A very informative knol exploring on the relationship of circumcision and human behaviour, written by George Hill, explains the side effects and the reasons why neonatal non-therapeutic circumcision is not recommended.

Behavioral changes in male infant after circumcision

Hill explained that study shows neonatal non-therapeutic circumcision may cause behavioral changes as follow:

• newborn infants who are undergoing unanesthetized cirumcision emit cries of extreme urgency.
• circumcision affects the sleep of newborn boys – the study shows significant increases in wakefulness after circumcision.
• babies feed less frequently and are less available for interaction after circumcision.

Behavioral changes in later life

The negative effects of circumcision in male newborns are carried away into the boys’ later life.

Some of the negative effects entering adulthood include:

• A sense of personal powerlessness
• Lack of trust in others and life
• Reluctance to be in relationships with women
• Low self-esteem
• Decreased ability to communicate

In my opinion, the studies imply that circumcision is better done in adulthood – both for medical and psychological benefits.

If you want to learn more on circumcision and human behavior, do make sure you visit George Hill’s knol.

Here’s why you should keep your eyes on swine flu:

This multi-authored knol is very comprehensive in covering the news and updates on swine flu – Articles, breaking news, video news, feeds and links from all over the Web to help you keep track on what’s happening to the pandemic flu.

The knol writers use the embedded Google Docs to share information, making it effective to less-clutter their knol page.

Make sure you visit this very useful knol to keep you well-informed about the development of swine flu outbreak.

Here is a great knol written by Jennifer Frank, a Family Physician, offering you 10 practical steps to prepare yourself for your doctor visit – You simply don’t want to wait for an hour just to learn that you forget to ask the all-important questions.

10 Steps to making the most out of your doctor’s Visit

1. Identify your Agenda: make sure that everyone from the receptionist to the nurse to the doctor knows what is on your agenda.
2. Make a List: Write down the top 3 things you want to discuss plus any others (if there is extra time).
3. Ask for the Time you Need: Make sure to let the receptionist know everything you want to discuss at the visit.
4. Be Honest: There is nothing we haven’t heard as doctors. And I do mean, nothing. So, feel free to spill all the gory details about whatever it is that is concerning you.
5. Be Patient: Usually it will take some time for the doctor to make a diagnosis (maybe after getting a lab, xray, or other test) and to formulate a treatment plan.
6. Be Nice to the Office Staff: I am amazed sometimes to find out that a patient who was perfectly nice to me was yelling at my receptionist just minutes before.
7. Make Sure You Understand: It recommends that patients ask (and write down the answers to) 3 questions:What is my main problem? What do I need to do? Why is it important for me to do this?
8. Tell the Doctor about Barriers: If you can’t read or can’t read well (this is actually very common), let your doctor know. If you can’t afford your medication, let your doctor know. If you are not willing to engage in lifestyle change (losing weight, quitting smoking, etc), let your doctor know.
9. Follow Up as Directed: If your doctor asks you to come back in 3 months to get that little spot on your arm checked, make sure to do it.
10. Be the Coach: Make sure that you act as the coach. Get input from and advice from your doctor, but take an active role in managing your health care.

For more details, please visit the knol.

All of a sudden, a passer-by collapse and drop in front of you. What would you do? Well, you could yell for help, but yelling without proper medical help is often ineffective in saving someone’s life.

No worries – Here is a knol written by Imron, an Emergency Physician, about the 7-step approach to do Cardiopulmonary Resuscitation (CPR) the right way.

CPR is accessible to everybody. You don’t need to be a health care professional to do CPR. In fact, CPR method is aimed for someone who has no medical background.

Don’t worry – There are only two needed to do CPR – You and a telephone/cell phone. Even better, three person is better than one (this could be achieved through yelling!) The second person helps you and the third person gets more help. A face shield/barrier could help you maintain hygiene during mouth-to-mouth breathing.

7 Steps to do CPR

1. Check for responsiveness
   Check for responsiveness by shouting and shaking the unconscious victim.
2. Call for help
   Call for help by dialling the local medical emergency response number in your city or call for help by telling someone next to you, to get medical help immediately.
3. Open airway
   Open the airway by performing head tilt-chin lift.
4. Look, listen and feel
   Look for movement of breathing, listen for breathing sounds and feel for airflow of breaths.
5. Give two rescue breaths
   Give two rescue breaths by mouth-to-mouth breathing.
6. Check for pulse
   Feel for presence of a carotid pulse in the neck.
7. Start chest compressions
   Begin chest compressions and breaths at 30:2 ratio.

For more detailed explanation on each step, please consult to the CPR knol.

What is insomnia? According to a knol by Rachel Manber, insomnia is a common sleep disorder that cause sufferers to have difficulty in sleeping although they are being sleep deprived.

There are two ways to treat insomnia: with and without medications.

With medication

The FDA has approved certain medications for the treatment of insomnia. These are called hypnotic medications or sleep medications.

Without medication

Psychologists have developed and tested a specific therapy for insomnia called cognitive behavioral therapy for insomnia. Cognitive behavioral therapy is a specific psychotherapeutic approach with variants for treating different mental conditions, such as depression, anxiety, and eating disorders.

With vs. without medication

According to Rachel’s knol, both medications are effective, although difference in characteristic.

Medication for insomnia starts working right away, whereas therapies and other non-medication treatment results emerge slowly. However, non-medication treatments are longer lasting than using medication for insomnia treatment.

If you would like to learn more about insomnia, I suggest you to visit Rachel’s knol.

Euthanasia issues always evolving around a fine line of “mercy killing” – usually motivated due to a person suffering from incurable illness and disease.

What is euthanasia? According to a knol written by Sam Vaknin on euthanasia:

Euthanasia is the intentional premature termination of another person’s life either by direct intervention (active euthanasia) or by withholding life-prolonging measures and resources (passive euthanasia), either at the express or implied request of that person (voluntary euthanasia), or in the absence of such approval (non-voluntary euthanasia). Involuntary euthanasia – where the individual wishes to go on living – is an euphemism for murder.

In my opinion, passive euthanasia is immoral – I agree with Sam on this. The withholding of medical treatments will result in a slow and potentially torturous death.

The issues on euthanasia has always been related to the right to live and the right to life. Questions, such as, “killing or letting die?” “morally acceptable or rightfully acceptable?” are always the debate topic among society members. The more issues raised, the more unanswered questions uncovered and the more moral dilemma issues raised.

To explore Sam Vaknin’s arguments on euthanasia, please visit his thoughtful knol.

Not only patients, health care organisations all over the world also involve physicians, nurses, pharmacists and other health care professionals collaborating multinationally with one another to improve health care.

A knol by Mr. Emerson Smith report some cases which very well described what’s going on in International health care today.

One thing he mention that I feel important is that hospitals and health care providers today are not competing with their local or regional competitors in winning patients – they have to compete health care providers from all over the world.

Mr. Emerson stated in his knol that in 2010, according to Deloitte Center for Health Solutions, there will be approximately $68 billion of health care departing the US for foreign health care providers.

The competition is stiff – hospitals today offer top-notch health care services at a very affordable cost, with focus on global markets. And it’s not something large hospitals and health care providers can ‘monopoly’ anymore – As an example, a small hospital – Galichia Heart Hospital in Wichita, Kansas, is targeting Canadian and British markets, offering coronary by-pass for patients without complications for a flat fee of $10,000. That is very affordable for such big operation.

The health care is so global today, in such a way that in recognising the increase of patients leaving the US, The American Medical Association approved its Guidelines on Medical Tourism in June 2008. Singapore has done this even before the US did – putting health care right in the middle of its tourism campaign.

Mr. Emerson explained about medical tourism as follow.

Medical tourism is, in essence, tourism that main purpose is not for vacationing, but to get the best health care a ‘tourist’ can – all in all, in a facility that threat them like royalty and for a reasonable cost.

He also noted that we should call it global medicine.

For more case studies and explanation on global health care issues, I suggest you to visit the knol.

Luckily he kept seeking for opinions, and finally found out that his son was not being bad – his son suffered from ADHD.

For those of you that are as clueless as me about ADHD, here’s an excellent knol that explained extensively about ADHD.

What is ADHD?

Dr. Russell Barkley, a Clinical Neuropsychologist who wrote the knol explain ADHD as follow:

ADHD is characterized by difficulties with frequent distractibility, coupled with an inability to sustain attention to tasks or persist toward goals as well as others, particularly if the situation demands effort… They (the ADHD sufferers – ed.) are typically fidgety, restless, hyperactive, and otherwise engage in frequent task-irrelevant behavior, or activity that is frankly inappropriate for the situation.

How do you know if someone suffer from ADHD?

The typical symptoms of ADHD, according to the knol, are:

• Poorly sustained attention or persistence of effort to tasks, particularly those that are relatively tedious, boring, and protracted.
• Impaired impulse control and delay of gratification.
• Excessive task-irrelevant activity or poorly regulated activity to situational demands. Most, but by no means all individuals with ADHD, are excessively fidgety, restless, and “on the go” as children.

There are certain conditions related to ADHD:

• Academic under-productivity, underachievement, and learning disabilities.
• Aggression or conduct problems.
• Excessive emotional displays or immaturity.
• Problems in social relationships.

What causes ADHD?

Dr. Barkley explained that the evidence for the hereditary or genetic basis of ADHD is now overwhelming and irrefutable. It is now believed that genetics probably accounts for 65-75% of all clinical cases.

Other, arguable causes may include social circumstances, the consumption of food additives, preservatives, or sugar, and individuals with seizures or epilepsy.

ADHD treatments

There is no cure to ADHD in present time. However, there are medical and behavioural treatments that reduce the symptoms and minimise the ADHD impact in the sufferers’ life.

There are also other treatments with no strong evidence in their effectiveness in treating ADHD, such as dietary management, long-term psychotherapy, chiropractic skull manipulation, sensory integration training or other physical movement-based programs such as metronome therapy or DORE clinic exercises, visual perspective training, and cognitive therapy or self-instruction training.

Biofeedback with EEG techniques (neurotherapy), cognitive training of working memory (CogMed), and training in meditation techniques remain experimental treatments at this time.

If you are interested in learning more on ADHD, make sure you visit Dr. Barkley’s knol.

One of the answers lies in the use of simulation in medicine.

An excellent knol written by Diane Sliwka and Manuel pardo explains all you need to know about the use of simulation in medicine.

According to the knol, simulation, in essence, is a technique for practice and learning that can be applied to many disciplines, such as aviation, nuclear power plants, space aeronautics, the military, business, and healthcare.

There are many types of simulation:

1. Standardized Patients: Standardized Patients (SPs) are actors or lay persons who are trained to reliably play the role of a patient in a clinical encounter.
2. Computer (Screen) Based Systems and Virtual Reality: Computers and virtual reality currently allow users to interact with an environment whose output is through a computer screen.
3. Part Task Trainers: Part task trainers are devices designed to replicate a particular part of the anatomy.
4. Hybrid Simulation: Hybrid simulation combines standardized patients with part task trainers.
5. Full Body Mannequin: Full body mannequin-based simulators are currently used primarily for training teams of doctors to respond to medical, emergency room, surgical, or obstetric patients.

Do those simulations really helps medical students and apprentices?

According to the knol and its sources – yes.

The features of simulation which best facilitate learning include:

1. providing feedback.
2. repetitive practice.
3. curriculum integration.
4. range of difficulty level.

The educational benefits of simulation in medical education include the following:

1. deliberate practice with feedback.
2. exposure to uncommon events.
3. reproducibility.
4. the opportunity for assessment of learners.
5. the absence of risk to patient.

You can read the more detailed explanation on simulation in medicine from the knol.

If you are interested to learn more about sunscreen and the right ways to use it for your protection, I suggest you to visit a knol by Dr. Suraj Venna.

Dr. Suraj Venna wrote a knol about sunscreen and address frequently asked questions regarding the use of sunscreen, for example: How often should I be using sunscreen? Are sunscreen truly waterproof? What should I look for when purchasing a sunscreen? and other interesting to know Qs and As.

From dozens of questions answered by Dr. Suraj, I found this question and answer useful:

Q: What should I look for when purchasing a sunscreen?

A: You want a broad spectrum sunscreen, one that covers both the UVA and UVB ranges, with an SPF of 15 for daily use, and at least 30SPF for prolonged sun exposure (30 minutes or greater). The Skin Cancer Foundation has a Seal of Recommendation embossed on the products that meet rigorous standards. For a sunscreen to attain this seal it must meet the following criteria:

• SPF (Sun Protection Factor) of 15 or more
• Testing of the sunscreen on a specified number of people
• Evaluated for possible adverse skin reactions
• If labeled water proof, it must prove this through testing

If you want to learn more about the use of sunscreen, you can visit Dr. Suraj’s very useful knol.