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| Friday, 3 December 2004 |
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Care in child's health where lies the responsibility? Prof. Leela de A. Karunaratne (Professor of Family Medicine Sri Jayawardenapura University) questions
The family has the primary responsibility and a liaison between families and the community which includes religions and cultural groups and centres of education is important. Healthcare is now often discussed as people's rights and with rights come responsibilities. Family physician Considering care given by the health professionals it is the family physician who could provide life long care and therefore needs to be actively involved in taking responsibility and sharing it with the others specially the obstetricians and paediatricians and also the specialised counsellors. Social transformation Also the holistic management of these problems need social transformation and the protection of human rights, and therefore it is a matter of great responsibility for the Government policy makers, non-governmental organisations and the legal system of the country. The media too has to play a very useful role by focusing on the issues in an attempt to bring about a change of attitude among all, particularly the children, families and the community. The final phase in the life cycle of the child is adult life and reproduction. When we focus on this phase, the important issues that could be envisaged are: - counselling in matters such as marriage, consanguinity or genetic disorders, and - reproductive healthcare and education. In addition to promotive, preventive and curative healthcare, since the health of parents is very relevant to the health of the child. Best chance - in a healthy family The best chance a child would have to grow and develop normally is in a healthy family. Healthy families do not just happen, they need to be planned particularly regarding size and spacing to ensure that every child is truly wanted. Reproductive healthcare depends much on people's beliefs, attitudes and life practices. Therefore, parents or those who plan to be, would need family orientated healthcare in the community at most times, but appropriate consultation and referral to the higher levels of healthcare should be available to them when necessary. Children prime concern The world took on a responsibility in 1978 to achieve health for all by the year 2000. Since then healthcare of children has become a prime concern for all countries. Our own country has achieved a great deal but there is much more than we could do. There is a challenge and an opportunity for those who are responsible. Responsibility also lies The responsibility also lies with a partnership of several groups - the policy makers, health managers, health professionals, the community and the family. The three components of healthcare - health promotion, disease prevention and management of health problems, operate at three levels of healthcare - primary, secondary and tertiary. Therefore, the first responsibility is to develop a well organised and balanced system, with underlying values of quality, equality, equity and cost effectivity. Relevant to people's needs Healthcare delivered by such a system should be relevant to people's needs and the best way to ensure this is to strength the primary level and to establish a good relationship and adequate communication between the levels. Desired outcome A good system of healthcare will have the desired outcome only if the care providers are dedicated, motivated and sensitive to the needs of child's health. These needs could be identified by focusing on the stages of a child's life and the sharing of responsibility could be determined. And now, in concluding I emphasise that the partnership for child healthcare must be sustainable and have a unity of purpose. The responsibility for care must be shared by all but the family and the community together with all the health professionals have a major role to play in nurturing the generations of the 21st century. ############# 2nd article by the SLMA Committee on building public awareness on over and under nutrition: How to prevent a Heart attack by Dr. D. P. Athukorale Over the past four decades there has been a steadily increasing morbidity and mortality from Coronary Heart (CHD). There seems to be a fearsome toll from among progressively younger age groups. Is this a part of the price we are obliged to pay for development? This article is aimed at helping people to stay alive and healthy with this brief account of the major risk factors known now to be associated with CHD and the additional each risk factor plays in the presence of others and what people can do to minimise the hazards that these risk factors entail. Another objective of this article is to enlighten you readers as to how simple precautions can minimise the risk of family members getting a heart attack. Can a heart attack be prevented? By the time symptoms of CHD such as angina appears, the underlying disease is likely to be far advanced as CHD often starts in youth and develops slowly. So prevention must start early in life. Some of the risk factors identified are almost casual and preventable. These are the following:- 1. High Blood Pressure (a) bad cholesterol (high serum LDL) (b) low good cholesterol (HDL) (c) high serum triglycerides 3. Heavy Cigarette smoking A high score of these listed risks, makes a person likely to have a heart attack. For example, a person with High Blood Pressure, high bad (LDL) cholesterol, who is a smoker, has a greatest risk of developing a heart attack than a person who has high blood pressure, high bad (LDL) cholesterol and never smokes. Similarly a diabetic who lives a sedentary life and is obese has a higher risk of getting a heart attack than an active diabetic and is not fat (high body mass index). Some of the factors such as heredity, being a male and old are not under one's control. But the majority of risk factors such as smoking, untreated High Blood Pressure, obesity and high bad (LDL) cholesterol are under one's control. The first step to prevent a heart attack is to undergo regular medical checkups with your family doctor who will check your height, weight, blood pressure and do tests such as ECG, lipid profile and blood sugar at a reliable laboratory. (1) High Blood Pressure must be diagnosed early as it can lead to CHD, stroke, heart and kidney failure. Irrespective of age systolic blood pressure must be below 145 mm. mercury and diastolic below 90mm. mercury. (2) Smoking is common. Nicotine and Carbon Monoxide and other poisonous substances in cigarettes bring down your good cholesterol (HDL), raise your bad cholesterol (LDL), increase the clotting tendency of blood and causes elevation of blood pressure and increases your heart beat (pulse). (3) High bad cholesterol (LDL) such as when it is over 100 mg/dl will make your family doctor advise you how to reduce the level. If there is no response to dietetic measures and exercise, he will prescribe a cholesterol lowering drug. Your good cholesterol (HDL) should be above 40mg/dl. Asians have lower levels than Europeans. Then your family doctor will advise you to stop smoking (if you are a smoker), take regular exercise and a special diet if you are too fat. Excessive consumption of polyunsaturated vegetable oils and deep frying in such oils, reduce your HDL (the good cholesterol) level. (4) High scrum triglycerides as mentioned earlier is a risk factor and such persons have a low level of good cholesterol (HDL). If the level is high (that is over 150mg/dl), you will be advised. (i) to take regular exercise Diabetics are prone to get high levels of the bad cholesterol and triglycerides and thickening of arteries (atherosclerosis). Blood sugar must be checked. (5) Obesity leads to CHD, high blood pressure, high levels of cholesterol and triglycerides and consumption of a high calorie diet and specially fats must be avoided. Regular exercise is essential. (6) Physical inactivity commonly leads to CHD which is less common among manual workers. Regular exercise has a beneficial effect on cholesterol and triglyceride levels. (7) Stress and anxieties, pent-up emotions effect the heart, ambitious, aggressive competitive life-styles over years led to CHD and may be more in men than women. (8) High levels of homocysteine is treated with folic acid. All persons over forty, those with a family history of CHD, High Blood Pressure and diabetes must consult the family physician for a checkup of all these risk factors. This in brief, is to increase awareness of a lifestyle that reduces the morbidity and mortality from CHD. ############# Kerala University on coconut oil: No cholesterol Coconut oil was recognised as a health oil in ayurvedic medicine almost 4,000 years ago. It has been used throughout Asia and the Pacific for thousands of years as both food and a medicine. Recent findings indicate that contrary to popular beliefs, coconut oil plays a unique role in our diets. In a study conducted by Prof. Rajmohan of the Biochemistry Dept. of Kerala University over three years the author concluded that consumption of coconut oil did not elevate blood cholesterol BSC. The main advantage of coconut oil is that its very low essential fatty acid content. Coconut oil contains a unique form of saturated fat that actually helps to prevent heart diseases, stroke and hardening of arteries. At a presentation made to AVOC Lauric Oils Symposium in 1996, it was stated that review of diet/heart disease literature relevant to coconut oil clearly indicates that coconut oil is likely to be beneficial in the prevention and treatment of heart disease. It was also revealed that coconut oil does not contribute to cholesterol and is at worst neutral with respect to fat. It was also revealed that people who consume coconut oil regularly in their diet are much healthier than people who don't. |
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