Saved by sand - A new blood clotting material is saving lives

POLICE detective Danny ohnson was on patrol outside Tampa, Florida, when a report came through of a possible shooting in a junkyard three blocks away. Arriving on the scene, he found an elderly man sitting on a tractor, with a large hole in his leg that was bleeding profusely.

Realising it would be some time before the ambulance arrived, Johnson opened a packet of sand-like material and poured it into the wound. Within seconds, the bleeding had practically stopped, and the man survived. "The medic told me that had I
not put the substance in there, the guy would probably have bled out and died," he says.

The material, called QuikClot, which is issued routinely to police officers in Hillsborough County, Florida, was developed
for the US military to cut down the number of soldiers who bleed to death on the battlefield. More than 85% of soldiers killed in action die within an hour of being wounded. Improved haemorrhage control "could probably save 20% of the soldiers who are killed in action," says Hasan Alam, a trauma surgeon at Massachusetts General Hospital, Boston.

The material is already used by the US Navy and a few American police departments. Researchers would like to see it used more widely, but one major safety problem has prevented this happening. Now developers are hoping that advances in the material and the design of new substances could see blood clotting treatments used by ambulance crews, in operating theatres, and even in the home.

Every US Marine and Navy serviceman in Iraq and Afghanistan carries the material. Its maker, Z-Medica of WaUingford,
Connecticut, claims it has saved 150 lives so far. The porous mineral powder is poured into the wound, where pores quickly
absorb water, which concentrates the blood's clotting factors and so speeds up clotting. In lab tests, blood treated with the
material clots in less than two minutes, compared with the 10 minutes or so for untreated blood. In studies on pigs with
severed arteries, the survival rate was 100%; with a standard gauze dressing, more than half the animals died.

The safety problem in the way of the material's wider use arises because of the large amount of heat the material releases when it absorbs water, sometimes enough to cause second-degree burns. In the face of a life-threatening injury, this may be a price worth paying. "The general feeling around the department is that if I get shot, I don't care if it bums," Johnson says. Despite this, the Navy and Marines advise soldiers to apply the material only after all other methods have failed, and it's not standard issue for US Army troops.

Instead, they carry HemCon, a special bandage of ground-up shrimp shells. The shells contain chitosan, a substance which binds strongly to tissue and seals wounds in much the same way as a tire patch seals a tire. This material has its own problems: because it comes in a bandage, it's difficult to apply to deep or oddly shaped wounds. The bandage is also too stiff to be used to treat gunshot wounds effectively, as it cannot be packed into a hole to create enough pressure to control the bleeding. As a result, many Army units buy QuikClot regardless of the policy at the top, says Z-Medica CEO Ray Huey.

Being a powder, QuikClot can be poured into any shape of wound, but if it is to be used more widely it cannot harm those it treats. Researchers Galen Stucky and Todd Ostomel at the University of California, Santa Barbara, who are collaborating with Z-Medica, have found a way to tune the material to control the amount of heat it releases. They've also learned that there is
much more to how the substance accelerates clotting than just water absorption, and are using this knowledge to develop a new
generation of materials that work even faster and should prove more acceptable for civilian use.

QuikClot releases heat when positively charged calcium ions in its pores react with water molecules. Other positive ions
release less heat when they react with water, so Stucky and Ostomel swap some of the calcium ions in the material for silver
ions by soaking the material in a silver-containing solution. They can control how much of the calcium they replace, allowing them to tune the material to release as much or as little heat as they choose. "Having some heat is good," Stucky says. "It facilitates the clotting process."

Although a variety of ions can be used, silver is particularly good because it has antibacterial properties, even at very low concentrations. The drawback is that silver is expensive and signifi cantly raises the cost.

Stucky's group is building on this work to develop new materials to control bleeding during surgery. For a material to be most effective it must have a large surface area like QuikCIot, and since calcium acts as a cofactor in many
clotting reactions some calcium ions must be present.

The team's new material, a bioactive glass made of silica and calcium, has larger pores than 0uikClot and a different consistency. Its large surface area, and efficiency in releasing calcium ions, makes it clot blood even faster. The large pores allow bigger molecules, such as enzymes found in the blood's clotting cascade, to be incorporated in the material and released into the wound, which could further improve clotting.

Unlike QuikClot, which is hard to make in anything but powder form, the bioglass can be squeezed out of a syringe, like a
paste, which would be easier to apply during surgery. Bioglass can also be left in the body after surgery, where it will eventually be absorbed - unlike the QuikCiot particles, which have to be removed from the wound after bleeding has stopped, a fiddly and time-consuming process.

Meanwhile, Z-Medica is hoping that its new, safer version of QuikClot will be taken up not only by surgeons and emergency
crews, but also by individuals. "Ultimately, we hope everybody will have a first-aid kit with a pack in their car," says Huey. -Premium Health News Service/TMSl

Getting Some Help

Getting some help

CONSUMERS and others looking for medical information that is not steeped in technical jargon or written for the highly literate have several choices available. They include:

1. Ask Me 3, sponsored by the Partnership for Clear Health Communication, offers a printable list of the three basic questions it says patients should ask at every appointment: What is my main problem? What do I need to do? Why is that important?

More specialised information is also available for health-care providers who deal with patients who have low health literacy, www.askme3.org.


2. The Harvard School of Public Health features photonovels that are essentially photographic comic books, plain-language glossaries that define such words as "dose" and "deteriorate" and other innovative material on its Web site. Some material is designed for specific groups, such as seniors or those who want more information aboutasthma.
www.hsph.harvard.edulhealthliteracy/in novative.

Blue about health - Literacy problems create a silent health-care epidemic.

Blue about health

Literacy problems create a silent health-care epidemic.

Low health literacy makes people struggle to understand what a doctor has told them or to comply with treatment recommendations as essential as taking the proper dose of medication. These symbols are part of the 28 devised by researchers to remove language barriers to health care that endanger patients. - Robert Wood Johnson Foundation.

TONI Cordeil recalled feeling reassuired when her gynaecologist said her problem could be fixed with an "easy repair' involving surgery. She readily agreed, she said, barely glancing at the consent forms because reading was difficult for her. She said she didn't ask any questions because she didn't know what to say.


During a routine postoperative check-up several weeks later, Cordell vividly remembers, she was stunned when the nurse asked, "How are you since your hysterectomy?"

"All I could think of was how could ! have been so stupid?" Cordell said of that day 30 years ago. "I just wanted to scream. I really didn't know I was surrendering part of my body."

Similar events occur every day, medical experts say, a consequence of the pervasive and largely unrecognised problem known as low "health literacy". Cordell, who received remedial reading instruction as an adult, said she believes her case was typical: She graduated from high school reading at a fifth-grade level, a deficiency she long sought to hide. She attributes her poor reading skills to a combination of dyslexia and a childhood medical condition.


In a 2004 report, the US Institute of Medicine defined health literacy as the ability to obtain and understand basic health information and services needed to make informed decisions. Low health literacy, the institute noted, affects an estimated 90 million Americans, who struggle to understand what a doctor has told them or to comply with treatment recommendations as essential as taking the proper dose of medication.

A 1999 report by the American Medical Association found that consent forms and other medical forms are typically written at the graduate school level, although the average American adult reads at the eighth-grade level.

Earlier this month, a Chicago-based organisation known as the Joint Commission, which accredits hospitals and clinics in the United States, unveiled a list of 35 recommendations to address the problem, which is estimated to cost taxpayers US$S8bil (RM203bil) annually. Among the recommendations developed by a panel of experts: adoption of communication techniques proven to be effective with patients, simplification of jargon-laden consent forms, and development of patient-friendly navigation signs, which may include the use of pictures or icons that are also recognisable to non-English speakers.

Low health literacy "is a silent epidemic that threatens the quality of health care," said Dennis O'Leary, commission president. Too many physicians and administrators, he said, fail to grasp the dimensions of a problem that affects every aspect of medical care and is a major impediment to patient safety.

Interest in health literacy comes at a time when Americans are expected to assume ever-greater responsibility for their care and are discharged from hospitals sicker and quicker, experts agree. Many patients are expected to comply with sophisticated drug regimens, to adjust or calculate medication doses or to manage complicated equipment with little training and less supervision.

A comprehensive assessment of adult literacy conducted in 2003 by the US Department of Education found that 43% of adults have basic or below-basic reading skills - they read at roughly a fifth-grade level or lower - and 5% are not literate in English, in some cases because it is not their first language.

The picture is even more dismal when it comes to numerical skills: Fifty-five percent of adults have basic or below-basic quantitative abilities; many are unable to solve simple arithmetic problems, including addition.

The statistics don't differ much from the literacy assessment conducted a decade earlier. That survey found that many Americans could not determine the difference between two prices using a calculator or were unable to write a brief letter explaining a credit card billing error.

Studies of health literacy have found that a surprisingly large number of adults were perplexed by the meaning of the term "orally", didn't know the difference between a teaspoon and tablespoon and were unable to calculate the proper dose of medicine. Low health literacy is more common among elderly or low-income patients and those with a chronic illness, researchers say.

A study published in the Journal of the American MedicalAssociation in 1995 found that more than 80% of patients treated at two of the nation's largest public hospitals could not understand instructions written at the foutthgrade level for the preparation of gastrointestinal X-rays known as an upper GI series.

A 1999 study of more than 3,200 Medicare recipients found that one in three native-born patients could not answer a question about normal blood sugar readings even after being given a paper to read that listed the correct answer.

And a study of 2,500 elderly patients published last year in the Journal of General Internal Medicine reported that patients with low health literacy were twice as likely to die during a five-year period as those with adequate skills, regardless of age, race or income.

"You still have physicians who use medical jargon too much," Davis added, citing the use of "hypertension" instead of "high blood pressure" and "febrile" rather than "fever". Because doctors are rushed, he noted, they tend to lapse into medical jargon because it is what they are used to.

O'Leary said that the Joint Commission's interest in the issue should serve as a signal to hospitals to ramp up their efforts to communicate better with patients. Literacy improvements might be included in future standards hospitals must meet, he said, because they are inextricably linked to patient safety.

At the Washington Hospital Center, the largest hospital in the District of Columbia and health-care provider for many low-
income and elderly patients, spokeswoman Paula Faria said administrators are aware of the problem and are examining admission
forms and other documents to see whether they are intelligible as well as culturally sensitive. "We want to make sure that people understand what they're reading and, if they can't read, what they're hearing," she said.

Faria said that some departments are using a technique endorsed by the Joint Commission known as "teach back". Instead
of asking a patient, "Do you have any questions?" - which will probably elicit little in the way of a useful response and puts the patient on the spot - doctors are taught to ask, "What is the most important thing you learned from our visit today?"

"You never want to put a patient in a situation where they feel like they're dense," Davis said.

Another effort regarded as promising, underwritten by drug manufacturer Pfizer, is called Ask Me 3. Designed by the Partnership for Clear Health Communication, a coalition of national health and literacy groups, the programme encourages patients to ask three simple quesflops and to be sure they understand the answers: What is my main problem? What do I
need to do? Why is that important?

Cordell, who has worked with the Ask Me 3 program as a patient advocate, said she also advises patients never to go to a doctor or to a hospital alone. Having another person present makes it more likely that necessary questions will be asked， she said.

Anyone who doesn't understand what a doctor or other health-care worker has said should speak Up, Cordell said. "You can say,‘Look, you're giving me stuff I can't manage,'" she advised.

Not so heavenly food - Appetite can be notoriously difficult to control, for many reasons.

Not so heavenly food

Appetite can be notoriously difficult to control, for many reasons.

The Chinese New Year season is still on. So far, I've had eight yee sang dinners and have gone to multiple open houses. During this time, I have eaten all sorts of foodstuff, including cookies, sweetmeats, cakes and fried foods. I believe I must have been eating about six or seven times a day. Is this considered overeating?

Yes! During festivals or occasions where there is plenty of delicious food available, it can be difficult to resist food, and thus, overeating.

But research has uncovered a more insidious underlying cause as to why some people just cannot resist food. According to the Journal of Neuroscience, there are areas in the brain that are triggered by visual images of food. These are called “reward centres”.

Scientists conducted an experiment where they used scans to show some test subjects pictures of highly appetising foods like chocolate cakes, bland foods like broccoli, and disgusting foods like rotten meat. They then measured brain activity using a sophisticated MRI scanner.

After testing, the participants completed a questionnaire that assessed their desire to pursue rewarding items or goals. The results showed that the participants' brain reward network is sensitive to images of appetising food.


This means that when you stimulate your brain's reward centres with food advertising (through TV, vending machines), attractive food product packaging and images of delicious food, it may result in overeating, and thus obesity, a lot of people are particularly susceptible to this.
I think I must have been one of them! But the puzzling thing is I still feel hungry after I've eaten quite a lot. I've been massively overweight for many years (weighing in more than 85kg) and have difficulty controlling my appetite and urges, especially when presented with such a wonderful array of delicious food in Malaysia.

According to scientists, appetite can be notoriously difficult to control. Most dieters regularly fail to control their food intake.

In the past, and even now, society looks at these people disparagingly, attributing their overeating to “lack of will power” or “greed”. Fat people or people who ate too much were blamed.

But the situation is much more complicated, as explained above. And for obese people, overeating is akin to drug addiction, research suggests. When they did MRI scans on several overweight people, they found that the regions of the brain that controlled satiety (“the impulse you get when your brain tells you that you have eaten enough and are satisfied”) were the same as those in drug addicts craving drugs.

This areas in the brain involved are the “hippocampus”, which controls emotional behaviour, learning and memory as well the orbito-frontal cortex, and the striatum.

Unfortunately, these are the same areas involved in drug abuse and craving. But it also means that appetite may be linked to emotion and addiction. More research is underway to prove these theories.

Is overeating a psychological disorder?
There is such a disorder called compulsive overeating. Compulsive overeating is characterised by uncontrollable eeating and consequent weight gain. Compulsive overeaters use food as their primary means to cope with stress, conflicts and daily life problems. You see, like alcohol, food can also be used to block out feelings and emotions.

Compulsive overeaters usually feel out of control and are aware their eating patterns are abnormal.

How will i know if i am a compulsive overeater?
Compulsive overeating frequently starts in early childhood. The child has never learned the proper way to deal with stress and so he uses food as a way of coping. He may have the idea that being overweight will keep other people at a distance because he is not attractive.

Compulsive overeaters are predominantly male overeaters. They know what they are feeling and doing is wrong. So the more they gain weight, the more they diet.

Dieting makes them so hungry that it leads to the next binge. There are feelings of powerlessness, guilt and shame.

So look out for these pointers:

1) Do you do binge eating? Binge eating means episodes of uncontrolled eating or bingeing. There is consumption of large
amounts of food, which is sometimes accompanied by a pressured, "frenzied" feeling. You may continue to eat even after you
feel uncomfortably full.

2) Do you fear that you might not be able to stop eating voluntarily?

3) Are you depressed or/and have self-deprecating thoughts, especially following binges?

4) Do you hide away from other people or withdraw from social activities because you are embarrassed about your weight?

5) Do you keep going on many different diets?

6) Do you attribute all your low feelings and failures to your weight? Does it become your life focus? Do youalways
believe you will be a better person if you are thin?

If you have answered yes to many of these, it is likely you are a compulsive overeater.

* Dr YLMgraduated as a medical doctor, and has writing for many years on various subjects such as medicine, health advice, computers and entertainment. The information contained in this column, is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other dgsurances:hs to such
information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Your Health Matters - Crisis intervention in

RECURRENT crisis is a common event in the natural history of an addict's life. Inevitably there will arise situations of confrontation between him and his family, concerned friends and even the law. If unresolved professionally, each crisis
escalates from one to another, sometimes with tragic results.

The drug addict is often totally unable to see the severity of his addiction and how this has led to the crisis.

The development of a crisis can be looked upon as a golden opportunity to reconnect and intervene in the addict's life
in a positive way. Crisis intervention is an act of love, it is gentle and supportive but firm in its ultimate goal, ie. to move the addict physically and mentally to the next step for professional help.

It is important that families and friends help plan and strategise in advance how they would approach the problem when
the opportunity arises.

It would be most useful to recruit the help of professionals in the field. The occurrence of the crisis is sometimes unpre-
dictable; but sometimes they can be craftily engineered to create a window of opportunity for intervention.


The need for crisis intervention

There are a number of factors that can
cause a crisis in the addict's life:

• Being found out by the family
• Running out of finances
• Police investigations
• Ultimatum from the employer
• Health reasons
• Time to quit - a rare occurrence

Addicts in crisis do show some form of reactive behaviour. Common reactions will include:

1. Shock, whereby the addict is stunned or numbed and feels helpless.
2. Anxiety due to being overwhelmed with a sense of failing apart.
3. Depression as when the addict feels immobilised and helpless in his predicament -time to quit but how!
4. Rage as the addict feels cornered and not able to worm/wrangle his way out.
5. Intellectualisation is used to rationalise the crisis so as to cut offthe pain.



Case history
Sara L is 18 years old and currently studying in a local college and on a twinning programme with a university in Australia.

She comes from a middle class family of five, Sara being the youngest of her siblings.

Over the last few months her parents have noticed a drastic change in Sara that has got them very worried. Upon checking
with the college, they were told that Sara had been cutting classes, her assignments were always late and her grades had plunged. Her friend disclosed that Sara had been borrowing money and was often in a daze.

They decided to confront her, but getting Sara to open up was no easy task, Sara went ballistic when her parents queried
about her performance at school. It was at this point that they noticed that Sara's eyes were glazed, there were scratch marks on her face and hands and she had developed a natural way of lying.

After almost an hour of screaming and arguing, Sara blurted out... "Okay I am a junkie but I can take care of myself as my
habit is under control!"

The above is a typical scenario when it comes to individuals whose addiction is discovered by their loved ones. There is
much denial coupled with resistance and reluctance to seek treatment. This is further compounded with the misperception that
unless you hit rock bottom, or as recovery groups say "bottomed out", the addict is not ready for help or treatment.

"... all the lies, all the rationalisations, all the illusions fall away as we stand face-to-face with what our lives have become.., the truth is we must pass through this place before we can embark upon the journey of recovery."

There is some truth in the above statement, but let us also be clear that it is not an absolute truth, simply because we also acknowledge that "not every act of growth is motivated by pain". This simply means that learning does not have to come from a painful or negative experience.., it can come from cognitive reframing, using proven recovery approaches and also learning from others who have been down the
same path!

Do we have to wait for Sara to become a full blown junkie.., from chasing the drag-on to shooting up the "highway"? Does she need to see her veins collapse.., her face crumble with premature ageing.., get into crime and eventually become involved in the flesh trader to feed her ever increasing habit.., or be infected with

STD's/HepC/HIV and die a miserable death?



Dealing with denial
When One confronts the addict with his problem, the first defence mechanism that one may encounter is denial. Denial is afatal aspect of addiction because it impairs the judgment of the affected individual, thus keeping them locked in ever destruc-tive patterns. This defensive manoeuvre distorts reality and will appear in various forms. Some of the commonest are:

Simple denial - Maintaining that something is not what it is, for example, insisting that substance dependency is not a problem despite obvious evidence that it is a problem and is perceived to be a problem by significant others.

Minimising- Admitting to some degree to a problem with chemical usage but in such a way that it appears less serious than
is actually the case.

Blaming - Denying responsibility for addictive behaviour and maintaining that the responsibility lies with someone or
something else.

Rationalisation - Offering excuses and justifications for addictive behaviour. The behaviou is not denied but an inaccurate explanation of its cause is given.

Intellectualisation - Avoiding emotional and personal awareness of the problem of addiction by dealing with it on a level of intellectual analysis or theorising.

Diversion - Changing the subject to avoid a topic that is threatening, for example, cracking a joke and making light of the situation.

Hostility - Becoming angry and irritable when reference is made to drug use and related behaviour, Anger works as it causes people to back off!

Those seeking to help the addict must be aware of which aspect of denial is being used by the addict. No matter how con-
vincing the addict can sound, they must maintain focus and not be influenced otherwise.

Beware that the addict always has another trick up his sleeve; he will take you into orbit and leave you there, probably even manage to get a few ringgit from you and is gone! The bottom line here is "one is too many and a thousand never enough" (12 Steps NA).



The goals of intervention
From the onset, the first step of intervention is to break down the denial strategies so that reality can shine through long enough for the addict to accept his predicament. Note that this is not a time for confrontation or an interrogation, rather "a care-frontation". Attack the denial and the defence wall

(Continue....)

Drug addiction - Denial is the chain that prevents addicts from seeking treatment

Drug addiction of the addict. One must show authentic care for the chemically dependent person. In short, you are presenting the moment of truth lovingly. Whenever possible, engage the help of a professional.

The skilled and experienced counsellor will need to turn the crisis into a solvable problem. Rapport must be established quickly as this will give confidence to all involved, especially the addict. To be credible, the intervention should be backed by a realistic treatment plan and intervention is the first step towards this plan.

The addict's "felt priorities" should be addressed before options for treatment can be presented. Upon refraining the problem as solvable, insight should be given to the addict on how he is making the situation worse.

After initial assessment has been done, the realistic options are presented to the addict. Rather than being presented as a directive, it has to be processed as if to empower the addict to seek treatment himself.

Invariably, there is the need for a support team to manage the crisis. The counsellor should facilitate this. The support team should consist of:

• Counsellor - to offer insight to the team and how to execute the game plan.
• Presenter - someone within the family or a religious figure who the addict has a sense of respect.
• Scout - someone who will make contact with treatment centres, locality, programme duration.
• Financial coordinator - this person takes care of all the financial implications.

It is absolutely important that the "enabler" is neutralised as this person can and will sabotage the intervention plan. The enabler is the person who does not allow the addict to face up to the consequence of his addiction; the addict will also use this person to his advantage.

Conclusion
In crisis intervention, it is not the role of professional counsellors to take responsibility for the addict or his significant others. The counsellor assists in decision-making but does not make the decision. No matter how many success stories they may have, they should never give false assurance or raise expectations too high as the client/significant others will be devastated if the outcome is negative.

In times of crisis, everyone who is involved will have to keep a clear head at all times, remain calm and composed and not he affected by the demands of the situation.

At the end of the day, the first crisis offers the best opportunity for early intervention and treatment. With each succeeding crisis, the challenge becomes more complex and demanding.

To families and friends with someone that they love who is addicted to drugs, the advice is to seek help early and be prepared to face and manage this first crisis as professionallv as possible.

* Dr Steven KW Chow is founding chairman of"DrsWhoCare" Federation of Private Medical Practitioners'Associations Malaysia. Christopher A. Sekar is an addiction counsellor and psychotherapist. This article is contributed by the Federation of private Medical Practitioners Associations Malaysia.

Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. 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 respon-
sibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Improving vision, naturally - The Bates Method is the mainstay of the natural vision improvement. Though it's not accepted by the mainstream

The Bates Method is the mainstay of the natural vision improvement. Though it's not accepted by the mainstream, it has many followers.

THE Bates Method is a system that is claimed by some to improve sight and restore the "natural habits" of seeing. It is the mainstay of the natural vision improvement movement.

First described by ophthalmologist William Horatio Bates in 1920 in a book entitled Perfect Sight Without Glasses, the Bates Method is rejected by mainstream opthalmology. However, many people claim to have been helped by the method.

In essence, the method is based on Bates' theory of accommodation of the eye, and his recommended practices for improving wsion. Accommodation is the process by which the eye maintains focus on the retina. So when the eyes change from viewing a distant object to a near object, accommodation is taking place.

Bates felt that the eye focuses by elongating the eyeball through use of the extraocular oblique muscles. This is contradicted by mainstream ophthalmology. The orthodox view is that accommodation of the eye is brought about by the action of the ciliary muscle on the eye's crystalline lens. Supporters believe that even if his theory is wrong, his methods do work.

The thrust of the Bates Method is that to have better vision, relaxing the eyes is vital. Strain or effort makes vision worse, so relaxing the eyes can help improve vision. The way to better eyesight is through relaxation of both mind and body.

To do this, there are several exercises that he recommends. We'll look at a few of these techniques:

Palming

This essentially requires you to close your eyes with the cups of your palms. The rationale behind it is that it calms the visual system. Make sure your palms are cupped to avoid exerting pressure on the eyeballs, and cup your palms in such a manner that as little light as possible is allowed through. The most important thing is to relax.

Imagery

While you are palming, you can also visualise anything. In your mind's eye, try to remember as much detail as possible of the scene or image you're visualising. Bates felt that the perfect memory can be produced if only one is free of strain.

Centralisation

This is aimed at promoting the correct use of the eyes. The centre of the retina, the fovea, is densely populated with retinal receptors. Hence, vision is at its best here. So, instead of staring at the entire image, focusing at the centre reduces the strain of trying to get the entire image in detail.

These are but some of the exercises recom- mended by Bates.

In addition to the exercise, there's also an aid to help improve vision. In essence, it's pinhole glasses, which gives the wearer smaller but sharper images via the pinhole effect, and may help train the eye.

It is recommended for use indoors, to be worn as a substitute for normal prescription glasses. Obviously, it should not to be worn during driving!

The holes in pinhole glasses (also known as stenopeic glasses) have the effect of reducing the width of the rays coming from the object you're viewing.

Pinholes can bring about clearer vision by blocking peripheral rays that "bend" improperly, and only letting into the eye those rays that pass through the central portion of the pupil. Hence, any refractive error is not noticed as much.

In effect, your eyes are wide open, but only the central portion is receiving light, and the improvement in visual acuity can be striking for some people. Using such glasses instead of prescription glasses for periods of time, along with the exercises recommended in the Bates Method, may help improve vision.

Stress and motivation in learnig - how stress affects your child's brain and learning

BRAIN-based learning is the informed process of using a group of practical strategies based on sound principles derived from brain research. It aims to help children learn according to how the brain learns best - naturally. It is a borderless approach to learning, crossing and drawing upon multiple disciplines such as chemistry, neurology, psychology, Sociology, genetics, physiology and nutrition. This holistic and multidisciplinary approach increases the learning potential of every child.


How stress affects your child's brain and learning
Good stress (eustress) helps learning by motivating problem solving. For your child to experience eustress, stress has to be occasional or intermittent. There must be enough rest between challenges. Your child has to feel the ability to overcome the problem and that he is still in control.

There are levels of good stress ... it is best to ensure that your child experience low stress when he is learning new information and not to be worried if stress levels rise during a test as it can help performance. However, try not to allow this stress to escalate to become bad stress.

Bad stress (distress) is when your child feels that he has a problem he doesn't want, can't find answers to, loses control
over circumstances or stress periods are protracted and constant. Bad stress increases and prolongs cortisol release and can damage neurons in the hippocampus. The hippocampus is responsible for emotions and memory in learning. Too much cortisol is also associated with reduced immunity and tense muscles resulting in headaches. All these will negatively affect leaming.

Stress can come in different forms - parental and peer pressure, violence (family violence or school bullies) and poor support Babies can experience stress too. Leaving a baby to "cry it out" increases stress levels. Not providing enough stimulation such as touching and a sense of security will affect the connectivity of a baby's brain, affecting learning.



What you need to know to help your child

• Share the responsibility of supporting and motivating your child. Studies suggest that peer or school environment is as or more powerful an influence on your child's learning. Work closely with your child's teachers, encourage mentoring and guide your child's friendships.

• Increase. their sense of safety at school and in the home. Encourage them to talk about their feelings such as fears, worries, hopes.

• Make your child feel accepted, at home and at school. Perceived increase in social status in school can have a very positive impact on learning.
• Allow outlets for stress such as writing journals, dance, art and crafts.
• Give your child lots of reassurance, encouragement and constructive feedback.
• Hold, cuddle and comfort your infants to increase a sense of security and to reduce stress and encourage mental development.

How to motivate your child using brain-based learning principles

Many parents offer rewards or "carrots" for good behaviour or performance. This is a well accepted method made popular by a branch of study called behaviourism.

Brain-based learning theorists suggest that parents consider other ways when motivating their child to learn. Providing
rewards may work to a certain extent, but may fail to encourage the child to learn because she wants to and may result in stereotypical, low risk and low creativity behaviour.

It may also create a dependency on rewards, whereby in the absence of a tangible reward, the child may be unwilling
to learn or perform.

Brain-based motivation and discipline suggests these alternative strategies to offering rewards.

• Meet your child's needs. Know what is important to your child at his age. For example, your four- to six-year-old child would need a lot of security, acceptance and predictability. A teenager may value peer acceptance, autonomy and independence. By understanding your child's needs, and meeting them, you would have a much easier time motivating them to learn.

• Let your child feel that he has a choice and some control over his learning. This will help him feel valued and empowered. For example, ask your child "would you like to learn Maths or English now?"

• Support and encourage curiosity. Be aware of opportunities to learn as your child expresses curiosity in various subjects. Support her by providing her with all the different sources and medium for learning about the subject, e.g. books, CDROM, videos.

• Support your child even if you are not too interested in the subject yourself. Do not belittle their choice of subject for curiosity, e.g. Hollywood celebrities, aliens. The process of learning and finding information is more important than the content.
  

• Share success stories such as how people have succeeded against all odds. Take a walk through a revered institution of learning to motivate older children.
  

• Mark success and achievements with emotions and cheers, even a little party. This stimulates endorphins (feel good hormone) that further boost learning and motivation.
  

• Affirm and reinforce to your child positive beliefs about their capability. I help them overcome any negativity they may have about themselves and work to bring out the positive.
  

• Provide acknowledgements, for achievements such as praising them appropriately in front of people they value. This will further boost their self confidence and spur them to want to perform.
  

• Be a role model. If you are enthusiastic about learning, it will rub off on your child.
  

Brain-based motivators aim to help your child learn by making him feel that he is learning because he wants to. This is thought to be more life long and personally meaningful.

These motivators usually do not cost any money while a love of learning is simply priceless !

Tired of jet lag - Jet lag is more severe where you cross several time zones

I RECENTLY went to the US for the first time, and found it very difficult to sleep. I would wake up at 2am and feel sleepy about 7pm. My friends said I was experiencing jet lag. l'd always thought jet lag was a sort of tiredness you get from sitting still in a plane for too long and being unable to sleep properly.

Jet lag is now known as one of the 84 known or suspected sleep disorders. It is also known as desynchronosis.

It happens when your biological or internal clock is out of sync with the local time. This occurs when you are travelling
to a new time zone or more specifically, crossing the earth's meridians.

In general, jet lag is more severe when:

• You cross several time zones. You are more likely to experience severe jet lag when you cross over to the other side of the world.
• You fly east rather than west. That's why you are more likely to take longer to recover from jet lag when you return from Europe to Malaysia than flying from Malaysia to Europe.
• When you fly east, you will have difficult , trying to get to sleep, because the time zone there is several hours ahead of you. Luckily for us in Malaysia, not many countries we typically fly to are many hours ahead of us. When you fly west (Europe, Middle East), you tend to feel very sleepy early on and wake early. This is because they are several hours behind US.

Some people are more susceptible to jet lag than others, usually those with increasing age. If you have a pre-existing
sleep disorder, your jet lag tends to be more severe. Jet lag can last for several days as your body remains in its original
biological clock. But when your body tries to adjust its circadian rhythm to the new time zone, symptoms result.



What is my body's circadian rhythm? Do I have a rhythm?

Your circadian rhythm (circa = about, dian = day) reflects changes in your bodily function that occur within a 24-hour period. This includes maintenance of body temperature, airway function, glandular and hormonal function and kidney maintenance.

Have you ever noticed that your body temperature rises throughout the day, drops around midnight and begins to rise again before 6am? This is the same with mental alertness and ability to fall asleep. These rhythms donot occur with light or dark. Even in full Antarctic winter, when it is fu||y dark people continue to wake up and sleep according to their 24-hour circadian cycles.

You are most likely to fall asleep during 3am to 5am and 3pm to 5pm. That's why you feel sleepy in the afternoon, especially after eating lunch. This natural sleepiness is not necessarily associated with having a heavy lunch.

To maximise daylight, the human body has long synchronised itself to be awake during the day and to sleep at night. This is regulated through the eyes, in particular, the retina, which feeds through a nerve network in the hypothalamus, the chief regulator of circadian rhythms.



Is difficulty in falling asleep or sleeping too early the only symptoms of jet lag? What about mood alteration?

There are many symptoms associated with jet lag other than sleep alterations. Some people feel bone tired.

In the next moment, they can feel elated and excited.

You can also have stomachaches and headaches. You can become irritable, have decreased awareness and decreased con-centration. Some symptoms you might experience are related more to the dry environment of long haul flights, like dry eyes, irritated sinuses, earaches, muscle cramps and bloating.

Most travellers return to their normal sleep-wake pattern after a day or two, although in some, this may persist for a week.



What can ! do for jet lag? Will taking sleeping pills during the flight help?

Sleeping pills may help some, especially those short acting ones, but are not always the answer for many, especially since they can have a lot of side effects that can impair your enjoyment of your trip once you get there/or home. Always consult a
doctor before you take a sleep aid of any sort.

There is actually no specific treatment for jet lag. However, here are some helpful
tips:

• Get a good night's sleep the night before you take your plane. Avoid alcohol, caffeine or cigarettes.
• Some people psychologically help themselves to adjust by resetting their watches to the new time zone as soon as they depart inside the plane itself. (The airlines certainly help you do that, serving meals as according to that particular time zone you are crossing, and not according
• to the time of your departure area.)
• Take a daytime flight if you are flying east (for example, from London to Malaysia). Then you can arrive almost at home time, or in the afternoon.
• Try to sleep at the normal time for that country When you arrive in your new time zone.

What about melatonin?

Melatonin is a hormone that is synthesised naturally by the pineal gland and is inhibited when your eye retina is exposed to light. Some people think it helps influence your circadian rhythm i.e advancing your biological clock so you need less sleep. Some people with jet lag benefit from it and some don't. More studies need to be done on it before it can be truly recommended for jet lag.

* Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health advice, computers and entertainment. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Fast foods under scrutiny

Inappropriate dietary patterns together with a sedentary lifestyle are major contributors to obesity and lifestyle diseases.

The topic of fast foods has been highlighted in this paper and other local press this past week. Several reporters have called me to seek information and explanation on the issue. Questions were mainly related to the ill effects of consuming fast foods and how to educate the consumer.

I feel it would be appropriate and timely for me to talk about fast foods in this installment of NutriScene. Through this article, would like to address several issues that would serve to educate the public regarding fast foods.

What are fast foods?

I do not believe there is an officially recognised definition of fast foods. What often comes to mind when we mention such foods is the Western franchised fast foods such as fried chicken, burger, hot dog, pizza and so on.

Taken more generally, fast foods can be taken to include meals that can be prepared in a short time and can be taken "on the go". They can also include a variety of local dishes and meals such as several noodle meals (for example,.fried, .soup or curry), several rice dishes (for example fried rice, chicken rice, nasi lemak, barbeque meat rice), and numerous others sold in hawker stalls and mamak restaurants.

The press write-ups these past few days have been referring to the Western franchised fast foods. The concept of "fast food" perhaps originated in the 1950s. The intense competition in the fast food industry brought about the concept of franchising these meals and the subsequent mushrooming of franchised fast food outlets in theUnited States and elsewhere in the world.

Fast foods probably made its first appearance in this country in the 1970s in the form of a bugger. The industry grew rapidly, spreading to even small towns throughout the Country.

What are the potential ill effects of consuming fast foods?

Non-communicable diseases, especially diet-related chronic diseases, have become the major disease burden and main causes of death in the country. These diseases include obesity, hypertension, diabetes, cardiovascular disease and certain cancers, It is now evident that the increase in these diseases is related to the changes in the lifestyle of the people. Major changes have taken place in the dietary pattern of Malaysians over the years. There has been a shift towards an "affluent" diet characterised by a reduced intake of starchy staples; decrease intake of fruits and vegetables; increased intakes of fats and oils, refined carbohydrates, meat/ fish/eggs; increased percentage of energy derived from fat; andincreased availability of animal sources of protein, fat and calories.

Western franchised fast foods have often been blamed for the increase in these chronic diseases.

Indeed, excessive consumption of fast foods does contribute to the increased risk of these diseases.

More correctly, the excessive consumption of ALL foods that arehigh in energy, fat, sugar, cholesterol, sodium and the insufficient intake of fruits and vegetables increases this risk. It is therefore inappropriate dietary pattern together with a sedentary lifestyle that are major contributors to these diseases.

Many of the risk factors for these diseases can be controlled. They can be prevented. It is thus imperative that all efforts be made to prevent these diseases. It is vital that we recognise the root causes of these problems and tackle them appropriately.

Empowering the people with knowledge to enable them to adopt healthy eating habits and an active lifestyle has been recognised as the long-term solution to reducing risk to these diseases.

Providing nutrition information on fast foods

As part of the effort to educate consumers on making food choices, the public should be informed of the nutrient content of fast foods. Fast food chains should contribute towards these efforts. The nutritional content of each type of food and drink sold in their outlets should be clearly and prominently displayed.

I find that at least one fast food chain is providing the content of several nutrients in a booklet that customers can pick up from the outlets. Such information is also available on the website of the chain. The serving size for each meal is provided, as well as the amount of calorie, protein, fat, carbohydrate and calcium.

I would urge that all fast food chains provide such information to the consumer. It should include

nutrient content for sample meals to be consumed, comprising several food items, such as a burger, chips and a soft drink. The industry and health professionals should help consumers understand and use such information to enable informed choices.

For example, the menu in a fast food outlet should inform a 20-year-old woman that consuming a meal comprising two pieces of fried chicken, a packet of French fries and a soft drink has 800 kcal and 36 grams of fat (which makes up 41% of the total energy). She should be aware that energy intake from this meal alone is already slightly more than half (40%) of her daily requirement of 2000 kcal:

Consumption of fast foods

There is no good data on consumption of fast foods by population groups in the country. But looking at the increasing number of outlets in the country over the years, fast foods are certainly gaining in popularity.

There is thus the concern that these fast foods may be gaining too strong a foothold in the dietary pattern of communities. I do understand and share such concerns.

Indeed it is important ~o address the issue in a comprehensive manner. The strategies should include providing education to the consumer on the role of such foods in the diet.

In addition to providing nutrition information of fast foods, the industry should be encouraged to provide healthier alternatives in these outlets. There could be greater scrutiny to reduce misleading advertising by these foods.

At the same time, it is important to be mindful that there are a number of other foods out there that may play a role in increasing risk to diet-related chronic diseases. There are some local dishes and meals that contain high fat and calorie. Several of these dishes also contain coconut milk (santan). These may also be called fast foods and they feature prominently in the daily diet of the community.

As more families eat out, the dependence of the population on these foods for meeting their nutritional needs become even more important.

Information to the people should include nutrient content of such local fast foods. The same young woman Should also be informed that eating a bowl of curry mee with a soft drink gives her 700 kcal and 37 grams of fat (47% of total energy)*. This energy intake is about 35% of her daily caloric need and the dish may contain a fair amount of santan.

There is of course a large variety of local fast foods, with widely differing nutrient content*. There are dishes and meals that have a nutritional profile and can be encouraged. There are also healthier ways of preparing these local dishes. 1 am of the opinion that we should tackle the problem by looking at the broader picture, i fear that focusing on one single type of foods may not achieve the intended objectives.

I realise I am repeating myself, but I have to say that the solution lies in promoting overall healthy eating to the people. Strategies are already identified in the National Plan of Action for Nutrition II, including working with the fast food industry. Let us activate those plans.

Promoting fast foods to children

Intense marketing and advertising are certainly important reasons for the success of the fast food chains. In view of this lack of knowledge and the inability of children to choose wisely, it is certainly not right to be pushing such foods to young children without some form of guidance. Considerations could be given by the authorities to curb advertising to this group of the population.

Parents have an important role to play by understanding the nutritional value of these foods and providing appropriate guidance to their children. Parents themselves should serve as good examples and eat sensibly. School authorities can also play effective roles in these efforts. In this respect, inter-ministry coop: eration should be enhanced to have effective educational programmes,commencing from primary schools.

To ear or not to eat

No one single food or type of food can be said to be the cause of obesity or other diet-related chronic diseases. It all depends on how much of these foods you are eating. It depends on how frequent you are eating these foods. The answer lies in what else you are eating for the day.

There is no simple guideline for eating fast foods. There is no guide on what is the "safe" number of fast food meals that can be taken in a week or a month. There are however guidelines on healthy eating (information available on: www.nutriweb.org.my).

All this sounds too complicated? Not really. As I have often emphasised, remember the key points: be disciplined in your eating, eat in moderation, go for variety.

One puff above the limit

By Dr BERNADINE HEALY

One puff above the limit PEST easier, robbers. The cops have some new villains to track down. They're called smokers. Recently, police in Bangor, Maine, took on the job of ticketing people spotted puffing on cigarettes in their cars if children under l8 are on board.

Last year, Arkansas and Louisiana enacted similar bans, and many other states, including New Jersey. New York, California, Kansas, and Utah, are considering them. Some propose fines as high as U55500 (RM1,750) and jail time.

To be sure, public policies like advertising bans and smoke-free public places have been highly effective in reducing exposure to second-hand smoke. And the goal of these new laws is just as laud

able.

But this particular anti-smoking campaign has more than libertarians concerned that government is

going too far in policing behaviour and trouncing privacy. Next, the health police could ticket parents

for buying children junk food or for letting them get too much sun at the beach. A more practical and

immediate concern however, may be whether enlisting the police to punish smokers will improve children's health.

Smoking is an ugly habit. It pollutes the air with toxic vapours that can be inhaled by innocent bystanders. This seems to explain why non smoking spouses of smokers face a small but increased

chance of lung cancer.

For children, as pointed out by the US surgeon general's 2006 report The Health Consequences of

Involuntary Exposure to Tobacco Smoke, homes filled with smoke increase youngsters' risk of respiratory problems like bronchitis, pneumonia, and asthma attacks. The report also revealed that Mom's smoking has a greater negative effect than Dad's.

But it's not just smoking during pregnancy that can do damage, The lungs of infants and toddlers

are also vulnerable to passive smoke, a risk that trails off and disappears as children grow older and

move into their teens, What does not disappear, however, is a child's risk of becoming an active smoker, facing a greater chance of cancer and heart disease later on in life.

There are few data on smoking in cars per se. The danger is inferred because of smoke concentration in a contained space. You might also infer that people so into their cigarettes that they have to light up in the confines of a ear represent a pretty hard-core group of smokers.

Smoking them out of their cars will only drive these tobacco addicts to light up more in their kitchens and faSrnily rooms, out of Light or reach of the health police.

But even among those who have not yet become addicted, the threat of a ticket may not be a deterrent. Over the past 20 years, more than 30 states in the United States have enacted laws imposing hefty fines, court appearances, loss of driver's licenses, school suspensions, or other penalties on teenagers caught buying, possessing, or using tobacco.

But these penances haven't worked very well, Neither policy-makers nor police are enthusiastic

about punitive approaches, and the laws are often enforced in an erratic and seemingly selective

way.

This suggests another problem for the smoking police: The odds are that the adults they will be singling out for smoking in cars with underage passengers will be disproportionately poor, uneducated,

and female, as today's smokers are tilted toward lower incomes and less formal schooling. And even

though more men smoke than women, more often than not, women will be the ones ferrying young children around in cars, They're called Morns. So be real. Will a fine or 30 days in jail improve the well-being of these often disadvantaged mothers and their children7

A former professor of mine used to preach that when she's caring for a child, be sure to "build up

Momma". Remember to tell her what a good job she's doing, and help her when she may be struggling. Momma is the one who bears the major responsibility for young children, day in and day out.

5be - no offense, Dads is the one who typically sets the tone for health behaviour in the home.

Yet young women are tailing up smoking in droves, and in what seems to be a curious fact of gender biology, once hooked it's harder for them to quit than men. Women respond differently to

smoking cessation programs and may also face more intense withdrawal s3rinpt ores..

Most parents who smoke want to give it up and sure don't want their kids to start. Morns may be

just the pressure point for Change. But don't punish them. Encourage, educate, and motivate them, and

provide program tailored to assist them in kicking their addiction. He p smokers become better

mothers. And let health experts, not cops walk the smoking beat, US News and World Report/Premium health News Services/TMSI

Protecting your heart from pain

The heart can easily be affected by a host of factors - stress, lack of sleep, and especinily the medication that we take.

The heart is strained by many obvious vices, but did you know that your choice of painrelief can also play an important role?

By Dr AIZAI AZAN

Your heart is the hardest-working organ in your body in one day alone it beats over 100,000 times and pumps 8,000 (1900) gallons of blood. In an aver age lifetime, your heart will beat over three billion times.

As with all things that don't require a conscious effort, the heart's steady work is easily over looked. Despite its obvious strengths however, the heart can easily be affected by a host of factors - stress, lack of sleep, and especially the medication that we take.

One of the most fundamental lessons for patients to learn is that all medication has the potential of causing side effects; in studies, even patients in control groups who are consuming placebos report that they experience side effects!

The objective of medication is to alleviate symptoms (such as the aches and pains associated with fever) and prevent a given condition from progressing further (such as diabetes or hypertension). Seen in this fight, there are clear benefits of treating a disease. The challenge lies in finding suitable treatment options where the benefits clearly outweigh the risks, ie side effects.

One of them was linked with increased risk for heart attack and stroke over long-term use.

As such, experts from around the world, including the American Heart Association. recommend that
the benefits and risks of NSAIDs are carefully weighed before being prescribed to patients. In addition, the recommendations stress that NSAIDs should be used at the lowest possible dose for the shortest duration necessary.

While this may seem extreme, consider that:
1. Evidence continues to grow that NSAIDs as a class contribute to increased risk for heart attack
(myocardial infarction. MI) and may aggravate chronic heart failure with increased risk of hospitalisation.

2. The evidence suggests that NSAIDs should be used with caution in people at risk of cardiovascular events, including patients with a history of chronic heart disease. hypertension, the elderly and those
taking anti-hypertensive or diuretic medication.

3. Many of the risk factors for NSAID-ralated side effects are associated with age-related chronic conditions, thereby increasing the risk of drug interactions in the elderly. Any NSAID use in high risk patients (for the long term) should be accompanied with protective measures such as low dose aspirin,and proton pump inhibitors should also be prescribed, and the patient should he closely monitored for elevated blood pressure, development of oedema and deterioration of renal function.

Despite greater awareness of healthcare issues, these facts are often overlooked or misunderstood, and in a dramatic reversal, has led to a backlash that has resulted in some people exercising a general mistrust of all pain relievers for fear of side effects, even though they may benefit from pain relief. instead of suffering in silence however, a better option is to speak to doc tars to gain a clearer understanding of the different types of pain relievers and which ones have an established safety profile.

For example, paracetamol has been safely used for decades, demonstrating that it is well tolerated across a wide range of patients, including the elderly and those with high risk cardiovascular events.

Specifically, patients with heart disease need to carefully consider their use of pain relief. For example, patients who take low dose aspirin to reduce the risk of heart attack and strokes need to be aware that a single dose of ibuprofen negates the protective effects of the aspirin by blocking its anriplatelet effects. In contrast, paracetamol has no such blocking action, making paracetamol the safer and more suitable option.

In conclusion, the best rule of thumb to follow is to use the drug with the fewest known risks. Some
suggestions that may help:

• Always know the name of the medication that you are taking.
• Be aware that some over-the-counter formulations for cold and flu may contain NSAIDs.
• Avoid taking any medication for a long period without first consulting a doctor - over the counter pain medications should not be taken for more than 10 days at a time.
• Alternatives for pain relief such as paracetamol, should be considered for patients with cardiovascular risk