Selasa, 21 Oktober 2008

The facts from Cholesterol

Cholesterol travels in the blood in packages called lipoproteins, which consist of cholesterol (fat) and protein. Cholesterol packaged in low-density lipoprotein (LDL) is often called "bad" cholesterol, because too much LDL in the blood can lead to cholesterol buildup and blockage in the arteries. LDL carries most of the cholesterol in the blood.

Another type of cholesterol package is high-density lipoprotein (HDL), often called "good" cholesterol. That is because HDL cholesterol helps transport cholesterol to the liver, which removes it from the body, preventing build up in the arteries.

A third type of lipoprotein, very low-density lipoprotein (vLDL), transports triglycerides in the blood; high levels of vLDL and triglycerides have been linked to increased risk of heart disease.

All women should begin blood cholesterol testing at age 20, with testing repeated at least every five years, more frequently if there are other risk factors for heart disease.

An LDL cholesterol level of less than 100 mg/dL is considered optimal.

A healthy diet, healthy weight and regular exercise can all protect against heart disease and high cholesterol levels, while your age (over 55 for women) and family history may increase your risk of heart disease and high cholesterol.

If there is too much cholesterol in your bloodstream, it builds up in the form of plaque on the walls of your arteries, narrowing them and eventually blocking them and reducing the blood flow to your heart. This process increases your risk of a heart attack.

Reducing your intake of high-cholesterol food lowers your risk of heart disease, but it has less impact on blood cholesterol levels than cutting back on saturated and trans fats. Some people with high cholesterol levels do not respond to changes in diet, however. They will need medication.

A desirable total cholesterol level for adults without heart disease is less than 200 mg/dL. An HDL cholesterol level of 60 mg/dL and above is considered protective against heart disease, while a level less than 40 mg/dL is considered a major risk factor for heart disease, according to the National Heart, Lung, and Blood Institute.

If you have heart disease, an LDL level (the "bad" cholesterol) above 100 mg/dL is considered high and you and your health care professional should identify steps to bring your LDL-cholesterol level into a desirable range, including exercise, diet changes and medication

The facts from Cholesterol

Cholesterol travels in the blood in packages called lipoproteins, which consist of cholesterol (fat) and protein. Cholesterol packaged in low-density lipoprotein (LDL) is often called "bad" cholesterol, because too much LDL in the blood can lead to cholesterol buildup and blockage in the arteries. LDL carries most of the cholesterol in the blood.

Another type of cholesterol package is high-density lipoprotein (HDL), often called "good" cholesterol. That is because HDL cholesterol helps transport cholesterol to the liver, which removes it from the body, preventing build up in the arteries.

A third type of lipoprotein, very low-density lipoprotein (vLDL), transports triglycerides in the blood; high levels of vLDL and triglycerides have been linked to increased risk of heart disease.

All women should begin blood cholesterol testing at age 20, with testing repeated at least every five years, more frequently if there are other risk factors for heart disease.

An LDL cholesterol level of less than 100 mg/dL is considered optimal.

A healthy diet, healthy weight and regular exercise can all protect against heart disease and high cholesterol levels, while your age (over 55 for women) and family history may increase your risk of heart disease and high cholesterol.

If there is too much cholesterol in your bloodstream, it builds up in the form of plaque on the walls of your arteries, narrowing them and eventually blocking them and reducing the blood flow to your heart. This process increases your risk of a heart attack.

Reducing your intake of high-cholesterol food lowers your risk of heart disease, but it has less impact on blood cholesterol levels than cutting back on saturated and trans fats. Some people with high cholesterol levels do not respond to changes in diet, however. They will need medication.

A desirable total cholesterol level for adults without heart disease is less than 200 mg/dL. An HDL cholesterol level of 60 mg/dL and above is considered protective against heart disease, while a level less than 40 mg/dL is considered a major risk factor for heart disease, according to the National Heart, Lung, and Blood Institute.

If you have heart disease, an LDL level (the "bad" cholesterol) above 100 mg/dL is considered high and you and your health care professional should identify steps to bring your LDL-cholesterol level into a desirable range, including exercise, diet changes and medication

One boy's experience: ashamed and afraid

Thirteen-year-old Mukesh (not his real name) was visiting his aunt when an older boy from the neighborhood lured him to a secluded area and forced him to have sexual relations. Ashamed and afraid of the consequences of reporting the incident, Mukesh did not tell his parents. Nor did he ever indicate that the abuse had occurred more than once. But it likely had, based on the fact that he developed painful anal sores and lesions symptomatic of a sexually transmitted infection. Disturbed by those symptoms, Mukesh informed his brother, who brought him to a hospital for treatment.

Mukesh's experience occurs all too frequently. In studies conducted in India, urban, semi-urban, and rural male youth from both institutional and community-based settings not uncommonly report sexual coercion by male peers and older boys and men. (1) Approximately a quarter of 23 patients seeking sexual abuse treatment at a health care facility in urban Thane City, India, were boys between ages six and 16 years. (2) And a third of 811 higher secondary semi-urban and rural school students (mean age, 16 years) participating in a study in urban Goa, India, reported at least one type of sexual abuse in the previous year. Multiple types of abusive sexual experiences, involving both male and female perpetrators, were common. (3)

Gender norms in India create a situation that is conducive to such male sexual coercion. Compared with girls, boys are afforded much greater freedom of mobility and are questioned little about their whereabouts. Social taboos against boys congregating at "adaas" (local dens where boys meet) do not exist.

Yet, the sexual coercion that is more apt to occur under these conditions is associated with various harmful consequences for many male youth. The nature of the association is unclear but, compared with boys not experiencing coercive sexual relations, boys who have been forced to have sex have poorer educational performance, poorer physical and mental health, more substance abuse, poorer relationships with their parents, and more consensual sex. (4) Sexual abuse has been associated with some young men growing anxious about their sexuality, sexual identity, and how peers perceive them. Many adopt harmful behaviors (such as abusing drugs and alcohol) or engage in risky sexual behaviors (such as unprotected, casual sexual relationships), seemingly to prove their masculinity. (5)

Given the high prevalence of sexual victimization of males in some settings, educational programs for young men that promote healthy sexual attitudes and development are essential. Workshops conducted by trained peers, counselors, and social workers are also needed to address boys' anxieties about sexual behavior and to educate them about the health risks of coerced sex, such as sexually transmitted infections, including HIV.

In school settings, bullying and violence must be aggressively discouraged, and teachers and significant others need to learn to be sensitive to adolescents' and young men's sexual health needs and concerns. Male students should be informed of the risk of sexual abuse and be taught that it is not acceptable. They need to be encouraged to develop and maintain healthy relationships with peers. Special programs to teach parents and older members of the community how to communicate with adolescents and address issues of sexuality and reproductive health should be organized by community-based organizations. Finally, resource centers are needed in communities to provide youth-friendly sexual health information, counseling, and other related services for boys and young men, such as self-help groups for victims.

In one sense, Mukesh was fortunate. Doctors in the hospital's outpatient department had been taught to screen for sexual abuse and were prepared to provide immediate support and referrals for further counseling and sexual health services at the hospital's adolescent center.

Mukesh asked for outpatient services and was counseled to take advantage of them. However, like many boys in his situation, he did not return for follow-up. As a result, his medical condition was never diagnosed or treated at the hospital. Perhaps he did not return for economic reasons or--more likely--because of the shame and stigma associated with his abuse. As in most cultures, admitting that he had been a victim of sexual abuse by another male could well have called Mukesh's masculinity into question. Like many young men, he may have been more willing to risk his health than to have others doubt his masculinity.

Systems genetics of alcoholism

Alcoholism is a common disease resulting from the complex interaction of genetic, social, and environmental factors. Interest in the high heritability of alcoholism has resulted in many studies of how single genes, as well as an individual's entire genetic content (i.e, genome) and the proteins expressed by the genome, influence alcoholism risk. The use of large-scale methods to identify and characterize genetic material (i.e, high-throughput technologies) for data gathering and analysis recently has made it possible to investigate the complexity of the genetic architecture of susceptibility to common diseases such as alcoholism on a systems level. Systems genetics is the study of all genetic variations, their interactions with each other (i.e., epistasis), their interactions with the environment (i.e., plastic reaction norms), their relationship with interindividual variation in traits that are influenced by many genes and contribute to disease susceptibility (i.e, intermediate quantitative traits or endophenotypes (1)) defined at different levels of hierarchical biochemical and physiological systems, and their relationship with health and disease. The goal of systems genetics is to provide an understanding of the complex relationship between the genome and disease by investigating intermediate biological processes. After investigating main effects, the first step in a systems genetics approach, as described here, is to search for gene gene (i.e, epistatic) reactions. KEY WORDS: Alcoholism; alcoholism etiology; genomics; genetics; systems genetics; epistasis; gene gene interactions; genome-wide studies; biological epistasis; statistical epistasis; risk factors; protective factors; disease etiology; literature review.

Alcohol addiction is a complex disease that results from a variety of genetic, social, and environmental influences. Alcoholism affected approximately 4.65 percent of the U.S. population in 2001-2002, producing severe economic, social, and medical ramifications (Grant 2004). Researchers estimate that between 50 and 60 percent of alcoholism risk is determined by genetics (Goldman and Bergen 1998; McGue 1999). This strong genetic component has sparked numerous linkage and association studies investigating the roles of chromosomal regions and genetic variants in determining alcoholism susceptibility. To date, some of these studies have identified potential susceptibility genes. However, the complex etiology of alcoholism lends itself to further investigation that takes into account the multiple layers of interaction between genes within the context of both the genome and environment.

Systems genetics offers a new approach to studying the progression of multifaceted diseases such as alcoholism. This new and emerging field is the result of the synergy of disciplines such as bioinformatics, biotechnology, epidemiology, genetics, molecular biology, physiology, psychology, and statistics, all of which contribute to a more complete understanding of the interactions and functions of the entire genome with given ecological and sociological contexts. Detecting, characterizing, and interpreting gene-gene and gene-environment interactions as risk factors for alcoholism is an important first step in a systems genetics approach that combines genomimics (2) and proteomics (3) data with methods to understand how biological processes work together to determine human health. This approach does not, however, negate the need to look for variants that directly impact disease independent of interaction effects (main effects) within the data.

A complete review of all results from genetic, genomic, proteomic, and metabolic studies of alcoholism is beyond the scope of this review. This article focuses on recent literature involving studies of genes selected based on biochemical evidence for their role in disease (i.e., candidate genes) and genome-wide studies, followed by an overview of the interaction among genes (i.e., epistasis) and its current and potential application in the study of alcoholism. This article concludes with a discussion of several methods currently being developed that incorporate a systems approach to genetics and their potential applications for the future study of alcoholism.

ALCOHOLISM GENETICS: A BRIEF OVERVIEW

The genetic architecture of susceptibility to a disease such as alcoholism can be defined as (1) the number of genes directly or indirectly involved, (2) the interindividual variation in those genes, and (3) the magnitude and nature of their specific genetic effects. Alcoholism develops in susceptible individuals as a result of genetic, environmental (e.g., alcohol consumption), and social influences, as well as their propensity for risk-taking behaviors (Ramoz et al. 2006). Because of this complex etiology, multiple levels of information must be integrated to more completely understand the genetic architecture of alcoholism. In the progression of multifactorial diseases such as alcoholism, gene-gene interactions result in a variety of differentially expressed proteins. These proteins also interact, resulting in certain biochemical and physiological characteristics that, in the presence of certain environmental influences, result in alcoholism. Although studies of alcoholism's etiology have been successful in identifying a few candidate genes for susceptibility, interindividual variation in these genes accounts for only a small proportion of the overall heritability of the disease. Much of the remaining heritability is potentially due to DNA sequence variations, with effects that are dependent on contexts defined by the rest of the genome and the environment.

The Inner Entreprenuer

Starting a new venture within an established company can satisfy the entrepreneurial itch — without the risks of going solo. Learn how “intrapreneurship” can give your career, and your company, a boost.

Ever dream of leaving your middle-management job and striking out on your own? For a lot of people, the glamour of the start-up is tempered by the very real danger of losing your safety net — especially at a time when most folks are hoping the economic slowdown doesn’t claim the job they already have. Maybe you like your current employer, but you can see yourself — and the company — doing much more. In either case, you’re a prime candidate for “intrapreneurship”: the art of spearheading a new product, service, or other venture within an existing firm.

On the surface, it looks like a win-win situation. You get to follow your dreams without having to make the business equivalent of a Hail Mary pass, and the company broadens its business. But launching a start-up within an up-and-running concern is trickier than it looks. Company politics, battles about resources, and entrenched or unenlightened management can leave you dreaming once again of that start-up in the garage. Read on to learn the do’s and don’ts of intrapreneurship from successful innovators at big companies; get essential tips from a Wal-Mart veteran; find inspiration in our innovation hall of fame; and watch our video to find out what it takes to become an intrapreneur.

HIV/AIDS; Facts to Know

The CDC reports that 529,133 people have died from AIDS between the start of the epidemic in 1985 and 2004. In 2004, 45,514 people were living with AIDS in the U.S.

At the end of 2003, an estimated 1,309,000 to 1,185,000 people in the U.S. were infected with HIV, with about one-fourth unaware of their infection. Through 2004, 944,305 cases of AIDS had been reported to the CDC since the epidemic began, 178,463 in women.

Worldwide, more than 80 percent of HIV cases are the result of heterosexual intercourse. According to the Joint United Nations Programme on HIV/AIDS, as of December 2005, 40.3 million people were estimated to be living with HIV/AIDS. Of these, 38 million were adults, 17.5 million were women, and 2.3 million were children under 15.

During 2005, AIDS caused the deaths of an estimated 3.1 million people worldwide, including 2.6 million adults and 570,000 children under 15.

The overwhelming majority of people with HIV-approximately 95 percent of the global total-now live in the developing world.

HIV infection can be passed from a mother to her baby before or during birth and through breastfeeding. Among HIV-infected pregnant women who have not received any preventive treatment, mother-to-infant HIV transmission rates range from 15 to 25 percent in developed countries to 25 to 45 percent in developing countries, where an estimated 1,600 HIV-infected babies are born each day. However, when women and their infants receive the antiretroviral drug AZT and other drugs during pregnancy and delivery the risk of transmission drops to below two percent.

Many people report no symptoms when they are first infected. However, some people have initial symptoms, called acute retroviral syndrome or primary HIV infection. The symptoms are similar to those of mononucleosis-such as fever, fatigue, joint ache, headache and sore throat-and last for one to three weeks. When primary HIV infection is recognized, some experts believe that starting treatment at this point may help control progression of infection down the road.

One of the benefits of improved drug treatment for HIV infection is that people are living longer before developing AIDS. In fact, the drugs have allowed many people to stop taking preventive therapy for AIDS-defining opportunistic infections such as Pneumocystis jirovecii pneumonia and mycobacterium avium complex.

As of 2006, there were at least 26 FDA-approved drugs used to treat HIV infection. The drugs, which fall into four classes, are used in combination with each other to help prevent resistance.

The riskiest behavior when it comes to HIV transmission is sharing needles to inject drugs with someone who is HIV infected. The next riskiest behavior is anal sex, followed by vaginal sex. However, you shouldn't play the odds, because the virus can easily be transmitted in an isolated sexual incident. You should never have unprotected anal or vaginal sexual intercourse with anyone whose HIV status you are unsure of. And keep in mind that HIV is two to four times more transmissible to women as to men.

Learning From Nutrition Volunteer

Mary Zybura, food program specialist at the Food and Nutrition Service's Concord, New Hampshire, field office, has had a busy week.

On Moday, she worked on authorizing food stores to accept food stamps. Tuesday, she reviewed food stamp quality control cases. Wednesday, she met with respresentatives from farmers' markets. Thursday, she conducted store visits.

It's Friday morning now, and Zybura is talking about her experiences as a volunteer last year for a project sponsored by the American Home Economics Association (AHEA). The project places nutritionists, dietitians, and home economists in Head Start centers to provide nutrition education to young children.

Administered by AHEA throughout the country, the volunteer consultant program is an outstanding example of cooperation between private and public institutions. Through it Head Start and the AHEA work together to improve children's nutritional wellbeing. And volunteers like Mary Zybura demonstrate that individual contributions and personal commitment can make a difference.

One of 18 volunteers in New Hampshire

Zybura, a registered dietitian with a master's degree in elementary education, was 1 to 18 volunteers working in New Hampshire Head Start centers last year. She and the other volunteers were recruited and trained by Valerie long, a cooperative extension specialist in food and nutrition, who began the project in her state 3 years ago by writing a grant request to AHEA headquarters in Washington, D.C.

As Long explains, the project grew out of a need for more nutrition education at Head Start. "Nutrition is an integral part of Head Start," she says, "but the program cannot afford to pay for nutrition education consultants. So Head Start entered into an agreement with AHEA whereby AHEA would develop a training curriculum and recruit professionals.

"AHEA receives funding for the project from the private sector," she adds, "so there is no cost to Head Start."

When AHEA approved Long's request. She began accepting applications. "It was a selective process," she say. " I looked at education, volunteer experience, and what an applicant hoped to get out of the project. I was looking for people who were interested in working with the low-income population and who were creative in dealing with limited resources in a program like Head Start."

Long says that in the project's first year in her state, approximately half of the volunteers were dietitians with traditional, clinical backgrounds. The other half were home economics teachers. The second year, there were far more dietitians. While the project is not operating in New Hampshire this year, Long hopes to see it start up again in the future.

Recruits received special training

After selecting the volunteers, Long would conduct a 2- or 32-day training session. The training, for which volunteers received professional credits, acquainted them with the project and Head Start and focused on the nutritional needs of children, ways children like to learn, strategies for working with parents, and creative teaching methods.

After the training was completed Long would match up volunteers with Head Start centers, usually by geographic area. The volunteers would then contact their assigned centers to set up appointments with the directors. In joining, volunteers committed themselves to 30 hours of teaching. They visited their assigned center to conduct nutrition sessions approximately once a month.

"We weren't interested in people who just wanted the professional development credits provided as part of the training," says Long. "We recruited people who wanted to help, who had good skills, and who could give a lot to the program--people like Mary Zybura.

"Mary was perfect. She has wonderful skills. and the project gave her the opportunity to work directly with clientele--she is the typical profile of someone who has a very interesting job but one that doesn't provide this direct contact."

Zybura was indeed an ideal volunteer for the program. In the 1970's she taught first through third grades in Rhode Island. In 1978 she became a registered dietitian and, since joining FNS in 1979, has worked with USDA's food assistance programs, including the Food Stamp Program. This was especially helpful for her as a volunteer because the families of many Head Start children receive food stamps.

Beyond that, Zybura met Long's most stringent criterion--she wanted to help. "This was an opportunity to use my expertise as a teacher and a nutritionist to help low-income people," she says, explaining why she volunteered. "Teaching and working with children come very naturally to me, and I've always thought nutrition education needs to begin with little people."

Worked closely with Head Start staff

Zybura and other New Hampshire volunteers worked closely with the staff of their assigned centers. They coordinated their lessons with the instructors; they worked with the cooks on nutrition and food safety issues; and they planned their lessons to parallel New Hampshire's Head Start nutrition curriculum. They wanted to make sure their teaching was consistent with the curriculum and that the learning experience was a lasting one for the children.