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HEALTH EDUCATION

MODULE CODE: 770/760/762/763/753/754ED81

MODULE NAME: HEALTH EDUCATION

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SYLLABUS
Learning Objectives:

At the end of the course students will be able to:

1. Acquire knowledge about physical and health education.
2. Understand the rules and the regulations of sports and games.
3. Develop the skills in organizing the physical education programmes in schools.
4. Develop the activities required for organizing physical education meets and
events.
5. Acquire knowledge about recreation, health and safety education
6. Acquire knowledge about common communicable diseases.
7. Understand the nature of injuries and to provide first aid.
8. Acquire knowledge about yoga and physical exercises.
9. Create awareness on different aspects of health and fitness.
10. Understand the diet modification in the treatment of under-weight and obesity.

Mode of Assessment: Attendance is Compulsory. A student should secure 85% of

attendance in the course to be eligible for appearing End Semester Examination.
Minimum 2 assignments carrying 10 marks each shall be submitted for evaluation
(Refer Assignment Policy). 2 Continuous Assessment Test covering 2.5 units are
conducted at 7th week and 14th week respectively for 10 marks each. There shall be a
End Semester Examination at the end of 17th week covering all 5 units for a 3 hour
duration and evaluated for 60 marks. (Refer Examination Guidelines).
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TABLE OF CONTENTS
UNIT TOPIC PAGE
Concept of Health Education
Meaning, Definition, Aims, Objectives and Importance of
Health Education - Personal Hygiene - Health Education in
I Schools - Health Instruction, Health Services, Safety Education: 7
Importance with reference to Schools, Play fields, Road,
School and Home
Causes and Prevention of Diseases
Life style disorders: Heart diseases, Cancer, HIV/AIDS,
Reproductive Helpless Health, Osteoporosis, Depression,
Intentional & Unintentional Injuries, Diabetes and Obesity - 44
II Back Pain: Causes, Symptoms and Prevention - Addiction:
Alcoholism, Smoking and Drugs - Impact of Pollution on
Human health - Communicable diseases: Malaria, Swine flu,
Typhoid, Cholera, Small Pox, Tuberculosis Causes, Symptoms
and Prevention.
First Aid – Principles and Uses
Principles of First Aid, First aid equipment, Fracture - causes
and symptoms and the first aid related to them, Muscular
III sprain causes, symptoms and remedies, First aid related to 125
haemorrhage -respiratory discomfort, Snake bite - First aid
related to natural and artificial carriage of sick and wounded
persons, Treatment of unconsciousness, Treatment of heat
stroke.
Yoga, Physical Exercises and Fitness
IV Meaning, Definition and Uses of Yoga - Essentials of Yogic
Practices - Eight limbs of Yoga - Methods and Benefits -
Physical Exercises, Types: Aerobic, Anaerobic, Effects of 169
Physical Exercises on various systems - Circulatory, Muscular,
Difference between Physical Exercises and Yoga - Fitness
components and its importance - Effect of Physical Exercises
on human body systems.
Food and Nutrition
V Meaning of Food, Classification, Constituents of Food, 194
Vitamins and Deficiency Diseases, Meaning of Nutrition,
Malnutrition - Causes - Balanced Diet and Diet for Obesity
and Under Weight
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UNIT I

MEANING OF HEALTH

The preamble to Constitution of the World Health Organization (WHO)

adopted by the International Health Conference states four dimensions to
health which is defined ―as a state of complete physical, mental, social and
religious well-being and not merely an absence of disease or infirmity.‖
Health depends upon many factors such as fresh air, sun light, diet, exercise,
rest and relaxation, sleep, cleanliness, right attitudes of mind, good habits
and way of life-style.
Purified water (potable water) is prepared by removing dirt from the water
and treating the water to remove or kill germs. In some areas, the
government purifies water that is delivered through secured plumbing; this
water is safe to use directly from the faucet for food and drink. In most of the
world, however, water should be purified before use. Foods should be
washed free of dirt and then peeled, cooked, boiled, or sanitized before
eating.
Components of Health (Four)
 Physical health
 Mental health
 Social health
 Spiritual health
Physical Health Definition: Physical health is a condition or quality of the
human organism expressing the adequate functioning of the organism in given
conditions, genetic or environmental.
Mental Health Definition: It is a state of well-being in which every individual
realizes his or her own potential, can cope with the normal stresses of life, can
work productively and fruitfully, and is able to make a contribution to her or his
community.
Social Health Definition: It is a harmonious relationship between an individual
or group and the physical, biological and socio-cultural environment.
Spiritual Health Definition: It is the individual‘s integration with the greater
whole of life, and is measured by the degree that we honour our
interconnectedness with all things.
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Indicators of Health: Indicators of health are the parameters to assess the health
status of a population.
Eight (8) Parameters of Health
 Mortality Indicators
 Morbidity Indicators
 Disability Rates
 Indicators of Health Care Resources
 Utilization Rates
 Indicators of Social and Mental Health
 Health Policy Indicators
 Indicators of Quality of Life
o Environmental Indicators
o Nutritional Status Indicators
Five (5) Determinants/Factors Affecting Health
 Genetics
 Environment
 Way Of Life
 Social Economic Status and
 Health Services
Concept of Hygiene: The term ―Hygiene‖ derived from Hygeia, the goddess of
health in Greek mythology. It is defined as, ―the science of health and embraces
all factors which contribute to healthful living‖.
Two (2) Facets of Hygiene
 Personal Hygiene (PH)
 Environmental Hygiene (EH)
Personal Hygiene means promoting standards of personal cleanliness within the
setting of the conditions where people live.
Factors of Personal Hygiene
 Bathing
 Clothing
 Washing hands and toilet
 Care of nails, skin, teeth and feet
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 Spitting
 Coughing
 Sneezing
 Personal appearance and
 Inculcation of clean habits in the young
Training in physical health should begin at a very early age and must be carried
through school age until the end of life.
Personal Hygiene is the basic concept of cleaning, grooming and it is the
first step to good health. Besides that it is consider as one of the most
important part of our daily lives at home and at workplace which help us to
protect ourselves and keep us with good health.
Concept of Personal Hygiene: Personal hygiene includes different habits
i.e., washing hands and brushing teeth which keep bacteria, viruses and
fungal far away from our bodies. Moreover these habits will help us to
protect our mental health and activity. Also good personal hygiene will help
us to keep feeling good about ourselves. Since those who do not take care of
their personal hygiene i.e., dirty clothes, body odour and bad breath will
suffer from discrimination and this will mainly leads to mental problems. But
the most important point in this subject, is that all people has their own
hygiene but some people do it better than others, this will mainly depends on
each person culture, society and family norm.
Medical Personal Hygiene: In the medical sector this term includes
personal attention to prevent the spread of germs and diseases, and this can
be take place by using of personal protective equipment barrier over the skin
these equipment includes gloves, boots and coverall. Also, good hand
washing, scrubbing and skin care can prevent work exposures to disease and
help in removing chemicals, germs and contamination.
Personal hygiene requires the cleaning of all parts of the body (face, hair,
body, legs and hands). The face and hair have to be cleaned because they
accumulate grime, emit bad odours and make one dull. Skin diseases such as
ringworm, scabies, sweat fungi, etc., can also occur. The hands and finger
nails have to be cleaned because the germs in between the fingers and finger
nails cause contagious diseases such as diarrhoea, worms, etc.
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The teeth and mouth have to be cleaned because they emit bad odours, cause
mouth and dental diseases such as cavities, gingivitis, etc., and stomach
disorders due to indigestion. Thus, one‘s face hair, body, legs and hands
should be cleaned thoroughly, and the teeth brushed properly. Ears, an
important part of the human body, should be kept clean and carefully
protected from injury.
Practice of personal hygiene should be carried out as daily, weekly, and
monthly activities. In addition to one‘s personal hygiene and cleanliness of
one‘s home and its surroundings, the classrooms and the school surroundings
should also be clean. Drinking impure water can cause cholera, diarrhoea,
dysentery, typhoid and hepatitis. Therefore, pure drinking water free from
germs and dirt, should be used. Improper sewage and garbage disposal can
lead to the spreading of contagious diseases through rats, mosquitoes, flies,
cockroaches and stray dogs. Only fly proof latrines should be used and
garbage disposed of properly.
Moreover this term i.e., medical hygiene also pertains to the hygiene
practices associated with the administration of medicine, and medical care,
these practices will lead to the prevention or minimization of diseases and
their spreading. In order to reach to the required point of minimization of
diseases and their spreading, there are some important points to do that:
1. Use of protective clothing and barriers, such as masks, gowns, caps,
eyewear and gloves
2. Disinfection of reusable materials or things (i.e. linen, pads, uniforms)
3. Isolation of infectious persons or materials
4. Sterilization of instruments used in surgical operations
5. Safe disposal of medical waste
It is clear from the above points the importance of personal hygiene in
preventing the incidence and spreading of different diseases which can affect
human health in different ways in some cases, deadly. Therefore it is a very
important to clarify the proper and the most effective ways that people who
work in medical and non-medical sectors to maintain personal hygiene at
workplace.
Elements of Environmental Hygiene: Environmental hygiene includes
 Domestic
 Community hygiene
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Domestic Hygiene means hygiene at home and your immediate

surroundings. Good hygiene is an important barrier to many infectious
diseases, including the faecal–oral diseases, and it promotes better health and
well-being. To achieve the greatest health benefits, improvements in hygiene
should be made concurrently with improvements in the water supply and
sanitation, and be integrated with other interventions, such as improving
nutrition and increasing incomes. There is need to improve personal and
community hygiene practices that help to prevent the spread of faecal–oral
diseases. If wastewater is not disposed of effectively it can serve as a
breeding ground for mosquitoes. People may also slip and fall in muddy
puddles, and children may play in them and risk waterborne illness.
Personal and Domestic hygiene

Hand washing Proper hand washing is one of the most effective ways of
preventing the spread of diarrhoeal diseases. Pathogens cannot be seen on
hands, and water alone is not always sufficient to remove them. Soap and
wood ash are both cleansing and disinfecting agents when used with water
and can be used to kill pathogens on hands and utensils. The most important
times that hands should be washed with soap and water are:
 After defecating
 After cleaning a child who has defecated
 Before eating or handling food
Promoting good personal hygiene often requires that community members
are mobilized towards this goal and awareness is raised about how to achieve
it. It is important that hygiene education programmes do more than simply
tell people that if they do not wash their hands they will become sick because
of pathogens they cannot see. This rarely works. Instead, education
programmes should try different methods to maximize community
participation in the programmes and to encourage people to promote good
hygiene.
To encourage hand washing to become part of the daily routine, suitable
facilities must be located near to places such as latrines and kitchens, where
they will be needed. If running water is available, the facilities should
include a tap and a sink as well as soap. Hands may also be washed at a tap.
If running water is not available, an oil can or bucket fitted with a tap is a
simple way of providing hand washing facilities; the larger the container, the
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less frequently it will need filling. Some containers are mounted on stands
with a ledge for soap.
Bathing Regular baths and laundry work are important for cleanliness and
good personal appearance. They also prevent hygiene-related diseases such
as scabies, ringworm, trachoma, conjunctivitis and louse-borne typhus.
Educational and promotional activities can encourage bathing and
laundering, but increasing the number of washing facilities and locating them
conveniently may be more effective. Bathing with soap is an important
means of preventing the transmission of trachoma—an illness that can cause
blindness and other eyesight problems.
Children‘s faces in particular should be washed regularly and thoroughly. If
a child has trachoma, a special towel or tissue should be used to wipe or dry
the child‘s face; the towel should never be used for other children because of
the risk of transmitting the disease. Ideally, programmes that promote
bathing should be combined with a programme to reduce the numbers of
flies, which spread trachoma and other diseases, and to improve sanitation.
For people to bathe thoroughly they must use sufficient water, but it may be
difficult to promote the use of more water for washing if water supplies are
distant and water must be collected by hand.
Many traditional bathing practices do not use water efficiently and ensuring
cleanliness may be difficult. By modifying existing practices, such as by
encouraging the use of water containers with taps, it may be possible to
improve the efficiency of water use. Community shower units, with separate
facilities for men and women, can also become income-generating
enterprises in larger villages, but the facilities require careful maintenance
and must be conveniently located. Operators should also allay concerns
about voyeurism, which may be particularly important to women. Such
problems are best resolved through discussion within the community.
Laundry: To promote laundering of clothes and bedding, laundry slabs or
sinks can be constructed near water points. They should be large enough to
wash bedding and other bulky items and be situated so that water drains
away from the laundry area and away from the water source. Locating
laundry places in natural water bodies, streams and irrigation canals is best
avoided if possible, since this practice can contribute to the transmission of
diseases.
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Food preparation in the home: As most food is likely to be prepared in the

home, it is important that families understand the principles of basic hygiene
and know how to prepare food safely. Before preparing food, hands should
be washed with soap or ash. Raw fruit and vegetables should not be eaten
unless they are first peeled or washed with clean water. It is also important to
cook food properly, particularly meat. Both cattle and pigs host tapeworms
that can be transferred to humans through improperly cooked meat; for this
reason, raw meat should never be eaten.
Eggs, too, must be cooked properly before eating, since they may contain
salmonella, a virulent pathogen. The kitchen itself should be kept clean and
waste food disposed of carefully to avoid attracting vermin, such as rats and
mice that may transmit disease. Keeping food preparation surfaces clean is
critical, because harmful organisms can grow on these surfaces and
contaminate food. Fresh meat should be cooked and eaten on the same day,
unless it can be stored in a refrigerator; if not, it should be thrown away.
Cooked food should be eaten while it is still hot and should not be left to
stand at room temperature for long periods of time, since this provides a
good environment for pathogens to grow. Food that is ready to eat should be
covered to keep off flies and should be thrown away if not eaten within 12–
16 hours. If food must be stored after cooking, it should be kept covered and
in a cool place, such as a refrigerator.
If a refrigerator is not available, food can be stored on ice blocks or in a
preservative such as pickling vinegar or salt. Food that is already prepared,
or food that is to be eaten raw, must not come into contact with raw meat as
this may contain pathogens that can contaminate the other foods (particularly
if slaughtering was not carried out hygienically).
Factors of Domestic Hygiene
 Use of soap
 Need for fresh air, light, and ventilation
 Hygienic storage of foods
 Hygienic disposal of wastes
 Need to avoid pests, rats, mice and insects
Community hygiene Some health measures can be undertaken only by the
community as a whole; these include water source protection, proper
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disposal of solid waste and excreta, wastewater drainage, controlling animal

rearing and market hygiene. Some of these issues have been described in
earlier sections. Individual community members play an important role in
community hygiene, and have a responsibility to their neighbours and to the
community to promote good health and a clean environment.
For example, everyone in the village must keep their houses and compounds
clean, because one dirty house can affect many conscientious neighbours and
contribute to the spread of disease. Community leaders can promote
cleanliness in the home by regularly checking on village households and by
using by-laws to encourage household maintenance.
Markets often represent a health hazard because foodstuffs may not be stored
properly and because the markets may lack basic services, such as water
supply, sanitation, solid waste disposal and drainage. Ideally, markets should
have several taps to provide traders and customers with ready access to safe
water for drinking and washing. Many vegetable and fruit sellers regularly
sprinkle their produce with water, and it is important that they have access to
clean water for this.
The sanitation facilities should also be appropriate for the number of people
who will visit the market, with separate facilities for men and women. Water
and sanitation facilities for a market are often relatively easy to support by
charging a small user fee, or by using part of the market fee to pay for such
services. If people are charged a fee to use the facilities, discounts can be
offered to traders who already support the facilities through their market fee.
Foodstuffs sold at the market should be inspected daily by health officials.
This is particularly important for meat and fish, which should be inspected
before sale to ensure that they have been prepared according to national
regulations and that they do not contain pathogens or other contaminants.
Markets usually generate a lot of solid waste and it is important that it is
disposed of properly, to prevent vermin such as rats and insects from feeding
and breeding among it.
The layout of market stalls should thus allow easy access for vehicles that
collect waste and clean the area. Solid waste should be collected and
disposed of daily, and preferably more often. Strategically located waste bins
(often concrete bunkers) can make this more effective. Market areas should
also be properly drained to prevent flooding and insect breeding. Successful
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refuse collection in west Africa In one west African market, refuse collection
was effective because there were enough disposal points, and because the
market was closed for a short time each day to allow waste to be collected
and the market to be cleaned. This made the market safer and more attractive
to customers.
Markets function most effectively when they have legal status, with market
fees and supervision, preferably by health officials based at the market. Well
run markets tend to have strong traders‘ associations and good links between
market associations and local service providers. Market traders can have a
strong voice in improving conditions, since they generate significant income
for communities and provide essential food distribution services.
Traders‘ associations can set up standards for the market, can successfully
manage water and sanitation facilities, and can organize regular waste
collection. If markets are held regularly, community members should seek
advice and support from local health staff on issues such as setting up an
association, establishing trading standards and penalties for contravention,
and on lobbying for service provision. As markets grow, the management of
services often gets easier because the growing number of fees collected
provides more income for services.
Animal rearing In many communities animal rearing is a means of
generating food high in protein content and nutritional value, and for
generating additional income. Animals can also provide many other
products, such as leather and fuel that improve the quality of life. However,
if it is not practised safely, animal rearing can have negative effects on the
health of the community. Animals should always be kept away from
households, particularly cooking areas and drinking-water sources, since
their excreta contain pathogens that can contaminate food and water.
Preferably, animals should be kept in compounds at least 100 metres from
water sources and 10 metres from houses.
Animal waste should be disposed of properly, away from homes and water
sources, or be used as a fertilizer. It is also best that animals are slaughtered
away from households and water sources, since the offal and wastes may
introduce contamination. Slaughtering must be carried out by qualified
individuals who follow the country laws governing slaughter practices..
Some disease vectors prefer animal hosts to humans. Pigs, for example, can
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be reservoirs of Japanese encephalitis, dogs can be reservoirs of some

illnesses and some mosquitoes prefer to feed on cattle rather than humans.
Placing animal shelters between mosquito breeding places and the village
may therefore provide some protection against malaria transmission.
Food hygiene: Contaminated food represents one of the greatest health risks
to a population and is a leading cause of disease outbreaks and transmission.
Food that is kept too long can go bad and contain toxic chemicals or
pathogens, and foodstuffs that are eaten raw, such as fruits or vegetables, can
become contaminated by dirty hands, unclean water or flies. Improperly
prepared food can also cause chemical poisoning: cassava leaf that has not
been properly pounded and cooked, for example, may contain dangerous
levels of cyanide. To promote good health, therefore, food should be
properly stored and prepared. Ways in which communities can prevent
health risks from food are discussed in the following sections.
Eating-places: In many rural communities food is bought and consumed at
eating places (cafes, restaurants or cantinas). If basic health and safety rules
for storing, preparing and handling food are not followed in the eating-
houses; these places will represent a health hazard for the customers and may
cause serious disease outbreaks. The most important aspects of food hygiene
in these establishments relate to sanitation, water supply and personal
cleanliness:
 Eating-houses should have clean water for washing and drinking, and
separate sanitation facilities, away from the kitchen area, for customers,
cooks and food-handlers.
 The staff should have clean uniforms each day and have regular medical
check-ups.
 Food should be freshly prepared daily and any that is spilled or not used
should be disposed of.
 The kitchens and eating areas must be kept clean and free of vermin and
insects.
 Eating-houses should also be well-ventilated, with adequate lighting, and
have procedures for dealing with fires and accidents.
For example, the eating area should not be too crowded, to allow customers
easy exit in the event of a fire. Most countries have legislation covering
eating-houses and their operation. As a rule, eating-houses require official
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approval before they can operate and are subject to regular checks. These
checks are likely to be increased in times of epidemics.
The community should recognize that eating-houses must be properly run
and maintained to ensure that they do not become a source of disease.
Eating-houses should be periodically checked, for example by health
officials, to make sure that the establishments do not pose health risks. If a
community member suspects an eating-house of posing a health hazard,
he/she should request an inspection by the appropriate local health
authorities.
Street food-vendors Street food-vendors are common in urban and semi-
urban areas, but they also operate in rural areas, particularly if there is a
market or community fair with bars and other drinking establishments.
Although people enjoy food from these vendors, in many cases the food is of
poor quality and it represents a serious health risk. Where street food-
vendors are legal, they should be regulated by the health authorities. Often
they are not legal, however, and in these cases steps should be taken to
promote their safe management of food and, where necessary, to prevent
them from selling their food.
This may be difficult if the demand for street food is high, and it may be
necessary to work closely with local health authorities. Street vendors should
be encouraged to locate close to water points and sanitation facilities where
they can keep hands and food clean. Community members can also work
with vendors to ensure that food is prepared and eaten immediately, rather
than being kept unrefrigerated for long periods.
Factors for Environmental Hygiene
 Improvement of basic sanitary services, including water supply
 Disposal of human excreta and other solid and liquid wastes
 Vector control
 Food sanitation
 Housing
Health Education in Schools: Schools face multiple types of demand every
day. They are places where society‘s main concerns all converge. How then
can health education find a place within the multiple roles of the education
system? It is straightforward to show that the issue of health education has
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links with the main issues that are currently examined in schools, and that it
is one of the ways in which the huge changes in our education system are
being expressed.
Health education, if it is not conceived of as the transmission of intangible
rules, can be an excellent way of drawing out and making explicit the
tensions between potentially conflicting areas of teaching activity, and of
exploring ways in which these tensions may be reduced. Health education is
a constituent part of any humanities education programme. The idea that
positive health behaviours can be acquired in childhood has led the political
authorities to assign schools the task of prevention. At least two ways of
interpreting these issues emerge, if the arguments are used in various types
of discourse are examined.
The first refers to security, and the second to promotion of individual and
social well-being. The first invokes the idea of the urgency of prevention (if
we do not act now, the consequences will be terrible in the future, and risk
destabilising our society)
Second invokes broader concerns (promoting social well-being, taking
responsibility for one‘s own health and that of the community). The first was
the predominant idea for a long time, but the emergence of both an ethics of
individual well-being and increased expectations that the State will provide
for individuals have led to greater emphasis on the second idea.
These two sources of legitimacy coexist in the educational system and
necessarily involve different ways of perceiving the role of schools and of
teachers. In this context, with its multiple layers of tension, the educational
system, its partners and the professionals involved in it are all called upon to
contribute to health education. The specific nature of work in schools arises
from the fact that such work is organised according to our country‘s
democratic project.
The foundation of democracy is confidence in citizens‘ ability to act in a free
and responsible way. However, the capacity to decide for oneself and to take
control over one‘s own existence is not innate. Education builds such
abilities. In health, then, the role of schools and others involved in education
(primarily the family) is to support pupils while they learn liberty and
responsibility. In other words, this is about giving citizens the means to
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decide for themselves, and not allow the media, commercial companies,
gurus or experts to do this form them.
The main consequence of considering health as part of this project that
underlies all school activity is the fact that health should not be considered as
an end in itself and the ultimate aim of existence. In a democratic society,
health cannot be a substitute for universal emancipation. It is a precondition
for being able fully to enjoy citizenship, and not an aim in itself. The first
step in a training plan is to set out clearly what is at stake. This is what we
shall attempt to do, succinctly, in this book.
Health education in teacher training: The specifications for teacher
training grant a significant place to health issues. Health and prevention are
issues that call upon the professional competencies of teachers, both as
subjects to be taught along with all non-subject areas of education, and as
components of the civil servant‘s role (acting in an ethical and responsible
way) ―to identify students who have difficulties with health issues and high-
risk behaviour‖ and ―to take responsibility for students who have
disabilities‖.
Finally, the issue of partnerships, which is central to health education, is
brought to the fore: working as a team and together with parents and partners
(in particular, medical and social work professionals, public services etc.).
More generally, this stresses the non-subject educational dimension of
teachers‘ professional practice and emphasises the need for professional
practice to take into account the school‘s collective programme, and for there
to be communication with students and parents. This will not lead to the
creation of a new area of training. Such a step would only contribute to the
fragmentation of teacher training.
Training in health education can be a way of bringing the disparate parts of
training together, rather than just adding yet more content. All teachers are
faced with the issues of high-risk behaviour, and ask themselves about the
role of schools in this area by asking
 Should they contribute to persecution of smokers, or to stigmatising fat
people?
 Should they contribute to the ―ideal body‖ movement, as our
individualistic societies tend to promote?
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 Should they abandon all conversation about sexuality, violence and

drugs?
And about their own individual roles
 How can and must I contribute to pupils‘ education in these areas, which,
although they are fundamental, lie between the public and private
spheres?
 What should I say to a pupil who has used cannabis and who seems not
to be doing well?
 How should I act with regard to alienation that is caused by stereotypes
about body shape, alcohol and sexuality?
Health education is one of the elements of the common culture shared by all
teachers, whether primary or secondary. From nursery schools to high
schools, ―teachers make multiple decisions for which there are many reasons
other than promoting students‘ learning: for example, in order to remain in
the students‘ favour, in order that students are not ―set up to fail‖, in order to
maintain a good atmosphere in class, in order to keep up their own
motivation levels, or in order to conserve their energy.
All teachers have to feel good enough in class in order to ―get through‖ each
day and ―last‖ throughout a career‖. Because health education is a marginal
area of teaching activity, the various factors that determine it should be taken
into account, and work should be done to bring health education together
with the other dimensions of the teaching profession. Such education is not
at the heart of teachers‘ professional identity, and it is not useful to act as
though it were.
The vast majority of teachers are aware of their role in this area, but the huge
number of prescribed activities in all areas means that health education
appears to be just one more activity, a further burden to be added to the
already heavy load. In order to make progress, we must take care to find the
teachers where they are and begin from there. Training for teachers in health
education cannot therefore be limited to organising information sessions on
various health related themes. Progress can only be made on this issue if it is
carefully integrated with the other aspects of the modern teaching profession,
and if it is placed at the heart of any plan to redefine teaching.
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Health Instruction: Education sector not only trains or prepares human

resources needed for the economy; it also produces leadership for various
spheres of life. The leadership coming out of the educational institutions
influences social and political dynamics in the country. Teachers, professors,
and education managers enjoy respect in the community, and they have the
potential to contribute significantly as catalysts of social change and
development.
For example, according to statistics issued by Pakistan over 34 million
children and young people of age 5-24 are enrolled in 228,304 educational
institutions in Pakistan (Pakistan Economic Survey (2008-09), Ministry of
Finance, Govt. of Pakistan, Islamabad, 161). Health sector cannot afford to
ignore this large group of 34 million students and 1.28 million teachers in
Pakistan. There is a need to reach out this important population group.
With School Health Programmes, health instruction will yield following
benefits to the country:
 Reduction in dropout rate
 Enhancement of quality of education and learning outcomes
 Improvement in health conditions of young population
 Disease control and an overall improvement in health conditions in the
society at large
There is an urgent need to plan and launch a comprehensive School Health
Programme under the auspices and partnership of Ministries of Health,
Environment and Education, and with the technical support from various UN
agencies and other donors and professional organizations.
Basic components/pillars of School Health Programme (SHP): A number
of factors influence the physical and mental health of school children, and
their learning process. These factors include health conditions of the children
themselves, physical and social environment in their school, quality of life of
their parents, their own knowledge about health promoting practices, and
availability of health services around them. Modalities and delivery forms of
school health related interventions can be grouped into following categories:
 School Health Environment
 School Health Education
 School Health Services
 School Nutrition Programme
 21

School Health Environment: School environment plays a pivotal role in the

retention and learning outcomes of students. Availability of proper facilities
is a pre-requisite for creating a healthy environment in a school. Provision of
following facilities contributes in creating a conducive environment for the
children in the school:
 Safe clean drinking water (with regular water quality monitoring)
 Gender and culturally appropriate sanitation/toilet facilities
 Adequately spacious class rooms
 Comfortable seating arrangements
 Play grounds etc.
 A child friendly environment
 Access for disabled and physically challenged.
In the absence of above facilities, overall health and mental concentration of
students will be negatively affected. Many children are likely to leave the
school due to its uncomfortable and unattractive environment.
School Health Education: Young children are at a greater risk of various
infections and diseases. Schools have the responsibility to educate their
students and foster among them healthy and hygienic behaviour. They need
to warn their students about various health risks, and guide them how to
protect themselves and others against diseases and other forms of ill-health
by adopting health and hygiene promoting habits and practices. Education of
students on health and hygiene issues, through integration of health and
hygiene information messages into the curriculum, and training of teachers
on following themes form part of the School Health programmes:
 Education about cleanliness, personal hygiene, and sanitation
 Non-Communicable diseases
 Communicable diseases, including H1N1 and Hepatitis, HIV and AIDS
 Education Guidance and Counselling for adolescent students on puberty
issues
 Anti-drugs and anti-tobacco education
 Healthy food (balanced diet) and clean drinking water Sports
 Physical education
 Population education
 Adolescence Education
 Environment education
 22

 Life skills based education

 Orientation of teachers and PTAs/SMCs to stop Corporal Punishment in
schools
Provision of information, knowledge, and skills to the children on above
subjects enable them to develop healthy behaviour and protect themselves
from diseases and practices which can make them vulnerable to various
hazards in their life.
School Health Services: Young children are prone to many diseases. In the
developing countries, where health services for the general public are poor
and overall knowledge about health care is low, parents and teachers are
unable to detect health problem of children which impede their learning as
well. Provision of health services to the children and young students in
following forms fall under this category:
 Health screening (medical check-up) of students on regular basis
 Referral of students with health problems to medical centres for
treatment or rehabilitation
 De-worming campaigns
School Nutrition Programmes: Nutritional level affects overall health, and
consequently the pace of learning among the children. In Pakistan, a
substantial ratio of children is malnourished, particularly in underdeveloped
areas, and among the disadvantaged groups. Nutritional inputs can increase
both attendance and quality of education. Provision of following inputs to
schools can be grouped under nutrition component of school health
programme.
 Good supplements for malnourished children
 Food as incentive to enhance enrolment and attendance
 Promotion of use of iodized salt
 School feeding or school lunch programme for all students in schools.
In the developed countries, school lunch or school feeding programmes are
widely supported. In a number of neighbouring countries, school feeding
programmes are in being implemented. Pakistan had launched this
programme in the past and its results were encouraging. However, it was
stopped mainly due to mismanagement.
 23

Good practices of SHP: A glance at the recent examples School Health

Programme has been institutionalized in some developing and developed
countries. In the recent past, a number of developing countries have also
come forward to launch some form of health related interventions for their
schools.
In Iran too, the Ministry of Health and Medical Education, in collaboration
with Ministry of Education and Training has launched the National
Integrated School Health Screening Programme. This programme aims to
identify children who have early signs of health problems.
„CHERISH‟ (CHampioning Efforts Resulting in Improved School
Health) in Singapore has launched a similar programme for school going
children. The CHERISH Award was launched in August 2000 to give
recognition to and encourage schools to establish comprehensive health
promotion programmes for students and staff through the fostering of good
physical, social and emotional health for optimal learning. This Award
provides a framework for establishing comprehensive health promotion
programmes in the school. It was modelled following the recommendations
of the WHO's Health Promoting School initiative; it uses a whole school
approach towards health promotion.
„Fit for School‟ programme in Philippines: Since 2003, ‗Fit for School‘
programme is being implemented in Philippines. Interventions at school
level include, daily supervised hand washing with soap prior to recess, daily
supervised tooth brushing with fluoride toothpaste, and biannual de-worming
of all children. The costs are comparatively low but benefits are high.
Selected evaluation of the programme have confirmed following impact:
 Infectious diseases including diarrhoea and respiratory infections are
reduced by 30 to 50%
 The progression of (dental) caries is reduced by 40 to 50%.
 The prevalence of helminthic (parasitic worm) infections sinks by 80%.
The number of children with below-normal height and weight is reduced by
20% School attendance rises by 20 to 25% Currently the programme is
implemented by Philippines Department of Education in close cooperation
with 20 different units of local government.
 24

The Department of Education has also launched a new school health

programme which seeks to address both malnutrition and academic
performance of elementary schools in selected schools nation-wide.
Programme is focusing on Pre-school and Grades I pupils. Each recipient
child is given a ration of one kilo of rice on each school day. In 2007, about
2.7 million children benefitted from this programme.
Concept of Disease: Disease is often construed as a medical condition
associated with specific symptoms and signs. It may be caused by external
factors such as pathogens or by internal dysfunctions, particularly of the
immune system, such as an immunodeficiency, or by hypersensitivity,
including allergies and autoimmunity. The term ‗disease‟ broadly refers to
any condition that impairs the normal functioning of the body, characterized
by specific signs and symptoms. For this reason, diseases are associated with
malfunctioning of the body‘s normal homeostatic processes.

―Iceberg‖ concept of disease

DEATH

CLINICAL
DISEASE SEVERE
DISEASE

SUB CLINICAL MILD ILLNESS

DISEASE

INFECTION WITHOUT
CLINICAL ILLNESS

EXPOSURE WITHOUT INFECTION

15

Definition: It is a definite pathological process in the human body or any

other living organism with a characteristic set of signs and symptoms. It may
affect the whole body or any of its parts, and its etiology, pathology, and
prognosis may be known or unknown.
Concept of Handicap means a disadvantage for a given individual, resulting
from an impairment or a disability, that limits or prevents the fulfilment of a
role that is normal (depending on age, sex and social and cultural factors) for
that individual‖.
 25

Concept of Disability means any restriction or lack of ability to perform an

activity in the manner or within the range considered normal for a human
being.
Concept of Impairment means any loss or abnormality of psychological,
physiological or anatomical structure or function. E.g. Loss of leg, foot,
Defective vision or Mental retardation
Sequence of Disease Becoming Handicap

Safety Education: Children are a precious resource, but as children, they

often lack the skills to protect themselves. It is our responsibility, as parents
and guardians, to safeguard children and to teach them the skills to be safe. It
is the adult responsibility as parent, caretaker and teacher to talk to children
about how to protect themselves against abduction, exploitation, and painful
experiences.
Every home should teach children about safety and protection measures. As
a parent active interest to protect in your children and listen to them is
critical to their wellbeing. Teach your children that they can be assertive in
order to protect themselves against abduction, exploitation, and
uncomfortable situations. Together children can be protected by teaching
them to be smart, strong, and safe.
There are two slightly different meanings of safety. For example, home
safety may indicate a building‘s ability to protect against external harm
events (such as weather, home invasion, etc.). It may also indicate that its
internal installations (such as appliances, stairs, etc.) are safe (not
dangerous or harmful) for its inhabitants.
Definition: Safety is the condition of a ―steady state‖ of an organization or
place doing what it is supposed to do. ―What it is supposed to do‖ is defined
in terms of public codes and standards, associated architectural and
engineering designs, corporate vision and mission statements, and
operational plans and personnel policies.
Discussions of safety often include mention of related terms. Security is such
a term. With time the definitions between these two have often become
interchanged, equated, and frequently appear juxtaposed in the same
 26

sentence. For any organization, place, or function, large or small, safety is a

normative concept. It complies with situation-specific definitions of what is
expected and acceptable. Using this definition, protection from a home‘s
external threats and protection from its internal structural and equipment
failures are not two types of safety but rather two aspects of a home‟s
steady state. In the world of everyday affairs, not all goes as planned.
Road safety education is very much essential in today's world as road
traffic is becoming increasingly busy. Years ago, it was safe for your child to
travel on the road without a care, but things have changed since then. Now
there are more cars, scooters, motorbikes, buses etc. on the road. Most of the
educational institutions now organize road safety education for
improving student road safety. This will contain educational activities that
help you to gain more knowledge about road safety.
As a parent, you will always try to wrap your children in your arms and take
them away from all risky situations. By providing proper road safety
education, you will be able to protect your child away from dangers caused
by road accidents. You can give them certain facts, show the possible
dangers and risks involved, explain ways to keep them safe and develop their
skills in understanding consequences.
There are many interesting ways by which you can teach your children about
road safety. You can create a traffic environment for your children, allow
them to ride their own bikes or scooters and learn the rules of the road. Also,
you can organize classes taken by police officials to make your children be
aware of basic road safety rules.
Principles of effective safety education
1. Encourage the adoption of, or reinforce, a whole school approach,
within the wider community: Resources may deliver all or part of whole
school approach and should encourage or reinforce a whole school approach.
A whole school approach encompasses the formal and informal curriculum,
policy (both as written and as implemented) and the relationships among
staff, pupils, parents, carers, with other agencies and with the wider
community.
2. Use active approaches to teaching and learning (including interactive
and experiential learning): Active approaches to teaching and learning
 27

include all strategies in and out of the classroom where the learner: seeks out
information for him or herself, develops a physical skill, engages in
discussion about a topic in pairs or groups (interactive learning), is engaged
in problem solving independently or in a group, adopts a role, or considers
an issue from someone else‘s viewpoint. Active learning may draw on the
learner‘s personal experience (experiential learning.) A resource should
describe how to manage the classroom climate e.g. using ground rules, using
distancing techniques.
3. Involve young people in real decisions to help them stay safe:
Involving young people includes young people‘s participation in real
decisions about keeping themselves safe, in and out of the classroom. Young
people may be involved in designing or participating in surveys,
participating in their school council, choosing which activities they want to
take part in outside the formal curriculum, in peer education projects, in
mentoring or peer support. Activities for young people should include
identification of hazards, participating in risk assessment (e.g. assessing
whether risks are trivial, tolerable or intolerable) and being part of actions to
control or manage risk to themselves and others.
4. Assess children and young people‟s learning needs: Local and national
evidence can help to identify factors that suggest children of a particular age
or group are at risk. Teaching and learning strategies to address these needs
should reflect the age and developmental stage of the learner, take account of
social and cultural needs and the effects of gender on safety related
behaviour and learning. Strategies to assess learning needs can involve open
ended forms of questioning, whether through informal discussion, mind
mapping, brain-showers and circle time. They may also include more
structured formats, such as surveys, focus group discussions, interviews or
‗draw and write‘ activities.
5. Teach safety as part of a comprehensive personal social and health
curriculum: A comprehensive personal social and health curriculum helps
children and young people learn how to keep themselves healthy and to stay
safe. It provides opportunities to learn specific and transferable skills and
knowledge in a wide range of circumstances, but with attention to feelings,
skills, attitudes, values and attributes. Topics should be introduced in the
early years at school and extended and revisited throughout the key stages,
 28

introducing more specific language, knowledge and skill as the child

develops (spiral curriculum).
A comprehensive personal social and health curriculum will offer pupils a
specific time and place to learn about being healthy and staying safe but will
also be cross curricular, drawing on different programmes of study (e.g.
maths, English, science, drama) to help young people access and use relevant
information.
6. Use realistic and relevant settings and resources: Real life data and
examples (but not those designed simply to shock) help to engage young
people and to challenge misconceptions e.g. ‗bullying is acceptable
behaviour among children‘ or ‗accidents just happen‘ where necessary.
(Using data in this way is also known as a normative approach).
7. Work in partnership: Develop links with supporting agencies such as
police, fire and rescue, local authorities, and educational charities where
these add value to work carried out in schools and other settings. Work with
parents/carers and members of the wider community by seeking their views,
providing information and guidance and involving them in developing and
implementing solutions.
8. Address known risk and protective factors: Risk and protective factors
can be anything that is associated with a greater or lesser probability of a
child or young person experiencing harm. Risk factors are not static and can
be divided into several domains: individual (e.g. knowledge or skill) school
(e.g. policy) peer group (e.g. attitudes) family e.g. (parental rules) and
community (e.g. crime). An understanding of risk and protective factors can
help those designing and delivering safety education resources to focus on
wider aspects of injury prevention and personal safety.
9. Address psychosocial aspects of safety e.g. confidence, resilience, self-
esteem, self-efficacy: Psychosocial risk and protective factors are individual
characteristics that may predispose children to injury, or to being a victim of
bullying, violence or abuse. Psychosocial aspects of behaviour operate
dynamically with environmental factors, reinforcing the importance of
incorporating individual protective factors (such as confidence, resilience,
self-esteem, self-efficacy) within a whole school, whole community
approach.
10. Adopt positive approaches to model and reward safe behaviour,
within a safe, supportive environment: It is helpful to identify the short
 29

and long-term benefits of maintaining safe and healthy behaviour, and of

modifying behaviour that is harmful to health. Children and adults learn from
observing and modelling the behaviour of others, including peers, and
generalise their expectation of positive outcomes across different domains.
The 10 principles were developed from the evidence published in national
and international peer reviewed journals up to 2005 which included studies
from such diverse sources as playground safety for nursery age children to
road safety for young pedestrians, bullying prevention, violence and self-
harm prevention.
The Importance of Safety Education: The purpose of knowing and
practicing safety regulations diligently is to ensure the maximum protection
of everyone involved with the healthcare agency, including doctors, nurses,
patients, families and other staff. Being knowledgeable and continuing safety
education about the safety regulations and practices is important in helping
the facility be competent in delivering proficient and safe care while
maintaining a protected environment from potential harm.
Along with the regular safety training, additional workshops can be available
or fliers could be made to be put into convenient and popular places to be
readily accessible to the staff members. Hands on experiences can be very
helpful. As well as gaining the first time experience, the possible reactions,
follow up events and consequences of the situation can be seen and thought
through which adds to the future action plan significantly With a new era
comes new possibilities. With new technology, new issues, new conflict,
everyone should be aware of new possibilities of threats such as bomb
threats, large scale fires, gunmen and hostage situations, terrorist attacks,
biohazard attacks and others.
Road Safety Education in Schools: Road traffic injuries are the single
biggest source of fatality among children aged 10 to 24 worldwide.
Awareness of traffic and road safety practices is literally a matter of life and
death for children. Road traffic injuries are the single biggest source of
fatality in the 10- to 24-year-old age group, worldwide. As awful as these
statistics are, fatal accidents represent a fraction of the heartbreak.
Education and training are important tools for managing hazards and controls
so that children can work more safely and be more productive in the different
environments that they live in. Another role of education and training,
 30

however, is to provide children with a greater understanding of the safety

and health programme itself. In most of the foreign countries, road safety
education is considered as a necessary education. It will be better, if you
provide basic road safety education by bringing it to early childhood,
primary and secondary schools
 Your children will get an overall idea about the principles of crossing
road, importance of helmets, how to use zebra crossings and awareness
of basic safety rules. Through this education, you will be provided with
knowledge and awareness about the safety of pedestrians, cyclists and
passengers
Education on student road safety can encourage a responsible adult to take
necessary action that will make children safe, secure and thereby help
them to have awareness about road safety. In road safety education,
parents, carers, teachers play a vital role in forming and developing
various skills related to road safety
 Assist in the child‘s developmental skill and ability to distinguish
between passengers, pedestrians, low traffic and heavy traffic. As a
parent, participation in safety programs can make it more effective and
successful
 As a parent, your role will have a great significance in safety programs.
You can become a good role model to your children by wearing a seat
belt while driving, reducing unnecessary speeding, avoiding careless
driving, taking care of other passengers and pedestrians. This can have a
positive impact on child's mind as they can follow you easily and thus get
adequate supervision on road
 By conducting safety programmes, you will not only be able to create
awareness among the younger ones, but also among elders about the
traffic strategies
 With the safety programmes the number of injuries and deaths caused by
road accidents can be reduced. Involvement of road safety professionals
helps one to better plan and support road safety programmes and provide
proper training to children and to create better awareness.
Solutions to consider: Children learn more from adult behaviour than may
be realised. The way an adult drives can have a huge influence on the
children, and the type of driver they will be in the future. Research shows
children begin absorbing their parents‘ or carer‘s driving behaviour from a
 31

very early age and they learn how to drive long before they get their learner‘s
permit.
Positive role modelling by parents has a huge influence on how children
drive in the future and instilling safe practices and attitudes from a young age
is a key factor in achieving our long-term goal of no serious injuries or lives
lost on our roads.
Road safety education plays a vital role in shaping the attitude and behaviour
of children as well as young people, thereby ensuring that they become a
responsible driver, passenger, pedestrian, and cyclist. Road safety education
can be organized at different levels by parents, schools and educational
institutions to emphasise the importance of road safety.
As parents, there is a need to set a good example of one who‘s aware of the
traffic rules and as one who abides by them. Thus, for example,
 While crossing a busy road, generally hold the child and do not allow
them to run ahead or walk behind.
 Teach them to be aware of when the road is safe and when it is not.
 Ask them to stay beside you away from traffic.

Following these simple tips would encourage your children to be keen while
following busy roads.
 When crossing the road, teach your kids how to choose a safe place via
which you can cross the road.
 Encourage them to decide if it is safe to move ahead. Also, teach them
about the various traffic signals.
 Schools need to play a wider role in ensuring road safety by properly
educating and informing the students about the importance of road
safety.
Security Measures: An ounce of prevention no matter how carefully
designed a school is to ensure safety; the school is not safe unless the school
community uses its safety features as they are intended every day. The
following are basic security measures recommended for all schools seriously
consider:
 Limit access to one main monitored entrance. One of the most
important security measures a school can take to prevent intruders or
other unwanted visitors is to have only one main entrance where people
 32

may enter and which is monitored at all times (with all other outside
doors locked).
 Modified entry plans should be in place for times when there are a
large number of visitors, for example, election days or assemblies.
While this limited access could be seen as a necessary evil, it can also be
serve as a way for a school to consistently connect with students, parent,
and visitors.
 A friendly face or even voice upon entrance is critical for a
welcoming community. The ―one door access‖ strategies only work if
staff and students do not let anyone into any other entrances. A known,
clear, and workable policy is needed to enforce this. For example, staff
can be told to routinely give directions to the main office that guide
visitors around the outside of the building.
If a staff member determines it is not safe for the visitor to do this (e.g., it
is pouring rain and the visitor walks with a cane), they escort the person
to the main office. Students are told to never let anyone in, including
staff, students or parents. Staff and parents are repeatedly reminded of
this, to avoid putting students in confusing situations.
 Visible visitor name badges are another measure to increase security
while welcoming visitors. Visitor badges allow staff to immediately
identify a visitor. Staff can be told to greet all visitors in a friendly
fashion and, if possible, to ask them if they need any help. Even frequent
visitors (e.g., parent volunteers) are expected to wear visitor badges to set
an example. Ensuring teachers can lock classroom doors from the inside
without using a key is another simple security measure that does not
interfere with learning. The ability to lock a door quickly and easily
during an incident may prevent potential intruders from entering.
Once safety protocols are developed, the next step is to orientate the whole
school community and relevant first responders to these protocols and then
practice them. Orientating the school community involves:
Staff: Presentations on school safety during regular staff meetings. Those
who are absent, including part-time or substitute staff, receive written
material and a staff contact to whom they can direct questions.
Staff with Special Duties: Counselling and nursing staff are trained in
―psychological first aid for schools‖ or trauma recovery. Teachers with
 33

students who need special accommodations receive training in those

modified procedures. Food service, maintenance, and administrative staff
receive training on their roles during incidents.
Students: Brief, age-appropriate explanations and discussions on the how
and why of safety protocols during regular class time. Those with disabilities
or other considerations receive further explanations allowing plenty of time
for questions.
Parents: Letters or e-mails explaining the procedures and the reason for
them. Parents of students with disabilities or other special circumstances
receive individual communications regarding these accommodations. For
new protocols, a meeting or training for parents may be appropriate.
School safety is often a critical obstacle to learning. Crime, violence and
abuse affect all aspects of every community, and schools are not always free
from fear, intimidation or victimisation. As responsible individuals each
person is committed to preventing, managing and responding to incidents of
crime and violence in schools. Prevention and early intervention are the most
reliable and cost-effective ways to support schools in consistently delivering
teaching and learning in an environment that is physically and socially safe.
Safety on the playground: Children have a right to play. The United
Nations Convention on the Rights of the Child upholds that right within
Article 31. Play is a fundamental part of childhood, but it is recognised that
children may encounter dangers when they play. Adults can help to keep
children reasonably safe when they play, but care must be taken not to stifle
the independence and self-expression that play provides. In developing play
provision it is the duty of all concerned to ensure that maximum benefit is
afforded to children. Local authorities, schools, kindergartens, landscape
architects and others looking to develop play areas are often at a loss to know
how to begin.
An important part of play is the presentation of challenges and the use of
imagination on the play area. Stimulating and exciting play areas not only
greatly help in the child‘s development but also, by providing an exciting
place for children to play, keep them away from much more dangerous
places to play such as railway lines, river and canal banks, road sides,
construction sites, and so on.
 34

Good and stimulating play areas need not be expensive (financially) but they
do require a little more time in the planning stage. A logical and systematic
approach to the process will greatly facilitate matters and consideration
should also be given at the early stages for the future management and
maintenance of the area. The same applies to upgrading of existing areas. A
little thought goes a long way.
Four components of playground safety: Safety on the playground, and
helping to protect students from injury, require planning, thought, training,
and deliberate action. Proper selection, placement, and maintenance of
playground equipment, along with effective supervision of playground
activities, can help prevent accidents or reduce their severity. To practice due
care for the safety of playground users in all phases of playground
administration; consider the following areas of playground safety:
A. Adequate, trained, equipped, and attentive playground supervision.
B. Students instructed on how to properly play on the playground equipment.
Written playground safety rules taught to all students, reviewed with
parents, and consistently enforced.
C. Playground equipment and surfacing that are selected, placed, and
installed meeting international safety guidelines.
D. Performing regular preventative maintenance of playground equipment
according to the manufacturer‘s recommendations.
It is necessary to perform routine playground equipment inspection to
identify hazards in the equipment and the playgrounds, and correcting those
hazards.
 Soft surface: Because nearly 80 % of playground injuries are caused by
falls to the ground, improper surfacing is the first thing parents should
watch for when inspecting a playground. Wood chips, mulch, wood
fibres, sand, gravel, shredded tires and rubber mats cushion falls well.
Avoid playgrounds with concrete, grass and dirt surfaces, as they are too
hard. The surface material should be at least 12 inches in depth and 6 feet
around each piece of playground equipment.
 Hard surface: This kind of surface is used for organised games and
sports such as basketball, squash and badminton.
 Swings: These are the pieces of moving equipment that are most likely to
cause injuries to children. Metal or wooden seats should be replaced with
 35

soft seats. Swings should be set far enough away from other equipment
so that children will not be hit by a moving swing
 Smooth sliding Slides: These should be well-anchored, have firm
handrails and good traction on the steps. There should be no gaps
between the slide and the platform, and there should be a bar at the top of
the slide so that children have to sit before going down. A great danger
with slides occurs when drawstrings on children‘s clothes get caught at
the top of the slide.
 Seesaws: Spring-loaded seesaws are best for young children. Avoid
adjustable seesaws with chains because children can crush their hands
under the chains. A traditional seesaw should have a tire or some other
object under the seat to keep it from hitting the ground.
 Merry-go-rounds, or “whirls” or “roundabouts”: are best for school-
age children. They should have hand grips, and the rotating platform
should be level, free of sharp edges and have adequate clearance to
prevent crushing or severing limbs.
 Climbing equipment: These must be used carefully. More children are
injured falling off climbing equipment or horizontal ladders than
anything else on the playground. Check that steps and handrails are in
good condition and make sure a guardrail or barrier surrounds raised
platforms. Any climbing ropes should be secured at the top and bottom.
The number of injuries caused by monkey bars is so significant that
many experts recommend that they be removed from all playgrounds.
Bullying: This is an on-going issue in educational institutions and
communities with significant negative long-term consequences for the young
people involved. A large and growing body of research indicates that
although bullying is a difficult problem to shift, school-based interventions
can be successful in reducing bullying behaviours.
Evidence indicates that bullying is most effectively addressed through
interventions that take a holistic, whole-school approach; include educational
content that allows students to develop social and emotional competencies
and learn appropriate ways to respond to bullying; provide support and
professional development to teachers and other school staff; and ensure
systematic program implementation and evaluation. Bullying can be
understood to occur in three forms:
 36

 Face-to-face bullying: This is also called direct bullying, is overt and

easier for adults to detect. It can include physical actions such as
punching or kicking, and verbal actions such as name-calling and insults.
 Covert bullying: This is also called indirect bullying, is hidden from
adults. It can include behaviours such as spreading rumours, excluding,
threatening, blackmailing, whispering and stealing friends (Cross et al.
2009). Although covert bullying was previously perceived as less
harmful than direct bullying, it is now recognised as having significant
potential for serious harm.
 Online bullying: This is also called cyber bullying, is a specific type of
covert bullying that uses electronic forms of contact (Smith et al. 2008a;
Sourander et al. 2010). Online bullying is difficult for adults to detect or
track, and can be particularly harmful to the targeted student because of
the large potential audience.
Anti-bullying efforts in Schools: The role of the school is to provide an
appropriate education for all its pupils. A stable, secure learning environment
is an essential requirement to achieve this goal. Bullying behaviour, by its
very nature, undermines and dilutes the quality of education. Research shows
that bullying can have short and long-term effects on the physical and mental
well-being of pupils, on engagement with school, on self-confidence and on
the ability to pursue ambitions and interests.
School-based bullying can be positively and firmly addressed through a
range of school-based measures and strategies through which all members of
the school community are enabled to act effectively in dealing with this
behaviour. While it is recognised that home and societal factors play a
substantial role both in the cause and in the prevention of bullying, the role
of the school in preventative work is also crucial and should not be
underestimated.
School-based initiatives can either reinforce positive efforts or help
counteract unsuccessful attempts of parents to change unacceptable
behaviour. Parents and pupils have a particularly important role and
responsibility in helping the school to prevent and address school-based
bullying behaviour and to deal with any negative impact within school of
bullying behaviour that occurs elsewhere. In this document, any reference(s)
to parent(s) can be taken to refer also to guardian(s) where applicable.
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Substance abuse or Drug-taking among young people can make school a

less safe and healthy place for all learners, whether they use drugs or not.
What is meant by ―drugs‖? A drug is any substance, synthetic or natural,
legal or illegal that is administered with the intention to bring about a change
in the behaviour, emotions and thoughts of a human being. Talking about
drugs in schools means:
 Alcohol
 Tobacco (cigarettes)
 Cannabis (dagga)
 Heroin
 Cocaine
 Ecstasy
 Other addictive drugs
 Medicines prescribed for someone else.
 Harmful amounts of medicines easily bought at a chemist or
supermarket.
Look for common signs that a young person might be at risk of drug abuse
which may include:
 Mood swings
 Trouble at school
 Concerns about them among their friends
 Unexplained need for money
 Change of friends
Schools and communities have a responsibility to all learners-including any
who may be at risk from drug use. They are encouraged to help learners at
risk, not ignore them. To help, schools, parents, the community need to work
in partnership. Here is a simple list of ways to help keep children safe at
school.
 Enforce zero-tolerance policies toward the presence of weapons, alcohol,
and drugs
 Establish and enforce drug-and gun-free zones
 Establish policies that declare that anything that is illegal off school is
illegal on school
 Engage learners in maintaining a good learning environment by
establishing a monitoring system among the children
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 Develop protocols in the school about ways to share information on and

handle at-risk learners
 Develop resource lists that provide referral services for learners who are
depressed or otherwise under stress
 Involve learners in designing and running programmes such as
mediation, mentoring, peer assistance, School Crime Watch, and graffiti
removal programmes
Children need a safe and comfortable environment to learn to the best of
their abilities. This means that they have to feel safe in their school and be
able to positively interact with their teachers and classmates. By doing the
following, parents and other adults can help make sure children have a
positive school experience.
Talk to your children about their day. Sometimes children won‘t tell you
right away if they are having problems at school. Ask your children if they
see anyone bullied, if they are bullied, or if anything else makes them feel
uncomfortable. Look for warning signs, such as a sudden drop in grades, loss
of friends, or torn clothing.
Teach children to resolve problems without fighting. Explain that fighting
could lead to them getting hurt, hurting someone else, or earning a reputation
as a bully. Talk to them about other ways they can work out a problem, such
as talking it out, walking away, sticking with friends, or telling a trusted
adult.
 Keep an eye on your children‘s Internet use. Many schools have
computers with Internet access. Ask your children‘s school if students
are monitored when they use the Internet or if there is a blocking device
installed to prevent children from finding explicit websites. Talk to your
children about what they do online i.e. what sites they visit, who they e-
mail, and who they chat with. Let them know they can talk to you if
anything they see online makes them uncomfortable, whether it‘s an
explicit website or a classmate bullying them or someone else through e-
mail, chat, or websites.
 Ask the children about the safety and emergency plans for your
children‘s school. How are local police involved? How are learners and
parents involved? What emergencies have been considered and planned
for?
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 Play an active role through the Parents-Teachers Association at your

children‘s school.
 Map out with children a safe way for them to walk to school or to the bus
stop. Avoid busy roads and intersections. Do a trial run with them to
point out places they should avoid along the way, such as vacant lots,
bushy areas, construction areas, and parks where there aren‘t many
people or adequate lighting.
 Teach children to follow traffic signals and rules when walking or biking.
Stress that they should cross the street at crosswalks or intersections with
scholar patrols when they can.
 Encourage children to walk to school or the bus stop with a sibling or
friend, and to wait at bus stops with other children.
 Teach children not to talk to strangers, go anywhere with them, or accept
gifts from them without your permission. Tell them that if they see a
suspicious stranger hanging around or in their school they should tell an
adult.
 Help children memorize their phone number and full address, including
the area code. Write down other important phone numbers such as your
work and cell phone on a card for your children to carry with them.
Safety at home: Every parent wants their children to grow up healthy and
strong in the place where they deserve to feel safest: at home. The good news
is that there are simple and easy steps that families can take to protect their
children.
Safety from falls
 Make sure to use safety gates at the tops and bottoms of stairs and attach
them to the wall, if possible.
 Keep babies and young kids strapped in when using high chairs, swings
or strollers. When placing your baby into a carrier, remember to place the
carrier on the floor, not on top of tables or other furniture.
 Properly install window guards and stops to prevent window falls.
Windows above the first floor should have an emergency release device
in case of fire.
Water Safety
 Actively supervise children in and around water. Avoid distractions of
any kind, such as reading or talking on the phone.
 40

 Once bath time is over, immediately drain the tub. Keep toilet lids closed
and keep doors to bathrooms and laundry rooms closed to prevent
drowning.
 Make sure home pools have four-sided fencing that is at least four (4)
feet high with self-closing, self-latching gates to prevent a child from
wandering into the pool area unsupervised.
 Every child is different, so enrol children in swimming lessons when you
feel they are ready. Teach young children from an early age not to go
near or in water without an adult. Older children should swim with a
partner, every time.
Safety from Poison
 Store all household products and cleaning solutions out of children‘s
sight and reach. Young kids are often eyelevel with items under the
kitchen and bathroom sinks.
 Keep cleaning products in their original containers. Do not put a
potentially poisonous product in something other than its original
container (such as a plastic bottle) where it could be mistaken for
something else.
 Put the toll-free Poison Help Number into your phone in case of
emergency:
Safety from Fire
 For the best protection, install smoke alarms on every level of your
home, especially near sleeping areas. Test batteries every six months.
 Create and practice a home fire escape plan with two ways out of every
room. In the event of a fire, leave your home immediately. Once you‘re
out of the house, stay out.
 Keep anything that can catch fire, such as dish towels or wooden spoons,
away from your stovetop. Have a fire extinguisher in the kitchen in case
of emergency, and make sure you know how it works.
 Blow candles out when you leave the room or before you go to sleep.
Preventing Burns
 Do not carry a child while cooking on the stove. It‘s better to put your
child in a high chair where you can still see them.
 Keep an eye on appliances such as irons, curling irons or hair dryers that
can heat up quickly or stay warm. Unplug and store these items after use.
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 Keep appliance cords out of children‘s reach, especially if the appliances

produce a lot of heat.
Preventing Scalds
 To prevent accidental scalding, set your water heater to 120 degrees
Fahrenheit or the manufacturer‘s recommended setting. Check the water
with your wrist or elbow before giving your baby a bath.
 To prevent hot food or liquid spills, use the back burner of your stove
and turn pot handles away from the edge. Keep hot foods and liquids
away from the edge of your counters and tables.
Safety from Carbon Monoxide
 Make sure your home has a carbon monoxide alarm. For the best
protection, install a carbon monoxide alarm on every level of your home,
especially near sleeping areas.
 Do not use a grill, generator or camping stove inside your home, garage
or near a window. Don‘t use your oven or stovetop to heat your home.
 If you need to warm a vehicle, remove it from the garage immediately
after starting. Do not leave a car, SUV or motorcycle engine running
inside a garage, even if the doors are open.
Safety from Medication
 Put all medicine and vitamins away and out of sight after every use.
 Use the dosing device that comes with the medicine, not a kitchen spoon.
Kitchen spoons are not all the same, and a teaspoon or tablespoon used
for cooking won‘t measure the same amount as the dosing device.
Safety from Furniture
 Mount flat-panel TVs to the wall to prevent them from falling off stands.
Follow the manufacturer‘s instructions to ensure that you have a secure
fit.
 Use brackets, braces or wall straps to secure unstable or top-heavy
furniture to the wall.
 If you have a large, box-style cathode ray tube (CRT) TV, place it on a
low, stable piece of furniture. If you no longer use your CRT TV,
consider recycling it
Sleep Safety
 Make sure babies sleep on their backs and in their own crib, bassinet or
play yard. Room sharing is a safer option than having your baby sleep in
bed with you.
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 Choose a firm mattress covered with a tight-fitting crib sheet for your
baby‘s crib. Avoid using soft bedding, pillows, stuffed animals and
bumpers in the crib.
Kitchen safety
 Make sure that any sharp objects/tools are in a drawer with a childproof
latch.
 Make sure to install a dishwasher lock.
 Make sure to install a stove lock and knob protectors.
 Make sure all chairs and stepstools are positioned away from the stove.
 Make sure that all pot handles on the stove are positioned inward or place
on the back burners.
 Make sure glass objects and appliances with sharp blades are stored out
of reach.
 Make sure the garbage can is behind a cabinet door and that a childproof
latch has been installed on the garbage can.
 Make sure all appliances are unplugged when not in use and that all
cords are out of reach.
 Make sure all matches and lighters are stored in a locked cabinet.
 Make sure the cabinet under the sink is free of any and all hazardous
chemicals, i.e. cleaning supplies
 Make sure all bottles containing alcohol are stored out of reach.
 Make sure all cords or wires are out of reach.
 Make sure refrigerator magnets or any small objects are out of reach.
 Make sure to install childproof latches are installed on all cabinet doors.
 Make sure you have a working fire extinguisher and that all family
members know how to use it.
 Make sure that your child‘s highchair has a safety belt with a strap
between their legs.
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UNIT II

CAUSES AND PREVENTION OF DISEASES

Introduction: Lifestyle means a pattern of individual practices and personal

behavioural choice related to elevated or reduced health risk. The diseases
which primarily arise from abnormal lifestyle of a person are grouped under
the term ―lifestyle diseases‖. The prevalence of lifestyle diseases is
increasing rapidly due to poor diet, little or no physical exercise and smoking
are major contributors to this increase.
Definition: Lifestyle diseases are ailments that are primarily based on the
day to day habits of people. Habits that detract people from activity and push
them towards a sedentary routine can cause a number of health issues that
can lead to chronic non-communicable diseases that can have near life-
threatening consequences.
Common lifestyle diseases
 Heart disease
 Diabetes
 Cancer
 Stroke
 Arthritis
 Migraine Headaches
 Sleep Disorders
 Musculoskeletal Disorders
 Nerve Compression Disorders
 Carpal Tunnel Syndrome
 Tendonitis
 Degenerative Neck & Back Disorders
 Pulmonary Disease
 Osteoporosis
 Arteriosclerosis
 Gallbladder Disease
 Kidney and Liver Disease
 Alzheimer‘s and Dementia
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Causes of Lifestyle Disease: The causes of NCDs can be divided into three
broad categories: modifiable behavioural risk factors, non-modifiable risk
factors and metabolic risk factors.
1. Dehydration: Dehydration of the muscles and tendons is a primary cause of
muscle fatigue, strain, tendonitis, and other disorders of the musculoskeletal
system.
2. Malnutrition: The lack of living foods in our diet along with the
overconsumption of dead foods causes chronic disease.
3. Inflammation: Inflammation is a primary cause of most lifestyle-related
disorders, including heart disease and musculoskeletal disorders.
4. Fatigue: Lack of sleep is associated with numerous, serious medical
illnesses including: high blood pressure, heart disease, stroke, obesity, and
mental impairment.
5. Poor physical fitness: It is widely recognized that there‘s a direct correlation
between poor levels of physical fitness and increased risk of chronic
diseases.
6. Poor health habits: Smoking, alcohol, drug use/abuse, sugar, fast food, soft
drinks, chocolate, artificial sweeteners, worry, and stress have a negative
impact on your health.
Modifiable behavioural risk factors: Behavioural risk factors such as
excessive use of alcohol, bad food habits, eating and smoking tobacco, physical
inactivity, wrong body posture and disturbed biological clock increase the
likelihood of Non-Communicable Diseases (NCDs). The modern occupational
setting (desk jobs) and the stress related to work is also being seen as a potent
risk factor for NCDs.
According to the WHO, more than 7 million people die each year due to the use
of tobacco and the fatality rate is projected to increase markedly in the years to
come. Excessive use of sodium in the diet causes 4.1 million deaths per year
while alcohol intake leads to around 1.65 million deaths due to NCDs. A simple
lack of physical activity has been claiming 1.6 million lives annually.

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Non-modifiable risk factors: Risk factors that cannot be controlled or

modified by the application of an intervention can be called non-modifiable risk
factors and include:
a. Age
b. Race
c. Gender
d. Genetics
Metabolic risk factors: Metabolic risk factors lead to four major changes in the
metabolic systems that increase the possibility of NCDs:
i. Increased blood pressure
ii. Obesity
iii. Increased blood glucose levels or hyperglycemia
iv. Increased levels of fat in the blood or hyperlipidemia
Increased blood pressure is the leading metabolic risk factor globally with 19%
of the global deaths attributed to it, followed by obesity and hyperglycemia.
A glance at the influences of lifestyle
Computer: People are spending much more time sitting over a place glued to
computer instead of being opting to be physically active, as result, activity of
standing-sitting has turned extremely minimal it reflects on one‘s health.
According to one study conducted, every 1 out of 7 university student begins to
feel pain after working for an hour on the computer. This leads to the needs of
getting neck disc replaced at an early age of 22-23 years.
Television: The trend of watching TV through long periods of time and may be
till late at night is on the rise. Excess of viewing television is also causing
lifestyle diseases such as type-2 diabetic, heart problem, and leads to the danger
of untimely death.
Mobile phone: These phones have brought in the biggest revolution in the
changing individual lifestyle. Excessive uses of mobile phones leads to the
development of tumours which develop into brain cancer according to one
research conducted by the World Health Organization (WHO). It has been
observed that around 40 % of the people using mobiles daily for 1-2 hours
continuously for the last 10 years develop brain or spine tumours.
Air conditioners: This artificial source of cooling has given rise to many
complications. It triggers arguments among the office colleagues on the score of

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its right temperature. They argue its cooling effect influences their output in the
workplace.
Other factors responsible for lifestyle diseases: Newer technologies,
machines, cars have made life easier and comfortable. All these advancements
made in the field of science have polluted the environment. These though have
raised the comfort levels of the people but have caused a disruption in the
ecological balance. Forests have been cut to pave ways for the opening up of
factories, mills and machines. Water, air have become polluted.
Adverse effects of conveniences: Rapid strides have been made in the field of
technology. Newer things are being invented daily. The priority of luxury items
in our life has increases by leaps and bounds. We want to get everything
through the short cut, within minutes, whether that is diet or work leading to
various sorts of strains on the state of one‘s health.
For this unhealthy lifestyle with increasing facilities, the racing life of today‘s
times is also responsible. One is ready to do anything for the sake of earning
excess of money, accumulating excess of comforts and conveniences and
acquiring success quickly. After all how much of pressure, strain and tension
can our body tolerate? Besides, keeping awake till the late hours in night,
sleeping till the late hours in the morning, watching TV for long, the use and
throw culture – all these habits are taking its toll on the state of one‘s body and
therefore health. This results into the body system being torn asunder turning
the normal functioning haywire. Slowly but surely the blood pressure, heart
diseases, diabetic, hyper tension begin to set in the body turning it sick.
There have been great changes in the life style of the children as well. The
condition of the ground in the name of sports is such that in place of playing on
the ground, the children are spending time on video games, indoor games, and
chatting on social networking sites. Sitting at the computers for hours at a
stretch has become a habit that is difficult to break. The increasing use of
automobiles has resulted in people doing less manual activity. Wrong dietary
habits, excessive uses of pre-packed and junk foods, no proper sleep, tension of
studies, depression related to career, unhealthy competition – all these not only
have affected the body and mind.
Lifestyle diseases are ailments that are primarily based on the day to day habits
of people. These habits detract people from activity and push them towards a
sedentary routine which can cause a number of health issues that can lead to
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chronic Non-Communicable Diseases (NCD) that can have near life-

threatening consequences. The world population has gained more than a decade
of life expectancy since 1980, rising to 69.0 years in men and 74.8 years in
women in 2015.
People are spending more years living with illness and disability. High blood
pressure, smoking, high blood sugar, high body mass index, and childhood
under nutrition were the world‘s leading risk factors for premature death and ill
health in 2015. Innovative approaches and effective and evidence based
interventions are required for the prevention, control and treatment of
cardiovascular diseases to reduce the burden and save lives. There is need to
develop broad and sustainable strategy for cardiovascular research and
prevention. Such a strategy should recognize the unique societal influences,
regional cultural diversity and the changing lifestyles as rates of urbanization
continue to increase dramatically.
Cardiovascular diseases that include heart attacks and stroke account for 17.7
million deaths every year, making it the most lethal disease globally. Cancer
kills around 8.8 million people each year, followed by respiratory diseases that
claim around 3.9 million lives annually and diabetes that has an annual
morbidity rate of 1.6 million. These four groups of diseases are the most
common causes of death among all NCDs.
According to WHO, low- and middle-income countries and the poorer people in
all countries are the worst affected by deaths due to NCDs. It is a vicious cycle
of risk where the poor are increasingly exposed to behavioural risk role in
driving people and their families towards poverty. It starts from an individual
and eventually affects entire countries.
Characteristics of NCDs
Complex etiology (causes): Non communicable diseases are driven by
seemingly unrelated causes such as rapid unplanned urbanization, globalization
of unhealthy lifestyles and population ageing. Apparent causes such as raised
blood pressure, increased blood glucose, elevated blood lipids and obesity may
be representations of deep lying lifestyle habits.5
Multiple risk factors: There are a number of risk factors that lead to the onset
and development of NCDs. The various types of risks can be divided into three
primary risk sets: modifiable behavioural risk factors, non-modifiable risk

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factors and metabolic risk factors, many of which are common for a number of
diseases.
Long latency period: The latency period of NCDs is generally long, often
stretching from many years to several decades.
Non-contagious origin (non-communicable): NCDs are not communicated
from one person to another, so it is a given that these diseases develop in a
person from non-contagious origins.
Prolonged course of illness: NCDs are chronic in nature and thus the course of
illness if often prolonged and takes years before a patient may be forced to opt
for medical care or intervention.
Functional impairment or disability: NCDs usually give rise to circumstances
that make it difficult for the patients to lead a normal life. Patients with chronic
NCDs may not be able to take part in regular physical activity, go to the office
or eat normally.
According to the World Health Organization the entire world is moving towards
public health disaster as approximately 16 million people annually fall victim to
lifestyle diseases prematurely. Just in 2012, non-communicable diseases were
responsible for the deaths of 38 million people worldwide, with 16 million of its
victims being under the age of 70. The need for public awareness isn‘t stressed
enough, but is important because lifestyle diseases are also the most easy to
prevent. Simply modifying your lifestyle to eliminate and reduce risks can make
a huge difference.
Factors responsible for these diseases
Unhealthy Eating Habits: Poor eating habits and food choices greatly increase
the risk of lifestyle diseases like cancer, heart disease, diabetes and various
other health conditions. Poor eating habits can include the over-consumption of
certain foods, dietary deficiencies and excessive intake of saturated fats and
refined or processed foods.
This affects people at both ends of the socio-economic spectrum, with different
types of diseases affecting both people. While developed nations and the urban
population tend to follow diets that are high in calories with saturated fats, red
meats and other junk food, they fail to follow a diet that can often include whole
foods and fresh produce including fruits, vegetables and cereals.

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Affluent and developed societies have diets characterized by a high salt intake,
increased consumption of fat and sugar and animal products. Another common
problem faced with urbanization and development is an increase in the prices of
fresh produce and products like organic fruits and vegetables, while refined and
processed foods are cheap and widely available. To cope with high-pressure
jobs and the fast paced lifestyle, people living in cities tend to make choices of
convenience when it comes to food.
Lack of Physical Activity: A sedentary lifestyle is one of the distinctive
features of urbanization, development and progress. Almost all inhabitants of
cities are engaged in occupations that require little physical activity. This is
clearly reflected from studies on physical activity of populations in Sub-Saharan
Africa. Chronic diseases are rare in the region because of the high levels of
physical activity.
The fast pace of urbanization across the continent has not surprisingly coincided
with a rise in chronic lifestyle diseases. While rural populations commute by
walking and engaging in physical activities like chopping wood or tilling fields,
urban populations spend most time indoor either in offices or at home. Public
transport and automobiles are used for commuting. In poorer districts where
safety is a concern, people spend even less time outdoors and instead watch
television at home.
Obesity: It has become one of the greatest problems for modern society as it
greatly increases the risk of numerous health conditions from diabetes and
hypertension to sleep apnea, osteoarthritis, lower back pain and gallbladder
disease. Obesity is also closely associated with cancer, coronary artery disease
and overall diminishes life expectancy. While the Body Mass Index or BMI is
normally used to calculate the extent of body fat and the extent of obesity, the
risk is also affected by your distribution of fat.
Stress and Anxiety: Stress does not just affect us emotionally or mentally, it
also has a clear physical effect as it aggravates and increases the risk of
conditions like obesity, cardiac disease, diabetes, asthma, Alzheimer‘s disease,
rapid aging and gastrointestinal problems.
Stress and anxiety can also affect one‘s ability to relax and get proper sleep,
contributing to a further deterioration in health and a host of other problems.
Stress does not refer to stress or anxiety that affect us from time to time due to

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the high pressure situations that develop at work or at home, but it refers to
frequent and constant stress..
The combination of work, relationship and financial stress can often be so
overwhelming that people tend to withdraw completely, shunning social contact
and sinking further into depression. Chronic depression poses even greater risks
to one‘s health and this problem often goes hand in hand with other unhealthy
habits like comfort eating, which contributes to the problem of unhealthy eating,
as well as a lack of physical activity. All of these add to the problem of obesity.
Obesity in turn further spirals depression because of the resultant poor body
image.
Poor Sleep: Sleep is one of the most neglected requirements for human health
and well-being. Several studies have clearly indicated the importance of sleep in
terms of both quantity and quality for general health as it affects various
metabolic, endocrine and neurological functions of the body. Poor sleeping
habits can also affect growth and development in infants and children. Sleep
disorders, when ignored or untreated can start to affect mood and behavioural
patterns thereby taking a toll on work and family relationships. This does not
just affect productivity and physical health, but it also can cause depression and
social disorders.
Smoking: Although there is a decline in the prevalence of smoking globally
over the past few years due to concerted global efforts to counter the problem,
smoking still poses a huge public health risk. Additionally, despite the decline
in prevalence, the number of smokers has risen because of the population
growth. Smoking is one of the biggest public health problems because of the
high risk it poses. Smoking is associated with various lifestyle diseases such as
numerous respiratory disorders like bronchitis and asthma, lung cancer, oral
cancer and other cancers, cardiovascular diseases, strokes and numerous other
health conditions.
It is estimated that around half of all smokers will contract some smoking
related lifestyle disorder that will prove fatal. According to a report published in
2007, nearly 5 million fatalities a year were attributed to smoking. What is
troubling is that passive smoking can pose just as big a threat to non-smokers,
leaving those in prolonged and close proximity to cigarette smoke just as
vulnerable to smoking related lifestyle diseases.

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Innovative approaches and effective and evidence based interventions are

required for the prevention, control and treatment of cardiovascular diseases to
reduce the burden and save lives. There is need to develop broad and
sustainable strategy for cardiovascular research and prevention. Such a strategy
should recognize the unique societal influences, regional cultural diversity and
the changing lifestyles as rates of urbanization continue to increase
dramatically. The involvement of the medical community in prevention efforts
is important.

Cardiovascular disease (CVD) is a class of diseases that involve the heart or

blood vessels. Cardiovascular disease includes coronary artery diseases (CAD)
such as angina and myocardial infarction, commonly known as a heart attack.
Other CVDs include stroke, heart failure, hypertensive heart disease, rheumatic
heart disease, cardiomyopathy, heart arrhythmia, congenital heart disease,
valvular heart disease, carditis, aortic aneurysms, peripheral artery disease,
thromboembolic disease, and venous thrombosis. The underlying mechanisms
vary depending on the disease in question.
Coronary Heart Disease (CHD): Also known as coronary heart disease and
ischaemic heart disease, CHD is one of the most common types of heart
problems faced today and is characterised by a reduction or blockage in the flow
of oxygen-rich blood to the heart muscle. This puts exaggerated strain on the
heart, which can lead to:
a. Angina – chest pain caused by lack of flow of blood to the heart
b. Heart attack – caused when the blood flow to the heart is suddenly but
completely blocked
c. Heart failure – the failure of the heart to pump blood properly to the rest of
the body
Cerebrovascular disease (strokes and TIAs): Cerebrovascular disease is the
disease of blood vessels supplying blood to the brain. When the blood supply to
the brain is cut off, a person suffers a stroke, which can be lethal. A transient
ischaemic attack, popularly known as a mini-stroke, occurs when the blood
supply to the brain is temporarily blocked. The acronym FAST is used to
signify the symptoms of a stroke or TIA. It stands for:
a. Face: Face drooping on one side is the most common visible symptom,
followed by dropping of mouth or eye.

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b. Arms: Weakness of numbness in one or both arms doesn't allow a person to

raise both of his or her hands up and hold them there.
c. Speech: Slurred or garbled speech in some cases, and in other cases: no
speech.
d. Time: It is time to call the emergency services if you see any of these
symptoms.
Other symptoms include:
i. Blurred or complete loss of vision in one or both eyes
ii. One-sided weakness or numbness of the body
iii. Sudden memory loss or confusion
iv. Sudden dizziness combined with any of the above mentioned symptoms
can be a definite sign
Peripheral Arterial Disease: Peripheral arterial disease is a disease of blood
vessels supplying the arms and legs. It happens when there is a blockage in the
arteries to the limbs usually the legs. Signs to watch out for:
a. Dull or cramping pain that gets worse with walking and better with rest
b. Hair loss on the limbs
c. Numbness or weakness in the limbs
d. Persistent ulcers on the legs and feet
Rheumatic heart disease: Rheumatic heart disease is characterised by damage
to the heart muscle and heart valves from rheumatic fever, caused by
streptococcal bacteria. Some of the most common symptoms are fever and
painful, tender joints.
Congenital Heart Disease: Congenital heart disease is a problem with the
structure of the heart, i.e. malformations of heart structure that exist at birth. The
problem can range from a small hole in the heart to a more severe problem such
as a defective heart muscle. Some of the common symptoms are shortness of
breath and having trouble exercising. In infants and younger kids, cyanosis, a
bluish tint to the skin, fingernails and lips can be an important marker. Risk
factors include:
i. Use of certain medications, drugs or alcohol during pregnancy
ii. Viral infections in the mother in the first trimester
iii. Genetic problems or issues with chromosomes of the child

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Pulmonary embolism due to Deep Vein Thrombosis (DVT): DVTs are blood
clots, often found in the veins of the legs, which can dislodge and move to the
heart and lungs, causing pulmonary embolism. This condition can be life-
threatening and special care should be taken if diagnosed with DVT. Symptoms
include:
a. Chest pain – may get worse with deep breaths
b. Sudden shortness of breath
c. Sudden cough or coughing up blood
d. Anxiety
e. Light-headedness and fainting
Aortic disease: These are a group of conditions that affect the aorta, the largest
blood vessel in the body. The aorta is responsible for carrying blood from the
heart to the rest of the body. An example of an aortic disease would be aortic
aneurism, where the walls of the aorta are weakened, leading to outward
bulging of the blood vessel. Usually symptomless, this condition can lead to
life-threatening circumstances if it bursts.
Preventing and Managing Cardiovascular Disease (CVD): Depending on the
type of CVD, an appropriate treatment plan can help alleviate the problem/s.
There are a number of treatments ranging from medication to surgeries that can
help, however, prevention is always recommended over treatment. To prevent
CVD, one must:
a. Stop smoking
b. Have a balanced diet with plenty of fibre
c. Exercise regularly (>150 minutes of aerobic activity per week)
d. Maintain a healthy weight and body mass index (BMI; aim for a BMI below
25)
e. Cut down on alcohol (<14 alcohol units per week)
f. Aspirin and anti-platelet therapy
Cardiovascular diseases are the leading cause of death globally. This is true in
all areas of the world except Africa. Cardiovascular diseases (CVDs) are a
group of disorders of the heart and blood vessels and they include:
 Coronary heart disease – disease of the blood vessels supplying the heart
muscle
 Cerebrovascular disease – disease of the blood vessels supplying the brain

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 Peripheral arterial disease – disease of blood vessels supplying the arms

and legs
 Rheumatic heart disease – damage to the heart muscle and heart valves
from rheumatic fever, caused by streptococcal bacteria
 Congenital heart disease – malformations of heart structure existing at
birth
 Deep vein thrombosis and pulmonary embolism – blood clots in the leg
veins, which can dislodge and move to the heart and lungs
Heart attacks and strokes are usually acute events and are mainly caused by a
blockage that prevents blood from flowing to the heart or brain. The most
common reason for this is a build-up of fatty deposits on the inner walls of the
blood vessels that supply the heart or brain. Strokes can also be caused by
bleeding from a blood vessel in the brain or from blood clots. The cause of heart
attacks and strokes are usually the presence of a combination of risk factors,
such as tobacco use, unhealthy diet and obesity, physical inactivity and harmful
use of alcohol, hypertension, diabetes and hyperlipidemia.
The risk factors for cardiovascular disease: The most important behavioural
risk factors of heart disease and stroke are unhealthy diet, physical inactivity,
tobacco use and harmful use of alcohol. The effects of behavioural risk factors
may show up in individuals as raised blood pressure, raised blood glucose,
raised blood lipids, and overweight and obesity. These ―intermediate risks
factors‖ can be measured in primary care facilities and indicate an increased risk
of developing a heart attack, stroke, heart failure and other complications.
Cessation of tobacco use, reduction of salt in the diet, consuming fruits and
vegetables, regular physical activity and avoiding harmful use of alcohol have
been shown to reduce the risk of cardiovascular disease. In addition, drug
treatment of diabetes, hypertension and high blood lipids may be necessary to
reduce cardiovascular risk and prevent heart attacks and strokes. Health policies
that create conducive environments for making healthy choices affordable and
available are essential for motivating people to adopt and sustain healthy
behaviour.
There are also a number of underlying determinants of CVDs or ―the causes of
the causes‖. These are a reflection of the major forces driving social, economic
and cultural change – globalization, urbanization and population ageing. Other
determinants of CVDs include poverty, stress and hereditary factors.

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The common symptoms of Cardiovascular Diseases

Symptoms of heart attacks and stroke: Often, there are no symptoms of the
underlying disease of the blood vessels. A heart attack or stroke may be the first
warning of underlying disease. People experiencing these symptoms should
seek medical care immediately. Symptoms of a heart attack include:
 Pain or discomfort in the centre of the chest;
 Pain or discomfort in the arms, the left shoulder, elbows, jaw, or back.

In addition the person may experience difficulty in breathing or shortness of

breath; feeling sick or vomiting; feeling light-headed or faint; breaking into a
cold sweat; and becoming pale. Women are more likely to have shortness of
breath, nausea, vomiting, and back or jaw pain. The most common symptom of
a stroke is sudden weakness of the face, arm, or leg, most often on one side of
the body.
Other symptoms include sudden onset of:
 Numbness of the face, arm, or leg, especially on one side of the body;
 Confusion, difficulty speaking or understanding speech;
 Difficulty seeing with one or both eyes;
 Difficulty walking, dizziness, loss of balance or coordination;
 Severe headache with no known cause; and
 Fainting or unconsciousness.

Rheumatic heart disease: This disease is caused by damage to the heart valves
and heart muscle from the inflammation and scarring caused by rheumatic
fever. Rheumatic fever is caused by an abnormal response of the body to
infection with streptococcal bacteria, which usually begins as a sore throat or
tonsillitis in children. Rheumatic fever mostly affects children in developing
countries, especially where poverty is widespread. Globally, about 2% of deaths
from cardiovascular diseases is related to rheumatic heart disease.
WHO response: Under the leadership of the WHO, all Member States (194
countries) agreed on global mechanisms to reduce the avoidable NCD burden in
2013. This includes a ―Global action plan for the prevention and control of
NCDs 2013-2020‖. This plan aims to reduce the number of premature deaths
from NCDs by 25% by 2025 through nine voluntary global targets. Two of the
global targets directly focus on preventing and controlling CVDs.

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Global action plan for the prevention and control of NCDs 2013-2020: The
sixth target in the Global NCD action plan calls for 25% reduction in the global
prevalence of raised blood pressure. Raised blood pressure is the leading risk
factor for cardiovascular disease. Reducing the incidence of hypertension by
implementing population-wide policies to reduce behavioural risk factors,
including harmful use of alcohol, physical inactivity, overweight, obesity and
high salt intake, is essential to attaining this target. A total-risk approach needs
to be adopted for early detection and cost-effective management of hypertension
in order to prevent heart attacks, strokes and other complications.
The eighth target in the Global NCD action plan states at least 50% of eligible
people should receive drug therapy and counselling (including glycaemic
control) to prevent heart attacks and strokes. Prevention of heart attacks and
strokes through a total cardiovascular risk approach is more cost-effective than
treatment decisions based on individual risk factor thresholds only and should
be part of the basic benefits package for pursuing universal health coverage.
Achieving this target will require strengthening key health system components,
including health-care financing to ensure access to basic health technologies and
essential NCD medicines.
Heart and blood vessel diseases, also called heart disease includes numerous
problems, many of which are related to a process called atherosclerosis.
Atherosclerosis is a condition that develops when a substance called plaque
builds up in the walls of the arteries. This buildup narrows the arteries, making
it harder for blood to flow through. If a blood clot forms, it can stop the blood
flow. This can cause a heart attack or stroke.
A heart attack occurs when the blood flow to a part of the heart is blocked by a
blood clot. If this clot cuts off the blood flow completely, the part of the heart
muscle supplied by that artery begins to die. Most people survive their first
heart attack and return to their normal lives to enjoy many more years of
productive activity. But having a heart attack does mean you have to make some
changes. The doctor will advise you of medications and lifestyle changes
according to how badly the heart was damaged and what degree of heart disease
caused the heart attack.
An ischaemic stroke is the most common type and it happens when a blood
vessel that feeds the brain gets blocked, usually from a blood clot. When the
blood supply to a part of the brain is shut off, brain cells will die. The result will

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be the inability to carry out some of the previous functions as before like
walking or talking.
A haemorrhagic stroke occurs when a blood vessel within the brain bursts.
The most likely cause is uncontrolled hypertension or blood pressure.
Some effects of stroke are permanent if too many brain cells die after a stroke
due to lack of blood and oxygen to the brain. These cells are never replaced.
The good news is that some brain cells don't die — they're only temporarily out
of order. Injured cells can repair themselves. Over time, as the repair takes
place, some body functioning improves. Also, other brain cells may take control
of those areas that were injured. In this way, strength may improve, speech may
get better and memory may improve. This recovery process is what
rehabilitation is all about.
Other Types of Cardiovascular Disease
Heart failure: This does not mean that the heart stops beating. Heart failure,
sometimes called congestive heart failure, means the heart is not pumping
blood as well as it should. The heart keeps working, but the body‘s need for
blood and oxygen is not being met. Heart failure can get worse if it is not
treated. If your loved one has heart failure, it is very important to follow the
doctor‘s orders.
Cardiovascular Treatment
Disease
Heart Valve Problems Medications
Heart Valve Surgery
Arrhythmia Medications
Pacemaker
Heart Attack Medications — clot busters (should be
administered as soon as possible for certain
types of heart attacks)
Coronary Angioplasty
Coronary Artery Bypass Graft Surgery
Stroke Medications — clot busters (must be
administered within 3 hours from onset of
stroke symptoms for certain types of strokes)
Carotid Endarterectomy (PDF)

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Heart valve problems: When heart valves do not open enough to allow the
blood to flow through as it should, it is called stenosis. When the heart valves
do not close properly and allow blood to leak through, it is
called regurgitation. When the valve leaflets bulge or prolapse back into the
upper chamber, it is a condition called prolapse. Discover more about the roles
your heart valves play in healthy circulation and learn more about heart
valve disease.
Cancer: This is a class of diseases characterized by out-of-control cell growth.
There are over 100 different types of cancer, and each is classified by the type
of cell that is initially affected.
Cancer harms the body when altered cells divide uncontrollably to form lumps
or masses of tissue called tumours (except in the case of leukaemia where
cancer prohibits normal blood function by abnormal cell division in the blood
stream). Tumours can grow and interfere with the digestive, nervous, and
circulatory systems and they can release hormones that alter body function.
Tumours that stay in one spot and demonstrate limited growth are generally
considered to be benign.
More dangerous, or malignant, tumours form when two things occur:
 A cancerous cell manages to move throughout the body using the blood or
lymphatic systems, destroying healthy tissue in a process called invasion
 That cell manages to divide and grow, making new blood vessels to feed
itself in a process called angiogenesis.
When a tumour successfully spreads to other parts of the body and grows,
invading and destroying other healthy tissues, it is said to have metastasized.
This process itself is called metastasis, and the result is a serious condition that
is very difficult to treat.
How cancer spreads: Scientists reported in that they have discovered an
important clue as to why cancer cells spread. It has to do with their adhesion
(stickiness) properties. Certain molecular interactions between cells and the
scaffolding that holds them in place (extracellular matrix) cause them to become
unstuck at the original tumour site; they become dislodged, move on and then
re-attach themselves at a new site.
The researchers say this discovery is important because cancer mortality is
mainly due to metastatic tumours, those that grow from cells that have travelled

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from their original site to another part of the body. These are called secondary
tumours. Only 10% of cancer deaths are caused by the primary tumours.
Causes of cancer
Cancer is ultimately the result of cells that uncontrollably grow and do not
die. Normal cells in the body follow an orderly path of growth, division, and
death. Programmed cell death is called apoptosis, and when this process breaks
down, cancer begins to form. Unlike regular cells, cancer cells do not
experience programmatic death and instead continue to grow and divide. This
leads to a mass of abnormal cells that grows out of control.
Genes – the DNA type: Cells can experience uncontrolled growth if there are
mutations to DNA, and therefore, alterations to the genes involved in cell
division. Four key types of gene are responsible for the cell division process:
oncogenes tell cells when to divide, tumour suppressor genes tell cells when not
to divide, suicide genes control apoptosis and tell the cell to kill itself if
something goes wrong, and DNA-repair genes instruct a cell to repair damaged
DNA. Cancer occurs when a cell's gene mutations make the cell unable to
correct DNA damage and unable to commit suicide. Similarly, cancer is a result
of mutations that inhibit oncogene and tumour suppressor gene function, leading
to uncontrollable cell growth.
Carcinogens: Carcinogens are a class of substances that are directly responsible
for damaging DNA, promoting or aiding cancer. Tobacco, asbestos, arsenic,
radiation such as gamma and x-rays, the sun, and compounds in car exhaust
fumes are all examples of carcinogens. When our bodies are exposed to
carcinogens, free radicals are formed that try to steal electrons from other
molecules in the body. Theses free radicals damage cells and affect their ability
to function normally.
Genes – the family type: Cancer can be the result of a genetic predisposition
that is inherited from family members. It is possible to be born with certain
genetic mutations or a fault in a gene that makes one statistically more likely to
develop cancer later in life.
Cancer and other medical factors: With age and advancing years, there is an
increase in the number of possible cancer-causing mutations in our DNA. This
makes age an important risk factor for cancer. Several viruses have also been
linked to cancer such as: human papillomavirus – a cause of cervical cancer,

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hepatitis B and C causes of liver cancer, and Epstein-Barr virus – a cause of

some childhood cancers. Human Immunodeficiency Virus (HIV) – and anything
else that suppresses or weakens the immune system – inhibits the body's ability
to fight infections and increases the chance of developing cancer.
Cancer classification: There are five broad groups that are used to classify
cancer.
 Carcinomas are characterized by cells that cover internal and external parts
of the body such as lung, breast, and colon cancer.
 Sarcomas are characterized by cells that are located in bone, cartilage, fat,
connective tissue, muscle, and other supportive tissues.
 Lymphomas are cancers that begin in the lymph nodes and immune system
tissues.
 Leukaemia is cancer that begins in the bone marrow and often accumulates
in the bloodstream.
 Adenomas are cancers that arise in the thyroid, the pituitary gland, the
adrenal gland, and other glandular tissues.
Treatments for cancer: Cancer treatment depends on the type of cancer, the
stage of the cancer (how much it has spread), age, health status, and additional
personal characteristics. There is no single treatment for cancer, and patients
often receive a combination of therapies and palliative care. Treatments usually
fall into one of the following categories: surgery, radiation, chemotherapy,
immunotherapy, hormone therapy, or gene therapy.
1) Surgery is the oldest known treatment for cancer. If a cancer has not
metastasized, it is possible to completely cure a patient by surgically
removing the cancer from the body. This is often seen in the removal of the
prostate or a breast or testicle. After the disease has spread, however, it is
nearly impossible to remove all of the cancer cells. Surgery may also be
instrumental in helping to control symptoms such as bowel obstruction or
spinal cord compression.
Innovations continue to be developed to aid the surgical process. Currently,
when a tumour is removed surgeons also take out a ―margin‖ of healthy
tissue to make sure no malignant cells are left behind. This usually means
keeping the patients under general anaesthetic for an extra 30 minutes while
tissue samples are tested in the lab for ―clear margins‖. If there are no clear
margins, the surgeon has to go back in and remove more tissue (if possible).

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2) Radiation treatment, also known as radiotherapy, destroys cancer by

focusing high-energy rays on the cancer cells. This causes damage to the
molecules that make up the cancer cells and leads them to commit suicide.
Radiotherapy utilizes high-energy gamma-rays that are emitted from metals
such as radium or high-energy x-rays that are created in a special machine.
Early radiation treatments caused severe side-effects because the energy
beams would damage normal, healthy tissue, but technologies have
improved so that beams can be more accurately targeted. Radiotherapy is
used as a standalone treatment to shrink a tumour or destroy cancer cells
(including those associated with leukaemia and lymphoma), and it is also
used in combination with other cancer treatments.
3) Chemotherapy utilizes chemicals that interfere with the cell division process
- damaging proteins or DNA - so that cancer cells will commit suicide.
These treatments target any rapidly dividing cells (not necessarily just
cancer cells), but normal cells usually can recover from any chemical-
induced damage while cancer cells cannot. Chemotherapy is generally used
to treat cancer that has spread or metastasized because the medicines travel
throughout the entire body.
It is a necessary treatment for some forms of leukaemia and lymphoma.
Chemotherapy treatment occurs in cycles so the body has time to heal
between doses. However, there are still common side effects such as hair
loss, nausea, fatigue, and vomiting. Combination therapies often include
multiple types of chemotherapy or chemotherapy combined with other
treatment options.
4) Immunotherapy aims to get the body's immune system to fight the tumour.
Local immunotherapy injects a treatment into an affected area, for example,
to cause inflammation that causes a tumour to shrink. Systemic
immunotherapy treats the whole body by administering an agent such as the
protein interferon alpha that can shrink tumours. Immunotherapy can also be
considered non-specific if it improves cancer-fighting abilities by
stimulating the entire immune system, and it can be considered targeted if
the treatment specifically tells the immune system to destroy cancer cells.
These therapies are relatively young, but researchers have had success with
treatments that introduce antibodies to the body that inhibit the growth of
breast cancer cells. Bone marrow transplantation (hematopoietic stem cell
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transplantation) can also be considered immunotherapy because the donor's

immune cells will often attack the tumor or cancer cells that are present in
the host.
5) Hormone therapy: Several cancers have been linked to some types of
hormones, most notably breast and prostate cancer. Hormone therapy is
designed to alter hormone production in the body so that cancer cells stop
growing or are killed completely. Breast cancer hormone therapies often
focus on reducing oestrogen levels and prostate cancer hormone therapies
often focus on reducing testosterone levels. In addition, some leukaemia and
lymphoma cases can be treated with the hormone cortisone.
6) Gene therapy: The goal of gene therapy is to replace damaged genes with
ones that work to address a root cause of cancer: damage to DNA. For
example, researchers are trying to replace the damaged gene that signals
cells to stop dividing (the p53 gene) with a copy of a working gene. Other
gene-based therapies focus on further damaging cancer cell DNA to the
point where the cell commits suicide. Gene therapy is a very young field and
has not yet resulted in any successful treatments.
Cancer prevention: Cancers that are closely linked to certain behaviours are
the easiest to prevent. For example, choosing not to smoke tobacco or drink
alcohol significantly lower the risk of several types of cancer – most notably
lung, throat, mouth, and liver cancer. Even if you are a current tobacco user,
quitting can still greatly reduce your chances of getting cancer.
Skin cancer can be prevented by staying in the shade, protecting yourself with
a hat and shirt when in the sun, and using sunscreen. Diet is also an important
part of cancer prevention since what we eat has been linked to the disease.
Physicians recommend diets that are low in fat and rich in fresh fruits and
vegetables and whole grains.
Certain vaccinations have been associated with the prevention of some cancers.
For example, many women receive a vaccination for the human papillomavirus
because of the virus‘s relationship with cervical cancer. Hepatitis B vaccines
prevent the hepatitis B virus, which can cause liver cancer.
Some cancer prevention is based on systematic screening in order to detect
small irregularities or tumours as early as possible even if there are no clear
symptoms present. Breast self-examination, mammograms, testicular self-

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examination, and Pap smears are common screening methods for various
cancers.
Diabetes: It is a disease in which your blood glucose, or blood sugar, levels are
too high. Glucose comes from the foods you eat. Insulin is a hormone that helps
the glucose get into your cells to give them energy. With Type 1 Diabetes, your
body does not make insulin. With Type 2 Diabetes, the more common type,
your body does not make or use insulin well. Without enough insulin, the
glucose stays in your blood. You can also have pre-diabetes. This means that
your blood sugar is higher than normal but not high enough to be called
diabetes. Having pre-diabetes puts you at a higher risk of getting Type 2
diabetes.
Over time, having too much glucose in your blood can cause serious problems.
It can damage your eyes, kidneys, and nerves. Diabetes can also cause heart
disease, stroke and even the need to remove a limb. Pregnant women can also
get diabetes, called gestational diabetes.
Blood tests can show if you have diabetes. One type of test, the A1C, can also
check on how you are managing your diabetes. Exercise, weight control and
sticking to your meal plan can help control your diabetes. You should also
monitor your blood glucose level and take medicine if prescribed.
There are three types of diabetes
1) Type 1 Diabetes: The body does not produce insulin. Some people may refer
to this type as insulin-dependent diabetes, juvenile diabetes, or early-
onset diabetes. People usually develop Type 1 Diabetes before their 40th
year, often in early adulthood or teenage years. Type 1 Diabetes is nowhere
near as common as Type 2 Diabetes. Approximately 10% of all diabetes
cases are Type 1. Patients with Type 1 Diabetes will need to take insulin
injections for the rest of their life. They must also ensure proper blood-
glucose levels by carrying out regular blood tests and following a special
diet.
2) Type 2 Diabetes: The body does not produce enough insulin for proper
function, or the cells in the body do not react to insulin (insulin resistance).
Approximately 90% of all cases of diabetes worldwide are Type 2. Some
people may be able to control their Type 2 Diabetes symptoms by losing
weight, following a healthy diet, doing plenty of exercise, and monitoring

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their blood glucose levels. However, Type 2 Diabetes is typically a

progressive disease – it gradually gets worse – and the patient will probably
end up have to take insulin, usually in tablet form.
Overweight and obese people have a much higher risk of developing type 2
diabetes compared to those with a healthy body weight. People with a lot of
visceral fat, also known as central obesity, belly fat, or abdominal obesity,
are especially at risk. Being overweight/obese causes the body to release
chemicals that can destabilize the body's cardiovascular and metabolic
systems. Being overweight, physically inactive and eating the wrong foods
all contribute to our risk of developing Type 2 diabetes.
3) Gestational Diabetes: This type affects females during pregnancy. Some
women have very high levels of glucose in their blood, and their bodies are
unable to produce enough insulin to transport all of the glucose into their
cells, resulting in progressively rising levels of glucose.
Diagnosis of gestational diabetes is made during pregnancy. The majority of
gestational diabetes patients can control their diabetes with exercise and
diet. Undiagnosed or uncontrolled gestational diabetes can raise the risk of
complications during childbirth. The baby may be bigger than he/she should
be.
Diabetes symptoms: The vast majority of patients with Type 2 diabetes
initially had pre-diabetes. Their blood glucose levels where higher than normal,
but not high enough to merit a diabetes diagnosis. The cells in the body are
becoming resistant to insulin. Studies have indicated that even at the pre-
diabetes stage, some damage to the circulatory system and the heart may already
have occurred.
Diabetes is a metabolism disorder: Diabetes (diabetes mellitus) is classed as a
metabolism disorder. Metabolism refers to the way our bodies use digested food
for energy and growth. Most of what we eat is broken down into glucose.
Glucose is a form of sugar in the blood - it is the principal source of fuel for our
bodies.
When food is digested, the glucose makes its way into our bloodstream. Our
cells use the glucose for energy and growth. However, glucose cannot enter our
cells without insulin being present - insulin makes it possible for our cells to
take in the glucose.

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Insulin is a hormone that is produced by the pancreas. After eating, the

pancreas automatically releases an adequate quantity of insulin to move the
glucose present in our blood into the cells, as soon as glucose enters the cells
blood-glucose levels drop.
A person with diabetes has a condition in which the quantity of glucose in the
blood is too elevated (hyperglycemia). This is because the body does not
produce enough insulin, produces no insulin, or has cells that do not respond
properly to the insulin the pancreas produces. This results in too much glucose
building up in the blood. This excess blood glucose eventually passes out of the
body in urine. So, even though the blood has plenty of glucose, the cells are not
getting it for their essential energy and growth requirements.
Controlling diabetes: All types of diabetes are treatable. Diabetes type 1 lasts a
lifetime, there is no known cure. Type 2 usually lasts a lifetime; however, some
people have managed to get rid of their symptoms without medication, through
a combination of exercise, diet and body weight control. If diabetes is not
adequately controlled the patient has a significantly higher risk of developing
complications.
Complications linked to badly controlled diabetes:
 Eye complications – glaucoma, cataract, diabetic retinopathy, and some
others.
 Foot complications – neuropathy, ulcers, and sometimes gangrene which
may require that the foot be amputated
 Skin complications – people with diabetes are more susceptible to skin
infections and skin disorders
 Heart problems – such as ischemic heart disease, when the blood supply to
the heart muscle is diminished
 Hypertension – common in people with diabetes, which can raise the risk
of kidney disease, eye problems, heart attack and stroke
 Mental health – uncontrolled diabetes raises the risk of suffering from
depression, anxiety and some other mental disorders
 Hearing loss – diabetes patients have a higher risk of developing hearing
problems
 Gum disease – there is a much higher prevalence of gum disease among
diabetes patients
 Gastroparesis – the muscles of the stomach stop working properly

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 Ketoacidosis – a combination of ketosis and acidosis; accumulation of

ketone bodies and acidity in the blood.
 Neuropathy – diabetic neuropathy is a type of nerve damage which can
lead to several different problems.
 HHNS (Hyperosmolar Hyperglycemic Nonketotic Syndrome) – blood
glucose levels shoot up too high, and there are no ketones present in the
blood or urine. It is an emergency condition.
 Nephropathy - uncontrolled blood pressure can lead to kidney disease
 PAD (peripheral arterial disease) – symptoms may include pain in the leg,
tingling and sometimes problems walking properly
 Stroke – if blood pressure, cholesterol levels, and blood glucose levels are
not controlled, the risk of stroke increases significantly
 Erectile dysfunction – male impotence.
 Infections – people with badly controlled diabetes are much more
susceptible to infections
 Healing of wounds – cuts and lesions take much longer to heal
It is possible to have diabetes with only very mild symptoms or without
developing any symptoms at all. Such cases can leave some people with
diabetes unaware of the condition and undiagnosed. Type 2 Diabetes and its
symptoms develop slowly. Type 1 Diabetes can go unnoticed but is less likely
to do so. Some of its symptoms listed below can come on abruptly and be
accompanied by nausea, vomiting or stomach pains.
 It is important to see a doctor if there is any suspicion of diabetes or if any
of the below signs and symptoms are present – prompt diagnosis and
management lowers the likelihood of serious complications.
 The most common symptoms are related to hyperglycemia (high blood
sugar levels), especially the classic symptoms of diabetes: frequent urination
and thirst. Fatigue related to dehydration and eating problems can also be
related to high blood sugars.
Common symptoms of diabetes
 Frequent urination: When there is too much glucose (sugar) in your blood
you will urinate more often. If your insulin is ineffective, or not produced at
all, your kidneys cannot filter the glucose back into the blood. The kidneys
will take water from your blood in order to dilute the glucose - which in turn
fills up your bladder

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 Disproportionate thirst: If you are urinating more than usual, you will
need to replace that lost liquid. You will be drinking more than usual.
 Intense hunger: As the insulin in your blood is not working properly, or is
not there at all, and your cells are not getting their energy, your body may
react by trying to find more energy – food.
 Weight gain: This might be the result of the above symptom (intense
hunger).
 Unusual weight loss: This is more common among people with Diabetes
Type 1. As your body is not making insulin it will seek out another energy
source (the cells aren't getting glucose). Muscle tissue and fat will be broken
down for energy. As Type 1 is of a more sudden onset and Type 2 is much
more gradual, weight loss is more noticeable with Type 1.
 Increased fatigue: If your insulin is not working properly, or is not there at
all, glucose will not be entering your cells and providing them with energy.
This will make you feel tired and listless.
 Irritability: Irritability can be due to your lack of energy.
 Blurred vision: This can be caused by tissue being pulled from your eye
lenses. This affects your eyes‘ ability to focus. With proper treatment this
can be treated. There are severe cases where blindness or prolonged vision
problems can occur.
 Cuts and bruises: Injuries do not heal properly or quickly: Cuts and bruises
take a much longer time than usual to heal. When there is more sugar
(glucose) in the body, its ability to heal can be undermined.
 More skin and/or yeast infections: When there is more sugar in your body,
its ability to recover from infections is affected. Women with diabetes find it
especially difficult to recover from bladder and vaginal infections.
 Itchy skin: A feeling of itchiness on your skin is sometimes a symptom of
diabetes.
 Gums are red and/or swollen/Gums pull away from teeth: If your gums
are tender, red and/or swollen this could be a sign of diabetes. Your teeth
could become loose as the gums pull away from them.
 Frequent gum disease/infection: As well as the previous gum symptoms,
you may experience more frequent gum disease and/or gum infections.
 Sexual dysfunction among men: If you are over 50 and experience
frequent or constant sexual dysfunction (erectile dysfunction), it could be a
symptom of diabetes.

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 Numbness or tingling, especially in your feet and hands: If there is too

much sugar in your body your nerves could become damaged, as could the
tiny blood vessels that feed those nerves. You may experience tingling
and/or numbness in your hands and feet.
Diabetes diagnosis: Diabetes can often be detected by carrying out a urine test,
which finds out whether excess glucose is present. This is normally backed up
by a blood test, which measures blood glucose levels and can confirm if the
cause of the symptoms is due to diabetes.
Human Immunodeficiency Virus (HIV): It harms your immune system by
destroying the white blood cells that fight infection. This puts you at risk for
serious infections and certain cancers. AIDS stands for acquired
immunodeficiency syndrome. It is the final stage of infection with HIV. Not
everyone with HIV develops AIDS.
 HIV most often spreads through unprotected sex with an infected person. It
may also spread by sharing drug needles or through contact with the blood
of an infected person. Women can give it to their babies
during pregnancy or childbirth.
 The first signs of HIV infection may be swollen glands and flu-like
symptoms. These may come and go within two to four weeks. Severe
symptoms may not appear until months or years later.
 A blood test can tell if you have HIV infection. Your health care provider
can do the test, or you can use a home testing kit. Or to find free testing
sites,
 HIV is a virus that attacks the immune system, which is our body‘s natural
defence against illness. The virus destroys a type of white blood cell in the
immune system called a T-helper cell, and makes copies of itself inside
these cells. T-helper cells are also referred to as CD4 cells.
 As HIV destroys more CD4 cells and makes more copies of itself, it
gradually breaks down a person‘s immune system. This means someone
living with HIV, who is not receiving treatment, will find it harder and
harder to fight off infections and diseases.
 If HIV is left untreated, it may take up to 10 or 15 years for the immune
system to be so severely damaged it can no longer defend itself at all.
However, the speed HIV progresses will vary depending on age, health and
background.

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Basic facts about HIV

 HIV stands for human immunodeficiency virus.
 There is effective antiretroviral treatment available so people with HIV can
live a normal, healthy life.
 The earlier HIV is diagnosed, the sooner treatment can start – leading to
better long term health. So regular testing for HIV is important.
 HIV is found in semen, blood, vaginal and anal fluids, and breast milk.
 HIV cannot be transmitted through sweat, saliva or urine.
 Using male condoms or female condoms during sex is the best way to
prevent HIV and other sexually transmitted infections.
 If you inject drugs, always use a clean needle and syringe, and never share
equipment.
 If you are pregnant and living with HIV, the virus in your blood could pass
into your baby‘s body, or after giving birth through breastfeeding.
Taking HIV treatment virtually eliminates this risk.
Acquired Immune Deficiency Syndrome (AIDS): This is not a virus but a set
of symptoms (or syndrome) caused by the HIV virus. A person is said to have
AIDS when their immune system is too weak to fight off infection, and they
develop certain defining symptoms and illnesses. This is the last stage of HIV,
when the infection is very advanced, and if left untreated will lead to death.
Basic facts about AIDS
 AIDS stands for acquired immune deficiency syndrome.
 AIDS is also referred to as advanced HIV infection or late-stage HIV.
 AIDS is a set of symptoms and illnesses that develop as a result of advanced
HIV infection which has destroyed the immune system.
 Treatment for HIV means that more people are staying well, with fewer
people developing AIDS.
Although there is currently no cure for HIV with the right treatment and
support, people with HIV can live long and healthy lives. To do this, it is
especially important to take treatment correctly and deal with any possible side-
effects.
The difference between HIV and AIDS
HIV AIDS
HIV is the virus that causes AIDS. AIDS stands for Acquired
Immune Deficiency Syndrome

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HIV and AIDS are not the same thing AIDS is the disease caused
by the damage that HIV does to
the immune system
People with HIV do not always have AIDS. AIDS develops when
you get rare, dangerous infections
or have a super low
number of CD4 cells.
HIV is the virus that is passed from person AIDS is the most
to person. Over time, HIV destroys an serious stage of HIV,
important and it leads to death over time.
kind of the cell in your immune system
(called CD4 cells or T cells) that helps
protect you from infections. When you do
not have enough of these CD4 cells, the
body cannot fight off infections the
way it normally can.
Without treatment, it usually takes about Treatment slows down the
10 years for someone with HIV to develop damage the virus causes and
AIDS. can help people stay healthy
for several decades before developing
AIDS.

Transmission of HIV
Sexual transmission: It can happen when there is contact with infected sexual
fluids (rectal, genital, or oral mucous membranes). This can happen while
having unprotected sex, including vaginal, oral, and anal sex, or sharing sex
toys with someone infected with HIV.
Perinatal transmission: A mother can pass the infection on to her child during
childbirth, pregnancy, and also through breastfeeding.
Blood transmission: The risk of transmitting HIV through blood transfusion is
nowadays extremely low in developed countries, thanks to meticulous screening
and precautions. However, among injection or IV drug users, sharing and
reusing syringes contaminated with HIV-infected blood is extremely hazardous.
HIV tests: When you get HIV, your immune system makes antibodies that try
to fight off the infection. The most common type of HIV test looks for these
antibodies in your blood or cells from your cheek.
It usually takes about 3 months for your body to make enough antibodies to
show up on an HIV test, but it could be even longer. The time after you first get
infected but would not test positive for HIV is called the ―window period.‖ If
you get tested during this time, you can get a negative result even if you do

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actually have HIV. You also have the biggest chance of giving HIV to other
people during the window period.
Kinds of HIV tests: Rapid HIV tests give you results in about 20 minutes.
Other tests take longer because they need to be sent out to a lab. HIV tests are
usually painless — you just gently rub the inside of your cheek with a soft
swab. Sometimes you‘ll give a blood sample for testing.
If a rapid HIV test at a clinic or a home test shows that you have HIV, get a
follow-up test to make sure the results are correct.
Early HIV symptoms: People usually look and feel totally healthy for a long
time after they‘re infected. It can take 10 years or more for HIV to show any
symptoms — or much, much longer than that for people who take HIV
medicines. That's why it's really important to get tested for HIV regularly,
especially if you‘ve had unprotected sex or shared needles. HIV treatments can
help you stay healthy much longer.
The first 2-4 weeks after being infected with HIV, you may feel feverish, achy,
and sick. These flu-like symptoms are your body‘s first reaction to the HIV
infection. During this time, there is a lot of the virus in your system, so it is
really easy to spread HIV to other people. The symptoms only last for a few
weeks, and then you usually do not have symptoms again for years. Once you
have HIV, you can give it to other people — whether or not you have symptoms
or feel sick.
Later HIV/AIDS symptoms: HIV destroys cells in your immune system called
CD4 cells or T cells. Without CD4 cells, your body has a hard time fighting off
diseases. This makes you more likely to get really sick from infections that
usually wouldn‘t hurt you. Over time, the damage HIV does to your immune
system leads to AIDS.
You have AIDS when you get rare infections (called opportunistic infections) or
types of cancer, or if you have lost a certain number of CD4 cells. This usually
happens about 10 years after getting HIV if you don‘t get treatment. With
treatment, it can take much longer to develop AIDS. The signs of AIDS include:
1. Bad yeast infections 10. Chronic pelvic inflammatory disease
2. Headaches 11. Feeling really tired, dizzy,
and lightheaded
3. Skin rashes 12. Having diarrhoea, fevers, or night
sweats for a long time

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4. Sore throat 13. Swollen or firm glands in your throat,

armpit, or groin
5. Getting many 14. Purplish growths on your skin or
bad infections inside your mouth
6. Losing weight quickly 15. Bleeding from the mouth, nose,
anus, or vagina
7. Deep, dry coughing spells 16. Feeling very numb in your hands or feet,
losing control of your muscles and
reflexes, not being able to move,
and losing strength in your muscles
8. Feeling short of breath 17. Getting Thrush, which is a thick,
white coating on your tongue
or mouth
9. Bruising more
easily than normal

Cure for HIV: No effective cure currently exists for HIV. But with proper
medical care, HIV can be controlled. Treatment for HIV is called antiretroviral
therapy or ART. If taken the right way, every day, ART can dramatically
prolong the lives of many people infected with HIV, keep them healthy, and
greatly lower their chance of infecting others. Before the introduction of ART in
the mid-1990s, people with HIV could progress to AIDS (the last stage of HIV
infection) in a few years. Today, someone diagnosed with HIV and treated
before the disease is far advanced can live nearly as long as someone who does
not have HIV.
Reproductive Health: The WHO‘s definition of reproductive health
specifically highlights the importance of an individual‘s right to maintain their
own sexual health status. Sexual health is the integration of emotional,
intellectual, and social aspects of sexual being in order to positively enrich
personality, communication, relationships and love.
The term ‗Reproductive Health‟ is most often equated with one aspect of
women‘s lives; motherhood. Complications associated with various maternal
issues are indeed major contributors to poor reproductive health among millions
of women worldwide. Half of the world‘s 2.6 billion women are now 15-49
years of age. Without proper health care services, this group is highly
vulnerable to problems related to sexual intercourse, pregnancy, contraceptive
side effects, etc. Death and illnesses from reproductive causes are the highest
among poor women everywhere.

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In societies where women are disproportionately poor, illiterate, and politically

powerless, high rates of reproductive illnesses and deaths are the norm. Ethiopia
is not an exception in this case. Ethiopia has one of the highest maternal
mortality in the world; it is estimated to be between 566-1400 deaths per
100,000 live births. Ethiopian DHS survey of 2005 indicates that maternal
mortality is 673per 100,000 live births. In Ethiopia, contraception use in women
is 14.7% and about 34% of women want to use contraceptive, but have no
means to do so according to the Ethiopian Demographic and Health Survey
(EDHS 2005).
Women in developing countries and economically disadvantaged women in the
cities of some industrial nations suffer the highest rates of complications from
pregnancy, sexually transmitted diseases, and reproductive cancers. Lack of
access to comprehensive reproductive care is the main reason that so many
women suffer and die. Most illnesses and deaths from reproductive causes could
be prevented or treated with strategies and technologies well within reach of
even the poorest countries. Men also suffer from reproductive health problems,
most notably from STIs. But the number and scope of risks is far greater for
women for a number of reasons.
The three fundamental principles of reproductive and sexual health are:
1) Capacity to enjoy and control sexual and reproductive behaviour
2) Freedom from shame, guilt, fear, and other psychological factors that may
impair sexual relationships;
3) Freedom from organic disorder or disease that interferes with sexual and
reproductive function.
Reproductive health further implies the right to satisfying and safe sex life.
This includes the ability to reproduce, but also the personal freedom to decide if,
when and how often to do so. Both men and women have the right to be
informed and to have access to safe, effective, affordable and acceptable
methods of family planning that are not against the law.
Reproductive health should also be understood in the context of healthy
relationships in which there is an understanding of the balance between
fulfilment and risk. Reproductive health contributes enormously to physical and
psychosocial comfort and closeness between individuals. Poor reproductive

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health is frequently associated with disease, abuse, exploitation, unwanted

pregnancy, and death
Components of Reproductive Health
 Quality family planning services
 Promoting safe motherhood: prenatal, safe delivery and post natal care,
including breast feeding
 Prevention and treatment of infertility
 Prevention and management of complications of unsafe abortion
 Safe abortion services, where not against the law
 Treatment of reproductive tract infections, including sexually transmitted
infections
 Information and counselling on human sexuality, responsible parenthood
and sexual and reproductive health
 Active discouragement of harmful practices, such as female genital
mutilation and violence related to sexuality and reproduction
Evidence for monitoring: Reproductive health indicators: A health indicator is
usually a numerical measure which provides information about a complex
situation or event. When you want to know about a situation or event and cannot
study each of the many factors that contribute to it, you use an indicator that
best summarizes the situation. For example, to understand the general health
status of infants in a country, the key indicators are infant mortality rates and the
proportion of infants of low birth weight.
Maternal health care quality, availability and accessibility can be measured
using maternal mortality. Reproductive health indicators summarize data which
have been collected to answer questions that are relevant to the planning and
management of RH programs. The indicators provide a useful tool to assess
needs, and monitor and evaluate program implementation and impact. Indicators
are expressed in terms of rates, proportions, averages, categorical variables or
absolute numbers.
Reproductive Health Indicators for Global Monitoring: There are seventeen
reproductive health indicators developed by the United Nation Population
Fund (UNFPA). The list and description of these indicators are given below.
1. Total Fertility Rate (TFR): Total number of children a woman would have
by the end of her reproductive period, if she experienced the currently

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prevailing age-specific fertility rates throughout her childbearing life. TFR

is one of the most widely used fertility measures to assess the impact of
family planning programmes. The measure is not affected by the age
structure of the female population.
2. Contraceptive prevalence (any method): Percentage of women of
reproductive age who are using (or whose partner is using) a contraceptive
method at a particular point in time.
3. Maternal Mortality Ratio (MMR): The number of maternal deaths per 100
000 live births from causes associated with pregnancy and child birth.
4. Antenatal care coverage: Percentage of women attended, at least once
during pregnancy, by skilled health personnel for reasons relating to
pregnancy.
5. Births attended by skilled health personnel: Percentage of births attended
by skilled health personnel. This doesn‘t include births attended by
traditional birth attendants.
6. Availability of basic essential obstetric care: Number of facilities with
functioning basic essential obstetric care per 500 000 population. Essential
obstetric care includes, parenteral antibiotics, Parenteral oxytocic drugs,
parenteral sedatives for eclampsia, manual removal of placenta, manual
removal of retained products, assisted vaginal delivery. These services can
be given at a health centre level.
7. Availability of comprehensive essential obstetric care: Number of
facilities with functioning comprehensive essential obstetric care per 500
000 population. It incorporates obstetric surgery, anaesthesia and blood
transfusion facilities.
8. Perinatal mortality rate: Number of perinatal deaths (deaths occurring
during late pregnancy, during childbirth and up to seven completed days of
life) per 1000 total births. Deaths which occur starting from the stage of
viability till completion of the first week after birth (22 weeks of gestation
up to end of first week after birth, WHO). Total birth means live birth plus
IUFD born after foetus reached stage of viability.
9. Low birth weight prevalence: Percentage of live births that weigh less than
2500 g.

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10. Positive syphilis serology prevalence in pregnant women: Percentage of

pregnant women (15–24) attending antenatal clinics, whose blood has been
screened for syphilis, with positive serology for syphilis.
11. Prevalence of anaemia in women: Percentage of women of reproductive
age (15–49) screened for haemoglobin levels with levels below 110 g/l for
pregnant women and below 120 g/l for non-pregnant women.
12. Percentage of obstetric and gynaecological admissions owing to
abortion: Percentage of all cases admitted to service delivery points
providing in-patient obstetric and gynaecological services, which are due to
abortion (spontaneous and induced, but excluding planned termination of
pregnancy)
13. Female Genital Mutilation (FGM) comprises all procedures involving
partial or total removal of the female external genitalia or other injury to the
female genital organs for non-medical reasons as defined by the World
Health Organisation (WHO).
14. Reported prevalence of women with Female Genital Mutilation (FGM):
Percentage of women interviewed in a community survey, reporting to have
undergone FGM.
15. Prevalence of infertility in women: Percentage of women of reproductive
age (15-49) at risk of pregnancy (not pregnant, sexually active, non-
contraception and non-lactating) who report trying for a pregnancy for two
years or more.
16. Reported incidence of urethritis in men: Percentage of men (15-49)
interviewed in a community survey, reporting at least one episode of
urethritis in the last 12 months.
17. HIV prevalence in pregnant women: Percentage of pregnant women (15-
24) attending antenatal clinics, whose blood has been screened for HIV, who
are seropositive for HIV, meaning that the person in the state of either
having or not having detectable antibodies against a specific antigen, as
measured by a blood test (serologic test). For example, HIV
seropositive means that a person has detectable antibodies to HIV;
seronegative means that a person does not have detectable HIV antibodies.

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18. Knowledge of HIV-related prevention practices: The percentage of all

respondents who correctly identify all three major ways of preventing the
sexual transmission of HIV and who reject three major misconceptions
about HIV transmission or prevention.
Gender and Reproductive Health Sex refers to biological and physiological
attributes of that identify a person as male or female. Gender refers to the
economic, social and cultural attributes and opportunities associated with being
male or female in a particular social setting at a particular point in time.
Osteoporosis means ―porous bone.‖ Viewed under a microscope, healthy bone
looks like a honeycomb. When osteoporosis occurs, the holes and spaces in the
honeycomb are much larger than in healthy bone. Osteoporotic bones have lost
density or mass and contain abnormal tissue structure. As bones become less
dense, they weaken and are more likely to break.
Normal bone is composed of protein, collagen, and calcium, all of which give
bone its strength. Bones that are affected by osteoporosis can break or fracture
with relatively minor injury that normally would not cause a bone to fracture.
The fracture can be either in the form of cracking as in a hip fracture or
collapsing as in a compression fracture of the vertebrae of the spine. The spine,
hips, ribs, and wrists are common areas of bone fractures from osteoporosis
although osteoporosis-related fractures can occur in almost any skeletal bone.
Causes for Osteoporosis: Osteoporosis causes bones to become weak and
brittle — so brittle that a fall or even mild stresses such as bending over or
coughing can cause a fracture. Osteoporosis-related fractures most commonly
occur in the hip, wrist or spine. Bone is living tissue that is constantly being
broken down and replaced. Osteoporosis occurs when the creation of new bone
doesn't keep up with the removal of old bone. Osteoporosis affects men and
women of all races. But white and Asian women — especially older women
who are past menopause — are at highest risk. Medications, healthy diet and
weight-bearing exercise can help prevent bone loss or strengthen already weak
bones.
Symptoms: There typically are no symptoms in the early stages of bone loss.
But once your bones have been weakened by osteoporosis, you may have signs
and symptoms that include:
 Back pain, caused by a fractured or collapsed vertebra

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 Loss of height over time

 A stooped posture
 A bone fracture that occurs much more easily than expected
Osteoporosis Prevention: Osteoporosis is more or less preventable for most
people. Prevention is very important because, while treatments are available for
osteoporosis, no cure currently exists. Prevention of osteoporosis involves
several aspects, including nutrition, exercise, lifestyle, and early screening.
Prevention of hip fractures in elderly people with osteoporosis: Elderly people
with osteoporosis can decrease their risk for hip fracture by maintaining muscle
strength, coordination, and balance with exercise programs. Throw rugs and
animals in pathways of the home should be minimized or eliminated. Good
lighting is essential for safe walking to the restroom both day and night.
Additionally, for those elderly people who use canes for walking, etc., it is
essential that the rubber tips of the canes are regularly checked for any signs of
wear. When this rubber wears through it presents a serious risk of causing the
cane (and, therefore, the person) to slip, which can result in serious bodily harm
– including hip fracture.
Diagnosis of osteoporosis: A routine X-ray can reveal osteoporosis of the bone
because the bones appear much thinner and lighter than normal bones.
Unfortunately, by the time X-rays can detect osteoporosis, at least 30% of the
bone has already been lost. In addition, X-rays are not accurate indicators of
bone density. Thus, the appearance of the bone on X-ray often is affected by
variations in the degree of exposure of the X-ray film.
 Osteoporosis is defined as a bone density T score of -2.5 or below.
 Osteopenia (between normal and osteoporosis) is defined as bone density T
score between -1 and -2.5.
It is important to note that while osteopenia is considered a lesser degree of
bone loss than osteoporosis, it nevertheless can be of concern when it is
associated with other risk factors (such as smoking, cortisone steroid
usage, rheumatoid arthritis, family history of osteoporosis, etc.) that can
increase the chances for developing vertebral, hip, and other fractures. In this
setting, osteopenia may require medication as part of the treatment program.
Diseases, Conditions and Medical Procedures that may cause bone loss:
There are many health problems and a few medical procedures that increase the

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likelihood of osteoporosis. If you have any of the following diseases or

conditions, talk to your doctor or health care provider about what you can do to
keep your bones healthy. The diseases that can cause and lead to osteoporosis
are Autoimmune Disorders, Digestive and Gastrointestinal Disorders, Medical
Procedures, Cancer, Hematologic/Blood Disorders, Neurological/Nervous
System Disorders, Blood and bone marrow disorders, Mental Illness,
Endocrine/Hormonal Disorders
Osteoporosis and Steroid Medicines: While steroid medicines can be
lifesaving treatments for some conditions, they can also cause bone loss and
osteoporosis. These medicines are often referred to as steroids, glucocorticoids
or corticosteroids. They should not be confused with anabolic steroids, which
are male hormones that some athletes use to build muscle.
Steroids are much like certain hormones made by your own body. Healthcare
providers prescribe them for many conditions, including rheumatoid arthritis
(but not osteoarthritis), asthma, Crohn‘s disease, lupus and allergies. They are
often prescribed to relieve inflammation. They are also used along with other
medicines to treat cancer and autoimmune conditions and to support organ
transplants.
Taking steroid medicines as pills in a dose of 5 mg or more for three or more
months can increase the chance of bone loss and developing osteoporosis. Talk
with your healthcare provider about taking the lowest dose for the shortest
period of time for your condition. If you need to take steroid medicines for
longer than this, you should take steps to prevent bone loss. While taking
steroids, it is especially important to get enough calcium and vitamin D. It‘s also
important to exercise and not smoke. You may also want to ask your healthcare
provider if you need a bone density test.
Calcium supplements for osteoporosis: Building strong and healthy bones
requires an adequate dietary intake of calcium beginning in childhood and
adolescence for both sexes. Most importantly, however, a high dietary calcium
intake or taking calcium supplements alone is not sufficient in treating
osteoporosis and should not be viewed as an alternative to or substituted for
more potent prescription medications for osteoporosis. In the first several years
after menopause, rapid bone loss may occur even if calcium supplements are
taken.

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Vitamin D for osteoporosis: An adequate intake of calcium and vitamin D are

important foundations for maintaining bone density and strength. However,
calcium and vitamin D alone are not sufficient to treat osteoporosis and should
be given in conjunction with other treatments. Vitamin D is important in several
respects:
 Vitamin D helps the absorption of dietary calcium from the intestines.
 The lack of vitamin D alone can cause calcium-depleted bone
(Osteomalacia), which further weakens the bones and increases the risk of
fractures.
 Vitamin D, along with adequate calcium (1,200 mg of elemental calcium),
has been shown in some studies to increase bone density and decrease
fractures in postmenopausal women but not in premenopausal or peri-
menopausal women.
Depression (major depressive disorder): This is a common and serious
medical illness that negatively affects how a person feels, thinks and acts.
Fortunately, it is also treatable. Depression causes feelings of sadness and/or a
loss of interest in activities once enjoyed. According to the World Health
Organization (WHO), depression is the most common illness worldwide and the
leading cause of disability. They estimate that 350 million people are affected
by depression, globally. It can lead to a variety of emotional and physical
problems and can decrease a person‘s ability to function at work and at home.
Depression symptoms can vary from mild to severe and can include:
 Feeling sad or having a depressed mood
 Loss of interest or pleasure in activities once enjoyed
 Changes in appetite — weight loss or gain unrelated to dieting
 Trouble sleeping or sleeping too much
 Loss of energy or increased fatigue
 Increase in purposeless physical activity (e.g., hand-wringing or pacing) or
slowed movements and speech (actions observable by others)
 Feeling worthless or guilty
 Difficulty thinking, concentrating or making decisions
 Thoughts of death or suicide
The symptoms must last at least two weeks for a diagnosis of depression. Also,
medical conditions (e.g., thyroid problems, a brain tumour or vitamin
deficiency) can mimic symptoms of depression so it is important to rule out

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general medical causes. Depression affects an estimated one in 15 adults (6.7%)

in any given year. And one in six people (16.6%) will experience depression at
some time in their life. Depression can strike at any time, but on average, first
appears during the late teens to mid-20s. Women are more likely than men to
experience depression. Some studies show that one-third of women will
experience a major depressive episode in their lifetime.
Depression is different from Sadness or Grief/Bereavement: Death of a
loved one, loss of a job or the ending of a relationship are difficult experiences
for a person to endure. It is normal for feelings of sadness or grief to develop in
response to such situations. Those experiencing loss often might describe
themselves as being ―depressed.‖ But being sad is not the same as having
depression. The grieving process is natural and unique to each individual and
shares some of the same features of depression. Both grief and depression may
involve intense sadness and withdrawal from usual activities.
Treatment of Depression: This is among the most treatable of mental
disorders. Between 80% and 90% of people with depression eventually respond
well to treatment. Almost all patients gain some relief from their symptoms.
Before a diagnosis or treatment, a health professional should conduct a thorough
diagnostic evaluation, including an interview and possibly a physical
examination. In some cases, a blood test might be done to make sure the
depression is not due to a medical condition like a thyroid problem. The
evaluation is to identify specific symptoms, medical and family history, cultural
factors and environmental factors to arrive at a diagnosis and plan a course of
action.
Medication: Brain chemistry may contribute to an individual‘s depression and
may factor into their treatment. For this reason, antidepressants might be
prescribed to help modify one‘s brain chemistry. These medications are not
sedatives, ―uppers‖ or tranquilizers. They are not habit-forming. Generally
antidepressant medications have no stimulating effect on people not
experiencing depression.
Antidepressants may produce some improvement within the first week or two
of use. Full benefits may not be seen for two to three months. If a patient feels
little or no improvement after several weeks, his or her psychiatrist can alter the
dose of the medication or add or substitute another antidepressant. In some
situations other psychotropic medications may be helpful. It is important to let

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your doctor know if a medication does not work or if you experience side
effects. Psychiatrists usually recommend that patients continue to take
medication for six or more months after symptoms have improved. Longer-term
maintenance treatment may be suggested to decrease the risk of future episodes
for certain people at high risk.
Psychotherapy: Psychotherapy, or ―talk therapy,‖ is sometimes used alone for
treatment of mild depression; for moderate to severe depression, psychotherapy
is often used in along with antidepressant medications. Cognitive behavioural
therapy (CBT) has been found to be effective in treating depression. CBT is a
form of therapy focused on the present and problem solving. CBT helps a
person to recognize distorted thinking and then change behaviours and thinking.
Psychotherapy may involve only the individual, but it can include others. For
example, family or couples therapy can help address issues within these close
relationships. Group therapy involves people with similar illnesses. Depending
on the severity of the depression, treatment can take a few weeks or much
longer. In many cases, significant improvement can be made in 10 to 15
sessions.
Electroconvulsive Therapy (ECT) is a medical treatment most commonly
used for patients with severe major depression or bipolar disorder who have not
responded to other treatments. It involves a brief electrical stimulation of the
brain while the patient is under anaesthesia. A patient typically receives ECT
two to three times a week for a total of six to 12 treatments. ECT has been used
since the 1940s, and many years of research have led to major improvements. It
is usually managed by a team of trained medical professionals including a
psychiatrist, an anaesthesiologist and a nurse or physician assistant.
Self-help: There are a number of things people can do to help reduce the
symptoms of depression. For many people, regular exercise helps create
positive feeling and improve mood. Getting enough quality sleep on a regular
basis, eating a healthy diet and avoiding alcohol (a depressant) can also help
reduce symptoms of depression. Depression is a real illness and help is
available.
With proper diagnosis and treatment, the vast majority of people with
depression will overcome it. If you are experiencing symptoms of depression, a
first step is to see your family physician or psychiatrist. Talk about your
concerns and request a thorough evaluation. This is a start to addressing mental
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health needs. Sadness, feeling down, having a loss of interest or pleasure in

daily activities – these are symptoms familiar. But, if they persist and affect our
life substantially, it may be depression.
Kinds of depression:
Persistent depressive disorder (also called dysthymia) is a depressed mood
that lasts for at least two years. A person diagnosed with persistent depressive
disorder may have episodes of major depression along with periods of less
severe symptoms, but symptoms must last for two years to be considered
persistent depressive disorder.
Perinatal depression is much more serious than the ―baby blues‖ (relatively
mild depressive and anxiety symptoms that typically clear within two weeks
after delivery) that many women experience after giving birth. Women with
perinatal depression experience full-blown major depression during pregnancy
or after delivery (postpartum depression). The feelings of extreme sadness,
anxiety, and exhaustion that accompany perinatal depression may make it
difficult for these new mothers to complete daily care activities for themselves
and/or for their babies.
Psychotic depression occurs when a person has severe depression plus some
form of psychosis, such as having disturbing false fixed beliefs (delusions) or
hearing or seeing upsetting things that others cannot hear or see (hallucinations).
The psychotic symptoms typically have a depressive ―theme,‖ such as delusions
of guilt, poverty, or illness.
Seasonal affective disorder is characterized by the onset of depression during
the winter months, when there is less natural sunlight. This depression generally
lifts during spring and summer. Winter depression is typically accompanied by
social withdrawal, increased sleep, and weight gain, predictably returns every
year in seasonal affective disorder.
Bipolar disorder is different from depression, but it is included in this list
because a person with bipolar disorder experiences episodes of extremely low
moods that meet the criteria for major depression (called ―bipolar depression‖).
But a person with bipolar disorder also experiences extreme high – euphoric or
irritable – moods called ―mania‖ or a less severe form called ―hypomania.‖

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Depression symptoms in children and teens: Common signs and symptoms of

depression in children and teenagers are similar to those of adults, but there can
be some differences.
 In younger children, symptoms of depression may include sadness,
irritability, clinginess, worry, aches and pains, refusing to go to school, or
being underweight.
 In teens, symptoms may include sadness, irritability, feeling negative and
worthless, anger, poor performance or poor attendance at school, feeling
misunderstood and extremely sensitive, using recreational drugs or alcohol,
eating or sleeping too much, self-harm, loss of interest in normal activities,
and avoidance of social interaction.
Depression symptoms in older adults: Depression is not a normal part of
growing older, and it should never be taken lightly. Unfortunately, depression
often goes undiagnosed and untreated in older adults, and they may feel
reluctant to seek help. Symptoms of depression may be different or less obvious
in older adults, such as:
 Memory difficulties or personality changes
 Physical aches or pain
 Fatigue, loss of appetite, sleep problems or loss of interest in sex — not
caused by a medical condition or medication
 Often wanting to stay at home, rather than going out to socialize or doing
new things
 Suicidal thinking or feelings, especially in older men
Obesity: It is an excess of body fat. It is difficult to directly measure body fat.
Body mass index (BMI) is a popular method of defining a healthy weight. BMI
should be used as a guide, along with waist size, to help estimate the amount of
body fat. BMI estimates a healthy weight based on your height. Because it
considers height as well as weight, it is a more accurate guide than body weight
alone. Obesity can shorten your life. It can also put you at risk of developing a
number of conditions. These include:
 High blood pressure
 Diabetes
 Heart disease
 Some forms of cancer

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Many other health risks are higher for people who are obese. These risks may
increase as the degree of obesity increases. Where you carry the extra weight is
also important. People who carry extra weight around their waist may be more
likely to experience health problems caused by obesity than those who carry it
in their legs and thighs. People become obese for a number of reasons. Often,
several of these factors are involved. Some of the most common reasons for
obesity are:
 Genetic influences: Your genetic makeup plays a significant role in your
chances of becoming obese. However, you still maintain most of the control
when it comes to your weight. Some rare genetic diseases make it almost
impossible to avoid obesity.
 Physiological influences: Some researchers believe that every person has a
predetermined weight that the body resists moving away from. Also, people
of the same age, sex and body size often have different metabolic rates. This
means their bodies burn food differently. Someone with a low metabolic
rate may require fewer calories to maintain approximately the same weight
as someone whose metabolic rate is high.
 Food intake and eating disorders: If you eat a lot, especially foods that are
high in fat and calories, you can become obese. Obesity also can result from
eating disorders, such as a tendency to binge.
 Lifestyle: If you lead a sedentary lifestyle, you are at a higher risk of
becoming obese. Your weight history: If you were overweight as a child or
adolescent, you are more likely to be obese as an adult. Pregnancy:
Pregnancy can contribute to obesity. Many women weigh more after each
pregnancy. Drugs: Some drugs can cause obesity. These include steroid
hormones and many drugs used to treat psychiatric conditions.
Symptoms: The primary warning sign of obesity is an above-average body
weight. Those who are obese may also experience:
 Trouble sleeping
 Sleep apnea. This is a condition in which breathing is irregular and
periodically stops during sleep.
 Shortness of breath
 Varicose veins
 Skin problems caused by moisture that accumulates in the folds of your skin
 Gallstones

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 Osteoarthritis in weight-bearing joints, especially the knees

Obesity increases your risk for:
 High blood pressure,
 High levels of blood sugar (diabetes)
 High cholesterol
 High triglycerides levels

Obesity is often a lifelong problem. Once excess weight is gained, it is not easy
to lose. Once lost, you will have to work
Prevention: To prevent obesity and maintain a healthy body weight, eat a well-
balanced diet and exercise regularly. Preventing obesity is important. Once fat
cells form, they remain in your body forever. Although you can reduce the size
of fat cells, you cannot get rid of them.
Childhood overweight and obesity: Childhood obesity is one of the most
serious public health challenges of the 21st century. The problem is global
and is steadily affecting many low- and middle-income countries,
particularly in urban settings. The prevalence has increased at an alarming
rate. Globally, in 2016 the number of overweight children under the age of
five is estimated to be over 41 million. Almost half of all overweight
children under 5 lived in Asia and one quarter lived in Africa.
Overweight and obese children are likely to stay obese into adulthood and
more likely to develop Non-Communicable Diseases like diabetes and
cardiovascular diseases at a younger age. Overweight and obesity, as well as
their related diseases, are largely preventable. Prevention of childhood
obesity therefore needs high priority.
The WHO Member States in the 66th World Health Assembly have agreed
on a voluntary global NCD target to halt the rise in diabetes and obesity. The
prevalence of overweight and obesity in adolescents is defined according to
the WHO growth reference for school-aged children and adolescents
(overweight = one standard deviation body mass index for age and sex, and
obese = two standard deviations body mass index for age and sex).
 What is overweight and obesity?
 Why does it matter?
 What are the causes?
 What can be done?

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Generally, although men may have higher rates of overweight, women have
higher rates of obesity. For both, obesity poses a major risk for serious diet-
related Non-Communicable Diseases, including diabetes mellitus,
cardiovascular disease, hypertension and stroke, and certain forms of cancer.
Its health consequences range from increased risk of premature death to
serious chronic conditions that reduce the overall quality of life.
Making healthy choices: Public awareness campaigns were also sensitized
with the inclusion of policy-makers, private sector partners, medical
professionals and the public in general. Aware that obesity is predominantly
a ―social and environmental disease‖, WHO is helping to develop strategies
that will make healthy choices easier to make.
Diet Unhealthy diets and physical inactivity are major risk factors for
chronic diseases. Reports of international and national experts and reviews of
the current scientific evidence recommend goals for nutrient intake in order
to prevent chronic diseases. People can become obese for different reasons.
Here are some of the most common ones:
1) Consuming too many calories: Most of the increased food consumption
has consisted of carbohydrates (sugars). Increased consumption of
sweetened drinks has contributed significantly to the raised carbohydrate
intake of most young American adults over the last three decades. The
consumption of fast-foods has tripled over the same period. Various
other factors are also said to have contributed to the increased calorie
and carbohydrate intake:
2) Leading a sedentary lifestyle: With the arrival of televisions, computers,
video games, remote controls, washing machines, dish washers and other
modern convenience devices, people are commonly are leading a much
more sedentary lifestyle compared to their parents and grandparents.
In some countries, dependence on the car has become so strong that many
people will drive even if their destination is only half-a-mile away. The
less you move around the fewer calories you burn. However, this is not
only a question of calories. Physical activity has an effect on how your
hormones work, and hormones have an effect on how your body deals
with food. Several studies have shown that physical activity has a
beneficial effect on your insulin levels - keeping them stable. Unstable
insulin levels are closely associated with weight gain.
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3) Not sleeping enough: Research has suggested that if you do not sleep
enough your risk of becoming obese doubles. The ‗epidemic‘ of obesity is
paralleled by a ‗silent epidemic‘ of reduced sleep duration with short sleep
duration linked to increased risk of obesity both in adults and in children.
These trends are detectable in adults as well as in children as young as 5
years. Professor Cappuccio explains that sleep deprivation may lead to
obesity through increased appetite as a result of hormonal changes.
Poorly balanced diets and the lack of physical exercise are key factors in the
increase of obesity and other metabolic diseases in modern societies. In
epidemiological studies in humans, the effect of the intake of fructose-
sweetened beverages also seems to be more intense in women. Although
there appears to be a consensus on the negative effects of fructose-
sweetened beverages there is still some debate over the effects of fructose
versus high fructose corn syrup - two studies of note are:
4) Lower rates of smoking (smoking suppresses appetite): According to the
National Institutes of Health (NIH), ―Not everyone gains weight when they
stop smoking. Among people who do, the average weight gain is between 6
and 8 pounds. Roughly 10% of people who stop smoking gain a large
amount of weight - 30 pounds or more.‖
5) Medications that make patients put on weight: According to an article in
Annals of Pharmacotherapy, some medications cause weight gain.
―Clinically significant weight gain is associated with some commonly
prescribed medicines. There is wide inter-individual variation in response
and variation of the degree of weight gain within drug classes..‖ (Vol. 39,
No. 12, pp. 2046-2054)
Obesity treatments have two objectives:
 To achieve a healthy weight
 To maintain that healthy weight

People who are obese are often discouraged because they think they have to lose
a lot of weight before any benefits are experienced. This is not true. Any obese
person who loses just 5-10% of their body weight will have significant
improvement in health – this would mean between 12-25 pounds for an obese
person who weighs 250 pounds.

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It is important for patients to realize that a small drop in weight is a good start
and a great achievement. Experts have found that obese people who lose weight
slowly and constantly, say one or two pounds each week, are more successful in
keeping their weight down when they have reached their target weight. People
who are seriously obese may be prescribed a very low calorie liquid diet. These
must be done with a health care professional.
Physical activity: The more you move your body the more calories you burn.
To lose a kilogram of fat you need to burn 8,000 calories (1 pound of fat =
3,500 calories). Walking briskly is a good way to start increasing your physical
activity if you are obese. Combining increased physical activity with a good diet
will significantly increase your chances of losing weight successfully and
permanently. If you are very obese, are unfit, or have some health problems,
make sure you check with a health care professional before increasing your
physical activity.
Health risks associated with obesity
Bone and cartilage degeneration (Osteoarthritis): Obesity is an important
risk factor for osteoarthritis in most joints, especially at the knee joint (the most
important site for osteoarthritis). Obesity confers a nine times increased risk in
knee joint osteoarthritis in women. Osteoarthritis risk is also linked to obesity
for other joints. A recent study indicated that obesity is a strong determinant of
thumb base osteoarthritis in both sexes. Data suggest that metabolic and
mechanical factors mediate the effects of obesity on joints.
Coronary heart disease: Obesity carries a penalty of an associated adverse
cardiovascular risk profile. Largely as a consequence of this, it is associated
with an excess occurrence of cardiovascular disease morbidity and mortality.
Gallbladder disease: Being overweight is a significant risk factor for
gallstones. In such cases, the liver over-produces cholesterol, which is then
delivered into the bile causing it to become supersaturated. Some evidence
suggests that specific dietary factors (saturated fats and refined sugars) are the
primary culprit in these cases.
High blood pressure (Hypertension): There are multiple reasons why obesity
causes hypertension, but it seems that excess adipose (fat) tissue secretes
substances that are acted on by the kidneys, resulting in hypertension.

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Moreover, with obesity there are generally higher amounts of insulin produced.
Excess insulin elevates blood pressure.
High total cholesterol, high levels of triglycerides (Dyslipidemia): The
primary dyslipidaemia related to obesity is characterized by increased
triglycerides, decreased HDL levels, and abnormal LDL composition.
Respiratory problems: Obesity can also cause respiratory problems. Breathing
is difficult as the lungs are decreased in size and the chest wall becomes very
heavy and difficult to lift.
Several types of cancer: In 2002, approximately 41,000 new cases of cancer in
the USA were thought to be due to obesity. In other words, about 3.2% of all
new cancers are linked to obesity
Sleep apnea: Obesity has been found to be linked to sleep apnea. Also, weight
reduction has been associated with comparable reductions in the severity of
sleep apnea.
Stroke: Rising obesity rates have been linked to more strokes among women
aged 35 to 54.
Type 2 diabetes: One of the strongest risk factors for Type 2 Diabetes is
obesity, and this is also one of the most modifiable as it can be partially
controlled through diet and exercise.
Controlling body weight: Body weight control is much more successful if you
can combine a well-balanced diet with regular exercise. Crash diets may have
short term results, but tend to have poor long-term success rates. If an individual
can manage to sleep between 7 to 8 hours continuously each 24 hour period,
your bodyweight control will be more successful. Sleep deprivation, or lack of
sleep can make you put on weight.
Alcohol: The scientific name for alcohol that people drink is ethyl alcohol or
ethanol. Beer, wine, and liquor all contain ethyl alcohol. Other types of alcohol,
like rubbing alcohol are poisonous if ingested. Excess alcohol is the most
common cause of preventable death. Alcohol is highly toxic to almost every
organ in the body but when alcohol is taken in allowed limits amounts it is
detoxified by the liver and therefore does little or no harm to the body.
Alcoholic drinks contain ethyl alcohol and it is metabolized in the body to
acetaldehyde. Both ethanol and acetaldehyde interfere with normal functioning

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of organs in the body including the heart and the liver and therefore if the liver
and the heart get damaged disease occur which may eventually kill, teenagers
maybe more prone to this effects in the youth as their organs are still developing
thus toxic substances from alcohol damage their body organs.
Alcohol Addiction: When people drink too much, with time they risk becoming
addicted to alcohol. This is called alcoholism, or alcohol dependence. It's a
disease, and it can happen at any age, Common signs include, loss of control not
being able to stop or cut down drinking, not feeling well after heavy drinking
(upset stomach, sweating, shakiness, or nervousness), neglecting activities
giving up or cutting back on other activities. Binge drinking happens when
someone drinks more than four (for women) or five (for men) alcoholic drinks
in about two hours, with the intention to getting drunk. Binge drinking is the
most harmful type of drinking. It usually happens at teen or student parties.
Excessive alcohol consumption increases HDL levels, increases risk of heart
disease, colorectal and breast cancer, hypertension and diabetes. It also
contributes to the development of various other lifestyle diseases and conditions
like liver cirrhosis. Individuals who cannot moderate alcohol intake are advised
to abstain from alcohol altogether as in such cases the risks far outweigh any
possible benefits.
Tobacco: The dangers of smoking are so great, but because of it governments
get a lot of tax money from tobacco and cigarettes manufacturers, they are less
hesitant to ban it totally. Government and society is aware of the danger that is
why they made it illegal for teens to possess and use cigarettes. Smoking of
tobacco can cause many with many diseases like respiratory and heart disease
including, respiratory infections, lung cancer as well as cancer of the larynx,
pancreas, stomach and cervix, bronchitis, emphysema and stillborn or premature
children.
Misbehaviour caused by alcohol can also have disastrous effects on a pupil's
educational attainment, as well on performance in tests of intellect in later life.
Compared with those pupils who have never truanted, pupils who had ever
truanted from school had increased odds of having drunk alcohol in the last
week (odds ratios of 2.24 for those who had truanted in the last year, 1.69 who
had truanted previously). 6.5% of permanent exclusions of children from
English state-funded secondary schools in 2010/11 were due to alcohol.

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Women, especially young women, encounter special risks in groups of drinking

friends and acquaintances. In many societies, a woman who drinks seems to
signal that she is at least approachable, and to some men an intoxicated woman
is by definition sexually available. Such concepts as ‗acquaintance rape‘ and
‗date rape‘ bear witness to recent concern with this problem. A large proportion
of unwanted sexual advances are mediated by alcohol.
Smoking causes surges in the concentrations of catecholamine‘s (the stimulator
chemical messengers of the autonomic nervous system) as well as increases in
carbon monoxide in the blood. Both of these short-term effects can exacerbate
existing heart disease, resulting, for instance, in attacks of angina (chest pain).
Nicotine raises blood pressure and heart rate, requiring the heart to work harder.
It also constricts the coronary arteries, thereby lessening the supply of blood and
oxygen to the heart muscle. It also promotes irregular heartbeats (cardiac
arrhythmias).
Passive smoking: Smokers are not the only people harmed by tobacco. Toxic
fumes from cigarettes pose a health threat to all those around smoker's family,
friends, and. Because the organic material in tobacco does not burn completely,
smoke contains many toxic chemicals, including carbon monoxide, nicotine,
and tar. As a result of this exposure, smokers‘ children have more colds and flu,
and they are more likely to take up smoking themselves when they grow
up. Smokers also affect other people as well e.g. passive smoking. This is the
involuntary inhaling of smoke from other people cigarettes and we all suffer
when we have people smoking around us. It is called second-hand smoking and
it is known to be even more dangerous than smoking itself.
Drug abuse is also associated with a range of adverse physical, psychological
and social outcomes. While heroin is the focus of much attention, other illicit
drugs such as cannabis, inhalants and cocaine also have harmful effects.
Inhalants can cause death from heart or respiratory failure and long-term side-
effects include permanent organ damage as well as impaired information-
processing abilities.
There are also health complications associated with cocaine use, including
disturbances in heart rhythm, respiratory failure and neurological effects, such
as strokes and seizures. Many of the health consequences of smoking tobacco
are also evident in relation to cannabis, for instance, chronic cough, bronchitis
and emphysema and an increased risk of lung and other cancers. .

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Marijuana: It is frequently referred to as ―pot,‖ ―weed,‖ or ―joint‖ is a very

popular illegal drug. Smoking marijuana can affect nerve cells in the brain,
cause short-term memory loss and can affect other aspects of your health.
Chewing Tobacco Chewing tobacco also is unhealthy. It can cause diseases and
cancer of the mouth, bad breath, discoloured teeth and lots of other problems. It
is very addictive.
Date drugs: Rohypnol, frequently called the ―date rape‖ drug, ―roaches,‖ and
―forget-me pill‖ can leave a young woman extremely vulnerable. It is odourless
and has no taste. Therefore, it can be easily slipped into a drink. Once it is
taken, an individual is virtually helpless to resist rape and other unwanted
advances and attacks. GHB (gamma-hydroxybutrate) is another ―date rape‖ type
drug. Common street names include ―Gamma G,‖ ―liquid ecstasy,‖ ―Growth
Hormone Booster,‖ and ―Grievous Bodily Harm.‖ It has effects similar to those
listed above. It too has been associated with sexual assault crimes, including
rape. The primary way to avoid being a victim is to never leave drinks
unattended.
Ecstasy: It is Methylenedioxymethamphetamine (MDMA) is a commonly used
drug. Street names include X, E, and Adam. Frequent or high doses can cause
damage in the brain‘s nerve cells. Mixing ecstasy with other drugs or alcohol
can have devastating effects. Side effects can include depression, confusion,
sleep problems, and in some cases death.
Inhalants: Substances and fumes from products such as glue, paint thinner,
white out, lighter fluid, and cleaning materials are known as inhalants. When
―sniffed‖ or ―inhaled‖ the fumes create an instant high. These products starve
the body of oxygen, cause the heart to beat at very fast and irregular rates and
can kill a person instantly. Other side effects include dizziness, slurred speech,
head ache and decreased performance in school
Cocaine: Use of cocaine has increased among youth over the years, along with
the myth that the drug is relatively safe, especially when it is sniffed rather than
injected or smoked as ‗crack‘. In fact, no matter how it is used, cocaine can kill.
It can disturb the heart's rhythm and cause chest pain, heart attacks, and even
sudden death. These effects on the heart can cause death even in the absence of
any seizures. Even in the absence of underlying heart disease, a single use of
only a small amount of the drug has been known to be fatal.

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Cocaine is a highly addictive substance, and crack cocaine is substantially more

addicting, as the drug is far more potent and is smoked. Users quickly develop a
tolerance to crack cocaine, needing more of the substance to achieve the desired
effects. Because the high from crack cocaine is so short-lived, users commonly
smoke it repeatedly in order to sustain the high.
This can lead to an even faster onset of addiction. Also, because crack cocaine
works on the brain's system of reward and punishment, withdrawal symptoms
occur when the drug's effects wear off. These symptoms can include depression,
irritability, and extreme fatigue, anxiety, an intense craving for the drug, and
sometimes even psychosis. Users will often keep using crack cocaine simply to
avoid the negative effects of withdrawal.
Some of the most common symptoms of alcohol abuse are:
 Experiencing temporary blackouts or short-term memory loss.
 Exhibiting signs of irritability and extreme mood swings.
 Making excuses for drinking such as to relax or deal with stress or feel
normal.
 Choosing drinking over other responsibilities and obligations.
 You cannot quit drinking or control how much you drink.
 You need to drink more to get the same effect.
 You have withdrawal symptoms when you stop drinking.
 The withdrawal symptoms include feeling sick, sweating, shakiness,
and anxiety.
 Troubled breathing.
 Impaired judgment.
 Headaches.
 Blackouts.
 Nausea.
 Distorted vision and hearing.
Signs someone else is addicted:
 Changes in personality and behavior like a lack of motivation, irritability,
and agitation.
 Bloodshot eyes and frequent bloody noses.
 Shakes, tremors, or slurred speech.
 Change in their daily routines.

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 Lack of concern for personal hygiene.

 Unusual need for money; financial problems.
 pupils of the eyes are larger or smaller than usual.
 Changes in appetite or sleep patterns.
 Sudden weight loss or weight gain.
 Deterioration of physical appearance, personal grooming habits.
 Unusual smells on breath, body, or clothing.
Interventions: A drug intervention is a structured, solution-oriented process
undertaken to persuade someone who is abusing drugs to seek help in
overcoming the addiction. Family, friends, and others involved in the person's
life use the intervention to demonstrate the extent of the effects of drinking and
related behaviours. A successful intervention is not a confrontation but an
opportunity for an addicted individual to accept help in taking the first step
toward recovery. Often, an interventionist is invited to serve as a guide and
educator before, during, and after the intervention.
Some drug addicts can and do recognize the extent of the problems stemming
from drug abuse and seek treatment without the need for an intervention. Most,
however, are reluctant or unable to realize that drugs are responsible for the
problems in their relationships, health, or work. They ignore the safety issues
related to drinking and driving and other high-risk behaviours. It is common for
addicts to deny that drugs are the source of the difficulties they face. They may
instead blame other people or circumstances in their lives. When that happens,
an intervention can break through the denial and help these individuals clearly
see the effects of their drug abuse on the people who matter most to them.
Preventing alcohol and drug abuse starts at home: Teach your children early
about the effects of substance abuse, to prevent addiction later in life. No parent
wants to see their child suffer from the negative effects of drug addiction, yet
many mistakenly believe there is nothing they can do to stop their kids from
experimenting with drugs and alcohol. Some parents think this behaviour is
normal and acceptable, but the fact is — the earlier teens start using drugs and
alcohol the greater their risk for alcoholism and drug abuse. Early substance
abuse prevention is one of the best ways to lower the risk for addiction, and this
prevention starts at home with families and parents. There are steps parents can
take to help their kids and teens steer clear of alcohol and drug abuse.

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Tips for Parents to Help Prevent Alcohol and Drug Abuse: The greatest
factor influencing a teen‘s choice not to use drugs is their parents. It is important
that kids and teens have good role models when it comes to alcohol and drug
abuse. While there is no way to guarantee the following steps will help:
1. Communication: Drug abuse prevention starts with communication.
Establishing good communication habits early on will make having difficult
conversations about substance abuse easier. Talk to your children daily and try
asking open ended questions that require more than a yes or no answer such as
―What was your favourite part about today?‖ instead of ―Did you enjoy
school?‖
Remember that communication is a two way street that involves both talking
and listening. When your children know you will listen to them they will be
more likely to come to you when concerns about substance use come up later.
The earlier you start talking to your kids about the dangers of substance abuse
the better, but it is not always easy to start these conversations. One option is to
use movies and television shows to spark conversations about irresponsible
behaviour. Educate yourself about the effects of drug abuse so you can relay
factual information to your children. Be sure to ask about their thoughts on
substance use and dispel any myths they might believe.
Common myths among youth are that everyone drinks and marijuana is not
harmful. This is not true, and they should know this. As well, having frequent
conversations about drug abuse is better than giving a one-time lecture. Teach
and role-play multiple ways to say no when alcohol and drugs will inevitably be
presented. If kids and teens know what they are going to say it will be easier for
them to resist peer pressure.
2. Get to know your children‟s friends: Be active in your child‘s life. Meet
your child‘s friends and their parents. Ask questions about where they are going
and what they are doing with their friends. Secretive behaviour and having new
friends that parents never meet are signs of drug abuse in teens. Talk about how
to be a good friend, and the fact that real friends would never reject someone
who does not want to do things that are unsafe or not allowed.
Let them know that doing things they know are unacceptable is not a good way
to fit in, and involve your children in activities such as scouting, sports, or other
afterschool clubs they are interested in where they can easily make friends while
learning new skills and developing healthy habits.

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3. Limit access to inhalants, prescription drugs and alcohol within the

home: Inhalants are the earliest abused substance. Common household products
such as glue, computer cleaners, and anything in an aerosol container can be
inhaled by children — and this type of drug abuse is extremely dangerous.
Replace potential inhalants with water based products and throw away products
that are not being used. Always store any products with the potential for abuse
in a safe place away from children.
Kids and teens often try alcohol for the first time within the home without
parents knowing. If you keep alcohol at home, store it in a safe place and
monitor alcohol levels in the bottle. If you suspect your teen has been drinking
alcohol, talk to them about it and enforce consequences. Prescription drug abuse
is also on the rise. Talk to your kids about the risks of using any medication not
prescribed to them. Throw away any prescriptions you are not taking, and store
any prescription drugs in a safe, locked place.
4. Make clear rules and consequences: Have clear rules regarding alcohol
and drug abuse. Discuss your rules, expectations and consequences in advance.
Involve your child in the process of determining what a reasonable curfew is
and what his or her consequences will be for breaking any rules. Let your child
know that you are not okay with them experimenting with drugs and alcohol
and that you would be very disappointed in them if this occurred. If rules are
broken, be sure to consistently enforce consequences.
5. Be a role model: The best thing you can do to help prevent your children
and teens from abusing substances is to be a good role model. This means not
smoking or doing drugs, and if you do drink do so in moderation and never
drink and drive. Demonstrate how to have fun, manage stress, and solve
problems without substances. Never host a party where underage drinking is
allowed in your home — not only is it illegal, but teen alcohol use is related to a
number of negative consequences including higher risk for developing
alcoholism.
As addiction is a genetically linked disease, if you or someone in your family
has battled addiction it is even more important to talk to your children early and
often about the risks of alcohol and drug abuse and how substance
experimentation can lead to the horrors of addiction. It is important for them to
know that their risk for developing addiction may be greater than their friends.
Overall, preventing future addiction starts early and at home. Consistent and

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caring communication, clear rules and consequences, and good modelling of

ways to cope without substances can go a long way.
Pollution is a degradation of the environment whatever its physical, chemical or
biological nature. It has an impact on the physiology and behavior of the
organisms exposed or on the characteristics of the biotopes consequently on the
composition and the structure of the populations. Pollution may be air, water
and soil. These have lot of impacts on the human life. Air we breathe, water we
drink and food we eat, where there is contamination of toxic chemicals leading
to cancer of the bones, skin, longs etc. Sound pollution may have significant on
human heart and nervous systems.
The Consequences of Pollution: We humans cause most of the pollution and
we will suffer the consequences if we don‘t stop. We are already seeing its
effects in the form of global warming, contaminated seafood, increased cases of
lung diseases and more. We live off the Earth and since we share everything on
Earth with every living thing on the planet, what happens in one area affects
everything too, no matter how far away. Pollution or the introduction of
different forms of waste materials in our environment has negative effects to the
ecosystem we rely on.
Environmental Pollution is an international journal that addresses issues
relevant to the nature, distribution and ecological effects of all types and forms
of chemical pollutants in air, soil and water.
Air Pollution: We release a variety of chemicals into the atmosphere when we
burn the fossil fuels we use every day. We breathe air to live and what we
breathe has a direct impact on our health. Breathing polluted air puts you at a
higher risk for asthma and other respiratory diseases. When exposed to ground
ozone for 6 to 7 hours, scientific evidence show that healthy people‘s lung
function decreased and they suffered from respiratory inflammation.
Air pollutants are mostly carcinogens and living in a polluted area can put
people at risk of Cancer. It damages the immune system, endocrine and
reproductive systems. High levels of particle pollution have been associated
with higher incidents of heart problems. The burning of fossil fuels and the
release of carbon dioxide in the atmosphere are causing the Earth to become
warmer. The toxic chemicals released into the air settle into plants and water
sources. Animals eat the contaminated plants and drink the water.

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Water Pollution: Just like the air we breathe, water is vital to our survival. We
need clean water to drink, to irrigate our crops and the fish we eat live in the
waters. We play in rivers, lakes and streams – we live near bodies of water. It‘s
a precious resource that can easily be polluted and the contamination can be
transferred to us and affect our health. Diseases such as amoebiasis, typhoid and
hookworm are caused by polluted drinking water.
Water polluted by chemicals such as heavy metals, lead, pesticides and
hydrocarbon can cause hormonal and reproductive problems, damage to the
nervous system, liver and kidney damage and cancer – to name a few. Being
exposed to mercury causes Parkinson‘s disease, Alzheimer‘s, heart disease and
death. A polluted beach causes rashes, hepatitis, gastroenteritis, diarrhea,
encephalitis, stomach aches and vomiting. Water pollution affects marine life
which is one of our food sources.
We live in an ecosystem where the action of one has the potential to affect the
many. This can be a good or a bad thing, depending on what the action is. Our
mistakes has polluted the environment that we live in and we are waking up and
owning to the fact. We are trying to reverse the damage. The good news is that
every positive action counts. The small effort you make towards a greener
environment can start a healing ripple effect. We may still save what is left of
our natural resources and make the world a better place to live in for our future
generation. Gases like sulphur dioxide and nitrogen oxide can cause acid rain.
Oil spill on water may lead to death of several wildlife species.
Water quality issues are a major challenge that humanity is facing in the
twenty-first century. Here, we review the main groups of aquatic contaminants,
their effects on human health, and approaches to mitigate pollution of
freshwater resources. Emphasis is placed on chemical pollution, particularly on
inorganic and organic micro-pollutants including toxic metals and metalloids as
well as a large variety of synthetic organic chemicals. Some aspects of
waterborne diseases and the urgent need for improved sanitation in developing
countries are also discussed.
Persistent organic pollutants (POPs) have affected water systems on a global
scale for more than five decades; during that time geogenic pollutants, mining
operations, and hazardous waste sites have been the most relevant sources of
long-term regional and local water pollution. Agricultural chemicals and waste-
water sources exert shorter-term effects on regional to local scales.

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Air pollution has both acute and chronic effects on human health, affecting a
number of different systems and organs. It ranges from minor upper respiratory
irritation to chronic respiratory and heart disease, lung cancer, acute respiratory
infections in children and chronic bronchitis in adults, aggravating pre-existing
heart and lung disease, or asthmatic attacks. In addition, short- and long-term
exposures have also been linked with premature mortality and reduced life
expectancy. These effects of air pollutants on human health and their
mechanism of action are briefly discussed.
Environmental pollution and food safety are two of the most important issues.
Soil and water pollution, in particular, have historically impacted on food
safety which represents an important threat to human health. Nowhere has that
situation been more complex and challenging than in China, where a
combination of pollution and an increasing food safety risk have affected a large
part of the population.
Water scarcity, pesticide over-application, and chemical pollutants are
considered to be the most important factors impacting on food safety.
Inadequate quantity and quality of surface water resources in China have led to
the long-term use of waste-water irrigation to fulfil the water requirements for
agricultural production. In some regions this has caused serious agricultural land
and food pollution, especially for heavy metals.
It is important, therefore, that issues threatening food safety such as combined
pesticide residues and heavy metal pollution are addressed to reduce risks to
human health. The increasing negative effects on food safety from water and
soil pollution have put more people at risk of carcinogenic diseases, potentially
contributing to ‗cancer villages‘ which appear to correlate strongly with the
main food producing areas.
Soil pollution can have a number of harmful effects on ecosystems and human,
plants and animal health. Soil pollution can also cause neuromuscular blockage
as well as depression of the central nervous system, headaches, nausea, fatigue,
eye irritation and skin rash. The chemicals may be foreign to the area, or they
may be naturally occurring materials that pollute the soil by being present in
dangerously high amounts. Soil pollution can have a number of harmful
effects on human health. Considering how soil is the reason we are able to
sustain ourselves, the contamination of it has major consequences on our health.

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Crops and plants grown on polluted soil absorb much of the pollution and then
pass these on to us.
Noise pollution can cause hypertension, high stress levels, tinnitus, hearing
loss, sleep disturbances, and other harmful effects. Sound becomes unwanted
when it either interferes with normal activities such as sleeping, conversation, or
disrupts or diminishes one‘s quality of life. It interferes with speech. In the
presence of noise we may not able to follow, what the other person is saying.
Noise leads to emotional and behavioral stress. A person may feel disturbed in
the presence of loud noise such as produced by heating of drums. Noise may
permanently damage hearing. A sudden loud noise can cause severe damage to
the eardrum. Noise increases the chances of occurrence of diseases such as
headache, blood pressure, heart failure, etc.
Noise leads to increased heartbeat, constriction of blood vessels and dilation of
pupil. Noise is a problem especially for patients who need rest. Noise may cause
damage to liver, brain and heart. For some people working in Industry, noise
could be a problem. For some people living in some neighbourhood where
people party a lot, like college students, noise could be a problem too. Some
people listen to music with amplifiers and big boom-boxes at a very high
volume, and noise could be a problem too. It is scientifically known that
frequent and long use of headphones at a loud volume for a prolonged period of
time could affect one's hearing.
Communicable Diseases are diseases that can be transmitted from person to
person. They are caused by infective agents (pathogens), e.g. bacteria and
viruses, which invade the body and multiply or release toxins to cause damages
to normal body cells and their functions. In severe cases, they may lead to death.
These infective agents can spread from a source of infection (e.g. patients, sick
animals) to a person through various routes of transmission. Communicable
diseases can cause epidemics and pandemics which have the potential to
overwhelm the capacity of communities; hence, they are also considered
disasters.
Crucial factors for the spread of communicable diseases include the infective
agent, the source of infection, the mode of transmission and the host - the so-
called ‗chain of infection‘. An infective agent is a microorganism (e.g. bacteria,
viruses, fungi and parasite) that will cause an infection.

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Communicable diseases are a major cause of mortality and morbidity in disaster

situations, particularly, where there is:
 Population displacement
 Collapsing health services
 Lack of disease control programmes
 Poor access to health care in urban and/or rural areas
 Malnutrition
 Interrupted supplies and logistics
 Poor coordination among agencies the risk of communicable diseases is
associated primarily with the size and characteristics of the affected
population7 specifically:
 Amount and availability of safe water
 Functioning latrines;
 Nutritional status of the displaced population;
 Level of immunity to vaccine-preventable diseases such as measles
 Level of access to health care services.
Communicable diseases, and the associated risk factors, can be grouped as
follows: Water-borne diseases Lack of access to safe water and inadequate
sanitation facilities transmission of water-borne and food-borne pathogens.
Diarrhoeal diseases such as cholera, typhoid fever and shigellosis can cause
epidemics with high rates of mortality. Hepatitis E has resulted in jaundice and
increased mortality in pregnant women. Leptospirosis is associated with
flooding and the increased proximity of rats to humans.
Vector-borne diseases: Malaria is endemic in over 80% of areas affected by
natural disasters. Increased risk of death from malaria arises from weakened
immunity due to:
 Malnutrition
 Co-infection
 Increased exposure to vectors owing to in- adequate shelter
 Collapse of health services
Other vector-borne diseases in risk areas include arboviruses, such as dengue,
yellow fever, Japanese encephalitis and Rift Valley fever, and tick-borne
illnesses including Crimean–Congo haemorrhagic fever and typhus. Diseases
associated with overcrowding Measles spreads easily in unvaccinated

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populations in the crowded conditions and outbreaks are common. Crowding

also facilitates the transmission of:
 Meningococcal disease
 Acute respiratory infections
 Tuberculosis infection
 Diarrhoeal diseases
Vaccine-preventable diseases: Increased risk of polio, tetanus, pertussis and
diphtheria is evident when levels of baseline immunization coverage are low.
Governments and communities can manage the risk of communicable diseases
in or causing disasters by safe water, sanitation, site planning:
 Provision of safe drinking water is the most important preventive measure. o
Planners and engineers are key to ensuring safe water and sanitation
infrastructure. Chlorine is widely available, inexpensive, easily used, and
effective against nearly all waterborne pathogens.
International Health Regulations (IHR) Implementation of country and sub-
national reporting to IHR provides an early warning of new and re-emerging
epidemic prone diseases.
Immunization: Mass measles immunization and vitamin A supplementation
are immediate health priorities in areas with inadequate coverage.
Prevention of malaria and dengue: Specific preventive interventions for
malaria based on an assessment of the local situation could include improving
drainage to reduce vector breeding sites.
Tuberculosis (TB) is an infectious disease that usually affects the lungs.
Compared with other diseases caused by a single infectious agent, tuberculosis
is the second biggest killer, globally. In 1993, the World Health Organization
(WHO) declared that TB was a global emergency; the first time that a disease
had been labeled as such. TB usually affects the lungs, although it can spread to
other organs around the body.
Doctors make a distinction between two kinds of tuberculosis infection: latent
and active.
Latent TB – the bacteria remain in the body in an inactive state. They cause no
symptoms and are not contagious, but they can become active. About one-
third of the world's population is believed to have latent TB. There is a 10

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percent chance of latent TB becoming active, but this risk is much higher in
people who have compromised immune systems, i.e., people living with HIV
or malnutrition, or people who smoke.
Active TB – the bacteria do cause symptoms and can be transmitted to others.
TB affects all age groups and all parts of the world. However, the disease
mostly affects young adults and people living in developing countries. In 2012,
80 percent of reported TB cases occurred in just 22 countries. The most
common diagnostic test for TB is a skin test where a small injection of PPD
tuberculin, an extract of the TB bacterium, is made just below the inside
forearm. The injection site should be checked after 2-3 days, and, if a hard, red
bump has swollen up to a specific size, then it is likely that TB is present.
Unfortunately, the skin test is not 100% accurate and has been known to give
incorrect positive and negative readings. However, there are other tests that are
available to diagnose TB. Blood tests, chest X-rays and sputum tests can all be
used to test for the presence of TB bacteria and may be used alongside a skin
test. MDR-TB is resistant to other first-line drugs and is more difficult to
diagnose than regular TB. It is also difficult to diagnose regular TB in children.
Treatments: The majority of TB cases can be cured when the right medication
is available and administered correctly. The precise type and length
of antibiotic treatment depend on a person's age, overall health, potential
resistance to drugs, whether the TB is latent or active, and the location of
infection (i.e., the lungs, brain, kidneys). People with latent TB may need just
one kind of TB antibiotics, whereas people with active TB (particularly MDR-
TB) will often require a prescription of multiple drugs. Antibiotics are usually
required to be taken for a relatively long time. The standard length of time for a
course of TB antibiotics is about 6 months. TB medication can be toxic to the
liver, and although side effects are uncommon, when they do occur, they can be
quite serious. Potential side effects should be reported to a doctor and include:
 Dark urine
 Fever
 Jaundice
 Loss of appetite
 Nausea and vomiting

It is important for any course of treatment to be completed fully, even if the TB

symptoms have gone away. Any bacteria that have survived the treatment could

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become resistant to the medication that has been prescribed and could lead to
developing MDR-TB in the future. Directly Observed Therapy (DOT) may be
recommended. This involves a healthcare worker administering the TB
medication to ensure that the course of treatment is completed.
Causes: The Mycobacterium tuberculosis bacterium causes tuberculosis. It is
spread through the air when a person with TB whose lungs are affected and
when the person coughs, sneezes, spits, laughs or talks. TB is contagious, but
the chances of catching TB from someone you live or work with are much
higher than from a stranger. Most people with active TB who have received
appropriate treatment for at least 2 weeks are no longer contagious. Since
antibiotics began to be used to fight TB, some strains of the disease have
become resistant to drugs.
Multidrug-resistant TB (MDR-TB) arises when an antibiotic fails to kill all of
the bacteria, with the surviving bacteria developing resistance to that antibiotic
and often others at the same time. MDR-TB is treatable and curable only with
the use of very specific anti-TB drugs, which are often limited or not readily
available. In 2012, around 450,000 people developed MDR-TB.
Prevention: A few general measures can be taken to prevent the spread of
active TB.
 Avoid other people by not going to school or work, or sleeping in the same
room as someone, will help to minimize the risk of germs from reaching
anyone else.
 Wear a mask, covering the mouth, and ventilating rooms can also limit the
spread of bacteria.
TB vaccination: In some countries, BCG injections are given to children to
vaccinate them against tuberculosis. It is not recommended for general use in
the U.S. The most important thing to do is to finish entire courses of medication
when they are prescribed. MDR-TB bacteria are far deadlier than regular TB
bacteria. Some cases of MDR-TB require extensive courses of chemotherapy,
which can be expensive and cause severe adverse drug reactions in patients.
People with compromised immune systems are most at risk of developing
active tuberculosis. For instance, HIV suppresses the immune system, making it
harder for the body to control TB bacteria. People who are infected with both
HIV and TB are around 20-30% more likely to develop active TB than those

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who do not have HIV. Tobacco use has also been found to increase the risk of
developing active TB. Over 20% of TB cases worldwide are related to smoking.
People with the following conditions have an increased risk:
 Diabetes
 Certain cancers
 Malnutrition
 Kidney disease
Also, people who are undergoing cancer therapy, anyone who is very young or
old and people who abuse drugs are more at risk. Travel to certain countries
where TB is more common increases the level of risk, too. The
following countries have the highest TB rates, globally:
 Africa – particularly West African and sub-Saharan Africa
 Afghanistan
 Southeast Asia: including Pakistan, India, Bangladesh, and Indonesia
 China
 Russia
 South America
 Western Pacific region - including the Philippines, Cambodia, and Vietnam

If left untreated, TB can be fatal. Although it mostly affects the lungs, it can
also spread through the blood, causing complications, such as:
 Meningitis: swelling of the membranes that cover the brain
 Spinal pain
 Joint damage
 Damage to the liver or kidneys
 Heart disorders: this is more rare
Fortunately, with proper treatment, the vast majority of cases of tuberculosis are
curable. Cases of TB have decreased in the United States since 1993, but the
disease remains a concern. Without proper treatment, up to two-thirds of people
ill with tuberculosis will die.
Symptoms: While latent TB is symptomless, the symptoms of active TB
include the following:
 Coughing, sometimes with mucus or blood
 Chills
 Fatigue
 Fever

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 Loss of weight
 Loss of appetite
 Night sweats
Tuberculosis usually affects the lungs, but can also affect other parts of the
body. When TB occurs outside of the lungs, the symptoms vary accordingly.
Without treatment, TB can spread to other parts of the body through the
bloodstream:
 TB infecting the bones can lead to spinal pain and joint destruction
 TB infecting the brain can cause meningitis
 TB infecting the liver and kidneys can impair their waste filtration functions
and lead to blood in the urine
 TB infecting the heart can impair the heart‘s ability to pump blood, resulting
in a condition called cardiac tamponade that can be fatal
The co-epidemics of TB and HIV In 2016, 57% of TB patients globally had a
documented HIV test result. In the African region, that has the highest TB/HIV
burden, 82% of TB patients knew their HIV status. Globally, 85% of reported
HIV-positive TB patients in 2016 were started on antiretroviral therapy.
Nevertheless, only 39% of the total number of people living with HIV estimated
to have developed TB in 2016 had been placed on antiretroviral therapy.
Prevention:
 Do not spend long periods of time in stuffy, enclosed rooms with anyone who
has active TB until that person has been treated for at least 2 weeks.
 Use protective measures, such as face masks, if you work in a facility that cares
for people who have untreated TB.
 If you live with someone who has active TB, help and encourage the person to
follow treatment instructions.
Smallpox is a serious, infectious, contagious, and sometimes fatal disease.
There is no specific treatment for smallpox disease, and the only prevention is
vaccination. The name smallpox is derived from the Latin word for ―spotted‖
and refers to the raised bumps that appear on the face and body of an infected
person. There are two clinical forms of smallpox. Variola minor is a less
common presentation of smallpox, and a much less severe disease, with death

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rates historically of 1% or less. Variola major is the severe and most common
form of smallpox, with a more extensive rash and higher fever.
There are four types of variola major smallpox: ordinary (the most frequent
type, accounting for 90% or more of cases); modified (mild and occurring in
previously vaccinated persons); flat; and hemorrhagic (both rare and very
severe). Historically, variola major has an overall fatality rate of about 30%;
however, flat and haemorrhagic smallpox usually are fatal. Smallpox outbreaks
have occurred from time to time for thousands of years, but the disease is now
eradicated after a successful worldwide vaccination program. The last naturally
occurring case in the world was in Somalia in 1977.
After the disease was eliminated from the world, routine vaccination against
smallpox among the general public was stopped because it was no longer
necessary for prevention. Smallpox is caused by the variola virus that emerged
in human populations thousands of years ago. Except for laboratory stockpiles,
the variola virus has been eliminated. However, in the aftermath of the events of
September and October, 2001, there is heightened concern that the variola virus
might be used as an agent of bioterrorism.
Transmission: Generally, direct and fairly prolonged face-to-face contact is
required to spread smallpox from one person to another. Smallpox also can be
spread through direct contact with infected bodily fluids or contaminated
objects such as bedding or clothing. Rarely, smallpox has been spread by virus
carried in the air in enclosed settings such as buildings, buses, and trains.
Humans are the only natural hosts of variola.
Smallpox is not known to be transmitted by insects or animals. A person with
smallpox is sometimes contagious with onset of fever (pro-drome phase), but
the person becomes most contagious with the onset of rash. At this stage the
infected person is usually very sick and not able to move around in the
community. The infected person is contagious until the last smallpox scab falls
off.
Typhoid fever is a type of enteric fever along with paratyphoid fever. The cause
is bacterium Salmonella typhi, also known as Salmonella enterica serotype
Typhi, which grows in the intestines and blood. Typhoid is spread by eating or
drinking food or water contaminated with the faeces of an infected person.
Typhoid fever is a bacterial infection that can spread throughout the body,
affecting many organs.
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Without prompt treatment, it can cause serious complications and can be fatal.
It's caused by a bacterium called Salmonella typhi, which is related to the
bacteria that cause salmonella food poisoning or the faecal-
oral transmission route. The bacteria that cause typhoid fever spread through
contaminated food or water and occasionally through direct contact with
someone who is infected. In developing nations, where typhoid fever is
endemic, most cases result from contaminated drinking water and poor
sanitation. The bacterium lives in the intestines and bloodstream of humans. It
spreads between individuals by direct contact with the faeces of an infected
person.
No animals carry this disease, so transmission is always human to human. If
untreated, around 1 in 5 cases of typhoid can be fatal. With treatment, fewer
than 4 in 100 cases are fatal. S. typhi enters through the mouth and spends 1 to 3
weeks in the intestine. After this, it makes its way through the intestinal wall
and into the bloodstream. From the bloodstream, it spreads into other tissues
and organs. The immune system of the host can do little to fight back because S.
typhi can live within the host's cells, safe from the immune system. Typhoid is
diagnosed by detecting the presence of S. typhi via blood, stool, urine, or bone
marrow sample.
Symptoms normally begin between 6 and 30 days after exposure to the
bacteria. The two major symptoms of typhoid are fever and rash. Typhoid fever
is particularly high, gradually increasing over several days up to 104 degrees
Fahrenheit, or 39 to 40 degrees Celsius.
The rash, which does not affect every patient, consists of rose-colored spots,
particularly on the neck and abdomen.
Other symptoms can include:
 Weakness
 Abdominal pain
 Constipation
 Headaches
Rarely, symptoms might include confusion, diarrhoea, and vomiting, but this is
not normally severe. In serious, untreated cases, the bowel can become
perforated. This can lead to peritonitis, an infection of the tissue that lines the
inside of the abdomen, which has been reported as fatal. Another infection,

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paratyphoid, is caused by Salmonella enterica. It has similar symptoms to

typhoid, but it is less likely to be fatal.
Treatment: The only effective treatment for typhoid is antibiotics. Other than
antibiotics, it is important to rehydrate by drinking adequate water. In more
severe cases, where the bowel has become perforated, surgery may be required.
Some people are asymptomatic carriers of typhoid, meaning that they harbor the
bacteria but suffer no ill effects. Others continue to harbor the bacteria after
their symptoms have gone. Sometimes, the disease can appear again. People
who test positive as carriers may not be allowed to work with children or older
people until medical tests show that they are clear.
Prevention: Countries with less access to clean water and washing facilities
typically have a higher number of typhoid cases.
Vaccination: Before traveling to a high-risk area, getting vaccinated against
typhoid fever is recommended. This can be achieved by oral medication or a
one-off injection:
 Oral is a live, attenuated vaccine. Consists of 4 tablets, one to be taken
every second day, the last of which is taken 1 week before travel.
 Shot is an inactivated vaccine, administered 2 weeks before travel.
Vaccines are not 100% effective and caution should still be exercised when
eating and drinking. Vaccination should not be started if the individual is
currently ill or if they are under 6 years of age. Anyone with HIV should not
take the live, oral dose. The vaccine may have adverse effects. One in
100 people will experience a fever. After the oral vaccine, there may be
gastrointestinal problems, nausea, and headache. However, severe side effects
are rare with either vaccine. The current vaccines are not always effective, and
because typhoid is so prevalent in poorer countries, more research needs to be
done to find better ways of preventing its spread.
Eliminating typhoid: Even when the symptoms of typhoid have passed, it is
still possible to be carrying the bacteria. This makes it hard to stamp out the
disease, because carriers whose symptoms have finished may be less careful
when washing food or interacting with others. People traveling in Africa, South
America, and Asia, and India in particular, should be vigilant.
Prevention: Typhoid is spread by contact and ingestion of infected human
faeces. This can happen through an infected water source or when handling

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food. The following are some general rules to follow when traveling to help
minimize the chance of typhoid infection:
 Drink bottled water, preferably carbonated.
 If bottled water cannot be sourced, ensure water is heated on a rolling boil
for at least one minute before consuming.
 Be wary of eating anything that has been handled by someone else.
 Avoid eating at street food stands, and only eat food that is still hot.
 Do not have ice in drinks.
 Avoid raw fruit and vegetables, peel fruit yourself, and do not eat the peel.
Smallpox is an infectious disease of the past that was eliminated worldwide by
vaccination. The disease was caused by the variola virus, which only spread
from person to person. Affected people became very ill with a high fever and a
characteristic rash. Up to one-third of people with smallpox died. Although the
disease has been wiped out, samples of the virus still exist in high-security
laboratories in the United States and Russia. This has led to concerns about use
of the virus in biological warfare. For this reason, some military personnel are
still vaccinated against smallpox.
Smallpox is highly contagious and remains contagious until all the scabs have
fallen off. Usually, the contagious period takes about three to four weeks after
the initial rash develops for the patient to be noncontagious. The incubation
period for smallpox is a little longer than that for many other viruses; symptoms
develop about seven to 17 days after exposure.
Transmission of smallpox is directly from person to person. Large, infectious
droplets of saliva are expelled during coughing or sneezing and then
inadvertently inhaled by another person. This usually requires close face-to-face
contact and is similar to the way that mumps, measles, and influenza are spread.
On average, a single individual would infect approximately 60% of their
household contacts. Infected objects, such as used silverware or heavily
contaminated bedding, may carry sufficient numbers of organisms to infect
another person if improperly handled, although this route of transmission is
much less common.
Symptoms: Fever is the most common initial symptom and can be quite high.
This is accompanied by body aches, chills, and headache. Often, the patient is
too unwell to get out of bed (malaise). Within a span of 24-48 hours, a rash
begins to appear everywhere on the body but especially on the legs, arms,
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mouth, and face. Pharyngitis (sore throat), abdominal pain, back pain, and
occasionally vomiting may also develop. The eyes may also be affected, leading
to potential blindness among survivors.
Symptoms in children are similar to those in adults. The rash also appears on the
palms and soles and goes through stages as the disease progresses. At the
beginning, the rash consists of red dots that become raised. The lesions rapidly
fill with fluid and may turn yellow, resembling pus. Rarely, the rash may start to
fill with blood (hemorrhagic smallpox), which is a poor prognostic sign.
After one to two weeks, the lesions scab over and eventually fall off, leaving
deep scars. One of the defining features of smallpox is that all the lesions on the
body are always at the same stage of development. This is in contrast
to chickenpox where new lesions form while old ones are healing.
Approximately one-third of people with smallpox died from the infection.
People who had an extensive rash were at higher risk of death. People who had
only a few lesions or a milder rash had a lower risk of death. Infections caused
by the variola minor strain were less severe and death occurred in only
approximately 1% of cases.
Treatment for smallpox is supportive, meaning that the patient should be kept
hydrated, fever should be treated with acetaminophen (Tylenol) or a similar
medication, and the patient should be closely monitoring to determine if there is
a need for blood pressure support. Although there are no medications that have
been proven to work against human infection, some medications have shown
promise in the laboratory. Intravenous vaccinia immunoglobulin (VIGIV) has
been used in early acquired accidental contaminations of the eyes or mouth. If
the patient is hospitalized, strict airborne and contact isolation procedures
should be followed; the room should have negative air pressure and HEPA air
filters.
There is an effective vaccine for the prevention of smallpox. The vaccine is
made from a virus called vaccinia. The similarity between these two names
(vaccine and vaccinia) is not coincidental because smallpox was the first
disease to be prevented by vaccination. In 2007, a second-generation smallpox
vaccine (ACAM2000) was licensed. The vaccine contains live vaccinia virus
but does not contain any smallpox virus.

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It is administered in a unique manner: a sharp, pronged piece of metal is dipped

in the vaccine and then used to prick the skin of the recipient. This is done
several times. If successful, the site of vaccination will develop
small blisters that scab and heal, leaving a scar. This process is called
scarification. While the blisters are active, the site should be kept clean, dry
and covered to prevent the vaccinia virus from spreading to others.
Many older adults still have a vaccine scar on their arms from being vaccinated
when they were younger. Smallpox vaccine, like other live vaccines including
the yellow fever vaccine, teaches the body's immune system to remember how
to make antibodies. There may still be a level of protection, even decades after
vaccination. However, revaccination would be recommended in the event of a
smallpox exposure. Interestingly, vaccination after exposure provides some
protection against severe disease.
Vaccination is no longer recommended for the general population because the
disease has been eradicated. Currently, the vaccine is given only to selected
military personnel and laboratory workers who handle the smallpox virus.
Vaccination side effects are uncommon but are sometimes serious and
potentially fatal. Complications occur in approximately 75 per million adults
who are vaccinated for the first time.
Vaccine complications lead to death in approximately one person for every
million people who are newly vaccinated. Complications are much less common
in revaccination. People with weak immune systems and those with skin
conditions like eczema are at higher risk for complications. Pregnant women
should not be vaccinated because of the risk of fetal death.
Treatment: The smallpox vaccine is the only known way to prevent smallpox
in an exposed person. Smallpox patients should be transferred as necessary,
with appropriate respiratory and contact isolation. One of the best ways to
prevent smallpox is through vaccination. Vaccine given to individuals before
exposure to smallpox can completely protect them. Vaccination within 3 days
after exposure prevents or greatly lessens the severity of smallpox in most
people. Vaccination 4-7 days after exposure offers some protection from disease
or may decrease the severity of disease. Vaccination does not protect patients
with smallpox who have already developed a rash.
Persons with known or possible exposure to smallpox should be vaccinated if
the exposure has occurred within 3 days, unless the patient has specific
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contraindications for which the risks of immunization are considered even

greater than the dangers associated with contracting smallpox. Persons with
known cardiac disease (eg, previous myocardial infarction, angina, congestive
heart failure and cardiomyopathy) should receive smallpox vaccination.
Myocardial infarctions and angina without myocardial infarction have been
reported following smallpox vaccinations. The association between smallpox
vaccination and these cardiac events is not clear.
Pregnant women who receive the smallpox vaccine are at risk of fetal vaccinia,
which usually results in stillbirth or death of the infant. Pregnant women should
not receive smallpox vaccination, and women should be advised against
becoming pregnant for 4 weeks after smallpox vaccination.
Cholera is an infectious disease that causes severe watery diarrhea, which can lead
to dehydration and even death if untreated. It is caused by eating food or drinking
water contaminated with a bacterium called Vibrio cholerae. Cholera outbreaks are
still a serious problem in many parts of the world. At least 150,000 cases are
reported to the World Health Organization each year. The disease is most common
in places with poor sanitation, crowding, war, and famine. Common locations
include parts of Africa, south Asia, and Latin America.
Causes: Vibrio cholerae, the bacterium that causes cholera, is usually found in
food or water contaminated by feces from a person with the infection. Common
sources include:
 Water supplies
 Ice made from municipal water
 Foods and drinks sold by street vendors
 Vegetables grown with water containing human wastes
 Raw or undercooked fish and seafood caught in waters polluted with sewage
When a person consumes the contaminated food or water, the bacteria release a
toxin in the intestines that produces severe diarrhoea. It is not likely you will catch
cholera just from casual contact with an infected person.
Symptoms of cholera can begin as soon as a few hours or as long as five days after
infection. Often, symptoms are mild. But sometimes they are very serious. About
one in 20 people infected have severe watery diarrhoea accompanied by vomiting,
which can quickly lead to dehydration. Although many infected people may have

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minimal or no symptoms, they can still contribute to spread of the infection. If not
treated, dehydration can lead to shock and death in a matter of hour
Signs of dehydration include:
 Rapid heart rate
 Loss of skin elasticity (the ability to return to original position quickly if
pinched)
 Dry mucous membranes, including the inside of the mouth, throat, nose, and
eyelids
 Low blood pressure
 Thirst
 Muscle cramps

Treatment and Prevention: Although there is a vaccine against cholera, the

World Health Organization do not normally recommend it, because it may not
protect up to half of the people who receive it and it lasts only a few months.
However, you can protect yourself and your family by using only water that has
been boiled, water that has been chemically disinfected or bottled water. Be sure to
use the bottled, boiled, or chemically disinfected water for the following purposes:
 Drinking
 Preparing food or drinks
 Making ice
 Brushing your teeth
 Washing your face and hands
 Washing dishes and utensils that you use to eat or prepare food
 Washing fruits and vegetables

To disinfect your own water, boil it for one minute (or 3 minutes at higher
elevations) or filter it and use a commercial chemical disinfectant. You should also
avoid raw foods, including the following:
 Unpeeled fruits and vegetables
 Unpasteurized milk and milk products
 Raw or undercooked meat or shellfish
 Fish caught in tropical reefs, which may be contaminated

Cholera is highly treatable, but because dehydration can happen quickly, it's
important to get cholera treatment right away. Hydration is the mainstay of
treatment for cholera. Depending on how severe the diarrhea is, treatment will
consist of oral or intravenous solutions to replace lost fluids. Antibiotics, which kill

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the bacteria, are not part of emergency treatment for mild cases. But they can
reduce the duration of diarrhea by half and also reduce the excretion of the bacteria,
thus helping to prevent the spread of the disease.
Malaria is a life-threatening mosquito-borne blood disease caused by a
Plasmodium parasite. It is transmitted to humans through the bite of
the Anopheles mosquito. Once an infected mosquito bites a human, the
parasites multiply in the host's liver before infecting and destroying red blood
cells. In some places, malaria can be treated and controlled with early diagnosis.
However, some countries lack the resources to do this effectively. Currently, no
vaccine is licensed for use in the United States or globally, although one is
available in Europe.
Symptoms: Malaria symptoms can be classified into two categories:
uncomplicated and severe malaria.
Uncomplicated malaria: This is diagnosed when symptoms are present, but
there are no signs to indicate severe infection or dysfunction of the vital organs.
This form can become severe malaria if left untreated, or if the host has poor or
no immunity. Symptoms of uncomplicated malaria typically last 6 to 10 hours
and recur every second day. Some strains of the parasite can have a longer cycle
or cause mixed symptoms. As symptoms resemble those of flu, they may be
undiagnosed or misdiagnosed in areas where malaria is less common. In
uncomplicated malaria, symptoms progress as follows, through cold, hot, and
sweating stages:
 A sensation of cold with shivering
 Fever, headaches, and vomiting
 Seizures sometimes occur in younger people with the disease
 Sweats, followed by a return to normal temperature, with tiredness
In areas where malaria is common, many patients recognize the symptoms as
malaria and treat themselves without visiting a doctor.
Severe malaria: In severe malaria, clinical or laboratory evidence shows signs
of vital organ dysfunction. Severe malaria can be fatal without treatment.
Symptoms of severe malaria include:
 Fever and chills
 Impaired consciousness
 Prostration, or adopting a prone position

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 Multiple convulsions
 Deep breathing and respiratory distress
 Abnormal bleeding and signs of anaemia
 Clinical jaundice and evidence of vital organ dysfunction
Causes: Malaria happens when a bite from the female Anopheles mosquito
infects the body. It is the Anopheles mosquito that transmits malaria. The
successful development of the parasite within the mosquito depends on several
factors, the most important being humidity and ambient temperatures. When an
infected mosquito bites a human host, the parasite enters the bloodstream and
lays dormant within the liver.
The host will have no symptoms for an average of 10.5 days, but the malaria
parasite will begin multiplying during this time. The new malaria parasites are
then released back into the bloodstream, where they infect red blood cells and
multiply further. Some malaria parasites remain in the liver and are not released
until later, resulting in recurrence. An unaffected mosquito becomes infected
once it feeds on an infected individual. This restarts the cycle. Early diagnosis is
critical for a patient‘s recovery.
The World Health Organization (WHO) strongly advises confirmation of the
parasite through microscopic laboratory testing or by a Rapid Diagnostic Test
(RDT), depending on the facilities available. No combination of symptoms can
reliably distinguish malaria from other causes, so a parasitological test is vital
for identifying and managing the disease. In some malaria-endemic areas, such
as sub-Saharan Africa, the disease's severity can cause mild immunity in a large
proportion of the local population. As a result, some people carry the parasites
in their bloodstream but do not fall ill.
Treatment: Treatment aims to eliminate the Plasmodium parasite from the
patient's bloodstream. Those without symptoms may be treated for infection to
reduce the risk of disease transmission in the surrounding population.
Artemisinin-Based Combination Therapy (ACT) is recommended by the
WHO to treat uncomplicated malaria. It is known for its ability to rapidly
reduce the concentration of Plasmodium parasites in the bloodstream.
Expanding access to ACT treatment worldwide has helped reduce the impact of
malaria, but the disease is becoming increasingly resistant to the effects of ACT.
Prevention: Research to develop safe and effective global vaccines for malaria
is on-going, with one vaccine already licensed for use in Europe. It is essential
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to seek medical attention for suspected symptoms of malaria as early as

possible. In emergency situations, local health authorities in some countries
may carry out ‗fogging,‘ or spraying areas with pesticides similar to those used
in household sprays. The WHO points out that these are not harmful for people,
as the concentration of pesticide is only strong enough to kills mosquitoes.
Swine flu (swine influenza) is a respiratory disease caused by viruses
(influenza viruses) that infect the respiratory tract of pigs. Swine flu can last
about one to two weeks in pigs that survive. In a number of instances, people
have developed the swine flu infection when they are closely associated with
pigs (for example, farmers, pork processors), and likewise, pig populations have
occasionally been infected with the human flu infection.
In most instances, the cross-species infections (swine virus to man; human flu
virus to pigs) have remained in local areas and have not caused national or
worldwide infections in either pigs or humans. Unfortunately, this cross-species
situation with influenza viruses has had the potential to change. Investigators
decided the 2009 so-called ‗swine flu‘ strain, first seen in Mexico, should be
termed novel H1N1 flu since it was mainly found infecting people and exhibits
two main surface antigens, H1 (hemagglutinin type 1) and N1 (neuraminidase
type1).
Swine influenza is transmitted from person to person by inhalation or ingestion
of droplets containing virus from people sneezing or coughing; it is not
transmitted by eating cooked pork products. The newest swine flu virus that has
caused swine flu is influenza A H3N2v (commonly termed H3N2v) that began
as an outbreak in 2011. The ‗v‘ in the name means the virus is a variant that
normally infects only pigs but has begun to infect humans. There have been
small outbreaks of H1N1 influenza since the pandemic; a recent one is in India
where at least three people have died.
The incubation period for swine flu is about one to four days, with the average
being two days; in some people, the incubation period may be as long as about
seven days in adults and children. The contagious period for swine influenza in
adults usually begins one day before symptoms develop in an adult and it lasts
about five to seven days after the person becomes sick. However, people with
weakened immune systems and children may be contagious for a longer period
of time (for example, about 10 to 14 days). In uncomplicated infections, swine
flu typically begins to resolve after three to seven days, but the malaise and

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cough can persist two weeks or more in some patients. Severe swine flu may
require hospitalization that increases the length of time of infection to about
nine to 10 days.
Symptoms of swine flu are similar to most influenza infections, in nasal
secretions, a barking cough, decreased appetite, and listless behaviour. Swine
flu produces most of the same symptoms in pigs as human flu produces in
people. There will be fever (100° F or greater), cough (usually dry), nasal
secretions, fatigue, and headache, with fatigue being reported in most infected
individuals. Some patients may also get a sore throat, rash, body (muscle) aches
or pains, headaches, chills, nausea, vomiting, and diarrhea.
In Mexico, many of the initial patients infected with H1N1 influenza were
young adults, which made some investigators speculate that a strong immune
response, as seen in young people, may cause some collateral tissue damage.
The incubation period from exposure to first symptoms is about one to four
days, with an average of two days. The symptoms last about one to two weeks
and can last longer if the person has a severe infection.
Some patients develop severe respiratory symptoms, such as shortness of
breath, and need respiratory support (such as a ventilator to breathe for the
patient). Patients can get pneumonia (bacterial secondary infection) if the viral
infection persists, and some can develop seizures. Death often occurs from
secondary bacterial infection of the lungs; appropriate antibiotics need to be
used in these patients.
Swine flu is definitively diagnosed by identifying the particular antigens
(surface proteins) associated with the virus type. In general, this test is done in a
specialized laboratory and is not done by many doctors‘ offices or hospital
laboratories. However, doctors' offices are able to send specimens to specialized
laboratories if necessary.
Treatment: The best treatment for influenza infections in humans is prevention
by vaccination. Work by several laboratories has produced vaccines. The first
H1N1 vaccine released in early October 2009 was a nasal spray vaccine that
was approved for use in healthy individuals ages 2-49. However, the use of
nasal spray has not been recommended since 2016. The injectable vaccine,
made from killed H1N1, became available in 2009. This vaccine was approved
for use in ages 6 months to the elderly, including pregnant females. Both of
these vaccines were approved by the Centre for Disease Control (CDC) only
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after they had conducted clinical trials to prove that the vaccines were safe and
effective. A new influenza vaccine preparation is the intradermal (trivalent)
vaccine is available; it works like the shot except the administration is less
painful. It is approved for ages 18-64 years.
Almost all vaccines have some side effects. Common side effects of H1N1
vaccines (alone or in combination with other flu viral strains) are typical of flu
vaccines used over many years and are as follows:
 Flu shot: Soreness, redness, minor swelling at the shot site, muscle aches,
low-grade fever, and nausea do not usually last more than about 24 hours.
 Nasal spray: runny nose, low-grade fever, vomiting, headache, wheezing,
cough, and sore throat
 Intradermal shot: redness, swelling, pain, headache, muscle aches, fatigue
Like all vaccines, rare events may occur in some rare cases (for example,
swelling, weakness, or shortness of breath). About one person in a million who
gets the vaccine may develop a neurological problem termed Guillain-Barre
syndrome, which can cause weakness or paralysis, difficulty breathing, bladder
and/or bowel problems, and other nerve problems. If any symptoms like these
develop, see a physician immediately.
Severe infections in some patients may require additional supportive measures
such as ventilation support and treatment of other infections like pneumonia that
can occur in patients with a severe flu infection. The CDC has suggested in their
guidelines that pregnant females can be treated with the two antiviral agents.
Diarrhoea, skin infections, hallucinations, and/or altered behaviour may occur
as side effects of this drug.
 Adult patients for whom therapy with an intravenous (IV) medication is
clinically appropriate, based upon one or more of the following reasons:
The patient is not responding to either oral or inhaled antiviral therapy, or
drug delivery by a route other than IV is not expected to be dependable or is
not feasible, or the physician decides that IV therapy is appropriate due to
other circumstances.
 Pediatric patients for whom an intravenous medication clinically
appropriate because:

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The patient is not responding to either oral or inhaled antiviral therapy, or drug
delivery by a route other than IV is not expected to be dependable or is not
feasible.
In general, preventive measures to prevent the spread of flu are often undertaken
by those people who have symptoms. Symptomatic people should stay at home,
avoid crowds, and take off from work or school until the disease is no longer
transmittable (about two to three weeks) or until medical help and advice is
sought. Sneezing, coughing, and nasal secretions need to be kept away from
other people; simply using tissues and disposing of them will help others.
Although vaccination is the best way to prevent the swine flu, there may be
times in the future when the swine flu vaccine may not be available. Currently,
there are no shortages of the trivalent flu vaccine that contains H1N1 antigens.
Without vaccination, the best strategy is to not allow any virus type to contact a
person's mucus. Quarantining any virus-infected people is an extreme measure
that may work in some instances (for example, China used this method), but
even with quarantining, the virus may still spread by people who have minimal
or no symptoms.
The methods are:
1. Kill or inactivate the virus before it reaches a human cell by using soap and
water to clean your hands; washing clothing and taking a shower will do the
same for the rest of your body.
2. Use an alcohol-based hand sanitizer if soap and water are not readily
available, and use sanitizers on objects that many people may touch (for
example, doorknobs, computer keyboards, handrails, phones), although
some researchers suggest that such sanitizers are generally ineffective.
3. Do not touch your mouth, eyes, nose, unless you first do items 1 or 2 above.
4. Avoid crowds, parties, and especially people who are coughing and
sneezing (most virus-containing droplets do not travel more than 4 feet, so
experts suggest 6 feet away is a good distance to stay). If you cannot avoid
crowds (or parties), try to remain aware of people around you and use the 6-
foot rule with anyone coughing or sneezing. Do not reach for or eat snacks
out of canisters or other containers at parties.
5. Avoid touching anything within about 6 feet of an uncovered cough/sneeze,
because the droplets that contain virus fall and land on anything usually
within that range.

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6. Studies show that individuals who wear surgical or N95 particle masks may
prevent inhalation of some H1N1 virus, but the masks may prevent only
about 50% of airborne exposures and offer no protection against surface
droplets. However, masks on H1N1 infected people can markedly reduce
the spread of infected droplets.
These six steps can help prevent individuals from getting H1N1 and other types
of infection, but for many people, adherence to them may be difficult at best.
However, there are some additional strategies that may also help prevent viral
infections in unvaccinated people according to some investigators. Saline nasal
washes and gargling with saline (or a commercial product) as a way to reduce or
eliminate viral virus from mucus membranes has been suggested.
Proponents of these methods base their rationale on the fact that flu viruses
usually take about two to three days to proliferate in nasal/throat cells. While
nasal washes and gargling may be soothing to some people, there are no studies
that indicate H1N1 or other viruses are killed, inactivated, or completely
removed by these methods; conversely, there are no data suggesting these
methods cannot have any effect on H1N1. However, with long-term nasal
washes using Neti pots, sinus infection with other pathogens may be
encouraged.
In the strictest sense of the word prevention, even effective vaccines do not
"prevent" infections. What they do accomplish is to alert the immune system to
be on guard for certain antigens that are associated with a specific disease-
causing agent (for example, H1N1 virus, pneumococcal bacteria). When the
agent first infects the host, its antigens are recognized, and these cause a rapid
immune response to occur that prevents the pathogen from spreading and
developing symptoms in the host. People, including physicians and researchers,
often term this complex response to vaccination as ―prevention of infection,‖
but what actually occurs is the prevention of further infection so well that
symptoms do not develop or are minimal in the host.
Control and prevention of lifestyle diseases: An important way of controlling
non-communicable diseases is by controlling the risk factors associated with it.
In other words, a number of communicable diseases can be prevented by
controlling the behavioural or lifestyle habits associated with those diseases.
There are a number of low-cost solutions that can be implemented by the
government and other involved groups to reduce the common modifiable risk

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factors. Monitoring the trends of non-communicable diseases and their

associated risks is crucial for guiding policies and guidelines.
A comprehensive approach is essential that involves all sectors including health,
finance, education, planning and others, to minimise the impact of lifestyle
diseases on individuals and society. The approach needs to instigate a
collaborative effort to minimise the risks associated with no communicable
diseases and at the same time inspire interventions to control and prevent them.
Lifestyle diseases are a threat to the socio-economic aspects of nations globally
and appropriate actions for their management are the need of the moment.
Management of lifestyle diseases includes proper diagnosis, screening and
treatment of these diseases in addition to providing palliative care for people
who require it. Quality lifestyle disease intervention needs to be delivered
through a primary healthcare approach where early detection and proper
treatment are prioritized.
A comprehensive strategy should be designed so that all stages of the life cycle
are targeted. Reducing demand for tobacco products and content of salt in foods
can help millions of people avoid unnecessary death and suffering from many
lifestyle diseases.

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UNIT III

FIRST AID – PRINCIPLES AND USES

Definition of First Aid: First Aid is the emergency care and treatment of a sick
or injured person before more advanced medical assistance, in the form of the
emergency medical services (EMS) arrives. Responsibilities of a first aid giver:
 Preserve life and provide initial emergency care and treatment to sick or
injured people
 Protect the unconscious
 Prevent a casualty‘s condition from becoming worse
 Promote the recovery of the casualty.
Philosophy of First Aid: In the pre-hospital setting, the key contributors to
survival and recovery from illness and injury are prompt and effective
maintenance of the body‘s primary functions:
 Airway
 Breathing
 Circulation
 Bleeding control (life threatening)
Medical research data suggests that effective support of these basic functions
provides the most significant contribution to positive outcomes for casualties in
the pre-hospital setting.
Exposure to Biological hazards: First aid givers may be exposed to biological
substances such as blood-borne pathogens and communicable diseases, whilst
dealing with a first aid incident. These may result from dealing with:
 Trauma related injuries
 Resuscitation
There are many different blood-borne pathogens that can be transmitted from a
penetrating injury or mucous exposure, in particular, Hepatitis B Virus,
Hepatitis C Virus and Human Immune deficiency Virus (HIV). Other diseases
not found in human blood may be carried in fluids such as saliva (e.g. Hepatitis
A and the organism that causes meningitis) or animal blood and fluid.
Universal Precautions: First aid givers should equip themselves with and use,
personal protection equipment. This equipment is used to minimise infection
from disease.

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Exposure sources: The following are common sources of exposure:

 All human body fluids and secretions, especially any fluid with visible blood
 Any other human material
Exposure routes: The following are typical means of exposure:
 Punctures or cuts from sharp objects contaminated with blood/fluid
 A spill of blood/fluid onto mucous membranes of the eyes, mouth and/or nose
 A spill of blood/fluid onto skin that may or may not be intact
 A laceration and contamination with blood/fluid from a bite
The expression ‗universal precautions‘ refers to the risk management strategy
used to prevent the transmission of communicable disease, by reducing contact
with blood and other body substances.
Universal precautions include:
 Wearing appropriate protective equipment for the task
 Treating all persons as if infectious
 Washing following completion of task
 Appropriate disposal of disposable protective items and/or equipment
 Maintaining good hygiene practices before, during and after tasks involving
contamination risk.
Universal Precautions are the most effective approach to protecting emergency
first aiders in a biological substance exposure situation. If these guidelines are
followed, the risk of infection can be significantly minimised. Immediate action
at scene following exposure:
For an open wound
 Encourage the wound to bleed, thoroughly wash with water for 15 minutes
and dress
 Do not attempt to use a caustic solution to clean the wound
 Seek medical advice as soon as possible.
For a splash to a mucous membrane
 Flush splashes to nose, mouth or eyes thoroughly with water for 15 minutes
 If the splash is in the mouth, spit out and thoroughly rinse out with water for
15 minutes
 If the splash is in the eyes, irrigate with the eyes open for 15 minutes
 Seek medical advice as soon as possible.

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For a splash to the skin

 At the scene, wash thoroughly with soap and water
 Seek medical advice quickly if the exposure is medium/high risk.
The primary assessment is a systematic checklist designed to maximise safety
and identify / treat immediate life-threatening problems. The steps to be
followed for an adult, child and infant casualty are remembered by the letters
given below:
DRS: D - Danger
R - Response
S - Send for help
ABCD: A - Airway
B - Breathing
C - CPR (Cardiopulmonary Resuscitation) + Control Major Bleeding
D - Defibrillation
CPR is continued until responsiveness or normal breathing returns.
First Aid kit: First aid equipment must be operated according to manufacturer‘s
instructions. The first aider should stay with the casualty unless it is necessary
to call for medical assistance, a rescuer of equal or higher ability takes over, or
continuing to give aid becomes unsafe. If you are trained in first aid, it is
imperative that you maintain currency of skills and knowledge. Routinely attend
refresher courses and be aware of changes to legislation, policy and procedures
and ARC guidelines in relation to first aid.
A well-stocked first-aid kit can help you respond effectively to common injuries
and emergencies. Keep at least one first-aid kit in your home and one in your
car. Store kits must be stored in a place that is easy to access and out of the
reach of young children. Make sure children are old enough to understand the
purpose of the kits know where they are stored. First-aid kits can be bought at
many drugstores or assembled individually. A basic first-aid kit includes:
Basic supplies
Adhesive tape Petroleum jelly or other lubricant
Elastic wrap bandages Plastic bags, assorted sizes
Scissors and tweezers Safety pins in assorted sizes
Nonstick sterile bandages and Bandage strips and ―butterfly‖
roller gauze in assorted sizes bandages in assorted sizes

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Eye shield or pad Soap or hand sanitizer

Triangular bandage Antibiotic ointment
Aluminum finger split Eyewash solution
Instant cold packs Thermometer
Cotton balls and cotton-tipped Breathing barrier
swabs
Disposable non-latex gloves Syringe, medicine cup or spoon
Duct tape First-aid manual
Antiseptic solution and towels

Medications
Aloe Vera gel Personal medications that do not need
refrigeration
Calamine lotion Pain relievers, such as acetaminophen
(Tylenol, others), ibuprofen (Advil,
Motrin IB, others) and aspirin (never give
aspirin to children)
Anti-Diarrhoea Hydrocortisone cream
medication
Laxative Cough and cold medications
Antacids Antihistamine, such as diphenhydramine
Antihistamine, such as Auto-injector of epinephrine, if prescribed
diphenhydramine by the doctor

Emergency items
Emergency phone numbers, including contact information for your family
doctor and pediatrician, local emergency services, emergency road service
providers, and the poison help line.
 Medical consent forms for each family member
 Medical history forms for each family member
 Small, waterproof flashlight or headlamp and extra batteries
 Waterproof matches
 Small notepad and waterproof writing instrument
 Emergency space blanket
 Cell phone with solar charger
 Sunscreen
 Insect repellant
 Whistle

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Check first-aid kits regularly to be sure the flashlight batteries work and to
replace supplies that have expired or been used up.
Fractures: A fracture is the medical term for a broken bone. Fractures are
common; the average person has two during a lifetime. They occur when the
physical force exerted on the bone is stronger than the bone itself. The risk of
fracture depends, in part, on your age. Broken bones are very common in
childhood, although children‘s fractures are generally less complicated than
fractures in adults. As you age, your bones become more brittle and you are more
likely to suffer fractures from falls that would not occur when you were
young. There are many types of fractures, but the main categories are
 Displaced
 Non-displaced
 Open
 Closed
Displaced and non-displaced fractures refer to the alignment of the fractured
bone. In a displaced fracture, the bone snaps into two or more parts and moves so
that the two ends are not lined up straight. If the bone is in many pieces, it is called
a comminute fracture. In a non-displaced fracture, the bone cracks either part or all
of the way through, but does move and maintains its proper alignment.
A closed fracture is when the bone breaks but there is no puncture or open wound
in the skin. An open fracture is one in which the bone breaks through the skin; it
may then recede back into the wound and not be visible through the skin. This is an
important difference from a closed fracture because with an open fracture there is a
risk of a deep bone infection. Due to unique properties of their bones, there are
some defined fracture subtypes that present only in children.

Recuperation time varies depending on the age and health of the patient and the
type of fracture. A minor fracture in a child may heal within a few weeks; a serious
fracture in an older person may take months to heal. A significant percentage of
bone fractures occur because of high force impact or stress.
However, a fracture may also be the result of some medical conditions which
weaken the bones, for example osteoporosis, some cancers, or osteogenesis
imperfecta (also known as brittle bone diseases). A fracture caused by a medical
condition is known as a pathological fracture.

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Types: There are several different ways in which a bone can fracture. The main
categories are complete, incomplete, compound and simple. Complete and
incomplete fractures refer to the way the bone breaks. In a complete fracture,
the bone snaps into two or more parts. In an incomplete fracture, the bone
cracks but does not break all the way through.
The severity of a fracture depends on its location and the damage done to the
bone and nearby tissue. Severe fractures can have dangerous complications if
they are not treated promptly, such as damage to blood vessels or nerves and
infection of the bone ( osteomyelitis) or surrounding tissue.
The recuperation time after a fracture varies depending on the age and health of
the patient and the type of fracture. A minor fracture in a child may heal within
a few weeks. A severe fracture in an older person may take months to heal.
 In a compound fracture, also called an open fracture, the bone breaks
through the skin. It may then recede back into the wound, so it is no longer
visible through the skin. Compound fractures are generally more serious
than simple fractures, because, by definition, they are infected.
 In a simple fracture, also called a closed fracture, the bone breaks but
there is no open wound in the skin.
Most human bones are surprisingly strong and can generally stand up to fairly
strong impacts or forces. However, if that force is too powerful, or there is
something wrong with the bone, it can fracture. The older a person becomes, the
less force our bones can withstand. Because children's bones are more elastic,
when they do have fractures they tend to be different. Children also have growth
plates at the end of their bones – areas of growing bone – which may sometimes
be damaged. There is a range of fracture types, including:
 Avulsion fracture is a muscle or ligament pulls on the bone, fracturing it.
 Comminute fracture is when the bone is shattered into many pieces.
 Compression (crush) fracture generally occurs in the spongy bone in the
spine. For example, the front portion of a vertebra in the spine may collapse
due to osteoporosis.
 Fracture dislocation is when a joint becomes dislocated, and one of the
bones of the joint has a fracture.
 Greenstick fracture happens when the bone partly fractures on one side,
but does not break completely because the rest of the bone can bend. This is
more common among children, whose bones are softer and more elastic.

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 Hairline fracture is a partial fracture of the bone. Sometimes this type of

fracture is harder to detect with routine x-ray.
 Impacted fracture is when the bone is fractured and one fragment of bone
goes into another.
 Longitudinal fracture is when the break is along the length of the bone.
 Oblique fracture is a fracture that is diagonal to a bone‘s long axis.
 Pathological fracture is when an underlying disease or condition has
already weakened the bone, resulting in a fracture (bone fracture caused by
an underlying disease/condition that weakened the bone).
 Spiral fracture is a fracture where at least one part of the bone has been
twisted.
 Stress fracture is more common among athletes. A bone breaks because of
repeated stresses and strains.
 Torus (buckle) fracture is when the bone deforms but does not crack.
More common in children. It is painful but stable.
 Transverse fracture is a straight break right across a bone.
The following fracture subtypes can present in children and adults:
 A comminute fracture is when the bone breaks into several pieces
 A transverse fracture is when the fracture line is perpendicular to the shaft (long
part) of the bone.
 An oblique fracture is when the break is on an angle through the bone
 A pathologic fracture is caused by a disease that weakens the bone
 A stress fracture is a hairline crack

Symptoms: The signs and symptoms of a fracture vary according to which

bone is affected, the patient‘s age and general health, as well as the severity of
the injury. However, they often include some of the following:
 Pain
 Swelling
 Bruising
 Discoloured skin around the affected area
 Angulation - the affected area may be bent at an unusual angle
 The patient is unable to put weight on the injured area
 the patient cannot move the affected area
 the affected bone or joint may have a grating sensation
 if it is an open fracture, there may be bleeding

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When a large bone is affected, such as the pelvis or femur:

 The sufferer may look pale and clammy
 There may be dizziness (feeling faint)
 Feelings of sickness and nausea.

If possible, do not move a person with a broken bone until a healthcare

professional is present and can assess the situation and, if required, apply a
splint. If the patient is in a dangerous place, such as in the middle of a busy
road, one sometimes has to act before the emergency services arrive.
Causes: Most fractures are caused by a bad fall or automobile accident. Healthy
bones are extremely tough and resilient and can withstand surprisingly powerful
impacts. As people age, two factors make their risk of fractures greater: Weaker
bones and a greater risk of falling. Children, who tend to have more physically
active lifestyles than adults, are also prone to fractures.
People with underlying illnesses and conditions that may weaken their bones
have a higher risk of fractures. Examples include osteoporosis, infection, or
a tumour. As mentioned earlier, this type of fracture is known as a pathological
fracture. Stress fractures, which result from repeated stresses and strains,
commonly found among professional sports people, are also common causes of
fractures.
Treatment: A doctor will carry out a physical examination, identify signs and
symptoms, and make a diagnosis. The patient will be interviewed – or friends,
relatives, and witnesses if the patient cannot communicate properly - and asked
about circumstances that caused the injury or may have caused it. Doctors will
often order an X-ray. In some cases, an MRI or CT scan may also be ordered.
Bone healing is a natural process which, in most cases, will occur automatically.
Fracture treatment is usually aimed at making sure there is the best possible
function of the injured part after healing.
Treatment also focuses on providing the injured bone with the best
circumstances for optimum healing (immobilization). For the natural healing
process to begin, the ends of the broken bone need to be lined up - this is known
as reducing the fracture. The patient is usually asleep under a general
anaesthetic when fracture reduction is done. Fracture reduction may be done by
manipulation, closed reduction (pulling the bone fragments), or surgery.

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Immobilization: As soon as the bones are aligned they must remain aligned
while they heal. Usually, the fractured bone area is immobilized for 2-8 weeks
using a cast made of plaster or Paris or splints. The duration depends on the
bone that is affected and any complications, such as a blood supply problem or
an infection.
This may include:
Plaster casts or plastic functional braces hold the bone in position until it has
healed.
Metal plates and screws are used to hold joints and current procedures may use
minimally invasive techniques.
Intra-medullary nails are when internal metal rods are placed down the centre
of long bones such as the femur. Flexible wires may be used in children.
External fixators: These may be made of metal or carbon fibre and they have
steel pins that go into the bone directly through the skin. They are a type of
scaffolding outside the body. If a broken bone has been aligned properly and
kept immobile, the healing process is usually straight forward.
Physical therapy: After the bone has healed, it may be necessary to restore
muscle strength as well as mobility to the affected area. If the fracture occurred
near or through a joint, there is a risk of permanent stiffness or arthritis – the
individual may not be able to bend that joint as well as before.
Surgery: If there was damage to the skin and soft tissue around the affected
bone or joint, plastic surgery may be required.
Delayed unions and non-unions: These are references to the time taken for the
bones to join.
 Non-unions are fractures that fail to heal, while delayed unions are those
that take longer to heal.
 Delayed unions are fractures that take time to heal due to various ailments
and medications.
 Ultrasound therapy: Low-intensity ultrasound is applied to the affected
area daily. This has been found to help the fracture heal. Studies in this area
are still on-going.
 Bone graft: If the fracture does not heal, a natural or synthetic bone is
transplanted to stimulate the broken bone.

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 Stem cell therapy: Studies are currently underway to see whether stem
cells can be used to treat fractures that do not heal.
Complications
 Heals in the wrong position - this is known as a malunion; either the
fracture heals in the wrong position or it shifts (the fracture itself shifts).
 Disruption of bone growth - if a childhood bone fracture affects the growth
plate, there is a risk that the normal development of that bone may be
affected, raising the risk of a subsequent deformity.
 Persistent bone or bone marrow infection - if there is a break in the skin,
as may happen with a compound fracture, bacteria can get in and infect the
bone or bone marrow, which can become a persistent infection (chronic
osteomyelitis). Patients may need to be hospitalized and treated
with antibiotics. Sometimes, surgical drainage and curettage is required.
 Bone death (avascular necrosis) - if the bone loses its essential supply of
blood it may die.
Prevention: the human body needs adequate supplies of calcium for healthy
bones. Milk, cheese, yoghurt, and dark green leafy vegetables are good sources
of calcium. Our body needs vitamin D to absorb calcium - exposure to sunlight,
as well as eating eggs and oily fish are good ways of getting vitamin D.
Physical activity: The more weight-bearing exercises you do, the stronger and
denser your bones will be. Older age not only results in weaker bones, but often
in less physical activity, which further increases the risk of even weaker bones.
It is important for people of all ages to stay physically active.
Examples include skipping, walking, running, and dancing - any exercise where
the body pulls on the skeleton.
Menopause: Oestrogen regulates a woman‘s calcium, decreases during
menopause, making calcium regulation much more difficult. Consequently,
women need to be especially careful about the density and strength of their
bones during and after the menopause. The following steps may help reduce
post-menopausal osteoporosis risk:
 Do several short weight-bearing exercise sessions each week.
 Do not smoke.
 Consume only moderate quantities of alcohol, or don't drink it.
 Get adequate exposure to daylight.

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 Make sure your diet has plenty of calcium-rich foods. For those who find
this difficult, a doctor may recommend calcium supplements.
First-aid treatment for a victim with a broken bone
Stop any bleeding: If they‘re bleeding, elevate and apply pressure to the wound
using a sterile bandage, a clean cloth, or a clean piece of clothing.
Immobilize the injured area: If you suspect there is a broken a bone in the
neck or back, help the person stay as still as possible. If you suspect there is a
broken a bone in one of their limbs, immobilize the area using a splint or sling.
Apply cold to the area: Wrap an ice pack or bag of ice cubes in a piece of cloth
and apply it to the injured area for up to 10 minutes at a time.
Treat them for shock: Help them get into a comfortable position, encourage
them to rest, and reassure them. Cover them with a blanket or clothing to keep
them warm.
Get professional help: Call the emergency line for help them get to the
emergency department for professional care. If the person does not appear to be
breathing or is unconscious, call for medical help and begin CPR if you suspect
that
 They have broken a bone in their head, neck, or back
 The fractured bone has pushed through their skin
 They are bleeding heavily

Otherwise, help them get to the emergency department by car or other means so
a doctor can diagnose their condition and recommend appropriate treatment.
Fractures (broken bones) are common injuries for first aid givers to have to deal
with. The correct first aid management of fractures is important as this will
reduce pain and promote fracture healing. When treating all fractures, or
suspected fractures, the following first aid steps should be followed:
 Do not attempt to push bone ends back under the skin. If traction is applied
and the bone end retracts back into the wound do not increase the amount of
traction further and inform the receiving ambulance crew or hospital
 Do not attempt to force a fracture or dislocation back into place – this could
cause further injuries.
Soft Tissue Injuries (STI): These injuries happen when trauma or due to
overuse of muscles, tendons or ligaments. Most soft tissue injuries are the result

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of a sudden unexpected or uncontrolled movement like stepping awkwardly off

a curb and rolling over your ankle. These are injuries we see every day at our
Edinburgh physiotherapy and sports injury clinics.
However, soft tissue damage can also occur from excessive overuse or
chronically fatigued structures, especially muscles and tendons. For example, if
you were to do a long run when already fatigued (from a previous run or
exercise), then it is possible to cause trauma or a strain to key running
musculoskeletal structures like your calf muscles or Achilles tendons.
The most common soft tissue injuries
 Ankle Sprain
 Back Strain
 Calf Strain
 Golfers/Tennis elbow
 Hamstring strain
 Wrist sprain
Strain: A strain is an injury to a muscle or tendon. Muscles move your
skeleton. When a muscle contracts it pulls on a tendon, which in turn is
connected to your bone. Muscles are made to stretch. However, if muscles are
stretched too far, a strain may occur. Pulling too far on a muscle or pulling a
muscle in one direction while it is contracting in the other direction, can cause
injuries within the muscle or tendon. Strains can also be caused by chronic
activities that develop an overstretching of the muscle fibres. Symptoms include
pain, muscle spasms, muscle weakness, swelling, cramping, and trouble moving
the muscle.
Degrees of Strains: This depends on the extent of damage to the tissue.
 First degree (mildest) – little tissue tearing; mild tenderness; pain with full
range of motion.
 Second degree – torn muscle or tendon tissues; painful, limited motion;
possibly some swelling or depression at the spot of the injury.
 Third degree (most severe) – limited or no movement; pain will be severe
at first, but may be painless after the initial injury.
Sprain: A sprain is an injury to a ligament. A ligament is a thick, tough,
fibrous tissue that connects bones together. Ligaments hold your skeleton
together in a normal alignment and prevent abnormal movements. However, the
ligaments can be injured by being stretched too far from their normal position.

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When too much force is applied to a ligament, such as in a fall, the ligaments
can be stretched or torn; this injury is called a sprain.
One of the most common sprains is the ―twisted ankle.‖ A twisted ankle occurs
often, usually during running, hiking and basketball. The other most commonly
injured ligaments are in the knee and wrist. The severity of a sprain can be
classified by the amount of tissue tearing, impact on joint stability, pain and
swelling.
Degrees of Sprains: This depends on the intensity or severity of the pain.
 First degree (mildest) – little tearing, pain or swelling; joint stability is
good.
 Second degree – broadest range of damage, with moderate instability and
moderate to severe pain and swelling.
 Third degree (most severe) – ligament is completely ruptured; joint is
unstable; severe pain and swelling; other tissues are often damaged.
Sports Injuries: The seven most common sports injuries are:
1. Ankle sprain
2. Groin pull
3. Hamstring strain
4. Shin splints
5. Knee injury: ACL tear
6. Knee injury: Patellofemoral syndrome — injury resulting from the repetitive
movement of your kneecap against your thigh bone
7. Tennis elbow (epicondylitis)
The most common sports injuries are strains and sprains: Sprains are
injuries to ligaments, the tough bands connecting bones in a joint.
Suddenly stretching ligaments past their limits deforms or tears them. Strains
are injuries to muscle fibres or tendons, which anchor muscles to bones. Strains
are called ―pulled muscles‖ for a reason: Over-stretching or overusing a muscle
causes tears in the muscle fibres or tendons.
Preventing the most common sports injuries: Every workout should start with a
gentle warm-up to prevent common sports injuries whether it is hiking, running, or
team sports, do some ―pre-participation training‖ first by lightly working the
relevant muscle groups in the weeks before the activity. And learn to recognize
when you have already left it all on the field to stop when you are fatigued.

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Muscle fatigue takes away all your protective mechanisms and really increases
your risk of all injuries. You can always come out to play again next weekend, if
you do not get injured.
Treating the most common sports injuries: Usually, the common sports
injuries are mild or moderate — there is some damage, but everything is still in
place. You can treat them at home using the PRICE therapy method described
later in this article. But you should expect that some common sports injuries
may take months to heal, even with good treatment. If a sprain or strain is
severe, however, the entire muscle, tendon, or ligament is torn away, and
surgery may be needed.
Treatment: Here are some specific tips for treating each of the most common
sports injuries:
1. Ankle sprain: Most athletes have experienced a sprained ankle, which
typically occurs when the foot turns inward. This turning stretches or tears the
ligaments on the outside of the ankle, which are relatively weak.
With an ankle sprain, it is important to exercise to prevent loss of flexibility and
strength — and re-injury. You can ask your doctor or physical therapist to help
you know what kinds of exercise you should do.
It is important to note where the sprain has occurred. A 'high ankle sprain' is
slower to heal and should probably be seen by a doctor to make sure the bones
in the lower leg did not separate. One way to recognize a high ankle sprain is
that this sprain usually causes tenderness above the ankle.
2. Groin pull: Pushing off in a side-to-side motion causes strain of the inner
thigh muscles, or groin. Hockey, soccer, football, and baseball are common
sports with groin injuries. Compression, ice, and rest will heal most groin
injuries. Returning to full activity too quickly can aggravate a groin pull or turn
it into a long-term problem. Any groin pull that has significant swelling should
be seen early by a physician.
3. Hamstring strain: Three muscles in the back of the thigh form the
hamstring. The hamstring can be over-stretched by movements such as hurdling
— kicking the leg out sharply when running. Falling forward while waterskiing
is another common cause of hamstring strains. Hamstring injuries are slow to
heal because of the constant stress applied to the injured tissue from walking.

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Complete healing can take six to 12 months. Re-injuries are common because
it's hard for many guys to stay inactive for that long.
4. Shin splints: Pains down the front of the lower legs are commonly called
―shin splints.‖ They are most often brought on by running — especially when
starting a more strenuous training program like long runs on paved roads. Rest,
ice, and over-the-counter pain medicine are the mainstays of treatment. The pain
of shin splints is rarely an actual stress fracture — a small break in the shin
bone. But you should see your doctor if the pain persists, even with rest.
Stress fractures require prolonged rest, commonly a month or more to heal.
5. Knee injury – ACL tear: The Anterior Cruciate Ligament (ACL) holds the
leg bone to the knee. Sudden ―cuts‖ or stops or getting hit from the side can
strain or tear the ACL. A complete tear can make the dreaded ―pop‖ sound,
always, if you suspect an ACL injury. ACL tears are potentially the most severe
of the common sports injuries. A completely torn ACL will usually require
surgery in individuals who wish to remain physically active.
6: Knee injury: Patellofemoral syndrome: Patellofemoral syndrome can
result from the repetitive movement of your kneecap (patella) against your thigh
bone (femur), which can damage the tissue under the kneecap. Running,
volleyball, and basketball commonly set it off. One knee or both can be
affected. Patience is key. Patellofemoral pain can take up to six weeks to clear
up. It's important to continue low-impact exercise during this time. Working out
the quadriceps can also relieve pain.
7. Tennis elbow (epicondylitis): Repetitive use of the elbow — for example,
during golf or tennis swings — can irritate or make tiny tears in the elbow's
tendons. Epicondylitis is most common in 30- to 60-year-olds and usually
involves the outside of the elbow. Epicondylitis can usually be cleared up by
staying off the tennis court or golf course until the pain improves.
Treating a Sprain or Strain Management: Follow the PRICE principle.
 P – Protect from further injury
 R – Restrict activity
 I – Ice application
 C – Compress application
 E – Elevate the injured area

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This PRICE principle limits the amount of swelling at the injury and improves
the healing process. Splints, pads and crutches will protect a joint or muscle
from further injury when appropriately used (usually for more severe sprains or
strains). Activity restriction, usually for 48- 72 hours, will allow the healing
process to begin. During the activity restriction, gentle movement of the muscle
or joint should be started. Ice should be applied for 15 -20 minutes every 60-90
minutes.
Over-the-counter pain relievers usually relieve the pain of common sports
injuries to a tolerable level. If they don't, it's probably time to see a doctor.
When to get medical attention for common sports injuries: You can be
tough — but you also need to be smart. If you suspect a serious injury or if you
have any of these signs, see a doctor:
 Deformities in the joint or bone — it looks ―crooked,‖ or moves abnormally
 You cannot bear weight or can't use the limb without it ―giving way‖
 Excessive swelling
 Changes in skin colour beyond mild bruising
 It is not getting any better after a few days of PRICE therapy

Compression, such as an elastic bandage, should be kept on between using ice

packs. You may want to remove the bandage while sleeping, but keeping it
compressed even during the night is best. Elevating the limb will also keep the
swelling to a minimum. If you suspect more than a mild injury, cannot put
weight on the limb, or it gives way, you should consult with a health care
provider.
Rehabilitation: This stage follows the first 48 to 72 hours. The second stage
focusses on gentle movement of the muscle or joint, mild resistive exercise,
joint position training and continued icing. During this stage, the individual may
gradually return to more strenuous activities, such as strengthening.
Pain should remain low during rehabilitation. If pain increases, it usually means
you have attempted to do too much. Throughout recovery one can still maintain
an aerobic training program. Options for training include stationary bicycling,
swimming, walking or running in the water. If the injury is more than mild
sprain or strain, it is best to consult the health care provider.
Causes: A sprain is usually caused by trauma to a joint (the space between
bones). Twisting or forces overstretch the ligaments (such as hyper-extension or

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hyper-flexion) and can cause tears in the ligament tissue, which can be graded
from mild to severe depending on the amount of damage. Sprains can happen
when people twist an ankle or knee or fall on an elbow or shoulder.
An acute strain can be the result of overstretching or a sudden twisting or
trauma to the muscles or tendons.
Chronic strains are the consequence of overuse of muscles and tendons, such
as with athletes who train constantly and do not rest adequately.
Risk Factors for Sprains and Strains: Anyone can get a sprain or strain,
however, some people may be at higher risk, including the following:
Athletes
 Jumping sports (for example, basketball, volleyball) carry a higher risk of
foot, knee, and ankle strains and sprains.
 Gymnastics, tennis, and golf carry a higher risk of hand, wrist, elbow,
rotator cuff, and arm strains and sprains.
 Contact sports (for example, hockey and football) carry a higher risk of
sprains and strains of any type, including but not limited to the fingers,
thumbs, toes, and neck.
 Endurance sports (for example, running and triathlon) carry a higher risk of
strains from overuse.
Common areas for sprains and strains in endurance athletes include hips, calves,
hamstrings, quads, and other parts of the legs.
 Those with a history of prior sprains or strains
 People who are overweight
 People who are starting physical activity or exercise programs for the first
time
 People with neurologic problems or balance disorders may be at higher risk
for strain and sprain injuries from falling.
Symptoms
 Swelling, bruising or redness, or open cuts as a consequence of the injury
 Pain when at rest
 Pain when the specific muscle or the joint in relation to that muscle is used
 Weakness of the muscle or tendons (A sprain, in contrast, is an injury to a
joint and its ligaments.)
 Inability to use the muscle at all

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Sprains tend to have symptoms more localized to the injured joint. When the
joint is injured, it is possible to feel a tear or pop in the joint. Pain is usually
immediate, and depending on the severity of the injury, it may not be possible to
use the joint.
Strains, whether acute or chronic, have symptoms localized to the muscle
groups or tendons that are injured. Pain can be over a small area, or a larger
area, such as a group of muscles. Pain can be immediate in an acute strain, or it
may be delayed in the case of an overuse injury.
If the strain or sprain is due to an athletic injury, you may see a sports-medicine
specialist. If the sprain or strain is severe, you may be referred to an
orthopaedist, a specialist in injuries and disorders of the musculoskeletal
system. Physical therapists may also be involved in rehabilitation.
Magnetic Resonance Imaging (MRI) is sometimes necessary to determine the
exact extent of the injury because strains and sprains occur in soft tissue and do
not show up on routine X-rays. A doctor will determine the severity of a sprain
or strain injury by degree or grade.
The main treatment (first aid) for all sprains and strains is RICE:
 Rest
 Ice
 Compression
 Elevation
A more severe sprain or strain may require evaluation by a doctor. Joint or
extremity splitting or immobilization may be needed. Some severe sprains and
strains may require surgery. Some sprain and strain injuries may require
physical therapy rehabilitation to help the tissue heal and to retain and
strengthen the muscles and tendons. For pain, over-the-counter pain relievers
may be helpful.
Non-steroidal anti-inflammatory drugs (NSAIDs) help reduce pain,
inflammation, and swelling (use in children varies; discuss with a paediatrician).
There are also some complementary therapies and home remedies that may help
reduce inflammation and ease pain. Consult a doctor before using any home
remedy, as many have not been scientifically tested or proven effective.
Haemorrhage: A haemorrhage is potentially life threatening. When there is an
open wound and blood loss, bleeding must be stopped and the wound must be
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protected. The possibility of infection and shock has to be considered, even if

the wound is minor and there is no major blood loss. Bleeding can be either
internal or external. Sometimes the injury/wound causes visible blood. In other
instances the injury is internal and the bleeding is not easily seen.

The amount of bleeding does not always indicate how serious the injury is. For
example, a small cut on the scalp might bleed more than a deep puncture wound
(a pointed object entering the skin). A small cut can become a serious medical
problem if not cleaned and treated correctly. Keeping an injury clean helps
prevent infections. Bleeding is more serious if you have a bleeding disorder or
are taking blood-thinning medication such as aspirin. People with diabetes and
other chronic diseases often heal slowly.
Symptoms: The most obvious sign of a wound may be bleeding. Blood-loss,
both internal and external, should also be considered if there is/are:
 Bruising
 Signs of Shock
 Paler than usual
 Clammy skin
 Dizziness, light-headedness or low blood pressure
 Trouble breathing
 Confusion, disorientation and weakness
 Dark tarry stools
 Painful or swollen stomach
 Blood-loss from openings like the mouth, ears etc.
 Blood in stool, urine, vagina (more than normal menstruation) or vomit. As
well as the obvious sign of blood coming from a wound.
Signs and symptoms of severe bleeding include:
 Weak, rapid pulse
 Pale, cool, moist skin
 Pallor, sweating
 Rapid, gasping breathing
 Restlessness
 Nausea
 Thirst
 Fainting, dizziness or confusion

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 Loss of consciousness.
Management
1. Apply pressure to the wound
 Remove or cut casualty‘s clothing to expose wound.
 Apply direct pressure over wound – instruct casualty to do this if possible.
 If casualty is unable to apply pressure, apply pressure using a pad and
bandage or your hands (use gloves if available).
 Squeeze the wound edges together if possible.
2. Raise and support injured part
 Lie casualty down.
 Raise injured part above level of heart.
 Handle gently if you suspect a fracture.
3. Bandage wound
 Apply a pad over the wound if not already in place.
 Secure with bandage - ensure pad remains over wound.
 If bleeding is still not controlled, leave initial pad in place, apply a second
pad and secure with bandage.
 If bleeding continues, replace second pad and bandage.
4. Check circulation below wound.
5. If severe bleeding persists give nothing orally.

Worksite emergencies can happen quickly, and everyone should know what to
do and it is that everyone should know first aid. To care for a major open wound
(bleeding freely or severely), you must act at once. Begin by applying direct
pressure over the wound with a clean, sterile dressing to slow the flow of blood
and promote clotting. If a sterile dressing is not available, use any clean cloth
such as a towel, handkerchief, or shirt. Avoid using your bare hands. To reduce
the risk of infection or disease transmission, put a barrier between you and the
victim‘s blood, such as disposable gloves or a layer of plastic wrap.
Next, if you do not suspect that the wound involves a broken bone, elevate the
injured area above the level of the heart. Elevating the wound will help to slow
the flow of blood. Remember to maintain direct pressure on the wound at all
times, or it may begin to bleed again. If the victim is able to help, have him or
her apply the pressure.
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Use a roll of gauze bandage to wrap snugly around the dressing to keep pressure
on the wound. Wrap the bandage around the injured body part, using
overlapping turns, covering the entire dressing. The bandage should be tight, but
not so tight that it restricts all circulation beyond the bandage. If blood soaks
through the bandage, put on more dressing and bandages.
Do not remove blood soaked ones. If the bleeding cannot be controlled, apply
pressure to a nearby artery, called a pressure point. A pressure point is a spot on
the body where you can squeeze the artery against the bone. This can slow the
flow of blood to the wound. There are two major pressure points in the body. If
the bleeding is from the leg, press with the heel of one hand on the femoral
artery in the groin - where the leg bends at the hip. If the bleeding is from the
arm, squeeze the brachial artery located on the inside of the upper arm.
Any severe bleeding can lead to a life-threatening condition called shock. Shock
is a condition in which the circulatory system fails to deliver blood to all parts
of the body. When shock occurs, the victim may become restless or irritable,
experience rapid breathing or pulse rate, have pale, cool, or moist skin, or drift
in and out of conscious ness. To care for a victim of shock
 Have the victim lie down or rest comfortably;
 Elevate the legs about twelve inches if there is no head, neck or back injury;
 Maintain a normal body temperature by covering with a blanket, but do not
overheat;
 Do not give them anything to eat or drink, even though they are likely to be
thirsty;
 Call your local emergency number immediately as a victim of shock
requires advanced medical care as soon as possible.
 Call for professional medical help quickly with any severe bleeding
emergency.
 Always wash your hands immediately after completing care, disinfect any
blood-contaminated of blood-soaked ban tourniquet unless you have been
medically trained to do so.
To control severe bleeding the steps are
 Apply direct pressure;
 Elevate the wound; apply a pressure bandage;
 Use a pressure point; and treat for shock.

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Causes: The most obvious sign of a wound may be bleeding. Blood-loss, both
internal and external, should also be considered if there is/are: Bleeding may be
the result of an injury, medical condition, or certain medications. Some medical
conditions that result in bleeding are:
 Ulcers, cancer and urinary tract infections.
 Falls or blows from tripping, car accidents, sports injuries etc.
 Sharp objects that puncture the skin, such as knives, scissors, nails, pencils
etc.
 Shaving cuts
 Bites from animals or humans
 Very dry skin that cracks and bleeds
 Side effect of medication
Prevention: Try to prevent falls
 Be careful using knives and scissors
 Do not pick up sharp objects like broken glass – instead use a broom or
brush
 Shave when alert and not in a rush
 Stay away from animals unless you know they are friendly.
 They might bite or scratch
 Check the skin and use lotion if it is very dry to prevent cracking
Minor cuts: Clean all cuts.
 Wash your hands with water and soap
 Wash the cut with mild soap and water
 Remove LOOSE dirt or objects from the wound
 Put pressure on the wound to stop bleeding
 Once bleeding stops, use antibacterial ointment (if ordered by doctor)
 Bandage the wound if it is likely to get dirty
 For larger, more serious cuts
 Apply pressure directly or with a dressing
 Seek medical attention immediately
 Observe for signs of shock
 Check that they are up-to-date on their Tetanus vaccine

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Importantly, there are some things one should not do during first aid:
 DO NOT remove objects that are stuck in the body Place pads around the
object and tape it so that it doesn‘t move. Then, seek medical help.
 DO NOT clean very big wounds. Try to stop the bleeding and seek medical
help.
 DO NOT assume a wound is clean. CLEAN IT if it is a small wound
 DO NOT remove bandages to see if the wound has stopped bleeding. This
might open the wound.
Document: Keep a record of how the injury happened and how it was treated.
Also note what will be done to prevent it from getting infected. In a work place
file an Incident Report (if required) and complete other documentation such as
writing down a description in the logbook if the person requires emergency
medical care.
Painful respiration: This is an unpleasant sensation while breathing. This can
range from mild discomfort to severe pain. In addition to the pain, it can also be
hard to breathe. Certain factors may make breathing harder, like the position of
your body or the air quality. Painful respirations can be a sign of a serious
medical problem or illness. This often requires prompt medical care. Painful
respiration is an unpleasant sensation while breathing. This can range from mild
discomfort to severe pain. In addition to the pain, it can also be hard to breathe.
Certain factors may make breathing harder, like the position of your body or the
air quality.
Respiratory distress in children is one of the most common reasons to present
to the emergency department or a practitioner‘s office. Respiratory distress can
result from disorders in the respiratory system or in organ systems that control
or influence respiration. Young children have an increased risk for respiratory
distress because of their anatomy and physiology. Nearly 20% of all emergency
department visits for children younger than 2 years are for respiratory disease.
Causes: The causes of respiratory distress are vast, and practitioners caring for
children should have a systematic approach to its diagnosis and management.
Cardiopulmonary arrest in children is largely due to respiratory failure (in
adults, cardiac causes are most common). Rapid evaluation and management of
severe paediatric respiratory disease may be necessary to prevent respiratory
failure.

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Symptoms:
 Loss of consciousness
 Shortness of breath
 Rapid breathing
 Nasal flaring
 Air hunger, or the feeling as though you are unable to get enough air
 Gasping for breath
 Choking
 Chest Pain
 Confusion
 Sweating profusely
 Pallor, or pale skin
 Cyanosis, blue discoloration of skin, lips, fingers, or toes
 Dizziness
 Coughing up blood
 Fever
Painful breathing can be a sign of a medical emergency or a symptom of a
serious condition. Even if you think the cause is minor, meeting with your
doctor can help ensure there is nothing more serious going on.
Causes: In some cases, an injury to the chest, like a burn or a bruise, can cause
painful breathing. In others instances, the cause may not be clear and you may
need to visit a doctor for an exam. Conditions that cause painful breathing can
vary widely in severity and include short-term illnesses as well as more serious
issues with the lungs or heart.
Illnesses: There are illnesses that can generate respiratory discomfort. Even
though the common cold can cause wheezing and minor breathing troubles,
painful respiration can be linked to more serious illnesses. It can be painful to
take a deep breath or you may have difficulty breathing when lying down,
depending on the cause.
Some causes can be:
 Pneumonia, a lung infection caused by a virus or bacteria
 Tuberculosis, a serious bacterial lung infection
 Pleurisy, inflammation of the lining of the lungs or chest cavity often due to
infection
 Bronchitis, infection or inflammation of the breathing tubes within the lungs

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 Shingles, a painful infection caused by the reactivation of the chicken pox

virus
Lung injuries and disorders can also cause painful breathing. Unlike short-
term illnesses, these conditions can cause long-term breathing problems. The
victim will likely feel pain when breathing in and out, and the breaths may be
shallow. Deeper breathing may cause coughing fits along with added pain.
Some of the possible causes include:
 Chronic obstructive pulmonary disease (COPD), also called emphysema
 Asthma
 Chemical or smoke inhalation injury
 Broken ribs
 Pulmonary embolism, blockage in one of the arteries of the lung
 Pneumothorax, or a collapsed lung
 Empyema, a collection of infected pus within the lining of your chest cavity
 Costochondritis, inflammation in the joints of the ribs that causes chest pain

Heart disease is another possible cause of painful respiration. In such cases,

you will likely feel slight pressure or squeezing around your heart area when
you breathe. This is typically felt on the left side, rather than the whole chest.
Heart-related chest pain can also cause:
 Burning sensations
 Dizziness
 Nausea
 Sweating
 Pain that moves into the neck or jaw

Types of heart disease that can contribute to painful respiration include:

 Angina, when blood flow to the heart is decreased
 Heart Attack, when blood flow to the heart is blocked
 Heart Failure, when the heart can‘t pump blood properly
 Pericarditis, inflammation of the sac surrounding the heart that causes a
sharp pain
Treatment: The treatment of this symptom depends on the cause. While you
can treat pneumonia with antibiotics, other conditions may require
anticoagulation medication or even surgery. Conditions like asthma and
emphysema usually require long-term care, including breathing treatments and a
prescription drug regimen.
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Change position: A shift in position may provide relief from painful breathing
after changing your body‘s position, especially if you have COPD. According to
the Cleveland Clinic, you can try elevating your head with a pillow if the pain
comes when you are lying down.
Short-term solutions: Besides medications, there are other preventive care and
short-term solutions that can help. Sitting down and focusing on your breath can
help if breathing becomes too much to handle during normal activities. Tell
your doctor if your painful respiration improves with rest. If painful respiration
interferes with your exercise routine, try lighter workouts such as Tai Chi
or yoga. The meditation and focus aspects of these workouts can also help you
relax while improving the breath.
Long-term respiratory care: You can lower your risk for lung diseases by
reducing your exposure to:
 Cigarette smoke
 Environmental pollution
 Workplace toxins
 Fumes

Diaphragmatic, or deep breathing, techniques can help encourage better

breathing over time and reduce pain. Preventing risk factors for heart disease
can also help prevent related illnesses and subsequent symptoms. You can lower
your risk for heart attack, angina, and other forms of heart disease by:
 Losing weight
 Lowering your blood pressure
 Decreasing Cholesterol Levels
 Exercising Daily
 Decreasing consumption of salt and saturated fats
 Quitting Smoking
 Controlling Diabetes
Those individuals with pre-existing cases of heart disease must be monitored by
a doctor. Make sure all medications as prescribed are taken and notify the
doctor if painful respiration worsens.
Snake bite: About 7,000 venomous snake bite cases are reported every year in
the United States. A bite from a venomous snake is rarely deadly — about 6
fatalities are reported every year — but it should always be treated as a medical

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emergency. Even a bite from a harmless snake can be serious, leading to

an allergic reaction or an infection. Venomous snake bites can produce an array
of symptoms, including localized pain and swelling, convulsions, nausea, and
even paralysis.
First aid steps you can take after a snake bite occurs include cleaning the
wound, remaining calm, and immobilizing the affected area. However, it‘s
essential to get to a medical facility immediately for emergency treatment. If
treated in time, the outlook for recovery is good.
Identifying venomous snakes: If you are unfamiliar with the different types of
snakes and unable to distinguish between venomous and non-venomous ones, it
can be difficult to know how to respond in the event of a bite. Always treat a
snake bite as if it‟s venomous. If you or someone you are with has been bitten
by a snake, you will know immediately. It‘s possible, though, for the bite to
happen quickly and for the snake to disappear.
To identify a snake bite, consider the following general symptoms:
 Two puncture wounds
 Swelling and redness around the wounds
 Pain at the bite site
 Difficulty Breathing
 Vomiting and nausea
 Blurred Vision
 Sweating and salivating
 Numbness in the face and limbs

Someone is bitten by a snake, you will not know if it‘s a dry bite or a venomous
bite – so to be safe, always treat any bite as a venomous bite. Dry bites,
whereby no venom is released, are painful and cause localised redness and
swelling. If the bite is venomous, other symptoms may include a stinging or
burning sensation on the skin and feelings of nausea, dizziness, anxiousness and
confusion. In severe cases, the bite may result in paralysis or coma. Knowing
what to do if bitten by a snake and giving proper first aid is essential in keeping
those numbers down and reducing them even further.
Snake venom is carried in the lymphatic system and not in the blood stream, as
many mistakenly believe. That‘s why the main aim of snake bite first aid is
to reduce lymphatic flow by applying continuous firm pressure over the
affected limb. This is known as the Pressure Immobilisation Technique (PIT).
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Immediate first aid should be applied to any snake bite victim. Follow the
steps below and don‘t forget to read the DON‘Ts printed in red at the bottom of
our guide.
Step 1: Lay the victim down and provide reassurance. CALL 000. Do not move
the victim unless further danger is present.
Step 2: With a broad (minimum 7.5cm wide) elastic bandage. Start at the toes
or fingers if bitten on the arm and wrap the bandage very firmly up the entire
limb. If the bandage does not cover the entire limb, start with a new bandage at
the point the last bandaged finished until the entire limb is covered. The
compression bandage should be firm enough to reduce lymphatic movement but
not constrict blood flow. Ensure you leave the tips of the toes/fingers out to
monitor circulation. The compression bandage should be firm enough to reduce
lymphatic movement but not constrict blood flow. Ensure you leave the tips of
the toes/fingers out to monitor circulation.
Step 3: Once the entire limb has been covered, mark the bite site with a pen or
some dirt from the ground. This is helpful for emergency services personnel.
Step 4: Once the entire limb has been covered, mark the bite site with a pen or
some dirt from the ground. This is helpful for emergency services personnel.
Splint the limb (including joints) to prevent movement. For bites to the leg, this
can be achieved by strapping the legs together using slings or other suitable
material. Bites to the arm can be supported in a sling or splinted. Do not remove
the bandage once applied. Make the victim comfortable and continue to provide
reassurance until arrival of emergency services.
 DO NOT wash the bite site
 DO NOT attempt to cut the venom out of the limb
 DO NOT attempt to suck the venom out of the limb
 DO NOT apply a tourniquet to the limb
 DO NOT move the person unless in immediate danger
 DO NOT try to catch and identify the snake
The Bite
 Poisonous snakes inject venom using modified salivary glands.
 During envenomation (the bite that injects venom or poison), the venom
passes from the venom gland through a duct into the snake's fangs, and
finally into its prey.

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 Not all bites lead to envenomation. Snakes can regulate whether to release
venom and how much to release. "Dry Bites" (a bite where no venom is
injected) occur in between 25%-50% of snake bites.
 This variation is species specific with approximately 25% of pit-viper bites
being "dry" and up to 50% of coral snake bites. Snake venom is a
combination of numerous substances with varying effects.
In simple terms, these proteins can be divided into 4 categories:
1. Cytotoxins cause local tissue damage.
2. Hemotoxins cause internal bleeding.
3. Neurotoxins affect the nervous system.
4. Cardiotoxins act directly on the heart.
The number of bites and fatalities varies markedly by geographic region.
Reporting of snakebites is not mandatory in many areas of the world, making it
difficult to determine the number of bites. Many articles are based on
population models with multiple assumptions leading to a wide range of
statistical reporting. Snakebites are more common in tropical regions and in
areas that are primarily agricultural. In these areas, large numbers of people
coexist with numerous snakes. Very few deaths occur per year from snakebites
in the United States. People provoke bites by handling or even attacking snakes
in a significant number of cases in the United States.
Snakebite Symptoms: Bites by venomous snakes result in a wide range of
effects. They range from simple puncture wounds to life-threatening illness and
death. The findings following a venomous snakebite can be misleading. A
victim can have no initial significant symptoms, and then suddenly develop
breathing difficulty and go into shock.
Signs and symptoms of snakebites can be broken into a few major categories:
 Local effects: These are the effects on the local skin and tissue surrounding
the bite area. Bites by vipers and some cobras (Naja and other genera) are
painful and tender. They can be severely swollen and can bleed and blister.
Some cobra venoms can also kill the tissue around the site of the bite.
 Bleeding: Bites by vipers and some Australian elapids can cause changes
in the victim's hematologic system causing bleeding. this bleeding can be
localized or diffuse. Internal organs can be involved. A victim may bleed

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from the bite site or bleed spontaneously from the mouth or old wounds.
Unchecked bleeding can cause shock or even death.
 Nervous system effects: The effect on the nervous system can be
experienced locally close to the bite area or affect the nervous system
directly. Venom from elapids and sea snakes can affect the nervous system
directly. Cobra (Naja and other genera) and mamba (Dendroaspis) venom
can act particularly quickly by stopping the breathing muscles, resulting in
death without treatment. Initially, victims may have vision problems,
speaking and breathing trouble, and numbness close to or distant to the bite
site.
 Muscle death: Venom from Russell's vipers (Daboia russellii), sea snakes,
and some Australian elapids can directly cause muscle death in multiple
areas of the body. There can be local effect of muscle death (necrosis), or
distant muscle involvement (rhabdomyolysis). The debris from dead
muscle cells can clog the kidneys, which try to filter out the proteins. This
can lead to kidney failure.
 Eyes: Spitting cobras and ringhals (cobra like snakes from Africa) can
actually eject their venom quite accurately into the eyes of their victims,
resulting in direct eye pain and damage.
Diagnosis: Diagnosis of snakebite is made based on the history of the event.
Identification or description of the snake can be helpful in developing a
treatment plan as not all snakes are venomous, and different kinds of anti-
venom exist for different species of snakes that are venomous. The doctor also
looks for evidence of fang marks or local trauma in the area of the bite. Pain
and swelling accompany most snakebites, venomous or not.
 The doctor treats breathing problems, shock, and/or immediately life-
threatening injuries even before a full workup is complete.
 The wound will be examined and cleaned.
 If a patient has symptoms, the doctor will likely send blood and urine
samples to the laboratory to look for evidence of bleeding, problems in the
blood clotting system, kidney problems, or muscle death. These problems
may not be initially apparent, but can have dire consequences if missed.
 The patient is monitored to look for worsening symptoms at the wound site,
or worsening systemic symptoms in the breathing or cardiovascular
systems.

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 A rare complication in very swollen limbs is compartment syndrome.

Limbs are divided into compartments of muscles, blood vessels, and
nerves. Severe swelling can cut off the blood circulation to a compartment.
When the circulation is cut off, the patient usually has severe pain and
numbness. Later, the limb may get white and cold. If not treated in time, the
limb may need to be amputated.
Snakebite Self-Care at Home: Common sense, hopefully, will guide a person's
efforts if they are bitten by a snake or witness to someone else being bitten.
Even a bite from a nonvenomous snake requires excellent wound care. The
patient needs a tetanus booster if he or she has not had one within 5 years. Wash
the wound with large amounts of soap and water. Inspect the wound for broken
teeth or dirt.
Take the following measures:
 Prevent a second bite or a second victim. Do not try to catch the snake as
this can lead to additional victims or bites. Snakes can continue to bite and
inject venom with successive bites until they run out of venom.
 Identify or be able to describe the snake, but only if it can be done without
significant risk for a second bite or a second victim.
 Safely and rapidly transport the victim to an emergency medical facility.
 Individuals should provide emergency medical care within the limits of
their training.
o Remove constricting items on the victim, such as rings or other jewellery,
which could cut off blood flow if the bite area swells.
o If a person has been bitten by a dangerous elapid (for example, sea krait [a
type of sea snake], black and yellow sea snake) and has no major local
wound effects, a pressure immobilizer may be applied.
o Wrap a bandage at the bite site and up the extremity with a pressure at
which you would wrap a sprained ankle. Then immobilize the extremity
with a splint, with the same precautions concerning limiting blood flow.
o This technique may help prevent life-threatening systemic effects of
venom, but may also worsen local damage at the wound site if significant
symptoms are present there.
o While applying mechanical suction (such as with a Sawyer Extractor) has
been recommended by many authorities in the past, it is highly unlikely
that it will remove any significant amount of venom, and it is possible that
suction could actually increase local tissue damage.

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o This technique is, in general, no longer recommended but is still listed as a

treatment technique in many medical publications. If a person decides to
try this technique, the instructions should be carefully followed.
 The two guiding principles for care often conflict during evacuation from
remote areas.
o First, the victim should get to an emergency care facility as quickly as
possible because antivenin (medicine to counteract the poisonous
effects of the snake's venom) could be life-saving.
o Second, the affected limb should be used as little as possible to delay
absorption and circulation of the venom.
Medical research supports the following warnings:
 Do NOT cut and suck. Cutting into the bite site can damage underlying
organs, increase the risk of infection, and sucking on the bite site does not
result in venom removal.
 Do NOT use ice. Ice does not deactivate the venom and can cause frostbite.
 Do NOT use electric shocks. The shocks are not effective and could
cause burns or electrical problems to the heart.
 Do NOT use alcohol. Alcohol may deaden the pain, but it also makes the
local blood vessels bigger, which can increase venom absorption.
 Do NOT use tourniquets or constriction bands. These have not been
proven effective, may cause increased tissue damage, and could cost the
victim a limb.
Snakebite Treatment: The doctor treats life-threatening conditions first. A
victim with difficulty breathing may need a tube placed in his or her throat and
a ventilator machine used to help with breathing. People who are in shock may
require intravenous fluids and possibly other medicines to maintain blood flow
to vital organs.
 If indicated and available for the specific type of snake, the doctor will
consider giving antivenin to victims with significant symptoms. This
therapy can be life-saving or limb saving. Giving an antivenin is a difficult
decision as the antivenin can have significant side effects including causing
allergic reactions or even anaphylactic shock, a life-threatening type of
shock requiring immediate medical treatment with epinephrine and other
medications. However, antivenin treatment is still the treatment of choice
but the physician and patient should be aware of the risks.

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 Antivenin can also cause serum sickness within 5-10 days of therapy.
Serum sickness causes fevers, joint aches, itching, swollen lymph nodes,
and fatigue, but it is not life-threatening.
 Even victims without significant symptoms need to be monitored for
several hours, and some people need to be admitted to the hospital for
overnight observation.
 The doctor cleans the wound and looks for broken fangs or dirt. A tetanus
shot is required if the patient has not had one within 5 years. Some wounds
may require antibiotics to prevent infection.
 The emergency medicine doctor may need to consult a surgeon if there is
evidence of compartment syndrome. Regardless, most clinicians suggest an
early consult of a surgeon to help monitor the patient in case compartment
syndrome develops. If treatment with limb elevation and medicines fails,
the surgeon may need to cut through the skin into the affected
compartment, a procedure called a fasciotomy. This procedure can relieve
the increased limb swelling and pressure, potentially saving the arm or leg.
Transportation of sick and wounded in First Aid: One of the chief
responsibilities of the medical service is the evacuation of sick and wounded.
Transportation must be carried out with all speed possible without endangering
life or limb. The transport employed in this movement will be determined by the
particular conditions existing in various stages of the journey. When necessary,
means of transport must be improvised.
Knowing the correct methods of transporting seriously injured persons is one of
the most important parts of first aid or emergency medical treatment. Careless
or rough handling not only may increase the seriousness of an injury, but may
result even in death. Unless there is a good reason for moving an injured person
immediately, do not transport the person until medical facilities, such as a litter
or an ambulance, are available.
Sometimes, when the situation is urgent and there are no medical facilities
available, the victim will have to be moved by you. For these cases you must
know the different methods of manual transportation of casualties.
If the casualty has a broken bone, never move the person until you have
immobilized the injured part by using splints to keep the injured part secure.
Following are many ways by which you can carry a wounded person both with
and without help. If another person is present to help, use one of the means to

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carry that are given below. Two-man lifts are more comfortable for the victim,
will enable you to carry the victim farther, and are less likely to aggravate
fractures or other serious injury.
Fireman‟s Lift: The fireman‘s lift is one of the easiest methods for one person
to carry the entire weight of another. It may be used for an unconscious person.
Mastery of this method is of special importance, as the preliminary steps this
method is used in many other one-man carries. You can always raise an
unconscious or disabled person from the ground. After moving the victim to an
upright position, you may use any of several other one-man carries to transport
him.
After raising the victim from the ground (as in the fireman's carry), seize his left
(right) wrist with your left (right) hand and draw the victim‘s arm around your
neck. The victim is thus able to walk, using you as a crutch. This carry is useful
when the victim is only slightly hurt,
such as in foot and ankle injuries.

Arms Carry: This is a good method for

carrying an injured person short
distances. Carry the patient high to
lessen fatigue. Never use this carry when
the victim has a broken back or leg.

Saddle-back carry: Having raised the

victim to an upright position, maintain a
pull on his arm and step in front of him.
Then stoop and raise him upon your back. Have the patient encircle your neck
with his arms, and clasp your hands beneath his
thighs.
Pack-strap carry: After raising victim from the
ground, step in front of him. Grasp the victim‘s
wrists with your hands and hoist the victim so that
his/her armpits are over your shoulders. This is a
good way of carrying an unconscious person, but do
not use it if there is a broken bone.
Fireman‟s drag: The victim‘s hands are tied around
your neck, enabling you to crawl along, dragging the

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victim, who may be unconscious. This method has the advantage of permitting
both you and the person you are carrying to remain low on the ground, and thus
protected from further fall or accident. Do not attempt to drag a person with a
broken neck or back.
Two-man supporting carry: This carry is easy and commonly used. The
victim may be unconscious, but if he has a
broken bone, do not use this method.
Two-man carry: This method of transportation
is particularly suited to lift a patient onto a litter
or other carrier.
Two-man saddle-back carry: This is a good
method to carry an unconscious person a short
distance. It should never be used if the injured
person has a fracture.
Four-hand carry: In this method, the
bearers rise together, lifting the victim.
This is a good carry for victims with
injuries of the head or feet. The patient
must be conscious so that he/she can
hold on.
a. First step: Each bearer grasps his
own left wrist with his right hand, and
then grasps the other bearer's right wrist
with his left hand.
b. Second step: The patient then sits on the interlocked hands of the bearers,
supporting him/herself by placing an arm around each of the bearers‘ necks.
Transportation is when there is a device capable of being carried by two or
more bearers for the purpose of transporting sick, injured, or dead persons.
Broadly there are two types.
Types:
 Walking: All sick and wounded patients who are able to walk from the
place where they became casualties to the medical installation designed for
their treatment, without aggravating their condition, are classified as
walking (or ambulant) cases.

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 Litter: All patients who are unable to walk either with or without assistance,
or whose condition might be aggravated by walking, are classified as litter
(or recumbent) cases. All litter cases, regardless of whether they occur in
posts, camps, or on the battlefield, will require more or less movement on a
Medical Department litter or on an improvised substitute.
A stretcher, litter, or chair is an apparatus used for moving patients who
require medical care. A basic type (cot or litter) must be carried by two or more
people. A wheeled stretcher (known as a gurney, trolley, bed or cart) is often
equipped with variable height frames, wheels, tracks, or skids. In American
English, a wheeled stretcher is referred to as a gurney.
Stretchers are primarily used in acute out-of-hospital care situations
by emergency medical services (EMS), military, and search and rescue
personnel. In medical forensics the right arm of a corpse is left hanging off the
stretcher to let paramedics know it is not a wounded patient.
Basic stretchers
Simple stretchers are the most rudimentary type. They are lightweight and
portable, made of canvas or other
synthetic material suspended between
two poles or tubular aluminum frame.
Many are stored as disaster supplies
and are often former military
equipmen
t.
The folding stretcher, also known as a top
deck or collapsible stretcher, is similar in design
to the simple stretcher, but features one or more
hinged points to allow the stretcher to be collapsed
into a more compact form for easier handling or
storage. Some
models may even allow the patient to sit
upright in a Fowler's or Semi-Fowler's
position.
The scoop stretcher is used for lifting
patients, for instance from the ground onto an

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ambulance stretcher or onto a spinal board. The two ends of the stretcher can be
detached from each other, splitting the stretcher into two longitudinal halves. To
load a patient, one or both ends of the stretcher are detached, the halves placed
under the patient from either side and fastened back together. With obese
patients, the possibility exists of accidentally pinching the patient's back when
closing the stretcher, so care must be made not to injure them when carrying out
this procedure.
The litter, also known as a rescue basket or Stokes basket, is designed to be
used where there are obstacles to movement
or other hazards: for example, in confined
spaces, on slopes, in wooded terrain.
Typically it is shaped to accommodate an
adult in a face up position and it is used in
search and rescue operations. The person is
strapped into the basket, making safe
evacuation possible. The litter has raised
sides and often includes a removable
head/torso cover for patient protection. After the person is secured in the litter,
the litter may be wheeled, carried by hand, mounted on an ATV, towed behind
skis, snowmobile, or horse, lifted or lowered on high angle ropes, or hoisted by
helicopter.
Wheeled stretchers: For ambulances, a collapsible wheeled stretcher, or
gurney, is a type of stretcher on a variable-
height wheeled frame. Normally, there is an
integral lug on the stretcher locks into a
sprung latch within the ambulance in order to
prevent movement during transport. It is
usually covered with a disposable sheet and
cleaned after each patient in order to prevent
the spread of infection. Its key value is to facilitate moving the patient and sheet
onto a fixed bed or table on arrival at the emergency department. Both types
may have straps to secure the patient once the victim is on the stretcher.
A wheel chair is a chair with wheels. It is used when walking is difficult or
impossible due to illness, surgery, injury, or disability. Wheelchairs come in a
wide variety to meet the specific needs of their users. They may include

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specialized seating adaptions, individualized controls, and may be specific to

particular activities, as seen with sports wheelchairs and beach wheelchairs.
The most widely recognised distinction is
between powered wheelchairs (―power chairs‖),
where propulsion is provided by batteries and
electric motors, and manually propelled
wheelchairs, where the propulsive force is
provided either by the wheelchair user/occupant
pushing the wheelchair by hand (―self-
propelled‖), or by an attendant pushing from the
rear (―attendant propelled‖).
Unconsciousness is when a person suddenly becomes unable to respond to
stimuli and appears to be asleep. A person may be unconscious for a few
seconds — as in fainting — or for longer periods of time.
Unconsciousness – First Aid: People who become unconscious do not respond
to loud sounds or shaking. They may even stop breathing or their pulse may
become faint. This calls for immediate emergency attention. The sooner the
person receives emergency first aid, the better their outlook will be.
Unconsciousness is when a person is unable to respond to people and activities.
Doctors often call this a coma or a comatose state. Other changes in awareness
can occur without becoming unconscious. These are called altered mental status
or changed mental status. They include sudden confusion, disorientation, or
stupor. Unconsciousness or any other sudden change in mental status must be
treated as a medical emergency.
Causes: Unconsciousness can be caused by nearly any major illness or injury. It
can also be caused by substance (drug) and alcohol use. Choking on an object
can result in unconsciousness as well.
Brief unconsciousness (or fainting) is often a result from dehydration, low blood
sugar, or temporary low blood pressure. It can also be caused by serious heart or
nervous system problems. A doctor will determine if the affected person needs
tests. Other causes of fainting include straining during a bowel movement
(vasovagal syncope), coughing very hard, or breathing very fast
(hyperventilating).

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Symptoms: The person will be unresponsive (does not respond to activity,

touch, sound, or other stimulation). The following symptoms may occur after a
person has been unconscious:
 Amnesia for (not remembering) events before, during, and even after being
unconsciousness
 Confusion
 Drowsiness
 Headache
 Inability to speak or move parts of the body (stroke symptoms)
 Light headedness
 Loss of bowel or bladder control (incontinence)
 Rapid heartbeat (palpitations)
 Slow heartbeat
 Stupor (severe confusion and weakness)

If the person is unconscious from choking, symptoms may include:

 Inability to speak
 Difficulty breathing
 Noisy breathing or high-pitched sounds while inhaling
 Weak, ineffective coughing
 Bluish skin colour

Being asleep is not the same as being unconscious. A sleeping person will
respond to loud noises or a gentle shake. An unconscious person will not
respond or react.
First Aid: If someone is awake but less alert than usual, wrong answers or not
being able to answer the question suggest a change in mental status. Please ask
the victim a few simple questions, such as:
 What is your name?
 What is the date?
 How old are you?
If a person is unconscious or has a change in mental status, follow these first aid
steps:
1. Call or tell someone to call the emergency number.
2. Check the person's airway, breathing, and pulse frequently. If necessary,
begin CPR.
3. If the person is breathing and lying on their back, and you do not think there
is a spinal injury, carefully roll the person toward you onto their side. Bend

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the top leg so both hip and knee are at right angles. Gently tilt their head
back to keep the airway open. If breathing or pulse stops at any time, roll the
person onto their back and begin CPR.
4. If you think there is a spinal injury, leave the person where you found them
(as long as breathing continues). If the person vomits, roll the entire body at
one time to their side. Support their neck and back to keep the head and
body in the same position while you roll.
5. Keep the person warm until medical help arrives.
6. If you see a person fainting, try to prevent a fall. Lay the person flat on the
floor and raise their feet about 12 inches (30 centimetres).
7. If fainting is likely due to low blood sugar, give the person something sweet
to eat or drink when they become conscious.
If the person is unconscious from choking:
 Begin CPR. Chest compressions may help dislodge the object.
 If you see something blocking the airway and it is loose, try to remove it. If
the object is lodged in the person's throat, DO NOT try to grasp it. This can
push the object farther into the airway.
 Continue CPR and keep checking to see if the object is dislodged until
medical help arrives.
There are a few „DO NOT‟ to be observed by the first aid giver to help the
victim to survive:
 DO NOT give an unconscious person any food or drink.
 DO NOT leave the person alone.
 DO NOT place a pillow under the head of an unconscious person.
 DO NOT slap an unconscious person‘s face or splash water on the face to
try to revive the individual.
Contact a Medical professional or the emergency number if the person is
unconscious and
 Does not return to consciousness quickly (within a minute)
 Has fallen down or been injured, especially if they are bleeding
 Has diabetes
 Has seizures
 Has lost bowel or bladder control
 Is not breathing
 Is pregnant
 Is over age 50

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If the person regains consciousness, call the emergency number, but also check
if the person:
 Feels chest pain, pressure, or discomfort, or has a pounding or irregular
heartbeat
 Cannot speak, has vision problems, or cannot move their arms and legs

Prevention: To prevent a person from becoming unconscious or fainting:

 Avoid situations where your blood sugar level gets too low.
 Avoid standing in one place too long without moving, especially if you are
prone to fainting.
 Get enough fluid, particularly in warm weather.
 If you feel like you are about to faint, lie down or sit with your head bent
forward between your knees.
 If the victim has a medical condition, such as diabetes, always check a
medical alert necklace or bracelet.
Heatstroke is a condition caused by your body overheating, usually as a result
of prolonged exposure to or physical exertion in high temperatures. This most
serious form of heat injury, heatstroke, can occur if your body temperature rises
to 104 F (40 C) or higher. The condition is most common in the summer
months. Heatstroke requires emergency treatment. Untreated heatstroke can
quickly damage your brain, heart, kidneys and muscles. The damage worsens
the longer treatment is delayed, increasing your risk of serious complications or
death.
Symptoms:
 High body temperature. A core body temperature of 104 F (40 C) or
higher, obtained with a rectal thermometer, is the main sign of heatstroke.
 Altered mental state or behaviour. Confusion, agitation, slurred speech,
irritability, delirium, seizures and coma can all result from heatstroke.
 Alteration in sweating. In heatstroke brought on by hot weather, your skin
will feel hot and dry to the touch. However, in heatstroke brought on by
strenuous exercise, your skin may feel dry or slightly moist.
 Nausea and vomiting. You may feel sick to your stomach or vomit.
 Flushed skin. Your skin may turn red as your body temperature increases.
 Rapid breathing. Your breathing may become rapid and shallow.
 Racing heart rate. Your pulse may significantly increase because heat
stress places a tremendous burden on your heart to help cool your body.

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 Headache. Your head may throb.

Treatment: If you think a person may be experiencing heatstroke, seek
immediate medical help. Call the local emergency services number. Take
immediate action to cool the overheated person while waiting for emergency
treatment.
 Get the person into shade or indoors.
 Remove excess clothing.
 Cool the person with whatever means available — put in a cool tub of water
or a cool shower, spray with a garden hose, sponge with cool water, fan
while misting with cool water, or place ice packs or cold, wet towels on the
person's head, neck, armpits and groin.
Causes: Heatstroke can occur as a result of:
 Exposure to a hot environment. In a type of heatstroke, called non-
exertional (classic) heatstroke, being in a hot environment leads to a rise in
core body temperature. This type of heatstroke typically occurs after
exposure to hot, humid weather, especially for prolonged periods. It occurs
most often in older adults and in people with chronic illness.
 Strenuous activity. Exertional heatstroke is caused by an increase in core
body temperature brought on by intense physical activity in hot weather.
Anyone exercising or working in hot weather can get exertional heatstroke,
but it's most likely to occur if you're not used to high temperatures.
 In either type of heatstroke, your condition can be brought on by:
 Wearing excess clothing that prevents sweat from evaporating easily and
cooling your body
 Drinking alcohol, which can affect your body's ability to regulate your
temperature
 Becoming dehydrated by not drinking enough water to replenish fluids lost
through sweating
Risk factors: Anyone can develop heatstroke, but several factors increase your
risk:
 Age. Your ability to cope with extreme heat depends on the strength of your
central nervous system. In the very young, the central nervous system is not
fully developed, and in adults over 65, the central nervous system begins to

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deteriorate, which makes your body less able to cope with changes in body
temperature. Both age groups usually have difficulty remaining hydrated,
which also increases risk.
 Exertion in hot weather. Military training and participating in sports, such
as football or long-distance running events, in hot weather are among the
situations that can lead to heatstroke.
 Sudden exposure to hot weather. You may be more susceptible to heat-
related illness if you're exposed to a sudden increase in temperature, such as
during an early-summer heat wave or travel to a hotter climate. Limit
activity for at least several days to allow yourself to acclimate to the change.
However, you may still have an increased risk of heatstroke until you've
experienced several weeks of higher temperatures.
 A lack of air conditioning. Fans may make you feel better, but during
sustained hot weather, air conditioning is the most effective way to cool
down and lower humidity.
 Certain medications. Some medications affect your body's ability to stay
hydrated and respond to heat. Be especially careful in hot weather if you
take medications that narrow your blood vessels (vasoconstrictors), regulate
your blood pressure by blocking adrenaline (beta blockers), rid your body of
sodium and water (diuretics), or reduce psychiatric symptoms
(antidepressants or antipsychotics).
 Stimulants for attention-deficit/hyperactivity disorder (ADHD) and illegal
stimulants such as amphetamines and cocaine also make you more
vulnerable to heatstroke.
 Certain health conditions. Certain chronic illnesses, such as heart or lung
disease, might increase your risk of heatstroke. So can being obese, being
sedentary and having a history of previous heatstroke.
 Complications
 Heatstroke can result in a number of complications, depending on how long
the body temperature is high. Severe complications include:
 Vital organ damage. Without a quick response to lower body temperature,
heatstroke can cause your brain or other vital organs to swell, possibly
resulting in permanent damage.
 Death. Without prompt and adequate treatment, heatstroke can be fatal.

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 Prevention: Heatstroke is predictable and preventable. Take these steps to

prevent heatstroke during hot weather:
 Wear loose fitting, lightweight clothing. Wearing excess clothing or
clothing that fits tightly won't allow your body to cool properly.
 Protect against sunburn. Sunburn affects your body's ability to cool itself,
so protect yourself outdoors with a wide-brimmed hat and sunglasses and
use a broad-spectrum sunscreen with an SPF of at least 15. Apply sunscreen
generously, and reapply every two hours — or more often if you're
swimming or sweating.
 Drink plenty of fluids. Staying hydrated will help your body sweat and
maintain a normal body temperature.
 Take extra precautions with certain medications. Be on the lookout for
heat-related problems if you take medications that can affect your body's
ability to stay hydrated and dissipate heat.
 Never leave anyone in a parked car. This is a common cause of heat-
related deaths in children. When parked in the sun, the temperature in your
car can rise 20 degrees F (more than 6.7 C) in 10 minutes.
 It is not safe to leave a person in a parked car in warm or hot weather, even
if the windows are cracked or the car is in shade. When your car is parked,
keep it locked to prevent a child from getting inside.
 Take it easy during the hottest parts of the day. If you can't avoid
strenuous activity in hot weather, drink fluids and rest frequently in a cool
spot. Try to schedule exercise or physical labor for cooler parts of the day,
such as early morning or evening.
 Get acclimated: Limit time spent working or exercising in heat until you're
conditioned to it. People who are not used to hot weather are especially
susceptible to heat-related illness. It can take several weeks for your body to
adjust to hot weather.
 Be cautious: If you take medications or have a condition that increases your
risk of heat-related problems, avoid the heat and act quickly if you notice
symptoms of overheating. If you participate in a strenuous sporting event or
activity in hot weather, make sure there are medical services available in
case of a heat emergency.

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UNIT IV

PHYSICAL EXERCISE AND FITNESS

Introduction: A well-rounded physical activity program includes aerobic

exercise and strength training exercise, but not necessarily in the same session.
This blend helps maintain or improve cardiorespiratory and muscular fitness
and overall health and function. Regular physical activity will provide more
health benefits than sporadic, high intensity workouts, so choose exercises you
are likely to enjoy and that you can incorporate into your schedule.
Health: It is a whole body state (including the physical body and the mind) in
which there is an absence of disease and that body maintains the necessary
biological balance between building enough physical and mental energy and
using physical and mental energy to allow us to live well.
Our ability to sustain this balance between this balancing of building and using
energy allows an ability to adjust to the demands of life, thereby allowing us to
survive. Each and every day, we humans must face numerous challenges, such
as exposure to the various elements, stress, muscular exertion, nasty
experiences, and the presence of things to make us sick like bacteria and
viruses. If we do not successfully adapt to these challenges, we are poorly
equipped to survive. And hence, we will be unhealthy.
Physical Fitness is the body‟s ability to withstand, recover from, and adapt
to stress-producing experiences that act upon it.
Or, stated another way: The bodily state of being physically capable of handling
challenges that rise above our normal resting state. And then return to normal.
Can I handle running four blocks? Or digging up your garden in the spring? Or,
like I did the other day, haul heavy kayaks up a hill from the water? To be
physically resilient means to be able to handle some physical stress and then
return to normal.
Mental Fitness is the mind‟s ability to withstand, recover from, and adapt
to stress-producing experiences that act upon it.
Or, stated another way: The mental state of being psychologically capable of
handling challenges that rise above our normal resting state allowing us to
return to normal. For example, how do you handle criticism? Can I manage a

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disappointment? To be mentally resilient means to be able to handle some

psychological stress and then return to normal.
Exercise is defined as the ‗activity requiring physical effort, carried out to
sustain or improve health and fitness‘. However, if we consider exercise to be
any form of physical activity, then exercise surely dates back to the origin of the
species, when humans exercised regularly, even if they may not have
understood the concept of exercise at the time. Hunting, ritualistic dancing, and
building shelter were – and still are - various forms of exercise.
To fully understand the relationship among exercise, fitness, and health, it is
necessary to know precisely what exercise is, as opposed to simply physical
activity. And this is an important distinction. The important distinction is that
exercise (both mental and physical exercise) is an activity that helps you to
adapt and build your level of physical and mental fitness and health.
Physical exercise is the performance of some activity in order to develop or
maintain physical fitness and overall health. It is often directed toward also
honing athletic ability or skill and in other instances mobility. Frequent and
regular physical exercise is an important component in the prevention of some
diseases such as

 Heart disease
 Cardiovascular disease
 Type 2 Diabetes
 Obesity
Exercises are generally grouped into three types depending on the overall effect
they have on the human body: Flexibility exercises such as stretching improve
the range of motion of muscles and joints; aerobic exercises such as walking
and running focus on increasing cardiovascular endurance; and anaerobic
exercises such as weight training, functional training or sprinting increase short-
term muscle strength.
Physical exercise is considered important for maintaining physical fitness
including healthy weight; building and maintaining healthy bones, muscles, and
joints; promoting physiological well-being; reducing surgical risks; and
strengthening the immune system.

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Purpose: Exercise is useful in preventing or treating coronary heart disease,

osteoporosis, weakness, diabetes, obesity, and depression. Range of motion is
one aspect of exercise important for increasing or maintaining joint function.
Strengthening exercises provide appropriate resistance to the muscles to
increase endurance and strength. Cardiac rehabilitation exercises are developed
and individualized to improve the cardiovascular system for prevention and
rehabilitation of cardiac disorders and diseases. A well-balanced exercise
program can improve general health, build endurance, and slow many of the
effects of aging. The benefits of exercise not only improve physical health, but
also enhance emotional well-being.
Studies have shown that a consistent, guided exercise program benefits almost
everyone coping with fatigue, distress, cognitive problems, and mental health
functioning to patients awaiting heart transplants. Exercise in combination with
a reduced-calorie diet is the safest and most effective method of weight loss.
Exercise and physical activity fall into four basic categories—endurance,
strength, balance, and flexibility. Most people tend to focus on one activity or
type of exercise and think they're doing enough. Each type is different, though.
Doing them all will give you more benefits. Mixing it up also helps to reduce
boredom and cut your risk of injury.
Difference between activities of daily life & structured exercise: Activities
of daily living (ADLs) are the activities you do on a regular basis that can help
to burn calories, maintain strength and agility, and keep active. Examples of
these include washing the car, gardening, raking leaves, washing dishes,
vacuuming, etc. These activities do not necessarily count as exercise. Be sure to
note the distinction in these ADLs as compared to structured exercises. You
need both types of movement in order to maintain an optimal level of physical
activity.
Structured exercise includes activities specifically geared toward a purpose,
usually to improve cardiovascular fitness, strength, flexibility, or balance and
agility. There are specific definitions as to what constitutes exercise. Some
activities may fit into both categories (exercise and ADLs) based on the
intensity and duration. One example of an activity fitting both categories would
be walking while mowing the lawn.
Before starting an exercise program, it is important to talk with your doctor to
determine any limitations you may have in regards to exercise. Exercise can be

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safe for almost anyone. However, certain limitations may be placed on

individuals who suffer from chronic conditions such as arthritis, heart disease,
hypertension, diabetes, osteoporosis, and certain pulmonary conditions, among
others.
Building an exercise routine takes time. Slowly incorporate exercise into your
weekly routine, starting with a reasonable amount you can build on. Eventually,
you should be able to incorporate some type of physical activity into every day.
Make sure that if your exercise routine is primarily outdoors you are able to
have a back-up plan for bad weather. You should plan for consistency. Exercise
benefits are best seen if the routine is maintained with minimal disruption.
Everyone has a different tolerance for exercise. If you start experiencing
feelings of burnout, re-evaluate your routine. Make changes that you feel can be
maintained. You can add more later once you feel more comfortable with your
routine.
Components of an exercise program: There are four (4) main components of
a well-rounded exercise program. These are:
 Cardiovascular exercises (aerobic exercise).
 Strengthening exercises.
 Flexibility exercises.
 Balance and agility exercises.
Aerobic exercises help to improve heart and lung function. Walking,
swimming, running, biking, dancing, and hiking are just a few examples of
aerobic exercise. The benefits of aerobic exercise include:
 Lower cholesterol and blood pressure.
 Increased endurance.
 A lower resting heart rate.
 Weight loss or maintenance.
 Stress relief.
 Improved sleep.
Aerobic exercise should be performed for 30 minutes, 5 to 7 days per week. If
time management is an issue, or poor endurance is an issue, break the 30
minutes into 3 sessions of 10 minutes each.

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Endurance or aerobic, activities increase your breathing and heart rate. They
keep your heart, lungs, and circulatory system healthy and improve your overall
fitness. Building your endurance makes it easier to carry out many of your
everyday activities.
 Brisk walking or jogging
 Yard work (mowing, raking, digging)
 Dancing

Strengthening exercises or resistance exercises can help to maintain strong

bones, break some of the stereotypes associated with aging, increase
metabolism, and help to achieve or maintain a higher level of function.
Resistance exercises can include the use of:
 Machine or free weights.
 Exercise balls.
 Hand weights or bands.
 Different types of exercises (such as Pilates or calisthenics).
Strength training is based on the overload principle. If you feel as though your
muscles have not been strained, then chances are they have not. Talk with your
therapist or allied health provider to determine what resistance exercises are safe
for you, and what weight or resistance is appropriate.
Strength exercises make your muscles stronger. They may help you stay
independent and carry out everyday activities, such as climbing stairs and
carrying groceries. These exercises also are called ―strength training‖ or
―resistance training.‖
 Lifting weights
 Using a resistance band
 Using your own body weight

Flexibility exercises are an important fitness component that helps to maintain

pain-free range-of-motion. There are many different reasons why stretching is
important, and orthopaedic issues may include different recommendations
specific to any conditions you may have. It is no longer recommended to stretch
prior to exercise. However, a proper warm-up of a lower-intensity
cardiovascular exercise is imperative.
Stretching can be performed daily, or several times a day, depending on the
recommendations of your therapists. Yoga and Tai Chi can also help with

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stretching. Ballistic stretching (or bouncing during a stretch) is not

recommended. Static stretching is when a stretch is held for a specific length of
time, usually several seconds to half a minute, and repeated. Dynamic stretching
is a method of stretching where the body is moving fluidly while attempting to
improve flexibility. Ask your therapist which methods of flexibility are
appropriate for you.
Flexibility exercises stretch your muscles and can help your body stay limber.
Being flexible gives you more freedom of movement for other exercises as well
as for your everyday activities.
 Shoulder and upper arm stretch
 Calf stretch
 Yoga

Balance/agility exercises Balance and agility are important not only in athletic
performance, but also in general fitness. Balance can be negatively impacted by
the aging process. It is never too early to try and improve balance and agility to
negate this aspect of aging. Depending on any limitations you may have, not all
exercises to improve balance may be appropriate for you. More basic or
beginner levels of balance include standing on one foot, walking heel to toe, or
standing on your toes. Tai Chi is also an excellent balance exercise for beginner
and intermediate balance abilities. Balance exercises help prevent falls, a
common problem in older adults. Many lower-body strength exercises also will
improve your balance.
 Standing on one foot
 Heel-to-toe walk
 Tai Chi

Benefits of physical exercise and fitness: Exercise and physical activity are
good for just about everyone, including older adults. No matter your health and
physical abilities, you can gain a lot by staying active. In fact, in most cases you
have more to lose by not being active. Here are just a few of the
benefits. Exercise and physical activity:
 Can help maintain and improve your physical strength and fitness.
 Can help improve your ability to do the everyday things you want to do.
 Can help improve your balance.
 Can help manage and improve diseases like diabetes, heart disease, and
osteoporosis.

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 Can help reduce feelings of depression and may improve mood and overall
well-being.
 May improve your ability to shift quickly between tasks, plan an activity,
and ignore irrelevant information.
The health benefits of regular exercise and physical activity are hard to ignore.
Everyone benefits from exercise, regardless of age, sex or physical ability.
1. Exercise controls weight: Exercise can help prevent excess weight gain or
help maintain weight loss. When you engage in physical activity, you burn
calories. The more intense the activity, the more calories you burn. Regular trips
to the gym are great, but don't worry if you can't find a large chunk of time to
exercise every day. To reap the benefits of exercise, just get more active
throughout your day — take the stairs instead of the elevator or rev up your
household chores. Consistency is key.

2. Exercise combats health conditions and diseases: Worried about heart

disease? Hoping to prevent high blood pressure? No matter what your current
weight, being active boosts high-density lipoprotein (HDL), or ―good‖
cholesterol and decreases unhealthy triglycerides. This one-two punch keeps
your blood flowing smoothly, which decreases your risk of cardiovascular
diseases. Regular exercise helps prevent or manage a wide range of health
problems and concerns, including stroke, metabolic syndrome, Type 2 Diabetes,
depression, a number of types of cancer, arthritis and falls.
3. Exercise improves mood: Need an emotional lift? Or need to blow off some
steam after a stressful day? A gym session or brisk 30-minute walk can help.
Physical activity stimulates various brain chemicals that may leave you feeling
happier and more relaxed. You may also feel better about your appearance and
yourself when you exercise regularly, which can boost your confidence and
improve your self-esteem.
4. Exercise boosts energy: Regular physical activity can improve your muscle
strength and boost your endurance. Exercise delivers oxygen and nutrients to
your tissues and helps your cardiovascular system work more efficiently. And
when your heart and lung health improve, you have more energy to tackle daily
chores.

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5. Exercise promotes better sleep: Regular physical activity can help you fall
asleep faster and deepen your sleep. Just do not exercise too close to bedtime, or
you may be too energized to sleep.

6. Exercise can be fun and social: Exercise and physical activity can be
enjoyable. It gives you a chance to unwind, enjoy the outdoors or simply engage
in activities that make you happy. Physical activity can also help you connect
with family or friends in a fun social setting.

Those who are physically active tend to live longer, healthier lives. Research
shows that moderate physical activity – such as 30 minutes a day of brisk
walking – significantly contributes to longevity. Even a person with risk factors
like high blood pressure, diabetes or even a smoking habit can gain real benefits
from incorporating regular physical activity into their daily life. As many dieters
have found, exercise can help you stay on a diet and lose weight. Regular
exercise can help lower blood pressure, control blood sugar, improve
cholesterol levels and build stronger, denser bones.
No matter your age or fitness level, these activities can help you get in shape
and lower your risk for disease:
Swimming: You might call swimming the perfect workout. The buoyancy of
the water supports your body and takes the strain off painful joints so you can
move them more fluidly. Research has found that swimming can also improve
your mental state and put you in a better mood. Water aerobics is another
option. These classes help you burn calories and tone up.
Strength training: If you believe that strength training is a macho, brawny
activity, think again. Lifting light weights won't bulk up your muscles, but it
will keep them strong. "
Walking: Walking is simple, yet powerful. It can help you stay trim, improve
cholesterol levels, strengthen bones, keep blood pressure in check, lift your
mood, and lower your risk for a number of diseases (diabetes and heart disease,
for example). A number of studies have shown that walking and other physical
activities can even improve memory and resist age-related memory loss.
All you need is a well-fitting and supportive pair of shoes. Start with walking
for about 10 to15 minutes at a time. Over time, you can start to walk farther and
faster, until you're walking for 30 to 60 minutes on most days of the week.

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Exercise combats ailments and illness: Physical activity or exercise can

improve your health and reduce the risk of developing several diseases like type
2 diabetes, cancer and cardiovascular disease. Physical activity and exercise can
have immediate and long-term health benefits. Most importantly, regular
activity can improve your quality of life. A minimum of 30 minutes a day can
allow you to enjoy these benefits.
A healthier state of mind: A number of studies have found that exercise helps
depression. There are many views as to how exercise helps people with
depression. Exercise may block negative thoughts or distract people from daily
worries. Exercising with others provides an opportunity for increased social
contact. Increased fitness may lift your mood and improve sleep patterns.
Exercise may also change levels of chemicals in your brain, such as serotonin,
endorphins and stress hormones.
Aim for at least 30 minutes a day: To maintain health and reduce your risk of
health problems, health professionals and researchers recommend a minimum of
30 minutes of moderate-intensity physical activity on most, preferably all, days.
Ways to increase activity: Increase in daily activity can come from small
changes made throughout your day, such as walking or cycling instead of using
the car, getting off a tram, train or bus a stop earlier and walking the rest of the
way, or walking the children to school.
Pre-exercise screening is used to identify people with medical conditions that
may put them at a higher risk of a experiencing a health problem during
physical activity. It is a filter or ‗safety net‘ to help decide if the potential
benefits of exercise outweigh the risks for you. Usually, the benefits will far
outweigh the risks. Print a copy of the adult pre-exercise screening tool and
discuss it with your doctor, allied health or exercise professional.
Precautions: Before beginning any exercise program, an evaluation by a
physician is recommended to rule out potential health risks. Once health and
fitness level are determined and any physical restrictions identified, the
individual's exercise program should begin under the supervision of a health
care or other trained professional. This is particularly true when exercise is used
as a form of rehabilitation.
If symptoms of dizziness, nausea, excessive shortness of breath, or chest pain
are present during exercise, the individual should stop the activity and inform a

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physician about these symptoms before resuming activity. Exercise equipment

must be checked to determine if it can bear the weight of people of all sizes and
shapes. Individuals must be instructed in the proper use of exercise equipment
in order to prevent injury.
Range of motion exercise refers to activity aimed at improving movement of a
specific joint. This motion is influenced by several structures: configuration of
bone surfaces within the joint, joint capsule, ligaments, tendons, and muscles
acting on the joint. There are three types of range of motion exercises: passive,
active, and active assists. Passive range of motion is movement applied to a
joint solely by another person or persons or a passive motion machine.
When passive range of motion is applied, the joint of an individual receiving
exercise is completely relaxed while the outside force moves the body part, such
as a leg or arm, throughout the available range. Injury, surgery, or
immobilization of a joint may affect the normal joint range of motion. Active
range of motion is movement of a joint provided entirely by the individual
performing the exercise.
In this case, there is no outside force aiding in the movement. Active assist
range of motion is described as a joint receiving partial assistance from an
outside force. This range of motion may result from the majority of motion
applied by an exerciser or by the person or persons assisting the individual. It
also may be a half-and-half effort on the joint from each source.
Anaerobic Exercise: Anaerobic means without oxygen. Anaerobic exercises
are activities that require quick bursts of power at high intensities. Sprinting and
weightlifting are anaerobic exercises.
 Oxygen is not present with anaerobic exercise. When we exercise
anaerobically glycogen is used as fuel. Once all the glycogen has been
depleted (usually in about two hours) you can expect to hit the proverbial
wall. Endurance athletes avoid this performance buster with carbo loading
before exercise (which when converted to sugar gives more energy) and
supplements during exercise to sustain energy.
 During anaerobic exercise your body builds up lactic acid, which causes
discomfort and fatigue at sustained levels. For this reason anaerobic exercise
or high intensity exercise happens in short bursts. It may be helpful to
consider the difference between a sprinter (anaerobic) and a marathoner

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(aerobic). Sprinting is an all-out effort that is sustained for a comparatively

short period while practising for a marathon is a sustained effort.
Benefits of Anaerobic Exercise: Anaerobic exercise helps
 Builds lean muscle mass. Calories are burned more efficiently in bodies that
have more muscle.
 Anaerobic exercise is especially helpful for weight management in that it
helps to burn more calories even in a body at rest.
 Anaerobic exercise can also help build endurance and fitness levels.
Types of Anaerobic Exercise
 Anaerobic exercise is very high intensity or at your maximum level of
exertion. Examples include sprinting and weight lifting.
 Consider using intervals, aerobic with some bursts of anaerobic exercise
mixed in periodically to improve weight loss and overall fitness.
Effect of exercise on the Respiratory system: Regular physical activity and
exercise improves quality of life, whether you are healthy or you have a lung
condition. Many people associate keeping fit with maintaining a healthy heart,
losing weight and reducing the risk of illnesses such as diabetes, but exercise
also helps keep lungs healthy. This factsheet explains how exercise affects the
lungs, how breathing is influenced by activity and the benefits of exercise for
people with and without a lung condition.
Any type of physical activity counts as exercise. It could be planned sport such
as running, swimming, tennis or bowls, an exercise training programme, or a
hobby such as cycling or walking. It could also include physical activities which
are part of your daily life, such as gardening, cleaning or walking to the shops.
In order to stay healthy, you should do 30 minutes of moderate exercise five
days per week. For a healthy person, moderate exercise might be walking at a
pace of 4 to 6 km per hour. If you have a lung problem, you would need to walk
fast enough to make you moderately breathless.
During exercise, two of the important organs of the body come into action: the
heart and the lungs. The lungs bring oxygen into the body, to provide energy,
and remove carbon dioxide, the waste product created when you produce
energy. The heart pumps the oxygen to the muscles that are doing the exercise.
When you exercise and your muscles work harder, your body uses more oxygen
and produces more carbon dioxide. To cope with this extra demand, your

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breathing has to increase from about 15 times a minute (12 litres of air) when
you are resting, up to about 40–60 times a minute (100 litres of air) during
exercise.
Your circulation also speeds up to take the oxygen to the muscles so that they
can keep moving. When your lungs are healthy, you keep a large breathing
reserve. You may feel ‗out of breath‘ after exercise, but you will not be ‗short of
breath‘. When you have reduced lung function, you may use a large part of your
breathing reserve. This may make you feel ‗out of breath‘, which can be an
unpleasant feeling, but it is not generally dangerous.
It is normal to get breathless during exercise. However, regular exercise can
increase the strength and function of your muscles, making them more efficient.
Your muscles will require less oxygen to move and they will produce less
carbon dioxide. This will immediately reduce the amount of air you will need to
breathe in and out for a given exercise. Training also improves your circulation
and strengthens your heart. Exercise will improve your overall physical and
psychological well-being. It can decrease the risk of developing other conditions
such as stroke, heart disease and depression.
Regular exercise is also one of the most important interventions to prevent the
onset of type-II diabetes. What can I do to help my lungs cope with exercise?
The most important thing to do to keep your lungs healthy is to look after them.
Smoking will affect your ability to undertake physical activity and reach your
true potential. If you quit smoking, you are likely to be able to exercise for
longer as early as two weeks after your last cigarette.
People who follow high-intensity training regimes, or who regularly train in
certain environments, may be at risk of developing asthma, or a condition
known as bronchial hyper-responsiveness in which the airways become
obstructed after exercise. Scientists believe this is caused by harmful substances
in the environment in which they are training, such as chlorine in a swimming
pool, or cold dry air on a ski slope. Endurance athletes have the potential to
inhale more harmful substances into their lungs, as they are exposed to these
conditions for longer periods of time.
It is important that you are aware of the symptoms associated with lung
problems, such as cough, shortness of breath or fatigue, and that you see your
doctor about them as soon as possible. When you visit the doctor, you may be
asked to take a Spirometry test. This tests your breathing and can help in the
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diagnosis of lung problems. You will be asked to breathe into a device that
measures the amount of air in your lungs and how fast you can breathe out.
Exercising with a long-term lung condition People with long-term lung
conditions can help improve their symptoms through regular exercise. If you
have a long-term lung condition, the thought of becoming quickly out of breath
can be daunting and you may not feel motivated to exercise.
All exercise programmes must be built up over time to allow the body to adapt.
It‘s important that you exercise at your own pace. If you reach a stage where
you are too breathless to talk, then slow down the pace or if necessary take a
short pause. The more you do, the more you will be able to do! Intermittent
exercises can also help you to deal with the shortness of breath. In this case you
alternate brief exercise, lasting 1–2 minutes, with moments of rest (or slower
exercise). This is called ‗interval training‘.
Chronic Obstructive Pulmonary Disorder (COPD), results in damaged
airways. This means that when you breathe out your airways become narrowed
before you have got rid of all the air in your lungs. Many people with COPD
find that pursing their lips enables them to breathe out more slowly and
effectively.
You may also find it easier to walk with braced arms (for example leaning on a
shopping stroller, or even by grasping the belt of your trousers). Patients with
severe lung disease can benefit from using a wheeled walking aid. If you suffer
from severe COPD, you may have problems bringing enough oxygen into the
body. If this is the case, you may need to take supplementary oxygen during
your activity. Your doctor will be able to assess this before you begin a training
programme.
Asthma and wheezing: If you visit a doctor, they can help you control your
symptoms. If asthma is well-controlled, it is possible for you to exercise at the
same level as a healthy person. Your doctor may prescribe medicine to control
your symptoms. Inhaled steroids, a common drug used by people with asthma,
are the most important controller medication you can take.
If you are an athlete hoping to compete in competitions, you should check
whether your medication is listed as a performance-enhancing drug. Most
asthma drugs (including inhaled steroids) have no restrictions during
competitions, but it important to check each drug you are planning to take. By

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receiving the best treatment, as early as possible, you will have the best chance
of competing on equal terms with non-asthmatic competitors.
The circulatory system consists of your heart, blood vessels and blood, and is
responsible for transporting life-giving oxygen throughout your body. When
you exercise, your body's need for oxygen increases; the harder you work out,
the more oxygen your body demands. To ensure that sufficient oxygen is
available for your muscles during activity, your body makes short- and long-
term changes.
Exercise and the Heart: The heart -- referred to as the myocardium, meaning
heart muscle -- is a four-chambered pump about the size of your fist, located
slightly left of centre in your chest. Its job is to pump blood. When you exercise,
your heart rate can increase from a resting average of 72 to 200 beats per
minute, depending on your fitness level and age. As you get fitter, your heart
becomes stronger and your resting heart rate decreases.
Exercise and Blood Vessels: Blood vessels carry blood throughout your body.
Arteries take blood away from your heart; veins return blood to your heart, and
capillaries drop off and collect blood at your muscles and lungs. As you
exercise, the hormone adrenalin causes your blood vessels to expand to allow
passage of a greater-than-normal volume of blood. This is called vasodilation,
which is a short-term response to exercise and is one of the reasons your surface
blood vessels may become more prominent during exercise. A long-term
response to exercise is the building of new capillaries so more oxygen can be
delivered to, and more carbon dioxide can be removed from, your working
muscles.
Exercise uses up a lot of energy, which the cells derive from oxidizing glucose.
Both glucose and oxygen have to be delivered by the blood. This means that the
heart has to work harder to pump more blood through the body. This means it
has to beat faster in order to achieve a higher throughput, as described by this
equation:
Blood flow = Heart Rate X Stroke Volume
Heart rate for a human being at rest is about 70 beats/min. During vigorous
exercise, heart rate can increase dramatically (the rule of thumb given for
maximal heart rate is 220 minus your age). This will result in an increase in
blood flow. When you exercise, blood is diverted from non-essential organs,

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such as those involved with your digestive and reproductive systems, and into
your working muscles.
This is termed blood pooling and ensures that your working muscles get as
much oxygen as they need. Once you have finished your strenuous exercise, it is
important to encourage the pooled blood to move out of the muscles and back
into general circulation. This is commonly achieved by performing a cool-down
consisting of light cardiovascular exercise and stretching.
The circulatory system responds to an increased need for blood by adjusting the
width of the blood vessels, primarily the arterioles and venules. The dependence
of vessel resistance on the radius of the tube is described by Poiseuille‘s law. he
circulatory system exploits this property rather nicely, by constricting blood
flow the organs that need less oxygen during exercise and widening the
arterioles to the organs which need more.
For instance, the brain may use up to 30% of total blood flow while you're
doing your homework, but when you're at the gym less than 10% of total blood
flow goes through it. On the other hand, muscles use less than 10% of blood
flow when at rest, but can take up to 50% of it when they're working. This
regulation is an essential mechanism for delivering oxygen and glucose to the
tissues that need it most.
Short and long term effects of exercise on the heart and blood circulation:
Short term effect: One single period of sufficient physical activity may only
affect the heart and blood circulation during the activity itself - without having
significant longer-term effects. that means that some time, e.g.. a day, after a
short burst of moderate activity the heart and blood circulation may have
completely reverted to their state before (not during) the activity.
Long-term effect: Frequent regular physical activity has longer-term effects
than on-off periods of similar activity. this means that the effects of the exercise
on the heart and circulation continue to affect the body long after the exercise
itself has ceased. Example: after a while someone who plays active sports such
as football or rugby or soccer for at least an hour three days a week would
benefits from the effects of this exercise on the heart of the player and the
circulatory system during the other days of the week as well - not just while
actively participating in the sporting activity.

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Effect of exercise to the muscular system: Exercise works as a stimulus and

gives stress to muscles. Warming up is a short time activity carried out prior to
any severe or skilled activity. It is important to warm up before exercising
which is usually done by including ten minutes of light activities, such as slow
jog, calisthenics and stretching. Through such a workout, we try to bring the
group of muscles expected to take part in the activity to follow, in a state of
readiness to respond efficiently. It makes the body more flexible and thus we
can avoid injuries resulting from sudden strain etc.
When we stretch our muscles slowly, it results in increased blood flow and
prevents injuries to the muscles, tendons, ligaments. Warm up exercises are not
supposed to be done vigorously. Any light exercise such as spot jogging,
cycling at slow pace, walking can be done. Warming up also prevents fatigue,
muscle pulls and soreness. This preparation before a competition or training is
called warming up.
Physiological Basis of Warming up: When we observe the contraction and
relaxation of an isolated muscle, we note that when the muscle is warmed, the
speed with which the muscle contracts and relaxes and the force of contraction
are increased. We can see that when a muscle is stimulated repeatedly, then the
first few contractions are small and the feeling of relaxation is not satisfying.
Whereas, when the contractions become stronger the feeling of relaxation is
also complete. These points to the fact that warming up does produce
physiological changes in the working of a muscle and that warming up helps in
building a strong and efficient formation for the working of muscles.
Short term effects:
 Blood flow because of increased volume of blood that is pumped to muscle
tissue.
 Muscle fatigue is short-term decline in the ability of a muscle to generate
force.
Another way to describe muscle fatigue is as the short-term inability to
continue to repeat muscular contractions with the same force.
 Muscle exhaustion when exercise continues through muscle fatigue without
rest after time it can lead to muscle exhaustion.
 Muscle damage often happens, because of over-stretching without a proper
warming-up or no warming-up before intense exercise.

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 Cramp uncontrollable and very painful muscle contraction.

Long term effects:
 Muscle size increases mainly due to muscle ability to adapt to stress over a
period of time which increases them in size.
 Muscle coordination increases when doing exercises which require skill and
technique e.g.: dribbling ball.
 Blood supply to muscles increases due to long-term exercise by that
improving delivery of various nutrients, minerals and vitamins to muscles
and making them more effective and faster at regenerating after injury or
workout.
 Muscle size – is mostly determined by persons genetics, but can be affected
with life choices like: anabolic steroids, exercise, and healthy food.
Exercising specific muscles regularly can increase their size by up to 60%.
This increase in muscle size is mainly due to increased diameter of
individual muscle fibres.
 Muscle coordination – It trains muscles to work more efficient and
effectively by working together. E.g.: when the prime mover contracts more
rapidly the antagonist (muscle) must also relax as quickly to prevent
blocking the movement.
 Blood supply – As a result of frequent exercise over a sustained period of
time both the quantity of blood vessels and the extent of the capillary beds
increases.
 Effects of exercise on muscular system would benefit by increasing size and
number of mitochondria, improved perception of muscle tone and also
overall improved:
 Coordination
o Power
o Balance
o Speed
o Agility
o Body composition
o Reaction time
o Muscular endurance
o Flexibility

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Effects of exercise on skeletal system: It‘s important to exercise in order to

have strong and healthy skeletal system. It will help you to feel well and strong.
Skeletal system is important part of fitness, because if you don‘t have strong
skeletal system, your bones may easily break from simple fall or you can
develop a disease. If you have strong skeletal system you will have greater
chance to avoid injury and if you get injured, bones will fix the injury way
faster than unhealthy and weak skeletal system.
Increased Synovial Fluid Production: The bones and joints are avascular, that
is, they have little or no blood supply. To keep joints healthy, stop cartilage
from drying out and keep cartilage lubricated and nourished, the joints produce
an oil-like substance called synovial fluid. According to "Sports Injuries: Their
Prevention and Treatment, Third Edition" by Per Renstrom, synovial fluid is
produced by the synovial membrane within the joints and is a short-term or
acute response to exercise. This means that joints require regular exercise to
stay lubricated, nourished and healthy.
Increased Joint Range of Movement: Exercise increases the production of
synovial fluid, which keeps joints lubricated and makes them supple. Synovial
fluid production increases the range of movement available at the joints in the
short term. Often, after long periods of immobility, the joints ―dry out,‖ stiffen
up and lose some of their movement range. Exercise increases the range of
movement available at the joints as more lubricating synovial fluid is released
into them. Mobility exercises such as arm circles and knee bends keep joints
supple by ensuring a steady supply of synovial fluid.
Increased Bone Density: Weight-bearing exercise such as strength training and
running put stress through your bones. In response to this stress, bodies produce
cells called osteoblasts, which build new bone and make bones stronger and
denser. Increased bone density can, prevent a condition called osteoporosis,
which is the weakening of bone and an increased likelihood of suffering
fractures. Osteoporosis is more common in older females but can affect either
sex at any age.
Stronger Ligaments: The bones are held together with non-elastic avascular
strap or cord-like structures called ligaments. Without ligaments, the joints
would be very unstable and would probably bend the wrong way. When
exposed to regular exercise, ligaments become stronger and more resistant to

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injury. Because ligaments have no or a very poor blood supply, any adaptations
are very slow to develop.
Short term effects: On skeletal system would be increased amount of synovial
liquid, to keep joints healthy, stop cartilage from drying out and keep cartilage
lubricated and nourished, the joints produce an oil-like substance. Synovial fluid
production increases the range of movement available at the joints in the short
term. Mobility exercises such as arm circles and knee bends keep joints supple
by ensuring a steady supply of synovial fluid.
Long term effects: On the skeletal system would be increased bone density,
size and weight of bones. They become stronger and flexible. More resistant to
injuries and faster recovery after injury. Increased bone density can prevent a
condition called osteoporosis, which is the weakening of bone and an increased
likelihood of suffering fractures. Osteoporosis is more common in older females
but can affect either sex at any age. And also the bones are held together with
non-elastic avascular strap or cord-like structures called ligaments. Without
ligaments, the joints would be very unstable and would probably bend the
wrong way. When exercising for long periods of time, ligaments become
stronger and more resistant to injury.
Alternative exercises
Yoga (alternative medicine): Yoga is a healing system of theory and practice,
it is a combination of breathing exercises, physical postures, and meditation,
practiced for over 5,000 years. Yoga is a complementary therapy that has been
used with conventional medicine to help treat a wide range of health problems,
but it does not cure any disease.
Studies show that yoga may help the following conditions:
 Anxiety and stress
 Arthritis – osteoarthritis and rheumatoid arthritis
Yoga increases body awareness, relieves stress, reduces muscle tension, strain,
and inflammation, sharpens attention and concentration, and calms and centres
the nervous system.
Yoga‘s positive benefits on mental health have made it an important practice
tool of psychotherapy. Researchers found that yoga outperformed aerobic
exercise at improving balance, flexibility, strength, pain levels among seniors,

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menopausal symptoms, daily energy level, and social and occupation

functioning, among other health parameters.
Yoga does more than calm a person down, it makes you flexible. The research
studies have recorded the effects of practicing yoga on mental-health issues
ranging from depression, schizophrenia, ADHD, sleep complaints and eating
disorders to cognitive problems.
Embracing yoga as a complementary treatment for mental disorders is not
uncommon. Yoga is a physical exercise that involves different body poses,
breathing techniques, and meditation. The therapy may help with depression
and your symptoms, such as difficulty concentrating or loss of energy. Many
people use yoga therapy to manage: mental and emotional problems, such as
stress, anxiety, or depression.
Regular yoga practice can influence weight loss, but not in the ―traditional‖
sense of how we link physical activity to weight loss. Many yoga practices burn
fewer calories than traditional exercise (e.g., jogging, brisk walking);
however, yoga can increase one's mindfulness and the way one relates to their
body. Yoga can torch major calories! It builds muscle, which causes fat to melt,
and can also increase your heart rate, which aids in boosting your metabolism.
These poses are some of the best to burn calories.
―The relaxation techniques incorporated in yoga can lessen chronic pain, such
as lower back pain, arthritis, headaches and carpal tunnel syndrome,‖ explains
Dr. Nevins. ―Yoga can also lower blood pressure and reduce insomnia.‖ Other
physical benefits of yoga include: Increased flexibility. Yoga and
meditation can have many surprising benefits on both your mental and physical
health. Practising yoga improves balance, endurance, flexibility, and strength,
while meditation helps keep the mind sharp, relieves stress and anxiety, and can
strengthen your immune system.
Yoga is considered a mind-body intervention that is used to reduce the health
effects of generalized stress. Yoga is believed to calm the nervous system and
balance the body, mind, and spirit. It is thought by its practitioners to prevent
specific diseases and maladies by keeping the energy meridians open and life
energy or prana (Sanskrit) flowing. Yoga is usually performed for
approximately 45 minutes. Yoga has been used to lower blood pressure, reduce
stress, and improve coordination, flexibility, concentration, sleep, and digestion.

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Yoga is a discipline aimed at integrating a person‘s physical, mental and

spiritual fitness. Exercise means any physical activity that stimulates the vital
organs of the body, nourishes them and strengthens them. Yoga is an ancient
discipline which is followed across the world today. It first originated in India,
more than 6,000 years ago. Maharishi Patanjali, was one of the great ascetics in
his time. Patanjali compiled all his knowledge about the discipline of making
one‘s mind, body and soul into one, which translates to the science of
unification.
Yoga involves many sitting and standing exercises that have breath inhaling and
exhaling activities as their focus. These exercises are called as asanas. India‘s
great saint and philosopher, Swami Vivekananda is often credited for making
yoga a part of western civilization, and eventually all parts of the world, when
he disseminated this knowledge on his visit to the United States back in the year
1890. In present times, yoga‘s multiple branches are exclusively practised by
people aiming at their various individual goals achievable thereby.
Tai Chi is an ancient Chinese tradition that, today, is practiced as a graceful
form of exercise. It involves a series of movements performed in a slow,
focused manner and accompanied by deep breathing. Yoga includes various
physical postures and breathing techniques, along with meditation. In the
present day, it is common to have Taiji classes that do not actually teach
fighting, or may teach only push hands. Many Tai Chi techniques are used in
other forms of fighting like Sanda Kickboxing.
Tai Chi is a non-competitive martial art known for both its defence techniques
and its health benefits. As an exercise, it comprises gentle physical exercise and
stretching with mindfulness. It has been shown to improve balance control,
fitness, and flexibility, and to reduce the risk of falls in older people.
While this is a popular aspect of Tai Chi, Tai Chi was developed as a martial
art. It wasn't only a practice for health, but a critical skill for defending against
attackers and even for protecting the Chinese emperor against assassins. Tai chi,
practiced as a martial art, will teach you useful self-defence techniques.
Practising Tai Chi is a great way to build and tone muscles. In particular, the
legs are working continuously. In a typical 20-minute Taijiquan routine, you
may perform the equivalent of 100 lunges. The upper body also gets a great
workout, as this practice utilizes weights and other methods. This gentle form of

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exercise can help maintain strength, flexibility, and balance, and could be the
perfect activity for the rest of your life.
Tai chi is often described as ‗meditation in motion,‘ but it might well be called
medication in motion. Tai chi is very calming and peaceful. Tai chi also offers
plenty of other benefits. Recent studies have found that the slow, graceful
exercise, which originated centuries ago as a martial art, can improve balance,
reduce stress and offer arthritis pain relief.
Tai Chi for Posture and Back Pain: Tai Chi is a form of exercise that has
recently been gaining popularity as a way to relieve and/or manage back
pain and neck pain. These people are using the same Tai Chi principles and
movements created in ancient China and still practised all around the world as a
healing exercise.
New studies appear almost daily on the benefits of exercise, from lowering your
risk of heart disease to improving memory. Whether you exercise for strength,
endurance, or flexibility, the functioning of the body is related to physiological
functioning. As discussed the circulatory, digestive, endocrine, excretory,
immune, integumentary, muscular, nervous, respiratory, and skeletal systems.
Then, we looked at both the long-term and short-term effects of exercise on
these systems. heart rate increases with physical activity to supply more
oxygenated blood to your muscles. The fitter you are, the more efficiently your
heart can do this, allowing you to work out longer and harder.
As a side effect, this increased efficiency will also reduce your resting heart
rate. Exercise affects the brain on multiple fronts. It increases heart rate, which
pumps more oxygen to the brain. It also aids the bodily release of a plethora of
hormones, all of which participate in aiding and providing
a nourishing environment for the growth of brain cells. More blood is pumped
to the exercising muscles to deliver that additional O2. Without enough oxygen,
lactic acid will form instead. Lactic acid is typically flushed from
the body within 30 to 60 minutes after finishing up a workout. Tiny tears form
in the muscles that help them grow bigger and stronger as they heal.
Isometric exercise: During isometric exercises, muscles contract. However,
there is no motion in the affected joints. The muscle fibres maintain a constant
length throughout the entire contraction. The exercises usually are performed
against an immovable surface or object such as pressing one's hand against a
wall. The muscles of the arm are contracting but the wall is not reacting or
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moving in response to the physical effort. Isometric training is effective for

developing total strength of a particular muscle or group of muscles. It often is
used for rehabilitation since the exact area of muscle weakness can be isolated
and strengthening can be administered at the proper joint angle. This kind of
training can provide a relatively quick and convenient method for overloading
and strengthening muscles without any special equipment and with little chance
of injury.
Isotonic exercise differs from isometric exercise in that there is movement of a
joint during the muscle contraction. A classic example of an isotonic exercise is
weight training with dumbbells and barbells. As the weight is lifted throughout
the range of motion, the muscle shortens and lengthens. Calisthenics are also an
example of isotonic exercise. These would include chin-ups, push-ups, and sit-
ups, all of which use body weight as the resistance force.
Isokinetic exercise Isokinetic exercise utilizes machines that control the speed
of contraction within the range of motion. Isokinetic exercise attempts to
combine the best features of both isometrics and weight training. It provides
muscular overload at a constant pre-set speed while a muscle mobilizes its force
through the full range of motion. For example, an isokinetic stationary bicycle
set at 90 revolutions per minute means that no matter how hard and fast the
exerciser works, the isokinetic properties of the bicycle will allow the exerciser
to pedal only as fast as 90 revolutions per minute.
Cardiac rehabilitation: Exercise can be very helpful in prevention and
rehabilitation of cardiac disorders and disease. With an exercise programme
designed at a level considered safe for the individual, people with symptoms of
heart failure can substantially improve their fitness levels. The greatest benefit
occurs as muscles improve the efficiency of their oxygen use, which reduces the
need for the heart to pump as much blood.
While such exercise does not necessarily improve the condition of the heart
itself, the increased fitness level reduces the total workload of the heart. The
related increase in endurance also should translate into a generally more active
lifestyle. Endurance or aerobic routines, such as running, brisk walking, cycling,
or swimming, increase the strength and efficiency of the muscles of the heart.
Preparation: A physical examination by a physician is important to determine
if strenuous exercise is appropriate or detrimental for an individual, especially
when the exercise program is designed for rehabilitation. Before exercising,
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proper stretching is important to prevent the possibility of soft tissue injury

resulting from tight muscles, tendons, ligaments, and other joint-related
structures.
Aftercare: Proper cool down after exercise is important in reducing the
occurrence of painful muscle spasms. Proper cool down stretching also may
decrease frequency and intensity of muscle stiffness the day following any
exercise program.
Risks: Improper warm up can lead to muscle strains. Overexertion without
enough time between exercise sessions to recuperate also can lead to muscle
strains, resulting in inactivity due to pain. Stress fractures also are a possibility
if activities are strenuous over long periods without proper rest. Although
exercise is safe for the majority of children and adults, there is still a need for
further studies to identify potential risks.
Normal results: Significant health benefits are obtained by including a
moderate amount of physical exercise in the form of an exercise prescription.
This is much like a drug prescription in that it also helps enhance the health of
those who take it in the proper dosage. Physical activity plays a positive role in
preventing disease and improving overall health status. People of all ages, both
male and female, benefit from regular physical activity. Regular exercise also
provides significant psychological benefits and improves quality of life.
Abnormal results: Exercise burnout may occur if an exercise program is not
varied and adequate rest periods are not taken between exercise sessions.
Muscle, joint, and cardiac disorders have been noted among people who
exercise. However, they often have had pre-existing or underlying illnesses.
Advantages: Significant health benefits are obtained by including a moderate
amount of physical exercise in the form of an exercise prescription. This is
much like a drug prescription in that it also helps enhance the health of those
who take it in the proper dosage. Physical activity plays a positive role in
preventing disease and improving overall health status. People of all ages, both
male and female, benefit from regular physical activity. Regular exercise also
provides significant psychological benefits and improves quality of life.
Whether you are overweight and trying to lose weight or want to improve your
physical fitness, well-being and quality of life, exercise can be part of the
equation. Gradually building up to a regular exercise routine has many benefits,
but sometimes it's easy to fall into some of the disadvantages associated with
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exercise. By obtaining your doctor's approval beforehand and creating a solid

game plan, you can make sure you'll enjoy the advantages of exercise.
Regular exercise can make you look better. Whether you want to lose weight,
improve muscle tone, increase muscle mass or simply maintain your current
physique, exercise -- often paired with a healthy, well-balanced diet -- can do
the trick. By keeping your body well-conditioned, you're less likely to have
physical limitations. Everyday activities, like carrying grocery bags, climbing
stairs and mowing the lawn, are done with ease, and your athletic performance
might also improve.
Disadvantages: Exercise burnout may occur if an exercise program is not
varied and adequate rest periods are not taken between exercise sessions.
Muscle, joint, and cardiac disorders have been noted among people who
exercise.
Impulsively starting to exercise, overdoing it and neglecting to rest can expose
you to the adverse effects of exercise. In addition to being more likely to suffer
injuries, exercising too much can leave you feeling weak, tired and dehydrated.
According to Washington and Lee University, over-exercising can also trigger
heart problems, osteoporosis and arthritis as well as problems conceiving and
loss of the menstrual cycle in women. In general, it's expert-recommended to do
at least 150 minutes of moderate cardio per week and include strength training
on two days.
Time and money should not be considered to be disadvantage. If you are
cramped for time, you can split up your workout into two or three sessions over
the day to better fit your schedule, or you can exercise at a vigorous intensity
and cut your workout in half. As for money, you can exercise right at home or
outside. Go for a brisk walk through the mall or park or walk up and down a
staircase. Small lifestyle changes can have a big impact.

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UNIT V

FOOD AND NUTRITION

Basic Nutrients are chemical substances in food that provide energy, act as
building blocks in forming new body components, or assist in the functioning of
various body processes. Food from each of six food groups: grains, vegetables,
fruits, milk products, meat and beans, and oils provide the necessary building
blocks of the human body. The six classes of nutrients are:
 Proteins
 Carbohydrates
 Fats
 Minerals
 Vitamins
 Water
A person should regularly eat or drink enough of all of these nutrients to grow
and remain healthy. For infant nutrition, mother‘s milk itself provides an ideal
balance of nutrients, with the gradual introduction of solid foods after four to six
months of age. If a variety from all food groups is eaten regularly, it is not
usually necessary to take supplements. Even carefully chosen vegetarian diets
that include dairy products or eggs can be quite sufficient. But if little or no
animal products are eaten, then grains must be eaten with legumes (beans, peas,
peanuts, and lentils), nuts, and seeds to provide balanced protein. Food and
drink must also be clean and free from disease-causing germs (bacteria, viruses,
and parasites) to be healthy.
Balanced Nutrition includes drinking plenty of clean water and regularly
eating foods which will provide
energy to do daily tasks without
difficulty. Nutrition is best
balanced by eating the correct
amounts of a large variety of
foods. This provides the protein,
carbohydrates, fats, minerals, and
vitamins needed for a healthy
body. The right amounts of water

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and exercise are also critical to good health. A balanced diet is often represented
by different symbols
 A wheel, plate, or circle symbol suggests a balance of foods is desirable.
 The rainbow symbol emphasizes variety.
 A pyramid symbol recommends the number of servings from various food
groups decreases from a solid foundation at the bottom (or the base) to the
top.
Different cultures may use different symbols of healthy food intake based on
foods available to them. All symbols have in common a variety of food intake
from different food groups. Certain vegetables such as potatoes also provide
carbohydrates and some vegetable protein, which needs to be eaten with another
protein food to be complete. Fruits provide different vitamins, minerals, and
fibre. They also provide sugars for quick energy.
Many factors affect nutrient needs and nutrient availability.
1. Physical condition
2. Nutritional status
3. Age
4. Genetic background
Purpose of Nutrition: Proper nutrition is a vital consideration to maximize
health and personal efficiency. Just as using the proper gasoline, oil, or radiator
fluid, is important for your vehicle, eating the proper food will directly affect
how the body will function. A proper diet will provide the necessary raw
material to allow bones and muscle to build and run the human machine. It will
provide the proper nutrients and energy for growth and healing. Good nutrition
promotes a healthier mind and body. It aids resistance to illnesses and provides
energy. The right foods help the athlete to:
1. Feel healthy
2. Sleep well
3. Speed the healing process when ill or injured.
Components of the Nutrition Pyramid: A person must find the balance
between food and physical activity. One should be physically active for 30
minutes most days of the week. Most children and teenagers should be
physically active for 60 minutes every day or most days of the week.

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Moderation: It is represented by the narrowing of the each food group from

bottom to top. The wider base stands for food with little or no solid fats or
added sugars. These should be selected more often. Narrow top stands for foods
containing more added sugars and solid fats. The more active you are, the more
of these foods can fit into your diet
Proportionality: This is represented by the different widths of the food group
bands. It suggests how much food a person should choose from each group.
Variety: This is represented by the 6 colour bands for the 5 food groups and
oils. It illustrates that foods from all groups are needed each day for good health
The Groups of the Pyramid
1. Grains
a. Eat 6 oz. every day. Grains include bread, cereal, pasta, crackers, rice or
pasta. Look for “whole” before the grain name on the list of ingredients. At
least 3 oz. should come from whole grains.

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Examples of 1oz. grains:

 1 slice of bread
 5 whole wheat crackers
 1 cup cooked oatmeal
 1 pancake
2. Vegetables
a. Eat 2 to 3 cups per day
b. Eat more dark green vegetables
c. Eat more orange vegetables
d. Eat more dry beans and peas
3. Fruits
a. Eat about 2 cups per day
b. Eat a variety of fruits
c. Choose fresh, frozen, canned, or dried fruit
d. Go easy on fruit juices. They do not contain fiber
4. Oils
a. Make most of your fat sources from fish, nuts, and vegetable oils
b. Limit solid fats like, lard, stick margarine, shortening, and butter.
5. Milk, Water and liquids
a. Drink 3 cups per day
b. Go low fat or fat free
c. If milk cannot be consumed, choose other calcium sources
6. Meats and Beans
a. Eat about 6oz each day
b. Choose low fat or lean meats and poultry
c. Bake it, broil it, or grill it
d. Vary your choices – with more fish, beans, peas, nuts, and seeds.
Food must be eaten in proper amounts to maintain good health. Eating disorders
are serious, negative eating behaviours that can be fatal if untreated. Generally,
obesity results from eating more while malnutrition results from eating less food
than needed for growth, maintenance, and daily activity. Daily energy needs can
be estimated based on age, height, weight, and level of activity. The body mass
index (BMI) can be a useful measure of the degree of under-nutrition or over-
nutrition.

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Promoting nutrition: A healthy and well-balanced diet is essential for good

health. When there is not enough food, or if the diet does not contain the right
balance of foodstuffs, people become more prone to illness and may become
undernourished or malnourished. Children, in particular, are vulnerable to poor
nutrition. Undernourishment and malnourishment can lower their resistance and
make them more likely to suffer from infectious diseases. Often, children will
eat only small amounts of food if it is spicy, even if it is nutritious, and it is
important to make children‘s food less spicy than adult food.
Also, because their stomachs are small, children can eat only small portions and
need to be fed more frequently than healthy adults. It is also important that
children are fed not just foods high in starch or carbohydrate (for instance rice
or cassava). Although these foods can quickly make a child feel full, he or she
may become malnourished if other key foodstuffs are not eaten. A well-
balanced diet usually has a mixture of food with protein (for example beans,
peas, meat, fish or eggs), carbohydrates (such as maize, potatoes, cassava, rice
and many other staple foods), vitamins (such as vegetables, fish, fruits or milk),
and some fats or oils (such as cooking oil).

Sometimes not all these foods are available and it is important that community
members ask health workers how to make best use of available foods for a
balanced diet. In many situations, nutrition can be improved by changing
agricultural or gardening practices. Often, even small plots of land can provide
nutritious food provided that the right crops are grown. Health workers or
agricultural extension workers can be asked for advice about which crops to
grow to provide community members with well-balanced diets. It is not possible
here to give a full discussion of the nutritional value of foods, or of what
constitutes a well-balanced diet.

However, it is important that communities request advice and support for

improving nutrition. The term 'food' brings to our mind countless images. We
think of items not only that we eat and drink but also how we eat them and the
places and people with whom we eat and drink. Food plays an important role in
our lives and is closely associated with our existence. It is probably one of the
most important needs of our lives. The food that we eat is composed of small
units that provide nourishment to the body. These are required in varying
amounts in different parts of the body for performing specific functions.

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This means that good nutrition is essential for good health. However, if our diet
provides the important units in incorrect amounts, either very less or in excess
of what is required, it results in an imbalance of nutrients in your body. The
condition is responsible for various deficiency diseases and slow or no growth
of the body. In this lesson you will learn about why food is essential, its
functions and components. You will also be introduced to the terms like
‗nutrition‘ and ‗nutrients‘. After learning the meaning of these terms, you will
then learn the sources and functions of the nutrients and the amounts required
by different individuals
Today, consumers are seeking foods that are sustainably produced, safe, tasty,
convenient, natural, healthy and good value. There is a large and international
food industry using science and technology to meet these demands. This
industry needs graduates with a fundamental scientific and technical knowledge
of food ingredients and products, along with a thorough understanding of the
science of how food helps us to optimise performance, avoid disease and enjoy
a good quality of life as we age
There are basically three important functions of food:
1. Social Function: Food and eating have significant social meaning. Sharing
food with any other person implies social acceptance. Food is also an
integral part of festivity everywhere in the world. Food also has a specific
significance and meaning in the religious context.
2. Psychological Function: We all have emotional needs, such as need for
security, love and affection. Food is one way through which these needs are
satisfied.
3. Physiological Function: There are three physiological functions performed
by food. These are energy giving, body building, regulating body processes
and providing protection against diseases. Let us see them in detail.
(i) Food provides energy: Everybody needs energy to do work. Energy is
required for walking, studying, eating, working in the house or outside.
You get this energy from the food that you eat. You need energy even
when you are resting. Different organs inside your body are always
working, for example, heart is pumping blood, stomach is digesting
food, lungs are breathing in air, etc. All these organs need energy for
their respective functions and food provides that energy.

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(ii) Food helps in body building: Have you ever wondered how a small
child grows into an adult? Our body is already made up of thousands of
small cells. New cells are added to these to help the body to grow. Food
is needed for the formation of new cells. Cells also die or are damaged
due to injury. New cells need to be formed and this repair work is done
with the help of food.
(iii) Food regulates body processes and provides protection against
diseases: Regulatory functions refer to the role of food in controlling
body processes, for example, our body temperature is maintained at
98.6° F or 37° C. Similarly, the heart beats are also maintained at 72
beats/minute. Excretion of waste products from the body is also regular.
If not, the body suffers from a disease called constipation which can lead
to further complications. All these processes are regulated by the food
that you eat. The food that we eat gives us strength to fight against
disease germs.
Nutrition and Nutrients: The meaning of nutrition. All of us eat food. Food
provides nourishment to the body and enables it to stay fit and healthy. The food
that we eat undergoes many processes, like, first the food is digested, then it is
absorbed into blood and transported to various parts of the body where it is
utilized. The waste products and undigested food are excreted from the body.
Nutrition is the process by which food is taken in and utilized by the body. It
has five stages which are
 Eating
 Digestion
 Absorption
 Transportation
 Utilization
Nutrients and their Functions: We all know that food helps in the
nourishment and health of our body. The nourishment is brought about by small
units called nutrients present in food. Nutrients are the chemical substances
present in food and are responsible for nourishing the body. Nutrients are of two
types:
1. Macronutrients
2. Micronutrients

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Both macronutrients and the micronutrients are equally essential for good
health. Each nutrient plays a significant role in the body.
Macronutrients: These are present in large quantities in foods and are also
required in large amounts by the body. Carbohydrates, proteins, fats and oils are
macronutrients.

Carbohydrates
Available carbohydrates: Carbohydrates are present in a large quantity as
starch in cereals, legumes, pulses and potatoes. They are present as simple
carbohydrates in sugar, fruits, honey and milk. Starch and sugars are easily
digested and provide energy to the body.
Unavailable carbohydrates or dietary fibre: They are present in the form of
cellulose and hemicellulose which are not digested in our body. They add bulk
to the stool and help in easy defecation process. Energy can be derived from
carbohydrates, fats and proteins and it is measured in kilo calories. However,
carbohydrates are cheapest sources of energy. If there is a short supply of
carbohydrates and fats in our body, proteins are utilized for energy production.
Function of proteins is to provide for body building. Therefore, carbohydrates
have to be consumed in proper amounts to spare proteins for body building
purpose.
Functions of carbohydrates are:
 Carbohydrates provide energy.
 Carbohydrates are the main source of energy.
 Carbohydrates spare proteins for body building function.
 Dietary fibre increases the bulk in stool and helps in defecation
Proteins: Protein are needed in the body for body building. 1 gm of protein
gives 4kcal of energy. Proteins are made up of smaller units known as amino
acids. There are all together 22 amino acids, out of which there are 8 amino
acids which our body cannot manufacture. Rest of the amino acids can be
manufactured by the body. Essential amino acids are those which our body
cannot manufacture and hence have to be supplied through the diet. Non-
essential amino acids are those amino acids which our body can manufacture.
Functions proteins: When the body does not get enough carbohydrates or fats
to meet its energy needs, proteins are broken down to supply these calories.

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When proteins are used for energy they are not available for other vital
functions.
(i) Needed for growth, maintenance and repair of tissues.
(ii) Necessary for production of enzymes, hormones, antibodies, haemoglobin,
etc.
(iii) Help in the clotting of blood
(iv) Provide energy, if necessary
Sources of Proteins: Meat, poultry, fish, eggs - Milk, cheese, paneer, curd -
soybeans, peas, pulses, - cereals, nuts and oilseeds like til, groundnuts, etc.
Special features
(i) Animal proteins, i.e., proteins from meat, eggs, milk, etc., are better than
vegetable proteins, i.e., proteins, from pulses, cereals, etc. This is because
proteins from vegetable sources do not contain all essential amino acids.
(ii) Including two or more sources of vegetable proteins in each meal helps to
improve the quality of proteins and their utilization.
Fats and Oils: Fats and oils are the concentrated source of energy in our diet. 1
gm. of fat gives 9 kcal of energy. Fats are made up of small units called fatty
acids. The nature of fats is dependent on the type of fatty acids present. Fatty
acids may be saturated or unsaturated. Saturated fatty acids are found in solid
fats whereas oils contain more of unsaturated fatty acids. Vegetable oils are rich
in unsaturated fatty acids. There is a difference between fats and oils. If a
substance is liquid at room temperature it is called oil and if it is solid at the
room temperature, it is known as fat.
Functions and sources of fats and oils Functions
 Provide concentrated source of energy
 Reduce the use of proteins for energy
 Carry fat soluble vitamins (A, D, E, K) into the body and help in the
absorption of these vitamins
 Help to maintain body temperature. The layer of fat under the skin helps to
conserve body heat
 Act as a cushion to certain vital organs
 Help in growth of tissues

Sources: Cooking oils, ghee, butter - Oilseeds, nuts - Meat, poultry, fish, eggs -
Whole milk, cheese

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Special features
(i) Fats improve the texture as well as absorb and retain flavours making meals
more appetizing.
(ii) Fats have properties that help them to remain in the stomach longer and
prolong the feeling of fullness.
Micronutrients: Other important nutrients which are present in small quantities
in foods but are essential for our body are called micronutrients. These are
minerals and vitamins and are required in very small quantities. If these
micronutrients are not eaten in required amounts, it results in deficiency
diseases.

Minerals and vitamins are called micronutrients

1. Vitamins: The body contains very little quantity of vitamins, however, you
will be surprised to know that they are responsible for all the major functions of
the body. These vitamins are of two types:
(i) Fat soluble: A, D, E and K
(ii) Water soluble: B and C
2. Minerals: They constitute a very small amount of the total body tissues.
However, these are essential for many vital processes and also for the
maintenance of the body. In total, there are about 19 minerals required by the
body in various amounts. Let us now study some of the important minerals.
Calcium: Calcium and phosphorus are available in sufficient quantities in milk,
curd, green leafy vegetables, ragi and oil seeds. Other foods also provide fair
quantity of calcium. The major function of calcium is the formation and
development of bones and teeth. Calcium is also required in blood clotting and
muscular contraction.
3. Calcium and phosphorus are available in sufficient quantities in milk,
curd, green leafy vegetables, ragi and oil seeds. Other foods also provide fair
quantity of calcium. The major function of calcium is the formation and
development of bones and teeth. Calcium is also required in blood clotting and
muscular contraction. Calcium is necessary for bone formation, blood clotting
and muscular contraction
Deficiency of calcium in the body results in poor bone development,
particularly in children, women and elderly. The deficiency disease is known as
osteoporosis. In this, the bones become brittle and people become prone to
frequent fractures.

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4. Iron is required in very small quantity by the body. It is an important

material present in haemoglobin which is a part of red blood cells and is
responsible for the red colour of blood. Whole grain cereals and pulses are the
major sources of iron in our diet. Other sources of iron are green leafy
vegetables, egg yolk, liver and meat. In our country, majority of the population,
especially women and children, suffer from iron deficiency disease called
anaemia. Young girls (12-18 yrs.) need move iron rich foods in their diets
because of loss of iron during the menstrual cycle. Extra iron is also needed
during pregnancy for healthy development and growth of the focus. This is not
because people do not consume food which are rich in iron but because the
absorption and utilization of iron is poor. This is due to the presence of certain
naturally occurring constituents in food called oxalates and phytates. These
oxalates and phytates are called inhibitors of iron. Vitamin C and proteins help
in better absorption of iron and are known as enhancers of iron. Iron is essential
for haemoglobin formation.
5. Iodine is an important substance present in thyroxine hormone produced
from thyroid gland. Thyroxine regulates various functions of the body. We get
iodine from water and food. The foods which grow in iodine rich soil provide
iodine. Sea foods are also rich in iodine. Iodine deficiency disorder is known as
goitre or enlargement of the neck region. Deficiency of iodine causes mental
retardation in children. Recent studies have shown a direct link between iodine
deficiency and academic performance of children. Iodine deficiency disorders
have been identified in many parts of the developing world.
Iodine is necessary for growth and development. To avoid goitre we must have
iodine rich food sources in our daily meals. Iodized salt is a good source of
iodine and we must consume it instead of the non-iodized salt. Make iodized
salt a part of your daily diet.
Certain food stuff like cabbage, cauliflower, radish, ladies finger, oilseeds etc.,
contains substances known as goitrogens which interfere with the body‘s ability
to produce and use thyroxine. These goitrogens are destroyed on cooking.
Therefore, these foodstuffs should be cooked before eating.
6. Water is the major constituent of our body. It forms about two-thirds of the
body weight. We can do without food more readily than water. It is present in
all the cells, being a vital part of all living tissues. It surrounds tissues and
organs, and gives protection from shock.

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Water helps in digestion, absorption and transportation of nutrients in the body.

It helps to excrete unwanted materials in the form of urine and maintains body
temperature through perspiration. Normally, we need to drink 6-8 glasses of
water every day. Other forms in which we can receive water are milk, juice,

Nutritional requirements are influenced by:

 Age
 Height/weight
 Sex
 Climatic condition
 Health
 Occupation
 Physiological condition
A sedentary worker needs lesser calories than a person performing heavy work?
There is a difference in energy requirements of males and females as well as
physically fit or sick persons. Notice the difference in nutritional requirements
of a woman during pregnancy and lactation and between boys and girls, men
and women.
Variations in energy needs according to activity are indicated in adult stage.
Special requirements of pregnancy and lactation are also covered in the
recommendation. A liberal margin of safety is provided in the recommended
allowances to cover individual differences for need of the nutrients.
Nutrition is a scientific discipline in which food is a major focus of interest. The
simplest definition of nutrition is the study of what happens to food once it
enters the mouth and thereafter. A more formal definition of nutrition is study of
processes by which the living organism receives and utilizes the materials
necessary for growth, renewal and maintenance
of body components. All foods contain some
essential substances which perform important
functions in our body. These essential substances
contributed by our food are called nutrients.
These nutrients help us to maintain our body
functions, that is, to grow and to protect our
organs from diseases and infections.

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The health of a person depends on the type and quantity of food stuff eaten.
Good nutrition is essential for a person to grow and develop normally and to
remain healthy throughout life. When a person does not eat proper food, the
body does not develop normally. There are chances that some organs of the
body may start malfunctioning or there may be some disease. Poor nutrition also
influences the mental and social well-being adversely.

Fat Soluble Vitamins: Functions and Sources

Nutrients Functions Sources
Vitamin A Essential for proper Liver, eggs, fish liver oils.
functioning of eyes, Milk and its products
that is, vision in dim light Green leafy vegetables, etc.

Necessary for healthy skin and Yellow or orange fruits and

linings of nose, mouth, throat, vegetables such as pumpkin,
eyes, ears, lungs and other organs carrot, papaya, mango, etc.
Vitamin D Necessary for formation and Exposure of skin to sunlight
maintenance of strong, healthy teeth (When the body is exposed to the
and bones sun rays, a substance in the skin is
converted into vitamin D and
Helps in the proper absorption and transferred to the blood stream)
utilization of calcium and Eggs, liver, fish liver oils
phosphorus in the body Milk, butter
Refined oils and ghee fortified
with vitamin D
Vitamin E Prevents destruction of certain All cereals, pulses,
substance in presence of vegetables oils
oxygen
Formed in the intestines by
Vitamin K Necessary for clotting of blood
bacteria normally present there
Green leafy vegetables, egg,
liver

Water Soluble Vitamins: Functions and Sources

Nutrients Functions Sources
Vitamin B Complex Necessary for Liver, poultry, meat, fish, eggs
utilisation of Whole grain cereals and pulses
There are eight B vitamins. carbohydrates in the Green leafy vegetables and milk
Together they are called body
vitamin Necessary for normal
B- complex. These are: functioning of nervous
thiamine B system
Riboflavin B, Niacin Essential for proper
2

growth

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Helps body organs to

function normally
Needed for formation
of red blood cells
Helps in digestion and
improves appetite
Vitamin C Necessary for the Citrus fruits like orange, lemon,
formation of substance guava, etc;
that help cells together Green leafy spinach, cabbage
Needed for strong teeth vegetables,
and bones. Sprouted pulses such as lentils
Helps in the production
of haemoglobin
Helps in the utilisation
of other nutrients in the
body
Helps in fighting germ
causing diseases

Good nutrition is a prerequisite for good health: Vitamin deficiency occurs

when there is insufficient or poor dietary intake of essential vitamins.
Inadequate levels of vitamins may result in an array of miserable conditions and
make the body feeble and vulnerable to many diseases.
Types of Vitamin Deficiency: Vitamin deficiency can be classified into two
types:
Primary deficiency is when an inadequate vitamin intake causes a person to
become deficient. It is due to not receiving the necessary levels of a vitamin
from your diet and this type is basic; it can be easily cured by adopting a special
vitamin diet or taking vitamin supplements.
Secondary deficiency happens when a deficiency occurs as a result of a disease
or lifestyle factor, this is called secondary deficiency. For example, smokers
need to increase their intake of vitamin C by 30-50%. Another example is when
someone‘s lifestyle causes them to get minimal sun exposure which causes a
deficiency in their vitamin D levels. This deficiency can affect the calcium
absorption needed for healthy bones.
Common Causes of Vitamin Deficiency: Disorders related to vitamin
deficiency are uncommon in developed nations due to an adequate food supply.
However, there are other factors that may give rise to these conditions.
 Diets low in fat reduces the absorption of vitamin E.

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 Alcohol consumption has an impact on folic acid levels.

 Medications can also cause vitamin deficiencies.
 Certain antibiotics such as isoniazid can cause B6 deficiency.
 Anticonvulsants can decrease absorption of Folic acid and drugs which can
interfere with folic acid metabolism.
Vitamin deficiency can lead to severe diseases
Primary vitamin deficiency when left untreated may expand and result in a
serious disease. Although there are so many different diseases that are linked to
the integrated deficiency of vitamins, the four most common diseases are as
follows:
Scurvy is a disorder of vitamin deficiency arising from a lack of vitamin C, also
known as ascorbic acid. Vitamin C is essential for immune function, wound
healing and collagen production. Collagen is a necessary component of
connective tissue in your bones, cartilage, skin and ligaments. Therefore,
vitamin C plays an important role in keeping your skin and bones healthy. It
also helps maintain healthy gums and teeth. Scurvy affects all these tissues.
Symptoms include gum disease, swollen and bleeding gums, loose teeth,
bruising of your skin, pain in your joints, slow wound healing, and general
weakness. Scurvy often occurs in elderly people with poor nutrition.
Rickets is a vitamin deficiency disorder caused by a lack of vitamin D. The job
of vitamin D in your body is to promote the growth and development of your
bones. It does this by helping your body absorb calcium from either a dietary
source or from a dietary supplement. Rickets manifests as skeletal deformities
with bowlegs and scoliosis which is a curvature in the spine; retarded growth;
soft and weak bones, resulting in bone fractures; decreased muscle tone; and
dental cavities. According the Centre for Disease Control and Prevention, the
prevalence of rickets is five cases for every million in children ranging from 6
months to 5 years old. It is recommended that breastfed babies receive
supplementation of vitamin D starting from the first month of birth to prevent a
vitamin D deficiency.
Pellagra is a deficiency disorder caused by a lack of vitamin B3, also known as
niacin or nicotinic acid. Vitamin B3 helps your body convert food to energy and
is important for your nerve health. Pellagra is not very common in developed
countries. However, alcoholics and malnourished people tend to be more at risk

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for developing this deficiency. Pellagra is characterised by a dark red rash

covering your face, neck, feet, hands and calves. Your mouth and tongue may
also be red, swollen and full of sores. You may suffer from diarrhoea, nausea,
vomiting or constipation. You may have trouble sleeping or feel extremely tired.
Beriberi is a vitamin deficiency disorder caused by a lack of vitamin B1, also
known as thiamine. Vitamin B1 is necessary for converting food to energy,
memory, brain and cognitive functions, nerve health, and the formation of blood
cells. Beriberi is rare, but alcoholics have a greater chance of developing it.
Symptoms of beriberi include numbness or tingling in your hands and feet, leg
swelling, possible paralysis, problems speaking, confusion, memory loss,
feelings of depression and trouble breathing. If beriberi is not treated, it could
result in a form of dementia or death.
Mineral deficiency: Minerals are specific kinds of nutrients that your body
needs in order to function properly. A mineral deficiency occurs when your
body doesn‘t obtain or absorb the required amount of a mineral. The human
body requires different amounts of each mineral to stay healthy. Specific needs
are outlined in Recommended Daily Allowances (RDA). The RDA is the
average amount that meets the needs of about 97% of healthy people. They can
be obtained from food, mineral supplements, and food products that have been
fortified with extra minerals.
A deficiency often happens slowly over time and can be caused by a number of
reasons. An increased need for the mineral, lack of the mineral in the diet, or
difficulty absorbing the mineral from food are some of the more common
reasons. Mineral deficiencies can lead to a variety of health problems,
Vitamin deficiency can be both mild and deadly in effect. It is always a better
option to incorporate a routine healthy eating regimen to avoid deficiencies of
any of the essential vitamins. Among all the key vitamins that play some role
for the well-being of human health, vitamin B-complex and vitamin D are
critical. Make sure you are getting enough of them and look for supplements if
your levels are not improving with a planned diet.
Malnutrition results from a poor diet or a lack of food. It happens when the
intake of nutrients or energy is too high, too low, or poorly balanced.
 Under nutrition can lead to delayed growth or wasting, while a diet that
provides too much food, but not necessarily balanced, leads to obesity. In
many parts of the world, under nutrition results from a lack of food. In some
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cases, however, undernourishment may stem from a health condition, such

as an eating disorder or a chronic illness that prevents the person from
absorbing nutrients.
According to the World Health Organization (WHO), malnutrition is
the gravest single threat to global public health. Globally, it contributes
to 45% of deaths of children aged under 5 years. WHO refers to
Malnutrition as deficiencies, excesses or imbalances in a person‘s intake of
energy and/or nutrients. The term malnutrition covers 2 broad groups of
conditions.
 One is ‗under nutrition‘—which includes stunting (low height for age),
wasting (low weight for height), underweight (low weight for age) and
micronutrient deficiencies or insufficiencies (a lack of important vitamins
and minerals).
 Two is overweight, obesity and diet-related non-communicable diseases
(such as heart disease, stroke, diabetes and cancer).
Malnutrition involves a dietary deficiency. People may eat too much of the
wrong type of food and have malnutrition, but this article will focus on under
nutrition, when a person lacks nutrients because they do not consume enough
food.
Poor diet may lead to a lack of vitamins, minerals, and other essential
substances. Too little protein can lead to kwashiorkor, symptoms of which
include a distended abdomen. A lack of vitamin C can result in scurvy.
According to the World Health Organization (WHO), 462 million people
worldwide are malnourished, and stunted development due to poor diet affects
159 million children globally. Malnutrition during childhood can lead not only
to long-term health problems but also to educational challenges and limited
work opportunities in the future. Malnourished children often have smaller
babies when they grow up. It can also slow recovery from wounds and illnesses,
and it can complicate diseases such as measles, pneumonia, malaria,
and diarrhoea. It can leave the body more susceptible to disease.
Consequences of Malnutrition: Malnutrition affects people in every country.
Around 1.9 billion adults worldwide are overweight, while 462 million are
underweight. An estimated 41 million children under the age of 5 years are
overweight or obese, while some 159 million are stunted and 50 million are

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wasted. Adding to this burden are the 528 million or 29% of women of
reproductive age around the world affected by anaemia, for which
approximately half would be amenable to iron supplementation.
Many families cannot afford or access enough nutritious foods like fresh fruit
and vegetables, legumes, meat and milk, while foods and drinks high in fat,
sugar and salt are cheaper and more readily available, leading to a rapid rise in
the number of children and adults who are overweight and obese, in poor as
well as rich countries. It is quite common to find under nutrition and overweight
within the same community, household or even individual – it is possible to be
both overweight and micronutrient deficient, for example.
In 2016, the United Nations General Assembly adopted a resolution proclaiming
the UN Decade of Action on Nutrition from 2016 to 2025. The Decade aims
to catalyse policy commitments that result in measurable action to address all
forms of malnutrition. The aim is to ensure all people have access to healthier
and more sustainable diets to eradicate all forms of malnutrition worldwide.
Malnutrition and starvation have devastating impact on children, adults and
especially on pregnant women. They also have severe and far-reaching socio-
economic impacts.
 Effects on children: Mental retardation, stunted growth, poor immune
system, micronutrient deficiency, GI tract infections, anaemia and inevitably
– death.
 Effects on pregnant women: Besides the health of the child being poor, a
pregnant woman might have difficult labour, postpartum haemorrhage and
anaemia.
 General effects: Weak immunity, inactivity of muscles, apathy, depression,
kidney function impairment.
Types of Malnutrition: Very few people are aware that malnutrition can be
caused not only by the lack of nutrients, but also by their excessive intake!
However, it is the malnutrition caused by the lack of essential micro-nutrients
that is a major global concern. The main types of malnutrition diseases are
growth failure malnutrition and micronutrient malnutrition.
1. Growth failure malnutrition, as the name suggests, is the failure of an
individual to grow as expected in stature or weight, according to his/her age and
gender. Growth failure malnutrition can take three serious forms:

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2. Acute malnutrition or wasting arises out of sudden, drastic weight loss. It

leads to three clinical malnutrition types:
 Marasmus: this occurs when body fat and tissues degenerate at an alarming
rate to compensate for the lack of nutrients. As a result, the body‘s internal
processes begin to slow down alarmingly fast as does the activity of the
immune system.
 Kwashiorkor: this is characterized by bilateral pitting oedema (fluid
retention) in the legs and feet. As a result, the under-nourished child may
actually look plump.
 Marasmic-kwashiorkor: This is characterized by both severe wasting and
oedema.
3. Chronic malnutrition or stunting happens over a long period of time and
has more long-lasting consequences. It begins before birth due to poor maternal
health and leads to stunted growth in an otherwise normally proportioned child.
Poor breast feeding, infections and lack of availability of proper nutrients are
the main causes behind it. Stunting is dangerous because it becomes irreversible
after an age. Therefore, it becomes important to nip it in the bud by providing
proper medical treatment to pregnant women and young girls.
4. Micronutrient malnutrition implies a moderate to severe lack of Vitamins
A, B, C and D, Calcium, Folate, Iodine, Iron, Zinc and Selenium. These
vitamins and minerals are of utmost importance in various body processes and
their deficiency can make an otherwise healthy person malnourished.
1. Iron deficiency causes anaemia, poor brain development and cardiac
functioning.
2. Iodine deficiency leads to impaired thyroid functioning and mental
retardation.
3. Vitamin D deficiency causes rickets and other bone development related
disorders.
4. Selenium deficiency leads to poor cardiac function, weak immunity and
osteoarthritis.
5. Vitamin A deficiency is a cause of poor vision, bone development and
immunity.
6. Vitamin B12 deficiency leads to nerve degeneration and poor RBC
formation
7. Folate or vitamin B9 deficiency causes slow growth and anaemia
8. Zinc deficiency can cause poor immunity, sensory perception and anaemia.

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Malnutrition is a cause for great concern in all developing nations. And the
governments across the globe are increasingly allotting more of their health
expenditure in this sector. So the next time you throw away food, or worry
about your meal plan, stop, count your blessings and reach out to feed a hungry
mouth.
Symptoms
 Lack of appetite or interest in food or drink
 Tiredness and irritability
 Inability to concentrate
 Always feeling cold
 Loss of fat, muscle mass, and body tissue
 Higher risk of getting sick and taking longer to heal
 Longer healing time for wounds
 Higher risk of complications after surgery
 depression
 Reduced sex drive and problems with fertility

In more severe cases:

 Breathing becomes difficult
 Skin may become thin, dry, inelastic, pale, and cold
 The cheeks appear hollow and the eyes sunken, as fat disappears from the
face
 Hair becomes dry and sparse, falling out easily

Eventually, there may be respiratory failure and heart failure, and the person
may become unresponsive. Total starvation can be fatal within 8 to 12 weeks.
Children may show a lack of growth, and they may be tired and irritable.
Behavioural and intellectual development may be slow, possibly resulting in
learning difficulties. Even with treatment, there can be long-term effects on
mental function, and digestive problems may persist. In some cases, these may
be life-long. Adults with severe undernourishment that started during adulthood
usually make a full recovery with treatment.
Causes: Malnutrition can result from various environmental and medical
conditions.
1) Low intake of food: This may be caused by symptoms of an illness, for
example, dysphagia, when it is difficult to swallow. Badly fitting dentures
may contribute.

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2) Mental health problems: Conditions such as depression, dementia,

schizophrenia, anorexia nervosa, and bulimia can lead to malnutrition.
3) Social and mobility problems: Some people cannot leave the house to buy
food or find it physically difficult to prepare meals. Those who live alone
and are isolated are more at risk. Some people do not have enough money to
spend on food, and others have limited cooking skills.
4) Digestive disorders and stomach conditions: If the body does not absorb
nutrients efficiently, even a healthful diet may not prevent malnutrition.
People with Crohn‘s disease or ulcerative colitis may need to have part of
the small intestine removed to enable them to absorb nutrients.
Coeliac disease is a genetic disorder that involves a gluten intolerance. It
may result in damage to the lining of the intestines and poor food
absorption. Persistent diarrhoea, vomiting, or both can lead to a loss of vital
nutrients.
5) Alcoholism: Addiction to alcohol can lead to gastritis or damage to the
pancreas. These can make it hard to digest food, absorb certain vitamins,
and produce hormones that regulate metabolism. Alcohol contains calories,
so the person may not feel hungry. They may not eat enough proper food to
supply the body with essential nutrients.
6) Lack of breastfeeding: Not breastfeeding, especially in the developing
world, can lead to malnutrition in infants and children.
Risk factors: In some parts of the world, widespread and long-term
malnutrition can result from a lack of food. In the wealthier nations, those most
at risk of malnutrition are:
 Older people, especially those who are hospitalized or in long-term
institutional care
 Individuals who are socially isolated
 People on low incomes
 Those who have difficulty absorping nutrients
 People with chronic eating disorders, such as bulimia or anorexia nervosa
 People who are recovering from a serious illness or condition

Diagnosis: There are several that can prevent the development and
complications of malnutrition. There are several ways to identify adults who are
malnourished or at risk of malnutrition, for example, the Malnutrition Universal
Screening Tool (MUST) tool. MUST has been designed to identify adults, and
especially older people, with malnourishment or a high risk of malnutrition. It is

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a 5-step plan that can help health care providers diagnose and treat these
conditions. MUST is only used to identify malnutrition or the risk of
malnutrition in adults. It will not identify specific nutritional imbalances or
deficiencies. The steps are:
 Step 1: Measure height and weight, calculate body mass index (BMI), and
provide a score.
 Step 2: Note the percentage of unplanned weight loss and provide a score.
For example, an unplanned loss of 5 to 10% of weight would give a score of
1, but a 10% loss would score 2.
 Step 3: Identify any mental or physical health condition and score. For
example, if a person has been acutely ill and taken no food for over 5 days,
the score will be 3.
 Step 4: Add scores from steps 1, 2 and 3 to obtain an overall risk score.
 Step 5: Use local guidelines to develop a care plan.
If the person is at low risk of malnutrition, their overall score will be 0. A score
of 1 denotes a medium risk and 2 or more indicates a high risk.
Treatment: For all risk categories, help and advice on food choices and dietary
habits should be offered. After the MUST screening, the following may happen:
Low risk: Recommendations include on-going screening at the hospital and at
home.
Medium risk: The person may undergo observation, their dietary intake will be
documented for 3 days, and they will receive on-going screening.
High risk: The person will need treatment from a nutritionist and possibly other
specialists, and they will undergo on-going care.
Treatment will depend on the severity of the malnutrition, and the presence of
any underlying conditions or complications. The healthcare provider will
prepare a targeted care plan, with specific aims for treatment. There will
normally be a feeding program with a specially planned diet, and possibly some
additional nutritional supplements.
People with severe malnourishment or absorption problems may need artificial
nutritional support, either through a tube or intravenously. The patient will be
closely monitored for progress, and their treatment will be regularly reviewed to
ensure their nutritional needs are being met.

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Diet: A dietician will discuss healthful food choices and dietary patterns with
the patient, to encourage them to consume a healthy, nutritious diet with the
right number of calories. Those who are undernourished may need additional
calories to start with.
Monitoring progress: Regular monitoring can help ensure an appropriate
intake of calories and nutrients. This may be adjusted as the patient's
requirements change. Patients receiving artificial nutritional support will start
eating normally as soon as they can.
Prevention: To prevent malnutrition, people need to consume a range of
nutrients from a variety of food types. There should be a balanced intake
of carbohydrates, fats, protein, vitamins, and minerals, as well as plenty of
fluids, and especially water. People with ulcerative Colitis, Crohn‘s disease,
Coeliac disease, alcoholism, and other health issues should receive appropriate
treatment for their condition.
Balanced Diet: The importance of nutrition and a balanced diet. Nutrition is
vital for your body and all of its systems to function properly, by having good
nutrition it will help you maintain a healthy weight, reduce body fat, provide
your body with energy, promote good sleep and generally make you feel better.
Benefits of a balanced diet: A healthy diet can protect the human body against
certain types of diseases, in particular non-communicable diseases such as
obesity, diabetes, cardiovascular diseases, some types of cancer and skeletal
conditions. Healthy diets can also contribute to an adequate body weight.
Eating a healthy, balanced diet is an important part of maintaining good
health, and can help you feel your best. This means eating a wide variety of
foods in the right proportions, and consuming the right amount of food and
drink to achieve and maintain a healthy body weight.
There are seven building blocks for a healthy diet, including carbohydrates,
proteins, fats, vitamins, minerals and fibre. Add water to the mix and you're
shaping up nicely! We take energy from food in the form of kilojoules.
A balanced diet is made up of the five food groups.
 1 Carbohydrates. This group contains starchy foods such as pasta, rice, oats,
potatoes, noodles, yam, green bananas, sweet potato, millet, couscous,
breads, breakfasts cereals, barley and rye
 2 Protein

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 3 Milk and dairy products

 4 Fruit and vegetables
 5 Fats and sugars
Definition of a Balanced Diet: The Foods Standards Agency defines a
balanced diet as having ‗a variety of foods, basing meals on starchy foods and
eating at least 5 portions of fruit and veg a day.‘ They also recommend having
moderate amounts of fish (2 portions a week one being oily) moderating the
amount of protein you have and having small or occasional amounts of food
high in fat or sugar.
The guidelines are there to inform the general public of what constitutes a
balanced diet in the eyes of the Food Standards Agency. If you follow these
guidelines it does not mean you are eating a balanced diet. For example the
guidelines state that you should have small amounts of food high in fat or sugar.
This is quite a vague statement, what is a small amount of high fat or sugary
foods? People will interpret this differently, some people will believe this means
they can eat sugary foods daily whilst others will think it means they can have
some sort of sugary food weekly.
The guideline to base meals on starchy foods, is that most people have diets that
are predominantly made up of carbohydrates focusing on these foods: Bread;
pasta and potatoes.
White pasta, bread, rice or any processed (refined) foods should be avoided
because they usually have been bleached to turn them into the white colour we
see in the supermarket (more appealing for the general public) it is during this
bleaching process that the grains lose all of their nutritional value and our
bodies cannot utilise these foods for energy. Having high amounts of processed
carbohydrates in the diet is a reason why as a nation we are becoming
overweight.
Make up of a balanced diet: A balanced diet should be one based on eating a
variety of different foods, and eating foods that have not been processed. This
means trying natural unprocessed foods. People should look to eat 5 portions or
more of fruit and vegetables a day, to reduce the amount of processed food they
eat, to ensure they drink at least 2 litres of water a day, to have a balance
between the amount of carbs, fats and protein they consume, to eat oily fish

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weekly, to reduce the amount of table salt they have (below 6g) and to reduce
the amount of sugar in their diet.
Low-Calorie Diet or an obese person: Obesity has reached epidemic
proportions in America, with more than one-third of adults and nearly one-fifth
of children classified as obese, according to the Centres for Disease Control
(CDC) and prevention. Excess weight is associated with an increased risk for
diabetes, heart disease and cancer. Therefore, losing weight should be a primary
health goal for the overweight and obese. Successful weight loss involves a 3-
pronged approach: nutrition, activity and behaviour modification.
Good nutrition is the foundation of any weight loss program. The first step in
good nutrition is choosing whole foods and avoiding processed foods. Processed
foods are often high in sugar, fat, salt and calories but low in nutrients. Whole
foods like fresh vegetables, fruits, eggs and lean meats are nutrient dense, which
means they fill you up and meet your body‘s requirements for good health. To
lose weight, you will need to consume fewer calories than you expend, so it is
important to be aware of calories and portion sizes.
Low-Carbohydrate Diet: If counting calories sounds like an obstacle to losing
weight, a low-carbohydrate diet plan might work better for you. Research
published in 2003 in The New England Journal of Medicine found that a low-
carb diet created more weight loss in obese participants than a conventional diet
during the first six months -- though the differences were the same after one
year.
Additionally, a study published in the Annals of Internal Medicine in 2004
found that a low-carb diet plan led to greater weight loss and improved
triglyceride and cholesterol levels in obese participants. On a low-carb diet plan,
you restrict carbohydrates -- particularly high-glycaemic varieties that affect
your blood sugar – in favour of eating more protein and fat. While eating this
way, you‘ll avoid grains such as bread, pasta, rice and oats; some high-sugar
fruits; root vegetables; and foods with added sugar, such as candy, ice cream
and desserts.
Portion Sizes: No matter which diet plan you choose, losing a significant
amount of weight requires a keen eye on determining and adhering to proper
portion sizes. Cut back on portions to eat less food and balance your caloric
intake. Start by weighing and measuring everything you eat, registered dietician
LuAnn Berry says on [Link]. Other tricks include using a smaller plate for
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your meals, because it holds less food, and ensuring that you read the nutrition
label for serving sizes and adjust your consumption as necessary.
Be positive: If you are overweight, chances are this is not your first attempt at
losing weight. Maybe you have lost a significant amount of weight in the past
only to regain it. That's not uncommon among people who struggle with excess
weight. According to the American Psychological Association, understanding
and modifying the behaviours and emotions related to weight management are
essential to successful weight loss. It is important to leave the past where it
belongs – in the past. Believe in your success and surround yourself with people
who boost your self-esteem and support your weight loss efforts.
The healthy recommendation to reduce weight is to aim for 1/2 to 2 pounds per
week. Rather than going on a very restrictive diet, strive for lasting lifestyle
changes that support modest, steady weight loss. And don't expect perfection.
When you falter, just get back on track at your next opportunity. Focus on
making long-term, lasting changes and you will reach a healthy weight.
The most established way for an obese person to lose weight is by focusing on
diet and cutting calories. According to the National Heart, Lung and Blood
Institute, you should cut your caloric intake by about 500 to 1,000 calories a day
to lose one to two pounds a week. Even if you‘re eager to shed your obese
status, resist the temptation to cut back on calories drastically. Generally
speaking, women can lose weight safely by consuming 1,000 to 1,200 calories a
day, and men should aim for 1,200 to 1,600 calories a day.
However, these calorie ranges are just a guide; speak to a doctor about the best
way for you to lose weight. Diets of fewer than 800 calories a day require
doctor supervision. A healthy low-calorie diet plan avoids saturated and trans
fats, cholesterol, too much sodium and added sugars. It includes low-fat dairy
products; lean proteins, such as fish, poultry and beans; whole grains; and fruits
and vegetables.
Combine Diet with Exercise: Although diet is a vital part of losing weight, a
study published in 2003 found that a lifestyle overhaul consisting of both a
healthy diet plan and physical activity was the most successful approach to
losing weight for obese patients. The American College of Sports Medicine says
an obese person should focus on low-intensity aerobic activity with the goal of
increasing duration and frequency, rather than intensity.

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It recommends four to five days of exercise for 30 to 60 minutes; break these up

into three 10-minute sessions if you were previously sedentary. Appropriate
activities include walking, swimming or cycling, all of which put minimal stress
on the joints. Once you have made improvements to your diet, it‘s time to
increase your daily activity. Choose an activity that you enjoy and can do
regularly. It should be something that can fit easily into your daily routine.
Walking is a good place to start for many people. A 30-minute walk burns
around 100 calories, on average. If walking isn‘t the right activity for you, find
one that is -- biking, swimming, rowing or whatever you enjoy and can
accomplish most days.
Nutritional aspect: You have to cut around 500 or more calories depending on
how much extra weight you have 500 calories per day times seven days a week
= 3500 calories, which is exactly what's in a pound of fat. Add this to the
thousands of extra calories burned each week from our new exercise program
we're on and we're talking about some serious fat loss. Cutting back on junk or
fast food alone may cut back those 500 calories or so that you are looking to
restrict from your diet. Now you need
Some healthy complex carbs:
 Whole wheat bread
 Oatmeal
 Whole wheat pasta
 Brown rice
 Potatoes
Some healthy protein supplies:
 Lean cuts of beef
 Fish
 Eggs (but don't eat too many yolks)
 Fat free cottage cheese
 Perhaps a little protein powder
 Skim milk
 Fat free yogurt
 Turkey
 Chicken
 Fat free peanut butter
 Any fruits or vegetables you can get your hands on
 Crisp, refreshing spring water

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 A good multivitamin

High-energy diet for the underweight: Firstly, eliminate all the causes of
underweight. Make sure that you do not suffer from underlying illnesses that
cause weight loss or hamper weight gain and those other important factors such
as medications, depression, or anxiety are not preventing you from gaining
weight. If you have a clean bill of physical and mental health, the solution to
underweight is to ingest more energy on a daily basis than you use up for
physiological processes and physical activity. This means that you must eat more
at each meal and have healthy snacks between meals. Here is an example of a
diet that will provide you with sufficient energy to assist with weight gain:
Foods that should be included every day:
 Full-cream milk: 750 - 1000 ml (3 to 4 cups)
 Meat, fish, eggs and other protein foods: 3-5 servings (90 to 150 g)
 Bread and cereals: 8-12 servings (e.g. up to 6 cups of starch a day)
 Fruit and vegetables: 3-5 servings
 Fats and oils: 90 g (6 tablespoons)
 Healthy desserts: 1-2 servings

Though being lean can often be healthy, being underweight can be a concern if
it's the result of poor nutrition or if you are pregnant or have other health
concerns. So, if you are underweight, see your doctor or dietician for an
evaluation. Together, you can plan how to meet your goal weight. Here are
some healthy ways to gain weight when you're underweight:
 Eat more frequently. When you're underweight, you may feel full faster.
Eat five to six smaller meals during the day rather than two or three large
meals.
 Choose nutrient-rich foods. As part of an overall healthy diet, choose
whole-grain breads, pastas and cereals; fruits and vegetables; dairy products;
lean protein sources; and nuts and seeds.
 Try milk based drinks. Don't fill up on diet soda, coffee and other drinks
with few calories and little nutritional value. Instead, drink smoothies or
healthy shakes made with milk and fresh or frozen fruit, and sprinkle in
some ground flaxseed. In some cases, a liquid meal replacement may be
recommended.

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 Watch when you drink. Some people find that drinking fluids before meals
blunts their appetite. In that case, it may be better to sip higher calorie
beverages along with a meal or snack. For others, drinking 30 minutes after
a meal, not with it, may work.
 Make every bite count. Snack on nuts, peanut butter, cheese, dried fruits
and avocados. Have a bedtime snack, such as a peanut butter and jelly
sandwich, or a wrap sandwich with avocado, sliced vegetables, and lean
meat or cheese.
 Top it off. Add extras to your dishes for more calories — such as cheese in
casseroles and scrambled eggs, and fat-free dried milk in soups and stews.
 Have an occasional treat. Even when you're underweight, be mindful of
excess sugar and fat. An occasional slice of pie with ice cream is OK. But
most treats should be healthy and provide nutrients in addition to calories.
Bran muffins, yogurt and granola bars are good choices.
 Exercise. Exercise, especially strength training, can help you gain weight by
building up your muscles. Exercise may also stimulate your appetite.
Fat has a bad reputation for causing people to be overweight and obese.
However, not all fat is bad. In fact, breaking down and storing energy
(calories) as fat is good. It‘s just one of the many ways the body uses food to
function, heal, and grow. Stored energy from fat helps you get through a
strenuous job or workout. It plays a key role in brain development, and in the
prevention of inflammation (swelling) and blood clots.
Fat contributes to healthy hair and skin, as well. You can determine whether you
are underweight by using a Body Mass Index (BMI) calculator. This online tool
considers your weight, height, age, and gender to calculate a score. If your BMI
is less than 18.5, you are underweight. Your doctor also can help determine if
you‘re underweight based on your height, weight, what you eat, and your
activity level.
Your doctor may put you on a weight gain program if you are underweight.
However, this is not permission to go crazy with junk food. Healthy weight gain
requires a balanced approach, just like a weight loss program. Eating junk food
may result in weight gain but it will constitute as healthy fat. However, it will
not satisfy the nutrition your body needs. Even if the fat, sugar, and salt in junk
food doesn‘t result as extra weight, it can still harm your body. For a healthy
weight gain, the following tips can help:

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 Add healthy calories. You don‘t need to drastically change your diet. You
can increase calories by adding nut or seed toppings, cheese, and healthy
side dishes. Try almonds, sunflower seeds, fruit, or whole-grain, wheat
toast.
 Go nutrient dense. Instead of eating empty calories and junk food, eat
foods that are rich in nutrients. Consider high-protein meats, which can help
you to build muscle. Also, choose nutritious carbohydrates, such as brown
rice and other whole grains. This helps ensure your body is receiving as
much nourishment as possible, even if you are dealing with a reduced
appetite.
 Snack away. Enjoy snacks that contain plenty of protein and healthy
carbohydrates. Consider options like trail mix, protein bars or drinks, and
crackers with hummus or peanut butter. Also, enjoy snacks that contain
―good fats,‖ which are important for a healthy heart. Examples include nuts
and avocados.
 Eat mini-meals. If you‘re struggling with a poor appetite, due to medical or
emotional issues, eating large amounts of food may not seem appealing.
Consider eating smaller meals throughout the day to increase
your calorie intake.
 Bulk up. While too much aerobic exercise will burn calories and work
against your weight goal, strength training can help. This includes
weightlifting or yoga. You gain weight by building muscle.
Before beginning a weight gain programme, talk to your doctor. Being
underweight may be due to an underlying health problem. It won‘t be corrected
by diet changes. Your doctor will be able to help you track your progress. He or
she will make sure that healthy changes are taking place.
People who are underweight typically are not getting enough calories to fuel
their bodies. Often, they are also suffering from malnutrition. Malnutrition
means you are not taking in enough vitamins and minerals from your food. If
you‘re underweight, you may be at risk for the following health issues:
 Delayed growth and development. This is especially true in children and
teens, whose bodies need plenty of nutrients to grow and stay healthy.
 Fragile bones. A deficiency in vitamin D and calcium, along with low body
weight, can lead to weak bones and osteoporosis.

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 Weakened immune system. When you don‘t get enough nutrients, your
body cannot store energy. This makes it difficult to fight illness. It may also
be difficult for your immune system to recover after being sick.
 Anaemia. This condition can be caused by not having enough of the
vitamins iron, Folate, and B12. This can cause dizziness, fatigue, and
headaches.
 Fertility issues. In women, low body weight can lead to irregular periods,
lack of periods, and infertility.
 Hair loss. Low body weight can cause hair to thin and fall out easily. It also
can cause dry, thin skin and health issues with teeth and gums.
Many underweight people are physically healthy. Low body weight is due to a
variety of causes, including:
 Genetics. If you‘ve been thin since high school and it runs in your family, it
is likely that you were born with a higher-than-usual metabolism. You also
may have a naturally small appetite.
 High physical activity. If you‘re an athlete, you probably know that
frequent workouts can affect your body weight. However, high physical
activity also can be a part of an active job or an energetic personality. If you
are on your feet a lot, you may burn more calories than people who are more
sedentary (inactive).
 Illness. Being sick can affect your appetite and your body‘s ability to use
and store food. If you‘ve recently lost a lot of weight without trying, it may
be a sign of disease, such as thyroid problems, diabetes, digestive diseases,
or even cancer. Talk to your doctor about sudden weight loss.
 Medicines. Certain prescription medicines can cause nausea and weight
loss. Some treatments, such as chemotherapy, can reduce appetite and
worsen weight loss from illness.
 Psychological issues. Our mental well-being affects every part of our lives.
Things like stress and depression can disrupt healthy eating habits. Severe
body image fears and distortions can lead to eating disorders. If you‘re
suffering from damaging emotional issues, talk to your doctor. He or she
can help you get the care, assistance, or counselling you may need.

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