Tobacco smoking and diabetes

Dr Arup Ratan Choudhury

The harmful effects of smoking. Studies show that smokers are five times more likely than that of the nonsmokers to have gum disease. For smokers with diabetes, the risk is even greater. If you are a smoker, diabetic and age 45 or order, you are 20 times more likely than a person without these risk factors to get severe gum disease.

Smoking increases your risk of getting type 2 diabetes
Some recent research shows there is a significant relationship between diabetes and smoking. The more you smoke, the more chance you have of getting diabetes. If you smoke 16 to 25 cigarettes a day, your risk for type 2 diabetes is 3 times greater than a non-smoker. When you quite smoking, your risk decreases during the years that follow.

Smoking affects the way insulin works in your body
In type 2 diabetes, the body does not respond to insulin made by the pancreas. Insulin helps blood glucose enter into the cells for fuel. When you smoke, your body is less able to respond to insulin. When your body resists insulin, your glucose level increase in the blood. Resistance does not start to reverse until you do not smoke for 10 to 12 hours.

Smoking makes it harder to control your diabetes
Studies show that smokers have poorer glucose control than non-smokers do. Smokers who quit have the same blood glucose control as non-smokers. When you have type 1 or type 2 diabetes, glucose control is very important. The HbA1c test checks how well you control your glucose level over 3 months. The goal is to keep your A1c at 7 percent or less. When you have diabetes and you smoke, your A1c level increases. If you quit smoking, your A1c level may decrease to the same level as a non-smokers.

Smoking increases your risk for getting other problems from diabetes
When you have diabetes and smoking habit, your chances are greater for getting other health problems form diabetes — complications. You can get serious eye problems, kidney problems, nerve problems, heart and blood vessel disease and so on.

Even for people who do not have diabetes but smoke, the risk of getting other health problems is greater. The more and the longer you smoke, the more your risk increases. Smoking and diabetes together greatly increase the danger of getting complications. To lower your risk, you must control your glucose levels and quit smoking. Diabetic people will be benefitted in many ways when they quit smoking.

Experts' views
All smokers need stop smoking in a clear, strong and personalised manner. Ask every tobacco user if s/he is willing to make and attempt to stop smoking at this time (within the next 30 days for example).

Assist all people with smoking cessation. For those unwilling to attempt cessation at this time, stress the 5 R's.

Relevance: provide individualised information on the hazards of smoking.

Risks: Emphasise the increased risks of heart disease and diabetes complications arising from the combination of smoking and diabetes.

Rewards: Review benefits of smoking cessation.

Roadblocks: Assure people of your willingness to assist in their efforts to stop smoking.

Repetition: Review people's thoughts about cessation during their following visit.

Key messages
* Review major steps of smoking cessation

* Set a date to stop smoking

* Identify likely relapse triggers and make specific plans for coping with them before stopping smoking

* Assess for nicotine replacement therapy

* Discuss any concerns about weight gain and other concerns related to diabetes

* Make referral for additional smoking cessation support, prescribe nicotine replacement, provide self-help materials, or otherwise assist in a specific plan

* Arrange for ongoing contact

* Schedule follow-up contact either in person or via telephone

* Follow-up contact should occur soon after the date set to stop smoking, preferably within the first week

The writer is Professor and Head of the Department of Dentistry, BIRDEM, Dhaka. E-mail: aratan@dab-bd.org

Vegetarian diet: How to get the best nutrition

Dr Md Rajib Hossain

Adopting a healthy vegetarian diet is not as simple as scraping meat off your plate and eating what is left. You need to take extra steps to ensure you are meeting your daily nutritional needs. Find out what you need to know about a plant-based diet.

Vegetarian diet planning
A healthy vegetarian diet consists primarily of plant-based foods, such as fruits, vegetables, whole grains, legumes, nuts and seeds. Because the emphasis is on nonmeat food sources, a vegetarian diet generally contains less fat and cholesterol, and typically includes more fiber.

Meat alternatives
Milk: Drink fortified soymilk, rice milk or almond milk in place of cow's milk.

Butter: When sautéing, use olive oil, water, vegetable broth, wine or fat-free cooking spray instead of butter. In baked goods, use canola oil.

Cheese: Use soy cheese or nutritional yeast flakes, which are available in health food stores.

Eggs: In baked goods, try commercial egg replacers a dry product made mostly of potato starch.

Ensuring adequate nutrition
A vegan diet, for example, eliminates food sources of vitamin B-12, as well as milk products, which are a good source of calcium. Other nutrients, such as iron and zinc, are available in a meatless diet, but you need to make an extra effort to ensure they are in yours.

Protein: Your body needs protein to maintain healthy skin, bones, muscles and organs. Vegetarians who eat eggs or dairy products have convenient sources of protein. Other sources of protein include soy products, meat substitutes, legumes, lentils, nuts, seeds and whole grains.

Calcium: This mineral helps build and maintain strong teeth and bones. Low-fat dairy foods and dark green vegetables, such as spinach, turnip and collard greens, kale, and broccoli, are good sources of calcium. Tofu enriched with calcium and fortified soy milk and fruit juices are other options.

Vitamin B-12: Your body needs vitamin B-12 to produce red blood cells and prevent anemia. This vitamin is found almost exclusively in animal products, including milk, eggs and cheese. Vegans can get vitamin B-12 from some enriched cereals, fortified soy products or by taking a supplement that contains this vitamin.

Iron: Like vitamin B-12, iron is a crucial component of red blood cells. Dried beans and peas, lentils, enriched cereals, whole-grain products, dark leafy green vegetables, and dried fruit are good sources of iron. To help your body absorb nonanimal sources of iron, eat foods rich in vitamin C such as strawberries, citrus fruits, tomatoes, cabbage and broccoli at the same time you consume iron-containing foods.

Zinc: This mineral is an essential component of many enzymes and plays a role in cell division and in the formation of proteins. Good sources of zinc include whole grains, soy products, nuts and wheat germ.

Since no single food provides all of the nutrients that your body needs, eating a wide variety helps ensure that you get the necessary nutrients and other substances that promote good health.

Don't Panic,
Manage the Disease

Professor M Abid Hossain Mollah

During the hot summer many parents are alarmed when their infants are afflicted with very high fever (103-105 degree F), continuous runny nose and cough for a few days. Anxious parents rush to the clinics and hospitals, when common medicines fail to get the temperature down.

Child specialists urge parents not to be panicked since this is a common flue caused mostly by the viruses such as rhinovirus which takes an epidemic form during this period of the year. They even suggest not to prescribe any antibiotics initially, because usually the temperature becomes normal within three or four days in case of rhinovirus flu.

"A few parents use high dose di-clofenac suppositories, non-steroidal anti-inflammatory drugs (NSAID), since ordinary paracetamols cannot reduce the temperature in case of such flu," says child specialist Professor M Abid Hossain Mollah, "But the use of NSAID is not wise. It may decrease body temperature drastically that may be even more harmful for babies.

"It is better to prescribe limited doses of paracetamols than to suggest any antibiotic initially. Any form of liquid intake should be increased. It may be pure water, juice or even soft drinks. In case of high fever, it's wise to wash the body with warm water. Only when the fever continues for a week, antibiotic can be prescribed after a thorough diagnosis."

And for treatment of cough Professor Mollah suggests to give babies raw tea. "Treatment of cough for babies is difficult, since most of the available medicines are cough suppressive. World Health Organisation (WHO) suggests tea is very effective to cure cough. I've also got good result prescribing tea instead of any medicine. Moreover, mixture of tulsi juice and honey can be used for cough," says Professor Mollah.

He also suggests parents to be aware of the amount of urine the baby is excreting. "In the late 1980s we recognised a good number of babies suffering from renal problems for viral infections. Though in these days it's not frequent, we should always be careful," he advises.

Following the old proverb 'prevention is better than cure', Professor Mollah suggests proper baby care can effectively keep children safe from diseases. He says, " According to the Infant and Young Child Feeding (IYCF), the guideline formed jointly by WHO and Unicef, children below two years of age should never be fed any type of commercial food. Till six months age only breast milk should be given to infants. Not even water or baby cereal should be given, suggests IYCF. After six months, along with breast milk, the child should be given natural food like khichuri, eggs and fruits.

"It's better to give more oil in baby food, because oil provides sufficient energy. Moreover, vitamin A that increases body resistance is fat-soluble. So use of more oil in khichuri or other types of naturally cooked food makes babies healthier", continues Professor Mollah, "At the same time parents must keep the babies clean all the time. They should be given baths regularly."

But, whenever a baby has symptoms like anemia, gradually becoming pale, lack of interest in playing and other things, she should be immediately taken to a child expert to find out the cause of anemia. In Bangladesh the most common cause of anemia in children is iron deficiency anemia. "In addition to the iron deficiency anemia there are possibilities of hemoglobin related disorders and thalassaemia, the name given to a group of inherited blood disorders that affect the body's ability to create red blood cells. So, symptoms like anemia, gradually becoming pale should seriously be considered, since in these days the rate of thalassaemia major afflicted babies has increased.

"An estimated six percent people in Bangladesh are carriers of thalassaemia which is not that much harmful, But when both of the parents are carriers, the baby becomes a thalassaemia major carrier. Each year seven to eight thousands babies are born carrying thalassaemia major in Bangladesh. The most serious types of thalassaemia can cause other complications including organ damage, restricted growth, liver disease, heart failure and even death."

For the preventive measure for life killing thalassaemia major disease Professor Mollah suggests, "In fact, we should initiate awareness generating programmes for preventing thalassaemia immediately, since treatment for such disease is very expensive. An introduction on thelaseamima may be included in academic curriculum. And marriage between blood relations should be discouraged."

Many countries in the world such as Italy, Cyprus, Greece and Iran have significantly decreased the rate of major thalassaemia through awareness generation programme. The carriers of thalassaemia should not marry each other. In many countries of the world people ask report of thalassaemia test before marriage. Such preventive measures have proved effective in those countries.

World No Tobacco Day 2009

Showing the truth: Health warnings on tobacco

Tomorrow is World No Tobacco Day. This year theme for the Day is “Tobacco Health Warnings”. Health warnings on tobacco product packaging are critical to any effective tobacco control strategy. They increase public awareness of the serious health risks of tobacco use and help to ensure that the packaging tells the truth about the deadly product within. Tobacco package health warnings that include images are a particularly powerful and cost-effective vehicle for communicating health risks.

Tobacco is the leading preventable cause of death. More than 1.2 million people die every year in South-East Asia Region due to tobacco use. The wide-spread use of tobacco products in the Region has resulted from unrestricted use of marketing tools by the tobacco industry, the addictive nature of nicotine and the lack of knowledge about the harmful effects of tobacco products among tobacco users and non-users in the form of second-hand tobacco smoke. The lack of regulation of the tools of a product that kills half of its users has exposed the population to the misinformation of the tobacco industry about the suitability of their products.

Yet tobacco product packaging in most countries provides little or no information of warn consumers of the risks. The WHO Framework Convention on Tobacco Control (FCTC) in its Article 11 mandates that countries should enact effective measures to ensure appropriate health warnings on tobacco products packages. It also says that these health warnings should be rotating, large, clear, visible, legible and include pictures or pictograms and occupy at least 50 percent or more and no less than 30 percent of the principal display areas.

Comprehensive health warnings about the dangers of tobacco use play a vital role in changing its image, especially among adolescents and young adults. Text and pictorial health warnings are useful to communicate the health risks of tobacco use, provoke more thought about the health risks of tobacco use and have a greater emotional response and generate increased motivation and intention to quit. They are particularly effective in communicating health effects to comparative low literate populations, children and young people.

Obama speech to offer personal commitment to Muslims

US President Barack Obama speaks on securing cyber infrastructure May 29.

President Barack Obama will offer a "personal commitment" to bridge US differences with Muslims in his long-awaited speech to the Islamic world next week in Egypt, aides said.

But White House advisors said Friday that Obama would not shy away from addressing "tough issues" in the speech on Thursday at the University of Cairo which will be co-hosted by Al-Azhar University, an ancient centre of Islam and learning.

"The speech will outline his personal commitment to engagement, based upon mutual interests and mutual respect," White House spokesman Robert Gibbs said.

"He will discuss how the United States and Muslim communities around the world can bridge some of the differences that have divided them.

"He will review particular issues of concern, such as violent extremism and the Israeli-Palestinian conflict and he will discuss new areas for partnership going forward that serve the mutual interests of our people."

Obama foreign policy advisor Mark Lippert added that the address, which makes good on an Obama campaign promise, would emulate some other speeches by the president which have touched on difficult issues.

"He doesn't hesitate to take on the tough issues in his speech, just harkening back to his Senate career when he delivered a very, very powerful message on corruption in Kenya," Lippert said.

"He continually raises these issues here with leaders when they come through both in private and through public statements, as well. You have a President who's not afraid to engage on very tough, tough issues."

Asked whether Obama would meet with Egyptian political dissidents during his visit, aides said that people from across the political spectrum would be invited to the speech.

Obama, who lived for several years as a child in mainly Muslim Indonesia and traces part of his ancestry to a Muslim family in Kenya, will open his trip next Wednesday in Riyadh, Saudi Arabia, holding talks on Middle East peace, Iran, terrorism and other issues with King Abdullah.

The next day, his visit to Cairo will include the speech and talks with Egyptian President Hosni Mubarak, who cancelled a visit to Washington this week because of the death of a grandson.

Obama then heads to Germany, where he will stay in the former East German city of Dresden, hold talks with Chancellor Angela Merkel and visit the former Nazi death camp at Buchenwald.

He will also visit US troops wounded in Afghanistan and Iraq and the US medical center at Landstuhl.

Obama's last stop will be in France on Saturday, where he will take part in 65th anniversary commemorations of the D-Day allied landings in Normandy, alongside French President Nicolas Sarkozy, British Prime Minister Gordon Brown and Canadian Prime Minister Stephen Harper.

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NKorea preparing to fire long-range missile:

North Korea is apparently preparing for a long-range missile test which may come within two weeks, a news report said here Saturday.

"A train carrying a long-range missile has been spotted at the weapons research centre near Pyongyang," an unidentified intelligence source was quoted as saying by Yonhap news agency.

"It is highly likely that the North may fire (the missile) and South Korean and US intelligence authorities are watching closely," the source told Yonhap.

The source said it was expected to take about two weeks before the North places the missile on a launch pad and gets it ready to be fired, adding the US and South Korea were closely monitoring North Korea's missile sites.

Two US defence officials in Washington said Friday US satellite photos had shown vehicle activity at two sites in North Korea, suggesting the regime might be preparing to launch a long-range missile.

The vehicle movements resembled work done before North Korea fired a long-range rocket last month, the officials, speaking on condition of anonymity, told AFP.

Tensions have been running high since the communist North fired a long-range rocket in April and carried out its second nuclear test Monday.

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How to read food labels

Swine flu: Two people hospitalised in Kolkata

Kolkata: A woman and her one-year-old child were admitted to a city hospital with symptoms of swine flu after they landed at the international airport.

"Forty-three-year-old Susmita Biswas and her baby, Gibson were admitted to Beliaghata Infectious Diseases Hospital with symptoms of swine flu. Their blood samples have been sent to New Delhi for tests," Medical Officer of the airport, Dr Amaresh Dey said.

Biswas lives in Canada and came from Frankfurt in a Lufthansa flight late last night, airport sources said.

In the past ten days, four persons have been hospitalised with symptoms of swine flu, but all of them tested negative after tests.

The global swine flu death toll has crossed the 100 mark with four new fatalities reported in Mexico and one in the United States. These are two countries where the outbreak was first reported.

Right before the latest North American deaths, the World Health Organisation had reported the global toll at 95, with over 13,398 people in 48 countries infected with the (H1N1)A virus since it was first uncovered last month.

According to official sources, the four deaths in Mexico have increased the toll to 89 with 100 new infections in the country, bringing the total to 4,821 in Mexico.

A second Swine flu death in Chicago brought the US toll to 15. Two more countries, the Dominican Republic and Uruguay, have each reported their first two confirmed cases of Swine flu, raising the number of countries with cases to 50.

How To Have Beautiful Skin

It's not enough to get a facial to keep your skin clear and beautiful. You need to have a great home skin-care routine.

Here's are the everyday habits you need to keep your skin beautiful:

* Eat a healthy diet with lots of fruits, vegetables and leafy green. Good nutrition is the basic building block of healthy skin.

* Drink plenty of water every day. (I fill a carafe to remind myself.)

* Get a professional facial to deep cleanse your skin at least four times a year, as the seasons change. Every four to six weeks is ideal.

* Throw away the soap and use quality products that are right for your skin type. Discuss your home skin-care routine with your esthetician.

* If you can't afford all the skin-care products right away, ask the esthetician which are most important to start, and which can be substituted with less expensive alternatives. Invest in additional products as you can.

* WEAR SUNSCREEN, even on cloudy days and in winter. Use a good-quality, high-SPF sunscreen. Sun damage is the single most important cause of premature aging. On my face, decolette and the back of my hands I use Ti-Silc Sheer SPF 45 Sunblock (compare prices). It's reasonably priced ($20-$24 for four ounces) and doesn't sting sensitive skin.

* Remember to put sunscreen on exposed areas like the back of your hands, neck and chest. They're often the first place to show your age.

* Cut out skin-damaging habits like smoking, excessive drinking and tanning booths.






Facials are given by an esthetician, a skin care specialist who has gone through a professional training program in the field of skin care.

Signs of A Good Esthetician

* She is impeccably groomed, warm and friendly.

* She is a stickler for cleanliness and sanitation. She keeps a clean table and washes her hands before she begins touching your face.

* The esthetician gives you a relaxing facial customized to your skin. She can do “extractions” (removal of blackheads, etc.) without causing too much discomfort and is responsive to your needs.

* He can answer any questions you have about what he’s doing and why.

* The good esthetician follows your lead in terms of how much “chat” there is. It’s your time!

* She asks about your home skin care routine and advises you on how to take care of your skin between facials.

* She tells you what products are best suited for your skin type without resorting to high-pressure sales techniques.

* A good esthetician recognizes skin problems that require a dermatologist. If you have a problem that needs a medical doctor, the esthetician lets you know.

Licensing requirements for estheticians vary by state. Most states require 600 hours of training, but Florida is considerably less strict, with just 260 hours of training. Feel free to ask where they were trained and what kind of program they went through.

If you're interested in becoming part of the spa industry, read more about finding spa jobs , going to massage school, or going to esthetician school .

10 Essential Health Tips (The Basics to Practice Every Day)

1. Move More
Make it a daily challenge to find ways to move your body. Climb stairs if given a choice between that and escalators or elevators. Walk your dog; chase your kids; toss balls with friends, mow the lawn. Anything that moves your limbs is not only a fitness tool, it's a stress buster. Think 'move' in small increments of time. It doesn't have to be an hour in the gym or a 45-minute aerobic dance class or tai chi or kickboxing. But that's great when you're up to it. Meanwhile, move more. Thought for the day: Cha, Cha, Cha…. Then do it!

2. Cut Fat
Avoid the obvious such as fried foods, burgers and other fatty meats (i.e. pork, bacon, ham, salami, ribs and sausage). Dairy products such as cheese, cottage cheese, milk and cream should be eaten in low fat versions. Nuts and sandwich meats, mayonnaise, margarine, butter and sauces should be eaten in limited amounts. Most are available in lower fat versions such as substitute butter, fat free cheeses and mayonnaise. Thought for the day: Lean, mean, fat-burning machine…. Then be one!

3. Quit Smoking
The jury is definitely in on this verdict. Ever since 1960 when the Surgeon General announced that smoking was harmful to your health, Americans have been reducing their use of tobacco products that kill. Just recently, we've seen a surge in smoking in adolescents and teens. Could it be the Hollywood influence? It seems the stars in every movie of late smoke cigarettes. Beware. Warn your children of the false romance or 'tough guy' stance of Hollywood smokers. Thought for the day: Give up just one cigarette…. the next one.

4. Reduce Stress
Easier said than done, stress busters come in many forms. Some techniques recommended by experts are to think positive thoughts. Spend 30 minutes a day doing something you like. (i.e.,Soak in a hot tub; walk on the beach or in a park; read a good book; visit a friend; play with your dog; listen to soothing music; watch a funny movie. Get a massage, a facial or a haircut. Meditate. Count to ten before losing your temper or getting aggravated. Avoid difficult people when possible. Thought for the day: When seeing red, think pink clouds….then float on them.

5. Protect Yourself from Pollution
If you can't live in a smog-free environment, at least avoid smoke-filled rooms, high traffic areas, breathing in highway fumes and exercising near busy thoroughfares. Exercise outside when the smog rating is low. Exercise indoors in air conditioning when air quality is good. Plant lots of shrubbery in your yard. It's a good pollution and dirt from the street deterrent. Thought for the day: 'Smoke gets in your eyes'…and your mouth, and your nose and your lungs as do pollutants….hum the tune daily.

6. Wear Your Seat Belt
Statistics show that seat belts add to longevity and help alleviate potential injuries in car crashes. Thought for the day: Buckle down and buckle up.

7. Floss Your Teeth
Recent studies make a direct connection between longevity and teeth flossing. Nobody knows exactly why. Perhaps it's because people who floss tend to be more health conscious than people who don't? Thought for the day: Floss and be your body's boss.

8. Avoid Excessive Drinking
While recent studies show a glass of wine or one drink a day (two for men) can help protect against heart disease, more than that can cause other health problems such as liver and kidney disease and cancer. Thought for the day: A jug of wine should last a long time.

9. Keep a Positive Mental Outlook
There's a definitive connection between living well and healthfully and having a cheerful outlook on life. Thought for the day: You can't be unhappy when you're smiling or singing.

10. Choose Your Parents Well
The link between genetics and health is a powerful one. But just because one or both of your parents died young in ill health doesn't mean you cannot counteract the genetic pool handed you. Thought for the day: Follow these basic tips for healthy living and you can better control your own destiny

Take care of your poor feet

A huge number of people develop foot pain in their 60s. Usually they think that foot pain is a part of the aging process and accept it walking with pain. But it can start as early as the 20s and 30s as well. With simple measures like proper footwear and regular exercise can play an important role in preventing foot problems.

On an average, healthy people walk the equivalent of three times around the Earth in their lifetime. That is a matter of enormous wear and tear on the 26 bones, 33 joints and more than 100 tendons, ligaments and muscles that make up the foot.

Excessive weight, diabetes and circulation problems can contribute to foot pain. The most common foot conditions that occur with age are arthritic joints, thinning of the fat pads cushioning the soles, plantar fasciitis (inflammation of the fibrous tissue along the sole), bunions (enlargement of the joint at the base of the big toe), poor circulation and fungal nails. The following questions will help you assess whether you should take more preventive action as you age.

Are you overweight? The force on your feet is about 120 percent of your weight. It can lead to plantar fasciitis and heel pain and can worsen hammertoes and bunions. It is also a risk factor for diabetes, leading to the next question.

Are you diabetic? Being farthest from the heart, the feet can be the first part of the body to manifest complications like poor circulation and loss of feeling, both of which can lead to poor wound healing and amputation. Diabetics should have their feet examined annually by a doctor and avoid shoes that cause abrasions and pressure.

Do you have poor circulation? If you suffer from peripheral artery disease — a narrowing of veins in the legs — your feet are more susceptible to problems. Smoking also contributes to poor circulation.

Do your parents complain about their feet? Family history is probably your biggest clue to potential problems.

Do your shoes fit? Feet flatten and lengthen with age, so if you are clinging to the shoe size you wore at age 21, get your feet measured (especially mothers — pregnancy expands feet).

Do your feet ever see the light of day? Fungus thrives in a warm, moist environment. Choose moisture-wicking socks (not cotton), use antifungal powders and air out your toes at home.

Do you walk? Putting more mileage on your feet is the best way to exercise the muscles and keep them healthy.Dr Md Rajib Hossain

Fitness programme: 6 steps to guide your selection

Fitness programmes abound, from yoga and Pilates to step aerobics and strength training — either at home or in a gym. So which type of fitness programme is best for you? Use these 6 simple steps to find out.

Step 1: Assess your fitness level
You probably have some idea of how fit you are. But assessing and recording baseline fitness scores can help you set your fitness goals and measure your progress. To assess your aerobic and muscular fitness, flexibility and body composition, consider recording:

* Your pulse rate before and after a one-mile walk

* How long it takes to walk one mile

* How many push-ups you can do at a time

* How far you can reach forward while seated on the floor with your legs in front of you

* Your waist circumference at the level of your navel

* Your body mass index

You may also want to consult a doctor before beginning an exercise programme, especially if you have been sedentary or you have any chronic medical conditions.

Step 2: Determine your fitness goals
Keeping your fitness level in mind, think about why you want to start a fitness programme. Perhaps your doctor has suggested that you start a fitness programme to lose weight. If you are already active, perhaps you want to rev up your fitness programme to prepare for a 5K race or get ready for a favorite sport. Having clear goals can help you stay motivated.

Step 3: Consider your likes and dislikes
Next think about the types of physical activities you enjoy most. After all, a fitness programme does not need to be drudgery. You are more likely to keep up with a fitness programme you enjoy.

If you love riding your bicycle, consider a spinning class. If you have a blast on the dance floor, an aerobics class that includes dance moves would be a good bet. If you are a social person and like to be active with others, a gym or health club membership may be the ticket. If you prefer to exercise alone or you find health clubs intimidating, exercises you can do at home may be best.

Step 4: Think variety
Varying your activities (cross-training) can keep exercise boredom at bay. Cross-training also reduces the risk of injuring or overusing one specific muscle or joint.

When you plan your fitness programme, consider alternating among activities that emphasise different parts of your body — walking, swimming and strength training, for example.

Step 5: Do the math
By now, you probably have a sense of which type of physical activities might be best for you. But you also need to make sure that your choices are in line with your budget.

If a gym membership or home exercise equipment is too pricey, consider cheaper options for getting in shape. You can base a fitness programme around brisk daily walks and inexpensive hand-held weights or resistance bands. You might consider buying used exercise equipment — or sharing the cost with a friend.

Step 6: Go for it!
You have thought through your likes and dislikes and the pros and cons of various types of fitness programs. Now it is time to get physical! Remember to start slowly and build up intensity gradually.

Each workout puts you one step closer to reaching your fitness goals. If you get bored or lose interest in your fitness programme, do not be afraid to try something new. Reassess your fitness level and set new fitness goals. The result? A future of improved fitness and better health.

Hearing aids: How to choose the right one

Many types of hearing aids exist. So which is best for you? Find out what to consider when choosing a hearing aid.Perhaps you have thought about getting a hearing aid, but you are worried about how it will look and wonder whether it will really help. Knowing more about the hearing aid options available to you, what to look for when buying a hearing aid and how to break it in may help alleviate some of your concerns.

Hearing aid styles
All hearing aids contain the same parts to carry sound from the environment into your ear. However, hearing aids do come in a number of styles, which differ in size and the way they are placed in your ear. Some are small enough to fit inside your ear canal, making them almost invisible. Others fit partially in your ear canal.

Generally, the smaller a hearing aid is, the less powerful it is, the shorter its battery life and the more it will cost. The following are common hearing aid styles.

Completely in the canal: Completely-in-the-canal hearing aids are molded to fit inside your ear canal and can improve mild to moderate hearing loss in adults.

In the canal: An in-the-canal hearing aid is custom molded and fits partly in the ear canal, but not as deeply as the completely-in-the-canal aid. This hearing aid can improve mild to moderate hearing loss in adults.

Half-shell: A smaller version of the in-the-canal hearing aid, the half-shell is custom molded and fills the lower portion of the bowl-shaped area of your outer ear. This style is appropriate for mild to moderately severe hearing loss.

In the ear (full shell): An in-the-ear (full-shell) hearing aid is custom made and fills most of the bowl-shaped area of your outer ear. This style is helpful for people with mild to severe hearing loss.

Behind the ear: Behind-the-ear hearing aids hook over the top of your ear and rest behind the ear. The hearing aid picks up sound, amplifies it and carries the amplified sound to an ear mold that fits inside your ear canal. This type of aid is appropriate for almost all types of hearing loss and for people of all ages.

Open fit: These are very small behind-the-ear-style devices. Sound travels from the instrument through a small tube or wire to a tiny dome or speaker in the ear canal. These aids leave the ear canal open, so they are best for mild to moderate high-frequency losses where low-frequency hearing is still normal or near normal.

Before the purchase: Steps to take
When looking for a hearing aid, explore your options to understand what type of hearing aid will work best for you. Also:

* Get a checkup. See your doctor to rule out correctable causes of hearing loss, such as earwax, an infection or a tumor, and have your hearing tested by a hearing specialist (audiologist).

* Ask about a trial period. A hearing aid should come with an adaptation period. It may take you a while to get used to the device and decide if it is useful.

* Check for a warranty. Make sure the hearing aid includes a warranty that covers both parts and labor for a specified amount of time.

* Beware of misleading claims. Hearing aids cannot restore normal hearing or eliminate all background noise. Beware of advertisements or salespeople who claim otherwise.

* Plan for the expense. The cost of hearing aids varies widely. Talk to your audiologist about your needs and expectations. If cost is an issue, good instruments are still available at reasonable prices.

After the purchase: Breaking in your hearing aid
Getting used to a hearing aid takes time. Your listening skills should improve gradually as you become accustomed to amplification. The sound you hear is different because it is amplified. Even your own voice sounds strange when you wear a hearing aid. When first using a hearing aid, keep these points in mind:

* Hearing aids will not return your hearing to normal. Unlike corrective eyewear that restores your vision to normal, hearing aids cannot restore normal hearing. They can improve your hearing, however, by amplifying soft sounds and reducing loud background noises.

* Allow time to get used to the hearing aid. It may take several weeks or months before you are used to the hearing aid. But the more you use it, the more quickly you will adjust to amplified sounds. By wearing your hearing aid regularly and taking good care of it, you will likely notice significant improvements in your quality of life.Dr Tareq Salahuddin

River-filling easier now

City's unsuccessful circular waterway clicks for grabbers; over 10,000 sand cargo boats make transportation cheapDredging of the rivers under the 'Circular Waterway' project facilitated encroachment on the rivers, riverbanks, floodplains, canals and other wetland as the grabbers could easily bring sand on cargo boats.

The Bangladesh Inland Water Transport Authority (BIWTA) dredged some rivers for developing the circular waterway. Now around 10,000 cargo boats are operating in and around the capital and most of them are serving the purpose of land developers.

The sand and soil carrying cargo boats, locally known as 'bolget', are the main transports operating on these river routes.

The housing companies used to fill up the southern and eastern side of the capital a few years ago. But now they are filling up the wetland and rivers in the northern parts. The 'bolgets' could not reach the northern parts as it was impossible for them to ply in the Turag then.

"But the government excavated the rivers for the Circular Water Way and now these boats can easily ply in there. So the riverbanks and other wetland are being filled up very quickly," says a BIWTA official speaking anonymously.

The private housing companies and earth fillers prefer 'bolgets' as each boat carries 5,000 to 10,000 cubic feet of sand at a time.

"If someone wants to carry 10,000 CFT of sand on trucks he will need at least 100 trucks," said an official working with a housing estate who does not want to be identified.

Developers say around 10,000 'bolgets' are carrying sand and earth to fill up wetland, floodplains and the rivers around the city.

Sources in the Ministry of Shipping say there are around 5,000 registered water vessels in the capital, most of which are mainly serving the purpose of 31 housing companies and private housing initiatives to fill up land.

Sometimes the cargo boats create such obstacles in the river routes that other modes of transport cannot move properly. In recent years, accidents on river routes around the capital have increased thanks to these boats.

When these boats are loaded, the upper deck almost goes down the water level. This makes it hard for other water transports to identify them at night and accidents occur as a result.

A couple of years ago BIWTA imposed a ban on plying of 'bolgets' at night so that other vessels don't face any obstacle.

No fishermen or fishing boats were visible during several visits to the Buriganga, Shitalakhya, Balu and Turag rivers in recent weeks. Only there were some dredgers and 'bolgets' either to fill up land or collect sand to fill up other parts of the rivers elsewhere.

Recently, The Daily Star published a series of reports on riverbed and riverbank filling. During investigation, it was found that all the filling was taking place by boats.

BIWTA Secretary Syed Monowar Hossain said they are taking preparations to evict all illegal grabbers.

"We won't allow anyone to illegally fill up the riverbanks, even if it is their own land. We'll go by the port act and rules and regulations applicable for the rivers," he said.

As the BITWA and other authorities sit idle, both the sides of the Dhaka flood protection embankment from Kamrangirchar to Gabtali through Rayer Bazar have meanwhile been filled up.

Some government agencies are also violating the laws and filling up the wetland.

The Rajdhani Unnayan Kartripakkha (Rajuk) has taken up its Uttara third phase project after dredging the Turag. They also dredged the river and used 'bolgets' to fill up wetland for the purpose.

Different housing estates occupied and filled up Dangurdia, Durdi, Vatara, Telikhola and Brahmankhola canals in Satarkul and Vatara unions under Badda police station in the last five years.

Rashidkhali canal, one of the most important canals in eastern Dhaka, was once 10 kilometres long and connected the Norai river. Different housing companies have filled up around eight kilometres of this canal.

The grabbers have also filled up canals from Meradia to Nandipara in recent years using the river route.

They have also made attempts to fill up areas from Gabtali to Ashulia towards Tongi.