Saturday, May 28, 2011

Cool it!: Keep cool while exercising



single
HEAT is no excuse for skipping a workout. If you’re not a gym junkie, here are ways to keep you cool while you sweat it out:

• Drink plenty of water before, during and after exercise since the heat will dehydrate your body even more.

• Cover your head with a bandanna soaked with water. Or if you’re wearing a cap, put a few ice cubes in it before you put the cap on.


• Occasionally, pour water on your head to cool it. If you cycle, carry a water spray.

• Eat well, preferably 5-6 small meals a day, to keep your body fed and hydrated. Fruit and vegetables are good options.

• Wear light-coloured, loose-fitting clothes made from cotton.


• Use sunscreen to avoid sunburn. Not only is sunburn detrimental to you, but it also prevents your body from staying cool.

• Change your workout hours to either very early in the day or late in the evening when it’s cooler. But don’t ignore safety.

• Avoid extreme changes in temperature. After an outdoor exercise, cool yourself down before going into an air-conditioned room.


• Listen to your body and don’t ignore early signs of heat stress such as muscle cramps, nausea, headaches and unsteady footing. Stop exercising and cool down.

• If you need to work out in the sun, try acclimatising yourself slowly by spending a few minutes for the first few days and then increasing it gradually.


Sumber

Cool it!: Keep cool while exercising


Monday, May 23, 2011

Kawal kolestrol tinggi

KOLESTROL ialah bahan lembut seperti lilin yang terdapat dalam aliran darah dan sel badan kita. Ia penting untuk membantu badan berfungsi dan pembentukan membran sel dan hormon yang dibawa melalui lipoprotein.

Lipoprotein Densiti Tinggi (HDL) adalah kolestrol baik yang mampu mengelakkan endapan kolestrol. Selain itu, Lipoprotein Densiti Rendah (LDL) merupakan kolestrol tidak baik yang boleh berkumpul pada dinding arteri dan membentuk plak yang menyumbat arteri.

Ini akan menyempitkan aliran darah dan oksigen yang membuatkan seseorang diserang sakit jantung atau strok. Justeru itu, amat penting bagi anda mengawas tahap kolestrol dan mengawalnya demi kesihatan jantung.

Semua orang tahu bahawa kolestrol mempunyai kaitan dengan penyakit kronik seperti kardiovaskular atau strok. Kita selalu dinasihatkan agar tidak mengambil telur, santan, daging atau makanan berlemak lain apabila kita mempunyai tahap kolestrol yang tinggi.

Namun, apabila semua langkah itu tidak berjaya merendahkan paras kolestrol , tidak ramai yang mengetahui tindakan seterusnya.

Salah satu caranya mengawal kolestrol dengan mengambil makanan serta minuman sihat yang mengandungi sterol tumbuhan.

Apa itu sterol? Sterol tumbuhan ialah molekul organik yang terdapat dalam tumbuhan yang telah terbukti secara klinikal boleh menghalang kolestrol dari diserap ke dalam darah.

Selain daripada makanan, sterol tumbuhan boleh diperoleh daripada suplemen.

Antaranya, Blackmores Plant Sterols Plus memberi anda pilihan untuk menyeimbangkan LDL:HDL (kolestrol 'jahat': kolestrol 'baik') dalam tubuh menerusi sterol tumbuhan.

Suplemen ini memberikan sterol tumbuhan yang relevan. Kandungan sterol membantu mengurangi penyerapan kolestrol. Selain itu,

Ketika proses pencernaan, sterol bersaing dengan kolestrol dalam proses penyerapan. Dengan itu, kolestrol lebih sedikit diserap dan lebih banyak dikeluarkan.

Diet sihat

Diet yang sihat serta seimbang akan membekalkan nutrien harian dan komponen makanan lain yang membolehkan anda memiliki minda serta tubuh yang sihat dan juga bertenaga untuk menjalani aktiviti-aktiviti harian anda. Sebaiknya, makanlah pelbagai jenis makanan kerana tiada makanan khusus yang dapat membekalkan semua nutrien yang diperlukan. Makanan yang berbeza dalam kumpulan yang sama (seperti beras, roti dan bijirin sarapan) membekalkan nutrien yang berbeza dalam jumlah yang berbeza.

Makanlah diet yang seimbang berasaskan buah-buahan, sayur-sayuran, bijirin penuh dan makanan tenusu rendah lemak serta kurangkan pengambilan lemak, gula dan garam.

Untuk mendapatkan keseimbangan kolestrol sihat, kurangkan kuantiti kolestrol dan makanan berlemak daripada daging.

Selain itu, tingkatkan pengambilan ikan (bukan ikan goreng) dan makan lebih buah-buahan, sayur-sayuran dan biji-bijian.

Gaya hidup sihat

Menjadi aktif secara fizikal adalah sama pentingnya dengan makan secara sihat . Aktiviti fizikal akan memperbaiki kesihatan kardiovaskular, kekuatan dan kefleksibilan membakar kalori untuk menjadikan anda sentiasa sihat dan langsing serta membuatkan anda kelihatan, rasa dan berfikir dengan lebih baik.

Senaman yang tidak mencukupi boleh menyebabkan berlebihan berat badan atau obes di mana akhirnya boleh mengakibatkan masalah kesihatan yang serius. Sekurang-kurangnya bersenam selama 30 minit setiap hari dengan berjalan kaki. Jika anda mempunyai berat badan berlebihan atau obes, maka anda perlu bersenam dengan lebih kerap (dan untuk jangka masa yang lebih lama) untuk mengurangkan berat badan yang berlebihan.


Sumber

Kawal kolestrol tinggi

Wednesday, May 18, 2011

The trouble with food


Adverse food reactions that wreak havoc in the body.

OUR solar system is merely a component of the universe. The planets revolve with intricate precision, but if for one split second, the Earth stalls, imagine the colossal wave of destruction.

Unlike the exactness of celestial bodies, our bodies take many hard knocks, and sometimes our well-being spins out of orbit due to certain morsels that we consume.

For the blessed majority, their digestive system is like a food receptacle, causing no trouble. Unfortunately, for the minority with a variety of intestinal peculiarities, such as food allergies and intolerance, eating a meal is a dicey experience as digestive torment often follows ingestion of “trigger” items.

Food reaction symptoms are sometimes confused with leaky gut syndrome, irritable bowel syndrome, inflammatory bowel disease, infective gastroenteritis, and food poisoning.

Food ‘maladies’

In Asia, the Chinese in particular believe that there is a balance in the body determined by the type of foods consumed, namely “heaty” and “cooling”. Nuisances like mouth ulcers, sore throat, skin boils, constipation, fever, toothache, nose bleeds, gosh, even cold sores, are often linked to taking heaty foods.

Other ailments like lethargy, weakness and rheumatism are attributed to cooling foods.

Going nuts: Common culprits known to frequently cause food allergies are peanuts, tree nuts, shell-fish, fish, eggs, dairy and wheat products.

The rationale is simplistically devoid of scientific logic, but the deep-rooted belief is adherent to the concept of yin and yang. If heaty, one consumes cooling foods, and vice versa.

Nutrition provides the human body with fuel for energy, building blocks for structures, and raw materials for the myriad metabolic processes. Under physiological circumstances, ingested food become digested, absorbed, and assimilated into the body.

The metabolic waste is processed in the liver, which is later channelled to be disposed of. So what is the problem?

Just like drugs, certain foods can wreak havoc in susceptible individuals. It can cause a whopping headache, an incessant itch, or one may be floored by intestinal turmoil. These are known as food reactions, which include food allergies and food intolerance.

To commence with the confusion, one can be allergic and intolerant to the same food, or allergic for one, and intolerant for the other person.

Food allergies

Many people erroneously attribute negative food reactions to allergies, but in fact, true allergy constitutes only between 3% to 5% of these incidences.

In sensitivity to a particular food or its component, the body mistakenly regards the incoming protein fragment as “hostile”, and in an attempt to protect the body, produces an antibody to this agent. These antibodies cleverly tag specialised immune cells, known as mast cells, and confer them immune memory.

Upon future exposure to the particular food, the tagged antibodies lock in the offending agent, like a password logon, opening a page where a cascade of chemicals are released.

One notable compound is known as histamine, which is the culprit for the various symptoms of allergy, depending on where it is released. In the skin, it causes dilatation of blood vessels, leading to redness, hives, rashes, itchiness and flushing.

In the airway, it causes mucous production and swelling, leading to nasal congestion, throat irritation and chest tightness, occasionally with difficulties in breathing.

In the gastrointestinal tract, allergy to the specific food can induce pretty nasty stomach upsets, with nausea, vomitting, abodominal cramps and diarrhoea, to mention a few.

In severe cases, there is a sudden drop in blood pressure and severe bronchoconstriction, culminating in a life-threatening situation known as anaphylaxis.

In contrast to food intolerance, food allergy symptoms occur rapidly after ingestion of the offending food. The common culprits known to frequently cause food allergies are peanuts, tree nuts, shell-fish, fish, eggs, dairy and wheat products. However, an individual may be allergic to any food.

Food intolerance

The majority of food trouble is caused by intolerance of what is in the food, or the food itself, rather than allergy. The immune system is not involved and the typical antibodies are not activated.

The manifestation is a direct result of the body being unable to handle the food item, with consequent symptoms which may mimic allergy, such as nausea, abdominal cramps, bloating, diarrhoea, itchiness and non-specific skin rashes.

The most common type of food intolerance is that to lactose (cow’s milk sugar), the digestion of which requires an intestinal enzyme called lactase to break down the sugar. As a result of deficiency of this enzyme, susceptible individuals often have gaseous bloating, abdominal cramps and diarrhoea after consuming milk, ice cream and cheese.

Intolerance to a group of chemicals known as amines are often overlooked as the cause of headaches, in particular migraine and cluster headaches. Histamine and tyramine are breakdown products of proteins in meat, cheese (especially aged cheese), wine and fermented soy products.

The levels are particularly high in cured meat, sausages and poorly kept foods. Certain overripe fruits like banana and avocado contain increased levels of tyramine.

A peculiar form of toxic food reaction to frozen sea food is known as scombroidal toxicity. Sea catches that are not immediately refrigerated or poorly cooled in the market place are subject to bacterial degradation, accumulating high levels of histamine.

Greenlip mussels cooked in white wine is fabulous, but the frozen stuff could potentially turn the insides out and the lips blue with stomach cramps!

Glutamate is a non-essential amino acid found in our foods and contributes to the brain’s pool of chemical messengers (neurotransmitters). Modified into the salt form, it is widely known as monosodium glutamate (MSG) and has gained worldwide popularity (or notoriety) as a taste enhancer. The “Chinese Restaurant Syndrome” occurs in individuals intolerant to MSG and describes the unpleasant hours after a tasty meal in Chinatown.

Though anecdotal (until there is enough scientific evidence), the symptoms include headaches, flushing, abdominal discomfort, insomnia, irritability and chest tightness. Pending further studies, it would be prudent not to sprinkle MSG onto our breakfast cereal.

Among Caucasians, a certain sensitivity to wheat, rye and barley, notably to a component protein found in them, called gluten, afflicts about one in 250. One has to differentiate true wheat allergy from gluten intolerance.

The former presents rapidly after consumption of wheat-based items and is in the form of an immune reaction. However intolerance to gluten, a.k.a. celiac disease, builds up over time, aided by genetic predisposition. The body produces antibodies to gluten, which assaults the intestinal lining, causing flattening of the hair-like villous projections, thereby leading to malabsorption of nutrients.

Symptoms vary and can cause confusion, with constipation, diarrhoea, cramps, bloating, nausea, etc, making early diagnosis difficult.

If one were to think that the story of food reactions ends here, there is more bad news. In days of antiquity, food was as organic as the word goes and animals back then had plenty of exercise, as they ran for their lives.

Modern day livestock are bred in confinement and are loaded with drugs and hormones. Convenience has reached a point where almost all of the foodstuff on the shelves today are processed, and anything with a shelf life that extends beyond natural freshness has chemicals added.

Salicylates, nitrites, sulphites are but a few of the well known additives that act as preservatives. There are also colouring, taste enhancers, stabilisers, emulsifiers etc, that literally numb the senses.

The list of food reactions is exhaustive, but enough has been said to impress upon the reader that the common symptoms are those related to the digestive system. Identifying the root of food reactions is difficult.

Furthermore, the approach to allergies and intolerance are different, thus the delineation of the underlying problem is essential for effective management.

One can start with a food diary, pinpointing reactions, time of ingestion, and type of foods consumed. However, if the allergy is severe, forget the notes and seek professional help.

The bizarre permutation of food reactions due to a particular food protein, natural substance in food, substances added by bacteria, fungi or man, can lead to a spectrum of intestinal upheavals that is often misdiagnosed, possibly inflating the incidence of such vague disease baskets like the irritable bowel syndrome and the leaky gut syndrome.

To add to the perplexity, one is not only mistaken for the other, but can transform to another.

Monday, May 16, 2011

25 peratus pelajar obes pada 2020?


NASI lemak menjadi pilihan utama ketika tinjauan bagi laporan khas mengenai para pelajar yang mengalami masalah obesiti di Sekolah Menengah Tinggi, Setapak, baru-baru ini.


ISU obesiti di kalangan pelajar semakin hangat diperkatakan hingga menu tradisi di kantin sekolah iaitu nasi lemak turut menerima tempiasnya.

Maka timbul persoalan, di manakah silapnya dan apakah yang akan terjadi jika masalah obesiti atau kegemukan ini dibiarkan berlarutan?

Berdasarkan statistik, sebanyak 73.8 peratus pelajar mempunyai pengetahuan mengenai pemakanan seimbang namun hanya 11.2 peratus yang mengamalkannya.

Ikuti laporan wartawan unit khas Utusan Malaysia, AZRAI MOHAMMAD dan SITI NURAZLINA JAMALUDIN mengenai isu membimbangkan itu.

Selain bertemu dengan pihak tertentu, tinjauan juga dilakukan di kantin-kantin sekolah selain mengikuti kehidupan seharian pelajar obes.

Esok, ikuti pula pengalaman Mohd. Khairul Mohd. Zain, 27, yang mempunyai berat badan luar biasa dan kajian Pertubuhan Kesihatan Dunia (WHO) yang mendapati Malaysia mempunyai paling ramai penduduk obes di Asia Tenggara.

KUALA LUMPUR 15 Mei – Satu perempat atau 25 daripada 100 pelajar di negara ini dikhuatiri akan mengalami masalah obesiti atau kegemukan pada 2020 yang juga berisiko mempunyai penyakit.

Anggaran tersebut berdasarkan trend peningkatan satu peratus obesiti pelajar setiap tahun yang peratusannya didapati terus meningkat.

Ketua Jabatan Dietetik dan Sajian Hospital Kuala Lumpur (HKL), Ridzoni Sulaiman menjelaskan, anggaran itu berdasarkan kajian pada 2007 yang mendapati hampir 12 daripada 100 pelajar berusia antara 13 hingga 17 tahun mengalami obesiti berbanding hanya dua orang dikesan 10 tahun sebelumnya.

“Maka itu tidak mustahil jika tidak ditangani segera, pada 2020 sejumlah 25 daripada 100 pelajar atau satu perempat daripada mereka akan mengalami masalah itu.

“Jika diperincikan lagi, ini bermakna 10 pelajar dalam kelas yang mengandungi 40 orang adalah pelajar gemuk yang tidak aktif dan berisiko berpenyakit,” katanya ketika ditemui di sini baru-baru ini.

Pada masa ini terdapat lebih 5.24 juta pelajar sekolah rendah dan menengah.

Ridzoni berkata, walaupun selepas pelbagai pendedahan dan usaha dilakukan kerajaan, gejala obesiti atau kegemukan di kalangan remaja khususnya pelajar sekolah masih gagal diatasi.

“Oleh sebab itu, kantin berperanan sebagai tempat membentuk pemikiran pelajar berkaitan pemakanan seimbang sekali gus boleh mempengaruhi ibu bapa di rumah.

“Seandainya pengusaha kantin sekolah mampu menyediakan hidangan yang mengandungi sayur-sayuran dalam setiap menu, budaya pemakanan sihat secara praktikal dapat dibentuk dan menggalakkan para pelajar membawa amalan tersebut ke rumah,” katanya.

Baru-baru ini, kerajaan telah mengambil langkah proaktif bagi menangani peningkatan masalah tersebut dengan mencadangkan larangan 15 jenis makanan 'tidak sihat' dijual di semua kantin sekolah rendah dan menengah.

Turut dicadangkan ialah supaya indeks jisim badan (BMI) wajib direkodkan dalam kad laporan prestasi pelajar berbanding amalan sebelum ini yang hanya mengkehendaki guru merekodkan berat dan ketinggian pelajar.

Mengambil pengalaman beliau ketika berada di Jepun, Ridzoni berkata, pakar nutrisi dan pengusaha kantin sekolah akan bekerjasama dalam memastikan hidangan dijual adalah sihat.

Tambah Ridzoni, pelajar memerlukan kalori sebanyak 1,500 hingga 2,200 dalam sehari bergantung pada aktiviti harian yang dilakukan dan pihak berkaitan seharusnya peka dengan jumlah kalori yang sepatutnya diambil.


Sumber

Obes

Custom-fit knees

Specially fitted implants for total knee replacements can now be made for each patient.

TOTAL knee replacement (TKR) is the surgical procedure of choice for advanced osteoarthritis of the knee.

Modern TKR is a reliable procedure that consistently alleviates the pain of arthritis and improves function. It is, however, continuously evolving to make it a faster and safer procedure while improving the long-term survivorship of the implants.

Built-to-fit

A fairly recent technology, which promises to satisfy all these requirements, is the use of patient-specific instruments (PSIs). These PSIs are manufactured with the aid of magnetic resonance images (MRIs) or computed tomography (CT) of the patient’s limb. These are then used during surgery to consistently and reliably improve the mechanical alignment of the limb, which has been proven to increase long-term success.

The surgical time is also significantly reduced.

Bone models of a patient’s femur and tibia, with the respective PSIs.

The entire planning of the surgery is done before the actual operation, with the dimensions, angles, and rotation of the bone cuts determined beforehand. Even the appropriate sizes of the implants are known before the actual surgery.

The large inventory that is necessary for the conventional procedure is greatly reduced, from several large trays, to a single box of instruments specific to the patient.

A set of bone models in exact dimensions as the patient’s own bone is provided by implant manufacturers such that the cuts can be simulated and measured for accuracy days before the operation.

During the actual surgery, the PSIs are mounted onto the patient’s bone and cuts are made after simply checking the components for accuracy.

The process of inserting large metal rods into the shaft of the bone in conventional surgery, which could lead to fat embolism, is avoided.

Bone models with the patient-specific implants (PSIs) mounted.

Reduced operative time and smaller number of instruments have been individually proven to reduce the infection rates of surgery in large-scale national registry data involving hundreds of thousands of patients.

The faster operation and smaller incisions in the muscle that is necessary with the use of PSIs could allow even faster mobilisation of the patient, and this too has proven efficacious in reducing the rare but potentially fatal thromboembolic complications of this surgery.

The mechanical alignment of the limb has been previously reliably improved with the use of computer navigated total knee replacement. The surgical time with computer navigation however, is significantly higher than conventional surgery, even in those who have published results of more than 1,000 cases.

The entire planning of the surgery, the dimensions of the cuts, and size of the implants are decided during the surgery. Computer navigation also utilises a larger inventory of instruments than conventional surgery, including overhead tracking monitors, which could result in a greater infection risk.

Additional measures proven to significantly reduce the risk of infection during surgery is the use of body-exhaust suits.

Computer navigation is also expensive and cannot reliably restore rotational alignment of the components (rotational malalignment has been shown to be the leading cause of unresolved anterior knee pain after surgery, causing poor patient satisfaction).

Another problem that has plagued computer navigation is with the multiple reports of fractures within weeks of the surgery, which requires another surgery to fix the fracture and prolonged immobilisation for the fracture to heal. This is caused by the large tracker pins which are drilled into the shaft of the femur (thigh bone) and tibia (leg bone) for computer navigation.

The mechanical alignment is also lost when such fractures occur.

Waiting period

The only downside of PSIs is that the patient will need to wait a month between the CT or MRI scans and the actual surgery. This is the time taken for the scanned images to be exported to a design centre where biomedical engineers use computer-aided design and manufacturing suites to chalk up a draft plan from the images.

This plan will be sent back to the surgeon for verification and approval before the PSIs are manufactured and shipped to the surgeon. The cost is hardly prohibitive, in the range of an additional 10% of the cost of conventional surgery.

Having used both computer navigation in the past and PSIs currently, I find that PSIs are a safer and more reliable option of restoring mechanical alignment when compared to computer navigation.

It also provides several added benefits that make it advantageous both for the elderly patient who requires a quick and less invasive surgery, as well as for the young who demand faster return to function and long-term survival of the implants.

When utilising this technology with several evidence-based practices, the overall safety and reliability of the procedure is enhanced. Advanced perioperative pain management techniques allow patients to actively bend their knee while being wheeled out of the operation room and walk with support the day after surgery with minimal pain (early mobilisation has been proven in studies to significantly reduce the incidence of deep-vein thrombosis, which could lead to the potentially fatal complication of pulmonary embolism).

No injections are given to the patient in most instances after the first post-operative day, and pain has been reliably managed with oral medications alone.

Occasionally, patients have been allowed to return home as early as the third day after surgery (at request).

On the whole, this is likely one of the more significant advances in knee replacement surgery in recent times. PSIs improve mechanical alignment without the added risks of computer navigation, provide a low learning curve in the hands of trained surgeons, and have several other added benefits that make it an attractive option for the treatment of advanced arthritis of the knee.

In essence, it is computer navigation in a safe little box.


Sumber

Custom-fit knees

A chronic disease?

Can breast cancer be considered a chronic disease, and, what are the support systems available to women with breast cancer?

A CHRONIC disease is a disease that persists for a long time. The US National Centre for Health Statistics defines chronic disease is one lasting three months or more.

Traditionally, diseases like hypertension or diabetes are considered chronic diseases, while cancers are generally not, as they usually present as a life-threatening condition, requiring urgent attention.

In cancers where treatment options are limited, and diagnosis is usually made at a late stage, such as seen in the majority of lung, gastric, and liver cancer, survival is poor. Hence, such cancers are not likely to be considered as a chronic condition.

Redefining breast cancer

However, survival rates for certain cancers, notably breast, colorectal and prostate, have risen steadily over the past 10 years. Because survival rates for breast cancer have improved so much, there are now more than four million women worldwide who have been diagnosed and treated for breast cancer over the past five years, compared to an incidence of slightly more than a million new cases per year.

Survival rates of breast cancer has increased to more than 80% in some of the more developed countries. Hence, there are more breast cancer survivors than any other cancer survivors.

It is no surprise that there are so many breast cancer support groups all over the country, while there is not a single lung cancer support group. Because of the large numbers of women living with breast cancer, the Institute of Medicine in the US now recognise breast cancer as a chronic disease, bringing greater focus to this area of research.

After the cancer

After being treated for breast cancer, there are still a few remaining issues. Chemotherapy can lead to an early menopause. With early menopause, women have to face problems with decreased libido, dry skin, earlier onset of osteoporosis (where the bones become brittle and prone to fracture), hot flushes, and depression.

While the majority of women deal with menopause well, there is a small proportion where menopausal symptoms persist, hence interfering with quality of life. For oestrogen-receptor positive breast cancer (which occurs in up to 60% of women with breast cancer in Malaysia), an anti-oestrogen drug called tamoxifen is prescribed for five years.

In premenopausal women (more than 60% of women with breast cancer in Malaysia are in the premenopausal age group), this may cause menopausal symptoms, such as hot flushes, dry skin, sleep disturbances, and genitourinary symptoms. Hence, these women experience a poorer quality of life.

Side effects of surgery may persist, such as numbness and pain of the upper limb, problems with shoulder movement, and lymphedema. Pain over the chest wall is also a common symptom.

These women also have to deal with discrimination at the workplace. Indeed it is not uncommon for women to be coerced into resigning from their jobs. Insurance companies will also not insure women with a “history of breast cancer”. Because of the stigma that a diagnosis of breast cancer brings, some women do not even tell their family members about their condition.

Quality of life

CanSORT (Cancer Surveillance and Outcomes Research Team) is a multidisciplinary group of investigators based at the University of Michigan and the Ann Arbor VA Centre for Clinical Management Research in the US, and studies the quality of cancer care across a continuum of care, from prevention to survivorship.

CanSORT studies the impact of cancer and its treatment on the quality of life, especially in breast cancer, to understand the unique issues that breast cancer survivors face.

In a study carried out by this group, women interviewed eight months after completion of breast cancer treatment report ongoing symptoms – fatigue, sleep disturbances, breast and arm discomfort, and reduced emotional well-being.

Younger women and women with a poorer health status at the time of diagnosis reported more symptoms, and younger women tended to report a lower quality of life overall.

Apart from discrimination, fear of recurrence persists, even in women with early-stage breast cancer, where the prognosis is excellent.

The slightest twinge of pain, even in their big toe, can send women into a panic and running to their doctors.

This fear of recurrence is difficult to cope with for some women, while others accept it pragmatically and move on with their lives, living every day to the fullest.

The breast cancer experience differs with each women, as coping mechanisms differ widely between women, based on their previous life experiences, educational level, socio-economic status, and degree of family support.

However, “benefit-finding” is a new concept where a woman, after experiencing a life threatening event, goes on to live life more fully, taking part in activities such as mountain-climbing or trekking.

A family affair

What about the role of the family in women surviving after a diagnosis of breast cancer?

One of a woman’s greatest fear is that her husband may leave her because of cancer, and certainly, among the less educated, there are myths that cancer can spread to the spouse and that sexual intercourse will bring on a relapse.

Some women are told by their family members that they cannot eat chicken and a whole host of other types of food, so social life which revolves around eating out, can be severely curtailed.

This is unlike other chronic diseases like hypertension and diabetes, where there are less superstitions and taboos.

In metastatic breast cancer, where the cancer has spread beyond the breast into areas like the bones, liver and lungs, it meant that it was time to write your will and get your affairs into order, because in the early years, only 10% of women were alive five years after a diagnosis of metastatic breast cancer.

However because of improved treatment, women are living longer with metastatic breast cancer and it is common now to see as many as 40% of women with metastatic breast cancer surviving five years or more. Hence, even metastatic breast cancer, which used to have such a bleak outlook, is being viewed as a chronic disease.

Ultimately, it is important to develop interventions and programmes to meet the needs of the breast cancer survivor. Interventions include decision making tools to assist women to make good decision about surgery, chemotherapy, and their treatment options, including breast reconstruction.

Interventions to help women to better manage their condition is also required so that a woman, after being treated for breast cancer, can move on and live a normal life, somewhat like a woman who has a chronic disease like hypertension, which is so common.


Sumber

A chronic disease


Sunday, May 15, 2011

Intervensi awal cegah kecacatan


JANGAN lengah membawa anak bertemu doktor andai berlaku sebarang komplikasi kesihatan yang serius.


PETIKAN ucapan Perdana Menteri, Datuk Seri Najib Tun Razak mengenai pentingnya pemahaman ibu bapa terhadap punca yang boleh menyebabkan kecacatan di kalangan kanak-kanak baru-baru mendapat perhatian ramai.

Beliau antaranya mengingatkan mengenai pencegahan awal yang boleh dilakukan segera, sekali gus dapat mengelak sebarang risiko kecacatan kekal kepada anak.

Beliau berkata demikian ketika merasmikan Program Semai Bakti, Kempen Intervensi Awal Mencegah Berlakunya Kecacatan Kepada Kanak-kanak anjuran Badan Amal dan Kebajikan Tenaga Isteri-Isteri Menteri dan Timbalan Menteri (Bakti) di Ipoh, Perak.

Sebenarnya kes kecacatan yang berpunca daripada kelalaian kita bukan perkara biasa di Malaysia. Mengimbas beberapa dekad lalu, ketika bidang perubatan negara masih lagi ditahap rendah, banyak berlaku perkara disebabkan beberapa perkara sebagai contoh demam panas. Walaupun kecacatan boleh dianggap takdir namun sebagai manusia, kita sekurang-kurangnya boleh mencuba untuk mengelaknya.

Bayi dan kanak-kanak adalah insan yang sangat terdedah kepada bahaya di persekitaran mereka. Lantaran itu, pemantauan kita sebagai ibu bapa, penjaga dan masyarakat sangat penting dalam memastikan tumbesaran mereka sempurna.

Menurut Perunding Pediatrik dari Hospital Pantai Cheras, Dr. Wong Chee Yeng, kecacatan di kalangan bayi serta kanak-kanak terbahagi kepada dua iaitu kongenital (sejak lahir) dan berpunca daripada kemalangan atau jangkitan.

"Kecacatan sejak lahir biasanya berpunca daripada kromosom atau genetik. Ia memang tidak boleh dielak. Namun kita boleh mengurangkan risiko seperti mengenalpasti puncanya," kata beliau.

Menjelaskan lebih lanjut beliau berkata, ibu yang berusia 40 tahun ke atas sangat berisiko melahirkan bayi yang mempunyai masalah kecacatan. Perkara itu boleh dielakkan dengan merancang kehamilan awal. Begitu juga dengan penyakit keturunan seperti talasemia dan hemofilia.

Beliau turut menyarankan ibu hamil agar menjaga pemakanan seperti mengambil asid folik mencukupi dan iodin bagi mengelak kecacatan pada janin.

Satu lagi kecacatan berpunca daripada kemalangan atau jangkitan kuman pada otak misalnya meningitis.

"Sebenarnya demam sahaja tidak boleh menyebabkan berlaku kecacatan pada bayi atau kanak-kanak. Memang orang selalu sebut demam panas boleh mengundang kecacatan, sebenarnya ia tidak benar. Kecacatan berlaku jika terdapat jangkitan kuman pada otak seperti meningitis atau encephalitis," katanya.

Ditanya pada umur berapakah seorang bayi itu terdedah kepada risiko kata beliau ia boleh berlaku pada sebarang usia malah kanak-kanak berusia 12 tahun juga boleh terdedah kepada meningitis.

Jangkitan kuman tersebut katanya boleh dielak melalui suntikan imunisasi.

Menurutnya, kes meningitis 20 tahun berkurangan kebelakangan ini selepas Kementerian Kesihatan Malaysia mewajibkan suntikan imunisasi Hib kepada setiap kanak-kanak.

Justeru beliau sangat berharap ibu bapa mengambil langkah pencegahan dengan mematuhi jadual imunisasi yang betul dalam usaha menghalang jangkitan tersebut.

Beliau tidak menolak terdapat juga bayi atau kanak-kanak yang sensitif kepada suhu tinggi ketika demam yang menyebabkan mereka mengalami sawan, namun perkara itu tidak mengundang kecacatan.

Ditanya sama ada mampukah janin yang mengalami kecacatan dirawat ketika dalam kandungan jelas beliau, di negara maju pembedahan melibatkan janin telah terbukti berjaya namun teknologi itu belum sampai ke Malaysia. Antaranya memperbaiki masalah spina bifida.

Saranan doktor:

1. Pastikan bekalan ubat paracetamol sentiasa disimpan di rumah. Periksa suhu badan anak, jika melebihi 38.5 C hingga 39 C bermakna anak demam. Andai perlu, guna ubat dubur untuk menurunkan suhu badan.

2. Lap seluruh badan dan kepala anak juga membantu untuk menurunkan suhu.

3. Jaga kebersihan kawasan rumah. Bagi pengasuh, perlu membasuh tangan setiap kali memegang seorang bayi sebelum bertukar kepada seorang lagi bagi mengelak jangkitan.

4. Ibu bapa dan penjaga perlu peka keselamatan anak. Jika anak kecil terjadi perhatikan keadaannya. Misalnya, muntah dan bertindak di luar kebiasaan (contoh, tiba-tiba diam, menangis atau sebagainya) anak perlu dibawa ke hospital untuk pemeriksaan lanjut.

5. Jangan berlengah membawa anak mendapatkan pemeriksaan doktor andai berlaku sebarang keadaan yang boleh membawa kemudaratan.

6. Pastikan anak tidak terdedah kepada bahaya kemalangan di dalam mahu pun luar rumah.


Sumber

Intervensi awal cegah kecacatan

Wednesday, May 11, 2011

High anxiety

Anxiety disorder is characterised by anxious feelings about a variety of issues and not being able to control worries.

ANXIETY is part and parcel of life. It is normal for everyone to experience anxiety at various times, e.g. prior to sitting for an examination, attending an interview for a job, consulting a doctor or retirement. These feelings have been described as uneasiness and can include worry or even fear. They can be mild or severe.

However, some people experience so much anxiety that it affects their daily lives. They are not able to control their worries and are anxious about a variety of issues and situations, and not specific ones. This condition is called generalised anxiety disorder (GAD).

Neverending worry: People with generalised anxiety disorder are so anxious about a variety of issues and situations that it affects their daily life

Those who have GAD are anxious almost all the time and usually have to try very hard to remember the last occasion they were relaxed. The stressful worries are uncontrollable and the person has a tendency to think of the worst. There is marked difficulty with the activities of daily living, whether it is work or social life. Some doctors have put a time line before diagnosing GAD, which is anxiety occurring continuously for about six months.

GAD is common. It has been reported to affect about 5% of the population in developed countries, with women slightly more affected than men. Many of those affected are in the third decade of life.

Causes

The causes of GAD are not well understood. Some people develop GAD after a stressful incident. Others develop it for no apparent reason. There is evidence to suggest that GAD is due to an imbalance of neurotransmitters in the brain, ie noradrenaline and serotonin. However, it is believed that GAD is more likely to be due to a combination of causes, which include a person’s genetic make-up, biological processes, life experiences, and the environment.

Clinical features

The clinical features of GAD include psychological and physical symptoms, which vary between individuals in number and severity.

The psychological symptoms include constant worries, restlessness, dreading something will happen, irritability, poor concentration, and easy distraction.

The physical symptoms are many and include irregular heart beat (palpitations), dizziness, difficulty breathing, excessive sweating, muscle aches, abdominal ache, frequent passing of urine, diarrhoea, tiredness and difficulty falling and staying asleep (insomnia). Women who have GAD may have missed or painful periods (dysmenorrhoea).

The symptoms may lead to a person with GAD going off work and avoiding contact with family and friends. This increases the loss of self esteem, which in turn may aggravate the worries and fears.

Although people who have conditions like phobias know the cause of their anxiety, people with GAD often do not know what causes their anxiety. This worsens their anxiety to the extent that they worry that a solution is not possible.

A consultation with a regular attending doctor will be helpful. It is essential that there is frankness and openness in the consultation as it will facilitate the making of a correct diagnosis. After hearing the patient out, the doctor will carry out a physical examination to exclude other conditions which may be causing the symptoms. If there is difficulty in making a diagnosis, the doctor may carry out laboratory and/or imaging investigations and/or refer the patient to a mental health team.

Management

GAD is managed with psychotherapy and/or medicines, depending on a patient’s individual needs. The doctor will discuss with the patient the management options prior to the commencement of treatment. It is important that a patient inform the doctor of his or her preferences and circumstances.

Psychotherapy is usually initiated prior to the prescription of medicines. A primary mode of psychotherapy is cognitive behavioural therapy (CBT). This involves helping a patient identify unrealistic beliefs and behavioural patterns, and then working together with the therapist to replace them with more realistic and balanced beliefs as well as alter behaviour. The patient is taught new skills and provided assistance in better understanding of situations that cause the anxiety.

It is important that a patient be patient and give sufficient time for CBT to take effect. CBT has been reported to be effective in treating about 50% of patients with GAD.

Another mode of psychotherapy is applied relaxation, which is as effective as CBT. It involves learning how to relax the muscles rapidly and practising the technique in situations that makes one anxious.

Medicines are also prescribed in the treatment of GAD. Depending on a patient’s circumstances, they are prescribed for the short term or the long term. The doctor will inform the patient about the side effects of the medicines and their interactions with other medicines that the patient may be taking. Short term medicines include antihistamines, benzodiazepines and other anxiolytics. The long term medicines include the selective serotonin reuptake inhibitors (SSRI) and venlafaxine.

Antihistamines are prescribed for the short term. They have a calming effect on the patient. The side effects include dizziness, blurring of vision, headache and dry mouth.

Benzodiazepines are very effective in treating anxiety, easing symptoms within an hour or so after consumption. However, they cannot be used for long periods because of their addictive potential if used for longer than four weeks and loss of effectiveness after this period. The side effects include loss of balance, drowsiness and confusion. It is important to avoid driving or operating machinery when taking benzodiazepines.

The SSRIs increases the level of brain serotonin. Their side effects include nausea, blurring of vision, dry mouth, poor appetite, poor libido and insomnia.

The consumption of SSRI requires medical supervision, which may include regular blood pressure and laboratory checks. It is important to follow the doctor’s instruction on how the SSRI is to be taken.

Venlafaxine is a selective serotonin and noradrenaline reuptake inhibitor (SNRI). It increases the amount of serotonin and noradrenaline in the brain. The side effects include nausea, dry mouth, constipation, insomnia and sweating.

It cannot be prescribed if there is untreated high blood pressure, a recent heart attack or when there is risk of irregular heartbeats. Regular monitoring of the blood pressure is necessary when taking this medicine.

Referral to a mental health team may be made by a patient’s regular attending doctor. The team includes psychiatrists, psychiatric nurses, clinical psychologists, occupational therapists and social workers.

After evaluation and assessment, a treatment plan will be formulated for the individual patient. This may include psychotherapies, treatment of other conditions that may have an effect on the anxiety, other medicines, and treatment by other specialists.


Sumber

High anxiety

Tuesday, May 10, 2011

PET scans

No, a PET scan doesn’t scan your pets. It’s a variation of a CT scan that produces three dimensional colour images.

THERE have been exponential advances in medicine in the last five decades, both in diagnostics and therapeutics. This has been made possible through technological discoveries or improvements in other fields of human activity. The CT or CAT scan is one such example.

The CT scan is a large ring-shaped medical device which produces a series of x-ray beams as it rotates around the body in small movements. Images are built up of the various parts of the body scanned during this process.

These images, which are called tomograms, are of greater detail than that of ordinary x-rays, which uses a single x-ray beam only. The CT scan can produce images of various body parts like the organs in the chest and abdomen, blood vessels, and bones.

A positron emission tomography (PET) scan is a variation of a CT scan that produces three dimensional colour images. It detects the presence of a radioactive substance, called a tracer, in the body, and produces images that show where the tracer is concentrated.

A PET scan is used in the diagnosis and evaluation of the development of a condition, as well as monitoring of the progress of treatment.

Illuminating images: A PET scan utilises radiotracers to illuminate parts of the body that are being investigated.

Preparation

A radioactive substance is produced in a device called a cyclotron. It is attached to a natural compound like glucose, water, or ammonia to produce a compound called a radiotracer, a small amount of which is then injected into a vein, or inhaled during breathing.

The radiotracer travels to the body parts that utilise the natural compound, eg radioactive fluorodeoxyglucose (FDG) is attached to glucose to produce a radiotracer which travels to body parts that utilise glucose. As cancer cells utilise glucose in a different manner than normal cells, FDG is used to demonstrate cancer tissue.

As the body breaks down the radiotracer, energy is produced by the positively charged particles, called positrons. The latter is detected and transmitted to a computer, where it produces three dimensional images. The rate of breakdown of the radiotracer in different organs and tissues vary, thereby producing images of different colours and brightness.

There is a standard operating procedure whenever a PET scan is ordered, with instructions given to the patient by the doctor prior to having the scan.

It is usual practice to advise a patient not to eat anything for four to six hours prior to a PET scan, and to drink plenty of water before that.

The patient will be asked about his or her medical condition, consumption of medicines, history of allergies, and the possibility of pregnancy in women in the reproductive age group. In general, PET scans are not done in pregnant women unless there are medical or surgical conditions that require evaluation and/or treatment. This is because of the possibility that x-rays may harm the developing foetus.

Children are more susceptible to radiation risks than adults. As such, PET scans are only done if the child has a serious condition, which is of greater risk than the PET scan itself.

Any jewellery or metal on the body has to be removed because they interfere with the scanning process. Hair clips, dentures, contact lenses, and hearing aids will also have to be removed, particularly if the head is to be scanned.

The patient will be asked to change into a hospital gown.

Some people have a fear of being closed in without means of escape (claustrophobia, which is derived from the Latin word claustrum, which means “shut in place”, and the Greek word phobos, which means “fear”). Having a PET scan can be claustrophobic. If one has this problem or an anxiety about the scan, one should inform the staff when making the appointment.

This is usually addressed by advice and information or the prescription of a sedative to be taken prior to the scan. It is advisable to arrange for a relative or friend to drive if one is going to take a sedative.

Scan

A small amount of radiotracer will be injected into a vein in the arm, or inhaled during breathing. It takes about 30 to 90 minutes for the radiotracer to travel round the body. One needs to be quiescent and refrain from talking or moving about.

At the appropriate time, the patient will be taken to the room where the PET scanner is located and asked to lie down on an examination table, which automatically moves in and out of the hollow part of the scanner. Images will only be taken of the body part that is inside the ring.

After the position of the examination table is adjusted to ensure that the exact part of the body is in the ring of the scanner, the radiographer or radiologist will leave the examination room.

He or she will carry out the scanning from a control room, which has a window with a full view of the patient. The reason is to reduce the radiation exposure to staff carrying out x-rays daily. Communication with the staff in the control room during the scan will be through an intercom.

The patient will be requested to be still and breathe normally to prevent any blurring of the images taken. One may be asked to breathe in, breathe out, or to hold the breath at certain stage(s) of the procedure.

The x-ray in the ring of the CT scan rotates around the patient, taking images as it does so. With the completion of each rotation, the bed on which the patient is lying is moved forward a little bit, and the cycle continues until the examination of the body part required is completed

The PET scan is painless. However, if one feels unwell or needs assistance, one can press a buzzer or use the intercom to contact the staff.

As the radiation exposure is small, there are no side effects. The drinking of large amount of fluids will help in getting rid of the radiotracer from the body. The radiotracer would usually be totally excreted from the body in a few hours.

The many x-ray images taken will be stored in a computer system. The radiologist will study and analyse the images taken on a monitor screen from various angles and then write a report for the doctor who ordered the scan.

With the completion of the scan, one can leave the hospital, unless one is hospitalised. It is advisable to ask the staff when to expect the results and to confirm one’s appointment with the doctor who ordered the scan.

Uses

A PET scan is a complementary investigation, ie it is used in conjunction with other imaging modalities like x-rays, CT scan, or magnetic resonance imaging (MRI). Its advantage over other imaging investigations is that it provides information about the functioning of a body part at the cellular level instead of providing information about what it looks like.

CT and MRI scans detect changes later than PET scans, after the disease has caused changes in the structure of organs or tissues.

PET scans are used in the diagnosis and evaluation of various medical conditions as well as in the monitoring of treatment.

The common uses of PET scans are:

> Cancer – showing up a cancer, determining its stage, showing if it has spread to other body parts, decision making on the best treatment, and showing how well the treatment is working.

> Heart disease – identification of diseased parts and assessment of function.

> Epilepsy – detection of the affected part of the brain and providing information about the suitability of certain medications.

> Alzheimer’s disease – diagnosis.

> Brain tumours – diagnosis.

> Lungs – diagnosis.

> Breasts – diagnosis, biopsy.

PETS scans are also used in research, eg brain function and ageing.

Risks

The exposure to radiation during a PET scan is generally at levels that are safe and insufficient to cause harm to a patient. The amount of radiation is about the same as in most CT scans. Moreover, the radiation does not last for very long in the body.

Pregnant or breastfeeding women are advised to inform their doctor before having a PET scan. This is because foetuses and infants are more susceptible to the effects of radiation because their organs are still growing.

An allergic reaction to the radiotracer may occur, although this is very rare, in which case there is pain, redness, or swelling at the site of the injection.

As with all things in medicine, the benefits and the risks of any intervention have to be considered.

If a PET scan is used in the diagnosis of a medical or surgical condition, or to monitor treatment, the benefits will have to outweigh the potential risks.


Sumber

PET scans

Cara guna enjin carian




APAKAH kaedah carian maklumat yang cekap dalam Internet terutama dalam menggunakan enjin carian ?

Apabila kita berbincang berkenaan dengan carian yang cekap dalam menggunakan enjin carian di Internet, ia merujuk kepada ketepatan maklumat yang diperolehi dalam masa secepat yang mungkin.

Enjin carian Google dibina dengan kaedah cariannya yang cekap dan pantas.

Namun begitu, ada beberapa perkara yang memerlukan kecekapan pengguna enjin carian tersebut untuk mendapatkan carian maklumat yang tepat dan pantas.

Ia boleh diumpamakan dengan sebuah kereta lumba yang canggih memerlukan pemandu yang cekap untuk beroleh kejayaan dalam sesuatu pertandingan perlumbaan kereta.

Perkara pokoknya adalah bagaimana untuk menyingkirkan terlebih dahulu laman-laman web yang tidak berkaitan dan keputusan carian yang tidak betul.

Di sini akan dibincangkan beberapa faktor insan atau penggunaan carian yang betul bagi mendapatkan hasil carian yang lebih tepat dengan masa yang pantas apabila menggunakan enjin carian di Internet.

Struktur binaan sesebuah enjin carian secara umumnya adalah sama di antara satu sama lain.

Namun begitu, contoh yang akan diambil dalam perbincangan ini menggunakan enjin carian Google.

Berikut adalah beberapa kaedah yang betul untuk mendapat carian maklumat yang tepat dan pantas menggunakan enjin carian di Internet iaitu:-

1. Penggunaan kata kunci atau terma yang unik dan spesifik dalam suatu carian yang dibuat.

Apabila sesuatu carian yang dibuat, enjin carian akan paparkan beratus ribu atau lebih alamat laman web. Jadi, untuk mengurangkan paparan tersebut, gunakan kata kunci atau terma yang sangat spesifik dan unik.

2. Penggunaan tanda tolak (-) dalam kata kunci pencarian. Fungsinya adalah untuk memperkecilkan lagi skop carian. Enjin carian akan menghasilkan keputusan carian yang di luar jangka terutama kata kunci yang digunakan mempunyai beberapa maksud. Tanda tolak ini akan berfungsi secara logik sebagai TIDAK atau penafian bagi sesuatu makna dalam kata kunci carian. Ia akan membuang beberapa keputusan carian yang tidak berkenaan. Sebagai contoh, sekiranya kita menggunakan kata carian berkenaan haiwan, kerbau. Maka segala yang berkaitan dengan kerbau akan dipaparkan seperti Kerbau Enterprise, nama bagi sebuah syarikat, kertas dan lain-lain. Jadi, boleh menggunakan tanda tolak untuk tidak merangkumi maklumat-maklumat yang tidak berkaitan tersebut seperti - Enterprise - Ker dan lain-lain.

3. Penggunaan tanda pengikat kata (" ") bagi mendapatkan kata kunci yang lebih bersifat spesifik dan merangkumi segala kata kunci tersebut. Ia tidak akan mencari maklumat secara umum yang berkaitan dengan kata kunci yang dicari. Ia adalah satu cara bagi mengurangkan paparan maklumat yang tidak betul, tidak berkaitan dan tidak tepat dalam sesuatu carian.

Contohnya adalah seperti kata kunci atau carian perkataan, "Membujur lalu melintang patah".

4. Pengunaan huruf besar dan huruf kecil. Kebanyakan enjin carian tidak membezakan sesuatu perkataan yang sama dengan huruf kecil, huruf besar dan yang berada dalam pengikat kata.

Jadi, jangan membuang masa dengan perkara-perkara tersebut. Sebagai contoh, kesemua perkataan yang berikut adalah sama dalam enjin carian.

*Perpaduan

*perpaduan

*PERPADUAN

nPerpaduan

nperpaduan

5. Tidak menggunakan perkataan kebiasaan dan tanda seruan. Ini kerana kebanyakan enjin carian akan abaikan perkataan kebiasaan yang digunakan dalam ayat untuk bahasa Inggeris seperti and, a, the, an, is dan lain-lain. Pengunaan tanda seruan juga akan diabaikan. Namun begitu, ia boleh digunakan dan enjin carian akan mengambil kira dalam proses carian sekiranya ia berada dalam pengikat kata (" ").

6. Penggunaan fungsi AutoComplete dalam enjin carian. Penyusunan terma kata carian daripada secara umum kepada yang lebih spesifik dalam kotak carian dapat banyak membantu memaparkan keputusan yang tepat dalam bentuk senaraian pada kotak carian tersebut. Inilah cara yang berkesan menggunakan fungsi AutoComplete dalam enjin carian. Pemilihan item yang bersesuaian pada kotak carian menjimatkan masa untuk menaip sesuatu terma carian. Fungsi AutoComplete ini bukan sahaja berada dalam enjin carian seperti Google tetapi ada pada pelayar web atau brwoser seperti Internet Explorer, Mozilla Firefox dan lain-lain.

7. Elakkan menggunakan kata carian berbahasa Inggeris yang mempunyai imbuhan perkataan seperti balls, tested, walking dan lain-lain. Lebih baik menggunakan perkataan asas seperti ball, test, walk dan lain-lain. Ini dapat mengurangkan paparan maklumat yang tidak tepat dalam menggunakan enjin carian.

Namun begitu, sekiranya carian maklumat memerlukan perkataan reading. Gunakan perkataan reading dalam carian maklumat kita.

8. Penggunaan Browser History atau fungsi sejarah dalam pelayar web seperti Internet Explorer, Mozilla Firefox dan lain-lain.

Kadang kala ada alamat laman web yang sudah kita layari untuk dapatkan maklumat.

Sekiranya ada keperluan lagi dan kita menggunakan enjin carian, seperti biasa ia akan paparkan banyak maklumat yang perlu kita perhalusi satu demi satu.

Jadi, alamat laman web yang sudah kita layari sebelum ini boleh diperolehi semula di bahagian Browser History ini.

Bagi memudahkan lagi carian kita, perlu kita mengingat masa dan tarikh laman web tersebut dilayari menggunakan pelayar web tersebut.

9. Hadkan masa carian dan tambahkan dengan pelbagai cara carian. Sekiranya dalam masa tertentu, masih belum menjumpai maklumat yang dicari, kita perlu ada kaedah atau perancangan yang lain seperti berikut:-

nPenggunaan enjin carian yang lain seperti Yahoo!, Lycos, Bing dan lain-lain.

nMembuat pertanyaan dengan menghantar soalan ke forum-forum elektronik yang berkaitan.

nMenggunakan pakar carian maklumat yang boleh membantu.

nMembuat panggilan telefon untuk sesuatu bantuan atau pertanyaan.

nBertanya soalan atau maklumat tersebut kepada rakan taulan.

10. Perincikan carian maklumat yang dibuat. Terdapat beberapa simbol yang boleh diguna pakai dalam carian bagi menambahkan kespesifikan carian dan mengurangkan skop carian. Ia dapat mengurangkan paparan maklumat yang tidak sesuai. Di antaranya adalah seperti berikut:-

nTanda tambah ( + ) - Enjin carian akan abaikan perkataan sambungan atau yang biasa digunakan dalam ayat seperti is, are, and dan sebagainya. Sekiranya perlu untuk kita masukan perkataan tersebut boleh menambah simbol tambah ini dipermulaan perkataan tersebut seperti giant +and city. Jadi, carian tersebut akan memaparkan segala maklumat berkenaan perkataan tersebut termasuk perkataan and.

nTanda aliran ( ~ ) - Dengan penambahan tanda ini didepan sesuatu perkataan, enjin carian akan mencari maklumat perkataan tersebut dan maklumat yang sinonim dengan perkataan tersebut. Namun begitu, tidak kesemua perkataan berupaya mendapatkan hasil yang baik dengan tanda ini terutama sekali perkataan singkatan dan mepunyai banyak makna seperti HTML, CSS, HTTP dan lain-lain. Contoh penggunaanya adalah seperti berikut, ~ HTML.

nTanda asterik ( * ) - Ia digunakan untuk mencari sesuatu perkataan bersama dengan terma lain yang tidak diketahui seperti berikut, pendekar *. Namun begitu, ia tidak boleh digunaka untuk sebahagian daripada perkataan seperti pendekar m*. Hasil carian akan memaparkan segala maklumat berkenaan dengan pendekar dengan tambahan apa-apa perkataan yang lain.

nTanda atau ( OR ) atau ( | ) - Ia digunakan untuk mencari salah satu perkataan-perkataan carian yang sesuai. Sebagai contoh, kenangan indah akan memaparkan maklumat kedua-dua perkataan tersebut tetapi kenangan | indah akan memaparkan kesemua maklumat berkenaan salah satu daripada perkataan carian tersebut.

nJulat penomboran - Perincian sesuatu carian yang bernombor boleh dikecilkan skop cariannya dengan menyatakan julat dan jenis pengukuran bagi nombor tersebut. Sebagai contoh, Windows Server 2005 .. 2008, iPad RM100 RM200 dan lain-lain.

nPenggunaan carian pintar atau Advanced Search yang mempunyai banyak pilihan dan kriteria untuk mengecilkan lagi skop carian seperti tarikh, negara, bahasa dan lain-lain. Ia boleh digunakan dengan mengklik butangnya yang terdapat di sekitar kotak carian.

nPenggunaan fungsi Wonder Wheel dalam enjin carian Google. Ia juga merupakan satu kaedah pencarian yang mengecilkan skop carian kepada carian yang lebih spesifik pada sesuatu perkara.

Ia boleh dibuat carian menerusi kotak carian Google.

Kemudian klik kepada perkataan Wonder Wheel disebelah tepinya.

Segala apa yang dibincangkan sama ada ia merupakan satu kaedah carian atau alat carian adalah merupakan perkara penting. Ini berguna untuk kita mendapatkan carian maklumat yang hampir tepat dalam masa yang pantas.

Segala maklumat yang tidak perlu dapat dihindarkan daripada paparan enjin carian.

Internet merupakan sebuah gudang maklumat yang mempunyai pelbagai jenis maklumat.

Tugas kita adalah untuk memperhalusi aspek carian maklumat agar berupaya mendapat maklumat yang tepat dalam masa yang pantas. Hampir kesemua enjin carian adalah berasaskan kepada bahasa Inggeris.


Sumber

Cara guna enjin carian

Kesan stres terhadap daya kerja


Stres boleh mengurangkan mood untuk melakukan kerja di pejabat.


PELBAGAI kejadian dan tragedi yang melibatkan tekanan atau stres dan kemurungan teruk sebenarnya boleh dielak dan diatasi, jika orang ramai mengambil berat mengenainya. Malah, ia boleh menjadi penyakit yang serius andai tidak diurus dan dikawal dengan baik.

Walaupun stres dikategorikan penyakit yang serius tetapi sayangnya ia tidak diambil berat.

Ini mungkin kerana masyarakat beranggapan bahawa stres hanya memberikan kesan seketika tanpa menyedari bahawa stres juga boleh menjejaskan seluruh badan dan minda.

"Ia boleh menjejaskan tingkah laku, fikiran, emosi, perhubungan dengan orang lain di pejabat dan rumah," ujar Pakar Perunding Psikiatri Hospital Gleneagles Kuala Lumpur, Dr. Nor Hamidah Mohd. Salleh ketika menyampaikan ceramah dalam Bengkel Stres Kehidupan anjuran Hospital Gleneagles.

Dr. Nor Hamidah memberitahu, wanita mempunyai risiko yang lebih tinggi mengalami stres dan kemurungan berbanding lelaki. Tidak ada sebab tertentu yang mengatakan punca mengapa wanita lebih berisiko tinggi berbanding lelaki.

Bagaimanapun, ia mungkin kerana wanita lebih mudah meluahkan perasaan dan dengan cara begini mereka cepat mendapatkan rawatan.

Lelaki biasanya tidak mudah meluahkan perasaan dan ini mungkin kerana anak lelaki dididik supaya menjadi 'lelaki sejati', iaitu tidak boleh menangis dan sebagainya.

Banyak kes yang dirawat di hospital melibatkan pesakit yang tidak membiasakan diri menyelesaikan masalah dari peringkat awal lagi.

Kadang-kadang masalah di tempat kerja juga memberi kesan terhadap institusi kekeluargaan sehingga memporak-perandakan perkahwinan itu sendiri.

Bagi penghidap stres, mereka bimbang, masyarakat akan memandang serong terhadap mereka dan tidak mahu dilabel kurang siuman.

Ujar Dr. Nor Hamidah, sebab itu masyarakat juga perlu prihatin dan sedar betapa stres dan kemurungan yang tidak dirawat dengan baik boleh memberi kesan kepada produktiviti kerja.

Ramai wanita stres?

Menurut Dr. Nor Hamidah, dalam satu kajian yang pernah dijalankan oleh Universiti Arizona terhadap 166 pasangan berkahwin mendapati, wanita melalui episod stres yang tinggi berbanding lelaki.

Bercerita mengenai punca masalah yang semakin meningkat itu katanya, desakan hidup dan persekitaran sebenarnya menjadi penyebab utama.

Kebanyakan wanita pada peringkat umur 35 hingga 45 tahun mengalami emosi yang stabil kerana ramai yang mula bijak menguruskan kewangan sementara anak-anak pula sudah membesar. Berbeza dengan wanita yang baru mendirikan rumah tangga atau mempunyai anak, mereka belum bijak menguruskan hal rumah dan kerja. Bagi wanita yang berumur 45 tahun ke atas, mereka pula berhadapan dengan perubahan hormon akibat menopaus.

Pendek kata wanita dwi kerjaya berhadapan dengan pelbagai cabaran iaitu penjagaan anak-anak, menjaga ibu bapa, beban kerja rumah, masalah dalam perkahwinan dan prestasi kerja.

Bijak

Namun seandainya seseorang bijak melalui setiap stres yang dialami, mereka mampu menjalani hidup dengan lebih berkualiti.

Jelas Dr. Nor Hamidah, kesihatan mental sama pentingnya dengan kesihatan fizikal.

"Mengambil berat tentang kesihatan mental membantu kita untuk merasa lebih sihat secara fizikal. Begitu juga sebaliknya kerana kedua-dua perkara ini saling berkait," katanya.

Dr. Nor Hamidah turut menasihatkan mereka yang mengalami masalah supaya ambil masa untuk rehat dan berani untuk berbincang mengenainya bersama saudara atau teman terdekat.

"Anda sendiri mungkin sedar dengan perbezaan diri apabila mengalami masalah mental seperti kemurungan. Malah rakan-rakan terdekat juga pasti akan sedar mengenainya. Seandainya ada yang menasihati anda agar bertemu pakar untuk mendapatkan rawatan, jangan tunggu lagi," katanya.

Dr. Nor Hamidah memberitahu, kerja, keluarga dan kawan-kawan memberi kesan kepada kesihatan mental dari sudut kebaikan dan keburukan. Justeru katanya, setiap individu perlu pandai mengimbangi kerjaya dan kehidupan mereka agar sihat mental dan fizikal.

Pengurusan stres di pejabat

Justeru itu, setiap organisasi perlu ada pengurusan stres di tempat kerja agar tidak menganggu produktiviti pekerja.

"Kita lihat banyak kejayaan menerusi perlaksanaan pengurusan kerja di pejabat. Kajian syarikat McDonnel Douglas pada tahun 1989 menunjukkan pengurusan stres di pejabat menurunkan 35 peratus kos penjagaan kesihatan pekerja. Pada tahun 1995, Perkhidmatan Salah Tingkahlaku dan Kesihatan Mental mendapati pengurusan stres di tempat kerja telah menurunkan 35 peratus masalahstres pekerja dan meningkatkan produktiviti sebanyak 14 peratus," ujarnya.

Mengulas lanjut tentang pengurusan ini, setiap organisasi perlu merujuk pekerja yang stres kepada pakar psikiatri, psikologi atau kaunselor.

Kebiasaannya, pekerja yang berhadapan dengan stres akan diberi cuti sakit sehingga seminggu. Jika kes serius berlaku, rawatan boleh dilanjutkan sehingga tiga bulan.

Ini penting untuk mengurangkan berlakunya darah tinggi - lelah - masalah kulit yang semakin teruk seperti jerawat, psoriasis, ekzema - serangan jantung - sinus/resdung - hilangan fungsi seksual dan pembiakan - strok - masalah berat badan - gangguan tidur - cirit-birit atau sembelit - migrain - gangguan kebimbangan - ulser perut - sakit kepala - kemurungan.


Sumber

Kesan stres terhadap daya kerja

Hormon untuk pertahan tulang


SENAMAN dan penjagaan makanan mampu mencegah osteoporosis peringkat awal di kalangan wanita.


Apabila bapa mertua saya mengalami kemalangan di rumah, kami semua berasa risau. Bapa mertua saya berusia 80 tahun. Beliau ialah seorang lelaki yang tegap dan kacak meskipun sudah lanjut usia.

Kesihatan bapa mertua saya sangat baik sekali. Beliau tidak ada penyakit jantung mahupun kencing manis. Tubuhnya sederhana, tidak terlalu gemuk atau kurus kerana amalan pemakanannya yang baik. Ingatannya juga sangat tajam. Beliau mampu bercerita kisah lalu dan kisah terkini melalui pembacaan surat khabar setiap hari.

Apabila bapa terjatuh, beliau mengadu sakit belakang. Kami membawa bapa berjumpa pakar tulang kerana khuatir tulangnya retak atau patah. Kadar patah tulang di kalangan orang tua sangat tinggi maka kerana itulah saya begitu prihatin dengan keadaannya.

Menurut doktor tulangnya tidak patah. Sebagaimana orang tua yang lain tulang bapa mengalami osteoporosis. Ini dapat dilihat melalui gambar sinar-x yang diambil. Tulangnya kelihatan berongga dan tidak kukuh.

Sakit yang dialami mungkin hanya sekadar kesan lebam pada ototnya. Ia tidak ada kena mengena dengan tulang. Bapa bernasib baik. Tulangnya yang nipis mudah patah.

Masalah osteoporosis ini sudah lama kami ketahui. Beberapa tahun lalu, bapa juga telah terjatuh dari motosikal. Oleh kerana khuatir maka kami telah membawanya ke hospital dan doktor mengatakan dia hanya mengalami osteoporosis.

Pelbagai usaha kami lakukan untuk meningkatkan jisim tulang bapa termasuklah dengan rawatan chelation, pengambilan kalsium tinggi serta menjaga makan minumnya. Namun begitu kami tidak berjaya meningkatkan jisim tulangnya.

"Mahukah puan mencuba hormon untuk tulang?" doktor pakar itu bertanya.

Saya amat tertarik dengan saranannya itu. Sebagai seorang doktor dan juga pengamal hormon saya teruja apabila seorang pakar tulang mengaplikasikan hormon ke dalam bidangnya.

Hormon parathyroid merupakan hormon yang terpenting bagi tulang. ''Sebagai anaboloik hormon, ia mampu meningkatkan jisim tulang dengan cara membolehkan pembinaan tulang baru," terangnya.

Bagaimanakah tulang terbina?

Pembentukan tulang manusia dimulai pada saat masih janin dan umumnya akan bertumbuh dan berkembang terus sampai sehingga 35 tahun. Berikut adalah gambaran pembentukan tulang. Sekiranya dari awal proses pertumbuhan, banyak kalsium ada dalam darah maka tulang akan terbentuk dengan baik.

Pada usia 0 - 30/35 tahun, proses ini dinamakan modeling kerana pada masa ini terbentuknya model tulang seseorang. Ini bermakna tulang kita tidak sama antara satu sama lain. Kerana itulah kita mempunyai rupa paras yang berbeza.

Mencegah

Pada usia 30 - 35 tahun, pertumbuhan tulang sudah selesai, waktu ini disebut remodeling di mana modeling sudah selesai tinggal proses penggantian tulang yang sudah tua dengan tulang baru yang masih muda. Setelah pembentukan tulang selesai, maka akan terjadi penurunan jisim tulang. Hal ini bisa dicegah dengan menjaga kandungan kalsium setelah tercapainya puncak jisim tulang.

Dengan mengambil kalsium 800 - 1200 mg sehari, jisim ini boleh dipertahankan.

Untuk mencegah penurunan jisim tulang, di mana penurunan ini akan mengakibatkan berkurangnya kepadatan tulang dan tulang akan mengalami osteoporosis.

Osteoporosis lebih baik dicegah dengan cara pengambilan kalsium yang cukup setelah usia 30 atau 35 tahun.

Kesimpulan:

Dalam proses pembentukan tulang, tulang mengalami regenerasi iaitu penggantian tulang-tulang yang sudah tua dengan tulang baru yang masih muda, proses ini berjalan seimbang sehingga terbentuk puncak jisim tulang. Setelah terbentuk puncak jisim tulang, tulang masih mengalami penggantian tulang yang sudah tua dengan tulang yang masih muda. Tetapi proses ini tidak berjalan seimbang di mana tulang yang diserap untuk diganti lebih banyak daripada tulang yang akan menggantikan, maka terjadi penurunan jisim tulang. Apabila keadaan ini berjalan terus menerus, akan terjadi osteoporosis.

Komposisi tulang

Tulang terdiri daripada dua bahan:

Matrik yang kaya mineral (70%) > Tulang yang sudah matang)

Bahan-bahan organik (30%) yang terdiri dari:

Sel (2%) : 1) Sel Osteoblast : yang membuat matrik (bahan) tulang / sel pembentuk tulang. 2) Sel Osteocyte : mempertahankan matrik tulang. 3) Sel Osteoclast : yang menyerap osteoid (95%) (resorbsi) bahan tulang (matrik) / sel yang menyerap tulang.

Osteoid (98%) : Matrik (bahan) tulang yang mengandung sedikit mineral (osteoid>tulang muda)

Hormon yang mempengaruhi tulang secara langsung ialah parathyroid hormone.

Kelenjar parathyroid berada berhampiran dengan kelenjar tiroid kita iaitu di leher. Akibat penuaan maka aktiviti hormon ini merosot. Ini membuatkan kalsium tidak dapat didepositkan dengan baik. Malahan kalsium yang dimakan tidak mampu di serap dan keluar semula daripada tubuh kita.

Dengan pendekatan moden iaitu meningkatkan kembali paras hormon parathyroid kepadatan tulang akan dapat ditambahkan secara semulajadi dan ini merupakan berita gembira buat kita.


Sumber

Hormon untuk pertahan tulang

Jaga pemakanan warga emas


KUrangkan pengambilan makanan yang berlemak bagi warga emas yang mengalami lebihan berat badan. - Gambar hiasan


STATUS pemakanan warga emas sangat dipengaruhi oleh perubahan-perubahan yang berlaku apabila usia semakin meningkat.

Akibat pengurangan deria rasa dan bau, keupayaan menghadam dan menyerap makanan, melihat dan mendengar, kehilangan gigi, ketahanan melakukan aktiviti fizikal, kurangnya pepejal otot, jumlah air dalam badan, kepadatan tulang dan kemurungan serta kekeliruan menyebabkan warga emas ini perlu diberi perhatian khususnya dalam hidangan makanan.

Justeru sebenarnya, apakah makanan yang baik untuk warga emas?

Ia merupakan semua makanan yang mewakili kumpulan makanan seperti yang digariskan dalam Piramid Makanan, iaitu makan sedikit makanan yang mengandungi lemak, minyak, gula dan garam. Makan sederhana susu dan produk tenusu, makan banyak sayur-sayuran dan buah-buahan dan makan secukupnya nasi, mi, oat, bijirin dan ubi.

Makanan yang kaya dengan kalsium terutamanya susu dan produk tenusu serta makanan lain yang kaya dengan kalsium seperti tauhu, sayur-sayuran berdaun hijau seperti bayam dan kailan, ikan bilis dan ikan sardin yang dimakan bersama-sama tulangnya baik untuk pemakanan warga emas.

Begitu juga makanan yang kaya dengan zat besi seperti daging lembu dan kambing, hati ayam dan sayur-sayuran seperti pucuk paku dan sawi, makanan yang kaya dengan zink seperti ikan dan makanan laut lain, hati dan daging, bijirin atau hasil bijirin mil penuh seperti sarapan pagi yang tidak ditambah gula, roti atau biskut mil penuh, capati dan semua jenis buah-buahan dan sayur-sayuran, air sama ada air kosong atau jus buah-buahan.

Panduan menyediakan hidangan

Hidangkan makanan dalam hidangan yang kecil dan sesuai dengan cita rasa setempat yang mempunyai kepelbagaian dari segi jenis, rasa, warna, bentuk, tekstur dan bau.

Gunakan pelbagai perencah asli seperti halia, lengkuas, bawang, daun bawang, daun sup, herba dan rempah asli seperti ketumbar, jintan dan halba untuk membangkitkan rasa makanan.

Pilih makanan yang kaya dengan nutrien sebagai asas menu, contohnya mi sup yang disediakan dengan sup daging adalah pilihan yang lebih baik jika dibandingkan dengan mi segera.

Cara menggalakkan warga emas makan

Galakkan mereka makan bersama kawan-kawan, juga berjalan-jalan sebelum makan untuk merangsang selera makan.

Bagi warga emas yang mengalami masalah mengunyah makanan sendiri, sediakan peralatan makan yang dapat membantu mereka berlatih menyuap makanan dengan sendiri jika perlu, bantu mereka menyuap makanan itu.

Sediakan ruang makan yang bersih, selesa dan ceria serta minta pendapat tentang makanan yang disediakan dan cuba perbaiki makanan daripada maklum balas yang diterima daripada mereka.

Makanan lembut perlu disediakan bagi warga emas yang tidak bergigi, memakai gigi palsu yang tidak sesuai atau yang mengalami masalah pernafasan seperti lelah dan mengah.

Ia boleh dilakukan dengan memotong kecil atau cincang makanan sebelum dimasak, pilih sumber protein lembut seperti telur, tauhu, tempe, keju, kacang panjang, dadih atau ikan yang berlemak. Gunakan daging cincang, bebola ayam, ikan, udang atau sotong, pilih sayur yang berdaun hijau untuk penghadaman.

Bagi warga emas yang mengalami masalah berat badan, faktor ini akan meningkatkan faktor risiko kepada penyakit-penyakit kronik seperti kencing manis, darah tinggi dan sakit jantung.

Warga emas yang berlebihan berat badan perlu menurunkan berat badan mereka. Untuk ini kurangkan penyediaan makanan bergoreng atau yang tinggi kandungan lemak, kurangkan penggunaan semua jenis minyak dan lemak, gula dan kurangkan saiz hidangan bagi setiap waktu makan.

Pilihlah buah-buahan sebagai snek bagi menggantikan kuih-muih. Untuk memudahkan penyediaan makanan warga emas yang menghidap diabetes, makanan dibahagikan kepada tiga kumpulan iaitu makanan yang bebas dimakan, yang perlu disukat dan yang perlu dielakkan.

Warga emas memang tidak akan lari dari keadaan osteoporosis, justeru perbaiki keadaan ini di kalangan warga emas daripada menjadi lebih buruk dengan menyediakan makanan yang lebih tinggi kandungan kalsium.

Pastikan warga emas terdedah kepada matahari untuk memperoleh vitamin D yang dapat membantu penyerapan kalsium dan galakkan mereka bersenam untuk meningkatkan kecergasan fizikal dan juga mengekalkan peningkatan jisim tulang mereka.

Anemia di kalangan warga emas berlaku disebabkan kurangnya pengambilan makanan yang kaya dengan zat besi, asid folik atau vitamin B. Anemia juga boleh berlaku disebabkan oleh jangkitan penyakit-penyakit kronik dan keadaan yang menganggu penyerapan zat besi oleh badan.

Sembelit pula merupakan masalah yang sering dialami oleh warga emas disebabkan kurangnya pengambilan air dan makanan yang kaya serat.

Ia juga boleh berlaku disebabkan oleh kurangnya aktiviti fizikal. Bagi mengatasi masalah sembelit di kalangan warga emas, golongan ini perlu mengamalkan minum air yang banyak, iaitu 6 hingga 8 gelas sehari walaupun mereka tidak merasa dahaga. Berilah mereka air kosong dan jus buah-buahan.

Apabila mereka makan, lebihkan kepada makanan yang mengandungi banyak air seperti sup, bubur dan puding juga makan makanan yang kaya dengan air dan serat seperti buah-buahan segar dan sayur-sayuran.

Melakukan aktiviti fizikal seperti berkebun dan berjalan juga dapat mengatasi masalah sembelit kerana fizikal mereka menjadi aktif.


Sumber

Jaga pemakanan warga emas

Saturday, May 7, 2011

Elak lambakan doktor kelas tiga


NEGARA sentiasa memerlukan doktor berkualiti tinggi. – Gambar hiasan


KUALA LUMPUR – Langkah kerajaan menghentikan kursus baharu perubatan di institusi pengajian tinggi (IPT) tempatan mampu membendung masalah lambakan doktor yang tidak berkualiti di pasaran ketika ini.

Presiden Persatuan Perubatan Malaysia (MMA), Dr. David Quek Kwang Leng berkata, masalah tersebut berpunca daripada kewujudan banyak IPT yang menawarkan pelbagai kursus perubatan. Beliau berkata, pertambahan jumlah kursus perubatan itu menyebabkan pelajar bebas memilih kursus dengan kos yang rendah pula.

“Ketika ini ramai pelajar boleh mendaftar kursus perubatan dengan mudah walaupun mereka sebenarnya tidak layak. “Mereka langsung tidak memikirkan tanggungjawab yang bakal digalas apabila sudah bekerja nanti,’’ katanya ketika dihubungi Kosmo! semalam. Beliau diminta mengulas keputusan Kementerian Pengajian Tinggi membekukan kursus baharu perubatan di IPT tempatan berkuat kuasa 1 Mei lalu hingga 30 April 2016. Tindakan itu dilakukan bagi memastikan pelajar perubatan mendapatkan latihan yang berkualiti dan menjadi seorang pegawai perubatan berdaya saing.

Kwang Leng menjelaskan, semua IPT di negara ini sama ada ia milik kerajaan mahupun swasta, bertanggungjawab sepenuhnya dalam melahirkan pegawai perubatan berkualiti tinggi. “Jika pelajar terbabit tidak mampu bersedia daripada semua segi, bayangkan bagaimana mereka hendak berdepan dengan pesakit yang kritikal. “Kita perlu melatih doktor yang terbaik dengan kualiti yang terbaik,” katanya. Pada masa ini nisbah jumlah pegawai perubatan kepada pesakit adalah 1:1000. Bagaimanapun kementerian percaya bahawa nisbah 1:400 dapat dicapai menjelang 2020 biarpun pembekuan tersebut dilakukan.


Sumber

Elak lambakan doktor kelas tiga

Sumber air dicemari bakteria




JAKARTA - Hampir 100 peratus sumber air minum di bandar-bandar besar di Indonesia dicemari bakteria E Coli dan Coliform.

Pengarah Penempatan dan Perumahan Badan Perencanaan Pembangunan Nasional (Bappenas), Nugroho Tri Utomo berkata, sebanyak 80 peratus daripada pencemaran itu berlaku hasil perbuatan manusia sendiri.

"Pencemaran berlaku kerana sikap kita sendiri, oleh itu kita perlu mengambil berat tentang sumber air kita, termasuk sistem perparitan," katanya ketika menghadiri Persidangan Kebangsaan Pengurusan Sumber Air Bersepadu di Jakarta.

Persidangan bertemakan 'Peranan Rakyat dalam Pengurusan Sumber Air Bersepadu' itu dianjurkan oleh Bappenas dan Danone Aqua sempena menyambut Hari Air Sedunia.

Menurut Nugroho, dianggarkan 3.5 juta orang akan berhadapan masalah kekurangan air pada 2025, dengan 2.5 juta daripada jumlah itu pula akan hidup tanpa tahap kebersihan yang sepatutnya.

Punca masalah itu ialah sikap manusia sendiri yang suka membazir dan mencemarkan sumber air.

"Di Indonesia, keperluan bekalan air bersih semakin meningkat dan kecenderungan pengguna air bersih turut bertambah.

"Jumlah peningkatan pengguna ialah antara 17 hingga 30 peratus per kapita untuk setahun, sedangkan jumlah air bersih yang ada semakin berkurangan ekoran pencemaran dan kerosakan," ujar Nugroho.

Sementara itu, anggota Dewan Air Nasional, Piter Hehanusa berkata, kira-kira 169 juta rakyat Indonesia belum dibekalkan dengan air bersih.

"Kerajaan memiliki 7.1 juta saluran air bersih yang hanya mampu membekalkan air kepada 35.5 juta orang dan hanya dinikmati penduduk bandar.

"Ini bermakna, sejumlah 82 peratus rakyat negara ini terpaksa menggunakan air yang tidak mematuhi piawaian kesihatan," katanya.

Ketua Pusat Sumber Daya Air Tanah dan Geologi Persekitaran dari Kementerian Tenaga dan Sumber Mineral, Dodid Murdohardono pula berkata, pencemaran air menjadi punca utama krisis air bersih di seluruh Indonesia.

Menurutnya, masalah ini diburukkan lagi dengan pengawasan yang lemah dan keengganan pelaksanaan undang-undang yang ketat. - AGENSI


Sumber

Sumber air dicemari bakteria

Friday, May 6, 2011

Irritated gut


We take a look at the most common gastrointestinal complaint patients see doctors for.

MAN HAS been credited (or accused, depending on gender bias) with thinking with more than one head.

This is, of course, not true, otherwise, he would be in double trouble. The fact is, that with each thought, there is emotion; and with each emotion, there is some biological stirring that defies voluntary control.

Crippling habit: Many IBS patients probably wish they could travel with a toilet as they frequently have the urge to empty their bowels.

Aside from the groin, there are the salivary glands that water when one sees, smells, tastes, or even thinks of one’s favourite morsel. The nervous stomach gurgles outside the examination hall, while the fear literally paralyses the speaker in front of a hostile audience.

The mind works on the body. However, when the biological outcome becomes an aberration of what is a “normal” reaction, it transcends into a state of “dys–ease”, or dysfunction. The latter encompasses sensations of illness without obvious underlying physical signs of disease.

The brain-gut axis

In the 1990s, scientists mooted the idea of a “brain–gut axis”. Anatomically, the intestines are rather detached from the brain, and yet, there is the suggestion of a complex highway of nervous communication between them.

Intestinal cellular radar assesses the state of affairs within the gut and sends signals to the higher control centres for information processing.

The brain is thought to regulate certain gut portfolios like appetite, fullness (satiety), digestion, absorption and defecation.

It also co-ordinates waves of muscle contraction and relaxation, known as peristalsis, which moves balls of food along the intestines, squeezing and compacting the digested material, and pushing the resultant faeces towards the rectum, which acts like a temporary storage depot.

The sensors here detect volumetric stretch of the walls and send a message to the brain to evacuate. If the act is postponed due to a variety of factors, the stools in deposit compound interest. Consequently, the waste dries up and hardens, leading to constipation.

Irregular peristalsis, coupled with bacterial fermentation, creates many “pockets” of gas, wreaking havoc with incessant flatulence.

Stress and emotional upheavals can derail the physiological intricacies of this brain–gut axis, paving the way for dysfunctional gut responses, and the physically and emotionally exhausting symptoms of Irritable Bowel Syndrome (or IBS, which affects up to 15% of the population).

A common problem

IBS is the most common gastrointestinal condition presented to doctors.

The diagnosis is made based on the exclusion of a detectable underlying disease, and fitted according to a set of criteria, which hinges on abdominal pain and discomfort that persists for more than 12 weeks out of a year as the main complaint.

In essence, IBS is a state of chronic ill health that robs one of quality of life. Forty percent of sufferers often have anxiety and co-existing psychological adjustment problems.

Various names have been coined for this condition, including nervous colon, spastic colon and irritable colon.

Abdominal pain and discomfort is the primary symptom, and is generally eased somewhat by defecation, which is almost always incomplete.

The stools are squeezed by a “tight” colon and the product is often scanty pencil-like dry faeces, but this does not mean that the storeroom is empty! Each time the wave of spasms comes along, or when the lavatory becomes available, the urge to move the bowels becomes almost a crippling habit, resulting in repeated visits to the loo many times a day.

A frustrating sensation known as “tenesmus” is the need to empty, yet straining with little luck, except milking out a little bit of mucous from the rear.

There is also a change in frequency and form of stools – loose diarrheoa, constipation or an alternation between the two.

As a result of the disturbed movement or motility, there is gaseous build-up with the sensation of bloating and regurgitation of stomach contents, causing heartburn.

Similar symptoms, many causes

IBS is not known to cause any significant long term disease. Conditions that may mimick it have to be excluded, some of which have serious pathology. Similar abdominal complaints, either some or all of the above, may occur in:

> Gastrointestinal infection (bacterial, fungal or parasitic)

> Lactose intolerance

> Sensitivity to gluten in coeliac disease

> The “Leaky Gut Syndrome” (refer to StarTwo, Leaking gut, April 20, 2011) mimicks some or all the symptoms of IBS

> Other more sinister underlying pathologies include Crohn’s disease, ulcerative colitis and cancer

The disturbing attendance of fever, weight loss and bloody stools should trigger alarm bells of a more serious condition.

Although the causes of IBS are largely unknown, this chaotic basket of symptoms can be triggered by diverse factors.

It has been observed to be set off by bacterial intestinal infections. There are some indications that a yet-to-be-identified chronic gut infection may be a contributory factor. An imbalance in bacterial population within the gut is also a suspect.

A lot of interest has been generated by the concept of the brain–gut axis. Stress, anxiety and other psychological derangements alter the sensitivity of the intestinal sensor cells to over-react to otherwise innocuous stimuli.

These cells release chemical signals that set the stage for further heightened sensitivity.

The brain falls in tandem with the gut and becomes extremely aware of intestinal sensations, feeding the stress–pain–anxiety cycle.

Investigations do not yield positive results. Blood and stool tests are normal. Many patients end up having either, or both – gastroscopy (viewing the upper gut) or colonoscopy (viewing the lower gut).

These procedures are like “a hammer looking for a nail”, and truly in IBS, nothing is found.

No effective treatment

Treatment of IBS is as disheartening as the symptoms. So much research and yet so little achieved. The wide array of drugs continuously being introduced illustrates the complex nature of this condition.

Ultimately, however, all pharmacological treatments merely manage the symptoms – antispasmodics, anti-diarrhoeals, laxatives, motility drugs, dyspeptic agents, etc, have all been used with just adequate results.

Targeting the brain–gut axis, various anti–anxiety and anti-depressants have been on trial with limited success.

Some of the side effects actually add to the patient’s misery. A drug targets a specific pathway and treats only a particular symptom, necessitating a potpourri of prescriptions for the plethora of varied complaints, with less than robust results.

A more holistic approach involves smoothening the edges of anxiety and stress, and resolving underlying internal conflicts.

Healthy lifestyle practices include taking up regular exercises, and having adequate rest and sleep. Adopting relaxation techniques like breathing exercises, yoga, qigong, etc, are helpful.

Since the trouble originates from the gut, it should not surprise the thinking individual that a large part of the reversal of this syndrome lies with nutritional intervention.

One should avoid large meals (beware buffets!) and “trigger” foods.

A trial of milk and wheat products avoidance may offer relief among some. Foods known to trigger allergies and intolerance should be omitted from the diet.

Taking smaller and more frequent meals certainly helps. Complete chewing and avoidance of large volumes of fluid with meals reduces some of the coexisting symptoms such as heartburn.

Spicy foods, caffeine, tea and alcohol may add more to the torment. Carbonated beverages, beans, sprouts, cabbages, fatty foods, etc, are examples of foodstuff that promote gaseous distention, compounding the abdominal discomfort.

Health supplements that purportedly help to reduce the symptoms of IBS have not been extensively studied.

From limited information, some probiotics containing certain strains of the Lactobacillus and Bifidobacterium groups confer some benefits for sufferers.

Taking the required amount of soluble fibre can ease constipation. However, the daily dosage is titrated according to symptoms as too much fibre can ironically cause more abdominal distention.

Peppermint oil (pure therapeutic grade essential oil) offers temporary relief.

As normal peristalsis is disordered in IBS, a well-crafted calcium and magnesium supplement may aid the restoration of motility. Magnesium has the added benefit of exerting a mild laxative effect, which is a welcome aid for IBS patients with predominant constipation.

As the discomfort follows regular food ingestion, a balanced replacement meal once or twice a day offers some relief from the overloaded diet.

While scientists debate over classification, causes and treatments, it is prudent for one to seek the key that opens the combination lock on the door of true health.

Unfortunately, as is often the case, it remains locked as the “easy not to do” (regular exercise), “hard to do” (dietary control), and “will not do” (taking optimal cellular and digestive supplements) complex, which ultimately cheats us of optimal health, leading us from one medical syndrome to another.


Sumber

Irritated gut