Health Care Directory 2013

JANUARY 2013

HEALTH CAREDIRECTORY2013

Part 1

HEALTHCARE DIRECTORYA SPECIAL ADVERTISING SUPPLEMENT OF THE BERMUDA SUN JANUARY 18, 2013 PAGE 1

Publisher Randy French

President Lisa Beauchamp

Editorial Amanda Dale

Editorial Layout Jack Garstang

Advertising Sales Carlita Burgess (Deputy Advertising Manager) Olga French, Diane Gilbert, Claire James

Creative Services Christina White, Colby Medeiros, Bakari Smith

Circulation & Distribution Nick Tavares

Bermuda Sun 19 Elliott Street, Hamilton, Bermuda HM 10

Tel 295-3902 Fax 292-5597 E-mail [email protected]

This special supplement is produced and published by Bermuda Sun Limited and printed in Bermuda by Island Press Limited.

The Bermuda Sun publishes twice weekly and is a subsidiary of MediaHouse Limited. We are members of the Inland Press Association, International Newspaper Marketing Association and the Newspaper Association of America. We are located at: 19 Elliott Street, Hamilton HM 10; P.O. Box HM 1241, Hamilton HM FX Tel: 295-3902 Fax: 292-5597. Visit our website: www.bermudasun.bm

Inside this supplement

What you can do to combat tooth decay Pages 2-3

Abused women speak of their trauma Pages 4-5

Signs, symptoms and prevention of stroke Page 6

Dietary advice to protect your heart Page 7

Hypnosis can help you quit smoking Page 9

Problem of cost containment in healthcare Page 10

What you can do about colds and flu Page 11

Pointers to designing your home gym Pages 13-14

Over 50s susceptible to osteoporosis Page 16

2 JANUARY 18, 2013 HEALTHCARE DIRECTORY: A SPECIAL ADVERTISING SUPPLEMENT THE BERMUDA SUN

BY CELIA MUSSON-NZABALINDADepartment of Health

Over the years I have often heard people say that they were born with soft teeth, or that everyone in their family has tooth prob-lems.

Enamel is the hardest structure in the human body and teeth are designed to last from the cradle to the grave; but even the hardest structure in the body can-not stand up to a daily acid bath.

Very few people truly inherit soft teeth, so why do you see families who dem-onstrate a family tendency toward decay?

The answer is found in the habits each family prac-tices. Even before a child is born many parents do not realize that they are setting that child up for a lifetime of dental disease.

Decay and periodontal (gum) disease are conta-gious. If parents and care-givers have decay, the child they care for is likely to have decay as well.

BacteriaThe bacteria which cause

dental diseases are passed from the mouth of the par-ent to the mouth of the child. These bacteria are found in abundance in the mouths of those with dental disease, but few bacteria are found in the mouths of those who are disease-free.

There are three compo-nents which are necessary for the development of dental disease bacte-ria, plaque and sugar. Controlling these three com-ponents is the key to pre-venting the disease process.

Bacteria reside in plaque, which builds up in the mouth every day. Removing the plaque minimizes the bacteria.

This is done by brushing twice daily for two minutes, flossing once a day, and using a tongue scraper once a day.

Sugar is found in refined and natural forms in many

foods, including healthy food.

The fact is we need a certain amount of carbohy-drates to supply the energy needs of the human body.

Teeth are detrimentally affected by sugar when the exposures come too fre-quently.

Bacteria use the natural or refined sugars in the diet to supply their nutritional needs. They break down the sugar and produce acid, which they then excrete into the plaque on the teeth.

The acid exposure lasts about 20 minutes and begins to break down the enamel on the teeth.

The saliva in the mouth gradually neutralizes the acid and the mouth returns to its normal alkali pH.

Minimizing acid expo-sure helps to minimize the chances of decay. But if you snack between meals you increase the number of sugar exposures and you increase the chances of developing decay.

Baby teeth are more sus-

ceptible to decay than per-manent teeth. The enamel is significantly thinner and it does not take as long for decay to penetrate through the enamel into the dentin, where it spreads.

Therefore, when children are fed food or liquids fre-quently, they are very likely to develop decay. Research shows that if a child has more than seven sugar exposures per day, the chances of decay increase significantly.

We advocate exclusive breast-feeding for at least the first six months. This means that no other foods or beverages are intro-duced.

With exclusive breastfeed-ing the chances of decay are less. Once other foods are introduced to a baby, the likelihood of decay increas-es significantly if there are

FEBRUARY IS ORAL HEALTH MONTH

What you can do to combat tooth decay

ISTOCK PHOTO

CULTIVATE GOOD HABITS: As young people grow, controlling plaque, bacteria and sugar exposures continue to be important.

The bacteria which cause dental diseases are passed from the mouth of the parent to the mouth of the child.

THE BERMUDA SUN HEALTHCARE DIRECTORY: A SPECIAL ADVERTISING SUPPLEMENT JANUARY 18, 2013 3

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

6:15-7:15am Island Flava

(Zumba Toning) - Bertha

6:15am-7:15amChallenge Ride

(Spinning) - Gladwin

6:15am-7:15amExtreme Ride (Spinning)

- Bertha

6:15am-7:15amZone Worx

(Spinning) - Cal

6:15am-7:15amCross Training

Ride - Bertha

8:30am- 9:30amZone Worx

(Spinning) - Cal

9:30am-10:30am Les Mills Body

Combat - Nerseh

9:30-10:30am Body Conditioning

/Zumba - Sharlene

9:30-10:30amKya Boot Camp

- Don

9:30-10:30am Cardio Fit - Sharlene

9:30am-10:30am Kya Boot Camp

- Don

8:30am- 10:00amUltimate Ride

(Spinning) - Gladwin

9:05am Toning/ Island

Flava - Bertha

11:00am - 12:00pmJujitsu

- Master Burnell

12:15-1:00pm Step/Kick - Sharlene

12:15pm-1:00pm Les Mills Body

Combat

12:15-1:00pm Island Flava


12:15-1:00pm Les Mills Body

Combat - Nerseh

12:15-1:00pm Kya Boot Camp

- Don

10:00am-11:15amCardio Combo

- Sharlene

1:05pm-2:00pmKya Boot Camp

- Don

1:00-1:45pm Core Fit

- Sharlene

1:15pm-2:00pm Spinning - Nerseh

1:00pm-1:30pmCore Strength

Training - Sharlene

1:00pm-2:00pmJujitsu

- Master Burnell

5:15-6:15pm Island Flava


5:30pm-6:30pm Extreme Fitness

- Bertha

5:15pm-6:15pmTotal Fit - Andrea

5:30pm-6:30pm Xtreme Fitness

- Bertha

5:15- 6:00pm Step, Kick &

Zumba SKZ - Sharlene

6:15pm-7:30pmPassion Ride (Spinning) -

Bertha

6:30-7:30pm Total Fit - Andrea

(Upper Deck)

6:30pm-7:30pm Cross Training

Ride - Bertha

6:30pm-7:30pm $5 Cash Ride

(spinning) only $5 - Cal

6:30pm-7:30pm Cross Training

Ride - Bertha

WEEKLY CLASS SCHEDULE

AEROBIC CLASSES ARE SUITABLE FOR ALL LEVELS OF FITNESSSCHEDULE EFFECTIVE DECEMBER 2012

HOURS: Monday Thursday 6:00am 8:30pm Friday: 6:00AM 8:00PM Saturday: 8:00AM- 3:00PM Sunday: 9:00AM 1:00PM Location: 12 Dundonald Street West, Hamilton Tel: (441) 292-4095

Health is Wealth - Call 292-4095 today and invest in yourself for less!

CROSS TRAINING MONDAY WEDNESDAY FRIDAY AT 5:30PM WITH ANDREA.

NO INITIATION FEE

SPINNING PUNCH CARD $150

AEROBIC PUNCH CARD

$125

25 CLASSES IN A PUNCH CARD*offer expires 31st of Jan.

greater than seven feedings. If a child has a sippy cup

or bottle and sips a little now and then, then each time the child drinks, there is another sugar exposure.

Similarly, the child who goes to bed with a bottle will usually fall asleep with a little milk in the mouth, and the teeth are then bathed in this for hours.

EnamelFirst the enamel is soft-

ened and white patches appear. Once the decay breaks through the enamel, brown spots are evident. By this time the decay is already quite large.

Controlling the frequency of food and beverage intake will help to train a child to develop proper feeding habits, as well as reduce the chances of decay.

It is the recommenda-tion of the American and Canadian Dental Associations that a childs first dental visit should be at the age of one, or six months after the first tooth

erupts. As young people grow, controlling plaque, bacteria and sugar expo-sures continue to be impor-tant.

It is common for children in middle and high school to increase their beverage intake. This increases the chance of tooth decay in the adolescent and youth popu-lation.

Brushing and flossingContinuing a regimen of

brushing twice daily for two minutes, flossing, and using a tongue scraper continues to be critical to the preven-tion process throughout life.

Brushing should be done with a soft brush with good bristles. Brushes with bent bristles should be replaced. In general it is good prac-tice to replace a toothbrush every three months.

Brushing for two min-utes without any method can lead to unsatisfactory results. It is important not to bounce around the mouth.

Right-handed people

start brushing in the outer surfaces of the teeth in the upper-right molar area and work around to the left side.

Then do the same thing on the surfaces next to the palate.

Finally, brush the biting surfaces. Then use the same methodical approach on the bottom teeth. People who are left-handed may be more comfortable starting on the upper-left teeth.

Flossing can be done once per day, either in the morn-ing or the evening. Using a tongue scraper can remove build-up and bacteria from the tongue and can dramati-cally improve the smell of the breath.

This simple routine will result in less decay and periodontal disease, and teeth that can last a lifetime.

Health benefitsA healthy mouth will also

improve the course of diabe-tes and heart disease.

The mouth can be a source of constant infec-tion, which causes the blood

sugars to be out of control, and it can also increase the build-up of blockages in the blood vessels (including the blood vessels in heart muscle).

It is never too late to start taking care of your mouth. Once decay is taken care of, the number of bacteria in the mouth will decrease.

A dental cleaning and daily care will improve the outcome of periodontal disease, while anti-bacterial mouth rinses can help get this condition under con-trol.

By taking care of your own teeth you are also help-ing to take care of the rest of your family.

DR CELIA MUSSON-NZABALINDA DDS is the senior dental officer for the Department of Health. For more information see www.gov.bm, e-mail [email protected]. Hamilton Health Centre 278-6440, St Georges Health Centre 297-1932, Somerset Health Centre 234-0239.


SUPPLIED BY THE CENTRE AGAINST ABUSE

Domestic abuse affects one in three women in Bermuda, according to the Governments Health Survey.

But help is at hand. The Centre Against Abuse is a registered charity which provides services to reha-bilitate both the victims and perpetrators of domestic abuse.

It also has a safe house for women and children escap-ing violence.

Most abusers are men and the Centre Against Abuse offers a Batterers Intervention Programme to deter this kind of behav-iour. The charity also works to build up awareness of domestic violence and abuse, going to schools, companies and the commu-nity, to educate the public.

Abuse knows no boundar-ies whether geographic, social, demographic or eco-nomic.

It also impacts a persons physical, mental and emo-tional health.

Below is the story of Maria (name changed to protect the womans identity), who suffered for years in a relationship with an abusive man. She sought help from the Centre Against Abuse and obtained a Domestic Violence Protection Order. She also received counselling to help her get her life back together.

Marias experienceThis is Marias account

of the final moments of her relationship:

I was at a party by myself. I went to the bar and got a drink. I noticed my abuser but ignored him. Then I went to the dance floor and started to dance.

My abuser came to me and said, Lets go, our son is in the car. I said, Cool, dont race me.

When I looked at my abuser, I knew he was mad, so I went after him. As soon as I got out the door, my abuser was there waiting

for me. He started to yell at me saying, How could you embarrass me, dancing with a guy? You want to act like a whore; Im going to treat you like one.

While saying that he was trying to pull off my clothes. I tried to stop him by hold-ing my top up. I threw my drink on him to stop him. Then he started pulling and dragging me along the ground.

ScreamingThe next thing I knew,

he was standing over me assaulting me. I heard my son screaming and crying from the car Momma! I tried to get up but couldnt. My abuser picked me up and put me in his car.

I was screaming and cry-ing, I hate you! I repeated myself over and over. My abuser was saying, I am sorry. I love you. I am sorry.

I didnt hit you. A friend gave me some ice, someone else gave me water and I tried to get the blood off of my face.

I was still crying, I was escorted by my friend to another car and was taken to the police station to file charges. The police took my statement and told me to go to the hospital and the Centre Against Abuse.

I had a broken hand, stitches on my lip, several chipped front teeth, road rash on my face and back, and my foot was badly bruised.

Survivors tale Below is an account of

how domestic violence can affect your health and well-being, written by an abuse survivor.

The types of abuses I was enduring in my marriage took their toll on my physi-

cal and mental health. I had developed various

types of chronic ailments: asthma, acute allergies, skin conditions, teeth grind-ing, nervousness, insom-nia, circulation problems, inflamed joints, gynaeco-logical concerns, and hyper-tension.

This also led to poor mental health, including increased alcohol use. Fortunately for me, I didnt lean on to the other sub-stances.

I already suffered from sinus problems, migraines, sensitive skin, and sensitiv-ity to prescribed antibiotics and allergies.

During my marriage my allergies were amplified to the point where I experi-enced anaphylactic shock and an acute food allergen; and both incidents required emergency medicine inter-vention. I underwent a

Abused womens trauma and how they

OVERSEAS ISTOCK PHOTO

PUT A STOP TO IT: The Centre Against Abuse can help if you are in an abusive relationship.


eventually got their lives back on tracksleep study and was fitted with a CPAP (continuous positive airway pressure) to assist my breathing dis-orders.

I had to visit the allergy specialist and that became an emergency situation. My partner was called to the doctors office as I was not asymptotic, and nearly died.

MedicationI was gaining weight,

despite the combined change of diet and exercise. I wasnt getting better; the medicine cabinet was lined with all types of medicines to assist with the ailments.

I became a walking pharmacy before I was 40; and was growing tired of the doctors visits. I decided to take another approach. I ventured into the non-medicinal arena, acupunc-ture, to assist with my health issues. Initially, the

change started to make me feel better. The relationship would have an unwanted flare-up and so would my health ailments.

LinkNot once did I consider

linking the relationship abuses to my health chal-lenges. I was still able to function professionally; but personally I was barely cop-ing.

Immediately, after my 40th birthday I was very ill for about three weeks, as it was one aliment after anoth-er. I just couldnt shake the flu bug and the stress bug had its hooks on my mind and body with a vengeance.

Once I left my partner I noticed some subtle chang-es. My weight reduced, I was drinking less alcohol, and my sleep patterns were improving. I was less irri-table with my home life and

the people in my space. My thoughts were not all over the place; I was becoming more stable and focused.

As I was healing my mind and broken spirit; unbeknown to me, I was also improving my health. My weight came off, I ate healthier, my eyes were brighter, I was smiling and laughing and living again.

Health changesJust recently, I expe-

rienced some dizziness, blurred vision and feeling faint. I shared with my phy-sician what I was experienc-ing. Much to my surprise it was my hypertension.

I was advised to stop the medication and to monitor my [blood] pressure. With simple lifestyle changes leaving an abusive rela-tionship and losing weight, I could control my hyperten-sion through my diet again.

I was absolutely elated by my personal commitment and discipline to myself, to restore my health.

I feel empowered by the passion of my own poten-tial and my transformation through self-discipline.

As a survivor of domes-tic violence I have restored my mental and physical health without supplements or prescribed drugs, and with the support of my fam-ily, friends and the extended family of the Centre Against Abuse.

The Centre Against Abuse helps up to 100 victims each year, and scores of abusers.

TO MAKE a donation via HSBC Bank Bermuda, ref-erence the Centre Against Abuse and account No. 010 284 636 001, or send a cheque to: Centre Against Abuse, 3 Brooklyn Lane, Hamilton.

Craftmatic Beds adjust into 1001 relaxing and comfortable positions to support your head, neck, shoulders, upper and lower back, hips, thighs, legs and feet. Muscles relax. The local blood circulation in your legs is unimpaired and can be increased by simply elevating your legs.

DOUBLE THE RETAIL SPACE LOWER PRICES MORE PARKING

Shop Discount Wednesday 5-15% off Close 6:30pm


SUPPLIED BY BERMUDA HOSPITALS BOARD (BHB)

A stroke occurs when a clot blocks the blood supply to part of the brain or when a blood vessel in or around the brain bursts. In either case, parts of the brain become damaged or die.

It is critically important that you call 911 immedi-ately if you notice signs or symptoms of a stroke, says Dr. Keith Chiappa, Chief of Neurology for Bermuda Hospitals Board.

The chance that you will survive and recover from a stroke is higher if you get emergency treatment right away.

The most common type of stroke is caused by a blockage of a blood vessel. Many patients are candi-dates for medicines that can reopen the blocked blood vessel but these medicines only work within the first three hours after a stroke and the earlier the better.

There is no room for delaying getting to the hos-pital. Every minute counts!

The five most common signs and symptoms of a stroke are:

Sudden numbness or weakness of the face, arm, or leg.

Sudden confusion or trouble speaking or under-standing others.

Sudden trouble seeing in one or both eyes.

Sudden dizziness, trou-ble walking, or loss of bal-ance or coordination.

Sudden severe headache with no known cause (the worst headache youve ever had).

Signs of a stroke always come on suddenly. If your symptoms go away after a few minutes, you may have had a mini-stroke, also called a transient ischemic attack (TIA).

TIAs may not cause permanent damage but can be a warning sign of a full stroke and if you notice the symptoms, you should still get help immediately, adds Dr. Chiappa.

Several conditions and

certain lifestyle choices can put people at higher risk for stroke.

The most important risk factors are:

High blood pressure. Heart disease. Diabetes. Cigarette smoking. Prior stroke.Everyone can take steps

to lower the risk for stroke, Dr. Chiappa explains.

Most importantly, you can do a lot to help prevent stroke by managing any medical conditions you might have and making healthy choices. Living a healthy lifestyle will greatly reduce your risk for stroke.

Here are simple tips for reducing your risk of a stroke:

Choose healthful meal and snack options. Be sure to eat plenty of fresh fruits and vegetables.

Eat foods low in satu-rated fat and cholesterol and high in fiber. Limiting salt or sodium in your diet can also lower your blood pressure.

Maintain a healthy weight. Being overweight or obese can increase your risk for stroke. To deter-mine whether your weight is in a healthy range, doc-tors often calculate a num-ber called the body mass index (BMI).

Doctors sometimes also use waist and hip measure-ments to measure a person's excess body fat. If you know your weight and height, you can calculate your BMI at this web link.

Be active. Physical activity can help you main-tain a healthy weight and lower cholesterol and blood pressure, and promote blood vessel and circulation health. It is recommended that adults engage in mod-erate-intensity exercise for at least 30 minutes on most days of the week.

Don't smoke. Cigarette smoking greatly increases your risk for stroke. So, if you don't smoke, don't start. If you do smoke, quitting will lower your risk. Your doctor can suggest ways to help you quit.

Limit alcohol use. Avoid drinking too much alcohol, which causes high blood pressure. If you have high cholesterol, high blood pressure, diabetes, or heart disease, here are steps you can take to lower your risk for stroke:

Have your cholesterol checked. Your healthcare provider should test your cholesterol levels at least once every five years. Talk with your doctor about this simple blood test.

Monitor your blood pressure. High blood pres-sure has no symptoms, so be sure to have it checked on a regular basis and treat-ed vigorously if elevated. This is also very important for avoiding kidney disease.

Manage your diabetes. If you have diabetes, closely monitor your blood sugar levels. Talk with your health care provider about treatment options.

Take your medicine. If you're taking medication to treat high cholesterol, high blood pressure, or diabetes, follow your doctor's instruc-tions carefully.

Always ask questions if you don't understand some-thing and do not stop taking the medications without physician guidance.

Talk with your health-care provider. You and your doctor can work together to prevent or treat the medical conditions that lead to heart disease.

Discuss your treatment plan regularly and bring a list of questions to your appointments.

While stroke can cause death or significant disabili-ty, such as paralysis, speech difficulties and emotional problems, concludes Dr. Chiappa, the good news is you can greatly reduce your risk through lifestyle chang-es although medication is necessary is many patients.

Remaining fit and healthy is often as simple as choosing to eat well, maintaining an appropriate weight, incorporating exer-cise, avoiding tobacco and cutting back on alcohol.

FEBRUARY IS HEART MONTH

Signs, symptoms and prevention of stroke

AFP PHOTO

LOSE WEIGHT: Being overweight or obese can increase your risk for stroke.


Dietary advice to protect your heartBY DR CARL LEVICKBermuda Hospitals Board

Patients frequently con-sult their physicians for dietary advice regarding the prevention of cardio-vascular disease. Given that 65 per cent of adult Bermudians are either overweight or obese, there is little doubt that a heart healthy lifestyle will mean reducing caloric intake for many people.

For gradual weight loss, cutting just 100 calories a day from your current diet will produce results.

Depending upon what you regularly eat, this could be as simple as eliminating one sugary drink a day.

Doing this consistently over the course of a year will result in about a 10 pound weight loss.

If you prefer more rapid results, cutting 500 calories per day will result in the loss of about one pound a week.

But what should your diet be comprised of?

It is generally accepted that saturated fat intake should be reduced for the prevention of cardiovascu-lar disease.

The main sources of satu-rated fat are from animal products: red meat and whole-milk dairy products, including cheese, sour cream, ice cream and but-ter.

Plant-based sources of saturated fat, such as palm kernel oil, often crop up in commercially prepared products, like non-dairy whipped toppings, coffee creamers, cookies, cakes and other processed food items.

The Dietary Approaches to Stop Hypertension (DASH) diet replaces saturated fat with carbo-hydrates, emphasizing the intake of fruits, vegetables and low-fat dairy products.

While this diet has been shown to lower blood pres-sure and LDL cholesterol, which is associated with plaque build-up in the arter-ies, it also lowers HDL cho-

lesterol, sometimes referred to as good cholesterol. Higher HDL levels are asso-ciated with cardiovascular health.

To determine which dietary approach would best impact cardiovascular health, studies were con-ducted at Johns Hopkins and Brigham and Womens Hospital. Patients followed three different healthful diets and their blood pres-sure results were then com-pared.

One diet reduced the amount of saturated fat with carbohydrates, as the DASH diet does. The other two replaced saturated fats with either proteins or unsatu-rated fat.

While each diet resulted in lower blood pressure and improved LDL choles-terol levels, the protein and unsaturated fat diets were clearly superior in terms of lowering blood pressure.

Unsaturated fats are derived from vegetables and plants and include olive, peanut and canola oils and nuts and avocados, which tend to lower LDL (bad) cho-lesterol and maintain HDL (good) cholesterol.

Other sources include safflower, sesame, corn, cot-tonseed and soybean oils. While these also tend to

lower LDL levels, consum-ing large quantities of these oils can lower your HDL cholesterol as well.

Examples of low-fat, pro-tein-rich foods include lean cuts of meat, skinless chick-en breast, fish and seafood. Beans and soy products, like tofu and soy milk are good sources of lean vegetable protein.

The protein diet reduced the 10-year risk of cardio-vascular disease by 21 per cent.

The unsaturated diet came in next at 19.6 per cent and the carbohydrate diet reduced the 10-year risk by 16 per cent.

Clearly, replacing satu-rated fats in your diet with protein or unsaturated fat can further lower your blood pressure, improve lipid risk factors and reduce cardiovascular disease.

Another important factor in maintaining heart health is to incorporate exercise.

Our bodies are made to move and you can reap sub-stantial health benefits even with minor adjustments to your routine.

Here are some practical suggestions for modifying your diet to achieve a heart healthy regime, along with tips for incorporating more movement in your daily life.

Dietary suggestions Eat breakfast people

who consistently eat break-fast are leaner.

Choose an unsweetened whole grain cereal topped with fruit and 1 per cent skim milk.

Eliminate cream in cof-fee or tea use low fat milk instead.

Use a sugar substitute. Switch to low fat ver-

sions of all dairy products. Choose low-fat, protein-

rich foods like lean cuts of beef, skinless chicken breast and fish.

Minimize cheese con-sumption.

Consume three or more servings of vegetables per day (avoid starchy vegeta-bles such as peas, corn and lima beans).

Replace refined grains/simple sugars with whole grains.

Limit dining out to once a week.

Switch from regular soda to sugar-free soda or water.

Exercise suggestions Purchase a pedometer

and aim to walk 10,000 steps a day.

Move any chance you get: walk around the house during TV commercial breaks or when you talk on the phone.

Park as far away from your destination as possible and walk the rest of the way.

Walk on your lunch break.

Join a gym. Exercise with a friend. Go dancing. Skip rope. Play outside with your

kids.s Join a basketball,

baseball, soccer, cricket or rugby team.

Run or walk on the beach or go swimming.

Take up golf, tennis or another social sport.

DR CARL LEVICK, MD FACC, is a cardiologist with Cardiology Associates, Bermuda Hospitals Board.

MCT PHOTO

1,000 STEPS: Buy a pedometer and count your steps, and aim for 10,000 steps per day.

s #ONTAINUPTOALCOHOLANDCAFFEIN

EEQUIVALENT

TOCUPSOFCOFFEEINONECAN

s (IGHLEVELSOFCAFFEINECANBOOSTHEART

RATEAND

BLOODPRESSURECAUSINGPALPITATIONS-IXING

THESE

DRINKSWITHALCOHOLFURTHERINCREASESTHER

ISKOF

HEARTRHYTHMPROBLEMS

s 3OMEENERGYDRINKSTHATHAVEBEENTE

STEDCONTAIN

THESAMEORMOREALCOHOLCONTENTTHANIS

FOUNDIN

BEERALCOHOLORWINEALCOH

OL

s #ONSUMINGENERGYDRINKSTHATCONTAI

NORARE

MIXEDWITHALCOHOLMAYMASKTHESIGNSOF

IMPAIRMENTANDINCREASEYOURRISKSOF

INJURY


The time for resolutions and change is traditionally at the beginning of a new year. How wonderful to

gain control over smok-ing and live a longer, healthier and happier life, starting right now.

Why is stopping so difficult? Because, although

smokers consciously under-stand the long-term risks of smoking, they have short-term emotional connections to smoking.

They associate smoking with pleasure, the percep-tion of being grown-up or sophisticated, and they often have a fear of not being able to stop.

Stopping smoking means breaking the addiction to nicotine, which is a deadly poison. A way to address this addiction is to break the habit of lighting up.

Like any habit, it can be changed if you are commit-ted to making the change.

Going it aloneSome smokers try to quit

on their own, but they usu-ally need several attempts before they are successful.

One way to quit on your own is to identify the times that you smoke (for exam-ple, with a cup of coffee, after a meal, with a drink) and pick one of these times to stop smoking. Then pick another time. In that way the need to smoke dimin-ishes.

Smokers often have internal conflicts. Part of the smoker wants to stop the health conscious part (adult), but another part still enjoys smoking (child).

Automatically reaching for the pack of cigarettes when stressed, when bored, when having that cup of coffee, when driving, at the end of the day, or after a meal all so regular and

without thought. Logically it makes no

sense to feel pleasure as you inhale poison into your body, but then smoking is not logical.

If you do something often enough (smoke after a meal) the behaviour shifts from a conscious behaviour to an automatic response.

Then, no matter how much you try to change the behaviour consciously, your subconscious mind reminds you to have a cigarette.

The only way to make a permanent change in your behaviour is to change your programmed subconscious mind.

HypnotherapyAn effective way of doing

this is with hypnotherapy.The reason that hypnosis

works so well is that bad habits and undesirable behaviours are rooted in the subconscious mind.

Although they once served a purpose (such as comforting you or making

you feel grown-up), they are patterns that have stuck and because they are so entrenched, it usually takes communication with the subconscious mind through the relaxed, focused state of hypnosis to help you reprogramme yourself to unlearn bad hab-its and replace them with lasting healthier habits.

Stress reductionOne of the chief side-bene-

fits of hypnosis is relaxation and the reduction of stress of both body and mind. While in a pleasant state of hypnosis, you focus and imagine achieving your desired goal whether it is to reach your ideal weight, stop smoking, exercise or become a better, more confi-dent speaker.

Hypnosis is the natural ability that we all have to focus our attention and sub-conscious thoughts on what we wish to achieve, instead of being at the mercy of old programming. It is a fast,

effective and pleasant way to overcome nicotine with-drawal symptoms without gaining weight or starting any other compensating bad habit.

DecideYou have the power of

your own mind to help you to become a comfortable non-smoker. Make the deci-sion today to break free from smoking and be in control of your healthy life starting now.

You can stick to your new years resolutions to stop smoking, achieve your ideal weight, stop procrastinat-ing, change habits, obtain more prosperity and reach your goals.

Whatever your new years resolutions are, hypnosis can help you succeed.

MONICA DOBBIE, certi-fied hypnotherapist, can be reached at 505 7531 or e-mail [email protected] and www.HypnosisBermuda.com

Hypnosis can help you quit smoking

AFP PHOTO

WANT TO STOP? If you have tried to stop on your own and failed then hypnosis may help you quit smoking.

Subconscious mind needs reprogramming to change bad habits

MONICA DOBBIEGuest Columnist


BY JENNIFER ATTRIDE-STIRLING

In healthcare, cost-con-tainment has been the hot topic for some time. But with health fees and premi-ums rising faster than peo-ples pay cheques, the issue has become increasingly urgent. This message has been heard loud and clear.

The problem is that cost-containment is not easy to do. Let me correct that: it is theoretically easy to do. There are many ways to cut costs, and these are well documented in the litera-ture with countless books, studies and scholarly arti-cles providing innumerable ideas, backed by evidence of how to contain health-care costs. So the theory is sound.

The problem is imple-mentation. Because there the devil resides, and the bottom line is that there are only two ways to reduce health costs: to use less health services, and/or pay less for them.

The reason is simple: healthcare costs are high because we spend a lot of money on healthcare money that goes into some-ones pocket.

So if we want health costs to go down (or, at least, not go up so much) it means that we have to put less money into someones pocket.

That much seems easy everyone likes to have a scapegoat. But, in fact,

to put less money into someones pocket usually requires that someone to do less.

In healthcare that means less testing, less procedures and less volume.

As a renowned health economist friend likes to say: cost reduction for one party generally means rev-enue loss for another.

I like to add that it also means activity reduction in the health system... but this is clearly less catchy.

ExcessesLooking at Bermudas

health spending we can see there are some areas where we use too much of the wrong types of healthcare.

For example: overuse of the emergency room to avoid co-pays or because its the only healthcare accessi-ble; patients who dont need to be in a hospital bed, but cant be discharged because services or funds are not available in more appropri-ate settings; and our pen-chant for diagnostic tests, where we have among the highest rates in the world (see graph).

These are some of the excesses driving our health costs. To reduce them, we will need to target misuse.

Nevertheless, there is good news; very good news, in my view. First, there is a terrific amount of buy-in across the health sector for cost-containment. Every stakeholder from

the hospital, to GPs to insur-ers is on-board, and all agree that we have to work together to achieve it.

Second, healthcare qual-ity is not at stake and wont be compromised. Its clear from the evidence that our use of health services is so bloated in certain areas, that there is much scope to decrease use without sacrificing quality one bit. Appropriate, medically nec-essary care should never be compromised.

And, lastly, the benefits of cost-containment are within our reach and, if we do things right, should see real improvements. So the future is bright. But we

will need to hold tight for now because devising these changes and bringing them about will most certainly rock the boat.

Hence the title of this article a take on the well-known poem with the line: water, water, everywhere, nor any a drop to drink. In health, we are spending on more services than we need. To spend less we will have to look seriously at which ones we really do need.

Money, money every-where... is there a drop we are prepared to cut?

JENNIFER ATTRIDE-STIRLING is CEO of Bermuda Health Council.

Money, money, everywhere; but not a drop to cut

ISTOCK PHOTO

HEALTH COSTS: Bermudas health spending needs examin-ing as we use too much of the wrong types of healthcare.

Number of MRI exams per 1,000 population, 2007 (or latest year available)

OECD is the Organization for Economic Cooperation and Development

Data for Bermuda only reflects exams at KEMH; excludes exams outside the hospital and overseas.

* Only include exams for out-patients and private in-patients (excluding exams in public hospitals).

SOURCE: Health in Review 2011

United States

Bermuda

Iceland

Luxembourg

Belgium

OECD11

Spain

Canada

United Kingdom

Hungary

Czech Republic

France*

Australia*

91.2

70.5

64.7

63.3

48.0

41.3

32.9

31.2

28.8

27.9

24.5

21.8

20.2

0 20 40 60 80 100

Exams per per 1,000 population


What you can do about colds and fluBY STEPHANIE SIMONS

Cold and flu season typically runs from November to March when we spend more time indoors and are in close contact with one another, increasing the chances that viruses will spread from person to person. While there are some similarities between colds and flu, they are not identical.

ColdsA cold is caused by a virus

and, according to the National Institute of Allergy and Infectious Diseases in the US, there are about 200 different viruses known to cause the symptoms of the common cold.

Symptoms usually begin two to three days after infection and often include stuffy nose, swelling of the sinuses, sneez-ing, sore or scratchy throat, cough and headaches.

Cold symptoms can last anywhere from two to 14 days, with the average duration being about a week. If your cold lasts longer than this with no improvement, or worsens, you should see your doctor.

Cold infections are transmitted in several ways: touching your skin or other surfaces that have germs on them and then touch-ing your eyes or nose; or inhaling drops of mucus full of cold germs from the air.

While there is no cure for the common cold, you can get relief from symptoms by getting plenty of rest, drinking fluids, gargling with salt in warm water or using throat sprays or sore throat lozeng-es, putting Vaseline on a sore and tender nose, and taking a pain reliever for headaches or fever.

Non-prescription cold remedies may relieve some of your cold symptoms but will not prevent or even shorten the length of a cold.

Many of these medications have side effects such as drowsiness, upset stom-ach or insomnia, so you should take them with care. If you have a cold, talk to your pharmacist about what might work for you.

Importantly, your pharmacist can also give you advice about the ways in which cold remedies may interact with prescription drugs that you may be taking.

FluInfluenza, or the flu, is a respiratory

infection caused by a variety of flu viruses. Flu outbreaks begin suddenly

and spread through the community quickly.

Children are two to three times more likely than adults to get sick with the flu.

How do people catch the flu? Well, as with a cold, you can catch the flu if someone around you who has the flu coughs or sneezes, or if you touch sur-faces that have been contaminated by

someone with the flu.

Flu viruses pass through the air and can enter your body through the nose or mouth. Flu symptoms vary from cold symptoms. In addition to sore throat and headaches, symptoms include fever, extreme tiredness, dry cough, nasal congestion and body aches.

According to the Food and Drug Administration in the US, you can help prevent against the flu by getting the flu vaccine each autumn.

Children, pregnant women, seniors, and anyone living in a nursing home, working in a health profession, or suffering from other health problems like asthma, diabetes or heart disease, should receive the vaccine.

See your own doctor or go to the government health clinic to receive it.

If you do get the flu, treatments are similar to those for the common cold,

including lots of rest, drinking plenty of liquids, and using over-the-counter medications.

However, if you or your child devel-ops a high or prolonged fever, has difficulty breathing or experiences shortness of breath, feels pressure in the chest, experiences shaking chills, is confused, or experiences severe or persistent vomiting, see a doctor right away.

This may be a sign of a more serious infection requiring immediate medical attention.

So what can you do to avoid catching a cold or getting the flu?

First, avoid close contact with people you know are sick, and wash your hands often.

Avoid touching your eyes, nose or mouth, since germs are often spread when you touch something that is con-taminated and then touch your eyes, mouth or nose. Eat a healthy diet, full of veg-

etables and fruit.Garlic boosts your immune

system, increasing resistance to infection and stress, so add garlic to your food when you cook.

Cheese and other dairy prod-ucts contain conjugated lin-oleic acid, a natural component of dairy fat that has boosted immune response in animal studies.

Vitamin C, found in cit-rus fruits and juices, and Echinacea also help boost the bodys immune system.

Zinc, found in chicken, meat, peanuts and peanut butter,

plays an important role in the proper functioning of the immune sys-tem in the body.

If you or your child does get sick, you should stay home from work or keep your child home from school to help prevent others from catching the illness.

Cover your mouth and nose with a tissue when coughing or sneezing. Remember to wash your hands often.

Try eating fresh ginger root to help decrease nausea. Chicken soups and warm beverages are another good idea, since they increase the flow of nasal secretions, helping alleviate cold symptoms.

This cold and flu season, lets hope Bermuda residents stay healthy.

STEPHANIE SIMONS is head phar-macist at Lindos Pharmacy in Devonshire.

MCT IMAGE


ARCHITECTURE INTERIOR DESIGN LANDSCAPE ARCHITECTURE

obm international7PVPLWK#REPLFRPREPLFRP

Pointers to designing your home gymWhile function matters

most in an exercise room, a well-designed room makes exercising more enjoyable.

Good design includes making a space right for its use and user. Many of the decorative elements that make your exer-cise room look better

also make it safer and more serviceable.

WallsColour can be very moti-

vating.Paint the walls of your exercise space to suit the type of exercise you plan on doing there.

Choosing a colour that induces the right mood for your exercise routine will

help you to stay focused and want to be there.

If you're a yoga enthusiast or simply want a spa-like effect, consider calming colours like sage green, lilac, silvery aqua or sky blue.

If you need all the help you can get to stay on that treadmill for the allotted time, choose a warm, ener-gizing colour, such as yel-low, orange or red.

Warm colours, especially brights, make a space feel smaller and warmer. If your room is small or if you have west-facing windows, tone it down by using lemony yellow, coral or a blue-based red.

You are going to be spend-ing some quality time in this room so make it enjoy-able by having pleasant sur-roundings.

Consider adding floor-to-ceiling mirrors on one of your walls. They'll bounce

light around, make the room look larger and allow you to make sure your form is correct.

FloorsExercise room floors need

to give and absorb shock. Avoid exercising directly on hard tile or concrete.

Hardwood floors are fine if they're not installed directly on concrete.

Carpet and rubber floor-ing will give some shock absorption.

If you do not want to redo the complete floor apply large interlocking thick foam tiles that look like jig saw puzzle pieces. Styles are available in many toy stores and will cover a fairly large area of the floor and give good shock absorption.

FurnishingsIn addition to any exer-

cise equipment you're using, you'll need storage

for other items, such as tow-els and rolled-up mats.

For an exercise room without closet space, con-sider adding a freestanding or wall-mounted shelving system.

If you exercise to videos, mount a flat-panel televi-sion on a wall mount with a swivel so that you can reposition the television as needed.

Add wall-mounted speak-ers and a music player if a lively beat helps you move.

Even if you have a closet in your exercise room con-sider having a wall-mounted shelf for you put your water bottle on in order to reduce accidental water spills.

Space planningA floor plan highlight-

ing your equipment will be important prior to setting up your room. Measure

See HOME GYM, page 14

MICHELE SMITHGuest Columnist


your exercise equipment in the fully extended posi-tion in all directions. This includes the height of the equipment to be sure that it fits. Make grid-paper tem-plates for each piece and arrange them on the floor plan.

Allow three feet of walk-ing space for major traffic patterns and at least two feet between each piece of equipment such as a tread-mill or stationary bike.

Place any large pieces of equipment close to the walls and leave an open space in the centre of the room for exercising on mats.

If any equipment is to be wall-mounted make sure there is sufficient block-ing within the wall cavity unless it is directly installed on concrete block.

LightingInstall clean-lined lighting

fixtures overhead, sconce and recessed that look

appropriate with your exer-cise equipment.

An overhead chandelier strung with baubles doesn't work. Install cooler bulbs such as compact fluorescent or LED lights.

If you will be using your room for cardio as well as yoga or stretching consider using a dimmer switch to change the mood of the room as your workout changes. Hugger ceiling fans also are a great idea to keep the air circulating.

Safety Your home gym should be

a safe place. Small children should not have access to this space unless they are supervised. Use zip ties to bundle any extra cords or cord covers to tuck them out of the way. Put a floor cover strip over any cords that have to cross the room.

A phone in your home gym is also a good idea in case you need to make an emergency call. Always keep water nearby to help you stay hydrated while you exercise.

Keep trackUse a bulletin board to

hang informational posters that describe common exer-cises, number of calories burned per workout, and other data related to your fitness goals.

Also, display an outline of your workout regimen. For example, fill in a large calendar with specific work-out goals for each day. Add the long-term results you hope to achieve, such as the number of pounds you want to lose.

Write a note each day to keep track of your progress. After a while, you'll get a long-term view of your workout's effectiveness, allowing you to fine-tune your regimen to achieve your fitness goals.

Spend carefullyAvoid buyer's remorse.

Purchase equipment that you know you will enjoy using. Otherwise, your expensive purchase will gather dust.

If you plan on having a treadmill or other large

piece of exercise equipment, consider buying used equip-ment if possible. Check garage and yard sales for low-priced fitness equip-ment.

If friends or family mem-bers have fitness equipment they don't use, make an offer. Inspect all prospec-tive purchases carefully to ensure they are in proper working condition.

Perhaps when starting out, keep it simple at first and add more equipment later.

Initial pieces of equip-ment could be resistance bands and tubes, a stability ball, balance board, yoga matt and weights.

Always be careful when using any exercise equip-ment. We exercise to stay healthy, strong and young but improper use can cause injuries.

MICHELE SMITH is man-aging director for OBM International Limited, Bermuda. She is a senior interior designer with exper-tise in solutions for seniors.

HOME GYMContinued from page 13


BY DR ANNABEL FOUNTAIN

Osteoporosis is a major public health issue but tends to be under-recog-nized and under-treated.

According to figures from the US, nearly 50 per cent of women and 20 per cent of men over 50 will suffer a fracture due to osteoporosis.

So what is osteoporosis? It is a condition which makes your bones weak, leading them to break more easily.

People with the condition sometimes break a bone just by falling at home. But this can be serious, especially if they break a hip.

Some people only learn they have osteoporosis after they break a bone during a fall or mild impact, or if they lose height as a result of bones in their spine col-lapsing. Healthy bones should not break easily, and so these injuries are called fragility fractures.

Some people have an increased risk of osteoporo-sis. They include: smokers; post-menopausal women, people who have taken steroids or other medica-tions for prolonged periods (some anti-epileptic drugs, Heparin, Prednisone, Vitamin A); those under-weight or malnourished; people with endocrine disor-ders such as an overactive thyroid or over-replacement with the thyroid hormone; and men with testosterone deficiency.

You cant change some risk factors such as age, sex, race and family history, but to reduce risk of fracture, diagnosis and early treat-ment is key.

You can be tested for osteoporosis with a special X-ray, the DXA scan, which measures bone density

You can also keep your bones as healthy as pos-sible by following a diet with enough calcium and vitamin D, which are essen-tial for bone formation and maintenance.

Men and pre-menopausal women should have at least 1,000 milligrams of calcium per day (from foods, bever-ages or supplements). Post-

menopausal women need more and should have 1,200 milligrams of calcium per day.

Sources of calcium include: milk, yoghurt, orange juice, tofu; cheese, cottage cheese, ice cream/frozen yoghurt, soy milk; beans; dark, leafy vegeta-bles, almonds, and oranges.

The Institute of Medicine recommends that men over 70 and post-menopausal women need 800 IU of vita-min D each day. Children and healthy adults should have 600 IU per day, up to age 70.

Vitamin D is manufac-tured by our skin when it is exposed to sunlight, or eaten as part of our diet.

If you sit in the midday sun for 15 to 20 minutes a day, you will make 1,000 IU of vitamin D. In the winter, particularly in the northern hemisphere, vitamin D sup-plements are an alternative.

The pigments in darker skin act as a sunscreen, so this skin makes less vita-min D.

Vitamin D deficientEven though we are in

sunny Bermuda, people who do not tend to spend time outside, such as the elderly, or who wear high factor sunscreen may be vitamin D deficient.

A 2010 study in Nutrition Journal found that 42 per cent of adults in the US were Vitamin D deficient. The highest rates were among African Americans and Hispanics.

Exercise also improves bone mass in younger women and will maintain bone density and increase its strength after meno-pause.

Physical activity also reduces the risk of falling and hip fracture in older women. You should exer-cise for at least 30 minutes, three times a week.

The National Osteoporosis Foundation (NOF) recommends medica-tion to treat post-menopaus-al women and men over 50 with a history of hip or

vertebral fracture.Drug therapy may also be

recommended if you have an estimated 10-year risk of hip fracture greater than 3 per cent, or osteoporosis-related fracture greater than 20 per cent.

Your physician can cal-culate the absolute risk of fracture using the World Health Organization FRAX calculator, at www.shef.ac.uk/FRAX.

TreatmentOsteoporosis medications

reduce bone loss, increase/maintain bone density and reduce the chance you will break a bone. You also need to take calcium and vitamin D for the medicines to work.

Most people being treated for osteoporosis take bisphosphonates first. They slow the breakdown of bone and come in pill or a shot form.

To avoid throat or stom-ach irritation, if you take them orally then take the pill in the morning on an empty stomach with eight ounces of water. Do not eat or drink anything else for at least 30 minutes. Avoid lying down for 30 minutes after taking it.

Raloxifene (Evista) and Tamoxifen are Selective Estrogen Receptor Modulators (SERMs). SERMs have oestrogen-like effects on the bone and pro-tect against post-menopaus-al bone loss.

They also decrease the risk of breast cancer in high-risk women. They may not be as effective as bisphosphonates or HRT and are not recommended for pre-menopausal women.

Hormone replacement therapy (HRT) is taken by some women to replace estrogen and progesterone, which are lost through menopause and which pro-tect against osteoporosis.

HRT is also useful for women who cannot take other osteoporosis medi-cine. It is a useful preven-tion for younger women with premature menopause (due to surgeries, cancer

treatment or other causes). Overall, HRT is not

recommended for osteopo-rosis in post-menopausal women, but some women with persistent menopausal symptoms and those who cannot tolerate other types of osteoporosis treatment still use it.

Another treatment is synthetic calcitonin a hormone which regulates calcium in the body and which is good for pain relief for vertebral fractures.

Parathyroid hormone (PTH) is from the parathy-roid glands and high doses of the synthetic hormone (Forteo) stimulate the body to make new bone. It is not recommended for pre-meno-pausal women.

Denosumab (Prolia) is a new medicine, given as an injection every six months. It is currently reserved for individuals who cannot take other osteoporosis medications, or who have severe osteoporosis which the usual medications fail to work on.

Osteoporosis causes bones to become abnormally weak and easily broken. It can be treated and prevented with diet, exercise, not smoking, regular exercise and cal-cium and vitamin D supple-ments.

If youre not getting enough calcium and vita-min D from your diet, it is recommended that you take supplements.

There are several medications that help to prevent osteoporosis in women after menopause. Bisphosphonates are the most recommended therapies. There are other options for patients who are intolerant of or unrespon-sive to bisphosphonates.

Your doctor may arrange follow-up tests to monitor how the bones respond to your osteoporosis treat-ment. This may include a bone density scan (DXA) or laboratory tests.

DR ANNABEL FOUNTAIN is director of endocrinology, Bermuda Hospitals Board.

Over 50s susceptible to osteoporosis

www.bfm.bm

Whether you are self-employed, part of a small business

or enrolled via a big company, good health cover is critical.

Thats why BF&M offers several bene t-rich plans to suit your

needs like dental coverage, vision care, prescription drug

plans, major medical bene ts and unlimited access to our

on-line wellness programme, Wellness Matters.

BF&M LIFEinsurancematters

112 Pitts Bay Road, Pembroke HM 08, Bermuda

/ColorImageDict > /JPEG2000ColorACSImageDict > /JPEG2000ColorImageDict > /AntiAliasGrayImages false /CropGrayImages false /GrayImageMinResolution 150 /GrayImageMinResolutionPolicy /OK /DownsampleGrayImages true /GrayImageDownsampleType /Bicubic /GrayImageResolution 200 /GrayImageDepth -1 /GrayImageMinDownsampleDepth 2 /GrayImageDownsampleThreshold 1.25000 /EncodeGrayImages true /GrayImageFilter /DCTEncode /AutoFilterGrayImages true /GrayImageAutoFilterStrategy /JPEG /GrayACSImageDict > /GrayImageDict > /JPEG2000GrayACSImageDict > /JPEG2000GrayImageDict > /AntiAliasMonoImages false /CropMonoImages false /MonoImageMinResolution 300 /MonoImageMinResolutionPolicy /OK /DownsampleMonoImages true /MonoImageDownsampleType /Bicubic /MonoImageResolution 200 /MonoImageDepth -1 /MonoImageDownsampleThreshold 1.25000 /EncodeMonoImages true /MonoImageFilter /CCITTFaxEncode /MonoImageDict > /AllowPSXObjects true /CheckCompliance [ /None ] /PDFX1aCheck false /PDFX3Check false /PDFXCompliantPDFOnly false /PDFXNoTrimBoxError true /PDFXTrimBoxToMediaBoxOffset [ 0.00000 0.00000 0.00000 0.00000 ] /PDFXSetBleedBoxToMediaBox true /PDFXBleedBoxToTrimBoxOffset [ 0.00000 0.00000 0.00000 0.00000 ] /PDFXOutputIntentProfile () /PDFXOutputConditionIdentifier () /PDFXOutputCondition () /PDFXRegistryName () /PDFXTrapped /False

/CreateJDFFile false /Description > /Namespace [ (Adobe) (Common) (1.0) ] /OtherNamespaces [ > /FormElements false /GenerateStructure false /IncludeBookmarks false /IncludeHyperlinks true /IncludeInteractive false /IncludeLayers false /IncludeProfiles true /MarksOffset 6 /MarksWeight 0.250000 /MultimediaHandling /UseObjectSettings /Namespace [ (Adobe) (CreativeSuite) (2.0) ] /PDFXOutputIntentProfileSelector /NA /PageMarksFile /RomanDefault /PreserveEditing false /UntaggedCMYKHandling /UseDocumentProfile /UntaggedRGBHandling /UseDocumentProfile /UseDocumentBleed false >> > ]>> setdistillerparams> setpagedevice

Documents

Health Care Directory 2013