So there you are. Sick. You’ve valiantly tried to fend it off but finally succumbed to all the symptoms promoted on the TV cold/flu commercials, and now you’re down. Or at least you should be.

But there’s a looming deadline at work, you’re overwhelmed with projects, pressures from the boss. Sick leave is exhausted, and you can’t miss a day’s pay, so you soldier on, incurring fear and loathing from co-workers who treat you like you have a contagious disease — which, just so happens, you do.

And the great debate rages on: do you go to work sick or stay home?

“Stay home,” said Dr. Steve O’Brien, vice president of medical affairs at Alta Bates Summit Medical Center in Oakland. “Nobody wants a sick person coming into the office. Think about it. you know you don’t like it when someone comes in sniffling and coughing all over the place. so don’t do that to them.”

Seems like common sense for the common cold and flu season — after all, who wouldn’t prefer to stay home, slurp some soup and catch up on daytime TV? But in this economy, it’s often a rare luxury, and the health of one’s bank account sometimes comes first and people force themselves to the office. There’s even a newly coined word for it: presenteeism. (The opposite of absenteeism.)

Joseph Siti, a woodworker in Berkeley, has been sick with the flu at least four times this year but has to go into his shop to meet deadlines. “I own my own business, so if I stop, I don’t make any money, and I don’t know when the next job is coming in.”

Even during the 2009 H1N1 crisis, when the Centers for Disease Control told people with flulike symptoms to stay home, more than 8 million struggled to work sick between September and November that year, according to a report from the Institute for Women’s Policy Research.

“If a person doesn’t have interaction with other people, you can go to work,” said Amy Nichols, director of hospital epidemiology and infection control at UCSF Medical Center. “But if you are symptomatic and working with the public and sharing surfaces or handling things other people will handle, stay home. Definitely if you have a fever or feel hot/cold with chills, stay home at least 24 hours after the fever is gone.

“I don’t care what your job is, the world will not stop if you don’t go to work,” she said. “It’s critical for contagion control, to avoid the domino effect.”

Tanya Tomassini, a project controller for an IT company in San Ramon, knows all about those dominoes. She was to fly out on a trip to Europe the day before Thanksgiving, but a few days before that, a couple of co-workers came into the office — very sick co-workers. She tried to avoid them like the plague, but to no avail.

“I ended up with one of the worst flu bugs imaginable,” Tomassini said. “I had to change my nonrefundable flights, which cost me $400, and I was too sick to even spend Thanksgiving with my family. Long story short, if you’re sick, stay home!” she said. “You don’t realize how much you can affect someone unintentionally.”

Businesses want you to stay away, too, if you’re truly ill.

Michelle Mendoza, owner of Connect HR, a human resources consulting firm in San Jose, admits it’s a tough subject.

“Here in Silicon Valley, there’s that passion of wanting to work all the time, but if you stay home one or two days, you get better faster instead of having it drag out for a couple of weeks.”

Generally, most companies have some type of sick leave policy or PTO (paid time off) available, she said. “From an employer’s standpoint, there’s a big incentive to give workers time to get better faster. many provide on-site flu shots or incentives for workers to get shots at the drugstore. It costs the employer money, but it’s less costly than having multiple people out sick. Or working sick and losing productivity.”

Indeed, a report by researchers at Cornell University found that ill workers on the job could account for up to 60-percent of corporate health costs.

“Your level of productivity drops significantly when you’re under the weather, said physician and radio personality Dr. Dean Edell. “There was a study showing that driving ability is impaired when you have the flu, to the equivalent of having a couple of drinks. so imagine how that affects your efficiency at work if you’re foggy-headed, taking any cold or flu medications that impair cognition.”

The best thing you can do to keep from spreading disease — or getting it — is wash your hands and keep work surfaces clean, said Bay Area health and fitness expert Joanie Greggains. “Avoid close contact with others, especially those who might easily get the flu such as people with chronic medical conditions such as diabetes, asthma or heart disease, pregnant women, young children and infants.”

Oh, and stay home.

“You’re going to get much better much faster,” O’Brien said. “Do it for your co-workers, but do it for yourself, too.”

Good ‘home sick’ DVDs

(Fun, not too stressful and won’t make you think too hard)1. “Ferris Bueller’s Day Off”2. “Home Alone”3. “Ghostbusters”4. “The Princess Bride”5. “Roman Holiday”

Bad ‘home sick’ DVDs

(Not helpful to watch people dying of disease)1. “Contagion”2. “Terms of Endearment”3. “Outbreak”4. “The Andromeda Strain”5. “The Omega Man”

(Medical Xpress) — the images of war often stay with those who have experienced it long after a conflict is over. While the physical wounds are apparent, we are learning more and more about the toll these conflicts take on a soldier’s mental health, particularly in terms of post-traumatic stress disorder, or PTSD, and depression.

While traumatic events such as a car accident, natural disaster or an assault may trigger PTSD in some people in the general population, the data collected from troops who have served in combat, such as during the Vietnam War and the conflicts in Iraq and Afghanistan, suggest that in many cases, soldiers exposed to deployment-related stressors have endured a more potent PTSD trigger that involves constant, ongoing stress.

“We’re seeing double the rate of PTSD in vets than in the general population,” said Ananda B. Amstadter, Ph.D., assistant professor of psychiatry at the Virginia Commonwealth University School of Medicine and the Virginia Institute for Psychiatric and Behavioral Genetics.

In the general American adult population, who are not in the military, approximately 8 percent of the population will meet criteria for PTSD at some point in their lives. for returning veterans, the scientific data suggest closer to 20 percent of veterans will have symptoms of PTSD or experience another comorbid psychiatry condition, such as depression or a substance use disorder.

According Amstadter, an active researcher in the area of traumatic stress, many of the troops returning home from service in Iraq and Afghanistan – Operation Iraqi Freedom and Operation Enduring Freedom – suffer from ongoing stress brought about by lengthy deployments and multiple tours. the PTSD symptoms endured by this population is not always just related to one isolated incident or event, and the more times they return to war, the more likely they will develop a stress-related psychiatric condition, such as PTSD, she said.

Further, research based on both troops from the Vietnam War era, and the conflicts in Iraq and Afghanistan, suggest that troops involved with direct combat-related exposure, such as a bombing or attack, are more likely to experience PTSD compared to a service member who has been involved with other aspects of deployment that do not involve direct exposure to combat – for example, those in military intelligence.

Amstadter said that individuals who experience PTSD generally have a cluster of symptoms including re-experiencing or reliving the event, avoiding anything or anyone that is related or reminds them of the event, numbing and increased arousal.

Amstadter said that when a person re-experiences or re-lives the event, he or she may have repeated memories or thoughts or repeated disturbing dreams of the trauma; may feel like the trauma was happening again; may feel upset when something triggers memories of the trauma; and may have physical reactions when something reminds them of the trauma. Numbing involves avoiding thinking or talking about the trauma, avoiding activities or situations that are related to the trauma, proving unable to recall parts of the event and showing a decreased interest in activities, a disconnection from others, a restricted range of emotions and a sense of a shortened future. Increased arousal includes sleeping difficulties, concentration difficulties and an exaggerated startle response.

PTSD and genomics

The focus of Amstadter’s work is to understand the post-trauma trajectory of symptoms by examining the environmental factors, as well as the biologic or neuroendocrine, and genetic factors of PTSD. through her research she hopes to help better predict the factors that differentiate individuals who either do not develop symptoms or who experience a naturalistic recovery, from those who develop long-lasting symptoms of a mental health disorder, such as PTSD.

“we know that PTSD is about 30 percent heritable,” Amstader said. “In other words, genes account for about one third of the variance in risk for PTSD. We’re trying to identify exactly which genes are involved, and how the environment might moderate these relationships.”

“If we can determine which genes are involved and understand the effects of a particular variant we may be able to identify people that may need help in the aftermath of a traumatic event,” she said.

For example, according to Amstadter, some theories suggest that there are a handful of sequence variants that you could be carrying around your entire life and if you’re never exposed to a traumatic event, your risk for PTSD is no higher than if you had the other form of the gene. But, if you are exposed to a traumatic event and you have that specific gene, you could be at an increased risk for developing PTSD than somebody with the alternate form of that gene.

To date, Amstadter said researchers have identified a host of different genes by conducting molecular genetic studies. However, replication of this work has not been consistent and further research is necessary.

Stress reactivity study

Through support from a National Institutes of Health grant, Amstadter and her team are examining the effects of combat history and PTSD status on stress reactivity in returning soldiers, and how their response to the stressor affects their drinking behavior, as well as the role of genetic variants that may play a role in stress-related drinking.

Amstadter and other mental health experts are seeing a lot of alcohol problems and other substance use issues in veterans returning from recent service. Some experts suggest that combat exposure and PTSD symptoms may lead some returning vets to feel like they are on edge all the time and they may be engaging in substance use to self-medicate.

“we are trying to identify the biological link between the effect of combat on somebody’s stress response and how that effects drinking in a controlled environment,” she said.

Combat exposure and fear conditioning

In other work, Erin Berenz, a post-doctoral fellow with Amstadter, is looking at how combat exposure and PTSD affect fear conditioning in veterans. the study is testing the hypothesis that people with PTSD acquire responses to trauma-related stimuli quicker than people without PTSD. Their theory is that if somebody has PTSD then his or her fear conditioning system is ramped up, so it is really easy for him or her to gain a stress reaction or a fear reaction to particular stimuli and then it’s really hard for that feeling to extinguish, or go away and return to a normal state.

Both the stress reactivity study and the fear conditioning study will pull from the same population sample of 240 veterans. Data from these participants will be gathered and analyzed in the coming months.

Collaboration with the Richmond VA

Through a project supported by the Mental Illness Research, Education, Clinical Center or MIRECC, VCU is working closely with mental health experts at the Hunter Holmes McGuire Veterans Affairs Medical Center in Richmond to understand post-deployment mental health issues.

The majority of VAs across the country are part of a network based on their geographic location and VCU is part of the multi-site center Mid-Atlantic MIRECC, which is led by Duke University. there are 22 different MIRECC groups across the country, each focused on a different aspect of mental health as it relates to helping veterans.

Amstadter and Vladimir Vladimirov, M.D., Ph.D., assistant professor in the VCU Department of Psychiatry, together with Richmond-based researchers Treven Pickett, Psy. D., associate chief and supervisory psychologist for Mental Health Service, and Scott McDonald, Ph.D., and MIRECC researchers Jeannie Beckman, Ph.D., and Mike Hauser, Ph.D., are collaborating on a study that will examine microRNA collected from veterans who are combat exposed with and without PTSD. further, their future work will examine genomics of PTSD – which includes the analysis of DNA and RNA – and not merely a genetic sequence.

Provided by Virginia Commonwealth University (news : web)

8 December 2010 last updated at 10:48 ET Share this page the cholera epidemic has prompted protests against the UN in Haiti

None of Nepal's soldiers serving with UN peacekeepers in Haiti was tested for cholera before they went, the Nepalese army's chief medical officer says.

Brig Gen Dr Kishore Rana told the BBC the UN did not require such a test unless a soldier had cholera symptoms.

Earlier on Wednesday, a Nepalese army spokesman rejected a report suggesting the Haiti epidemic had originated from its soldiers.

Cholera has killed more than 2,000 Haitians, prompting anti-UN protests.

Brig Gen Rana contradicted previous statements by the Nepalese army which has maintained that all its troops were given a thorough medical test – including being tested for cholera – before being deployed to Haiti in October.

He said that UN protocol had been followed during the pre-deployment medical, but that none of the troops exhibited symptoms of cholera – so no follow-up tests were done.

His comments come after the leaking of a report by a French disease expert which suggested UN peacekeepers were the most likely source of the cholera epidemic sweeping Haiti.

‘Hypothetical’

Sources who saw the report by epidemiologist Renaud Piarroux said it had evidence the outbreak was caused by river contamination from Nepalese troops.

The report was rejected by army spokesman Ramindra Chhetri on Wednesday.

"We strongly condemn the making of such allegations with no firm evidence or facts," the AFP news agency quoted him as saying.

He said the report's conclusions were "hypothetical" and said the Nepalese base in Haiti had been tested three times and no cholera had been found.

The cholera epidemic has killed 2,120 people, and nearly 100,000 cases have been treated, according to the Haitian government.

The report by Mr Piarroux found that the source of the outbreak was a Nepalese peacekeeping base, whose toilets contaminated the Artibonite river, media reports on Tuesday said.

The river was the main focus of the outbreak when it began in October, but cholera has since spread throughout the country.

The UN mission in Haiti, Minustah, said there was "no conclusive evidence" that UN peacekeepers were the source of the epidemic.

Minustah said the report by the French expert was "one report among many", but it was taking it "very seriously".

Many Haitians have blamed the Nepalese peacekeepers for bringing cholera to the country, and there have been violent demonstrations against them.

‘Not local’

The strain of cholera had already been matched to one from South Asia, although it is present in other Latin American countries.

Cholera is endemic in Nepal; last year, the disease killed more than 300 people in the far west of the country and this September, there was an outbreak in the capital Kathmandu.

Medical experts say it is possible to carry the disease without exhibiting symptoms.

In an interview last week, Mr Piarroux said it was clear cholera had been introduced to Haiti, which had not seen an outbreak of the disease for more than a century.

"It started in the centre of the country, not by the sea, nor in the refugee camps. the epidemic can't be of local origin. That's to say, it was imported," he told AFP.

UN peacekeepers have been in Haiti since 2004 to help restore political stability after years of unrest.

They have also been helping relief efforts following last January's massive earthquake, which killed about 230,000 people.