Health consequences of noise exposure

Anew release sent to us on health consequences of noise exposure by the Asia Pacific Regional Headquarters of Siemans Medical Instruments states that exposure to not only can cause headaches, fatigue elevated blood pressure but also found to affect a child’s learning and even could affect an unborn child in the womb.

The release which is of educative value to the parents, and the public in general states.

Noise is harmful to more than just the auditory system. It can stress the circulatory, respiratory and digestive systems as well. Continued exposure to noise can cause headaches, fatigue and elevated blood pressure. Noise has also been shown to interfere with children’s learning and can even affect an unborn child.

Hearing loss due to noise exposure is common and is difficult to distinguish from hearing loss due to old age.

In some cases the noise damage is due to a single, very loud impact type noise (e.g. explosion). In this case the loss is immediate and usually incurable.

In other cases the hearing loss is due to less intense, but continuous loud sounds (e.g. machinery). The loss accumulates over time, and since there is no pain, may pass unnoticed at first.

Noise induced hearing loss

* Often Painless

* Often unnoticed

* Gradual, but real

* Permanent

* Preventable

Pain is rarely associated with hearing loss from noise unless it is from a sudden very loud impact noise. The damage normally occurs slowly and you may be unaware of any changes in your hearing for several years.

When you lose your hearing from excessive noise you cannot bring it back. However you can prevent it from occurring in the first place. There are some danger signals that may alert you to noise levels that can be damaging to your ears.

Current exposure to noise can have a temporary effect often accompanied with ringing in the ear. This may recover overnight. However if the exposure is prolonged and repeated, damage then occurs to the sensory cells and leaves blank areas which no longer respond to certain pitches of sound. Therefore misunderstandings when listening to speech arise.

Danger signals

* Ringing or buzzing in the ears during or after noise exposure

* inability to carry on a normal conversation because of excessive background noise

* Speech of others sounding muffled or unclear

When you notice these signals, your hearing may be at risk.

The safe exposure limit is up to 85dBA over 8 hours. For every 3dB above this level the exposure time is halved. A disco can be over 100dBA so the safe exposure time is only 15 minutes! Care should be taken to identify situations that may be potentially dangerous to your hearing so that the necessary precautions can be taken BEFORE damaged is caused.

Protect your ears in all noisy situations. Consult your ear specialist if you notice a problem with your ears or your hearing.

Cross cutting issues influencing health

Most medical schools in Sri Lanka have made a tremendous effort to present to students, a student centred, problem based, integrated, community based and system based curricula with emphasis on personal and professional development and the development of behaviourial and generic skills.

Have we forgotten something as we went down this path? How good or bad is the knowledge and awareness of undergraduates, postgraduates and practicing doctors, about cross cutting issues which influence health?

The June 2008 Final MBBS Paediatrics paper of the Faculty of Medicine Colombo had the following question.

The world faces a food crisis. This could significantly effect the nutritional status of children. Mention the most vulnerable age group of children that would be affected by this crisis in Sri Lanka, Give reasons.

Suggest measures to reduce the impact of this problem in your MOH area.

We congratulate the Paediatrics Department on this question and look forward to hearing how students responded to it. Several other cross cutting issues come to mind which undergraduates, postgraduate and CPD programmes could focus on. E.g.

Some cross cutting issues

* Global warming and its health effects

* The economy of the country

* Health and social effects of alcoholism

* The problem of substance abuse in Sri Lanka

* Values perceptions and services regarding the disabled and children with special needs.

* Dealing with the problems of malnutrition and under nutrition.

* Food safety

* Patient safety

* Gender issues.

* The problem of violence in the society

* The problems of refugees and internally displaced persons.

* Poverty and health

* Mental well-being

* Health problems of an ageing population

* The Millennium Development Goals

* Ethical and professional practice

* The environment and health

It is an accepted truism that assessments guide learning. it is also a fact that when seminars are held on these important issues, attendance is poor because undergraduates and postgraduates do not expect that examination papers will have questions set on them and practicing doctors seldom perceive any direct relevance of these issues and concepts to their everyday practice.

May I suggest to all Faculties of Medicine and the PGIM that at least one question or a part of a question is set on these and other cross cutting issues at every written examination and to Colleges and the SLMA that CPD programmes include workshops and seminars on them and the award of generous CPD points to participants. Undergraduates, postgraduates and doctors may them be motivated to attend them.

A web based interactive Certificate Course is also possible if a medical education unit or the PGIM or the education committee of the SLMA are willing to take up the challenge.

Courtesy SLMA News

Red meat primes body for intestinal germ: study

Asteady diet of red meat makes the body more susceptible to a virulent form of intestinal bug that can cause bloody diarrhoea and even death, according to a study to be published on Thursday.

Researchers in the United States and Australia said persistently eating red meat appears to prime the body for exposure to this potent form of Escherichia coli (E. coli).

The meat naturally contains sugar molecules called Neu5Gc that accumulate in cells lining the intestines and blood vessels.

These molecules also act as a sort of magnet for the toxins exuded by the E. coli strain, thus making it easier for the poisons to enter the blood stream, they said.

“Prior meat eating would set one up for the toxin to bind when it shows up,” explained Ajit Varki, a researcher at the University of California at San Diego, one of the study’s co-authors. The Neu5Gc molecule is virtually absent in other foods such as fish, poultry and vegetables and fruits, Varki told AFP in an email exchange.

The investigation, published in the London-based journal Nature, is led by Travis Beddoe of Monash University in Melbourne.

In experiments, the team first tested the affinity of the E. coli bacteria for Neu5Gc using cultured human cells in a lab dish.

“The human samples showed the presence of the Neu5Gc toxin binding sites in the gut and the kidney, the two target organs for the disease,” said Varki.

The researchers then confirmed the positive results using genetically modified mice in which the gene which naturally produced Neu5Gc was suppressed.

E. coli is found in the lower intestine of animals and humans. Many of its strains are harmless, but others can cause serious, sometimes fatal health problems. There are about 75,000 cases of E. coli-related to food poisoning every year in the United States, including an average of 60 fatalities, according to the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. Most outbreaks have been traced to undercooked ground beef tainted with faecal matter post-slaughter.

E. coli can also be transmitted through unwashed vegetables grown in farmland irrigated by sewage-contaminated water.

AFP

Laughter The Best Medicine

A doctor got a call one night from a man, whose wife he had operated on about 2 years ago, removing her inflamed appendix.

The man told the doctor, that he felt his wife was having appendicitis and needs an operation. The doctor replied, whoever heard of a second appendix, because he had removed her appendix about 2 years ago.

The man replied “Doctor you may not have heard of a second appendix but surely you have heard of a second wife. I am sure.”

HealthWatch/Apollo health education programme - 1st talk

A

ustralian qualified clinical Embryologist Dr. Madara Ralapanawa (MD Master in Clinical Embryology, Australia), the head of Colombo Apollo Hospital’s recently opened Fertility Centre with up to date clinical and laboratory facilities to help childless couples get children through IVF (In-Vitro Fertilisation) technique has agreed to give a talk to interested couples on this IVF also called ‘test tube babies’ shortly.

The talk will be at the Apollo Hospital auditorium. Date and time will be announced in this page next week. Dr. Ralapanawa prefers to base his talk on your questions on IVF or ‘test tube babies’ as we commonly identify this procedure. So please send your questions to HealthWatch and we will send them to the doctor. This will be the first health education programme, we are organising in association with the Apollo Hospital.

Other health topics

Also please write to us about other health topics which you would like Apollo Hospital doctors to talk about under our Daily News/Apollo Health Education Programme.

Depression in children

Dr. Ruwan M. Jayatunge

Depression is a mood disorder which can affect adults as well as children. In general terms depression is an overwhelming feeling of hopelessness, sadness and lack of self-worth. It is more than a sad feeling. Depression is common among adults. Unlike adults childhood depression is difficult to distinguish.

They often express their feelings through behaviour. Depression affects child’s overall energy, mood, expressions of emotion and behaviour.

According to the British experts at least two per cent of children under 12 struggle with significant depression, and by teenage years this has risen to five per cent. Following the geopolitical and economic conditions in Sri Lanka a significant number of children are affected by childhood depression. Most of these cases are undiagnosed and not receiving adequate treatment.

Depressed children have prolonged anhedonia (the inability to experience pleasure), hopelessness, and failure to experience an increase in mood in response positive events and sometimes have inattentive features similar to Attention Deficit Hyperactivity Disorder or aggressive behaviour similar to Conduct Disorder. The affected children are mostly alienated and they often have learning difficulties due to difficulty in concentrating and impaired memory.

Reasons for depression in children

Genetic factor: the family history of depression

Adverse life events (maternal or paternal deprivation, death of a close family member)

Childhood trauma (child abuse, witnessing traumatic events)

Excessive social demands (exam stress, academic failure)

Physical illnesses (depressive episodes in post viral fever, thyroid hormonal imbalance)

Symptoms and behaviours associated with depression in children

Crying, feeling sad, helpless or hopeless

Feeling discouraged or worthless

Loss of interest or pleasure in others or most activities

Fatigue and loss of energy nearly every day

Bad temper, irritable, easily annoyed

Fearful, tense, anxious

Repeated rejection by other children

Drop in school performance

Inability to sit still, fidgeting or pacing

Repeated emotional outbursts, shouting or complaining

Doesn’t talk to other children

Repeated physical complaints without medical cause (headaches, stomach aches, aching arm or legs)

Significant increase or decrease in appetite

Change in sleep habits

Suicidal thoughts, feelings or self-harming behaviour in children

As a result of childhood depression serious and critical symptoms such as suicidal ideation and deliberate self harm can be seen among the affected children. According to the International Journal of Adolescent Medicine and Health (2008) the summarized report findings from 13 nations indicate that there may be a link between bullying and suicidal ideation in children and adolescents. Depressed children have a risk of committing suicide.

Risk factors for development of childhood depression

There are number of risk factors associated with childhood depression. Personality traits - characteristics that influence reactivity to stress play a major role in development of depression.

Children who lack social skills, problem solving skills often shattered by lie stress and easily go in to depression. Lacks of family cohesion, expressiveness, organization too negatively affect the child’s overall mental health.

Parental life philosophy too plays a major role. Negative views of self, the world and one’s future, devaluation of the child’s abilities, excessive criticism can lead to depressive feelings in a child.

Repeated physical, emotional or verbal abuse at home or school could be a vital risk factor.

Treatments in childhood depression

Medication and psychotherapy are foremost treatment modes in depression. Many Physicians use SSRIs (Selective Serotonin Reuptake Inhibitors) to treat childhood depression. Frequently medicating is combined with psychotherapy. A variety of psychotherapeutic techniques have been shown to be effective in childhood depression. CBT or Cognitive Behaviour Therapy helps to correct negative thought patterns and erroneous negative assumptions. CBT encourages the child to use positive coping behaviours.

Social skills training are important in childhood depression since the affected children lack social skills. The children are thought initiating conversations, responding to others and transforming in to positive communication style. Some therapists use Interpersonal Therapy which is focused on relationships, social adjustment and mastery of social roles.

The recent research in USA and Europe indicate that EMDR (Eye Movement Desensitization and Reprocessing) is effective in treating childhood depression. EMDR (Eye Movement Desensitization and Reprocessing) is a much easier and less painful process than traditional therapy for resolving depression and trauma. EMDR is an information processing psychotherapy that was developed to resolve symptoms resulting from disturbing and unresolved life experiences.

It uses a structured approach to address past, present, and future aspects of disturbing memories.

Visual disability a cause for depression too

Cosultant OphthalmologistDr Upali Mendis

speaking on-Evidence Based Diagnosis of Glaucoma at the 17th annual sessions of the Sri Lanka College of Opthalmologists held at Hotel Taj Samudra in Colombo last week said, that some people wait till visual becomes very weak to consult a doctor about it without knowing, that it is a controllable glaucoma conditioned disease if treated at the early stages, which could save the person going into blindness suffering injuries in falls, road accidents and sometimes leading into bouts of mental depression.

He was making this year’s Dr. Sivasubramanium memorial oration”.

Speaking further he said, very often doctors detect this glaucoma condition when people go to them for glasses and are examined for vision defects. Here when the doctors suspect the person for glaucoma condition.

The doctors do what is called the fundus examination to test intra ocular pressure for confirmation of the glaucoma conditions. There are also cases where doctors finding it difficult to based the glaucoma condition on results of the intra ocular pressure alone. Carryout, the optic disc examination tests, and visual field examination tests.

These visual field defects appear when about 30 percent of the nerve fibre in the retina are affected.

Glaucoma is a chronic life long disease and the patient may become blind without appropriate treatment.

Recognition for Centenarian Study

Daily News Healthwatch-associated Prof Colvin Gooneratne Centenarian Study is to be awarded recognition and commendation at the World Congress Integrated Medicine at BMICH this Friday Nov 7.

Prof Gooneratne will be speaking on the initiation and progress of the Centenarian Study, along with other speakers as well. Chairman of the Congress will be Dr Geethanjan Mendis.