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| Sunday, 27 April 2003 |
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| News Business Features Editorial
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Compiled by Carol Aloysius Psychological management of depression in pregnancy For women most psychological disorders will rise in the childbearing years with a 2-3-fold onset of new cases in the first few weeks after childbirth. In women with significant antenatal depression (depression during pregnancy) there are associated risks for the unborn baby by way of: * Maternal suicidal behaviour, * Associated drug abuse or alcohol abuse, * Poor antenatal clinic attendance or self care, * Inadequate nutrition. The negative impact of postpartum (after the child birth) depression on the early mother-infant relationship and on the child's social, emotional and behavioral development is well documented. A significant proportion of these women would have been depressed from pregnancy onward. Clearly it would be best for both mother and child to treat depression and anxiety from pregnancy onward. Risk factors of antenatal depressions are: * Past history of depression and anxiety disorder or other psychological conditions, * Past history of abuse or poor parental care, * Poor quality of relationship with, or absence of a partner, * Domestic violence (past or present), * Current major stressors or losses, * Drug and alcohol abuse, * Low self esteem, dysfunctional personality or coping style. The more risk factors the more support and interventions a mother will need, irrespective of the presence of current symptoms. Psychologists use a scale called the Edinburgh Postnatal Depression Scale, to assess the amount of depression a woman might be suffering from. This will include questions about: * Current mood (depressed, irritable or anxious): * Loss of interest, social withdrawal: * Loss of self esteem and depressive thoughts: * Panic attacks or agoraphobia: * Sense of hopelessness or suicidal plans. Sleep, energy and appetite are variable during pregnancy and therefore are less reliable to detect depression or anxiety disorders. Self-harming behaviour, often in the context of volatile interpersonal relationships or domestic violence, and history of abuse or inadequate parenting should alert the psychologist of a personality dysfunction. These women need intensive counselling as they are likely to have ongoing problems in attaching securely with their infant and in some cases may be unable to provide a safe environment for the child. In the treatment, it is very important to meet the partner to assess their attitude to the pregnancy, level of support and/or conflict with in the relationship. In mild to moderate depression or anxiety, or for those with low self-esteem, supportive counselling, cognitive behavioral therapy, breathing exercises or stress management will be beneficial. In moderate to severe depression or panic disorder, antidepressant drugs have to be used. The issue of drug use in pregnancy remains a matter of assessing the risk-benefit ratio for individual cases. Studies conducted in US and Australia has shown that there is no increase in the rate of major congenital abnormalities above the usual risk in the general population. There was also no increase in behavioral deficits or developmental delays compared to non-exposed children of depressed mothers. It is good to use the minimum effective dosage and reduce the dose in the week before delivery and observe for withdrawal symptoms in the first few days after delivery. The breastfed child will need to be monitored for adverse reactions. Dr. R. A. R. Perera (Consultant Psychologist) Banned substances : who uses them and why by Kelum Perera What are banned substances? Why are sportsmen prevented from taking such substances? Drugs or substances which are banned to sportspersons by the IOC, FDA and IFBB are classified under the following headings, Diuretics, Stimulants, narcotic analgesics, fat burners, pro hormones, Insulin, appetite suppressants, thyroid drugs and mostly anabolic steroids. Other than these, other substances include cocaine, ephedrine hcl, marijuana and opium. Who takes these drugs? Almost all the professional bodybuilders. Track and Field athletes take drugs to improve strength, endurance and muscles. What are Diuretics? Diuretics are tablets which when given, increases urine output. So the athlete loses his/her weight drastically before a competition. But this loss is only water and not fat. Bodybuilders use this to reduce the amount of water accumulated under the skin so they may look ripped and striated on the stage. But there is a downside of this usage. Diuretics can significantly help to shed the steroid particles and other banned substances stored in the body before a urine test. This is done mostly by bodybuilders and powerlifters since they normally use steroids. So by taking some tablets daily for 2-3 days not only makes them ripped but also enable them to shed the banned substances and ultimately they will be negative in the urine test. Below are some of the diuretics banned by the Olympic Committee. Midamor, Bumex, Demadex, Aldactone, Lasix, Diuracil, Diamox, Osmitrol, Calomel. How do they work? Mostly through the Kidneys. The kidneys regulate the water retention through salt (Sodium/Potassium) retention. If the kidneys detect dehydration in the body the kidneys tend to keep sodium and retaining more water. The body has two main water regulating hormones. Aldosterone and antidiuretic hormones regulate the filtering of water in the kidneys. The more aldosterone we have the more sodium we retain and more potassium we urinate. The antidiuretic hormone regulates the kidneys filtering of blood and water. The more antidiuretic hormone we have the more water we retain. Diuretics create an atmosphere where the kidneys filter more blood and retain more waste. The kidneys work hard and release more sodium. Sodium is accompanied by water. Ultimately more we urinate. This is just a small portion of the functions of diuretics. The downside of diuretics is that the athlete may end up in a kidney failure, dizziness, comas or even die through inside bleeding. But on most occasions diuretics used correctly is a safe thing. In fact diuretics are used to reduce the blood pressure in the medical world. Diuretics are not performance enhancing drugs. What are narcotic analgesics? They are a kind of drugs produced by Opium Poppy alkaloids or related synthetical substances which are measured by narcotic morphine sulfate which hypnotise opiate receptors in the brain. They are used to subside pains related to sports. The side-effects of these drugs include vomiting, dizziness, nervousness, cramps and inner unrest. The following are some of the banned and analgesics. Nubain, Hycodan, Talwin, Numorphan, Demerol, Dilaudid. What are stimulants or performance enhancing substances? These are stimulants of the sympathetic nervous system which is also called the automatic nervous system. Stimulants make the athlete feel amphoric, vigilant and more energetic. They are not mass builders nor will they make a cricketer hit the ball hard. Cocaine and other stimulants make the nervous system to release noradrenaline and adrenaline from the adrenal glands. In our body we have alpha and beta receptors. These hormones (adrenalines) bind with these receptors and stimulate the body giving a huge pump to the user. However this does not make the user stronger. Gecko helps 'tail off ' lymph disease in humans Many lizards shed their tails, and then regrow them - now researchers from the University of Adelaide believe this act could also help treat a lymphatic condition in humans A research team from the University of Adelaide have examined how a lizard's lymphatic network responds when it loses its tail, and how this could be applied to the human condition of lymphoedema (the swelling of limbs due to the body's lymphatic system being impaired). Secondary lymphoedema is a common side effect associated with mastectomies and other similar forms of radical surgery. "For our study we examined the common Australian gecko Christinus marmoratus and the way it regenerates its tail," Dr. Daniels said. "It is obviously a major trauma to lose a body part and then regrow it, but geckos and other lizards seem to be able to do it with a minimal amount of stress and swelling around the affected area. "Our study showed that an increase in production of a certain protein growth factor contributed to the gecko being able to quickly regenerate the lymphatic system at the site of its tail loss. This growth factor is similar to the VEGF protein found in the human body." Dr. Cooter said the findings are encouraging for the treatment of lymphoedema in humans, but much more research is needed. (Adelaidean News) Launching of Arthritis Foundation in Sri Lanka GlaxoSmithKline Consumer Healthcare under the auspices of the Panadol Information Center is supporting the launch of the Arthritis Foundation. This project is the initiative of the Sri Lanka Association of Rheumatology and Medical Rehabilitation. Arthritis is a degenerative disease that not only cripples patients but also disrupts lives. Under the banner of "get on with arthritis, get on with life" the Panadol Medical Information Center hopes to promote a more productive life for those inflicted with the disease. The objectives of the Arthritis Foundation is to promote the education and training of Doctors and allied health professionals with the latest techniques in the rehabilitation of arthritis patients. It will also help increase community awareness in the needs of those suffering from the disease. Finally it will assist and promote programs to help patients self manage the disease. The Foundation will be managed by a sub committee appointed by the general committee of the Sri Lanka Association of Rheumatology and Medical Rehabilitation. A press release quotes Dr. Mrs. Lilani Weerasekera - Consultant Rheumatologist, the Secretary of the Association as saying, "Arthritis in its many manifestations is on the increase due to other factors that are influencing like early detection etc. In most cases there is no cure for arthritis. The patient simply has to learn how to cope with the illness and manage the pain with the use of analgexis and physiotherapy." Panadol is promoted as a first line treatment in pain management for arthritis patients as it is does not lead to gastric risks and has minimum side effects. The term arthritis encompasses a number of diseases including osteoporosis, gout and Rheumatoid Arthritis. These diseases are largely characterized by inflammation and deformation of the joints, stiffness, muscle weakness and muscle spasms around the affected joint which affects a patient's mobility. The link between health and human rights (Extracts from 'Health & Human Rights' publication by the WHO) There are complex linkages between health and human rights: for example, violations or lack of attention to human rights can have serious health consequences. Health policies and programmes can promote or violate human rights in the ways they are designed or implemented. Vulnerability and the impact of ill health can be reduced by taking steps to respect, protect and fulfil human rights. Key Human Rights relevant to health include the following: . Torture: "No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. In particular, no one shall be subjected without his free consent to medical or scientific experimentation." . Violence against children: "All appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, mal-treatment or exploitation, including sexual abuse..." shall be taken. . Harmful traditional practices: "Effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children" shall be taken. . Participation: The right to "... active, free and meaningful participation." . Education: The right to education, including access to education in support of basic knowledge of child health and nutrition, the advantages of breast-feeding, hygiene and environmental sanitation and the prevention of accidents. . Food and nutrition: "The right of everyone to adequate food and the fundamental right of everyone to be free from hunger..." . Standard of living: Everyone has the right to an adequate standard of living, including adequate food, clothing, housing, and medical care and necessary social services." Persons suffering from mental disabilities are particularly vulnerable to discrimination. Not only does this impact negatively on their ability to access appropriate treatment and care but the stigma associated with mental illness means that they experience discrimination in many other aspects of their lives, affecting their rights to employment, adequate housing, education, etc. What is "The Right To Health"? "The right to health does not mean the right to be healthy, nor does it mean that poor governments must put in place expensive health services for which they have no resources. But it does require governments and public authorities to put in place policies and action plans which will lead to available and accessible health care for all in the shortest possible time. (United Nations High Commissioner for Human Rights, Mary Robinson.) A rights based approach to health A rights based approach to health refers to the processes of: . Using human rights as a framework for health development. . Assessing and addressing the human rights implications of any health policy, programme or legislation. . Making human rights an integral dimension of the design, implementation, monitoring and evaluation of health related policies and programmes in all spheres, including political, economic and social. Ensuring health systems are made accessible to all, especially the most vulnerable or marginalized sections of the population, in law and in fact, without discrimination on any of the prohibited grounds. Using a gender perspective, recognizing that both biological and sociocultural factors play a significant role in influencing the health of men and women, and that policies and programmes must consciously set out to address these differences. Health legislation and Human Rights Law Health legislation can be an important vehicle towards ensuring the promotion and protection of the right to health. In the design and review of health legislation, human rights provide a useful tool to determine its effectiveness and appropriateness in line with both human rights and public health goals. In this context, HIV/AIDS has caused many countries to revisit their public health laws, including in relation to quarantine and isolation. Restrictive laws and policies that deliberately focus on certain population groups without sufficient data, epidemiological and otherwise, to support their approach may raise a host of human rights concerns. Two examples in this regard are health policies concerning the involuntary sterilization of women from certain population groups that are justified as necessary for their health and well-being, and sodomy statutes criminalizing same-sex sexual behaviour that are justified as necessary to prevent the spread of HIV/AIDS. Government capacity to develop national health policy and legislation that conforms to human rights obligations needs to be strengthened. This includes developing the tools to review health related laws and policies to determine whether, on their face or application, they violate human rights, and providing the means to rectify any violation which exists. You & Your Doctor by Dr.Sampath Nanayakkara "Eye Pressure" Q: What is pressure in the eyes. Is it the same as high blood pressure? What causes it? what treatment available to cure it? A: Glaucoma is one of the many causes of preventable blindness. The normal pressure inside the eye is 15-22 mm. How does this pressure maintained; by a balance between the liquid production inside the eye and its outflow, through a tiny cannal. When there is an increased production of liquid or block to the outflow, elevates pressure inside the eye ball producing the condition - Glaucoma. Injury to eye, diseases of the lens, prolonged use of prednisolon (Drug) are some of the causes. In mild type of this disease the patient has occasional attacks of dimness of vision, in which he sees haloes around lights. Eventually he develops a severe attack with impairment of vision associated. Severe pain in the eye and repeated vomiting. Special eye drops have considerably improved the outlook of this condition if defected early. **** Laser treatment for cataract Q: Dear Doctor, I was operated for cataract. Of late, my sight is getting rather blurred. I've been advised to take laser treatment. Could you kindly let me know what laser treatment for the eyes is like. I'm very worried about it and would like to know whether to undergo it. Anxious. A: Laser - is a term which has been coined from the initials of the words "Light Amplification by Stimulated Emission of Radiation". It has been found possible to produce beams of light of such intensity and penetrative power that they can, for instance, be beamed all the way to the moon, and bounced back. Such powerful Laser beams are also finding applications in medicine since recent years. Some types of beam can be used to cut through human tissues just as a surgeon's knife would. This is called Laser Surgery. The main medical importance of the Laser surgery is for disorder of the Retina of the eye (Retina is the screen at the back of the eye). The thermal and Iouining properties of the Laser beam when focused on the Retina produces a localized therapeutic effect in condition such as Diabetic Retinopathy and Detached Retina. Laser treatment is safe and very effective. Therefore do not hesitate to undergo it for your problems. ***** Top tips on getting more fluid * Leave a jug or container of fluid on your desk and fill your glass frequently until it's all gone. Take a drink every time you stop for a break. Drink a variety of fluids so that you don't get bored with the same beverage all the time. Carry a drink with you everywhere you go, even in the car. Remember to drink more if you're exercising or if it's very hot. Signs of dehydration The effects of dehydration range from thirst and weakness to impaired kidney function. In extreme cases, dehydration can even lead to coma and death. Signs of dehydration: Mild: Thirst, Headache, Fatigue, Flushed skin, Dry mouth and throat. Moderate: Rapid heart rate, Dizziness, Low blood pressure, Weakness and lack of energy, Highly concentrated urine but low in volume. Severe: Muscle spasms, Swollen tongue, Poor blood circulation, Increased weakness, Failing kidney function. |
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