Contamination at the Cosmetics Counter

By Diane Griffith, HealthAtoZ writer

Have you ever stopped at a department store cosmetics counter to try out makeup samples? If so, you may want to avoid the practice in the future. Recent testing by a professor at Rowan University in New Jersey has revealed staph and strep contamination, as well as E. coli, in the majority of these products. The professor, Dr. Elizabeth Brooks, tested skin, eye and lip makeup from 20 cosmetic companies.

Bacteria and other germs

The bacteria found in the samples can cause such infections as conjunctivitis (pink eye) and acne. Bacteria can enter your skins’ pores and multiply. E. coli is a fecal contaminant, meaning someone with poor bathroom hygiene can touch and taint a makeup sample. An unsuspecting customer who tests the makeup a few minutes later can apply contaminated makeup to her face. Some samples found at makeup counters also have been found to be infected with molds and other fungi organisms.

Preservatives

When you open a container of makeup, microorganisms from the air can enter. That is why cosmetics contain preservatives, which kill such bacteria and keep the products from becoming infected.

When you use cosmetics in your home, the preservatives within them usually have a whole day to kill bacteria that may have entered. In the store, however - especially during busy weekend hours - there may be a gap of only minutes between each use, which does not give preservatives enough time to act.

Avoiding infection

For the same reason, sharing your own cosmetics with a friend can also spread contamination. Makeup can become infected with bacteria that the brush or applicator picks up from the skin. Moistening an applicator or brush with saliva can make contamination even worse.

Since there are no regulations regarding makeup counter samples, use them at your own risk. Some stores clean samples regularly, or throw them out if they see people applying them to skin or lips directly. Some companies require salespeople to dip samples in alcohol and dry them off before offering them to customers. In addition to alcohol, many salespeople use cotton balls, antibacterial brushes and Q-tips® to apply makeup.

If you feel you must test, here are some tips to make it safer:

  • Test makeup on your wrist or the back of your hand instead of applying it to your face or lips directly.
  • Always clean your hands first to prevent exposing makeup to bacteria.
  • Insist on a new, unused applicator before testing any product.
  • Use testers during weekdays. Makeup counters are busiest on weekends and preservatives are not given a chance to work because of the continuous exposure. Bacteria that formed over a busy weekend will start to die off as the week progresses.
  • Wash your skin immediately after trying on makeup.
  • Don’t try on lipstick or eye makeup, even if a cotton swab is provided.
  • Use makeup counters where samples are dipped in alcohol before being offered to customers. Alcohol may help kill bacteria.
  • Close makeup containers tightly when not in use.
  • Keep makeup out of sunlight. Sunlight can destroy preservatives.
  • Don’t use eye cosmetics if you have any type of eye infection. If you discover an infection, discard any makeup you were using at the time.

If there is bacterial growth on makeup, you may notice a change - either in its color, smell or consistency - at which point it should be thrown out. It is recommended that mascara be discarded after three months.

Learning About Your Condition

By Diane Griffith, HealthAtoZ writer

You’ve been poked and prodded. You’ve had the tests and anxiously awaited the results. Finally, the verdict is in. Now you know what’s been ailing you.

Maybe it’s a condition you’ve heard of before - or maybe it’s completely unfamiliar and you’re having trouble even pronouncing it. Whether you’ve just been diagnosed with allergies or Raynaud’s disease, one thing is certain: Now that you have a diagnosis, it’s time to learn everything you can about your condition so you and it can live together in peace.

Do some research

If you want to learn more, you’ve come to the right place. Click on the HealthAtoZ “Diseases and Conditions” tab to look up your condition. An overview on the disorder will appear along with tabs containing information on risk factors, causes, treatment options, doctor visits, self care, lifestyle changes, medications, tests and procedures, etc. There are articles listed under these tabs that relate specifically to your condition. In addition, you can search the HealthAtoZ encyclopedia for any disorder or for other terms.

If you wish to educate yourself further, there are a wealth of resources available on the Internet.

Using the Internet

  • Go to the Centers for Disease Control and Prevention Web site at http://www.cdc.gov/ and search the alphabetical index, or enter your condition into the search box for a list of articles related to that disorder.
  • The National Institutes of Health has a similar Web site at http://health.nih.gov, which you can search alphabetically or by entering the term into the search box.
  • Also through the NIH, you can access MedlinePlus, a medical library that includes a medical encyclopedia and a medical dictionary, extensive information on prescription and nonprescription drugs, health information from the media, and links to thousands of clinical trials. MedlinePlus is updated daily and can be bookmarked at the URL: medlineplus.gov.
  • Organizations exist for just about any disease or condition. By using the search feature on Healthfinder.gov, you can find Web sites for most of them, such as the American Diabetes Association (http://www.diabetes.org), the American Heart Association (http://www.americanheart.org), the American Cancer Society (http://www.cancer.org) and the American Lung Association (http://www.lungusa.org), as well as numerous lesser-known organizations.
  • If your condition is something rare, you can go to http://www.rarediseases.org, the site for the National Organization of Rare Disorders (NORD). NORD will provide you with information on the disorder as well as Web links for organizations dedicated to that disease.

Fewer medical mistakes are made when you are educated about your condition. The best thing you can do to treat your disease is to learn about it. Don’t let your disorder take over your life - empower yourself with knowledge and take charge of your health.

If you have not yet seen a doctor, don’t diagnose yourself by reading an article. See your doctor and discuss your concerns.

The Eyes: Windows to Disease?

By Melissa Tennen, HealthAtoZ writer

The eyes may be the windows to the soul, but they may also offer a peek at the heart - and the rest of you.

Just by examining your eyes, your eye doctor can tell whether you have hypertension (high blood pressure) or diabetes in some cases. Hypertension and diabetes are diseases that can start slowly and without symptoms, but can cause major damage throughout your body, including your eyes, if they are not controlled.

The blood vessels

Checking the blood vessels at the back of the eye as part of an exam offers the doctor a unique glimpse into the body’s vast network of blood vessels. In fact, it is the only examination that allows a doctor to look directly at any network of blood vessels in the body without surgery.

The blood vessels in the eyes are especially delicate and vulnerable. A good thing about this unique glimpse is that damage in this area of the eye can be the first physical sign of diabetes or high blood pressure. It’s a good thing, because if these problems are spotted early, it helps prevent further health problems, such as heart attacks.

Detecting disease

Let’s talk first about diabetes. This is a disease in which the body cannot properly use its fuel supply of sugar, meaning sugar builds up in the blood. This excess sugar can damage blood vessels throughout the body, including the eyes.

Equally as dangerous, high blood pressure usually does not have symptoms, but, if uncontrolled over the years, can lead to heart disease, heart attacks and stroke.

Detecting these problems early is not the only reason eye exams are important. Any kind of damage to this particular network of blood vessels can cause some loss of vision and, in the worst case, blindness.

Examination

To see this type of damage, the doctor looks at the back of your eye. The doctor is not only looking for diabetes and heart disease, but is also checking for eye diseases like cataracts (a clouding of the eye).

The doctor may use something called an ophthalmoscope. This is a magnifying device - usually used with a light - that the doctor shines into your eyes. The doctor will probably use special eyedrops to make your pupil (the black part of your eye) larger in order to better see the back of your eye.

When to have an eye exam

How often you should get an eye exam depends on your age, race, medical history, family history of eye disease and whether you have any problems with your eyes. Every child should receive a vision screening exam by age five.

For people with healthy eyes who are not experiencing any vision problems, the Healthy Vision 2010 initiative of the National Eye Institute recommends that you get a dilated eye exam at least every two years. This exam can detect changes in your retina or optic nerve. If you experience any degree of sudden vision loss, eye pain, or irritation, you should see a doctor right away, however.

You should see an eye doctor more often than every two years if:

  • You have diabetes.
  • You have a family history of eye diseases such as glaucoma, macular degeneration and corneal diseases.

Is it Time for a Change?

By Melissa Tennen, HealthAtoZ writer

The messages are trumpeted everywhere - eat better, exercise, lose weight, lower your blood pressure and cholesterol levels, and watch your stress. It’s like a broken record. But wait. Maybe it’s time for you to do something.

Take stock of your health. Is your weight higher than you would like? Do you rarely exercise? Do you smoke? Do you skip the doctor’s office? Do you reach for the potato chips instead of carrot sticks?

If you answered “yes” to any of these questions, then it’s time to make changes and improve your life. Good health is the best gift you can give yourself - and your family. Wellness should not just mean the absence of disease.

Sure, change is difficult. But for new habits to set in, change must come slowly. Take small steps and set mini-goals for yourself.

Setting goals: easier than you think

One secret to changing your life is to set goals — big one and little ones. Tell yourself, “I’m going to walk one block today.” This is a mini-goal. “When I feel stronger and less winded, I’ll walk two blocks.” Another mini-goal. “Eventually I’ll be walking a mile.” The big goal.

Months or even a year later, you’ll be doing your ultimate goal of walking two miles every day. Realistic goals mean gradual goals. You have to be patient. Listen to your body. When it tells you it’s tired, take it easy. Never force yourself because that could mean injury or frustration.

Make a pact or contract with yourself. Decide what you want to do and how you plan to get there. Write it all down and include the reasons why you are making this change - to look better, to lose weight, to feel better, to help with your present conditions or to prevent disease.

Here’s a sample contract:

Goal: I’m going to eat less fat.
The first step: I’ll have yogurt instead of ice cream after dinner.

Goal: I want to exercise for 30 minutes most days of the week.
The first step: I will walk around the block.

Keeping tabs

Keeping track of your progress can be a great motivator. Use a journal, a log sheet or some other way to record your successes and how you want to improve your routine. Note the changes. Are you losing weight? Do you feel better about yourself?

Celebrate everyday victories

Go ahead and pat yourself on the back every time you do something good for yourself and reach one of your mini-goals. Did you eat two servings of vegetables today instead of one? Did you walk a mile instead of a half mile? Did you drop a pound? Yes, these are small accomplishments, but small accomplishments eventually lead to big ones. These are all stepping stones on your path to wellness.

Celebrate each little victory. Get a pedicure. Take a bubble bath. Buy a new CD. Go dancing with your loved one. Your victories are unique and so too are your rewards. Remember, don’t celebrate with a chunk of cake or a cigarette. Your celebrations should reinforce your new habits.

Make it your strategy to get healthier and improve your life.

New Dietary Guidelines Call for More Exercise, Fewer Calories


The ABCs of Knowing Your Numbers

By Melissa Tennen, HealthAtoZ writer

What are your numbers? Not your cell phone, home or work numbers. Actually, we’re talking cholesterol and high blood pressure. Ah, those numbers.

Chances are, if you are like most people, you don’t know what they are. In fact, you may not have had your cholesterol and blood pressure checked in a while. These measurements, however, can add to or subtract from a long and healthy life.

High blood pressure and cholesterol can do serious damage to your body if not controlled. You won’t have symptoms, but that doesn’t mean you are in the clear.

High blood pressure is the force of blood in your arteries. In most cases, the cause is unknown, although risk factors such as smoking and poor diet increase your risk. High blood pressure increases your risk for heart attack, heart failure, stroke and kidney failure.

High cholesterol is equally dangerous, increasing your risk for heart disease. Cholesterol is a waxy substance made by the liver and used by the body to insulate nerves and to make cell membranes and hormones. Other sources are meat, poultry, fish and dairy products. Cholesterol forms thick, hard deposits in the artery walls, causing arteries to thicken and become blocked.

There are plenty of good reasons to know your numbers:

  1. Motivation. Understanding your numbers helps motivate you to take better care of yourself. Whether they are good or bad, you should know what your numbers are, what they mean and if you need to make any changes. Sometimes your blood pressure and cholesterol numbers may not indicate a need for medication, but they may be high enough to warrant diet and exercise changes. They won’t change on their own and they don’t have a cure, but they can be managed effectively.
  1. Times have changed. Doctors have changed their approaches to treating high blood pressure and high cholesterol. Nowadays, they are much more aggressive at tackling high levels, and, depending upon your health, often aim to get your numbers as low as possible. Even if your blood pressure numbers have not changed since you last saw the doctor, it doesn’t mean they are at safe levels. Guidelines for treatment have changed in recent years to allow doctors and their patients to help ward off diseases and complications earlier on. Treatment has improved, and many medications can effectively control your condition.
  1. Your doctor has many patients. For you, you are the most important patient. You need to be your own best advocate. When the nurse scribbles your blood pressure readings in your chart, ask what the numbers are and what they mean. Check with your doctor about a cholesterol test and find out the results and how you need to follow up.
  1. Same you, different doc. Most people don’t stick with the same doctor throughout their lives. You move, you change jobs, your needs change. You may need to see several doctors at once. You have to be the one to keep on top of your health. Keep your numbers in your wallet for your doctor.

Healthy adults should check their cholesterol every five years. Blood pressure should be tested every two years. If you have high blood pressure or cholesterol, your doctor will recommend more frequent checks.

Remember, know your numbers. It’s a matter of life and death.

Own Your Own Health

By Melissa Tennen, HealthAtoZ writer

By doing your homework, you can be your own best advocate in the doctor’s office and in life. Your health is not just your doctor’s business - it’s yours too.

Studies show that people who know about their treatment and care are more likely to take better care of themselves.

“Knowledge is power and helps patients make informed decisions,” says Roberta Pagon, M.D., professor of pediatrics and an adjunct professor of Medicine and Ophthalmology at the University of Washington in Seattle.

Given the large number of patients a doctor has, most doctors can’t spend a lot of time with you. The typical visit lasts 15 minutes at most, and usually less.

First, your symptoms

A lot of the diagnosis depends on what you report to your doctor. If you don’t do your homework, there may be symptoms you hadn’t considered.

“Patients have a lot of time to think about their condition. There are thousands of conditions. Rarely is a doctor an expert in more than a few diseases. The more informed, the quicker we can find a diagnosis.”

“If patients have some background about their condition, they can ask the doctor informed questions,” Pagon says.

Taking charge

Since you are reading this article, you have already started empowering yourself. Here are some things to keep in mind:

  • Do as much research as possible before your first visit. That way you can have at least a general understanding of what’s going on, and ask better questions. For instance, if you have knee pain, read about how knees are constructed.
  • Learn about your symptoms and possible treatments so you can be actively involved in treatment options.
  • Use only accredited medical sites, such as this one. Accredited means the material on the site has been reviewed for accuracy by an independent panel of experts, such as URAC or HON. That means the information is credible and accurate. Also, government sites like the CDC, FDA, or National Institutes of Health are always sure bets.
  • Make the most of your time. By being prepared, you won’t waste precious time.
  • Create a list of questions or concerns for your doctor during your next visit.
  • Join reputable patient support groups over the Web. Frequently, these kinds of groups are a wellspring about treatments, how effective they are, side effects, etc.
  • Learn about clinical trials. Go to www.clinicaltrials.gov. Discuss with your doctor if clinical trials would apply to your condition.

Disease Prevention in a Spray Can

By Diane Griffith, HealthAtoZ writer

There’s a simple way to avoid Lyme disease, West Nile virus and other diseases carried by mosquitoes and ticks. Insect repellants - especially those containing the ingredient DEET - are the best protection available. They’re easy to use and affordable, yet less than 40 percent of us use them. In fact, in the two states hardest hit by West Nile Virus - California and Arizona - 65 percent of the residents questioned in a Harvard survey responded that they did not use insect repellant.

DEET

DEET does have its drawbacks. Many people are turned off by the smell, think it feels greasy or say it irritates their skin. There have been rare cases of neurological damage and seizures in people who applied DEET repeatedly, something product labels warn against.

How repellants work

The female mosquito is attracted to our breath and perspiration. Repellants mask these smells, making us unattractive for feeding. Some people are more attractive than others to a mosquito because they emit scents that mosquitoes find especially desirable. If mosquitoes seem to find you particularly appetizing, washing repeatedly - especially with antibacterial soap - will help repel them.

Insect-related diseases

Aside from West Nile Virus and Lyme disease, mosquitoes and ticks carry other diseases - all of which can be prevented with repellant. Two types of encephalitis - La Crosse and St. Louis - can cause swelling of the brain in children. In rare cases, there can be permanent damage, and even death.

Other tick-related illnesses affecting children and adults include Rocky Mountain spotted fever, tularemia and ehrlichiosis. If not treated, these diseases can be fatal.

Types of repellants

Until recently, DEET was the only product believed to effectively repel insects. Now, several other repellants are also being recommended:

  • Picaridin: This repellant has recently become available in the United States. Products containing 19.2 percent picaridin can provide protection for at least nine hours. Cutter Advanced® is presently the only American product with picaridin. It contains a 7 percent concentration, which lasts about two hours.
  • Lemon eucalyptus: This plant-based repellant provides protection similar to that of DEET. It is found in OFF! Botanicals® and Repel Lemon Eucalyptus ®. It shouldn’t be used on children under age 3.
  • Permethrin: An insecticide that is applied to clothing, shoes and camping equipment - but not to skin - to repel insects. Permethrin impregnated clothing is now available from mail order sporting goods stores, making insect protection more convenient.

Choosing a product

Consider the amount of time you plan to spend outdoors. The higher the concentration, the longer the repellant will last. DEET concentrations range from 4.75 percent (providing protection for 90 minutes) to 23.8 percent (providing protection for 5 hours).

Using repellants safely

When applying repellants, follow these guidelines:

  • Follow label directions.
  • Cover exposed skin and clothing. Don’t apply under clothing.
  • Don’t apply to cuts or open skin.
  • When returning indoors, wash treated skin with soap and water.
  • To apply repellant to your face, first spray on hands, then rub on your face, avoiding your eyes and mouth. Apply repellant to children’s faces in the same way.
  • Don’t apply repellant to children’s hands.
  • Don’t allow children to apply their own repellant. Keep it out of their reach.
  • Don’t apply DEET to children under 2 months of age. Use low concentrations on children older than 2 months.
  • If you experience a reaction, call your local poison control center or 1-800-222-1222.

Some Good Reasons to Kick the Habit

By Melissa Tennen, HealthAtoZ writer

What comes to mind when someone tells you that smoking is dangerous? Lung cancer? Birth defects? Emphysema? Well, it’s a bit more complicated than that; a lot more, in fact. Smoking affects nearly every organ in the body and can cause serious health problems:

  • Leukemia
  • Cataracts
  • Cancer
  • Pneumonia
  • Gum disease
  • Heart disease
  • Emphysema
  • Peptic ulcers
  • Aortic aneurysm (swelling of an artery)
  • Osteoporosis (weak bones)
  • Increased risk of wound infections after surgery
  • Problems getting pregnant and carrying a baby

It’s little wonder that tobacco causes so many problems. Tobacco has more than 4,000 chemicals, with more than 60 known to cause cancer. Some of these substances include ammonia, tar, arsenic, lead and carbon monoxide.

Smoking kills half a million people each year and is blamed for one third of all cancers. Smoking can cause cancer of the mouth, throat, lung and bladder. Besides cancer, smoking can affect your body in many other ways.

Your lungs

Smokers get colds and respiratory infections more easily than nonsmokers. Plus, when you smoke, you inhale poison. These poisons damage the membranes lining the inside of your lungs. Over the years, a smoker’s lungs become very thick, black and scarred. Tiny hairs that clean your lungs of dust cannot work as well, which can lead to infection. Such damage can cause emphysema, in which the air sacs in the lungs become so large that is difficult to breathe.

Because emphysema destroys air sacs, the lungs transfer less oxygen to the bloodstream, causing shortness of breath. The lungs also lose their elasticity, so patients experience difficulty exhaling. Early symptoms include shortness of breath and coughing.

Asthma and smoking can be a deadly mix because smoking is extremely harmful to the respiratory system. Asthma is a potentially life-threatening disease of the bronchial tubes, the airways that branch into the lungs. The airways of a person with asthma are sensitive and can be triggered by allergens and smoke. When a person inhales tobacco smoke, irritating substances settle in the lining of the airways and can set off asthma attacks.

Your heart and brain

A smoker’s risk of heart attack is more than twice that of a nonsmokers’, according to the American Heart Association. The chemicals from cigarettes damage blood vessel walls, leading to high blood pressure. High blood pressure directly increases the risk of coronary heart disease, heart attack and stroke, especially when combined with other risk factors. Because of the effects smoking has on the body, it becomes harder to exercise and strengthen your heart.

Cigarette smoking is the biggest risk factor for sudden cardiac death. Smokers have two to four times the risk of nonsmokers. Smokers who have a heart attack also are more likely to die suddenly, within an hour of the attack. Cigarette smoking acts with other factors to greatly increase the risk for coronary heart disease. People who smoke cigars or pipes seem to have a higher risk of death from coronary heart disease (and possibly stroke), but their risks aren’t as great as those of cigarette smokers.

If you have diabetes, constricted blood vessels from smoking can worsen foot ulcers and lead to blood vessel disease and leg and foot infections. People with diabetes who smoke are three times more likely to die of cardiovascular disease than nonsmokers with diabetes. Smokers with diabetes are more likely to get nerve damage and kidney disease, too.

Smoking also can cause an abdominal aortic aneurysm, which is an artery that balloons outward. This can kill you. The chemicals from cigarettes damage blood vessel walls, too, leading to high blood pressure and a greater risk for blood clots.

Your digestive system

Smoking can increase the risk for peptic ulcers, which are sores in the stomach and intestines. Ulcers in smokers tend to be more severe than in nonsmokers and more likely to kill. Heartburn and acid reflux happen more in smokers and are more severe. Also, the liver cannot process medications as well as it should.

Your teeth and gums

Researchers believe smokers are more likely than nonsmokers to develop gum disease because of their poor immune systems.

Your bones

The exact relationship between smoking and brittle bones is not yet clear. It’s possible that smokers have higher risk factors for osteoporosis than nonsmokers because they tend to be thinner, drink more alcohol, exercise less and follow less-healthy diets. Smoking increases the risk of limited joint mobility.

Your looks

If health problems aren’t enough to scare you, consider your appearance. Smoking increases skin wrinkles and stains your teeth and fingers. Researchers believe smoking reduces blood flow to the skin. This means vitamins (such as vitamin A, which reduces sun damage) have a harder time reaching the skin’s surface.

Your chances for having a healthy baby

The chemicals in cigarettes make it harder to become pregnant and even affect sperm counts. If you smoke during pregnancy, it can interfere with the baby’s supply of oxygen. This increases your risks for miscarriage, premature delivery and having a low-birth-weight baby.

Fighting Aging: It’s All in Your Attitude

By Melissa Tennen, HealthAtoZ writer

Jo Sotak gets up every morning to walk two miles. She’s 76. Jo has no diabetes, no incontinence, no high blood pressure, no osteoporosis, no heart disease, no cancer - not even a walker or a cane. She does have high cholesterol and osteoarthritis, but takes her medications as prescribed.

You would never think of Jo as “elderly,” - and she doesn’t either.

Entering your 70s, 80s and 90s should mean challenging the very idea of growing old. It doesn’t have to mean walkers and canes. Your goal should be to live a long time, but to spend that time being as healthy and strong as you can.

The key to staying independent, physically fit and mentally sharp is to not see old age as frailness and nursing homes. Look at yourself as strong, capable and intelligent.

A recent study by Yale University showed that the more television seniors watched, the more negative their images of aging became. Participants between the ages of 60 and 92 were divided into two groups. Both groups filled out viewing diaries for a week, with one group filling out an additional page about how the elderly were portrayed on television. That group showed greater awareness of negative images of the elderly, who barely had roles on television and were often the butts of jokes.

A study in Circulation: The Journal of the American Heart Association revealed that while fitness declines with aging, exercise plays a key role in helping us stay independent.

Researchers tested 375 men and 435 women, ages 21 to 87, on treadmills every four years. The rate of decline in fitness was 3 percent for people in their 20s and 30s, but 20 percent for people in their 70s.

The good news is that exercise can raise fitness levels in the elderly by 15 percent to 20 percent - similar to being 10 to 20 years younger.

As we age, our muscles shrink. Muscle strength decreases by 10 percent every decade. Strength training can help.

The following are common myths about aging:

  • Myth: Being old means being sick.

    Fact: Only about 5 percent of the elderly live in nursing homes today. Better health care and medication - along with a better understanding of the roles of diet and exercise - help us live longer, healthier lives.

  • Myth: Older people can’t learn new things.

    Fact: Not true. The keys to staying sharp are exercising regularly, having good relationships with friends and family, engaging in activities you enjoy and believing in yourself.

  • Myth: It’s too late to become healthy.

    Fact: It’s never too late. Even if you have a health condition, you can decrease your risk of a heart attack and diabetes-related problems by exercising and eating right.

  • Myth: It’s all in the genes.

    Fact: Some aspects of aging - as well as certain conditions and diseases - are passed down. However, eating right and exercising go a long way in improving your health. Taking your medication and getting your screenings also help, and if you smoke - stop.

Having a positive attitude and taking good care of yourself won’t erase your chances for disease or mean you can ignore conditions like diabetes and heart disease. You will, however, be able to better deal with these conditions.