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| Sunday, 8 June 2003 |
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Features |  |
| News Business Features Editorial
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Compiled by Carol Aloysius No Tobacco Day fell on May 31 : The killer weed Sri Lanka holds the dubious honour of being placed 11th among male smokers and 84th among female smokers in the world. The Alcohol and Drug Information Centre reveals that the ratio of women smokers is likely to be higher as a significant number of women in the plantation and agricultural sectors indulge in smoking and drinking due to fatigue and stress. by Hana Ibrahim It seems so easy. To puff your stress and tension away when the going gets too tough. There is no need to bother about the long-term consequences of death and disability, when a puff seems so easy, and makes you feel so much better, so in control. But you might, want to pause for a while to look at some facts as to why smoking is bad for you and accept that statistics don't always lie. According to medical experts cigarette smoking is the principal cause of preventable diseases, disability and premature death. They point out that the overall death rate of smokers in 70 per cent higher than that of non-smokers and the risk is proportionately greater in younger age groups. Sri Lanka holds the dubious honour of being placed 11th among male smokers and 84th among female smokers in the world. The Alcohol & Drug Information Centre reveals that the ratio of women smokers is likely to be higher as a significant number of women in the plantation and agricultural sectors indulge in smoking and drinking due to fatigue and stress. The Centre also reveals that more than 25% youth are enticed into smoking daily by the unfair practises of the tobacco companies which more often than not sponsor youth related events. The death toll from tobacco related sickness in Sri Lanka is 20,000 persons per year. And daily expenses in maintaining the habit run into Rs. 50,000,000. One third of the family income in low income groups is wasted on cigarettes and alcohol. What's in a cigarette? Around 4000 different chemical substances that are pharmacologically active - antigenic, cytotoxic, mutagenic and carcinogenic. How these substances get activated depends on the type of tobacco, the temperature of combustion, length of the cigarette, porosity of the paper, additives and filters, and volatile substances that are distilled into it - nitrogen, oxygen, carbon dioxide and particulate matters. Some contributants act directly on the membranes while others are absorbed into the blood or dissolved in saliva and swallowed. Substances that have the strongest effect: . Nicotine - strong addictive power, dangerous for blood vessels and lungs and is a major source of addiction. . Carbon dioxide - binds to haemoglobin (the oxygen-carrying molecule). Several different carcinogens. . Ciliotoxins - that destroy the cellular layer of the airway. What diseases do they cause? Atherosclerotic vascular diseases, cancer and chronic obstructive lung disease. These account for most of the excess mortality and morbidity. Atherosclerotic vascular disease - coronary artery disease, cerebro-vascular disease (stroke) and peripheral occlusive arterial disease (intermittent cloudification - angina in the legs). Cancer - of the lungs, larynx, oesophagus and mouth (oral). In certain cases cancer of the urinary tract, bladder, stomach, kidney and the pancreas. In females smoking has also been attributed to cervical cancer. Thirty percent of all cancer-related deaths have been attributed to smoking. Chronic obstructive lung disease - chronic bronchitis and lung emphysema, characterised by chronic cough, sputum and shortness of breath, increased frequency of pneumonia and influenza deaths. Smoking also leads to: Pregnancy related complications, delayed conception, low infant birth weights. It also leads to high risk of gastric and duodenal ulcers and reflux diseases. Further it nullifies the effect of medication, especially in cases of coronary artery disease, because the high toxicity in nicotine affects the liver enzyme system and changes the metabolism of the drugs. It decreases the effects of coronary artery by-pass, negating the restorative values of the surgery. In addition many people are known to have more than one risk factor leading to a sort of synergistic reaction where the effect is bigger than the sum. They are: Increased risk of lung cancer when asbestos pollution is combined with cigarette smoking. Increased risk of oral and laryngeal cancer when combined with intake of alcohol. Dose response relationship also counts - the younger you are when you start smoking, the more cigarettes you smoke, and the more you smoke, the more you inhale and the more you inhale, the higher the risk. And it isn't just the smokers who are affected. New research reveals that the risk of passive smoking is considerably underestimated, in relation to lung cancer, allergies and bronchial asthma. It is also said to cause respirator tract infection in children. So why do people smoke? No one has a clear answer. Some attribute addiction caused by the nicotine in cigarette as a major factor. Others cite psychological factors -primarily habituation, rather than addiction. And now the big question - can a person really stop smoking and if so what does that involve? Yes, if the person is determined and sufficiently motivated. There have been a great number of different psychological methods introduced to make people give up smoking. Areas were the government and society could also help -Higher taxes on tobacco. - Banning of smoking in public places (this limits the areas were one can smoke). - Elimination of advertisement and promotional activities of tobacco companies. But above all it is important to achieve primary smoking prevention - meaning Never Start. Those who could help in these areas are people who deal with children and teenagers. ############ Helping people to stop smoking by Dr. R.A.R. Perera, Consultant Psychologist 'No doctor needs to be reminded of the tremendous burden of disease produced by the tobacco industry and its products, and doctors need to examine their approach to the nicotine-addicted person. Tobacco addiction is a constant source of frustration for physicians, particularly those who treat respiratory disease. At times it seems as though doctors are singularly unsuccessful in changing the patients' smoking behaviours. However, when one considers that nicotine is one of the most highly addictive substances known, and is coupled with a complex series of behaviours that develop as part of smoking rituals and practices, one begins to understand the tenacity of tobacco addiction. Patients who smoke, no matter what their current health status, should be given firm, unequivocal but non-judgmental advice to quit each time they are seen. Astonishingly, most adult smokers report that their doctor has never advised them that they should stop smoking. Studies have shown that even brief physician intervention can result in a 1-year cessation rate in 7% of patients. As a first step in advising patients to stop smoking the doctor should explain the benefits of quitting smoking. * Indicate the health and financial benefits. * Make these benefits relevant to the problem the patient has (e.g Cough, high blood pressure, anxiety, difficulty in sleeping, sexual difficulties). Explain that the doctor understands the difficulties associated with attempts at quitting. The doctor should be positive and supportive point out that the single greatest predictor of success in smoking cessation is the number of 'quit-attempts' made in the past. Tips to stop smoking * A person should decide on his own reason for quitting. * Decide on a quitting date, but avoid times of stress or social pressure * Develop a series of strategies to deal with those particular times of day and circumstances that are usually associated with smoking. * Try to smoke fewer cigarettes, and try to smoke the 'lightest' cigarettes available - this may accustom the body to lower levels of nicotine * Enlist the support of family and friends, explain in advance the possibility of moodiness and irritability and seek their understanding and encouragement. * In the event of a setback, avoid the tendency to relapse completely (smoke a less number of cigarettes). * Scare tactics never help - most smokers understand the need to quit, but feel powerless to do so. When the addiction is very strong (usually identified by the fact that they smoke their first cigarette each day immediately on awakening) some may benefit from the use of small amount of prescribed nicotine, either in the form of chewing gum or delivered through the skin by a patch. By this they can defer nicotine withdrawal with substitution therapy, and deal with those circumstances, situations, settings and stimuli powerfully associated with smoking. The doctor should advise the patient to use the patch for the recommended period despite the fact that cessation 'seems easy' while using the nicotine replacement. While the gum and patch may be equivalent, the patch is far easier to use and delivers a relatively constant level of nicotine and the quitters receive less nicotine than they would if smoking. In addition they do not receive any of the 4000 or more other chemicals found in tobacco smoke. Passive smoking increases respiratory problems, particularly in asthmatics. The risk of lung cancer is increased by 30 per cent. Children remain central to the tobacco issue. Most smokers start during childhood and become addicted to the habit by their early 20s. ********* Landmark anti smoking pact A significant step forward in the global war against tobacco smoking was taken recently when 192 countries approved the first international treaty against smoking, including an advertising ban aimed at kicking a habit that kills nearly five million people a year. The historic anti-smoking pact, agreed by member states of the world Health Assembly, requires countries to ban or set tight restrictions on tobacco advertising, sponsorship and promotion within five years. ********* Some 'killing' facts on tobacco * Tobacco smoke contains 4000 chemicals of which about 60 have or are suspected to be carcinogens. * Smoking is responsible for 90% of lung cancer, 75% of chronic bronchitis and emphysema, 25% of ischaemic heart diseases. * Every cigarette takes 7 minutes off your life. * Total premature deaths from tobacco worldwide in 2000 amounted to 4.2m (3.4 million men and 0.8 million women) * About 50 per cent of young people who continue to smoke will die of smoking. * According to the UN International Agency for Research (IARC) tobacco smoke is a more deadly carcinogen and triggers a broader variety of cancer including stomach, liver, cervical, nasal, sinus, uterus and kidney cancer. * Forty per cent of world's children exposed to passive smoke suffer from pneumonia, bronchitis, coughing, wheezing, asthma and middle ear diseases. ############ The current heat wave can lead to various health problems. One of them is a sweat rash or ... Prickly heat by Dr. A. M. Aboobucker Prickly heat (sweat rash) which is also referred to as lichen tropicus, miliaria rubra and heat rash is a skin condition commonly seen in hot climates. It is an acute obstructive disorder of the ducts of the sweat glands, where the sweat escapes into the epidermis (the outermost layer of the skin), producing numerous minute blisters (papulovesicles), with redness and severe itching. It affects both adults and children. Newcomers to tropical climates are usually attacked by this disorder until their bodies grow used to the changes in conditions. Prickly heat usually attacks the stout or those too warmly clad and hence inclined to sweat freely. The eruption appears in the form of pin-point to pin-head sized, sharp-pointed, bright red papules, often capped with tiny vesicles or pustules, which appear suddenly in great numbers The usual seat of the eruption is the trunk which includes the chest, abdomen and back, but it may also appear on the face, neck, arms, legs or other regions. The papulovesicles are discrete but closely crowded together and often there is more or less redness of the skin due to congestion of the capillaries (erythema). The vesicles of prickly heat do not rapture spontaneously, hence there is no weeping of the skin surface; if torn by scratching, a crust forms and is shed in a few days. Pricking and itching sensations are often terribly severe and anything that stimulates the blood circulation or promotes sweating aggravates the itching. The eruption is extremely fitful in its character, frequently appearing and disappearing many times in twenty-four hours. This disorder occurs more when the weather becomes hot. Faulty or superfluous clothing, too many free use of stimulating foods or drinks, and absorption of toxic products from intestinal disorders may cause profuse sweating. Irritating properties of the sweat itself may also cause the blockage of the sweat glands producing the rash. This condition is apt to relapse in successive years, during hot weather. The duration of this disorder is about a week for a single outbreak but during a hot spell, fresh crops are likely to prolong the attacks. During the outbreak of the disorder a change of air or cooler weather usually mitigates the attacks at once. Externally cooling lotions or dusting powders such as calamine, nitrate of bismuth and starch, Lycopodium powder or pure talcum powder are used and may help to mitigate the attack, but the only completely effective treatment is to keep the body cool. Light clothing - cotton for choice - and frequent baths or showers are essential in preventing recurrence. One of the homoeopathic remedies such as Apis mel., Arsenicum album, Bryonia, Juglans regia, Rhus tox., Rumex, Sulphur, etc, may be given according to the symptoms to expedite the cure. ############ Foot care : Heel spurs Heel spurs are the best known heel problems. A heel spur is a point of excess bone growth on the heel. The calcium extends either toward the toes, from the bottom of the heel, or back toward the Achilles tendon. Heel spurs can be confirmed only by X-ray. Warm soaks and rest will soothe painful heel spurs. A prescribed orthotic device can provide support. If the spur is particularly painful, your doctor might also inject the area with a streoid for immediate relief. If the pain is severe, you might need to have the spur removed. Accurate and correct surgical procedure can minimize damage to the bone and ligament but it still takes at least six weeks to recover from heel surgery. From 'Foot care book' ############ Supplement with a dose of caution Functional foods : what are they? The International Food Information Council (IFIC) defines functional foods as, 'foods that provide health benefits beyond basic nutrition . In Japan which was the first national authority to establish a specific regulatory framework for functional foods, classed as 'Foods for Specific Health Use' (FOSHU), functional foods are defined as those containing 'effective substances in addition to providing basic nutrition and taste: Food items approved in Japan, as eligible to display the FOSHU label, must first demonstrate the presence of physiologically active components that are stable in food materials and have been proven using standard scientific procedures - including human trials, to be effective against specific diseases such as hypertension, allergy, raised blood-cholesterol levels. To date, over 200 food products have been approved as FOSHU. Traditional foods believed to have intrinsic health benefits, such as omega-3 fatty acid-rich fish, like salmon and isoflavone-rich soy, both of which appear to reduce the risk of cardiovascular disease and some cancers, represent the simplest examples of functional foods. Foods fortified with nutrients or enhanced with phytochemicals or botanicals, as well as foods and beverages with added ingredients such as calcium in orange juice, also fall within the realm of functional foods. As ongoing research highlights the varied benefits of food components, many more functional foods have been discovered and many new foods have been developed in recent years. Cholesterol reduction, cardio-vascular disease and osteoporosis are the most attractive targets for the development of functional foods, followed by child development, high blood pressure, diabetes, GI disorders, menopause and lactose intolerance. Calcium; soy protein; peptides and isoflavones; plant sterols and stanols; dietary fibre; vitamins B6, B-12, and folic acid; omega-3 fatty acids; conjugated linoleic acid and avocado oil; vitamin D; diacylglycerol; manitol; xylitol; oligosaccharides; garlic; polyphenols, anthocyanins; and coenzyme Q10 are some of the food components that have received considerable attention from food manufacturers. Some foods products which first entered the market as functional foods may gain widespread acceptance, moving them from specialist health foods, to mainstream products. Margarines rich in polyunsaturated fatty acids are one example of this. Continued research and product development of margine spreads, has resulted in further innovations, such as the introduction of esterified phytosterols and phytostanols, on the basis of extensive evidence that these compounds are effective in lowering blood-cholesterol levels. Another large functional food area is that of dairy foods containing friendly or probiotic bacteria claimed to promote gut health, by balancing the intestinal flora, 'comforting' the GI tract, improving the GI condition and mineral absorption. Cereals and grains fortified with calcium, vitamin C, vitamin E or phytoestrogens are also gaining popularity. Drinks too, are a fast developing area of functional foods. In Japan fermented drinks and drinks with plant extracts, vitamins, sodium chloride, potassium chloride, calcium lactate, yeast, dietary fibre, or polyphenols are popular. Regulations As the dietary supplement and functional food industry grows, quality control has become an issue of utmost importance. In October, 2002, 340 representatives of Asian governments with members of the global supplement industry met at the IADSA Asian conference in Bangkok. A panel of regulatory experts from nine Asian countries identified the need for a common approach to regulations across the region and concluded that Codex Alimentarius may be the best route to a final agreement for the region. They also called for a marketing framework based on sound science, fair claims, product quality, safety and the widest freedom of choice for dietary supplements and functional foods. However, much needs to be done to facilitate the exchange of information, discussion and the establishment of common ground. Courtesy: Food Facts Asia |
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