Taare Zameen Par

THOMAS ALVA EDISON, inventor of the telephone, microphone, the phonograph and the electric light bulb, was thought to be a dunce at school. He could never learn the alphabet or math; his spelling and grammar were appalling.

Statistics show that about 10 per cent of school going children experience specific learning disability called Dyslexia (dys meaning difficulty and lexia meaning words) The World Federation of Neurology defines Dyslexia as "a disorder manifested by difficulties in learning to read, despite conventional instruction, adequate intelligence and socio-cultural opportunity".

Runs in families

There is evidence to show that Dyslexia runs in the families and is hereditary. A person can also become dyslexic due to external factors like birth trauma, oxygen deprivation or accidents resulting in brain injuries, epilepsy and drugs prescribed for the control of seizures can also cause dyslexia. The degree of dyslexia can range from mild to severe. Children who are mildly dyslexic learn to cope by themselves.

Children who display symptoms of dyslexia are not dull. Constant criticism and failure can affect the children emotionally. They develop low self-esteem and school becomes a stressful place for them. They may even be prone to depression and outbursts of anger. In many cases, it is not just the child who suffers but also the entire family. Parents are upset and angry at the child's non-performance. The child is pushed from school to tuition teacher and failure becomes a part of life.

Parents should accept the fact that the child has a learning disability and take suitable remedial measures. They should not compare the child with other children. They should consult other parents who have faced such pressures and also find out more about the problem.

Teachers also have a role to play in creating a positive environment. A school must have teachers qualified in remedial education to identify and give them help. A teacher who handles 40-50 children in a class will no doubt find it difficult to give individual help during the regular hours, but he/she can certainly try to meet the special needs of these children by giving them some concessions, especially in the primary classes.

Positive atmosphere

Both parents and teachers must try to create a friendly and cordial atmosphere for the children. They must not criticise the children constantly. These children are not lazy or dull. They need to be taught in a special way to bring out their best. They have several strengths. Adults must not give an impression that they are concentrating on the child's weaknesses alone.

Dyslexia can be identified early — by the time the child is five years old. Early identification and intervention is much easier than remedial education in late years. Schools can also adopt appropriate systems of modifications in their evaluation. There is an urgent need to establish learning centres and train more teachers and parents in recognising and dealing with this problem.

What to look for

A student who is dyslexic:

Will answer correctly orally but cannot do so in writing.

Will read "was" as "saw"; "14" as "41"; "91" as "61".

Has difficulty in differentiating the sounds of letters like `p' and `b' or `t' and `d'.

Loses pace while reading and often skips lines.

Draws well but has a very poor handwriting.

Hates spelling and reading

What parents can do

Help the child in the following ways:

To manage time

To put things in their places

To focus attention

To read and do homework

To take the right books to school

Give precise and clear instructions

Do not give punishments for clumsiness, delay in completing work

Give constant positive inputs

Instruct using `do's' rather than `don'ts'

Impart social skills

What teachers can do

Teachers can help in the following ways:

Give less written work

Test children orally

Give marks for content.

Introduce abstract ideas through pictures and objects

Give precise clear, short instructions

Give extra time to finish tests

Do not punish for poor handwriting or messy work

Emphasise quality of work

Avoid punishment for minor misbehaviour

Problem areas

Children with dyslexia may also have problems in areas like organisation, memory, physical coordination, attention and concentration, languages and social behaviour.

Organisation could include find the time, date and year, completing assignments, locating belongings.

Under Memory, the problems could include remembering directions; learning maths, new procedures, alphabets and spellings; identifying letters; remembering names and events.

Physical Coordination includes problems with manipulating small objects; learning self-help skills, cutting, drawing, handwriting, climbing and running and other sports.

Attention and Concentration include problems with completing a task, acting before thinking, restlessness, daydreaming.

Language problems may include pronouncing words, learning new words, following directions, understanding requests, relating stories, responding to questions, reading comprehension.

Social behaviour includes problems with making and keeping friends, impulsive behaviour, accepting changes in routine; interpreting non-verbal clues and working as a team.

DO YOU KNOW WHAT TO EAT ?

A SURGE in energy intakes is evident from our daily food consumption with the focus shifting from meals to snacks and from at-home to away-from-home foods. Forsaking healthy, home-cooked meals, many of us are today gorging on calorie-rich, nutrient-poor snacks, beverages and sweets.

This shift has become rather gigantic in the West, with many studies across age groups showing that people are consuming a large proportion of their daily food via snacks rather than sit-down meals. This trend favours quick, easy, often non-nutritious, foods and high-calorie treats.

Changing lifestyle

The situation is no different in India; fast foods, street foods and processed foods are becoming part of our lifestyle. Of these, energy dense foods coupled with negative lifestyle factors and lack of physical activity are contributing to debilitating health conditions.

Obesity and the incidence of non-communicable diseases are on the rise. In part, the problem is being attributed to the virtual replacement of conventional foods by processed products due to lifestyle changes. The concern is understandable, but today, only the processed food industry is under scan. It is necessary to understand that all processed foods need not necessarily be considered "junk foods". Similarly, all the fast foods and street foods need not necessarily be `junk'.

Health effects

Since junk foods are high in energy, excessive consumption, coupled with lack of adequate physical activity, may contribute to obesity.

Studies in the West, which tested this hypothesis, found that those who ate these foods, compared to those who did not, consumed more total energy, fat, added sugars and less fibre, fruits and non-starchy vegetables. This shift indeed has become a cause for increased risk of obesity. However, in these countries, junk foods (contributing empty calories) have virtually replaced traditional diets.

However, in the Indian context, there are no large-scale studies to understand the extent of junk food consumption and its role in causing obesity among people of different age groups. However, there are reports based on isolated studies on consumption of "fast foods" among the young people.

An All India Institute of Medical Sciences (AIIMS) study looked into the role of junk foods in causing obesity and hypertension among adolescents. Yet another study in Ludhiana found higher prevalence of obesity and hypertension among urban adolescents, who consumed junk food more frequently as compared to their rural counterparts.

Food labels


The food-based dietary guidelines for Indians formulated by the National Institute of Nutrition (NIN) clearly indicate that processed foods, sugar, salt and saturated fats should be consumed judiciously. Food labels play a pivotal role in helping people understand health effects of various ingredients and thus make informed choices. The Indian Government has initiated stringent regulations in this direction. The current laws make it mandatory to depict the name of the manufacturer, place of manufacturing, date of packing, best-before date and ingredients. Along with all these details, through latest amendments, the Government has now made it mandatory for packaged food makers to furnish the details about the number of kilocalories per 100 gm of the food along with the fatty acids, additives and the processing aids used (if any).

The recent amendment also makes it compulsory that the numerical information on nutrients be expressed as percentage of Required Dietary Allowances (RDA) prescribed by the Indian Council of Medical Research (ICMR). These regulations will definitely go a long way in helping us make healthy choices.

However, experiences in developed nations indicate that there is a need to go a step further and make the labels more user-friendly by use of symbols. The traffic light scheme, designed to provide at-a-glance information on whether a food is high, medium or low in total fat, saturated fat, sugar and salt, is becoming more popular.

If not the nutrition awareness and ability to analyse the health effects of various foods, at least consumer education on these issues is essential for us to understand what is "junk" in these foods.

Dr.V. Sudershan Rao is a Senior Research Officer and G.M. Subba Rao is Research Officer at the National Institute of Nutrition, Hyderabad. E-mail: vemulasr@yahoo.com; gmsubbarao@yahoo.com

* * *

What's what?

# Processed foods are those subjected to technological modifications either for preservation or to convert into ready-to-eat items like ready mixes, dehydrated foods, canned foods, confectionery, bakery, dairy products and breakfast foods. They require technology and machinery, and so are a little costlier. In India, manufacture of processed foods is rising in the unorganised, small-scale and cottage industries causing concern that they may not conform to food standards.

# Fast foods are pre-cooked or cooked to order within minutes like burgers, fried fish, milk shakes, chips, salads, pizzas and sandwiches.

# Street foods, as defined by Food and Agriculture Organisation (FAO), are a wide range of ready-to-eat items and beverages prepared and/or sold by vendors and hawkers, especially in streets and public places. Idly, Vada, Dosa, Chat items, sandwiches prepared and sold on the streets. Safety in handling and serving is a bigger concern than nutritional impact.

# Junk foods are those food that contain little or no proteins, vitamins or minerals but are rich in salt, sugar, fats and are high in energy (calories). Examples are chocolates, artificially flavoured aerated drinks, potato chips, ice creams and French fries.

# Any food, processed or unprocessed, street or fast food, can be termed 'junk' only if it has these above features.

WHEN DEPRESSED WHAT TO DO ?

ANAND felt miserable. He felt sad most of the time. He had lost all interest in his work and leisure activity. No activity was pleasurable. Favourite songs sounded flat. He had to push himself to do simple tasks, which appeared like a big burden.

He was convinced that his job was the cause for his mood state. He felt hopeless about the situation in the office. "I will feel better only when I throw this job away," he reasoned. As the thoughts intensified, he resigned. The HRD manager urged him to reconsider his decision, but Anand was adamant.

Consequences

For the first three days, he felt relieved that the burden was off. The sadness lingered. He hoped that he would be able to snap out of it soon. Three weeks later, the sadness, the low interest level and the inability to enjoy were still present. He did not have enough motivation to look for a new job.

Gradually, the consequences of leaving his job stared at him. Boredom, loneliness and the financial implications made him wonder whether his judgment was wrong.

He felt guilty about his resignation. He felt embarrassed to ask his ex-office to reconsider him. Ultimately when he did contact, the HRD manager pleaded helplessness.

Resignation, divorce, suicide are some decisions that would appear perfectly logical and rational when one is depressed. While depressed, one would perceive the world through a filter, tinted with sadness. The person tends to focus on the negative aspects of self, environment and the future. ("I am worthless", "This office has gone to dogs" and "By 2007, my skills will have no demand"). The negative thoughts will not be based on ground reality and will be irrational.

When all seem lost, suicide might appear to be the only logical solution. When the sadness fades away, many more solutions would become visible and the option of suicide would seem illogical.

Suicide is not the only decision that is irreversible. A hasty dispatch of a legal notice to one's spouse can lead to an irreversible spiral of events.

Do not take major decisions when you are depressed, as your judgment will be coloured by your mood state. Postpone them until your mood has improved.

Once your mood is normal, if you want to resign your job for other reasons, it is fine. In such a situation, you would plan your resignation, finances, alternate job etc.

Before considering divorce you might decide to work through your marital conflicts with your spouse. As for suicide, you will not get suicidal ideas when your mood is cheerful.

A CUP THAT CHEERS

THINK of tea drinkers and invariably the British come to mind. The fact is that tea arrived in the U.K. at about the same time as it did in Europe. But it was the British who took to it with a passion; changing the original Chinese brew by adding sugar and milk.

Over time, the upper classes saw tea taking as a sign of civilised behaviour, and as a fashionable social event. There were others in those damp cold climes who were comforted by the hot cuppa.

For tea aficionados, the 19th Century British Prime Minister William Gladstone said of the brew, "If you are cold, tea will warm you; if you are too heated, it will cool you; if you are depressed, it will cheer you; if you are excited it will calm you." Endorsements like that popularised the beverage in the U.K. Demand went skywards. Traders, planters and everyone dealing with tea were smiling all the way to the bank. In addition to booming tea sales, the dairy and sugar industry also grew.

New drink

Around the time tea became a hot item in Great Britain, in the U.S., Richard Blechynden, a tea plantation owner, accidentally discovered iced tea. The story goes that Blechynden was serving hot tea on a particularly blistering summer day at the 1904 World's Fair in St. Louis. The customers were looking for something tall and cool. Blechynden poured the beverage over ice and added a sprig of mint and a lime wedge. And, a delicious new drink was born.

Current statistics reveal that the average Brit puts back some 3.5 cups a day, compared to, for example, the average American who consumes less than half a cup. As figures go, however, the English are not really the world' s No. 1 tea drinkers. That honour goes to the Irish. Generally associated with whiskey and Guinness, the Irish actually put back more than four cups a day!

But let's go back to where it all started, to China where the average is one cup a day. In early China, it is said that tea was consumed for its health benefits. Some 4,000 years ago, tea's medicinal and healing properties were well known. No traditional Chinese meal setting is complete without a pot of tea. Whether it is breakfast, lunch or dinner, the ubiquitous pot is always around. Served in small cups, the light to amber brew is imbibed in small sips throughout the meal, between mouthfuls of food, to enhance the taste of food, and for reasons of health.

In the teeming marketplace of Wanchai, Hong Kong — where timeless Cantonese traditions fight for a place in the sun with Western influences such as Coke, Gatorade and so on — a popular tea-shop owner said, "No other food or drink can offer more benefits than tea". To drive home the point, he pointed to a framed picture behind him, "Better to be deprived of food for three days than tea for one".

Scientific research around the world is now corroborating what the Chinese chai-wallah said. A recent study at Harvard Medical School, published in the Journal of American Heart Association, May 07, 2002, was found that tea drinkers not only reduce their chances of developing heart disease but that they may be actually prolonging their lives after a heart attack. Regular tea drinkers had "significantly elevated survival rates as compared with those who didn't".

Health benefits

This is probably the first large scale scientific study to suggest that drinking tea can actually protect the heart after damage has already occurred. Researchers suspect that the antioxidant-rich flavonoids, water-soluble natural chemicals that abound in green and black teas, may provide the link between tea consumption and survival.

In earlier studies, there was evidence to show that these chemicals can prevent the "oxidation of low-density lipoprotein, and that they can enhance the blood vessels' ability to relax in patients with cardiac disease". Research also indicates that tea lowers total cholesterol levels, as well as improving the ratio of good (HDL) cholesterol to bad (LDL) cholesterol.

The beverage of choice in many parts of the world, long touted as having healing properties is now being backed by credible scientific evidence be it heart attack or cancer or rheumatoid arthritis or high cholesterol. A cup of tea at least twice a day may make a big difference to health.

British poet William Cowper described tea as "the cup that cheers but does not inebriate". That was in the 18th century. Today as we explore and find out its secrets and benefits, perhaps it's time to take a second look at the humble brew.

ORTHOPAEDIC INJURIES-PROBLEMS IN WOMEN

WOMEN are predisposed to developing certain musculo-skeletal problems in middle age. The differences in bones and joints of men and women help one understand women's increased susceptibility to certain injuries, knee, ankle and foot problems and stress fractures. This is not confined to athletes, even housewives and working women are prone to these problems.

Differences

There are both anatomic and physiological differences. There is more fat around the upper arm, buttocks and thighs gives women a more rounded appearance. When women undergo orthopaedic surgery, they require a slightly different protocol for pain management, physiotherapy and thromboembolic prophylaxis.

The extra padding around the arm, thighs and buttocks in women may lessen their chances of injury to the acromio-clavicular joint, clavicle, humerus after a sports-related fall. The female pelvis is wider than that of men. So the hip from which the thighbones descend is more widely set and there is a resultant outward muscular pull on the kneecap. The Q angle, formed by the direction of the pull of the quadriceps tendon and the patellar tendon, is more in women (17° against 5° in men.) Wide hips lead to an increased Q angle and can cause knock-knees, outward twisting of the shinbone and pronated feet.

The most common complaint in young and middle-aged women is anterior knee pain, which frequently arises from the under surface of the kneecap (patella) due to softening of the cartilage and wear and tear.

Common complaints

The main cause of this is misalignment due to the increased Q angle. It causes a more powerful component in the outer thigh muscle leading to a lateral vecot force on the kneecap. Thus the kneecap moves slightly out of joint.

Women's knees are more likely to dislocate outward. They can also be titled slightly outward thus predisposing to one-sided wear and tear. Pain in the knees can increase while climbing stairs or squatting. Some girls add to their problems by wearing high heels. The downward flexion gait increases the compressive force at the knee joint. Luckily, this pain can be banished after special exercises and only a small proportion require kneecap surgery.

Another knee problem that has been observed in sportswomen is a higher incidence of anterior cruciate ligament injuries. The exact reason for this is not yet clear. It may be partly due to the decreased size of the intercondylar notch at the lower end of the femur (thighbone), different biomechanical pattern of muscular activity and landing mechanism.

Women are more prone to developing bunions. This is more common in the West and may be due to improper footwear. Hallux valgus, a condition in which the big toe angles outwards excessively, is more common in girls. Callosities may develop on the inner side of the toe joint. Wearing high heels may lead to contracture of the Achilles tendon leading to tendon problems behind the heel and also pain under the heel. Women have lesser muscle mass than men due to hormonal differences.

Hormones

Female hormones also lead to ligamentous and tendon laxity. They also influence bone mass and density. Estrogen causes conservation of bone mass and osteoporosis results after menopause. Exercise-induced amenorrhea can lead to osteoporosis. Post-menopausal women develop stress fractures in their feet after prolonged and repetitive exercise and need to increase their intake of calcium. Women athletes can also develop stress fractures of the tibia.

Since cosmetics is an important factor in women, surgical incisions and wound closure techniques need to be planned well. Women tend to opt for minimally invasive arthroscopic techniques for shoulder and knee surgery.

Women also have a lesser pain threshold than men. After surgery, they require more painkillers. Persistent pain can lead to slow rehabilitation and calls for a more effective pain management.

Why Undescended Testis Surgery in children ?

IN some mammals the testis stays inside the body and comes out only during the breeding season. In human beings, the testis is located outside the body in the scrotal sac. The sperm production is best at temperature two degrees less than the body temperature. This is why the testes are located outside the body.

How it happens

When the baby is formed in the womb, the testis starts developing inside the baby's belly. As the foetus grows, the testes gradually descend and reach the sac. When this does not happen, or is arrested half way, the result is "Undescended Testis". This is seen in 30 per cent of boys born before date (preterm). Among full term boys, the likelihood is one to three per cent.

When the newborn is examined, the paediatrician may suspect the problem when the scrotum is poorly formed. In such cases, one can wait for three to six months for spontaneous descent. After six months, the chances of spontaneous testis descent are low and one should seek medical help.

Problems

If the problem is not corrected at the right age, the following problems may occur:

Infertility: When the testis does not descended, it is exposed to higher body temperature, and sperm production is affected. In later life the patients have reduced sperm count and thus have problems in fathering children (50-70 per cent less than normal).

Torsion: When the testis is not descended, it is free to move around. This makes it easy to get twist and cut off its own blood supply. The scrotum gets red and tender within a few hours. If an emergency operation is not done within six hours, the testis is lost.

Testicular Tumour: There is also a small risk of tumour development. If the testis is not brought down, the tumour can develop without being noticed and become advanced before treatment.

Correction

For boys with Undescended Testis, surgical correction is recommended within one year (maximum two years). The testis is usually found in the lower part of the belly and fixed to the scrotum after achieving enough length. When the testis is too high inside the belly, a laparoscopic operation is performed to bring it out in two stages with the help of key hole surgery.

Usually the success rate is 95 per cent. When only one testis is affected, and surgery is performed at the right time, there is 80 per cent chance for fertility and paternity. When both testes are affected, there is still 50 per cent chance.

HOW TO TACKLE GUM DESEASE ?

PERIODONTAL Disease (PD) is commonly referred to as "Gum Disease". "Periodontal" means surrounding the tooth. PD is the disease of the surrounding structures of the tooth — the bone, gums and fibres that attach the tooth to the bone. There are different kinds and may affect one or multiple teeth. It can be broadly classified into the following stages.

Gingivitis: This is the first stage in which only the gums are affected. The gums get red, puffy and tend to bleed easily. This is a reversible stage and can be cured with simple procedures.

Early Periodontitis: Gingivitis, if untreated, progresses into Early Periodontitis when plaque and calculus burrow in between the gums and the tooth creating a pocket. This weakens the support and makes the tooth loose. This stage generally requires more advanced forms of treatment, which may also be surgical.

Advanced Periodontitis: This is the most severe form that sees a lot of bone damage. The teeth become very mobile. This stage is quite difficult to treat and requires very advanced treatment modalities.

Causes

The prime cause is plaque, a sticky film composed of bacteria and its by-products that are constantly formed around the teeth. If not regularly removed it turns into a hard calcified substance called calculus, which can only be removed with special instruments. The bacteria in plaque produce toxins, which cause differing grades of infection leading to destruction of the periodontal structures. Other factors that might aggravate PD are smoking, pregnancy and puberty, medications like Phenytoin and Nifidepine, uncontrolled diabetes and other systemic diseases.

Symptoms

The most common symptoms are bleeding gums, especially while brushing; red and puffy gums; persistent bad breath; gums separating from the teeth; pus-like discharge from the gums; mobile and drifting teeth with discomfort while biting.

Some people do not have any of these symptoms. Many experience almost no pain till the tooth has reached its last almost untreatable stage.

Treatment

A general dentist usually treats early forms. To manage advanced stages a Periodontist or a specialist in the diagnosis, prevention and treatment of PD is required. A small measuring instrument called the periodontal probe is used and X-rays are taken to assess the destruction. The treatment varies from scaling procedures to surgical therapy. In some cases Tissue Regenerative therapy may be suggested. Scaling is the removal of all visible plaque and calculus. Contrary to popular belief, this does not harm your teeth. Patients are generally advised to get their teeth scaled once a year. Advanced treatment involves surgical correction to arrest the disease and to repair and regenerate the lost structures.

Prevention

Once PD is treated, patients require Supportive Periodontal Treatment (SPT). During SPT, the periodontist evaluates periodontal health, examines and removes any new formation of plaque and calculus and traps the disease process, if it recurs, in its initial stages. This addresses only 50 per cent of the problem, it will arrest the disease process and possibly repair some damage. The other part is to be able to maintain the state of health in what is now slightly compromised dentition.

PD is a chronic disease and often recurs without ongoing supportive therapy. Supportive therapy involves getting a regular check up and scaling once in six months; brushing regularly twice a day; and seeing the dentist the moment any symptom appears.

Brushing

Use fluoride toothpaste as fluoride makes teeth stronger and more resistant to acid attacks. This in turn helps to prevent tooth decay. Brushing the teeth combats plaque, which builds up daily. Removing plaque not only makes the teeth feel clean, but also helps to prevent bleeding gums, and makes your breath fresher too. Try to brush in the morning and last thing at night. Brushing at night is important as it protects teeth against acid attack while you are asleep.

Choose a soft or medium (not hard) brush with a small head to reach difficult corners. Replace the brush once it wears out.

Place the bristles of the toothbrush where the teeth and gums meet. Then, move the toothbrush back and forth using small, gentle movements to remove plaque from the gum region where it collects.

Hold the toothbrush like a pen, so that brushing is not too hard. Use a finger grip, not a fist grip. Don't hurry. Make time to clean every tooth.

Always remove partial dentures and braces before brushing and clean them separately.

Your dentist or hygienist can check if teeth are cleaned properly and can remove any tartar that may build up that brushing can't remove.

They can also give advice about the need for dental floss or other special cleaning aids.