31 March, 2017

India harbours nearly 195 million 'undernourished' people

A seminar in Guwahati on Wednesday, declared nearly 195 million of India's total population as 'undernourished', being devoid of access to healthy diet.

Assam featured among the bottom five states of the country, with its health and nutrition indicators showing 36.4 percent children under five years of age stunted and infant mortality rate at a high 48 percent.

The seminar 'Transforming the Food and Nutrition Landscape in Assam', organised by Coalition for Food and Nutrition Security, India (CFNS) and Inter Agency Group (IAG), Assam, stressed the need for an urgent and concerted action along with a new development agenda to tackle hunger, food insecurity and malnutrition in the state.

Opportunities for achieving food and nutrition security in a sustainable way have been globally identified and many countries are making progress on it.

Assam Chief Secretary V K Pipersenia stressed on the need for urgent action on the issue and said that the state can tackle the problem besides setting an example for other states.

The seminar also discussed how resources can be optimally utilised to improve the present situation and what best could be done to achieve the state targets.

Source: www.zeenews.india.com

31.03.2017

Sometimes we will never know the value of a moment, until it becomes a memory

Dr. Seuss

30 March, 2017

Rajya Sabha Passes Bill to Ensure Rights for HIV Patients

Top of Form

Bottom of Form

The Indian government announced that nobody would be denied treatment for AIDS, as the Rajya Sabha passed the HIV and AIDS (Prevention And Control) Bill, 2014, with a voice vote.

"Test and treatment policy (with regard to AIDS) has been adopted by the government and we will ensure that nobody is denied treatment," Health and Family Welfare Minister J.P. Nadda told the Upper House while replying to a two-hour debate on the bill. 

The bill seeks to prevent and control the spread of HIV and AIDS and prohibits discrimination against persons affected with the disease. It was first introduced in the Rajya Sabha on February 11, 2014, by the then Health and Family Welfare Minister Ghulam Nabi Azad. 

Nadda moved the Bill in the house after the lunch recess and the members from across parties discussed it with enthusiasm.  The minister thanked all the members for their suggestions and assured the nation through the house that every possible effort would be made to control the spread of the virus and those affected would be treated well. 

"All types of pro-active measures have been taken. Special care is being taken to deal with the affected," he said, adding that care is also being taken to ensure that the virus does not get transmitted through mother to child.  The minister said that Rs 2,000 crore have been allotted to the National AIDS Control Programme (NACP) for the next financial year. 

"Blood banks across the country are also being upgraded to end spread of the virus through blood transfusion," he said. 

Source: www.medindia.net

30.03.2017

You will miss the best things if you keep your eyes shut

Dr. Seuss

28 March, 2017

Eye movements may reveal whether a person is lying, says study

As per a study, eye movements can reveal whether a person is lying about recognising someone they know.

The finding could be valuable to police when trying to confirm key identities in criminal networks such as terrorist cells or gangs, researchers said.

 Using eye tracking technology, researchers from the University of Portsmouth in the UK found that people's eyes move in a different pattern when looking at faces they recognise.

"Criminal accomplices often deny that they know other members in their networks.

However, if a co-conspirator denies recognition in this way, their eye movements when viewing photos of those suspects, may reveal this type of lie," said Ailsa Millen, lead author of the study.

The researchers recorded the eye movements of 59 participants while looking at 200 digital colour photographs of familiar and unfamiliar faces.

Familiar faces included people the participants knew in real life, famous celebrities and those only seen briefly before the experimental trials.

Sometimes the participants lied about whether they recognised the photos, sometimes they told the truth.

Source: www.zeenews.india.com

28.03.2017

It often requires more courage to dare to do right than to fear to do wrong

Abraham Lincoln

27 March, 2017

India ranks 122nd in happiness index, behind terror-riven Pakistan and poorest-of-poor Nepal

India ranked 122nd, behind terror-riven Pakistan and poorest-of-poor Nepal in the global list of the happiest countries, according to a United Nations report released on Monday. India came down by three slots, as last year it was placed at 118th spot. It was behind the majority of South Asian Association for Regional Cooperation (Saarc) nations, apart from war-ravaged Afghanistan, that stood at 141.  Among the eight Saarc nations, Pakistan was at 80th position, Nepal stood at 99, Bhutan at 97, Bangladesh at 110 while Sri Lanka was at 120. However, Maldives did not figure in the World Happiness Report. Norway took the top spot from Denmark as the happiest country in the world. The Scandinavian nation, which was ranked fourth in last year’s report, jumped to the top this year on the basis of several key calculations, including levels of caring, freedom to make life decisions, generosity, good governance, honesty, health and income.

Other factors by which 155 countries were measured in the annual World Happiness Report are: inequality, life expectancy, GDP per capita, public trust (i.e. a lack of corruption in government and business), and social support. Denmark, Iceland, Switzerland and and Finland round out the top five, while the Central African Republic came last in the World Happiness Report. Western Europe and North America dominated the top of the table, with the US and Britain at 14th and 19th positions, respectively. Syria placed 152 of 155 countries — Yemen and South Sudan, which are facing impending famine, came in at 146 and 147. The World Happiness Report was released to coincide with the United Nations’ International Day of Happiness on March 20.

Source: www.thehealthsite.com

27.03.2017

A mistake is only an error, it becomes a mistake when we fail to correct it

John Lennon

25 March, 2017

GPS is making our brain dull

Using GPS navigation to get to your destination may 'switch off' parts of the brain that would otherwise be used to simulate different routes, a study has found.

The study by researchers at University College London(UCL) in the UK involved 24 volunteers navigating a simulation in central London while undergoing brain scans. They investigated activity in the hippocampus, a brain region involved in memory and navigation, and the prefrontal cortex which is involved in planning and decision-making.

They also mapped the labyrinth of London's streets to understand how these brain regions reacted to them. When volunteers navigated manually , their hippocampus and prefrontal cortex had spikes of activity when volunteers entered new streets. This brain activity was greater when the number of options to choose from increased, but no additional activity was detected when people followed satnav instructions. "If you are having a hard time navigating the mass of streets in a city, you are likely putting high demands on your hippocampus and prefrontal cortex," said Hugo Spiers from UCL.

"When we have technology telling us which way to go, however, these parts of the brain simply do not respond to the street network. In that sense our brain has switched off its interest in the streets around us," he said.

Previous research has shown that the hippocampi of London taxi drivers expand as they learn to memorise the streets and landmarks of central London. The latest study suggests that drivers who follow satnav directions do not engage their hippocampus, likely limiting any learning of the city street network.

The study was published in the journal Nature Communications

Source: www.timesofindia.com

25.03.2017

There are no problems,

only solutions

John Lennon

24 March, 2017

India bears about 25 percent of global TB cases: Study

A new research has found that India bears the highest burden of tuberculosis (TB), around 25 percent of global cases. The findings said, an urban tuberculosis case infects more individuals per year while a similar case in rural area remains infectious for longer period.

The new study was conducted by the researchers from the Centre for Disease Dynamics, Economics and Policy (CDDEP). They have developed an approach to estimate the extent of TB in India using previous estimates from nearby countries and a current understanding of the TB transmission.

The results of the findings are published in The International Journal of Tuberculosis and Lung Disease. Results show differences in urban and rural TB. While an urban TB case infects more individuals per year, a rural TB case remains infectious for appreciably longer, suggesting the need for interventions tailored to these different settings.

The study said,"Simple models of TB transmission, in conjunction with necessary data, can offer approaches to burden estimation that complement those currently being used".

An urban TB case will infect an average of 12 people per year and remains infectious for about one year, while a rural case will infect an average of 4 people per year, but remains infectious for more than two years.

The study co-author and CDDEP Director Ramanan Laxminarayan said, "We urgently need improved estimations of the burden of tuberculosis. To implement appropriate policies and interventions, it is important to understand the current extent of the disease, as well as transmission dynamics". The study has been released just before the World Tuberculosis Day on March 24.

This is the second year of the two-year theme, 'Unite to End TB,' with a focus on addressing stigma, discrimination, marginalization, and overcoming barriers to access care.

According to reports, the disease is estimated to kill 4,80,000 Indians every year although it is now believed that these numbers are under-represented and the mortality could be 5,00,000 a year.

Source: www.zeenews.india.com

24.03.2017

There’s nothing you can know that isn’t known

John Lennon

23 March, 2017

Health is right, not charity

The Union Cabinet has given its approval to the National Health Policy 2017. A new health policy was long overdue as the present one is at least 15 years old. The NHP 2017, has several positives to it. For one, it proposes increasing public health expenditure to 2.5% of the GDP from the current 1.3%. This is still far short of the 5% of GDP recommended by the World Health Organisation. Given the magnitude of India’s health concerns, one wonders how far the proposed increase in public health expenditure will go in improving public health in the country. The new health policy prioritises primary healthcare; more than two-thirds of the expenditure will be on primary care. It also envisages increasing public access to quality healthcare through provision of free drugs, free diagnostics and free emergency and essential healthcare services in public hospitals. It is well known that expenditure on health drives many Indian families into severe debt. That can be expected to reduce with the implementation of the new policy. Non-communicable diseases, which account for the bulk of India’s illness-related expenditure and fatalities, will get more attention under the new health policy. In the pipeline is a new comprehensive healthcare package to cover cardiovascular diseases, diabetes, cancers as well as mental health, palliative and rehabilitative care at the primary healthcare level.

Still, the NHP 2017, is disappointing. It appears to be a rehashed version of the 2002 policy. The proposal to raise public health expenditure to 2.5% of the GDP figured in the old policy too. The 2017 policy is also a weaker version of the 2015 draft. The 2015 draft promised that public health expenditure approximating 2.5% of GDP would be implemented by end-2017. The 2017 policy defers that deadline to 2025. Many of the targets that NHP 2017 sets out to achieve are not new. Both NHP 2002 and 2017 set the target for maternal mortality ratio at 100. The NHP 2002 had set the deadline at 2010. The maternal mortality ratio (MMR) target was not achieved. Indeed, in 2015-16, India’s MMR was 167. The NHP 2017, has now set the deadline at 2020. Will these and other targets be achieved this time around? Much will depend on the political will to implement the policy. In this regard, the NHP 2017, does not bode well.

The policy lays bare the government’s irresolute commitment. Instead of making health a fundamental right, as the 2015 draft promised, it advocated an “assurance-based approach.” Assurances that are not justiciable often end up being empty promises. The people of this country should not have to depend on the government’s goodwill for access to health services. This should be a right they are entitled to.

Source: www.deccanherald.com

23.03.2017

The best thing about the future is that it comes one day at a time

Abraham Lincoln

22 March, 2017

Lifestyle changes can lead to 10-point drop in blood pressure

For the 30% of adult Indians who suffer from hypertension, the best prescription could just be "lifestyle changes''. In the first randomized, double-blinded trial of an online behavioral intervention for high blood pressure, participants reduced their systolic blood pressure (the higher number in a blood-pressure reading) by 10 mmHg, compared with a 6 mmHg reduction for those taking part in a web-based control intervention. The Canadian research was presented at the just concluded American College of Cardiology's 66th annual scientific session in Washington.

A press release sent by the American College of Cardiology quoted the study's lead author Robert P Nolan as saying, "The electronic counseling (e-counseling) intervention had an effect similar to that of adding an additional blood-pressure-lowering medication." The University of Toronto study thus underlines the need for lifestyle counseling intervention to complement medicines taken to reduce high blood pressure.

The trial involved 264 participants aged 57.5 years on average with an average blood pressure of about 140/90 mmHg. Study participants enrolled through the website of the Heart and Stroke Association of Canada and were randomly assigned to e-counseling or a control group. Both groups received emails weekly, but the emails to the e-counseling group provided links to online multimedia and interactive tools to increase motivation and skills to begin and sustain a heart-healthy lifestyle. The emails to the control group linked to generic information about heart-healthy living and reducing high blood pressure.

After 12 months, in addition to the average reduction of 10 mmHg in systolic blood pressure in the e-counseling group compared with 6 mmHg in the control group, the e-counseling group also saw a statistically significant average reduction of 4 mmHg in pulse pressure compared with 1.5 mmHg in the control group, said the release.

Source: www.timesofindia.com

22.03.2017

You cannot escape the responsibility of tomorrow by evading it today

Abraham-lincoln

21 March, 2017

Don't fail to take care of your nails

For diabetics it is vitally important that they learn to care for their nails. Nails protect our fingers and toes from injury and trauma. In diabetes, the sensation in the fingers and toes decreases, and poor or neglected feet often lead to ulceration, infection and even amputation.

Diabetic people are more susceptible to a fungal infection called as onychomycosis, and approximately 50% of all nail infections arc onychomycosis. In onychomycosis, nails become thick and brittle with sharp edges that can cause injury to surrounding skin Ignored small cuts on fingers and toes are home for such fungal and bacterial infections. An untreated infection can lead to foot ulcer and gangrene. Many people with diabetes have lost a part or whole foot due diabetic foot ulcers. Thus, it is important to protect your nail from developing such conditions.

Several pathways can lead to ulceration in patients with diabetic neuropathy including biomechanical issues causing calluses to stepping on a foreign body and ignored dystrophic, mycotic and neglected toenail. According to studies, one in three patients with diabetes has onychomycosis and diabetics are 2.77 times prone to this infection compared to non-diabetics. An untreated infection can lead to foot ulcer and gangrene. Many people with diabetes have lost a part or the whole foot due diabetic foot ulcers. Thus, it is important to protect your nail from developing such conditions.

The best way t0 keep nails free from fungus is to have good hygiene. Ensure to keep fingernails and toenails clean and always dry your feet before putting on socks and shoes A diabetic person should only wear comfortable and well-fitting shoes with synthetic socks that will wick moisture away from the skin of the foot. Always wear shoes or sandals while using public shower facility or public pools. Do not use artificial nails as they trap water under the pails and this moisture will promote fungus growth. Moreover, keep your nail care kit clean and sterilize it with alcohol every time before use.

You can prevent serious complications of diabetic foot like amputation resulting from a dystrophic fungus infested toenail; just remember the importance of nail care and make it a routine.

Source: www.timesofindia.com

21.03.2017

He has a right to criticize, who has a heart to help

Abraham-lincoln

20 March, 2017

Apps, social media pushing back sleep time over 1.5 hours

Is WhatsApp keeping you up way past your bedtime? You are not the only one, say doctors at Bengaluru-based National Institute of Mental Health and Neuro Sciences (Nimhans). A study has revealed that the use of the internet for Facebook and WhatsApp is making people put off sleep by more than one and a half hours (100 minutes) every day.

In a 2016 study by the Service for Healthy Use of Technology (SHUT) clinic at Nimhans, researchers found that internet use was also making people wake up 90 minutes later. The study, published in January in the Indian Journal of Occupational and Environmental Medicine, also found that while the quality of sleep was above average, most people usually checked their phones and tablets at least four times after going to bed. The prescription: shut off devices as you near bedtime.

Sleep disorders and sleep loss, say doctors, can contribute to conditions varying from heart disease to anxiety. A 2015 study by a private hospital in Gurgaon revealed that 90% of young heart attack victims were those who did not sleep well. The application keeping most people up was WhatsApp (58.5%), says psychiatrist Dr Manoj Kumar Sharma, additional professor at SHUT clinic and one of the lead researchers of the study.

"This was followed by Facebook usage (32.6%). Messenger applications other than WhatsApp and Hike were used rarely (65.7%).Gmail was shown to be frequently used by participants (45.3%)," he adds. The research, says Sharma, also showed that 60% of the participants used their mobile phone along with devices such as desktops, laptops and tablets at home as well; 42% of the participants acknowledged that they put off work just to be on the internet.

Dr Suresh Kumar, neurophysician at Chennai-based Sree Balaji Medical College and Hospital, says he is seeing more patients with "delayed sleep phase syndrome (DSPS)", where instead of the usual sleep cycle of eight hours from around 10 pm to 6 am, people are going to bed only by 3 am and waking up at 11 am. "It's not just adults; children too are sleeping at 1 am," he says. Doctors say people with DSPS, otherwise referred to as "social jet lag", are not successful at maintaining normal 9-5 workdays and complain of fatigue, headache, decreased appetite or depressed moods.

Source: www.timesofindia.com      20.03.2017

Absorb what is useful, discard what is not and add what is uniquely your own

18 March, 2017

Drug addiction may cause tooth decay

If you are addicted to drugs, its high time you call it a quit as a research has found that doing drugs can also cause tooth decay.

The findings, led by Hooman Baghaie from the University of Queensland in Australia, showed that drug use affects oral health through direct physiological routes such as dry mouth, an increased urge for snacking, clenching and grinding of teeth and chemical erosion from applying cocaine to teeth and gums.

The lifestyle that often accompanies problematic drug use also affects oral health through high sugar diets, malnutrition, poor oral hygiene, and lack of regular professional dental care.

Patients with substance use disorders also exhibited greater tooth loss, non-carious tooth loss and destructive periodontal disease.

In addition, tolerance to pain killers and anaesthetics also contributes to poor dental care, the researchers said, in the paper published in the journal Addiction.

Oral health has significant consequences on quality of life and general health. In addition to functional and self-esteem issues that accompany bad teeth, the chronic inflammation and bacteraemia (bacteria in the blood) characteristic of poor oral health increases the incidence of coronary heart disease, stroke, diabetes and respiratory disease.

Researchers suggested that doctors and clinicians should screen people with substance use disorders for oral diseases and arrange for dental care as needed.

"They should consider using sugar-free preparations when prescribing methadone as well as warn patients of the oral health risks associated with dry mouth and cravings for sweet foods," Baghaie suggested.

For the study, the team combined the results of 28 studies from around the world, which collectively provided data on 4,086 dental patients with substance use disorder and 28,031 controls.

Source: www.zeenews.india.com

18.03.2017

I destroy my enemies when I make them my friends

Abraham Lincoln

17 March, 2017

'Performing namaz can reduce lower back pain'

Performing the namaz right could be an effective way to reduce lower back pain, according to a new research paper published in the latest edition of the International Journal of Industrial and Systems Engineering.

"Five times a day, roughly 1.6 billion Muslims worldwide, bow, kneel, and place their foreheads to the ground in the direction of the holy city of Mecca, Saudi Arabia, as part of the Islamic prayer ritual, the Salat. The ritual is one of the five obligatory elements of the faith set forth by the holy book, the Qur'an,'' said a press release sent by Binghamton University, State University of New York. "The complex physical movements of the ritual can reduce lower back pain if performed regularly and properly,'' it said.

The university's Mohammad Khasawneh, who is the main author of the study, said, "One way to think about the movements is that they are similar to those of yoga or physical therapy intervention exercises used to treat low back pain.''

Researchers analyzed statistics based on the movements of computer-generated digital human models of healthy Indian, Asian, and American men and women, and models with lower back pain. Khasawneh's group found that the bowing portion is the most stressful on the lower back, but for individuals with low back pain, using proper knee and back angles during the ritual can reduce pain. The angles are based on individual body shapes.

"The kneeling posture (sujud) increases the elasticity of joints. It is recommended for these individuals (those with lower back pain) to spend more time in the kneeling posture," Khasawneh said. On the flipside, using incorrect angles and movements can increase pain.

Source: www.timesofindia.com

17.03.2017

Be brave and take risks. Nothing can substitute experience

16 March, 2017

Beware! Coloring your hair can up chances of breast cancer

Researcher Sanna Heikkinen from the University of Helsinki in Finland and Finnish Cancer Registry evaluated the contribution of the use of hormonal contraceptives and hair dyes on breast cancer risk factors. “The biggest risk factor in breast cancer is high age and known lifestyle-related risk factors include late age at first birth, small number of children, high alcohol consumption and sedentary lifestyle,” said Heikkinen. They analysed self-reported survey data from 8,000 breast cancer patients and 20,000 controls from Finland. The results suggested that use of other hormonal contraceptives was, by contrast, associated with 32 percent higher breast cancer risk among younger women under 50 when compared to women who did not use hormonal contraceptives.The team also investigated the amount of opportunistic mammography, which was found to be very common. More than 60 percent of responders reported having had a mammography before the screening age of 50. “Women should be more extensively informed of the harms of opportunistic mammography, such as accumulating radiation burden and the potential consequences of false positive or negative findings,” Heikkinen noted.

Breast cancer is a type of cancer originating from the breast tissues. Both men and women can be afflicted by it though it’s rarer in men. Along with cervical cancer it’s one of the most common types of cancer that afflicts women. One of the major issues with breast cancer is that it is often not detected soon enough. This is due to low awareness about the disease. Detecting it early can significantly reduce the death risk.Some common symptoms of breast cancer are:

1.      A hard ‘lump’ or a ‘knot’ in the breast. Usually, these lumps are painless.

2.      Occasionally, a clear cut lump cannot be felt, but a ‘lumpish’ feel is there. And this feel is different as compared to the same area of the opposite breast.

3.      Bloody or a blood stained nipple discharge

4.      A recent ‘in drawing’ or ‘inward pull’ on the nipple or even a change in direction.

5.      Changes in the skin over the breast, which feels thick, hard and like an ‘orange’ peel

6.      Occasionally, small ‘knots’ or nodes may be felt in the armpit.

Source: www.thehealthsite.com

16.03.2017

The more we value things, the less we value ourselves

11 March, 2017

Pollution, poor sanitation kill India's under-5 kids

India accounts for the second highest death rate of children under 5 years due to environmental risks -mainly pollution and poor sanitation -in the WHO southeast Asia region, which includes Bangla desh, Indonesia and Bhutan.

In fact, India fares far worse than China and is among the top 35 countries in the world with the highest death rate among under-5 children attributable to an unhealthy environment. While India recorded 248.14 deaths among children under-5 per lakh people annually, Myanmar (also part of the WHO's southeast Asia region) reported over 297, new assessments by the UN agency show.

Globally , more than 1 in 4 deaths of children under 5 years are attributable to unhealthy environments. Every year, environmental risks -such as indoor and outdoor air pollution, second-hand smoke, unsafe water, lack of sanitation, and inadequate hygiene - take the lives of 1.7 million children under 5, according to two new WHO reports. Highlighting the need for improved sanitation in India to save children, the WHO report said 44% of India's population defecate and urinate in open spaces, leading to greater risk of infectious diseases such as diarrhoea and acute respiratory infection along with malnutrition.

Lack of menstrual hygiene is also seen as a major cause of infection among young girls and mothers.

"National behaviour change handwashing programmes in India and China would produce large economic gains from reduced diarrhoea and acute respiratory infections such as a 92-fold return to investment in India and a 35-fold return to investment in China, "said one of the reports `Don't Pollute My Future!

The other report, 'Inheriting a Sustainable World: Atlas on Children's Health and the Environment', shows a large portion of the most common causes of death among children aged 1 month to 5 years - namely diarrhoea, malaria and pneumonia -are preventable by interventions such as access to safe water and clean cooking fuels.

Source: www.timesofindia.com

10.03.2017

Attract what you expect, reflect what you desire and become what you respect

10 March, 2017

Half of 4.3 million TB cases were not documented in India, Indonesia, Nigeria: WHO

The World Health Organization (WHO) has said that almost half of the estimated 4.3 million cases of tuberculosis cases worldwide were not documented in 2015 by the health authorities in India, Indonesia and Nigeria.

Noting that there were estimated 10.4 million new TB cases worldwide in 2015, the global health body said that six countries including India accounted for 60 per cent of these.

Out of these new cases, 5.9 million were men, 3.5 million were women and 1 million were children. WHO said that people living with HIV accounted for 11 per cent of the total figure.

"Six countries accounted for 60 per cent of the new cases -- India, Indonesia, China, Nigeria, Pakistan and South Africa," it added.

The global body said, "In 2015, 6.1 million new TB cases were notified to national authorities and reported to the WHO. This reflects a 4.3 million gap between incident and notified cases, with India, Indonesia and Nigeria accounting for almost half of this gap".

2017 is the second year of the two-year "Unite to End TB" campaign for World TB Day and this year the WHO will place a special focus on uniting efforts to "Leave No One Behind", including actions to address stigma, discrimination, marginalisation and overcome barriers to access care.

It is also an opportunity to mobilise political and social commitment for further progress in efforts to end TB, it said. The WHO said that about 4,80,000 people worldwide developed multidrug-resistant tuberculosis (MDR-TB) in 2015. In addition, around 1,00,000 people developed resistance to rifampicin (the most effective first-line medicine) and needed MDR-TB treatment.

"The MDR-TB burden largely falls on three countries -? China, India, and the Russian Federation ?- which together account for nearly half of the global cases," the WHO said.

MDR-TB is a form of TB caused by bacteria that do not respond to isoniazid and rifampicin, the two most powerful, first-line anti-TB drugs. TB is one of the top 10 causes of death worldwide. In 2015, 10.4 million people suffered from TB and 1.8 million died from the disease, including 0.4 million of those with HIV.

"Over 95 per cent of TB deaths occur in low- and middle-income countries," it said.

Source: www.zeenews.india.com

10.03.2017

Dream big, set goals, take action