180 Degree Health?

hat if what you’ve been told about health was wrong? What if there really was no strong evidence and even less logic suggesting that saturated fat is harmful? Or that having high cholesterol levels causes heart disease? What if eating fat doesn’t make you fat, and that eating a lot of calories has nothing to do with being overweight? Would it really surprise you if, seeing how poor the health of the world’s wealthiest nations has become, that the answers to how to reverse many of our health crises was precisely that – the reverse?

New information abounds – cutting edge discoveries have been made in recent times that are in complete contradiction to the verbatim recommendations to eat less, mostly Brussels sprouts and grape skins, treat butter like a virus, and run a marathon every day. It is a complete 180 to what you’ve heard before, and it’s all right here, unencumbered by outdated theories and stubborn old beliefs.

New Route To Potential Breast Cancer Cure Discovered

UK scientists have discovered a new route to a potential cure for breast cancer, one that focuses on how the cancer manipulates genetic pathways to spread through the body, rather than on how tumors develop in the first place. They are already working on a new drug to switch off the cancer's effect on the pathways and say it could be ready in a couple of years, but experts suggest this could be rather optimistic.

The landmark study was the work Dr Justin Stebbing of Imperial College London (ICL) and other colleagues from ICL and also from the Howard Hughes Medical Institute, Cold Spring Harbor Laboratory in New York, USA. They have written a paper on it in the 24 August online before print issue of the Proceedings of the National Academy of Sciences, PNAS.

Stebbing, who is senior lecturer and consultant medical oncologist at ICL was reported by the Daily Express as telling the media that the new discovery was a "step on the way" to a potential cure for breast cancer.

"It helps us understand the way breast cancer cells grow and divide and if we understand this then we understand how to stop it," said Stebbing.

Breast cancer is the most common cancer of women in the western world, in Britain alone it kills 12,000 women a year.

In most cases the cancer depends on estrogen to fuel tumor growth, and current treatments focus on inhibiting the activity of the estrogen receptor. These treatments, for example tamoxifen, have been very successful at reducing deaths from breast cancer.

"The estrogen receptor is incredibly important in breast cancer," said Stebbing.

"Most of the treatments around treating breast cancer are blocking it or inhibiting the oestrogen but despite that about half of all women relapse," he added.

Many patients relapse because they eventually become resistant to hormone therapies.

Cancer is essentially a process where cell growth gets out of control. One of the ways that healthy cells stop growth getting out of control is via microRNA molecules that use genetic pathways to control various cellular processes in the body, such as making proteins.

As Stebbing explained:

"The way to cure breast cancer or any cancer is by fundamental biological understanding of what turns cells on and off, stopping the way tumours grow."

Stebbing and colleagues' breakthrough has been to discover how cancer cells switch off the microRNA molecules that control cell division to unleash the growth and proliferation of malignant cells.

"We can use these microRNAs as a new treatment and make them do what current drugs don't do," said Stebbing.

He said they had found a new microRNA pathway that the estrogen receptor activates. In normal cells estrogen encourages the production of microRNAs, but then as more of them are produced, they switch off estrogen activity, and this keeps cell division under control. Stebbing described this as a "perfect circle".

"But in breast cancer cells, production of the molecules is turned off," said Stebbing, and this is how the control over cell division is then lost and the malignant cells proliferate.

So their aim is to produce a drug that restores the "perfect circle" by stopping the deactivation of the microRNAs.

"If we know how to stop it then we can cure it. This only applies in oestrogen positive breast cancer but this could save millions of lives," said Stebbing.

Experts welcomed the discovery but had reservations about a drug being available soon.

According to the Daily Express, Dr Laura Bell, of Cancer Research UK, said it was far too early to say whether the discovery will "translate into clinical benefits for people with cancer". She said there was still a lot of work to be done.

Agreeing, Dr Alexis Willett, of Breakthrough Breast Cancer reportedly said, "this research is still at a very early stage".

5 Facts You MUST Understand if You Are Ever Going to Lose Your Belly Fat and Get Six Pack Abs

1. Many so-called "health foods" are actually cleverly disguised junk foods that actually stimulate you to gain more belly fat... yet the diet food marketing industry continues to lie to you so they can maximize their profits.

2. Ab exercises like crunches, sit-ups, and ab machines are the LEAST effective method of getting flat six pack abs. We'll explore what types of exercises REALLY work in a minute.

3. Boring repetitive cardio exercise routines are NOT the best way to lose body fat and uncover those six pack abs. I'll show you the exact types of unique workouts that produce 10x better results below.

4. You DON'T need to waste your money on expensive "extreme fat burner" pills (that don't work) or other bogus supplements. A special class of natural foods is much more effective. I'll tell you about these natural foods and their powers below.

5. Ab belts, ab-rockers, ab-loungers, and other infomercial ab-gimmicks... they're all a complete waste of your time and money. Despite the misleading infomercials, the perfectly chiseled fitness models in the commercials did NOT get their perfect body by using that "ab contraption"... they got their perfect body through REAL workouts and REAL nutrition strategies. Again, you'll learn some of their secrets and what really works below.

cancer

Cancer is the uncontrolled growth and spread of cells. It can affect almost any part of the body. The growths often invade surrounding tissue and can metastasize to distant sites. Many cancers can be prevented by avoiding exposure to common risk factors, such as tobacco smoke. In addition, a significant proportion of cancers can be cured, by surgery, radiotherapy or chemotherapy, especially if they are detected early.

preagnant

Women who are taking antidepressants are faced with a very difficult choice when they become pregnant, and for many of them the risks vs. benefits of continuing the treatment are not very clear, according to the findings in the joint report from the American College of Obstetricians and Gynecologists and American Psychiatric Association.

This report confirms that there are far more questions than there are answers about the danger antidepressants pose to infants that are born to women who take them. The report also presents guidelines to help patients and physicians identify who should and should not consider stopping the medication treatment. The report concluded that women who are pregnant that have bipolar disorder, experience psychotic episodes, or are suicidal or have a history of attempts to commit suicide should not be taken off antidepressants.

Charles Lockwood, an OB-GYN at the Yale University School of Medicine, said, “We know that untreated depression poses real risks to babies. That is not conjecture. We know much less about the risks associated with antidepressant use. It is clear that more study is needed.”

According to a previous study, the rate of antidepressant use by women who were pregnant more than doubled between the years 1999 and 2003. The study found that in 2003, approximately one in eight women took antidepressants as some point while they were pregnant. Greater use of the selective serotonin reuptake inhibitor or SSRI antidepressants such as Zoloft, Prozac and Paxil were largely responsible for this increase. These medications were generally considered to be safe for pregnant women at that time, but safety concerns soon emerged, especially regarding the antidepressant Paxil.

Separate studies that were conducted in the U.S. and Sweden suggest that there was an increased risk for congenital heart defects in infants born to women who took Paxil while they were pregnant. These reports lead the FDA to issue an advisory in December of 2005 warning about the potential risk that was based on early results of these two studies. However, the joint panel found that the evidence that linked Paxil use during pregnancy to the heart problems in infants to be inconclusive. Lockwood stated that if this risk is real, it is probably no just limited to Paxil. He says, “It is very likely to be a class effect and not just this one drug.”

The use of SSRI’s during pregnancy has also been linked in some other studies to an increased risk for a low birth weight, preterm delivery and even miscarriage. However, once again, this report found no definitive link between the use of antidepressants and these outcomes with pregnancy.

The joint panel states, “Antidepressant use in pregnancy is well studied, but available research has not yet adequately controlled for other factors that may influence birth outcomes including maternal illness or behaviors that can adversely affect pregnancy.” This report was published in both the American College of Obstetricians and Gynecology journal Obstetrics and Gynecology and the American Psychiatric Association journal General Hospital Psychiatry.

The joint panel concluded that a gradual reduction of the antidepressant dosages and stopping the antidepressants altogether may be appropriate for women who are thinking of getting pregnant if they have had mild or no symptoms for the past six months or longer.

The joint panel also recommends that:

* Women who are already expecting should not attempt antidepressant withdrawal if they suffer from sever depression.
* Women who are psychiatrically stable who wish to stay on their antidepressants during their pregnancy should consult their psychiatrist and ob-gyn about the potential benefits and risks.
* Women that suffer from recurrent depression or those who still have symptoms despite the medication treatment may benefit from psychotherapy when it is available.

Ariela Frieder, M.D., who is a psychiatrist that specializes in treating women who are pregnant that suffer from depression at the Montefiore Medical Center in New York City, says that her patients tend to be very concerned about how the antidepressants will affect their infants and much less aware of the dangers that are posed by untreated depression. Frieder was a practicing ob-gyn in her native Argentina before she moved to New York where she completed her residency in psychiatry. She said, “Many women want to stop treatment abruptly and even stop on their own, but this can be very risky.”

Jennifer Wu, MD, who is an OB-GYN who practices at New York’s Lenox Hill Hospital, agrees with Frieder. “The old conventional wisdom was that pregnancy was a honeymoon period for depression and that patients would be able to come off their medications and be OK. But we have learned that this is not true. It has become more and more apparent that pregnancy is a vulnerable time for patients with a history of depression.”

Persons with Albinism in Tanzania

Albinism is a genetically inherited disorder which results in a lack of pigmentation in the hair, skin and eyes of those affected. In almost all cases a significant visual impairment is also involved, with most persons with albinism being legally blind.

More information on albinism can be obtained HERE

Albinism is a rare genetic condition occurring in both genders regardless of ethnicity. In North America and Europe it is estimated that 1 in 20,000 people have some form of albinism. In Tanzania however, it is 5 times as common with 1 in 4,000 people being affected.

Working Conditions	[About this section]	Back to Top

Hours. Average weekly hours of nonsupervisory workers in private health care varied among the different segments of the industry. Workers in offices of dentists averaged only 27.1 hours per week in 2006, while those in psychiatric and substance abuse hospitals averaged 35.7 hours, compared with 33.9 hours for all private industry.

Many workers in the health care industry are on part-time schedules. Part-time workers made up about 19 percent of the health care workforce as a whole in 2006, but accounted for 38 percent of workers in offices of dentists and 31 percent of those in offices of other health practitioners. Many health care establishments operate around the clock and need staff at all hours. Shift work is common in some occupations, such as registered nurses. Numerous health care workers hold more than one job.

Work environment. In 2006, the incidence of occupational injury and illness in hospitals was 8.1 cases per 100 full-time workers, compared with an average of 4.4 for private industry overall. Nursing care facilities had a higher rate of 9.8. Health care workers involved in direct patient care must take precautions to prevent back strain from lifting patients and equipment; to minimize exposure to radiation and caustic chemicals; and to guard against infectious diseases, such as AIDS, tuberculosis, and hepatitis. Home care personnel who make house calls are exposed to the possibility of being injured in highway accidents, all types of overexertion when assisting patients, and falls inside and outside homes.

Health

At the time of the creation of the World Health Organization (WHO), in 1948, Health was defined as being "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity".^[1][2]

This definition invited nations to expand the conceptual framework of their health systems beyond issues related to the physical condition of individuals and their diseases, and it motivated us to focus our attention on what we now call social determinants of health. Consequently, WHO challenged political, academic, community, and professional organisations devoted to improving or preserving health to make the scope of their work explicit, including their rationale for allocating resources. This opened the door for public accountability [3].

Only a handful of publications have focused specifically on the definition of health and its evolution in the first 6 decades. Some of them highlight its lack of operational value and the problem created by use of the word "complete." Others declare the definition, which has not been modified since 1948, "simply a bad one." [4]. More recently, Smith suggested that it is "a ludicrous definition that would leave most of us unhealthy most of the time." [5].

In 1986, the WHO, in the Ottawa Charter for Health Promotion, said that health is "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." Classification systems such as the WHO Family of International Classifications (WHO-FIC), which is composed of the International Classification of Functioning, Disability, and Health (ICF) and the International Classification of Diseases (ICD) also define health.

Overall health is achieved through a combination of physical, mental, emotional, and social well-being, which, together is commonly referred to as the Health Triangle.

Gear Guide: A Simple Way to Measure Body Fat at Home

I’d been thinking recently that knowing how much I weigh is all well and good, but it doesn’t tell me about the kind of weight I’m carrying. How much fat is burdening this body of mine? Do I have an excess amount of it, dragging me inexorably toward unappealing destinations like heart disease and diabetes? Since I don’t belong to a gym or have a trainer on hand to perform such calculations, I chose to do the deed at home (twice!) with Sequoia Fitness’ new Defender Body Fat Caliper and Warrior Digital Body Mass Caliper.

I last had my body fat measured several years ago, before I began working with weights on a regular basis, and my percentage was in something the American College of Sports Medicine (ACSM) not so tactfully calls the “over-fat” range. I’ve since developed the sense to follow my own fitness-editor advice and have been strength training three times a week pretty regularly for the past year or so. Adding that to my workout routine has helped me finally lose that last, stubborn 5 pounds—and I was eager to see what sort of body-fat shrinkage it might’ve led to as well. Time to bring on the calipers!

The Defender is the more basic of Sequoia’s new calipers. The instructions show three areas to measure; for women, it’s the hip, thigh, and tricep. After setting the gauge on the caliper, you grasp a skinfold per the directions and squeeze just until the little indicator turns green. The instructions suggest doing it several times to get the most accurate reading. My three hip readings ranged from 15 to 20 millimeters, so that seemed like a good idea. (I ended up taking the average of the three readings.)

My thigh readings had a similar range. The third measurement, along my right tricep, was impossible to do by myself—I couldn’t see the little monitor to tell when it turned green—so I roped my husband into helping. (He later tried doing his own measurements and needed my help with the chest reading.) Then I added the three numbers together, squinted to try to make out the super-tiny type on the Body Fat Wheel Chart (folks over 40, beware!), finally managed to match my sum with my age, and voilà: There was my body fat percentage, which I was happy to find now falls squarely within ACSM’s “normal” range (a marked improvement over my last measurement—score one for strength training).

The next day, I put the Warrior to the test. I was stymied at first when the battery compartment wouldn’t stay shut; I finally had to tape it. That small hurdle overcome, though, it was a cinch to use. Once you punch in your age, weight, and gender, you’re ready to take your readings (same places as with the Defender). You clamp until you hear a beep—no green indicator to watch for. I still needed help on the triceps measurement, but overall it was easier to use than the Defender. The results (once again in the “normal” range) come up after you “accept” the third measurement. You can even store them so you can check your progress the next time you measure.

This gadget also gives you a “lean body mass” measurement—in other words, how much of your weight is something other than fat (think muscle, bones, etc.). Oddly, the instruction booklet, which gives body fat ranges, doesn’t say anything about interpreting the lean body mass number. As a result, I didn’t find it that helpful—except as a future means to scare away a telemarketer. (“No subscription for me, thanks, but did you know I have 31 pounds of body fat?”)

It’s true that calipers aren’t the most accurate way to measure body fat (getting a DEXA scan at a lab or hospital is, but it’ll set you back several hundred dollars each time you do it), mostly because the person wielding them might not be doing it exactly right. But really, unless you’re an athlete, does it truly matter if your reading is a couple of percentage points off the mark? Not in my book. I’ll stick with the Sequoia calipers to do the job—making sure, of course, to keep some Scotch tape and a magnifying glass close by.

Product: Sequoia Fitness Warrior Digital Body Mass Caliper and Defender Body Fat Caliper

H1N1: Disabled child latest death

SERDANG, sun: A six-year-old child with Down's Syndrome and a hole in the heart is the latest of three deaths resulting from complications due to influenza A (H1N1).

Health Minister Datuk Seri Liow Tiong Lai said the child who died on Thursday of "pneumonia with underlying Down's Syndrome and Pulmonary Hypertension" was admitted to the hospital on Aug 9 after suffering for two days of H1N1 symptoms.

He said another three-year-old also succumbed to H1N1 complications after being admitted to the hospital on Aug 1 for fever and cough and suffering breathing difficulties for five days.

"The child died on Friday due to severe pneumonia," he said after launching the Serdang Lifelong Health Carnival at SRJK (C) Serdang Baru 1 here.

Liow said the third death was a 50-year-old man who died on Friday after he was warded on Aug 3 due to fever, diarrhea, vomiting and breathing difficulty.

He said the man died of "septicemia with severe pneumonia".

He said the three deaths raised the H1N1 death toll in the country to 62, while 238 new cases brought the number of H1N1 infections to 3,857 cases, so far.

Liow said to date, 213 patients were being treated at the normal wards while 33 more were at the Intensive Care Unit, 16 of whom had risk factors such as chronic illnesses (7), asthma (3), obesity (2), mental illness (2), pregnancy (1) and post-delivery (1).

He said the Health Ministry found many of those infected with H1N1 did not cooperate well in controlling the pandemic.

He reminded the public to promptly seek treatment at nearby clinics or hospitals if they had H1N1 symptoms and reminded doctors to not postpone antiviral treatments to patients.

He said under Section 12 (1) of the Infectious Diseases Control Act 1988, anyone who knows of a disease that can spread to the public and purposely ignore quarantine warnings and infect others will be fined RM2,000 or a maximum penalty of RM10,000 or two years of imprisonment or both. -- BERNAMA

Money talks in cancer

A breast cancer survivor reveals its painful burden on family resources and how having health insurance saved her life.

YOU’VE just been diagnosed with cancer, and the doctor is discussing treatment options. Should cost be a deciding factor?

The prices can be staggering. Consider this scenario: There are two equally effective options to battle cancer, the kind spreading through the body – but one costs RM$60,000 more than the other.

One in eight people with advanced cancer turns down recommended care because of the cost, according to a new analysis from Thomson Reuters, which provides news and business information. Among patients with annual incomes under RM$40,000, one in four in advanced stages of the disease refuse treatment. Do they pay out of their own pockets, sometimes in the thousands of ringgit? Or do they forgo the therapy to preserve what modest assets they may have for their families’ futures?

Cancer care is expensive.

My first encounter with cancer was when my dad was diagnosed with stomach cancer in 1998. Our battle lasted six months before he succumbed to it. But our financial woes lingered long after that.

Dad was a 70-year old pensioner when he was diagnosed with advanced stomach cancer. It was a dreadful disease to have. Upon his diagnosis, we were determined to give him the best medical care possible and do everything we possibly could.

It was a big commitment, and we soon realised that our means to fulfill that commitment were rather limited. The six months after diagnosis was a very trying period for all of us. In those six dark months, all our savings were depleted and credit cards used to the maximum.

I still remember it as though it were yesterday. My family and I were gathered in uncomfortable chairs in the gloomy hospital lounge. It was late in the evening and we were at our wit’s end. Dad had a terrible two days of pain and the doctors informed us that we were fighting a losing battle. “Take him home,” they said, “you’re wasting your money.” We were physically tired, emotionally drained, and financially exhausted.

We had by then exhausted our resources. Yet we were unwilling to take him home ... it sounded so final. We hoped, in his last days, to keep him as comfortable as possible. How were we going to proceed? Our bank accounts were dry and credit cards used to the limit.

We considered many options – mortgaging the house, applying for personal loans, borrowing some money from friends and relatives….

We decided the next morning we were going to do something about it.

But the next morning, dad passed away. It was as though he knew that we had reached the end of our resources. It took us a few years after that to emerge from the financial crisis that the cancer had caused.

We had overlooked and underestimated the financial burden of cancer and its impact on my dad, the patient, and us, the family. An individual does not face cancer alone, a family does. My dad’s stomach cancer had cost him his life. We all miss him dearly. At the same time, the cancer had cost us a substantial amount of money, for my dad did not possess a health insurance or medical policy.

Having witnessed our struggles, my church member, an insurance agent, got our whole family insured. And what a blessing it was.

In 2008, I was in Wellington, New Zealand, working on my doctoral thesis when I was diagnosed with aggressive, advanced breast cancer after a needle core biopsy. Having discussed my options with the breast consultant over there, I decided to return home for treatment.

All the bad memories of the dark moments we had battling with my father’s stomach cancer came rushing back. I remembered the physical fatigue, emotional pain, and the financial drain cancer can cause. I shuddered. It took us so long to climb out of the financial hole cancer had caused and now I was being sucked into it again. I knew financial cancer could mentally kill me faster than breast cancer.

Being a civil servant, I first explored my treatment options in our public hospitals. Because of the large number of patients they were already servicing, I was put on a three-month waiting list. As I explored other avenues, the deciding factor for treatment was cost. Each doctor discussed my treatment options and the cost. It was a grim picture they painted.

By now I was feeling so lost and overwhelmed. I couldn’t think. My family was frantic.

I felt like I was drowning. I was lucky; I had a cushion to fall back on. My health insurance came to the rescue. My medical card enabled me to get prompt treatment, which is an important factor in fighting cancer. My medical card gave me the freedom to find the best doctors and best treatment available in town. My medical card helped save my life.

I soon discovered that there is much more to the cost of treatment than hospital, physician, and medication bills. Out-of-pocket expenses for transportation, food supplements, over-the-counter medications, distractions, telephone bills, complementary medicines, and many other hidden costs can be a significant drain on finances. The total financial damage came close to RM80,000. Because my medical card absorbed the bulk of the cost that was incurred during the treatment, the out-of-pocket expenses were more manageable.

I am so very thankful to my insurance agent who got me insured. Because of my medical card,

I could focus on getting better and not waste my energy worrying about finances and the astronomically expensive treatment.

Having triumphed over my cancer, I truly believe that God, and my dad, are watching out for me. They are doing that through the blessings of family, friends, my doctors, and most importantly, health insurance.

For further information, e-mail starhealth@thestar.com.my. The views expressed are those of the writer and readers are advised to always consult expert advice before undertaking any changes to their lifestyles. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Heart Attack

What Is a Heart Attack?

A heart attack occurs when blood flow to a section of heart muscle becomes blocked. If the flow of blood isn’t restored quickly, the section of heart muscle becomes damaged from lack of oxygen and begins to die.

Heart attack is a leading killer of both men and women in the United States. But fortunately, today there are excellent treatments for heart attack that can save lives and prevent disabilities. Treatment is most effective when started within 1 hour of the beginning of symptoms. If you think you or someone you’re with is having a heart attack, call 9–1–1 right away.
Overview

Heart attacks occur most often as a result of a condition called coronary artery disease (CAD). In CAD, a fatty material called plaque (plak) builds up over many years on the inside walls of the coronary arteries (the arteries that supply blood and oxygen to your heart). Eventually, an area of plaque can rupture, causing a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can mostly or completely block the flow of oxygen-rich blood to the part of the heart muscle fed by the artery.
Heart With Muscle Damage and a Blocked Artery

Figure A shows an overview of the heart and coronary artery. Figure B shows a cross-section of the coronary artery with plaque buildup and a blood clot.

Figure A is an overview of a heart and coronary artery showing damage (dead heart muscle) caused by a heart attack. Figure B is a cross-section of the coronary artery with plaque buildup and a blood clot.

During a heart attack, if the blockage in the coronary artery isn’t treated quickly, the heart muscle will begin to die and be replaced by scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.

Severe problems linked to heart attack can include heart failure and life-threatening arrhythmias (irregular heartbeats). Heart failure is a condition in which the heart can’t pump enough blood throughout the body. Ventricular fibrillation is a serious arrhythmia that can cause death if not treated quickly.
Get Help Quickly

Acting fast at the first sign of heart attack symptoms can save your life and limit damage to your heart. Treatment is most effective when started within 1 hour of the beginning of symptoms.

The most common heart attack signs and symptoms are:

* Chest discomfort or pain—uncomfortable pressure, squeezing, fullness, or pain in the center of the chest that can be mild or strong. This discomfort or pain lasts more than a few minutes or goes away and comes back.
* Upper body discomfort in one or both arms, the back, neck, jaw, or stomach.
* Shortness of breath may occur with or before chest discomfort.
* Other signs include nausea (feeling sick to your stomach), vomiting, lightheadedness or fainting, or breaking out in a cold sweat.

If you think you or someone you know may be having a heart attack:

* Call 9–1–1 within a few minutes—5 at the most—of the start of symptoms.
* If your symptoms stop completely in less than 5 minutes, still call your doctor.
* Only take an ambulance to the hospital. Going in a private car can delay treatment.
* Take a nitroglycerin pill if your doctor has prescribed this type of medicine.

Outlook

Each year, about 1.1 million people in the United States have heart attacks, and almost half of them die. CAD, which often results in a heart attack, is the leading killer of both men and women in the United States.

Many more people could recover from heart attacks if they got help faster. Of the people who die from heart attacks, about half die within an hour of the first symptoms and before they reach the hospital.

2009 A(H1N1) pandemic
Illustration of influenza antigenic shift.
Main article: 2009 flu pandemic

In the 2009 flu pandemic, the virus isolated from patients in the United States was found to be made up of genetic elements from four different flu viruses – North American Mexican influenza, North American avian influenza, human influenza, and swine influenza virus typically found in Asia and Europe – "an unusually mongrelised mix of genetic sequences."[13] This new strain appears to be a result of reassortment of human influenza and swine influenza viruses, in all four different strains of subtype H1N1.

Preliminary genetic characterization found that the hemagglutinin (HA) gene was similar to that of swine flu viruses present in U.S. pigs since 1999, but the neuraminidase (NA) and matrix protein (M) genes resembled versions present in European swine flu isolates. The six genes from American swine flu are themselves mixtures of swine flu, bird flu, and human flu viruses.[14] While viruses with this genetic makeup had not previously been found to be circulating in humans or pigs, there is no formal national surveillance system to determine what viruses are circulating in pigs in the U.S.[15]

On June 11, 2009, the WHO declared an H1N1 pandemic, moving the alert level to phase 6, marking the first global pandemic since the 1968 Hong Kong flu.[16]

At the time of the creation of the World Health Organization (WHO), in 1948, Health was defined as being "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity".^[1][2]

This definition invited nations to expand the conceptual framework of their health systems beyond issues related to the physical condition of individuals and their diseases, and it motivated us to focus our attention on what we now call social determinants of health. Consequently, WHO challenged political, academic, community, and professional organisations devoted to improving or preserving health to make the scope of their work explicit, including their rationale for allocating resources. This opened the door for public accountability [3].

Only a handful of publications have focused specifically on the definition of health and its evolution in the first 6 decades. Some of them highlight its lack of operational value and the problem created by use of the word "complete." Others declare the definition, which has not been modified since 1948, "simply a bad one." [4]. More recently, Smith suggested that it is "a ludicrous definition that would leave most of us unhealthy most of the time." [5].

In 1986, the WHO, in the Ottawa Charter for Health Promotion, said that health is "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." Classification systems such as the WHO Family of International Classifications (WHO-FIC), which is composed of the International Classification of Functioning, Disability, and Health (ICF) and the International Classification of Diseases (ICD) also define health.

Overall health is achieved through a combination of physical, mental, emotional, and social well-being, which, together is commonly referred to as the Health Triangle.

Healthcare today in Malaysia

Healthcare in Malaysia is divided into private and public sectors. Doctors are required to perform 3 years of service with public hospitals throughout the nation, ensuring adequate coverage of medical needs for the general population. Foreign doctors are encouraged to apply for employment in Malaysia, especially if they are qualified to a higher level.

Malaysian society places importance on the expansion and development of healthcare, putting 5% of the government social sector development budget into public healthcare — an increase of more than 47% over the previous figure. This has meant an overall increase of more than RM 2 billion. With a rising and aging population, the Government wishes to improve in many areas including the refurbishment of existing hospitals, building and equipping new hospitals, expansion of the number of polyclinics, and improvements in training and expansion of telehealth. Over the last couple of years they have increased their efforts to overhaul the systems and attract more foreign investment.

There is still a shortage in the medical workforce, especially of highly trained specialists. As a result certain medical care and treatment is available only in large cities. Recent efforts to bring many facilities to other towns have been hampered by lack of expertise to run the available equipment made ready by investments.

The majority of private hospital facilities are in urban areas and, unlike many of the public hospitals, are equipped with the latest diagnostic and imaging facilities. Private hospitals have not generally been seen as an ideal investment – it has often taken up to 10 years before companies have seen any profits. However, the situation has now changed and companies are now looking into this area again, particularly in view of the increasing interest by foreigners in coming to Malaysia for medical care.^{[citation needed]}

Since the Nipah virus outbreak in 1999, the Malaysian Health Ministry have put in place processes to be better prepared to protect the Malaysian population from the threat of infectious diseases. Malaysia was fully prepared during the Severe Acute Respiratory Syndrome (SARS) situation (Malaysia was not a SARS affected country) and the episode of the H5N1 (bird flu) outbreak in 2004.

The Malaysian government has developed a National Influenza Pandemic Preparedness Plan (NIPPP) which serves as a time bound guide for preparedness and response plan for influenza pandemic. It provides a policy and strategic framework for a multisectoral response and contains specific advice and actions to be undertaken by the Ministry of Health at the different levels, other governmental departments and agencies and non governmental organizations to ensure that resources are mobilized and used most efficiently before, during and after a pandemic episode.

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Holding one nostril closed inhale and exhale slowly and deeply. Then hold the opposite nostril closed, inhale and exhale deeply. This breath is often done in preparation for deep relaxation or meditation. You will notice that usually one or the other of the nostrils is more open. If you breath on a small hand mirror, the patch of mist from one nostril will be larger than from the other. The ancient practitioners of Yoga in India were aware of the significance of this and employed this knowledge to enhance health and consciousness. Western science did not notice this phenomena until the 1800's. It has been found recently, through the application of current neuro-science, that the practice of alternate nostril breathing helps to balance the right and left hemispheres of the brain.

All govt clinics to get Tamiflu

PUTRAJAYA: Beginning today, all government health clinics nationwide will be supplied with the antiviraldrug Tamiflu to treat patients with symptoms of influenza A (H1N1) in the high-risk group.

Private clinics and hospitals can also buy the drug from their suppliers and pharmacies from today to treat patients but must ensure that:

i) IT is prescribed to only those with underlying diseases, high-risk groups such as pregnant women, those who are obese, asthmatic, diabetic, have low immunity and heart problem and show symptoms of H1N1;

ii) IT is given to those highly suspected of having the disease, such as those who came back from overseas, had confirmed cases in their schools and workplaces, came in contact with a confirmed victim and are showing symptoms; and,

iii) IT is strictly not prescribed for those who are healthy and have no symptoms of the disease as taking it under such circumstances would negate the effects of the drug when they actually contract the virus.

Health director-general Tan Sri Dr Ismail Merican said in many countries such as the United States, Hong Kong, Mexico, Japan, Denmark and Canada, citizens had taken the drug as a “prophylaxis” but it had proven to be counterproductive.

This, he said, was because they eventually became resistant to Tamiflu, negating the effects of the drug when they actually were infected by H1N1.

“I strongly advise all doctors not to prescribe and Malaysians not to take Tamiflu, if they are not ill. It will not
protect against getting the disease. Those who take it will become resistant to the drug and some may even develop side effects,” he warned.

Dr Ismail also called on pharmacists nationwide not to dispense the drug to anyone without prescription from a doctor.

“We have no problem controlling the drug in government hospitals and health clinics. We are worried about the private sector. People must understand that the drug needs to be used carefully as countries around the world are sharing the supply.”

Dr Ismail also urged healthcare providers to take precaution to avoid being infected. He said there were doctors and staff in four public and private hospitals down with H1N1.

Over the past 24 hours, 16 new cases of H1N1 have been confirmed while another person has died, bringing the death toll from the virus to 14.

There have been 1,492 confirmed cases of H1N1 to date. The latest to succumb to the virus was a 57-year-old man who suffered from diabetes and hypertension. He had been admitted to the Putrajaya Hospital on Tuesday and
died the following day.

Globally, there were 199,146 confirmed cases with 1,446 deaths reported in 171 countries.

In Malaysia, 1,421 people have recovered while 11 are being treated in intensive care units, while 43 others are being treated with antiviral drugs in isolation wards.

Asked if all the people who died had co-morbid problems, Dr Ismail said only two did not.

He urged members of the public not to insist on doctors in private and public hospitals and clinics to take throat swabs unnecessarily as the Institute for Medical Research was flooded with some 300 to 500 throat swabs daily.

He also urged doctors to take swabs of only those whom they deemed absolutely necessary.

Regenerating cartilage

With a simple, new technique, orthopaedic surgeons can now regenerate damaged cartilage in injured joints with stems cells harvested from their patients’ own blood.

AS she took the last steps to the top of Batu Caves, Joanna Hart was exhilarated. It was not something expected she could ever achieve at this point of her life, not when only two years ago, at age 34, she was offered an option usually given to people twice her age: a knee replacement for her left knee.

“Every time I go for X-rays, the radiologist look at the result and go, “‘Gosh, what happened to your knee? Your knee looked like a 70-year-old’s!’ It was very bad,” she described.

The medical history of her left knee was as extensive as it was active. Recurrent dislocations when she was 16 to 19 years old had resulted in a bad knee. “I was doing the high jump, long jump, relay, netball and hockey then. And so when I was 19 my kneecap dislocated – it wouldn’t stay in, it kept coming out,” she explained.

Her doctors recommended surgery to set her kneecap in the correct position to avoid it from dislocating further. However, it ended up giving her a different set of problems. The kneecap was set too high and it was rubbing against her bones.

“Over the years, all the cartilage got worn away,” she said. And as a result of that, bone spurs (osteophytes) started growing where her cartilage had worn off.

“As a midwife, I was very active. And I kept fracturing off those osteophytes and they got stuck in my joint,” she said. “And by then I wouldn’t be able to straighten or bend my leg because it’ll be locked. So, I had to go for surgery – they’ll pull the bit out, sew it up, and off I go again. This kept happening over a period of about 10 years.”

But being physically active in her line of work had kept her knee mobile. It was only when she stopped working that the spurs began building up in her joints again.

“Again, I couldn’t straighten my leg. So, I went to see a surgeon, who looked at the results of my arthroscopy (a minimally invasive surgical procedure to examine or treat a joint), and told me that I needed a total knee replacement,” she said.

As Hart was not keen on the idea, she hesitated – until she found another option that she could accept.

Stem cell repair

What Hart stumbled upon was a minimally invasive procedure, which was in its final stages of research in goats.

Using stem cells from goats, the doctors were able to stimulate cartilage regeneration in the goats’ knees.

“My quality of life was getting lesser by the day because at that point, after all the surgeries, I had to give up athletics, netball and hockey. And then I had to give up jogging and running,” Hart said.

However, what mattered most to her were not the activities she had to give up, but the life she was looking forward to with her children.

“I have two young children and I want to be able to go horse riding and skiing with them. A knee replacement is only going to stop the pain, but it would not make the restrictions any better.”

So, after the completion of animal studies (now accepted for publication in the Arthroscopy: The Journal of Arthroscopic and Related Surgery), Hart proceeded with the surgery. “Now I’m able to jog a little – more like shuffling, really – but I’m moving around a lot more, and I’m going for a skiing holiday this Christmas!” she said with a big grin.

“It’s really simple,” said orthopaedic surgeon Dr Saw Khay Yong, who led the research. “Once the diagnosis of cartilage injury is made, we then start with surgery where the patient has arthroscopy with subchondral drillings into the damaged cartilage areas.

“The stem cells are then harvested one week after surgery. It is a weekly injection into the knee joint starting at one week after surgery, for five consecutive weeks.”

Getting creative with old tools

“Peripheral blood stem cells (PBSCs) have been used by haematologists to treat leukemia patients for the last 20 years and subchondral drilling (the drilling of bone under cartilage layers) is also an established procedure in orthopaedics,” he said.

It all came together when Dr Saw and his colleagues, spurred by the desire to find another alternative to conventional methods of treating damaged cartilage, decided to give stem cells a try.

“If you look at cartilage injuries, currently there are a lot of possible solutions, but the results are inconsistent,” he said.

As some of the current options to treat damaged cartilage (autologous chondrocyte implantations, cartilage transfers and cartilage transplants) may be quite expensive and they often require multiple surgeries, they have never been attractive to him, Dr Saw said.

“So, we started to look into ways we can use stem cells to regenerate our cartilage with the University Veterinary Hospital at Universiti Putra Malaysia,” he added.

Their study in goats started in 2005, where Dr Saw’s team harvested stem cells from goat bone marrow and injected them into the goats’ knees after creating defects (by drilling holes in the cartilage and bone in their joints). When the study was completed in 2007, they proceeded to perform the procedure in humans.

What the procedure does is to accelerate the natural healing process that happens in articular (or hyaline) cartilages in the knee.

“Usually, when you have a partial thickness injury (when the cartilage wear has not exposed the underlying bone), there is no evidence of repair. But when you have a full thickness injury that penetrates into the bone, you can access the bone marrow stem cells within it, which will then initiate repair,” he explained.

By creating full thickness injuries by drilling holes in the bones where cartilage has worn out, you can create an environment where the cartilage can start to heal. And, to aid the process, doctors provide the building blocks: stem cells and hyaluronic acid (a chemical present in cartilage).

But how do the stem cells know where to go? Dr Saw explains: “When you drill the bone, it forms a blood clot. And when that happens, injured cells send out homing signals that attract stem cells from the bone marrow. After that, physiotherapy will provide the environment for the cells to grow into cartilage cells.

“And in this procedure, we provide the stem cells through injections,” he adds.

For the young and active

Although two-year results of the procedure in his patients are encouraging, Dr Saw is not recommending it for everyone.

As it takes a lot of physiotherapy and time – about two years – to achieve best results, he reckons that this might not be the best alternative for the elderly.

Former Miss Malaysia and model Betty Anne Brohier, 43, would attest to the challenges one has to face during recovery. A torn (and later removed) left meniscus (cartilage in the knee joint) when she was in her teens had stopped her from participating in sports but her job as a model has kept her on her feet (and heels) most of the time.

“It used to be quite painful but I thought it was fine. But throughout the years the pain became worse and it affected both knees,” she said.

Her left knee was on the verge of ”collapsing” when she finally agreed to undergo the procedure. “After the surgery, I stayed in the hospital for one week. Following that, for about six months, I used to go for physiotherapy three to four hours every day,” she said.

The road to recovery was long as she needed to learn how to walk and use her leg again. It took her six weeks after surgery to be able to move her leg. Another five months was spent moving around in crutches.

“No pain, no gain, I guess,” she pointed out.

Should Junk Food Help Pay for Health Care?

Congress is considering a ten percent "fat tax" on junk food to help pay for the expansion of health care coverage. But as the economist points out, defining junk food is tricky. While sugary drinks, fries, and burgers might be lumped under this umbrella of fatty foods, they vary on the junky spectrum. Should it be based strictly on fat, calorie, or sugar content?

Others have suggested a more direct, though controversial, approach to the tax: charging people based on BMI or body fat content. One Economist reader had the following to say:

"The common denominator among smokers is cigarettes, so we tax cigarettes. The common denominator among alcohol-abusers is alcoholic beverages, so we tax alcoholic beverages. The common denominator amongst obese people is body fat content (not sugary drinks), so we should tax body fat content."

Do you think spiking up junk food prices would make a big difference on eating habits and health? Or would taxing by weight be more effective?

Better health, take charge

Remember back-to-school checkups, immunizations

What you should know

Back-to-school time requires planning by parents and students.

A child's health affects the ability to learn and participate in activities.

A back-to-school check-up and immunizations are very important for several reasons. First, certain shots are required before a child can go to school. Go to health.state.tn.us/CEDS/ required.htm for the required list. Second, check-ups and screenings can identify problems that might keep a child from learning. Screenings may include tests for vision, hearing, and behavior problems. Third, a check-up is very important if a child plans to play sports or enjoy another physical activity like cheerleading or dance.

Memphis City Schools Regional Health Clinics serve all schools. These clinics can help students with blood pressure, dental issues, vision, lab and hearing tests. They screen children for crooked spines (scoliosis). The clinics are assisted by the professional staff of the Memphis Health Center. School clinics follow up on minor problems such as earaches, in-school injuries or health problems identified during schools hours. They refer children to doctors in the Memphis area for needed follow-up care.

Despite requirements, many children in the Memphis area don't get the recommended shots and screenings. Local school officials are working with health care providers to encourage parents to take a more active role in this issue.

Many kids go to school with health problems. In Memphis, school screenings have shown that nearly 20 percent of kids had uncorrected vision problems. About 8 percent had poorly controlled asthma. Many students were overweight or obese. More than 78 percent of high school students ate fruits and vegetables less than five times a day. (2007 Youth Risk Behavior Survey)

Sports physicals are required by many school teams. Parents and schools want to be sure that a student athlete is healthy enough for an intense sport. A physician's report can also let a coach know if a student has any special needs. A check-up might help a parent learn if exercise will make an old injury worse. A check-up might also show if chronic problems such as asthma or diabetes need to be managed differently with more activity.

The American Academy of Pediatrics recommends that backpacks be no more than 10 to 20 percent of a child's weight. Backpacks should have a padded back and two wide, padded shoulder straps.

What you should do

Make sure that your child's school emergency contact form is accurate and current.

Make a health checklist of things to do before school starts. These may include getting immunizations, hearing or vision tests, or a sports physical. It might also include getting a rolling backpack for heavy books. Set an official bedtime to be sure a child gets the recommended number of sleep hours for his or her age.

Let your child's school know if your child has a special health need. Most schools have a form to instruct school staff to give needed medication. Report if your child has allergies, epilepsy or another chronic condition.

Be sure your child eats a nutritious breakfast before school. If lunch is provided by the school, teach your child what to choose at the school lunch counter.

Schedule an appointment early with a pediatrician. Don't wait until registration time when pediatricians' offices are overwhelmed with last-minute checkups.

Get to know the health services available at your child's school.

Listen to recommendations from your child's teacher, school or doctor about the care your child needs.

Understand when your insurance can help your child. Some schools assist in enrolling children in TennCare.

Keep a record of the shots that your child has had. This record will be requested by schools even through college.

If your child will be playing sports, arrange a thorough sports physical. Be sure that the physical includes an exam of the heart, other organs, and joints. A blood test can also provide important information, such as whether your child is anemic.

ACIP Issues Targeted Recommendations for H1N1 Vaccinations This Fall

Pregnant women and young children should go to the front of the line when vaccine for the novel influenza A (H1N1) virus becomes available in the fall, according to the CDC's Advisory Committee on Immunization Practices, or ACIP.

During a July 29 emergency meeting convened to address issues surrounding the H1N1 virus, ACIP recommended that vaccination efforts focus on five key populations:

• pregnant women,
• people who live with or care for children younger than 6 months of age,
• health care and emergency services personnel,
• individuals 6 months to 24 years of age, and
• people ages 25 to 64 years who are at increased risk from novel H1N1 because of chronic health conditions or compromised immune systems.

As of July 24, the CDC said there were 43,771 confirmed or probable H1N1 cases in the United States, with more than 5,000 hospitalizations and 302 deaths linked to the outbreak. Patients ages 5 to 24 years have the highest incidence of infection, and children from birth to 4 years of age have the highest rate of hospitalization.

The CDC said that targeting the aforementioned groups should help reduce the impact and spread of the novel virus. The targeted populations include people who are at higher risk of disease or complications, those who are likely to come in contact with novel H1N1, and those who could infect infants.

"Children under 6 months are not able to be vaccinated directly," said Anne Schuchat, M.D., director of the CDC's National Center for Immunization and Respiratory Diseases, during a July 29 media briefing"And because they can't be directly protected, the public health strategy is to protect those around them to keep from spreading the virus to them."

A recent report in The lanced detailed the high risks for pregnant women associated with the virus. According to that report, of 34 confirmed or probable cases of H1N1 infection in pregnant women reported to the CDC between April 15 and May 18 of this year, six proved fatal. All six deaths occurred in women who had developed pneumonia and subsequent acute respiratory distress syndrome requiring mechanical ventilation.

Schuchat said pregnant women have been disproportionately affected by the novel virus and are four times more likely to be hospitalized compared with members of the general population who are infected.

She also reiterated that health care workers should receive the H1N1 vaccine and the seasonal flu vaccine to protect themselves, their patients and their colleagues.

The targeted groups account for about 159 million people, or more than half the nation's population. Meanwhile, CDC experts told ACIP that the agency expects there to be 120 million doses of the vaccine -- which likely will need to be administered as a two-dose series -- by October. Another 80 million doses are expected to become available each month thereafter.

Although the number of estimated doses available in October doesn't equal the number of people recommended for vaccination, the shortfall might not be an issue. Schuchat said seasonal influenza vaccine is recommended for 83 percent of the population, but less than 40 percent of Americans receive the vaccine each year.

The CDC said it does not anticipate a shortage of H1N1 vaccine, but in the event that vaccine supply is limited, ACIP members recommend that the following groups receive the vaccine before others:

• pregnant women,
• people who live with or care for children younger than 6 months of age,
• health care and emergency services personnel with direct patient contact,
• children 6 months to 4 years, and
• children 5 to 18 years who have chronic medical conditions.

The smaller, prioritized groups would include about 42 million people, CDC officials said.

"I expect those priority groups to disappear pretty quickly based on demand," said Doug Campos-Outcalt, M.D., M.P.A., the AAFP's liaison to ACIP and associate head of the department of family and community medicine at the University of Arizona College of Medicine, Phoenix. "The public doesn't perceive this disease to be serious. I think there will be vaccine pretty quickly for anyone who wants it."

Meanwhile, ACIP recommends that physicians and other clinicians begin offering seasonal flu vaccinations as soon as possible. Seasonal flu vaccine typically is administered in the fall, but the CDC is pushing for an early start to immunizations to make room for H1N1 immunizations when the vaccine becomes available.

"You don't need to wait to give that shot," Campos-Outcalt said of seasonal flu vaccine. "You can give it now, and immunity will last through the flu season."

Schuchat said it's likely that seasonal flu vaccine and H1N1 vaccine can be given during the same visit, and that is one of many issues that will be addressed during clinical trial that now are getting under way.

In related news, the FDA announced this week that it had issued an emergency use authorization, or EUA, for the Focus Diagnostics Influenza H1N1 (2009) Real-Time Reverse Transcription Polymerase Chain Reaction (RT-PCR) diagnostic test. It is the third diagnostic test authorized under an EUA since a public health emergency regarding the H1N1 virus was declared in April.