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Positive Health

Health in broad sense does not merely means absence of disease or provision of diagnostic, curative, and preventive services. It also include as defined by WHO in its definition of health, as a state of physical, mental and social well being. The harmonious balance of this state of humans when integrated in his environment, constitute Positive Health.

The Positive Health implies the notion of “perfect functioning” of the body and mind. The Positive Health conceptualizes health biologically, as a state in which every cell and every organ of the body function at optimum level and in perfect harmony with the rest of the body. It conceptualizes health psychologically, as a state in which individual feel a sense of perfect well being and socially, as a state in which the individual’s capabilities for participation in the social system are optimal. These were the ideas of positive health few years ago, but at present in practical point of view, these ideas seem to be little ridiculous.

“The concept of perfect positive health can not become a reality because, men will never be so perfectly adapted to his environment that his life will not involve struggle, failures and sufferings” Dubos has said. Because everything in our life has to change, therefore perfect positive health will always remain a mirage. In this concept health has been described as a potentiality. The ability of an individual or social group, to modify itself continually, in the face of changing condition is what defines positive health. Doctor and community health worker face with the same situation, as faced by a farmer for insects. The job is never is done.

Recently, a broader concept has emerged, that the quality of life has been an essential part of health. The quality of life depends on not only medical action, but also economic, cultural, social factors operating in the community.

Concepts of Health: a Broad Perspective

Health is one of those terms which most people find it difficult to define although they are confident of the meaning of health. World Health Organization (WHO) defines health as follows “health is a state of complete physical, mental and social well being and not merely an absence of disease or infirmity”. In recent years the definition has been amplified to include the ability to lead “socially and economically productive life”. Many people criticize this definition as too broad. Some people say health can not be defined as “state”, and it is a process continuous adjustment to the changing demands of living. Health is a dynamic concept. Health helps people to work well, live well and enjoy themselves. That’s why many people consider the WHO definition of health as too idealistic, rather than realistic. The definition refers to situations that may exist in some but not all the people at a time. It is irrelevant to everyday demand as nobody can qualify as healthy that is perfect physiological, biological, and social functioning. In sort if we accept the WHO definition of health, we all are sick.

Dimensions of health:

1) Physical dimension: it implies the perfect functioning of the body. It is a biological state in which every cell and every organ is functioning at optimum capacity and is in perfect harmony with the rest of the body. The signs of physical health are a clean skin, bright eyes, lustrous hair, firm flesh, not too fat, a sweet breath, good appetite, sound sleep, regular activity of the bowels and bladder and smooth easy coordination of body movements.

2) Mental dimension: mental health is not mere absence of mental disease. It is the ability to respond to varieties of experiences of life with flexibility and a sense of purpose. If a person can not respond with confidence to different experiences of life, he is not healthy mentally.

3) Social dimension: social well being is harmony and integration within the individual, between each individual and other member of society and in the world where they live. Social dimension is the quantity and quality of an individual’s interpersonal relationships and the extent of involvement with the community.

4) Spiritual dimension: time has come to give serious consideration to the concept of spiritual dimension of health. It is the ‘something’ intangible that transcend physiology and psychology.

5) Emotional dimension: historically mental and emotional health was seen as a single unit. But as new research is coming out the difference is emerging. Mental health is “knowing” or “cognition”, but emotional health is more of “feeling”.

6) Vocational dimension: it is a new dimension and part of human life. When work is fully adapted to the human goal, capacity and limitation, it plays a role in promoting physical and mental health. The importance of this dimension is exposed when a person lose his job or faced with mandatory retirement.

7) Other dimensions: a few other dimensions are also suggested like philosophical dimension, cultural dimension, socioeconomic dimension, educational dimension, environmental dimension, nutritional dimension, curative dimension and preventive dimension.

Marine Poisoning & its management

Scombriod poisoning

Scombriod fish (mackerel like) include bluefin and yellowfin tuna, albacore, needle fish, skipjack, bonito etc. non scombroid fishes can also contain scombrotoxin. Poisoning with scombrotoxin is called pseudoallergic fish poisoning.

Under inadequate refrigeration/preservation these fishes undergo baterial decomposition and formation of amino acid L- histidine to histamine, histamine phosphate, and hydrochloride. Histamine level of 20 to 50 mgs/100 gm of fish has been noted. But it may be as high as 400 mg/100 gm. The toxin is heat stable and not destroyed by cooking or heating. Affected fish is of typical taste, but it may be without any specific taste or odor. Distribution of poison may not be same, this explain why some people do not get sick after eating same fish.

Symptoms develop within 15 minutes to one hour. Itching, urticaria, flushing which is sharply demarketed, nausea, vomiting, diarrhea, abdominal cramps, epigastric pain, headache, difficulty in swallowing, thirst, burning of mouth, dizziness, high pulse rate, feeling of warmth without increase in core temperature. These symptoms may resolve without any treatment within a day.

Treatment include antihitaminics and symptomatic treatment.

Paralytic Shellfish Poisoning

Paralytic Shellfish poisoning is induced by ingestion of aquacultured filterfeeding organisms like oysters, clams, starfish, mussels, scallops, and sand crabs etc. The toxin they have is accumulated by feeding the planktons where they live. The toxin is water soluble and heat stable. It can also kill large numbers of marine life. Commonest toxin is saxitoxin.

Symptoms appear within few minutes of ingestion of the toxin. It includes loss of sensation of tongue, lips, gums, which may progress rapidly to neck and extremities. Other symptoms include lightheadedness, incoordination, disequilibrium, incoherence, weakness, thirst, salivation, difficulty in swallowing, diarrhea, vomiting, abdominal pain, headache, loss of vision etc.

Treatment is supportive and based on symptoms.

Ciguatera poisoning

Ciguatera poisoning is the commonest non bacterial food poisoning associated with fish in USA, most of the cases occurs in Florida and Hawaii. Poisoning involves tropical and subtropical coral reef fish. Poisoning involve five different types of toxins. These toxins are heat, cold, drying, and gastric acid resistant. These five toxins are colorless, tasteless, and odorless.

Symptoms occur within 15 to 30 minutes of ingestion. They include abdominal pain, diarrhea, vomiting, chills, itching, numbness of throat and tongue, sensation of ‘carbonation’ during swallowing, tremor, fatigue, and headache.

Treatment is symptomatic and supportive. Activated charcoal (100 gm) in sorbitol is useful if given within three hours of ingestion of the toxin. Sedatives can be given if patient is apprehensive. Adequate hydration should be given if there is dehydration.

Snake Bite & its Management

There are thousands of different species of snakes in the world. But very few of them are poisonous. More than 50,000 people die each year due to poisonous snake bite. This may be only the tip, because many go without reporting. Venomous snakes are divided into the following categories Viperidae (old world vipers, asian pit vipers etc), Elapidae (cobras, coral snakes and Australian venomous snakes), Hydrophiidae (all sea snakes), Atractaspididae (burrowing asps), and Colubridae.

It is very difficult to differentiate venomous from non venomous snakes. Fang marks are of no diagnostic value. Symptoms of snake bite include fear of impending death, nervousness, local swelling, redness of the site, sharp pain. More than 20% (75% of sea snakes) of the bite are ‘dry’ type which means either no venom or insufficient venom to cause serous problem or death.

First Aid Measures: If the bite of the snake is in limb it should be immobilized and firm pressure bandaging of the bite area and few inches above the bite site should be tied. These measures significantly delay the spread of the venom. Patients are generally apprehensive and nervous and they should be reassured and sedated if necessary.

Treatment of snake bite:

1) The site of the bite should be cleansed properly and left strictly alone. Nothing should be done with the bite site, otherwise chances of infection increases. Tetanus prophylaxis should be done with tetanus toxoid. If there is necrosis of skin, it should be sloughed off and skin grafting if required.

2) If required sedatives can be administered. General measures like intravenous fluids should be given.

3) Anti venoms should be given only if there is clear evidence of systemic poisoning. But some authorities prefer to give anti venom within four hours if diagnosis of snake bite is confirmed, to avoid necrosis. Anti venom is available for some common snakes only depending on the country, within country also different regions have different types of snakes so also anti venom. If snake is not common in an area anti venom for that particular snake may not be available. If it is available than it should be made sure that it is clear and has no opacities. Depending on the severity 20 to 100 ml is diluted in two units of normal saline and given by slow infusion. Adrenalin (1:1,000 solutions) should be kept ready in case anaphylactic shock (dangerous allergic reaction) develops. Giving anti venom at the earliest is very important because once the venom is lodged it is very difficult to dislodge the venom from the site.

Scorpion Stings

Scorpions are arachnids that feed on arthropods, lizards, which they grab with crablike claws and inject paralyzing venom from stinger which is present at the tip of the tail. There are about one thousand different species of scorpions, out of which only the bark scorpion in USA produces venom which can be lethal to humans. Scorpion sting cause about 5,000 deaths every year worldwide. They feed at night and remain hidden at day time. They like cool places and can enter houses and hide in shoes, cloths, bedding or may enter sink in search of water. Scorpions stings humans only when disturbed.

Scorpion sting can cause sharp local pain, which is followed by swelling of the area, burning sensation, itching etc. Allergic reaction may develop. If condition is severe there will be restlessness, blurring of vision, salivation, lacrimation, running nose, speech difficulty. Muscle cramp, drop in blood pressure, seizure, nausea, vomiting can occur. Symptoms become severe in 5 hours and subside in a day or two.

Offending scorpion should be tried to identify. Treatment of scorpion sting consists of local application of ice pack, cleaning of the bite site, tetanus prophylaxis with toxoid. Painkillers like brufen, diclofenac and antihistaminics like cetirizine, fexofenadine can be given for symptomatic relief. Patient should be advised to be calm and reassurance is given. Specific antivenin if available should be administered in serious cases. But antivenin should be reserved for selected cases only because it can cause potentially dangerous side effects. A C. sculpturatus antivenin is available but not yet approved by FDA. It is available in Arizona State University for use in Arizona only, mainly for research purpose.