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A tremendous amount of social and emotional development takes place during early childhood. As kids experience temper tantrums, mood swings, and an expanding social world, they must learn more about their emotions as well as those of other people.

Social-Emotional Experiences of Early Childhood

Throughout the toddler years, temper tantrums are quite common. There’s a good reason why people often refer to this stage as the “terrible twos”!

Toddlers tend to have rapid mood swings. While their emotions can be very intense, these feelings also tend to be quite short-lived. You might be stunned at how your child can go from screaming hysterically about a toy at one moment to sitting in front of the television quietly watching a favorite show just moments later.

Children at this age can be very possessive and have difficulty sharing. Learning to get along with other children is an essential skill, however. In just a few short years, your child will go from spending most of their time with family and close friends to spending a large chunk of the day interacting, learning, and playing with other kids at school.

Emotional development and social skills are essential for school readiness. Examples of such abilities include paying attention to adult figures, transitioning easily from one activity to the next, and cooperating with other kids.

Help Kids Develop Social and Emotional Skills

So how can you help your child learn how to play well with others? Social competence not only involves the ability to cooperate with peers; it also includes such things as the ability to show empathy, express feelings, and share generously. Fortunately, there are plenty of things that you can do to help your kids develop these all-important social and emotional skills.

Model Appropriate Behaviors

Observation plays a vital role in how young children learn new things. If your child sees you sharing, expressing gratitude, being helpful, and sharing feelings, your child will have a good solid understanding of how to interact with other people outside the home.

You can model these responses in your own household with both your child and other members of the family. Every time you say “please” or “thank you,” you are demonstrating how you would like your children to behave.

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Reinforce Good Behavior

Most importantly, be sure to offer praise when your children demonstrate good social behaviors. Helping your children feel good about themselves also plays an important role in developing a sense of empathy and emotional competence. By creating a positive climate where children are allowed to share their feelings, children will naturally begin to become more generous and thoughtful.

Reinforcement not only makes young children feel good about themselves, but it also helps them understand why certain behaviors are desirable and worthy of praise.

Teach Empathy

Parents can also boost empathy and build emotional intelligence by encouraging their children to think about how other people feel. Start by inquiring about your child’s own feelings, asking about events in your child’s life. “How did you feel when you lost your toy?” “How did that story make you feel?”

Once children become skilled at expressing their own emotional reactions, begin asking questions about how other people may feel. “How do you think Nadia felt when you took away the toy she was playing with?”

By responding to questions about emotions, children can begin to think about how their own actions might impact the emotions of those around them.

Teach Cooperation

Cooperation is one skill that benefits tremendously from direct experience. Giving your child the opportunity to interact and play with other kids is one of the best ways to teach them how to relate to others. While your toddler may find playing with peers frustrating at times, since kids often lack patience and the ability to share, things will gradually begin to improve with age and experience.

As children play and interact, they also begin to develop social problem-solving skills. Early attempts might involve plenty of arguments and conflict with siblings and peers, but eventually, kids learn how to negotiate and compromise with other children.

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Emotional intelligence, otherwise known as EQ, helps us better understand what motivates others. It also helps us work more cooperatively with others.

The more skillful you are at discerning the feelings behind others’ signals the better you will be able to control the signals you send back to them. As a result, you will be more successful in life.

Emotional intelligence is a widely discussed topic in psychology and it has received extensive media attention over the past two decades (Matthews, et. al 2002).

Emotional intelligence is a set of skills that are thought to contribute to the appraisal of emotions in oneself and others. It can also help contribute to the effective regulation of emotions as well as feelings (Salovey & Mayer, 1990).

In comparison to emotional intelligence, the idea of an IQ tends to be more focused on solving problems. This is a much more clear-cut way of looking at things when compared to something like EQ.

However, as we know, there are many other factors involved when it comes to predicting success.

In the 90’s, Salovey and Mayer suggested that one’s ability to understand, regulate and use emotions could actually be measured and studied.

The publication of Goleman’s emotional intelligence book in 1995 signified the beginning of a new trend. As a result, this concept became much more widely recognized.

While not everyone agrees with the idea of Goleman’s model of emotional intelligence, there is general agreement that it does exist, and that it is a factor that comes into play in terms of professional and personal success.

Goleman’s prototype describes Emotional Intelligence or EQ in terms of five realms that are split among four sections. Two of these realms are related to personal competencies while others are related to social competencies.

5 Key Emotional Intelligence Skills

Have you ever known people who always seem to keep their cool, who are able to handle even the most awkward social situations with grace, and who always seem to make others feel at ease? Chances are pretty high that those individuals possess what psychologists refer to as emotional intelligence.

Emotional intelligence involves the ability to understand and manage emotions. Experts agree that this type of intelligence plays an important role in success, and some have suggested that emotional intelligence, or EQ, might even be more important than IQ. In any case, research has suggested that possessing emotional intelligence skills is linked to everything from decision-making to academic achievement.

So what does it take to be emotionally intelligent? Psychologist and author Daniel Goleman has suggested that there are five components of emotional intelligence. Fortunately, you can learn to improve these emotional intelligence skills. By working on and increasing these skills, you can become more emotionally intelligent.

Self-Awareness

Self-awareness, or the ability to recognize and understand your own emotions, is a critical emotional intelligence skill. Beyond just recognizing your emotions, however, is being aware of the effect of your actions, moods, and emotions on other people.

To become self-aware, you must be capable of monitoring your own emotions, recognizing different emotional reactions, and then correctly identifying each particular emotion. Self-aware individuals also recognize the relationships between the things they feel and how they behave.

These individuals are also capable of recognizing their own strengths and limitations, are open to new information and experiences, and learn from their interactions with others. Goleman suggests that people who possess self-awareness have a good sense of humor, are confident in themselves and their abilities, and are aware of how other people perceive them.

How to Improve Self-Awareness

• Ask for constructive feedback
• Keep a journal
• Learn new skills
• Meditate
• Pay attention to your thoughts and emotions
• Pursue your passions
• Practice mindfulness
• Reflect on your experiences
• Set goals
• Use positive self-talk
• Work on building a growth mindset

Self-Regulation

In addition to being aware of your own emotions and the impact you have on others, emotional intelligence requires you to be able to regulate and manage your emotions.

This doesn’t mean putting emotions on lockdown and hiding your true feelings—it simply means waiting for the right time and place to express them. Self-regulation is all about expressing your emotions appropriately.

Those who are skilled in self-regulation tend to be flexible and adapt well to change. They are also good at managing conflict and diffusing tense or difficult situations.

Goleman also suggests that those with strong self-regulation skills are high in conscientiousness. They are thoughtful about how they influence others, and they take responsibility for their own actions.

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How to Improve Self-Regulation

• Be mindful of your thoughts and feelings.
• Build distress tolerance skills.
• Find ways to manage difficult emotions.
• Look at challenges as opportunities.
• Practice your communication skills.
• Recognize that you have a choice in how you respond.
• Use cognitive reframing to change thought patterns and emotional responses.
• Work on accepting your emotions.

Social Skills

Being able to interact well with others is another important aspect of emotional intelligence. Having strong social skills allows people to build meaningful relationships with other people and develop a stronger understanding of themselves and others.

True emotional understanding involves more than just understanding your own emotions and those of others. You also need to be able to put this information to work in your daily interactions and communications.

In professional settings, managers benefit by being able to build relationships and connections with employees. Workers benefit from being able to develop a strong rapport with leaders and co-workers. Important social skills include active listening, verbal communication skills, nonverbal communication skills, leadership, and persuasiveness.

How to Improve Social Skills

• Ask open-ended questions.
• Find icebreakers that will help start conversations.
• Notice other people’s social skills.
• Practice good eye contact.
• Practice your social skills.
• Practice active listening.
• Show interest in others.
• Watch your body language.

Empathy

Empathy, or the ability to understand how others are feeling, is absolutely critical to emotional intelligence. But it involves more than just being able to recognize the emotional states of others.

It also involves your responses to people based on this information. When you sense that someone is feeling sad or hopeless, how do you respond? You might treat them with extra care and concern, or you might make an effort to buoy their spirits.

Being empathetic also allows you to understand the power dynamics that often influence social relationships, especially in workplace settings. This is important for guiding your interactions with different people you encounter each day.

Those competent in this area are able to sense who possesses power in different relationships. They also understand how these forces influence feelings and behaviors. Because of this, they can accurately interpret different situations that hinge on such power dynamics.

How to Build Empathy

• Be willing to share your own feelings.
• Engage in a cause such as a community project. 
• Listen to other people.
• Practice loving-kindness meditation.
• Talk to new people.
• Try to imagine yourself in someone else’s place.

5

Motivation

Intrinsic motivation is another important emotional intelligence skill. People who are emotionally intelligent are motivated by things beyond external rewards like fame, money, recognition, and acclaim.

Instead, they have a passion to fulfill their own inner needs and goals. They seek internal rewards, experience flow from being totally in tune with an activity, and pursue peak experiences.

Those who are competent in this area tend to be action-oriented. They set goals, have a high need for achievement, and are always looking for ways to do better. They also tend to be very committed and are good at taking initiative.

How to Improve Motivation

• Avoid overusing extrinsic rewards.
• Celebrate your results.
• Focus on setting small, measurable goals.
• Introduce challenges to keep things interesting.
• Set goals to help build intrinsic motivation.
• Work with a friend or co-worker to find accountability.

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Lifespan development involves the exploration of biological, cognitive, and psychosocial changes and constancies that occur throughout the entire course of life. It has been presented as a theoretical perspective, proposing several fundamental, theoretical, and methodological principles about the nature of human development. An attempt by researchers has been made to examine whether research on the nature of development suggests a specific metatheoretical worldview. Several beliefs, taken together, form the “family of perspectives” that contribute to this particular view.

German psychologist Paul Baltes, a leading expert on lifespan development and aging, developed one of the approaches to studying development called the lifespan perspective. This approach is based on several key principles:

• Development occurs across one’s entire life, or is lifelong.
• Development is multidimensional, meaning it involves the dynamic interaction of factors like physical, emotional, and psychosocial development
• Development is multidirectional and results in gains and losses throughout life
• Development is plastic, meaning that characteristics are malleable or changeable.
• Development is influenced by contextual and socio-cultural influences.
• Development is multidisciplinary.

Development is lifelong

Lifelong development means that development is not completed in infancy or childhood or at any specific age; it encompasses the entire lifespan, from conception to death. The study of development traditionally focused almost exclusively on the changes occurring from conception to adolescence and the gradual decline in old age; it was believed that the five or six decades after adolescence yielded little to no developmental change at all. The current view reflects the possibility that specific changes in development can occur later in life, without having been established at birth. The early events of one’s childhood can be transformed by later events in one’s life. This belief clearly emphasizes that all stages of the lifespan contribute to the regulation of the nature of human development.

Many diverse patterns of change, such as direction, timing, and order, can vary among individuals and affect the ways in which they develop. For example, the developmental timing of events can affect individuals in different ways because of their current level of maturity and understanding. As individuals move through life, they are faced with many challenges, opportunities, and situations that impact their development. Remembering that development is a lifelong process helps us gain a wider perspective on the meaning and impact of each event.

Development is multidimensional

By multidimensionality, Baltes is referring to the fact that a complex interplay of factors influence development across the lifespan, including biological, cognitive, and socioemotional changes. Baltes argues that a dynamic interaction of these factors is what influences an individual’s development.

For example, in adolescence, puberty consists of physiological and physical changes with changes in hormone levels, the development of primary and secondary sex characteristics, alterations in height and weight, and several other bodily changes. But these are not the only types of changes taking place; there are also cognitive changes, including the development of advanced cognitive faculties such as the ability to think abstractly. There are also emotional and social changes involving regulating emotions, interacting with peers, and possibly dating. The fact that the term puberty encompasses such a broad range of domains illustrates the multidimensionality component of development (think back to the physical, cognitive, and psychosocial domains of human development we discussed earlier in this module).

Development is multidirectional

Baltes states that the development of a particular domain does not occur in a strictly linear fashion but that development of certain traits can be characterized as having the capacity for both an increase and decrease in efficacy over the course of an individual’s life.

If we use the example of puberty again, we can see that certain domains may improve or decline in effectiveness during this time. For example, self-regulation is one domain of puberty which undergoes profound multidirectional changes during the adolescent period. During childhood, individuals have difficulty effectively regulating their actions and impulsive behaviors. Scholars have noted that this lack of effective regulation often results in children engaging in behaviors without fully considering the consequences of their actions. Over the course of puberty, neuronal changes modify this unregulated behavior by increasing the ability to regulate emotions and impulses. Inversely, the ability for adolescents to engage in spontaneous activity and creativity, both domains commonly associated with impulse behavior, decrease over the adolescent period in response to changes in cognition. Neuronal changes to the limbic system and prefrontal cortex of the brain, which begin in puberty lead to the development of self-regulation, and the ability to consider the consequences of one’s actions (though recent brain research reveals that this connection will continue to develop into early adulthood).

Extending on the premise of multidirectionality, Baltes also argued that development is influenced by the “joint expression of features of growth (gain) and decline (loss)” This relation between developmental gains and losses occurs in a direction to selectively optimize particular capacities. This requires the sacrificing of other functions, a process known as selective optimization with compensation. According to the process of selective optimization, individuals prioritize particular functions above others, reducing the adaptive capacity of particulars for specialization and improved efficacy of other modalities.

The acquisition of effective self-regulation in adolescents illustrates this gain/loss concept. As adolescents gain the ability to effectively regulate their actions, they may be forced to sacrifice other features to selectively optimize their reactions. For example, individuals may sacrifice their capacity to be spontaneous or creative if they are constantly required to make thoughtful decisions and regulate their emotions. Adolescents may also be forced to sacrifice their fast reaction times toward processing stimuli in favor of being able to fully consider the consequences of their actions.

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Development is plastic

Plasticity denotes intrapersonal variability and focuses heavily on the potentials and limits of the nature of human development. The notion of plasticity emphasizes that there are many possible developmental outcomes and that the nature of human development is much more open and pluralistic than originally implied by traditional views; there is no single pathway that must be taken in an individual’s development across the lifespan. Plasticity is imperative to current research because the potential for intervention is derived from the notion of plasticity in development. Undesired development or behaviors could potentially be prevented or changed.

As an example, recently researchers have been analyzing how other senses compensate for the loss of vision in blind individuals. Without visual input, blind humans have demonstrated that tactile and auditory functions still fully develop and they can use tactile and auditory cues to perceive the world around them. One experiment designed by Röder and colleagues (1999) compared the auditory localization skills of people who are blind with people who are sighted by having participants locate sounds presented either centrally or peripherally (lateral) to them. Both congenitally blind adults and sighted adults could locate a sound presented in front of them with precision but people who are blind were clearly superior in locating sounds presented laterally. Currently, brain-imaging studies have revealed that the sensory cortices in the brain are reorganized after visual deprivation. These findings suggest that when vision is absent in development, the auditory cortices in the brain recruit areas that are normally devoted to vision, thus becoming further refined.

Development is contextual

In Baltes’ theory, the paradigm of contextualism refers to the idea that three systems of biological and environmental influences work together to influence development. Development occurs in context and varies from person to person, depending on factors such as a person’s biology, family, school, church, profession, nationality, and ethnicity. Baltes identified three types of influences that operate throughout the life course: normative age-graded influences, normative history-graded influences, and nonnormative influences. Baltes wrote that these three influences operate throughout the life course, their effects accumulate with time, and, as a dynamic package, they are responsible for how lives develop.

Normative age-graded influences are those biological and environmental factors that have a strong correlation with chronological age, such as puberty or menopause, or age-based social practices such as beginning school or entering retirement. Normative history-graded influences are associated with a specific time period that defines the broader environmental and cultural context in which an individual develops. For example, development and identity are influenced by historical events of the people who experience them, such as the Great Depression, WWII, Vietnam, the Cold War, the War on Terror, or advances in technology.

Other Contextual Influences on Development: Cohort, Socioeconomic Status, and Culture

What is meant by the word “context”? It means that we are influenced by when and where we live. Our actions, beliefs, and values are a response to the circumstances surrounding us. Sternberg describes contextual intelligence as the ability to understand what is called for in a situation (Sternberg, 1996). The key here is to understand that behaviors, motivations, emotions, and choices are all part of a bigger picture. Our concerns are such because of who we are socially, where we live, and when we live; they are part of a social climate and set of realities that surround us. Important social factors include cohort, social class, gender, race, ethnicity, and age. Let’s begin by exploring two of these: cohort and social class. 

A cohort is a group of people who are born at roughly the same time period in a particular society. Cohorts share histories and contexts for living. Members of a cohort have experienced the same historical events and cultural climates which have an impact on the values, priorities, and goals that may guide their lives.

Development is Multidisciplinary

Any single discipline’s account of development across the lifespan would not be able to express all aspects of this theoretical framework. That is why it is suggested explicitly by lifespan researchers that a combination of disciplines is necessary to understand development. Psychologists, sociologists, neuroscientists, anthropologists, educators, economists, historians, medical researchers, and others may all be interested and involved in research related to the normative age-graded, normative history-graded, and nonnormative influences that help shape development. Many disciplines are able to contribute important concepts that integrate knowledge, which may ultimately result in the formation of a new and enriched understanding of development across the lifespan.

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Introduction

“Health care is an important determinant of health. Lifestyles are important determinants of health. But… it is factors in the social environment that determine access to health services and influence lifestyle choices in the first place.” WHO Director-General Dr Margaret Chan

Many factors combine together to affect the health of individuals and communities. Whether a person is healthy or unhealthy is determined by his/her circumstances and environment. To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors such as access and use of health care services often have less of an impact.

Determinants of Health

The range of personal, social, economic and environmental factors that influence health status are known as determinants of health.
These can be classified as:

1. the social and economic environment,
2. the physical environment,
3. the person’s individual characteristics and behaviours.

There are many commonly accepted determinants of health but there is no single definition.  The Office of Disease Prevention and Health Promotion (ODPHP) has broadly categorised the determinants of health and these have been summarised below:

Policy-making

Policies at the local, state and federal level affect individual and population health. Increasing taxes on tobacco sales, for example, can improve population health by reducing the number of people using tobacco products.

Social Factors

Social and physical determinants of health reflect the conditions of the environment in which people are born, live, learn, play, work and age. Also known as social determinants of health, they impact a wide range of health, functioning and quality-of-life outcomes. They represent economic and political systems, physical and social environments, as well as health service access.

Examples include:

• Availability of resources to meet daily needs, such as educational and job opportunities, living wages or healthful foods
• Social norms and attitudes such as discrimination
• Exposure to crime, violence and social disorder
• Social support and social interactions
• Socioeconomic conditions such as concentrated poverty
• Quality schools
• Transportation options
• Urbanisation and the built environment such as buildings or transportation
• Worksites, schools and recreational settings

Health Services

Both access to health services and the quality of health services can impact health.  Barriers to accessing health services include lack of availability, high cost, lack of insurance coverage and limited language access.  These barriers to accessing health services lead to unmet health needs, delays in receiving appropriate care, inability to get preventive services as well as hospitalizations that could have been prevented.

Individual Behaviour

Individual behaviors such as diet, physical activity, alcohol, tobacco and other drug use also play a role in health outcomes.

Biology and Genetics

Some biological and genetic factors affect specific populations more than others.  Examples of biological and genetic determinants of health include age, sex, inherited conditions and genetic make-up.

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Improving Health World Wide

WHO have identified three “common interventions” for improving health conditions world wide:

1. Education

A large number of studies have demonstrated a strong link between better education and better health, and education has been shown to be a reliable predictor of lower mortality rates. The probability of being in good or very good health is higher for people with university or post-secondary education.

2. Social Protection

Countries with some sort of social protection (i.e. a safety net or social security system) show improved health and economic outcomes in circumstances where people become unable to earn a living.

3. Urban Development

The physical environment where communities live has a great impact on the health of the residents. Factors which have a negative impact on health include overcrowding, damp living conditions and crime (in particular fear of crime). The WHO concludes that health outcomes “are largely determined by the accessibility to adequate housing and to healthy and safe urban environments and by transport conditions”.

Relevance to Physiotherapy

In our contact time with our patients, we spend a lot of time understanding their health and social status. In other words, we explore the determinants that might be affecting their health and in particular ones that we can influence. The model we use to analyse and understand these determinants of health is the biopsychosocial model of health care.

It is essential that health care workers dedicated to improving health increase their effectiveness by addressing the “upstream” causes of health in the community and by engaging in ways to change the broad policies, systems and environments that shape the social and economic conditions that, in turn, so strongly influence health.  Swain et al describe opportunities for the health-care professional to address social determinants of health. They suggest that to be most effective at improving the health of families and communities and to ensure the greatest impact for the investment of resources, health professionals need to expand their repertoire of skills and activities both with their individual patients and in the policy arena.

who’s response

The determinants of health include:

• the social and economic environment,
• the physical environment, and
• the person’s individual characteristics and behaviours.

The context of people’s lives determine their health, and so blaming individuals for having poor health or crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control many of the determinants of health. These determinants—or things that make people healthy or not—include the above factors, and many others:

• Income and social status – higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health.
• Education – low education levels are linked with poor health, more stress and lower self-confidence.
• Physical environment – safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. Employment and working conditions – people in employment are healthier, particularly those who have more control over their working conditions
• Social support networks – greater support from families, friends and communities is linked to better health. Culture – customs and traditions, and the beliefs of the family and community all affect health.
• Genetics – inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses. Personal behaviour and coping skills – balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health.
• Health services – access and use of services that prevent and treat disease influences health
• Gender – Men and women suffer from different types of diseases at different ages

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The word health refers to a state of complete emotional and physical well-being. Healthcare exists to help people maintain this optimal state of health.

According to the Centers for Disease Control and Prevention (CDC), healthcare costs in the United States were $3.5 trillion in 2017.

However, despite this expenditure, people in the U.S. have a lower life expectancy than people in other developed countries. This is due to a variety of factors, including access to healthcare and lifestyle choices.

Good health is central to handling stress and living a longer, more active life. In this article, we explain the meaning of good health, the types of health a person needs to consider, and how to preserve good health.

What is health?

Regular exercise contributes to good health.

In 1948, the World Health Organization (WHO) defined health with a phrase that modern authorities still apply.

“Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

“A resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities.”

This means that health is a resource to support an individual’s function in wider society, rather than an end in itself. A healthful lifestyle provides the means to lead a full life with meaning and purpose.

In 2009, researchers publishing inThe Lancet defined health as the ability of a body to adapt to new threats and infirmities.

They base this definition on the idea that the past few decades have seen modern science take significant strides in the awareness of diseases by understanding how they work, discovering new ways to slow or stop them, and acknowledging that an absence of pathology may not be possible.

Types

Mental and physical health are probably the two most frequently discussed types of health.

Spiritual, emotional, and financial health also contribute to overall health. Medical experts have linked these to lower stress levels and improved mental and physical well-being.

People with better financial health, for example, may worry less about finances and have the means to buy fresh food more regularly. Those with good spiritual health may feel a sense of calm and purpose that fuels good mental health.

Health inequities affect all of us differently. Visit our dedicated hub for an in-depth look at social disparities in health and what we can do to correct them.

Physical health

A person who has good physical health is likely to have bodily functions and processes working at their peak.

This is not only due not only to an absence of disease. Regular exercise, balanced nutrition, and adequate rest all contribute to good health. People receive medical treatment to maintain the balance, when necessary.

Physical well-being involves pursuing a healthful lifestyle to decrease the risk of disease. Maintaining physical fitness, for example, can protect and develop the endurance of a person’s breathing and heart function, muscular strength, flexibility, and body composition.

Looking after physical health and well-being also involves reducing the risk of an injury or health issue, such as:

• minimizing hazards in the workplace
• using contraception when having sex
• practicing effective hygiene
• avoiding the use of tobacco, alcohol, or illegal drugs
• taking the recommended vaccines for a specific condition or country when traveling

Good physical health can work in tandem with mental health to improve a person’s overall quality of life.

For example, mental illness, such as depression, may increase the risk of drug use disorders, according to a 2008 study. This can go on to adversely affect physical health.

Mental health

According to the U.S. Department of Health & Human Services, mental health refers to a person’s emotional, social, and psychological well-being. Mental health is as important as physical health as part of a full, active lifestyle.

It is harder to define mental health than physical health because many psychological diagnoses depend on an individual’s perception of their experience.

With improvements in testing, however, doctors are now able to identify some physical signs of some types of mental illness in CT scans and genetic tests.

Good mental health is not only categorized by the absence of depression, anxiety, or another disorder. It also depends on a person’s ability to:

• enjoy life
• bounce back after difficult experiences and adapt to adversity
• balance different elements of life, such as family and finances
• feel safe and secure
• achieve their full potential

Physical and mental health have strong connections. For example, if a chronic illness affects a person’s ability to complete their regular tasks, it may lead to depression and stress. These feelings could be due to financial problems or mobility issues.

A mental illness, such as depression or anorexia, can affect body weight and overall function.

It is important to approach “health” as a whole, rather than as a series of separate factors. All types of health are linked, and people should aim for overall well-being and balance as the keys to good health.

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Factors for good health

Good health depends on a wide range of factors.

Genetic factors

A person is born with a variety of genes. In some people, an unusual genetic pattern or change can lead to a less-than-optimum level of health. People may inherit genes from their parents that increase their risk for certain health conditions.

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Environmental factors

Environmental factors play a role in health. Sometimes, the environment alone is enough to impact health. Other times, an environmental trigger can cause illness in a person who has an increased genetic risk of a particular disease.

Access to healthcare plays a role, but the WHO suggest that the following factors may have a more significant impact on health than this:

• where a person lives
• the state of the surrounding environment
• genetics
• their income
• their level of education
• employment status

It is possible to categorize these as follows:

• The social and economic environment: This may include the financial status of a family or community, as well as the social culture and quality of relationships.
• The physical environment: This includes which germs exist in an area, as well as pollution levels.
• A person’s characteristics and behaviors: A person’s genetic makeup and lifestyle choices can affect their overall health.

According to some studies, the higher a person’s socioeconomic status (SES), the more likely they are to enjoy good health, have a good education, get a well-paid job, and afford good healthcare in times of illness or injury.

They also maintain that people with low socioeconomic status are more likely to experience stress due to daily living, such as financial difficulties, marital disruption, and unemployment.

Social factors may also impact on the risk of poor health for people with lower SES, such as marginalization and discrimination.

A low SES often means reduced access to healthcare. A 2018 study in Frontiers in Pharmacology indicated that people in developed countries with universal healthcare services have longer life expectancies than those in developed countries without universal healthcare.

Cultural issues can affect health. The traditions and customs of a society and a family’s response to them can have a good or bad impact on health.

According to the Seven Countries Study, researchers studied people in select European countries and found that those who ate a healthful diet had a lower 20-year death rate.

The study indicated that people who ate a healthful diet are more likely to consume high levels of fruits, vegetables, and olives than people who regularly consume fast food.

The study also found that people who followed the Mediterranean diet had a lower 10-year all-cause mortality rate. According to the International Journal of Environmental Research and Public Health , this diet can help protect a person’s heart and reduce the risk of several diseases, including type 2 diabetes, cancer, and diseases that cause the brain and nerves to break down.

How a person manages stress will also affect their health. According to the National Institute of Mental Health, people who smoke tobacco, drink alcohol, or take illicit drugs to manage stressful situations are more likely to develop health problems than those who manage stress through a healthful diet, relaxation techniques, and exercise.

Preserving health

The best way to maintain health is to preserve it through a healthful lifestyle rather than waiting until sickness or infirmity to address health problems. People use the name wellness to describe this continuous state of enhanced well-being.

“Wellness is the optimal state of health of individuals and groups. There are two focal concerns: the realization of the fullest potential of an individual physically, psychologically, socially, spiritually, and economically, and the fulfillment of one’s roles and expectations in the family, community, place of worship, and other settings.”

Wellness promotes active awareness of and participating in measures that preserve health, both as an individual and in the community. Maintaining wellness and optimal health is a lifelong, daily commitment.

Steps that can help people attain wellness include:

• eating a balanced, nutritious diet from as many natural sources as possible
• engaging in at least 150 minutes of moderate to high-intensity exercise every week, according to the American Heart Association
• screening for diseases that may present a risk
• learning to manage stress effectively
• engaging in activities that provide purpose
• connecting with and caring for other people
• maintaining a positive outlook on life
• defining a value system and putting it into action

The definition of peak health is highly individual, as are the steps a person may take to get there. Every person has different health goals and a variety of ways to achieve them.

It may not be possible to avoid disease altogether. However, a person should do as much as they can to develop resilience and prepare the body and mind to deal with illnesses as they arise.

WHO remains firmly committed to the principles set out in the preamble to the Constitution

• Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
  
• The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.
  
• The health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest co-operation of individuals and States.
  
• The achievement of any State in the promotion and protection of health is of value to all.
  
• Unequal development in different countries in the promotion of health and control of diseases, especially communicable disease, is a common danger.
  
• Healthy development of the child is of basic importance; the ability to live harmoniously in a changing total environment is essential to such development.
• The extension to all peoples of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health.
  
• Informed opinion and active co-operation on the part of the public are of the utmost importance in the improvement of the health of the people.
  
• Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures

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Public health is “the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals.” — CEA Winslow

Public health: The approach to medicine that is concerned with the health of the community as a whole. Public health is community health. It has been said that: “Health care is vital to all of us some of the time, but public health is vital to all of us all of the time.”

The mission of public health is to “fulfill society’s interest in assuring conditions in which people can be healthy.” The three core public health functions are:

• The assessment and monitoring of the health of communities and populations at risk to identify health problems and priorities;
• The formulation of public policies designed to solve identified local and national health problems and priorities;
• To assure that all populations have access to appropriate and cost-effective care, including health promotion and disease prevention services, and evaluation of the effectiveness of that care.

Public health is defined as the science of protecting the safety and improving the health of communities through education, policy making and research for disease and injury prevention.

The definition of public health is different for every person. Whether you like to crunch numbers, conduct laboratory or field research, formulate policy, or work directly with people to help improve their health, there is a place for you in the field of public health. Being a public health professional enables you to work around the world, address health problems of communities as a whole, and influence policies that affect the health of societies.

Public health involves the application of many different disciplines:

• Biology
• Anthropology
• Public policy
• Mathematics
• Engineering
• Education
• Psychology
• Computer science
• Sociology
• Medicine
• Business
• and others

What do public health professionals do?

As a public health professional, you will be trained to perform one or more of these ten essential services:

• Monitor the health status of a community to identify potential problems
• Diagnose and investigate health problems and hazards in the community
• Inform, educate, and empower people about health issues, particularly the underserved and those at risk
• Mobilize community partnerships to identify and solve health problems
• Develop policies and plans that support individual and community health efforts
• Enforce laws and regulations that protect health and ensure safety
• Link people to needed personal health services and ensure the provision of health care when otherwise unavailable
• Ensure a competent public health and personal health care workforce
• Evaluate effectiveness, accessibility, and quality of personal and population-based health services
• Research new insights and innovative solutions to health problems

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Introduction to Epidemiology

Epidemiology is the “study of distribution and determinants of health-related states among specified populations and the application of that study to the control of health problems.” — A Dictionary of Epidemiology

These materials provide an overview of epidemiology investigations, methods, and data collection.

The Science of Prevention

Public health is responsible for everything from clean air and water to safe workplaces; from controlling the spread of infectious diseases and preventing chronic diseases to improving prenatal nutrition; from reducing automobile accidents to designing quality health systems. Partnering with national and local governments, public health scientists respond to natural disasters, pandemics, and any other threat to population health. And while medicine is vital for each of us when we get sick, public health benefits everyone, young and old, rich and poor, healthy and unhealthy, millions at a time, and in ways that ensure health beyond what any of us alone can accomplish.

The Role of Research and Discovery

Although the history of public health is filled with important discoveries, this is a science that thrives on continuous exploration. Public health scientists examine familiar areas of disease, disability, and safety, as well as conditions that alter the health landscape such as technological advancement, novel infections, and environmental shifts.

The field is divided into several areas of specialty, each with its own approach to improving health. Epidemiology is the cornerstone science of public health defining the causes, distribution, and prevention of disease and disability. When populations experience the effects of ill health, epidemiologists find solutions. Biostatistics, with the capacity to measure, monitor, and analyze complex data, is a force in population sciences, from genetics to precision medicine, from brain science to clinical trials. Biostatisticians extract meaning from big data, leading us to quantifiable evidence used by all public health disciplines.

Environmental Health Sciences examines our environment to explain how it contributes to health, whether measuring the effect of toxic substances on brain development, reducing levels of arsenic found in drinking water, or understanding how climate change and air pollution affect health. When health is impaired due to social forces such as racism, homelessness, or homophobia, Sociomedical Sciences is called upon to explain and alleviate the burdens of ill health.

Considering topics like humanitarian assistance, migration, and reproductive health, Population and Family Health studies the unique issues that affect health for the most vulnerable, including children, refugees, and expectant mothers. Health Policy and Management evaluates health systems to build knowledge of how nations and local organizations can deliver more health at lower cost. Researchers train professionals to become leaders everywhere—from government to nonprofits, from hospitals to the insurance industry.

Understanding the links between tuberculosis and overcrowding in turn-of-the-century New York City brought about massive changes in housing, sanitation, and treatment—and a dramatically lower rate of TB infection.

To expand access to antiretroviral HIV medication across sub-Saharan Africa, massive systems were designed to create access to medicine and care, and improve disease prevention in countries without any reliable healthcare infrastructure, saving millions of lives and changing the course of the AIDS pandemic.

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For many people, sex is mainly synonymous with penile-vaginal intercourse. Yet there are many ways to have sex. There are also several ways to have lesbian sex, which can involve a variety of techniques, including oral sex, fingering, and the use of sex toys.

The logistics of lesbian sex can vary depending on several factors, which include:

• a person’s gender identity
• the sex assigned to a person at birth
• a person’s body parts
• a person’s relationship with their bodies

For example, a woman whom doctors designated male at birth may use her penis during sex or may wish to avoid all contact with her penis.

With a variety of techniques available and different understandings of what constitutes good sex, communication is crucial.

In this article, we will define what sex is, debunk myths surrounding lesbian sex, and suggest how people may prepare for lesbian sex.

Sex definition

Lesbian sex can be pleasurable, creative, and satisfying.

There is no consensus on the single medical definition of sex. Doctors and researchers usually assume it involves some form of genital contact. However, sex extends well beyond penile-vaginal intercourse.

Many people consider sex to be a mutually voluntary activity with other people that involves sexual contact. However, this is open to interpretation, and sex may mean different things to different people. Some people even consider kissing a form of sex.

This means there is no single definition for lesbian sex, nor any specific sex act that all lesbians enjoy. Some types of lesbian sex may include:

• Oral sex: Orally stimulating a partner’s genitals.
• Manual sex: Stimulating a partner’s genitals or other erogenous zones with the hand or fingers.
• Mutual masturbation: Engaging in manual sex simultaneously, so that each partner stimulates the other.
• Penetrative sex: Penetration with a penis, for example, when a lesbian is assigned male at birth. Or it could involve sex toys or a strap-on dildo.
• Masturbation: Masturbating, sometimes while talking to or kissing a partner.
• Scissoring or humping: Mutual genital contact, where each partner rubs their genitals on the other’s genitals.

Debunking myths about lesbian sex 

Some myths about lesbian sex include:

Each partner plays a gender role in the relationship: For example, one partner always penetrates the other. Lesbians, like all other people, may embrace a wide range of roles. Sometimes, one partner might always be the one who penetrates the other, but often partners switch roles or have different types of sex.

All lesbians have sex by scissoring: There are many ways to have lesbian sex, and many lesbians never scissor.

Lesbian sex is safe: While pregnancy is not possible if both partners were female at birth, it can still be possible with a trans woman. Also, lesbians can and do transmit sexually transmitted infections (STIs). People should not presume to be at low or no risk based on their sexual orientation.

Lesbian sex cannot be violent, and there is no such thing as lesbian rape: Lesbians can and do rape other women, and research suggests that intimate partner violence occurs among lesbian couples.

Lesbians feel disinterested or lose interest in sex: This myth draws upon sexist stereotypes about women’s sexuality. Like everyone else, lesbians’ interest in sex varies from person to person, and across the lifespan.

Being lesbian means someone was born female, or cannot be transgender: Gender identity is not the same as sexuality or assigned sex. The gender label a person receives at birth does not matter. A person labeled male or female at birth can still identify as lesbian.

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How to prepare 

There is no right time to have sex, just as there is no right way for sex. Whether a person has sex for the first time, or they have had years of sex with the same partner, consent and communication are key. Some strategies that can help prepare a person for sex include:

• talking with a partner about views on sex and sexuality
• getting tested for STIs
• communicating during sex about what feels good

Manual stimulation 

During manual stimulation, one partner stimulates the other partner’s genitals, often the clitoris and vagina. Every person has different preferences and different anatomies, so it is important to talk about what feels good.

Some partners like to masturbate mutually, which means they stimulate each other simultaneously.

Oral sex 

Oral sex involves the use of the mouth and tongue to stimulate a partner’s genitals. Many lesbians find stimulation on the clitoris is pleasurable.

Some people also like to include aspects of manual stimulation into oral sex. People who enjoy oral stimulation can position themselves so each partner can perform simultaneous oral sex on each other.Medical News Today NewsletterKnowledge is power. Get our free daily newsletter.

Penetrative sex 

Many people believe penetrative sex is impossible in a lesbian relationship. This is untrue. Some lesbians might have penises if they were assigned as males at birth. Others choose other forms of penetration. People who enjoy penetrative sex may use:

• one or more fingers, with techniques that may provide more intense stimulation, such as fisting
• sex toys, such as dildos or vibrators
• a strap-on, some of which may offer mutual penetration

Safer sex tips 

The safest way to have sex as a lesbian is to use barrier methodsTrusted Source, such as dental dams, to ensure people do not share bodily fluids. Those who want to avoid this practice can have safer sex by:

• minimizing the number of partners they have
• avoiding sex with men
• cleaning all sex toys before and after use
• seeing a doctor for any pain, itching, burning, or other signs of STIs

Summary 

Lesbians can have many different types of sex. A person can explore various sexual activities in a consensual way to help them achieve sexual satisfaction.

Creativity, open communication, and a focus on safety can help partners enjoy the experience.

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Lymphedema refers to swelling that generally occurs in one of your arms or legs. Sometimes both arms or both legs swell.

Lymphedema is most commonly caused by the removal of or damage to your lymph nodes as a part of cancer treatment. It results from a blockage in your lymphatic system, which is part of your immune system. The blockage prevents lymph fluid from draining well, and the fluid buildup leads to swelling.

While there is presently no cure for lymphedema, it can be managed with early diagnosis and diligent care of your affected limb.

Symptoms

Lymphedema signs and symptoms, which occur in your affected arm or leg, include:

• Swelling of part or all of your arm or leg, including fingers or toes
• A feeling of heaviness or tightness
• Restricted range of motion
• Aching or discomfort
• Recurring infections
• Hardening and thickening of the skin (fibrosis)

The swelling caused by lymphedema ranges from mild, hardly noticeable changes in the size of your arm or leg to extreme changes that make the limb hard to use. Lymphedema caused by cancer treatment may not occur until months or years after treatment.

When to see a doctor

Make an appointment with your doctor if you notice persistent swelling in your arm or leg.

If you already have the diagnosis of lymphedema of a limb, see your doctor if there is a sudden dramatic increase in the size of the involved limb, as it may suggest a new process is occurring.

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Causes

Your lymphatic system is crucial to keeping your body healthy. It circulates protein-rich lymph fluid throughout your body, collecting bacteria, viruses and waste.

products. Your lymphatic system carries this fluid and harmful substances through your lymph vessels, which lead to lymph nodes. The wastes are then filtered out by lymphocytes — infection-fighting cells that live in your lymph nodes — and ultimately flushed from your body.

Lymphedema occurs when your lymph vessels are unable to adequately drain lymph fluid, usually from an arm or leg. Lymphedema can be either primary or secondary. This means it can occur on its own (primary lymphedema), or it can be caused by another disease or condition (secondary lymphedema). Secondary lymphedema is far more common than primary lymphedema.

Causes of secondary lymphedema

Any condition or procedure that damages your lymph nodes or lymph vessels can cause lymphedema. Causes include:

• Surgery. Removal of or injury to lymph nodes and lymph vessels may result in lymphedema. For example, lymph nodes may be removed to check for spread of breast cancer, and lymph nodes may be injured in surgery that involves blood vessels in your limbs.
• Radiation treatment for cancer. Radiation can cause scarring and inflammation of your lymph nodes or lymph vessels.
• Cancer. If cancer cells block lymphatic vessels, lymphedema may result. For instance, a tumor growing near a lymph node or lymph vessel could enlarge enough to block the flow of the lymph fluid.
• Infection. An infection of the lymph nodes or parasites can restrict the flow of lymph fluid. Infection-related lymphedema is most common in tropical and subtropical regions and is more likely to occur in developing countries.

Causes of primary lymphedema

Primary lymphedema is a rare, inherited condition caused by problems with the development of lymph vessels in your body. Specific causes of primary lymphedema include:

• Milroy’s disease (congenital lymphedema). This disorder begins in infancy and causes lymph nodes to form abnormally.
• Meige’s disease (lymphedema praecox). This disorder often causes lymphedema around puberty or during pregnancy, though it can occur later, until age 35.
• Late-onset lymphedema (lymphedema tarda). This occurs rarely and usually begins after age 35.

Risk factors

Factors that may increase your risk of developing lymphedema after cancer, from cancer treatment or from other secondary causes include:

• Older age
• Excess weight or obesity
• Rheumatoid or psoriatic arthritis

Complications

Lymphedema in your arm or leg can lead to serious complications, such as:

• Infections. Possible infections that can result from lymphedema include a serious bacterial infection of the skin (cellulitis) and an infection of the lymph vessels (lymphangitis). The smallest injury to your arm or leg can be an entry point for infection.
• Lymphangiosarcoma. This rare form of soft tissue cancer can result from the most-severe cases of untreated lymphedema. Possible signs of lymphangiosarcoma include blue-red or purple marks on the skin.

Prevention

If you have had or you are going to have cancer surgery, ask your doctor whether your procedure will involve your lymph nodes or lymph vessels. Ask if your radiation treatment will be aimed at lymph nodes, so you’ll be aware of the possible risks.

To reduce your risk of lymphedema, try to:

• Protect your arm or leg. Avoid injury to your affected limb. Cuts, scrapes and burns can invite infection. Protect yourself from sharp objects. For example, shave with an electric razor, wear gloves when you garden or cook, and use a thimble when you sew. If possible, avoid medical procedures, such as blood draws and vaccinations, in your affected limb.
• Rest your arm or leg while recovering. After cancer treatment, exercise and stretching are encouraged. But avoid strenuous activity until you’ve recovered from surgery or radiation.
• Avoid heat on your arm or leg. Don’t apply ice or heat, such as with a heating pad, to your affected limb. Also, protect your affected limb from extreme cold.
• Elevate your arm or leg. Whenever possible, elevate your affected limb above the level of your heart.
• Avoid tight clothing. Avoid anything that could constrict your arm or leg, such as tightfitting clothing and, in the case of your arm, blood pressure cuffs. Ask that your blood pressure be taken in your other arm.
• Keep your arm or leg clean. Make skin and nail care high priorities. Inspect the skin on your arm or leg daily, watching for changes or breaks in your skin that could lead to infection. Don’t go barefoot.

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Chest trauma accounts for 25-50% of all trauma-related deaths in the world. Trauma to the chest can result in broken ribs, pulmonary injury, cardiac injury, and blood vessel damage. Stove-in chest is a complex type of flail chest injury. Flail chest describes damage to the chest due to significant blunt force trauma, such as in a car accident or act of violence. Stove-in chest is a rare type of trauma to the thorax that occurs most often in car accidents. Here are the facts about this serious injury.

Diagnosing Stove-In Chest

Victims of stove-in chest may visit the emergency department with severe chest pain and difficulty breathing, or dyspnea. Doctors may use tracheal intubation, mechanical ventilation, or chest tube insertion to enable breathing while assessing a chest injury. Diagnosing stove-in chest requires scans, x-rays, and radiographs. This type of chest injury occurs when a segment of the chest wall collapses.

Stove-in chest differs from typical flail chest in that the latter describes only blunt force trauma to the chest. Flail chest happens when part of the chest wall moves due to fractures of three or more ribs, posteriorly and anteriorly in each rib. There are several different types of flail chest injuries depending on the location of the fractures. Stove-in chest occurs when the wall of the chest collapses, due to three or more ribs breaking upon impact.

Flail chest and stove-in chest require significant force over a large area of the chest, such as the thorax, to cause multiple rib fractures at once. Striking the steering wheel in a car accident, for example, could cause flail chest or stove-in chest. In some cases, the force of impact of a seatbelt across the chest can cause impact injuries. These injuries are so dangerous because they can easily affect the heart and lungs, leading to pulmonary contusion, respiratory insufficiency, and death.

Prognosis and Treatments for Stove-In Chest Injuries

Stove-in chest has a high rate of immediate mortality, but there is a chance of recovery with proper medical treatment. If the patient does not die upon impact, doctors can confirm stove-in chest using x-rays.

The chest wall will show collapse due to abnormal motion in three or more ribs. Depending on the nature of the injury, doctors will choose the appropriate treatment method moving forward. Here are two examples:

• Vehicle accident – Blunt force trauma can break multiple adjacent ribs in several places, leading to a part of the chest wall moving independently. Patients with stove-in chest from car accidents typically require surgery to fix the fractures and physiotherapy reduce the risk of complications.
• Assault or act of violence – Gunshot wounds or stabbings can lead to penetration injuries, typically requiring surgery. Patients with penetrating chest trauma may deteriorate rapidly depending on the nature of the injury. However, they may also recover faster than patients with blunt chest injuries.

Doctors will also have to treat related injuries, such as those to the lung, airways, heart, blood vessels, and other structures within the torso. Complex flail chest and stove-in chest injuries require tailored medical treatment according to each individual patient. The risk of complications is too high for one type of treatment to work across the board. For example, in one fatal stove-in chest injury, failure to ventilate the patient early (the patient exhibited good gas exchange) may have contributed to the formation of the empyema, or pus buildup in the pleural space, that caused the patient’s death.

Stove-in chest is one of the most life-threatening injuries that can occur in an accident. If you or someone you loved suffered this type of injury, seek help from an experienced attorney. Someone may be liable to pay for your physical injuries, pain and suffering, and emotional distress.

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Gangrene is death of body tissue due to a lack of blood flow or a serious bacterial infection. Gangrene commonly affects the arms and legs, including the toes and fingers, but it can also occur in the muscles and in organs inside the body, such as the gallbladder.

Your risk of gangrene is higher if you have an underlying condition that can damage your blood vessels and affect blood flow, such as diabetes or hardened arteries (atherosclerosis).

Treatments for gangrene include surgery to restore blood flow and remove dead tissue, antibiotics if there is an infection, and hyperbaric oxygen therapy. The earlier gangrene is identified and treated, the better your chances for recovery.

Gangrene is when part of your body tissue dies. This often occurs because the tissue is not getting enough blood from your circulatory system.

Gangrene usually affects your extremities — the areas farthest from your heart, such as your toes and fingers. However, it can affect other parts of your body as well. Gangrene can even affect your internal organs.

The condition typically starts in a specific body part, such as a leg, hand, or internal organ. Gangrene can spread through your body and cause you to go into shock if left untreated. Shock is a condition marked by a variety of symptoms including low blood pressure. Shock can be life-threatening and is considered a medical emergency.

Gangrene is a medical emergency that could lead to amputations or death. Recognizing and treating the condition as fast as possible will improve your outlook.

Types of gangrene

Dry gangrene

All of your organs (such as your liver, heart, and muscles) need oxygen to function properly and survive. The oxygen is carried to different parts of your body by your blood. Dry gangrene occurs when one of your body parts isn’t getting enough oxygen. Eventually, the body part will start to deteriorate and die. With dry gangrene, the skin is closed and there is no evidence of infection.

Wet gangrene

Wet gangrene happens when your body tissues become infected with some type of bacteria. The tissues react to the presence of the bacteria by growing moist and breaking down. This process causes the death of your tissues. It’s more of an emergency than dry gangrene because of the possibility of infection spreading to other parts of the body.

Gas gangrene

Bacteria called Clostridia cause gas gangrene. These bacteria create an infection that causes gas bubbles and toxins to develop inside the affected area. The resulting gases cause tissue death. This type of gangrene can be fatal, though it’s rare in the United States.

Internal gangrene. Gangrene that affects one or more of your organs, such as your intestines, gallbladder or appendix, is called internal gangrene. This type of gangrene occurs when blood flow to an internal organ is blocked — for example, when your intestines bulge through a weakened area of muscle in your stomach area (hernia) and become twisted.

Left untreated, internal gangrene can be deadly.Fournier’s gangrene. Fournier’s gangrene involves the genital organs. Men are more often affected, but women also can develop this type of gangrene. An infection in the genital area or urinary tract causes this type of gangrene. Meleney’s gangrene. This rare type of gangrene — also called progressive bacterial synergistic gangrene — is usually a complication of surgery. People with Meleney’s gangrene develop painful skin lesions one to two weeks after their operations.

Symptoms

When gangrene affects your skin, signs and symptoms may include:

• Skin discoloration — ranging from pale to blue, purple, black, bronze or red, depending on the type of gangrene you have
• Swelling
• Blisters
• Sudden, severe pain followed by a feeling of numbness
• A foul-smelling discharge leaking from a sore
• Thin, shiny skin, or skin without hair
• Skin that feels cool or cold to the touch

If you have a type of gangrene that affects tissues beneath the surface of your skin, such as gas gangrene or internal gangrene, you may also have a low-grade fever and generally feel unwell.

If the germs that caused the gangrene spread through your body, septic shock can occur. Signs and symptoms of septic shock include:

• Low blood pressure
• Fever, although some people may have a body temperature lower than the normal 98.6 F (37 C)
• Rapid heart rate
• Lightheadedness
• Shortness of breath
• Confusion

When to see a doctor

Gangrene is a serious condition and needs emergency treatment. Call your doctor right away if you have persistent, unexplained pain in any area of your body along with one or more of the following signs and symptoms:

• Persistent fever
• Skin changes — including discoloration, warmth, swelling, blisters or lesions — that won’t go away
• A foul-smelling discharge leaking from a sore
• Sudden pain at the site of a recent surgery or trauma
• Skin that’s pale, hard, cold and numb

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Causes

Causes of gangrene include:

• Lack of blood supply. Your blood provides oxygen and nutrients to your body. It also provides your immune system with antibodies to ward off infections. Without a proper blood supply, your cells can’t survive, and your tissue decays.
• Infection. An untreated bacterial infection can cause gangrene.
• Traumatic injury. Gunshot wounds or crushing injuries from car crashes can cause open wounds that let bacteria into the body. If the bacteria infect tissues and remain untreated, gangrene can occur.

Recognizing the signs of gangrene

External gangrene

Sometimes the first sign of dry gangrene is a reddish line that develops around the affected tissue. This line may later turn black.

Other signs that might indicate you have gangrene include:

• a wound that is red, sore, or swollen
• a wound that is filled with pus or gives off a bad smell
• an isolated area of your body feels cold
• lacking a sense of touch in an isolated area
• sores that keep coming back in the same place on your body
• part of your skin has turned an unusual color (greenish-black, red, blue, or bronze)

Internal gangrene

It’s also possible to experience internal gangrene, which affects your inner tissues or organs. In this case, you may not have any symptoms on your skin or limbs. However, you may have pain, an unexplained fever that lasts a long time, or low blood pressure. You may also experience confusion.

How is gangrene diagnosed?

Your doctor may suspect that you have gangrene based on your medical history and symptoms. They may also use a combination of additional diagnostic methods to determine your condition.

Lab analysis of tissue or fluid samples

A scraping of tissue from your affected body part may be examined with a microscope to look for dead cells.

Blood tests

An abnormally high white blood cell count can indicate a gangrenous infection.

Medical imaging

Some kinds of imaging are helpful in diagnosing the spread of gangrene in your internal tissues. These tests could include X-rays, MRI scans, or CT scans.

An anarteriogram test may be performed if doctors suspect that your gangrene is related to a circulatory problem. This test uses X-rays to monitor the flow of a special dye through your arteries, showing whether any arteries are blocked.

Risk factors

Several factors increase your risk of developing gangrene. These include:

• Diabetes. If you have diabetes, your body doesn’t produce enough of the hormone insulin (which helps your cells take up blood sugar) or is resistant to the effects of insulin. High blood sugar levels can eventually damage blood vessels, decreasing or interrupting blood flow to a part of your body.
• Blood vessel disease. Hardened and narrowed arteries (atherosclerosis) and blood clots also can block blood flow to an area of your body.
• Severe injury or surgery. Any process that causes trauma to your skin and underlying tissue, including an injury or frostbite, increases your risk of developing gangrene, especially if you have an underlying condition that affects blood flow to the injured area.
• Smoking. People who smoke have a higher risk of gangrene.
• Obesity. Obesity often accompanies diabetes and vascular disease, but the stress of extra weight alone can also compress arteries, leading to reduced blood flow and increasing your risk of infection and poor wound healing.
• Immunosuppression. If you have an infection with the human immunodeficiency virus (HIV) or if you’re undergoing chemotherapy or radiation therapy, your body’s ability to fight off an infection is impaired.
• Medications or drugs that are injected. In rare instances, certain medications and illegal drugs that are injected have been shown to cause infection with bacteria that cause gangrene.
• Complications of COVID-19. There have been a few reports of people getting dry gangrene in their fingers and toes after having COVID-19-related blood clotting problems (coagulopathy). More research is needed to confirm this association.

Complications

Gangrene can lead to serious complications if it’s not immediately treated. Bacteria can spread quickly to other tissues and organs. You may need to have a body part removed (amputated) to save your life.

Removal of infected tissue can lead to scarring or the need for reconstructive surgery.

Prevention

Here are a few suggestions to help you reduce your risk of developing gangrene:

• Care for your diabetes. If you have diabetes, make sure you examine your hands and feet daily for cuts, sores, and signs of infection, such as redness, swelling or drainage. Ask your doctor to examine your hands and feet at least once a year, and try to maintain control over your blood sugar levels.
• Lose weight. Excess pounds not only put you at risk of diabetes but also place pressure on your arteries, constricting blood flow and putting you at risk of infection and slow wound healing.
• Don’t use tobacco. The chronic use of tobacco products can damage your blood vessels.
• Help prevent infections. Wash any open wounds with a mild soap and water and try to keep them clean and dry until they heal.
• Watch out when the temperature drops. Frostbitten skin can lead to gangrene because frostbite reduces blood circulation in an affected area. If you notice that any area of your skin has become pale, hard, cold and numb after prolonged exposure to cold temperatures, call your doctor.

Gangrene treatment

Antibiotics

Your doctor may prescribe antibiotics if bacteria are present. These are typically given intravenously, or through a needle directly into the bloodstream.

Vascular surgery

For people with poor circulation that results in gangrene, vascular surgery (surgery on the arteries or veins) may be recommended in order to improve the flow of blood through the veins to body tissues.

Hyperbaric oxygen chamber

Placing a person with gas gangrene in a special oxygen-rich environment can slow the growth of bacteria. This allows the skin to begin healing. It also brings oxygen to the damaged tissue to promote healing.

Tissue debridement

In serious gangrene cases, the dead tissue or body part may need to be removed. This process is called debridement. Debridement can be done with surgical tools or with chemicals. The goal of this type of surgery is to remove the affected areas to prevent the spread of infection and rid the body of the dead tissue.

One alternative form of debridement, known as maggot debridement, uses fly larvae to eat away bacteria and dead tissue. Though rare, this practice can still be used by physicians in the United States and abroad.

Doctors are sometimes able to restore the flow of oxygen to the affected area. Skin grafts can repair any damaged tissue. This procedure uses a piece of your healthy skin from elsewhere on the body to cover the damaged area.

Amputation

For severe cases, amputation of a limb, finger, or toe could be necessary to save your life. People who must have part of an arm or leg amputated due to gangrene may be fitted with a prosthesis, or artificial limb, to replace the missing body part.

What is the long-term outlook for gangrene?

Gangrene can sometimes be treated without serious complications, especially if it is caught early. However, it can lead to amputation in some serious cases, particularly if it’s not treated quickly.

Gangrene can even be fatal for some individuals. This is rare, but it can occur if:

• you have other serious medical issues that complicate your treatment
• the gangrenous area covers a large part of your body
• treatment is not provided quickly enough

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