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Dr K K Aggarwal

While people are concerned about cancer, which still remains a controversial issue, there are other future health problems caused by use of mobile phones especially smart phones. Prolonged use of mobile phone can cause neck pain, dry eyes, computer vision syndrome, anxiety (ringxiety), phobias (nomophobia) and insomnia.

Addressing a press conference on the occasion of World Environment Day, Padma Shri & Dr. BC Roy National Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India; Dr. Narendra Saini  Secretary General Indian Medical Association; Dr. Sanjay Gupta, Senior Orthopedic Surgeon at Moolchand Medcity; Dr. J Nagpal Sr. Psychiatrist and Padma Shri Awardee and Dr. A K Grover Sr Eye Specialist Ganga Ram Hospital said that in India, the hazards of radiation are much more than in the West because of active and passive mobile phone radiations and also because of combined use of other radiations such as from computers, microwaves and frequent x-ray done by doctors.

Fifty crore people in the world use mobile phones. These phones release low power radio frequency waves, which transmit radio frequency radiations from 500-800 mGH through the antenna placed near the head.

Heart Care Foundation of India conducted a survey, which included 25 nurses of one hospital, 25 office staff of one public company, 25 media desk executives of one electronic TV media house and 87 family physicians from all across Delhi. The observations were as follows:

 Use of Smart phones

 

  • Ten percent office staff, 20% nurses and 60% media house desk executives and 31% family physicians used smart phones. Amongst family physicians, 11.5% spent < 30 minutes on their smart phone daily; 7% 30-60 minutes; 3% 60-90 minutes; 2% 90-120 minutes; 4% 120-240 minutes and 9% > 240 minutes.
  • 80 % office staff, 80% nurses, 80% media desk executives and 41% family physicians are on Face book. Amongst family physicians, 26% used it for less than 15 minutes; 7% 15-30 minutes; 9% between 30-60 minutes; 2% between 60-90 minutes and 5% more than 120 minutes. 25% family physicians connected to Face book from their phones.
  • 20 % office staff, 30% nurses, 70% media desk executives and 25% family physicians have a Twitter account. Among family physicians, only 50% used it regularly and 25% used it daily. Of the daily users, 90% used it for less than 5 minutes.
  • Only 7% family physicians blogged.
  • Thirty-six percent family physicians retrieved emails from their phone.

 Smart phone addiction, a new disease

  • On an average, nurses recharged their phone battery twice in a day; media desk executives and doctors did it three times in a day.
  • Sixty-one percent doctors find someone to call as soon as they leave their office or as soon as their flight lands.
  • Seventy percent family physicians keep their cell phone with them constantly. Even at home they keep it in their pocket or right next to them.
  • 43% of them fiddle with their cell phone whenever they have downtime (even when they are not on the phone or they only have a very few minutes to kill).
  • 33% of them always feel anxious about their cell phone, especially when they are unable to use it (meeting, plane, class, church)
  • 28% of them are uncomfortable and fidgety when they are not using their cell phone.
  • 7% family physicians feel the need to talk on the phone almost all the time.
  • Sixty-three percent of family physicians sleep with their cell phone under the pillow or on a night stand right next to the bed.  This number is 20-50% for nurses, office staff and media desk executives.

Nomophobia

Sixty percent of youth aged 20-30 years fear losing their mobile phone, called nomophobia; 43% of family physicians suffer from nomophobia.

Cell phone anxiety

  • 43% family physicians experienced high levels of anxiety, stress, or insecurity, whenever they were without their cell phone.
  • 50% of the mobile phone users experienced ringxiety.
  • 25% family physicians sometimes believed their phone was ringing, but when they answered it or listened longer they found that it wasn’t ringing at all (phantom ringing).
  • 15% family physicians reported feeling stressed when they received their cell phone bill and then experienced shock once they actually saw the amount.
  • 22% family physicians reported being unable to resist special offers on the latest cell phone models.

Severity of anxiety

  • The mean social media addiction score (calculation based on 17 dependence questions) for doctors was 5.5. (Any score of more than 8 requires social media curfew and social media holidays along with counseling).
  • Only 6% family physicians reported feeling no anxiety at all.
  • Mild anxiety (score < 4) was present in 43% family physicians (average score 3)
  • Moderate anxiety (score 5-7) was present in 25% of family physicians (average score 6).
  • 26% family physicians had a score of > 8 indicating presence of social media addiction (average score 10).
  • The mean social media addiction score (calculation based on 17 dependence questions) was 6.3 for office staff, 9 for desk executives and 8 for nurses.

Mobile phone as a cause of conflict

  • 26% family physicians had been teased because they had their cell phone even while working out or doing some other activity.
  • 48% doctors said that their personal cell phone use had increased significantly.
  • Face book was the cause of conflict in 20 % of situations for a family conflict (second to TV).
  • 23% family physicians experienced problems at work because of their cell phone use.
  • 18% family physicians had had problems with family or friends because of the cell phone use.

 Mobile phone as a cause of disturbed sleep

  • On an average, office staff spent 20 minutes, nurses 30 minutes and media house desk executives 60 minutes surfing on their smart phones on the bed.
  • 26% family physicians were disturbed by a smart phone alert in the night; 7% reported getting disturbed daily (average 3 times).
  • Only 40% doctors and 30% of nurses, hospital staff and media executives would stop using their mobile phones 30 minutes before sleep.
  • 50% mobile phone users woke up in the night because of smart phone alerts.
  • 40% people had disturbed sleep pattern because of smart phone use.

Mobile phone use while driving

Using or talking on a mobile phone while driving is more dangerous than driving under the influence of alcohol. Using mobile phone while driving reduces reaction time by 30% compared to people under the influence of alcohol and 50% compared to persons without alcohol. The reaction time under the influence of mobile phone is half a second longer. This amounts to a car traveling with a speed of 70 miles /hour to cover a distance of 46 feet before stopping.

36% doctors said that they receive emergency calls on mobile when they are driving. When they stop and answer, 20% of the calls are marketing calls enough to get frustrated and 30% of the calls are emergency calls from their patients.

 Mobile phone as a cause of day time distraction

  • 32% family physicians reported being distracted by a smart phone alert during a meeting.
  • 30% of non doctors said that they got distracted in a meeting because of an SMS or email alert.

 Mobile phone breaks and holidays

 Only 48% family physicians took cell phone breaks while at work.

Use of mobile phone in the Operation Theatre

In a US survey of cardiopulmonary bypass technicians published in the journal Perfusion, 50% used a smart phone during surgery, 43% in a cardiac OT, 50% talked on cell phone and 50% texted on their phones. In cardiac OT, 20% perfusionists accessed emails, 15% used internet and 3% checked or posted on social networking sites during surgery.

A similar survey conducted by Heart Care Foundation of India in one of the corporate hospital in Delhi found:

  • Ninety percent of nurses and 50% of OT technicians also reported taking calls during the surgery.
  • Ten percent doctors, 20% nurses and 50% technicians would check their messages (SMS) even during surgery.
  • No doctor or nurse tweeted during the surgery, but 50% of the technicians who have a Twitter account said that they do use Twitter and tweet during the surgery.
  • None of the doctors, nurses or technicians used their emails or accessed their Face book accounts during surgery.
  • Doctors do talk and attend to their mobile phones while surgery is going on and communicate through a nurse or a junior who works as a bridge between the surgeon and the caller.

The reason given for picking up the phone was to rule out emergency calls, but the reason for use of SMS or Twitter was boredom.

Computer vision syndrome

Computer vision syndrome is a temporary condition resulting from focusing the eyes on a computer display for protracted and uninterrupted periods of time.

Some symptoms are headaches, blurred vision, neck pain, redness in the eyes, fatigue, eye strain, dry eyes, irritated eyes, double vision, vertigo/dizziness, polyopia and difficulty refocusing the eyes. These symptoms can be further aggravated by improper lighting conditions (glare or bright overhead lighting) or air moving past the eyes (overhead vents, direct air from a fan).

Computer vision syndrome affects some 90% of the people who spend three hours or more a day at a computer.

BlackBerry thumb

Overuse of the thumb to operate a mobile device may lead to BlackBerry thumb.

BlackBerry thumb is a neologism that refers to a form of repetitive strain injury caused by the frequent use of the thumbs to press buttons on PDAs, smartphones, or other mobile devices.

It is also called wiiitis, nintendinitis, playstation thumb or cellphone thumb.

Thumb lacks the dexterity that the other four fingers have. This is especially common in those who use these devices for such activities at high speeds comparable to that of touch typing.

Symptoms of BlackBerry thumb include aching and throbbing pain in the thumb or sometimes other fingers and in the wrist.

Other diseases

  • Wii Knees, Touch-Screen Finger, Text Neck, and the dreaded Smartphone Saggy Face, Phantom Vibration Syndrome.
  • Wii knees; Tenderness or soreness in the knees from excessive use of the Nintendo Wii Fit. Similar in nature to tennis elbow.
  • Saggy face (saggy jowls, double chins and “marionette lines” often develop from the angles at which people use their trendy new mobile devices. Leaning your head to hold your mobile phone in between your face and shoulder is believed to cause facial skin and muscle to lose its elasticity more quickly than normal).

HCFI and IMA suggestions to prevent and treat mobile phone addictions

  • Face book holidays: One should take a full one week face book holiday if one is suspected to have social media addiction.
  • Electronic curfew:  Everybody should have 30 minutes of electronic curfew before they sleep. (Electronic curfew means not using mobile phones and other mobile devices for 30 minutes before sleep).
  • Use mobile only when mobile.
  • Limit mobile talk time to less than 2 hours a day
  • Once the battery is discharged, call it a day for mobile use.
  • Follow the formula of “20-20-20” to prevent dry eyes: Every 20 mins, focus the eyes on an object 20 feet (6 meters) away for 20 seconds or close the eyes for 20 seconds, at least every half hour.
  • To prevent computer vision syndrome, spend less than 3 hours on a computer.
  • Using other fingers to press buttons on handheld device can prevent BlackBerry thumb.

 

For the first time, 10000 children, teacher and parents will be trained in Cardiopulmonary Resuscitation 10 (CPR 10) in one day to commemorate World Health Day. The event will be organized on 6th April, 2013, Saturday at SKV School, Yamuna Vihar,East Delhi in association with Directorate of Education, Delhi Government. Never in history have so many people been trained in CPR in one day.

Addressing a press conference, Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Vice-President (Elect) National IMA said that the Foundation has already trained more than 35000 people and over 5 lives have been saved in the last three months where the general public could save the person’s life after sudden death. A 16-year-old school girl from Birla Vidya Niketan Pushp Vihar saved her uncle and a teacher from SD Public School Pitampura saved her grandmother by doing successful CPR.

Besides hands-only CPR 10 training, on the spot competitions will also be organized like cartoon, poster, slogan and poem on the subject to sensitize teachers, parents and children, said Mr. Sandeep Marwah, Chairman, Asian Academy Film & Television Institute, Noida.

Hands-only CPR 10 is based on the mantra – “within 10 minutes of death (earlier the better), for at least next 10 minutes (longer the better), compress the chest of the victim continuously and effectively with a speed of 10×10=100 per minute.

The theme for World Health Day this year is high blood pressure. Cardiovascular disease is the number one cause of death in urbanIndiaand over 70% of deaths amongst cardiovascular deaths are linked to hypertension, said Dr. KK Aggarwal. Besides learning CPR 10, school children should also learn about good dietary habits which include, eating more fiber, less salt, zero trans fats and zero refined carbohydrate, he further added.

About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 31145 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute.”

Healthcare for all not possible with the present budget

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In his speech when presenting the budget, the Finance Minister said that health for all and education for all is his priority but the budget allocation is only Rs. 37330 crores, which is an increase of only 7.5% in the last years allocation (planned and non-planned budget together). Medical fraternity expected it to be at least 2-3% of the GDP. Even allocation to AYUSH is only 1069 crores against 1650 crores allocated to six AIIMS-like institutions. If the Government really wanted to do something for promoting healthcare, they could have allocated for six AIIMS-like AYUSH institutions whose purpose should have been prevention so that people do not require allopathic tertiary care.

There are no tax holidays or tax exemptions for doctors living in rural areas in the present budge. Also, there was no relief for making VISA easy for medical tourism.

The Rs. 110 crores allocated for disability is not sufficient. Rs. 6000 crores should have been allocated for providing free generic drugs for people coming to government hospitals. This announcement was lacking in the budget.

Rs. 150 crores have been allocated for the care of the elderly, who constitute 8% of the total population. Elderly people usually do not have insurance as insurance companies do not give them a cover. At least 8% of the total health budget should have been allocated for the elderly.

Allocations to National Health Mission (NHM) (which covers both rural and urban population budget) is only Rs. 21200 crores, which is less than the amount used last year for which rural mission. It aims to provide urban mission money from the money received from the rural mission project. Separate budget should have been allocated for the urban mission.

Rs. 4727 crores allocated for training, education and research is also inadequate as unless you patent your own equipments and drugs, you are going to be dependent on foreign market.

India Medical Association in its recent meeting with Economic Advisor, Ministry of Health, Government of India had offered that every private doctor should be incorporated for providing healthcare facilities across the country, where the Government only had to invest on the human resource.

The government can start MD in Rural Medicine with a curriculum that teaches the art of treating the patients in limited resources. After that people can choose and do their respective post graduation. This way the doctors will not feel that it is a burden on them. There will be additional degree in MD in Rural Medicine Surgery. Such doctors serving in rural areas should be given income tax-free income.

Paste CPR mantra in every notice board of schools

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Conducting a Hands Only Hands on CPR 10 camp at St. Froebel Public School, Paschim Vihar, Padma Shri & Dr. B C Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA, said that origin of CPR in our country goes back to our mythology when Savitri saved Satyavan as the first person in the history of mankind.

Over 1000 school children were trained on the spot.

Dr. Aggarwal said that the CPR mantra “within 10 minutes of death (earlier the better), at least for the next 10 minutes (longer the better – upto 25 minutes in adults and 35 minutes in children), compress the centre of the chest of the victim effectively and continuously with a speed of 10×10 i.e. 100 per minutes” should be pasted in every school and college wall. He said that all security persons, PCR vans should be taught Hands Only CPR because they are the first ones to arrive whenever there is a incidence of sudden death. Dr. Aggarwal said that CPR technique should be incorporated in the school syllabus.

About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 26098 people since 1st November 2012.

Inaugurating the seminar on ‘Psyche Behind Rape: Treatment-cum-punishment’, Dr. K Vijaykumar, National President, IMA said that on one hand, IMA supports stringent punishment to the rape accused, on the other hand, IMA is for providing correct sex-education in the school at the right age and also educating the society, especially, the youth so that they do not end up in psyche, which provokes rape in the society.

Addressing the seminar, Dr. Narender Saini, Secretary General, IMA said that the IMA will come out with guidelines on “How a medical doctor should tackle a patient with suspected rape?”

Moderating the session, Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, National Vice President (Elect.), IMA said that it is crucial for the doctor to examine both the rapist and the rape victim for HIV-AIDS, Hepatitis B and Hepatitis C, all which can be transmitted through sexual route. The rape victim as well as of the accused should be checked for these infections at baseline, then again at 6 weeks to 3 months. Post exposure HIV prophylaxis should be given to all rape victims.

The other faculty in the seminar included Dr Vinay Aggarwal Past President IMA;  Dr. D.R. Rai, Senior Vice President, IMA;  Mr. Ajay Kumar, Aaj Tak;  Dr. S K Pal and Dr Anil Goel (Andrologists); Ms Indu Malhotra (Senior Advocate); Dr. BB Rewari (NACO);  Dr. Jitender Nagpal (Psychiatrist); Dr Anita Kant (Gynecologist);  Dr. Ajay Gambhir (Pediatric and Finance Secretary, IMA), Ms Kalpana Kapoor (Educationist) and Dr Sarvesh Tandon (Finance Secretary IMA East Delhi Branch).

Following were the salient points of the seminar:

  • Right sex education should be started in school age. IMA will come out with suggestions regarding curriculum.
  • All doctors dealing with rape victims should ensure total confidentiality of the victim and examine them properly.
  • All rapists are also brought to medical doctors for examination which includes tests for their sexual potency. They should also be checked for presence of sexually transmitted diseases.
    • There has a suggestion from the Government that chemical castration can be one of the punishments to the rapist. The same cannot be done without involving the medical fraternity. The oral tablet for chemical castration given daily cannot be the punishment for rapist. One can only give injections which reduce testosterone levels but the same injection has to be given every 3-6 months and the effects are reversible.
    • Chemical castration injections are not safe and health-friendly. In the long run, they can cause thinning of bones and cardiovascular diseases.
    • Chemical castration injections will also promote corruption since influential people will force or bribe the police and the doctors to give a water injection and write anti-testosterone injection has been given.
    • A paraphiliac rapist has been differentiated from a non-paraphiliac rapist.
    • Sexual contact with a girl who is less than 16 years of age is a rape even if the sexual contact is with mutual consent.
    • The percentage of rapes is not reported. Majority of the rapes are reported from JJ Cluster areas.
    • False allegations may be made in the following situations:
  • Consensual live-in relationship where one refused to marry.
  • One is caught in an extramarital affair.
  • As a part of revenge
  • Under the influence of alcohol and drugs
  • In an atmosphere of pornographic movie
  • Date rapes and under the influence of date rape drugs
  • Presence of stepfather and stepbrother in the house.
  • Blackmailing a rich person after consensual relationship
  • Showing your supremacy of raping a girl in the society so that nobody speaks against the Dada.
  • To show off amongst your friends that you can do it and you did it.
  • Politically motivated
  • You plant a girl to somebody.
  • Examination of a rape victim
  • First and foremost make the woman/girl/child comfortable – she has been through physical and emotional trauma.
  • Take her to a room or corner with adequate privacy
  • A short recount of her trauma is necessary so that the doctor knows where all she has been violated.
  • All the surfaces – cheeks, ears, nose, breasts, arms, legs, thigh (inner parts), abdomen, locally the private parts, even anal opening should be examined for scratches, cuts,  bite marks, blood, dried white patches etc.
  • Examine the hair over vulva for blood or white discharge
  • Check the hymen for fresh/ old injuries
  • Examine the clothes of the victim e.g. underclothes or other clothes depending on how the victim has been violated; they should be collected in transparent bags and sealed to be sent for lab examination
  • After that swabs are taken from vagina (and other areas if relevant) to be tested in lab for sperms, PSA, DNA testing. Sometimes, blood or hair of the rapist can be picked up for DNA matching.
  • Medical treatment of the victim requires prevention of the following:
    Pregnancy – give i-pill; Sexually transmitted diseases (STDs) – fungal vaginitis, syphilis, HIV prophylaxis; The wound, if any, need to be cleaned, stitched, antibiotics, tetanus toxoid etc. to be given.; Psychological support is very important; preliminary blood test for HIV after consent and counseling, and subsequent follow up test is necessary

Types of rapes

Rape generally encompasses nonconsensual vaginal, anal, or oral penetration that involves force or threat of force (physical or psychological), lack of consent, or inability to provide consent because of age, intoxication, or mental status. Rape is categorized according to the relationship between the perpetrator and the victim.

  • Stranger rape describes nonconsensual sexual penetration between individuals who do not know each other before the sexual act
  • Acquaintance rape describes nonconsensual sexual penetration between individuals who know each other in some capacity before the sexual act
  • Date rape is a subset of acquaintance rape in which nonconsensual sexual penetration occurs between two people who are in a romantic relationship. Date rape can occur when the victim is alert and rational or irrational, semiconscious, or unable to respond due to alcohol or other drug use. Verbal coercion, threats or use of physical force, or the use of alcohol or illicit drugs may occur as precipitating events.
  • Pendency of Gang Rape Cases and Rape Cases in Delhi Alone: No. of cases file in court last year 568.
S. No. District Gang Rape Cases Rape Cases Total
1. Central 4 51 55
2. North 8 26 34
3. West 14 105 119
4. New Delhi 5 5
5. South 11 106 117
6. South-East 18 107 125
7. East 13 62 75
8. North-East 15 137 152
9. North-West 23 131 154
10. Outer 23 79 102
11. South-West 21 75 96
  Grand Total 150 884 1034

Dr. KK Aggarwal, Vice President-Elect IMA

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Padma Shri & Dr.BC Roy National Awardee, Dr. KK Aggarwal took over as National Vice President (Elect) of the Indian Medical Association. The 2-year term will include the first year as Vice President (Elect) and the second year as Vice President

In the past, Dr. Aggarwal has served the National IMA as its Academic and Research Wing Head and also Finance Secretary.

At the State level, Dr. Aggarwal has served as President of Delhi Medical Association and President, Indian Medical Association, New Delhi Branch for three years.

Dr. Aggarwal said that today there are several issues concerning the medical profession. One of them is to provide affordable quality health care to people across the country. Today, if a person gets heart attack, he will not get the few basic same treatments at different setups and locations where he happens to reach with acute heart attack.