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Aging milestonesChanges in old age depends on attitude as much as person to person. In young old age some changes begin to take place in a person’s appearance. Wrinkles, warts, age spots begin to form on the body. Hair begins to thin or becomes grey and even height lessens because the bone density decreases. While in ‘old‘ old age these changes are already permanent. Men might look distinguished if in good health, but women all look grandmotherly. In ‘young’ old age, cells begin to decay and muscle mass declines and immunity is no longer as strong as it used to be. People lose energy as the age progresses.  ‘Old’ old age brings in a lot of physical decline, profound changes in appearance and motor abilities, as also in sensation. Skin gets less elastic and becomes thin and blood vessels can break under the skin. The senses also begin to become dull. Eye lenses get affected and color perception and reading ability becomes very low. Hearing loss may lead to paranoia and ‘old’ old age people begin to think everyone is plotting against them because they can’t hear properly about what others are saying. Sense of smell also declines, but the taste remains almost intact. In ‘young’ old age, reflexes also slow down and so do the motor abilities. By the time they reach ‘old‘ old age most adults find that their response time has become quite reduced. This can be seen most in driving situations where it is difficult for ‘old‘ old aged adults to operate their vehicles as they have poor spontaneous responses. The ‘young’ old adults do not lose as much of their motor abilities as the ‘old‘ old adults, especially when holding small things like needles and pins. Of course, there are changes in sexuality and there may be a decline in the ability to have sex as men may not have an erection and women become dry due to lack of female hormones. Cognitive decline in 40% to 60% of older adults can be arrested with remedial training. Despite all the changes, most people even in their 70s remain comparatively active if they do not suffer any illness. Mental, physical, and social activity is necessary to maintain the quality of life. Old people begin to withdraw from work and other important roles and allow the younger people to take over. They are a lot happier as is also advised in Vedic literature as vridhashram. While activities are important, disengagement is equally important. Memory loss becomes aggravated and other cognitive abilities begin to decline and there are many ‘old‘ old adults who get Alzheimer’s and lose the ability to look after themselves. Old people also dwell on questions of death and sometimes go through a phase of denial and then anger that they have so little time left. Acceptance of death comes, but after a struggle and the idea of losing the family saddens them. Old people require support in their declining years as they begin to lose their faculties.
Mammary duct ectasiaSigns and Symptoms In most of the cases, female patients do not have any symptom. In few cases, women may present with nipple discharge, tenderness or inflammation of the surrounding region. In some cases, there may be a lump over the breast or the nipple may get inverted. Causes Exact cause of mammary duct ectasia is unknown. But few possible cause or risk factors have been proposed by the doctors : Increasing age - Probability of developing mammary duct ectasia increases with age. With ageing, the breast changes its nature. Glandular tissue is replaced by fatty tissue. This change may lead to duct ectasia. Smoking- Milk ducts are widened due to smoking. This increases risk of inflammation which may lead to duct Ectasia. Inverted nipple - Inverted nipple obstructs the milk duct. It may lead to inflammation followed by duct ectasia. Complications Complications of duct ectasia may be may be of varying severity. They are usually minor, but sometimes become serious. Localized discomfort- Discomfort occurs due to pain and swelling around the nipple. Nipple discharge - Ectasia is frequently associated with discharge of thick and sticky fluid from nipple. Infection- Bacterial infection may develop due to stagnation of fluid in the milk duct. If it is neglected, it may lead to localized collection of pus known as abscess. Abscess requires surgical treatment. Abscess is drained surgically. Diagnosis The doctor usually diagnoses duct ectasia by clinical examination. However, few investigations may be required. Mammography- X-ray of the breast tissue is known as mammography. It helps the doctor to evaluate the breast tissue. Ultrasound- Ultrasound enables the doctor to evaluate milk ducts beneath the nipple. Treatment Duct ectasia is usually relieved by treatment. Following are the treatment options : Medications: The doctor prescribes antibiotic therapy for 10 to 14 days. It may be accompanied by mild painkillers like ibuprofen, etc. for initial few days till the remission of the disease sets in. Most of the cases are usually relieved by medications. Surgery: If duct ectasia is not controlled with medications then the doctor chooses to remove the duct ectasia surgically. Surgery is required very rarely.  Self care measures Following self-care measures often provides relief to the patients. These remedies can be adopted at home. The patient may wear a breast pad or support bra. The patient may apply warm compression to the affected region. The patient must stop smoking. The patient may be advised to sleep on the opposite side of the affected breast. Female patients should be educated regarding mammary duct ectasia so that they can detect possible symptoms of duct ectasia themselves. This will help to prevent possible complications of mammary duct ectasia and early diagnosis will provide early cure.
Teenage troubles for autistic kidsTeenage brings along with it a lot of physical and psychological problems. Your body undergoes a lot of changes, the way the world looks at you is changing and you are not in the position to accept all this. Teenage is one of the most painful periods in one's life.  For an autistic child teenage can be compared to living a nightmare day in and day out. Here is a look at the problems of teenage from an autistic kid's point of view: Social Interaction The ability to interact socially is absent in autistic kids. They are loners who prefer to be left alone and undisturbed in their own worlds. Such a child is a natural target for bullying and ragging by other kids of his age group. At times even if the autistic child wants to come out and make friends, he is not able to do so due to lack of the required skills. Teenage is a period where you need at least one friend to confide in. It can be an extremely difficult phase when you are all alone. Puberty This is the dramatic time in life dilled with hormones and emotions. Your body undergoes lots of changes and you are confused about so many things. You don't know whom to ask or whom to turn to for guidance. Autistic children do not have the maturity to understand this phase. Special issues for autistic teens and sexuality include: Knowledge of physical changes in body. Knowledge of 'good' and 'bad' touch. Ability to communicate about a 'bad' touch or action. Keeping 'safe' distance from others. Handling menstrual cycles. Avoiding 'self-touch' in public. It can be a phase of emotional turmoil for the parents. They need to work closely with their child's special teachers to chalk out a plan that will be best suited to the child in handling puberty successfully. Self-help skills Simple self-help skills like hygiene can be a challenge for teenagers with autism. Improper motor skills, compliance, and sensory problems may interfere with a teen's progress. The proper training of hygiene and grooming can help to add these elements into the daily routine. The right approach is to simplify each task into simple small steps. The positive reward system is a great source of encouragement, as positive motivation always help the teenagers. Higher Functions Autistic teenagers are socially awkward. They lack the power to comprehend and process complex social cues which includes sarcasm, body language, humor, emotional responses and facial expressions. What complicates the problem is that the autistic child lacks empathy and hence may appear rude. Such kids are likely to be teased a lot in school settings.
Teach your kid to stand up to bulliesAlmost everyone has heard of the beach bully who goes around kicking sand in the face of the skinny lad. That's the quintessential imagery associated with bullies and it has stayed with us for over 3 decades since the first ads came out. The ads generally endorsed body building products using the classic 'Before' and 'After' construct, i.e. before you got your face sandblasted by the beach bully and after you took that protein shake or muscle builder to get even. Bullying is a phenomenon where a person or group wilfully targets someone with the intention of troubling them over a specific thing. (Bullies generally pick on someone they perceive as physically, mentally, financially, socially or racially inferior.) There is no age-limit for bullies as the bully could be a school going kid with an attitude problem or a fully grown adult, who could indulge in it from sheer force of habit or due to a mental problem. Again there is no age limit for the victim as well. Anybody could really be a target for the bully menace, right from school children, teenagers, disabled or even old people. Well bullying has changed considerably in these times and you also have the e-bully version where insecure bullies go about harassing people, especially teenagers over the internet. Bullies resort to tactics like causing public humiliation or embarrassment to hapless victims or resort to threats or other control-based abusive behaviour. Ok so everyone has undergone bullying from time to time but the question is should you allow it to happen to your teenaged son or daughter? Mind you, here it isn't simply a question of some leg pulling by friends or teachers but some serious malice that could well destroy your teenager's confidence and cause permanent scars on his self-esteem. Yes, if your teenager is being subjected to bullying then teach him how to kick the sand right back in the bully's face. Before we learn how to do that let's see the types of bullying that your kid could be subjected to: Verbal bullying This includes teasing or making caustic remarks directed at someone on a regular basis. The school bully does that, doesn't he? As you would probably remember from your own school days that fat lout who made you quiver with fright as he snatched your lunch box away to feed the dogs. Yes, the very same guy who pulled your sister's pig-tails and called you names which made you go red in the face. You could do nothing but pray he wouldn't notice you somehow. Well so something similar could be happening with your teenager. Verbal bullying need not be done by a school friend. Even a responsible teacher could target someone for deprecatory remarks causing much embarrassment, ridicule andfeelings of inadequacy to a teenager. Sometimes kids look up to their teachers for encouragement and support and those very people could actually damage a child's self-esteem by unjustified criticism and bullying behaviour.Teenage girls could suffer taunts and remarks about certain physical traits and since they are at a delicate age where their bodies are undergoing changes, such verbal abuse can indeed cause long-term depression or personality issues. Physical bullying Physical bullying is where your teenager could be subjected to physical harassment at the hands of the bully. Whether it is a simple case of holding your teenager's hand or unprovoked physical assault, the end result is the same-injuries to the body and mind. The bully may not go as far as inflict any visible scars on the teenager's body but the episodes could certainly cause great fear and trauma to him. Even teenage girls are not spared physical abuse at the hands of bullies. In certain cases, teens suffering from long-term bullying actually took some extreme measures by committing suicide or breaking down completely. Internet bullying Internet bullying is where your teenager is probably most vulnerable. At least school bullying is restricted to school, but here your teenager is at the mercy of just about everyone - from the school bully to the earnest paedophile! Causing embarrassment on public forums, threats of physical or sexual harm is the most common and as a parent you have to take every step possible to not just protect your child but also help him take care of himself or herself. The bully menace The school bully is comparatively easier to deal with than the internet lout! Well, one can't be too sure of that statement either since these days,school kids are known to blow up their own classmates or participate in a heist with adult precision. Always watch out for the classic signs of bullying. If your child appears withdrawn or disturbed after school hours then gently probe and encourage your child to tell it all. If you feel there is enough reason to think your child is being subject to bullying then bring it to the notice of the school immediately as others could have similar complaints. Do not admonish your child or scold him as it could cause him to withdraw in to the shell that the bully provided him in the first place. Parents and elder siblings can be bullies too so remember that. Teach your child to stand up to bullies. The bully is generally an insecure person who uses brute force to feel good about himself, at the cost of others. The school bully generally has his way and is not used to being challenged. Teach your child to look the bully in the eye and register protest. This will go a long way in teaching your child how to fight back and not take any nonsense from others.If the situation worsens, then always keep a track of your teenager's whereabouts especially if it is a girl. Once the bully realizes that he is being tracked he generally lies low or picks on someone else. Internet bullying requires different measures. You can monitor your child's online activities and teach them to never ever share any personal information or photographs online or on forums which are off-limits for children and adolescents. You can complain to the authorities if things get out of hand. If someone repeatedly issues threats to your teenager, either online or in real life, is a cause for real concern and one must take them seriously. If your child does not learn to cope with bullies it could affect him well in to adulthood, where he will feel helpless and easily scared by imposing people or even develop a hatred for authority figures. Bullying can fuel an already weak personality in to gaining an inferiority complex; the flip side is that kids who have been subjected to bullying can repeat the same patterns on their younger siblings or at school. So a bully creates another bully if continued unchecked. Mental problems in children are on the rise, so bullying is also no longer an innocent joke but could be a serious crime. Bullies whether children or grown-ups, suffer from some personality disorder or a serious inferiority complex which makes them compulsive trouble makers and their victims are generally people who cannot hit back or are vulnerable. Take Hitler for instance. Wasn't he just a bully who was unhappy in his own life? Look what he did to millions of innocent people. Wasn't that a bully gone berserk?  
Cleanliness - A clean body, clean mindPhysical Benefits: Killing of Germs: Disinfecting your living area allows negligible scope for breeding and spreading of germs and bacteria. Though not visible to your eyes, many of these can cause severe illnesses. Prevention of Food Contamination: Clean cooking utensils and counter tops allow for low risk for contamination of food. The parts of the utensils which have come in contact with fish, raw meat, or eggs are recommended to be washed with hot water and soap. Make sure you wash your hands to avoid spreading of any bacteria in your house.  Keeps Illnesses and Allergies at Bay: Many allergies could be caused due to dirty mattresses, carpets, sheets, walls, and furniture. In order to keep away mold, dust mites, cobwebs, and mildew, make sure you dust, mop, and vacuum the house on a regular basis. The sheets should be washed at least once a week with hot water and detergent. Floors and walls, wardrobes, and refrigerator should be cleaned using disinfectant sprays up to 2 to 3 times per month. Thoroughly clean your carpet and upholstery at regular intervals. Psychological Benefits: Association of Non-Cleanliness with Moral Lapse: In a review by Current Directions in Psychological Science, it has been found that physical cleanliness does not only physically benefit a being, it also results in weighing the person on a moral radar. When we perceive a physical contamination, we respond in the same way as we would in case of an act of moral disobedience. This response includes repulsion and disgust accompanied by their behavioural components like scowling and frowning. Sense of Accomplishment: Those who clean their house and living space have been found to have a consequent sense of accomplishment that adds to the way one feels about oneself. Clarity and Organization of Thoughts: It has been discovered that those living in a clean and neat environment tend to have a greater capacity to think than those who live in a messy and unclean atmosphere. Proactive Sanitation Teaching for Children: Start with your own home. A child emulates its parents, and if the parents practice cleanliness as part of their lives, children would notice and follow suit. Children tend to connect who they are with their home environment and as they grow up they ensure that such a cleanliness of their world around is maintained.  towards their immediate surroundings, thus ensuring that they do not contribute towards pollution and environmental degradation, at least on an individual level.
Algophobia: The fear of painAlgophobia is the fear of pain:  an abnormal and consistent feeling that is far beyond what would be considered normal. The term is derived from the Greek words, Algos meaning pain and Phobos meaning fear. Our bodies are designed in a way that when there is a painful stimulus it reacts. How the body reacts to the pain is an individualistic phenomenon. Some people have a very low threshold for pain, and even the slightest pain evokes a huge response in them. Where as others can withstand a good amount of physical pain before their bodies give in. Some people dread even the tiniest amount of pain. They foresee situations that will cause pain in them. The way they react to even the smallest amount of pain is far more than the normal level of acceptance. Such people are said to be suffering from Algophobia. Algophobia is a learned behaviour, say behavioral psychologists. For example you may have heard from several people how hitting your shin on the furniture in the dark is the worst possible pain ever. So you tend to keep a watch and if it is dark, you move around extra-carefully to avoid bumping into the furniture and getting hurt. This would be considered normal, cautious behaviour. But if the same thought keeps buzzing in your head continuously and you go to extreme lengths to avoid that pain, you could be algophobic. Old people are the ones who have excessive fear. The age factor along with fear of death plays a vital role in old people developing this fear. For example an old lady may hear about all the ailments and pains that afflict old age people and may become apprehensive about it. She may develop irrational fears that more often than not, are also imaginary. She may start experiencing the pains even before anything actually happens to her. It may seem unrealistic to a normal person, but for algophobics pain can be a severely dreaded thing. Therefore they will go to great lengths to avoid pain at all levels, including day-to-day activities. They will not go into the dark, handle tools, avoid lifting heavy objects or even avoid playing any type of contact sports. If a task has a scope for injury and pain, they will avoid it! Frequently a pathological complaint of Hyperalgesia occurs along with algophobia. Hyperalgesia is a condition of increased sensitivity to pain due to damage to the peripheral nerves and pain receptors. Pain in such cases may be directly in the damaged tissues or in the surrounding areas. An interesting fact is that hyperalgesia can occur due to long term use of painkillers especially strong ones like opium and its derivatives. Algophobia is treated with behavioural therapy, psychotherapy and anti-anxiety medications. Hypnotherapy also has shown beneficial effects.  
Sleep tight at every good night!A good night's sleep! Oh, what would some of us give for that luxury! Sure, you can blame it on the fast paced world and the things you have to do to keep the competition off your turf, and millions of other reasons to be sleep deprived. Yes, sleeping soundly and regularly is well within our control. Maybe it has eluded you so far and you are caught in a vicious circle of staring at the ceiling for hours on end; so read on to see what simple things you can do to gently drift off in to the arms of nature's greatest restorative- beauty sleep. Do's and don'ts for beauty sleep Fix a regular bed time, so that your brain will adjust to this by sending sleep signals to the body. If your bedtime is completely at the mercy of your activities then even as fatigue sets in the body will refuse to obey. So, even as your body is screaming for rest, the mind does otherwise. This is where good old discipline comes in to play. Take in to consideration the activities which are absolutely necessary to do and note the frequency with which they are likely to interfere with your bedtime before setting a realistic bed time. Initially the mind will refuse to obey, and you are most likely to get up, after tossing and turning in bed, to switch on the computer or whatever it is that you do when you cheat your bedtime. Rest assured, in a couple of days the brain will get used to this sleep routine and prepare you for shut down. Sleeping well also largely depends on how stress free you are. If the mind is in a state of constant excitement or anxiety, sleep will elude you. So when you lie down to sleep you need to fade out and blank everything out- joy and sorrow; expectations and ambitions, all of these out for later access! Tell yourself that tomorrow is another day and what you need today, is a state of neutrality! That's what most Indian philosophers would want you to do anyway. A good eight hours of sleep may depend largely on our minds but external factors can matter too. Sleep comes easily when your mattress is comfortable and not too soft or too hard. Use a pillow that won't give you neck pain, as any discomfort in the neck is likely to throw sleep off gear. Wearing clean night clothes can give you better quality of sleep. That goes for the bed spread as well.  Try this for yourself. Tight and uncomfortable night clothing is not recommended as this will only make you wriggle about for comfort. A cozy blanket and some clean nightclothes make great bedtime mates. Some people have a nightcap to help them sleep better while others still, drink themselves to sleep. Alcohol in large doses can only numb but does not help you sleep and you will only find yourself waking up frequently. Sleeping pills can be habit forming and might have serious side effects in the long run. So try simple remedies like a glass of warm milk or hot chocolate before bedtime to help you sleep better. Avoid stimulants like coffee, tea or nicotine before bedtime as that can keep your nerves all hyper thus making sleep quite difficult to come by. Computers and television are also largely responsible for us staying up late and disrupting our sleep patterns. We often find ourselves mechanically flipping channels or browsing without any real need for it. Try and go offline before bedtime, especially if you want to be able to schedule your sleep time. Television or movies can excite the brain and then you will find it difficult to fall asleep. So about an hour before bedtime switch off the telly or computer and just sit quietly and do some deep breathing exercises. Just sit cross legged for about ten minutes and relax your body. You are now ready for a deep slumber.
Bile block - Understanding gallbladder problemsRavi was a young intern working the night shifts in a government hospital when he was asked to examine a patient who had just been brought in. The patient was a 45-year-old, a fat man, who was complaining of pain in the right side of the abdomen along with nausea and vomiting. On inquiry it was revealed that he had eaten a very heavy fat-laden dinner. Remembering what his surgery professor had taught him about cholelithiaisis, Ravi immediately guessed what the diagnosis could be. He, however, sent the patient for a blood test and an abdominal scan. The reports confirmed Ravi’s suspicions- cholelithiasis, gallstones. The gallbladder is a tiny pear shaped organ that lies just below the liver. It is responsible for storing the bile that is produced by the liver for digesting food. It ensures the smooth outflow of the bile from the bile ducts. When the bile components aggregate in the gallbladder, they build up to form gallstones, similar to kidney stones. The gallstones are usually small enough to pass on to the intestines and be eliminated without causing too much trouble. At times, these stones may be big enough to block the outflow of the bile and give rise to a variety of symptoms depending on the size of the stone and severity of the block. The symptoms include -  Intermittent colic. A bloated sensation with constant nausea. Inability to tolerate fats. Vomiting.  Fever with chills if the stone becomes infected. Gall stones though found in both sexes, is more common in females. The risk factors for developing gallstones include - Diabetes. Organ transplant. Diseases like hemolytic anemia, sickle cell anemia. Liver cirrhosis. Failure of the gallbladder to empty properly, e.g., during pregnancy. Rapid weight and nutrition loss due to any reason. Gallstones are confirmed by a blood test to check the liver function and by an abdominal scan. Medications to dissolve the stones, and surgery in case of large stones that do not dissolve with medications, are the treatment options.
Aids defining cancersIn fact the presence of such aids defining cancers is an indication of advanced AIDS having developed in these patients. However, the reasons for these cancers are unclear. It is possible that since people with AIDS have low immunity, they become more susceptible to these cancers. The double attack of these already complex diseases complicates treatment plans too. Thus, it needs care under experienced doctors who specialize in these diseases. The cancers that define AIDS are: Kaposi's Sarcoma:This is a type of skin cancer. It was usually found usually in people who have received organ transplants. Nowadays it is also most prevalent in homosexual men with HIV/AIDS and is also called epidemic Kaposi's Sarcoma.  It causes lesions to show up in multiple points in the body such as skin, lymph nodes, liver, lungs, spleen and digestive tract. Non-Hodgkin Lymphoma:This is the second most commonly associated cancer with HIV/AIDS. The various sub types of NHL are primary central nervous system lymphoma and primary effusion lymphoma. Approximately 4-10% people with HIV/AIDS develop NHL. Other kinds of cancers are anal cancer, liver cancer, mouth cancer, Hodgkin's lymphoma, testicular cancer, melanoma, throat cancer, colorectal cancer and multiple skin cancers.  Treating Cancer in HIV people: Till anti-HIV medication were not discovered the future for infected people was bleak. They were already sick and their bodies weak even before their cancer treatment were started. Presently the cancer treatment is mixed with anti-HIV drugs. However, depending upon the extent of cancer and the need of AIDS care, variations are made between chemotherapy and other HIV related drugs needed. Treating Kaposi's Sarcoma: Often anti-HIV drugs are enough to treat this cancer. The lesions, which are viral, shrink, as the immune system gets better. Sometimes chemotherapy and radiation may also be needed if the lesions are internal. Treating Non-Hodgkin Lymphoma: AIDS related NHL is fast growing and needs intense chemotherapy treatment. Introduction of highly active anti-retroviral therapy and use of drugs that help the infected body make new blood cells has relieved a major concern for HIV patients where previously due to their low blood cell count, chemotherapy could not be administered to them. But with these advances, acutely monitored chemotherapy treatments can be administered now. Treating Cervical Cancer: In case of women who have a good immune system and invasive cervical cancer can still be treated similarly as non-HIV women. They can even do well in surgeries and other conventional treatments. Discovering Cancer Early: Screening helps discover presence of cancer when no symptoms are evident. However AIDS defining cancers cannot be detected through screening. Thus, close monitoring, regular checkups and a keen lookout for symptoms of these cancers can help discover the ailment if present. Pap tests help discover cervical cancer in women. However, in case of HIV women, these should be undertaken more often. Even as often as 2 tests a year, 6 months apart in the first year of HIV detection. If the tests are clear, they should get Pap tests done regularly once a year henceforth. For other AIDS related cancers, the screening tests are still being devised. Lowering Cancer Risk: HIV ruins the body's immune system making it susceptible to a variety of diseases. Good health practices are a must for those detected with HIV in order to ward off cancer. They should surely not smoke or consume alcohol. Injection drugs and unsafe sexual practices also pose increased threat of cancer. Maintaining balanced diets, physical activity and proper body weight are extremely important and helpful too.
Busting misconceptions about homosexualityIn the past few years, homosexuality has become a subject of public discourse in India. Thanks to gay pride marches and the Delhi High Court's historic ruling decriminalizing same-sex intercourse in 2009, more people today are willing to accept homosexuality as normal. However, there are still a large number of people who are still confused about whether homosexuality is normal. Homosexuals are people who get attracted to people of the same gender. Gay is a term used for both male and female homosexuals, but some prefer the term 'lesbian' when it comes to women homosexuals. Some misinformed people consider homosexuality as a purely decadent western phenomenon which is far from the truth. Homosexuality finds its place in recorded history throughout the world. So is homosexuality abnormal? A few decades ago a gay person would have ended up on a psychiatrist's couch where attempts would have been made to re-orient him/her towards the heterosexuality. However, as the American Psychology Association notes, "No, lesbian, gay, and bisexual orientations are not disorders. Research has found no inherent association between any of these sexual orientations and psychopathology. Both heterosexual behavior and homosexual behavior are normal aspects of human sexuality." Some scientists are trying to find a genetic link to homosexuality. Results so far have not established a definite link. A whole lot of factors could play a role in deciding sexual orientation - genetic, hormonal, developmental, social, and cultural. One cannot safely conclude that being "gay" is in one's genes and is therefore, hereditary. Legalizing gay marriages Same-sex marriage is legally recognized in several jurisdictions within the United States. As of April 2013, nine states—Connecticut, Iowa, Maine, Maryland, Massachusetts, New Hampshire, New York, Vermont, and Washington—as well as the District of Columbia and three Native American tribes[1]—have legalized same-sex marriage, representing 15.7% of the US population.
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