1. A SPECIAL INTEREST SECTION BY MEDIAPLANET
DENTAL HYGIENE FOR LIFE
Whether you have natural teeth or wear dentures, your oral health matters!
Your dental hygienist can recommend the oral care routine that’s right for you.
ORAL HEALTH FOR OVERALL HEALTH
Visit www.dentalhygienecanada.ca for more
DENTAL
HYGIENE
CANADA
Publisher: Jessica Papp Business Developer: Samantha Blandford Managing Director: Martin Kocandrle Production Director: Carlo Ammendolia Lead Designer: Matthew Senra
Account Managers: Joyce McCaffrey, Melissa MacDonald Cover photo: Joey Carman Photo credits: All images are from Getty Images unless otherwise credited.
Send all inquiries to ca.editorial@mediaplanet.com. This section was created by Mediaplanet and did not involve Maclean’s Magazine or its editorial departments.
HEALTHY AGINGPERSONALHEALTHNEWS.CA
AGING GRACEFULLY WITH HOWIE MANDEL
We all face challenges as we age:
ourhealthdeclines,friendsand
family pass away,our children
move on.But,for people living
with a mental health condition,these changes
and the instabilities they bring can be particu-
larly challenging. Howie Mandel believes the
keyto agingwell is to be proactive in nurturing
ourmentalhealthandbreakingdownstigma.
In Canada,an estimated 20 percent of adults
over the age of 65 suffer with mental health
issues that range from depression and anx-
iety disorders to dementia and Alzheimer’s
disease.An aging population means a heavier
burdenonCanada’shealthcaresystem:by2041,
rates of mental illness for Canadian adults be-
tween the ages of 70 to 89 are projected to be
higherthanforanyotheragegroup.
Howie Mandel’s relationship with mental
health issues is personal and long-lived. The
comedian has endured obsessive compulsive
disorder (OCD) and attention deficit hyperactiv-
ity disorder (ADHD) for his entire life.Now aged
60 and facing the next chapter of his life,Man-
del is championing the benefits of adopting an
open,proactivedialoguearoundmentalhealth.
“Yourmentalhealthisanorgan.Itisasinthat
mental health is not part of our everyday cur-
riculum,”saystheAmerica’sGotTalentjudge.“It’s
somuchmoreimportantthananythingelse,we
shouldallbeproactiveandcognisant.”
Being proactive with your mental health
means adopting healthy habits and tending
to your diet,sleep,and exercise.Keep an agile
mind doing activities that require mental
and physical dexterity, such as painting and
reading. Social interactions through person-
al relationships are key to maintaining your
wellbeing.Foster newrelationships bytaking
up hobbies,enrolling in classes,or volunteer-
ing in your community.
Tackling mental health issues head on
Mandel’s struggle with OCD took its toll on his
family’s life.Terry,his wife of 36 years,eventu-
ally gave him an ultimatum: get help or leave.
Mandel will never be cured of OCD or ADHD,
but he’s learned to manage them.Mandel is in
therapyandonmedication,buthebelievescar-
ing for one’s mental health goeswell beyond.
“We should all, from day one, learn to tend
to our mental health,” he says.“You should be
open,you should talk.Ifyou can afford it,there
should always be a counsellor in your life to
give you coping skills.” Learning coping skills
forchangeanddevelopinghealthyhabitsearly
on will give you a better chance of fending off
mental health issues later on in life.
What’s really needed is a shift in how we
perceive our mental health. As Mandel says,
“Wetakecareofourdentalhealthbutwedon’t
take care of our mental health.”
The key to healthy aging is to dispel any re-
mainingstigmaattachedtomentalhealth,and
for everyone — diagnosed with a condition or
not — to make tending to it a part of everyday
life so as to develop coping mechanisms for the
challengesthatlifewillinevitablyoffer.
Themostimportantthingforpeopleexperien-
cingmentalhealthissuesistoreachouttosome-
one,speaktoyourdoctororalovedone—chances
areyou’renotaloneinyourexperiences. Mandel’s latest project is the Hot Docs Film Festival
Official Selection documentary Committed, which
launched on September 6, 2016.
By Bronwen Keyes-Bevan
2. M
eet Bob. Bob has always
been an outgoing senior,
active in his seniors’ resi-
dence,and chattywith other
residents and staff. How-
ever,Bob hasn’t been himself recent-
ly. He is quiet, rarely leaves his
room, and no longer social-
izes with other residents.
One of the care aides
notices he isn’t eating
his meals,he has lost
weight, and is irrit-
able when she tells
jokes to encourage
himtosmile.Whatis
the reason for Bob’s
sudden withdrawal?
Hisoralhealth.
Bob’s arthritis had
been getting progressive-
ly worse, making it impos-
sible for him to brush his own
teeth.Hebecameembarrassedtosmile
and socialize because of the appearance of his
teeth,and he feared his bad breath could be de-
tected by others. The medications he was on
were causing his mouth to become extreme-
lydry,which made communicating even more
challenging. Eventually, the lack of daily oral
care led to tooth pain. Eating meals became
uncomfortable,even unbearable at times. Bob
quicklybecameweak and frail.
Finding a solution
We all know Bob. Many of us have experi-
enced aspects of his story, either with our
parents or with other older adults for whom
we care. Research has shown that many
seniors suffer from gum disease and
tooth decay caused by plaque —
consisting of food debris and
bacteria — which accumu-
lates in the mouth. For-
tunately, most oral dis-
eases and infections can
be prevented through
daily and professional
oral health care.
Dental hygienists
are oral health care pro-
viders who deliver pre-
ventive and therapeutic
oral care in a variety of set-
tings,including mobile prac-
tices that allow them to provide
services to seniors in their own
homes or in long-term care facilities. Af-
ter a comprehensive assessment,the dental
hygienist will work with seniors and their
caregivers to develop an individualized oral
care plan. Seniors like Bob deserve the pre-
ventive oral health care that dental hygien-
ists provide.Let’s make it happen.
Donna Scott, Registered Dental Hygienist
Oral Health for
Healthy Aging
INDUSTRY SPOTLIGHT
When you mention retirement, most
peoples’ thoughts probably turn to
whether their savings are adequate so
that they can comfortably make the
move away from their regular paying
jobs. But, when it comes to making the
transition into retirement, it’s about
much more than money.
When you’re just a few months away from re-
tirement,there are many other aspects of your
life you need to consider,and you’ll have many
more questions you need answered.The good
news is there’s a new web-based resource that
can help bring you up to speed on what you
need to know and provide reassurance that
you’vecoveredallthebases.
Developed by the Canadian Life and Health
Insurance Association (CLHIA), Retiring Soon?
is a one-stop resource that gathers infor-
mation on all aspects of your life in retire-
ment — not only the money, but also health
benefits, lifestyle considerations, organiz-
ing important documents, and much more.
RetiringSoon?hasyoucoveredforthefollowing:
•Howtoapplyforgovernmentbenefitssuchas
CPPandQPP.
• Howtoconvertworkplacepensionand
personalRRSPsintoretirementincome.
•Howtoorganizefamilyandfinancial
documents.
•Theroleoffinancialadvisors.
•Howtoavoidfraud.
And, after you’ve made your way through
its three main sections, Retiring Soon? offers
a handy summary to make sure you haven’t
missed any steps. This one-of-a-kind web-
based tool is accessible on computers,tablets,
and smartphones.
Moving from theworkplace into retirement
can be a daunting process,but it doesn’t need
to be if you are confident that you’re ready to
take the next step.Retiring Soon? can give you
that much-needed confidence.
Retiring Soon? What You Should Know
Supporting Partner
5
Tips to Boost
Your Brain Health
A SPECIAL INTEREST SECTION BY MEDIAPLANET FACTS
Our brains have the ability to reorganize
and adapt themselves to form new
neural connections throughout our
lifetime. Scientists have shown brains
to be malleable enough to be rewired
— so that one area can assume the
function of another. Here are five easy
ways to stimulate your brain.
1
Exercise your brain by playing
an instrument, reading a novel,
learning a new language, or taking
on a new hobby.
2
Practise positivity and action-
oriented thinking. Keep a
gratitude journal to help drive
positive thinking and be optimistic.
3
Consume superfoods like
omega-3 fatty acids, which
positively affect mood, memory,
and brain performance.
4
Sleep well to reboot your
brain. A good sleep flushes out
accumulated toxins and cements
new learning and memories through
neuroplasticity.
5
Increase your social network and
interactions, as they have been
shown to boost brain function as
much as intellectual stimulation.
Source: Dr. Jennifer Pearlman
3. A SPECIAL INTEREST SECTION BY MEDIAPLANETPERSONALHEALTHNEWS.CA
The Art
of
Aging
S
heridan College, one of On-
tario’s leading post-second-
ary institutions, recognized
that they had a role to play
in contributing to applied
research into issues affect-
ing older Canadians.In 2003,
they established the Centre for Elder Re-
search with a goal of enhancing the quality
of life of older adults and their families.
The surprising benefits of
engagement in the arts
Perhapssurprisingly,theCentre’sresearch
shows a positive relationship between par-
ticipation in the creative and performing
arts and healthy aging. As a health promo-
tion strategy, arts programs get a stand-
ing ovation. The physical and psychosocial
benefits people gain include increased fit-
ness, life satisfaction, and self-confidence.
And, when older adults are engaged in the
arts, they tend to be more likely to stick
with it than other forms of exercise. As an
example, a group of women who partici-
pated in a dance study at the Centre in 2010
are still dancing.
“We know that the confidence seniors
gain from being engaged in the arts is crit-
ically important, because they are more
likelytoengageinotheractivities,”saysPat
Spadafora, the Centre’s director. “There are
the physical benefits from some arts forms,
but we also know that social isolation and
loneliness can be hugely detrimental to
one’s health. Engagement in the arts can
contribute to social inclusion.”
Gillian Saunders, Dance Discipline Head,
Music Theatre — Performance, at Sheridan,
says the fundamental element of dance that
appeals to everyone is the music. “By using
different types of music, participants have
an immediate response,” she says. “This be-
gins to develop the social connection, and
eventually leads to improved self-esteem
and a sense of inclusiveness, all of which
contribute to overall health.”
Preventing falls and other health
concerns
It has been demonstrated that many older
adults who participate in dance and other
artistic activity see positive gains in their
flexibility, balance, and range of motion.
“Falls are a significant concern for older
adults,” says Spadafora. “If, through the
arts, we can improve balance and help to
prevent falls and other health issues, then
that’s a good thing.”
Spadafora believes that when people are
inactive, it may mean we haven’t found
the right key to unlock their interest, sug-
gesting we need to create more opportun-
ities so that people have choice. Maybe for
some it isn’t dance, but woodworking, or
sculpting, or writing, instead. The Centre is
currently working on a project that bridges
art and technology, so people who may not
be able to get into a site can still participate
in these programs.
Supporting Partner
For the first time in Canadian history, there are more
adults 65 years of age or older than children under 14.
This huge demographic shift means we need to ensure
programs are in place to support healthy aging.
“If, through the arts, we
can improve balance and
help to prevent falls and
other health issues, then
that’s a good thing.”
By Ken Donohue
A group of participants dancing at
the Centre for Elder Research
ballet-based project.
4. A SPECIAL INTEREST SECTION BY MEDIAPLANET
HOWMEDICINAL
CANNABISHELPED
ACANCERSURVIVOR
LIVEAGAIN
For one prostate cancer survivor
with severe radiation burns,medical
cannabis offers effective pain relief.
“It affects the nerve endings
or pain that I’m having more
than it affects my level of
consciousness.”
R
adiation treatment for
Kelly Oliphant’s Stage
4 prostate cancer left
him with radiation col-
itis and cystitis. “I have,
from one hip to the
other in the front, a six-
inch belt that burns constantly,” Oliphant
explains. “It’s like having a sunburn on
the inside of your skin.One doctor related
it to having shingles.”
Oliphant endured a year-long process
of trying different pain treatments and
medications that caused unpleasant side
effects, with little reprieve from the burn-
ing pains. That was until a doctor at a Sas-
katoon cancer clinic suggested Oliphant
give medical cannabis a try.
“The effects were almost immedi-
ate,” Oliphant attests. “It dulled the pain
and numbed it off.” The pain-killing ef-
fects of medical cannabis allow Oliphant
to resume some of his regular activities,
like landscaping the garden of his home
in Battleford, Saskatchewan. “Before I
started using it, if I was to get down on
my hands and knees, I needed a cane to
get back up because the pain was that in-
tense. Now I can get back up on my own.”
Oliphant is just one of many Canadians
benefiting from the use of medical canna-
bis, helping to improve qualities of life by
delivering effective chronic pain manage-
ment. But, patients still face stigmas due
to inaccurate notions and beliefs linking
its use to the street drug.
“Everybody thought I was just going to
be a stoner and laying around,” Oliphant
says. “They’ve seen that it’s not like that at
all.”Incontrast,Oliphantisabletogoabout
his day as normal — gardening, shopping
for groceries, and interacting with the
community. “It affects the nerve endings
orpainthatI’mhavingmorethanitaffects
my level of consciousness. If I was to have
someandfiveminuteslaterIwastalkingto
you,you’dneverknow.”
The science of medical cannabis
While Oliphant chooses to vaporize his
medical marijuana, patients can also take
cannabis orally using an oil extract, which
resultsinaslowerrelease.Eitherway,med-
ical cannabis treatment works by inter-
fering with pain signals sent to the brain.
Two active chemical ingredients in medic-
al cannabis, delta-9-tetrahydrocannabinol
(THC) and cannabidiol (CBD), bind to nerve
receptors, which can help to relieve the
symptomsofchronicpain.
“Despite the stigma that still exists, for
many of our patients cannabis is a tool to
help mitigate the symptoms they feel as
a result of their condition,” shared Brent
Zettl, President and CEO of CanniMed
Ltd., one of Canada’s licensed producers of
medical cannabis. “In the majority of in-
stances, patients use an extremely small
amount of medical cannabis per day to
manage symptoms such as pain.”
In Oliphant’s case, he only requires a
half a gram per day at most, vaporized
about four or five times a day, depending
on his activity level. “If I’m outside work-
ing in the yard, I might take it a little bit
more than if I’m just sitting and watching
TV,” Oliphant explains.
For sufferers of migraines, musculo-
skeletal disorders, including arthritis, or
any conditions that cause chronic pain
thathasn’tfoundeffectivetreatmentwith
conventional medications, Oliphant en-
courages them to give medical cannabis a
try. “Don’t be held up by the stigma of it,”
hesays.“Iwoulddefinitelytellthemtotry
it for any kind of chronic pain. I’m using it
because it works. It saved me.”
Andrea Yu
SUPPORTED BY CANNIMED
For more information visit cannimed.ca
5. How Ageism
Is Robbing
Seniors of Their
Independence
A
recentreportbythe
Sheridan Centre for
Elder Research and
Revera, a company
specializing in care
and service for seniors,found that
ageism remains a pervasive prob-
lem in Canada.In fact,when asked
to identify the most tolerated form
of social prejudice in the country,
an astonishing 42 percent selected
ageism,which is more than double
that of racism (20 percent) and sex-
ism (17 percent). Furthermore, 25
percent of Canadians admitted to
treating someone differently be-
cause of their age.
Yet, the fact is that many of us
don’t even realize we’re exhibiting
ageist, harmful behaviours. Some-
times, in an effort to help a senior,
we make choices for them or as-
sist them without asking. In real-
ity,whatwe maybe doing byour so-
called helpful acts is actually rob-
bingolderadultsofthefundamental
things we all need for a full, active
life:independenceandchoice.
Retiring our stereotypes
about aging
Hazel McCallion, the 95-year-old
former Mayor of Mississauga,Chief
ElderOfficeratRevera,andChancel-
lor of Sheridan College,understands
all too well the negative effects of
curbing a senior’s independence.
“Society has created stereotypes
and prejudices about older people
— making assumptions about what
seniors want and need, assuming
they can’t think for themselves, or
even feeling that they aren’t valued.
There’s a big difference between of-
Most Canadians would be shocked to
learn that — often without even knowing
it — we are depriving our senior citizens
of independence and dignity.
feringsupportandjumpinginwhen
it’s not appreciated or needed.Strip-
ping a person of their independence
in the name of helping hurts far
morethanithelps.”
Thomas Wellner, President and
CEO of Revera, also believes we
need to change our approach to
aging.“Today,our society tends to
view aging as a slow period of de-
cline.In reality,it is another stage
of our lives that can be rich with
learning, opportunity, and tre-
mendous happiness.”
Unfortunately, many of us con-
tribute unconsciously to the nega-
tive images and stereotypes sur-
rounding aging through the way
we speak and think.As Hazel says:
“Forindividuals,weneedtochange
our thinking, and change our lan-
guage. We have to stop assuming
we know what older people want
and,quite simply,ask them.We al-
soneedtostopreferringtoagingin
a negative way — like saying we’re
having a ‘senior’s moment’ or we
‘can’t teach an old dog new tricks.’
It’s demeaning to hear those kinds
of statements.Changing ageist be-
haviours doesn’t cost a dime, and
the positive results are obvious.”
Fortunately, there are simple
steps we can all take to help com-
bat ageism.We can stop making as-
sumptions aboutwhat older adults
need and want. Seniors must also
take responsibility for how they’re
treated and not allow themselves
to fall preyto antiquated notions of
what elder adults can and cannot
do. Policy-makers and organiza-
tionsshouldensurethey’reconsid-
ering the needs of older Canadians
and help them safeguard their in-
dependence. Hazel sums up the
solution best: “It’s time for us all to
agree that ageism is getting old.”
Sandra MacGregor
Hazel McCallion, 95-year-old former Mayor of Mississauga and Chief Elder Officer at Revera and Chancellor of Sheridan College.
A SPECIAL INTEREST SECTION BY MEDIAPLANETPERSONALHEALTHNEWS.CA
6. Another
senior
momentbrought to you by
““
“
We’re challenging the perception of what it means to be a senior.
Ageism has become the most tolerated form of social prejudice. And that has to end.
At Revera, we’re challenging the negative attitudes that prevent older people from living rich,
full lives by showing just how positive aging can be.
Ageism is getting old. Let’s do something about it.
Reveraliving.com
7. A SPECIAL INTEREST SECTION BY MEDIAPLANETPERSONALHEALTHNEWS.CA
M
aureen Fleming wasn’t one
to skip out on work, but
nearly 20 years ago she woke
up and realized that going
to her volunteer position at
a Waterloo women’s treatment centre that day
was not a possibility. Fleming, who was 43 at
the time,recalls that the program coordinator
was upset, saying all Fleming had to do was
come in and sit.
“That’s all well and good,” Fleming had re-
sponded,“but I can’t get anyclothes on.”
Fleming was suffering from shingles, a dis-
ease caused bythevaricella zostervirus,which
is also responsible for chickenpox. After the
classic red, itchy blisters of chickenpox clear
up,the virus lays dormant in patients and can
be reactivated later in life as shingles, also
known as herpes zoster,causing a painful rash
and possible nerve damage.
“Everybodyis at risk for shingles,to some de-
gree,” says Dr. Peter Watson, a neurologist at
the University of Toronto and author of Herpes
Zoster: Postherpetic Neuralgia and Other Compli-
cations.“It occurs at all ages,but the risk starts
to climb at age 50 and then it’s just a straight
increase in incidence with every further dec-
ade.” According to Health Canada,nearly 3 out
of every 10 Canadians will get shingles in their
lifetime, and two thirds of those cases will
occur in patients 50 and over.
What a pain
For Fleming, it first started with a small rash
around her belly button. “It felt like hives,
itchy and painful,but it didn’t look like hives,”
she recalls. Simply wearing pants or fitted
shirts, and having the material rub against
her stomach, was too painful for Fleming. It
was more than a week before she could com-
fortably wear regular clothes again. Dr. Wat-
son explains the reason shingles cause such
searing pain is because the virus attacks the
nervous system. He adds that complications
from the disease can cause persistent pain,
vision loss or possibly loss of an eye, facial
paralysis, and even an increase in the risk of
stroke or heart attack.
The rash on Fleming’s stomach eventual-
ly cleared, but she says the nerve pain — one
of the most common side-effects of shingles
— returned. “It feels like your skin is kind of
tight,and that it’s going to crack,” she says.
The lifetime risk of this persistent pain,
known as post-herpetic neuralgia,is 30 percent
amongst shingles patients.And,because it is re-
lated to age,Dr.Watson explains the risk can be
as high as 50 percent for those 60 or older who
get shingles — and it can beverydebilitating.“It
reallyturnsapatient’slifeupsidedown,”hesays.
Avoiding shingles
While there is no cure for shingles, there is
now a vaccine that can help patients avoid
Fleming’s experience.
The shingles vaccine is approved for Can-
adians over the age of 50 and cuts the likeli-
hood of developing shingles in half.The injec-
tion, which is considered safe with minimal
side effects by Health Canada,also significant-
ly reduces the risk of complications such as
post-herpetic neuralgia.
Recognizingtheimportanceoftheshinglesvac-
cine,theOntariogovernmentisnowprovidingfree
vaccinationstopeoplebetweentheagesof65–70.
Dr.Watson says the vaccine is a much-needed
tooltohelpcombatshingles.“Havingseenmany
patients deal with this disease first hand,when
the vaccine came along, I thought, ‘thank God,
we’regoingtobeabletopreventthis.’”
Fleming’s message to Canadians is simple:
“Ifyou have had chickenpox,get the shot.”
Ishani Nath
Shingles
A Pain
That Lasts
What you can do to avoid shingles.
Dr. Peter Watson
Neurologist,
University of Toronto
8. A SPECIAL INTEREST SECTION BY MEDIAPLANET
C
ardiacarrest—whentheheartsud-
denly stops functioning — used to
mean certain death. Today, phys-
icians are able to implant small,
lifesaving defibrillators directly
into patients who are at risk for cardiac arrest to
helpresettheheartincaseofemergencies.
Implanted cardiac defibrillators, common-
ly known as ICDs,deliver a shock to the heart
when they detect an abnormal heart rhythm.
These devices are currently the gold standard
forhelpingtreatcardiacarrest—whichoccurs
anestimated40,000timesinCanadaeachyear,
according to the Heart and Stroke Foundation.
However,these devices are not built to last as
long as patients are nowliving.
“When we first started doing defibrillators
in people, we weren’t thinking of them living
for another 20, 30, or 40 years,” says Dr. Soori
Sivakumaran, an electrophysiologist and an
associate clinical professor at the University
of Alberta. “But, as cardiac therapies improve,
people are living longer.I’ve put devices inwhen
patientswereintheir70sandthey’renow90.”
Traditional ICDs
In ICDs, electric wires that connect the
defibrillator to the heart are called the leads
—Dr. Sivakumaran refers to them as “the
Achilles heel of the system.”
These leads run through blood vessels into
theheart,whichcansubjectthemtoinfections.
Dr.Sivakumaranrecentlyhadapatientwhowas
admitted with a urinary tract infection that
spread to the blood and settled on the leads of
the patient’s ICD.“So,for the infection to clear,
we had to take out the device and the leads,”
says Sivakumaran, adding that because these
leads often get attached to the veins and the
heart,removalismucheasiersaidthandone.
In addition, traditional ICDs have leads
that are prone to wear and tear over time.
“Those leads are subjected to a lot of stresses
because they’re in a liquid environment that
can seep in through the lead, and the lead is
flexing and extending with every heartbeat,so
there’s mechanical strain,” he says,adding that
once a lead is 10–15 years old, it has a higher
rate of failure.
Improved options
Dr.Sivakumaran has a patient in his early 20s
witharareheartconditionthatputshimatrisk
forcardiacarrest.Sincethepatientis young,the
doctorisoptingforadifferenttypeofICD.
A subcutaneous ICD (S-ICD) serves the
same purpose as its predecessor, but instead
of being implanted inside the heart, the leads
are run outside of the rib cage — from the left
armpit across the chest, just under the skin.
With this device, physicians do not have the
same concerns surronding risk of infection in
the heart,possible damage to blood vessels,or
whethertheleadswilllast.
“We don’t have to have the same degree of
worry we would with a standard defibrillator,”
says Dr. Sivakumaran, which is particularly
important now that patients are living longer.
“Theyoungerpatientsare,thebetterthebenefit
may be from S-ICDs, because they basically
needadefibrillatorfortherestoftheirlives.”
With patients living longer than ever before,
S-ICDsofferasolutionthat,likecardiacpatients,
cankeepongoingforyearstocome.
S-ICD With patients living longer, fuller lives, a cardiac expert
explains how new ICDs are being designed to last long-term.
The Life-Saving Device
That’s Made to Last
Transvenous ICD System Subcutaneous ICD System
The S-ICD
TM
System
Protection Without Touching the Heart
Learn more at www.SICDsystem.com
The S-ICD
TM
System
Protection Without Touching the Heart
Learn more at www.SICDsystem.com
The S-ICD
TM
System
Protection Without Touching the Heart
Learn more at www.SICDsystem.com
By Ishani Nath
