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| HEALTH & FITNESS |
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Obese
children: daily exercise a must Systemic flaws behind surgical errors New asthma drug Aspirin may prevent skin cancer
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Obese
children: daily exercise a must The problem of obesity in children is slowly assuming mammoth dimensions in the present-day scenario. This is mainly being attributed to lifestyle changes, which have slowly sneaked into our society due to great technological advancements. Obesity is defined as being overweight (i.e. an individual weighing 10 per cent more than the ideal body weight). A child weighing around 30 pounds or more than the ideal body weight is considered obese. Factors causing childhood obesity: genetic history, sedentary lifestyle, wrong eating habits, preference for TV/computer/indoor games over outdoor games, travelling by vehicles rather than walking, and using elevators instead of stairs. Complications due to childhood obesity are numerous and life long. The most important is the increased risk of heart disease, diabetes, breathing problems, peer pressure leading to depression, anxiety and sleeping disorder. It is imperative that all obese children undergo a thorough medical evaluation for any hormonal imbalance. In the absence of any physical disorder, the aim should be to reduce the intake of calories and increase the level of physical activity. Reduction in the intake of calories entails the following: *Do not skip meals. A good nutritious breakfast is mandatory. Avoid fatty foods, as they are loaded with calories. *Avoid junk/ fast foods. *Consume lots of fruits and vegetables. *Avoid soft drinks/snacks like chips, cookies and chocolates. Choose healthy drinks like milk (for strong bones/teeth), fresh fruit juices and plenty of water. Physical exercises: This is the most important activity. The motivation to initiate a exercise is crucial. It is advisable to let the children know that exercises should be a part and parcel of daily living and are done to improve the stamina and health. Pressurising to lose weight quickly does not help. This rather acts as a deterrent. If it takes time to put on weight it definitely takes more time and effort to lose the same. Do not weigh everyday. Regular physical activity starts showing effect in about three or four weeks. Exercises: Aerobic activity should be undertaken for at least 60 minutes per day in one go or for shorter periods spanning 10-15 minutes throughout the day. Activity could be in the form of various aerobic activities like running, cycling, swimming, dancing or team sports - hockey, football, basketball, etc. A stretching regimen of five or seven minutes before and after training should be religiously pursued. *For aerobic training an intensity of 55-60 per cent of the maximum heart rate should be set. At the end of each month aerobic tests are conducted to assess the physical capacity and further physical training intensity adjusted. Some interesting exercises for children: *Jumping rope, hoola hoops, etc. *Stand up and stretch arms up, touch toes, then crouch down. *Jump up, then go back down to crouch, Stand up. *Biceps curls - stand on both feet holding a bar and do biceps curls. *Swiss ball exercises for abdominal muscles. *It is safe for children to do push-ups, sit-ups. Weight exercises were traditionally thought dangerous for children as they put stress on the joints, which are already under pressure due to the excess weight. Supervised strength training programmes for children are safe and effective, as long as they have been designed properly. Exercise machines for adults are not likely to be suitable for children. Resistance band exercises are not only safe for children but can also improve muscle strength and increase the strength of growing tendons, ligaments and bones. It is generally recommended that training programmes for children should focus on the proper exercise technique and the number of repetitions, rather than the amount of weight lifted. Therefore, a single set of high (12 to 20) repetition number, performed with moderate resistance, is likely to be more effective in improving both muscular strength and endurance in children, compared with multiple sets of lifting heavy-weights. Physical education in schools, proper motivation and an interesting exercise schedule can control or cut down the number of obese children, which is increasing day by day. — The writer is a former
doctor/physiotherapist, Indian Cricket Team.
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Systemic flaws behind surgical errors If we weigh medical errors in the scale of theory, analysis and application that is used to assess the error in the non-medical areas, we might be able to segregate the poor outcome from individual errors from the ones resulting from general flaws in the system. According to one study, the annual incidence of adverse surgical events is 3 per cent of which 54 per cent were preventable. Some of the reported preventable errors are: *Retention of foreign bodies *Wrong-site/wrong person/wrong surgical procedure *Medication errors such as wrong drug, wrong dose, wrong patient, wrong time and wrong route of administration *Blood transfusions errors A surgeon is usually thought to be accountable for the overall outcome of the surgery and viewed as the “captain of the ship.” With this, errors tend to be personalised and equated with negligence. The point is not that surgeons should avoid responsibility. However, focusing on individual errors does a real harm in under-reporting of the errors and developing a defensive attitude on the part of the surgeon. Minimising such defensiveness requires that greater emphasis be placed on measurement for improvement rather than on measurement for judgment. The concepts of performance and error should be incorporated into surgical education by introducing an objective-based curriculum for the surgical trainees that would provide them with defined skills and knowledge. The blame-and-shame approach must be eliminated from the learning atmosphere. The surgeons, many a times, have to face unspecified and unpredictable situations and need to take instant decisions depending on their knowledge, experience and skill. Thus surgical trainees should be made aware of the expected actions from them in the presence of uncertainty. Strategic factors for the performance and error include an individual’s physical and psychological well-being. Errors increase as the time taken on a work increases. No hazardous industry usually permits its employees to work for long hours, which is a common practice in hospitals. The general rule of “ban on recruitment and creation of new posts” existing in public institutions is crippling the functioning of these institutions. Patient care has more role of team work as compared to any other industry. Too informal cultures in the team undermine the patterns of responsibility and hinder effective decision-making. Conversely, too strong a hierarchy makes it excessively difficult for juniors to question decisions made by those at higher levels of authority. Rigid behaviour of incompetent seniors leads to a lethargic and passive culture in the team, impairs the ability to cope with unforeseen events and discourages the initiative. Thus, team leaders of the surgical units should be chosen depending upon the individual’s surgical skills rather than merely on the number of years of service or the age of the individual. The team members must share a clear understanding of the ground realities of the situation and the expected actions from them. This understanding is referred to as situational awareness. In operation theatres, teams from nursing, surgery and anesthesia co-exist. Adopting a “System Approach” has impressively improved the safety and quality in non-medical settings. Thus, it is worthwhile to consider a similar approach to patient care. A system is defined as a regularly interacting or interdependent group of items that form a unified whole; in the context of patient safety, the term system refers to the individual components of care. A simple system may involve a specific task; a complex system may involve smaller, simpler sub-systems. The three most common factors learnt from a non-medical systemic approach and applicable to surgery are inexperience, breakdowns in communication (e.g., improper handovers and personnel conflicts), and fatigue or excessive workload. Often, these factors interact. A system should be developed where an adverse incident automatically gets recorded. Regular periodic medical audits in medicine should be made mandatory. This is an important tool to introspect and to assess the failures and their causes. The approach of such audits is usually based on recognising medical injuries rather than errors. It is now an established fact that all medical injuries are not caused by negligence. The aim of such audits is purely to improve on the existing system rather than finding faults with individuals. In the developed world, medical audits are usually a routine. In our country, unfortunately, most of even the best institutions are not following this practice. It is crucial for all parties involved in health care to acknowledge that many surgical errors are attributable to systemic flaws rather than to incompetence or neglect. Making efforts to improve a surgeon’s performance, patient safety, and the overall quality of surgical care not only is in the interest of the patients but also in the surgeons’ own best interests. —
The writer is associated with the Department of Orthopaedics, Government Medical College and Hospital, Sector 32, Chandigarh.
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New asthma drug London:
A new drug promises to halve attacks in people with severe asthma by targeting the cause of their attacks. Xolair (omalizumab), which has just been approved for use in the UK, is given as an injection to severe asthma sufferers every two to four weeks. Trials have shown that it can reduce hospital admission for asthma patients by nearly half (47) per cent. It can also reduce asthma attacks in severely affected patients by 55 per cent. The drug blocks the antibody immunoglobulin E (IgE), which is involved in the allergic process in asthma. It is designed as an additional treatment for patients who suffer from severe, persistent allergic asthma that cannot be controlled with standard therapy. Xolair was approved for use in the US in June 2003 and has already been licensed in several other countries ,including Australia, Canada and Brazil. The drug, developed by Novartis, is recommended for patients with persistent allergic asthma who have severe problems such as reduced lung function, despite using high dose inhaled treatments.
— ANI
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Aspirin may prevent skin cancer Sydney:
The common painkiller aspirin, already found to be effective in reducing the risk of heart disease, may also help lower the incidence of skin cancer, Australian researchers have said. According to a study undertaken by the Queensland Institute of Medical Research, regularly taking non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin could offer increased protection against skin cancer and sunspots. “We found that people who regularly used aspirin and other NSAIDs had significantly lower risks of developing skin cancer than people who did not use them,” researcher David Whiteman said. “Moreover, we found that among people who had never had skin cancer, those who regularly used aspirin had significantly lower numbers of sunspots.”
— AFP
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Stress and tempting food Washington:
If you are desperately trying to keep your own front in the battle of the bulge, then here is something that you should be wary of, a study has narrowed in on a recipe for overeating, comprising stress, deprivation and tempting food. Two studies in the October issue of Behavioral Neuroscience show that when animals are stressed, deprived and exposed to tempting food, they overeat, with different degrees of interaction. The powerful interplay between internal and external factors helps explain why dieters rebound and even one cookie can trigger a binge if someone’s predisposed to binge. The findings also implicate the brain’s opioid, or reward, system in regulating overeating, especially when the food is extra- tempting — and not only in under-fed animals.
— ANI
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