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Selye described the role of adrenal hormones in emergency situations like fight, flight and fright and the role of glucocorticoids in long term stress. He proved to the scientific world that in such situations the adrenal hormones played a vital role and their presence can be measured by their break down products in the urine (catecholamines).
Even before the medical world could adequately utilize this research, stress became a household word. From a noun it became a verb (stressed) and now it is being increasingly used as an adjective (stressful). Stress aggravates symptoms of a disease and even retards healing. It is now recognised that it may even affect behaviour, sleep and sexual patterns.
When we look back at our younger days, I remember as a house surgeon examining close to 100 patients in the outpatient. Have a quick bite of some stale food in the mid afternoon and then attend to 20-25 admissions in the wards. We were on call for the night writing histories and putting up drips on patients and next morning we had to be ready for the bosses by 8.30 am with all the reports and summaries of treatment. Was it stress at its peak? Specially when you had to listen to admonition and unsavoury remarks from your seniors!! Was it stress or plain fatigue?
Today stress begins before joining medical school. You have to be a super genius to score 96-99% marks and then have high scores in Entrance Exams. To get high scores Private Tuitions and Classes are a must, resulting in severe financial problems. Passing the ever changing patterns of exams with all its inconsistencies. Then clinical training and getting the right slot of your speciality. Chasing this you may land up in a totally different State or pay awesome capitation fees in Private Medical College.
With the mushrooming of new Hospitals, attachments have become easier. But you have to perform. The stress of getting patients (or else? booted out) higher goals of income, peer jealously and keeping up with the Joneses. Also increasing litigations. Very stressful indeed.
Is stress harmful? A little stress or momentory stress may be good for the individual. Helps you to perform better.
A sportsman needs it in the last mile, a stage artist for the climax, even a student appearing in an exam. It is chronic stress repetitive and on going that is harmful.
Industrialists in Japan were the first to discover that performance of industrial workers improved if they broke the working hours in the middle of the shift, especially if sports, yoga and other light sports were introduced. Executives were sent on holidays on company expense. The media went ga-ga over the new industrial concepts. Destressing massages, spas, bars and exercises came up. Holiday homes and destressing holiday schedules were announced by travel agents. Magazines and private tutors also became available.
Doctors have been great advocates of antinever spared a thought for themselves. It is only after the corporates have taken over the running of hospitals that they felt doctors need to destress. Doctors are encouraged to play sports like tennis, badminton or go for jogging or long walks. Some take to yoga and meditation. Music is the best destresser. It takes you to dream land far away from realities of the mundane life. Also painting. I was pleasantly surprised to read that many Delhi hospitals have introduced dancing and pop music in their relaxation classes.
I envy the doctors who get to learn Salsa, Tango and other Latin American dances at the cost of the hospital. But I hope the atmosphere is full of bonhomie and fun. No talks about bosses, patient data, blood counts and histology reports. No shop talk. It must also involve participation of all residents. Even Medical Associations have started organising group picnics, socials and foreign tours. All of them have become popular.
It will be interesting to conduct a double blind study of the results of destressing of doctors!! Have we been successful in lowering the rate of BP, diabetes and other stress related diseases in the participating doctors?
FOLIC ACID SUPPLEMENTATION AND PREVENTION OF STROKE
`Our meta-analysis provides coherent evidence that folic acid supplementation can significantly reduce the risk of stroke in primary prevention'
The efficacy of treatments that lower homocysteine concentrations in reducing the risk of cardiovascular disease remains controversial. Xiaobin Wang and colleagues did a meta-analysis of data from randomised trials to assess the efficacy of folic acid supplementation in the prevention of stroke. They found that folic acid supplementation significantly reduced the risk of stroke; a greater beneficial effect was seen in those trials with a treatment duration of more than 36 months. Furthermore, in countries where grain is fortified with folic acid, further folic acid supplementation had little effect on the risk of stroke. The researchers conclude that supplementation can effectively reduce the risk of stroke in primary prevention, and that the effect of such supplementation on the risk of stroke is probably causal. In a Comment, Cynthia Carlsson discusses the strengths and weaknesses of the study.
Lancet Infect Dis, 2007; 7 : 1841, 1876.
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
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