These risk behaviours pose:

The deadliest threat to youth

DR. VIRAJ Peramuna MO, OPD Colombo National Hospital, sending this article on Risk Behaviours of Youth which are the deadliest to them says this article is based on a study carried-out by the Centre for Disease Control and Prevention in the States but the findings are of general interest to us here in Sri Lanka as well because we find our youth also falling fast into this category.

The facts revealed in this study, as carried in this article which is based on the article on the subject in the FPReport Vol. 6 No. 6 is a timely warning for the authorities here to plan-out what preventive action we could take to save our youth from falling into this debacle.

Six risk behaviours pose deadliest threat for youth

Health problems that most often lead to death among people ages 10 to 24 trace back to just six categories of behaviour, according to the Centres for Disease Control and Prevention.

These behaviours wreak havoc on the health of young people and lead to cardiovascular disease and other health concerns in later years, said director of the CDC's Division of Adolescent and School Heath Lloyd Kolbe.

"The bottom line is that these behaviours contribute to the most serious health, educational and social problems that we as a nation face", he said.

Here are the risk behaviours and details from the CDC's 1997 risk assessment survey of U.S. high-school students.

Tobacco use - Every day, nearly 3,000 young people take up daily smoking. Seventeen per cent of students said they smoked cigarettes on 20 or more days during the past month.

Unhealthy dietary behaviours- Almost three fourths of high schoolers don't get the recommended servings of fruits and vegetables each day, and 40 per cent are trying to lose weight.

Inadequate physical activity- Daily participation in physical education classes has dropped to 27 per cent and most students report little physical activity on a regular basis.

Alcohol and other drug use- More than half, said they drank alcohol during the past month, and more than a quarter reported using marijuana during the last month.

Sexual behaviours that can result in HIV infection, other sexually transmitted diseases and unintended pregnancies- Every year, almost 1 million adolescents become pregnant, and about 3 million become infected with an STD. Almost half of high schoolers said they've had sexual intercourse.

Behaviours that may result in intentional injuries (such as violence and suicide) and unintentional injuries (such as motor vehicle crashes)-

Nineteen per cent of students said they never used safety belts, 37 per cent reported riding with a drunken driver during the past month and another 37 per cent had been in a physical fight during the past year.

Studies show that societal institutions have a powerful influence on youth, Kolbe said. Families, schools, religious and community groups, media, employers and Government could make a major impact by working together to spread a common message: Reduce risk behaviours.

That's where FPs come into the picture. Kolbe urged family physicians to get involved at the office, in schools, in the community and in legislatures. Youth pay attention to their physicians' advice, he said. They may not act on it the first time, but they hear what you're saying.

"Family physicians can also counsel family members on how to address risk factors and can be enormously persuasive with other organisations", Kolbe added. "Decision makers really do listen to family physicians".

Pregnancy complications need more attention

PROF. MICHAEL de Swiet of Queen Charlotte's Hospital, Jaffna calls upon the obstetricians here to pay more attention to improved service to pregnancy complicated area in the healthcare services.

Prof. Michael was speaking as the chief guest at the Sri Lanka College of Obstetricians and Gynaecologists at their 38th annuals sessions held at the Sri Lanka Foundation Institute in Colombo last week.

He said:

Medicine in Sri Lanka has an enviable reputation for the ability to achieve remarkably high standards of healthcare with limited resources. So I suspect that conclusions that I draw relating to obstetric care based on my Uk experience are equally valid in Sri Lanka.

Maternal mortality is a good index of obstetric care. Changes in maternal mortality reflect changes in maternity care as well as many other factors, medical and non-medical.

Maternal mortality in the UK has fallen from about 70/100,000 maternities in the 1950's to 12/100,000 in the first triennium of this millennium, a considerable achievement by all involved in maternity care. But direct deaths have fallen far more than indirect deaths.

In the 1950's there are more than three times more direct deaths than indirect. In the 1990's the numbers were equal and by 1999 there were more indirect than direct deaths.

Indirect deaths such as deaths from heart disease tend to be medical rather than obstetric or surgical - medical conditions have thus become more important causes of maternal mortality. Heart disease is a leading cause of maternal mortality in Sri Lanka as it is in the UK.

Further more the management of the leading direct causes of maternal mortality, thromboembolism and hypertension are largely medical rather than surgical. So overall about three quarters of all maternal deaths could be considered 'medical'.

For example, UK deaths from hypertension are declining. The decrease is both in the pulmonary and in the cerebral causes of death.

This suggests that the medical management of hypertension with antihypertensive therapy is working to reduce cerebral haemorrhage; but also the management of fluid balance, which is implicated in the pulmonary deaths, must not be forgotten.

Obstetricians must pay more attention to and develop skills in the management of medical complication of pregnancy. (The UK tendency in specialised obstetric care has been to develop fetal medicine at the expense of maternal medicine.) Maternal medicine is not just for physicians.

There will never be sufficient obstetric physicians nor should there be to look after all medical problems in pregnancy.

What mothers must do to get a baby born with positive mind

DR. UPALI Marasinghe Consultant Paediatrician Colombo South Teaching Hospital in a study has found that it is possible to get a baby born with a positive mind through a process of socio-spirituality between the parents.

He explained this in an article in the Annual scientific session publication of the Sri Lanka College of Obstetricians and Gynaecologists.

Socio-spirituality - a new dimension in maternal health

Maternal health should be addressed in a different perspective in promotion of maternal and prenatal health, balanced maternal mind becomes the key factor.

Motherhood is the supreme manifestation of 'loving kindness'. She assumes a position of par excellence, that all have to look up to her with respect and concern.

When a woman becomes a mother she is endowed with four noble qualities with her; namely, metta, karuna, muditha and upekka (pali). Out of these metta, the loving kindness is the strongest.

We try to inculcate this quality, when we interact the mother with the unborn baby.

A French educationist Jean Rousseau referred to the fetus as a 'Witless tadpole'. That was more than 200 years ago. During last three decades we have discovered more about the mind and personality of babies, than previous centuries.

As we are aware, prenatal care too involves mind-body interactive process.

It is a fact that all of us concentrate on physical aspects of pregnancy and child birth. Of course it is vital, but we should not forget the mental capabilities of the unborn baby.

Pre and peri-natal psychologists have recently proved the existence of significant sensory capabilities of the unborn. For instance, fetal ear starts to develop very early in the embryo much earlier than the other parts of the Central Nervous System.

By mid term, the auditory nerve is completely melanized. The ossicles in the inner ear are the only bones in the human body to attain final size and form.

Dominic Perpura, a neuroscientist from Albert Einstein Medical College USA showed that the baby in the womb has formed the brain structures necessary for learning and even being aware of the environment, sometime between 28 and 32 weeks of development.

He found that the cerebral cortex the seat of 'thought' is at least as developed during this period of gestation as it is after birth.

Studies show that the personality formation takes place through intense communication between parents, especially the mother. The mother's emotional state is presumably shared by the fetus.

Mother under constant and extreme stress are more likely to have babies who are premature, lower than average weight, hyperactive, irritable and colicky. In extreme cases, these babies may be born with thumbs sucked raw or even with ulcers.

If behavioural messages are loving and constant, parents can nurture a back and forth dialogue with the unborn. In our holistic approach we invite prospective parents to a centre where we conduct participatory spiritually interactive sessions with them. It had been very effective and follow up analysis looks very encouraging.

These will be discussed in detail during our talk. We have now developed teaching materials to conduct these programmes using scientific literature and developing a system of mindful thinking.

This new way of thinking and action suitable to buttress it would enable the mother to develop the loving kindness in a positive way which would enhance the interaction they have.

The parents together would be able to play a role that ultimately helps the growing baby. We expect a child developing in such psycho-sphere to be born as a blessed one with a positive mind.

The backward health situation in Jaffna

DR. S. NAVANEETHAN (Consultant Obstetrician and Gynaecologist) Teaching Hospital, Jaffna in a paper presented on how the war affected the maternal healthcare services in Jaffna at the 38th Annual Scientific Sessions of the Sri Lanka Obstetricians and Gynaecologists held in Colombo last week states:

Reproductive health in conflict affected areas

The war in North and East had affected the maternal health to a serious extent, directly and indirectly pushing the state of health at least 30 years back.

Prior to the war, the North remained as the area with lowest maternal mortality rate and lowest stillbirth rate. Now North is topping the list indicating the state of the maternal health.

The improvement trend of maternal health observed nationally was not reflected in North and East. Studies have shown high incidence of nutritional deficiencies among mothers and children, possibly due to fishing and farming restrictions and loss of livelihood. In severe war-torn areas it is feared that falling literacy rates may have long-term impacts in health of the future generations.

There is gross shortage of nurses, midwives, Medical Officers, Specialists and other paramedical staff.

Funds allocated to Northern health institutions are comparatively low to similar institutions from other parts of the country. Due to shortage of manpower and funds most of the peripheral units are non functional and 80% of maternity cases are handled by one and only General Hospital in Jaffna.

Teenage pregnancies and septic abortions remain as major issues to be addressed. Following the Ceasefire Agreement, situation is improving but it may take many years to catch up the lost pace.

BMJ study finds:

Small at birth remains single and mostly die of heart disease

A recent study done by the British Medical Journal on low birth weights, and unmarried people in society has revealed that most of the low birth weights remain unmarried in life, and the unmarried mostly die of heart disease.

The BMJ reports this study thus: A recent study in the BMJ found that men who were small at birth were less likely to marry, but can slow growth also explain why unmarried people are more likely to die of heart disease?

Researchers from Stockholm University compared death rates for heart disease and stroke of never married and ever married people before and after adjusting for early biological and social factor (birth weight, marital status of the mother, and social class at birth) and social factors in adult life (occupation, education and income).

They found that boys whose growth was slowest were least likely to marry and that death rates from heart disease and stroke were higher in unmarried men than in married men.

However, they suggest that differences associated with marital status in rates of heart disease or stroke are unlikely to have their roots in early growth restriction. Adult occupation, income, and education are far more important.

Despite biological and social factors evolving together and influencing each other, early growth may not explain why unmarried people have higher death rates, they conclude.

Sent to HealthWatch by Dr. Dennis Aloysius