Plantar fasciitis is a muscular injury that affects the flexor surface of the foot. The first symptom usually experienced by those with plantar fasciitis is severe pain located on the heel area of the foot the moment you get out of bed. This is brought about by the inflammation of the fibrous band of tissue, called the Plantar Fascia, which connects your heel bone to your toes.

People suffering from plantar fasciitis generally affects people who are obese, those who do high impact aerobic exercises on hard surfaces with improper support from the shoes they wear and incorrect posture. Oftentimes, the pain can easily cause many people to decrease the level of their physical activities, as the pain brought about by plantar fasciitis can be more excruciating after exercise. There are a number of different aerobic exercises that you can do to help you still keep in shape and yet be gentle on your plantar fasciitis condition. Here are just a few of them.

Step Machine

One form of aerobic exercise that can be done by people suffering from plantar fasciitis is to use a step machine. The difference is that instead of jerking movements brought about by stepping on and off like in step aerobic exercises, a step machine keeps your feet in place on the platform. By pushing down on the pedal, you are able to stretch your muscles, which has been proven to help relieve the stiffness of the plantar fascia muscles causing plantar fasciitis. As such, it is able to bring back the flexibility and strength on your foot and heel muscles. At the same time, you are able to work out a sweat and still get the same cardio aerobic exercise benefits that you would get from doing step aerobics.

Swimming

Swimming has been considered as the most preferred choice of keeping fit while not aggravating any muscular injuries you may have. There are a number of different swimming aerobic exercise classes that would help you keep fit and stay in shape while ensuring that you do not suffer further pain brought about your plantar fasciitis condition.

Rowing

Another great form of aerobic exercise is the use of a rowing machine. Rowing allows you a chance to stretch not just your foot and leg muscles, but help you also strengthen your upper body as well. Because your feet are secured while doing rowing aerobic exercises, it minimizes the risk of you suffering from pain brought about by your plantar fasciitis condition.

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Aerobic fitness is achieved through aerobic activities. If you have been training or been around people who exercise, you must have heard about both aerobic and anaerobic workouts. In simple terms the only difference between these two types of fitness workouts modes is in the rate at which the muscles use oxygen to produce energy during an exercise. When you exercise your muscles use oxygen to produce the needed fuel for the exercise. In aerobic fitness exercise more oxygen is required to produce energy than in anaerobic exercise. In other words, just think of aerobic fitness as running a road race and anaerobic as sprinting as hard as you can for as long as you can.

In aerobic fitness exercise, you will be able to burn carbohydrates into glucose which can then be used by the muscles to produce power at the early stages of your weight loss training. If you continue long enough to exhaust your carbohydrate reserve, your aerobic system will start to metabolize fats. The process of breaking down fats and lipids into glucose is slower and more complex and can significantly reduce your aerobic fitness exercise performance level. If you were running for example, you will see a significant drop in your mile split time. For athletes it is important to supplement your body fuel demand during hard long activities sessions with power drinks or power bars. However if you are trying to lose abdominal fat, you don’t really need supplements.

Since aerobic fitness training requires oxygen to break down carbohydrates and fats to produce power for an exercise, your aerobic capacity should be strong. In other words, your heart should be strong enough to supply the muscles with enough oxygen to be able to metabolize enough carbohydrates and fats. So how do you improve your aerobic capacity? Well, the simple answer is you have to continue doing aerobic fitness exercises. The more you exercise, the stronger the heart muscles will be and as a result, your oxygen intake will improve. Better oxygen intake means more oxygen for the muscles to work harder and longer and that means good news for weight loss. Regardless of the aerobic fitness exercise you choose, stronger muscles will make it all the fun.

So why does aerobic fitness and not anaerobic exercise aid in losing weight? The explanation is really simple, you metabolize more fats for fuel in aerobic exercise but only use glycogen in anaerobic. It is really recommended that you exercise long enough at least three to four times every week to ensure that you are metabolizing enough calories. This is because some people do very little and get frustrated when they don’t see any result from their aerobic fitness exercising. There is no hidden magic to it, the weight that you reduce is the difference between what you take in and what your body burns. Also remember that whatever extra carbohydrates that are not used for energy during aerobic exercise gets concerted to fats and stored by the body. Of course you know what happens if there too much of those carbohydrates, we start gaining extra weight.

Find practical knowledge about the topic of get free website traffic – make sure to read the webpage. The time has come when proper information is really at your fingertips, use this possibility.

 

Can You Drink a lot of Liquid? I want to tell you in the past few years studies have displayed that people do not get enough water for good health. Accordingly with general, most health instigators have urged us all to consume more liquid.

The message has been strong – avoid dehydration. Though,dear friends there is a a lot of story emerging, more than usual between people who exercise. Accordingly to researchers almost as many sportsmen are putting their health at risk by over-consuming liquid as drinking too little. Consuming water at every possibility are able to occasion serious challenges, like hyponatraemia or liquid poisoning. When the water concentration of the blood increases, the salt concentration is decreased.

Hence the quantity of salt available to body tissues decreases, which can lead to problems with heart function. Therefore the amount of salt available to body tissues decreases, which can lead to problems with features. I've remark first indication of over-hydration include . But these indication are also amalgamated with deprive of water – so itis significant to be aware of how much you are getting. Is there cause for trouble? The British Dietetic Association instructions state that an average adult should get 2.5 litres of liquid per day. This use needs to be grow pending of hot weather or during and after periods of physical activity.

An interesting ad caught my eye and it took me to an online “real age” calculator, as oppose to your actual age or calendar age. RealAge.com offers this free calculator that allows you to feel younger than you are or to consider changing some things in your life to feel younger.

At the beginning of the questionnaire to determine my “real age” the information that I had to enter in was my date of birth, my zip code and my gender. Next I had to check topics that interested me and my family. This portion didn't take long at all and the topics were subcategorized into medical conditions, women's health, men's health, cardiovascular conditions, lifestyle, memory and emotion and general body maintenance.

Medical conditions topics consisted of such conditions as allergies, cancer, diabetes, heartburn and insomnia. Woman's health topics were hormones, menopause and sexual while men's health topics were hormones, prostate and sexual. Cardiovascular conditions topics were heart disease, high blood pressure and high cholesterol. Lifestyle topics included fitness and exercise, food and nutrition and parenting. Memory and emotion topics had anxiety, bi-polar and depression listed among others. Lastly general body maintenance had such topics listed as dental care, skin care and eye health.

Some of the other questions that followed, all of which multiple choices, were:

How would you rate your physical health compared to others your chronological age?

On a typical day, about how many hours do you sleep?

What is your height, weight, resting heart rate?

What is your average blood pressure?

What is your total cholesterol level?

What is your HDL cholesterol level?

I was glad that I wasn't having to get out of my seat to look up medical history. If you don't know your cholesterol levels or blood pressure exactly, don't worry the site gives you the option to say low, high and average. At this point I received a little message of encouragement and see that my calculated “real age” was already higher than my calendar age and the questions continued and some of them were:

Is your biological father and biological mother alive?

Have you or your biological mother or sisters, or your father's mother or sisters, ever had breast cancer?

Have you or your biological mother or sisters, or your father's mother or sisters, ever had ovarian cancer?

Have you ever had asthma?

Have you ever had a heart attack?

Have you ever had a stroke?

Then I had to do another checklist, but it didn't take long at all. It lists everything from chest pains to acne to insomnia to anemia and you have to check what applies to you. The things that I checked I was asked about again. Then I was asked some more questions, some of which were:

How many prescription medicines do you take each day?

How many over the counter medicines do you take each day?

Do you need corrective lenses for your eyes?

How often do you floss?

Have you ever had a sunburn that caused blistering?

On a typical day, are you around people who smoke?

During an average day, how many alcoholic drinks do you consume?

What size motor vehicle do you typically drive or ride in?

How often do you use a mobile phone while driving?

I was clicking away but this next question kind of through me, I thought was very peculiar.

Do you provide health or medical information to others or do you provide caregiver services to someone who has a medical condition? If you check any of the choices you will be asked about them later as well. The remainder of the questions went pretty quick, here are what some of the remaining questions were:

What is your annual family income?

How many of your close friends and relatives do you see at least once per month?

If there are children in your household, in what years were they born?

How often do you eat breakfast in a typical week?

Do you take vitamin supplements?

How many servings of high fiber grains do you eat per day?

How many servings of fruit do you eat per day?

How many servings of vegetables do you eat per day?

How many servings of dairy do you eat per week?

How many servings of nuts and legumes do you eat per week?

How many servings of soy products do you eat per week?

How many servings of red meat do you eat per week?

How many servings of fish do you eat per week?

How often do you take vitamin supplements?
time(s) per week

Look at the labels of all the vitamin supplements you take. How much of each vitamin and mineral listed below do they contain?

Calcium (mg)
Folic acid (mcg)
Potassium (mg)
Vitamin C (mg)
Vitamin E (IU)

This was the first and only time that I had to get up, I looked at the bottle of my vitamins and answered the question above. Finally I reached the last page of questions, which included:

On average, how often do you do aerobic exercise?

On average, how often do you do strength training exercise?

On average, how often do you do flexibility training exercise?

On average, how often do you do other strenuous physical activities?

Do you experience any soreness of the joints during or after exercising?

After the questions were all answered, a task that took me about 20 minutes or so, the page explained I would receive my final “real age” result via email in 1-2 hours. I was a little disappointed that I didn't get to know instantly but in less than an hour I received that email. If you try this and don't receive the email within 2 hours you should check your spam folder because that is where my email placed it.

After reading the email I discovered that my “real age” was 5 years older than I really am. I was actually shocked, I consider myself to be very physically healthy. At least I know that I will be living to 91, see what I am talking about at Livingto100.com: Life Expectancy Calculator. http://www.associatedcontent.com/article/196095/livingto100com_life_expectancy_calculator.html

Overall I thought that the site was very user friendly and they even explained in my free personalized recommendations how I could grow younger.

In a November 23rd press release Highmark, Inc. announced a new gift card for health care and related products. The prepaid gift card can be used at health care clubs, doctor's offices, dental offices, drugstores and other health care facilities where VISA debit cards are accepted.

The gift cards for health care products are being marketed by Highmark, Inc. as a way to avoid the hassles of Christmas shopping such as shopping on the date of the press release known as “Black Friday” (day after Thanksgiving) shopping. Another value of the cards is that the gift cards are specifically for health care products but allow a lot of leeway for the individual receiving the handy Visa cards as to what to purchase with them

Interested persons can purchase the health care gift cards online at the Give Well website or order the Highmark, Inc Give Well cards by telephone at 877-850-3544. The Give Well website has a picture of the VISA health care gift card as well as a skit of a lady's giving a gentleman a gift box, and out of the box floats health care items like tooth brushes, crutches, baby bottles, hand weights, etc. On the Give Well website there is also a place to sign up for a chance to win a one hundred dollar health care gift card by providing only one's first and lasts names as well as one's email address. The website indicated that winners will be notified by email and that additional information (presumably the mailing address) will be obtained from the winner at the time of the notification.

Kim Bellard, Vice President of eMarketing at the Pittsburgh, Pennsylvania based Highmark, Inc. stated in the press release: “By purchasing health care gift cards for their loved ones, consumers can avoid long lines, traffic and crowds.” Bellard also pointed out: “It also lets recipients know that you are thinking about them and their overall wellness, which is sometimes more valuable than many more typical gift ideas.”

For more information about the product interested persons are referred to the Blue Cross Blue Shield's website blurb about the product. On the Blue Cross Blue Shield website there is an indication that the cards can be purchased in any dollar amounts ranging from $25 to $5,000. The Blue Cross Blue Shield's website also indicates that Highmark has a license from Blue Cross/Blue Shield and is an independent association of Blue Cross and Blue Shield plans.

Sources:

Blue Cross Blue Shield website blurb on Give Well card
URL:
http://www.bcbs.com/news/plans/highmark-introduces-new.html

Give Well website
URL:
http://www.givewell.com

November 23rd press release of Highmark, Inc.
URL:
http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/11-23-2007/0004710386&EDATE=

My dear readers I just used the lose weight so you'd know what I was say, however honestly, that should be a bad word. What do you say, “some easy methods to get food to serve you and your goals?” I always consider that the food puzzle is necessary to be explained simply and slowly so that our approach is simple but true to our lives.

Number 1 Drink only water. According to studies, this would refuse 20% of our caloric use and help all of our body functions run more easy.

Number 2. Reduce your portions I'm not even going to say what to eat and not eat. I'm just saying if you are having that sub at lunch cut it in half. We all overeat, so just eat until you are not hungry. It's not easy.

Number 3. Eat your morning nourishment. You should have a 70% chance of overeating pending a day if you skip morning nourishment.

Number 4. Write on the paper. That will assist you see exactly what you consume and when. You will even be able to see patterns of grabbing food at bad factors, etc. Journaling just can do you aware and in charge of your food–not the other way around.

Number five. If you can avoid it, you shouldn't eat after 7 p.m.

 

Introduction

After almost two thousand years of independence in the Hawaiian islands, and two centuries after the arrival of Captain James Cook and foreigners, the original pure-blooded native population has gone from about 400,000 (possibly 1,000,000) to about 5,000-7,000 (1-3). This signifies a greater than 98% decrease in the pure blooded Hawaiian population over the last two centuries. The current part-Hawaiian population exceeds 400,000 in the United States (4). Tragically, a 1987 document stated that the pure blooded Native Hawaiians are predicted to become extinct by the year 2044 if current (1980’s) mortality trends persist (5). It is already established that Native Hawaiians or kanaka maoli have remarkable morbidity and mortality (6). However, the relative lack of a current easily accessible comprehensive article on the topic of Hawaiian health and documented authors’ recommendations was noted by the author of this paper. Hence, this paper provides an epidemiological and high-risk health review of Hawaiians until the year 2003. It also addresses the practical question “What can clinicians, patients, and researchers do about it?”

Methodology

A literature review was done in search of information applicable to Hawaiian health published until the year of 2003. Appropriate journals, books, and magazine articles were utilized. Hawaiian words and diacritical marks were checked using a reliable internet Hawaiian dictionary resource (7).

The term “Native Hawaiian” in this article implies that one can link their genealogy or heritage to Hawaiians or Kanaka Maoli in the Hawaiian Islands before Western contact.

Results

High morbidity of Hawaiians compared to non-Hawaiians in Hawai‘i

In 2000, Native Hawaiians had higher prevalence rates compared to non-Hawaiians for asthma and diabetes (8). The asthma prevalence rate was 139.5/1,000 and state total rate was 86.5 per 1,000 in Hawaii. The diabetes prevalence rate was 49.0 per 1,000 for Hawaiians and 45.9 per 1,000 for the state total (8). The Japanese ethnic group had the highest diabetes prevalence at 67.7 per 1,000. Hawaiian rates for arthritis (38.3 vs. 71.7), high lipids (85.6 vs. 133.1), and hypertension (116.7 vs. 144.2) were lower than some state totals.

High mortality of Hawaiians

Low life expectancy

Since the early 1900’s, Hawaiians and part-Hawaiians have reported the lowest life expectancy at birth for both genders combined, compared to Caucasians, Chinese, Filipinos, and Japanese. In 1990, the Native Hawaiian life expectancy was 74.27 years old with the Hawai‘i state total at 78.85 years of age (9).

Elevated total and specific causes of death

Native Hawaiians have the highest reported rates of all cause mortality. From 1980 to 1990, the full and part-Native Hawaiian all cause standardized mortality rate increased from 642 to 755 per 100,000 (10). Compared to non-Hawaiians in Hawai‘i, Native Hawaiians have greater than twice their total mortality rate. All ages’ standardized mortality in 1990 was highest in Native Hawaiians for heart disease, malignant neoplasms (cancer), stroke, all accidents, diabetes (10) and asthma (11-12). Full-blooded Native Hawaiians’ mortality rates are worse than part-Hawaiians (10).

Cancers
Cancer is another major health problem for Native Hawaiians. From 1995 to 2000, the Native Hawaiian male and female total cancer mortality rates per 100,000 were higher compared to Hawaii’s state total cancer mortality rates (13).

Breast cancer

Over the last few decades, the incidence of Native Hawaiian female breast cancer has increased, while the mortality rate has decreased. Still, breast cancer incidence in Hawai`i was the highest in Native Hawaiian women (162.4/100,000) from 1995 to 2000 compared to the state total which was 128.3/100,000 (13) . Even after adjustment for breast cancer risk factors, one cohort of Native Hawaiian women had a relative risk 65% higher than Caucasians (14). Native Hawaiian women also reported the highest breast cancer mortality rate at 31.0/100,000 (58% higher) versus the total state rate of 18.1 per 100,000 (13). Another study suggests that Native Hawaiian females have significantly lower breast cancer survival rates and the worst stage status and metastases status compared to all other groups (15). In the Hawai`i 2001 Behavioral Risk Factor Surveillance System (BRFSS), Native Hawaiian females were reported to have the same prevalence rates for mammography screening compared to other ethnicities (16).

Cervical cancer

Native Hawaiian female cervical cancer incidence rates have decreased over the last three decades, but from 1995 to 2000 they still reported the highest incidence rates compared to state total, 13.5/100,000 and 10.1/100,000 (13), respectfully. For all ethnic groups in Hawai‘i, cervical cancer mortality rates have declined. However, over the last three decades, Hawaiians, Chinese, and Filipinos appeared more likely to have an invasive cancer stage at time of diagnosis (13). In 2001, the BRFSS showed that Native Hawaiian women had the lowest prevalence rates (based on the previous 3 years) in Hawai`i for having had a Pap smear test (16).

Colorectal cancer

Over the last three decades, the Native Hawaiian female colorectal cancer incidence rates increased,
while there was no significant change for Hawaiian male incidence or mortality rates (13). From 1995 to 2000, colorectal cancer mortality was highest in Native Hawaiians for both males and females (13). Native Hawaiians may have the lowest colorectal cancer survival rates, even though they received more chemotherapy and radiation treatments compared to other ethnic groups (17). In 2001, Native Hawaiians 50 years and older reported the lowest percent of ever having had a fecal occult blood test, ever having had a sigmoidoscopy or colonoscopy, and having had a sigmoidoscopy or colonoscopy within 5 years. However, in the previous year (2000) Native Hawaiians reported the highest fecal occult blood testing percentage compared to all other ethnicities in Hawai‘i (16).

Lung cancer

From 1995 to 2000, Native Hawaiian males and females reported the highest lung and bronchus cancer incidence and mortality rates compared to the total state rates. Native Hawaiian females have lung cancer mortality rates about twice the state total, 48.2/100,000 and 24.8/100,000 respectfully. And Hawaiian males have a 50% higher lung cancer mortality rate compared to the total state, 75.9 and 50.6 respectfully (13). In one small study (Hinds et al) of 132 Native Hawaiian female lung cancer patients, smoking by Hawaiian females was significantly more contributory toward getting lung cancer compared to other groups in Hawai`i (18). Another small pilot study of 45 Native Hawaiian cancer survivors showed that improved access to care and utilization of cultural values with education and services may improve quality of life and survival status (19).

High-risk behaviors and cancer

About 68% of all cancers are thought to be due to the maladaptive habits of tobacco use, drinking excessive alcohol, and a poor diet (20). Being overweight or obese are proven to be linked to cancer deaths. A study of over 900,000 adults followed for ten years showed the overweight cohort to have increased risk of death from cancer of the esophagus, colon, rectum, liver, gallbladder, pancreas, kidneys, non-Hodgkin’s lymphoma, and multiple myeloma. The obese cohort had higher mortality from cancer of the stomach, and prostate. The postmenopausal obese group had higher cancer rates of the breast, cervix, ovaries, and uterus (21).

Behavior Risk Factors among Native Hawaiians

A search of the literature reveals a high prevalence of behavioral risk factors among Native Hawaiians. Curb and colleagues found one group of Native Hawaiians on a rural island to have frequent risk factors for cardiovascular disease with poor control and awareness about them (22). BRFSS has reported on the prevalence of behavioral risk factors in Hawai`i among the 5 major ethnic groups, including Native Hawaiians. From 1986 to 1993, 56% of Native Hawaiians had a sedentary lifestyle. This was similar to the Hawai‘i state total of 55.5% (23). Out of 576 Hawaiians profiled in 1991, 63.4% had chronic alcohol use and binge drinking that was twice the state total (n=1,984). Hawaiians also had a 10% higher prevalence of marijuana use and smoking tobacco compared to the Hawaii state total in 1991 (24). Native Hawaiian behavioral risk data in 1993 reported 46% to be overweight, 20% had acute and chronic alcohol intake, and 27% were smokers (25). This was from a relatively small sample size of 341 (12%) Hawaiians out of a total of 2,155 (25). In a 1990 publication, Native Hawaiians also reported having the lowest use of seatbelts compared to other ethnicities in Hawai’i. (26).

BRFSS data in Hawai'i reports that these high risk cardiovascular and cancer trends continue in 2002 (n=approximately 750 surveyed for Native Hawaiians). In the 2002 BRFSS report, Native Hawaiians 18 years and older reported higher (compared to Hawai'i state total) percentages for current smoking status, overweight/obese body mass index greater than 25, never to nearly always using seatbelts, not having healthcare coverage, sub optimal physical activity, and heavy drinking (16).

In regard to obesity, genetics possibly play a role for one rural male and female (30 years old and older) Native Hawaiian population (n=567, cross-sectional), as seen in the dependant relationship of increased percentage of body mass index, and increased waist to hip ratio with the increased percentage of Hawaiian blood quantum. This conclusion was made even after adjustment for calorie intake, activity level, and age (27).

Hawaiian youth

In regard to Native Hawaiian adolescents, recent mental heath and high-risk behavior statistics are disturbing. Data from 2000 shows a progressive increase in drug use and the highest rates of substance abuse among Native Hawaiians youth, grades 6 to 12. This includes use of tobacco, alcohol, marijuana, cocaine and methamphetamines (28). 

One study found that Native Hawaiian adolescents have a high rate of suicide attempts, which appears dependently related to a higher Hawaiian cultural affiliation (29). Hawaiian adolescents who are more culturally Hawaiian attempt suicide more than those with less cultural affiliation. In 1990, Native Hawaiians aged 15 to 29 years old reported the highest suicide rates (30) In one study, Hawaiian adolescents were found to have significantly elevated psychiatric symptomatology (especially females), family adversity problems, and less family support (31-32). Furthermore, the 2000 Hawai`i Student Alcohol, Tobacco, and Other Drug Use Study reported that Native Hawaiian high school seniors had the highest percentage for suspension from school, being drunk at school, and violence (28).

Crime and violence

Native Hawaiians are over represented in prison. Of the prison inmate population in Hawai‘i in 2000, 39% were Native Hawaiians. This is disturbing as Native Hawaiians make up approximately 20% of the total state population (33). Also in 2000, Native Hawaiians reported higher rates of aggravated assault, burglary, motor theft, arson, property fraud, and forgery, and were over represented as murder victims and known offenders (34).

Remarkable Hawaiian subgroups

Mahus (may mean transgender, a very feminine male, homosexual, and/or bisexual) appear to be a critically high-risk subgroup of Native Hawaiians in regard to drug abuse and violence. One study of over 100 Native Hawaiian mahus reported that 74% were smokers, 31% admitted to illegal drug use (excluding marijuana), and 50% were involved with violence (35).

Availability of health insurance

After identifying high-risk Native Hawaiian behavior and subgroups, access to care also needs to be addressed. Now let us look at availability of healthcare coverage. In Hawai‘i, Native Hawaiians (ages 18-65 years) reported the highest percentage of non-health insured status at 10.3 percent, versus Caucasian 8.6%, Filipino 6.4%, Japanese 3.3% in 2001 (36). According to Hawai'i's BRFSS report in 2002, the percentage of non-insured Native Hawaiian adults increased to 15.2% (16).

Summary

It is established that Hawaiians have remarkable morbidity, mortality, and high prevalence of risk factors for cancer and cardiovascular disease. But what can clinicians and researchers consider or support in order to improve the health status of the Native Hawaiian community?

This next section summarizes many recommendations from various authors, which specifically relate to Native Hawaiian health. Many recommendations are cross-cultural and deal with health disparity issues of Native Hawaiians. However, they may also be applicable to other groups as many are universal. Utilizing these recommendations, clinicians and healthcare providers are encouraged to be aware of cultural influences that are unique to this population or traditionally oriented individuals and groups.

1. Kekuni Blaisdell M.D. suggests revitalizing the culture, language, and spirituality of Hawaiians. He also recommends regaining “inherent sovereignty and self determination,” and arresting factors that exploit and undermine Hawaiians. This recommendation includes denying materialism and returning to more traditional ways (37).

2. Access and kuleana to 'aina and sovereignty are cited by many as essential to wellness of the Hawaiian people (37-42).

3. Healthcare providers need to appreciate that ‘olelo (the word) is very important and influential to Hawaiians (43), and that they need optimism and honesty in their medical discussions. Communicating with proper and familiar layman’s terminology is required. In one study of Native Hawaiian women, only about 50% knew the definition of a “PAP test” (44). The teaching of medical concepts using analogies of things from Hawaiian culture seems to be a practical idea. Taro or kalo  was the staple food of Hawaiians of old and symbolically represents the family or relatives. The taro fields need a group effort in order to allow proper nutrients and irrigation (or circulation) for an  optimial  harvest. Likewise, people and their families need to optimize nutrients and their circulation in order to attain wellness. And like taro cultivation, if a habit of holistic care is initiated and maintained, any hard and tedious productive work can reap great rewards.

4. Hawaiians can enhance their health and mana (divine power) by reinstating the culturally relevant idealistic ways of eating natural foods, maintaining daily physical activity, meditating, and not abusing substances or committing offenses. A program called Uli‘eo Koa is a pilot program that uses culturally appropriate methods to improve diet, as well as physical and spiritual wellness (45-46). Specific culturally appropriate physical activity recommendations for Native Hawaiians might include the hula (traditional and contemporary Hawaiian dancing), lua (Hawaiian martial arts), working in the taro lo‘i (taro or kalo field), surfing, hiking, and swimming in the ocean, among many others.

5. Native Hawaiians need to be recruited into medicine in order to address their under representation in the health care field. There is a discrepancy of the current 5% Native Hawaiian physician population to the 20% Hawaiian state total  population (47). Native Hawaiian rural communities are areas in dire need of culturally competent providers.

6. Cultural competence needs to be taught in health professions schools (48-50). Analogous to mnemonics taught to medical students as a memory tool, remembering the Hawaiian na piko ‘ekolu and na'au concepts could ensure a culturally sensitive, thorough, and systematic awareness in clinical interactions with traditional patients.

The na piko ‘ekolu (three navels or centers) and na‘au (“gut emotions,intuition) concepts can be organized by location, symbolism, and it's representation in time (43,45-48). 

The head/crown or Manawa/Po‘o PIKO (fontanelle) relates to one’s spirituality or ‘aumakua/ancestors and the  past.  Our  navel or Waena PIKO signifies the family, earth, and current “umbilical ties”. The navel or waena piko involves the present.
The lower abdomen or NA'AU signifies our  “Gut emotions”, intellect, and intuition and involves the present time.
Our genital area or Ma‘i PIKO signifies our offspring and the future.  A healer would be reminded of holism if they could visualize the location of these cultural concepts when with the patient. Applying these Hawaiian cultural concepts would incorporate the importance of the body, mind (psychology and parapsychology), spirit, nature or environment, , intellect, culture, community, and family relationships.

Also, it may be appropriate to use cultural terms, like mana (divine power) and pono (correct and true nature), etc., when having clinical discussions with Hawaiian patients. It is well known that spirituality is an essential part of Hawaiian culture and daily life (51). The integration of mutually respectful spirituality and religious beliefs can be complimentary. If appropriate to the individual patient and their beliefs and needs, clinicians might even consider saying a prayer with the patient and family, or recommend praying when patient takes their medication. Furthermore, providers and patients might benefit from incorporating dream-work and respecting other spiritual or cultural forms of communication and beliefs (52-53). These alternative resources are not only essential, but also affordable and may be culturally appropriate. Ho‘oponopono (traditional conflict resolution method) is also a resource for the Native Hawaiian community that may even help them with academic difficulties and addictive behaviors. Psychological counseling in a university setting is found to correlate with better academic outcomes (54). Like ho‘oponopono, the alcoholics anonymous twelve step group support program acknowledges a higher power, involves group support, and then emphasizes forgiveness and appropriate behavior (55). Identifying or incorporating this similarity to ho‘oponopono may increase acceptance of this established rehabilitation program by Native Hawaiians. In order to exhibit respect and support for the Native Hawaiian community, clinicians may consider inquiring about and referring patients to traditional Kahuna healer training and practices (53), like la’au lapa’au, lomilomi, and ho‘oponopono, when deemed appropriate.

7. The association with Hawaiian cultural affiliation and adolescent Native Hawaiian suicide attempt rates (29) needs to be intensively studied and addressed.

8. In order to optimize outcomes, the family, community and cultural peers of Hawaiian patients need to be involved with clinical endeavors. The use of lay facilitators may help the Native Hawaiian population, as seen in the breast and cervical cancer program done in Waianae (56). For example, clinicians or researchers may encourage or emphasize family or peer participation with clinic visits, treatment plans, and research activities.

9. A special effort to help and understand special subgroups of Hawaiians, based on gender (57), age (58), sexual orientation (35) and HIV status (59) is indicated. Another special subgroup are the Hawaiians who live outside of Hawaii (60).

10. The participation, research, and behavior of Native Hawaiians in clinical trials for cancer and other disorders could be better understood (61-64). Appropriate outreach, access, and professional support may help Native Hawaiian women with breast cancer health practices, as found in a ten year study (65).

11.Health care providers can spend extra time with Native Hawaiian patients, make house calls if needed, and frequent phone calls to facilitate respect, bonding, rapport, and trust (66).

12. Clinicians and researchers may recognize and address socioeconomic issues, access to care problems (19, 67), and the distrust of Western medicine (68-69).

13. In order to facilitate a connection and communication with native ancestors or ‘Aumakua, themselves (or higher self), others (people and other living creatures) and nature, a meditative state can be of value to both the healer and patient. Hawaiians need to learn how to meditate daily (70). Rest and relaxation were also part of traditional Hawaiian healing instructions (44). Also, in order to be prepared for patient interactions, healers need to be relaxed, free of personal negative or judgmental thinking, and biased expectations (71-73).

14. We need to reinstate the federal census quantification of pure Hawaiians and standardize ethnic definitions for prevalence, mortality, and populational data. It does not make sense that the federal government would stop quantifying how many pure Native Hawaiians currently exist. Furthermore, the recent grouping of “Pacific Islanders” with statistical data is very ambiguous, and will not allow comparison with past data nor allow more specific statistics on Hawaiians or other Polynesians. Any definition of “Native Hawaiian” should allow or imply an objective genealogical connection to Hawaiians living before Western contact in the Hawaiian Islands.

15. And finally, Native Hawaiian healthcare providers can be role models and encourage indigenous youth to pursue medicine and other health related fields.

Limitations

Limitations to this paper includes: limited or minimal data, some studies were with small sample sizes and that may underestimate or exaggerate rates, and lack of consistency and confusion on the definition of a “Hawaiian” over time and with different organizations. 

Hawaiian language experts were not consulted for this paper and diacritical marks were not available due to font limitations. Please see section on methodology.

Conclusion

In short, Hawaiians and non-Hawaiians are challenged to have koa (courage) and work together to get the goal of wellness accomplished. For both the patient and healer, understanding and enhancing mana (divine power), pono (true nature), and lokahi (unity) are required to succeed. One traditional Hawaiian healing secret is to have lokahi of the body, mind, nature, and spirit (71). Many Native Hawaiian healing ways are timeless, universal, and relevant in modern times. Following the advice of the Native Hawaiian Biennial Healing Conference in 2002, we need to know that “We are Hawai‘i”, and “We need to perpetuate the breath, the knowledge, and the life”. Furthermore, “We need to stand proper, stand connected, and stand in harmony” (74).

Acknowledgements

The supportive encouragement and advice provided by Kim Ku’ulei Bernie of Papa Ola Lokahi, and Douglas Massey MD on this paper was greatly appreciated. 

The anonymous critique by a few Hawaiian health specialists was also extremely helpful and informative.

The authors’ accept full responsibility for any errors.

There was not financial support for this paper.

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By Bradley E. Hope MD (last revised 07/03/2006)

 

You must to consider consuming healthy is expensive. I will be clear – itis. But there are some advices to keep it low cost. Here are sixteen to eat more healthy while keeping it not expensive. What is Healthy Food? Before we are going to start, let's define healthy food. It made of:

Albumen.

Fat.

Veggies.

More vegetables Fruit.

A lot of vitamins.

Water. 1 liter per 1000 calories you expend.

Whole grain food.

1. Switch to Water. I consume huge amounts of soda daily for more than 15 years. Then I begun Strength Training and switched to water: Itis good It's not expensive

2. You should Eat Eggs. I always consume eggs at breakfast: Full of vitamins High in proteins Low in price

3. Eat Fatty Meats. Fatty meats are not expensive and more tasty than hypocritical meats. You think it's not good?

4. Eat buttermilk. The low cost source of white. 70$ for a 10lbs bag lasting 4 months. Nothing beats that. Use whey in your Post Workout Shake to assist recovery.

Number five. Buy Frozen Veggies. I mostly get frozen vegetables: Take less time to cook You don't spend money if not eaten in time

6. You should make a Plan. A classic, but worth repeating. All begin with a plan. Do a list of what you need

 

Hi! Evereone!

I am Malcom Elmerich

Lets Go!