|
|
 |
 |
| Sunday, 20 June 2004 |
 |
|
 |
Features |  |
| News Business Features Editorial
|
The burden of sexual ill health
Sexual ill health among young people world-wide accounts for 20 per cent of the global burden of ill-health for women and 14 per cent for men. The World Health Assembly has thus adopted the WHO's first strategy on Reproductive health, which targets among other things, the combating of sexually transmitted diseases (STDs). Dr. Shantha Hettiarachchi of the National STD/ AIDS Control Program talks to Sunday Observer staffer Carol Aloysius about the repercussions of STDs on health, and the steps taken to prevent them. Q: Judging by the numbers of persons who attend your clinics islandwide, there appears to be a rise in STDs especially among young people. Why is this? A: It isn't so much a question of an increased number of patients as an increased awareness among high risk groups of the adverse effects of these diseases on their health. Because of our awareness programms more people are now attending our clinics for treatment. Q: What are the new trends that you have observed in recent years in relation to patients with STDs? A: We are now seeing younger patients, some as young as 12 years. The latter category are mostly children who have been sexually abused by paedophiles. Young people are also increasingly being engaged as sex workers which is of grave concern to us. Q: What do you do when a patient comes to you? A: Before examining him, we first have a thorough consultation and ask him questions about his sexual life. It is important to know the patient's history, his family background and his sexual partners, before we treat him. Q: What are the most common signs of a sexually transmitted disease? A: Ulcers, a discharge or a lump. Q: What are the most common causes for each of these? A: In the case of ulcers, the most common cause in Genital Herpes caused by a virus called Herpes Simplex. This is more common in the age group 30 to 50 years. The second cause for ulcers is Primary Syphilis. The causative organism is a bacteria called Treponema Pallidum. Q: What about discharges? What brings on a discharge? A: Discharges can be urethal and vaginal. The causes are gonorrhoea and Non gonococcal urethritis in the case of males and non specific cervicitis for women. There are two other common causes for vaginal discharge in females. They are, a) Trichomoniasis b) Candidiasis (a non STD fungal disease) and c) Bacterial vaginosis. (non STD). Q: Can a female get infected with these diseases without sexual activity? A: Yes any female can develop the latter two conditions. Q: What are the common causes for lumps? A: Genital warts. The causative organism being the virus called Human Papilloma virus. Human papilloma virus may cause cytological changes in the cervix (of female patients). This can lead to carcinoma of the cervix. Pre-cancerous stages can be detected in these patients by doing a pap smear. If the changes are detected in the pap smear it must be confirmed by a biopsy. Q: Can sexually transmitted infections be completely cured? A: All STDs can be treated and cured to a point. Q: Mention some. A: When a new patient is diagnosed suffering from Syphilis, gonorrhoea, non gonococcal urethritis and Tridomoniasis as well as non STDs. we can completely cure him. Q: Can these diseases recur even after treatment? A: STDs due to viruses can recur. Hence the patients can be asymptomatic carriers which means they can spread the disease easily. Q: Can STDs lead to HIV/AIDS? A: Yes .If you have an ulcer the HIV virus can enter the body quite easily. Q: I understand that women are particularly vulnerable to these diseases. How do they affect their health? A: STDs can affect child bearing and lead to infertility. In fact, STD's are recognised as the most common preventable cause of tubal infertility. STDs such as chlamydial infection or Gonorrhoea in the lower genital tract can ascend into the upper genital tract causing pelvic inflammatory diseases (PID) that can produce inflammation, scarring and eventually blockage of the fallopian tubes. Many cases of infertility after delivery or abortion can also be due to STDs. If a woman has gonorrhoea or chlamydial infection during pregnancy, her estimated risk of PID increases 50% to 100% if she either gives birth or has an abortion. Infections such as gonorrhea and non-gonoccoccal cervitities of the vaginal tract can lead to poor health in women and in turn they can transmit these diseases to their new born children. Q: What is the target population for the national program for preventing STDs? A: All those within the reproductive age, but more specifically sex workers, garment factory workers, the forces, students , school drop-outs, beach boys, massage clinics and karoke bars. In fact, anyone and any place that promotes sexual activity. Q: Where do you have your clinics? A: We have our main centre at De Saram Place, Maradana. We also have 23 other STD clinics attached to the main hospital in all districts including Jaffna. We hope to start clinics in Mannar very soon. Galle and Trincomalee. Q: What is your message to those at risk of developing STDs? A: I would tell them to change their lifestyle and stick to one partner when having sex. There are several links between HIV and other STDs. One link is life-style or behaviour. The second link is biological. A person with untreated STD is more likely to transmit and contract HIV during unprotected sex. an ulcer in the genital area can easily lead to the HIV infection entering the body. So if they have a sexually transmitted disease, they must have early treatment. Efficient and early treatment of a sexually infectious disease is an important preventive measure for HIV. ###### Health changes in the old Old age brings about significant changes both physical and mental and psycho-social well-being of a person. Signs of physiological (external) changes include the following: Grey hair - grey beard - Wrinkles in the face, forehead, cheeks, nasal edges - dryness in the skin - teeth broken and discoloured - Bald head - stooped shoulders - Hunched body - Thick lensed glasses resting on eyes - sometimes dentures inside the mouth and hearing aids in the ears. Physiological (internal) changes affect the: Musculo-Skeletal System commences its degenerative process Central Nervous System - Arteries that supply blood to the brain may get thickened and as a result, motor and sensory functions may get diminished - Neural tissues deteriorate causing reduction in sensory activities. Respiratory System - Breathing rate may be diminished to about 12-16 p/m (average healthy person 16/20) Cardio Vascular System - Heart rate is becoming lower than the normal (normal person 72-80 p/m.) Gastro Intestinal Tract - Lack of appetite may cause less intake of food items Genito Urinary Tract - As the intake of fluid is becoming less, the out-flow also gets less. Sensory - Audio - Visual functions may be impaired. Changing functions of sense receptors and the vestibular receptors in the inner ear are more likely to take place even without any awareness. In advancing age, one may have to be guided in his motor activity entirely by vision. Mental changes (emotional) - Once a man of hope in all age hopeless feelings gradually sets in. A feeling of helplessness surrounds him. He feels uncomfortable about his losing of capacities and capabilities. Mental changes (intellectual) - Loss of memory due to physical deteriorations may lead to diminish his intellectual functions at a higher level. Alzhiemer's disease may lead him dimentic situation, giving much problems to others and his immediate care givers. Deterioration of his intellectual abilities, short term and long term memory powers, motivation, reasoning capacities, problem solving abilities, decision making powers, healthy communication skills, perceptual abilities, all these and many more, give rise to the feelings of neglect and more and more rejection. Physical impacts - Functional deterioration of memory centres and lack of intent in current activities are most common features that could be seen at this stage. Diminished physical stamina, loss of weight, change in skin coloration and many other organic impairments may take place. Mental impacts - Due to impaired physical and mental facilities combined with loss of self esteem, he may feel a sense of uselessness - helplessness - loneliness - rejection - stress - anxiety - sometimes - depression. Psycho-social impacts - He becomes frustrated, aggressive towards his family members - he may not conform to his family routine - he may blame everybody. Relationship with peers, relatives, and other social group may be diminished. What society can do As members of the human society, human family it is our duty and responsibility to assist him rather than discard him. We can do so in the following way: We can render him supportive care physically (basic physiological needs), Actively listen to him - let him share his life's past experiences with us, Counsel him - Empathize with him in his grievances. We may stimulate his memory powers - which is a proven therapy for Alziemer's syndromme - Encourage him to walk even for short periods - Accompany him in gardening - mild physical exercises. Give him mild Breathing Exercises and Relaxation Therapies. The most important task will be to give him very high doses of 'T.L.C.' (Tender Loving Care).Then, his energies could be re-channelled into new and fruitful roles in the society, where he will find solace and comfort. Dr. H. R. S. Keerthisinghe, Consultant Clinical & Counselling Psychologist ####### Calcium: Who needs it ? Calcium requirements vary throughout our lifetime, with greater needs during the period of rapid growth in childhood and adolescence, during pregnancy and lactation and in later adult life. Because 99 per cent of the total body calcium is bone, the need for calcium is largely determined by skeletal requirements. Calcium intake of exclusively breastfed infants during the first six months of life in the range of 250-330mg a day, with a fractional calcium absorption between 55-60 percent. Low based milk formulars contain nearly twice the calcium content of human milk. Children and young adults between 11-24 years also need high intake of calcium. Peak adult bone mass is largely achieved by 20 years of age. Therefore optimal calcium intake in childhood and young adulthood is critical. A calcium intake of 1,200 - 1,500 mg/day is recommended for this age group. Once peak adult bone mass is reached, bone turnover is stable in men and women. For those between 25 years to 65 years, calcium is still important. Between 25 and 50 years, women should maintain a calcium intake of 1,000mg a day. In postmenopausal women who are receiving estragon replacement therapy, a calcium intake of 1,000 mg per day is recommended to maintain calcium balance and stabilise bone mass. Adult men also sustain fractures of the hip and vertebral though less frequently than women. An optimal calcium intake of 1,000 mg per day is thus recommended for men in this age group. For pregnant and lactating women calcium is very essential, as pregnancy represents a significant physiological stress on maternal skeletal homeostasis. A full term infant accumulates about 30 grams of calcium during gestation, most of which is assimilated into the fetal structure during the third trimester. During lactation 160-300 mg per day of maternal calcium is lost through production of breast milk. Women who are lactating should ingest at least 1,200 mg of calcium per day. In the case of men and women over 65 years of age and older calcium absorption is less. Calcium insuffiency due to low calcium intake and reduced absorption call translate into an accelerated rate of bone loss in older people, causing osteoporosis or brittle bone disease. ####### From our readers ... Effects of fluoride on teeth This letter refers to the above article published in your esteemed paper on Health Alert section. I request the following contents to be forwarded to Dr. Srilal A. Silva and readers of the Observer. I refer to the last paragraph - Harmful effects, the use of "ingini" seeds to reduce fluoride content. This has been proved by several scientists in Sri Lanka that by application of ingini seeds it does not reduce the fluoride content in water. On the other hand new earthenware pot reduces the fluoride content in water. However, when the usage of earthenware pot is more than two weeks it does not reduce the fluoride content in water. This is for the simple reason that the fluoride absorption capacity of the earthenware has been exhausted. The same principle has been adopted in the low cost domestic fluoride filter developed by the National Water Supply and Drainage Board in 1994 and presently 3000 such units are used by the affected communities in the dry zone areas of Sri Lanka. The filter material used is freshly burnt brick pieces and this has to be replaced every three months. The cost of replacing the bricks is Rs. 50. Presently a joint programme has been launched with the health staff in these affected areas and distribute this filter unit on a subsidized rate of Rs. 300. The target group is the families with children of age less than four years or pregnant mothers. They have to use this filter for nearly five years by changing the bricks every three months intervals. Encouraging results of low incidence of dental fluorosis has been reported from Olukarada - Kekirawa, Waragoda - Thalawa, Meewewa - Palagala by use of these filter units. It is to be mentioned that this is the only method practised to reduce fluoride content of water using filter medium which is freshly burnt bricks pieces available in the locality. All the other methods available used either chemicals or prepared filter media which has to be provided to the communities from time to time. J.P. Padmasiri (Regional chemist Peradeniya) |
|
News | Business | Features
| Editorial | Security Produced by Lake House |
