HEADLINES [click on headline to view story]:

Your Health & Happiness

The Doctor's Consultation 

Agony Column

Camera Class by Snapshot

Dr Byte's Computer Conundrums

Money Matters

Life in the Laugh Lane

Your Health & Happiness: Harm reduction – a window of opportunity

Owen Elias,
Programme Coordinator, Health & Development Networks (HDN)

“Harm reduction recognises that some people in society will choose to use drugs, and refuses to condemn them to the resulting suffering. We need to remember that drug users are human beings and treat them humanely whatever choices they make,” says Paul Hardacre, Training Coordinator, Asian harm reduction network (AHRN).

Paul Hardacre, AHRN Training Coordinator

Paul Hardacre spoke at the monthly NGO forum held at Health and Development Networks (HDN) on May 31, 2005. The theme of the forum, ‘Harm Reduction – a window of opportunity’ was taken from the title of an AHRN film which formed part of the presentation.

AHRN is an information and networking organisation that links individuals and organisations, who are working to prevent the spread of HIV among injecting drug users. As well as information sharing AHRN also works on advocacy for harm reduction enabling policies, program development, training and research.

Seeking to clarify and define what is meant by Harm Reduction, Paul was keen to debunk the common misconception that harm reduction is about legislating for the legalisation of drug use. Harm reduction is essentially an attempt to reduce individual, social and economic harms associated with drug use, with out judging the choices made by drug users. This means providing drug users with the information and support they need to stay healthy.

Cover of the Window of Opportunity video.

Harm reduction is a pragmatic approach that recognises that a drug free society is an impossible utopia. “What we are working for is not a drug free society but a ‘drug poor’ society”, Paul said.

Harm reduction interventions can include outreach to drug using populations, peer education, drop-in centres, provision of information and education, voluntary counselling and testing and needle and syringe exchange programmes. The later form of intervention is the one that most often makes the headlines, and is often perceived quite negatively by the general public.

Needle and syringe exchange programmes are an important means of preventing the spread of HIV among injecting drug users and their communities. Despite the opposition faced by these programmes there is no evidence to suggest they increase drug use or crime in the areas where they operate.

Another important aspect of some harm reduction programmes is pharmacotherapy. Pharmacotherapy is, most commonly, the use of methadone as a replacement for heroin, though it may include other drug replacement therapies. This form of treatment is designed to counter the compulsive cravings suffered by many drug users, which increase the potential risks associated with drug use. Pharmacotherapy can allow drug users to regain control of their lives and provide a way out of drug dependency.

The ‘Window of Opportunity’ video presented us with the image of a teenage boy injecting himself in the groin on the streets of an Asian city and asked us; “Is this boy a criminal or does he need help?”

For more information on harm reduction please contact AHRN. Tel: 053 893175, 893144 Website: www.ahrn.net.

The NGO forum takes place on the last Tuesday of every month. For more information please contact Owen Elias at Health and Development Networks, 053 418 438 or owen@hdnet.org

The Doctor's Consultation: Gallstones - the 82 percent story?

by Dr. Iain Corness

As medical students, we learned the Five F’s of gallstones. The mnemonic went Fat, Fair, Female, Fertile and Forty as these represented the typical gallstone sufferer. Unfortunately, like all catchy mnemonics it isn’t quite true, as 10 percent of men also have gallstone problems.

Unsure of where your gall bladder is hiding and what it is supposed to be doing? It is found under your lower ribs on the right side of your body and is attached to the underside of your liver and is involved with digestion. In its natural healthy state it is like a hollow sausage attached by a tube (called the bile duct) to your stomach. It is when it gets gallstones inside it that you begin to get a problem.

So where do these gallstones come from? Well, 80 percent of them are made of our old friend Cholesterol, or Cholesterol mixed with pigment, that’s why you can get such pretty colours, though I am yet to see any made into a necklace, but it could catch on, I suppose. The Cholesterol stays in solution until something happens to slow down the emptying of the gall bladder, or thicken the solution, such as happens during fasting or through not drinking enough - water (sorry to have raised your hopes for an instant). This results in what we call biliary “sludge” which then hardens and turns into gallstones.

Factors which increase the likelihood of developing gallstones include increasing age, obesity, a diet high in animal fats and certain medical conditions such as diabetes. Oh yes, pregnancy also increases the incidence. (With all these problems that can happen with procreation, it is a wonder the human race survived this far!)

The management of gallstones has also changed dramatically over the past 20 years because of three main factors. The first was the development of Ultrasound visualization. At last we had a way of diagnosing gallstones, and painlessly too. Not only could we now “see” the gallstones, but we could tell if they were the cause of pains in the belly by being able to pick out inflammation in the gall bladder wall.

The second development was ERCP (you know how we love acronyms in medicine) which stands for Endoscopic Retrograde Cholangio Pancreatography. At the end of the operating telescope (the Endoscope) the surgeon can sneak into the bile duct and scoop out stones that are blocking the duct which have been causing jaundice.

The third development was Laparoscopic Cholecystectomy and was pioneered in 1987 by a French surgical team. Instead of practically sawing you in half to get at the gall bladder, hiding under the liver as I mentioned before, this is a much less invasive method, where the operating laparoscope is inserted through a small incision in the abdominal wall, and the surgeon does the job under the direct vision. While this results in less trauma, shorter hospitalisation and quicker recovery, it is not always successful as it may be too difficult to snare the gall bladder, and the operation may have to be converted to the older “open” method.

It is also important to remember that gallstones can be found incidentally, and if they are causing no problems, the answer is simply to leave them alone. The chances of developing symptoms over 20 years are about 18 percent, or so the good books tell me, so with an 82 percent chance of getting off with nothing, who is going to volunteer for an operation you probably will not ever need? What “gall” to even suggest it!

Agony Column

Camera Class: The Nikon D2X. Is this the ultimate digital camera?

by Harry Flashman

While still adhering to traditional film, but carefully watching the digital alternatives, I had thought that I would like to have a play with the Nikon D1X. There was only one thing stopping me - the price. Last time I looked they were around 250,000 baht!

However, because I was so tardy in making up my mind (or saving the bikkies), Nikon decided not to wait for me and has introduced the new Nikon D2X this year. Officially, Nikon describe it as their 12.4 Megapixel Digital SLR with Wi-Fi options.

Having looked at the specifications for this camera, I would describe it as the most advanced picture taking device currently available, with the capabilities of a small photographic studio system. Hearkening back to my own studio, this was set up with medium format cameras, IR senders to trigger remote Broncolor flash units, which were all independently programmable and other ‘in-camera’ capabilities. Looking at the Nikon D2X, and incorporating their Wi-Fi (wireless remote) control option and Nikon’s TTL Speedlight system, this combination would beat my old system hands down. Not only total control of all functions, but even remote triggering for the camera with five frames per second speed.

The Speedlight system bears some explanation. Called i-TTL Speedlight Technology, this was first seen on the D2H Nikon, and is the same (or better) than studio multiple flash heads. Where you had to run around setting each flash head power settings individually, the i-TTL technology in the D2X allows photographers to wirelessly control in full TTL, up to three groups of Speedlights, with any number of individual speedlights in each group. This works for photographers who now do not need to ever calculate flash and distance ratios, because the i-TTL systems is capable of making all exposure calculations in real time, wirelessly, during the exposure to deliver a perfect flash exposure in any situation.

Photographers can even maintain full control of each group of Speedlights from a master, on-camera Speedlight, by dialing up or down flash exposure values for each group. This technology can potentially distill an entire portrait lighting system into a small set of multiple SB800 and SB600 Speedlights.

While creative control is a bonus, if done easily, the end result still needs to be pin-sharp and colour rendition needs to be excellent. After digital conversion, a new processing method has been added to increase precision for smoother display of tones from highlight portions to shadow portions of the image and smoother gradations with consistent and smooth transitions, all with exceptionally pure color rendition.

Professionals need their cameras to be fast. The D2X is ready to shoot the instant it is turned on having an almost imperceptible 37 milliseconds shutter lag time, an area which has been a problem with high resolution digitals in the past.

The time between each shot is reduced as well, so the D2X is capable of shooting 5 frames per second at full 12.4 megapixel resolution for up to 21 jpegs. If that is not fast enough for the action photographers, the D2X has a High Speed Cropped Image mode that allows 8 frames per second by using a dual area sensor that records only 6.8 million pixels in the centre of the sensor. The D2X also has a high-speed AF system that features eleven auto-focus sensors of which nine are cross type and placed in the rule of thirds layout.

Battery life with high performance cameras can be a problem, but Nikon claim approximately 2,000 shots per charge, with accurate real-time displays. This sounds almost unbelievable, but I doubt if Nikon would tell us lies!

With the Wi-Fi option to be able to operate the camera some distance away, this makes this the most complete camera system today, in my book. At the beginning of this article I said there was one thing that had stopped me getting a Nikon D1X, and that was the price. With the new D2X, there are two factors stopping me - firstly the price, and secondly the cost! But I would certainly like one! Go for a virtual look at http://www.niko ndigitalusa.com

Dr Byte's Computer Conundrums

by Dr Byte, Citec Asia

If you are one of the lucky ADSL users in Chiang Mai, you have most probably been suffering the lack of zoom and speediness that we have come to expect from these services. At one time or another over the last 3 or 4 weeks, CAT, CMNet, Loxinfo, KSC, jINet and all the others have had problems that have impacted on our international internet connections in one way or another. Like a deck of cards falling over, a fire in one of CAT’s Chiang Mai Telephone Exchanges around 4 weeks ago seemed to start the pain. Failing routers, bandwidth issues, virus attacks, and power supply outages have increased our expected 40ms connection speeds to more than 4000ms and what that means is your connection to your favourite web page is so slow to load, you can have breakfast, mid-morning tea and lunch while waiting.

I was talking with Roger, Chiang Mai and he asked me about making some e-mail stationery for his business. If you thought colourful stationery was only for handwritten notes, think again. If you use Outlook Express, not only does it come with a swag of built-in stationery for your use, you can create your own and download some pretty neat stuff from the web too.

Stationery in Outlook Express usually has a background image or colourful strip at the top or on one side. It also uses a complementary type face so your email looks good. For business users, adding a banner or even a small animated banner is really simple too. Outlook Express can be configured to use a particular stationery design by default and you can then, if desired, select a different stationery (or none at all) on a message by message basis.

Configuring
stationery

Check and make sure you have selected Rich Text (HTML) for mail format. If not, select that option from the Format menu. It won’t work unless you do that.

Next, to add stationery to a new message, in the New Message window, choose Format, Apply Stationery and choose a stationery to use.

To set a stationery design for all outgoing messages, choose Tools > Options > Compose tab and, in the Stationery area, click Mail and click Select. Click on a stationery style to view it in the Preview window (click Show Preview if the window isn’t visible). Click OK to use this stationery for all new messages.

If no design pleases your eagle eye, check on the internet for other offerings. You can also use Outlook Express by selecting Tools > Options, Compose, in the Stationery area check the Mail checkbox and click Download More. If you’re connected to the internet, you’ll be taken to the Outlook Express stationery download site where you’ll find a list of downloadable stationery, together with instructions for downloading and installing it.

Custom-designed options

If you still haven’t seen what you want, create your own custom stationery. Ideal for the business user or someone who wants a unique style all their own. Choose Tools > Options > Compose and, in the stationery area, click Create New - this is a better choice than Edit, which opens an HTML editor, like FrontPage. The Outlook Express editor is much simpler.

When the Stationery Setup Wizard appears, click Next. Choose a background from the list or click Browse to use your own picture or logo. Choose the Position for the image and whether to tile it over the page. Choose a background colour - if the logo is a GIF with the background made transparent, the background colour of the stationery will show through the image. Click Next.

Now choose a font - remember to select a plain font that is likely to be on everyone’s computer. Use the Colour option to choose a font colour and, if desired, choose Bold or Italics. Click Next.

Adjust the placement of the text in the message. Do this if you use an image down the left of the page or centred at the top to avoid the message being typed over the picture. Click Next and give the stationery a name. Click Finish then, in the Compose dialog Stationery area, click Mail, then Select and choose the new design to make it your default stationery.

In the next column, I have a few more Questions and Answers to share with you. Don’t forget to keep your preferred anti-virus and spysweepers up to date. Do a full hard disc scan and sweep at least once a week. Don’t open e-mails with funny attachments if your not expecting them and last but not least, make sure your firewall is on. Dr Byte appears in Chiangmai Mail every 2 weeks and if you have any questions or suggestions you would like to make, you can contact me at Dr Byte, Chiangmai Mail.

Money Matters: European Union Savings Tax Directive - the real facts

Alan Hall
MBMG International Ltd.

From July 1, 2005, new tax legislation will become effective throughout the European Union. This could impact on anyone holding deposits or savings within any EU country, and the tax havens of Gibraltar, The Isle of Man and the Channel Islands. Knowledge of how they may affect Europeans is vital to those people who have savings within this area.

As a culmination of long-stated EU intentions to comply with OECD anti-money laundering standards and the increased global pressure to act against money laundering that built up following the ‘war on terror’, the EU Finance Ministers agreed a Savings Tax Directive which finally comes into force this summer. This requires all registered institutions in all the EU states to exchange information on interest payments on savings and deposit income of non-resident private individuals so that they can be taxed at the appropriate rates in their home country.

The majority of EU countries will adopt this method of exchange of information. In other words, if you hold deposits in one EU country and reside in another, the country where the deposits are held will inform your country of residence so that you can be taxed there.

There are exceptions to this - Luxembourg, Austria and Belgium have elected to instead deduct a withholding tax at source. Switzerland, Isle of Man and the Channel Islands will also be adopting the withholding tax option, even though they are not members of the EU.

In practice, this means that for the countries adopting the exchange of information route, on an annual basis, details of interest earned from private bank accounts and investments shall be passed to the account holder’s home country.

In the case of countries choosing instead to levy withholding tax, then this will be deducted at source from interest payments at an initial rate of 15% subsequently rising to an eventual 35%. The withholding jurisdiction will retain 25% of the tax revenue and will forward the remaining 75% to the home country of the account holder, but without any details of the account holder.

The legislation will cover bank deposits that pay interest, as well as investment income that generates from fixed interest securities (government and corporate bonds). However trusts, offshore investment bonds and life insurance based products are excluded from the directive and therefore offer a legitimate means of tax planning. However, it should be remembered that under the arrangements already in place between the government of the UK and the authorities in both The Isle of Man and the Channel Islands then any withdrawals from such products that exceed twice the basic rate tax band in any tax year are automatically notified to the Inland Revenue if the policy holder is UK resident.

What this all means in practice is that:

1) Anyone whose residential address (according to the data held by their EU bank or financial institution) needs to look at the withholding tax and information exchange consequences of the changes in legislation and evaluate their impact and explore alternative structures;

2) Investments and deposits of any individual who might return to the EU or Switzerland at some future time might also be affected.

It has come to our attention that a number of organizations have been sending out rather scare mongering communications that have caused some considerable alarm amongst the expatriate community, without explaining who will be affected immediately and who may be affected in the future. Unless you currently hold EU domiciled investments or deposits AND you also have an EU residential address, then this should just be a matter to be addressed as part of your overall planning for the future IF you may subsequently resume residence of an EU country. If not, then there are unlikely to be any implications stemming from this.

We have prepared a detailed review of the arrangements for those persons who will be affected. The introduction to this was published last year in our weekly columns in both the Pattaya Mail and the Chiangmai Mail. Simply email us at info@mbmg-international.com if you require a full copy, or contact us to arrange to discuss this further.

The above data and research was compiled from sources believed to be reliable. However, neither MBMG International Ltd nor its officers can accept any liability for any errors or omissions in the above article nor bear any responsibility for any losses achieved as a result of any actions taken or not taken as a consequence of reading the above article. For more information please contact Alan Hall on alan@mbmg-international.com

Life in the Laugh Lane: I was born in Fargo, but I take pills for it

by Scott Jones

Fargo, North Dakota, USA, almost Canada, suburb of the North Pole. You may have seen the black comedy movie “Fargo”, which is actually a documentary, although I’ve never personally known anyone who stuffed a body into a wood-chipper. Yes, many people in Fargo actually do talk like that: “Uff dah, ya sure, you betcha. I tink we might haff ta eat some lutefisk tonight.” (Lutefisk is a Norwegian fish dish made from cod soaked in lye, an official poison, until it’s a translucent pile of preserved, decomposed tissue which fills the house on Christmas Day with fumes so noxious they almost trigger the uncontrollable Vomit Reflex. I’ve never eaten it, but I have stepped in it.)

Standard skyline near Fargo with North Dakota State Tree on the left

For some strange reason, thousands of Scandinavians left their beautiful, mountainous, fjord-filled homeland to settle in perhaps the flattest place on the planet. When God was creating the earth from a ball of clay, he dropped it, making a flat spot where it hit the floor. As a cosmic joke, he kept this horizontal, featureless plane and called it North Dakota, though “Frozen Rectangular Pancake” would have been more appropriate. Winter lasts 465 days a year, interrupted by a few days of “spring” when the snow mutates with dirt into living lumps of sludge on streets and lawns. Fargo sits next to, or often in the middle of, the Red River, though “Smelly Brown Ditch” would have been more appropriate. In spring when the river overflows its banks, the highest points in eastern North Dakota, the water may flood 75 kilometres on either side. (It’s like spilling a bucket of water on your kitchen floor.) If summer falls on a Sunday, everyone goes outside for a picnic. Meals match the geographic landscape: plain plains food. “Spicy” is limited to the use of onions and “hot” is mainly coffee. Unless you love the sky, grey and 40 below, or miles and miles of miles and miles of monochromatic wheat fields, there’s not much beauty in North Dakota. Last year they held the Miss Fargo Beauty Pageant and no one won. The one good thing about being from Fargo? Wherever I go, it’s better.

So, besides the food and the weather in Thailand, I love the mountains and valleys. And some of the roads, though you never know what will or won’t be around the corner. Photo 1: A very, very, very steep hill near Pai. The bikers are dead now. Photo 2: Your brakes and wheels may survive the first hill, but not the next. Photo 3: Even if your wheels make it, there may not be a road.

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