Healthwatch

Vanda 100 Centenaria

A Guiness Book Record for Sri Lanka:

Edward Arambewala

In a Daily News associated Centenarian study project by Prof, Colvin Goonaratne in which a specially grown Vanda Orchid at the Peradeniya Botanical Gardens was dedicated to honour Centenarians for living up to 100 years.

Considering it as an achievement in life by naming it ‘Vanda 100 Centenaria’ is being considered a Guiness Book record for Sri Lanka and the medical profession here, as this is the first time in the world human life has been honoured and respected that way in the world.

This will be discussed at a meeting convened by Prof. Colvin Goonaratne at the SLMA on Tuesday 7, April to present for discussion a constitution for officially setting up the Centenatian study project as Sri Lanka Association for the Welfare and Respect of Centenarians.

Among the Principle objectives of the Association are:

1. To Cherish Centenarians as an enduring symbol of inviolable fundamental human rights and the inalienable sanctity of human life.

2. To promote the welfare of Centenarians in regard to accommodation nutrition, health and social and cultural engagement.

3. To establish links and collaborate with similar associations worldwide that promote the welfare of centenarians.

This naming event took place on August 24 in 2001 at the Botanical Gardens. A Centenarian family here made the prposal to officially write to the Guiness Book Authorities to get this officially entered in the records.

Those who are having centenarians in their families and who wish to attend this meeting please contact Prof.

Colvin on 0773488289 or the Project Coordinator Edward Arambewala on 2632007, mobile 0724246400.

Can your child hear?

Mihiri Wickramarachchi

Two to three out of a thousand newborn babies in the world have a hearing loss. However, hearing is crucial for the development of every child. To understand hearing loss, you should understand how we hear.

Hearing loss results in the inability to hear many speech and environmental sounds. There are three types of hearing impairment: Sensorineural hearing loss is the most common type. It originates in the inner ear (cocohlea) or along the auditory nerve. This loss can be congenital (present at birth) or acquired after birth.

Congenital causes could be

- hereditary factors

- viral infections

- prematurity

- birth trauma such as anoxia

Acquired causes could be

- reactions to ototoxic drugs

- ear infections

- Meningitis

- Encephalitis

- head injury

- noise exposure

Conductive hearing loss occurs when the outer or middle ear is blocked or does not work properly. If this is of temporary nature, it is often possible to correct the hearing loss with surgery and/or treatment with medication. Common causes of conductive hearing loss :

- injury of the outer ear itself

- blockage of the ear canal due to cerumen or other small objects like food, beads or insects

- infections of the outer or middle ear, often with effusion

- perforation of the tympanic membrane

- congenital deformities

Mixed hearing loss is caused by a combination of both sensorineural and conductive factors.

Whatever type of hearing loss your child may be experiencing, its important to remember that each case is unique. Even with the same hearing threshold, the impact of the hearing loss is different for every child.

How do we test hearing?

When we test hearing, we try to quantify and qualify the hearing in terms of the degree and the type of hearing loss. There is a range of diagnostic tests to chooses from. Those depend on the child’s age, physical ability and developmental level. The right solution can be chosen based on the degree and type of hearing loss.

Subjective methods

* Pure tone audiometry is the test of hearing tones. It measures the softest sound across a range of frequencies that a child is able to hear.

* Visual Reinforcement audiometry (VRA) involves the observation of a child’s behavioral reactions to sounds.

* Play audiometry also utilizes behavioral methods and observation to determine the child’s hearing levels. The child’s response to sounds across a wide range of frequencies is recorded on an audiogram.

Objective methods

The hearing sensitivity of infants and very small children may be measured by using Electrophysiological tests. These do not cause discomfort to the child. In fact, these tests are often performed when infants are sleeping.

* Auditory Brainstem Response (ABR) is through taping electrodes to the baby’s skin and measuring brain wave responses to sounds presented through small earphones.

* Otoacoustic Emmissions (OAE) is through putting a small probe tip slightly into the entrance of the infant’s ear canal, and recording the inner ear’s response to sounds presented by the probe.

Ongoing audiological follow- up is crucial for every child with hearing loss. Regular testing is necessary to check that the hearing loss has not changed and if hearing instruments are worn, that they are in good working condition, and functioning optimally for the individual hearing loss.

What is an Audiogram?

This is a picture of hearing sensitivity. It displays the softest level in decibels (dB) at which sounds are perceived by the child. This is referred to as the child’s hearing threshold.

The louder the sounds have to be presented before the child can hear them, the greater the hearing loss.

What is your child’s hearing loss?

Minimal hearing loss (16-25 dB) is like lightly blocking both ears with your fingers. With this type of loss, your child will have difficulty in hearing very soft speech or speech from a distance.

It will be harder when there is background noise, just like in an auditorium or classroom. Hearing instruments might be useful.

Mild hearing loss (26-40 dB) is similar to minimal hearing loss, but has greater effects. Your child may hear speech, but certain segments, especially short words, word endings and indistinct word sounds, tend to drop out.

Background noise in classrooms and in other listening environments makes it even more difficult for the child to hear. Hearing instruments are usually recommended.

Moderate hearing loss (41-55 dB) may cause the child to miss over 50% of speech, and even more with background noise. Hearing instruments are necessary to provide amplification for the child to hear. Without amplification, the child may often have limited vocabulary, produce faint or unclear articulation of speech sounds and develop limited communication skills.

With Moderate to severe hearing loss (56-70 dB) most sounds are not audible to the child. Speech and language skills may not fully develop without proper and early amplification through hearing instruments. The child may also need support from speech and language therapists.

With Severe to profound hearing loss (71 dB and above) most environmental sounds and even speech are almost inaudible. Speech is unlikely to develop without amplification through hearing instruments or other interventions.

Such children will often be referred to various specialized supportive and alternative communication methods (e.g. lip reading, sign language).

Fluctuating hearing loss - children who frequently have middle ear infections may experience varying degrees of hearing loss. These episodes of temporary hearing loss may last for several months or longer.

Even though this is temporary, the child’s speech and language skills may still be affected. The child may “hear” but will constantly miss certain fragments of information.

A child who suffers from High frequency hearing loss (1,500 - 8,000 Hz) will experience difficulty perceiving consonant sounds. Significant portions of important information may be lost from the speech signal.

High levels of background noise will make it even harder to listen.

Unilateral hearing loss implies one ear has normal hearing and the other has a hearing loss, which can create an imbalance in hearing. The child may have difficulties locating sound sources and voices. In addition, the child may have difficulty separating soft spoken speech from background noise, especially if the speech is originating from the side with hearing loss. A hearing instrument is sometimes recommended.

How can we help?

The earlier a hearing loss is identified and intervention provided, the better the diagnosis for the child’s speech and language development. “Early intervention” is the steps a family can take to improve their child’s full communication ability.

The particular intervention needed for each child is unique

Intervention may include hearing instruments, the use of an FM system at home and / or in school, or even a cochlear implant.

Some intervention may extend to communication training based on the communication method chosen. Communication methods include auditory verbal (focusing on speech and listening skills); sign language; cued speech which uses hand movements to assist in understanding spoken words), and total communication, which involves simultaneous signing and speaking.

A high level of parent involvement and support will do wonders for a child’s success, with whichever communication method and types of intervention used.

Hearing Instruments

What is a Hearing instrument? It is a battery powered, electronic device with microphones that amplify sound in the ear. With the results of the audiogram, we can determine the right type of hearing instrument and features that best fit the hearing loss.

No hearing instrument can solve every hearing problem or restore normal hearing. Those are designed to provide amplification, so that the child can hear better in many situations.

Wearing two hearing instruments, also known as binaural amplification, is recommended when there is hearing loss in both ears. It offers your child balanced hearing and better understanding of speech in noisy environments.

Hearing instrument Technology -Modern digital hearing instruments are small, but powerful electronic devices which can be programmed precisely to match a child’s hearing loss. Hearing instruments usually have four or more separate amplifier channels. This is important in order to add the right amount of amplification to the different frequencies. Nothing should be under- or over- amplified.

Safety is priority here. For a young child, a hearing instrument must be safe and hardy. Those should have a child-safe battery door lock to prevent the child from having access to the small battery. Its earhood should be easy to attach, but hard to remove. The outer surface of the instrument should be nanocoated to avoid dirt and humidity, thus catering to a child’s daily wear and tear.

Changes of behaviour and mental factors

Now the experts observe that many overweight or obese patients who fail to lose weight, or use diet and exercise to lose weight but then regain it, do so in part for emotional or psychological reasons or because of a poor understanding of the need for behavioural change.

Learning about nutrition and exercise is simply not enough; in many such persons, behavioural and psychological factors must be addressed or these factors will prevent them from permanently changing their behaviour for achieving weight loss goals.

There are stages of behaviour change in gaining weight loss as follows:

Precontemplation You may be unaware that the problem exists, see noneed for diet or exercise changes, and notinterested in discussing the behaviour

Contemplation You are considering the risks and benefits ofchanging weight behaviour, you are waiting forthe right moment to begin diet and exercise, and wish the problem behaviour would solve itself

Preparation and You plan to initiate weight behaviour change and determination are motivated and ready to learn about diet andexercise

Action You have achieved consistency with changed weightbehaviour, weight loss is visible, and you believethat maintenance is possible

Maintenance You have incorporated new weight behaviour in daily life, avoid backsliding, and confident aboutmaintaining the change

Termination You have maintained new weight behaviour for 1 yr,avoid relapses and confident about maintaininglifestyle and behaviour

As it can be observed, each stage has its own psychological factors to be thought of. Overall process is a mental process or a thought process. Each stage is unique and a different state of mind is needed to maintain or remain in that stage. Identifying and accepting a problem is very important in first phases.

Some times we hesitate to accept about the bad things or conditions about ourselves. The way we behave, as we think is right. So initial acceptance and initialising an action to solve the problem is one of the difficult barriers to overcome.

In preparation stage the motivational factors are very important. You should be motivated by yourself or you should be pushed by others. External environmental factors will play a prominent role for motivation. More you read about obesity, more you listen to discussions, more you hear from your peers, you will be motivated more to change yourself.

Maintenance stage is very important among these. You have to accept your changed behaviour and incorporate that to your life. You must develop a mentality, that new lifestyle is far more healthy and beneficial for getting forward with your life.

For example avoiding junk food which is rich in fat is very much beneficial to change and if you are positive about maintaining that lifestyle change you are in right tract emotionally. That is very important.

Some examples of psychological conditions and obesity:

Following cases give some idea about the psychological conditions and how those will effect the management of obesity. These are true cases observed in USA and these may be true for any country.

To be continued

Courtesy: Slim Life

Laughter the best medicine:

Three childbirths in six weeks

The medical director of a firm was baffled by an employee who kept asking four days off each time on the excuse that his wife had childbirth.

The worker’s first and second requests were granted without question although they were only a few weeks apart.

But when a fortnight later, he came in with the same story, the director took him to task.

“How is it possible,” he asked pointedly. “For your wife to have three childbirths in six weeks?”

“She is a midwife,” was the reply. “Whenever she goes out on a job, I have to stay at home and take care of the kids.”

Sent by K. Serasinghe, Moratuwa