Health and Physical Education WS31002

51 person, will be imprisoned from 2 years to 10 years and fined from 4,000 baht to 20,000 baht. Anyone buying or taking the person mentioned will get the same punishment. The required components of abducting a child are: 1. Abducting from parents, care takers or guardians. 2. Not having the child’s consent. 3. Unreasonable commitment. Remark Abducting children = Illegally taking away children who are immature from the surveillance of the parents or guardians whether they are willing or not. Abducting children whose ages are not over 13 years old and they are not willing is a crime. Anyone who buys or sells the children who have been abducted, will be punished the same as the one who abducts them. Those who take or buy the children to be prostitutes, or mistresses to someone, or for rape, will be seriously punished. Abducting children who are over 13 years old but not over 18 years old even though they are willing and if taken for indecency or for trading for profit will be guilty of a crime similar to abducting for rape or prostitution. How to contact the police Notifications To get convenient, rapid service and as required by law and by governmental regulation, when going to the police station, you should prepare the necessary documents such as the notice of rape, any documents which can be shown to the police, and the clothes of the person who was raped. There might be semen stains or other stains from the rape on the clothes. Alsoany of the accused belongings that might have been droped at the scene. Be sure to bring the house registration, the birth certification of the victim, any photos,the accused address and any other pertinent documents. All these documents must be shown to the police officers. When bringing complaints to the enquiry officials, in addition to bringing the documents to be shown it would be good to bring any witnesses knowing or involved in the incident . This will help to finish the matter as quickly as possible.

52 Activities Explain the following questions in the class. 1. How many stages of sexual development are there? What are they? 2. Sexual emotion may be divided into 3 stages, what are they? 3. How can we deal with sexual emotions? 4. What factors cause incident guilt? 5. According to the law, what is illegally abducting immature children?

53 Chapter 3 Food and Nutrition Theme Understand the problems, causes, and prevention of sickness caused by nutrition deficiency as well as learn to manage a suitable food program. Learning Expectations 1. Understand the problems, causes, and prevention of sickness caused by malnutrition. 2. Describe the principles of food sanitation and proper food handling habits. 3. Be able to properly set a diet program suitable for various ages including elderly or sick persons. Scope 1. Malnutrition 2. Food sanitation 3. Setting a diet program suitable for all members of the family

54 1. Malnutrition Thailand is well known for its fertility and the many varieties of food. Thailand also produces more than enough food for the citizens of the country, and also exports a lot to other countries every year. However, despite this abundance, reports show that some of the citizens in the country still are malnourished , especially infants and preschool children. These children do not have full physical growth and their resistance to infection is low. In addition, the personal habits of the Thai people cause malnutrition because they whatever they prefer without considering the nutritional content. This leads to malnutrition unintentionally. Learning the causes and how to prevent malnutrition will help the children and juveniles to enjoy good health and full growth. When food is taken into the body, it will be digested by our internal organs and provide nutrition as follows: Provides the energy for essential body processes such as breathing, digestion, muscular performance and all other bodily activities. Essential for the proper growth of children, as well as repairing and maintaining the body. Maintains the bodies immune system. Provides fuel for all bodily actions. Therefore when insufficient nutrition is taken into the body, the body cannot function properly. This is called malnutrition. Some important clinical results from malnutrition common in Thailand: 1. Protein and calorie deficiency Protein and calorie deficiency is caused from our body getting inadequate protein, carbohydrate, and fats. This problem can often be found in children under 6 years old especially infants and preschool children. This is because of bad treatment and insufficient knowledge of nutrition. There are two types of malnutrition, kwashiorkor and marasmus. 1.1 Kwashiorkor is a symptom of protein malnutrition and usually happens when infants are fed from sweetened condensed milk mixed with dry milk and given supplementary food which is mostly rice or flour. This provides insufficient protein for growth and other bodily systems become defective. The symptoms in an infant include a pale and swollen face, legs, body, dry and fragile hair, dry skin, depression, easy infection, and impermeable cognition.

55 1.2 Marasmus is a symptom of a lack of protein, carbohydrate and fat. The symptoms are similar to those of kwashiorkor but no swelling of the body, face, and legs. The body will be very thin, with a big head, protruding belly, wrinkled and peeling skin like an old manand frequent diarrhea. However, there might be both the kwashiorkor and the marasmus in one person. Prevention and treatment for a lack of protein and calories Surveys show that a lack of protein and calories is most common in infants and pre-school children in the Northeastern part of Thailand. The Health Department also reports that these symptoms can also be found in pregnant women and women who are breast feeding. Some women believe that protein is bad for their health, so they get only 80 percent of the calories and 62 -69 percent of the protein that they should have. The lack of protein in infants and teenagers is an important problem in Thailand. To solve the problem, children are encouraged to drink milk , especially breast milk. A lot of nutrients can be found in milk. Some government sections have also produced food with high protein and low cost for the poor. The Institute of Research and Development in Food Production, Kasetsart University has produced protein from crops to complement animal protein called ‚ Protein Kaset ‛ and ‚ Green seaweed Protein‛. 2. Vitamin deficiency While the body needs protein, carbohydrate, and fat, it also needs vitamins and minerals for good health. These help keep the organs normal. Although our body needs only small amounts of these nutrients if we are lacking in them, the body will not be healthy and might get various diseases. In Thailand, the vitamins most lacking include vitamins A, B1, B2 and C the details of which are as follows.-

56 Vitamin A Deficiency is caused from eating low fat and inadequate vitamin A. Vitamin A deficiency suspends the growth of children causing them to have dry and rough skin like a toad. There is inflammation of the skin at the bottom, arms, legs, elbows, knees, and chest. In addition, there is inflammation in the nostrils, ears, mouth, salivary gland, conjunctiva, dry white and black cornea, scars at the white cornea, opaque and thick pupils and if it is severe they become blind or cannot adjust eyesight in the darkness. We call this, partially blind or night blindness. Prevention of vitamin A deficiency can be done by eating food with adequate fat such as eggs and milk, green and yellow vegetables such as morning glory, kale, gourd, yam and fruits like papaya and ripe mango.For infants, they should have supplementary food with liver and mashed egg yolk. Vitamin B1 deficiency happens from eating food with low vitamin B and eating food which obstructs the absorption of vitamin B1. Vitamin B1 deficiency, known asberiberi, will cause numbness in the hands and feet. The muscles of the hands and feet are weak. Some patients may have a swollen body and if it is severe, it may cause shivering, cardio-megaly, breathlessness, exhaustion, and even death if not treated promptly.

57 Prevention and Treatment of vitamin B1 deficiency can be done by always eating food with adequate vitamin B1 such as brown rice, liver, dried beans, and beef. Foods which destroy vitamin B1 include raw pickled fish, raw oysters, and tea, etc. These foods should be avoided. Vitamin B2 Deficiencyis caused from eating food without enough vitamin B2. Anyone who lacks this vitamin will have lesions or cracks at both corners of the mouth or small clear flakes at the nose. The tongue will be redder than usual and painful or there may be lesions at the walls of the mouth and tickling and burning pain at the eyes. These symptoms are called canker sores. The patient will be tired, bored with food, and upset. Prevention and Treatment of Vitamin B2 Deficiency can be done by always eating food with adequate vitamin B2 such as fresh milk, flavored milk, soybean milk, dried beans, brown rice, vegetables, and fruits, etc. Vitamin C Deficiency is caused from eating food without enough vitamin C. Anyone who lacks vitamin C will get sick easily because they have a low resistance to disease. They will have red, swollen gums and bleed easily. If it is severe, the teeth become loose and bleeding gums which we call, scurvy. Prevention and Treatment of Vitamin C Deficiency can be done by always eating food with adequate vitamin C such as oranges, lemons, tamarind, tomatoes, guava, coriander, etc.

58 The vitamins that are most problematic are mostly water-soluble vitamins like vitamin B. Fat-soluble vitamins such as vitamin E and K will not usually be a problem because some of these vitamins can be synthesized by our own body like vitamin D which we get from the sunlight of outdoor activities. The ultra-violet radiation from the sun can change a kind of fatty substance under our skin to vitamin D. For vitamin K, our body can synthesize it from bacteria in the large intestine. Vitamin A however, which can be found in vegetables and the yellow, red, and green colored fruits is easily lost when heated. 3. Mineral Deficiency Minerals help control the normal functions of our organs, and are important for the composition of significant parts of our body such as bones, teeth, blood, muscles, etc. If our bodies lack minerals, our organs may malfunction causing various diseases as discussed below: Calcium and phosphorus deficiency is caused from eating food without enough calcium and phosphorus. Anyone who lacks calcium and phosphorus will get the rickets, most common in children, pregnant women, or lactating women. It causes swollen joints, bow legged, muscle slackness, joints of the front ribs bulging causing what is known as chicken breast . Rickets result from not only lacking minerals but also from not getting sufficient sunlight. Prevention and the Treatment of calcium and phosphorus deficiency can be accomplished by always eating food with a lot of calcium and phosphorus like fresh milk, fish with bones, green vegetables, fish oil, etc. Iron deficiency is caused from eating food without enough iron or there is an abnormality in the digestive system and malabsorption. Anyone who lacks iron be anemic because the body produces less hemoglobin than usual and makes our body tired, bored with food, and to have a low resistance to disease. Symptoms include pale eyelids, inflammation of the tongue, fragile nails, and less capacity for work.

59 Prevention and Treatment of iron deficiency can be accomplished by always eating food containing iron and high protein such as liver, gizzard, beef, green vegetables, etc. Iodine deficiency is caused from eating food containing low iodine or having any substance block the absorption of iodine in our body. Anyone who lacks iodine will get a goiter and the thyroid glands are often swollen. This affects physical and mental development. Children grow up slowly, have impaired cognition, and may be dumb and deaf. This is a common condition for people who live in the Northern and the North-eastern parts of Thailand. Prevention and Treatment of the Iodine Deficiency can be accomplished by eating sea food such as shrimp, shellfish, crab, fish, etc. If sea food is not available, we should eat healthy salt a mixture of sea salt and iodine used for cooking. In addition, we should avoid food which blocks the absorption of iodine such as raw cabbage. Cabbage should always be cooked before eating. Conclusion. Malnutrition not only has harmful effects to the body, but it also obstructs people’s way of live and the development of the country. Hence, it is extremely important that everyone should choose food with high quality nutrients based on the 5 groups of primary food. We should eat an appropriate amount of such food to satisfy the body’s needs in daily life in order to be strong and healthy. However, diseases related to the nutrients are not only caused by lacking nutrients, but having too much of them can also cause unhealthy conditions. Being very fat is known as ‚ obesity‛.

60 Obesity is caused from eating more food than the body needs resulting in the accumulation of fat in the body. Obesity generally causes the following symptoms: nervousness, low immunity, heart disease, diabetes, hypertension, etc. Nowadays, Thai society has changed especially in big cities where everyone has to rush to work. The consumption habits of people are becoming more like those of western countries. Food like pizza, sandwiches, fried chicken, potato chips, etc, is loaded with fatty acids with high cholesterol. The best way to prevent ‚obesity‛ is to avoid eating that kind of food, choosing food with less fat and getting regular exercise. If you are overweight, consult your physician for advice. Do not use special soaps, creams or medicine which promises to make you lose weight because they may be harmful to your health. 2. Food Sanitation Food Sanitation means the various ways to manage food including improvement, preservation and enhancement. All these can make the food we eat clean, safe, and appetizing and finally, good for our health. Food means anything we can eat for supporting life.- 1. Any substances we can eat or drink by mouth or bringing any substance into our body what so ever by any means but not including medicine, psychotropic substances, or drugs. 2. Any substances used in food production including food additives, color, and any flavoring substances. 2.1 The Importance of Food sanitation Food is an significant factor for humans because everyone must eat survival. However, only considering the value of nutrition, taste, or filling the stomach then these are not enough. Clean and safe food should also be taken into consideration. If the food we eat is tasty but dirty, it will be harmful to our health. It may cause stomachaches, diarrhea, vomiting, dizziness, faintness, parasitic diseases, paleness or even chronic sickness This is known as ‚disease caused by food carrier‛. The severity of this disease depends on the type and the quantity of the disease, vermin, or toxin we eat. Therefore we should eat

61 clean food without disease, vermin, and toxin. How to manage and control the quality of clean food is called ‚Food Sanitation‛ 2.2 Significant factors that cause food to be dirty and contaminated. Some factors that cause dirty food. Food becomes dirty because contaminants become mixed up in the food. Some important contaminants are disease, vermin, and toxins. All these can contaminate food during the process of producing, transportation, preparation, storage, distribution, serving, etc. Some contaminants are as follows: 1. Disease, vermin, and toxins. 2. Diseases can be carried by insects, animals , humans, containers, equipment, environment, water, dirt, fertilizer, air, etc. 3. The processes relating to food such as producing, transporting, preparing, cooking, keeping, distributing, serving, etc. 4. Consumers 2.3 Basic problems of food sanitation Food and drink are necessary for human beings. At present, infections of the gastrointestinal tract is a significant cause of illness and death in Thailand. Diseases such as cholera, dysentery, typhoid, some types of diarrhea are still common. These illnesses significantly diminish lives and the economic status of the people. The best way to solve this problem is to prevent the disease by controlling food sanitation and the environment to prevent spreading the diseases . We should control and improve the way we clean along with clean drinking water and the elimination of feces to provide hygienic conditions. At present, the Thai population growth rate is rather high especially in the large urban areas such as the Sanitary District and Municipal Areas which are in the developing process. More people are working and eating out. If a food shop or restaurant does not control or caring about cleanliness, it will create illness and death to people. This growing population is the cause of the increase ingastrointestinal tract infections.

62 2.4 The diseases from eating incorrectly nutrition and food sanitation. For safety in choosing an areas products, consumers should study and understand the nature of the products especially about food and can be guided in choosing as follows.- 1. Food impurity. According to the Food Act B.E.2522, food impurity includes 1) Food mixed with any harmful substance 2) Food mixed with any substance causing its quality to decline except a substance that is essential for the production and is allowed by the official authority 3) Food mixed or garnished by any methods with the intend to cover defects or poor quality of such food 4) Food which is produced, packed, stored unhygienicly. 5) Food which is produced from poultry contaminated with disease that can be transferred to humans. 6) Food which is packed in any container which may be harmful to health. 2. Adulterated Food. The Food Act defines the characteristic of adulterated food as follows.- 1) Food which lacks standard and quality as required 2) Food from which some ingredients or valuable materials are extruded and distributed as whole food or under the same brand name. 3) Food which is produced artificially but distributed as genuine. 4) Food which has a fake label or tries to misinform consumers about the quantity, quality, or any other characteristic of the food product, including mislabeling the country of origin At present, Thailand produces more and more ready-made food. Some distributors purposefully induce impurities into the food products. To deceive consumers they mix chemicals into the food to get better profits and take advantage of the consumers. The Office of Food and Drug Administration, Ministry of Public Health tries hard to control food quality by sending Food and Drug Commissioners to inspect the sources of the food production. They also collect samples of the food from the markets and send them to be analyzed whether or not their quality is in accordance with the Food Act. Still, a lot of food mixed with chemicals and impurities is sold in the markets as mentioned below. 1) Colored Food. Colored food well known to consumers includes roasted red pork, sour pork, Thai sausage, fish balls, dried shrimps, prawn crackers, and red sauce.

63 The Department of Medical Science, Ministry of Public Health inspects the food colors which might be harmful to health. They found that 90% of the food colors contain lead and copper. 2) Pepper. Flour is mixed into the ground pepper to increase the volume. The best way is to buy pepper seeds and grind them to get real pepper. 3) Saltpeter. This makes beef look reddish, soft and appetizing. It is often used to improve fish, bacon, and beef. Saltpeter can be harmful if we eat too much of these products because the saltpeter they put in, can cause cancer. 4) Ketchup. Potato puree is artificially reddened and sold as ketchup. If we want natural ketchup, we should boil fresh tomatoes. This will also provide the nutrients we need. 5) Artificial vinegar. Acetic acid diluted with water or concentrated orange juice is often sold as vinegar. 6) Fish sauce. Producers boil pork skin or bone, cow or water buffalo bone, add salt, coloring, and flavors to the brew and then sell it as fish sauce. 7) Coffee and tea. Producers make instant coffee from roasted tamarind or corn seeds or roasted rice. Instant tea is made from tea leaves mixed with wasted tea leaves and color. 8) Meatball. Borax is mixed into the meat to make it crispy. The Medical Science Department collected samples of meatball from 8 distributers and found that 7 of them mixed borax into the meatballs which causes food adulteration and is unsafe for consumers. 9) Cooking oil. Most of it is extracted from rubber seeds and mixed with bean oil or coconut oil. These oils are not safe to consume because they contain dangerous substances. 10) Preserved food. Many kinds of food such as chili paste, sauce, golden ball cake, jackfruit seed cake, including instant food in boxes are treated with preservatives like salicylic acid which is harmful for health. The Ministry of Public Health permitted Sodium Benzoate in concentrations of not more than 0.1% by weight as preservative.

64 11) Food with pesticides. Some kind of famous food is treated with pesticides like DDT mixed with salt water to destroy worm infection and to better preserve salted fish. These pesticides are harmful for health. 3. The Harmfulness from adulteration and contamination Although some food contaminant may not be harmful, it is still considered to be cheating the consumer. Some contaminants are less harmful while others are more harmful depending on the quantity and attributes of the contaminant in food. The Public Health Department manages to control such food and informs the public of the harmfulness of the adulteration and contaminated food which is: 1) Harmfulness of borax in food. Some kinds of food such as meatballs and pork sausage usually contain borax. If we consume these foods in large quantities, we accumulate too much borax in our body which may cause death. 2) Harmfulness of sodium cyclamate. Sodium cyclamate used in food or drink for sweetness may cause cancer to the consumers. 3) Harmfulness of toxic pesticides residua. Most of the residua are found in vegetables, fruits and meat. Since usually only small amounts of the residua pesticides are in the vegetables, fruits, and meat we consume each time, they will not immediately affect our body. But if we continually consume them for an extended time, they will become harmful and even paralyze the consumer or lead to death. 4) Harmfulness of Sodium carbonate in food. Sodium carbonate or washing soda, if mixed into fresh meat to soften it before cooking, may be harmful for our body. This substance is able to erode the soft tissue of the gastro intestine. It can make us feel queasy, get severe diarrhea and may cause death if consumed in quantities exceeding 30 grams. Conclusion Food sanitation is any procedure during developing, maintaining or adjusting food concerned with consumer’s health because food is essential for life, helps to build up body energy and strength. With energy and strength people can resist diseases and live a happy life. Food is utterly useful for our body, but if it is dirty and contaminated with diseases or toxins, it is harmful to our body. Microorganisms found in food are helminths, but also contaminants from toxins or chemical substances are found in food.

65 3. Setting a Diet Program Suitable for the Members of the Family 1. Diet for a healthy person Many kinds of nutrients are useful for our body. Proteins, carbohydrates, and fats are the nutrients which give us energy; and the body needs a lot of them. Some vitamins and minerals do not give us energy but are essential for the working of the systems in our body and help prevent illnesses to continue a happy life. Every human needs different levels of various nutrients depending on sex and age for proper growth. Usually we eat a variety of food stuff and each of it is composed of different nutrients which are needed in different quantities. The different nutrient quantities our body needs are shown in the following table: The quantity of energy and nutrients Thai people need per day Category Age Weight Calories Protein minerals (mg) vitamins (mg) (kg) (cal) (g) calcium iron A B1 B2 C Children 7 – 9 20 1,900 24 50 4 1.4 0.8 1.0 20 10 – 12 25 2,300 32 60 8 1.9 0.9 1.3 30 Boys 13 – 15 36 2,800 40 70 11 2.4 1.1 1.5 30 16 – 19 50 3,300 45 60 11 2.5 1.3 1.8 30 Girls 13 – 15 38 2,355 38 60 16 2.4 0.9 1.3 30 16 – 19 46 2,200 37 50 16 2.5 1.9 1.2 30 Men 20 – 29 54 2,550 54 50 6 2.5 1.0 1.4 30 30 – 39 2,450 54 50 6 2.5 1.0 1.4 30 40 – 49 2,350 54 50 6 2.5 0.9 1.3 30 50 – 59 2,200 54 50 6 2.5 0.9 1.3 30 60 – 69 2,000 54 50 6 2.5 0.8 1.1 30 70+ 1,750 54 50 6 2.5 0.7 1.0 30 Women 20 – 29 1,800 47 40 16 2.5 0.7 1.0 30 30 – 39 1,700 47 40 16 2.5 0.7 0.9 30 40 – 49 1,650 47 40 16 2.5 0.7 0.9 30 50 – 59 1,550 47 40 6 2.5 0.9 0.8 30 60 – 69 1,450 47 40 6 2.5 0.6 0.8 30 70+ 1,250 47 40 6 2.5 0.5 0.7 30

66 Category Age Weight Calories Protein minerals (mg) vitamins (mg) (kg) (cal) (g) calcium iron A B1 B2 C pregnant +200 +20 100 26 2.5 0.8 1.1 505 women Breastfeeding +1,000 +40 120 26 4.0 1.1 1.5 0 woman Each kind of food we consume gives different nutrients and energy. By selecting what to eat in each meal, one should consume alternate nutrients so that our body can get appropriate and enough nutrients. If our body does not get the nutrients it needs, we might develop malnutrition. Table of dietary components and energy in some diets per 100 grams Carbohydr Fiber Minerals (mg) Vitamins (mg) ates s Diet Energy Protein Fat (g) (g) Calci Phos Iro A B1 B2 C (kcal) (g) (g) um phor n (IU) (mg) (mg) (mg) Starch us noodle (cooked) rice (cooked) 88 1.0 0 20.3 - 7 7 0.6 - ** ** 0 white sticky rice 155 2.5 0.4 34.2 0.1 5 36 0.6 0 0.02 0.0 0 355 7.0 0.3 81.1 0 12 46 1.3 0 0.06 1 0 Seeds peanuts (boiled) 0.0 soybean (cooked) 3 coconut (coconut milk) 316 14.4 26. 11.4 1.3 45 178 1.5 25 0.56 0.1 5 130 11.0 3 10.8 1.6 73 179 2.7 30 0.21 2 0 Vegetables 259 4.6 5.7 1.7 0 11 132 1.4 0 0.05 0.0 1 gourd kale 28. 9 2 0.0 2 28 4.1 0.4 4.2 1.0 126 30 4.6 18. 0.17 0.1 48 35 3.0 0.4 6.8 1.0 230 56 2.0 07 0.10 3 93

67 Carbohydr Fiber Minerals (mg) Vitamins (mg) ates s Diet Energy Protein Fat (g) (g) Calci Phos Iro A B1 B2 C (kcal) (g) (g) um phor n (IU) (mg) (mg) (mg) us raw papaya 26 1.0 0.1 6.2 0.9 38 20 0.3 5 0.02 0.1 40 Thai morning glory 30 3.2 0.9 2.2 1.3 30 45 1.2 25 0.08 3 - (red) 0.0 3 0.0 9 Fruits cultivated banana 100 1.2 0.3 26.1 0.6 12 32 0.8 - 0.03 0.0 14 water melon 21 0.3 0.2 4.9 0.2 8 10 0.2 375 0.03 4 6 guava 51 0.9 0.1 11.6 6.0 13 25 0.5 233 0.06 0.0 160 mango (ripe) 62 0.06 0.3 15.9 0.5 10 15 0.3 89 0.06 3 36 tangerine 44 0.6 0.2 9.9 0.2 31 18 0.8 3,13 0.04 0.1 18 33 0.0 5 0.0 5 Meats 4,00 chicken 302 18.0 25. 0 0 14 200 1.5 0 0.08 0.1 - pork (no lard) 376 14.1 0 0 0 8 151 2.1 809 0.69 6 - mackerel 93 21.5 35. 0.6 0 42 207 1.5 - 0.14 0.1 0 egg 163 12.9 0 0.8 0 61 222 3.2 - 0.10 6 0 Soya 37 2.8 0.6 3.6 0.1 18 96 1.2 1,95 0.05 0.1 0 milk(unsweetened) 62 3.4 11. 4.9 0 118 99 0.1 0 0.04 8 1 cow milk 5 50 0.4 1.5 141 0 3.2 0.0 2

68 Carbohydr Fiber Minerals (mg) Vitamins (mg) ates s Diet Energy Protein Fat (g) (g) Calci Phos Iro A B1 B2 C (kcal) (g) (g) um phor n (IU) (mg) (mg) (mg) us 0.1 6 2. Diet for pre–school children Pre–school children should get all groups of diets such as rice, vegetables, fruits, meat, and milk. We should advise them to eat a variety of diets by not selecting only their favorite food stuff. The cleanness of the diet should be of concern and the diet should be digested easily. If the food stuff is too hard or sticky for them to chew on, we should chop or boil it. The children should consume soup from broth or thin soup because they can get vitamins and minerals from soup as well. Children should have boiled vegetables and fresh fruit juice. When they grow up, we give them fresh fruits and vegetables. In a day, pre–school children should have 4 - 5 scoops of rice or grain, 1 egg, 2 - 3 scoops of green leave vegetables and other vegetables, 2 - 3 pieces of fruit such as one banana, a piece of papaya, 5 - 6 spoons of meat, 1 egg, and 3 - 4 spoons of other meat. They should drink milk every day. Rotation of the diet should be done from day to day and once a week liver might be added. Prepare an appropriate quantity of the diet, not too strongly seasoned and easy to chew. Avoid snacks, sweetened candy, toffee, pop soda, and high fat diet. Have them join the meal with adults and do not scold or force them to eat because it may cause further problems. If they are back from playing, do not let them eat immediately. Wait at least 15 minutes before serving the meal. 3. Diet for the elderly We should regard the individual when setting the diet for the elderly because each of them may like different kinds of diet. Sometimes it is not necessary to have all nutrients in one meal. We should 1) set the diet divided into 4 -5 meals a day to reduce distention. 2) prepare soft diet, easy to digest, not strongly seasoned. If serving vegetables, chop and boil or steam them to soften them. 3) try to avoid a diet which produce gas or belly ache such as some kinds of nuts . 4) have good quality diet such as complex carbohydrates, which are not in the process of rubbing off vitamins, add protein from fish. 5) steam the diet which is better than fried to reduce consuming too much fat.

69 6) add plenty of vegetables and fruits such as ivy gourd, morning glory, kale, tomatoes, tangerine, ripe bananas, ripe papaya to increase the fiber content and thus helping the excretory system. 7) encourage some activities such as exercises to help increase the appetite. 8) cheer up the elderly so they maintain a good state of mind, give attention to them so they do not feel leftover or be nobody in the family. 9) prepare colorful diets for stimulate the appetite by using natural colors. The diet should be warm, even hot to increase appetite. 10) do not serve too spicy food as it may cause stomach ache or uncomfortable feeling after consumption. Spicy food may affect the digestive tract. In conclusion, diet for the elderly is important. Since the diet they consume will affect their health. The elderly themselves should understand how to select a useful diet. Consuming a good diet can enhance health; so we should prepare ourselves from early age to grow and become a healthy elderly. 4. Diet for patients When people are sick, they have to specially care about their health and hygiene including the diet. Different sicknesses need different diets, such as: Ordinary diet for general patients who are not seriously ill must be prepared with the ordinary 5 groups of a diet. Sufficient diet for their need is appropriate. Soft diet is the diet for the patient who cannot chew food as usual. They might be the patient after recovering from illness or the patient who is ill with acute digest tract such as diarrhea, etc. This kind of diet will be soft meat, mild tasting, easily digested without hard waste, not too fat like milk cream, not fried eggs, steamed or grilled fish, ground meat, soup, steamed or boiled chicken, thin soup, boiled low-fiber vegetables without strong smell, fruit juice, ripe bananas, etc. Tube diet is administered to patients after recovering from surgery or to patients with stomach or intestine problems. The diet should easily be digested without waste. There are 2 kinds of these diets: (1) Liquid diet such as lemon tea with sugar, coffee with sugar, clear soup with no fat, clear rice milk, and dissolved sugar, glucose, etc. Let them have little by little every 1 - 2 hours. When the patients can eat more, gradually increased the quantity.

70 (2) Concentrated liquid diet is concentrated rice milk, wet ground rice, concentrated soup, all kinds of milk, milk mixed drink, fruit juice, boiled vegetables soup, ice cream, soup with ground liver, etc. Special diet for specific illness is prepared according to a physicians’ recommendation for some types of illnesses which must be a carefully prepared and specially controlled diet in which protein is limited liver sickness, low-fiber diet for severe diarrhea, high-fiber diet for large intestine ineffectiveness, low calorie diet for diabetes, high protein diet to recover after surgery, and low sodium diet for heart diseases. Setting the Menu for the Diabetic Patient 1. Punctually consuming all 3 meals of the same quantity and not to eat anything between meals. 2. Not having sweets, desserts in syrup, sweet syrup, pop soda, sweetened milk, alcoholic beverage, beer, strongly sweetened fruits, preserved fruits, and sweet fruit preserve. 3. The diet in the starch group should be controlled such as rice, bread, dumplings and vegetables substituted with sugar and starch from pumpkin, or sweet fruits like durian, and longan, etc. 4. The diets should contain proteins from chicken, crab, fish, shrimp, beef, pork, and protein from plants like bean and tofu. Besides, they should consume a lot of fibers such as coarse rice, lentils, string beans, and all kinds of vegetables suitable for a diabetic patient, which are fat, or fattening foods and some plant oil such as coconut milk, coconut oil, and palm oil. Setting the Menu for patients with chronic renal failure 1. Low protein diet of 40 grams a day supplement with the 9 types of essential amino acid alternatively a high protein diet of 60 -75 grams a day. 2. Try to use egg yolk and fish as the protein source. 3. Avoid gizzards. 4. Avoid animal and coconut fats. 5. Refrain from a salty diet and limit the amount of water. 6. Refrain from fruits except in the morning before dialysis. 7. Refrain from food with high phosphate content such as grains, butter, and egg yolk.

71 Setting the Menu for a Cancer Patient Cancer is a malignant tumor happening in the tissue or cells in the organs of our body. The general symptoms are low appetite and weight loss. Having cancer at the esophagus, the stomach, or the intestine will create more problems in eating than having cancer at the other organs. After being diagnosed, the patients should be treated by a specialist in cancer treatment and should adjust themselves to accept the treatment. This treatment may take a long time. Appreciating consuming the diet and suitable nutrition can help when undergoing cancer treatment. If the gastro intestine is working normally, one could eat coarse rice together with fish, vegetables and fruits especially tomatoes, green vegetables, ripe papaya, guava, etc. Increase the consumption of beans especially soybeans such as head sprouts, white tofu, soybean milk, etc. Avoid having a fatty or fried diet. Emphasize on boiling and steam cooking. In case the cancer patient cannot eat normally, he can be fed with medical food or though a feeding tube. In this case, the patient or the caregiver should consult a physician or nutritionists to understand and carry out the method appropriately. The cancer patient should follow up and evaluated the result of the treatment. The patient should weigh themselves frequently, and if the weight does not change much, it shows that they get enough energy. 5. Diet for Exerciser The people who normally exercise will use much energy. They need a diet which provides more energy than usual. The exerciser should have an adequate diet as mentioned below: 1. Diet before exercise. Before having exercise, we should not eat because it may cause angina and the exercise cannot be done as planned. Before having exercise, we should have all the food we eat digested. The meal we eat should be taken 3 - 4 hours before the exercise. Snacks should be eaten 1 - 2 hours before having exercise and should be low fat, low protein but high carbohydrate. In addition, avoid having food that can cause gas in the stomach such as fermented food, strong seasoning, etc. 2. Diet during an exercise. While exercising, the body will produce sweat to regulate body heat and release waste out of our body. So we should drink water or mineral drinks to compensate for water and mineral loss. Never eat a meal during an exercise because it may cause angina. Undigested food is an obstruction for exercise. 3. Diet after the exercise. How much energy we lost during the exercise depends on the length and the manner of that exercise. After an exercise, we should eat to compensate the energy loss. Some kind of exercise requires nutrients to compensate the energy loss

72 and create new energy for the next time. Therefore, we have to eat properly and enough nutrients as well. 4. Water. In addition to eating the 5 major food groups, water is utterly important for us because it helps our excretory system to work effectively. And since we lost a lot of water while exercising, we have to drink enough water to compensate the loss of water. During some kind of exercises we need to drink water while exercising as well. Conclusion Whether we are healthy or not depends on important factors, such as choosing a quality diet, freshness without contaminant, and eating various kinds of food to get all 5 groups of nutrition. People’s ages and physical conditions vary, so it is necessary for us to choose the appropriate diet in suitable proportions for our body’s needs to get all the nutrients. These nutrients which we gain must not be too much or too less, so they can make us healthy and give a happy live. Activities 1. Students divide into groups of 5 and make a mind map to help their friends understand these items: Group 1 What are the functions of the nutrients? Group 2 What are the symptoms of the diseases caused by proteins and calories? Group 3 What are the symptoms of iodine deficiency? Group 4 How does vitamin C affect our body? 2. Students write 3 diet plans and report them to the class. A diet menu for pre–school children; all 3 meals for 3 days. A diet menu for the elderly; all 3 meals for 3 days. A diet menu for diabetic patients; all 3 meals for 3 days.

73 Chapter 4 Enhancing Health Theme Knowing about developing, planning, and enhancing our health and that of the family and participating in activities to improve community health and able to tell the principle methods of exercise, for oneself, for the others, and the community. Learning Expectations 1. Able to develop their own health and that of the family. 2. Being able to describe the diseases, and to set exercise programs for themselves and for others. Scope 1. The aggregation for developing the health in the community 2. Exercising for health 1. The Aggregation for Enhancing Health in the Community. 1.1 The meaning of health When we are born, we wish to live with a happy life. A happy life depends on many factors and one of the important factors is the health of body and mind. When we have a healthy life and good mental health, we are able to adjust ourselves and have the self-confidence not to worry or being stressed. We can spend our life with others in the society and can be a good member of society. The word ‚health‛ defined by the World Health Organization means the condition of the integrity of body and mind, and be able to live in the society happily without illnesses or being handicapped. 1.2 The importance of health Health is utterly important for the life of human beings because happiness or distress of the human being depend on their health. The importance of health can be explained in 3 levels: 1) The self-importance. Any person will be happy or in distress depending on his or her health. If they are healthy and have no illness including good mental health and are without envy, they are surely happy. On the contrary, if they are not healthy and are always ill including a not so good mental health and always envy to the others, so body and mind will degenerate, they will be unhappy all their life.

74 2) The importance to the family. Health is an important part affecting the success or failure of a family. The family consists of the basic members, i.e. father, mother, and children. If the parents and their children are healthy, physically and mentally, the family will be happy as well. But if they have problems of the body and mind, the family may fail. 3) The importance to society. A single society comprises so many members. Each one is physically and mentally unique which can create many problems. Those might be physical or mental problems and may lead to illnesses such as obesity, stress from social problems, etc. 1.3 The characteristics of a healthy body and mind. Anyone who is healthy must healthy, both physically and mentally, so that they can live in the society happily. Good health means that the body, including all organs and systems, is strong and well functioning and can work efficiently. The characteristics of the healthy people are as follows: 1. Having a healthy and strong body and can balance the body firmly as well as perform active movements. 2. Being able to do the daily life activities effectively. 3. The body organs and its systems are strong and work normally and effectively. 4. The growth rate of the body parts is appropriately to the age. 5. Being free of illnesses and congenital diseases. 6. Having enough rest and a fresh look. Good mental health means being able to adjust to the environment, and having a bright mind and self–competence. The characteristics of the good mental health are: 1. Being able to adjust themselves to the society and any kind of environment such as at home, at school, or at work, etc. 2. Having self-confidence, independent mind, making reasonable decisions, and respecting others’ opinions, not being stubborn and ready to face problems. 3. Being able to face whatever happens in life whether success or failure. 4. Having good self-control by not showing too much anger, hate, love, sadness, dissatisfaction.

75 5. Knowing how to love the others who are close or those who are acquainted, and also having good wishes towards others. 6. Being happy at work, untiring, and not often changing jobs. 7. Having enthusiasm, hope in life, and being able to stand and wait for hope. 8. Being optimistic, not paranoid, and satisfied with their own status. 9. Having a sense of humor, pursuing happiness, not having too much stress, and able to relax themselves appropriately. 10. Having a rest wherever or whenever they can. 1.4 The principles of health care, physically and mentally. People who have good physical and mental health are a worthy resource for the society; they have the knowledge of hygiene and sanitation. The principles of taking care of physical and mental health are: 1. Having a good eating habit by consuming clean and sanitary food useful to the body, from which the body gets all nutrients, eating fresh vegetables and fruits every day, drinking enough clean water at least 6 - 8 glasses every day, and not drinking coffee, tea or any kind of narcotics. 2. Knowing how to exercise appropriately. Exercising can help our organs and systems to work fully efficient and enhance the health and strength of our body. We should exercise every day at least 30 minutes. We should consider our physical condition, age, places, and appropriateness, before choosing a type of exercise. 3. Knowing how to clean our body properly. Each of us has different activities and the ways of life. The excretory system will expel waste from our body and if we do not keep our body clean, it may get various illnesses. So we must clean ourselves by taking a shower at least 2 times a day, brushing the teeth at least twice a day, washing our hair at least twice a week, and keeping finger and toe nails cut, and warring clean clothes. 4. Developing Excretion Habits. Everybody should, at least once a day, excrete. If not doing so, waste will be accumulated in the body resulting in harmfulness to the excretion system, causing hemorrhoids, constipation, or inflammation to the urinary tract.

76 5. Having enough rest. Resting will help us to relax. Our organs and systems need rest to be fresh for the next day. Not only the body but the brain needs to rest as well. 6. Adjusting to the environment. In daily life, individuals have to meet many people either at home, at work, at school, or even at government offices. We can happily live in society if we understand and accept individual differences, reduce conflicts, and are sympathetic toward each other. 7. At the time of swelter, because body will lost water and sweat more than usual. This can make Going into health services regularly. If we are sick, we should know how to use the appropriate health service to cure of sickness. Not only the health services that we can use, we also prevent by having the body checkup periodically. Activities Having the students observe themselves whether they are healthy and good mental health or not and which part should be improved and how to do it. Let them write the answers and then discuss in front of the class and let them share the ideas how to improve them and what to suggest. 1.5 Aggregation for enhancing health in the community Taking care of and improving health and mental health for each person are important and should habitually be done . The important elements are appropriately choosing what to eat with proper nutrition, having enough rest, and always having exercise. If all these can be done suitably for the body, they can live with a happy life and efficiently perform the duty . However, only taking care of their own heath is not enough if someone in the family has the health problem, it will affect everyone in the family such as the expenses for the treatment, health rehabilitation, etc.- From this reason, we should encourage family’s members and friends in the community to know and understand about how to take care of health in the proper ways along with persuading them to join the activities enhancing health in the community for the healthiness as well as good mental health and good relations to one others. The activities which lead to enhancing health in the community are: 1. the aggregation for collaborative learning about practicing how to take care of individual’s health such as pregnant women, mother after delivery, teenagers, elderly, and patients, etc.- 2. the aggregation for having exercises and playing sports. At present, the community is interested in supporting the exercise like aerobic exercise, and the sport competition among people in the community, etc.-

77 3. the aggregation for the activities for leisure and recreations such as travelling, singing and playing music, working for the community such as planting trees in the public area, etc.- these should not be hard activities but only for the pleasure and good relationships among the group members. 4. the aggregation for the religious activities such as making merits, religious practices, and meditation, etc.- The aggregation for joining these activities should cover health, of food and nutrition, exercising, relaxation, recreations, and developing mental health. This happens if we gather activities, the members in the family, friends, and people in the community and help create the enjoyable and increase knowledge to strengthen individuals, family, community, and finally our country. 2. Exercises for health An exercise is a major factor which can help learners develop body, mind, emotion, and society. There are several kinds of exercises depending on the purposes such as exercises for recreation, exercises for developing the body capability, exercises for competition, and exercises for treatment. No matter what the purposes of the exercise are, we should follow the following steps: Step 1 Preparing for the body readiness before exercising, can be divided into 2 parts: 1. Preparing the body to be ready before taking exercises includes: - perfect and strong health and having enough rest. - do not have any illness which is an obstacle to such exercise. - preparing the places and the equipment. - do not eat too much. - dressing up suitably for the kinds of the exercising activities - knowing correctly how to use or play with the equipment. 2. Preparing the readiness before taking exercises. This means that we should warm up our body by the following steps: - warming up every part of our body to be ready to have exercise. - spending 5 – 10 minutes to warm the body. Warming up the parts of the body which are used for the exercise more than others. - starting warming up slowly at first. - specially emphasizing of warming up more at the body joints than of the others. - stretching muscles and joints in warming up the body. - getting ready to have the exercise. The result of warming up the body. The effects of warming up the body are as follows:

78 - making the body condition ready to have the exercise. - helping the body systems function effectively especially the coordination between nerves and muscles. - help adjust the temperature in the body suitable for having the exercise. - help reduce and protect the injury while having the exercise. - making the body have skills or capabilities to effectively exercise. Step 2 Having exercise. In general, it takes us about 20 minutes and more for exercising. The maximum of time spending for exercising depends on other factors like their body and mind not feeling fatigue or injured. For the state of mind, feeling ready to enjoy having exercise. All these are important factors of having exercise for health. In general, having exercise for health takes around 20 – 60 minutes a day depending the activities we have, such as walking, running, playing sports, and aerobic dance, etc.- The following principles concerning having exercise for health should be taken into consideration:  The frequency of exercise means the number of days for having exercise, generally, having exercise every day or at least every other day.  The intensity of exercise means the capability of an individual in having exercise; the pulse rate is used for the determination.  The length of the time for exercise means the time to spend when having exercise. It’s about 20 – 60 minutes a time.  The types of exercise refer to any kind of exercise used such as sports, activities for exercise, etc Step 3 Adjusting the body to normal after taking exercise. This is the utterly necessary step because while the body works hard and immediately stops, it will cause bad result to the body such as muscles ace, having a fever, etc. Therefore, it is necessary to follow the steps mentioned below:  do not stop exercising immediately. Should warm( cool down) the body slowly for a period of time and then stop. The time for cooling down is about 10 – 20 minutes.  do not drink too much of water or eat at once.  have a rest for a while to adjust the body before taking a shower.  changing clothes after having exercise because the clothes worm while exercising are wet and might make us sick.

79  should use the muscles stretching equipment for making them relaxed and help reduce the after exercise-waste and the injuries caused from the exercise as well. The effects of having exercise on various parts of the body. 1. The effects on the muscles are: - The muscles are bigger( the muscle’s fibers are thicker) and stronger. - The muscles have more efficiency in function; that is, they cause the body work harder and longer. - The function of the muscles will naturally be adjusted while having exercise. - The muscles can be more tolerated when undergoing pain. 2. The effects on the systems of bones and joints are: - The bones, especially the kids’, are thicker. - Bones will be harder and increase the density of the mass bones. 3. The effects on the respiratory system are: - making the respiratory system more efficient. - the lung is bigger and having more capacity. - The respiration rate is decreasing because each time of breathing will affect its efficiency in pumping more blood ( the normal respiration rate is 16 -18 times/minutes) 4. The effects on the blood circulation are: - The pumping of the blood circulation is better and makes the heartbeat rate decrease. - The heart is bigger and the heart muscle is stronger. - The artery will be tough and flexible. 5. The effects on the other systems. The autonomous nervous systems keep working balance (Sympathetic and Parasympathetic) resulting in adjusting the organs to suitably exercise and fast recovering from any illness. Adrenal gland is more developing and more cumulative of hormone. Liver can function more effectively and have more weigh because there are more cumulative glycogen and essential substances for exercise, increasing glycogen’s amount and weight as well as essential substances for the body. 6. Help prevent the obesity. The correct and proper exercise can help the body use the energy from the nutrients by will not cumulate them more than our need. But if lack of exercise, all the nutrients will be cumulated and changed to fat and inserting in the tissue all over our body. This causes the obesity.

80 7. The result to mind, emotion, intelligence, and social. To mind. Frequency of exercise not only making the body stronger but also making the mind cheerful at the same time. Whenever our body is without illness and we have the opportunity to have exercise like playing in team; then we will get generosity, carefulness, fairness, knowing how to lose and win and forgiveness. To emotion. The exercise can make our temper cool down, and not stressful from the daily work so it helps us work efficiency. To intelligence. The frequent exercise can make us discerning, clever, and creative, which can be used the daily life. To society. We can adjust ourselves to our associates and to the others because playing sports or exercise in a big group can cause good understanding and leaning the others’ behaviors. Besides, they can have good personality, good leadership, good human relationship, and can stay happy in the society. Exercising is not only useful , it can also be harmful to us if we have improper exercise, we may get hurt or injured. It is always found that the number of the injured from the exercise is rather high although they used to take part in the International Sport Competition before. If we have not enough understanding or knowledge of that type of the exercises, there might be some injury while having the exercise. Suggestion in having exercise 1. Start to exercise slightly and increase to be harder for the next day especially for the one who never has the exercise at all. 2. Those who have recovered from the illness or congenital diseases must consult the physician before having exercises. 3. Those who are over 40 years old must consult the physician if they need to have more exercise. 4. Stop taking the exercise immediately if having a feeling of faintness feeling , panting, or having fast pulse rates. If they need to have continual exercise , consult the physician first. 5. Choose the appropriate exercise for themselves before starting to have exercises. 6. Using every part of the body more than usual while having exercise to get more benefits. This causes being short of breath, getting faster pulse rates and being tired. 7. Those who do not have enough free time can choose to have easy exercise at home such as jogging and jumping rope, etc.- 8. Some of the equipment such as a shaker, pulling or pushing equipment, may be or may not be useful depending on how much strength we put on the equipment.

81 9. We should have exercise at least 20 – 30 minutes every day. As long as we have food every day then we should have exercise every day as well. 10. To have fun and motivation of exercise, we should record our pulse and breathing rates while taking exercises. 11. the body tired and fainted( exception for the professional athletic who is necessary to have exercise) 12. Gradually making progress each time of the exercise, so no other short cut can cause the efficiency of the body. When we should not exercise Exercises make our bodies stronger both physically and mentally Those who exercise will appreciate all the aforementioned. Exercise is like a narcotic drug in that if you exercise regularly and suddenly stop, you will feel depressed. This is because exercise releases endorphins which are the body’s own morphine. Exercising will make you feel better and be happier. Caution: You should stop exercising if you have any of the following conditions: 1. If you are ill or have a fever or inflammation anywhere on your body. 2. After you have recovered from an illness, it is best to avoid strenuous exercise as your body is still weak, which can slow recovery. 3. Avoid exercising immediately after eating. The blood in your body is being used for digestion and is not available to sustain muscular effort. 6. During the hot season, the body will lose water and sweat more than otherwise. Be sure to drink plenty of water and visit health services if you feel ill Also be sure to get regular health checkups. Activities Have students discuss their health and consider ways to improve their health. Have them write answers on the board and discuss with the class. 1.1 Enhancing health in the community Taking care of and improving health and mental health for each person is important and should be a regular part of your life . Proper nutrition, getting enough rest, and sufficient exercise are the important elements of a healthy lifestyle If these things become part of your life then you can have a happy life and efficiently perform your duties. 5. However, it is not enough simply to take care of yourself. If someone in your family has a health problem, it affects everyone. There will be expenses for treatment, rehabilitation and so on. For this reason, we should encourage all family members and our friends in the community to understand how to take

82 care of their health and should understand how to persuade them to join into healthy activities and lifestyle. This will enhance health in the community and promote good relations. Some things that you can do to enhance your communities health are: Collectively learn how to take care of individuals such as pregnant women, mothers after delivery, teenagers, the elderly and persons with chronic diseases. 6. Have group exercises and encourage community sports. Encourage your community to support aerobic exercise and sports competitions. 7. Promote leisure activities such as traveling, singing and playing music. Organize community work events such as planting trees in public areas. All of these activities should not be hard labor, but only for pleasure and promoting good relationships. 8. Encourage religious activities such as making merit, meditation, etc. So, try to promote activities that encourage good health, food and nutrition, exercise, relaxation, recreation, and mental health. This can happen if we gather the members of our family, friends and the people in our communities to help create enjoyable activities. This will strengthen ourselves, our families, our communities and our country. 2. Exercises for health Exercise is important to develop body, mind, emotion and society. There are many kinds of exercise depending on whether it is for recreation, developing the body, competition, or medical treatment. No matter what the purpose of exercise is, we should follow the following steps: Step 1 Prepare the body before exercise, This can be divided into 2 parts: 3. Things to do which promote a healthy exercise environment: - be healthy and get enough rest - do not exercise when sick - be sure to exercise in proper places with good equipment - do not eat too much. - dress suitably for the kinds of the exercise - Know how to use the equipment correctly 4. Prior to beginning your exercise session. Warm up your body as follows: - warming up every part of our body - spend 5 – 10 minutes to warm the body. Warm up the parts of the body which are used for exercise more than others. - start warming up slowly at first. - emphasizing warming up the joints. - stretch muscles and joints.

83 - get ready to have the exercise. The results of warming up the body. The effects of warming up the body are as follows: - makes the body ready to have exercise. - helps the body systems function effectively, especially the coordination between nerves and muscles. - helps adjust the temperature in the body to be suitable for exercise. - helps reduce and protect the body from injury - makes the body have skills or capabilities to effectively exercise. Step 2 Having exercise. In general, we will exercise for 20 minutes or more. The maximum of time spent for exercise depends on other factors like your body and mind not feeling fatigued or injured. Mentally you should feel ready to enjoy having exercise. All these are important factors of exercising for health. In general, exercising for health takes around 20 – 60 minutes a day depending the activities we choose, walking, running, playing sports, aerobic dance, etc.- The following principles concerning exercising for health should be taken into consideration:  The frequency of exercise means the number of days for exercising, generally, exercising every day or at least every other day.  The intensity of exercise means the capability of an individual in exercising; the pulse rate is used for the determination.  The length of the time for exercise means the time to spend when exercising. It’s about 20 – 60 minutes a time.  The types of exercise refer to any kind of exercise used such as sports, activities for exercise, etc Step 3 Adjusting the body to normality after exercising. This is a necessary step because when the body works hard and immediately stops, it can cause bad results to the body such as muscles ache, having a fever, etc. Therefore, it is necessary to follow the steps mentioned below:  do not stop exercising immediately. You should cool down the body slowly for a period of time and then stop. The time for cooling down is about 10 – 20 minutes.  do not drink too much water or eat at once.  have a rest for a while to adjust the body before taking a shower.  change clothes after exercising because the clothes worn while exercising are wet and might make you sick.

84  use muscle stretching equipment to help them relax and help reduce after exercise-waste and the injuries caused from the exercise as well. The effects of exercising on various parts of the body. 8. The effects on the muscles are: - The muscles are bigger (the muscle’s fibers are thicker) and stronger. - The muscles have more efficiency in function; that is, they allow the body to work harder and longer. - The function of the muscles will naturally be adjusted while having exercise. - The muscles can tolerate more pain. 9. The effects on the bones and joints are: - The bones, especially children, are thicker. - Bones will be harder and more dense. 10. The effects on the respiratory system are: - the respiratory system is more efficient. - the lungs are bigger and have more capacity. - The respiration rate decreases because each breath will be more efficient and pump more blood ( the normal respiration rate is 16 -18 times/minutes) 11. The effects on the blood circulation are: - The blood circulation is better and makes the heartbeat rate decrease. - The heart is bigger and the heart muscle is stronger. - The arteries will be tough and flexible. 12. The effects on other systems. The autonomous nervous systems work in balance (Sympathetic and Parasympathetic) resulting in adjusting the organs to exercise and quickly recovering from any illness. The Adrenal gland develops and accumulates more hormones. The Liver can function more effectively and weighs more because there are more glycogen and essential substances for exercise, increasing glycogen’s amount and weight as well as essential substances for the body.

85 13. Help prevent obesity. correct and proper exercise can help the body use the energy from nutrients and will not store them as fat more than we need. Without exercise, all nutrients will be accumulated and stored as fat all over our body. This causes obesity. 14. The results to the mind, emotions, intelligence, and society. To the mind. Frequency of exercise not only makes the body stronger but also makes the mind cheerful at the same time. Whenever our body is without illness and we have the opportunity to exercise like playing in teams; then we will be generous, careful, fair, know how to lose and win and how to forgive. To emotions. Exercise can make our temper cooler, and relieve stress from daily work so it helps us work efficiently. To intelligence. frequent exercise can make us more discerning, clever, and creative, which can be used in daily life. To society. We can adjust ourselves to our associates and to others because playing sports or exercising in a big group can create good understanding and leaning of others’ behaviors. Besides, it can help you have a good personality, learn good leadership, and have good human relationships which will help you to stay happy in society. However, exercise can also be harmful to us if exercise improperly. It is possible to get hurt or injured. The number of people injured from exercise is rather high even if they took part in International Sport Competitions before. If we do not have enough understanding or knowledge of that type of exercise, there might be some injury while exercising. Suggestions for exercising 13. Start to exercise slowly and gradually increase the intensity day by day. This is especially important for someone who has never exercised at all. 14. If you have just recovered from an illness or congenital diseases you should consult a physician before exercising. 15. Those who are over 40 years old should consult a physician if they to increase their exercise. 16. Stop exercising immediately if you have a feeling of faintness , panting, or a fast pulse rate. If you need to have continual exercise, consult a physician first. 17. Choose the appropriate exercise for yourself before starting to exercise. 18. Use exercises that work as many muscles as possible at the same timeto get more benefit. This may cause you to be short of breath, have a faster pulse rate and feel tired. 19. Those who do not have enough free time can choose to exercise at home such as jogging and jumping rope, etc.-

86 20. Some exercise equipment such as a shaker, or pulling or pushing equipment, may or may not be useful depending on how much weight we put on the equipment. 21. We should exercise at least 20 – 30 minutes every day. As long as we have food every day then we should exercise every day as well. 22. To have fun and remain motivated to exercise, we should record our pulse and breath rates while exercising. 4. Stop exercising if your body feels tired and faint (exception for the professional athletic who must exercise) Some symptoms which may require you to stop exercising. In some cases when the body is temporarily weak such as after having diarrhea, too little sleep or you exercised too much you may have to suspend exercise for a period of time. Watch for the following symptoms. If you have even one or more, immediately stop exercising 1. feel unusually tired 2. unusually strong and fast pulse rate 3. hard to breathe 4. feel dizzy or headache 5. feel queasy 6. feel faint 7. pulse rate is over 140 times a minute for the elderly and over 160 times a minute for adults Remember that if anyone has one of these symptoms, immediately stop exercising and rest until recovered. Do not keep exercising until you have consulted with a physician or until the body is as strong as usual. The types of exercises for health are as follows: 1. Walking is the most convenient and easy exercise. It is very useful for enhancing the bodies efficiency as much as other kinds of exercise and sports. We can walk anywhere and at any time. To walk efficiently, follow these guidelines: 1.1. Begin with standing, relaxing, and breathing normally. 1.2. While walking, hold your head up and look straight forward. You might get a neck ache or a back ache if you bend your head down. 1.3. Walk with full steps. 1.4. Walk slowly for 5 minutes at the beginning and then begin walking faster until your pulse rates reach the standard for your age. Beginners may start with 10 minutes of walking or until you feel tired then not

87 walk for 1 or 2 days to let your body rest. Then start to walk longer times and work up to at least 30 minutes, 3 -5 times a week. 1.5. While walking, both hands should be in relaxed position, swing the arms forward and back vigorously. While walking if your heartbeat is not fast enough, increase the speed of walking and swing your arms more forcefully. This will make the pulse rate increase. 1.6. Using special walking or running shoes that protect your heels support your weight to protect your feet from injury. 2. Running. Running is an excellent exercise because it is as easy and convenient as walking. There are many ways to run depending on your preference such as jogging, marathon running, running on in place, or running on a machine. You should run 2 -5 kilometers each time and not over 5 times a week. The following are some easy techniques for running 2.1. Running in place . Lift up each foot about 8 inches; this type of running will limit the movement of the joints and not allow you to stretch and exercise the muscles as much as other exercises. This is the disadvantage of this exercise compared to the others. 2.2. Running on a machine is safer than running outdoors because we do not have to contend with rain, sunlight, dust, dogs, etc. A variety of informationis shown on the screen of the treadmill such as the speed, the distance run, and your pulse rate. All of this is basic information that allows us to adjust our workouts and keep track of our progress. The disadvantage of running on a treadmill is that they are expensive to buy or even to use at a fitness center. So if you can use public exercise services such as at municipalities, provincial administration, provincial sports and recreation development offices, provincial tourism and sports, and the Sports Authority of Thailand. Everyone can use the services at these organizations. 2.3. Outdoor running is good because we get fresh air especially running in a park or out of town/ We see pleasant scenery which helps us feel better without any expense. Just remember to consider safety if you are running alone. 3. Riding a bike. Riding a bike is a useful exercise for body balance, being active, and practicing self-tolerance as well. Riding a bike in a park or at places no air pollution is not only useful for our body but also beneficial for our health. We gain happiness from seeing scenery and breathing fresh air, which is different from riding at home or at a fitness center . Some tips for riding a bike are as follows: 3.1. Adjust the bike seat to a height suitable for you. Generally, your knee should be only slightly flexed when fully extended on the pedal.

88 3.2. Using the tips of your toes on the pedals, not the heels. 3.3. If it is a fixed bike, pedal at an easy level for 3 -4 minutes to warm up your body first. Then gradually increase the difficulty until your pulse rate is at the proper level for your age. Finally, decrease the difficulty again slowly as you finish until you stop completely. This is warm up and warm down which helps protect your body from injury. 4. Aerobic exercises are very popular. We can exercise every part of our bodies with this kind of exercise. Aerobic exercise tones and strengthens most muscle groups and is especially good for your heart. Some tips for aerobic exercise are as follows: 4.1. Move your body all the time to make the pulse rate increase to the proper level for your age. 4.2. Spend about 20 -30 minutes for this exercise each time, 3 times a week. 4.3. Use a good ventilated place for the aerobic exercise and if it is a hard floor, wear good exercise shoes to support your feet. 4.4. Avoid jumping because the impact is not good for your feet or knees. We can choose any of these exercises which are appropriate for the time and place. So find some free time each day for exercise activities or playing sports. It will make us stronger and more healthy both physically and mentally. There are many other forms of exercise which we can choose from depending on our interest and body readiness, time, place, and equipment such as swimming, rhythmic activities, dancing, Thai traditional dancing, a club dance, yoga, etc. Sports include soccer, volleyball, and basketball which can be played in teams. These can enhance our health and form relationships in the community. Exercise for patients Patients with diabetes, heart disease, high blood pressure, and any congenital disease who can move normally can properly exercise depending on the symptoms and status of their illness. Exercise can assist recovery. However, there are both pros and cons of exercising. If we do not know suitable ways to exercise, then it may cause harm. Therefore, it is advisable to consult a physician and have your body checked first. According to Dr. Jarouyporn Toranin, an expert in the field of Physical Education. The principles of exercising for patients are as follows: Patients who are able to move can follow the following instructions. 1. Begin exercising then gradually increase the time and intensity of the exercise.

89 2. Exercise at least 3 times a week, 10 -15 minutes a day. 3. Use every part of the body for the movements especially the muscles of the abdomen, arms, legs, back, and trunk. The cardiac muscles and arteries must work hard. 4. For those who have high blood pressure, if the systolic is over 130 millimeters mercury and the diastolic is lower than 90 millimeters mercury, you must have a physical checkup by a physician and wait until the systolic is lower than 130 millimeters mercury and the diastolic is lower than 90 millimeters mercury. Then they can begin exercising . 5. For patients with diabetes who have over 200 milligrams of sugar in their blood must lower it to under 160 milligrams first. Then they can begin exercising. or Take the drugs prescribed by your physician and decrease consumption of starch and sugar and increase consumption of vegetables and unsweetened fruit instead. 6. all heart disease patients must consult their physicians before exercising or running. 7. Anyone over 60 years old or overweight, should consult their physicians before exercising. 8. Everyone, whether ill or not who are over 30 years old should have their physical and mental condition checked before exercising. After receiving permission from a physician, then gradually begin to exercise. For anyone who is ill, exercise should start with walking which is the safest exercise. Try walking for 2 weeks to prepare yourself for working out harder. If the body get appropriate exercise, the patient will feel refreshed, sleep soundly, be joyful and stronger. After slowly walking for the first two weeks, the patients should begin to walk faster with longer steps in weeks 3 -4 if they are not seriously ill. At the beginning of week 5, the patients can take turns between slowly walking and jogging unless they begin to feel dizzy, have a rapid heartbeat, are out of breath, or become faint. If those symptoms occur, the patients should stop exercising. After they start to jog, they should jog slowly 5 – 10 minutes each day and gradually increase thereafter. Another way to safely exercise is to stretch using the following instructions: 1. Stretch for 10 minutes a day. 2. Practice 6 -7 postures each day. In the first 2 weeks practice 5 -10 times for each posture, and 12 times in week 3 and 4 3. Changing the postures in order not to get bored. You should exercise the large muscles such as legs, arms, neck, shoulders, etc. 4. Jogging in place or jumping rope should be done carefully, especially for the elderly and the seriously ill.

90 5. Although exercise can make you feel well and fresh, over exercising can be harmful to the body; each posture should be practiced 30 times and not more than 3 postures a day. 6. Check the progress of exercising by weighing yourself. People with the appropriate body proportions should not have a lot of changes in weight. 7. Check your pulse rates at the neck or the wrist. A normal males’ pulse rates Pulse rate is 70 -75 times per minute, and for females it should be 74 – 76 times per minute. Patients with fever have higher pulse rates. After exercising for some time, your pulse rate should decrease by 5 – 10 times per minute showing that your heart now works better. Conclusion Each type of exercises has special characteristics that have to be taken into consideration such as riding a bike can affect the joints of the knees. If they are inflamed, we should avoid riding a bike and wait until the symptoms are relived. Therefore, when choosing an exercise you should think about the limitations of your body. Try to avoid causing harm to yourself. If you are ill, wait until you have recovered and always start exercising little by little and gradually increase. Those who have congenital diseases should consult their physicians before exercising They should watch for any unusual symptoms occurring before and after exercising . Exercise which is recommended by your physicians certainly more useful than harmful for patients. However what is recommended for one patient may not be suitable for others. Activities 1. Learn how to check your pulse at the neck and the wrist. 2. If exercising with friends, determine everyone’s state of health then divide them into groups of similar abilities. 3. Set exercise programs each group depending on their physical condition and readiness. 4. Demonstrate the exercises to the groups and tell them how useful each exercise is.

91 Chapter 5 Genetically Transmitted Diseases Syllabus Knowing about and practicing good habits for the prevention of genetically transmitted diseases and being able to suggest information and sources of services to prevent the diseases in families and in the community. Learning Expectations 1. Explain genetically transmitted diseases, the causes, symptoms, prevention, and the treatment of these diseases. 2. Explain the principles and reasons to co–plan with the community for the prevention and avoidance of genetically transmitted diseases. 3. Explain the effect of behaviors and health on disease prevention. Content area 1. Genetically transmitted diseases 2. significant genetic diseases 2.1 Thalassemia 2.2 Hemophilia 2.3 Diabetes 2.4 Allergy 1. Genetically transmitted diseases What are genetically transmitted diseases? Human beings are born with different characteristic such as skin color, tall-short, fat-skinny, curly or straight hair, and intellectual level. These characteristics are controlled or determined by the genes transmitted from their parents. If there are any abnormalities hidden in the genes such as disabilities or disease, these abnormal characteristics will be transmitted to their children. We call these genetically transmitted diseases. The abnormalities hidden in the genes of their parents may come from their ancestors or from a mutation of the gene. These are cells which have been changed. This can happen from such factors as receiving radiation or from some types of chemical substances.

92 The abnormalities which can be transmitted from the genes occur in both sexes. Some are transmitted only to males and others only to females. This is controlled by the dominant or recessive genes of the human chromosome. What is a chromosome? Chromosomes are an organized structure of DNA and protein found in cells. It is a single piece of coiled DNA containing many genes. The abnormality of chromosomes will create an imbalance in the genes. If there is much abnormality or imbalance while getting pregnant, the infant might be misproportioned or dead after delivery. If there is not too much abnormality, the infant may survive but may be handicapped or have low intelligence, etc. There are 22 pairs or 44 bars of chromosome in our body. These can be divided into two types which are: - Autosome is the body chromosome which consists 22 pairs or 44 bars. - Sex Chromosome is composed of 1 pair or 2 bars . - Female chromosomes will be XX type. - Male chromosomes will be XY type. Abnormalities Transmitted from the Genes in the body Chromosome( Autosome) - Occur equally to both sexes. - characteristics which are controlled by the recessive genes include thalassemia, albinism, and sickle red blood cells. - characteristics which are controlled by the dominant gene include neurofibromatosis, short fingers , and dwarfism. Abnormalities Transmitted from the Genes in the sex Chromosome - Occur to both sexes but can be more in either of the sexes. - characteristics which are controlled by recessive genes on the chromosome X are baldheadedness, color blindness, disease decreased enzyme – G-6-PD, muscular dystrophy, being gay is controlled by a recessive gene on chromosome X which can occur more in males than in females (one X gene of male) How severe is the abnormality of the genes or the genetic disease? 1. Severe enough to cause death since the infants are in the womb and they lack water due to some of blood diseases. 2. Not dead immediately but they may die afterward from the muscular atrophy.

93 3. Low intelligence, handicapped, and cannot help themselves such as the down syndrome groups. 4. Not severe but may have trouble for daily living such as color blindness. examples of genetic abnormality which are commonly found are the down syndrome groups, muscular atrophy disease, and some types of leukemia. Can we prevent genetic abnormality in infants? Some of the genetic abnormalities can be detected in early pregnancy by examining the abnormality of the chromosomes and screening the parents for thalassemia, and whether they are carriers of any disease or not. When any abnormality is found, consult a physician who is specialist in that disease to help plan for safe pregnancy. When should I have chromosome analysis ? 1. Before making a decision to have a child, couples should have a screen to check the heredity and find if there is a risk factor. 2. In the case of infertility, frequent abortion, a child has died after delivery, disordered by birth, or retarded child. 3. pregnant women who are over 35 years of age. 4. In the case of receiving radiation or any toxin which might affect the chromosome. 5. In case there is already a child showing any abnormality after delivery or retardation. How else can we check for chromosome abnormality ? Checking the chromosome for abnormality can be done by 1. blood 2. cells in the amniotic fluid 3. infant cells 4. marrow cells 5. other cells 2. Significant Genetic Diseases Genetic diseases which are often found are thalassemia, hemophilia, color blindness, albino disease, diabetes, and down’s syndrome or other disorders which can be inherited from the parents. These may cause a lot of problems such as crippling or death if it is not diagnosed before getting married. These will affect people and their family’s ways of life. Therefore, it is advisable for the couples to have their physical checkup before getting married or getting pregnant.

94 2.1 Thalassemia Thalassemia is a blood disorder passed down through families (inherited) in which the body makes an abnormal form of hemoglobin, the protein in red blood cells that carries oxygen. The disorder results in excessive destruction of red blood cells, which leads to anemia. It is equally found in both females and males and is inherited from parents in countries all over the world as well as in Thailand. In Thailand, 1 percent of the patients of thalassemia, 30 -40 percent of whom (about 20 -25 million) are carriers. When these patients are married, their children may also have this disease. It is estimated that there are about 500,000 persons with this disease. Thalassemia can result in anemia since it produces red hemoglobin bringing oxygen to every part of the body. Normal hemoglobin is composed of alpha globin and non-alpha globin with the proportion 1:1 . Usually, the leftover will be accumulated in the cells in the forms of an unstable product which can easily destroy cells. Types and Symptoms Thalassemia can be categorized into two parts, which are alpha thalassemia and beta thalassemia. Beta thalassemia results from the beta in hemoglobin is not completely produced, so it causes less oxygen delivery. Beta thalassemia consists of different types according to the genes. If one of the two types of the genes is not completely produced, it can result in severe anemia. In this case, the patient inherits disordered genes from parents. If the anemia is not severe, it is necessary to frequently get blood transfusions. The patients can live a long time until they are adults. However, if there is sever anemia, it may cause death. The symptoms usually begin when the patients are six months old, but they can live longer if they are frequently given blood. Anyway, they will sooner or later lose their lives since organs like the heart and liver are destroyed. thalassemia is spreading in South East Asia and around the Mediterranean. 2.2 Alpha thalassemia occurs when a gene or genes related to the alpha globin protein are missing or changed (mutated). It is spreading most rapidly in South East Asian countries such as Thailand, China, the Philippines and some parts of Africa. You must inherit a gene from both parents to develop Alpha major. if there is any disorder concerning producing this gene, there will not any effect except passing it along to your children. However, disorderly production of the alpha 2 gene will cause only a little

95 anemia and treatment is not necessary. On the contrary, disorderly production of alpha 3 genes will result in anemia, the symptoms of which varies from less severe to most severe. Sometimes it may be called ‚hemoglobin H‛; the patient needs to get more blood. What’s more, if something is wrong in producing alpha 4 gene, the patient will die in a short period of time which is called ‚hemoglobin bard‛. Symptoms The patient will be anemic, the white part of the eyes becomes yellow together with yellow skin, enlarged liver and spleen, darkened skin, shapeless face bones, a flat nose, a thick skull, high bumps on the cheeks, wide and large jaws, protruding upper teeth, fragile bones, slow growth, small size of the body, a swollen belly, etc. In Thailand, there are about 60,000 patients suffering from this disease. The symptoms of thalassemia vary from having no symptoms at all to very severe causing death while the baby is still in the womb or shortly after delivery. The patient will have anemia and macrocytic anemia, and they always need to get more blood. Sometimes, they have frequent infections or colds depending on the type of thalassemia. The potential carriers are as follows: - A person who has relatives who have the disease. - parents who have children or a child affected by the disease. It may be assumed that one or the other of them is the carrier and has amorphic genes. - persons whose family members suffer from thalassemia. - persons who have thalassemia and marry persons without amorphic genes, their children will have amorphic genes. - persons who have a special blood test to check for hemoglobin disorders. The chances for children to be affected by thalassemia - If both parents have suffered from thalassemia, every child will have thalassemia. - If both parents have amorphic genes, for each pregnancy, 25% of the children will be affected by thalassemia, 25% of the children will not be affected, and 50% of the children will have amorphic genes.

96 - If either of the parents has amorphic genes, for each pregnancy, 50% of the children can be affected by thalassemia, and 50% of them may have amorphic genes. - If one of the parents has thalassemia, and the other does not, for each pregnancy, every child will have amorphic genes or will be carriers. - If either of the parents has thalassemia and the other has amorphic genes, for each pregnancy, the chance for children to have thalassemia will be 50%, and the chance for children to have amorphic genes will be 50%, so in this case, no children will be unaffected. Treatment 1. Have the patients take one pill of folic vitamins a day. 2. Give the patients some more blood when they become anemic. 3. Cut out the spleen when the patients need blood frequently because the spleen will become enlarged resulting in a feeling of fullness in the stomach which causes the patient to consume less food. 4. Do not take any medication for blood supplement. 5. The patients with severe anemia and large amounts of iron must get more blood, but they may have to get an injection to remove the iron. Transplantation of the bone marrow Transplanting original marrow cells in Thailand was successful, and so was transplanting the bone marrow for several children. The principle is to transplant the bone marrow from siblings (even different sexes) and to have medical checks and assistance. Changing the genes is currently being researched using the latest medical technology How to prevent thalassemia - Training medical personnel in order to gain knowledge and the capability to diagnose or advise the methods for treatment. - Informing the public about thalassemia in order to find out who is at risk and give them suggestions how to take care of themselves. - Giving advice for couples proposing marriage to have a blood test to find out whether they are at risk from thalassemia and give them suggestions concerning the chance to be affected from the disease including giving appropriate suggestions for persons who already have thalassemia.

97 2.3 Diabetes Diabetes is a condition of having a high blood sugar level caused by a lack of insulin or having less insulin due to insulin resistance. This results in a high blood sugar level for a long period of time, which can cause other diseases affecting other organs such as the eyes, kidneys, and nervous systems. How is insulin essential to the body? Insulin is one of the most important hormones in the body. Its duty is to bring glucose to the tissues within the body to be metabolized for energy. If the body lacks insulin, sugar cannot be used causing a high blood sugar level resulting in the symptoms of diabetes; the metabolism in the body cannot use carbohydrates for energy anymore and begins to use fat and protein. . Diabetes symptoms The sugar level of normal people is between 100 mg. and 110 mg. before breakfast and two hours after having breakfast, the sugar level is between 100 mg. to 140 mg. To diagnose diabetes, we have to have the blood tested. Symptoms frequently found are 1. frequent urination: normal people do not urinate at night or just only once. When the sugar level in the blood is more than 180 mg especially at night sugar will be driven out of the tissues by osmosis. This condition makes us urinate more frequently and we lose more water as well. Sometime we can see ants gather around eating the sugar in the urine. 2. Patients are often thirsty because of losing water from urinating. 3. Patients are always hungry, but they lose weight because the body cannot use sugar for the energy resulting in using fat and protein from the muscles instead. 4. Patients feel easily fatigued and lose weight because the body cannot use sugar so it will digest fat and protein out of the body. Also weight lose from losing water from urination. 5. Other symptoms include itching, infection, wounds slowly healing ofs, etc. - itching around skin infected from fungus especially around a women’s vagina which results from dry infected skin. - not able to see clearly and frequently changing eyeglasses because of short eye sight, cataracts, caused by the high blood sugar level.

98 - feeling of numbness, no feeling in the arms or legs, lack of sexual desire owing to a high blood sugar level for a long period of time. - Easily getting foot injuries because the patients cannot feel anything when they are injured. 2.4 Allergy Allergies are caused from an active reaction to allergen. Normally people do not have this reaction. Some common allergens include dust, fungus in the air and food, animals’ fur, flowers,, etc. The substance that causes this active reaction is called an ‚allergen‛. Allergies can be categorized into 4 types according to the organs affected: - infected nasal cavity which is sensitive to the weather - infected eyes - asthma - infected skin Allergies are common in Thailand. According to statistics, about 15 to 45% of people suffer from nasal allergies. In other words, almost half the population suffers from this allergy. Allergies can be inherited by genes just like others such as bald heads, height, eye color, etc. However, although the parents are allergic to something, the children may not have any symptoms of allergy. Usually, if either of the parents suffers from allergy, the children may have a 26% chance of having the allergy, but if both parents have an allergy, their children have a greater chance of suffering from the allergy especially nasal allergies. Allergies may completely disappear when the patients become adults, but most of them cannot be cured; the symptoms usually occur only once in a while.

99 Conclusion Genetic diseases are an important problem which can result in the patients’ death. There is no treatment to make them disappear; the only thing that can be done is to relieve the symptoms, or to control the symptoms. Therefore, having a physical checkup and a screen for genetic diseases and getting advice is essential for a couple who are getting married. This can protect them from the diseases before getting pregnant. Activities Answer the following questions and write down the answers in their portfolios and explain them in front of the class. 1. What are the causes of thalassemia? How many types are there? What are they? 2. What causes allergies and which organs can be affected by allergies? 3. Conduct a survey finding out who suffers from allergies in order to find the cause and the methods of prevention together. Having exercises makes our body stronger both physically and mentally Those who usually exercise will appreciate all mentioned above. Some says exercise is like a kind of narcotics that if we always have it and then quit it for a while, we do not feel refreshed. This is true because the body runs endorphin hormone while having exercises which make us happy. Caution: Breaking off taking an exercise if we are in the following condition: 1. Having illness or feeling unwell especially if having a fever or inflame at any part of the body. 2. After recovering from illness because the body is still weak so if having exercise at this time, the body becomes more exhausted, resulting in slow recovery. 3. After having a meal because the blood in the blood circulation will be used for digestion, so it is not enough to feed the muscles. It causes them to less efficiently work, which may easily get a cramp. 4. When the temperature is high since the body will loss more water than usual. The symptoms indicate exercise quitting. Some cases the body is temporary weak such as after the diarrhea, sleeplessness and the usual exercise may be too heavy. So if we have the following symptoms even one or more, immediately quitting exercise. They are 1. feel unusual tired 2. unusual strong and fast pulse rate 3. hard of breathing

100 4. feel dizzy or headache 5. feel queasy 6. fainted 7. pulse rate is over 140 times a minute for elderly and over 160 times a minute for adult Remember that if anyone has one of these symptoms, immediately quitting exercise and resting until having a recovery. Do not keep on having the exercise until having consulted with the physician or until the body is as strong as usual. The types of exercises for health are as follows: 1. Walking is the most convenient and easy exercise but it is still useful and enhancing for the body efficiency as much as the other kinds of exercise and sports. We can walk anywhere and at any time. How to efficiently walk should be conducted as follows: 1.1 Begin with standing, relaxing, and normally breathing. 1.2 While walking, bend up the head and look straight farthest because we might have a neck ache or a back ache if we bend the head down. 1.3 Walking with full steps. 1.4 Walking slowly for 5 minutes at the beginning and then walking faster until the pulse rates reach the maximum standard of 200 times a minute. For the beginners they may start 10 minutes of walking or until feeling a little tired then quit for about 1 – 2 days and start to walk longer to at least 30 minutes, 3 -5 times a week. 1.5 While walking, both hands are in relaxing positions, swinging the whole arms back and forth to have a centrifugal force. While walking if the heartbeat is not fast enough, increase the speed of walking and give more force while swinging the arms. This will make the pulse rate increase. 1.6 Using the special shockproof shoes to protect the heels and the toes and can also support the weight and prevent the feet from injury. 2. Running. Running is a famous exercise for people because it is as easy and convenient as walking. There are many kinds of running depending on the convenience and self- favor of the individual such as joking, marathon running, running on fixed place, or running on the belt. Running should cover 2 -5 kilometers each time and not over 5 times a week. The following are some easy technics of running