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Sunday, 1 July 2012





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Self-harm, a growing trend among youth

Maryam* was a beautiful girl, had a good academic record, shone in sports and came from a middle-class family. Loved by her friends and teachers, she was the star at school having won several accolades. But everyday, there were cuts on her arms and wounds that were visible even on her legs. Nobody knew what was going on but it was evident that she was cutting herself but she was hiding her problems without talking to anyone.

Self-injury is not a new trend in Sri Lanka and it still affects a considerable proportion of the population, at some point in their lives. While some get over it, there are many who suffer in silence and still continue to mutilate themselves.

In Sri Lanka, the condition of “teenage cutting”, self-mutilation, self-harm or self-injury is not properly understood. While a doctor might treat a teenager for a wound or an injury, there are signs that show if a wound has been accidental or intentional.

Many people have been successful in hiding their injuries so they cut themselves in places where it is not visible but what they should know is physical wounds might heal but mental scars will never fade. They also say it is accidental and do not know that there are ways of determining how a cut is made when it is self-made.

More often than not, a doctor might ask the teenager if they have depression or any other ailments, but since teenagers often consult a doctor with their parents, the injury will be treated and not followed up. Also, parents tend to influence doctors saying that teenagers have no problems but do not realise (or do not accept) that there might be issues beyond just the self-inflicted wound.


At present, Sri Lanka does not have the statistics with which to determine the number of self-injury cases. Even though we have specialised units dealing with abuse and teenage pregnancy, there is no such hospital dealing with self-injury especially pertaining to the youth.

However, an international expert, Dr. Marcel de Roos, a psychologist with a PhD from Holland has been doing research and treating such cases. Practising in Sri Lanka for three years now, Dr. Roos said, “I have successfully treated about 15 cases of teenage self-injury by not just giving them anti-depressant drugs but talking and counselling them.”

The doctor said that self-harm or self-mutilation can consist of any form of trying to hurt oneself. “I have seen cuts not only on the arms and wrists but also side cuts on the neck and thighs. There have been one or two cases on the belly as well,” he said.

According to him, there are no exact figures of the prevalence of self-harm, but he sees it as a growing condition which is turning into a disease.

“In Sri Lanka, the culture is such that nobody talks about it in the open and problems at home are supposed to be kept at home and not divulged to anybody.

If outsiders know about it, they don't interfere or because they don't want to get into trouble,” said the doctor. He said that sorting out problems at home is good but more often than not, there have been cases of abuse, violence or pressure from family members which drives teenagers to turn to self-harm as a mode of escapism. There are teenagers with problems who turn to alternative forms of self-harm such as drinking alcohol and smoking because they use such habits to escape their problems.

Such experiences could have been associated with neglect, humiliation or the loss of loved ones and a lack of self-esteem is formed and it becomes difficult to express their feelings, especially with others.

Besides abuse, low self-esteem is also a problem which stems from past issues and gives the teenager equal amount of pain when they can't deal with the problem. Dr. Roos said that there are teenagers who lead a good life at home with loving parents but if they are bullied in school or are in love with someone they cannot have, they might cut themselves because they think there is nobody to talk to or nobody will listen. Often they even hide their problems from their friends unless someone comes up to them and tries to talk to them.


“For the teenager, when the emotional pain is too much to handle, they cut themselves because physical pain is easier to deal with than mental agony. They feel helpless or depressed which drives them to cut themselves,” said Dr.Roos. According to experts, there is distribution among the genders of teenagers who injure themselves. It is known that men often engage in different forms of self-harm (predominantly hitting themselves) than women (predominantly cutting themselves). Loneliness is also another reason why teenagers would cut themselves.

“During adolescence, teenagers will want to shut themselves out from the rest of the world, talk less to their parents and try to be close to their friends. They think their friends are right and if led astray, it can have deadly consequences,” he said.

The problem in Sri Lanka is that parents are not aware of this condition to determine what is going on. There are different levels of society where people have to be educated and find what is wrong and what is right. Often they are concerned about the well-being of their children, but they might not see the warning signs.

“In helping their children, parents should talk and listen to their child. Parents might have a certain perception but for teenagers it might be something entirely different,” he said. Dr. Roos said that children should have trust in their parents and shouldn't treat their family members as the enemy but should be friends. He said, “When your child trusts you enough, she will open up and tell her story. If necessary, parents should look for psychological help.”

Dr. Roos said that if counselling is needed, go to the right people because doctors might only tell the teenager to take pills to stop depression but this doesn't solve the problem. So it is best to tackle it from the root cause and tell the teenager that they can always talk about anything that is bothering them.

He said, “Try to be there for your teenager and don't judge them if they come out with some startling revelations. Just take your child seriously and look for a way to help deal with the problem together.”

In Sri Lanka, the pressure from parents as the teenager to perform academically is a big issue and also, during consultations, the parents sit in with the child.

“I usually talk to the parents and with their permission, sit with the teenager and ask them personally what is going on and then the truth comes out,” he said.

The teenager needs reassurance and this is more than just keeping blades, knives and scissors away from them. Adolescence is the most important time in a teenager's life and there will be obstacles so dealing with it, getting help and knowing.

Before practising in Sri Lanka, Dr.Roos said he saw the same problem among models when he was in Holland. “It is a difficult thing to see, beautiful girls with everything they could wish for, falling prey to self-injury because they aren't happy with themselves,” he said.

Dr. Roos said, “When in therapy the whole personality should be taken into account and not only just the physical signs of cutting.”


He said that therapy and recovery process can take a long time in a teenager to heal but finding alternative methods of coping with the feelings of anxiety or stress or “numbness” is often a good start.

“Dabbling in other hobbies and stimulating the mind to do other things instead of wasting time on such negative emotions is good for the teenager.”

Also channelling the energies into a sport such as tennis or going to the gym will help the teenager deal with the pain better instead of looking at hurting themselves. Dr. Roos said, “However, the real change has to come from within, which means that the teenager understands that she has every reason to feel angry and hurt.

That she starts to understand why she feels guilty, ashamed or powerless. That she can cry and feel her hurt and that the feeling of hurt will slowly ebb away.

That she has the right to exist and be herself.”If you're a teenager, take heed and ensure that if you or a friend has a problem, deal with it the proper way.

We should be happy and love ourselves because we have been given a beautiful body and a lovely life so we should not waste or ruin it.

*Names changed to protect identities


[The types of self harm]

Self-mutilation was a non-fatal expression of an attenuated death wish and thus coined the term partial suicide. In 1938, Karl Menninger refined his conceptual definitions of self-mutilation. His study on self-destructiveness differentiated between suicidal behaviours and self-mutilation. These are classified as follows:

* Neurotic - nail-biters, pickers, extreme hair removal and unnecessary cosmetic surgery.

* Religious - self-flagellants and others.

* Puberty rites - hymen removal, circumcision or clitoral alteration.

* Psychotic - eye or ear removal, genital self-mutilation and extreme amputation organic brain diseases – which allow repetitive head-banging, hand-biting, finger-fracturing or eye removal.

* Conventional - nail-clipping, trimming of hair and shaving beards.


Detecting streptococcal infection in newborns

A more accurate, faster diagnostic test for Group B Streptococcal infection in babies has been reported in the *Journal of Medical Microbiology*. The new test could allow better treatment and management of the disease and reduce the risk of mortality among newborns. Group B streptococcus (GBS) infections, caused by the bacterium Streptococcus agalactiae, are the most common cause of meningitis, septicaemia and pneumoniain newborns. In 2010 there were 506 cases of GBS infections in infants across England, Wales and Northern Ireland.

Health researchers have developed a novel test that accurately detects whether the GBS bacterium is present in samples of blood or spinal fluid in less than two hours. It detects the presence of the cylB gene in S. agalactiae, which is an important disease-causing factor. GBS bacteria live harmlessly in the female genital tract of women and are carried by 20-30 p.c. of pregnant women.

The bacteria can also form part of normal skin and gut flora. GBS can be transmitted from mothers to newborns during delivery.

1-3 p.c. of infants who become colonized with the bacterium go on to develop blood infections within their first week of life, which can be fatal. Lead Author, Dr Aruni de Zoysa, Senior Scientist at the Streptococcus reference Unit who developed the new diagnostic test believes that this test should have a positive impact on management of GBS infections in babies.

“If we can allow clinicians to diagnose GBS infection quickly and accurately, this will mean antibiotic treatment can start sooner. Better management of the disease in this way should reduce the risk of mortality,” she said.

Dr de Zoysa explained that the new test has a number of advantages over traditional methods for detecting GBS infection. “Currently, GBS infection is only able to be diagnosed by taking blood samples and waiting for the bacteria to grow in the laboratory, which is time-consuming and can sometimes be unreliable,” she said.

“Our new test, although still in the early stages of development, is an invaluable tool that is based on detecting DNA, which makes diagnosis far more accurate and allows us to get results much faster.” The assay also uses very small sample volumes, which is an advantage particularly for newborns.

“As there is no vaccine at present for GBS, rapid and accurate detection of GBS bacterium is crucial to reduce the risk of infant deaths from GBS infection,” stressed Dr de Zoysa


Neuronal stress linked to Alzheimer's disease

A link has been found between brain insulin resistance (diabetes) and two other key mediators of neuronal injury that help Alzheimer's disease (AD) to propagate. The research found that once AD is established, therapeutic efforts must also work to reduce toxin production in the brain.

Alzheimer's disease is one of the most common degenerative dementias, and more than 115 million new cases are projected worldwide in the next 40 years. There is clinical and experimental evidence that treatment with insulin or insulin sensitiser agents can enhance cognitive function and in some circumstances help slow the rate of cognitive decline in AD.

Alzheimer's and other neurodegenerative diseases destroy the brain until the patients finally succumb. To effectively halt the process of neurodegeneration, the forces that advance and perpetuate the disease, particularly with regard to the progressive worsening of brain insulin/IGF resistance, must be understood. “Brain insulin resistance (diabetes) is very much like regular diabetes,” de la Monte said. “Since the underlying problems continue to be just about the same, we believe that the development of new therapies would be applicable for all types of diabetes, including Alzheimer's disease, which we refer to as Type III diabetes.”

She said, “This study points out that once AD is established, therapeutic efforts should target several different pathways - not just one. The reason is that a positive feedback loop gets going, making AD progress. We have to break the vicious cycle. Restoring insulin responsiveness and insulin depletion will help, but we need to reduce brain stress and repair the metabolic problems that cause the brain to produce toxins.” Ultimately, these findings will help to expand ways to both detect and treat AD.

Growing evidence supports the concept that AD is fundamentally a metabolic syndrome that leads to abnormalities linked to brain insulin and insulin-like growth factor (IGF) resistance. In AD, brain insulin and IGF resistance and deficiencies begin early and worsen with severity of the disease. The rationale behind the progression of the disease is that insulin-resistance dysregulates lipid metabolism and promotes ceramide accumulation, thereby increasing inflammation and lipid metabolism, causing toxic ceramides to accumulate in the brain. The end result is increased stress that threatens the survival and function of neurons in the brain. - MNT

Public ignorance about impact of lung disease

New data released by the Forum of International Respiratory Societies (FIRS) to coincide with World Spirometry Day has revealed a worrying lack of understanding and concern among the public about the world's biggest killer - lung disease, which now claims the lives of almost four million people a year.

Despite the high incidence of lung disease, research done across four continents revealed that people are far more worried about cancer, heart disease and stroke.

This lack of concern is even more striking as data shows that while the other major diseases have been decreasing as a cause of death in the last three decades, death due to COPD has doubled in the same period.

As well as underestimating the impact of lung disease, the public poll reveals a lack of understanding about how to manage it.

Despite the fact that simple lung tests like spirometry can help detect conditions such as COPD and asthma before the onset of debilitating symptoms, the survey revealed that the majority, 57 p.c., of respondents have never had their lungs tested.

The research also revealed that 70 p.c.thought that those with lung disease were unable to undertake even moderate exercise like swimming or going to the gym.

However, in reality, physical activity can help to manage and improve the symptoms of lung disease such as breathlessness, even in the most severe cases.

As the world gears up to the Olympics, FIRS is using the new data to urge people to get their lungs tested and to get active to improve their lung health.

What's more, with only 41 p.c. of those already suffering from a lung disease claiming to have discussed the importance of physical activity with a healthcare professional, FIRS is encouraging current patients to approach healthcare practitioners to talk about the benefits of exercise. On World Spirometry Day, and throughout the build up to the Olympics, healthcare professionals will be taking to the streets across the globe to run public lung testing events to raise awareness of spirometry testing.

The test, which usually takes less than 10 minutes , is the most effective way of testing lung health.

The Chair of FIRS and President of the European Respiratory Society (ERS),Klaus Rabe, said:“Chronic lung disease is a major health issue but - as the FIRS poll shows - its burden continues to be underestimated. There is widespread ignorance not only around the seriousness of lung disease but about what can be done to prevent it. As countries celebrate the achievements of the world's best athletes - we feel the time is right to focus on how we can all improve our lung health.

“Respiratory physicians understand more and more about the importance of exercise but our research confirms ignorance is still out there. Even gentle walking for those with severe disease can help in improving lung capacity and general well being and we must get this message through to patients”.

Monica Fletcher, Chair of the European Lung Foundation, who has co-ordinated the global initiative of WSD said: “World Spirometry Day provides a point in time for people to understand the importance of getting their lungs tested.

Early diagnosis for lung conditions can lead to more effective interventions which, in turn can help alleviate symptoms and slow the progression of the disease.”

A number of high-profile athletes are supporting the campaign, to highlight what can be achieved by those suffering from lung diseases and encourage more people to take up exercise. Some 448 competitors in the 2004 Olympics in Athens had chronic lung conditions.

Supporters include Norwegian Olympic rower, Olaf Tufte, who has won two gold and one silver medal, despite suffering from severe allergic asthma.Talking about his own experiences of lung disease, Olaf said:

“I am determined not to let my asthma limit me or restrict my ambitions. Instead, I see it as one challenge among many that I need to master in order to come top in my sport. People with lung conditions can lead healthy, active lives - if they take steps to ensure their condition is identified early enough and treated well.”

- medicalxpress



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