2006-PB-20 December 2006 Consumer Directed Health Care John Goodman Abstract: Consumer driven health care (CDHC) is a potential solution to two perplexing problems: (1) How to choose between health care and other uses of money, and (2) how to allocate resources in an industry where normal market forces have been systemically suppressed. In the consumer-driven model, consumers
Conversely, injection forms, though being painful and needing help of medical personnel for application, help to quickly achieve necessary concentration of preparation in blood buy antibiotics online Antibiotic is usually chosen in an empiric way (at random). But when choosing one is obligatory guided by definite rules.
Fuelaotearoa.co.nzHow does energy availability affect the Did you know that 99 percent of women’s peak BMD is attained by our early 20s? The opportunity to further increase BMD is very limited after this time. Thus, the adolescent and If female athletes and exercising women do not have sufficient teenage years are a particularly important time for optimising energy available for adequate hormonal production, it can affect their ATHLETE BUT I
bone mass and strength through nutrition and weight-bearing menstrual cycle. The severity of abnormalities ranges from subtle or exercise. Coaches and parents have a responsibility to ensure non-observable changes to irregular and inconsistent cycles with the young female athletes and exercising women are not experiencing RUN EVERYDAY.
most severe presentation being complete loss of menstrual cyclicity.
an energy deficit, primary or secondary amenorrhea, and that they When my monthly menstrual periods slowly Other factors such as genetics and life-stress can also contribute are conducting sufficient weight-bearing exercise.
disappeared a few years ago, I didn’t think too much to the development of energy-related menstrual disturbances. What are some of the signs and symptoms of low of it. Lots of my friends had similar experiences, so we And, it is important to note that body weight and fat, per se, do not mediate the development of menstrual disturbances in energy availability and Female Athlete Triad? assumed it was normal. I regret not seeking advice exercising women. Indeed, amenorrhea is observed in exercising back then…” – 30-year-old recreational runner women who have body fat levels the same or even higher than their peers with regular menstrual cycles. There is much individual variation between women, exercising women should be aware Dr. Holly Thorpe, Senior Lecturer of Sport & Leisure Studies, University of
of their own unique energy requirements and avoid comparing Waikato and Maria Bentley, PhD candidate at AUT University & endurance
athlete, are the directors of fuelaotearoa.co.nz, a new educational website for
Continuum of the Reproductive Disturbance female athletes and exercisers. Here they respond to the query.
t Irregular or absent menstrual cycles and infertility t Increased risk of musculoskeletal injuries and stress fractures irstly, changes in the menstrual cycle is a common of female athletes and exercising women. For this reason, the concern in female athletes and other exercising women. Triad is diagnosed in any exercising woman (no, not just thin, t Increased cardiovascular disease risk factors Research by leading experts at the University of Penn elite athletes!) who exhibits signs or symptoms consistent with t Impaired exercise training and sport performance State (USA) has shown that four out of five recreational the pathological end of any one or more of these spectrums (low female runners who ran for two hours or 16 kilometres energy availability, amenorrhea or low BMD).
per week for a year experienced mild reproductive abnormalities. This is sobering because subtle menstrual disturbances are t Eating less than needed in an effort to improve performance or asymptomatic, and thus go unnoticed by female athletes and exercising women. A further study suggests up to 46 percent of Eumenorrhea > regular, consistent, ovulatory cycle (26 – 35 days) similarly trained women may develop amenorrhea (a cessation of menstrual periods). These reproductive abnormalities occur when Image used with permission of Fuel Aotearoa insufficient dietary energy is available to fuel exercise and all the What can I do to minimise the risks? I’ve heard the word before but what Most importantly, if you are concerned about changes in So why haven’t I heard of this before? your menstrual cycle, you should consult with your GP or a Amenorrhea is the most extreme of energy-related menstrual Given the high prevalence of low energy availability, body image health professional. Our website offers a list of nutritionists, disturbances and is characterised by constant low levels of estrogen concerns, disordered eating and exercise addictions among athletes endocrinologists, psychologists and sports doctors who are and progesterone that completely suppress the various stages of and exercisers, it is a concern that the potential y harmful effects of working with women across the country on these issues.
the ovulatory cycle. Put simply, it refers to hormonal changes that energy deficiency in combination with exercise are rarely discussed cause a cessation of the menstrual cycle.
t We also encourage you to take a proactive approach toward in the media and by health professionals. Unfortunately, many your own relationship to exercise, food, and your body: Amenorrhea can be classified as primary or secondary. Primary health providers are not up-to-date on the latest research amenorrhea refers to girls whose menstrual cycles have not begun t Make sure your body has enough calories to “fuel” and “refuel” and do not refer or manage afflicted women appropriately.
by age 15 years, and secondary amenorrhea refers to previously your daily exercise. It is very difficult to know what is needed, Ongoing stigma and misinformation has lead to some confusion so it is advised to get advice from a sports nutritionist to design menstruating women who have an absence of menstrual periods among exercising women: What happened to my period? Wil it a balanced and healthy nutrition plan. Keep a journal of your impact my chances of having children in the future? What will exercise practices, nutrition and menstrual cycle.
Exercise without adequate energy availability can affect the be the state of my bones in 20 years time? These are important menstrual cycle. However, there are various other causes of t Your menstrual cycle is a good indicator of health. If your period questions, so we developed the Fuel Aotearoa website to make the continuum between health and disease.
amenorrhea including pregnancy, pituitary gland tumours, disappears for three or more consecutive cycles, consult your GP scientific research accessible to female athletes, exercisers, coaches chronic stress, and polycystic ovarian syndrome. Diagnosis is a and ask them to recommend a specialist for further advice.
and parents. Our aim is to empower girls and women to experience Image used with permission of Fuel Aotearoa complex process and we encourage women to seek professional t Try to listen to your family or friends if they express concerns the numerous benefits associated with exercise and sport while advice if they have observed changes in their menstrual periods.
about excessive weight loss, or disciplined exercise regimes. avoiding the negative consequences of the Female Athlete Triad Refuel for life: What is the importance of Sometimes family and friends see things you don’t, and most often they are expressing their concerns because they love you.
What is the Female Athlete Triad? How does it Energy availability is a key feature of the Female Athlete Chronic low energy availability can have a direct negative t While exercising and dieting might be important for Triad. Low energy availability develops when insufficient calories effect on bone mineral density (BMD) via effects on various maintaining or achieving the body you want today, try are consumed to meet the demands of exercise training. If the metabolic and ovarian hormones, and also insufficient intake to think about the long-term health of your bones and In 1992, the American College of Sports Medicine (ACSM) magnitude or duration of energy imbalance is too large, the body of nutrients, vitamins and minerals that are important for reproductive system. Ask yourself – do you still want to be coined the term, “Female Athlete Triad” to illustrate the must prioritise calories that are available. That is, energy is drawn maintaining bone health. It is important to note that BMD able to walk, run, or dance, well into your old age? Might you unique risks facing female athletes. The Triad describes the away from physiological processes and body systems that are not may not be fully restored in exercising women when nutritional three separate but interrelated spectrums of energy availability, essential for immediate survival and towards those essential for and hormonal status is once again optimised. Thus, chronic low menstrual function and bone mineral density (BMD). Clinical life. For some women, low energy availability is by accident but energy availability poses a significant threat to the long-term See fuelaotearoa.co.nz for more information on the Female Athlete Triad, energy deficiency, and how it manifestations (see the purple triangle in the diagram) include relates to recreational exercisers. Holly and Maria are available to provide educational seminars to groups for many others, exercising and restricting caloric intake is done health of exercising women by increasing the risk for fractures and of female athletes, exercising women and coaches.
but are not limited to, disordered eating behaviours, amenorrhea with the aim to lose or maintain a particular weight.
and bone mineral loss, which are detrimental to long-term health
REAWAKENING OF MEN What are the tasks of men today? ‘Knights Without Armour’ (A. Kipnis) an excellent men’s book looks at these tasks, I would like to share my thoughts. Admitting the wound. Many men say “I’m fine”… but in actuality men’s wounds go deep. Men carry shame, perhaps from not living up to who they thought they would grow up to be. Resisting the word ‘victi