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  1. 1. MISAMIS UNIVERSITY GRADUATE SCHOOLUPDATES ON: Air Pollution, Water Pollution, Stress, Exercise, Bio Statistics,and Epidemiology Submitted to: Prof. Maricar M. Mutia Submitted by: Reynel Dan L. Galicinao 02/26/2011
  2. 2. Air Pollution Claims 5,000 Filipino Lives Annually –JEFFERSON ANTIPORDA Manila Times July 14, 2010 A t least 5,000 Filipinos are dying every year because of pulmonary diseases caused by poor air quality in the country, a clean air advocate organization said on Tuesday. During a news forum held at Annabel’s Restaurant on Tomas Morato Street inQuezon City, lawyer Glynda Bathan of the Clean Air Initiative for Asian Cities said that their figure of5,000 was based on a study they conducted on effects of air pollution mostly caused by motorvehicles. Respiratory illnesses such as asthma, bronchitis and pneumonia as well as heart disease, areamong the results of prolonged exposure to air pollutants, which are fatal to very young and veryold individuals. Based on the study, pulmonary and respiratory illnesses are among the top 10 leadingcauses of mortality in the Philippines while heart disease is still the No. 1 killer in the country. Bathan said that her group has called the attention of President Benigno Aquino 3rd throughan open letter for his administration to make a priority the campaign against air pollution as he didthat on unauthorized use of blaring sirens and blinkers. The government in the past imposed measures to help eliminate if not minimize air pollutionin the country, including compulsory emission testing for vehicles, banning of incinerators andclosing of open dumps. Vehicles are the major source of air pollution particularly in Metro Manila while faultydriving habits and poor vehicle maintenance contribute to the increase in harmful pollutantsreleased into the air. The Coalition for Clean Air Advocates (CCAA) said that it will be offering free emission testingspecifically to public utility vehicles as their contribution to help promote the Clean Air Act. Henry Tan, the head of the CCAA, announced that they have started the free emissiontesting but have been implementing it on a voluntary basis. CCAA member Alex Loinaz reminded motorists to maintain their vehicles regularly by gettinga tune-up, changing oil and checking the radiator. He said that motorists should use their vehicles’ air-conditioning system only when needed,and to avoid overloading and engine idling for a long period of time.http://www.tucp.org.ph/news/index.php/2010/07/air-pollution-claims-5000-filipino-lives-annually/REACTION:The situation presented is very alarming.. Air pollution exacerbates, ifnot causes, some respiratory disorders. We see the rise in the number ofthese respiratory disorders such as asthma, pneumonia, and bronchitis. Thegovernment must employ measures to strictly implement the provisions ofthe Clean Air Act to minimize air pollution in the Philippines. Thevehicle owners must also be responsible in the maintenance of theirvehicles to avoid contributing to air pollution. Air Pollution & Pregnancy -Bob Hirshon for AAAS, the Science Society 2|Page
  3. 3. P olluting young minds. Exposing pregnant women to a common air pollutant may impact their childrens intelligence. Air pollution may adversely affect a childs intelligence—starting in the womb. This according to a new study in Krakow, Poland,led by Columbia University environmental health scientist Frederica Perera. Her team monitoredhealthy, non-smoking pregnant women for exposure to common air pollutants called polycyclicaromatic hydrocarbons, or PAHs. The children of women with higher PAH exposure scored lower oncognitive tests at age five. And thats of concern because of the link between such tests and futureacademic performance. The study controlled for such factors as the mothers education, and exposure tosecondhand smoke and lead. Perera says the only real way to reduce the risk of PAHs is to produceless of them, by burning less fossil fuel. Its obvious that air pollution can negatively impact peoples health—by aggravating asthma,for example, or in more extreme cases, contributing to lung cancer. However, this study shows thatthe effects of air pollution arent limited to those who actually breathe it in directly. Rather, it showsthese pollutants can find their way into a developing fetus, with measurable consequences later inlife. Polycyclic aromatic hydrocarbons, or PAHs, are a by-product of burning fossil fuels like coaland oil. Its hard to escape them entirely, but some areas have higher concentrations of PAHpollution than others. This study tracked pregnant womens exposure to PAH in two ways: First, theresearchers gave the women a small, backpack-mounted air sampling device, which they wore at alltimes during their pregnancy. Second, the women came in for regular checkups, and blood andurine samples were taken to look for chemical signatures of PAH exposure. The researchers continued to follow the womens children after they were born. At the ageof five, each child took a test of intellectual ability, similar to an IQ test. They then divided the groupof children in half, with those of higher prenatal PAH exposure in one group, and lower PAHexposure in the other group. High-exposure children scored worse on the cognitive test than closelymatched low-exposure children, even after accounting for many potential confounding factors,including PAH exposure after birth. The difference was small but statistically significant: the equivalent of about 2.8 IQ points.That may not seem like much, but consider that a small difference in a score on a standardized testcould make the difference between qualifying for a scholarship or not, getting into a particularcollege, and so forth. And the findings raise larger concerns about chronic PAH exposure, whichcontinues throughout ones life from both air pollutants (especially in urban areas) and dietarysources (like smoked or barbecued foods). On the flip side, if PAH pollutants can impact adeveloping fetus, it stands to reason that other environmental pollutants also may have a significantimpact in the womb.http://www.sciencenetlinks.com/sci_update.php?DocID=411REACTION:As presented in this study, air pollution not only affects the peopleinhaling the polluted air but also the fetuses inside their mother’s wombs.The study found out that it affects the intelligence of the babies. Thegovernment must enforce measures to prevent air pollution from factories,vehicles, and other sources. Fences reduce water pollution October 20, 2010 3|Page
  4. 4. T here are plenty of high-tech ideas to tackle pollution, but recent research suggests that some of the biggest gains in keeping our waterways clean could come from a more traditional technology – fences. Simply fencing off streams and drainage ditches so farm animals can’t deposit manure in andaround them could cut levels of faecal pollution dramatically, according to scientists. This wouldprotect the health of people exposed to river water and help Britain comply with EU rules on waterquality. The researchers created a model of the various factors that lead to faecal pollution – and theharmful bacteria it contains – in rivers. They then used the model to work out how effectivedifferent methods aimed at cutting faecal pollution would be, using the Humber river basin as acase study. Fencing off streams came out ahead by a big margin – the model suggests that by the timewater flows out of a region of intensive dairy farming, its E. coli concentrations would be 58.59 percent lower with fenced streams than without. As well as keeping animals away, the fencesencourage the development of an overgrown riverbank zone which can help filter out faecal matterthat’s washed off fields. This is just one of several possible ways to address the problem. ‘But animals having directaccess to the water seems to be one of the major risks,’ saysDanyel Hampson, a PhD student at theUniversity of East Anglia and lead author of the paper, published in Water Research. ‘The simplesolution of fencing off cattle from rivers is probably one of the most effective ways farmers have ofreducing faecal matter contaminating watercourses. From the farmer’s point of view, it is a solutionthat they can get on and do.’ Alternatives may be less effective, more expensive and more disruptive for farmers. Forexample, reducing the number of dairy cows in the area, the second-most-effective measure, wouldonly lead to an 11.58 per cent reduction. The third-most-effective, cutting fertiliser use by 20 percent to make grass less nutritious so that fewer cows can be kept on it, would cut bacterial rates byless than ten per cent. Both these measures would probably be much more painful for farmers. Human sewage and farm manure are the two main causes of faecal pollution in the UK.Improvements in sanitation mean the former is rarely a problem unless heavy rain overloads sewers.Manure from livestock, and especially from dairy cows, is now thought to be the main source ofpollution. This endangers people enjoying the water. Illnesses range from nausea and diarrhoea todebilitation and, in extreme cases, death. Contaminated water also does major economic damage;it’s estimated that exposure to polluted waters, as well as damage to shellfish beds and otherproductive areas, costs some $12 billion around the world each year. Britain doesn’t have such a culture of spending leisure time on rivers as some other nations,but stomach upsets caused by faecal pollution are all too familiar to canoeists and otherwatersports enthusiasts. Pollution can also affect bathers at coastal beaches near the mouths ofcontaminated rivers. In many rivers, there can be so much faecal pollution that a drop of 60 per cent or so will stillleave dangerous concentrations. An earlier piece of research, based on a study of water quality atBrighouse Bay on Scotland’s west coast, showed that bacterial levels in many rivers can be so highthat no feasible measures would be enough to make rivers comply with WFD requirements. Themain benefit of reducing faecal pollution in rivers is that bathers at nearby beaches will be at greatlyreduced risk. 4|Page
  5. 5. This earlier study, in Environmental Pollution, also provided empirical support for the newmodel’s conclusions; it concurred that stream-bank fencing was likely to be one of the mosteffective methods to tackle the problem. Others possible measures include taking more care whenstoring manure and applying slurry as a fertiliser. The model will also help policy-makers understand how responsibility for episodes of faecalpollution is divided between the agricultural and water and sewage sectors. ‘We need to find outexactly where the pollution is coming from,’ says Hampson. ‘Neither the wastewater industry northe agricultural sector wants to pay for dealing with this problem if it isn’t responsible for creatingit.’ The research was carried out under the Rural Economy and Land Use (Relu) programme byresearchers from UEA, the University of Wales in Lampeter, the University of Aberystwyth and theUniversity of Reading. Relu is a multidisciplinary research initiative bringing together research to illuminate thechallenges faced by rural areas due to environmental, economic and social change. It is a collaboration between the Economic and Social Research Council, the Biotechnologyand Biological Sciences Research Council and the Natural Environment Research Council, withfurther funding provided by the Scottish Government and the Department for Environment, Foodand Rural Affairs.http://planetearth.nerc.ac.uk/news/story.aspx?id=847REACTION: Water pollution is another major problem in our environment in thePhilippines. Although this study is done in UK, this method of reducingwater pollution can be useful in our country. Many people, especially inrural areas, still use the river to take a bath and wash their clothes.However, some farmers also bring their animals near the rivers to eat thegrass and drink water from it. This causes the increase in the number ofEscherechia coli in the rivers which makes the water dangerous forpeople. It can cause diarrhea, nausea and vomiting, and dehydration,among others, which may lead to death. The use of fences preventsthe animals from going close to the river and depositing theirmanure. People living near the river must also disciplinethemselves as not to throw human waste on the river or riverbanksthereby decreasing water pollution. 5|Page
  6. 6. Beach PollutionHow serious and extensive is beach pollution in the United States? P ast monitoring studies have shown that beach pollution is usually infrequent or confined to local areas. Problems can develop in areas near pollution sources after a heavy rainfall or when a sewage treatment plant malfunctions. Pollution can alsooccur from disruption or damage to wastewater collection and treatment infrastructure due tosevere natural events like hurricanes or flooding. There is not enough information available now to define the extent of beach pollutionthroughout the country. A few states have comprehensive beach monitoring programs to test thesafety of water for swimming. Many other states have only limited beach monitoring programs, andsome states have no monitoring programs linked directly to water safety at swimming beaches. What we do know is that beach pollution is a persistent problem, based on the number ofbeach closings and swimming advisories that continue to be issued annually. Nearly 4000 beachclosings and swimming advisories were issued by state and local governments in 1995. Mostproblems with beach pollution have been reported for ocean, bay, and Great Lakes beaches, butthese problems are not limited to coastal areas. However, we currently do not have access toinformation about the safety of swimming beaches at rivers and other lakes across the country. A primary goal of the Beaches Environmental Assessment, Closure, and Health (BEACH)Program is to work with state, tribal, and local governments to compile information on beachpollution to define the national extent of the problem.What are the primary causes and sources of water pollution at beaches? The majority of beach closings in the United States are due to indications of the presence ofhigh levels of harmful microorganisms found in untreated or partially treated sewage. Most of thissewage enters the water from combined sewer overflows, sanitary sewer overflows, andmalfunctioning sewage treatment plants. Untreated storm water runoff from cities and rural areascan be another significant source of beach water pollution. In some areas, boating wastes andmalfunctioning septic systems can also be important local sources of beach water pollution. Combined sewer systems are designed to carry both raw sewage and storm water runoff tosewage treatment plants. During heavy rainstorms, these systems can become hydraulicallyoverloaded and discharge a mixture of raw sewage and polluted runoff from streets into localwaterways. The discharges pollute water around the outfalls and at downstream beaches. Heavy rainfall can also hydraulically overload separate sanitary sewer systems which carryraw sewage to sewage treatment plants. This is especially a problem for systems with excessinfiltration of rainfall through the ground into leaky sanitary sewers and with large inflows fromsources such as roof drains connected directly to sewers. When flows exceed the capacity of thesystem, sewers can overflow and discharge untreated sewage from manholes and bypasses at pumpstations and sewage treatment plants. The discharges flow into local waterways and pollute thewater. People who swim in water near storm drains can become ill. A recent Southern Californiaepidemiological study, for example, revealed that individuals who swim in areas adjacent to flowingstorm drains were 50 percent more likely to develop a variety of symptoms than those who swimfurther away from the same drain. Swimmers who did not avoid the drains experienced anincreased risk for a broad range of adverse health effects. These include fever, nausea, andgastroenteritis; flu-like symptoms -- such as nasal congestion, sore throat, fever, and/or coughing--are also possible. Storm drains can even be a source of problems during drier weather because 6|Page
  7. 7. broken pipes or connections to sanitary disposal systems may contribute pathogens to the stormdrains.What harmful microorganisms can be found in polluted water and what illnesses do they cause? Polluted runoff and untreated sewage released into the water can expose swimmers tobacteria, viruses, and protozoans. These pathogens (disease-causing organisms) can be present at ornear the site where polluted discharges enter the water. Children, the elderly, and people withweakened immune systems are most likely to develop illnesses or infections after swimming inpolluted water. Swimming-related illnesses are typically minor. This means that they require little or notreatment, respond readily to treatment, and have no long-term health effects. The most commonillness associated with swimming in water polluted by sewage is gastroenteritis. It occurs in a varietyof forms that can have one or more of the following symptoms: nausea, vomiting, stomachache,diarrhea, headache, and fever. Other minor illnesses associated with swimming include ear, eye,nose, and throat infections. In highly polluted water, swimmers may occasionally be exposed tomore serious diseases like dysentery, hepatitis, cholera, and typhoid fever. Agencies monitoring for beach water pollution usually analyze the water samples theycollect for indicator species to assess the water for harmful levels of pathogens. Collecting andmeasuring the pathogens directly can be difficult and potentially hazardous. Good indicator speciesare microorganisms that are easy to collect and analyze for, safe to handle, representative of thepathogen of concern for characteristics like growth, and always present when pathogens arepresent or vice versa.http://water.epa.gov/type/oceb/beaches/pollution.cfmREACTION: Beaches are wonderful places to go and relax because of its freshair, clean water, and serenity. However, beaches are becoming more andmore polluted. As the number of people going to the beaches increase, thewastes left in the beach also increases. Some people living in theseashore also make the water a giant urinal and toilet. Some factoriesalso throw their wastes in the seas. This factors lead to beach pollutionand makes the water unfit and dangerous for swimming. The government mustcontinually monitor the safety of the seawater for swimming and implementmeasures to prevent water pollution. Beach-goers must also takeresponsibility by maintaining the cleanliness of the beaches. As one signsays “Take only pictures and leave only footprints.” 7|Page
  8. 8. Effects of Exercise and Stress Management Training on Markersof Cardiovascular Risk in Patients with Ischemic Heart Disease: A Randomized Controlled Trial JAMA. 293(13):1626-1634.Background O bservational studies have shown that psychosocial factors are associated with increased risk for cardiovascular morbidity and mortality, but the effects of behavioral interventions on psychosocial and medical endpoints remain uncertain.Objective To determine the effect of the addition of aerobic exercise training or stress managementtraining to routine medical care on psychosocial functioning and markers of cardiovascular risk inpatients with known ischemic heart disease (IHD).Methods 134 patients with documented IHD and evidence of exercise-induced myocardial ischemiawithin the past year were enrolled. Patients underwent mental stress testing and a cycle ergometerexercise stress test. Gated equilibrium radionuclide ventriculography was performed prior to andduring each of the stress tests to assess for segmental wall motion abnormalities. Flow-mediateddilation of the brachial artery, heart rate variability, and baroreflex sensitivity were also measured.Patients were then randomized to usual care, usual care plus supervised aerobic exercise training(35 minutes at 3 times per week), or usual care plus stress management training (1.5-hour weeklysessions). After 16 weeks, baseline measurements were repeated.Results 124 (93%) patients completed the study. Improvement in treadmill duration was 19% for theexercise training group, 9% for the stress management arm, and 1% for the usual care group.Patients in the exercise and stress management training groups showed lower depression scores,reduced distress scores, smaller reductions in left ventricular function during mental stress testing,and lower mean wall motion abnormality scores compared with the usual care group. These groupsalso showed significant improvements in flow-mediated dilation of the brachial artery versus thecontrol group. Only the stress management training group showed improvements in heart ratevariability and baroreflex sensitivity when compared with the usual care group.Conclusion This study showed that behavioral treatments provide added benefits to routine medicalcare in patients with ischemic heart disease. Patients who underwent 4 months of either aerobicexercise or stress management training showed improvements in psychosocial functioning, lessemotional distress, lower levels of depression, and improved markers of cardiovascular risk. This thefirst study to demonstrate favorable effects of stress reduction on vascular endothelial function.Comments This study was not designed to evaluate the effects of exercise or stress management onmorbidity and mortality, and improvements in the cardiovascular markers studied may notnecessarily translate to reduced clinical events. Nevertheless, this study adds to the body ofevidence regarding the beneficial effects of exercise and stress reduction in patients with IHD.Perhaps, future studies could look at the effects of alternative exercise regimen that also targetstress reduction, such as yoga, Pilates, and tai chi. These alternative exercise regimens may be moreattractive to some of our elderly, obese, or more debilitated patients.-SThttp://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=594794 8|Page
  9. 9. REACTION: This study added to the many studies showing the beneficial effectsof exercise and stress management. Indeed, exercise and stress managementhelps not only in healthy people but also people with diseases. In thestudy conducted, people with ischemic heart disease demonstratedimprovements in psychosocial functioning, less emotional distress, lowerlevels of depression, and improved markers of cardiovascular risk whenthey exercised and managed their stresses. People must be encouraged topractice these healthy behaviors for its many benefits. We as nurses canhelp by encouraging and educating our patients about the importance ofstress management and exercise to maintain health. 9|Page
  10. 10. APA Stress Survey: Children are more stressed than parents realize For the first time, APAs Stress in America survey included results of a survey of young people on what causes their stress and how that stress manifests itself by Public Relations Staff S tress related to school pressure and family finances has a greater impact on young people than parents believe, according to the American Psychological Associations (APA) 2009 Stress in America survey. Building on past research indicating that stress isa top health concern for U.S. high school students, psychologists say that if teens dont learn healthyways to manage that stress now, it could have serious long-term health implications. The third annual Stress in America survey polled 1,568 adults from around the nation on thestress in their lives and its effects. This year, for the first time, the report also included the results ofa YouthQuery survey among 1,206 young people aged 8-17 years old on what causes their stressand how it manifests itself, among other things. The surveys, conducted online by Harris Interactive on behalf of APA between July andAugust 2009, are a key component of APAs Mind/Body Health public education campaign. Thecampaign emphasizes the role of psychologists in health promotion and how they help people withbehavioral and emotional issues. APA released the survey on November 3 at a well-attended media event in New York City.More than 20 prominent outlets-most of which share the campaigns target audience of women andfamilies-attended the event, including the Wall Street Journal, Prevention, Self, Ladies Home Journal,Family Circle, Womens Day and Redbook. APA Executive Director for Professional Practice Katherine C. Nordal, PhD, healthpsychologist Helen Coons, PhD, and Barbara Roth, national director for youth and family programsat the YMCA of the USA, addressed the audience. The YMCA and APA are partnering to provide families with resources and strategies forhealthy living. The partnership addresses the impact individual behaviors such as healthy eating andregular physical activity can have on reducing risk factors for chronic diseases and managing stress.Roth spoke about the importance of family-strengthening activities, such as eating meals togetheror taking walks, to enhance communications in a family, ultimately helping to increase parentalawareness of kids stress and worries. According to the survey, many parents dont realize how stressed their children are. Nearlyhalf (45 percent) of teens ages 13-17 said that they worried more this year, but only 28 percent ofparents think their teens stress increased. And while a quarter (26 percent) of tweens ages 8-12 said they worried more this year, only17 percent of parents believed their tweens stress had increased. Similarly, only 2-5 percent ofparents rated their childs stress as extreme (an 8, 9 or 10 on a 10-point scale) when 14 percent oftweens and 28 percent of teens said they worry "a lot" or "a great deal." Parents responses about sources of stress for their children were out of sync with whatchildren reported as sources of worry. Children were more likely to say they worried about theirfamilys financial difficulties than parents were to say this was a source of stress for their children(30 percent vs. 18 percent of parents). In addition: 10 | P a g e
  11. 11.  Tweens (30 percent) and teens (42 percent) said they get headaches vs. 13 percent of parents saying that their children get headaches,  Tweens (39 percent) and teens (49 percent) cited difficulty sleeping vs. 13 percent of parents saying that their children have difficulty sleeping, and  Tweens (27 percent) and teens (39 percent) reported eating too much or too little vs. 8 percent of parents saying that their children eat too much or too little.http://www.apapracticecentral.org/update/2009/11-23/stress-survey.aspxREACTION: Stress is experienced by everyone. Not only among adults but eventeens and children. The study showed the various causes the stress of theyoung people. It also showed how stress manifests itself. Children arealso affected by the affairs of their parents including financial problems.The children’s stresses are often neglected or underestimated by theirparents. Teens and children also manifests stress by headache, difficultysleeping, and eating too much or too little. Parents must also listen totheir children and consider the stresses they are facing. We as nurses canassess the stresses of pediatric patients and help or facilitate them infinding ways to handle or resolve the stresses. 11 | P a g e
  12. 12. Effects of Prior Moderate Exercise on Postprandial Metabolism and Vascular Function in Lean and Centrally Obese Men J Am Coll Cardiol. 44(12):2375-2382.BackgroundObjective E ndothelial function is impaired after fat ingestion, the degree of which appears to be proportional to the increase in postprandial lipemia. It has been suggested that moderate exercise can reduce postprandial lipemia. The authors hypothesized that a session of exercise prior to fat ingestion can also attenuatethe impairment of endothelial function seen in the postprandial state. A secondary aim was toinvestigate whether these exercise-induced changes would differ between 2 groups of subjects withdifferent metabolic profiles.Methods Two groups of middle-aged men-10 centrally obese and 10 lean-were enrolled in the study.These subjects differed in insulin sensitivity and insulin-regulated postprandial glucose and lipidmetabolism. Subjects underwent 2 oral fat tolerance tests; subjects walked on a treadmill for 90minutes at an intensity of 50% of the maximal oxygen uptake before one test, and were sedentarybefore the other test (control). Endothelium-dependent and endothelium-independent forearmmicrovascular function was assessed using laser Doppler imaging.Results Exercise significantly reduced (by 25%) postprandial triglyceride concentrations in both thelean and centrally obese groups. Fasting and postprandial microvascular responses to acetylcholine(endothelium-dependent) were 25% and 15% higher, respectively, after exercise compared tocontrol. On the other hand, response to 1% sodium nitroprusside (endothelium-independent) wasnot different in the fasted state but was 20% higher postprandially after exercise compared tocontrol. Exercise-induced improvement in endothelial function did not differ between the 2 groupsand was sustained up to the day after a single exercise session.Conclusion This study showed that a single session of moderate exercise significantly improved smallvessel vasodilator function in both the fasted and postprandial states in centrally obese and leanmiddle-aged men. This effect was sustained up to 24 hours after exercise. This study suggests thatmoderate exercise is effective in attenuating many of the adverse metabolic and vascular changesseen after ingestion of dietary fat.Comments The novel finding in this study is that the beneficial effects of exercise on postprandialendothelial function can be sustained up to 24 hours after a single session of moderate exercise.Extrapolating this finding would suggest that moderate exercise performed regularly could result inmaintenance of endothelial health, which may impact on cardiovascular risk. Even inactive centrallyobese subjects were able to tolerate the moderate exercise session used in this study. As clinicians,we can use studies such as this in helping to motivate our patients to engage in an active lifestyle.http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=579564 12 | P a g e
  13. 13. REACTION: This study shows that moderate exercise is effective in attenuatingmany of the adverse metabolic and vascular changes seen after ingestion ofdietary fat. People must exercise to maintain physical health and achievethe many benefits of exercise. In the study, exercise was found toincrease metabolism thereby preventing weight gain. In today’s societymore and more people are becoming overweight and obese. We as nurses playa big role in educating patients and the public about exercise and itsmany benefits. We ourselves must be model of regular exercise and healthyweight. 13 | P a g e
  14. 14. Periodical Exercise Therapeutics Update & Commentary: Exercise and Cortisol Sports Med 823(2): 106Resistance exercise overtraining and overreaching: neuroendocrine responses P hysiological effects of weight training are not nearly as well studied as those of aerobic exercise. This lengthy article reviews the neuroendocrine responses to weight training and overtraining. Only the section of the article dealing with cortisol will besummarized. For the purpose of this article the authors will be defining overtraining as an increasein number of repetitions or number of circuits or amount of weight lifted, leading to strengthdecrements. Often this decrease in performance is accompanied by generalized fatigue. The direct stimulus for release of cortisol from the adrenal gland is ACTH(adrenocorticotropic hormone) from the anterior pituitary. ACTH is released due to CRH(corticotropin releasing hormone) from the hypothalamus. CRH is released regardless of the type ofstress, i.e. physical, emotional. traumatic, etc. This cascade of hormonal responses to stress isknown as the HPA axis (hypothalamic, pituitary, adrenal). Overtraining of any sort may lead todysfunction of the HPA axis. The release of cortisol in response to an exercise bout (moderate to high intensity foraerobic exercise and for all types of weight training bouts) is seen as beneficial. Cortisol is needed tohelp maintain blood glucose, while facilitating the metabolic shift towards greater fat oxidation. Typically, the greater the amount of weight being lifted (i.e. greater stress), the higher therise in cortisol during training. Moving to greater training volumes (more repetitions per exercise) orhigher intensities (lifting greater weights) too quickly, may lead to higher resting cortisol levels. Yetwhen weight lifting is undertaken, cortisol levels may actually decline during the exercise bout.Commentary: Cortisol is the classic "stress" hormone. Dr. Hans Selye, a pioneering stress physiologist,clearly established the essentiality of cortisol in allowing the body to withstand all types ofstresses.(1) Selye found that if the adrenal glands were removed from animals they would quicklydie, unable to deal with normal life stresses. It would appear that some amount of cortisol is beneficial during a stress (e.g. weighttraining bout), while too much cortisol can become detrimental. When the volume of weighttraining is too great, it appears that even during rest, cortisol blood levels remain high. Cortisol cancause muscle tissue to break down thereby explaining why strength might actually start to decreasewith higher levels of training (i.e. overtraining).http://www.encognitive.com/node/12817REACTION: A saying goes this way, “Too much of a good thing is bad”. That isproven in this study. Physical exercise has its many benefits. Weighttraining improves strength, endurance, and overall body physique. However,when the volume of weight training os too great, it becomes detrimental tothe body. Cortisol, the hormone released during stress, causes muscletissue to breakdown when it is in excessive amounts as a result of toomuch weight training or overtraining. We must do weight training regularlyand begin with lighter weights to prevent over exertion and fatigue to themuscles and excessive release of cortisol. 14 | P a g e
  15. 15. A Filipino family consumed 8.9 kg of ordinary rice a week (Results from the Family Income and Expenditure Survey (FIES) A ccording to the 2006 Family Incomeordinary rice was consumed byapproximately 15 million families at an and Expenditure Survey (FIES),average of 463 kg per family per year or8.9 kg a week (Table 1). Classified asordinary rice are regular commercialvarieties like C-4, Intan, Macan and IR-8.For special rice, the average consumptionby about 4.1 million families consuming itwas 329 kg per family annually, or 6.3 kga week. Special rice includes well-milledcommercial varieties of rice like Wag-wag(1st class), Milagrosa, Sinandomeng,Dinorado, 7Tonner and other fancy varieties. On the other hand, the average consumption byapproximately 2.2 million families for NFA rice was 255 kg per family per year or 4.9 kg a week. Meanwhile, a family belonging to the bottom 30 percent income group consumed 390 kg ofordinary rice in a year or a 7.5 kg weekly, on the average. This consumption is lower compared tothe average consumption of a family in the upper 70 percent income group which was estimated at494 kg a year or 9.5 kg a week. The average annual consumption of special rice and NFA rice byfamilies in the bottom 30 percent income group was almost the same (238 kg per family and 237per family, respectively). For families in the upper 70 percent income group, the annual averageconsumed was higher for special rice (343 kg per family) than NFA rice (273 kg per family). For the rice consumption byincome decile, the averageconsumption of ordinary rice rangedfrom 287 kg a year or 5.5 kg a week forthe first income decile to 500 kg a yearor 9.6 kg a week for the seventhincome decile. The consumption ofordinary rice by families in the eight tothe tenth decile income groups wassomewhat lower compared to familiesin seventh income decile, with anaverage annual consumption of 494 kgper family per year for the eight incomedecile, 498 kg for the ninth incomedecile and 492 kg for the tenth incomedecile. The average consumption ofspecial rice ranged from 183 kg perfamily a year or 3.5 kg a week for thefirst decile to 413 kg a year or 7.9 kg aweek for the tenth decile. Theconsumption of NFA rice was noted to be higher among families in the third income decile (285 kg ayear on the average) and fourth income decile (297 kg a year on the average) than among familiesbelonging to other income groups (Figure 2). 15 | P a g e
  16. 16. Source: Income and Employment Statistics Division (IESD) National Statistics Office Manila, PhilippinesPage last revised: December 29, 2010http://www.census.gov.ph/data/sectordata/sr10559tx.htmlREACTION: This study proves that rice is main staple food among majority ofFilipinos. 8.9 kg of ordinary rice is consumed by a Filipino family perweek. It is a mojor source of carbohydrates in a typical Filipino diet.The price of rice must be continually guarded by the concerned governmentagencies, that is Department of Trade and Industry and National FoodAuthority.. Rice supply must also be maintained by the government toprevent rice shortages, which has happened in the past, and overimportation leading to excessive rice supply in which some are alreadyunfit for human consumption due to the long storage period. 16 | P a g e
  17. 17. PHILIPPINE POPULATION WENT UP BY 12 MILLION PERSONS Date Released: November 25, 2010Total population grew by 2.04 percent annually A s of August 1, 2007, the Philippines had a total population88,566,732 persons, an increase of12,062,655 persons over the May 1, of2000 population count of 76,504,077persons. The 2007 census figure isalmost twelve times the Philippinepopulation in 1903 (7,635,426persons), when the first census wasconducted. The increase in Philippinepopulation translated to an averagepopulation growth rate (PGR) of 2.04percent annually during the period2000 to 2007. The annual PGRrecorded during the period 1995 to2000 was 2.36 percent. The household population of the country in 2007 was 88,304,615 persons, higher by11,991,134 persons from the household population of 76,313,481 persons in 2000. The number ofhouseholds, meanwhile, increased by 21.4 percent from 15,275,046 in 2000 to 18,539,769 in 2007.The average household size in 2007 was 4.8 persons, lower than the average household size of 5.0persons in 2000.Average household size of the country in 2007 was 4.8 persons The average household size in the Philippines in 2007 was 4.8 persons. Seven regions hadaverage household sizes higher than the national figure, namely: the Autonomous Region in MuslimMindanao (ARMM), 5.8 persons; Region XIII (Caraga), Region IX (Zamboanga Peninsula), and RegionV (Bicol), each with 5.0 persons per household; and Region X (Northern Mindanao), Region VI(Western Visayas), and Region VIII (Eastern Visayas), each with 4.9 persons per household.Meanwhile, the NCR had the lowest average household size of 4.4 persons.Males outnumbered females Of the 88,304,615 household population, 50.5 percent were males while 49.5 percent werefemales. This resulted to a sex ratio of 102 males for every 100 females, slightly higher than the sexratio of 101 males per 100 females in 2000. Regions VIII and XIII posted the highest sex ratio of 106each. Moreover, NCR, Region IV-A, and ARMM were the only three regions which reported morefemales than males, that is, with sex ratios of less than 100.Median age increased to 22 years In 2007, the median age of the countrys household population was 22 years, which meansthat half of the household population was below 22 years old. The median age in 2000 was 21 years.Median age was highest in the NCR (24 years) and lowest in ARMM (18 years). Children aged 0 to 4 years and 5 to 9 years comprised the largest age groups, each makingup 12.0 percent of the total household population, followed by age groups 10 to 14 years (11.6percent) and 15 to 19 years (10.5 percent). 17 | P a g e
  18. 18. The age-sex distribution of the household population showed more males than females inage groups 0 to 54 years. Females outnumbered their male counterparts in the older age groups (55years old and over).Higher proportion of females than males among the voting-age population At the national level, the voting-age population (18 years old and over)in 2007 numbered 51.1 million,accounting for 57.9 percent of the totalhousehold population. The size of thevoting-age population recorded in 2000was 43.4 million, or 56.8 percent of thetotal household population. There weremore females (50.1 percent) than males(49.9 percent) among the voting-agepopulation. The five regions with the highestproportion of voting-age populationwere all located in Luzon: NCR (63.6percent), Region I (59.9 percent), RegionIV-A (59.7 percent), and Regions II and III(59.6 percent each). ARMM had thelowest proportion of voting-agepopulation with 50.1 percent.Dependency ratio decreased to 66 dependents per 100 persons in the working-age group Of the total household population, 60.3 percent belonged to the working-age population (15to 64 years). Young dependents (below 15 years) comprised 35.5 percent while old dependents (65years and over) accounted for 4.1 percent. The overall dependency ratio of the Philippines in 2007 was 66 dependents for every 100persons in the working age group, down from 69 dependents in 2000. Of the 66 dependents, 59were young dependents while seven were old dependents. Across the country, 10 regions posted a dependency ratio higher than the national figure:Region V (83.7 percent), Region IV-B (83.0 percent), ARMM (80.6 percent), Region VIII (80.4percent), Region XIII (74.0 percent), Region IX (70.5 percent), Region VI (69.6 percent), Region X(69.3 percent), Region XII (67.7 percent), and Region VII (67.4 percent). NCR had the lowestreported overall dependency ratio of 51 dependents for every 100 persons in the working age group.More males than females among never-married Of the household population 10 years old and over, 45.3 percent were married while 44.3percent were never married. The rest of the household population was categorized as follows:widowed (4.3 percent), divorced/separated (1.2 percent), in common law/live-in maritalarrangement (4.5 percent), and had unknown marital status (0.4 percent). Among never-married persons, a higher proportion of males (53.8 percent) than females(46.2 percent) was reported in 2007. Meanwhile, the proportion of females was higher than malesamong married persons (50.4 percent), widowed (76.0 percent), divorced/separated (62.7 percent),and those in common law/live-in marital arrangement (50.7 percent). Across regions, CAR (47.4 percent) had the highest proportion of never-married personswhile Region II (51.9 percent) had the highest proportion of married individuals. Moreover, it is 18 | P a g e
  19. 19. observed that Region I (5.4 percent) reported the largest proportion of widowed while NCR had thelargest proportions of common law/live-in (7.3 percent) and divorced/separated (1.9 percent)persons.Females outnumbered males among academic degree holders Of the household population 5 years old and over, 36.7 percent had attended or completedelementary education, 32.5 percent had reached or finished high school, 8.0 percent were collegeundergraduates, and 8.6 percent were academic degree holders. Among those with academic degrees, there were more females (56.2 percent) than males(43.8 percent). Similarly, among those with post baccalaureate courses, females (56.3 percent)outnumbered males (43.7 percent). Moreover, the highest proportion of household population 5 years old and over who had notreached nor completed any grade level was in ARMM. Similarly, ARMM had a population with theleast proportion of academic degree holders (3.4 percent). The NCR had the least proportion ofhousehold population with no grade completed (3.7 percent) and the highest proportion withacademic degree holders (15.1 percent). The region with the highest proportion of householdpopulation with post baccalaureate course was CAR (0.3 percent) and the least was Region III (0.1percent).School attendance was higher among females than among males About three out of five persons (63.3 percent) in the household population 5 to 24 years oldhad attended school at anytime during the School Year 2007 to 2008. School attendance was higheramong females (64.0 percent of all females aged 5 to 24 years) than among males (62.7 percent ofall males aged 5 to 24 years) during the said school year. For the whole Philippines, the top five regions in terms of school attendance among persons5 to 24 years old during the School Year 2007 to 2008 were CAR (68.9 percent), Region V (67.2percent), Region VI (66.9 percent), Region I (66.0 percent), and Region IV-B (65.6 percent). ARMMhad the lowest in terms of school attendance with 55.5 percent.102 households per 100 occupied housing units In 2007, there were 18.2 million occupied housing units in the country. This number is 22.0percent higher than the 14.9 million occupied housing units recorded in 2000. A ratio of 102households per 100 occupied housing units was recorded in 2007, slightly lower than the ratio of103 households per 100 occupied housing units posted in 2000. The number of persons peroccupied housing unit was 4.9 persons in 2007, lower than the ratio of 5.1 persons per occupiedhousing unit in 2000.Majority of occupied housing units had outer walls and roof made of strong constructionmaterials Among the 18.2 million occupied housing units in the Philippines in 2007, the most commonconstruction materials used for outer walls were concrete/brick/stone (36.8 percent), halfconcrete/brick/stone and half wood (20.8 percent), and bamboo/sawali/cogon/nipa (19.8 percent).In 2000, the most common construction materials used for the outer walls wereconcrete/brick/stone (30.8 percent), bamboo/sawali/cogon/nipa (22.8 percent), and wood (22.7percent). As to the construction materials of the roof, 75.0 percent of occupied housing units hadroofs made of galvanized iron/aluminum in 2007. In 2000, galvanized iron/aluminum was also themain construction material used for the roof with 67.6 percent of all occupied housing units in thecountry. Source: Household Statistics Department 19 | P a g e
  20. 20. National Statistics Office Manila, PhilippinesPage last revised: December 15, 2010http://www.census.gov.ph/data/pressrelease/2010/pr10162tx.htmlREACTION: The article discussed about the population in the Philippines.Our population is obviously on the rise and if it continues thisway, there might come a time where the resources would not beenough for every Filipino The rise of the population would mean anincrease in poverty.. It is now the proper time to pass theReproductive health bill in order to halt or slow down the increaseof our population. We as nurses can serve as advocates for maternalhealth by promoting contraception and presenting the choice to thecouple for them to decide which method would be ideal for them. 20 | P a g e
  21. 21. Epidemiology of Tuberculosis C Robert Horsburgh, Jr, MD, MUSIntroduction A n understanding of the epidemiology of tuberculosis (TB) is critical for effective control. The global burden of tuberculosis, risk factors for transmission, and the epidemiology of tuberculosis in the United States will be reviewed here. Theepidemiology of drug-resistant tuberculosis is discussed separately.Global Burden More than 2 billion people (about one-third of the world population) are estimated to beinfected with tuberculosis. The global incidence of TB peaked around 2003 and now appears to bedeclining slowly. In 2006 the World Health Organization (WHO) issued the following estimates:  The prevalence of active infection was 14.4 million, corresponding to a prevalence rate of219/100,000 persons.  The incidence of new cases was estimated to be 9.2 million, corresponding to an incidence rateof 139/100,000.  Twelve of the 15 countries with the highest estimated TB incidence are in Africa, where the TBincidence rate was 363/100,000  In 2006 there were 1.7 million deaths from TB worldwide, a death rate of 25/100,000. The epidemiology of tuberculosis varies substantially around the world. The highest rates(100/100,000 or higher) are observed in sub-Saharan Africa, India, China, and the islands ofSoutheast Asia and Micronesia. Intermediate rates of tuberculosis (26 to 100 cases/100,000) occurin Central and South America, Eastern Europe, and northern Africa. Low rates (less than 25 cases per100,000 inhabitants) occur in the United States, Western Europe, Canada, Japan, and Australia. Poverty, HIV and drug resistance are major contributors to the resurging global TB epidemic.Approximately 95 percent of TB cases occur in developing countries. Approximately 1 in 14 new TBcases occur in individuals who are infected with HIV; 85 percent of these cases occur in Africa. Anestimated half million cases of multidrug resistant (MDR)-TB also occur annual in Africans; evenhigher rates of drug resistant infections occur in Eastern Europe.http://www.uptodate.com/contents/epidemiology-of-tuberculosisREACTION: The incidence of tuberculosis is increasing not only in thePhilippines but throughout the world. The rate of deaths related to TB isalso alarming. Nurses can play a great role in the control of TB. We mustencourage and educate patients to finish the course of treatment toprevent multi-drug resistant strain of TB. We must also educate the publicabout the disease including preventive strategies. Nurses, as front linersin healthcare, have direct contact with patients with active TB diseasethat may be communicable. . We must also employ the necessary measures toavoid contracting the disease while caring for our patients. 21 | P a g e
  22. 22. Epidemiology, Prevention and Treatment of Cervical Cancer in the Philippines Efren J. Domingo and Ana Victoria V. Dy EchoDepartment of Obstetrics and Gynecology, University of the Philippines College of Medicine, Manila, Philippines C ervical cancer remains to be one of the leading malignancies among Filipino women. High-risk human papillomavirus (HPV) types, such as 16 and 18, are consistently identified in Filipino women with cervical cancer. Factors identified to increase thelikelihood of HPV infection and subsequent development of cervical cancer include young age atfirst intercourse, low socioeconomic status, high parity, smoking, use of oral contraception and riskysexual behaviors. Cancer screening programs presently available in the Philippines include Papsmears, single visit approach utilizing visual inspection with acetic acid followed by cryotherapy, aswell as colposcopy. However, the uptake of screening remains low and is further compounded bythe lack of basic knowledge women have regarding screening as an opportunity for prevention ofcervical cancer. Prophylactic HPV vaccination of both quadrivalent and bivalent vaccines has alreadybeen approved in the Philippines and is gaining popularity among the Filipinos. However, there hasbeen no national or government vaccination policy implemented as of yet. The standard oftreatment of cervical cancer is radiotherapy concurrent with chemotherapy. Current researches aredirected towards improving availability of both preventive and curative measures of cervical cancermanagement. Cervical cancer is the second most common malignancy and is the most common cause ofcancer-related mortality among Filipino women. Although considered as a preventable disease, theburden of cervical cancer in the Philippines remains to be moderately high, where the cost ofnationwide organized cytology screening has been a significant limitation. In a country whereexisting health infrastructure is not sufficiently developed to support cytology-based screeningprogram, the use of alternative screening modalities, such as visual inspection of the cervix aided byacetic acid (VIA) with or without magnification, is currently under evaluation. In addition,prophylactic human papillomavirus (HPV) vaccination for the prevention of infection and relateddisease is being considered as an additional cervical cancer control strategy.Burden of Cervical Cancer in the Philippines According to the Filipino cancer registry 2005 annual report,1 the incidence of cervical cancerremained stable from 1980 to 2005, with an annual age-standardized incidence rate of 22.5 casesper 100,000 women.2 In 2005, there were 7,277 new cases of cervical cancer, with 3,807 reporteddeaths. The overall 5-year survival rate was 44% and mortality rate was 1 per 10,000 women.1 Thehigh mortality rate was attributed to the fact that 75% of women were diagnosed at late stagedisease with treatment being frequently unavailable, inaccessible or non-affordable.The Philippine General Hospital (PGH) has been the countrys government tertiary center reportingthe highest number of new cervical cancer cases. In 2006, 466 new cases were reported, of which68% were squamous cell carcinoma, 21% adenocarcinoma, 3% adenosquamous and 8% of otherhistology. Among these cases, more than half (52%) were diagnosed as stage III.HPV Prevalence in the PhilippinesHPV prelavence in cervical cancer The strong association between HPV and cervical cancer is well established. The reportedprevalence of all HPV types is 93.8% in squamous cell carcinoma and 90.9% in adenocarcinomas.4HPV 16 and 18 are the 2 most common HPV types, although HPV 18 alone is relatively morefrequent in the Philippines compared to the type distribution estimates in the world. Other commonHPV types in decreasing frequency are 45, 52, 51. For women with squamous cell carcinoma, themost common HPV type is 16, followed by types 18, 45, 52 and 51; whereas for women withadenocarcinoma, HPV type 18 is the most common,4 followed by types 16 and 45. 22 | P a g e
  23. 23. HPV prevalence in women with normal cytology For Filipino with normal cervices, the reported incidence of HPV of any type is 9.2%. HPVtype 45 is the most common, followed by HPV types 16 and 18.Conclusion Cervical cancer has remained a leading cancer in women in the Philippines. For close to fivedecades, standard Pap screening has been available for opportunistic screening, but organizedprograms have yet to be implemented, largely due to high costs and needs for infrastructure withinthe health system. Recently, alternatives to Pap smear screening have been introduced, where VIA-cryotherapy programs are being actively evaluated. HPV vaccination has been approved in thePhilippines with new efforts to integrate primary prevention at the forefront of cervical cancercontrol. Since the NIH recommendation in 1999, concurrent chemoradiation is still the standardtreatment for cervical cancer. Though it may be a challenge, future directions should be towardsimproving availability of both preventive and curative measures of cervical cancer management tothe general population.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676501/REACTION: Human Papilloma Virus (HPV) is highly preventable by immunization.It is alarming to note however that the incidence rate is high in thePhilippines. We must remember that HPV can cause cervical cancer. Thegovernment must ensure availability of the HPV vaccine to all women. Thosewho cannot afford the immunization must be subsidized by the government,especially the at risk population. Nurses can offer valuable help byinforming the public about the disease and its prevention, i.e. byimmunization, and be role models by getting the vaccine themselves. 23 | P a g e