Parents commend HealthWatch:

School bags on health study gets under way

HealthWatch initiated 'Schoolbag on health issue' with the participation of Apollo Hospital in Colombo got under way last Sunday with a group of parents who assembled at Apollo auditorium to discuss the issue with the HealthWatch Apollo School Bag Committee (HASBC) undertaking to collect the preliminary data from students for the study proper.

This is to be done by getting the students to fill up a questionnaire prepared by the HASBC, which the parents agreed to get done within two weeks.

Teachers don't stick to time table

At the discussion most of the parents placed the blame on school bag weight problem on the teachers, whom they said never stick to the day's subjects mentioned in the time table, and want the students to bring all the text and writing books every day.

This leaves the children with no choice but to pack all their books into the school bag which, leave alone the students, even the parents sometimes find difficult to lift, and carry to school and back day in and out.

Camel look

One parent interjecting - "Excuse me, I was listening to a programme in the All India Radio recently on this same subject, where a listener aptly described the picture of a student going to school with a heavily loaded school bag on his back as a humped camel walking.

"That's very true", responded all at the meeting. The heavily laden school bag being the hump.

Thick monitors exercise books adds to weight

Besides the time table not being followed, another factor contributing to the weight, the parents said was the insistence on the part of the school authorities that the writing should be all done in thick monitors exercise books.

Parents said they could not think of any valid reason why the normal 40 and 80 paged exercise books could not be used for writing, as they (the parents) did when they were schooling.

The parents said they could not see any difference in taking down notes in a normal exercise book and a monitors exercise book, as far as studies are concerned.

Teacher demonstrates

A teacher conducting computer classes, attended the meeting with two students, got the students to demonstrate how he taught them to lift school bags correctly in the scientific way, with weight getting distributed equally on the body. He said that way he was trying to meet this problem even in a limited way.

Only one tenth of the body weight

Dr. Dhillon told the parents, normally a person should not carry any weight more than 1/10 of his or her body weight.

This applies mostly in the growing years in a person's life.

If we weigh the school bags children are carrying today in relation to their ages, we will find that in ninety per cent of the cases they violate this standard. Consequently there is the risk of them being subjected to many health problems in later life.

Regulations on school bags

In New Zealand and in California there are Federal regulations governing the manufacture of school bags, to ensure that students carry weight in relation to their age and weight to school. Such regulations have not yet come to countries in this part of the world.

Educating parents, teachers, students and authorities

Dr. Dhillon said in this school bag issue, we have to educate both parents, teachers and students, and even the state authorities concerned. This is not something that could be done in a hurry. Scientific data has to be gathered first, in relation to the problem in this part of the world, which we don't have at the moment.

He was glad that the parents who had come in response to the school bag committees invitation to discuss the issue, were all keen to help in this task.

Such cooperation was most valuable in tackling the issue. He said the committee at the two earlier meetings it had had prepared a questionnaire to be answered by students, which will give some data on the problem.

Parents undertook to get the questionnaire distributed

Parents who came for the meeting were given copies of the questionnaire which they undertook to distribute among schoolchildren, get their responses, and return to the School Bag Committee within two weeks.

Holy Family and Methodist College

Two of the parents who attended the meeting, whose children were attending Holy Family and Methodist College, said that in the primary section of these two schools some attempt is being made to find a solution to this problem by providing lockable desks for the children who leave their books in the desks, and take home only the ones needed for home work. That way the bags were not heavy.

Parents commend

Parents expressed their appreciation and gratefulness to the Daily News HealthWatch for taking up this issue in collaboration with the Apollo Hospital, Colombo and to Doctors Dhillon, Dennis Aloysius, Githanjan Mendis in the committee and the committee coordinators Chammika de Silva (Apollo) Edward Armabewala and Anjalie Garnier of Daily News HealthWatch and Features Desk for all the hard work being done in getting up this issue and keeping it going.

School Bag Committee comprise Dr. Dennis J. Aloysius (Family Physician and Member HealthWatch Medical Advisory Panel) Chairman, Dr. Mandeep S. Dhillon (Consultant Orthopaedic Surgeon, Apollo) Co-Chairman and Dr. Githanjan Mendis (Consultant Neurologist, and Sports Medicine Unit head, Ministry of Sports) and Committee Coordinators Chammika de Silva (Marketing Manager, Apollo) Edward Arambewela (HealthWatch) and Anjalie Garnier (Sub-Editor HealthWatch Daily News.

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Irrational drug use a serious problem

Health Action International Asia Pacific (HAI) in a study had found that over 50 per cent of the medicines used in the world are inappropriately prescribed, dispensed and sold.

HAI in an article on this subject to the HealthWatch says:

Rational drug use means patients receiving medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community.

We find more than 50 per cent of all medicines worldwide are prescribed, dispensed or sold inappropriately, while another 50 per cent of patients fail to take them accordingly. This is irrational drug use.

Poly pharmacy (the use of too many medicines per patient), inappropriate use of antimicrobials, often in inadequate dosages for non-bacterial infections, over use of injections when oral formulations would be more appropriate, failure to prescribe in accordance with accepted clinical guidelines, inappropriate self medication are a few common instances of irrational use.

A few causes of irrational drug use:

* Irrational prescribing practices of doctors

* Dispensing by pharmacists and drug sellers

* Drug pricing policies and promotional activities of the pharmaceutical industry

* Lack of information, education and communication on rational drug use to providers and consumers

* Lack of effective control and regulatory mechanisms on drug use and

* Lack of political will and leadership to promote rational use.

The consequences of this malpractice would not merely deprive the patient of the full benefits of available drugs leading to poor patient outcome but would also result in ineffective treatment, harmful effects and adverse reactions thereby increasing the household and government drug/health expenditures, morbidity and mortality rates, antimicrobial resistance giving away to expensive newer generation antimicrobial treatment and non-sterile injection use transmitting blood borne infections like Hepatitis B and HIV/AIDS.

The following steps have to be taken to correct this problem

* A mandated multi-disciplinary national body to coordinate medicine use policies

* Develop and implement a comprehensive National Drug Policy (NDP), based on the Essential Medicines Concept, as a part of the national health policy.

* Establish transparent procedures for developing, disseminating, utilizing and revising national Standard Treatment Guidelines (STGs) with updated drug price information.

* Establish procedures for developing and revising an Essential Drug List (or hospital formulary) based on STGs and use in practice, training and supply.

* Require hospitals to establish representative Drugs and Therapeutics Committees (DTC) with defined responsibilities for monitoring and promoting quality use of medicines

* Establish a national/regional drug information centers to disseminate independent medicine information and to track after complaints on adverse effects or problem drugs.

* Encourage active involvement by consumer organizations in public education about drugs, and devote government resources to support these efforts

* Implement an appropriate and enforced regulation Authority backed up by the judiciary.

* Develop a strategic approach to improve prescribing in the private sector through appropriate regulation and long-term collaborations with professional associations

* Establish systems to monitor key pharmaceutical indicators routinely in order to track the impact of health sector reform and regulatory changes

Sufficient government expenditure to ensure availability of medicines and staff at any time

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Fast food consumption causes obesity and Type II diabetes

by Dr. D. P. Atukorale

Frequency of obesity has risen at an alarming rate in all age groups in all the developed countries such as USA and UK and this epidemic of obesity is fast spreading to urban and suburban areas of developing countries like Sri Lanka.

In USA, the age adjusted prevalence of obesity defined as a body-mass index (BMI) 30 kg/m2 or greater was 30.5% in 1992-2000 compared with 22.9% in 1988 - 1994.

About 2 of every 3 U.S. adults, 4 of 5 African - American women were overweight or obese in 1999 - 2000. In USA, in children and adolescents, the prevalence of being overweight rose by 50% in the past decade to about 15% and this epidemic of obesity is fast spreading to urban and suburban areas of Sri Lanka.

The medical and economic outcomes of excessive bodyweight are great. One particularly ominous public health issue as a result of obesity is the occurrence of glucose intolerance and type II diabetes in obese adolescent and young adults.

The epidemic of obesity can be attributed to environmental factors affecting diet or physical activity level (lack of exercise).

One potentially important dietary factor for obesity is consumption of fast food which can be defined as convenience food purchased in self-service or carry-out eating places. In the urban and suburban parts of Sri Lanka fast food consumption has increased by leaps and bounds during the last decade.

In USA, fast food has grown into a dominant dietary pattern with a current estimate of 247115 restaurants. The consumption of fast food by USA children has risen from 2% of total energy in the late 1970 to 10% of energy in the 1990s.

Several factors inherent in fast food as it now exists could promote a positive energy balance and thereby an increased risk of obesity and diabetes including excessive portion size with single large meals often approaching or exceeding individual daily energy requirement.

Palatability emphasizing primordial taste, preferences for sugar, salt and fat, high energy density and high glycaemic load might also enhance risk of diabetes through energy - independent mechanisms.

With a view to investigate the association between reported fast food habits and changes in body weight and insulin resistance over a 15 year period in young black and white adults in USA, Mark A. Pereira et al studied 3031 young (age 18-30 years in 1985-86) black and white people who were followed up with repeated dietary assessment.

After adjustment for life-style factors, it was found that baseline fast food frequency was directly associated with changes in body weight. Changes in fast food frequency over 15 years was also directly associated with insulin resistance in both black and white people.

People who visited fast food restaurants more than twice a week gained an extra 4.5 kg of body weight and had a two fold increase in insulin resistance.

The researchers concluded that fast food consumption has a strong positive association with weight gain and insulin resistance suggesting that consumption of fast food increases the risk of obesity and type II diabetes.

In Sri Lnaka too, as the habit of fast food consumption is increasing in our urban and suburban areas, as our obesity and diabetes in adolescents and young adults is increasing, it is high time that our health educators epidemiologists, physicians and dieticians carry out a survey of obesity type II diabetes and fast food consumption.

Reference: Mark A. Pereira, Lancet, 2005:365; 36-42.