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Nail Fungus (Onychomycosis)
DEFINITION
Nail fungal infection, formally called Onychomycosis, is an
infection of the nails by a fungus, typically dermatophyte (Trichophyton rubrum).
EPIDEMICS
You are not alone. Nail fungal infection is of high
prevalence. About 20-30% of adults are infected by the age of 60. More than 30
millions of Americans are suffering the infection. Men are more likely to be
infected than women. Elder people are more likely to be infected than younger
ones. People with immune system disorders, such as HIV and diabete, tend to be
infected. People with the family history of infection have higher chance to be
infected. People who work or play with their hands or feet continually exposed
to moisture are at higher risk. Toenails have 6-7 times more incidences than
fingernails. Injury nails are easier to get infected. The big toe is usually the
first one to be infected.
GENESIS
The infection is a progressive procedure. The fungal
infection starts distal edge (outside tip) of a nail, with patches of white or
yellow discoloration. It indicates that you have been infected by the fungus and
your immune system is unable to defeat them. If the condition is left untreated,
the journey of nail fungal infection is progressing. The fungus makes it home
the nail bed (the place where the nail meets the skin) of dark, warm and
moisture. They grow and multiply. They digest the keratin, the protective
protein. As a result, the keratin goes into over-production, which causes an
excess to separate the nail from the nail bed. The texture, color and growth of
the nail are changing. It loses luster and shine, and discolors; it becomes
brittle and crumbly; it grows irregularly. The fungus works its way inward. The
symptoms are getting more severe. The nail can become quite painful.
The infection is a procedure of multiple stages. The fungus first breaks the barriers to get onto the nail bed; then they reside on the nail bed; finally they multiple and expand. The barriers include physical one and immune system. The fungus rarely invades an intact nail. Usually, there is some kind of trauma allowing the physical barrier to be breached. Prolonged wetness can also allow the barrier to be breached. Sometimes, prolonged athlete’s foot allows the barrier to be breached. After the fungus gets into the nail, people have immune system barrier to embody them and prevent them from surviving. People suffering some sort of immune disorders or inheriting a certain type of immune system could lose the last barrier. Even after the fungus breaches both barriers, they require a wet, warm and dark environment to survive. Keeping foot dry all time is a good way to prevent fungal infection. As the favorable conditions exist, the fungus will thrive and expand gradually meanwhile the nail deteriorates.
RISK FACTORS
Therefore, any factors that help breach the barrier or
provide the favorable conditions could be the risk factors. These factors may
include:
PREVENTION
Any measures that protect the barrier, enhance and maintain
immune system and prevent the formation of the favorable conditions would be
preventive. These prevention tips include:
TREATMENTS
The infected nail is hard to be treated because the fungus
is under the nail, which prevent medicine from direct application on infected
area. And because the toe nails are distal part of a whole body, it is hard to
get the medicine to the effective level at the toe part. Other nail medical
conditions can mimic fungal infection. Most doctors will confirm the diagnosis
by sending a nail clipping for laboratory evaluation. In general, the earlier
the treatment is, the better the result will be. When there are patches of white
or yellow discoloration on nails, you should see a doctor. The doctor will make
diagnosis and design treatment plan.
Several types of treatments include topical cream treatments, oral medical treatments and surgical treatments. The topical creams are applied onto the infected nail. The efficacy of the topical treatment depends on the penetrating capability. The more the active ingredient get into the nail, the more effective the treatment will be.
Several oral drugs are available on the market. A course of treatment usually takes about 6-12 weeks, costs about $500 and has a 50-70% chance of curing the condition. Since the oral medicines have to go through the whole body to get into the tip of a toe, they have side effects on liver and kidney. Liver enzymes and blood should be monitored during the course of treatment. Other side effects could include nausea, diarrhea and rashes. There is a potential for interaction with other medications you may be taking. Therefore, some people may not able to take these medications because of other medications that you are taking or other medical problems. The nail fungal infection is not only difficult to be cured, but also have high chance of recurring.
IMPACTS
Structural factors at work, the absence of decision
authority, reduced prospects for vocational training and for occupational
mobility, are thought to be important. In a situation where migrants do not have
established economic or social support, the loss of resources could have a
disproportionate effect in reducing an individual's ability to cope with stress.
The degree of psychological effect of demotion is likely to correlate with the
level of expectation. Perceived unjust demotion is also likely to be more
damaging to health than just demotion, through anger, humiliation and
helplessness. The negative health effect of anger is considered as a result of discrimination. Some of the
upward mobility would have been the result of underemployment immediate
post-migration. Migration is associated with class movements and with a process
of deskilling. Some could not practice their trades because of the lack of
relevant documents to show evidence of training. A temporary strategic decision
to obtain the necessary knowledge and experience is made before making a choice.
Mobility affects health-related behaviors and specific diseases among migrants.
The clinical benefits of skills acquired by the patients and their relatives in the applied condition could have been counterbalanced by enhanced crisis and support services offered to the subjects in the supportive family condition. Premature closure is unwarranted on other grounds as well. Depressive symptoms are associated with subsequent unemployment and decreased family income. Subsequent unemployment and income loss includes having a history of unemployment; being unmarried and less educated. Depression is a predictor of subsequent unemployment and low family income. Depressive symptoms lead to decrements in socioeconomic status. Several potential mechanisms may explain the association between depressive symptoms, loss of income, and unemployment. Depression may lead to impaired job performance, absenteeism, tardiness at the workplace, a reduction in work hours, or a change to a new position. Loss of productivity due to low achievement and reduced effectiveness at work may result in diminished compensation. Young adults with depressive symptoms may be vulnerable to loss of employment during periods of economic downturn. Depressive symptoms may be associated with decreased family income. Depression and loss of income may be mutually reinforcing. Alleviating symptoms of depression may lead to better work performance. Remission of depression is associated with better work outcomes. Improved depression scores might be associated with increased self-perceived work performance. Intensive treatment of depression may be associated with increased employment. Alleviating symptoms of depression may lead to better work performance and compensation. The association of depression with loss of family income and unemployment may reach far beyond the burden of economic hardship. Low socioeconomic status has been associated with impaired physical, psychological, and social functioning. Low socioeconomic status may act as a mediator in the pathways between depressive symptoms and poor health outcomes. Depressive symptoms may act as a mediator between low socioeconomic status and poor health. The loss of family income and unemployment associated with depressive symptoms may have implications for the lifetime productivity and earnings of many young adults. The disorder, depressive symptoms may have serious economic consequences. Depression is a common, serious, easily diagnosed and treatable disease. Depressive symptoms are associated with subsequent loss of family income and unemployment among working young adults. Depressive symptoms lead to decrements in socioeconomic status. The measures of subjective distress, depression and social alienation are significantly associated with incident hypertension. There is a significant negative association between emotional stability and the incidence of hypertension. Anxiety is predictive of hypertension. The association persisted after adjustment for smoking and for initial systolic blood pressure. Education, alcohol use, relative weight, and glucose tolerance are not associated with incident hypertension. The psychosocial stressors are most predictive of hypertension in the low-status work. Differential distribution of behavioral risk factors accounted for much of the association between psychosocial factors and incident hypertension. A high incidence of hypertension may be associated with low education or with depressive symptoms. These are largely related to smoking, obesity, and a sedentary lifestyle. The excess hypertensive risk related to psychological distress is mediated by increases in health risk behaviors in distressed individuals. Some of the hypertension-promoting effect of life stress could be explained by behavioral and sociodemographic factors.
Psychosocial stressors predict hypertension strongly. Unemployment could be particularly devastating for men. The association between job strain and raised ambulatory blood pressure has been found. Differential access to medical care is of great importance in socioeconomic patterns of hypertensive disease. Psychosocial stressors at baseline increase risk of developing hypertension in the general population. The effects of work stressors and separation or divorce are unlikely because of poor health status leading to more work stress or marital dissolution. Work disability is severe enough to lead to unemployment. Work stress and marital dissolution can affect health behaviors, eg, by increasing smoking and alcohol consumption, altering dietary pattern, and disturbing restful sleep. Stress also increases susceptibility to infectious disease. Work stress and marital dissolution may result in poor decision making, causing risky behaviors. A grim environment of poverty, dangerous and declining neighborhoods, illicit drug and alcohol abuse, unemployment, drug dealing, and prior incarceration is the milieu where violence thrives. Poverty, drug dealing, other drug and alcohol addiction, and carrying handguns will not be eliminated quickly even if massive government programs attack these. The prevalence of substance abuse and drug dealing is probably underestimated. Detoxification and rehabilitation centers are scarce nationally. Drug dealing is one of the few lucrative vocations for the inadequately educated poor. The efficacy of the approach is unclear. Unemployment undoubtedly plays a role in encouraging drug dealing and hanging around the streets in dangerous neighborhoods. There are federally funded efforts to try to prepare poorly educated young men to enter the mainstream workforce. A variety of institutional, legislative, and market-driven pressures have sought to increase the amount of generalist care while decreasing specialist care. Acne affects the lives of adults in various ways, including their employment, social behavior, and body dissatisfaction. Severe acne is more likely to be associated with psychological factors such as anxiety, and with greater effects on patients' lives. The psychosocial effects of acne on quality of life are found to be influenced by patients' self-perception of their acne ' severity. These segments have traditionally been categorized as being of low socioeconomic status. The reasons for this increased vulnerability remain poorly understood. One of the classic debates surrounding the causes of psychiatric disorders among low-income patients has been the direction of causality in this relationship. The disability associated with psychiatric disorders often results in unemployment and loss of income. These individuals have low social and economic standing. Being of low socioeconomic status adds to the risk of experiencing a psychiatric disorder. These individuals often live in threatening situations and lack the material and social resources. Socioeconomic status, reflected primarily in terms of employment status, seems to exert a stronger influence than ethnicity on the risk of experiencing a psychiatric disorder. Culturally competent delivery of health care to these patients requires an understanding of the larger social context. Without such an understanding, these disorders will remain undetected and untreated. Patients having received physician advice to quit smoking prior to receiving educational materials about quitting are more likely to make a quit
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