Friday, November 9, 2018

Noise pollution: Safe noise levels

Everyday noise exposure over time has an impact upon our ability to hear and on the degree of hearing loss that develops. Constant exposure to loud noise can cause high frequency sensory neural hearing loss.

An exposure of 90 dB (which is equivalent to the noise made by a power lawn mower or passing motorcycle) is allowed for 8 hours, 95 dB for 4 hours, 100 dB only for 2 hours, 105 dB ( power mower) for one hour and 130 dB for (live rock music) 20 minutes.

Listening to music at 110-120 dB damages the hearing in less than an hour and a half.

A short blast of loud noise - greater than 120 to 155 dB - such as from fire crackers can cause severe to profound sensorineural hearing loss, pain, or hyperacusis (pain associated with loud noise). Most unregulated large bombs can produce a noise of more than 125 dB. Hence, the manufacture and sale of fire crackers generating a noise level of more than 125 dB at 4 meters distance from the point of bursting are prohibited.

The permissible noise limits in residential areas are 45 dB in night time and 55 dB in day time. 

The limits are 50 dB in daytime (6am to 10 pm) and 40 dB in night time (10 pm to 6am) in Silence zones, which are areas up to 100 meters around hospitals, educational institutions and courts.

A normal conversation is about 60 dB. Noise from other rooms, hallway noises, or noise within the hall itself such as conversation of the audience, noise from AC/fans, phones ringing, turning paper, etc. adds to the decibels.

Background noise interferes with auditory communication and adversely affects speech perception and speech recognition. It also affects attention and memory. For a proper attention span, the noise levels should be below 50 dB.  

Exposure to noise beyond permissible limits is a health hazard. Noise is a major avoidable cause of hearing loss. It not only affects the ears but the entire human body. The heart rate and BP increase. Noise at night disturbs sleep, especially for the elders and young ones. Sounds above the permissible level produces personality changes, affects human productivity and also increases the formation of free radicals in the human body.

It is recommended that people who are continuously exposed to a noise level of greater than 85 dB should be provided hearing protection in the form of muffs or plugs.

Vedic literature has described four gradations or levels of sound: Para (background noise of nature, no spoken sound), pashyanti (observed sound or perceived in mind), madhyama (audible sound), and vaikhari (articulated sound or spoken words). We should speak in pashyanti and madhyama.

Noise shifts the body to sympathetic mode and takes us away from conscious-based decisions. Hence, we should make an effort to speak softly to minimize the ambient noise levels.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

Wednesday, November 7, 2018

Diwali - The Festival of Inner Purnima on Outer Amavasya

Diwali is celebrated on the day of Amavasya, but the festival is symbolized by inner happiness, lighting or Purnima.

In mythology, the moon is symbolized as cool positive thoughts.

Purnima is marked by positive thoughts, whereas amavasya is predominantly marked by negatives thoughts as during Amavasya. Since, there is darkness all around, Amavasya is usually considered inauspicious. Diwali, however, is the only day in a year where one experiences positive thoughts on the day of Amavasya. Hence, it is believed that the festival of Diwali denotes inner Purnima and outer Amavasya.

Diwali is the only Amavasya where one does not do Shraadh pooja.  Unlike other amavasyas, when no new projects are started nor any new purchases done, on Diwali Amavasya (falling in Chaturmas), it is considered auspicious to start any new project. Even deaths on this Amavasya are considered auspicious (unlike on other Amavasya days).

Diwali celebrations also coincide with the end of Chaturmas, the four months of negative state of mind.

The purification process in Chaturmas starts with the first Navratra falling on Amavasya. During these nine days, one undergoes mind, body and soul detoxification by not thinking negative thoughts, doing positive things and acquiring soul-based knowledge.

The mind and body detoxification during Navratras end with killing of Tamas (Kumbhakarna), Rajas (Meghnath) and ego (Ravan) and the victory of consciousness (Rama) over the evil.

These benefits do not lead to inner Moksha or happiness until 20 days, the day of Diwali. To continue getting the benefits of Navratras, one needs to fast with a positive state of mind every fourth day till Diwali.

On Sharad Purnima, the fast involves thinking positive with a cool mind to get health benefits. Four days later, Karvachauth again is observed as a fast and worship of the Moon with positive thoughts and longevity benefits. Four days later on Ahoi Ashtami, one worships the moon and the stars with positive thoughts and acquires fertility benefits.

On the day of Dhanteras one acquires a win over the fear of death (Yama). On this day, the fast involves deeper meditation (Samudra manthan) to get all the benefits of Samadhi.

At the end of the meditation in the state of Samadhi, one gets in touch with the consciousness or the God, the insight gets illuminated and a person experiences bliss, a state of ecstasy of inner happiness and that is what is called experiencing inner Purnima on the day of outer Amavasya and the festival is celebrated as Diwali.

This entire one month of purification of thoughts helps to combat the depression phase that often sets in with the onset of winter.

Let us all worship this Diwali is a state of positive mental state…

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

Tuesday, November 6, 2018

Adverse health effects of particulate matter

Whenever we talk of air pollution, suspended particulate matter or PM as it is commonly referred to, is generally taken as representative of the level of pollution. In all there are eight air quality parameters, which are taken into consideration when the Air Quality Index (AQI) is calculated: Suspended particulate matter (PM2.5 and PM10), sulfur dioxide (SO2), ozone (O3), nitrogen oxides (NO2), carbon monoxide (CO), ammonia (NH3) and lead (Pb).

Particulate matter consists of a complex mixture of solid and liquid particles of organic and inorganic substances suspended in the air. It is mainly made up of sulfates, nitrates, ammonia, sodium chloride, black carbon, mineral dust and water and allergens (fragments of pollen or mold spores).

When outdoor levels of particulate matter are high, their levels also increase indoors.

Depending on the size, there are three types of particulate matter: PM 10, PM 2.5 PM and PM 0.1.

·         PM 10 are particles with a diameter of 10 microns or less (coarse particles). Sources include crushing or grinding operations and dust stirred up by vehicles on roads.

·         PM 2.5 are particles with a diameter of 2.5 microns or less (fine particles).

·         PM 0.1 are particles with a diameter of 0.1 microns or less (ultra-fine particles).

The sources of fine and ultra-fine particles include motor vehicles, power plants, biomass burning, agricultural burning, and industrial emissions. They remain suspended in the air for longer periods of time than coarse particles and hence, are more likely to be inhaled.

The size of the particles has a direct association with their effect on health. PM 10 particles can penetrate and remain deep inside the lungs, while PM 2.5 and PM 0.1 can penetrate the lung barrier and enter the blood system. They have more health damaging effects as they can affect all organs of the body. Fine particles (PM2.5) are the main cause of reduced visibility (haze).

As per international recommendations, both PM 10 and PM2.5 should be less than 40. For India, the PM10 levels should be less than 100 and PM 2.5 levels should be less than 60.

The larger PM 10 particles can irritate the eyes, nose and throat. PM10 mainly affects the respiratory system and may precipitate an acute asthma attack and acute exacerbation of chronic bronchitis or may cause other respiratory problems such as cough, wheeze.

The fine and ultra-fine particles also affect the heart so they may trigger an acute cardiovascular event such as heart attack or stroke or atrial fibrillation as they increase the resting blood pressure due to sympathetic overactivity and cause endothelial dysfunction and thickening of the blood. 

PM 2.5 and PM 0.1 particles also have a greater association with increased mortality due to heart disease.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

Monday, November 5, 2018

Should we use face masks to reduce exposure to pollution?

Over 5 million workers wear respirators in 1.3 million workplaces throughout the United States. So, it is an established fact that face masks do help preventing damage from particulate matter.

These respirators protect people against insufficient oxygen environments, harmful dusts, fogs, smokes, mists, gases, vapors and sprays. These hazards are known to cause cancer, lung impairment, heart attacks, paralysis, or death.

Respirators are of two types. Some remove contaminants and particulate matter from the air and are called particulate respirators. The example is N95 respirators.

Others are powered air-purifying respirators with cartridges/canisters which filter out chemicals and gases. These respirators protect by supplying clean respirable air from another source. Respirators that fall into this category include airline respirators, which use compressed air from a remote source, and self-contained breathing apparatus, which include their own air supply. They are like personal air purifiers.

N95 mask, the easily available one are particulate respirators and filter particles ≥1 micrometer in diameter with at least 95% efficiency given flow rates up to 50 liters per minute. The main disadvantage is, to be effective, N95 masks must fit to a person's face with less than 10% seal leakage. Secondly, 90% of our time is spent indoors and indoor pollution may be as bad as or even worse than the outdoor pollution.

N95 respirators are not designed for children or people with facial hair. Because a proper fit cannot be achieved on children and people with facial hair, so the N95 respirator may not provide full protection.

N95 respirators can be surgical or industrial types. The ones used in hospitals are surgical ones and the one used in the industry are industrial certified.

The industrial ones are manufactured for use in construction and other industrial type jobs that expose workers to dust and small particles are regulated.

These products are labeled “For occupational use”.NIOSH approves them for at least 95% filtration efficiency against certain non-oil based particles. Adjustable nose clip helps in obtaining a secureseal.

All respirators must be put on and taken off in an area outside of the contaminated area. Putting a respirator on or taking it off even for a few seconds in a contaminated area can expose the wearer to significant levels of hazards.All requirefit-testing and must be adjusted to your face to provide the intended effectiveness of filtering 95% of particles with mass median diameter of 0.3 micrometers. They are not certified to be fluid resistant.

Simple surgical mask may not help to protect from pollution.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

Everyone should have health insurance

People who are government employees or PSUs are automatically insured as ESI is compulsory. Most corporates have an insurance policy.

Regardless, there are many who still do not have a health insurance.

Most of us have cars and we have a car insurance policy as protection from damage due to accidents or floods or thefts. We shop for and buy the best insurance for our car, which can be expensive, as high as Rs 40,000/- or even higher, depending on the car model. Nonetheless, we make regular payments every year with no questions asked. 

The day to day stress takes a toll on our health. In the rush of the day, we ignore our health. And, health insurance takes a back seat and becomes less of a priority.

When we comply with the terms of the insurance policy, why do we not do the same for our body?

The advantages of health insurance are manifold. A basic health insurance policy safeguards against medical expenses, especially unplanned for medical expenses, when you may not have adequate funds to cover the cost of treatment.

If you have insurance, do not spend the entire sum in one go. Opt for day care or try to minimize hospital stay as much as possible.

Everybody should have health insurance. It’s no longer an “option”; health insurance is now a must.

After all, “Health is wealth”. Nothing is more valuable than good health.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

Saturday, November 3, 2018

What is individual social responsibility?

As individuals, we are not isolated units, but are a part of the society we live in. All of us are connected to each other. This is what our Vedas also teach us. “Vasudhaiva kutumbakam” i.e. “the whole world is one family” is a fundamental principle of Vedic philosophy.

Society helps us to grow as individuals. So while we take from the society, it’s only right that we also give back. Because its only then will we have a true sense of belonging to the community we live in.

Each one of us therefore has a social responsibility to work for the welfare of people, outside our immediate circle or the community. This is individual social responsibility.

Individual social responsibility is not exclusive to betterment of people; it also means, what we as individuals can contribute towards improving our environment.

Our ancient scriptures have described what charity is and what its benefits are.

In Chapter 17, Shloka 20, the Bhagawad Gita says,

दातव्यमिति यद्दानं दीयतेऽनुपकारिणे |
देशे काले पात्रे तद्दानं सात्विकं स्मृतम् || 20||

“dātavyam iti yad dāna dīyate ‘nupakārie
deśhe kāle cha pātre cha tad dāna
sāttvika smitam”

“Charity given to a worthy person simply because it is right to give, without consideration of anything in return, at the proper time and in the proper place, is stated to be in the mode of goodness”.

In Chapter 18, Shloka 5, the Bhagawad Gita says

यज्ञदानतप:कर्म त्याज्यं कार्यमेव तत् |
यज्ञो दानं तपश्चैव पावनानि मनीषिणाम् || 5||

yajña-dāna-tapa-karma na tyājya kāryam eva tat
yajño dāna
tapaśh chaiva pāvanāni manīhiām

“Actions based upon sacrifice, charity, and penance should never be abandoned; they must certainly be performed. Indeed, acts of sacrifice, charity, and penance are purifying even for those who are wise.”

In Chapter 18, Shloka 6, the Bhagawad Gita says

एतान्यपि तु कर्माणि सङ्गं त्यक्त्वा फलानि |
कर्तव्यानीति मे पार्थ निश्चितं मतमुत्तमम् || 6||

etāny api tu karmāi saga tyaktvā phalāni cha
kartavyānīti me pārtha niśhchita
matam uttamam

“These activities must be performed without attachment and expectation for rewards. This is my definite and supreme verdict, O Arjun.

The Ramayana also concurs in the following verse:

“pragaa chāri pada dharma ke kali mahu ek pradhāna
jena kena bidhi dīnhe dāna karai kalyāna [v6]”

“Dharma has four basic tenets, one amongst which is the most important in the age of Kali—give in charity by whatever means possible.”

The Skandh Purā states:

nyāyopārjita vittasya daśhamānśhena dhīmata
kartavyo viniyogaśhcha īśhvaraprityarthameva cha [v7]

“From the wealth you have earned by rightful means, take out one-tenth, and as a matter of duty, give it away in charity. Dedicate your charity for the pleasure of God.”

In Islam, all Muslims who meet the necessary criteria of wealth are required to give 2.5% of their total wealth to the needy as ‘Zakat’.

Sikhism also requires Sikhs to donate one-tenth of their earnings as “Daan” towards the common resources of the community.

As doctors, we should devote 10% of our time to charity in the form of free OPDs or camps.

Charity is selfless; therefore any act of charity teaches us “aparigraha” or non-possession or non-attachment; it fosters an attitude of helping others; the joy it brings to us is abundant.

Charity or daan or individual social responsibility is voluntary, but as Mahatma Gandhi said, “The best way to find yourself is to lose yourself in the service of others.”

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA