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The Health Thread

Supporting and Educating Strategies for Children with Autism Spectrum Disorders

Dr. Mukti Thapaliya

Written by Dr. Mukti Thapaliya, RTLB Cluster 9, Ph.D. in Education

Introduction

This article describes the meaning of Autism Spectrum Disorders (ASD), the characteristics of ASD, the diagnosis process of ASD, ASD diagnosis instruments, and the strengths and interests of children with ASD. The article also presents supporting and educating techniques, behaviour management strategies and communicating strategies for students with ASD.

Understanding Autism Spectrum Disorders

Before the publication of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) (APA, 2013), various terms were used to refer to children with complex neurodevelopmental conditions (e.g., ASD, atypical autism, childhood psychosis, childhood schizophrenia, and autism). The term “autism” was defined differently from childhood schizophrenia and other psychoses, such as “pervasive developmental disorders” (PDDs), after the publication of DSM-III. Moreover, DSM-IV included several subtypes of PDD: autism, AS, PDDNOS, Rett syndrome, and disintegrative disorder (APA, 2013). After the DSM-5, the subcategories were eliminated and replaced with the single diagnosis of “ASD” and the DSM-5 revised the diagnostic criteria for children with autism spectrum disorders (APA, 2013). The term ‘ASD’ is used throughout this article – consistent with DSM-5 diagnostic criteria.

Characteristics of students with ASD

Students with autism may experience difficulties in the following areas. Table 1 presents characteristics of students with autism.

Table 1 characteristics of students with autism

Communication Social interaction Restricted and repetitive patterns of behaviour

●      delay in speech and language

●      have trouble understanding other people

●      hard communicating what they want

●      could use body parts or objects to indicate what they want to say

●      may have an unusual tone, pitch, or accent

●      may not understand non-verbal communication (e.g., facial expressions, body language, and gestures)

●      may have difficulty following instructions

●      Sometimes may appear not to hear at all

 

●      may not join in play with other students and may appear disinterested in other people

●      may prefer to play or be alone

●      may not play as often as same-aged peers

●      rarely bring toys and objects to share with other students

●      may not respond to other people’s greetings or smiles

●      may experience difficulty with social situations and understanding social rules

●      may not understand others’ emotions, thoughts, or actions

●      difficulty with eye contact

 

●      A strong preference for routine and order

●      get very upset if their routines are interrupted

●      may have trouble with transitioning to new environments

●      may have a special interest that they enjoy talking about a lot

●      may use behaviour including challenging behaviour as a way of communicating

●      may appear to be clumsy and have poor motor skills

●      may make unusual movements or sounds

●      may have poor problem-solving or organisational skills

●      hyper or hypo-sensitive to various stimuli (link to sensory)

(Altogether Autism, 2023; APA, 2013).

Strengths and interests of students with ASD

Students with ASD excel in various learning styles, including acquiring knowledge. Specifically, they may be good at:

  • rote learning
  • remembering information for extended periods
  • detailed and chunk-based learning
  • paying close attention to small details
  • concentrating on narrow topics of interest
  • using visual information meaningfully
  • using concrete information, understanding and following rules
  • actions and thought logical processes
  • follow strict rules

Diagnosis process for students with ASD

There are several theories about the causes of ASD, but none of them have been scientifically proven (Autism New Zealand, 2020; Thapaliya, 2023a, 2023b). Researchers are still investigating varied factors that might contribute to the development of ASD. Some studies suggest that people with ASD may have genetic predispositions, whereas other research signals viral infections, structural and functional brain abnormalities, and dysfunctional immune systems (APA, 2013).

The diagnostic process requires input from multiple professionals (e.g., child psychologists, educational psychologists, pediatricians, clinical psychologists, audiologists, and teachers) and parents (APA, 2013). Professionals also involve an evaluation process. Specifically, the following criteria are commonly used to diagnose ASD:

  • assessments of multiple areas of functioning (e.g., intellectual and communication skills, a review of developmental history)
  • parental input
  • medical tests (a loss of hearing test and eye test before considering a diagnosis of ASD)
  • assess multiple areas of functioning
  • collect information from a variety of settings
  • provide a single coherent view
  • provide implications for adaptation and learning
  • liaison with schools and other agencies to support the implementation of recommendations
  • developmental history
  • diagnostic assessment of speech, language and communication
  • sensory and motor skills assessments
  • medical evaluations

Figure 1 presents the two diagnosis domains of ASD based on DSM-5:  communication and repetitive patterns of behaviour (APA, 2013).

(APA, 2013)

Diagnostic instruments

The following diagnostic tools may be used to diagnose autism spectrum disorder.

  • Diagnostic and Statistical Manual of Mental Disorders (DSM)- 5
  • Asperger Syndrome Diagnostic Interview (ASDI)​
  • Asperger Syndrome Screening Questionnaire (ASSQ)​
  • Australian Scale for Asperger syndrome (ASAS)​
  • Autism Behaviour Checklist (ABC)​
  • Autism Diagnostic Observation Schedule (ADOS) and ADOS-G​
  • Autism Screening Questionnaire (ASQ)​
  • Autistic Diagnostic Interview (ADI, and also ADI-R)​
  • Childhood Asperger Syndrome Test (CAST)​
  • Childhood Autism Rating Scale (CARS)​
  • Child Communication Checklist (CCC)​
  • Checklist for Autism in Toddlers (CHAT)​
  • Diagnostic Interview for Social Communication Disorders (DISCO)​
  • Gilliam Autism Rating Scale (GARS)​
  • Parent Interview for Autism​ (PIR)
  • Pervasive Developmental Disorders – mental retardation (PDD-MR)​
  • Social Response Scale (SRS)​
  • Treatment and Education of Autistic and related Communications Handicapped Children (TEACCH) checklist​
  • Wing Autistic Disorder Interview Checklist​ (WADIC)

Teaching and learning strategies for students with ASD

Researchers recommend a wide range of teaching approaches, methods, and techniques to teach students with autism, such as structured teaching programmes, social stories, visual cues, sensory corners in the classroom, and using assistive technology to deliver course content in the classroom (Autism New Zealand, 2020; Bevan-Brown & Dharan, 2016; Thapaliya, 2023). The following section describes key teaching strategies for students with ASD.

Rules of 5 (Fewer than 5 words, wait 5 seconds)

In this strategy, teachers have to present the information in sentences that only have five words. Teachers can give students five seconds to comprehend each statement so they can focus on and understand what you said. For example,

  • Stay in your seat
  • Hand on pencils only
  • Use friendly words
  • Raise your hand to speak
  • Focus on your task

Use the student’s name first

Saying the student’s name first gets the students’ attention and allows them to work out that the teacher is speaking to them. For instance, teachers can frequently remind them to do the task. Tom, time for math.

Giving positive direction

Teachers need to give positive direction while instructing students with autism in the classroom because students with autism may have trouble when they hear the word ‘no’. For example, ‘Please use a tissue, instead of saying ‘Stop picking your nose!’.

First-then strategies

A first-then strategy may provide the students with a visual means of introducing a new task in a way that they can understand. This technique helps to establish a routine and controlled environment for students with autism. Specifically, teachers can use a first-then strategy to increase independence, provide predictable environments/activities, clarify expectations while providing sequencing of events, support transitions (activity to activity or between locations), reduce verbal information (prompts) provided to a child and increase motivation for completing an adult-directed task/activity (MoE, 2023). For example, first reading a passage, then having a break time.

Give warnings before an activity finish

It is recommended to give students prior warnings before ending a favourite activity to prevent anger. Three warnings, accompanied by visual cues, are the usual practice (Autism New Zealand, 2020; MoE, 2023). For example,

  • Hunter, you have ten minutes left to complete your math task.
  • Hunter, you have five minutes left to complete your math task.
  • Hunter, math time is finished.

Use assistive technology

Using assistive technology (e.g., computers, iPads), can help reduce learning barriers in the classroom while teaching students with autism spectrum disorders (Autism New Zealand, 2020; MoE, 2023; Thapaliya, 2023a). Using computers can be a useful tool for teaching literacy and language skills (e.g., listening, speaking, reading, and writing) and numeracy skills. Jacklin and Farr (2005) reported the benefit of using computers with students with autism spectrum disorders in the classroom because they provide a “visual impact on what they are learning” (p. 208). While completing academic tasks, students with autism spectrum disorders may gain a sense of predictability, confidence, and self-control (Murray, 2015).

Learner profile

A learner profile includes everything about students’ learning needs, strengths, and individual needs in the classroom. In other words, the learner profile can assist schoolteachers, school psychologists, and school staff in understanding the perspectives of ākonga (student) and their whānau/parent), forging relationships with them, and tailoring instruction to fit the needs of individual students (MoE, 2023). Specifically, a learner profile can provide information about students (e.g., how to communicate with students, likes, and dislikes) (Thapaliya, 2023b).

Provide visual support

Visual support refers to a shared set of tools that are employed for a variety of tasks and are more permanent than words. Visual support consists of objects that are used to visually enhance a person’s understanding of the information, physical environment, social situation, and abstract concepts (Rutherford, et al., 2020).

Visual support may assist expressive communication by serving as a substitute for words, signs, gestures, and physical acts. Visual support can support people in meeting their developmental stage by offering a variety of skills (e.g., skill acquisition, motivation to learn, and utilizing their new learning). Similarly, visual support can offer students with ASD the structure, routine, and sequence they need to participate in everyday tasks (Thapaliya, 2023b).

. For instance,

Social story support

Researchers claim that social skills are the most effective way to manage students with ASD behavioural issues if they are taught within the natural environment (Fleury et al., 2014; Murray, 2015; Ostmeyer & Scarpa, 2012). Social skills can provide an opportunity for imitative skills and observation skills for students with autism spectrum disorders, as well as help them get support from their peers and tutors.

There are three types of story support (Autism New Zealand, 2020) to improve students with ASD behaviour:

  1. Story for self-esteem provides a positive story of student’s behaviour and learning. Also, it was applied to enhance students’ self-esteem and confidence.
  2. Story for information offers practical information (e.g., how to brush teeth), calming strategies to reduce their anxiety, and a new classroom timetable.
  3. Story for understanding is used to explain misunderstood communication and enhance students’ comprehension of course content.

Sensory regulation

Sensory overload sensitivity is a component of the autism spectrum diagnosis. This does not imply that all autistic students will be sensitive to sensory stimuli (APA, 2013). Students with ASD may have sensitivities to sights, sounds, smells, tastes, touch, and balance. They can experience both hyper- and hyposensitivity (under-reactivity) to a variety of stimuli. Most people combine the two in some way.

Acoustics, lighting, noise-cancellation headphones, low-arousal workspace, and scheduling regular breaks are some suggested strategies to prevent sensory overload for students with autism (Autism New Zealand, 2022). If teachers provide frequent breakout time throughout the day and calming and self-managing activities for students with autism, these activities will help students with autism cope with the classroom environment (e.g., prevent overload anxiety issues). For instance,

  • Give students frequent break
  • Check in- and check-out times
  • Curate a reading corner and breakout space with toys and sensory cushions

Lego therapy

LEGO-based therapy may help to develop social skills in children with autism spectrum disorder (Autism New Zealand, 2020; MoE, 2023; Thapaliya, 2023). Initially, Lego- therapy was designed to help children with ASD, but now it has been used to help kids with various social and communicative issues. In Lego-based therapy, there will be three people:

Engineer: reads the visual instructions and designs

Supplier: finds the pieces as directed by the engineer

Builder: builds the pieces

Lego-based therapy may help to:

  • promote social interaction
  • develop turn-taking skills and share with others
  • collaborate with others for problem-solving
  • develop language and motor skills
  • increase motivation and self-esteem
  • improve participation and engagement skills
  • feel calm and relaxed

Universal Design for Learning

Universal support approach refers to the Universal Design for Learning (UDL). The UDL has three principles and guidelines that assist in enhancing learning, including for students with ASD. According to students’ interests and learner variability, teachers can select certain guidelines to apply in their teaching and learning activities (Rao & Torres, 2016). The UDL framework has three principles: i) multiple means of engagement; ii) multiple means of representation; and iii) multiple means of action and expression (CAST, 2018)

The multiple means of engagement principle offer choices for developing likes, purposes, and self-regulation among students. The multiple means of representation principle is structured to assist learning through recognition networks and provide multiple ways of representing the curriculum. The multiple means of action and expression connect to strategic networks in the brain, and they play a key role in language learning and skill development (CAST, 2018).

Behaviour managing strategies

Students with ASD might display problematic, challenging, and aggressive behaviour (e.g., difficulty in listening to their teachers and following instructions, self-harm, difficulty following classroom rules, and repetitive disruptive behaviour). Instructional and behavioural support from behavioural therapists, educational psychologists, and clinical psychologists is put in place to assist students with spectrum disorders (Fleury et al., 2014). The use of technological interventions such as iPads is an effective intervention for decreasing challenging behaviours in the classroom. The following section describes Applied Behaviour Analysis (ABA), Functional Behavioural Analysis (FBA), and Cognitive Behaviour Therapy (CBT) to manage behaviour of students with autism spectrum disorders.

Communication managing strategies

Augmentative and Alternative Communication (AAC)

Augmentative Alternative and Communication (ACC) refers to a range of tools and techniques that assist people with complex communication needs. Students with cerebral palsy, autism spectrum disorders, developmental disabilities, childhood apraxia of speech, language delays, and other medical conditions that result in speech loss can benefit from the use of augmentative and alternative communication (ACC) (Mitchell & Sutherland, 2020).

In other words, the term ‘augmentative’ refers to resources that support and improve the existing communication abilities of a student. For instance, a student with ASD may use an iPad with communication software that produces a synthetic voice in response to a selected image. ‘Alternative’ describes communication systems that are designed to substitute for learners’ lost language and speech or are unlikely to develop in the future. For example, communicating effectively with students who have severe ASD can be challenging, especially in social situations, classrooms, and in their future endeavours where speech is a necessity. However, a high-tech system with speech output could be a temporary solution to serve as their primary means of communication.

There are three types of ACC solutions: No-tech, low-tech, and high-tech.

  • No-tech AAC is widely known for utilizing voluntary motor movements (e.g., sign language and facial expression analysis) to convey non-verbal messages.
  • Low-tech AAC utilizes simple resources such as books and whiteboards with large lexicons of words and images to support communication. For example, Pictogram Ideogram Communication (PIC), Rebus Signs, Picture Communication Symbols (PCS) and Picture Exchange Communication System (PECS) are some examples of low-tech ACC. In preschools and schools, PECS is very popular. PECS is a functional communication system that is used as a communication tool for students with speech and language difficulties. PECS teaches students to select cards with line drawings, symbols, or photos of desired items or activities and then give them to another person (e.g., communicative partner, peer, teacher, or parent) to receive the object or task.
  • High-tech AAC involves the use of electronic devices (e.g., iPads, laptops, computer applications and mobile phones) and speech generating devices (e.g., Proloquo2go) to achieve an AAC goal. Similarly, students with a range of difficulties (e.g., people with visual impairment) and neurological conditions may benefit from software programmes such as text- to- speech output options.

Conclusion

This article explored the meaning of autism, characteristics of students with ASD, and the diagnosis process for ASD. It presented supporting and teaching strategies. managing challenging behaviour and communication strategies for students with ASD.

REFERENCES

  1. Altogether Autism, (2023). Autism, what is it? https://www.altogetherautism.org.nz/what-is-autism/.
  2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5). American psychiatric association.
  3. Autism New Zealand. (2020). Tilting the Seesaw Handbook (Ed.) Wellington: Author.
  4. Bevan-Brown, J., and Dharan, V. M. (Eds.). (2016). Autism spectrum disorder in Aotearoa New Zealand: Promising practices and interesting issues (pp. 155-168). Wellington: NZCER Press.
  5. Center for Applied Special Technology (CAST). (2018). UDL and the learning brain. Wakefield, MA http://www.cast.org/products-services/resources/2018/udl-learning-brain-neuroscience
  6. Fleury, V. P., Hedges, S., Hume, K. Browder, D. M., Thompson, J. L., Fallin, K., and Vaughn, S. (2014). Addressing the academic needs of adolescents with autism spectrum disorder in secondary education. Remedial and Special Education, 35(2), 68-79. doi:10.1177/0741932513518823.
  7. Jacklin, A., and Farr, W. (2005). The computer in the classroom: A medium for enhancing social interaction with young people with autistic spectrum disorders? British Journal of Special Education, 32(4), 202-210.
  8. Ministry of Education, (2023, April). Resource Teachers: Learning and Behaviour Service.  https://www.education.govt.nz/school/student-support/special-education/resource-teachers-learning-and-behaviour-service 
  9. Murray, J. (2015). Practical Teaching Strategies for Students with Autism Spectrum Disorder: A Review of the Literature. BU Journal of Graduate Studies in Education, 7(2), 68-75.
  10. Ostmeyer, K., & Scarpa, A. (2012). Examining school-based social skills program needs and barriers for students with high-functioning autism spectrum disorders using participatory action research. Psychology in the Schools, 49(10), 932-941. doi:10.1002/pits.21646
  11. Rao, K., & Torres, C. (2016). Supporting academic and affective learning processes for English language learners with universal design for learning. TESOL Quarterly, 51(2), 460–472. https://doi.org/10.1002/tesq.342.
  12. Rutherford, M., Baxter, J., Grayson, Z., Johnston, L., & O’Hare, A. (2020). Visual supports at home and in the community for individuals with autism spectrum disorders: A scoping review. Autism, 24(2), 447-469.
  13. Thapaliya, M. (2023a). Exploring Inclusive Practices for Students with Autism Spectrum Disorders in Mainstream Classrooms: A Case from New Zealand. Psychology Research and Practice2(2). DOI: 10.37155/2972-3086-0202-2.
  14. Thapaliya, M.P. (2023b). Teaching Children with Autism Spectrum Conditions in Mainstream Classrooms. Kathmandu University. (Face-to-face workshop contribution

Micro plastics: A Silent Threat to Reproductive Health and Fertility

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Written By THT Editorial Team

Dr. Asmita Pandey

Reviewed by Dr. Asmita Pandey, Fertility Expert, M.D. (OB/GYN) 

Microplastics, often abbreviated as MPs, are small plastic particles under 5 millimeters that are now widely recognized as an environmental issue. They have made their way into our water systems and the broader food chain, prompting extensive studies on how they might affect reproduction in different species, humans included. This article explores the possible ways in which microplastics could be affecting reproductive health and fertility.

Oxidative stress

Oxidative stress is a cellular phenomenon that happens when there’s a mismatch between the creation of free radicals, like reactive oxygen species (ROS), and the body’s antioxidant defenses that neutralize their damaging effects This mismatch can cause harm to cells and tissues, playing a role in various diseases and the aging process. (Pizzino et al., 2017).

When it comes to microplastics (MPs), oxidative stress is a major issue. MPs can cause oxidative stress by interfering with the cells’ electron transfer processes, which results in an excess of ROS. These ROS can harm important cellular components such as lipids, proteins, and DNA, all vital for cell health and function (Abdal Dayem et al., 2017). For example, research has indicated that MPs exposure can increase ROS in oyster sperm, leading to reduced fertilization success. Likewise, studies on rats have shown that polystyrene MPs (PS-MPs) can induce oxidative stress in ovarian cells, affecting ovulation (Ferrante et al., 2022)

Hormonal Havoc: Disrupting the HPG Axis

The Hypothalamic-Pituitary-Gonadal (HPG) Axis is an essential hormonal system that controls reproductive functions. It’s a network involving the hypothalamus, pituitary gland, and gonads (ovaries or testes), which are responsible for producing and regulating sex hormones vital for reproductive health. (Mikhael et al., 2019)

Microplastics (MPs) have been identified as disruptors of the HPG Axis, causing hormonal imbalances that could impact fertility. Research has indicated that exposure to polystyrene MPs (PS-MPs) in male mice can lower testosterone levels and affect the balance of other important hormones such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These hormonal alterations can hinder the growth and maturation of reproductive organs, adversely affecting the development of offspring (Zhang et al., 2022). In female mice, exposure to MPs has resulted in similar hormonal disturbances, with changes observed in FSH and estradiol levels. (Liu et al., 2021)

Regarding reproductive success, it’s known to be an energy-demanding process that relies on ample resources for the creation of gametes, fertilization, and embryo growth. MPs pose a threat to an organism’s energy metabolism, which can influence reproductive success.

Evidence suggests that MPs can modify the patterns of food intake and energy distribution within organisms, which may lead to a decrease in reproductive output (Jewett et al., 2022). For example, studies on oysters have shown that MPs can reduce the activity of enzymes that are crucial for energy production during sperm development. This reduction could lead to sperm quality issues and, consequently, affect the viability of the offspring. (Sussarellu et al., 2016)

Microcirculation Woes: A New Frontier

Microcirculation is the process of blood flow through the body’s tiniest vessels, like capillaries. It’s crucial for supplying tissues with nutrients and oxygen and for eliminating waste. Any interference with microcirculation can greatly affect reproductive health.

Recent research has shown that microplastics (MPs) can negatively impact microcirculation. This can cause developmental issues and raise the mortality rate of embryos in water-dwelling species such as zebrafish. For instance, exposure to MPs and nanoparticles (NPs) has been linked to microcirculation damage, especially in vital areas like the tail, which is important for proper growth. (Zhang et al., 2022)

Human Health Implications

The increasing concern about microplastics (MPs) and their effect on human reproductive health is quite substantial. There has been a noticeable decrease in male semen quality over the last 80 years, and environmental pollutants, including MPs, are suspected to be contributing factors. Insights from animal studies have highlighted potential mechanisms through which MPs may influence health, such as oxidative stress, inflammation, and hormonal disturbances.

Direct research on the impact of MP exposure on male infertility in humans is not yet available, but animal studies have suggested a minimum human equivalent dose of MPs that could result in poor semen quality. This dose is estimated to be 0.016 mg/kg/day. The proximity of this figure to the levels of MP exposure observed in some countries points to a possible threat to human reproductive health. It underscores the importance of ongoing research to fully understand the effects and to develop appropriate exposure guidelines.

Conclusion

The research collectively points to a considerable risk that microplastics (MPs) present to reproductive health in various species. It’s vital to grasp the damaging mechanisms—like oxidative stress, hormonal imbalance, energy shortage, and microcirculation problems—to devise ways to lessen their effects. With MPs increasingly becoming a part of our environment, it becomes more pressing to confront their reproductive consequences. This calls for thorough policy-making and additional studies to safeguard human health. 

For further information about reproductive health, please book your consultation with fertility expert here.

REFERENCES

  1. Pizzino G, Irrera N, Cucinotta M, Pallio G, Mannino F, Arcoraci V, Squadrito F, Altavilla D, Bitto A. Oxidative Stress: Harms and Benefits for Human Health. Oxid Med Cell Longev. 2017;2017:8416763. doi: 10.1155/2017/8416763. Epub 2017 Jul 27. PMID: 28819546; PMCID: PMC5551541.
  2. Abdal Dayem A, Hossain MK, Lee SB, Kim K, Saha SK, Yang GM, Choi HY, Cho SG. The Role of Reactive Oxygen Species (ROS) in the Biological Activities of Metallic Nanoparticles. Int J Mol Sci. 2017 Jan 10;18(1):120. doi: 10.3390/ijms18010120. PMID: 28075405; PMCID: PMC5297754.
  3. Ferrante MC, Monnolo A, Del Piano F, Mattace Raso G, Meli R. The Pressing Issue of Micro- and Nanoplastic Contamination: Profiling the Reproductive Alterations Mediated by Oxidative Stress. Antioxidants (Basel). 2022 Jan 19;11(2):193. doi: 10.3390/antiox11020193. PMID: 35204076; PMCID: PMC8868557.
  4. Mikhael S, Punjala-Patel A, Gavrilova-Jordan L. Hypothalamic-Pituitary-Ovarian Axis Disorders Impacting Female Fertility. Biomedicines. 2019 Jan 4;7(1):5. doi: 10.3390/biomedicines7010005. PMID: 30621143; PMCID: PMC6466056.
  5. Zhang C, Chen J, Ma S, Sun Z, Wang Z. Microplastics May Be a Significant Cause of Male Infertility. American Journal of Men’s Health. 2022;16(3). doi:10.1177/15579883221096549
  6. Liu, Z., Zhuan, Q., Zhang, L., Meng, L., Fu, X., & Hou, Y. (2021). Polystyrene microplastics induced female reproductive toxicity in mice. Journal of Hazardous Materials, 416, 125912. https://doi.org/10.1016/j.jhazmat.2021.125912
  7. Jewett E, Arnott G, Connolly L, Vasudevan N, Kevei E. Microplastics and Their Impact on Reproduction-Can we Learn From the C. elegans Model? Front Toxicol. 2022 Mar 24;4:748912. doi: 10.3389/ftox.2022.748912. PMID: 35399297; PMCID: PMC8987311.
  8. Sussarellu, R., Suquet, M., Thomas, Y., et al. (2016). Oyster reproduction is affected by exposure to polystyrene microplastics. Proceedings of the National Academy of Sciences, 113(9), 2430-2435. https://doi.org/10.1073/pnas.1519019113

 

Exercise and aging: maintaining mobility and independence

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Written By THT Editorial Team

Reviewed by Liza Nagarkoti , BSc Nursing, MA(Nutrition), Project Officer (Health) LWF Nepal

As we age, maintaining mobility and independence become increasingly important. Exercise is an effective way to promote these qualities and to prevent age-related health problems. In this article, we will explore the role of exercise in aging, the benefits of exercise for older adults, and how to safely and effectively exercise as you age.

The Benefits of Exercise for Older Adults

Exercise is essential for maintaining physical and mental health as we age. Regular exercise can help:

Improve balance and coordination – This can help prevent falls, which are a common cause of injury and loss of independence in older adults.

Maintain muscle mass and bone density – Regular strength training can help maintain muscle mass and bone density, which can decrease the risk of osteoporosis and fractures.

Improve cardiovascular health – Regular aerobic exercise can improve cardiovascular health, lower blood pressure and reduce the risk of heart disease.

Improve mood and cognitive function – Exercise has been shown to improve mood, reduce anxiety and depression, and improve cognitive function. Safe and Effective Ways to Exercise at Home

Start slow and gradually increase intensity – If you are new to exercise or have not exercised in a while, start with low-impact activities like walking or yoga, and gradually increase intensity as your fitness improves.

Choose activities you enjoy – The best exercise is the one that you will stick with. Choose activities that you enjoy and that are appropriate for your fitness level.

Incorporate strength training – Strength training is important for maintaining muscle mass and bone density. Use weights, resistance bands, or bodyweight exercises to improve strength.

Be mindful of your body – Listen to your body and be mindful of any pain or discomfort. If something doesn’t feel right, stop the exercise and consult with your doctor or a qualified fitness professional.

Incorporate balance and flexibility exercises – Balance and flexibility exercises are important for maintaining mobility and preventing falls. Yoga, tai chi, and stretching exercises can help improve balance and flexibility.

Exercise and Aging: Maintaining Mobility and Independence

As we age, our bodies change, and we may experience a decrease in mobility and independence. Exercise can help slow down these changes and improve overall health and well-being. Recent research has shown that regular exercise can help older adults maintain their ability to perform daily tasks and improve their quality of life.

A study published in the Journal of the American Geriatrics Society found that a program of moderate-intensity exercise, including strength and balance training, improved mobility and prevented disability in older adults. Another study published in the Journal of Aging and Physical Activity found that regular exercise improved balance, gait, and mobility in older adults with Parkinson’s disease.

In conclusion, exercise is an essential component of healthy aging. By incorporating safe and effective exercise into your daily routine, you can improve your physical and mental health, maintain your mobility and independence, and improve your quality of life. Consult with your doctor or a qualified fitness professional before starting any exercise program, especially if you have a medical condition or are taking medication.

REFERENCES

 

  • Centers for Disease Control and Prevention. Physical Activity and Health. https://www.cdc.gov/physicalactivity/basics/older_adults/index.htm
  • Rikli RE, Jones CJ. Development and validation of a functional fitness test for community-residing older adults. Journal of Aging and Physical Activity. 1999; 7:129-61.
  • Keysor JJ. Does late-life physical activity or exercise prevent or minimize disablement? A critical review of the scientific evidence. Am J Prev Med. 2003; 25:129-36.
  • Pahor M, Blair SN, Espeland M, et al. Effects of a physical activity intervention on measures of physical performance: Results of the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) study. J Gerontol A Biol Sci Med Sci. 2006; 61:1157-65.
  • Petruzzello SJ, Landers DM, Hatfield BD, et al. A meta-analysis on the anxiety- reducing effects of acute and chronic exercise. Sports Med. 1991; 11:143-82.
  • Fiatarone MA, O’Neill EF, Ryan ND, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med. 1994; 330:1769-75.
  • Campbell AJ, Robertson MC. Rethinking individual and community fall prevention strategies: A meta-regression comparing single and multifactorial interventions. Age Ageing. 2007; 36:656-62.2.

Tubal Blockages and Infertility: Understanding Causes, Diagnosis, and Treatment Options

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Written By THT Editorial Team

Dr. Asmita Pandey

Reviewed by Dr. Asmita Pandey, Fertility Expert , M.D. (OB/GYN) 

Infertility is a complex and emotionally charged issue that affects many couples worldwide. Among the various causes, tubal factor infertility is a key concern, as it involves blockages in the fallopian tubes which are crucial for egg transportation and fertilization. This article explores the intricacies of tubal blockages, including their causes, methods for diagnosis, and the treatment options available.

Understanding the Causes of Fallopian Tube Blockages

Fallopian tube blockages can arise from a variety of medical conditions:

  • Female Genital Tuberculosis (FGTB):Tuberculosis can lead to both primary and secondary infertility, with a significant percentage of FGTB cases resulting in tubal blockages. The disease can cause unilateral and bilateral blockages, damage to the tubal cilia, and adhesions that affect fertilization and implantation (Sharma et al., 2018).
  • Pelvic Inflammatory Disease (PID):This infection of the female reproductive organs is often caused by sexually transmitted infections like chlamydia or gonorrhea. The inflammation and scarring from PID can lead to obstructions in the fallopian tubes. (Jennings & Krywko, 2018)
  • Endometriosis:A condition where tissue similar to the lining of the uterus grows outside of it, endometriosis can lead to the formation of adhesions and blockages in the fallopian tubes. (Smolarz, Szyłło, & Romanowicz, 2021)
  • Prior Surgeries:Surgical procedures in the abdominal or pelvic area, such as those for appendicitis or ectopic pregnancies, can result in scarring that may constrict the fallopian tubes. (Ghobrial, Ott, & Parry, 2023)
  • Hydrosalpinx:This occurs when a blocked fallopian tube fills with fluid, often as a result of infection, endometriosis, or past surgeries. (Lai, Masten, & Markese, 2024)

Diagnosing Tubal Factor Infertility

To diagnose tubal factor infertility, several methods are employed:

  • Hysterosalpingogram (HSG):An X-ray procedure that uses a special dye to reveal blockages or structural irregularities in the fallopian
  • Sonosalpingogram (SSG):This technique uses ultrasound imaging and a saline solution to evaluate the health of the fallopian tubes and uterus.
  • Laparoscopy:A minimally invasive surgical procedure that allows for the direct visualization of the fallopian tubes to detect blockages, scar tissue, and endometriosis.
  • HyCoSy:An ultrasound technique that assesses whether the fallopian tubes are open or blocked by using a fluid containing small bubbles (Women’s Imaging, n.d.).

Treatment Options to Restore Fertility

The treatment for tubal blockages varies based on the severity and location of the obstruction:

  • Salpingectomy:The surgical removal of one or both fallopian tubes, which can improve the chances of successful IVF treatment (Strandell et al.1999).
  • Selective Tubal Cannulation:A nonsurgical technique that uses X-ray guidance to clear blockages near the uterus. This method is an excellent alternative to microsurgical tubal anastomosis (Watrelot & Chauvi, 2011)
  • Tubal Reanastomosis and Fimbrioplasty:Surgical procedures that either reverse a tubal ligation or repair damaged parts of the fallopian tube (Alberta Health Services, n.d.).
  • Salpingostomy:A procedure that creates a new opening at the blocked end of the fallopian tube, often near the ovary. (Singhal, 2022)
  • In Vitro Fertilization (IVF):A process where eggs are retrieved from the ovaries and fertilized in a lab, with the resulting embryos transferred to the uterus, bypassing the fallopian tubes.

The Future of Tubal Factor Infertility Treatment

Research continues to advance in the field of reproductive medicine:

  • 3D Imaging and Robotic Surgery:These technologies are improving the precision of surgical procedures for tubal repair (Alkatout et al., 2024).
  • Tissue Regeneration:Strategies are being explored to regenerate damaged fallopian tube tissue, offering a potentially less invasive approach to restoring fertility (Sethi et al., 2024).

Conclusion

Choosing the optimal treatment for tubal blockages is a highly personalized decision. It requires the expertise of a fertility specialist who can navigate the best options, taking into account factors such as the woman’s age, the extent of tubal damage, and the cause of the blockage.

For further information, please book your consultation with expert here.

REFERENCES

  1. Sharma JB, Sharma E, Sharma S, Dharmendra S. Female genital tuberculosis: Revisited. Indian J Med Res. 2018 Dec;148(Suppl):S71-S83. doi: 10.4103/ijmr.IJMR_648_18. PMID: 30964083; PMCID: PMC6469382.
  2. Jennings, L. K., & Krywko, D. M. (2018). Pelvic Inflammatory Disease. StatPearls Publishing. Retrieved from https://europepmc.org/article/MED/29763134
  3. Smolarz B, Szyłło K, Romanowicz H. Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature). Int J Mol Sci. 2021 Sep 29;22(19):10554. doi: 10.3390/ijms221910554. PMID: 34638893; PMCID: PMC8508982.
  4. Ghobrial S, Ott J, Parry JP. An Overview of Postoperative Intraabdominal Adhesions and Their Role on Female Infertility: A Narrative Review. J Clin Med. 2023 Mar 15;12(6):2263. doi: 10.3390/jcm12062263. PMID: 36983263; PMCID: PMC10051311.
  5. Lai JM, Masten M, Markese A. Development of Hydrosalpinx After Prior Vaginal Hysterectomy and Bilateral Salpingectomy. Cureus. 2024 Jan 19;16(1):e52573. doi: 10.7759/cureus.52573. PMID: 38371103; PMCID: PMC10870105.
  6. Strandell A, Lindhard A, Waldenström U, Thorburn J, Janson PO, Hamberger L. Hydrosalpinx and IVF outcome: a prospective, randomized multicentre trial in Scandinavia on salpingectomy prior to IVF. Hum Reprod. 1999 Nov;14(11):2762-9. doi: 10.1093/humrep/14.11.2762. PMID: 10548619.
  7. Watrelot, A., & Chauvi, G. (2011). Current practice in tubal surgery and adhesion management: A review. Reproductive BioMedicine Online, 23, 53–62. doi:10.1016/j.rbmo.2011.05.010
  8. MyHealth Alberta. (n.d.). Fallopian tube procedures for infertility. Retrieved from https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=hw203637
  9. Singhal, S. (2022, August 24). What is Salpingostomy? Birla Fertility & IVF. Retrieved from https://birlafertility.com/blogs/what-is-salpingostomy/
  10. Women’s Imaging. (n.d.). Hystero-Salpingo Contrast Sonography (HyCoSy). Retrieved from https://womensimaging.net.au/what-we-do/gynaecology/hysterosalpingo-contrast-sonography/

Silent crisis on your plate: declining food quality

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Written By THT Editorial Team

Sanjogta Thapa Magar

Reviewed by Sanjogta Thapa Magar, Food Microbiologist

In an era marked by rapid advancements in food production and seemingly endless choices, a concerning paradox has emerged: the overall quality of our food appears to be in decline. This trend has far-reaching implications for public health, environmental sustainability, and the very enjoyment we derive from our meals. While the causes are complex and intertwined, several key factors contribute to this erosion of food quality.

A primary culprit lies in the intensification of industrial agriculture. Driven by demands for higher yields and lower costs, this model often prioritizes quantity over quality. The heavy reliance on monocropping, where vast swaths of land are devoted to a single crop, depletes soil nutrients and reduces biodiversity. A study published in the journal “Nature” found that intensive agriculture leads to significant declines in essential micronutrients in crops   (Assunção et al., 2022). Furthermore, the widespread use of chemical fertilizers and pesticides in this system contributes to a buildup of potentially harmful residues in our food supply and disrupts delicate soil ecosystems.

The decline in nutritional value extends to animal-based products as well. Factory farming methods, where animals are raised in confined spaces and fed diets designed for rapid weight gain, often produce meat and dairy products lower in beneficial nutrients like omega-3 fatty acids. A meta-analysis published in the “British Journal of Nutrition” revealed that organic milk and meat contain significantly higher levels of omega-3s, a finding with implications for heart health (Średnicka-Tober et al., 2016). These industrial practices not only diminish food quality but also contribute to environmental degradation and raise ethical concerns about animal welfare.

The rise of ultra-processed foods represents another significant threat to food quality. Designed for convenience and long shelf life, these products are often heavily laden with refined sugars, unhealthy fats, sodium, and artificial additives. Their omnipresence in supermarkets and aggressive marketing can displace the consumption of whole, minimally processed foods. Research increasingly links diets high in ultra-processed foods with a higher risk of chronic diseases including obesity, type 2 diabetes, and certain cancers (Monteiro et al., 2019). Ultra-processed foods tend to be low in fiber, vitamins, and minerals, essentially replacing nutrient-dense options with empty calories.

Furthermore, the pursuit of visual perfection and extended shelf life in the food industry has led to the selective breeding of fruits and vegetables for uniformity and durability rather than flavor or nutritional content. This practice can result in produce that is visually appealing but bland and less nutritious compared to heirloom varieties. Studies have shown that modern varieties of certain fruits and vegetables can have lower levels of antioxidants and other beneficial compounds than their older counterparts (Davis et al., 2004).

Globalization of the food supply chain, while bringing wider choices, also has downsides. Food transported over long distances often requires harvesting produce before it has fully ripened, compromising both taste and nutrients. The extended storage and transportation periods involved also necessitate higher levels of preservatives and artificial ripening techniques. This focus on non-perishability sacrifices the natural peak-season goodness of whole foods.

Economic pressures can further impact food quality. Consumers seeking lower prices may unknowingly incentivize production methods that cut corners by emphasizing mass output over the use of higher-quality ingredients or sustainable practices. This pressure can especially damage small-scale food producers who may struggle to compete with industrial operations.

Addressing the decline in food quality requires multi-faceted solutions. Supporting local and sustainable agriculture, where possible, helps shift away from industrial models and promotes growing practices that prioritize soil health and biodiversity. Choosing organic options can reduce exposure to pesticide residues and support agricultural methods that are more environmentally responsible. Moreover, prioritizing whole, minimally processed foods over ultra-processed options is a vital step toward a healthier diet.

Consumer awareness and education play a crucial role. Understanding food labels, seeking out seasonal produce, and rediscovering the art of home cooking can empower individuals to make informed choices and regain control over the quality of their food. Advocacy for policies that promote transparency in food labeling, support sustainable agriculture, and limit the marketing of unhealthy foods to children is also essential for systemic change.

While improving food quality may not be easy, it’s undoubtedly necessary. By recognizing the root causes of this decline and actively supporting alternatives, we can reclaim a food system that nourishes our bodies and the planet.

REFERENCES

  1. Assunção, A. G. L., Cakmak, I., Clemens, S., González-Guerrero, M., Nawrocki, A., & Thomine, S. (2022). Micronutrient homeostasis in plants for more sustainable agriculture and healthier human nutrition. Journal of Experimental Botany, 73(6), 1789-1800. DOI: 10.1093/jxb/erac014
  2. Średnicka-Tober, D., Barański, M., Seal, C. J., Sanderson, R., Benbrook, C., Steinshamn, H., … & Mattei, J. (2016). Higher PUFA and n-3 PUFA, conjugated linoleic acid, α-tocopherol, and iron, but lower iodine and selenium concentrations in organic milk: A systematic review and meta- and redundancy analyses. British Journal of Nutrition, 115(6), 1043–1060. DOI: 10.1017/S0007114515005073
  3. Monteiro, C. A., Cannon, G., Levy, R. B., Moubarac, J.-C., Louzada, M. L. C., Rauber, F., Khandpur, N., Cediel, G., Neri, D., & Martinez-Steele, E. (2019). Ultra-processed foods: What they are and how to identify them. Public Health Nutrition, 22(5), 936–941. DOI: 10.1017/S1368980018003762
  4. Davis, Donald R., et al. “Changes in USDA Food Composition Data for 43 Garden Crops, 1950 to 1999.” Journal of the American College of Nutrition, vol. 23, no. 6, 2004, pp. 669–682.

Sexual Health after Prostate Surgery: Overcoming Challenges and Embracing Recovery

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Written By THT Editorial Team

Dr. Asmita Pandey

Reviewed by Dr. Erena Pradhan, Consultant Urologist, MS, MCH

The Journey to Recovery

Prostate cancer treatments, especially the surgical procedure known as radical prostatectomy, have profound effects on a man’s sexual health. This operation can alter erectile function, ejaculation, and overall sexual contentment (Hyun 2012). Both patients and healthcare providers need to grasp the intricacies of sexual health following prostate surgery to tackle these challenges and discover successful recovery strategies effectively.

Sexual Health and Prostate Surgery

Radical prostatectomy, a gold standard method for treating localized prostate cancer, may cause a range of postoperative sexual health concerns. One of the most common issues is erectile dysfunction caused by damage to the nerves that control erections (Bratu et al. 2017). While nerve-sparing surgeries are designed to reduce this risk, they’re not suitable for everyone, and some men may face persistent erectile dysfunction that necessitates continued support for fulfilling sexual activity. (Cancer Research UK, 2023).

Post-surgery, men might also encounter ejaculation issues, most commonly retrograde ejaculation, which is caused by destruction of the natural mechanism of preventing the backflow of semen into the urinary bladder. Also in radical prostatectomy, lack of seminal fluid production, leads to what’s known as dry orgasms (orgasm without ejaculation), which can alter the physical sensation of climax (Koren & Koren, 2020). Additionally, the removal of the prostate gland can change sexual sensations during anal intercourse, potentially affecting sexual pleasure and intimacy, particularly in same-sex relationships. (Alexis & Worsley, 2018).

Pathways to Sexual Health Recovery

Addressing the sexual health challenges after prostate surgery involves a variety of strategies and interventions to aid patients in reclaiming sexual function and satisfaction. Penile rehabilitation programs are vital in fostering erectile recovery by preserving the oxygenation of penile tissue and muscle health, as well as aiding nerve healing. (Müller et al., 2008) (Elliott & Matthew, 2017)

Medical treatments, including oral medications like sildenafil and tadalafil, can improve blood flow to the penis, aiding in achieving erections. For cases where more conservative treatments don’t yield results, vacuum devices and penile implants provide alternative solutions for erectile dysfunction (Wang et al., 2023). These methods are geared towards restoring penile erection and enhancing sexual performance after surgery.

A Holistic Approach to Sexual Well-being: 

Confronting the sexual health changes following prostate surgery which is often an unspoken aspect demands a holistic strategy that considers both the physical and psychological facets of sexual wellness. With an understanding of the potential complexities introduced by prostate cancer treatments and the implementation of personalized recovery plans, patients can improve their quality of life and rediscover gratifying sexual experiences.

In summary, active management of sexual health problems after prostate surgery through counselling, rehabilitation, and medical treatments is crucial in aiding patients on their path to restoring sexual function.  Healthcare providers can combine their medical knowledge with comprehensive care practices to help individuals effectively navigate the complexities of sexual health following prostate cancer therapy.

REFERENCES

  1. Hyun JS. Prostate cancer and sexual function. World J Mens Health. 2012 Aug;30(2):99-107. doi: 10.5534/wjmh.2012.30.2.99. Epub 2012 Aug 31. PMID: 23596596; PMCID: PMC3623527.
  2. Bratu O, Oprea I, Marcu D, Spinu D, Niculae A, Geavlete B, Mischianu D. Erectile dysfunction post-radical prostatectomy – a challenge for both patient and physician. J Med Life. 2017 Jan-Mar;10(1):13-18. PMID: 28255370; PMCID: PMC5304365.
  3. Cancer Research UK. (2023). Sex and erection problems after treatment for prostate cancer. Retrieved from https://www.cancercenter.com/community/blog/2023/06/sex-after-prostate-cancer
  4. Koren G, Koren D. Retrograde Ejaculation-a Commonly Unspoken Aspect of Prostatectomy for Benign Prostatic Hypertrophy. Am J Mens Health. 2020 Mar-Apr;14(2):1557988320910870. doi: 10.1177/1557988320910870. PMID: 32146870; PMCID: PMC7065283.
  5. Alexis O, Worsley AJ. The Experiences of Gay and Bisexual Men Post-Prostate Cancer Treatment: A Meta-Synthesis of Qualitative Studies. Am J Mens Health. 2018 Nov;12(6):2076-2088. doi: 10.1177/1557988318793785. Epub 2018 Aug 16. PMID: 30112965; PMCID: PMC6199434.
  6. Müller, A., Tal, R., Donohue, J. F., Akin-Olugbade, Y., Kobylarz, K., Paduch, D., Cutter, S. C., Mehrara, B. J., Scardino, P. T., & Mulhall, J. P. (2008). The effect of hyperbaric oxygen therapy on erectile function recovery in a rat cavernous nerve injury model. The Journal of Sexual Medicine, 5(3), 562-570. https://doi.org/10.1111/j.1743-6109.2007.00727.x
  7. Elliott, S., & Matthew, A. (2017). Sexual Recovery Following Prostate Cancer: Recommendations From 2 Established Canadian Sexual Rehabilitation Clinics. Retrieved from https://pcscprogram.ca/wp-content/uploads/2022/01/Sexual-Recovery-after-Prostate-Cancer-Elliott-Matthews.pdf
  8. Wang CM, Wu BR, Xiang P, Xiao J, Hu XC. Management of male erectile dysfunction: From the past to the future. Front Endocrinol (Lausanne). 2023 Feb 27;14:1148834. doi: 10.3389/fendo.2023.1148834. PMID: 36923224; PMCID: PMC10008940.

The unseen risks of synthetic fragrance: Safeguarding your health

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Written By THT Editorial Team

Dr. Kishor Adhikari

Reviewed by Prof Dr. Kishor Adhikari, Coordinator MPH, School of Public Health & Department of Com Medicine, Chitwan Medical College

Let’s step into a room with the fresh smell of clean sheets or sweet vanilla. These scents are part of our everyday life, offering a quick getaway for our noses. But what if these nice smells are hiding something harmful? This article takes a closer look at synthetic fragrances, showing the health risks they might have and how we can stay safe.

Fragrances are everywhere in products we use all the time. They might stay on our skin like in creams and perfumes, get washed off like in shampoos or shaving creams, or be part of things we use around the house. These products have chemicals that can make our skin react and, if we’re exposed to them enough, can cause skin allergies. (van Amerongen et al., 2021).

The chemical composition of Synthetic fragrances:

It’s quite shocking to learn that about 95% of the chemicals used in synthetic fragrances come from petroleum (Landrigan et al., 2023). This includes not just any chemicals, but some really nasty ones like benzene derivatives, which are known to cause cancer, and a whole bunch of other toxic stuff (Steinemann, 2016). So, every time we enjoy these scents, we’re actually exposing ourselves to a dangerous mix of chemicals, often without realizing it (Sarantis et al., 2010).

Synthetic fragrances are more than just a pleasant aroma in the air; they mess with our body’s hormonal system (Diamanti-Kandarakis et al., 2009). It’s like they crash the body’s system, setting off a chain reaction of health problems that can affect everything from our ability to have children to increasing the risk of hormone-related cancers (National Institute of Environmental Health Sciences, 2024).

The inhalation of synthetic fragrance can cause trouble for someone with asthma, setting off symptoms that can be really tough to deal with (Rádis-Baptista, 2023). It’s sad that the scents we use to relax or feel good might actually make it hard to breathe.

When it comes to our skin, it can react badly to synthetic fragrances, leading to irritation or even allergies (van Amerongen et al., 2021). What’s meant to make us feel nice and smell great can sometimes end up causing a lot of discomfort instead.

 Health Risks associated with synthetic fragrances:

Fragrances do more than just make us feel good; they might also help with stress and boost our memory. But there’s a downside. They can cause a bunch of health issues, like skin irritation, allergies, reactions that aren’t just rashes, sensitivity to sunlight, and other sudden skin problems. These issues can really mess with our day-to-day life and how we enjoy it.  (Pastor-Nieto & Gatica-Ortega, 2021).

Respiratory Distress:

The inhalation of synthetic fragrances can be a silent trigger for respiratory issues, particularly for those with pre-existing conditions like asthma. The volatile organic compounds (VOCs) in these fragrances can irritate the airways, leading to asthma attacks and exacerbating chronic lung diseases (Rádis-Baptista, 2023). Moreover, a study by the (Bălă et al., 2021) has highlighted that long-term exposure to certain VOCs can result in serious respiratory complications, including chronic obstructive pulmonary disease (COPD) It is possible that inhalation exposure of those with asthma, or otherwise susceptible individuals, to fragrance materials (and/or other components of domestic cleaning products) might trigger or exacerbate an asthmatic reaction (Basketter, Huggard, & Kimber, 2019)

Skin Irritation and Allergies: More than Skin Deep Synthetic fragrances are a common cause of contact dermatitis, a type of skin inflammation that results in itchy, red, and sometimes painful rashes. These fragrances contain allergens that can disrupt the skin’s protective barrier, making it more susceptible to irritation (van Amerongen et al., 2021). Furthermore, research has shown that certain fragrance compounds can sensitize the skin, leading to allergic reactions upon subsequent exposures  (Giménez-Arnau, 2019)

Cancer Risk: The Scented Shadow Perhaps the most alarming risk associated with synthetic fragrances is their potential link to cancer. Benzene derivatives, commonly found in these fragrances, are classified as carcinogens and have been associated with an increased risk of various cancers, including leukemia and lymphoma (Kazemi et al. 2022). A recent study has also raised concerns about the presence of other carcinogenic compounds in synthetic fragrances, suggesting a possible connection to breast and ovarian cancers (Steinemann, 2016).

Multiple Chemical Sensitivity (MCS): MCS is triggered by exposure to low levels of common contaminants, even at concentrations considered non-toxic for the general population. Imagine navigating a world where everyday scents transform into adversaries. (Zucco & Doty, 2021).

Chemical Intolerance (CI): CI is a condition resulting from exposure to odorous or pungent substances, impacting both physiology and brain function. Individuals with CI may process sensory information differently, experiencing heightened activity in the amygdala, responsible for emotions and fear responses. This heightened sensitivity may result in both physical and psychological distress. (Azuma et al., 2019).

Strategies to Minimize Exposure

Read Labels Carefully: Scrutinize product labels for the term “fragrance” and opt for those with transparent ingredient lists. Seek out brands that disclose the specific components of their fragrances.

Choose Natural Alternatives: Favor products scented with natural essential oils rather than synthetic fragrances. These oils not only provide delightful scents but also offer therapeutic benefits. Essential oils like lavender, eucalyptus, and citrus can uplift mood without compromising health.

Ventilate Indoor Spaces: Proper ventilation helps reduce indoor fragrance exposure. Open windows, utilize air purifiers, and minimize the use of air fresheners. Fresh air serves as nature’s best deodorizer.

DIY Fragrance Solutions: Empower yourself by creating personalized scents using essential oils. Experiment with blends that resonate with your senses, either by mixing them with carrier oils or using them in diffusers.

Educate Others: Advocate for informed choices by spreading awareness about the risks of synthetic fragrances. Encourage friends and family to make conscious decisions, contributing collectively to a healthier environment.

 Conclusion

While synthetic fragrances may exude an air of harmlessness, their impact on health is profound. As consumers, we wield the power to make discerning choices, opting for scents that enhance our lives without compromising well-being. By comprehending the hidden dangers and taking proactive steps, we can shield ourselves and future generations from the fragrant pitfalls that surround us.

Remember, health is our most precious fragrance—handle it with care.

REFERENCES

  1. van Amerongen, C. C. A., Ofenloch, R. F., Cazzaniga, S., Elsner, P., Gonçalo, M., Naldi, L., Svensson, Å., Bruze, M., & Schuttelaar, M. L. A. (2021). Skin exposure to scented products used in daily life and fragrance contact allergy in the European general population – The EDEN Fragrance Study. Contact Dermatitis, 84(6), 385-394. https://doi.org/10.1111/cod.13807
  2. Landrigan PJ, Raps H, Cropper M, Bald C, Brunner M, Canonizado EM, Charles D, Chiles TC, Donohue MJ, Enck J, Fenichel P, Fleming LE, Ferrier-Pages C, Fordham R, Gozt A, Griffin C, Hahn ME, Haryanto B, Hixson R, Ianelli H, James BD, Kumar P, Laborde A, Law KL, Martin K, Mu J, Mulders Y, Mustapha A, Niu J, Pahl S, Park Y, Pedrotti ML, Pitt JA, Ruchirawat M, Seewoo BJ, Spring M, Stegeman JJ, Suk W, Symeonides C, Takada H, Thompson RC, Vicini A, Wang Z, Whitman E, Wirth D, Wolff M, Yousuf AK, Dunlop S. The Minderoo-Monaco Commission on Plastics and Human Health. Ann Glob Health. 2023 Mar 21;89(1):23. doi: 10.5334/aogh.4056. Erratum in: Ann Glob Health. 2023 Oct 11;89(1):71. PMID: 36969097; PMCID: PMC10038118.
  3. Steinemann, A. C. (2016). Fragranced consumer products: exposures and effects from emissions. Air Quality, Atmosphere & Health, 9, 861–8661
  4. Sarantis, H., Naidenko, O. V., Gray, S., Houlihan, J., Malkan, S., Archer, L., Scranton, A. G., Nudelman, J., & Davis, M. (2010). Not so sexy: The health risks of secret chemicals in fragrance. Campaign for Safe Cosmetics and Environmental Working Group. Retrieved from www.ewg.org/sites/default/files/report/SafeCosmetics_FragranceRpt.pdf1
  5. Diamanti-Kandarakis E, Bourguignon JP, Giudice LC, Hauser R, Prins GS, Soto AM, Zoeller RT, Gore AC. Endocrine-disrupting chemicals: an Endocrine Society scientific statement. Endocr Rev. 2009 Jun;30(4):293-342. doi: 10.1210/er.2009-0002. PMID: 19502515; PMCID: PMC2726844.
  6. National Institute of Environmental Health Sciences. (2024). Endocrine disruptors. Retrieved from https://www.niehs.nih.gov/health/topics/agents/endocrine
  7. Rádis-Baptista G. Do Synthetic Fragrances in Personal Care and Household Products Impact Indoor Air Quality and Pose Health Risks? J Xenobiot. 2023 Mar 1;13(1):121-131. doi: 10.3390/jox13010010. PMID: 36976159; PMCID: PMC10051690.
  8. Bălă, G.-P., Râjnoveanu, R.-M., Tudorache, E., Motișan, R., & Oancea, C. (2021). Air pollution exposure—the (in)visible risk factor for respiratory diseases. Environmental Science and Pollution Research, 28, 19615–19628. https://doi.org/10.1007/s11356-021-12412-7
  9. Basketter, D. A., Huggard, J., & Kimber, I. (2019). Fragrance inhalation and adverse health effects: The question of causation. Regulatory Toxicology and Pharmacology, 104, 151-156. https://doi.org/10.1016/j.yrtph.2019.03.011
  10. Giménez-Arnau, E. (2019). Chemical compounds responsible for skin allergy to complex mixtures: How to identify them? Dermatochemistry Laboratory, University of Strasbourg-Institut de Chimie, CNRS UMR 7177, Institut le Bel. Retrieved from http://www.unistra.fr/index.php?id=egimenez
  11. Kazemi Z, Aboutaleb E, Shahsavani A, Kermani M, Kazemi Z. Evaluation of pollutants in perfumes, colognes and health effects on the consumer: a systematic review. J Environ Health Sci Eng. 2022 Feb 3;20(1):589-598. doi: 10.1007/s40201-021-00783-x. PMID: 35669814; PMCID: PMC9163252.
  12. Zucco, G. M., & Doty, R. L. (2021). Multiple chemical sensitivity. Brain Sciences, 12(1), 46. https://doi.org/10.3390/brainsci12010046
  1. Azuma K, Uchiyama I, Tanigawa M, Bamba I, Azuma M, Takano H, Yoshikawa T, Sakabe K. Chemical intolerance: involvement of brain function and networks after exposure to extrinsic stimuli perceived as hazardous. Environ Health Prev Med. 2019 Oct 22;24(1):61. doi: 10.1186/s12199-019-0816-6. PMID: 31640568; PMCID: PMC6806489.
  2. Pastor-Nieto, M. A., & Gatica-Ortega, M. E. (2021). Ubiquity, hazardous effects, and risk assessment of fragrances in consumer products. Current Treatment Options in Allergy, 8(1), 21-41. https://doi.org/10.1007/s40521-020-00275-7

Tuberculosis: Causes, Prevention and Management

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Written By THT Editorial Team

Sujata Shakya

Reviewed by Sujata Shakya, Public Health Practitioner, Assistant Professor, Public health (IOM)

Tuberculosis (TB) is a contagious infectious disease caused by the bacterium Mycobacterium tuberculosis. It primarily affects the lungs but can also impact other parts of the body. Understanding the causes, prevention, and management of TB is essential for controlling its spread and reducing its impact on public health.

Causes of Tuberculosis:

Tuberculosis is caused by the transmission of Mycobacterium tuberculosis from an infected individual to a susceptible person. The bacteria can be spread through the air when an infected individual coughs, sneezes, or speaks, releasing respiratory droplets containing the bacteria (1). Factors such as overcrowded living conditions, poor ventilation, and compromised immune systems increase the risk of TB transmission (2).

Prevention of Tuberculosis:

Preventative measures play a crucial role in reducing the incidence of TB. Some examples of preventative measures include:

Vaccination: Bacille Calmette-Guérin (BCG) vaccine is used to prevent severe forms of TB in children. It provides partial protection against TB and reduces the risk of disseminated TB in infants and young children (3). However, the BCG vaccine’s effectiveness in preventing pulmonary TB, the most common form of the disease, varies and is generally less effective in adults.

Infection Control: Implementing effective infection control measures is crucial to prevent the spread of TB. This includes identifying and promptly isolating individuals with active TB, ensuring proper ventilation in healthcare facilities, and promoting cough etiquette (4).

Screening and Testing: Active case finding and early detection of TB cases are essential for preventing further transmission. Regular screening of high-risk populations, such as close contacts of TB patients, healthcare workers, and individuals living with HIV, is recommended. Diagnostic tests such as sputum smear microscopy, molecular tests, and chest X-rays are used to detect TB infection (5).

Treatment of Latent TB Infection: Individuals with latent TB infection, who have the TB bacteria in their bodies but do not have active disease, can progress to active TB if not treated. Treating latent TB infection with antibiotics, such as isoniazid or rifampin, can prevent the development of active TB disease (6).

Management of Tuberculosis:

TB management focuses on early diagnosis, appropriate treatment, and adherence to medication. Some key aspects of TB management include:

Directly Observed Therapy (DOT): DOT is a strategy in which healthcare providers or trained community health workers directly observe patients taking their TB medications. This approach ensures treatment adherence and helps prevent the development of drug-resistant TB (7).

Drug Therapy: TB is treated with a combination of antibiotics for a specific duration. The standard treatment regimen for drug-susceptible TB includes a combination of isoniazid, rifampin, ethambutol, and pyrazinamide. Drug-resistant TB requires more complex treatment regimens using second-line drugs (8).

Contact Investigation: Identifying and testing individuals who have had close contact with TB patients is crucial for early detection of TB cases and preventing further transmission. Contact investigation involves screening and testing close contacts to identify latent TB infection or active TB disease (9).

Adherence Support: Ensuring treatment adherence is vital for successful TB management and prevention of drug resistance. Providing patient education, counseling, and support services can improve medication adherence and treatment outcomes (10).

Conclusion:

Preventing and managing tuberculosis requires a comprehensive approach involving vaccination, infection control measures, screening and testing, treatment of latent infection, and effective management of active TB cases. By implementing evidence-based preventative measures and ensuring early diagnosis and appropriate treatment, communities can work towards reducing the burden of tuberculosis and protecting public health.

REFERENCES

Endometriosis: Understanding Its Impact and Exploring Treatment Avenues

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Written By THT Editorial Team

Dr. Asmita Pandey

Reviewed by Dr. Asmita Pandey, Fertility Expert , M.D. (OB/GYN) 

Endometriosis is a disorder where endometrial-like tissue forms outside the uterine cavity, causing chronic pelvic discomfort, intense menstrual pain, dyspareunia, and potential infertility (Parasar et al. 2017). This ectopic endometrial tissue can adversely affect a woman’s reproductive health. While treatments focus on symptom relief and enhancing life quality, endometriosis remains incurable. (Malvezzi et al. 2020).

Symptoms of Endometriosis: Endometriosis manifests as ectopic tissue growth resembling the uterine lining, leading to symptoms that can profoundly affect a woman’s well-being. Notable symptoms include:

Dysmenorrhea: Affected women may suffer from debilitating cramps during menstruation, often radiating to the abdomen or back, surpassing typical menstrual discomfort. (Chauhan et al.2022)

Pain during Intimacy: The condition may result in pain during or following sexual activity, causing considerable distress. (Chauhan et al. 2022)

Painful Excretory Functions: Pain may occur during bowel movements or urination, especially coinciding with menstrual periods. (Mayo Clinic, 2024)

Menorrhagia or Metrorrhagia: There may be unusually heavy flows during periods or bleeding between cycles, disrupting the regular menstrual pattern. (Chauhan et al. 2022)

Infertility: Often linked to infertility, endometriosis might be identified in fertility assessments for women struggling to conceive. (Bulun et al. 2019)

Fatigue: Persistent tiredness or exhaustion can interfere with daily routines and affect overall health.

Additional Symptoms: Other possible symptoms include mood disorders, low body weight, increased pain sensitivity, and irregular spotting or bleeding outside of menstrual cycles.

Approaches to Managing Endometriosis:

Analgesics: Medications such as NSAIDs, including ibuprofen, and analgesics like paracetamol, are utilized to alleviate endometriosis-related discomfort.

Endocrine Therapy: This strategy involves reducing estrogen levels to diminish endometriosis lesions and lessen discomfort. Treatment modalities encompass oral contraceptives, progestins, and GnRH analogs.  (Bulun et al. 2019)

Operative Interventions: Selective surgery, often via laparoscopy, aims to excise endometriosis lesions while retaining reproductive organs, potentially enhancing fertility prospects. (Chauhan et al. 2022)

Reproductive Assistance: In cases of endometriosis-induced infertility, options such as surgical lesion removal, ovarian stimulation coupled with IUI, and IVF are explored. (Lee et al. 2020)

It’s crucial to recognize that treatment choices hinge on various personal factors, including age, symptom intensity, reproductive aspirations, and personal preferences. While these interventions aim to mitigate symptoms and elevate life quality, they are not curative. Engaging in a dialogue with a medical professional is vital to tailor treatment plans to one’s unique health profile.

For further information on endometriosis treatment options and considerations, please refer to the provided sources or book consultations here.

REFERENCES

  1. Parasar P, Ozcan P, Terry KL. Endometriosis: Epidemiology, Diagnosis and Clinical Management. Curr Obstet Gynecol Rep. 2017 Mar;6(1):34-41. doi: 10.1007/s13669-017-0187-1. Epub 2017 Jan 27. PMID: 29276652; PMCID: PMC5737931.
  2. Malvezzi H, Marengo EB, Podgaec S, Piccinato CA. Endometriosis: current challenges in modeling a multifactorial disease of unknown etiology. J Transl Med. 2020 Aug 12;18(1):311. doi: 10.1186/s12967-020-02471-0. PMID: 32787880; PMCID: PMC7425005.
  3. Chauhan S, More A, Chauhan V, Kathane A. Endometriosis: A Review of Clinical Diagnosis, Treatment, and Pathogenesis. Cureus. 2022 Sep 6;14(9):e28864. doi: 10.7759/cureus.28864. PMID: 36225394; PMCID: PMC9537113.
  4. Bulun SE, Yilmaz BD, Sison C, Miyazaki K, Bernardi L, Liu S, Kohlmeier A, Yin P, Milad M, Wei J. Endometriosis. Endocr Rev. 2019 Aug 1;40(4):1048-1079. doi: 10.1210/er.2018-00242. PMID: 30994890; PMCID: PMC6693056.
  5. Mayo Clinic. (2024). Endometriosis – Symptoms and causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656
  6. Lee D, Kim SK, Lee JR, Jee BC. Management of endometriosis-related infertility: Considerations and treatment options. Clin Exp Reprod Med. 2020 Mar;47(1):1-11. doi: 10.5653/cerm.2019.02971. Epub 2020 Feb 24. Erratum in: Clin Exp Reprod Med. 2020 Jun;47(2):153. PMID: 32088944; PMCID: PMC7127898.

Licorice Root: A Simple Guide to Its Sweet Benefits

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Written By THT Editorial Team

Dr. Hari Sharan Aryal

Reviewed by Dr. Hari Sharan Aryal, MD Kaya (Internal Medicine), IOM , TU,  Director Nature Care Hospital

Licorice root (जेठी मधु), from the plant Glycyrrhiza glabra, is more than just a candy flavor. It’s been used in traditional medicine for ages because of its health benefits.

Stomach Saver: This root is like a superhero for your stomach. It’s got substances—glycyrrhizin and flavonoids—that fight off ulcers by forming a protective layer on the stomach’s surface, reducing acid, and helping heal ulcers which has been supported by findings from Rahnama et al. (2013), who studied the healing effects of licorice on Helicobacter pylori infected peptic ulcers.”

Virus Fighter: Licorice root might also be a secret weapon against viruses, especially those that mess with your liver. It’s got stuff in it that stops viruses from multiplying and tweaks your immune system to help your liver stay healthy as demonstrated by Wang et al. (2015), licorice has been identified to have significant antiviral and antimicrobial properties.”

Swelling Be Gone: Got swelling? Licorice root might help with that too. It’s got anti-inflammatory powers that could take down swelling, which is great news if you’re dealing with arthritis, asthma, or skin issues which is supported by the findings of Yang et al. (2017), who investigated the anti-inflammatory properties of licorice.”

Cough Calmer: And if you’ve got a cough that won’t quit, licorice root might be your go-to. It’s been used to soothe your throat and help you get rid of mucus, making it easier to breathe and lessening coughs ( Seladi-Schulman 2022)

Stress Buster: Licorice root is also an adaptogen, which means it helps your body deal with stress. It can help keep your cortisol—your body’s stress alarm—under control, which might make you feel more chill. (Armanini et al. 2004)

But, Heads Up: Just like with anything, you can not have too much of a good thing. If you go overboard with licorice root, it can throw your body’s mineral balance out of whack, leading to high blood pressure and low potassium, which is no bueno. (Wahab et al. 2021)

Doctor Knows BestSo, it’s super important to use licorice root the right way. Talk to a healthcare pro before diving in, especially if you’ve got other health stuff going on or you’re taking meds that might not play nice with it. And keep an eye on your potassium levels to stay safe.

REFERENCES

  1. Rahnama M, Mehrabani D, Japoni S, Edjtehadi M, Saberi Firoozi M. The healing effect of licorice (Glycyrrhiza glabra) on Helicobacter pylori infected peptic ulcers. J Res Med Sci. 2013 Jun;18(6):532-3. PMID: 24250708; PMCID: PMC3818629.
  2. Wang L, Yang R, Yuan B, Liu Y, Liu C. The antiviral and antimicrobial activities of licorice, a widely-used Chinese herb. Acta Pharm Sin B. 2015 Jul;5(4):310-5. doi: 10.1016/j.apsb.2015.05.005. Epub 2015 Jun 17. PMID: 26579460; PMCID: PMC4629407.
  3. Yang R, Yuan BC, Ma YS, Zhou S, Liu Y. The anti-inflammatory activity of licorice, a widely used Chinese herb. Pharm Biol. 2017 Dec;55(1):5-18. doi: 10.1080/13880209.2016.1225775. Epub 2016 Sep 21. PMID: 27650551; PMCID: PMC7012004.
  4. Seladi-Schulman, J., Ph.D. (2022, November 10). The 7 best teas to help ease a cough. Healthline. Retrieved from https://www.healthline.com/health/tea-for-cough
  5. Armanini D, Mattarello MJ, Fiore C, Bonanni G, Scaroni C, Sartorato P, Palermo M. Licorice reduces serum testosterone in healthy women. Steroids. 2004 Oct-Nov;69(11-12):763-6. doi: 10.1016/j.steroids.2004.09.005. PMID: 15579328.
  6. Wahab S, Annadurai S, Abullais SS, Das G, Ahmad W, Ahmad MF, Kandasamy G, Vasudevan R, Ali MS, Amir M. Glycyrrhiza glabra (Licorice): A Comprehensive Review on Its Phytochemistry, Biological Activities, Clinical Evidence and Toxicology. Plants (Basel). 2021 Dec 14;10(12):2751. doi: 10.3390/plants10122751. PMID: 34961221; PMCID: PMC8703329.