Worldwide Doctor

BDV-119389-BDV

2009-05-10T16:50:00.001+08:00

This a tester post...... will back soon
BDV-119389-BDV

Winning Costumers in Online Business

2009-05-08T10:04:00.003+08:00

The basic rule of every business is we sell things to earn money. We can't expect any earnings if we don't make any sales, including when you try to involve in online business. There are so many business blogs that you can read on internet as a basic knowledge for starting business.

A business review written, winning customers is essential for the success of your enterprise. And this is absolutely true for online businesses. In fact, the entire world is your market, and you could potentially reach more people through the World Wide Web. However, the internet offers a more impersonal channel in our dealings with people, making it more difficult to gain their trust and favor. Promote your business to reach costumers as much as you want, This is the common way in the "World Wide Web" century. It's more cheaper than conventional marketing methods.

Winning customers is more than just luck. In the highly competitive world of online marketing, trust plays an integral role in achieving our goals. Try your best to win your customers' trust. Take care of it. And for sure, this trust would fuel good business for you for many years to come.

Simple Gift for Your Family

2009-05-07T09:01:00.006+08:00

Have you experienced very confusing when want looking for a gift for our family, especially for made them remember you everyday? May be, some of us think when we give a gift, it should be an expensive thing because of it should be “special”. I was one of the people that think like that.

Some times, we forget the meaning of gift. We forget the main goal of giving something to someone. We always forget about the useful of the thing that we gave to some one, and that will make them always remember us.

Have you thought about given coffee sleeves to you father in Father’s day, or mom agenda for your mother in Mother’s Day or even a personalized placemat for your baby on his first birthday? Simple but all that things are useful. They will use them everyday and that mean they could remember you every day. So, it will be better if we give something usefully.

International SOS - HIV Counselor, Assistance/ Operations Coordinator

2009-05-06T10:53:00.002+08:00

International SOS is the world’s leading provider of medical assistance, international healthcare, security services and outsourced customer care. The company was founded in Indonesia in 1984 and now employs over 4,000 people worldwide, with offices in over 65 countries. The company is aiming to accelerate the growth of the business across Indonesia. The company is aiming to accelerate the growth of the business across Indonesia. We are looking to appoint dynamic new talent to join our company in the following role:

HIV Counselor (Papua)
Responsibilities:
We require HIV Counselor to help us service our current customers and grow our business with them. In this challenging role you will support, develop and evaluate strategies that encourage community participation in activities. You will also responsible to make presentation and give counseling to community.

Requirements:

Bachelor Degree from Psychology , having experiences in related field will be advantage
Good English and Bahasa Indonesia language skills
Able to work individually and in tight schedule
Able to understand the issues and interests of the communities involved
A team work player with good interpersonal and good oral and written communication skills
Mature and pleasant personality with a strong personal drive
Willingness to be assigned to any of International SOS remote location all over Indonesia and abroad

Assistance/ Operations Coordinator
Responsibilities:
As Assistance/ Operations Coordinator you are part of our Alarm Center Team, where you will be put into situation that test all your skills. You may called upon to coordinate a member’s medical care abroad, support a team of professionals in the field or manage remote site service delivery.

Requirements:

Fresh graduated ( Academy/ University ) preferably with 1 (one) year or more experiences in telephone and administrative work, or customer service
Fluent English ( both written and spoken )
Computer literate ( MS Word, Excel )
Strong communication and interpersonal skills
Able to work independently on tasks at hand as well as in a team
Strong work ethic demonstrated by behavior, appearance, attitude and initiative
Flexibility to undertake new assignments to contribute to department improvements
Respect confidentially of company, medical and personal documentation
A high standard of administrative skills, correspondence in English and management of filling systems
Willing to work extra hours/ on shift schedule

If you meet our requirement above please send your application letter ( with CV and latest photograph ) to:
hrdsos_recruitment@internationalsos.com

Coffe Sleeve : Simple Idea multi million dollar business

2009-05-05T16:52:00.005+08:00

In 1991, Jay Sorensen, a gas station owner and part-timer real estate agent, has an experience that changes his life forever. While driving on the road, he spilled coffee in his lap and soon gave him inspiration for a new invention in hot beverage industries with disposable cups.

He comes with a unique idea for cardboard hearts fit-sized with standard drinking cup that allows consumers to keep them safe to drink their beverages without getting burned. His coffee cup sleeve, and this become his patent, is The Jay Jacket (later renamed Java Jacket).

Sorensen got a simple idea into a multi-million dollar family business. Currently, the business continues to grow and develop equal to more than 350 million cartons of beverages such as waffle sleeves sold. Sorensen's distribution has grown outside the coffee house to include convenience stores, borders book stores and other special shops throughout the country.

He is the first insulating coffee sleeves to go to coffee market. However, Sorensen has not been supported from the competition. His Portland-based family owned company offers a handful of outstanding employees dedicated to customer service combined with the aggressive market strategy have allowed for the Java Jacket, their coffee sleeve brand, remains the market leader.

Tamiflu para el tratamiento de la gripe

2009-05-05T08:01:00.005+08:00

"No tome Tamiflu a menos que tenga la gripe" Yo esta leyendo un periódico de Singapur que le ha enviado por mi amigo debido a spreadness de influenza porcina. En el artículo intenta la gente dijo acerca de cómo usar Tamiflu debido a la gente trata de almacenamiento en Tamiflu como profilaxis contra la gripe porcina. Una cosa que es necesario subrayar en este artículo es "Tamiflu no es una vacuna". Prescription significa que la droga no vacunar contra la gripe porcina a nadie, pero se destina para el tratamiento, especialmente dentro de las 48 horas de alguien infectado por el virus H1N1.

Tamiflu
Fármaco antiviral Tamiflu con la composición de oseltamivir fosfato. Cada cápsula contiene 98,5 mg de oseltamivir ophospate equivalente a 75 de oseltamivir. Tamiflu se presenta en cápsulas duras con una luz de color amarillo / tapa opaca y gris / cuerpo opaco.

Tamiflu está indicado para el tratamiento de la gripe en adultos y niños de 12 años y más.

Puede tomarse con o sin alimentos. Sin embargo, teniendo con los alimentos pueden mejorar la tolerancia en algunos pacientes. El tratamiento debe comenzar en el primer o segundo día de la aparición de los síntomas de la gripe. La dosis oral recomendada de Tamiflu es de 75 mg dos veces al día, durante 5 días.

Esta droga contaraindicated a las personas con hipersensibilidad a oseltamivir fosfato a cualquier componente del producto.

Común las reacciones adversas medicamentosas (RAM) asociados con el tratamiento con oseltamivir incluyen: náuseas, vómitos, diarrea, dolor abdominal y dolor de cabeza. RAM raras son: la hepatitis y el aumento de las enzimas hepáticas, erupción cutánea, reacciones alérgicas incluyendo anafilaxia y síndrome de Stevens-Johnson

(para más información, por favor acceda a la Wikipedia y en la web oficial de Tamiflu)

Tamiflu for influenza treatment

2009-05-04T08:30:00.007+08:00

"Don't take Tamiflu unless you have flu" I read this on a Singapore's newspaper that just sent by my friend due to spreadness of Swine Influenza. In the article try to told people about how to use Tamiflu due to people try to stocking up on Tamiflu as prophylaxis against swine flu or pig influenza. One thing that need to underline on this article is "Tamiflu is not a vaccine". It mean the prescrition drug will not inoculate anyone against swine flu, but is intended for treatment, especially within 48 hours of someone infected by H1N1 virus.

Tamiflu
Tamiflu is antiviral drug with composition of oseltamivir phospate. Each capsule containing of 98.5 mg oseltamivir ophospate equivalent to 75 of oseltamivir. Tamiflu is presented as hard capsule with a light yellow/opaque cap and grey/opaque body.

Tamiflu is indicated for the treatment of influenza in adults and children 12 years and older.

It may taken with or without food. However, taking with food may enhance tolerability in some patients. Treatment should begin within first or second day of onset of symptoms of influenza. The recommended oral dose of tamiflu is 75 mg twice daily, for 5 days.

This drug contaraindicated to person with hypersensitivity to oseltamivir phosphate to any component of the product.

Common adverse drug reactions(ADRs) associated with oseltamivir therapy include: nausea, vomiting, diarrhea, abdominal pain, and headache. Rare ADRs include: hepatitis and elevated liver enzymes, rash, allergic reactions including anaphylaxis, and Stevens-Johnson syndrome

(for more information, please access Wikipedia and Tamiflu's official website)

Porcina influenza (Spanish version of swine influenza)

2009-05-04T08:15:00.006+08:00

Porcina influenza (gripe porcina, la gripe porcina) es una enfermedad respiratoria de los cerdos causada por los virus de la influenza tipo A que causa brotes regulares en los cerdos. En lo general, las personas no obtienen la gripe porcina, pero las infecciones humanas y pueden hacer realidad. Porcina gripe A (H1N1) virus es contagiosa y se propaga de humano a humano, según se informó.

Al igual que la gripe estacional, gripe porcina en los seres humanos puede variar en gravedad, desde leve a grave. CDC, reportó entre 2005 hasta enero de 2009, 12 casos humanos de gripe porcina se detectó en los EE.UU., sin muertes que se producen. Sin embargo, la infección por la gripe porcina pueden ser graves. En septiembre de 1988, previamente sano de 32 años embarazada en Wisconsin fue hospitalizado por neumonía después de haber sido infectado con la gripe porcina y murió 8 días después. Un brote de gripe porcina en Fort Dix, Nueva Jersey se produjeron en 1976 que causó más de 200 casos con enfermedad grave y varias personas en una muerte.

Los síntomas de la gripe porcina en humanos son similares a los síntomas de la gripe humana regular, que incluyen fiebre, tos, dolor de garganta, dolores en el cuerpo, dolor de cabeza, escalofríos y cansancio. Algunas personas han informado de la diarrea y los vómitos con la gripe porcina. En el pasado, una enfermedad grave (neumonía e insuficiencia respiratoria) y se han reportado muertes con la infección por la gripe porcina en las personas. Al igual que, la gripe estacional, gripe porcina puede causar un empeoramiento de las condiciones médicas crónicas.

Propagación de esta especie porcina gripe A (H1N1) del virus se cree que está sucediendo en la misma forma en que se propaga la gripe estacional. Virus de la gripe se propagan principalmente de persona a persona a través de la tos o los estornudos de las personas con gripe. A veces, las personas pueden infectarse al tocar algo con el virus de la gripe y luego tocarse la boca o la nariz. Las personas infectadas pueden ser capaces de infectar a otros a partir del 1 º día antes de desarrollar síntomas y hasta 7 o más días después de enfermarse. Esto significa que podemos ser capaces de transmitir la gripe a otra persona antes de saber que estamos enfermos, así como al tiempo que estamos enfermos.

Para evitar la infección siempre recuerde lavarse las manos. Trate de mantenerse en buena salud general. Duerma bastante, mantenerse físicamente activo, gestionar el estrés, beber mucho líquido y comer alimentos nutritivos. Trate de no tocar las superficies que puedan estar contaminados con el virus de la gripe. Evite el contacto cercano con personas que estén enfermas. Algunos virus y bacterias pueden vivir 2 horas o más en superficies como mesas de cafetería, puertas y escritorios. Lavarse las manos con frecuencia le ayudará a reducir la posibilidad de conseguir la contaminación de estas superficies comunes.

Los gérmenes pueden propagarse cuando una persona toca algo que está contaminado con gérmenes y después toca sus ojos, nariz o boca. Gotitas de tos o estornudos de una persona infectada se mueven a través del aire. Los gérmenes pueden propagarse cuando una persona toca las gotitas respiratorias de otra persona en una superficie como un escritorio y después toca sus propios ojos, la boca o nariz antes de lavarse las manos.

CDC recomienda el uso de oseltamivir o zanamivir para el tratamiento y prevención de la infección por estos virus de la gripe porcina. Prescripción de medicamentos antivirales son medicamentos (pastillas, líquido o un inhalador) que lucha contra la gripe por el virus de la gripe de mantenimiento de la reproducción en su cuerpo. Si usted se enferma, los medicamentos antivirales pueden hacer más suave su enfermedad y hacer que usted se sienta mejor más rápido. También pueden evitar las complicaciones graves de gripe. Para el tratamiento, los medicamentos antivirales funcionan mejor si se inició poco después de enfermarse (dentro de 2 días de síntomas).

Las personas con infección por el virus de la gripe porcina debe considerarse como potencialmente contagiosas en la medida en que son sintomáticos y posibles para un máximo de 7 días siguientes a la enfermedad de inicio. Los niños, especialmente los niños más pequeños, podría ser potencialmente contagiosas durante períodos más largos

Pig Flu (Swine Influenza)

2009-04-27T16:57:00.007+08:00

source : Centers for Disease Control and Prevention

Swine influenza (swine flu, pig flu) is a respiratory disease of pigs caused by type A influenza viruses that causes regular outbreaks in pigs. In normally, people do not get swine flu, but human infections can and do happen. Swine influenza A (H1N1) virus is contagious and is spreading from human to human, as reported.

Like seasonal flu, swine flu in humans can vary in severity from mild to severe. CDC, reported between 2005 until January 2009, 12 human cases of swine flu were detected in the U.S. with no deaths occurring. However, swine flu infection can be serious. In September 1988, a previously healthy 32-year-old pregnant woman in Wisconsin was hospitalized for pneumonia after being infected with swine flu and died 8 days later. A swine flu outbreak in Fort Dix, New Jersey occurred in 1976 that caused more than 200 cases with serious illness in several people and one death.

Swine flu's symptoms in human are similar to the symptoms of regular human flu, that include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting with swine flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with swine flu infection in people. Like, seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

Spread of this swine influenza A (H1N1) virus is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose. Infected people may be able to infect others beginning 1 day before symptoms develop and up to 7 or more days after becoming sick. That means that we may be able to pass on the flu to someone else before you know we are sick, as well as while we are sick.

To prevent of infection always remember to wash your hands. Try to stay in good general health. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. Try not touch surfaces that may be contaminated with the flu virus. Avoid close contact with people who are sick. Some viruses and bacteria can live 2 hours or longer on surfaces like cafeteria tables, doorknobs, and desks. Frequent hand washing will help you reduce the chance of getting contamination from these common surfaces.

Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk and then touches their own eyes, mouth or nose before washing their hands.

CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with these swine influenza viruses. Antiviral drugs are prescription medicines (pills, liquid or an inhaler) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms).

People with swine influenza virus infection should be considered potentially contagious as long as they are symptomatic and possible for up to 7 days following illness onset. Children, especially younger children, might potentially be contagious for longer periods.

Pig Flu (swine influenza) : A new epidemiology case

2009-04-27T14:59:00.007+08:00

World were shocking with an influenza-like illness (ILI) that spread around the world. A deadly strain of the flu virus has killed people in Mexico and there are fears that it is spreading across North America.

As reported in World Health Organitation, Mexico has reported three separate events of influenza-like illnesses. In the Federal District of Mexico, surveillance began picking up cases of ILI starting 18 March. The number of cases has risen steadily through April and as of 23 April there are now more than 854 cases of pneumonia from the capital. Of those, 59 have died. In San Luis Potosi, in central Mexico, 24 cases of ILI, with three deaths, have been reported. And from Mexicali, near the border with the United States, four cases of ILI, with no deaths, have been reported.

Of the Mexican cases, 18 have been laboratory confirmed in Canada as Swine Influenza A/H1N1, while 12 of those are genetically identical to the Swine Influenza A/H1N1 viruses from California. The majority of these cases have occurred in otherwise healthy young adults. Influenza normally affects the very young and the very old, but these age groups have not been heavily affected in Mexico.

The majority of these cases have occurred in otherwise healthy young adults. Influenza normally affects the very young and the very old, but these age groups have not been heavily affected in Mexico.

Because there are human cases associated with an animal influenza virus, and because of the geographical spread of multiple community outbreaks, plus the somewhat unusual age groups affected, these events are of high concern.

The Swine Influenza A/H1N1 viruses characterized in this outbreak have not been previously detected in pigs or humans. The viruses so far characterized have been sensitive to oseltamivir, but resistant to both amantadine and rimantadine.

The World Health Organization has been in constant contact with the health authorities in the United States, Mexico and Canada in order to better understand the risk which these ILI events pose. WHO (and PAHO) is sending missions of experts to Mexico to work with health authorities there. It is helping its Member States to increase field epidemiology activities, laboratory diagnosis and clinical management. Moreover, WHO's partners in the Global Alert and Response Network have been alerted and are ready to assist as requested by the Member States.

Put Your Links For Free

2009-04-27T08:36:00.010+08:00

I'm in open hand to receive any link request to put in this blog. But, to prevent difficulties in access this blog (due to heavy contents), it will need a special page for the link. I made this posting as a solution for that problem. This will be a page for all link request. You just need to make a comment about this, and remember to put your link request in your comment, don't forget to give a little description about your link. Your link will be added in the posting as soon as I update this blog, and your comment will be deleted after that.

This posting will have a same function with "paid to review" posting. But, you don't need to pay me for that :).

Success for all of us......
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Golf is an Easy Game for All People

2009-04-22T08:54:00.007+08:00

Currently, golf is not a luxury game anymore. People can play golf in ranges that are spread everywhere, especially in developed countries. Both, mini-ranges or wide ranges are easy to reach. Anyone can play it, because it’s easy to play. We can found kids and their parents were playing golf in a mini range, and they looked enjoying the game.

Learn the game is not too difficult, the tutorials can be found at the courses in so many places, and the cost is also cheap. Or, we can also get the course by online through the internet at sites such as Golfkurs Platzreife , although it’s in Dutch, but with google translation, it will be easier to learn how to play golf in your own language. If you need an instructor beside you when learn the game, you just need to go to any golf ranges, they will provide to you an instructor. May be it will be difficult at the first, but when you understand the techniques and the principles, you will be a golf addicted.

At the past, we could only found the golf tools and equipments in a big store and those will be expensive stuffs. But now, we can get those easier in sport stores anywhere. The sport stores have made the golf tools and equipments as one of items that they must sell. We also can get it easily via online at the golf shops on the internet. We just access the golfshop and choose the tools and equipment that you need for playing golf. Beside that, you can book a golf range by using internet.

Who ever found this game should be proud with all the golf currently development. And he should thanks to Tiger Woods and other golf professional players that have made golf known by people around the world. It’s become a game for all people and a game that easy to play.

Hot tea can gain the risk of oesophageal cancer

2009-04-19T10:59:00.010+08:00

A study of a population in Northern Iran gives a conclusion that the hot tea has associated with a high risk of esophageal cancer . It reported for the first time on 27 March 2009 in the British Medical Journal (BMJ).

Farhad Islami, MD, from the Shariati Hospital, Tehran University of Medical Sciences in Iran, and colleagues writen that the relation between drunk hot drink and esophageal cancer risk has been reported in several studies from various parts of the world. "In Golestan, tea and water consumed by common people, compared with the average intake. An ecological research shows that the population of Golestan drink tea at a higher temperature than the people who live in neighbour areas with lower incidences of esophageal cancer" they reported.

The objective of this research is to evaluate relation between drinking tea habits in the province of Golestan in Northern Iran, which is a region with high incidence of squamosh cancer cells (SCC), and the risk of suffering the disease. Dringking tea habit and the temperature at which tea is usually drunk also determined for healthy people who are registered in the research. The researches were reporting that drinking hot tea, a common habits in the province of Golestan, is associated with a high risk of esophageal cancer.

Also the researches write that a large proportion of Golestans that drunk hot tea, then this habit can be counted as an important part of the esophageal cancer cases in this population. Informing the public about the dangers of drinking hot tea can help in reducing the incidences of the cancer in the Golestan and in a population that has a similar high risk due to teh same habit.

David C. Whiteman, from the Queensland Institute of Medical Research at the Royal Brisbane Hospital in Australia, recommended to tea to cool down the tea for 5 - 10 minutes before drinking. He added that mechanism of heat need to encourage the development of tumor explored further and may provide a better feedback about the basics of this discovery. This is not a warning, however, and this should not reduce the enthusiasm of people to respect the dringking tea ceremony. Instead, we must follow the recommendations resulting from this research is to take time 5 to 10 minutes between making and pouring tea, which will be enough provide a sense of good and not cause injury due to heat.

Té caliente Esofagus aumentar el riesgo de cáncer

2009-04-18T11:10:00.011+08:00

Un estudio de la población en el norte de Irán a la conclusión de que el té caliente estrechamente asociada con un alto riesgo de sufrir cáncer esofagus. Se ha informado de que por primera vez el 27 de marzo de 2009 en el British Medical Journal (BMJ).

"La relación entre el calor húmedo y esofagus el riesgo de cáncer ha sido reportada en varios estudios de diversas partes del mundo", informó por Farhad Islami, MD, del Hospital de Shariati, la Universidad de Teherán de Ciencias Médicas en Irán, y sus colegas. "En Golestán, el té y el agua son las bebidas consumidas por el público en general, en comparación con la media de la ingesta. Ecológico investigación muestra que la población de Golestán beber té a una temperatura superior a las personas que viven en zonas cercanas a la incidencia del cáncer esofagus inferior .

El objetivo de esta investigación es evaluar la relación entre los hábitos de beber té en la provincia de Golestán, en el norte de Irán, que es una región con alta incidencia de cáncer de células squamosa esofagus (carcinoma de células squamosh, SCC), y el riesgo de padecer la enfermedad. Té hábitos y la temperatura a la que el té es bebido por lo general también determinará para las personas sanas que están registrados en la investigación.

Beba té de aduanas se encuentran en los 300 pacientes que novijenkins histologis ha sufrido esofagus SCC en comparación con las 571 personas que sufrieron las mismas cosas en el ambiente de la vecina en un caso de control de estudios y 48.582 personas en el grupo de investigación novijenkins cohorte. Resultados de la investigación indican el final de la SCC esofagus con té hábito.

Hábito de beber té negro se informó en el 98% de los voluntarios, la media del volumen diario de más de 1 litro. Informó que la temperatura es inferior a 60 ° C en el 39,0% de los voluntarios, 60 ° C a 64 ° C en el 38,9%, y 65 ° C o superior encuentran el 22,0%.

En caso-control, el riesgo de padecer cáncer aumentó esofagus caliente para el té o el té es muy caliente en comparación con el té caliente. También aumentó significativamente el riesgo para el té 2 a 3 minutos después de verter, o menos de 2 minutos después de verter el té en comparación con al menos 4 horas después del vaciado.

"Beber té caliente, una práctica común en la provincia de Golestán se asocia con un riesgo elevado de cáncer esofagus", informó por los investigadores.

Limitaciones de esta investigación es la posibilidad de sesgo de información sobre la cantidad y la temperatura del té se consume, la investigación, la validación se realiza en personas sanas, la posibilidad de sesgo, y es que faltan algunos datos.

"Una gran proporción de Golestán que beber té caliente y, a continuación, este hábito puede ser considerado como una parte importante de la esofagus casos de cáncer en esta población", escriben los investigadores. "Informar al público sobre los peligros de beber té caliente puede ayudar a reducir la incidencia de cáncer en la Golestán y esofagus en una población que tiene un alto riesgo similar debido a un hábito."

En asistente editorial, David C. Whiteman, del Instituto Queensland de Investigación Médica en el Royal Hospital de Brisbane en Australia, se recomienda el té se enfríe durante 5 minutos antes de beberla.

"Mecanismo de calor necesario para estimular el desarrollo de tumor de estudiarse más a fondo y pueden proporcionar una mejor información acerca de los fundamentos de este descubrimiento", escribe el Dr. Whiteman. "Es significativo que esto no es una advertencia, sin embargo, y esto no debe reducir el entusiasmo de la gente respecto a la ceremonia del té. Por el contrario, debemos seguir las recomendaciones resultantes de esta investigación a meberikan de 5 a 10 minutos de tiempo entre toma y verter el té, que será suficiente proporcionar un sentido del bien y no causar lesiones causadas por el calor ".

Teamwork : We can find it in sports

2009-04-16T10:10:00.013+08:00

“Teamwork” is a new term, but the concept has existed since the beginning of living things. Teamwork is a concept of multiple individuals work together to accomplish a common objective.

We can find teamwork in sports, especially in team sports, and those are the most common and easier samples of teamwork. There is no such thing as a one person of basketball team or football team that works alone. A striker in soccer can make a goal without a support from his team. The team consists of many individuals working together against the opponent. Without teamwork, a volleyball team has no chance of getting their goal unless they are lucky, or their opponents aren’t any good. . Even for a cheerleader team, there must be a team work for making a good performance that will become a good support for the sport team.

Also in individual sports, such as boxing or tennis, a boxer can't beat his opponent without preparing him self. And to do that he need a good teamwork from his coach, manager, etc. Even their stuff's supplier for training is one part of his team.

So, teamwork is working, and it will be better when every team member puts in a same effort to reach the common objectives.

WHO Wants Money Spent on Making Hospitals Safe

2009-04-14T11:40:00.003+08:00

By Ben Blanchard

BEIJING (Reuters) Apr 07 - The World Health Organization launched a campaign on Tuesday to get countries, especially in disaster-prone areas, to spend more money on hospital safety to ensure buildings are not damaged when needed most.

WHO Director-General Margaret Chan said the cost of constructing, or retrofitting, buildings able to withstand earthquakes, floods or strong winds was insignificant when compared with the cost of having hospitals collapse in the midst of a disaster.

"In large emergencies, such as those caused by earthquakes, or floods, some countries have lost as much as 50 percent of their hospital capacity to respond right at the time when life-saving functions and services were most acutely needed," Chan told a news conference in Beijing.

"When a new hospital is built, construction specifically designed to withstand earthquakes and extreme weather events adds about four percent to the cost," she said. "This is a very small amount when you consider the huge investment in a hospital, and the huge investment lost when a hospital collapses."

The WHO pointed to disasters such as the 2004 Indian Ocean tsunami in which around two-thirds of health facilities in Indonesia's badly hit Aceh province were damaged. Pakistan and Algeria suffered similarly during recent earthquakes.

Hospitals were also damaged during last year's massive earthquake in southwest China's Sichuan province, in which approximately 80,000 people died.

"Experience in Latin America and the Caribbean shows that retrofitting a structurally sound facility will cost no more than one percent of the hospital's budget," Chan said.

"Abundant experience demonstrates the tremendous pay-off... when hospitals remain standing and functioning as beacons of security and solidarity in the midst of disaster and despair."

Stop Smoking Hypnosis

2009-04-10T11:02:00.009+08:00

Millions of people smoke, and to many, particularly those that have been smoking for some time, the prospect of quitting seems daunting. An addiction to nicotine is a serious one, and is multifaceted: there is a physical component, in that your body craves the nicotine the cigarettes contain, and a psychological one, in that many habits and situations become associated with cigarettes for the smoker.

For these reasons it is important that you come up with a plan of attack in order to quit smoking: although the cold-turkey technique works for some people, the vast majority of smokers will have success only with a more comprehensive plan. When you first consider the prospect of quitting smoking, it's probably going to seem far fetched, but keep in mind that thousands of people - people that are no different from you - quit smoking every year. If they can do it, there's no reason that you can't. Many smokers also feel that after a certain age it is "too-late" to quit smoking. Simply put, this isn't true, and should not be used as an excuse to avoid an attempt to quit smoking: the health benefits of quitting smoking begin the very day you stop.

Before you actually have your last cigarette, begin to build up your willpower. Your willpower is going to be your most important tool in quitting, and it's very unlikely that you will be successful without it. Spend some time thinking of the reasons you want to quit smoking. Learn about the health benefits of quitting, for both yourself and the people around you. Do some math and come up with some figures for the amount of money you'll save by not buying cigarettes, and think of something you'll use that money for.

Once you've built up your willpower, it's time to have your last cigarette. To keep your spirits up, understand that the human body is incredibly resilient, and your health will improve as soon as you stop smoking - literally. 8 hours after your last cigarette, carbon monoxide levels and oxygen levels in your blood stream will return to normal. At 24 hours after your last cigarette, you statistically reduce your chance of a heart attack. Only 48 hours after your last cigarette, your sense of taste and smell will improve as your nerve endings start growing. As you continue to stay smoke free, think of the longer-term benefits to quitting in order to keep your willpower up: even after 2 weeks your lung power will begin to increase, and continue to do so over time.

Other aspects of your health will continue to improve in various ways. The ultimate motivator should be the knowledge that 15 years after quitting, your risk of death is almost the same as someone who has never smoked - a remarkable fact that illustrates our the human body's surprising ability to restore itself. By coming up with a concrete plan to quit smoking you will greatly increase your chances of success. Crucial is understanding the important role that your willpower will play in the process, and planning to build up this willpower weeks before you attempt to quit. Once you've stopped you have to keep the strength of this willpower up, and to do so, remind yourself of the health benefits you will be privy to immediately after butting out that last cigarette.

About the Author
Abbas Abedi writes for http://www.instantstressmanagement.com.

Burn Calories To Lose Weight

2009-04-10T10:43:00.005+08:00

Do you depend on standard aerobic and cardio work for fat loss? If you do, you probably spend 30 minutes of exercise trying to burn a certain amount of calories. Does burning 500 calories a day cause you to lose one pound of weight per week? Well, according to statistics, it should. But if it did, you more than likely would not be still reading this article.

Here is a great fat loss tip I will uncovered.

Fiction: You have to burn at least 500 calories per workout to lose weight. Fact: One of the worst inventions to lose fat was the calorie counting stairmaster, exercise machines, and treadmills.

Millions of men and women are now obsessed about how many calories they burn per workout, because of these inventions. You're probably one of these people, watching every calories as it creeps up ever so often during a slow cardio workout. Without taking to mind that you can wipe out a thirty-minute, 300-calorie cardio session with one mouthful of a glazed donut. There are far too many people being mislead to believe that if they don't burn 300-500 calories per workout, then they will not lose weight. After all, isn't this what you've been told over and over again in those shinny stylish fashion/fitness magazines?

There are many problems with this kind of approach to weight loss. For the record, it's hard to tell if the calorie counter machines are even accurate enough. One story on CBS news proved that calorie counting machines overestimated calorie burning numbers up to twenty percent!

If you are still depending on slow cardio for progressive fat loss, you will find that it is relatively useless and at the very least, ineffective. It will take a long time for you to burn a large number of calories and one study has shown that men who only used cardio workouts for fat loss ended up with a lower resting metabolic rate. By only depending on cardio you will basically undo the calorie burning you are trying to achieve. On the other hand, men in the same study that used weight training did not undergo a lower metabolism.

So what is the recommendation to losing fat in a faster and more effective way? The answer is to use weight lifting and interval workouts to burn less calories in less exercise time, but with a high intense form of training.

Your body will burn greater amounts of calories after exercise using intervals than it would after doing slow cardio and your metabolic rate will stay high. A fair amount of experts call this method the "after burn effect". So how are you supposed to do intervals, you may ask? Well, you could do a sprint for thirty seconds and rest for ninety seconds and redo that for six sets - using the bicycle is preferred or the treadmill if you are familiar with it.

Within that short time span the interval training will cause your muscles to go wild with energy. I like to call it a metabolic turbulence. This insane metabolic boost causes lots of calories to burn after exercise to get your body back under control. The results will cause you to burn more calories and fat in the post exercise period as your body attempts to get things back to normal.

Now there is a single time that you would want to count your calories, but that is only when you are counting up to determining how many calories you take in per day. Remember, you can wipe out an entire calorie burning workout in less than one minute just by eating junk food. Without some discipline and structure in your nutrition, there is nothing that any program can do to help you lose weight. So there you have it, workout nutrition discipline and interval training. These are the two anti-calorie counting methods that will help you get lean by losing fat.

About the Author

James S. Wallace http://www.yourhealthevolution.com/

Hopkins Scientists ID 10 Genes Associated With a Risk Factor for Sudden Cardiac Death

2009-04-09T18:47:00.003+08:00

Dateline: BALTIMORE, March 22 (AScribe Newswire) —

One minute, he's a strapping 40-year-old with an enviable cholesterol level, working out on his treadmill. The next, he's dead.

That an abnormality in his heart's electrical system had managed to stay on the Q.T. — until it proved lethal — is characteristic of sudden cardiac death, which annually claims more than a quarter million Americans. A dearth of discernable symptoms and lack of detectable molecules circulating in the blood makes the prediction of sudden cardiac death largely dependent on genetic risk factors.

Having identified 10 common variants of genes that modify the timing of the contraction of the heart, known as the QT interval, scientists in the Johns Hopkins University School of Medicine, in collaboration with an international contingent of researchers, now provide new insight about the underpinnings of the QT interval which, when prolonged or shortened, predisposes to sudden cardiac death.

QT interval, which is determined from a standard electrocardiogram (ECG), reflects the time it takes for the heart (ventricles) to contract and then reset for the next heartbeat.

Publishing March 22 in Nature Genetics, the international team including researchers from the Technical University in Munich, Johns Hopkins and others, used DNA samples previously collected for epidemiological studies to analyze the genomes of 15,842 individuals whose QT intervals had been measured by electrocardiogram. With DNA microarray chips, each able to assess hundreds of thousands of markers in each sample, followed by bioinformatic techniques to increase the number of markers, the researchers screened approximately 2.5 million markers to detect subtle alterations in the sequences of these genomes that modify the QT interval.

By focusing on 2.5 million sites in a genome of 3 billion sites, the scientists surveyed one-one-thousandth of nearly 16,000 genomes. This relatively small but still extremely powerful screen correlates genomic architecture with QT intervals, according to Aravinda Chakravarti, Ph.D., a professor in the McKusick-Nathans Institute of Genetic Medicine.

These common variants at 10 locations across the genome represent perhaps dozens of yet-to-be-identified genes that affect this trait, Chakravarti adds. Of the 10, one that had been previously identified — Nos1ap — was confirmed. Several others were suspected culprits, the effects of which hadn't been demonstrated in preliminary screens.

However, almost half were surprising new genes that no one would have guessed as being involved in cardiac biology, says Dan Arking, Ph.D., an assistant professor in the McKusick-Nathans Institute of Genetic Medicine. So it really does open up a new world of investigation because these are genes that would have never come up if we had only focused on a list of known candidate genes.

A separate study, led by Christopher Newton-Cheh, M.D., M.P.H., of the Massachusetts General Hospital Center for Human Genetic Research and Cardiovascular Research Center , found similar results from more than 13,000 individuals. We were very reassured to see such strong replication in two independent studies, says Newton-Cheh.

While any single genetic variation in any one individual does not necessarily imply a significant alteration to QT interval, much less increased risk of sudden cardiac death, there is meaning that resides in the collective.

The power of this genetic analysis is a result of screening many thousands of samples, says Chakravarti: We're not very good at predicting what happens to any one, single sample. It's sort of like, I could examine in great detail how important my vote was in the last election, but it's trivial compared to the collective vote. An individual's genome is important as part of the study's whole, but individually, it's of little consequence.

Likewise, if scientists analyze the effect on QT interval by any one of the genetic variants, the alteration amounts to just a couple milliseconds, which is not a huge amount, says Arking: But if you put all 10 genetic variants together, that bumps up the QT interval by about 20 milliseconds, which is significant.

This latest study builds on research published in 2006, when a screen of 100,000 sites in individuals of European ancestry first showed that the Nos1ap gene is associated with the QT interval; and subsequent research showing that sequence changes in Nos1ap are also a risk factor for sudden cardiac death. A third paper, published in January 2009 in PLoS one, widened the original screen to include multiethnic populations; that study confirmed that Nos1ap genetic variants alter QT interval in all populations and, in fact, have a stronger effect in women than men.

The reason people die from this cardiovascular disorder is because we know nothing about the antecedents, Chakravarti says. It's like a truck barreling down a slope: there's no way to stop it. The only way out is to understand the science of this in a deep, meaningful way. If we know, we can begin to intervene.

The research was supported in part by National Heart, Lung and Blood Institute, National Human Genome Research Institute, National Institute on Aging, National Institutes of Health, Donald W. Reynolds Cardiovascular Clinical Research Center at Johns Hopkins University, German Federal Ministry of Education and Research, Fondation Leducq, State of Bavaria, Ministry of Health of the Autonomous Province of Bolzano, South Tyrolean Sparkasse Foundation, and the Heinz Nixdorf Foundation.

Authors of the paper, in addition to Chakravarti and Arking, are Georg B. Ehret, Anna Kottgen, W.H. Linda Kao, Josef Coresh and Man Li, Johns Hopkins University; Arne Pfeufer and Christine Happle, Technical University Munich, Germany; Serena Sanna, Gianluca Usala, Mariano Dei, Silvia Naitza and Marco Orru, Istituto di Neurogenetica e Neurofarmacologia, Cagliari, Italy; Martina Muller and H.-Erich Wichmann, Helmholtz Center Munich; Gerhard Steinbeck and Stefan Kaab, Klinikum Grosshadern, Munich; Goncalo R. Abecasis and Vesela Gateva, University of Michigan; Christian Fuchsberger, Peter P. Pramstaller and Andrew A. Hicks, EURAC European Academy, Italy; Siegfried Perz, Helmholtz Center Munich; Maja Barbalic and Eric Boerwinkle, University of Texas Health Science Center; Benno Putz and Bertram Muller-Myhsok, Max Planck Institute of Psychiatry, Munich; Angelo Scuteri, Istituto Ricovero e Cura per Anziani, Rome; Ronald J. Prineas, Wake Forest University School of Medicine; Samer S. Najjar and Edward Lakatta, National Institute on Aging; Thomas W. Muhleisen, University of Bonn; Stefan Mohlenkamp and Karl-Heinz Jockel, University Hospital of Essen, University Duisburg-Essen; and David Schlessinger, National Institute on Aging.

CONTACTS: Johns Hopkins Medicine Media Relations and Public Affairs: Maryalice Yakutchik, 443-287-2251, myakutc1@jhmi.edu or Audrey Huang, 410-614-5105, audrey@jhmi.edu

NOTE TO EDITORS: Video clips of Chakravarti and Arking are available at: http://www.hopkinsmedicine.org/Press%5freleases/2009/03%5f22%5f09. .html

ON THE WEB:

http://www.hopkinsmedicine.org/geneticmedicine/

http://www.nature.com/ng/index.html

Weight Loss is Key to Reduced Diabetes Risk

2009-04-09T10:51:00.003+08:00

The American Diabetes Association has just released a study showing definitively that the best strategy for preventing type 2 diabetes is weight reduction. Diabetes risk was lowered by 58% in people on the study-implemented weight loss regimen, as compared to no change for placebo subjects.

In the study, subjects randomized to the “intensive lifestyle intervention” (aka the Diabetes Prevention Program) or to a placebo group. For every kilogram of weight loss, there was a 16% reduction in risk. The study not only compared the lifestyle intervention subjects with placebo subjects, but additionally analyzed the effect of each lifestyle change within the lifestyle intervention group—weight loss, a reduced fat diet, and regular exercise—to determine which was the best predictor of reduced diabetes risk. While the actual weight lost served as the best predictor, and therefore was the key factor in type 2 diabetes prevention in the study, the researchers point out that the weight loss amounts to a highly correlated measuring tool for reduced risk, with real results grounded in the lifestyle changes that brought on the weight loss.

“Lower percent of calories from fat and increased physical activity predicted weight loss,” they write. “Increased physical activity was important to help sustain weight loss. Among 495 participants not meeting the weight loss goal at year 1, those who achieved the physical activity goal had 44% lower diabetes incidence.” (The weight-loss goal in the Diabetes Prevention Program was to reduce weight by 7%.) Thus, the weight loss predictor incorporates the other two predictors, making regular exercise and reduced fat diets vital to the fight against type 2 diabetes.

Targeting weight loss, then, ultimately means modifying your diet to include less saturated fats,and adding regular moderate exercise to your weekly routine. A total of 1,079 high-risk people, ages 25 to 84, participated in the study over a three-year period. Their mean age was 50 years. The mean body mass index (BMI) was 33.9 kg/m2. A BMI of 20 to 25 is considered healthy, with 25.1 to 30 indicating slight-to-moderate overweight, and over 30 qualifying as clinical obesity. (Visit www.bariatricedge.com to calculate your BMI.) All of the study’s subjects had a compromised ability to process glucose when they began the study, but had not yet developed type 2 diabetes. On the diet, fat intake was reduced to less than 25% of total calories.

The study represents an ongoing revision in focus in the literature from managing diabetes to
preventing it, and within that area of research, a de-emphasis on heredity and other risk factors,and an emphasis on proactive and definitively proven preventive techniques—namely weight management through a reduced fat diet and regular exercise.

(Diabetes Care, 2006, Vol. 29, No. 9, pp. 2102-2107; American Diabetes Association, www.diabetes.org)

Jobs for Medical Professionals on Blue Dot

2009-04-08T15:01:00.002+08:00

BLUEDOT, is the first health care consultancy and services company in Indonesia which provides the most complete health care services to the clients, such as employee health benefits consultancy; health insurance consultancy; managed care; third party administration; medical evacuation and repatriation and other assistance services; health care providers network (doctors, clinics, hospitals, pharmacies, clinical laboratory, optics, ambulances) and other services.

Paramedic
Requirements:
Candidate must possess at least a Bachelor’s Degree in Nursing, Pharmacy/Pharmacology, Medicine or equivalent.
At least 3 year(s) of working experience in the related field is required for this position.
Male, 28-35 years old
Certified Emergency Response for Trauma (Basic Trauma Life Support)
Certified Emergency Response for Cardiac (Basic Cardiac Life Support)
Certified for First Aid & Basic Life Support
Indonesia Manpower Ministry Occupational Health Certificate (Hiperkes)
Able to communicate in English (oral & written)
Computer skill
Certified in Medical Fitness

Medical Personel (Doctor)
Requirements:

Candidate must possess at least a Bachelor’s Degree in Medical Science
Male, 28-40 Years Old
At least 3 year(s) of working experience in Medical Emergency Response.
Certified Emergency Response for Trauma (Advance Trauma Life Support/ATLS)
Certified Indonesia Man Power Occupational Health (HIPERKES)
Certified Advance Cardio Life Support/ACLS
Able to communicate in English both oral and written
Computer Skill
Post PTT

Payroll Staff
Requirements:

Female, 23-28 years old
Having good knowledge in Taxation (PPh 21, PPh Masa, SPT)
Certified in Brevet Pajak A & B
Able to operate Microsoft Windows
Minimum 2 years experrience at Payroll Position
Able to work in a Team

Send your complete resume with certificate and recently photograph to:
PT Insan Dharma Nusa
Blue Dot Centre Blok K, L, M
Jl. Gelong Baru Utara No. 5-8 - Tomang
Jakarta Barat 11440
or email : bluedotgroup@yahoo.com or anastasia.reni@idn.co.id

Chain of Survival

2009-03-23T21:11:00.005+08:00

Chain of Survival is a procedure that uses to help a person with cardiac arrest. Contain of 4 chains that connected each other, and if we do the right, it will gain the rate of survival for injured person.

Early Access

Every person should know how to assess an emergency condition. Activate Emergency System by call the emergency Medical Services (EMS) to get rapid response and help. In a condition where there is no communication system around you, just shout out for help.

Early CPR

The first one who found the casualty should do rapid assessment and CPR as soon as possible, it's mean every one must know how to do that. An Early CPR could gain the survival rate.

Early Defibrillation

CPR will be more effective if combine with External Defibrillation. Rapid application of an Automatic External Defibrillation will gain the survival rate. AED is working to restore electric activities on hearth. Electric shock given to restricts the uncoordinated impulses in ventricle fibrillation. An AED can operate by anyone.

Early ACLS

Advance Cardiac Life Support (ACLS) is an advance life threatening that provide by medical personnel. A rapid medical personnel access to the casualty is an important thing life threatening efforts, that's why a rapid information/call to emergency services put in the first procedure and while waiting for EMS arriving, the witness or other one can make a first threatening (CPR and AED).

Cadena de Supervivencia

2009-03-23T21:09:00.005+08:00

Cadena de Supervivencia es un procedimiento que utiliza para ayudar a una persona con paro cardíaco. Contener de 4 cadenas que conectados entre sí, y si lo hacemos la derecha, va a ganar la tasa de supervivencia de la persona lesionada.

Principios de acceso

Toda persona debe saber cómo evaluar una condición de emergencia. Activar el Sistema de Emergencia por la llamada de emergencia de Servicios Médicos (SME) para obtener una respuesta rápida y ayuda. En una condición en la que no hay ningún sistema de comunicación a su alrededor, sólo gritar para pedir ayuda.

Principios de la RCP

El primero que encontró la víctima debe hacer una evaluación rápida y RCP lo antes posible, es decir cada uno debe saber cómo hacerlo. Una de las primeras CPR puede obtener la tasa de supervivencia.

Desfibrilación Temprana

CPR serán más eficaces si se combinan con Desfibrilación Externa. Rápida aplicación de una desfibrilación externa automática obtendrá la tasa de supervivencia. AED está trabajando para restablecer la electricidad en las actividades del hogar. Descarga eléctrica limita la posibilidad de que la falta de impulsos en la fibrilación ventricular. Un AED pueden operar por cualquier persona.

Principios de ACLS

Anticipo cardíacos Life Support (ACLS) es un anticipo de vida o muerte que ofrecen por el personal médico. Un rápido acceso a personal médico de la víctima es un importante esfuerzo en peligro la vida, por eso una rápida información y llamar a los servicios de emergencia puesto en el primer procedimiento y en espera de que lleguen SEMA, el testigo u otra se puede hacer una primera amenaza (CPR y DEA).

Traveling on high (Part 2) : High Altitude Illnesses

2009-03-20T14:31:00.007+08:00

(Taken from some references in internet, this article created by me when I was active on hiking few years ago, this in Indonesia Verson, hope can make it in english soon.)

PENYAKIT PADA PENDAKIAN

Telah dijelaskan sebelumnya mengenai kondisi-kondisi tubuh yang terjadi akibat adanya perubahan di lingkungan ketingian. Kegagalan tubuh dalam beradaptasi dalam peroses aklimatisasi dapat berakibat timbulnya berbagai gangguan atau penyakit akibat ketinggian.

1. Acute Mountain Sickness (AMS)
AMS merupakan representasi atas intoleransi tubuh terhadap hypoxia.AMS ini tergantung kepada ketinggian, kecepatan mendaki, seberapa lama eksposure, latihan dan kebugaran individual. Gejala AMS antara lain :

Sakit kepala, merupakan gejala yang paling sering muncul. Biasanya terasa sangat nyeri dan berdenyut di daerah bitemporal. Pada keadaan yang lebih buruk dapat timbul vertigo dan apathy.
Gangguan tidur (susah tidur), yang disebabkan oleh periodic breathing yang makin sering terjadi.
Fatigue (rasa lelah), akan semakin memburuk akibat gangguan tidur.
Napas yang tidak adekuat dan rasa pusing, akibat makin berkurangnya oksigen, dapat berlanjut pada dyspnea
Nausea dan anorexia (mual dan kehilangan nafsu makan), timbul sebagai akibat dari semakin berkurangnya nafsu makan atau bisa juga akibat dari kurangnya intake cairan. Muntah merupakan indikasi makin memburuknya keadaan penderita dan dapat berlanjut pada timbulnya dehidrasi.

Gejala-gejala ini biasanya mulai muncul ketika pendaki telah mencapai ketinggian 1000 mdpl.

AMS dapat diderita oleh siapa saja. Pria atau wanita, anak hingga orang tua memliki kemungkinan yang sama. Kondisi fisik yang bagus tidak terlalu menjamin untuk terhindarkan dari AMS. Kondisi fisik yang fit dan menghindari rokok dianggap dapat membantu mencegah AMS tetapi hal ini tidak selamanya benar. Orang dengan penyakit paru, jantung, dan hipertensi sebaiknya menghubungi dokter sebelum melakukan pendakian.

AMS dapat dicegah dengan mengatur pendakian yang memberikan waktu bagi tubuh untuk melakukan aklimatisasi. Walaupun kemampuan setiap orang untuk beraklimatisasi berbeda, tapi UIAA Mountain Medicine Centre memberikan standar untuk aklimatisasi, pada ketinggian diatas 3000 meter, pendaki harus tidur satu malam pada setiap pendakian setinggi 300 meter, dan setiap mencapai 1000 meter harus menginap paling kurang dua hari.

AMS dapat pula dicegah dengan mempercepat proses aklimatisasi, dengan jalan mengkonsumsi acetazolamid (Diamox) dengan dosis 125 mg setiap 12 jam, selama kita tidak melakukan pendakian (istirahat). Perlu diingat untuk beristirahat jika merasa lelah dan tidak melanjutkan pendakian selama terdapat gejala-gejala AMS.
AMS ditangani dengan jalan membiarkan penderita beristirahat dan pengobatan secara simptomatik, berikan oksigen jika tersedia, serta terapi cairan jika perlu. Tapi pengobatan yang paling baik dan cepat adalah segera turun sampai pada ketinggian dimana gejala-gejala menghilang, biasanya hingga 500-1000 meter dari ketinggian semula.

Pengobatan lainnya adalah memakai portable hyperbaric chamber (Gamow atau Pac Bag). Jangan pernah meninggalkan penderita AMS dalam keadaan sendiri.
Hindari mengkonsumsi zat sedatif (alkohol, antihistamin, obat tidur) selama pendakian, karena akan mempercepat timbulnya gejala-gejala AMS, bahkan bisa memperburuk keadaan penderita AMS.

AMS yang tidak disadari atau ditangani akan menyebabkan komplikasi yang lebih buruk. Komplikasi yang dapat muncul adalah High Altitude Cerebral Edema (HACE) dan High Altitude Pulmonary Edema (HAPE).

2. High Altitude Cerebral Edema (HACE)
HACE pada dasarnya adalah AMS yang memburuk. Penyebabnya adalah pembengkakan otak akibat akumulasi cairan.

Gejalanya dari HACE adalah perubahan mental atau gangguan berpikir, tingkah laku, dan perasaan mengantuk (letargi). Dapat pula ditandai dengan menurunnya sistem koordinasi anggota gerak penderita, dikenal dengan ataxia, yang mirip dengan keadaan seseorang yang berjalan dibawah pengaruh alkohol. Untuk keadaan ini dapat diuji dengan tandem gait test (jalan diatas garis lurus). Jika seseorang tidak dapat melakukan tes ini maka dapat dicurigai menderita HACE.

Penanganan HACE tidak ada selain segera turun hingga tempat dimana gejala bisa berkurang atau hilang sama sekali (seperti pada AMS), jangan pernah menunggu hingga pagi tiba. Penundaan dapat berakibat fatal. Pemberian obat simptomatis hanya akan mengurangi gejala yang timbul. Dexamethasone (steroid) dapat digunakan untuk mengurangi gejala yang timbul dengan dosis 8 mg i.m. atau peroral pada pemberian pertama dilanjutkan 4 mg setiap 6 jam berikutnya. Pada saat evakuasi bantuan oksigen dan kantong bertekanan sangatlah membantu penderita.

Setelah gejala mulai hilang penderita dengan HACE tidak diperkenankan untuk kembali melakukan pendakian sebelum mendapatkan perawatan dari dokter. HACE dapat cepat sembuh dengan sempurna jika turun secepat mungkin dan pada jarak ketinggian yang cukup.

3. High Altitude Pulmonary Edema (HAPE)
HAPE adalah penyebab kematian paling umum di ketinggian. Pada dasarnya, HAPE disebabkan akumulasi cairan atau darah di dalam paru-paru sehingga penderita mengalami kesulitan bernafas.

Tanda paling awal HAPE adalah menurunnya exercixe tolerance dan meningkatnya recovery time. Biasanya timbul batuk kering kadang disertai pink sputum (dahak bercampur darah), kuku dan bibir bewarna biru sampai abu-abu (cyanosis). Semakin parah, saat istirahat semakin sulit untuk bernapas (dada terasa sesak) dan kadang terdengar bunyi gelembung di paru-paru (gurgling). Nantinya berkembang menjadi perubahan mental, ataxia dan koma (HACE).

Situasi ini bisa ditolong dengan bantuan oksigen. Obat seperti Nifedipine (Adalat XL) juga terbukti efektif, 30 mg tiap 12 jam secara oral. Pemberian dexamethasone juga dapat membantu (sama dengan HACE). Cara yang terbaik adalah turun ke ketinggian lebih rendah. Situs Outsidemag.com beberapa waktu lalu pernah mengutip hasil penelitian di New England Journal of Medicine, dikatakan bahwa obat salmeterol yang biasa dipakai untuk asma ternyata juga mengurangi risiko HAPE. Bedanya dengan Nifedipine yang diberikan peroral, salmeterol ini bisa dihisap langsung sehingga cepat masuk ke paru-paru. Salmeterol ini adalah nama kimia untuk merek Serevent.

Jurnal medis Lancet menyatakan HAPE ternyata lebih sering menimpa pendaki dari yang diperkirakan semula. Dulu HAPE dipercaya hanya menimpa 2-4% pendaki yg berada di ketinggian lebih dari 2400 mdpl. Tapi riset terbaru menemukan bahwa 60 persen pendaki di gunung Monte Rosa (14.957 kaki) di daerah Alps ternyata menunjukkan tanda-tanda subklinik HAPE lalu 15 % lagi menunjukkan tanda klinik HAPE.

4. High Altitude Pharyngitis and Bronchitis
Dikenal dengan istilah "Khumbu Cough". Mereka yg menghabiskan waktu lebih dari 2 minggu di basecamp Everest biasanya menderita tenggorokan kering dan batuk kronis.

Saat bernafas cepat, sering melalui mulut, udara tidak dilembabkan seperti pada hidung. Udara yang dingin dan kering membuat tenggorokan dan saluran pernafasan kering sehingga timbul batuk kering. Kadang batuknya sangat parah sampai mencederai tulang rusuk. Pada dasarnya, bisa disembuhkan kalau turun. Pendaki ada yang mencoba trik seperti makan permen batuk sampai ke cara tidur dengan pake masker.
Penyakit ini akan hilang dengan sendirinya jika pendaki kembali berada di ketinggian normal.

Traveling on high (Part 1) : Acclimatisation

2009-03-20T13:58:00.012+08:00

(Taken from some references in internet, this article created by me when I was active on hiking few years ago, this in Indonesia Verson, hope can make it in english soon.)

Pendakian adalah sebuah kegiatan yang memberikan kesenangan terutama bagi mereka yang menyukai petualangan dan tantangan. Dibalik kesenangan dan tantangan tersebut terdapat resiko yang kadang harus ditanggung oleh pendaki, akibat dari perubahan yang terjadi di dalam tubuh sebagai kompensasi terhadap keadaan lingkungan.

Keadaan lingkungan pada pendakian yang dapat menyebabkan terjadinya perubahan kondisi tubuh, anatara lain :

- tekanan udara yang lebih rendah
- kadar oksigen menurun (SaO2 kurang dari normal)
- suhu yang rendah
- kelembapan udara meningkat
- tingkat radiasi sinar matahari yang tinggi

Perubahan-perubahan keadaan lingkungan tersebut akan terus berubah selaras dengan perubahan ketinggian. Ketinggian, oleh The International Society of Mountain Medicine, dibagi atas :

- High altitude : 1500 - 3500 m
- Very high altitude : 3500 – 5500 m
- Extreme altitude : > 5500 m

AKLIMATISASI
Sebagai usaha untuk beradapatasi pada keadaan lingkungan tersebut - terutama akibat kurangnya oksigen - tubuh mengalami aklimatisasi. Proses ini berjalan lambat dan kadang butuh waktu lebih dari satu hari. Perubahan fisiologis terjadi pada sistem pernapasan, peredaran darah, dan sitem tubuh lainnya dengan maksud meningkatkan distribusi oksigen. Aklimatisasi tergantung pada kecepatan pendakian, tingkat stress dan fisiologis individual. Kemampuan individu untuk beraklimatisasi juga berbeda.
Perubahan fisiologis (normal) yang terjadi akibat ketinggian :
1. Sistem respirasi
Saat naik, kecepatan bernafas kita akan bertambah pula. Ini biasa dimulai sejak ketinggian 1500M hal ini dikenal dengan Hypoxic Ventilatory Response (HVR). HVR bervariasi pada tiap orang dan dipengaruhi oleh stimulan (misalnya kafein dan coca), serta depresan (misalnya alkohol dan antihistamin). Kebugaran fisik tidak terlalu berpengaruh terhadap HVR. HVR yang baik akan meningkatkan aklimatisasi, HVR yang kurang baik akan memudahkan terkena penyakit ketinggian. Karena kecepatan nafas bertambah, semakin banyak oksigen (O2) yang dihirup. Tapi kita juga akan semakin banyak mengeluarkan karbondioksida (CO2) sehingga terjadi perubahan kimiawi dalam tubuh. Dalam waktu 24 sampai 48 jam, ginjal berusaha menyelaraskan dengan perubahan kimiawi tersebut dengan mengeluarkan bikarbonat (artinya kita akan semakin banyak mengeluarkan urin selama aklimatisasi).

2. Sistem sirkulasi
Ketinggian akan membuat tubuh dalam keadaan stress. Sebagai respon, adrenalin dilepaskan ke dalam darah. Akibatnya, muncul peningkatan ringan pada tekanan darah dan detak jantung. Semakin lama di ketinggian, detak jantung kembali ke tingkat normal. Volume plasma darah juga menurun akibat peningkatan urin. Penurunan ini bisa mencapai angka 15 % dalam tiga hari pertama aklimatisasi. Jadi sangat penting untuk minum banyak air sehingga tidak terjadi dehidrasi. Pulmonary vessel juga akan menyempit selama berada di ketinggian. Dampaknya terjadi tekanan pada arteri pulmonary dan menjadi satu faktor timbulnya pulmonary edema (cairan bocor ke paru-paru).

3. Pola tidur
Salah satu kontrol pernafasan adalah kadar karbon dioksida (CO2) dalam darah. Jika kadarnya meningkat, otak menyuruh kita bernafas. Kalau tingkat oksigen menurun, otak juga menyuruh kita bernafas. Saat kita bernafas dengan cepat di ketinggian, semakin banyak karbon dioksida yg dihembuskan -otak merasakan kadar yg rendah- secara spontan kita akan berhenti bernafas. selanjutnya kadar oksigen akan menurun dari tidak adanya nafas itu, otak menyuruh kita kembali bernafas sehingga kita bernafas dan menghembuskan lagi karbon dioksida. Jadilah seperti satu siklus yg tak berujung. Fase tak bernafas tadi bisa mencapai 30 detik atau lebih. Istilahnya periodic breathing dan sering terjadi selama aklimatisasi. Ini tentu bisa mengganggu pola tidur yg normal. Mungkin kita pernah tiba-tiba bangun karena merasa tercekik dan perlu bernafas sekali lagi. Saat aklimatisasi berlanjut, fenomena ini akan berkurang tapi tidak akan menghilang sepenuhnya.

4. Penurunan kondisi tubuh (deteriorasi)
Ketinggian 5800 M merupakan batas habitasi jangka panjang yang normal. Masalah pada ketinggian ini banyak, antara lain; turunnya berat badan, rasa cepat ngantuk/lemas, dan susah tidur. Semakin tinggi, penurunan-penurunan tadi semakin sering terjadi. Di atas 8000M (atau the Death Zone), penurunan terjadi secara cepat, bahkan kematian bisa terjadi secara tiba-tiba. Tak heran kalau pendaki Everest kebanyakan memakai suplai oksigen. Masalah turunnya berat badan adalah persoalan yang serius. Penyebabnya ada dua; turunnya selera makan dan susahnya menyerap nutrisi makanan. Selera makan ini turun sesuai ketinggian, makin tinggi makin turun selera makan kita. Tubuh kita saat itu juga cuma nyerap setengah dari lemak makanan serta tiga perempat karbohidrat dari kebiasaan normalnya.