Key Features of Chronic Dizziness Improve Diagnosis and Therapeutic Outcomes

http://www.medscape.com/viewarticle/552715
News Author: Laurie Barclay, MD
Release Date: February 26, 2007;

February 26, 2007 — Key clinical features of chronic dizziness may improve diagnosis and therapeutic outcomes, according to the results of a prospective cohort study reported in the February issue of the Archives of Otolaryngology, Head & Neck Surgery.

"The relationships among [chronic subjective dizziness (CSD)], anxiety disorders, neurotologic conditions, and other medical causes of chronic dizziness are not fully understood," write Jeffrey P. Staab, MD, MS, and Michael J. Ruckenstein, MD, of the University of Pennsylvania Health System in Philadelphia, and colleagues. "The current investigation sought to clarify the prevalence and comorbidity of medical and psychiatric causes of chronic dizziness."

From 1998 to 2004 at a tertiary care balance center, 345 men and women, aged 15 to 89 years, were referred for evaluation of chronic dizziness (duration of ≥ 3 months) of uncertain cause. These patients were systematically directed through multiple specialty examinations until definitive diagnoses were reached.

Nearly all patients with CSD were diagnosed with psychiatric or neurologic illnesses, including primary and secondary anxiety disorders (n = 206; 59.7%) and central nervous system conditions (n = 133; 38.6%). The latter group included migraine headaches, mild traumatic brain injuries, and neurally mediated dysautonomias. Six patients (1.7%) had dysrhythmias, and 4 of 5 patients with migraine or dysrhythmias had comorbid anxiety.

"Chronic dizziness has several common causes, including anxiety disorders, migraine, traumatic brain injuries, and dysautonomia, that require different treatments," the authors write. "Key features of the clinical history distinguish these illnesses from one another and from active neurotologic conditions. The high prevalence of secondary anxiety may give a false impression of psychogenicity."

Of the 6 patients with dysrhythmias, all had psychiatric disorders. The most significant dysrhythmias were atrial fibrillation and Wolfe-Parkinson-White syndrome.

"This study demonstrated the clinical usefulness of CSD as a diagnostic concept to identify patients with persistent dizziness sustained by nonotologic mechanisms," the authors conclude. "High levels of coexisting anxiety frequently dominated the clinical picture and confounded recognition of associated medical illnesses. Key diagnostic features were identified in the clinical history for each illness. Careful inquiry about these key features during otologic evaluations may increase diagnostic precision and lead to more specific treatment recommendations for these perplexing patients."

This study was not supported by commercial funding, and the authors have disclosed no relevant financial relationships.

Arch Otolaryngol Head Neck Surg. 2007;133:170-176.

Building blocks of democracy

http://www.thejakartapost.com/detaileditorial.asp?fileid=20070227.E01
Editorial
February 27, 2007

Chief economics minister Boediono's observation over the weekend about the linkage between the per capita income level and the sustainability of democracy is not a choice between India's democracy and China's authoritarian path, nor an issue of development first, democracy later.

Rather, the essence of his speech Saturday during his inauguration as professor of economics at Gadjah Mada University in Yogyakarta was a strong warning that without significant improvement in the living conditions of the people, the democratic process in the country will not be sustainable.

With decades of experience in political and economic issues, Boediono is highly competent in analyzing the links between poverty and the sustainability of democracy. He supported the conclusions of several economic studies that the country should reach some sort of middle-income threshold to be able to sustain democracy, citing a per capita income of more than US$6,000 on a purchasing power parity basis (PPP), as a strong foundation.

Since Indonesia's per capita income is still $4,000 on a PPP basis, the democratic process in the country could be highly vulnerable to political and social instability.

How does poverty threaten representative government in Indonesia, the world's third-largest democracy?

Democracy means little to the 40 million unemployed and underemployed people, and the 110 million who live on less than $2 a day. It means little to poor people such as unemployed university graduates who have nothing to lose. They are instead ripe for being exploited by radicals for causes they think would dramatically change the condition for their own good.

Mass poverty, income inequities are fertile soils for radical groups, whether religious- or secular-based ones. Democracy therefore must be supported by a broad-based social-economic development to make the process sustainable.

Chronic, absolute poverty, which increased last year by almost 11 percent, means an increasing number of people have become increasingly impatient about what they think as the failure of democracy to deliver better living conditions.

Economic hardships could play into the hands of religious and political extremists, as disillusioned people get more and more desperate, and radical ideas and solutions they used to reject sound more acceptable. Poverty and unemployment make people frustrated and make them highly vulnerable to being manipulated by extremists or radicals eager to organize the people's anger into a force that can sabotage the democratic system.

Hence, productive employment is key to reducing threats to democracy, because as long as people are content, there will not be the kind of dissatisfaction that can breed violence or militant extremists. If young people have work then they are busy and less likely to fall in with extremist groups.

Boediono's message warns that the failure to cope with poverty and unemployment could strengthen radical movements in Indonesia, thereby threatening its nine-year-old democracy and the path toward a market-based economy. Worsening living conditions also could foil military reform, which is a central component of the democratic process.

However, as Boediono also asserted, democracy is only one of the prerequisites for equitable economic development. The rule of law is another key factor, especially in a country such as Indonesia, which is still in a transition from three decades of authoritarian rule into a nascent democracy. The fact that the masses are accustomed to following authority has thus far left room for politicians to escape accountability.

The chief economic minister's observation should prompt the government to focus on equitable growth, the kind that generates a lot of jobs, because inequitable income distribution also threatens democracy.

The government has acknowledged that the quality of growth over the past five years has declined, in that one unit of growth produced a smaller number of jobs because investors tried to avoid labor-intensive businesses, citing the high costs of what they see as overly rigid labor regulations.

If this trend continues it will require an annual economic growth of more than 7 percent to absorb the unemployed and new job seekers entering the labor market annually. This is rather a bleak outlook because the economy grew only 5.5 percent last year, down slightly from 5.6 percent in 2005. It is projected to expand by only 6.3 percent this year. Even that target has been seen by most analysts as too optimistic, due to the slower-than-expected pace of economic reforms.

The strongest message of Boediono's observation about the link between per capita income and democracy is for the government to demonstrate stronger leadership in speeding up reforms, not only in the economy but also in basic infrastructure and public administration.

House backs 'de-radicalization'

http://www.thejakartapost.com/detailheadlines.asp?fileid=20070227.@01&irec=0
Headline News
February 27, 2007

Ridwan Max Sijabat, The Jakarta Post, Jakarta

The House of Representatives on Monday threw its weight behind a government "de-radicalization campaign" aimed at stopping the establishment of hard-line religious groups and countering terrorism.

In a hearing with Coordinating Minister for Political, Legal and Security Affairs Widodo A.S. here, members of the House's defense, political and foreign affairs commission also said the government should make a concerted effort to deal with poverty, unemployment and underdevelopment, which they said contributed to terrorism and violence in the name of religion.

Also attending the hearing were Home Minister M. Ma'ruf, Defense Minister Juwono Sudarsono, Maritime Affairs and Fisheries Minister Freddy Numberi, Indonesian Military Commander Air Chief Marshall Djoko Suyanto, National Police chief Gen. Sutanto and National Intelligence Agency head Syamsir Siregar.

"De-radicalization is urgently needed to improve the people's awareness of terrorism and ensure an understanding of religion and their teachings. The problem is not religions themselves but some of the people who claim to be adherents. Such a move will help the government win full support from the people to counter terrorism," the chairman of the House commission, Theo Sambuaga, said at the conclusion of the rare meeting with the ministers and security authorities.

During the hearing, the commission questioned what it called the "repressive approach" employed by the police in the pursuit of 29 wanted radicals in Poso, Central Sulawesi. It also asked about the progress in the hunt for fugitive Malaysian bombmaker Noordin M. Top, the prosecution of terrorist suspects and the possible execution of five terrorists sentenced to death for their involvement in the 2002 Bali bombings.

Many legislators also expressed their concern over a recent rise in air and sea accidents, and questioned whether it was possible terrorist attacks were behind any of the accidents. They said many people were now afraid to take planes, ferries or trains.

"From a recent tour of several provinces, we found many people have suspicions that terrorism is behind the increasing number of sea and air accidents. We got the impression that the government is seen as less than professional in managing the transportation sector and investigating accidents," Andreas Parera of the Indonesian Democratic Party of Struggle (PDI-P) said.

Other legislators asked the government to take concrete measures to lift more people out of poverty and give them jobs, saying the poor and disenfranchised were more at risk of being exploited by terrorists. They pointed out that most of the young people recruited by Noordin M. Top and slain terrorist mastermind Azahari were from poor families.

"Poverty, unemployment, underdevelopment, injustice and the skyrocketing prices of basic commodities are real threats to our internal security," Happy Bone Zulkarnain of the Golkar Party said.

The antiterror desk chief at the Coordinating Ministry for Political, Legal and Security Affairs, Ansyaad Mbai, said the government has enhanced cooperation with religious leaders, clerics and communal leaders to prevent the misuse of religious teaching to justify terrorist attacks.

He said the government has won support for the campaign from the two largest Muslim organizations in the country, Nahdlatul Ulama and Muhammadiyah.

Meanwhile, National Police chief Gen. Sutanto defended the police's handling of terrorist suspects, including the wanted radicals in Poso. He said the police had procedures in place to ensure the protection of human rights.

Outgoing WB rep in Jakarta says alternatives to CGI would be useful

http://www.thejakartapost.com/yesterdaydetail.asp?fileid=20070224.L01

Business and Investment - February 24, 2007

The Jakarta Post, Jakarta

While supporting the winding up of the Consultative Group on Indonesia (CGI), outgoing World Bank country director Andrew Steer said dialog and discussions with the international donor community will continue to be useful for the nation's development programs.

"I think it would be a pity if there is not some kind of a forum to discuss important issues. I mean, Indonesia does need to think about how to bring in trade, investment, ideas and technology," he said Friday on the sidelines of a farewell meeting with The Jakarta Post.

"It would be useful if it is replaced by something, not necessarily one big forum. It could be thematic forums on infrastructure, on education, on health," he explained.

He said that while ministers had made it very clear that dialog will continue, "down below in the bureaucracy, there is a bit of confusion."

The government has said it has no plans to set up any kind of formal or regular forum as a substitute for the CGI, though it has stressed that it will continue to engage in dialog with international lenders and donors.

"No, we consider it unnecessary to establish another forum. But we may hold informal discussion forums, like seminars," said Mahendra Siregar, the deputy for international economic cooperation at the Coordinating Ministry for the Economy, during a discussion Tuesday on the future of Indonesian government financing after the CGI.

In farewell remarks on Indonesia, Steer said he was optimistic about the nation's economy, saying it was on the right track to fully recover from the 1997 Asian financial crisis.

"When I first came here about 4.5 years ago, the No. 1 item on the budget was interest (payments on foreign debts)," he said. "Indonesia had to allocate more than 25 percent of the budget to pay interest. Now, it only allocates 10 percent," he said.

Steer also praised Indonesia's achievements in reducing the debt-to-GDP ratio from 100 percent in 1999 to the current figure of 38 percent.

"It is also a remarkable fact that Indonesia has now launched what may be the biggest educational reform in the world," he said, adding that the government had doubled spending on education over the last few years. "If it goes ahead, it could have a remarkable impact."

However, Steer said Indonesia must be able to speed up the building of roads, rail links, ports and power plants to attract investment and boost growth. "It would actually be very interesting to know why education spending has rapidly increased whereas infrastructure spending has not," he said.

Urgent humanitarian need in Papua

http://www.thejakartapost.com/yesterdaydetail.asp?fileid=20070224.F05
Opinion and Editorial
February 25, 2007

When Indonesia faces disasters which it cannot physically or financially deal with, such as the tsunami that ravaged Aceh, it looks to the international community for support, and that support is willingly given.

In the case of Australia, we send our most able disaster experts and medical teams to assist Indonesia immediately and unquestioningly. Tragically the lives of nine young Australian air force medical personnel were lost in the Nias rescue effort.

Now Papua is in need. Due to the current military operation underway in Puncak Jaya, thousands have been forced to flee their villages, to seek refuge away from their food gardens and now face critical shortages. A human, man-made tragedy rather than a natural disaster, despite Puncak Jaya being a relatively short distance from the world's most lucrative gold and copper mine, the U.S.-owned PT Freeport, and at the same time as flood-borne disease spreads in the republic's own heartland.

Yet in Papua, the international community is quarantined, prevented from providing humanitarian assistance and emergency food and medical supplies. Why is this so? How many will die because of Jakarta's intransigence?

According to the WHO's latest report on Indonesia, released recently, Papua now has a 2 percent HIV prevalence in the general community, a rate 20 times higher than the rest of Indonesia. Since the early 1990s, warnings of an impending AIDS pandemic in the indigenous population were ignored. Some believe it was deliberate policy to assist in Papua's depopulation.

While this claim is officially denied, illegal brothels, many linked to the security forces, continue to operate without clinical oversight and employ HIV-infected migrant prostitutes.

The arrival of bird flu in Papua last year was, though predicted, not prevented. There remain no effective quarantine measures at ports where the majority of migrants, livestock and produce enter Papua from other islands, mainly Java and Sulawesi.

Now the international community is again asking why Indonesia does not put the well-being of the indigenous Papuan population first, but is repeatedly told that Papua's problems are an "internal affair" which only Jakarta can solve in a "peaceful and just manner".

The usual rerun of Jakarta's defensive stance, that international attention focused on Papua's troubles is a conspiracy which threatens Indonesian sovereignty, is boring, outdated and irrelevant in the face of these crises. To continue to restrict access to this troubled place denies the reality of the magnitude of the problems facing the Papuan people.

JOHN WING
Australia

Should 30-something men share the bill on a date?

http://www.thejakartapost.com/detailheadlines.asp?fileid=20070225.@03&irec=2
February 25, 2007

On one occasion, I was introduced to a 40-year-old man by an acquaintance. I received a call inquiring whether it was OK to be introduced to him and to give him my number.

Without hesitation, I agreed. These days, I'm open to being introduced to any kind of gentlemen. That is something I would not have wanted 10 years ago.

"Hi Angel, this is Arnold. I got your number from *** ."

The first text message (SMS) came when I was having my hair done at a modern Jakarta salon.

"Oh hi," I replied and the SMS conversation continued for a while. After some time, there was no indication that he would prefer to call, especially to ask questions that shouldn't be asked by SMS, simply because an SMS reply would be too long.

At the end of the SMS exchange, he asked me to meet up to take in a movie.

It was not too much of a surprise that our first date would be at the movies, but the real shock came from his last SMS that day: "You can choose the movie and venue. I'll pick up the bill or do you want to share it? LOL" (Lots of love).

I was stunned. I didn't know how to reply and lost all interest to meet or get to know him.

A little voice inside me was saying "Does he actually want to take me out? If so, does he really want to pick up the bill or does he expect me to pay on our first date?"

In modern-day society, people acknowledge the existence of gender equality. Women are regarded as equals in terms of work (and salary?), their rights and the respect they are due.

In the old days, men were somehow considered superior to women -- the ones who were expected to protect women, including supporting them and paying for everything.

Fast-forward to the present and values have changed. Gender roles are more evenly divided and equality is more common.

As women started to have better jobs and occupy more senior positions at work, more and more women received a higher income.

In this regard, we used to think that the ego of men would be threatened by greater equality for women and their growing role in society.

Men do not feel as superior as they did before and women now have more power. How are men coping with this situation?

Within Indonesian culture, the gentlemen are the ones who usually pay for the ladies. In Western countries and elsewhere, men usually pay on the first date, women the next.

I've lived in three continents so far and have never seen a culture that expects women to pay on the first date. In this example, I really don't know which culture he had adapted to.

He said he used to live in the United States but, as far as I know, even there men still respect women by paying on the first date.

*****

I was on holiday in Jakarta when Nivo, 34, called me one Saturday and asked whether I would like to go out with him. He used to be my date a couple of years ago and happened to be on how own this time around.

Janice, a friend from Singapore, was staying with me, but since I was departing for Singapore the next day, I would have no other opportunity to go out with him, so I told him that I had a friend staying with me.

He said it was OK to bring her along, so we confirmed the time to meet.

At around 1 p.m that day, he showed up and took us for a barbecued seafood lunch. The food was delicious and Janice was really satisfied with it. Then, after we'd finished, we asked for the bill. The waiter brought it and gave it to Nivo.

He studied it for about three seconds and gave it to me. I was surprised when he handed it to me. In Indonesia, it is the custom that the guy will pay first and the woman will pay her share later.

Sometimes, the guy prefers to pay as a matter of pride. Adding to my surprise, he didn't even ask me how much he had to pay, even after he'd taken us home. He just said "thank you".

I was dumbfounded. Janice asked me later that night whether Nivo had paid, and I could only shake my head helplessly in reply.

She was surprised and said that probably he'd forgotten and might SMS me later as a matter courtesy. That night, no SMS came. In fact, I'm still waiting for it.

*****

A friend of mine (aged 32) told me that she was once out on a date with a guy (37). After the lunch, they were not sure where to go, so my friend suggested they go for a cup of coffee.

The guy she was dating said that probably they should just go to her house instead for coffee.

My friend was really shocked at his response. To her mind, not only was the guy stingy -- he also wanted a free coffee!

*****

These stories were a subsequent source of amusement for my friends and me. We just couldn't believe that not only were these guys calculating characters; it also seemed that they didn't even have the pride to be "the man" anymore.

Is this case with all men over 30 or did we just happen to have unlucky dates?

The truth is, although modernity means equality, deep down, women would still hope that the latter explanation was the real one.

(The names in this article have been changed to spare embarrassment)

-- Miss Twinky

Hidden Calorie Countdown

http://onhealth.webmd.com/script/main/art.asp?articlekey=52249&ecd=wnl_wlw_021707

Avoid sneaky calories that could wreck your diet

By Jennifer Warner
WebMD Weight Loss Clinic - Feature

Reviewed By Brunilda Nazario, MD

Could your morning bagel or afternoon pick-me-up be sabotaging your diet? Hidden calories in many of today's most popular foods can derail even the most dedicated dieter or health-conscious eater.

You may know about the 580-calorie Big Mac, but how about the 700-calorie cup of coffee and 590-calorie muffin? Or the 660-calorie salad with 51 grams of artery-clogging fat?

Those are just some examples of the worst offenders. But by learning the calorie count of some common grab-and-go foods and adopting some simple preparation and ordering strategies, experts say you can banish many of the biggest diet busters.

Breakfast: When a Doughnut Might Be Better Than a Bagel

Having just a bagel or muffin at breakfast may sound innocent enough, but dietitians say the size of those breakfast staples has basically tripled in recent years in many cases.

Muffins that were once the size of tennis balls now more closely resemble softballs, and bagels have grown from about four inches in diameter to more than six. Of course, that means the calorie counts have also risen exponentially. For example:

• Muffins. With 590 calories and 24 grams of fat, a Dunkin' Donuts Chocolate Chip muffin makes a 200-to-300 calorie doughnut look relatively healthy. Even the reduced-fat blueberry muffin packs 450 calories.
• Bagels. A traditionally sized bagel, like Lender's Original frozen bagels, has about 200-300 calories, but a fresh bagel from Starbucks or Dunkin Donut's now has more than 400 calories.

"People will say a bagel is a bagel, but you really have to focus on the size of that bagel and muffin. And you may just have to say that half of that big bagel is adequate," says Melanie Polk, MMSc, RD, director of nutrition education at the American Institute for Cancer Research.

Lunch: Choose Your Salad Wisely

Although fast food chains are now offering expanded salad choices at lunchtime, grabbing a salad at lunch isn't always a healthy choice.

"Just because it's called a salad doesn't mean it's low in calories," says Keith Ayoob, EdD, RD, spokesman for the American Dietetic Association. He says lettuce is low-cal and healthy, but it's what goes on top, such as fatty dressings, bacon bits, croutons, and crispy noodles, that can pile up the calorie count and fat quickly.

Take McDonald's Bacon Ranch Salad, for example. Choosing "crispy" (i.e. fried) chicken over grilled adds an extra 8 grams of fat and 100 calories (70 of them from fat). Top it with a packet of the Newman's Own Ranch Dressing that's offered with the salad and you've suddenly got a lunch calorie count of 660 and 51 grams of fat. At that rate, you'd be better off with a Big Mac, which weighs in at 580 calories and 33 grams of fat.

But Ayoob says there are ways to slim down the salad offerings at fast food restaurants and salad bars:

• Have the salad done "your way." Most people wouldn't think of ordering a burger with toppings they don't want, and the same goes for salads. "Just because it comes with a host of options doesn't mean you have to take all of them," says Ayoob.
• Explore different salad toppings. Try a new vegetable, such as hearts of palm, or options that add extra protein without a lot of fat, such as tuna, chickpeas, kidney beans, or a hard-boiled egg.
• Use cheeses sparingly. Sprinkle on a small amount of grated cheese for added flavor and volume without as much fat or calories as using cheese chunks or cubes.
• Adopt the "stab-and-grab" method. Order salad dressing on the side and use the "stab and grab" method of dipping your fork into the dressing before grabbing each bite. You'll end up using less dressing and still get flavor in every mouthful.

Snacks: Mega-Calorie Coffee and Triple-Sized Chips

Stopping at the vending machine or Starbucks for a mid-afternoon pick-me-up could end up costing you more calories than lunch if you're not careful.

A venti (that's large in non-barista speak) Mocha Coconut Frappuccino with whipped cream gives you much more than a java jolt with 710 calories and 26 grams of fat. If you're in the mood for something hot and sweet, a large café mocha with whipped cream at Starbucks will cost you 490 calories and the same 26 grams of fat.

But experts say it is possible to get your caffeine fix without breaking the calorie bank by following this advice when ordering:

• Ask for your beverage to be made "skinny." (That's with nonfat or skim milk.)
• Skip the whipped cream on top.
• Order the smallest size.

By applying those rules, you can slim down that café mocha to 170 calories and 1.5 grams of fat and get still 30% of the recommended daily amount of calcium and 11 grams of protein at the same time.

Or you can make your own iced coffee beverage by combining coffee, ice, skim milk, cocoa powder or cinnamon, and a packet or two of sugar-free sweetener.

At the vending machine, Polk warns that a bag of chips might contain more than you bargained for. Snack-sized bags that once contained only a single serving of potato chips are now up to two to three times bigger.

"Snacks have gotten bigger than ever," says Polk. "You really have to read that nutrition label and look at how many servings are included and look at the number of calories. For most people, once they have that bag open, they're going to eat the whole thing."

Dinner: Time for Portion Patrol

When it comes to eating a healthy dinner at a restaurant or at home, a little portion control can go a long way, says nutritionist Christina Stark, MS, RD, of Cornell University.

Stark says portions served at most restaurants are up to two and three time larger than the standard serving size, which is the amount of food that serves as the basis for standard nutritional information and calorie counts.

"A commonsense idea is that no matter how many calories are in a serving or a portion, half the serving is half calories," says Stark. So she says sharing main-course entrees at restaurants is always a good idea.

Other tips for avoiding hidden calories when eating out at dinner include:

• Take note of the portion sizes people are eating as you walk into a restaurant. If they look big, order accordingly. For example, order a salad and split an entrée with your dining partner.
• Ask for a half portion when ordering, or have the server bring a doggie bag at the start of the meal, divide your portion in half, and take the rest home for the next day.
• Beware of descriptions such as "crispy" or "crunchy" on a menu. That usually means the item was fried in fat. Other hidden-calorie code words that indicate fatty items include "creamy," "sautéed," or "braised in its own juices."

At home, Stark says a practical experiment is to try measuring out a serving size of some of the foods you eat on a regular basis, such as chicken, cereal, peanut butter, cheese, etc., at home to see what a single serving size really looks like. To find out what a standard serving size of a food is, read the nutrition facts label or check the USDA Web site, www.usda.gov/cnpp/Pubs/Brochures/HowMuchAreYouEating.pdf.

"Most people pick out the same bowl every morning and put in same amount of cereal without thinking," says Stark. "But before eating it, try pouring it into a measuring cup and see how it compares to the serving size printed on the side of the box."

Then she says, you can decide for yourself whether you need to adjust your portions.

Liquid Calories: Don't Belly Up to the Bar

Ayoob says liquid calories from spending too much time at the bar or lingering over a bottle of wine can also catch many dieters off guard.

The average calorie count of a glass of wine or bottle of beer is about 100-150 calories. Considering the average wine bottle contains about four glasses of wine, splitting a bottle at dinner easily adds 300 calories.

Aside from lowering your inhibitions and making you more likely to overeat, Ayoob says liquid calories are especially dangerous to diets for other reasons as well.

"There is evidence that when people take in liquid calories they don't tend to compensate by eating less of other things the way they do when they eat solid foods," Ayoob tells WebMD.

That means most folks have their drink and their dessert, too. To avoid that pitfall, Ayoob recommends:

• Order wine by the glass rather than by the bottle.
• Alternate alcoholic beverages with non-alcoholic ones, like club soda or water.
• Dilute your drink with club soda, such as a wine spritzer, to give yourself more volume with less alcohol.

By following this advice, experts say health-conscious eaters and dieters can avoid having hidden calories sneak up on them or their waistlines.

Published September 15, 2003.

Mind and Body Fitness for Lifelong Good Health

http://onhealth.webmd.com/script/main/art.asp?subject=mind_and_body_fitness

Use movement to explore the connection between body and mind.

By Shannon James
WebMD Weight Loss Clinic - Feature

Reviewed by Louise Chang, MD

Mind and body fitness? Many people who want to get into shape don't realize there is more to fitness than well-toned muscles. There's no shortage of exercise regimes that just promote the perfection of the body, or the idea of fitness as a part of a weight loss plan.

Centuries ago, Western culture lost its focus on the interconnectedness between the body and the mind or spirit, and how each has the power to affect the other. Cultivating a love of movement can help you get beyond the concept of physical fitness as separate from mental fitness – and toward a lifelong program of good health through mind and body fitness.

Whether you choose yoga or another form of movement for exercise, remember that our bodies are made to move to feel good. So when you incorporate regular activity in your life, you’re moving closer to overall mind and body fitness. But if you are overweight, this can be more difficult. You can improve your mind-body connection for better mind and body fitness – it’s just important to choose realistic fitness options.

You might consider redefining exercise as any activity that unites your mind and body and reduces your stress level. In fact, high levels of stress have been linked to weight gain, and certainly can lead to emotional eating. Finding activities that are both enjoyable and easy to do is important when developing any type of exercise plan.

It's important to be realistic about what we expect from ourselves. Consider your goals. Is 30 to 60 minutes on a treadmill a reasonable time frame at this point in your life? Are you setting yourself up for failure or success when you create this expectation for yourself? Would it be more enjoyable to you to do some stretching and a shorter period of time on the treadmill?

Developing an exercise plan that fits your lifestyle and your desires is critical. Surprisingly, long-term weight loss is linked more closely to whether a person sticks to their fitness routine than to what that routine actually consists of. A routine that is gentle and pleasurable is more likely to lead to the long-term gains you are seeking.

All-or-nothing thinking about exercise leads us to first bite off more than we can chew and then give up all together. Just walk into a gym in the month of January and try to get on a Stairmaster. There's a good chance you'll have to wait in line. But by March or April, there are usually plenty of free machines.

It is also important to tailor your fitness goals to your preferences. Some people like the idea of getting out of the house in the evening and going to the gym. Others prefer staying home and doing a quieter exercise routine after the demands of a stressful day. Either approach, or a combination of the two, can result in improved mind and body fitness.

What is critical is for you to come to know yourself and to take yourself seriously. If you like to be home in the evenings, find things to do in your home or consider an occasional walk with friends or family. If you crave the company of others, head for the gym. Think about what would please you most, and follow your inner voice.

Many people who are preoccupied with food and body issues tend to pay too much attention to the needs of others, while paying too little attention to their own needs. While you may intend to benefit your children with their countless activities, the added stress can cause an imbalance within your family. Can you take a look at your schedule (or your family's) and reschedule some time for yourself? What would it be like to say no?

Long-term weight loss can take time. And we can get demoralized when we don't see immediate results. But remember that maintaining an exercise routine is associated with physical as well as mental well-being. Where has our focus on the numbers on our scale gotten us? Some would say it has taken us to more harsh thoughts, more bingeing and grazing on food, and, ironically, less fitness rather than more.

It may be that the best exercise you can do right now is to throw your scale into the garbage. Focus on how you're feeling with your exercise routine. Is it something you enjoy and can maintain? Is it reducing your stress level and allowing a connection between your mind and body? If so, you'll probably keep it up, and fitness of mind and body and spirit will be yours.

Don't forget how important it is to see your physician before starting any type of exercise routine, and to following his or her recommendations. So try to be gentle with yourself and realistic about how to proceed.

There is tremendous confusion in our society about how to approach health and fitness. You may have tried losing weight before and failed. But consider the possibility that we as a society have not failed at dieting and weight loss. Rather, dieting has failed us as an effective tool for fitness.

Remember that fitness of mind and body belong together, and that exercise is very narrowly defined in our society. So redefine exercise as any activity that reduces stress and connects your mind and body. You'll be more likely to continue your exercise plan and achieve the outcome you're looking for.

Published February 2006.

Humanitarian agencies warn Darfur operations approaching breaking point

http://www.oxfam.org/en/news/2007/pr070129_darfur

Oxfam Press Release – 29 January 2007

African leaders, Ban Ki-Moon must take action at AU Summit or it could be too late

Aid agencies today warned the enormous humanitarian response in Darfur will soon be paralysed unless African and global leaders at the AU Summit take urgent action to end rising violence against civilians and aid workers. They said African Heads of States and new UN Secretary General Ban Ki-Moon will fail the people of Darfur if they do not take concrete steps to herald the start of a new chapter in the region and ensure an immediate ceasefire is both agreed and adhered to.

The six agencies – Action Against Hunger, CARE International, Oxfam International, Norwegian Refugee Council, World Vision and Save the Children – said aid workers are facing violence on a scale not seen before in Darfur, leaving access to people in need at the conflict’s lowest point at a time when the humanitarian need is greater than ever. Attacks on civilians are again rising and forcing even more people to flee their homes, and a breakdown of the aid response will leave millions in even greater danger. The worsening four-year-old crisis must not be allowed to deteriorate any further.

“The conflict has dragged on far too long and is now worse than it’s ever been. To wait any longer puts hundreds of thousands of lives in danger and risks a total breakdown of the entire humanitarian response. Today must be the time the African Union, the UN and the international community says enough is enough,” said Irũngũ Houghton, Pan Africa Policy Advisor for Oxfam in Addis for the Summit.

Fresh fighting in January has left more than 350 people dead* and forced tens of thousands more from their homes. Splits in the rebel movements and a widespread lack of accountability have left Darfur increasingly lawless, leading to the direct targeting of aid workers. The violence has spread throughout Darfur and crossed the border into Chad. Even major towns and cities are now plagued with violence and have seen fighting and hijackings on the streets.

More than a month after an attack on aid workers in Gereida – the most violent of the conflict so far, which saw staff raped, beaten and subjected to mock executions – it is still far too dangerous for agencies to return to the camp, the world’s largest for displaced people, where 130,000 have sought refuge from attacks on their villages. Temporary evacuations of staff from other locations across Darfur have continued, with nearly 500 aid workers withdrawn since the start of December. In early January, the UN warned that malnutrition rates are again rising close to emergency levels. Progress made in stabilizing conditions over the past four years is in serious danger of being reversed.

The six agencies warn the Summit will fail unless:

1. African Heads of States led by Chairperson Denis Sassou Ng’uesso and new UN Secretary General Ban Ki-Moon greatly increase the pressure on all parties to the conflict to ensure attacks on civilians and aid workers end immediately, and ensure that perpetrators of violence are held to account.

2. The African Union Commission does more to end the growing violent attacks. The AU’s credibility with the people of Darfur is at an all-time low. AU troops in Darfur must immediately try to regain the civilian population’s confidence by implementing the following proactive protection measures:

• Regular “firewood patrols” accompanying women who collect essential firewood and animal fodder outside the camps. Although previously in place these have now ceased in most locations in Darfur.
• A 24/7 presence inside the main camps and towns to ensure safety of civilians
• Making more effective use of the Ceasefire Commission to bring violators to account.
  

“The international community has failed the people of Darfur by not providing the AU force with the funds, equipment and support that it needs. But the AU can – and must – do more with the resources already at its disposal. There is no reason why firewood patrols cannot resume immediately,” said Hussein Halane, Save the Children Country Director in Sudan.

Aid agencies working on the ground in Darfur have repeatedly called for the AU force to be strengthened, but despite two years of promises from the entire international community, the AU is now providing even less protection than before.

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* UN/Sudan government figures

Contact

For more information, please contact:

At the Summit, in Addis Ababa:
Ismaila Dieng, +251 911079009, diengisma@gmail.com

UK:
Clare Rudebeck, Oxfam, +44 (0) 7769 887 139, crudebeck@oxfam.org.uk

France:
Sylvain Trottier, ACF, +33 1 43358224

Ethnic Chinese and discrimination: What next?

http://www.thejakartapost.com/detailheadlines.asp?fileid=20070216.A05&irec=4

February 16, 2007
Inter-ethnic relations remain a thorny issue in the country despite the enactment of last year's citizenship law, which criminalized discrimination and scrapped the "non-indigenous" citizen status. Ahead of the Chinese New Year The Jakarta Post's Kornelius Purba and Dwi Atmanta interviewed law expert Frans Hendra Winata and lawmaker Fahri Hamzah of the Prosperous Justice Party on the issue of inter-ethnic relations in Indonesia.

Question: Do you think discrimination against Chinese Indonesians still occurs here?

From a legal point of view, the issue of discrimination has been settled beyond doubt since the citizenship bill was passed last year. State does not tolerate at all any form of discrimination. But we have to acknowledge that social problems, be they the legacy of the past regime or a current phenomena, will always emerge and will involve elements of discrimination.

We can make improvements in the implementation of our political decisions and legislation, so that people will be aware of discriminatory practices and the heavy penalties they may face for violating the law. Apart from efforts to enlighten the public, there must be concrete measures to prove that perpetrators of discrimination will be punished.

When we decided to endorse the law, we thought about the future of this big and plural nation, which comprises 17,000 islands and thousands of ethnic groups. We realized then that discrimination would remain a lasting issue. The law is therefore the answer to skepticism about the commitment of the political elite to anti-discrimination.

The problem lies in implementation. The government is too slow to issue operational regulations; and officials in the field do not care much about discrimination. Educating officials is imperative, but it's more important that leaders be able to set a good example by drawing the line when it comes to attacks on ethnic groups or communal clashes. The government cannot take half-hearted action against discrimination.

On top of that, people have to realize that our plurality is a valuable asset. They must not be afraid of expressing differences or mingling with people of a different ethnicity or religion.

We need to prove to the world that Indonesia is the best example of inter-ethnic, inter-racial and inter-religious management. Indonesia could fare better than the U.S., which is known for its melting pot, in that sense. Our plurality is given and natural, not the result of migration.

How about ethnic prejudice against Chinese Indonesians, particularly when it comes to business?

It's a natural instinct. A sense of ethnicity cannot be denied. Intimacy based on ethnicity is a certainty, but we must know how far it can go. There is no problem if ethnic intimacy or exclusiveness prevails within a family. But problems can arise when ethnic intimacy reaches out into enterprises or public institutions. We cannot tolerate such practices, even in a family business, because they affect the public interest.

We are not intelligent enough to manage such an issue. Such practices actually break no law but they have emerged as a sensitive ethnic issue. That's what happens here. A businessman of a certain ethnicity runs a company and it turns out that he or she only employs people of the same ethnicity or pay them better than other employees of different ethnicity.

How do we overcome this prejudice?

First of all the law must be strictly enforced. But we have to develop ethics as a basis for our inter-ethnic relations.

While political democracy is well in place, we still need to consolidate our economic democracy. When the government launched a campaign for the use of biofuel, only certain businesspeople come up with bids to take part in the project. The recipients of trillions of rupiah in bank loans for the biofuel program are limited to old players.

Cultural democracy faces the same problem. Who dominates TV programs? We know the artists who star in TV serials are those with Western faces. Local cultures are dying, and global culture takes their place. Are we aiming to turn into an alien nation?

That's why the government has to make full use of its mandate to implement the law and uphold economic and cultural democracy. Do you see any progress in the fight against discrimination in the country after the reform movement of 1998?

The reform movement gave the government momentum to help people who are "disoriented" or unprepared for the fight against discrimination. There is a need to promote common sense and move in a progressive way to put an end to all forms of discrimination.

I think the most dangerous form of discrimination occurs between the central and regional governments. Despite the regional autonomy law, development still centers on Jakarta. Most regional governments survive from state budgets. The success of a regional government is measured by how much state money a governor, regent or mayor can bring back home from Jakarta.

Regional governments have been frustrated. People in the regions are like baby birds who are fed by -- and dependent on -- their hunting mother to survive. The Prosperous Justice Party has proposed an extension of the anti-discrimination law so that it can deal with discrimination against regional governments. How come after 61 years of independence, we still find people in East Nusa Tenggara dying of starvation?

Should we learn from Malaysia's protection of indigenous people?

Discrimination is totally unacceptable. Even Malaysia is facing problems as minority groups react strongly to that policy. What we need to do is look for the fairest playing field and formulate it together. All groups must feel they are given an equal opportunity. That will make us a big nation.

We need to forget the past and old grudges. What made Chinese Indonesians successful entrepreneurs were ancient rules that prevented them from running for political posts or nurturing careers in the police or military. But old vengeance recurred when some (Chinese Indonesian) business tycoons (accused of graft) showed their lack of nationalism by fleeing the country to escape justice, taking state money with them. That did not happen all of sudden, but as part of a long process. Therefore we need to give all groups equal room so we can have proper dialog.

Medical journal says decision to withhold H5N1 virus from WHO 'understandable'

http://www.thejakartapost.com/detailgeneral.asp?fileid=20070216145205&irec=0

February 16, 2007

JAKARTA (AP): Indonesia's decision to withhold samples of its bird flu virus from the World Health Organization unless an agreement is reached on commercial development of a vaccine is "understandable," a leading medical journal said.

Indonesia, the country hardest-hit by bird flu, is worried that large drug companies will use its H5N1 strain to make vaccines that will be too expensive for developing nations to afford in the event of a global pandemic that could kill millions.

It has reason to worry, the British medical journal The Lancet wrote in an editorial Thursday. It called on WHO to push for an international agreement ensuring that developing countries have access to future bird flu vaccines.

"To protect the global population, 6.2 billion doses of pandemic vaccine will be needed, but under current manufacturing capacity the world can only produce 500 million doses," it said.

"In a pandemic, it is industrialized countries that will have access to available vaccines, whereas developing countries where a pandemic is likely to emerge will be left wanting."

Last week, Indonesia signed a memorandum of understanding to provide U.S. drug manufacturer Baxter Healthcare Corp. with strains of its virus in exchange for technology to manufacture a vaccine.

Other organizations, including WHO, would only have access to Indonesian samples if they agree not to pass them on to commercial vaccine makers.

Indonesia's move was "understandable" and its concerns justified, The Lancet said. (**)