Health And Beauty: Bread, cereals and other starchy foods

Your weight

Expert advice to help you maintain a healthy weight

Dissatisfied with your weight?

We're bombarded with scare stories about weight, from size zero to the obesity 'epidemic'. But a healthy weight is determined by different factors for each of us. Our expert advice is designed to help you achieve and maintain a healthy, life-enhancing weight.

Overweight or underweight?

Being the right weight has a positive effect on wellbeing but also on our health, as being the wrong weight can cause a range of medical problems.

This food group is your body's main source of energy and contains bread, pasta, rice, potatoes, noodles, chapatti, cereals and other starchy carbohydrates.

Refined and unrefined grains

The foods listed above (apart from potatoes) are all produced from grains, such as wheat, corn or rice. They should be a part of all meals, filling about a third of your plate. They can come in two forms – refined or unrefined (often known as whole grains).

Refined grains have been stripped of their outer bran coating and inner germ during the milling process, leaving only the endosperm. They include white rice, white bread and white pasta.

In a whole grain the bran, germ and endosperm are all still present. The bran is an excellent source of fibre; the germ is a source of protein, vitamins and minerals; and the endosperm supplies most of the carbohydrates, mainly in the form of starch. Unrefined or whole grain forms provide far more nutrients than their unrefined counterparts.

Whole grains are rich in phytochemicals and antioxidants, which help to protect against coronary heart disease, certain cancers, and diabetes. Studies have shown people who eat more whole grains tend to have a healthier heart.

Most people get their whole grain from wholemeal bread or whole grain breakfast cereals such as porridge, muesli or whole wheat cereals. Choose a whole grain variety over processed or refined grains, and look out for added sugar or salt.

Health And Beauty: Tackling nutritional problems for older people

Your weight

Expert advice to help you maintain a healthy weight

Dissatisfied with your weight?

We're bombarded with scare stories about weight, from size zero to the obesity 'epidemic'. But a healthy weight is determined by different factors for each of us. Our expert advice is designed to help you achieve and maintain a healthy, life-enhancing weight.

Overweight or underweight?

Being the right weight has a positive effect on wellbeing but also on our health, as being the wrong weight can cause a range of medical problems.

Maintaining health as we age can be challenging, so a diet rich in nutrients is increasingly important as we grow older.

Factors that affect nutrition

There are many factors that influence nutritional status in older adults, and they can be broadly grouped into four main areas:

Those that naturally occur during the ageing process, such as a reduced ability to absorb nutrients efficiently, or a sore mouth due to dentures

Disease-specific conditions such as cancer, which place greater nutritional demands on people

Some drugs that interact with nutrients and prevent absorption, for example aspirin, which can interfere with the absorption of vitamin C

Social influences, such as not being able to get to shops, or social isolation

Continuing to enjoy food and to eat a diet that maintains nutritional status is key to coping with illness. Poor nutrition has been shown to increase the risk of infections, bed sores, chest infections and poor wound healing. Good nutritional status will help ensure a quicker recovery.

Health Insurance

Health insurance is insurance that pays for medical expenses. It is sometimes used more broadly to include insurance covering disability orlong-term nursing or custodial care needs. It may be provided through a government-sponsored social insurance program, or from private insurance companies. It may be purchased on a group basis (e.g., by a firm to cover its employees) or purchased by individual consumers. In each case, the covered groups or individuals pay premiums or taxes to help protect themselves from high or unexpected healthcare expenses. Similar benefits paying for medical expenses may also be provided through social welfare programs funded by the government.

By estimating the overall risk of healthcare expenses, a routine finance structure (such as a monthly premium or annual tax) can be developed, ensuring that money is available to pay for the healthcare benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity.^[1]

How it works

A health insurance policy is a contract between an insurance company and an individual or his sponsor (e.g. an employer). The contract can be renewable annually or monthly. The type and amount of health care costs that will be covered by the health insurance company are specified in advance, in the member contract or "Evidence of Coverage" booklet. The individual insurered person's obligations may take several forms:^[8]

• Premium: The amount the policy-holder or his sponsor (e.g. an employer) pays to the health plan each month to purchase health coverage.
• Deductible: The amount that the insured must pay out-of-pocket before the health insurer pays its share. For example, a policy-holder might have to pay a $500 deductible per year, before any of their health care is covered by the health insurer. It may take several doctor's visits or prescription refills before the insured person reaches the deductible and the insurance company starts to pay for care.
• Copayment: The amount that the insured person must pay out of pocket before the health insurer pays for a particular visit or service. For example, an insured person might pay a $45 copayment for a doctor's visit, or to obtain a prescription. A copayment must be paid each time a particular service is obtained.
• Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a copayment), the co-insurance is a percentage of the total cost that insured person may also pay. For example, the member might have to pay 20% of the cost of a surgery over and above a co-payment, while the insurance company pays the other 80%. If there is an upper limit on coinsurance, the policy-holder could end up owing very little, or a great deal, depending on the actual costs of the services they obtain.
• Exclusions: Not all services are covered. The insured person is generally expected to pay the full cost of non-covered services out of their own pocket.
• Coverage limits: Some health insurance policies only pay for health care up to a certain dollar amount. The insured person may be expected to pay any charges in excess of the health plan's maximum payment for a specific service. In addition, some insurance company schemes have annual or lifetime coverage maximums. In these cases, the health plan will stop payment when they reach the benefit maximum, and the policy-holder must pay all remaining costs.
• Out-of-pocket maximums: Similar to coverage limits, except that in this case, the insured person's payment obligation ends when they reach the out-of-pocket maximum, and the health company pays all further covered costs. Out-of-pocket maximums can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.
• Capitation: An amount paid by an insurer to a health care provider, for which the provider agrees to treat all members of the insurer.
• In-Network Provider: (U.S. term) A health care provider on a list of providers preselected by the insurer. The insurer will offer discounted coinsurance or copayments, or additional benefits, to a plan member to see an in-network provider. Generally, providers in network are providers who have a contract with the insurer to accept rates further discounted from the "usual and customary" charges the insurer pays to out-of-network providers.
• Prior Authorization: A certification or authorization that an insurer provides prior to medical service occurring. Obtaining an authorization means that the insurer is obligated to pay for the service, assuming it matches what was authorized. Many smaller, routine services do not require authorization.^[9]
• Explanation of Benefits: A document sent by an insurer to a patient explaining what was covered for a medical service, and how they arrived at the payment amount and patient responsibility amount.^[10]

Prescription drug plans are a form of insurance offered through some employer benefit plans in the U.S., where the patient pays a copayment and the prescription drug insurance part or all of the balance for drugs covered in the formulary of the plan.

Some, if not most, health care providers in the United States will agree to bill the insurance company if patients are willing to sign an agreement that they will be responsible for the amount that the insurance company doesn't pay. The insurance company pays out of network providers according to "reasonable and customary" charges, which may be less than the provider's usual fee. The provider may also have a separate contract with the insurer to accept what amounts to a discounted rate or capitation to the provider's standard charges. It generally costs the patient less to use an in-network provider.

Swine Influenza

Swine influenza (also called H1N1 flu, swine flu, hog flu, and pig flu) is an infection by any one of several types of swine influenza virus. Swine influenza virus (SIV) is any strain of the influenza family of viruses that is endemic in pigs.^[2] As of 2009, the known SIV strains include influenza C and the subtypes of influenza A known as H1N1, H1N2, H3N1, H3N2, and H2N3.

Swine influenza virus is common throughout pig populations worldwide. Transmission of the virus from pigs to humans is not common and does not always lead to human influenza, often resulting only in the production of antibodies in the blood. If transmission does cause human influenza, it is called zoonotic swine flu. People with regular exposure to pigs are at increased risk of swine flu infection. The meat of an infected animal poses no risk of infection when properly cooked.

During the mid-20th century, identification of influenza subtypes became possible, allowing accurate diagnosis of transmission to humans. Since then, only 50 such transmissions have been confirmed. These strains of swine flu rarely pass from human to human. Symptoms of zoonotic swine flu in humans are similar to those of influenza and of influenza-like illness in general, namely chills, fever, sore throat, muscle pains, severe headache, coughing, weakness and general discomfort.

Signs and symptoms

In swine

In pigs influenza infection produces fever, lethargy, sneezing, coughing, difficulty breathing and decreased appetite.^[11] In some cases the infection can cause abortion. Although mortality is usually low (around 1-4%),^[2] the virus can produce weight loss and poor growth, causing economic loss to farmers.^[11] Infected pigs can lose up to 12 pounds of body weight over a 3 to 4 week period.^[11]

In humans

Main symptoms of swine flu in humans^[65]

Direct transmission of a swine flu virus from pigs to humans is occasionally possible (called zoonotic swine flu). In all, 50 cases are known to have occurred since the first report in medical literature in 1958, which have resulted in a total of six deaths.^[66] Of these six people, one was pregnant, one had leukemia, one had Hodgkin disease and two were known to be previously healthy.^[66] Despite these apparently low numbers of infections, the true rate of infection may be higher, since most cases only cause a very mild disease, and will probably never be reported or diagnosed.^[66]

In this video, Dr. Joe Bresee, with CDC's Influenza Division, describes the symptoms of swine flu and warning signs to look for that indicate the need for urgent medical attention.
See also: See this video with subtitles on YouTube [1]

According to the Centers for Disease Control and Prevention (CDC), in humans the symptoms of the 2009 "swine flu" H1N1 virus are similar to those of influenza and of influenza-like illness in general. Symptoms include fever, cough, sore throat, body aches, headache, chills and fatigue. The 2009 outbreak has shown an increased percentage of patients reporting diarrhea and vomiting.^[67] The 2009 H1N1 virus is not zoonotic swine flu, as it is not transmitted from pigs to humans, but from person to person.

Because these symptoms are not specific to swine flu, a differential diagnosis of probable swine flu requires not only symptoms but also a high likelihood of swine flu due to the person's recent history. For example, during the 2009 swine flu outbreak in the United States, CDC advised physicians to "consider swine influenza infection in the differential diagnosis of patients with acute febrile respiratory illness who have either been in contact with persons with confirmed swine flu, or who were in one of the five U.S. states that have reported swine flu cases or in Mexico during the 7 days preceding their illness onset."^[68] A diagnosis of confirmed swine flu requires laboratory testing of a respiratory sample (a simple nose and throat swab).^[68]

The most common cause of death is respiratory failure, other causes of death are pneumonia (leading to sepsis)^[69], high fever (leading to neurological problems), dehydration (from excessive vomiting and diarrhea) and electrolyte imbalance. Fatalities are more likely in young children and the elderly.

Prevention

Prevention of swine influenza has three components: prevention in swine, prevention of transmission to humans, and prevention of its spread among humans.

Prevention in swine

Methods of preventing the spread of influenza among swine include facility management, herd management, and vaccination (ATCvet code: QI09AA03). Because much of the illness and death associated with swine flu involves secondary infection by other pathogens, control strategies that rely on vaccination may be insufficient.

Control of swine influenza by vaccination has become more difficult in recent decades, as the evolution of the virus has resulted in inconsistent responses to traditional vaccines. Standard commercial swine flu vaccines are effective in controlling the infection when the virus strains match enough to have significant cross-protection, and custom (autogenous) vaccines made from the specific viruses isolated are created and used in the more difficult cases.^[70][71] Present vaccination strategies for SIV control and prevention in swine farms typically include the use of one of several bivalent SIV vaccines commercially available in the United States. Of the 97 recent H3N2 isolates examined, only 41 isolates had strong serologic cross-reactions with antiserum to three commercial SIV vaccines. Since the protective ability of influenza vaccines depends primarily on the closeness of the match between the vaccine virus and the epidemic virus, the presence of nonreactive H3N2 SIV variants suggests that current commercial vaccines might not effectively protect pigs from infection with a majority of H3N2 viruses.^[72][73] The United States Department of Agriculture researchers say that while pig vaccination keeps pigs from getting sick, it does not block infection or shedding of the virus.^[74]

Facility management includes using disinfectants and ambient temperature to control virus in the environment. The virus is unlikely to survive outside living cells for more than two weeks, except in cold (but above freezing) conditions, and it is readily inactivated by disinfectants.^[2] Herd management includes not adding pigs carrying influenza to herds that have not been exposed to the virus. The virus survives in healthy carrier pigs for up to 3 months and can be recovered from them between outbreaks. Carrier pigs are usually responsible for the introduction of SIV into previously uninfected herds and countries, so new animals should be quarantined.^[51] After an outbreak, as immunity in exposed pigs wanes, new outbreaks of the same strain can occur.^[2]

The Management of Acute, Chronic and Cancer Pain

For thousands of years, doctors have been helping to relieve their patients' pain with a variety of medications and treatments. Like other areas of medicine, a new subset of doctors have become specialists in treating pain. They are focused on managing all types of pain - studying what causes it, how the body reacts to it, how different medications dull or eliminate the pain, and how other treatments can be used to relieve many painful conditions.

What type of training does a pain medicine doctor have?
Like other physicians, anesthesiologists earned a college degree and then completed four years of medical school. They spent four more years learning the medical specialty of anesthesiology and pain medicine during residency training. Many anesthesiologists who specialize in pain medicine receive an additional year of fellowship training to become a "subspecialist," or an expert in treating pain. Some also have done research, and many have special certification in pain medicine through the American Board of Anesthesiology (ABA). The ABA is the only organization recognized by the American Board of Medical Specialties to offer special credentials in pain medicine.

MEDICATIONS FOR MANAGING PAIN

Due to rapid advances in medicine, a wide variety of medications and treatments are available for acute, chronic and cancer pain. Patients often will be prescribed medications before receiving other forms of therapy. In addition, your pain medicine doctor may conclude that a combination of medication and treatments may be right for you. Your therapy plan will be tailored to your specific needs and circumstances.

Your pain medicine doctor may suggest that you use certain over-the-counter pain relievers or may prescribe stronger medicine for your condition. DO NOT MIX PAIN PRESCRIPTION DRUGS WITH OVER-THE-COUNTER PAIN RELIEVERS WITHOUT CONSULTING YOUR DOCTOR. Advise your doctor if you are taking any herbal medicines or dietary supplements.

Common pain relievers - Nonaspirin pain relievers such as acetaminophen (Tylenol®) can relieve headaches and minor pain but do not reduce swelling. They are sometimes used in combination with other drugs to provide greater pain relief.

Anti-inflammatory drugs - Aspirin (Anacin®, Bayer®), coated or buffered aspirin (Ascripton®, Bufferin®) and aspirin with acetaminophen (Excedrin®) may be used to reduce swelling and irritation as well as to relieve pain. There also are non-steroidal anti-inflammatory drugs (NSAIDs, commonly called "N-sayeds") such as ibuprofen (Advil®, Motrin®) and naproxen (Aleve®). Anti-inflammatory drugs are used to relieve pain, inflammation and fever. There also are steroidal drugs (like cortisol and prednisone), available only by prescription, that are used to treat more serious inflammatory conditions such as chronic arthritis.

Opioid pain medications - Morphine-like drugs called opioids are prescribed to treat acute pain or cancer pain. They are occasionally used for certain chronic, noncancer pain as well.

Anti-depressants - These drugs were originally used only to treat depression. Studies now show, however, that they also can relieve certain pain. Available only by prescription, they often are used to help you sleep better at night.

Anti-seizure medicines - These medications are used to relieve what some patients describe as "shooting" pain by decreasing abnormal painful sensations caused by damaged nerves.

Other medicines - The doctor may also prescribe other types of medication that will be helpful for your specific pain problems. In addition, medications that counteract the side effects of opioids or treat the anxiety and depression associated with pain may also be prescribed.

Heart disease

Types of heart disease

Coronary heart disease

Main article: Coronary heart disease

Coronary artery disease is a disease of the artery caused by the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium. Angina pectoris (chest pain) and myocardial infarction (heart attack) are symptoms of and conditions caused by coronary heart disease.

Over 459,000 Americans die of coronary heart disease every year^[5]. In the United Kingdom, 101,000 deaths annually are due to coronary heart disease.^[6]

Cardiomyopathy

Main article: Cardiomyopathy

Cardiomyopathy literally means "heart muscle disease" (Myo= muscle, pathy= disease) It is the deterioration of the function of the myocardium (i.e., the actual heart muscle) for any reason. People with cardiomyopathy are often at risk of arrhythmia and/or sudden cardiac death.

• Extrinsic cardiomyopathies - cardiomyopathies where the primary pathology is outside the myocardium itself. Most cardiomyopathies are extrinsic, because by far the most common cause of a cardiomyopathy is ischemia. The World Health Organization calls these specific cardiomyopathies^{[citation needed]}:
  • Alcoholic cardiomyopathy
  • Coronary artery disease
  • Congenital heart disease - see below
  • Nutritional diseases affecting the heart
  • Ischemic (or ischaemic) cardiomyopathy
  • Hypertensive cardiomyopathy
  • Valvular cardiomyopathy - see also Valvular heart disease below
  • Inflammatory cardiomyopathy - see also Inflammatory heart disease below
  • Cardiomyopathy secondary to a systemic metabolic disease
• Intrinsic cardiomyopathies - weakness in the muscle of the heart that is not due to an identifiable external cause.
  • Dilated cardiomyopathy (DCM) - most common form, and one of the leading indications for heart transplantation. In DCM the heart (especially the left ventricle) is enlarged and the pumping function is diminished.
  • Hypertrophic cardiomyopathy (HCM or HOCM) - genetic disorder caused by various mutations in genes encoding sarcomeric proteins. In HCM the heart muscle is thickened, which can obstruct blood flow and prevent the heart from functioning properly.
  • Arrhythmogenic right ventricular cardiomyopathy (ARVC) - arises from an electrical disturbance of the heart in which heart muscle is replaced by fibrous scar tissue. The right ventricle is generally most affected.
  • Restrictive cardiomyopathy (RCM) - least common cardiomyopathy. The walls of the ventricles are stiff, but may not be thickened, and resist the normal filling of the heart with blood. ** Noncompaction Cardiomyopathy - the left ventricle wall has failed to properly grow from birth and such has a spongy appearance when viewed during an echocardiogram.

Cardiovascular disease

Main article: Cardiovascular disease

Cardiovascular disease is any of a number of specific diseases that affect the heart itself and/or the blood vessel system, especially the veins and arteries leading to and from the heart. Research on disease dimorphism suggests that women who suffer with cardiovascular disease usually suffer from forms that affect the blood vessels while men usually suffer from forms that affect the heart muscle itself. Known or associated causes of cardiovascular disease include diabetes mellitus, hypertension, hyperhomocysteinemia and hypercholesterolemia.

Types of cardiovascular disease include:

• Atherosclerosis

Ischaemic heart disease

• Ischaemic heart disease - another disease of the heart itself, characterized by reduced blood supply to the organs.

Heart failure

Main article: Heart failure

Heart failure, also called congestive heart failure (or CHF), and congestive cardiac failure (CCF), is a condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood throughout the body. Therefore leading to the heart and body's failure.

• Cor pulmonale, a failure of the right side of the heart.

Hypertensive heart disease

Main article: Hypertensive heart disease

Hypertensive heart disease is heart disease caused by high blood pressure, especially localised high blood pressure. Conditions that can be caused by hypertensive heart disease include:

• Left ventricular hypertrophy
• Coronary heart disease
• (Congestive) heart failure
• Hypertensive cardiomyopathy
• Cardiac arrhythmias

Inflammatory heart disease

Inflammatory heart disease involves inflammation of the heart muscle and/or the tissue surrounding it.

• Endocarditis - inflammation of the inner layer of the heart, the endocardium. The most common structures involved are the heart valves.
• Inflammatory cardiomegaly
• Myocarditis - inflammation of the myocardium, the muscular part of the heart.

Valvular heart disease

Main article: Valvular heart disease

Valvular heart disease is disease process that affects one or more valves of the heart. The valves in the right side of the heart are the tricuspid valve and the pulmonic valve. The valves in the left side of the heart are the mitral valve and the aortic valve.

• Aortic valve stenosis
• Mitral valve prolapse
• Valvular cardiomyopathy

AIDS

Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV).^[1][2][3]

This condition progressively reduces the effectiveness of the immune system and leaves individuals susceptible to opportunistic infections and tumors. HIV is transmitted through direct contact of a mucous membrane or the bloodstream with a bodily fluid containing HIV, such as blood, semen, vaginal fluid, preseminal fluid, and breast milk.^[4][5]

This transmission can involve anal, vaginal or oral sex, blood transfusion, contaminated hypodermic needles, exchange between mother and baby during pregnancy, childbirth, breastfeeding or other exposure to one of the above bodily fluids.

AIDS is now a pandemic.^[6] In 2007, it was estimated that 33.2 million people lived with the disease worldwide, and that AIDS had killed an estimated 2.1 million people, including 330,000 children.^[7] Over three-quarters of these deaths occurred in sub-Saharan Africa,^[7] retarding economic growth and destroying human capital.^[8]

Genetic research indicates that HIV originated in west-central Africa during the late nineteenth or early twentieth century.^[9][10] AIDS was first recognized by the U.S. Centers for Disease Control and Prevention in 1981 and its cause, HIV, identified in the early 1980s.^[11]

Although treatments for AIDS and HIV can slow the course of the disease, there is currently no vaccine or cure. Antiretroviral treatment reduces both the mortality and the morbidity of HIV infection, but these drugs are expensive and routine access to antiretroviral medication is not available in all countries.^[12] Due to the difficulty in treating HIV infection, preventing infection is a key aim in controlling the AIDS pandemic, with health organizations promoting safe sex and needle-exchange programmes in attempts to slow the spread of the virus.

Contents

[hide]

• 1 Symptoms
  • 1.1 Pulmonary infections
  • 1.2 Gastrointestinal infections
  • 1.3 Neurological and psychiatric involvement
  • 1.4 Tumors and malignancies
  • 1.5 Other infections
• 2 Cause
  • 2.1 Sexual transmission
  • 2.2 Exposure to blood-borne pathogens
  • 2.3 Perinatal transmission
  • 2.4 Misconceptions
• 3 Pathophysiology
  • 3.1 Cells affected
    • 3.1.1 The effect
    • 3.1.2 Molecular basis
• 4 Diagnosis
  • 4.1 WHO disease staging system
  • 4.2 CDC classification system
  • 4.3 HIV test
• 5 Prevention
  • 5.1 Sexual contact
  • 5.2 Exposure to infected body fluids
  • 5.3 Mother-to-child transmission (MTCT)
• 6 Treatment
  • 6.1 Antiviral therapy
  • 6.2 Experimental and proposed treatments
  • 6.3 Alternative medicine
• 7 Prognosis
• 8 Epidemiology
• 9 History
• 10 Society and culture
  • 10.1 Stigma
  • 10.2 Economic impact
  • 10.3 Religion and AIDS
  • 10.4 AIDS denialism
  • 10.5 Active pursuit of HIV infection
• 11 Notes and references
• 12 Further reading
• 13 External links

Back pain

Back pain (also known "dorsalgia") is pain felt in the back that usually originates from the muscles, nerves, bones, joints or other structures in the spine.

The pain can often be divided into neck pain, upper back pain, lower back pain or tailbone pain. It may have a sudden onset or can be a chronic pain; it can be constant or intermittent, stay in one place or radiate to other areas. It may be a dull ache, or a sharp or piercing or burning sensation. The pain may be felt in the neck (and might radiate into the arm and hand), in the upper back, or in the low back, (and might radiate into the leg or foot), and may include symptoms other than pain, such as weakness, numbness or tingling.

Back pain is one of humanity's most frequent complaints. In the U.S., acute low back pain (also called lumbago) is the fifth most common reason for physician visits. About nine out of ten adults experience back pain at some point in their life, and five out of ten working adults have back pain every year.^[1]

The spine is a complex interconnecting network of nerves, joints, muscles, tendons and ligaments, and all are capable of producing pain. Large nerves that originate in the spine and go to the legs and arms can make pain radiate to the extremities.

Contents

[hide]

• 1 Classification
• 2 Associated conditions
• 3 Underlying sources and causes
• 4 Treatment
  • 4.1 Short-term relief
  • 4.2 Conservative treatments
  • 4.3 Surgery
  • 4.4 Emerging treatments
  • 4.5 Treatments with uncertain or doubtful benefit
  • 4.6 Clinical Trials
• 5 Pregnancy
• 6 Cost to national governments
• 7 See also
• 8 References
• 9 External links

Abortion

An abortion is the termination of a pregnancy by the removal or expulsion from the uterus of a fetus/embryo, resulting in or caused by its death. An abortion can occur spontaneously due to complications during pregnancy or can be induced, in humans and other species. In the context of human pregnancies, an abortion induced to preserve the health of the gravida (pregnant female) is termed a therapeutic abortion, while an abortion induced for any other reason is termed an elective abortion. The term abortion most commonly refers to the induced abortion of a human pregnancy, while spontaneous abortions are usually termed miscarriages.

Abortion has a long history and has been induced by various methods including herbal abortifacients, the use of sharpened tools, physical trauma and other traditional methods. Contemporary medicine utilizes medications and surgical procedures to induce abortion. The legality, prevalence, and cultural views on abortion vary substantially around the world. In many parts of the world there is prominent and divisive public controversy over the ethical and legal issues of abortion. Abortion and abortion-related issues feature prominently in the national politics in many nations often involving the opposing pro-life and pro-choice worldwide social movements. Incidence of abortion has declined worldwide, as access to family planning education and contraceptive services has increased. Abortion incidence in the United States declined 8% from 1996 to 2003.^[1]

Abortion methods

Gestational age may determine which abortion methods are practiced.

Medical

Main article: Medical abortion

"Medical abortions" are non-surgical abortions that use pharmaceutical drugs, and are only effective in the first trimester of pregnancy.^{[citation needed]} Medical abortions comprise 10% of all abortions in the United States^[13] and Europe.^{[citation needed]} Combined regimens include methotrexate or mifepristone, followed by a prostaglandin (either misoprostol or gemeprost: misoprostol is used in the U.S.; gemeprost is used in the UK and Sweden.) When used within 49 days gestation, approximately 92% of women undergoing medical abortion with a combined regimen completed it without surgical intervention.^[14] Misoprostol can be used alone, but has a lower efficacy rate than combined regimens. In cases of failure of medical abortion, vacuum or manual aspiration is used to complete the abortion surgically.

Surgical

A vacuum aspiration abortion at 8 weeks gestational age (6 weeks after fertilization).
1: Amniotic sac
2: Embryo
3: Uterine lining
4: Speculum
5: Vacurette
6: Attached to a suction pump

In the first 12 weeks, suction-aspiration or vacuum abortion is the most common method.^[15] Manual Vacuum aspiration (MVA) abortion consists of removing the fetus or embryo, placenta and membranes by suction using a manual syringe, while electric vacuum aspiration (EVA) abortion uses an electric pump. These techniques are comparable, and differ in the mechanism used to apply suction, how early in pregnancy they can be used, and whether cervical dilation is necessary. MVA, also known as "mini-suction" and "menstrual extraction", can be used in very early pregnancy, and does not require cervical dilation. Surgical techniques are sometimes referred to as 'Suction (or surgical) Termination Of Pregnancy' (STOP). From the 15th week until approximately the 26th, dilation and evacuation (D&E) is used. D&E consists of opening the cervix of the uterus and emptying it using surgical instruments and suction.

Dilation and curettage (D&C), the second most common method of abortion, is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. Curettage refers to cleaning the walls of the uterus with a curette. The World Health Organization recommends this procedure, also called sharp curettage, only when MVA is unavailable.^[16] The term D and C, or sometimes suction curette, is used as a euphemism for the first trimester abortion procedure, whichever the method used.

Other techniques must be used to induce abortion in the second trimester. Premature delivery can be induced with prostaglandin; this can be coupled with injecting the amniotic fluid with hypertonic solutions containing saline or urea. After the 16th week of gestation, abortions can be induced by intact dilation and extraction (IDX) (also called intrauterine cranial decompression), which requires surgical decompression of the fetus' head before evacuation. IDX is sometimes called "partial-birth abortion," which has been federally banned in the United States. A hysterotomy abortion is a procedure similar to a caesarean section and is performed under general anesthesia. It requires a smaller incision than a caesarean section and is used during later stages of pregnancy.^[17]

From the 20th to 23rd week of gestation, an injection to stop the fetal heart can be used as the first phase of the surgical abortion procedure^{[18][19][20][21][22]} to ensure that the fetus is not born alive.^[23]

Other methods

Bas-relief at Angkor Wat, Cambodia, c. 1150, depicting a demon inducing an abortion by pounding the abdomen of a pregnant woman with a pestle.^[24]

Historically, a number of herbs reputed to possess abortifacient properties have been used in folk medicine: tansy, pennyroyal, black cohosh, and the now-extinct silphium (see history of abortion).^[25] The use of herbs in such a manner can cause serious — even lethal — side effects, such as multiple organ failure, and is not recommended by physicians.^[26]

Abortion is sometimes attempted by causing trauma to the abdomen. The degree of force, if severe, can cause serious internal injuries without necessarily succeeding in inducing miscarriage.^[27] Both accidental and deliberate abortions of this kind can be subject to criminal liability in many countries. In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage.^[28] One of the bas reliefs decorating the temple of Angkor Wat in Cambodia depicts a demon performing such an abortion upon a woman who has been sent to the underworld.^[28]

Reported methods of unsafe, self-induced abortion include misuse of misoprostol, and insertion of non-surgical implements such as knitting needles and clothes hangers into the uterus. These methods are rarely seen in developed countries where surgical abortion is legal and available.^[29]