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| Sunday, 16 June 2002 |
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Features |  |
| News Business Features Editorial
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Children most at risk from environmental hazards Inadequate drinking water and sanitation, indoor air pollution, and accidents, injuries and poisonings: these are just three of the causes of the approximately 3 million deaths suffered annually by children under age five due to environmental hazards. 1.3 million children under five in developing countries died from diarrhoeal diseases caused by unsafe water supply, sanitation and hygiene in the year 2000. According to WHO's publication "Health and Environment in Sustainable Development - Five years after the Earth Summit" 60% of the 2.2 million deaths a year in children under five caused by acute respiratory infections are associated with indoor air pollution (e.g., from the burning of biomass fuels in small, confined spaces), the lack of adequate heating and/or other unsanitary living conditions. Accidental injuries - including road traffic accidents, drowning, burns and poisonings - are the cause of over 400,000 deaths per year in children under five. The lost or compromised ability to be active which children suffer from environmental degradation is vast. Yet, until recently, no specific efforts had been made to address the environmental hazards which specifically affect children. Children are not "little adults": they are in a dynamic process of growth and development, and they are particularly vulnerable to the acute and chronic effects of pollutants in their environments. For this reason, WHO created the Task Force for the Protection of Children's Environmental Health. The International Conference on Environmental Threats to the Health of Children held in Bangkok, Thailand in March this year, was the first major event to address this issue.
Diabetes mellitus Diabetes mellitus is a chronic disease caused by inherited and/or acquired deficiency in production of insulin by the pancreas, or by the ineffectiveness of the insulin produced. Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems, in particular the blood vessels and nerves. There are two principal forms of diabetes: * Type 1 diabetes (formerly known as insulin-dependent) in which the pancreas fails to produce the insulin which is essential for survival. This form develops most frequently in children and adolescents, but is being increasingly noted later in life. * Type 2 diabetes (formerly named non-insulin-dependent) which results from the body's inability to respond properly to the action of insulin produced by the pancreas. Type 2 diabetes is much more common and accounts for around 90% of all diabetes cases worldwide. It occurs most frequently in adults, but is being noted increasingly in adolescents as well. Certain genetic markers have been shown to increase the risk of developing Type 1 diabetes. Type 2 diabetes is strongly familial, but it is only recently that some genes have been consistently associated with increased risk for Type 2 diabetes in certain populations. Both types of diabetes are complex diseases caused by mutations in more than one gene, as well as by environmental factors. Diabetes in pregnancy may give rise to several adverse outcomes, including congenital malformations, increased birth weight and an elevated risk of perinatal mortality. Strict metabolic control may reduce these risks to the level of those of non-diabetic expectant mothers. Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) refer to levels of blood glucose concentration above the normal range, but below those which are diagnostic for diabetes. Subjects with IGT and/or IFG are at substantially higher risk of developing diabetes and cardiovascular disease than those with normal glucose tolerance. The benefits of clinical intervention in subjects with moderate glucose intolerance is a topic of much current interest. Symptoms: The symptoms of diabetes may be pronounced, subdued, or even absent. * In Type 1 diabetes, the classic symptoms are excessive secretion of urine (polyuria), thirst (polydipsia), weight loss and tiredness. * These symptoms may be less marked in Type 2 diabetes. In this form, it can also happen that no early symptoms appear and the disease is only diagnosed several years after its onset, when complications are already present. Prevalence: * Recently complied data show that approximately 150 million people have diabetes mellitus worldwide, and that its number may well double by the year 2025. Much of this increase will occur in developing countries and will be due to population growth, ageing, unhealthy diets, obesity and sedentary lifestyles. * By 2025, while most people with diabetes in developed countries will be aged 65 years or more, in developing countries most will be in the 45-64 year age bracket and affected in their most productive years. Diagnosis: * WHO has published recommendations on diagnostic values for blood glucose concentration. The diagnostic level of fasting blood glucose concentration was last modified in 1999. Treatment: * The mainstay of non-pharmacological diabetes treatment is diet and physical activity. * About 40% of diabetes sufferers require oral agents for satisfactory blood glucose control, and some 40% need insulin injections. This hormone was isolated by Frederic Banting and Charles Best in 1921 in Canada. It revolutionized the treatment of diabetes and prevention of its complications, transforming Type 1 diabetes from a fatal disease to one in which long-term survival became achievable. * People with Type 1 diabetes are usually totally dependent on insulin injections for survival. Such people require daily administration of insulin. The majority of people suffering from diabetes have the Type 2 form. Although they do not depend on insulin for survival, about one third of sufferers needs insulin for reducing their blood glucose levels. * Insulin is unavailable and unaffordable in many poor countries, despite being listed by WHO as an essential drug. Access to insulin by those who require it is a subject of special concern to international health agencies and national health authorities. Complications * Diabetic retinopathy is a leading cause of blindness and visual disability. Diabetes mellitus is associated with damage to the small blood vessels in the retina, resulting in loss of vision. Findings, consistent from study to study, make it possible to suggest that, after 15 years of diabetes, approximately 2% of people become blind, while about 10% develop severe visual handicap. Loss of vision due to certain types of glaucoma and cataract may also be more common in people with diabetes than in those without the disease. Good metabolic control can delay the onset and progression of diabetic retinopathy. Loss of vision and blindness in persons with diabetes can be prevented by early detection and treatment of vision-threatening retinopathy: regular eye examinations and timely intervention with laser treatment, or through surgery in cases of advanced retinopathy. There is evidence that, even in developed countries, a large proportion of those in need is not receiving such care due to lack of public and professional awareness, as well as an absence of treatment facilities. In developing countries, in many of which diabetes is now common, such care is inaccessible to the majority of the population. * Diabetes is among the leading causes of kidney failure, but its frequency varies between populations and is also related to the severity and duration of the disease. Several measures to slow down the progress of renal damage have been identified. They include control of high blood glucose, control of high blood pressure, intervention with medication in the early stage of kidney damage, and restriction of dietary protein. Screening and early detection of diabetic kidney disease are an important means of prevention. * Heart disease accounts for approximately 50% of all deaths among people with diabetes in industrialized countries. Risk factors for heart disease in people with diabetes include smoking, high blood pressure, high serum cholesterol and obesity. Diabetes negates the protection from heart disease which pre-menopausal women without diabetes experience. Recognition and management of these conditions may delay or prevent heart disease in people with diabetes. * Diabetic neuropathy is probably the most common complication of diabetes. Studies suggest that up to 50% of people with diabetes are affected to some degree. Major risk factors of this condition are the level and duration of elevated blood glucose. Neuropathy can lead to sensory loss and damage to the limbs. It is also a major cause of impotence in diabetic men. * Diabetic foot disease, due to changes in blood vessels and nerves, often leads to ulceration and subsequent limb amputation. It is one of the most costly complications of diabetes, especially in communities will inadequate footwear. It results from both vascular and neurological disease processes. Diabetes is the most common cause of non-traumatic amputation of the lower limb, which may be prevented by regular inspection and good care of the foot. Prevention: Large, population-based studies in China, Finland and USA have recently demonstrated the feasibility of preventing, or delaying, the onset of diabetes in overweight subjects with mild glucose intolerance (IGT). The studies suggest that even moderate reduction in weight and only half an hour of walking each day reduced the incidence of diabetes by more than one half. Diabetes is a serious and costly disease which is becoming increasingly common, especially in developing countries and disadvantaged minorities. However, there are ways of preventing it and/or controlling its progress. Public and professional awareness of the risk factors for, and symptoms of diabetes are an important step towards its prevention and control. WHO Fact Sheet Radiation protection in Sri Lanka by Kapila de Silva Nuclear Technology is used for numerous purposes in Sri Lanka. The Atomic Energy Authority (AEA) established by an Act of Parliament in 1969 functions as the National Regulatory Authority for protection from ionization radiation. The main responsibility of the AEA which comes under the purview of the Ministry of Science and Technology is the protection of the public, radiation workers and the environment from undue exposure to ionizing radiation. As such the AEA has promulgated regulations on radiation protection and radiation protection activities are carried out by the Authority in accordance with these regulations. Regular inspections are carried out by the inspection team of the Authority at places where radioactive materials and irradiating apparatus (X-ray machines, C.T. scanners, Gamma Cameras etc.) are used. During these inspections it is investigated whether the authority can be satisfied with the activities carried out at these places, and whether internationally accepted standards are maintained. Thus by carrying out these inspections the AEA ensures that radiation workers as well as the general public are not over exposed to ionising radiation. The AEA provides a personnel monitoring service to monitor the
radiation doses received by workers who are occupationally exposed to
radiation. The AEA ensures that exposure levels are within the
internationally recommended levels. Rapid diagnosis of Dengue Fever An IAEA funded project title "Rapid Diagnosis of Dengue Virus Infection" using a RT-PCR dot-blot hybridization assay is in progress with the co-ordination of the Atomic Energy Authority. The counterpart institutions are Department of Virology of the Medical Research Institute, Department of Chemistry of the University of Colombo and Department of Parasitology at the University of Kelaniya. The objective of the project is to establish a rapid detection technique for laboratory diagnosis of dengue virus infections and to detect the strain differences of dengue viruses in Sri Lanka. This technique was initially established at the University of Colombo and subsequently transferred to the medical Research Institute (MRI) Colombo. Serum samples of fever cases from the government hospital in Colombo and its suburbs are to be screened by the RT-PCR dot-blot hybridization assay after it is fully established at the MRI. The fundamental principal of applying the PCR in diagnostic medicine is that if a given DNA fragment is present, it will be multiplied by, perhaps, a million fold through the reaction, yielding so much of the substance that it can be detected easily. By this process millions of copies of the original DNA fragment can be made in as little as one hour. This is a very sensitive and specific method, requiring only a small sample of blood. The advantage is that the amplification permits accurate detection of very small numbers of pathogens, such as present in early cases of dengue. It is possible to detect infection much earlier than with conventional methods, there by improving the management of dengue natients and reducing fatalities. Nuclear News
Clear thinking and psychology Many theorists believe that emotions or motives cloud people's thinking. Freud for example, believed that sexual motives bend and shape people's thinking. Psychologists maintain that lack of training in clear thinking rather than emotions, is what hinders thinking. People must continuously make judgements about each other. They must make decisions about others, characteristics e.g. Age, sex, occupation personality, and so forth. In thinking through such judgements people ideally ought to use the same rigorous standards that are used by scientists. However, because people can't make exact tests and carry out complex statistical procedures on an intuitive level, they often make errors in thinking. Let us consider two strategies that people use in making social judgements. First is the availability bias. People generally rely on their immediately available memories in making judgements. They don't take careful accounts of all instances, as scientist might, but instead simply rely on what at the time is available in the memory. More formally, they use an available 'heuristic', or habit of solving problems. To illustrate, suppose you were asked whether your mother is a nurturant person. To answer this question as a scientist you would want an accurate record of all your mother's actions over time. This information would enable you to make a precise statement about your mother's character. Of course no one has such records. All that usually is available are scattered memories, and these may change with circumstances. Thus, if you were asked about your mother's nurturance on a day that happened to be your birthday and your mother had forgotten your birthday, your available memories probably would be unfavourable to your mother. On another day, when she was more motherly, your memories might be different and you might give a much different answer. The availability bias would have caused you to make errors in judgement. A second faulty strategy of thinking is false consensus bias. People tend to see their own actions as being relatively normal, appropriate, and in consensus with others, while viewing others who behave differently as being odd or deviant. For example, parents who batter their children may be more likely to see such action as being normal than parents who don't. Neither group has an accurate and reliable count of the incidence of child abuse in the society. People can get through life quite successfully despite these faulty patterns of thought. However, a person who knows about them may be somewhat cautious in making social judgements. Dr. R.A.R. Perera, Consultant Psychologist, Police Hospital. |
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