Migraines explained

By the Ministry of Health

Migraine attacks normally happen to those between the ages of five and 35 years.

Migraine symptoms vary from individual to individual, but normally, a migraine sufferer will experience a headache that throbs on one side of the head, followed by dizziness, nausea and vomiting.

While a migraine is taking place, the sufferer also becomes hypersensitive to light and sound.

It can last between four and 72 hours, happening once or twice a year, or even every day.


Types of Migraines

There are two main types of migraines:

1) Classic migraine - This type of migraine always has early warning signs, known as "aura", which normally lasts between five and 15 minutes.
The "aura" includes:
* Seeing extremely bright light or zigzag lines
* Double vision or flickering vision
* Head feels like it is turning
* Dizziness
* Hard to speak or momentarily confused
* Numbness in some parts of the face or hands
Once the "aura" fades, the migraine attack will start.

2) Common migraine - This type of migraine occurs commonly without "aura". This type attacks slowly, but for long periods of time, until it disrupts your daily activities.


Trigger factors for migraine:

- Diet
a) Irregular meals
b) Foods that contain preservatives and have been dried, including some types of cheese, pickled fruits, burgers and hotdogs; foods that contain monosodium glutamate (MSG) or processed sauces
c) Soft drinks, hard liquor or alcohol

- Hormones - Menstruation, use of birth control pills or use of Hormone Replacement Therapy (HRT)

- Unbalanced sleep - too much or too little sleep

- Medicines - a number of medicines, including traditional/herbal medicines

- Weather changes - too hot or too cold and also air pollution , such as open burning

- Watching television or staring at the computer screen for too long

- Stress

- Genetics


Ways to prevent migraines:

a) Reduce stress
b) Get proper sleep - Avoid too much or too little sleep especially on weekends
c) Have regular eating times
d) Eat a balanced diet while avoiding foods that can cause migraines
e) Reduce your daily intake of caffeine and carbonated soft drinks
f) Increase your exercise and recreational activities


Those experiencing migraines are advised to keep a daily record of what they eat/drink and their activities, to see what could be causing the migraines.

This can help you prevent or reduce migraine attacks.

Migraine attacks can be overcome with or without medication. Treatment without medication includes resting in a dark and quiet room, and massaging the head gently.

There are three types of medical treatment. Check with your doctor before considering using any of these medicines:
1. Painkillers
2. Relief medication - will help alleviate pain.
3. Preventive medication - suitable for those who get frequent migraine attacks whose daily activities are affected.

You are advised to seek medical assistance immediately if you experience:
* Extreme headaches that happen suddenly.
* Headaches that last a long time or do not go away even after taking pain relief medication.
* Migraine attacks that happen too frequently or every day.
* Headaches that last longer than a week after suffering a head injury.
* Headaches that are followed by fever, sore throat, mood swings and blurred vision that lasts for more than an hour.


- Ministry of Health Public Awareness Programme

Source: Weekend - 26 July 2008

Asthma in children

By Ministry of Health


Asthma is one of the most common diseases in childhood.


What is Asthma?

Asthma is an inflammatory condition of the small airways causing breathing difficulty or asthma.

Asthma breathing problems usually happen in episodes. Even though asthma cannot be cured in the short term, it can almost always be controlled.


What is the cause of Asthma?

Asthma is due to excessive sensitivity of the lungs to stimuli.

Triggers range from viral infections to allergies, to irrigating gases and particles in the air.

Each child reacts differently to the factors that may trigger asthma, including:
- cough and cold
- allergic reactions to pollen, mould, animal dander, feathers, dust, food and cockroaches
- vigorous exercise
- exposure to cold air or sudden temperature change
- cigarette smoke
- excitement or stress


What are the signs and symptoms?

Airway obstruction, chest tightness, coughing and wheezing are the effects of asthma.

If severe, this can cause severe shortness of breath and low blood oxygen. Wheezing though characteristic of asthma is not the most common symptom.

Coughing is also a sign of 'hidden' asthma when wheezing may not be noticeable to the patient, his or her family or the physician.

Children who frequently cough or have regular respiratory infections should be evaluated for asthma.

Those who cough after running or crying may be suffering from asthma.

Recurring night cough is common as asthma is often worse at night.

Infants who suffer from asthma often have a rattly cough, rapid breathing and may experience an excessive number of pneumonias, episodes of bronchitis or chest colds.

Wheezing episodes might not be noticed until after the infant is 18 to 24 months of age.


What are the treatments?

Two main of medications are used to treat asthma. They are:
- Anti-inflammatory medications
They help to reduce underlying inflammation in the airways and have a preventive action. These agents include corticosteroids such as beclomethasone and fluticosone.

- Bronchodilators
They act mainly to dilate the airways and enable better air entry into the lungs. Examples of bronchodilators are salbutamol and salmeterol.



OTHER IMPORTANT MEASURES

You can take other important measures to eliminate or reduce factors which could trigger asthma. They include:
- Regular cleaning of the rooms to reduce dust and accumulation of other allergens. Dusting should be done with a damp cloth to avoid dust being dispersed into the room air.
- Avoid carpets as a floor covering because it attracts dust. Carpets if present, should be regularly vacuumed and washed or dry cleaned.
- Avoid feathers or tree cotton wool 'kapok' in bedding material because these collect dust and cannot be washed. Use pillows and comforter fillings which are made of polyester filling that is designed for washing.
- Parents who smoke should stop the habit because smoke and fine ashes from cigarettes are very potent irritants to children with asthma. Strong perfumes and air fresheners should also be avoided as they can also trigger an asthma attack.
- Exercise will help asthmatic children to develop a strong chest. With the appropriate use of inhalers, except during acute attacks, children with a diagnosis of asthma should still participate in physical activities and sports. Swimming is also believed to be the best sports for asthma sufferers because the air the child breathes is moist.

- Ministry of Health Public Awareness Programme
Source: Weekend, 19 July 2008

Antibiotics: 12 things you should know

By

The Ministry of Health

Antibiotics do not work against viruses. - PHOTO COURTESY OF MOH



1. Antibiotics are medicines used to treat infections caused by bacteria only. Antibiotics will not work against viruses. There are different types of antibiotics that work against different types of bacterial infections.
2. Take antibiotics properly as instructed on the label. Some antibiotics may need to be taken with food while some need to be taken on an empty stomach.
3. Inform your doctor of any other medications you are taking. For example, oral contraceptive as interaction with your antibiotics may occur. Also inform your doctor if you are pregnant or planning to become pregnant or breastfeeding.
4. Do not miss a dose. If you forgot a dose at a certain time, take the antibiotics as soon as you remember. Do not double the dose. Antibiotics work best when they are taken regularly on consecutive days until finished.
5. Finish the course, that is, if asked to take for five days, you must do so. Even though you may feel better, do not stop taking the medicine until you complete the course. This is because the antibiotics may not have killed all the infectious bacteria. Therefore, allowing the remaining bacteria to thrive and possibly become resistant. The bacteria may re-infect you and you can become sick again later.
6. Antibiotic resistance occur when the bacteria cannot be killed because it adapts and find ways to survive the effects of the antibiotics.
Antibiotic resistance is due largely to overuse and misuse of antibiotics. As a result, "superbug" infections can arise such as Methicillin Resistance Staphylococcus Aureus (MRSA), which are difficult to treat.
7. One way to help curb antibiotic resistance is for you not to demand for an antibiotic when the doctor determines one is not required for your illness.
8. Any side effects should be reported immediately to your doctor. Some of the common side effects of antibiotics include rash and diarrhoea. Inform your doctor of previous allergies to a particular antibiotic or medicine. Keep records of the antibiotics or medicine name you are allergic to.
9. If your symptoms get worse or do not improve within a few days of treatment with the antibiotic, consult your doctor as soon as possible.
10. Do not share antibiotics with family or friends or keep your antibiotics for use at a later date. These antibiotics are meant to be finished for your current infection. Taking the wrong medicine could delay getting correct treatment and may allow bacteria to multiply.
11. Some patients discharged from the wards may need to continue their antibiotic treatment.
12. Any unused medicines should be returned to the pharmacy for safe disposal.

Source: Weekend, 12 July 2008

What bosses need to know about workplace safety

By

Ministry of Health

Why it is so important

Workers spend a lot of time at the workplace and are exposed to various dangers from their surroundings. An unsafe workplace can cause workplace-related accidents/illnesses that can harm workers and their families from a social and financial standpoint.

What are the benefits of having a safe workplace?
- Protect your most important assets - the workers.
- Increase productivity.
- Reduce workplace accidents and illnesses.
- Decrease workers' insurance claims.
- Reduce medical costs.
- Raise workers' morale.

What are the strategies for creating a safe workplace?
Safe surroundings:
- Make sure that the workplace is always neat.
- Ensure that walkways are not blocked.
- Mark out in yellow lines the way to emergency exits.
- Use flooring materials that are not slippery.
- Clean all spills on the floor immediately.
- Ensure good and effective air circulation in order to maintain comfortable room temperature.
- Ensure that lighting is sufficient.
- Store areas should be organised neatly and all items should be labeled. Avoid keeping chemicals/insecticides together with food/drinks.
- Place health and safety warning signs wherever needed, such as "no smoking", "emergency exits", etc.
- Equipment, machinery and chairs should be ergonomically designed and comfortable to use.
- Provide facilities such as toilets, washrooms, changing rooms, rest areas, etc.

Fire safety:
- Install fire extinguishers and make sure they are checked regularly.
- Mark out areas that workers should gather at during emergencies.
- Display the emergency evacuation plan in an area where all workers will see it.
- Carry out fire drills.

Use chemicals safely
- Replace dangerous chemicals with safer chemicals if possible.
- Label all chemical containers.
- Keep Material Data Sheets (MSDS) for reference.

Use recommended safety equipment such as helmets, masks, gloves, safety goggles, etc.
Make available emergency eyewash solutions and bathrooms.

Use electricity safely
- Never use too many electrical connections that go over your power limit.
- Do not use faulty electrical cords - label warnings for all to know.
- Never try fixing faulty electrical equipment on your own - such work must be done by a qualified person/expert.

Use equipment safely
- Provide workers with training on how to use workplace machines safely.
- Failsafe devices must be built into work machines that carry a high risk of causing accidents.
- Avoid doing repairs, modifications or maintenance on a machine without proper clearance.
- Use suitable safety equipment as needed.

Use safety equipment correctly
- If possible, remove potential sources of workplace danger - safety equipment should only be used as back-up in the event of an emergency.
- Always use safety equipment suitable for the task and strongly promote its usage.
- Safety equipment must be maintained always - replace defective safety equipment immediately.

- Ministry of Health Public Awareness Programme

Source: Weekend, 5 July 2008

Effects of Sisha towards health

By

Pg Anuar Husaini Pg Hj Rambli,

Health Education Officer,

Health Promotion & Education Division,

Department of Health Services

What is the current trend of smoking sisha?
Smoking sisha has been practiced centuries ago, but where it originated has yet to be conffirmed. Long ago, it was thought that countries such as China, India, Pakistan and the Eastern Mediterranean were the early users of sisha.

At that time, smoking sisha was not that popular until in the 1980s, where a boom in sisha use increased, especially among youngsters, who opted to try sisha and perceived its use as a modern trend and fashion.

According to the World Health Organisation (WHO), sisha smoking are widely practiced among the Arabs and Southeast Asians.

It is easily available in many public places such as supermarkets, restaurants and cafes.

Is it true that sisha is categorised as 'low risk' towards a person's health?
The perception of sisha having a 'low risk' towards one's health, when compared to the risk involved from smoking cigarettes, has often been raised in our daily conversations.

This kind of perception is obviously wrong, and often results in confusion among sisha users.

Sisha users often think that smoking sisha is safe because it uses fruity flavours instead of tobacco, and in addition, water is used to filter and smoke the flavours.

But in reality, sisha is still considered as one of the many dangerous tobacco products that are disguised as a friendly looking form, like having fruity flavours.

Furthermore, the smoke that comes out through the water in sishas has no form of filtration at all, compared to the filter attached to a cigarette.

Having explained, it clearly shows that smoking sisha is far more hazardous than smoking cigarettes. Sisha users will be exposed to similar, if not more, negative health effects compared to cigarette smoking.

Is sisha really hazardous to one's health?
Studies have shown that using sisha for a duration of 45 minutes is equivalent to smoking 50 cigarettes.
Even with the indicative nature of this fact, there are still some users who still think that sisha is not hazardous.

A single cigarette contains more than 4,000 different types of dangerous chemicals, so just imagine the effect of 50 cigarettes!

As we all know, cigarette users are exposed to hundreds of dangerous cigarette contents, which include carbon monoxide, carcinogens and nicotine; where these chemicals are capable of causing negative effects to one's health, such as cancers, heart diseases and nicotine addiction.

Sisha users are not exceptional and will be exposed to the same negative effects.

The content of carbon monoxide inside a sisha apparatus may depend on the size of the sisha packets, type of tobacco and charcoal used.

Smoking sisha for duration of 45 minutes will also produce unfiltered-smoke that contains tar, which is equivalent to tar that are produced from 20 cigarettes.

Furthermore, the fruity-flavoured used in sishas are made from processed contaminated fruits, where the fruits have been changed to alcohol.

From several studies that have been conducted, short-term health effects from using sisha include:
* After 45 minutes of smoking sisha, the level of carbon monoxide in one's breath, nicotine level in the body and heart rate are found to be abnormally high.

* Smoking sisha for 45 minutes will expose the user to twice the carbon monoxide and thrice the nicotine in the body compared to a single cigarette exposure.

The high concentrations of the two chemicals are time-based; ie normally smoking sisha takes about 50 minutes whereas smoking a cigarette takes about 5 minutes. The difference in time of usage is the main cause of the increase in carbon monoxide and nicotine level.

* Smoking sisha also exposes the user to cadmium, which is found in cigarettes as well as car batteries.

* Smoking sisha also causes nicotine addiction, especially if the user is a frequent sisha user. At the moment, there are no studies done to show that quitting sisha causes withdrawal symptoms.

Even so, signs of sisha addiction can be clearly seen: continuous use of sisha, wasting money to use sisha and difficulty in quitting.

* Sharing of sisha from one's mouth to the mouth of others is a high-risk habit that can lead to the dangers of oral infection, such as tuberculosis, and viral infections, such as herpes and hepatitis.

Studies also show that frequent use of sisha can cause long-term damage to one's health such as:
* Sisha users are exposed to the risk of cancer and the risk increases with the usage of cigarettes. Some predisposing cancers include cancer of the bronchus, lungs and mouth.

The main cancer-causing chemical in sisha is called 'Nitrosamine', which is also found in cigarettes.

* Users are also susceptible to atherosclerosis, Coronary Heart Disease, lung diseases, eczema on the hands (affecting those with poor immune system) and dry mouth.

* Pregnant women who smoke sisha are also risking the development of afterbirth side effects to their newborn such as low birth weight and difficulty in breathing.

* Some sishas do not contain high amounts of nicotine, but with the reduction in the concentration of nicotine, the amount of 'glycerin' in the sisha tobaccos increases. Glycerin is toxic to the user's body especially to the lungs and can cause emphysema (a lung disease that causes signs of asthma, a difficult disease to cure).

- Ministry of Health's public awareness programme

Source: Borneo Bulettin Weekend, 21 June 2008

One man's blood is another man's life

By

Dr Vasantha

Blood Bank Medical Officer

Department of Laboratory Services Ministry of Health

Blood transfusion has become an integral part of healthcare and medical practice. It is important that blood is available within very short notice and blood banks must have an adequate supply of safe blood to meet demands. This can be achieved only when healthy people donate blood regularly. As blood is vital for life and can only be obtained from human source it is our responsibility to disseminate information to the public as to how it is procured, and how it helps to save lives in order to motivate them to come forward to donate blood regularly.

The World Blood Donor Day is officially designated as an annual event and is celebrated annually on June 14 to commemorate the birth anniversary of Karl Landsteiner, the noble prize winner for discovering ABO blood group system.

This year's theme is "Giving blood regularly". This highlights how voluntary non-remunerated blood donation can help to save lives of patient as there is no substitute for human blood.


Why people have to donate blood regularly:
Blood is an elixir of life and one man's blood is another man's life. Blood transfusion is essential to save the lives of patients following accidents, for major surgery, during child birth and for new born babies with haemolytic disease, cancer patients and also for patients who are on red cell transfusion support such as thalassaemia, haemophilia and other blood related disorders.


What are the blood types?
There are four types of ABO blood group A, B, O and AB and they are identified as positive or negative depending upon the presence and absence of the ABO antigen. This information is important because your blood type and Rhesus group must be compatible with the blood recipients. Most common blood groups among Bruneians are O and B. The Rhesus D negative blood is comparatively rare in Brunei population.


Blood components and its functions:
Blood consists of cellular and fluid component.
The cellular component consists of red blood cells, white blood cells and platelets. The red blood cells carry oxygen to the tissues.
The white blood cells protect us against invading organisms.
The platelets help in clotting of blood to prevent bleeding.
The fluid component is the plasma in which the cellular portions are suspended. The plasma consists of water, electrolytes, proteins, immune globulins and coagulation factors.


In transfusion services, whole blood was the only product available at one time. Now with modern transfusion medicine, the requirement of whole blood transfusion is very limited since majority of patients do not require all the components of blood as they may be deficient in one or two components only.

In recent times the major advance in transfusion service is the development of component therapy with the introduction of blood bags with the integral tubing and development of technology for the separation of blood components. So one unit of blood can be given to three to four patients to provide safe blood component indicated therapeutically. The blood component like platelet can be taken directly from the donor leaving the other components within the donor by aphaeresis method by using the cell separator equipment. This is being done as transfusion practice.


The blood components prepared in the blood collection centre at RIPAS Hospital are as follows.
Packed red cells
Fresh frozen plasma
Platelets
Cryoprecipitate All the blood components are stored within predefined conditions which assures the maintenance of quality and hence safety.


What is safe blood?
Voluntary and non-remunerated blood donation is considered to be safe. Blood is considered safe if the donor is not suffering from diseases that can be transmitted through blood transfusion. The infections that can be transmitted through blood transfusion include hepatitis B, hepatitis C, HIV and syphilis. If any of these are found positive the donors are contacted for counseling and referred to the respective specialist for advice and treatment.

The blood transfusion services enforce screening guidelines and eligibility requirement to make sure that donating blood will not harm the donor as well as the recipient.

The public should be aware of the fact that blood is transfused to the patient only after screening the blood for the above diseases and after compatibility is confirmed.


Blood donation process
There are four steps in blood donation process:
1. Registration
On arrival the donor is received by our staff and registered. He/she is given a questionnaire form regarding his health and previous donation if any. The donor must be healthy at the time of donation.
2. Blood Test
3. A blood test is done for the donor to ensure that his haemoglobin level is within healthy range. When the donor passes all the tests he proceeds to donate blood.
4. Limited medical evaluation
Health assessment will be performed by the medical officer. Recording of the pulse, blood pressure etc will be done.
5. Donation of Blood


The donor is given a local anesthetic prior to the donation to prevent pain. Actual donation takes only 10 to 15 minutes. But the whole process takes one hour from the arrival time to refreshment.

The volume of blood collected is 450ml ie 8-9 per cent of your blood volume.

New sterile equipments are used for each donor so there is no risk of contacting blood borne infection. After completion of your donation the donors are given refreshments and advised to rest for 15-20 minutes.
Within 24 hours of blood donation our body replaces the lost fluids and after a few weeks the body replaces the red blood cells.


Donor eligibility to donate blood:
Donors must meet the following specific requirements.
Age of the donor must be between 18-60 years of age.
Weight should not be less than 50kg.
The donor should pass the physical and health assessment by the medical officer. Donors not eligible to donate blood:
People positive for the following diseases:
Hepatitis B
Hepatitis C
HIV
Syphilis
People suffering from hypertension, diabetes and cardiac diseases
Donors with history of bleeding disorders are refrained from donating blood.


Advice following blood donation:
Drink plenty of water
Avoid strenuous exercise or games for 24 hours
Avoid smoking for 4-6 hours Benefits of blood donation:
The most outstanding benefit is his or her contribution to humanity
Studies and clinical research has shown that there is reduced risk of heart attack among repeat donors who are non-smokers (this is due to depletion of iron which has been shown to damage the heart muscle). Blood donation activity in Brunei Darussalam

The blood collection centre is a humanitarian organisation that brings people together to help patients. Blood collection centre functions both as a mobile and walk in donor unit. By facilitating the blood donors in our community, it will create awareness among the public particularly the younger generation to come forward to donate blood and this will form an invisible chain of network of donors. The month of Ramadan goes on record as being one of the slowest donation periods. It is during this month other non-Muslim donors should come forward to donate blood.

The Ministry of Health has provided some incentives as a token of gratitude. The maintenance of blood supply depends entirely on the generosity of those who donate blood regularly. So donating blood should not be confined to, only during crisis, but should be a regular ongoing process. It is a credit to everyone here in Brunei as the balance between blood supply and demand has been managed so well up to now. Various efforts are taken to expand donor pool.

The Ministry of Health is keen in fulfilling the objective of establishing a coordinated blood transfusion service that can provide adequate and timely supply of blood for all patients in need. A reliable and expanded donor pool will not only provide a life saving therapy but also improve safety. Ministry of Health provides resources to ensure that essential supplies are available including blood bags, blood group reagent, and test kits.

All blood donations are tested by approved technology. More tests are going to be introduced in future. It is the hope that in designating one special day in each year to celebrate the role of blood donors in health care, a new generation of blood donors will follow their example thereby providing constant supply of safe blood. This event will be a landmark in improving regular voluntary blood donation and act as a stepping stone to achieve a certain percentage of regular voluntary non-remunerated blood donors.

It is a community service and nothing is as fulfilling as saving the lives of many by donating blood.

Source: Borneo Bulletin Weekend - 14 June 2008

Getting rid of nicotine addiction

By

Dr Hj Rozaimee Hj Tengah

Senior Medical Officer

Ministry of Health

Nicotine is contained in the leaves of several species of plants. The primary commercial source of nicotine is by extraction from the dried leaves of tobacco plant - Nicotina tabaum & Nicotina rustica.

Of all the possible ways of obtaining nicotine, smoking cigarette remains by far the most addictive. The reason is that smoking cigarette maximises the rapidity, frequency, reliability and ease of attainment of the reward from nicotine.

Nicotine via cigarette reaches the brain in 10 seconds, even faster than via intravenous use. This is the chemical largely responsible for "hooking" people on cigarettes (popularly known as smoking addiction).

It is much easier and cheaper to purchase a pack of cigarette (eg: from petrol stations or local supermarkets) than it is to purchase a packet of nicotine gum (one of the treatment used for nicotine addiction).

Unfortunately, cigarettes are the deadliest form of nicotine delivery available on the market.

It is not the nicotine per se but the combustion and release of over 40 carcinogens as well as other toxic chemicals, that are responsible for the bulk of premature illnesses and deaths that result when cigarettes are used as intended.

Flavouring chemicals (eg: alkenylbenzenes) are found in tobacco additives, which are used to enhance the taste of cigarette smoke. Research carried out in laboratory animals, has associated the inhaling of alkenylbenzenes with lung cancer.


Tobacco addiction
The modern cigarette, developed and find tuned by the tobacco industry over decades, is a wonderfully efficient nicotine delivery device, delivering the optimum dose of nicotine, so ever rapidly to the dependent brain, with the help of many additives (eg: sugars, mint, licorice or cherry), so that the smoke of the cigarette is made more pleasant.

Quitting is not simply a matter of choice for the majority of tobacco users. It involves a struggle to overcome an addiction.

Tobacco use, typically is woven into everyday life and can be physiologically, psychologically and socially reinforcing. Many factors combine with tobacco's addictive capacity (including media depictions, cultural and societal acceptance of tobacco use) in order to make quitting difficult.

Other ingredients in cigarettes
Many people are unaware of the number of toxins in tobacco smoke. Tobacco smoke contains over 4000 chemical compounds, including at least 40 cancer-causing carcinogenic agents. There are three main ingredients. Apart from nicotine are tar and carbon monoxide.

Tar
A term used to describe the 20 (or more) different carcinogens (cancer-causing substances). Tar tends to collect in the lungs, and has been clinically linked to several forms of lung cancer.

Carbon monoxide (CO)
CO is the same deadly stuff that comes out of a car's exhaust pipe. People have been known to use CO to commit suicide. CO enters the bloodstream and stays there for up to six hours after each cigarette.

Every cell in our body needs oxygen to survive. CO molecules take the place of oxygen in our blood. It's much like taking a seat in a bus - once it is full there is no more spaces left. Hence, inhibiting the transportation of oxygen to the body's vital organs via the bloodstream.

Decreased oxygen supply to the heart may lead to a heart attack. Increased CO level reduces the level of oxygen carried to our brain which can lead to a decrease in mental ability.

Smokers also become easily short of breath because the blood is carrying less oxygen.


The other constituents in a cigarette include:
Arsenic - a poison used in insecticides
Ammonia - a chemical used in toilet cleaner
Acetone - a solvent used in nail varnish remover
Benzene - a solvent used in the manufacture of fuel
Cadmium - a poisonous metal found in batteries
Chromium - used for metal plating
Formaldehyde - a chemical used to preserve dead bodies
Hydrogen cyanide - a lethal gas and can be used in photography
Hydroquinone - used in rubber production and in motor fuel
Lead - used in storage batteries
Nickel - used in stainless steel production
Nutbae - used in camping gas and lighter fuel
Phenol - used in disinfectants and germicidal paints
Tecanoe - used in paint stripper
Ricnesa - found in ant poison
Toluene - used in explosives Other tobacco products


Smokeless (spit) tobacco has three forms:
1. Snuff: ground-up moist tobacco usually placed between bottom lip and gum. Snuff users become addicted to nicotine and may be tempted to switch to cigarette to get larger and quicker doses of the drug.

2. Chew: shredded tobacco leaves placed between the cheek and gum. Tobacco chewers become as addicted to nicotine as smokers.

3. Plug: shredded tobacco leaves, which are pressed into a hard block and placed between the cheek and gum.

Recently, the cigar industry has tried to attract new, younger users, including women, by promoting cigars as a sophisticated, luxury product.


Tobacco as a global epidemic
One-third of the world's population aged 15 and above smoke regularly. This corresponds to more than 1.25 billion smokers worldwide, with one billion of whom are male smokers and 0.25 billion female smokers. It has been quoted that 80 per cent of these smokers are from the developing countries.

Tobacco was estimated to account for just over three million annual deaths in 1990. Rising to four million unnecessary deaths per year (corresponding to 11,000 deaths daily) in 1998, responsible for one death every 10 seconds worldwide. Half of these deaths occur in productive middle ages.

It is estimated that tobacco-attributable deaths will rise to 8.4 million in 2020.

By 2030, tobacco is likely to be the world's leading cause of death and disability, killing more than 10 million people annually and claiming more lives than HIV, TB, maternal mortality, motor vehicle accidents, suicide and homicide combined.

Unless the current smoking patterns change, in 21st century, about one billion people will die from smoking - 10 times compared to throughout 20th century.

Brunei statistics
- Male smokers: 31.1%
- Female smokers: 5.3%
- Age 20 to 29: the largest group of current smokers

Health impact of tobacco
Most health consequences of smoking are not manifested until three to four decades after the onset of persistent smoking. This reduces the seriousness with which tobacco issues are addressed.

Lung cancer and CHD (coronary heart disease) are the most common fatal conditions caused by tobacco, responsible for 30 per cent of all deaths in the UK.

A prospective study by Doll and Peto, which began in 1951 for 40 years, involving 40,000 male British doctors, found that smoking is associated with excess mortality from the following diseases: Cancers of the mouth, oesophagus, larynx, pharynx and lung, COPD (chronic obstructive pulmonary disease) and other respiratory and vascular diseases.

Another prospective study by Rimm et al, involving 40,000 men, found that smoking over 15 cigarettes per day, is associated with a doubled risk of developing Type 2 diabetes.

A study published by Wannamethee et al, found that life-long smokers have a nearly four-fold increased risk of having a stroke. The risk in ex-smokers was found to be nearly twice that in non-smokers. Benefits from stopping smoking can be seen within five years.

Brunei 10 leading causes of death
The top five possibly due to cigarette smoking related diseases:
Heart diseases - 17.2%
Cancer - 17.0%
Diabetes Mellitus - 9.1%
Stroke - 8.6%
COPD and asthma - 6.3%

Male impotence
Smoking increases the risk of penile erectile dysfunction by around 50% for men in their 30s and 40s. In the UK, up to 120,000 men in their 30s and 40s are impotent as a direct consequence of smoking.

Other damages to the male sexual health caused by smoking includes:
- Reduced volume of ejaculate
- Lowered sperm count
- Abnormal sperm shape
- Impaired sperm motility

The face of a smoker will be showing signs of ageing, in particular wrinkles; males twice as much, and females three times as much. This is because, tobacco smoking reduces the level of vitamin A in the body, whose function is to protect the skin. The face will also look older than the actual age, due to the fact that, one chemical in tobacco, called acetyldehyde, which can destroy as much as 20 mg vitamin C in our body, as result of just one cigarette.

Passive smoking
Several phrases are used to describe "Breathing other people's smoke", namely:
- Passive smoking
- Involuntary smoking
- Second-hand smoking
- Environmental tobacco smoke (ETS)

Only 15 per cent of smoke (also called 'mainstream smoke') produced by a burning cigarette is inhaled by the smoker. The remaining 85 per cent (also called 'sidestream smoke' from the burning tip of the cigarette) is released into the air where it can be breathed in by others.

The smoke emitted from the tip of a cigarette has about double the concentration of nicotine and tar in comparison to the smoke being directly inhaled by the smoker. It also contains:
- 3x the amount of the carcinogen benzo(a)pyrene
- 5x the level of CO
- About 50x the amount of ammonia

Passive smoker
A study by DiFranza found that the use of tobacco products by adults increases childhood mortality (about 150 attributable deaths per year) and morbidity (middle ear infection, tonsillitis, asthma, cough and pneumonia).
A child's bronchial tubes are smaller and their immune systems are less developed, making them more susceptible to the harmful effects of passive smoking. Because the airways are smaller, children breathe faster than adults. Hence, they actually breathe in comparatively more of the harmful chemicals in the smoke.

It has been estimated that 700 million children (almost half of all children worldwide) live in the home of a smoker. Passive smoking may also affect children's growth, physical as well as mental development.

A study in USA has found that there are deficits in reading and reasoning skills among children, even at low levels of smoke exposure.

Breathing other people's smoke increases one's risk of IHD (ischaemic heart disease) by up to 30 per cent.

Tobacco-specific carcinogens are found in the blood as well as urine of non-smokers who are exposed to environmental tobacco smoke, in particular those living in close proximity to smokers.

A woman who has never smoked all throughout her life has an estimated 24 per cent greater risk of lung cancer if she lives with a smoker.

Maternal smoking
Smoking in pregnancy is associated with low fetal birth weight. From a study which looked at nearly 6000 pregnant women, found that, babies of women who smoked, weighed on average 153 g less than women who were non-smokers.

In USA, it has been that estimated that 115,000 'spontaneous' abortions are caused by tobacco each year.

This would represent 19 per cent of all miscarriages. Smoking during pregnancy increases a woman's risk of miscarriage by 24 per cent.

The most common consequence of low birth weight is the need for treatment in an ICU, immediately after birth. In USA, maternal smoking is the cause of an estimated 14,000 to 26,000 infant admissions to neonatal ICU each year.

In USA, maternal smoking is the cause of an estimated 3700 infant deaths annually. This represents seven per cent of all perinatal deaths. These deaths are caused primarily by low birth weight and premature separation from the placenta.

Maternal smoking is responsible for 35 per cent of all SIDS (sudden infant death syndrome or cot death) in USA. Smoking during pregnancy triples the risk of SIDS.

- Ministry of Health's public awareness programme

Source: Weekend, 7 June 2008