Nasheed on “druggies”, the antisocial and all the brouhaha from me (Part 1) June 7, 2007

Nasheed, in his blog mentioned the importance of an integrated approach when looking at substance abuse. My comments in brackets below.

Root cause of many issues is inevitably being linked to substance abuse (i think not..this is just another lame attempt by some one to make a vulnerable group from society being labelled as the “BEAST”). It is dawning on us all that enforcement alone is not working (that is right :)). A wholesome and integrated approach including rehabilitation, penalty, reintegration, community support, policy decisions, enforcement techniques, monitoring and supervision mechanisms, control of borders and tackling anti social behavior in a big way would all need to be included in our approach to fight this deadly (i think this word is too graphic to use here) reality.

I cant agree more on an integrated approach. Unavoidably and explicitly, the words “anti-social” began ringing several bells in my head. I will try to tell a little on what i know about anti-social behaviours. Please allow me.

In short antisocial means “against the society”. No arguing about that. Unacceptable social behaviour or antisocial behaviour among children, adolescents and adults is a much talked about subject. History proves that during different times, different labels had been given to this category of people who showed a certain type of trait or behaviours. When talking about antisocial behaviour, morals and responsibility come in to the picture and thats where this whole subject gets messy. Hold on. I am getting there. Or at least i will try.

The first description of antisocial behavior was known to be mentioned during 1853. In 1853 it was possibly then known as “moral insanity”. It is known that in 1843, what is known as the M’Naghten rule, ruled out a person from getting punishment if the person is not aware of the crime. In 1887, a person was found not responsible for a crime if the person lost the power to choose between right and wrong. In 1941 a person displaying antisocial aspects was depicted as “the mask of sanity”. Like the M’Naghten rule, in 1954 a Durham rule stated that a person was not responsible if the act was a product of mental disease or mental defect and in 1978 the rule of diminished capacity came in to being, giving the mentally disordered criminal guilty to a lesser extent.

There is a reason for me in mentioning all that.

1. Antisocial behaviour is on the rise in our country.

2. Majority of population is young.

3. How many of those “anti-socials” will fit in to the category of a psychiatric illness or disorder?

4. How many does fit in to the antisocial personality disorder (ASPD) type as categorised in the DSM IV.

I know the religious fanatics and some others will be going crazy by now, if they are reading this. They will be saying to themselves that morality and responsibility is a religious issue. Well, let them say what ever they want. Maldiveshealth is dedicated to the special ones in the society for the year of 2007 and where ever, and however i can, i would like to create awareness on the injustice being brought to the vulnerable groups in our society.

DSM IV describes ASPD as “a pervasive pattern of disregard for, and violation of the rights of others that begins in childhood or early adolescence and continues into adulthood”. This pattern has also been referred to as psychopathy, sociopathy or dissocial personality disorder. To fit in to the DSM IV criteria, the individual with ASPD has to be over 18 years of age. They display aggression towards animals and people, destruction of property, deceitfulness or theft and involves in serious violation of rules. They also repeatedly performs these acts with disregard to feelings of others, they are manipulative in order to profit personal pleasures (obtain money, sex, power). They make decisions on the moment without forethought and without consideration for the consequences to self or others. People having ASPD are irritable and aggressive, involves in physical fights , spouse beatings, child beatings, which are common practices. Furthermore, the DSM IV describes them as extremely irresponsible, who fail to make amendments or compensate for their behaviours, have a lack of empathy, callous, cynical and contemptuous of the feelings of others. ASPD is more common in Males (3%) than females (1%). ASPD can occur together with other personality disorders like narcissistic PD, Histrionic PD, Borderline PD, Paranoid PD . The highest prevalence age category recognized as having ASPD is among the adolescent age group. Understanding adolescent delinquency requires understanding adolescents themselves. In doing so we can’t neglect the environment and biology of the adolescent youth in understanding delinquency and antisocial behaviour among this age group.

There is much debate regarding the predisposing factors to ASPD. One of the strong influences comes from geneticist gurus supporting a relationship between genes and ASPD. One such view states that a “disinhibition-disorder gene carried by a parent could result in marital chaos and separation and that it is this inherited gene and not the fact that the parents separated that causes antisocial personality in the child” (I know ..i know.. the religious freaks will be going even more crazier now. Just hold on and tolerate this post will ya). Identifying the responsible gene hence is much more economically viable and could identify high risk individuals and thus treat them before things got out of hand. The geneticist gurus dispute the social causations totally, and solely base their assumptions on genetics. Some studies done in Denmark, Sweden and the US on ASPD and criminality shows only moderate genetics being influential as measured by characteristics of biological parents. Some may argue saying that it is too early to link antisocial behaviour, illegitimacy, or intelligence with genetics as it is only the beginning of the Genome Project. I think it may give a very justifiable and viable answer to a very big problem.

How ever, there are other predicaments which may arise from genetic labelling such as the controversy and dilemma parents has to face if they found out that their child is having an extra Y chromosome. There might be unalterable implications for children of the stigma the children might have to face with genetic labelling. It is also questionable whether violent television, violent cartoons, violent movies and ready access to guns (in US), ready access to heroin (in Maldives) are having any impact on a child becoming aggressive and later on in showing antisocial behavior. Does these social factors outweigh the possible genetic factors? There is more support toward the environmental and upbringing aspects of children and the link between ASPD in adolescents. With the decline of genetic influences, environmental factors become more influential.

……………………..(Part two coming soon)….

The Nasheed effect June 5, 2007

It is happening and it is not funny.

Ask for it and save your loved ones life May 21, 2007

This is just another example of how your assertiveness could save your life or your loved ones life. A doctor writes on how her life was saved by her moms insistent behavior.

Ok, so now that I’ve given you a really good example of the dangers of VIPs bullying doctors, I will present the flip side of the coin:  a good kind of patient aggressiveness.

A 10 month old baby was vomiting and febrile, and her new mom brought her in to the hospital for an evaluation.  She was told that it was gastroenteritis (my favorite diagnosis of late) and that the baby would get over it soon enough.  The young mother insisted that she knew her baby, and that the infant had never been this fussy and that there really did seem to be something more serious at play.  Again, she received eye rolls from everyone from technicians to nursing staff to physicians.  “New mothers are so histrionic,” everyone thought. 

But as the evening wore on, the baby became fussier and fussier, and began scratching herself all over.  The nurses came in and tied her chubby arms and legs down so that she wouldn’t tear her skin.  The mom wrung her hands all night.  The doctor went home, yawning and sure that the baby would be fine in the morning.

Several episodes of violent, projectile vomiting ensued, and the mother pleaded for someone to take another look.  No one would listen, as the doctor had written in the chart that the baby had gastroenteritis, so that was what it was.

In the middle of the night, after the physician had gone home, the mom insisted that the nurses page him to come back to the hospital.  The nurses initially refused, but the mother told them that she would personally make their night miserable if they didn’t comply.   The annoyed physician came back to the hospital against his better judgment, and found the mother and baby looking far worse than when he’d left.  In fact, the baby’s vitals were becoming unstable and her abdomen was quite distended.

The physician ordered an abdominal x-ray series.  It showed an advanced intussusception and the belly was distended with gangrene.  He knew that she was likely to die.  He asked the mother if she wanted him to call the general surgeon (who had no experience with operating on babies) or if she’d like to take a chance and get the infant to an academic center in New York City that had a team of pediatric surgeons on call.  Time was of the essence, but surgical expertise varied greatly between the two options.  The mom could tell that the physician was terrified, and her instincts told her that she should get the most experienced doctor to operate on her baby.

A few hours later, the baby was rushed into the O.R. at Columbia Presbyterian Hospital.  The pediatric surgeon on the case told the mother that it was unlikely that the child would live, but that he promised not to give up on the baby.  At that point, the baby was septic and seizing.

In a truly miraculous turn of events, the surgeon was able to resect the dead bowel and save the baby’s life.  If the baby had arrived even a few minutes later, she probably wouldn’t have made it.

So in this case, I applaud the mother for being persistent and forcing the medical staff to take a closer look at this “gastroenteritis.” In our imperfect medical system, patients and families must sometimes advocate for themselves in order to get the attention they require.  This story, in particular, means a lot to me, because I still bear the abdominal scar from the surgery.

 

Source : revolutionhealth

Official break time May 2, 2007

I am taking a break from blogging. See you all in a few months time.

The Truth sleeps in the morgue indeed April 15, 2007

The pictures say it all. Follow the links for more information.

In Maldives no postmortem can be done to confirm the cause of death. There is no coronors office. No trained personnel to deal with murder cases. The man in the picture was taken out from the harbour this morning and police wanted to bury him as soon as possible. Haveeru daily reports Maldives police as saying that he must have hit his head on something as he was falling in to the sea. As we all can see from the pictures, it is eveident that repeated blows can only do that to some ones face.

Is the Maldives police again trying to conceal something? It can be said that they are, since they tried initially to bury the body without even trying to identify the body or even collecting any evidence.

You can follow the story with these links.

DO

What happened to Hussain Solah

Mysterious death leads to street violence

Doctors day March 31, 2007

Smokers have heard all of the reasons for quitting before: smoking increases their risk for lung disease, heart disease and cancer, and the habit will literally take years off their life. But one reason to quit may not be as well known– smokers require special consideration when undergoing anesthesia for a surgical procedure.

More from here.

Can the US help us March 24, 2007

The US is having one of the biggest debates in reforming their health care policies. What does that have to do with us? Well, we can learn from it. Read about it and hopefully establish a good health care system for us all.

The HEALTH CARE ANSWERS WE NEED raises some good questions even we should ask a potential presidential canditate of ours.

 1. Will the candidate’s plan really cover everyone—with a decent guaranteed level of coverage—at an affordable cost?

2. Does the candidate offer a public plan, like Medicare, that has a predictable, guaranteed level of benefits that “cannot be taken away?” 

etc….

An obese baby March 24, 2007

Now this is obesity at its best. It seems that this “little” fella eats 1kg rice and milk equivalent to 5 litres in a single day. Must be a  mini god   to some of the Indians.

Health promotion March 20, 2007

Jakarta Declaration, 1991, p.1 defines health promotion as

It (health promotion) is a process of enabling people to increase control over and to improve their health. Health promotion, through investments and actions, acts on the determinants of health to create the greatest health gain for people, to contribute significantly to the reduction of inequalities in health, to ensure human rights, and to build social capital. The ultimate goal is to increase health expectancy, and to narrow the gap in health expectancy between countries and groups.  

 

Fake drugs March 1, 2007

International narcotics control board reports that 50% of the drugs used in the developing countries are fake. You can read their report from their website here.