced tissue can develop into growths or lesions which respond to the menstrual cycle in the same way that the tissue of the uterine lining does – that is, each month the tissue thickens.
But outside the uterus, often the tissue is unable to separate itself and shed from the organ it's adhered to. When this happens each month it can create scarring, adhesions and inflammation which can go on to cause pain, infertility and bowel problems.
Endometriosis is often categorised by health professionals in stages, starting at Stage 1 which has relatively few implants of endometrium outside the uterus, through to Stage 4 which has extensive implants as well as many adhesions.
Even today with the widespread knowledge of this condition, it's believed many cases remain undiagnosed, written off as just "painful periods".
Research has found that the average delay between the onset of symptoms and diagnosis is still six to 10 years. That's a long time, considering that the condition can worsen over the years without treatment for some women and further hamper their future plans to conceive.
This article was written by Fiona Baker for Kidspot, Australia's best family health resource. Sources include Jean Hailes for Women's Health endometriosis website.
Last revised: Wednesday, 2 November 2011
This article contains general information only and is not intended to replace advice from a qualified health professional.


text:
BREAKING NEWS: Four firefighters shot, two died from their injuries, at the scene of a fire on Lake Road in Webster, NY. The fire was at 191 Lake Road near Bay Road, 3WHAM reports. The victims were taken by Mercy Flight to area hospitals. The other two firefighters are listed in guarded condition at Strong Hospital. The lone gunman has been apprehended, but his condition is not clear. There is no active shooter right now, but sheriff's deputies are still looking for other possible suspects, WHEC reports. DEVELOPING STORY.
USA Today reports: "Webster, N.Y., police Chief Gerald Pickering said "one or more shooters" fired at the firefighters when they arrived around 5:45 a.m. ET at the scene near the shore of Lake Ontario in western New York state.
Visit NBCNews.com for breaking news, world news, and news about the economy