But one U.S. ear specialist called the data used for the study “very weak,” adding that the study failed to prove a connection between cell phone use and tinnitus.

The study’s lead researcher, Dr. Hans-Peter Hutter of the Institute of Environmental Health at the Medical University of Vienna, said “high intensity, long duration of mobile phone use might be associated with occurrence of tinnitus. Therefore, we are recommending a far more conscious and cautious way of using mobile phones.”

The study authors cited studies showing that tinnitus affects 10 percent to 15 percent of people in the developed world, and they said that number is increasing. The condition can severely affect quality of life for many sufferers, and little can be done to reduce the troublesome ringing, hissing or roaring.

For the study, published online July 19 in the journal Occupational and Environmental Medicine, Hutter’s team studied 100 people treated for chronic tinnitus and 100 without it. The participants were asked a variety of questions about their cell phone use.

Based on the participants’ responses, the researchers estimated that people who used a cell phone before the first symptoms of tinnitus appeared were 37 percent more likely to develop the condition than those in the control group. Also, people who used their cell phone for at least 10 minutes a day were 71 percent more likely to develop tinnitus than the other study participants.

Most people in the study used their cell phones on both ears, but tinnitus typically affected one ear — 38 percent of participants mentioned the left ear and about the same percentage said it distressed them most of the time. Twenty-nine percent reported also suffering from vertigo, or dizziness.

The researchers said that the high amount of microwave energy being absorbed by the cochlea in the inner ear might explain the possible connection.
Hutter said loud noise is the main risk factor for tinnitus. But, he added, “we are observing a widespread use of mobile phones and an increasing intensity of use. Therefore, even a small enhancement of the risk by mobile phone use could be of public health importance.”

Dr. Thomas J. Balkany, director of the University of Miami Ear Institute, said this study failed to show that using cell phones causes tinnitus.
“The data are very weak,” Balkany said. “They [the study authors] haven’t looked into the common causes of tinnitus in the kind of detail that would be necessary. These include stress and anxiety and depression, [and] the huge impact of MP3 players,” he said.
A weak relationship seems to exist between tinnitus and cell phone use, Balkany said, “but it’s not causative in any way.”
A much larger study would be needed to determine whether cell phones really can cause tinnitus, he said.

Hutter said protective measures are easily implemented to protect hearing. These include discouraging cell phone use by children and teenagers, using headsets, and reducing the number and length of cell phone calls.

Regards,
Oduwo Noah Akala
Chairman,
Afya Kenya Foundation.
n.oduwo@afyakenyafoundation.org

What led you to decide on OB/GYN as a specialty
My decision to enter the field came from a desire to give women a voice in our reproductive health, a voice that, at the time, I wasn’t sure the men who dominated the field were hearing. Now, over 20 years later, I’ve realized that we women gynecologists have probably not changed things as much as I had hoped — we’re just too busy getting the work done. Still, I couldn’t imagine myself doing anything else!

Do you see many women with abnormal Pap tests? How do you counsel them?
I am privileged to work at Cornell Medical College, where George Papanicolou invented the Pap test (smear) in 1942. We have a bust of him in our lobby that I pass every day when I come to work, reminding me how the work of just one individual can change the lives of millions.

And yes, I treat women with abnormal Pap tests. Fortunately, for the overwhelming majority of these women, the abnormal Pap will ultimately prove to be nothing more than a short-lived infection with HPV — human papillomavirus — that will resolve within 1 to 2 years. For these women, I counsel them to avoid cigarette smoking, use condoms, and eat four to six servings of fruits and vegetables daily. These are all strategies shown to shorten the duration of HPV infection. For the small percentage of women whose abnormal Pap indicates precancerous cell changes, we can easily and effectively treat them so that they never develop cervical cancer. This is similar to removing a precancerous skin mole to prevent skin cancer.

What do women need to know about the HPV vaccine?
The HPV vaccine immunizes against HPV16 and 18, the two strains of HPV that cause about 70 percent of cervical cancers in the United States. The vaccine is safe, and at least for as long as it has been studied, effective against infection with these two strains of HPV. Whether it will ultimately protect against cancer remains to be seen. In this regard, it is important to understand what the HPV vaccine does not do. It does not protect against all strains of HPV (and there are over 20 of them!). So, we don’t know, for instance, if over time, we will begin to see cervical cancer rates decreasing as the vaccine becomes widely used, or if other strains of HPV will step in to fill the void. If you are already infected with HPV strains 16 or 18, the vaccine will not make them go away more quickly. While there may be some crossover protection against other strains, we do not know if the vaccine will ultimately prevent infections or cervical cancer from these strains. Finally, we do not yet know how long the vaccine remains effective — will we need to give boosters at 10 or 20 years later? Given the duration of sexual activity in women’s lives, as well as the trend towards multiple sexual partners at all ages, this is a very important question. Today, most of us are infected in our younger years with HPV and develop natural immunity that protects us in later years. Will the immunity from the HPV vaccine protect us as well? Only time will tell.

All of that said, I have no concerns about the safety of the vaccine, and I do offer it to my patients — as long as they understand its limitations. Ultimately, I wait for the day that we have a vaccine that covers all the known HPV strains, is cost effective, and is widely available to those who need it most — namely women in the developing world without access to regular Pap tests.

If women are too old to get the vaccine, how can they protect themselves from HPV?
Many of these women are already protected from HPV due to natural immunity from prior infections that have gone away.

The most important thing to do to protect against HPV is to limit your number of sexual partners. It’s become almost my mantra — limit sexual activity to those you really care about (dare I use the word “love”?) and you’ll be ahead of the rest of your peers in preventing cervical cancer. And of course, use condoms with new partners, though these are not 100 percent effective against the HPV virus.

But you know what? Even if you do all those things, you may still get HPV. A recent study found that in 50 percent of newly formed young couples, one or both partners had HPV.

At some point, if you really care about someone, you need to just be with them and let the fear go. Get the vaccine if you are of age, but know it is not 100 percent protective and not a blessing to sleep around. And most importantly, get your Pap test — odds are we’ll pick up any problem long before it’s going to put you at significant risk. The Pap test has served us extremely well for over half a century, most of which time we had no idea HPV even existed.

What are the most important things that women can do to protect their reproductive health?
Limit your number of sexual partners, use condoms with new partners and always use effective contraception unless you are planning a pregnancy. Have regular Pap tests and know your family health history so you and your doctor can plan for targeted screening or prevention when it’s appropriate and available. Eat a healthy balanced diet, maintain a normal weight, and exercise regularly. And, oh yeah — don’t smoke.

You love cooking. How can women balance eating great food and staying physically fit?
If you remember that all food has calories and know how many calories you need on a daily basis to support your energy expenditure, then it’s a matter of simple mathematics to figure out how much wonderful food you can eat and still maintain a healthy weight (or in my case, lose the excess weight). Add in exercise and you can eat (or lose) more, and have the added benefit of feeling and looking better, not to mention helping keep your blood pressure and cholesterol in a healthy range.

Regards,
Oduwo Noah Akala
Chairman,
Afya Kenya Foundation.
n.oduwo@afyakenyafoundation.org

Oduwo Noah Akala
Chairman,
Afya Kenya Foundation.
n.oduwo@afyakenyafoundation.org
www.afyakenyafoundation.org

Signs and symptoms may show up in minutes, if not immediately but can be delayed as much as 2 weeks. If the bleeds are large enough to put pressure on the brain, signs of increased pressure or damage to part of the brain will be present.

Other signs and symptoms of subdural hematoma can include any combination of the following:
A history of recent head injury as was the case with the Prime Minister
Loss of consciousness or fluctuating levels of consciousness
Irritability
Seizures
Pain
Numbness
Headache (either constant or fluctuating)
Dizziness
Disorientation
Amnesia
Weakness or lethargy
Nauseas or vomiting
Loss of appetite
Personality changes
Inability to speak or slurred sppech
Difficulty walking
Altered breathing patterns
Blurred Vision
Abnormal movement of the eyes.

Risk factors
Factors increasing the risk of a subdural hematoma include very young or very old age. As the brain shrinks with age, the blood vessels in the head become more vulnerable to tears.

Regards,
Oduwo Noah Akala
Chairman,
Afya Kenya Foundation.
n.oduwo@afyakenyafoundation.org
www.afyakenyafoundation.org

At Home
-Fry foods with a little bit of olive oil rather than butter, margarine, or lots of vegetable oil.
-Use canola oil when baking.
-Prepare fish such as salmon or mackerel twice a week.
-Sprinkle slivered nuts or sunflower seeds on your salads instead of bacon bits.
-Eat Canadian bacon or lean ham instead of bacon.
-Try low-fat frozen yogurt instead of regular ice cream.
-Eat broiled, baked, roasted, or grilled chicken without the skin instead of fried chicken.
-Add lettuce, tomato, and other vegetables, rather than cheese, to your sandwiches.
-Eat extra lean ground beef (5% fat) instead of regular ground beef (25% fat).
-Try whole-wheat tortillas instead of regular flour tortillas.
-Try whole-wheat or multigrain bread instead of white bread.
-Try low-fat, low-sodium crackers instead of regular crackers.
-Eat water-packed rather than oil-packed tuna.
-Use mustard, catsup, or low-fat mayonnaise on your sandwiches instead of regular mayonnaise.
-Try making sandwiches with 95% to 97% fat-free lunch meats.
-Use lemon juice, herb vinegar, or reduced-calorie salad dressings on your salads.
-Choose nonhydrogenated peanut butter. You can tell that it’s nonhydrogenated if there’s some oil on top of the peanut butter. Hydrogenated peanut butter is all solid at room temperature.
-Eat lower-fat cookies, such as graham crackers or fig bars.
-Choose canned fruits packed in water rather than syrup.

Eating Out

In any restaurant:
-Ask for salad dressing, gravy, or sauce on the side and use sparingly.
-Choose main dishes that are broiled, baked, roasted, or grilled, instead of deep-fried or pan-fried.
-Don’t be afraid to make special requests, such as asking that something be cooked with less fat.

When ordering a sandwich:
-Add lettuce and tomato.
-Ask for whole-wheat or rye bread.
-Choose mustard instead of mayonnaise.

At Chinese restaurants:
-Have brown rice instead white rice.
-Order a side dish of steamed broccoli.

At fast food places:
-Order smaller burgers. Skip the cheese and bacon.
-Order a grilled chicken sandwich.
-Order garden or grilled chicken salads with low-fat dressings.
-Choose water or low-fat milk instead of regular soda.

At pizza places:
-Ask for vegetable toppings, such as mushrooms or peppers, rather than meat toppings.
-Get whole-wheat crust.
-Request half the cheese.
-Eat a salad with low-fat dressing in place of a slice of pizza.

Regards,
Oduwo Noah Akala
Chairman,
Afya Kenya Foundation .
n.oduwo@afyakenyafoundation.org

An injury in which an object enters the body or a structure and passes all the way through is called a perforating injury, while penetrating trauma implies that the object does not pass through. Perforating trauma is associated with an entrance wound and an often larger exit wound.

Penetrating trauma can be caused by a foreign object or by fragments of a broken bone. Usually occurring in violent crime or armed combat, penetrating injuries are commonly caused by gunshots and stabbings or even explosive circumstances such as yesterday‘s.

Penetrating trauma can be serious because it can damage internal organs and presents a risk of shock and infection. The severity of the injury varies widely depending on the body parts involved, the characteristics of the penetrating object, and the amount of energy transmitted to the tissues. Assessment may involve X-rays or CT scans, and treatment may involve surgery, for example to repair damaged structures or to remove foreign objects.

Assessment can be difficult because much of the damage is often internal and not visible. The patient is thoroughly examined. X-ray and CT scanning may be used to identify the type and location of potentially lethal injuries. Sometimes before an X-ray is performed on a person with penetrating trauma from a projectile, a paper clip is taped over entry and exit wounds to show their location on the film. The patient is given intravenous fluids to replace lost blood. Surgery may be required; impaled objects are secured into place so that they do not move and cause further injury, and they are removed in an perating room. Foreign bodies such as bullets may be removed, but they may also be left in place if the surgery necessary to get them out would cause more damage than would leaving them. Wounds are debrided to remove tissue that cannot survive and other material that presents risk for infection.

Regards,
Oduwo Noah Akala
Chairman,
Afya Kenya Foundation.
n.oduwo@afyakenyafoundation.org

Varicose veins can often be seen on the skin. Some other common symptoms of varicose veins in the legs include:
-Aching pain that may get worse after sitting or standing for a long time
-Throbbing or cramping
-Heaviness
-Swelling
-Rash that’s itchy or irritated
-Darkening of the skin (in severe cases)
-Restless legs

Should I see a doctor about varicose veins?

You should see a doctor about varicose veins if:
-The vein has become swollen, red, or very tender or warm to the touch
-There are sores or a rash on the leg or near the ankle
-The skin on the ankle and calf becomes thick and changes color
-One of the varicose veins begins to bleed
-Your leg symptoms are interfering with daily activities
-The appearance of the veins is causing you distress
-If you’re having pain, even if it’s just a dull ache, don’t hesitate to get help. Also, even if you don’t need to see a doctor about your varicose veins, you should take steps to keep them from getting worse.

How can I prevent varicose veins and spider veins?

Not all varicose and spider veins can be prevented. But, there are some steps you can take to reduce your chances of getting new varicose and spider veins. These same things can help ease discomfort from the ones you already have:
-Wear sunscreen to protect your skin from the sun and to limit spider veins on the face.
-Exercise regularly to improve your leg strength, circulation, and vein strength. Focus on exercises that work your legs, such as walking or running.
-Control your weight to avoid placing too much pressure on your legs.
-Don’t cross your legs for long times when sitting. It’s possible to injure your legs that way, and even a minor injury can increase the risk of varicose veins.
-Elevate your legs when resting as much as possible.
-Don’t stand or sit for long periods of time. If you must stand for a long time, shift your weight from one leg to the other every few minutes. If you must sit for long periods of time, stand up and move around or take a short walk every 30 minutes.
-Wear elastic support stockings and avoid tight clothing that constricts your waist, groin, or legs.
-Avoid wearing high heels for long periods of time. Lower-heeled shoes can help tone your calf muscles to help blood move through your veins.
-Eat a low-salt diet rich in high-fiber foods. Eating fiber reduces the chances of constipation, which can contribute to varicose veins. High-fiber foods include fresh fruits and vegetables and whole grains, like bran. Eating less salt can help with the swelling that comes with varicose veins.

Regards,
Oduwo Noah Akala
Chairman,
Afya Kenya Foundation.
n.oduwo@afyakenyafoundation.org

• Age (older than 40 years for men, 45 years for women)
• Male sex• Family history of coronary heart disease
• Smoking
• Hypertension (high blood pressure)
• Diabetes
• Obesity
• Unhealthy cholesterol levels—high total cholesterol, low HDL cholesterol, high LDL cholesterol, high triglycerides
• Low physical activity
• Accumulation of abdominal fat (“apple” body shape)

MAKE CHANGES FOR A HEART-HEALTHY LIFESTYLE

Small changes each day can add up to a much healthier life and decreased risk of developing coronary heart disease. Even losing 10% of excess body weight can dramatically lower heart disease risk.

Taking walk breaks at work, scheduling appointments for exercise, exercising with a friend or family member, actively playing with your pet or children, and taking the stairs instead of the elevator are all small steps to improve overall fitness. Get 30 minutes of physical activity most days of the week and 2 days of strength and flexibility training per week.

Involving your spouse or partner and family can improve success rate of lifestyle changes and make everybody healthier at the same time. Adding whole-grain foods to your diet can easily be done without sacrificing taste: use red meats sparingly, eat white meat from chicken or fish in small portions (4 ounces), add nuts, and avoid processed foods, while eating at least 5 servings of fruit and vegetables each day.

Regards,
Oduwo Noah Akala
Chairman,
Afya Kenya Foundation.
n.oduwo@afyakenyafoundation.org

1. Re-experiencing symptoms:
Flashbacks — reliving the trauma over and over, including physical symptoms like a racing heart or sweating
Bad dreams
Frightening thoughts

Re-experiencing symptoms may cause problems in a person’s everyday routine. They can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger symptoms.

2. Avoidance symptoms:
Staying away from places, events, or objects that are reminders of the experience
Feeling emotionally numb
Feeling strong guilt, depression, or worry
Losing interest in things that were enjoyable in the past
Having trouble remembering the dangerous event

Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.

3. Hyperarousal symptoms:
Being easily startled
Feeling tense or “on edge”
Having difficulty sleeping, and/or having angry outbursts

It’s normal to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD. When the symptoms last more than a few weeks and become an ongoing problem, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months.

Regards,
Oduwo Noah Akala
Chairman,
Afya Kenya Foundation.
n.oduwo@afyakenyafoundation.org

That’s the message from new research that found that elderly individuals who were obese or overweight had significantly less brain tissue than individuals of normal weight.

“The brains of obese people looked 16 years older than their healthy counterparts while those of overweight people looked 8 years older,” said UCLA neuroscientist Paul Thompson, senior author of a study published online in Human Brain Mapping.

Much of the lost tissue was in the frontal and temporal lobe regions of the brain, the seat of decision-making and memory, among other things.

The findings could have serious implications for aging, overweight or obese individuals, including a heightened risk of Alzheimer’s, the researchers said.

“We’re all trying to protect our bodies and our brains from aging and this is just one factor that’s accelerating that on top of all the other factors such as pollution, smoking, alcohol. We all lose some tissue as we get older and they’re saying this is being accelerated,” said Paul Sanberg, distinguished professor of neurosurgery and director of the University of South Florida Center for Aging and Brain Repair in Tampa.

Obesity puts you at a much higher risk for type 2 diabetes, cancer and heart disease, as well as cognitive problems.

The findings seem to explain why heavier people are more prone to such cognitive conditions. “This is the first study to show physical evidence in the brain that connects overweight and obesity and cognitive decline,” said Thompson, who is professor of neurology at UCLA.

The researchers studied brain images of 94 people in their 70s who had participated in an earlier study looking at cardiovascular health and cognition. None of the participants had dementia or other cognitive impairments. They were followed for five years, and any volunteers who developed cognitive symptoms were excluded from the study.
Clinically obese people had 8 percent less brain tissue, while the overweight had 4 percent less brain tissue compared to normal-weight individuals.

Dr. Jonathan Friedman, an associate professor of surgery and neuroscience and experimental therapeutics at the Texas A&M Health Science Center College of Medicine noted that the causal relationship here is not clear. Theoretically, he said, a smaller brain might mean appetite and weight-control centers of the brain are actually propelling the weight-gain process.

Thompson believes it may be a vicious cycle. “Each one is contributing to the other,” he said. A person’s genetics may be contributing to overeating and weight gain, which leads to less activity, which leads to a shortfall in the oxygen and nutrients that the brain needs to thrive and grow.

“Obesity affects every system in your body. The body can’t be splintered. It’s completely linked. We are what we eat and we eat too much,” he said. “The bottom line is that an obese, sedentary person is going to have a breakdown of every organ system, and that includes a greater chance of impotence and infertility and other things that people don’t generally think are directly related to obesity.”

Regards,
Oduwo Noah Akala
Chairman,
Afya Kenya Foundation
n.oduwo@afyakenyafoundation.org