No Cancer Link With Cell Phone Towers

June 24, 2010 (London, United Kingdom) — There is no association between a pregnant mother's proximity to a cell phone tower and early childhood cancers, according to results of the largest study of its kind to date.

Paul Elliott, MD, PhD, professor of epidemiology and public health medicine from Imperial College, London, United Kingdom, led the research. The paper was published online June 22 in BMJ.

"We found no pattern to suggest that the children of mums living near a [cell phone tower] during pregnancy had a greater risk of developing cancer than those who lived elsewhere," Dr. Elliot told Medscape Oncology.

He added that unlike previous studies of associations between cancer and cell phone towers, this study used larger numbers of cases so was not subject to the selection and reporting biases seen with smaller sample sizes.

Case–Control Study

In this British study, data on nearly 1400 children younger than 4 years were drawn from the national cancer registry. All case subjects had leukemia or tumors of the central nervous system or brain from 1999 and 2001. Each child with cancer was matched with 3 control subjects for sex and date of birth from the national birth register.

The distance between registered address at time of birth and the nearest of 81,781 cell towers was assessed for each case. Likewise, total power output across all towers within 700 meters (765 yards) of the cell tower was recorded. The researchers then computed modeled power density at each birth address for towers within 1400 meters (1531 yards). Exposure beyond 1400 meters was considered to be at background levels.

This information was correlated with the incidence of cancers of the brain and central nervous system, leukemia, and non-Hodgkin's lymphomas, and all cancers combined.

In their paper, the authors acknowledge that despite low levels of exposure from cell phone towers, there are theoretical concerns about the effects on children because of the relatively greater dose (per kg body mass), the potentially greater susceptibility of children than of adults, and the potential effects of lifelong cumulative exposure to radiofrequency electromagnetic fields.

Only cancers with a short latency period, typically within the first 4 years of life, were investigated. In addition, the study was restricted to exposure of children in utero, although the authors state that postnatal exposure might be relevant to the incidence of early childhood cancers.

"We only looked at estimated exposures during the fetal period and were unable to look at exposure patterns for the children after birth. This is clearly a limitation and it would have been good to look at data after birth, if they had been available. However, our findings do not suggest any link between early childhood cancers and [cell phone tower] exposure," added Dr. Elliott.

Encourage Patients Not to Worry

In an accompanying editorial, John Bithell, MA, DPhil, honorary research fellow at the Childhood Cancer Research Group, University of Oxford, United Kingdom, points out that of the 3 surrogates of exposure considered in the study, the most convincing is the modeled power density at varying distances from the nearest tower. "This is probably the best measure used in an epidemiological study to date."

However, he adds that individual exposure could still vary substantially according to building design, lifestyle, and migration, so the prospects for good estimates of individual exposure are poor.

Based on these results, he concludes that the medical profession should encourage their patients not to worry about harm caused by proximity to cell phone towers. "The epidemiological evidence is also supported by experimental evidence, which has so far failed to show any biological effects — in vivo or in vitro — that might lead us to worry about the impact on health," concluded Dr. Bithell.

However, Sam Milham, Jr. MD, MPH, former chronic disease epidemiologist at the Washington State Department of Health and clinical associate professor at the University of Washington, School of Public Health, Seattle, believes the study used the wrong metric.

"All cell towers operate on direct current, which is changed from the grid alternating current (AC) by switching power supplies. These interrupt the AC current and create high-voltage transients, which get back into the grid. The transients are a potent carcinogen," he explained.

Dr. Milham, who was approached by Medscape Oncology for comment, is currently investigating a cluster of cancers in school teachers in Palm Springs, California. He explained the relation between distance from tower, transient levels, and cancer cases.

"It has a cell tower 20 feet from a classroom wing. The transient levels in the classrooms are inversely related to distance from the tower base, and the cancer cases are found to be overrepresented in the rooms near the tower. This is a close-in phenomenon. I also find very high transient levels in firehouses and businesses near cell towers."

"The BMJ study's high-dose group, by distance, was under 612 meters [669 yards]. If they can show me that the case–control risks were similar for residences less than 100 and 200 meters [109 and 218 yards, respectively] from the tower, I'll accept their findings," Dr. Milham said.

The study was funded through the UK Mobile Telecommunications Health Research (MTHR) Programme, an independent body set up to provide funding for research into the possible health effects of mobile telecommunications. The MTHR is jointly funded by the UK Department of Health and the mobile telecommunications industry. Dr. Elliott and Dr. Milham have disclosed no relevant financial relationships. Dr. Bithell reports a beneficial interest in shares in Vodafone Group not exceeding £3000 in value.

How Does the San Francisco Syncope Rule Perform in Canada?

How Does the San Francisco Syncope Rule Perform in Canada?
The rule had a sensitivity of 90% for predicting serious outcomes at 30 days

Patients with syncope often are admitted to the hospital despite negative
emergency department (ED) evaluations. The San Francisco Syncope Rule was
developed to identify syncope patients who are at sufficiently low risk for
serious outcomes to be safely discharged home after ED evaluation. The rule
classifies patients as high risk if they have histories of congestive heart
failure, hematocrit <30%,>
or triage systolic blood pressure <90>
to have 96% and 98% sensitivity for predicting serious outcomes at 7 days
and 30 days, respectively, but has not performed as well in subsequent
validation studies in the U.S. and Australia, where sensitivities ranged
from 74% to 90% (JW Emerg Med Sep 19 2008 and JW Emerg Med Jun 8 2007).

To evaluate performance of the rule in Canada, researchers retrospectively
applied the rule to 505 patients who presented to a single tertiary care
hospital with syncope during an 18-month period. Serious outcomes were
defined as death, myocardial infarction, arrhythmia, pulmonary embolism,
stroke, subarachnoid hemorrhage, significant bleeding, any procedural
intervention to treat a related cause of syncope, any condition causing or
likely to cause a return emergency visit, and hospitalization for a related
event. Overall, 9.7% of patients had serious outcomes within 30 days. The
rule had a sensitivity of 90% for predicting these outcomes.

Comment: The results of this study are consistent with those from other
validation studies. The San Francisco Syncope Rule will likely need to be
improved and then validated before it is adopted in practice. Until then,
clinical judgment should continue to guide treatment and disposition.

— Richard D. Zane, MD, FAAEM
Published in Journal Watch Emergency Medicine

SOUTH AFRICAN DOCTOR INVENTS FEMALE CONDOMS WITH "TEETH" TO FIGHT RAPE

South African doctor invents female condoms with 'teeth' to fight rape

Dr. Sonnet Ehlers was on call one night four decades ago when a devastated rape victim walked in. Her eyes were lifeless; she was like a breathing corpse. "She looked at me and said, 'If only I had teeth down there,'" recalled Ehlers, who was a 20-year-old medical researcher at the time. "I promised her I'd do something to help people like her one day." Forty years later, Rape-aXe was born. Ehlers is distributing the female condoms in the various South African cities where the World Cup soccer games are taking place. The woman inserts the latex condom like a tampon. Jagged rows of teeth-like hooks line its inside and attach on a man's penis during penetration, Ehlers said.

Once it lodges, only a doctor can remove it -- a procedure Ehlers hopes will be done with authorities on standby to make an arrest. "It hurts, he cannot pee and walk when it's on," she said. "If he tries to remove it, it will clasp even tighter... however, it doesn't break the skin, and there's no danger of fluid exposure." Ehlers said she sold her house and car to launch the project, and she planned to distribute 30,000 free devices under supervision during the World Cup period. "I consulted engineers, gynecologists and psychologists to help in the design and make sure it was safe," she said.

After the trial period, they'll be available for about $2 a piece. She hopes the women will report back to her. "The ideal situation would be for a woman to wear this when she's going out on some kind of blind date ... or to an area she's not comfortable with," she said. The mother of two daughters said she visited prisons and talked to convicted rapists to find out whether such a device would have made them rethink their actions. Some said it would have, Ehlers said.

Critics say the female condom is not a long-term solution and makes women vulnerable to more violence from men trapped by the device. It's also a form of "enslavement," said Victoria Kajja, a fellow for the Centers for Disease Control and Prevention in the east African country of Uganda. "The fears surrounding the victim, the act of wearing the condom in anticipation of being assaulted all represent enslavement that no woman should be subjected to." Kajja said the device constantly reminds women of their vulnerability. "It not only presents the victim with a false sense of security, but psychological trauma," she added. "It also does not help with the psychological problems that manifest after assaults."

However, its one advantage is it allows justice to be served, she said. Various rights organizations that work in South Africa declined to comment, including Human Rights Watch and Care International. South Africa has one of the highest rape rates in the world, Human Rights Watch says on its website. A 2009 report by the nation's Medical Research Council found that 28 percent of men surveyed had raped a woman or girl, with one in 20 saying they had raped in the past year, according to Human Rights Watch.

In most African countries, rape convictions are not common. Affected women don't get immediate access to medical care, and DNA tests to provide evidence are unaffordable. "Women and girls who experience these violations are denied justice, factors that contribute to the normalization of rape and violence in South African society," Human Rights Watch says.

Women take drastic measures to prevent rape in South Africa, Ehlers said, with some wearing extra tight biker shorts and others inserting razor blades wrapped in sponges in their private parts. Critics have accused her of developing a medieval device to fight rape. "Yes, my device may be a medieval, but it's for a medieval deed that has been around for decades," she said. "I believe something's got to be done ... and this will make some men rethink before they assault a woman."

Jadilah Pasien Pintar! (In Bahasa Indonesia)

Jadilah Pasien Pintar!


Salah satu sebab mengapa orang enggan pergi ke dokter atau rumah sakit, bisa jadi karena persoalan komunikasi. Hal ini diungkapkan guru besar Fakultas Kedokteran Universitas Indonesia, Prof. Daldiyono Hardjodisastro, dalam bukunya yang berjudul Pasien Pintar dan Dokter Bijak.

Dalam buku tersebut diungkapkan, untuk mendapat hasil maksimal dari pertemuan dengan dokter, pasien harus mempersiapkan diri, di antaranya:

* Mengenakan pakaian yang memudahkan dokter melakukan pemeriksaan.

* Mencatat keluhan yang hendak disampaikan ke dokter secara lengkap, kapan dirasakan, dan upaya yang sudah dilakukan untuk mengurangi rasa sakit. Beritahukan pula penyakit yang pernah atau sedang diderita, obat yang sedang diminum, serta jika ada alergi.

* Dari tanya jawab soal keluhan dan pemeriksaan fisik pasien, dokter akan menegakkan diagnosis kemudian memberikan terapi, termasuk resep obat. Pasien berhak mendapat informasi yang jelas mengenai hasil pemeriksaan, menanyakan bila ada yang belum jelas, juga mengambil keputusan untuk menerima atau menolak saran dokter tentang terapi yang akan diberikan. Jika pasien tidak menerima keputusan dokter, ia berhak mencari pendapat kedua (second opinion) dari dokter lain.

* Pasien yang pintar perlu bertanya dan mengetahui obat apa yang diresepkan dokter serta manfaatnya.

* Jika kondisi keuangan tidak memungkinkan, pasien perlu meminta obat generik. Hilangkan persepsi bahwa penyakit harus cepat sembuh. Ingat, pengobatan memerlukan waktu, kesabaran, dan ketekunan. Tak jarang, ada dokter terbawa kemauan pasien yang ingin cepat sembuh, sehingga melakukan berbagai jenis pemeriksaan yang belum tentu diperlukan atau memberi obat berlebihan.

* Sebaliknya, dokter yang bijak adalah yang mampu berkomunikasi secara efektif dengan pasien. Dokter mau mendengarkan keluhan pasien, menjawab pertanyaan dan menjelaskan situasi pasien, memberi nasihat cukup, serta tidak sekadar memberi resep, sehingga pasien merasa puas.

* Kemampuan berkomunikasi merupakan inti dari pekerjaan dokter. Kepandaian sebenarnya hanya nomor dua. Pasalnya, 60 persen pasien sebenarnya tidak sakit, tetapi mengalami kelainan fungsional. Hanya 40 persen yang benar-benar sakit, itu pun 20 persennya akan sembuh sendiri.

Lalu, bagaimana menghadapi dokter yang tidak komunikatif? Konsultan gastroenterologi-hepatolog

i ini menyarankan untuk meninggalkan ruangan dan segera pindah dokter jika memungkinkan.

Jika Merasa Tak Puas

Pernah dikecewakan oleh pelayanan di rumah sakit? Agar keluhan Anda tersampaikan dengan baik, berikut beberapa caranya:

* Jika mempunyai keluhan, catat dengan jelas tanggal, hari, dan jam kejadian, kalau perlu nama petugas yang memberikan pelayanan. Kemudian Anda dapat menghubungi bagian humas maupun customer service rumah sakit tersebut.

* Ada rumah sakit yang kepala perawatannya bertugas mengurus masalah atau keluhan, sehingga pasien disarankan menghubungi Kepala (Bidang) Perawatan bila merasa tidak puas. Bila masalah belum terpecahkan, tidak tertutup kemungkinan langsung maju ke direktur atau pimpinan rumah sakit.

* Anda dapat menghubungi perwakilan Persatuan Rumah Sakit Seluruh Indonesia setempat. Persi mempunyai kepengurusan di semua wilayah di seluruh provinsi di Indonesia.

* Manfaatkan kotak saran yang ada di setiap rumah sakit untuk mengomunikasikan hal-hal yang dianggap pasien (konsumen) tidak patut dilakukan oleh petugas rumah sakit. Hal ini merupakan masukan positif agar pihak rumah sakit memperbaiki diri. Tanpa masukan dari konsumen, pengelola rumah sakit akan selalu merasa bahwa pelayanan yang diberikan sudah cukup baik. Jadi, masukan atau kritik harusnya diterima sebagai satu mekanisme kontrol dari pengguna jasa rumah sakit.

* Jika merasa tidak puas dengan layanan dokter, konsumen dapat langsung mengklarifikasi dengan dokter yang merawat terlebih dahulu. Termasuk adanya dugaan kesalahan prosedur layanan (obat, dosis, maupun tindakan).

* Sangat tidak dibenarkan bila sewaktu pasien melakukan klarifikasi, dokter tidak melayani dengan baik, misalnya menghindar atau mengaku tidak punya waktu. Seorang dokter yang memberikan layanan kepada pasien sudah terikat satu kontrak, yang dikenal dengan kontrak terapeutik (Prof. Dr. Leenen), sehingga dokter bersangkutan harus memberikan penjelasan atas setiap pertanyaan pasien. Sikap profesional harus dijaga oleh para dokter.

* Pahami hak pasien, salah satunya mendapatkan informasi yang jelas dan benar. Pergunakan hak itu dengan baik, beritahu dokter bahwa Anda berhak mendapatkan informasi yang Anda inginkan. Bila ada yang kurang jelas, misalnya soal pilihan jenis obat (generik atau paten), dosis, tindakan medis, pasien juga memiliki hak bertanya atas kuitansi tagihan rumah sakit bagi penderita rawat inap untuk diklarifikasi hingga jelas benar, juga mengenai penggunaan obat dan peralatan yang harus bayar.

* Mencermati dan meneliti tindakan medis apa saja yang sudah lakukan, apakah sesuai dengan yang seharusnya dibayarkan. Adalah hak pasien untuk mengetahui setiap rupiah yang dikeluarkan untuk membayar biaya rumah sakit.

Red : Kes. Kompas

When Fights Over Money Ruin Marriages

Much has been written about how tough economic times have forced couples to postpone divorces. They just can't afford it. Legal costs and accountant fees grow as a union dissolves and a two-income household lives cheaper than a two-household pair of singles. As the economy improves, we will probably see divorce rates creep up. But even if money woes are keeping couples together, financial disputes remain the root cause of irreconcilable differences

Here are seven common financial issues that can lead to divorce:

Paycheck Envy
More women are entering marriage with assets of their own and many are earning more than their spouses. According to the Bureau of Labor Statistics, one in three married women out-earns her husband. That amount expands to more than half if they earn $55,000 or more. Men can feel threatened by not having their traditional bragging rights as breadwinners. For women, it means they have their own money to protect from the irresponsible actions of a mate. With more at-stake, women can't afford to be deferential to their mate the way past generations were.

Debt
Utah State University professor Jeffrey Dew authored a widely cited study that concluded that couples who argue about finances at least once a week are 30% more likely to divorce than those who only vent occasionally about money issues. Couples with no assets were 70% more likely to divorce compared to couples with assets of $10,000. Cutting into the ability to build assets is America's longstanding addiction to credit cards, but there may be cause for optimism. Having amassed a record-setting $988 billion in revolving debt in 2008, Americans chipped away at nearly $90 billion of it last year, according to the Federal Reserve. Fewer credit cards and less debt should mean increased savings, more assets and potentially happier couples.

Bills
As part of a survey last year, Fidelity Investments found that less than half of couples make day-to-day financial decisions together on issues such as budgeting and paying bills (45%). In many couples, one person always pays monthly bills early while the other might procrastinate until the due date and beyond. Cutting checks can be even more stressful when an unnecessary shopping spree blows the monthly budget or a mate doesn't take kindly to the premium cable channels or costly text messages their better half piles into the mix.

Saving
While one half of a relationship may be thrifty, dedicated to building savings and committed to a retirement plan, the other may be more carefree, with a "live for today, you can't take it with you" outlook.

Investing
One can assume that investment decisions are increasingly dividing couples if both partners are financially savvy. Risk tolerance may be incompatible, with goals out-of-synch.

Dump
Apple or go long may be as divisive a debate as how often a mother-in-law should visit. Looking over an investment portfolio or 401(k) plan, one spouse may want to explore emerging market funds, while the other dismisses anything but safe domestic large caps and bonds. Can a quant guy find true happiness with a fundamental-analysis kind of gal?

Differing Expectations
There's no shortage of men and women who value money more than love and companionship. You may be quite content to "live on love" and weather financial situations "for better or worse." But she may feel entitled to a McMansion in a tony suburb and a Mercedes in which to drive your kids to private school. Trouble will be brewing along with her high-priced lattes.

Secret Stash
Financial infidelity is a newly coined term that describes situations in which a spouse hides cash or credit from his mate. It may seem a good idea to have a secret credit card or bank account that you can dip into, but your partner will probably take great offense at the covert action. Beyond the financial dishonesty on display, such hidden reserves may be a warning sign of even bigger transgressions -- keeping a slush fund to pay for strip club tabs or supporting a mistress on the sly.

The Link Between Endometriosis and Cancer

Endometriosis and Cancer Risk

Women with endometriosis appear to be more likely to develop certain types of cancer. What scientists know about the link -- and why it might occur -- were the focus of a session at the inaugural symposium of the Endometriosis Foundation of America.

"We've got pretty good evidence that there's some increase in the risk for ovarian cancer" with endometriosis, said Louise Brinton, PhD, Chief of the Hormonal and Reproductive Epidemiology branch at the National Cancer Institute, in an interview with Medscape following the session. "But there are still other cancers that need further study."

Dr. Brinton's interest in the long-term effects of endometriosis led her to Sweden about 20 years ago. Using the country's national inpatient register, she identified more than 20,000 women who had been hospitalized for endometriosis. After an average follow-up of more than 11 years, the risk for cancer among these women was elevated by 90% for ovarian cancer, 40% for hematopoietic cancer (primarily non-Hodgkin's lymphoma), and 30% for breast cancer. Having a longer history of endometriosis and being diagnosed at a young age were both associated with increased ovarian cancer risk.

"We found an increased risk for tumors with increasing years of follow-up," said Dr. Brinton, "making it unlikely that the ovarian cancer diagnoses were related to increased surveillance during endometriosis treatment." Also of special interest was the finding that "women whose site of origin of endometriosis was the ovary ... had a particularly high risk for ovarian cancer."

Dr. Brinton and colleagues published their research in 1997. A larger, more recent examination of the Swedish register, published in 2006 by Anna-Sofia Melin and colleagues, produced similar results.

"The 2 studies indicate a high risk related to follow-up time and site of origin of endometriosis, which suggests a biologic effect between the 2 diseases," said Dr. Brinton. On the other hand, confounding factors could be at work. For example, women being treated for endometriosis are more likely to be experiencing infertility, which affects risk because childbearing offers some protection against ovarian cancer.

A 2002 pooled case-control study by Roberta B. Ness and colleagues found that the odds of developing ovarian cancer were 50% higher among women diagnosed with endometriosis, even after adjusting for factors such as duration of oral contraception use and number of births. The risk was even higher -- a 3.5-fold increase -- for women with endometrioid or clear cell tumors, 2 subtypes of ovarian cancer. A 2005 case-control study by Brinton and colleagues also found a 2.5- to 3.5-fold increase in endometrioid and clear cell tumors among women with endometriosis.

The overall lifetime risk for ovarian cancer is 1.4%, according to the American Cancer Society. Endometriosis affects as many as 7% to 15% of women of reproductive age.

Farr Nezhat, MD, Chief of Gynecologic Minimally Invasive Surgery and Robotics at St. Luke's and Roosevelt Hospitals in New York City and Professor of Obstetrics and Gynecology at Columbia University, spoke on the pathogenesis of endometriosis and ovarian cancer. Dr. Nezhat also cited research on the link between epithelial ovarian cancer and endometriosis. According to a 2000 study of women with ovarian cancer by Hiroyuki Yoshikawa and colleagues, endometriosis was present in 39% of the women with clear cell tumors and 21% of those with endometrioid tumors, vs just 3% of those with serous or mucinous tumors.

Dr. Nezhat's own research with Liane DeLigdisch and colleagues also identified a link between endometriosis and ovarian cancer. A pathology review of samples from 76 patients with stage 1 ovarian cancer revealed that most were associated with endometriosis or endometrioma. Most patients presented with pelvic pain or adnexal mass, supporting the idea that healthcare providers should be alert to the possibility of ovarian cancer in women with a history of endometriosis.

Studies have been inconsistent on whether endometriosis is linked to breast cancer or non-Hodgkin's lymphoma. Anecdotal evidence has linked endometriosis to melanoma, brain and endocrine cancers, and thyroid cancer. Large epidemiologic studies are required to examine these associations.

The Pathogenesis of Endometriosis and Cancer
What do endometriosis and ovarian cancer have in common? A lot, it turns out.

"Both of these diseases are progressive and depend on estrogen for their growth," said Dr. Nezhat. Studies have shown that endometrial tissue shows elevated activity of aromatase, an enzyme used for a key step in the biosynthesis of estrogens.

Another factor that appears to play a role in both diseases is inflammation. "We know that inflammation can cause cancer, as in hepatitis of the liver and asbestosis of the lung," said Dr. Nezhat. Endometriosis is characterized by a chronic inflammatory state, which leads to the release of cytokine. These cytokines may promote the growth of tumors by causing unregulated mitotic division, growth, and differentiation.

"If you combine inflammation with estrogen, it's going to be a vicious circle," said Dr. Nezhat.

The 2 diseases share numerous other characteristics. For example, both are related to early menarche and late menopause, infertility, and nulliparity. Factors that relieve or offer protection against both conditions include tubal ligation, oral contraceptives, hysterectomy, and progesterone exposure.

Mutations in genes that are known to suppress tumors, such as PTEN, p53, and bcl, have been found in both ovarian tumors and adjacent endometriotic lesions.

Of course, links between the 2 diseases don't prove that one causes the other. But Dr. Nezhat said there's reason to believe that endometriosis contributes to ovarian cancer, as evidenced by Dr. Brinton's finding that cancer risk increases with duration of endometriosis.

If endometriosis does increase the risk for ovarian cancer, then treating it might reduce the risk. "Endometrial implants produce estrogen and inflammation," he said. "So if you remove the endometriosis, you should theoretically reduce the risk for cancer."

Advice to Surgeons and Patients
Dr. Nezhat said that surgeons who operate on women with endometriosis, which includes fertility specialists performing in vitro fertilization (IVF), need to be alert to the possibility of ovarian cancer. "Do an ultrasound during the preoperative evaluation and during the follow-up," he told Medscape. He also cautioned surgeons to biopsy any ovarian cysts instead of draining them. "Every adnexal mass has to be thoroughly evaluated," he said.

Although the elevated risk for ovarian cancer appears to be real, Dr. Brinton emphasized that women with endometriosis should not become anxious about it. "Even though we see a 2- to 3-fold increase in the risk for ovarian cancer, it's still a very rare condition," she said. "The absolute risk is low."

The New FIGO Staging for Carcinoma of the Vulva, Cervix, Endometrium, and Sarcomas

The International Federation of Gynecology and Obstetrics (FIGO) staging systems for vulva, cervix, endometrium, and sarcomas have been revised for the first time in over a decade. The purpose of the staging system is to provide uniform terminology for better communication among health professionals and to provide appropriate prognosis to the patients which results in treatment improvement. This is a constantly evolving process as new therapeutic modalities are developed, new imaging and surgical approaches are applied, and more prognostic information becomes available. The previous system did not reflect the prognosis in some patient subsets where medical research and practice have shown explosive growth of new knowledge in recent years. The 41st Annual Meeting of the Society of Gynecologic Oncologists was held in March 2010. Several abstracts reported retrospective studies that evaluated the prognostic significance of new 2009 FIGO staging guidelines compared to the old 1988 FIGO system. In endometrial cancer, the reduction in the substages within stage I, and the separation of pelvic and para-aortic nodal involvement further clarified important prognostic factors that yielded clear delineation of survival. The new 2009 FIGO vulvar cancer staging system was validated by clearly demonstrating distinct groups with differing survivals. The following revisions on carcinoma of vulva, cervix, and endometrium staging will replace prior tables 41-6, 41-8, and 41-9, respectively.

Carcinoma of the Vulva

IA Tumor confined to the vulva or perineum, = 2cm in size with stromal invasion = 1mm, negative nodes

IB Tumor confined to the vulva or perineum, > 2cm in size or with stromal invasion > 1mm, negative nodes

II Tumor of any size with adjacent spread (1/3 lower urethra, 1/3 lower vagina, anus), negative nodes

IIIA Tumor of any size with positive inguino-femoral lymph nodes
(i) 1 lymph node metastasis greater than or equal to 5 mm
(ii) 1-2 lymph node metastasis(es) of less than 5 mm
IIIB
(i) 2 or more lymph nodes metastases greater than or equal to 5 mm
(ii) 3 or more lymph nodes metastases less than 5 mm

IIIC Positive node(s) with extracapsular spread

IVA
(i) Tumor invades other regional structures (2/3 upper urethra, 2/3 upper vagina), bladder mucosa, rectal mucosa, or fixed to pelvic bone
(ii) Fixed or ulcerated inguino-femoral lymph nodes IVB Any distant metastasis including pelvic lymph nodes

Carcinoma of the Cervix

IA1 Confined to the cervix, diagnosed only by microscopy with invasion of <>
IA2 Confined to the cervix, diagnosed with microscopy with invasion of > 3 mm and <>
IB1 Clinically visible lesion or greater than A2, <>
IB2 Clinically visible lesion, > 4 cm in greatest dimension
IIA1 Involvement of the upper two-thirds of the vagina, without parametrial invasion, <>
IIA2 > 4 cm in greatest dimension
IIB With parametrial involvement
IIIA/B Unchanged
IVA/B Unchanged

Carcinoma of the Endometrium

IA Tumor confined to the uterus, no or < ½ myometrial invasion
IB Tumor confined to the uterus, > ½ myometrial invasion
II Cervical stromal invasion, but not beyond uterus
IIIA Tumor invades serosa or adnexa
IIIB Vaginal and/or parametrial involvement
IIIC1 Pelvic node involvement
IIIC2 Para-aortic involvement
IVA Tumor invasion bladder and/or bowel mucosa
IVB Distant metastases including abdominal metastases and/or inguinal lymph nodes

Uterine sarcomas were staged previously as endometrial cancers, which did not reflect clinical behavior. Therefore, a new corpus sarcoma staging system was developed based on the criteria used in other soft tissue sarcomas. This is described as a best guess staging system, so data will need to be collected and evaluated for further revision.

Uterine Sarcomas (Leiomyosarcoma, Endometrial Stromal Sarcoma, and Adenosarcoma)

IA Tumor limited to uterus <>
IB Tumor limited to uterus > 5 cm
IIA Tumor extends to the pelvis, adnexal involvement
IIB Tumor extends to extra-uterine pelvic tissue
IIIA Tumor invades abdominal tissues, one site
IIIB More than one site
IIIC Metastasis to pelvic and/or para-aortic lymph nodes
IVA Tumor invades bladder and/or rectum
IVB Distant metastasis

Adenosarcoma Stage I Differs from Other Uterine Sarcomas
IA Tumor limited to endometrium/endocervix
IB Invasion to < ½ myometrium IB Invasion to > ½ myometrium

MANAGEMENT OF SEVERE COPD REVIEWED

Various strategies and recommendations to treat patients with severe chronic obstructive pulmonary disease (COPD) are provided in a clinical review published in the April 15 issue of the New England Journal of Medicine.

"The sentinel clinical feature of severe ...COPD is dyspnea on exertion," writes Dennis E. Niewoehner, MD, from the Pulmonary Section, Veterans Affairs Medical Center in Minneapolis, Minnesota. "Its onset is usually insidious, and it may progress to severe disability over a period of years or decades. Other common symptoms include cough, sputum production, wheezing, and chest congestion."

The typical clinical manifestations of advanced COPD result from severe airflow obstruction, which can be confirmed by spirometry. Although physical findings may include a barrel-shaped chest, inspiratory retraction of the lower ribs (Hoover's sign), a prolonged expiratory phase, and use of the accessory muscles of respiration, these findings are sometimes absent even in patients with severe COPD.

Failure to confirm COPD with spirometry often leads to misdiagnosis. However, spirometry is a poor guide for decision making regarding treatment continuation or modification in an individual patient. Spirometric evidence of airflow obstruction is defined as a ratio of the postbronchodilator forced expiratory volume in 1 second (FEV₁) to a forced vital capacity of less than 0.70. Overall severity of COPD can be classified based on FEV₁ percentage of the predicted normal value, as well as on clinical criteria, such as the degree of breathlessness caused by specific tasks and the frequency of exacerbations.

Exacerbations often require medical visits and hospitalizations, causing a dramatic increase in healthcare costs. The relative risk for treatment failure (defined as no resolution or clinical deterioration) is lowered by approximately 50% when antibiotics are used for COPD exacerbations. Antibiotics are most effective in patients who have cough productive of purulent sputum.

Complications of severe COPD include pulmonary hypertension and cor pulmonale resulting from chronic hypoxemia and hypercapnia. Severe COPD is also associated with an elevated risk for cardiovascular disease, osteoporosis, lung cancer, depression, and other systemic diseases.

Management Strategies

Management should include patient education during the initial visit, which should focus on the signs and symptoms of a severe exacerbation and the need for prompt recognition and treatment. The most important aspect of management is smoking cessation, which should be addressed at every visit, as long as the patient continues smoking.

Pharmacotherapy may include an inhaled long-acting β2-agonist, an inhaled long-acting anticholinergic agent, and/or an inhaled corticosteroid. The long-acting β2-agonists salmeterol and formoterol offer at least 12 hours of sustained bronchodilation, whereas the inhaled long-acting anticholinergic agent tiotropium is effective for at least 24 hours.

Drugs from 2 of these 3 classes should be combined for patients with severe, exacerbation-prone COPD. Because they lower the relative risk for a severe exacerbation by 15% to 20%, these medications should be continued even if they do not provide symptomatic relief. Adverse events of long-acting bronchodilators are typically mild.

For rescue use, a short-acting bronchodilator should be given. Albuterol or other short-acting β2-adrenergic agonist and ipratropium bromide, a short-acting anticholinergic agent, may be used alone or combined. Patients should be instructed regarding proper inhaler technique. The faster onset of action of albuterol vs ipratropium bromide may give patients more rapid relief.

Long-term oxygen therapy should be prescribed and used for 18 hours or more each day if arterial oxygen saturation is 88% or lower at rest in a stable clinical state.

Patients with COPD should be vaccinated against influenza every autumn, and they should also receive pneumococcal vaccination, with revaccination as needed, unless there is a contraindication.

Patients with access to pulmonary rehabilitation should be offered this therapy, provided there are no medical contraindications.

The recommendations in this review are generally consistent with guidelines on the management of COPD published by the Global Initiative for Chronic Obstructive Lung Disease, the American Thoracic Society-European Respiratory Society, and the American College of Physicians.

Conclusion: Uncertainty Remains

"The role of disease-management programs for patients with COPD remains uncertain," Dr. Niewoehner concludes. "Randomized, controlled trials of case management for COPD have shown promise in reducing hospitalization rates, but the evidence is insufficient to make specific recommendations. Pulmonary rehabilitation improves health status and exercise capability for selected patients, but national surveys indicate that few patients complete such programs, and it is unclear how best to maintain the benefits achieved."

Dr. Niewoehner has received consulting fees from Boehringer Ingelheim, Adams Respiratory Therapeutics, GlaxoSmithKline, AstraZeneca, Nycomed, and Forest Research Institute and speaking fees from Boehringer Ingelheim, Pfizer, Sepracor, and Nycomed.

N Engl J Med. 2010;362:1407-1416.

HEALTH TIPS FOR MUSICIAN

HEALTH TIPS FOR THE MUSICIAN

Being healthy means you don't miss gigs, and don't have to spend money you would rather spend on studio time or instruments on a doctor's visit. Here are a few ways you can keep a little more of that money in your pockets, and where it can do more for your career.

WATER IS YOUR FRIEND

Sometimes the simplest things are the hardest to do. There is a lot to be said for drinking more water and less other things. Water has no calories, costs very little to nothing, and is great for keeping vital things like vocal cords and skin healthy. There are few things more irritating than a scratchy throat or split fingers if you are trying to play your instrument, and drinking plenty of water can help prevent both of these. This can also help you keep your skin less wrinkled and your weight down, allowing you to need less money in the long run trying to fix appearance problems as you age, and, in this sadly Hollywood-image field we are in, can probably up your chances of getting contracts simply because you are more youthful and healthy looking than your competition. If you happen to play in a very air-conditioned or heated area, keeping the place humidified can also keep your instruments in better shape and prevent a lot of cracking problems in things like wooden parts and skins, saving you money in repairs and replacement costs. To help keep humidity in the place if you can't afford a humidifier, try keeping a few potted plants around-keeping them moist enough to be healthy seems to keep the air around them the right moisture level as well. Keeping some lotion around that you find works helps a lot, too-seal in all that good moisture to your hands and face.

LEARN TO RELAX

This is another simple thing that is really hard to do. Many musicians have a really hard time "coming down" from a stage show, big meeting with industry bigwigs, or a really good writing session. Many methods exist to allow one to sit still and force oneself to unwind without the need for chemicals so you can get a decent night's sleep. Consider taking a class in Yoga or meditation; find something that really helps you wind down like a warm bubble bath, reading or some other pursuit. Things that work for me, strangely enough, are working on my taxes (so boring it numbs my brain out), curling up in front of the television watching cartoons, a long, slow workout followed by a hot shower or reading a book-especially if the book has a lot of imagery or highly technical data to absorb. I've also found that doing the meditation trick of thinking about sitting and relaxing doing something that soothes you is very helpful-many classes do the scene about sitting on a beach and thinking about being there, while I find thinking about doing yard work or building very relaxing. The important thing is to bore yourself with something that is fun for you, or lets you feel you are accomplishing something beneficial to you. Avoiding chemicals also prevents you from becoming habituated to them-something that can hurt you in the long run. Longer and longer runs or reading can only do you good, while costly chemical solutions often end careers in one way or another. Try to find fun, healthy, low-cost rituals instead.

CREATIVE FIDGETING

You can never really get enough practice, so try to find ways to practice even if you don't have your instrument around. Flexing your fingers backwards like your hands are eagle claws about to strike is great for many instrumentalists, as is doing this then drawing your fingers towards your palms after doing the claw stretch, as if you were about to make a fist, but then allowing the finger to come back to the initial position. I find this is a great way to work kinks out if I have been doing too much work with a pencil, too, at times when I have been frantically writing lyric ideas down. Pretending you are doing scales with both fingers or trying to make your fingers hold a certain chord position helps, too. Drawing your knees up as high as you can one at a time while sitting watching television or doing desk duty at work can help keep your legs and waistline in shape, too, and this can not only help your appearance but help things like your singing or ability to stand holding your instrument for longer periods of time, too. Try surfing the web for other fun exercises you can do while seated-there are lots of fun ones, and any exercise helps keep your weight down and helps you avoid all the health problems associated with that.

So try these simple suggestions and see how it helps your writing. It is amazing how much more endurance you may find you'll have just by drinking more water, learning to relax, and getting a little more exercise.

CARCINOGENS FROM PARENT'S " TOBACCO SMOKE FOUND IN THEIR BABIES"

Carcinogens From Parents 'Tobacco Smoke Found In Their Babies'

PHILADELPHIA - When mom or dad puffs on a cigarette, their infants may inhale the resulting second-hand smoke. Now, scientists have detected cancer-causing chemicals associated with tobacco smoke in the urine of nearly half the babies of smoking parents.

"The take home message is, 'Don't smoke around your kids,'" said Stephen S. Hecht, Ph.D., professor and Wallin Chair of Cancer Prevention at The Cancer Center at the University of Minnesota.

According to a study of 144 infants, published in the May issue of Cancer Epidemiology, Biomarkers & Prevention, Hecht and his colleagues found detectable levels of NNAL* in urine from 47 percent of babies exposed to environmental tobacco carcinogens from cigarette smoking family members.

NNAL is a cancer-causing chemical produced in the human body as it processes NNK**, a carcinogenic chemical specific to tobacco. "The level of NNAL detected in the urine of these infants was higher than in most other field studies of environmental tobacco smoke in children and adults," Hecht said. "NNAL is an accepted biomarker for uptake of the tobacco-specific carcinogen NNK. You don't find NNAL in urine except in people who are exposed to tobacco smoke, whether they are adults, children, or infants."

A previous study by Hecht and his colleagues indicated that the first urine from newborns whose mothers smoked during pregnancy contained as much as one-third more NNAL compared to the babies in the current study. The newborn infants, however, took in the carcinogen directly from their mothers through their placentas rather than by breathing second-hand smoke in the air in their family homes and cars. In the current study, when babies had detectable levels of NNAL, Hecht said that family members smoked an average of 76 cigarettes per week, in their home or car while the babies were present. In children of smokers whose babies had undetectable levels of NNAL in their urine, the average number of cigarettes smoked by family members was reported at 27 per week. "With more sensitive analytical equipment, the NNAL from urine of babies in lower frequency cigarette smoking households would most likely be detectable " Hecht said.

While studies have not determined how the long term risk of exposure to cancer-causing tobacco smoke affects the genetics of babies during their early years when they are growing rapidly, Hecht said that this study demonstrated substantial uptake of NNK and its metabolite NNAL in infants exposed to environmental tobacco smoke. "These findings support the concept that persistent exposure to environmental tobacco smoke in childhood could be related to cancer later in life," he said. Hecht conducted his study in collaboration with Steven G. Carmella, Ky-Ahn Le, Sharon E. Murphy, Angela J. Boettcher, Chap Le, Joseph Koopmeiners, Larry An, and Deborah J. Hennrikus from the Transdisciplinary Tobacco Use Research Center and The Cancer Center, University of Minnesota.

* 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol
** 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone

PO CHAI PILLS WILL CAUSE A CANCER (in Bahasa Indonesia)

Obat Sakit Perut Po Chai yang Sebabkan Kanker

Departemen Kesehatan Hong Kong melarang dan menarik kembali peredaran dua jenis obat sakit perut tradisional China Po Chai. Akankah obat yang telah dikonsumsi anak-anak hingga manula sejak berusia ratusan tahun itu berakhir?

Pil Po Chai telah menjadi akrab di kalangan masyarakat Asia termasuk di Indonesia. Jika anak-anak sakit perut, ibu-ibu zaman dulu hingga saat ini masih menggunakan Po Chai untuk penyembuhannya.

Pil Po Chai digunakan untuk meredakan gangguan pencernaan, mulas, muntah, diare dan kembung. Obat ini juga digunakan untuk mencegah mabuk.

Seperti dilansir dari data perusahaan pochaipills.com, pil Po Chai pertama kali dibuat oleh Li Shiu Kei di Foshan, Guangdong pada tahun 1896. Li kemudian mengembangkan usahanya ke Hong Kong setelah perang saudara di China yang berakhir pada 1936.
Di Hong Kong, Li kemudian mengibarkan bendera Li Chung Shing Tong (Holdings) Limited yang menjual pil Po Chai ke seluruh dunia. Sedangkan perusahaan di Guangzhou, China di bawah bendera Wanglaoji Guangzhou Pharmaceutical Company Limited hanya menjual obat untuk
daratan China saja.

Po Chai adalah ramuan herbal yang mengandung Halloysitum, akar Rhizoma, Oryzae Satiae, daun Herba Menthae, Selerotrum Porifungal, Radix Puepariae, daun Herba Agastaches, Excarpium Citri, Cortex magnoliae dan daun Masse Fermentata Neaven. Namun kini Po Chai bakal susah dicari.

Departemen Kesehatan Hong Kong melarang dan menarik obat-obat Po Chai dari pasaran sejak 24 Maret 2010.

Selain Hong Kong, Singapura sudah terlebih dahulu melarang penjualan obat ini sejak 8 Maret 2010.

Dalam keterangannya seperti dilansir dari news.gov.hk, Selasa (30/3/2010), Departemen Kesehatan Hong Kong memerintahkan semua pil Po Chai baik dalam bentuk kapsul maupun botol ditarik dari gerai ritel lokal.

Penarikan tersebut dilakukan setelah mempelajari hasil temuan otoritas Singapura yang melarang obat yang mengandung phenolphthalein dan sibutramine karena menyebabkan kanker dan obesitas. Po Chai ternyata mengandung dua bahan tersebut.
Hasil temuan Departemen Kesehatan Hong Kong, obat yang tercemar ini adalah bahan bubuk dalam kapsul. Dua kapsul yang dicurigai berbahaya yang telah diekspor ke Singapura itu adalah kapsul nomor 21217 dan 21133.

Dan juga berdasarkan pengalaman saya dalam praktek sehari-hari, dalam 3 tahun belakangan ini, saya menemukan reaksi alergi (Drug Eruption) pada pasien saya yang mengkonsumsi pochai pills ini. Semoga bermanfaat.

OBAMA ; HEALTH & EDUCATION POLICY GRANTED

OBAMA ; HEALTH & EDUCATION POLICY GRANTED



President Obama signed into law Tuesday a package of revisions to his
new health-care overhaul that includes a measure aimed at making higher
education more affordable.

The provision ends what Obama called a long-standing "sweetheart deal"
for banks in federally guaranteed student loans.

In a speech and signing ceremony at the Alexandria campus of Northern
Virginia Community College, Obama said the health-care reform
legislation and the revisions represent "two major victories ... that
will improve the lives of our people for generations to come."

He said the Health Care and Education Reconciliation Act of 2010 would
save taxpayers $68 billion in the coming years by cutting out the role
of banks and lending institutions as middlemen in federally guaranteed
student loans. The money is to be channeled into the Pell Grant
program, invested in community colleges and historically black colleges
and used to make student loans more affordable by capping repayments at
10 percent of discretionary income starting in 2014.

Republicans in Congress were unified in their opposition to the health-
care overhaul, and a spokesman for Senate Minority Leader Mitch
McConnell (R-Ky.) criticized the student-loan legislation Tuesday,
saying it would have "devastating consequences" for employees of
lending institutions. He pointed to estimates that 30,000 jobs could be
lost nationwide. The largest student lending firm, SLM Corp., known as
Sallie Mae, has said it could be forced to lay off nearly 30 percent of
its 8,600 U.S. employees.

Obama said billions of dollars that could have been spent helping more
students to attend college or easing tuition burdens went instead to
"padding student lenders' profits." He told the audience that major
banks "hired an army of lobbyists" to defeat the legislation and that
Sallie Mae "spent more than $3 million on lobbying last year alone."

Before signing the bill, Obama paid tribute to lawmakers who had "the
courage to do what's right" by supporting the health-care and student
loan legislation in the face of attacks he described as "fierce and
unrelenting -- and inaccurate."

Obama said the education measures would help meet his national goal of
having the highest proportion of college graduates in the world by
2020.

Because of the reforms, he told a cheering crowd at the community
college, "the foundation on which America's future will be built is
stronger than it was one year ago."

"Today we mark an important milestone on the road to health-insurance
reform and higher-education reform," Obama said. "But more broadly,
this day affirms our ability to overcome the challenges of our politics
and meet the challenges of our time."

Obama was introduced by Jill Biden, the wife of Vice President Biden.
An English teacher at the Alexandria school, she was asked by Obama to
host a summit on community colleges at the White House this fall.

"I am pleased to say that the reforms in this bill will make a huge
difference to those Americans who need it most," Biden said.

FAT-LIPID PREJUDICE

ANOTHER WRONG MYTHS ABOUT FAT-LIPID
(well i'll try to put it on a better prospective)

Lemak sering kali dituding sebagai "biang keladi" obesitas serta berbagai jenis penyakit berbahaya lainnya. Akibatnya, kian hari kian banyak saja perempuan yang menyingkirkan lemak dari menu sehari-hari.
Padahal, beberapa di antara pernyataan buruk tentang lemak itu hanyalah mitos yang menyesatkan.

Mitos 1: Jangan Minum Susu kalau Mau Kurus, Tubuh kita membutuhkan protein, vitamin (A dan D), mineral, dan suplai energi yang terkandung di dalam susu. Susu juga amat baik karena kandungan kalsium yang tinggi (116-290 mg kalsium per 100 gram susu). Kekurangan kalsium akan membuat Anda rentan terserang osteoporosis dan kekurangan produksi hormon yang bisa membantu mengurai lemak di dalam tubuh.

Tip: Minumlah susu 1-2 kali sehari. Perempuan berusia di bawah 30 tahun masih boleh mengonsumsi susu full cream. Susu low fat ataupun nonfat adalah pilihan terbaik bagi yang usianya di atas 30 tahun.


Mitos 2: Avokad adalah Jenis "Buah Terlarang" Lemak di dalam avokad adalah asam lemak omega-9, jenis lemak baik yang justru mampu menekan kadar kolesterol jahal (LDL). Avokad juga kaya serat sehingga bisa menyerap kelebihan LDL dan membuangnya bersama sisa-sisa pembakaran. Avokad pun kaya kalium yang berkhasiat menstabilkan debar jantung dan tekanan darah serta memelihara kesehatan sistem saraf. Juga kaya vitamin E dan B yang penting untuk menjaga kesehatan kulit, mencegah penuaan dini, dan memperkuat imunitas tubuh.

Tip: Santap avokad tanpa tambahan dressing, seperti susu, cokelat, ataupun gula. Avokad juga lezat dinikmati sebagai pengganti mentega atau butter untuk melapisi roti.


Mitos 3: Mentega Lebih Baik daripada Minyak Goreng Mentega terbuat dari krim susu sehingga kandungan kolesterol di dalamnya justru lebih tinggi dibandingkan minyak goreng. Terlebih, minyak goreng yang terbuat dari bahan nabati, seperti minyak zaitun, minyak kanola, atau minyak wijen. Meski minyak goreng nabati mengandung lebih banyak lemak dibandingkan mentega, sebagian besar kandungan lemak yang terdapat di dalamnya tergolong lemak "baik" yang mudah diuraikan tubuh.

Tip: Hindari memproses makanan dengan cara digoreng dan pilihlah makanan yang direbus, dikukus, atau ditumis. Jika terpaksa mesti menggoreng, pilihlah jenis minyak nabati.


Mitos 4: Banyak-banyak Makan Telur Itu Aman Memang banyak olahragawan yang makan telur banyak-banyak demi mendapatkan tubuh berotot. Tapi, mereka punya panduan diet yang membatasi jumlah konsumsi telur dan mengimbanginya dengan asupan nutrisi lain. Telur memang mengandung banyak zat gizi, seperti vitamin B-kompleks, asam amino esensial, seperti mineral (besi, fosfor, dan kalsium). Namun, selain kaya gizi, kandungan kolesterol di dalam kuning telur amat tinggi sehingga konsumsinya harus dibatasi.

Tip: Batasi makan telur menjadi 2 butir per minggu. Bersama telur, konsumsilah sayur-sayuran yang kaya vitamin A, D, E, dan K, seperti wortel dan tauge, untuk membantu melarutkan lemak.


Mitos 5: Pantang Makan Daging Bikin Tubuh Langsing Daging adalah bahan pangan yang kaya protein serta asam amino esensial yang penting bagi tubuh. Di dalam daging ikan terkandung asam lemak omega-3 yang berguna mencegah penyakit jantung serta omega-6 yang mampu meningkatkan pembakaran energi dalam tubuh, mengatasi retensi (penarikan air dalam tubuh) dan penyakit jantung koroner.

Tip: Perbanyak konsumsi ikan dibandingkan daging sapi dan ayam. Buang kulit dan bagian yang berlemak. Jika ingin menyantap steak, hindari steak prime rib atau T-bone yang banyak lemak.


Mitos 6: Doyan Es Krim Bikin Badan Melar Es krim yang berbahan dasar susu memang mengandung lemak dan kolesterol dalam jumlah bervariasi. Tetapi, jangan lupa, di dalam setiap jenis makanan terdapat zat gizi yang baik dan buruk bagi tubuh. Selain lemak dan kolesterol, es krim juga mengandung banyak sekali mineral (kalsium, magnesium, natrium, kalium, besi, seng, dan iodium), protein, serta vitamin A, B, D, dan E. Kalsium malah mampu meningkatkan produksi hormon yang bertugas menguraikan lemak dalam tubuh.

Tip: Pilih es krim rendah lemak, sorbet, ataupun gelato. Lebih baik lagi, nikmatilah es krim dengan dicampur beraneka macam potongan buah.


Mitos 7: Kacang-kacangan adalah Camilan yang Menggemukkan Penelitian di Purdue University menyatakan, menyantap kacang-kacangan bisa mendatangkan rasa kenyang lebih lama dibandingkan camilan diet, seperti biskuit beras dalam jumlah sama. Lemak dalam kacang adalah omega-9, lemak "baik" yang mampu menurunkan level LDL. Kacang almon, hazelnut, dan walnut mengandung asam amino arginine yang mampu memperlebar pembuluh darah arteri dan menurunkan tekanan darah.

Tip: Menurut penelitian, mengemil kacang 5 kali seminggu masing-masing 1 bungkus kecil dapat menurunkan risiko serangan jantung sebesar 25-39 persen. Tapi, konsumsi kacang yang dipanggang, jangan yang digoreng.

SHISHA...WOULD IT BE WORST THAN CIGARS ???

DO YOU KNOW ABOUT SHISHA ???
WOULD IT BE WORST THAN CIGARS ???


Selama ini shisha dikenal sebagai bentuk relaksasi dari Timur Tengah yang dianggap aman dan tidak menimbulkan efek yang membahayakan.. ternyata persepsi tersebut SALAH!!!!!

WHY????!!!

Check This Out.....

ROKOK ARAB BERIBU RASA
Shisha kerap disebut rokok arab, karena diusung pertama kali oleh negara-negara Timur-Tengah. Meski tak seperti rokok pada umumnya, pada prinsipnya shisha sama dengan rokok yaitu dinikmati dengan cara menghisap dan mendapatkan ketenangan dari bahan dasar tembakau. Bedanya, untuk menghisap shisha digunakan alat khusus bernama Bong.

Perbedaan berikutnya, penikmat shisha bisa mendapatkan sensasi berbeda karena tersedia dalam beragam aroma, dari buah-buahan hingga aneka bunga.

Lantas Kenapa berbahaya?????!!!!

Menurut Agen Anti Tembakau Prancis (L'Office Francais de prevention du Tabagisme OFT) menyatakan :

1. Satu hisap shisha setara dengan 70 hisapan rokok biasa.
2. Kandungan tar dari asap 1 shisha sama dengan 27-102 batang rokok.
3. Menghisap 1 shisha sama aja dengan menghirup karbon monoksida setara 15-52 batang rokok biasa.

Nahh.. Bahaya-bahaya dari racun utama shisha seperti CO, Tar dan Nikotin adalah sebagai berikut:

1. Karbon Monoksida Karbon monoksida (CO) apabila terhirup ke dalam paru-pari akan ikut peredaran darah dan akan menghalangi masuknya oksigen yang dibutuhkan oleh tubuh. Hal ini dapat terjadi karena gas CO bersifat racun, ikut bereaksi secara metabolis dengan darah (hemoglobin)

Ikatan karbon monoksida dengan darah (karboksihemoglobin) lebih stabil daripada ikatan oksigen dengan darah (oksihemoglobin). Keadaan ini menyebabkan darah menjadi lebih mudah menangkap gas CO dan menyebabkan fungsi vital darah sebagai pengangkut oksigen terganggu.
Keracunan gas karbon monoksida dapat ditandai dari keadaan ringan, berupa pusing, rasa tidak enak pada mata, sakit kepala, dan mual. Keadaan yang lebih berat dapat berupa detak jantung meningkat, rasa tertekan di dada, kesukaran bernafas, kelemahan otot-otot, gangguan pada sisten kardiovaskuler, serangan jantung sampai pada kematian.

2. Tar

Tar adalah substansi hidrokarbon yang bersifat lengket dan menempel pada paru-paru. Tar bukanlah zat tunggal, terdiri atas ratusan bahan kimia gelap dan tergolong sebagai racun pembuat kanker

3. Nikotin

Nikotin sangat mempengaruhi dan dapat mengubah fungsi otak dan tubuh kita. Nikotin membuat si perokok merasa relaks dan kemuadian merasa lebih energik dan bersemangat, atau sebaliknya. Efek ini umum dikenal sebagai biphase effect. Sialnya, semakin sering seseorang merokok, akan semakin merasa ketagihan dan bertambah pula dosis yang akan kita gunakan.

Saat seseorang menghisap sebatang rokok, nikotin akan diserap dalam tubuh (darah), diringi dengan pelepasan Adrenalin dan pemblokade-an hormone insulin. Adrenalin lebih dikenal sebagai hormon “Fight or Flight”.
Jika anda mencintai film horror, atau sangat suka dengan roller-coaster, pasti sangat familiar sekali dengan efek Adrenalin ini, yang juga akan anda alami saat merokok:

• * Detak jantung yang sangat cepat
• * Meningkatnya tekanan darah
• * Tarikan nafas yang berat dan cepat

Saat Adrenalin dilepas tubuh kita pun akan melepaskan cadangan glukosa ke dalam darah. Kemudian, insulin akan memerintahkan sel tubuh untuk menyerap kelebihan glukosa dalam darah. Efek ini sering disebut sebagai hyperglycaemic, yaitu tingginya kadar gula dalam darah. Inilah alasan kenapa saat merokok, seseorang tidak merasa lapar dan akan tahan untuk tidak makan selama berjam-jam. Lebih banyak dijumpai perokok yang berbadan kurus dibandingkan perokok yang kelebihan berat badan.

Dalam jangka panjang, Nikotin dapat meningkatkan kadar kolesterol dalam darah, mengakibatkan si perokok, walaupun sudah lama berhenti merokok, sangat rentan terhadap serangan jantung dan stroke. Ini sebagai akibat dari rusaknya pembuluh arteri dalam darah, yang salah satu fungsinya, mengedarkan oksigen ke seluruh tubuh.

Di dalam otak, sebagai respon terhadap Nikotin, otak akan memerintahkan tubuh untuk membuat zat endorphin lebih banyak lagi. Endorphin adalah senyawa protein yang lebih tepat disebut sebagai body’s natural pain killer. Struktur kimia Endorphin tidaklah jauh berbeda dengan painkiller kelas atas seperti morphine. Endorhpin dapat membuat seseorang merasa relaks dan euphoria. Terkadang, merokok (endorphin) dapat menstimulus sex anda.

CIRCUMSITION, SUNAT MENCEGAH RESIKO TERTULAR HIV/AIDS

New York - Bukti baru menyebutkan sunat dapat mencegah tertular HIV (virus yang melemahkan kekebalan tubuh), juga penyakit lain yang mematikan jutaan orang. Kini beberapa dokter mempertimbangkan kembali pandangan mereka tentang prosedur ini.Sunat adalah prosedur operasi yang sudah umum. Tetapi juga menjadi hal yang sensitif jika terkait budaya dan agama. Bahkan di komunitas medis sendiri, masih ada perdebatan dan pro-kontra mengenai alasan dilakukannya sunat pada anak lelaki.

Selama beberapa dekade, sadar akan kepekaan ini, kalangan medis diam tentang sunat.Sekarang bukti-bukti memperlihatkan bahwa prosedur memotong kulup pada penis dapat mencegah sejumlah penyakit menular seksual.

Penelitian yang dilakukan oleh Pusat Pengendalian dan Pencegahan Penyakit (CDC), Amerika Serikat, di Afrika Selatan, Kenya, dan Uganda antara 2005 dan 2007 menunjukkan bahwa sunat pada laki-laki dewasa mengurangi risiko tertular HIV hingga 50 - 60 persen. Hal ini telah mengarah ke pengembangan program yang menawarkan sunat di sejumlah negara Afrika, yang didukung oleh Organisasi Kesehatan Dunia, dengan prediksi bahwa dalam jangka panjang sunat dapat menyelamatkan jutaan nyawa.

Sunat sempat memicu kontroversi di Amerika. "Sunat merupakan prosedur medis yang tidak etis," kata Georganne Chapin, direktur eksekutif Intact America, yang bersikap kontra terhadap sunat. "Kami tidak akan membiarkan mereka melakukan tindakan ini pada anak cowok mereka.

"Dengan mencermati bukti-bukti manfaat sunat, seperti yang diperoleh peneliti dari CDC di tiga negara Afrika tersebut, Ronald H. Gray, profesor pada Universitas Johns Hopkins, mengatakan, "Bukti-bukti yang diperoleh makin kuat dengan adanya hasil uji coba tentang potensi manfaat sunat.""Sunat secara substansial tentu akan mencegah sejumlah infeksi," kata Gray.

"Risikonya jauh lebih kecil dibanding manfaatnya."Selain mengurangi risiko HIV, riset menunjukkan sunat memotong risiko terkena HPV (virus penyebab kanker leher rahim) dan herpes, menurut ulasan Gray yang diterbitkan Januari 2010 di Archives of Pediatric & Adolescent Medicine. Menurut Gray, perempuan yang berhubungan seks dengan pria yang bersunat sedikit kemungkinan terkena HPV dan infeksi bakteri.

Wanna be a Doctor ??? (State of Mind)

Saya Ingin Jadi Dokter, Om!!!


Setiap orang pastinya memiliki cita-cita ataupun harapan akan menjadi apa dan bagaimana dia kelak di masa yang akan datang. Cita2 juga dapat menjadi impian sekaligus pelecut semangat seseorang untuk dapat terus berusaha dan berkarya dalam mencapai apa yang dicita-citakan tersebut. Cita-cita dapat mucul seiring dengan berjalannya waktu berdasarkan hobi, kemampuan, ketrampilan, maupun pengalaman hidup seseorang. DIharapkan setiap orang bisa memiliki cita-cita dan memilikinya sejak usia sedini mungkin. Sedini mungkin??
Ketika iseng-iseng menanyai beberapa anak-anak usia sekitar di bawah 5 tahun, termasuk juga melihat kolom `Sahabatku` di salah satu koran lokal edisi hari Minggu, ternyata rata-rata anak-anak yang masih ingusan ini sudah punya cita-cita. Dan hebatnya lagi sebagian besar dari mereka dengan `mudah`nya menyebutkan : “Saya ingin jadi dokter, Om!!”. Saya cukup terhenyak, mengingat keputusan saya untuk bercita-cita menjadi seorang dokter baru muncul pada saat saya duduk di kelas III SMU. Apakah benar anak-anak ini sudah mengetahui `konsekuensi` yang harus ditempuh ketika bercita-cita menjadi seorang dokter? Bahwa betapa besar pengorbanan tenaga, waktu, biaya untuk mewujudkan cita2 mereka. Atau jangan-jangan anak-anak yang masih ingusan ini bahkan belum tahu apakah arti cita-cita itu sebenarnya. Dan kemungkinan apa yang mereka lontarkan secara spontan, yang dikatakan sebagai cita-cita itu sebenarnya merupakan harapan atau keinginan dari orang tua mereka
yang sedari kecil sudah berusaha ditanamkan dalam otak mereka. Ah, ataukah saya lah yang terlalu `negative thinking` terhadap mereka? Namun ada satu hal yang pasti di sini, hingga sekarang profesi dokter masih menjadi salah satu profesi yang paling diinginkan oleh banyak orang.
Setiap tahun saat persiapan tes penerimaan mahasiswa baru, maka salah satu jurusan yang paling padat peminat adalah jurusan Fakultas Kedokteran. Hampir semua keluarga ingin anaknya ada yang menjadi dokter. Dokter dipandang memiliki derajat status yang lebih tinggi, memiliki uang banyak, hidupnya pasti makmur dan sejahtera. Tidak heran setiap tahun betapa banyak orang tua yang bersusah payah dan berjerih lelah untuk memasukkan anak mereka ke fakultas kedokteran, syukur-syukur bila diterima di universitas favorit. Bahkan tidak sedikit yang rela mengeluarkan uang hingga ratusan juta rupiah sekedar untuk memuluskan `impian`nya itu.
Memang benar bahwa ketika anda menjadi seorang dokter, maka dapat dikatakan kehidupan anda minimal akan tercukupkan. Hal ini didasarkan pada kenyataan bahwa ke mana pun anda pergi, kebutuhan akan seorang dokter selalu akan ada. Malahan banyak pula dokter yang karena profesinya itu dapat hidup berkelimpahan. Memang benar pula ketika dokter masih dianggap strata yang cukup tinggi di mata masyarakat. Saya teringat seorang teman, yang notabene bukan seorang dokter, diminta oleh keluarganya untuk mencari kerja saja di fakultas kedokteran sebagai pegawai, dengan harapan kalau-kalau saja dapat memperoleh jodoh seorang dokter di sana!!!
Namun, apakah benar menjadi dokter itu sangat menyenangkan??? Pengalaman saya, menjadi dokter itu perlu perjuangan yang sangat berat. Semasa menuntut ilmu di bangku kuliah pun, seorang mahasiswa kedokteran diharapkan memiliki waktu belajar yang `lebih` dibandingkan teman-teman lainnya. Menjadi dokter pun memerlukan waktu yang lebih panjang, sekitar 4 tahun kuliah ditambah 2 tahun praktek di RS sebagai co-asisten. Belum lagi ketika selesai mereka akan melakukan proses `pengabdian` di daerah-daerah selama beberapa tahun. Belum lagi bila mereka ingin melanjutkan ke pendidikan spesialistik yang akan memakan waktu 4-5 tahun.
Dokter pun dihadapkan dengan tanggung jawab yang lebih besar dimana yang dilayani secara langsung adalah manusia sebagai obyek. Terasa perbedaan dalam hal besarnya tanggung jawab ketika, misalnya seorang montir yang sedang `membedah` sebuah mobil dibandingkan dengan seorang dokter yang tengah `membedah` seorang pasien di meja operasi. Seorang dokter pun sering kali harus menempatkan tugas dan tanggung jawab mereka sebagai dokter sebagai prioritas utama dalam hidup. Betapa banyak dokter yang harus menghabiskan waktu kerja maupun jaga malam di rumah sakit ataupun pusat pelayanan kesehatan lainnya setiap hari, sehingga keluarga seolah-olah menjadi prioritas nomor dua. Belum lagi saat ini profesi dokter saat ini sering `diganggu` oleh segelintir oknum-oknum yang mencari-cari kesalahan dengan memanfaatkan istilah `malpraktek`.
Saya teringat cerita teman saya. Dikatakan jadi dokter sekarang sudah berbeda dengan menjadi dokter pada 30 atau 40 tahun lalu. Pada jaman lampau, kebutuhan banyak namun tenaga dokter masih kurang. makanya tiap lulusan akan langsung terangkat menjadi PNS atau pun terserap di lapangan kerja yang lain. Namun sekarang situasi sudah beda. Setiap penerimaan PNS, terutama di kota besar, formasi dokter yang tersedia paling cuma 2-3 orang saja, sementara peminatnya bisa berjumlah ratusan. Makin banyaknya universitas dengan fakultas kedokteran, juga membuat persaingan antar dokter menjadi lebih berat, utamanya di kota besar, dimana sebagian besar dokter memilih berkarya di kota besar. Sungguh miris melihat dokter praktek swasta yang memasang tarif sekali periksa pasien yang hanya `sebanding` dengan seporsi nasi campur, mengingat betapa besarnya tanggung jawab yang dipikul oleh dokter tersebut dalam menangani pasiennya.
Namun terlepas dari itu semua, saya tidak menyesal menjadi seorang dokter. Dokter tetaplah adalah suatu profesi yang mulia. Adalah suatu kebahagiaan yang tak terkira, ketika seorang pasien datang ke pada dokter berterima kasih karena ternyata setelah berobat, penyakit yang dideritanya itu akhirnya sembuh. Mungkin hal itulah yang selalu menjadi kekuatan dan kebahagiaan terbesar menjadi seorang dokter.
Saya senang menjadi seorang dokter. Saya senang mendengar anak-anak itu memiliki cita-cita mulia ini sedari kecil. Saya senang mendengar mereka berkata : “Mama, saya ingin menjadi seorang dokter!!”