“The GE grant provided some stop-gap funding to help stabilize us and give us more time to develop a sustainability strategy so we wouldn’t have this problem going forward,” says Marsha Broussard, director of the School Health Connection program. The $2 million grant has the potential to greatly improve healthcare for the more than 38,000 students across the under-served Orleans Parish alone.

The GE Foundation grant is part of GE’s Developing Health program, a 3-year, $50 million program that aims to improve access to primary care in targeted underserved communities across the United States.

School-based health centers like the ones run by LPHI provide comprehensive preventive, primary care, and primary mental health services for enrolled school students. In addition to providing healthcare for children who would otherwise delay treatments or seek emergency room care, the school health centers also offer things like vision care and trauma, violence and bullying prevention.

“This specific grant to Orleans Parish will expand access to preventive, primary care, and primary mental health services for adolescents in the area,” says said Bob Corcoran, president, GE Foundation. The Developing Health program made similar grants to free and/or non-profit community health centers in other under-served areas around the country, including Atlanta, Baltimore, Cincinnati, Houston and New York.

“One of our goals is to use the grant to increase the number of kids we serve,” says Broussard. “We hope to have two new clinics opening this year. We believe the GE grant will help us serve 500 new users this year which means 1500 more clinic visits.”

CONNECT THE DOTS

Learn more about the Louisiana Public Health Initiative and its ongoing efforts to improve healthcare for Louisiana residents.Explore what the GE Foundation and its Developing Health program are doing to solve some of the world’s most difficult problems and help underserved clinics.

*A Simple Solution to Help Combat Cholera in Haiti. With more than 1.5 million people left homeless by the January 12 earthquake, the recent cholera outbreak is a grave threat. The disease can cause such severe vomiting, diarrhea and dehydration that it can kill within hours. Yet a simple treatment—hailed as one of the greatest medical advances of the past 150 years—can save lives at an average cost of just $6 per patient. Known as oral rehydration therapy (ORT), it’s made of three ingredients available almost everywhere: sugar, salt and water. Clinical trials in Bangladesh in the 1960s showed that ORT works just as well as IV fluids, at a fraction of the cost. Since then, it has saved more 40 million lives around the world, and is now being used as one of the treatments in Haiti.

*Cigarette Smoking: A Global Health Challenge. Smoking kills 5 million people a year, more than twice as many as HIV/AIDS does. The carnage is greatest in lower and middle-income countries like China, home to one-third of the world’s smokers. To help snuff out this deadly habit, 168 nations, including China, have signed on to the world’s first tobacco control treaty, which requires partner nations to use scientifically proven strategies, such as restrictions on cigarette ads, high cigarette taxes, prominent warning labels on cigarette packs with both written and graphic warnings. In the U.S., the FDA released for comment  36 proposed warning labels, including one with a toe tag on a corpse. The World Health Organization tobacco control treaty also requires measures for protection from exposure to tobacco smoke in public places, thus helping to protect kids and nonsmoking adults from the many hazards of secondhand smoke.

*What’s Triggering the Global Autoimmune Disease Epidemic? Being too clean could be making us sick. That’s the reasoning behind the “hygiene hypothesis,” the theory that lack of exposure to dirt, germs and intestinal parasites are weakening our immune systems, making us more susceptible to autoimmune diseases. Rates are soaring in developing countries around the world, with 5 to 7 percent of the population affected. Incidence of inflammatory bowel disease (IBD) has jumped from one in 10,000 people to one in 200. Researchers at Tufts Medical Center in Boston are testing an unusual “medication” for Crohn’s disease (a type of IBD): an investigational treatment with live whipworms, an intestinal parasite. Their study found that 50 percent of those treated with the worm therapy had a major improvement, versus 15 percent of the control group.

*India Workplace Study Offers Solutions to “Lifestyle Diseases.” Everyone has heard of diseases of poverty, such as malaria and TB. But did you know there are also illnesses of prosperity? So-called  “lifestyle diseases” like type 2 diabetes and heart disease, already an epidemic in developed nations, are now attacking in fast-developing countries like India as the population moves from farm labor to desk jobs. But a workplace program costing just $7.30 a year per employee has shown remarkable promise for promoting healthy behavior. Workers were given videos, posters, booklets and counseling sessions to help them exercise more, eat more fruits and vegetables, cut down on salt, and quit smoking, As a result, risk factors for cardiovascular disease and diabetes dropped dramatically.

*How the Mediterranean Diet Helps the Heart. Research suggests that the well-known Mediterranean diet may help trim risk for heart disease, cancer, Alzheimer’s and Parkinson’s disease. But until recently, scientists didn’t know why it works so well. Earlier this year, scientists in Spain discovered that natural chemicals called polyphenols, found in virgin olive oil actually change the expression of genes that otherwise promote heart disease. The study reported that polyphenols dialed down expression of genes that promote inflammation, a cardiovascular risk factor, and also reduced oxidation of lipids the contribute to heart disease, such as cholesterol and trigylerides—findings that open a whole new window into the profound impact of healthy eating habits.

*Diabetes Discovery in Northern Sweden. Globally, 285 million adults are living with diabetes, described as one of the most challenging health problems of the 21^st century. To probe the mysteries of this complex disease, scientists in a small town in Sweden are studying blood samples stored in a medical “biobank.” They’ve already identified nine genetic defects that trigger high blood sugar and are investigating why obesity influences risk. Other research suggests that people at high risk for the disease can delay—or even prevent—it by losing weight through a low-fat, reduced calorie diet and regular exercise–simple lifestyle changes that can trim the threat significantly.

*Anti-HIV Gel A Promising Prevention Method for Women. In what may be a major breakthrough, a study in South African has shown for the first time that a vaginal microbicide gel can help reduce HIV infection in women. Those who applied it most consistently during the nearly three-year trial had a 54 percent drop in risk, compared to women who used a placebo. Although the still experimental gel, which contains tenofovir—an anti-viral drug commonly used to treated HIV—appeared safe and effective in the study, further research is essential to confirm the findings. Even partial protection would be a huge victory in South Africa, where one out of three women is infected with HIV by age 20. The gel is not currently approved for sale anywhere in the world, but if preliminary results are supported by further research and the product is mass-produced in the future, is likely to cost less than 25 cents per application.

*Indonesia’s New Health Regime. One of the best—and least expensive—ways for developing countries to cope with daunting medical challenges is by learning from each other. One  “frugal innovation” that could help boost the health of Indonesia’s people is emulating Bangladesh’s telemedicine program, in which mobile health entrepreneurs—usually local women—go from house to house in villages where doctors are scarce, using portable technology, such as handheld ultrasound devices, and questionnaires to check on the health of neighbors.  Doctors in a central location analyze the data and provide treatment advice—an approach that could also expand access to care in Indonesia, suggests Old problems, fresh solutions: Indonesia’s new health regime, an Economist Intelligence report sponsored by GE.

*Tuberculosis: New Weapons Against an Old Disease. TB is an ancient disease found in Egyptian mummies. Today, it affects two billion people—one-third of the world’s population.  Multidrug resistant TB is now an epidemic in India and China. GE scientists in those countries—and the U.S.—are exploring if existing technologies could be adapted to create point-of-care tests for faster diagnosis. “A rapid test could help control TB, since it continues to spread until patients are diagnosed, isolated and treated with the right drugs,” says Lee Reichman, MD, MPH, executive director, New Jersey Medical School Global Tuberculosis Institute, who isn’t involved with the GE effort. “I applaud GE for working to improve care of a disease that isn’t sexy or in the news because it mainly affects poor people in developing nations. With TB killing two million people a year, advances are desperately needed.”

*Why Do the Japanese Live the Longest? The average Japanese woman will live to celebrate her 86^th birthday, the longest life expectancy in the world. And so many Okinawans survive to age 100—or beyond—that there is an ongoing study of their extraordinarily longevity. Three simple, healthy habits that may help explain it are an active lifestyle, even in old age; a heart-healthy diet rich in fruits, whole grain, vegetables and oily fish; and the cultural tradition of “hara hachi bu,” only eating until they feel 80 percent full.

CONNECT THE DOTS

To learn more about global health, visit the websites of the World Health Organization and the Global Health Council. The U.S. Department of Health and Human Services’ Office of Global Health Affairs offers information on refugee health, global health threats and other resources.

One way to improve the health and survival of low birthweight (LBW) infants is keeping them warm. Hypothermia—a major contributor to both illness and infant mortality—affects an estimated 11 to 54 percent of neonates in India. The problem is far less common in the U.S., where frail newborns are routinely put in incubators that can cost up to $20,000 apiece—a price that can be unaffordable for hospitals in India and other developing nations.

Today, GE announced a global partnership with the nonprofit organization Embrace to distribute a low-cost infant warmer that looks like a tiny sleeping bag. It can keep a baby warm for up to six hours and will initially be distributed in India, starting next year. The Infant Warmer, which will cost less than $200, has three components: a cozy sleeping bag to swaddle the baby, a sealed pouch of wax, and a heater. The pouch can be heated with water or electricity and fits in a compartment in the sleeping bag.

“Every newborn needs warmth, but low birthweight and premature infants are more prone to hypothermia because very small babies have less subcutaneous fat to insulate their bodies and their shiver mechanism is less developed,” says Aparna Katakam, director of marketing for GE Healthcare Maternal Infant Care. “I’ve seen the need for the Infant Warmer in India, where it could fill a gap in transporting newborns with complications from rural facilitie to higher level hospitals for more advanced care. This can involve a two or three hour ambulance ride where babies are wrapped in blankets without any way to monitor their temperature.”

Two years ago, graduate students taking a course in Entrepreneurial Design for Extreme Affordability at Stanford were given the challenge of developing a low-cost incubator for developing countries, working with a nonprofit. That was both the genesis of Embrace, which was founded by a team of engineers and MBAs, and for the warmer, adds Katakam. “The project was started to provide broad access to an affordable infant warmer, using widely available materials like wax, which is both easy to procure and highly cost-effective to generate body temperature heat for babies who need it. “

CONNECT THE DOTS

To learn more about the infant warmer or watch a video, visit Embrace’s website. Also check out the San Francisco Chronicle’s article, “Embrace may keep babies warm—and alive.” For a look at other frugal innovations that are helping save lives in developing countries, read our blog post, “Indonesia’s New Health Regime.”

For decades in the United States, Mad Men puffed away in their offices, crooners crooned in smoky clubs, and the Marlboro Man and Virginia Slims models hooked millions of people on cigarettes. The American public slowly woke up to the mortal dangers of cigarette smoke, and today, thanks to warning labels, cigarette taxes, advertising bans and public-health messages, U.S. smoking rates have fallen dramatically. But in many nations, this public health progress has not been duplicated, and even in the United States, one in five people still smoke and efforts to reduce smoking have stalled.

Smoking harms in a plethora of ways, some well known, some less so. It more than doubles the rate of coronary heart disease and stroke, raises the rate of lung cancer by a factor of 13, and hikes the rate of chronic obstructive pulmonary disease by more than 12-fold, according to the U.S. Centers for Disease Control and Prevention. It’s been clearly linked to infertility, pre-term delivery, still birth and sudden infant death syndrome, and it lowers bone density in older women and leads to more hip fractures, the CDC says.

Smoking also harms indirectly, sometimes in surprising ways. More than 90 million nonsmoking Americans, including more than half of U.S.. children between 3 and 11 are exposed to secondhand smoke, according to the CDC. More surprisingly, smoking has been linked to unemployment. In France, only 20 percent of the overall population smokes, compared to a 50 percent rate of smoking among that nation’s umeployed.

Smoking’s carnage is greatest in lower and middle-income countries, with China among the hardest hit. Some 250 million smokers—one third of the world’s total—live in China, and the Chinese Centers for Disease Control and Prevention reports that smoking is already linked to more than 1 million deaths a year in that nation, according to a report by Xinhua, the government-run news service. More than half of men smoke, and the tobacco industry is pushing for Chinese women to join them, says Andrew Hyland, Ph.D., a research scientist at Roswell Cancer Institute and deputy editor of the journal Tobacco Control. And 75 percent of Chinese smokers have no plan to quit smoking, according to a survey that Fong and his colleagues reported in the October issue of Tobacco Control.

Rates are sky-high in China in part because smoking is socially acceptable there, Hyland says. The Chinese government also has a massive conflict of interest. China Tobacco, the nation’s tobacco producer, is state-owned, and tobacco taxes account for more than 7 percent of the Chinese GDP. “China is where the U.S. was 50 or 60 years ago” with respect to smoking, Hyland says.

To fight smoking, nations joined forces in 2006 to forge the first-ever global health treaty, the World Health Organization Framework Convention on Tobacco Control (FCTC). Today 168 nations have signed on to the FCTC to fight smoking and protect their citizens. (The United States is not among them. “Companies that make money by selling tobacco happen to be housed in the U.S.,” Hyland points out.)

In November the FCTC signatory nations met for a week in Punta del Este, Uruguay, to share tactics and gear up for the antismoking battle, says Fong, who attended the conference. The treaty requires nations to resort to scientifically proven antismoking policies. These include bans on cigarette advertising and promotion, high cigarette taxes, prominent labels on the cigarette pack, with both words and graphic images. The U.S. FDA, which just last year gained the authority to regulate tobacco, has adopted some of those tactics. In November they announced 36 proposed warning labels for cigarette packages, including one with a toe tag on a corpse.

FCTC-mandated policies also include laws mandating smoke-free public places. “As long as the government is diligent and educates people, you can have a highly successful law,” says Fong, who has investigated antismoking efforts worldwide. Sometimes surprisingly effective: In Ireland, Fong recalls, “People said, ‘Oh my goodness, making pubs free will destroy the culture.’”  Now 96 percent of Irish pubs are smoke free, slashing damaging exposure to second hand smoke.

With health workers worldwide determined to snuff out smoking, there’s a lot of reason for hope, even in China. The recent survey by Fong’s team found that Chinese support for laws that mandate smoke-free public places squares with levels in countries where smoking levels have been slashed, such as Ireland and France. And the FCTC has made antismoking efforts front and center internationally. “It’s on every country’s agenda,” Fong concludes.

CONNECT THE DOTS:

The Centers for Disease Control and Prevention provides some grisly facts on smoking and secondhand smoke, if you want to know more about how bad for you they are. And you can read more about the WYO’s Framework Convention on Tobacco Control here.

“The primary indication for these lifesaving devices is as a bridge to transplants for heart failure patients, but LVADs can also be a bridge to recovery since some people recover enough that they don’t need transplants,” says Patricia Chang, MD, director of University of North Carolina’s heart failure and transplant program. “With older machines, the longest patients could survive was a year or two and blood clots and infections were frequent complications.”

Unlike first generation LVADs, which were large, bulky and used pulsed pumping, the HeartMate II is much smaller with continuous flow pumping. “The new generation devices are a major breakthrough because people with failing hearts can now survive five years—or more—with dramatically improved quality of life,” says Dr. Chang. In January of this year, the FDA approved the HeartMate II as “destination therapy” for severe heart failure patients who are not eligible for transplants due to age or medical condition. It’s the first LVAD to receive such approval and has been approved as a bridge to transplant since 2008.

For Ainsley, who went into heart failure in 2008, due to cardiac damage from three heart attacks, the technology has given him a second change at a normal life. “My doctor said I was the sickest person in the hospital and gave me a LVAD that looked like a Chevrolet fuel pump,” he recalls. “Having it was weird and amazing. I felt like a bionic man, because after four months of recovery, I could climb ladders again, do 50 pushups, and go deep sea fishing.”

The HeartMate II system takes over the function of the diseased left ventricle, the heart’s muscular pumping chamber, to move more oxygenated blood through the body, boosting patients’ energy and potentially helping them live long enough to get a donor heart. (About 3,000 Americans are currently on the heart transplant waiting list). The device consists of a pump with inflow and outflow conduits implanted in the chest. A driveline exits the chest wall and hooks up to a lightweight eternal controller and batteries, worn in holsters or a fanny pack. The device is approved for airline travel and doesn’t interfere with aviation electronics.

Becoming so ill that he needed a LVAD has been an important health wake-up call for Ainsley. “I used to run 5K races, but when everyone else was stretching before the race, I’d be behind a tree smoking.” After being warned he wouldn’t qualify for a heart transplant if he smoked even one more cigarette, the dad of two finally found the motivation to kick the habit for good. “Quitting was the hardest thing I ever did, but I wanted to live,” says Ainsley, who is now healthy and physically active after receiving a new heart last year.

CONNECT THE DOTS

For more patient and caregiver information on the HeartMate II Left Ventricular Assist System, visit the manufacturer’s website. To learn about heart failure symptoms, treatments, and news, visit the Mayo Clinic website or MedlinePlus. The FDA has a report on heart devices, including recent approvals and the National Heart Lung and Blood Institute offers an overview of LVADs. Reports and statistics on organ transplantation are online at United Network for Organ Sharing (UNOS). Now there’s a free app to sign up as an organ donor: DonateLives, available at the iTunes store. You can also enroll through a state registry or UNOS.

When it comes to procedures like hernia repair, gallbladder removal, appendectomies, bariatric and gynecological surgery, a revolutionary procedure called single-incision laparoscopic surgery is available.

“It’s clear that the patients want to have operations with fewer incisions,” says Santiago Horgan, M.D, chief of Minimally Invasive Surgery at UC San Diego Health System. “Patients feel that the cosmetic result is important today more than ever but it is our obligation to bring them data.”

Horgan says that the doctor must make a thorough evaluation of the patient to determine if he or she is a good candidate for single-incision surgery.

Truly revolutionary is Natural Orifice Translumenal Endoscopic Surgery (NOTES). This procedure involves passing surgical instruments and a tiny camera through a natural orifice, such as the mouth or the vagina, to the desired organ. Because there are no major incisions through the skin, muscle, and nerves of the abdomen, most patients experience a quicker recovery with less pain and scarring while reducing the risk of post operative hernias. In 2008, Horgan used this procedure to perform the first ever appendix removal through the vagina in the United States of a 24 year-old graduate student. The operation took 50 minutes from start to finish.

The possibilities for minimally invasive surgeries seem endless. In February 2009, Horgan led a surgical team that removed a patient’s diseased kidney through one incision hidden in the belly button. “We are currently testing these scarless procedures for the treatment of cancer, obesity and digestive disorders,” says Horgan. “Being able to perform a surgery with fewer incisions and requiring a shorter hospital stay is particularly attractive to cancer patients who may face repeated surgeries.”

Horgan thinks that as natural-orifice surgery becomes more familiar and as more procedures are successfully performed, the acceptance of it will grow. “In five years, either our approach or something similar will become standard care,” he says. “This technique is changing the way we think about surgery.”

CONNECT THE DOTS

Here’s where to learn more about minimally invasive surgery and whether it is right for you.

McKenzie died from meningococcal meningitis, a bacterial infection that causes inflammation and swelling of the membranes that surround the brain and spinal cord.

“It was devastating,” says her mother, Laurie Hartwig. “We didn’t know a single thing about meningitis and it never crossed our minds that our daughter could be at risk.”

College students like McKenzie are susceptible to the disease due to certain lifestyle factors like crowded living conditions such as dormitories and boarding schools. The disease is spread by close contact with an infected person or through the air when someone with the disease coughs or sneezes.

On average, 11 percent of the 1,500 Americans infected with the disease each year will die. Among those who survive, approximately 20 percent suffer long-term consequences, such as brain damage, kidney disease, hearing loss or amputations. The good news is that the majority of these infections are preventable with the vaccine that protects against four of the five most common strains of meningococcal disease.

Knowing that McKenzie’s death was preventable spurred Laurie Hartwig to join the National Meningitis Association’s Moms on Meningitis, a coalition of mothers who have either lost children or whose children’s lives have been drastically affected by the disease.

“Our ultimate objective is to spread the word about the vaccine so that parents don’t have to go through such pain and suffering because it’s preventable,” says Hartwig. “You have immunization records on your child from infancy. When they’re 12-18, this is the next group of immunization to keep them healthy.”

To date, 40 states have enacted legislation that requires college freshmen be immunized against the disease or informed about the risk.

“I think that probably only 25% of people probably know about this,” says Hartwig. “We still have a lot of education to do.”

CONNECT THE DOTS

The Hartwig family established the Menkenzie Meningitis Foundation to promote awareness about the disease and the importance of immunization.

Learn more about the disease from the Meningitis Foundation of America and the National Meningitis Association, which also offers an educational video, Getting It: A Disease…A Vaccine that features stories of meningococcal disease survivors and families affected by the disease.

Find out what your state is doing to combat these unnecessary tragedies.

About 800,000 Americans suffer strokes each year and many of them don’t get brain saving treatment in time. With stroke, every second counts; every second that you wait to call 911 means brain cell death that can’t be recovered – an average of 1.9 million neurons lost for each minute in which stroke is untreated according to one study.

But there is a simple way to recognize that you or someone around you might be having a stroke – the FAST acronym. That stands for Face, Arms, Speech, and Time, explains Brian Silver, MD, a neurologist at Henry Ford Medical Center in Detroit and a spokesperson for the American Heart Association.

FAST was developed in 1998 and has been validated as a quick and accurate tool for identifying stroke, Silver says. Even kids can understand the key warning signs:

* Face: Symptoms include one corner of the mouth drooping. Ask the person to smile. If it resembles one you had the last time you had dental work, there may be a problem.

* Arm: Symptoms include one arm not reaching as high as the other, or one arm drifting when the person is asked to raise his or her arms.

* Speech: Symptoms include slurring and difficulty repeating a sentence.

* Time: These symptoms are serious and it’s time to call 911.

If you have or see these symptoms, call 911 immediately, says Dawn Kleindorfer, MD, a professor of Neurology at the University of Cincinnati School of Medicine and part of the Cincinnati/Northern Kentucky Stroke team. “When a stroke is beginning, the more time that goes by, the more brain dies,” she says. In addition, the main treatment, tissue plasminogen activator (tPA) has to be given within three hours of the onset of stroke. The farther along that timeline it’s given, the less helpful the drug is, and after that period of time it can even be dangerous.

Some people find it easy to dismiss some of the FAST symptoms. Maybe you slept funny and that’s why your arm is numb, Kleindorfer says. Maybe you think you’re just tired and that’s why you can’t talk right. Even if other symptoms – vertigo and severe headaches are also common symptoms – many people don’t get to the hospital quickly.

Other people don’t want to seem foolish. Some call a friend or relative, and then maybe their doctor, who may or may not call back quickly. Still, others may fear the cost of an ambulance ride. The stroke itself can addle one’s brain into denying there’s a problem. “I had one patient recently whose teenage daughter wanted to call 911,” she recalls. “The mom insisted nothing was wrong even though she was paralyzed and lying on the floor. She told her daughter if she made the call, she’d be grounded.” Happily, the girl made the call and the woman made a complete recovery and now runs marathons.

The sad thing is that only 3-4% of patients come in quickly enough to get tPA – and that’s double what it was a few years ago. The key is education – knowing what to look for and that it’s better to be sent home with nothing wrong than to die or be permanently disabled by a stroke.

The future holds more potential treatments. It’s possible there will be a longer window for using tPA in the future, and Kleindorfer says there are combination drug treatments in trial. There’s also a newer treatment called the MERCI retriever which is threaded through blood vessels to remove the clot that triggered the stroke. While this may create an eight hour treatment window for some patients, it’s still urgent to recognize symptoms and call 911. FAST.

CONNECT THE DOTS

* Find the nearest stroke center through the American Stroke Association.

* GE has an award winning stroke awareness program.

* Current treatment options are available through the American Heart Association.

“This isn’t just a policy issue for me. This is a passion. This is my mission. I am determined to work with folks across this country to change the way a generation of kids thinks about food and nutrition,” Mrs. Obama said of the Let’s Move campaign.

The Let’s Move website can help parents determine whether or not their kids are overweight or obese. It directs you to an online calculator to determine their BMI, a measurement of weight in relation to height. And it outlines how parents can start to modify kids’ diets along healthier lines – less fast food, more fruits and vegetables and low fat foods, fewer but healthier snacks. (Ditch the Cheetos; choose the carrot sticks!)

Let’s Move is also tackling the problem of school lunches in an effort to make them healthier and will encourage schools to start nutritious breakfast programs, too. For at home help on preparing healthy meals, you can check the Let’s Move website for videos featuring chefs who have visited the White House and cooked for the health-conscious Obamas. You’ll find recipes and cooking instructions.

As far as exercise is concerned, Let’s Move provides information on how families can encourage kids to get more physical activity. The goal is an hour a day of exercise, but it can be in 10-minute increments, not all at once. Note to parents: making sure kids get enough sleep is important, too. The Let’s Move website cites a recent study showing that for every extra hour of sleep kids get, the risk of being overweight or obese drops by nine percent.

Once Mrs. Obama gets the kids shaped up, maybe she can turn her attention to the rest of us. I, for one, would like my arms to look like hers!

CONNECT THE DOTS

What we used to call “baby fat” is no longer considered cute. It raises serious health risks for kids including asthma, gallstones, heart disease, high blood pressure and metabolic syndrome, a combination of high blood pressure, high cholesterol and other risks factors for heart disease.