Poor sleep can lead to high blood pressure in teens

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WASHINGTON: Poor sleep habits can do more than annoy parents and make teenagers drowsy in school they can lead to high blood pressure, US researchers reported on Monday.

Teens who slept fewer than 6 1/2 hours a night had more than twice the risk of high blood pressure and those with troubled sleep had more than triple the risk, the team at Case Western Reserve University in Cleveland, Ohio found.

Writing in the American Heart Association journal Circulation, the researchers found the pattern held even when adjusted for sex, weight and socioeconomic status.

“Our study underscores the high rate of poor quality and inadequate sleep in adolescence coupled with the risk of developing high blood pressure and other health problems,” said Dr Susan Redline, the pediatrician who led the study.

“We also found that a low sleep efficiency may be more consistently associated with pre-hypertension than a shorter sleep period.”

High blood pressure can damage arteries and kidneys, causing stroke, kidney disease and other illnesses.

Redline’s team studied 238 13-to-16-year-olds and found 14 per cent of the adolescents had high blood pressure or readings at the borderline, called pre-hypertension.

For adults, high blood pressure is defined as a reading of 140/90 or above, but for children it is defined as being in the 90th percentile for their age.

They had the volunteers fill out sleep diaries but also measured their movements while in bed to gauge whether they were really asleep. On average, the teens got just 7.7 hours of sleep a night, while they need nine hours at that age.

And 16 per cent of the teens had low sleep efficiency, meaning they had trouble falling asleep much of the time or woke up too early. Another 11 per cent slept less than 6 1/2 hours a night.

“These associations may have a large public health impact,” Redline said in a statement.

“Part of the problem is the technological invasion of the bedroom with computers, cell phones and music,” Redline said.—Reuters

Not a drop to drink

AT a recent seminar on water management in Karachi, most participants complained of the poor quality of drinking water in their respective localities.

According to newspaper reports, high levels of fluoride have been found in wells in the Thar area, while the Jinnah Postgraduate Medical Centre (JPMC) in Karachi is getting contaminated water. There are also reports of the presence of arsenic in the wells of Arbab Allah Bux village near Tando Allahyar.

This write-up attempts to put water quality problems in their true perspective in order to inform the reader about the source of water contamination and measures that are appropriate to specific water quality problems.

The Karachi Water & Sewerage Board claims to provide potable water that has been purified at water treatment plants. Citizens, on the other hand, complain that they get contaminated water. The appropriate way is to have a third party analyse the water quality once a month and make public its findings.

No matter what input has gone into the designing of a water treatment plant, it will not yield safe drinking water unless it is operated according to the designed considerations. For example, the typical permissible filtration rate for rapid-sand filters (the type of water treatment plants used in Karachi) is three gallons per minute per square foot. If this rate is exceeded, the filter units are unable to give the desired treatment, and the final water quality will be poor. Similarly, the use of chemicals in low quantities or of inferior quality will affect the efficiency of the plant.

Because of inadequate pressure, water cannot reach the underground tanks of homes. People have to use suction pumps to draw water. The widespread use of suction pumps creates negative pressure in the pipes, allowing sewage to be drawn in through weak joints. The sensible approach, in this case, would be to provide drinking water 24 hours a day, seven days a week, with adequate pressure. This would prevent the use of suction pumps and there would be no water contamination.

Escherichia coli are organisms normally used as indicator organisms, indicating fecal contamination. Since the identification of E.coli is complex and time-consuming, the thermotolerant coliform count is often used. Thermotolerant coliform organisms can ferment lactose at 44oC and comprise primarily E.coli and a few strains of other organisms (Enterobacter, Klebsiella and Citrobacter).

Coliform organisms are less resistant to disinfection. Enteroviruses and the cysts of some parasites are more resistant. Therefore, the absence of coliforms in disinfected water does not necessarily indicate the absence of enteroviruses or the cysts of Cryptosporidium, Giardia, amoebae and other parasites.

While over 80 per cent of the people in Karachi boil water, many still suffer from health problems (fatigue, neurological problems and carcinogenic complications). The reason is simple. Boiling inactivates bacterial contaminants only. It does not remove potential health-threatening contaminants like DDT, lead, nitrates, chromium, trihalomethanes (THMs), etc. Also, it is debatable, whether boiling fully inactivates enteroviruses and cysts.

Since there is no provision of tertiary or advanced water treatment in Karachi’s plants, all health-threatening contaminants in raw water escape treatment and end up in finished water. Source protection is not practised by water service providers. Because of the heavy use of agrochemicals in catchment areas, chemicals like DDT, phosphates and nitrates flow down to the raw water source. Industrial wastewater is not treated. Heavy metals, therefore, also find their way to the raw water source.

THMs are formed when chlorine reacts with humic substances in raw water. THMs include chloroform and bromoform. Chloroform is carcinogenic. Water service providers need to switch disinfectants from chlorine to chlorine dioxide or ozone to prevent the formation of THMs. Drinking water in Karachi has never been tested for THMs.

Arsenic contamination in groundwater is due to the presence of arsenic ores in the underground strata. Two possible suggestions can be made. One, arsenic-laden wells should be discarded. Surface water or wells not affected by arsenic should be used. In case of surface water, full-scale water treatment would be required.

Second, if there is no other choice, filters kits may be used. However, proper tests must be carried out to ensure that these are able to remove arsenic and to note the time period during which they are effective. Filter kits, depending on the water quantity use and the levels of arsenic in raw water, typically lose their efficiency after two months of operation. The World Health Organisation has given the maximum permissible limit of arsenic in drinking water as 0.01 milligrams per litre (mg/l).

Fluoride is unique in the sense that drinking water must have a fluoride level of 0.5 mg/l to prevent dental decay. On the other hand, if the level of fluoride is greater than 1.5 mg/l, it will cause dental fluorosis (yellowish or brownish striations or mottling of the enamel) and crippling skeletal fluorosis. For mitigation, the first option would be to find alternate water sources. If this is not possible then defluoridation techniques (activated alumina, contact precipitation, bone charcoal) are available, which can be used. Activated alumina can concurrently remove other anions such as arsenate.

Three decades of experience in water engineering have shown me that when it comes to water quality problems, water service providers adopt an evasive attitude and resort to a blame-game. Also, technical expertise in the water department is of poor calibre.

Despite the fact that it is known that the catchment areas feeding the water source have changed drastically over the years in terms of their characteristics and the type of water received, water service providers are content with the rapid-sand water treatment system. They know quite well that conventional water treatment plants are ineffective in removing heavy metals, pesticides and agrochemicals.

Water treatment plants in Karachi and Hyderabad must have tertiary or advanced water treatment units in addition to the rapid-sand filtration system so that toxic contaminants, which are not removed by conventional water treatment plants, can be eliminated. Likewise, disinfection byproducts (THMs) should also removed by adopting the appropriate disinfection system.
Courtesy Daily Dawn Lahore / By By F.H. Mughal

Assessing a legacy

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NOW that he’s gone, his legacy will be debated. As the hysteria subsides and the political pantomime of heroes and villains takes a brief hiatus, the question many will have is: what did Musharraf mean for Pakistan? The answer: it depends and it’s relative.

It depends on what is good for Pakistan. Democracy? Then the general was bad for this country on Oct 12, 1999, and nothing he did subsequently could ever rectify that. The moral outrage of his latter-day opponents is a conceit. If Musharraf is at fault he is at fault for being a dictator, not for being a failed dictator — which is the crux of his critics’ complaint. A dictator is a dictator is a dictator. And no amount of subsequent goodness can ever overcome that.

But the people cheered on the dictator when he first arrived, so we need to descend from lofty ideals to more pedestrian measures: was he good for politics? No. Forget his seven-point agenda, his four-point strategy and his eight-year regime for a moment. The most devastating, straightforward assessment of his effect on politics is a statement of fact: his last rites as a politician were read by the very political leaders he sought to bury eight years ago. Coming full circle cannot be a success, especially when it is the opposite of the plan. The three-stage transition to democracy that Musharraf laid out eventually became a three-step ouster of himself.

So shall we conclude that he was bad for Pakistan then? Not on that basis alone. The people of Pakistan have alternated between rejecting and accepting their politicians. Yesterday’s heroes are today’s villains and vice versa. Musharraf’s problem is that dictators do not get a second chance. To assess his eight years on the basis of his ignominious end would be to fall into the trap of the politicians’ good/bad binary. The people do not see the world in those terms; they appreciate shades of grey. And the people clearly want something more than goodness from their politicians. But what is that something more against which the Musharraf era can be judged?

At first blush economic growth is a good measure. Polls and anecdotal evidence suggests the state of the economy is a key indicator of the public’s level of satisfaction. Not coincidentally, the economy was one of the pillars of the Musharraf era. But it is a very tricky exercise. Should the Musharraf era be assessed in comparison to what was achieved in the 1990s or on the basis of the resources that were available to the general in the 2000s? And how does one account for heightened expectations? In the 1990s governments aspired to a five per cent growth rate; today it would be received with great dismay. Then again, the governments of the 1990s would probably have killed to have the monetary inflows that a confluence of politics, war and a liquid global economy gave Pakistan this decade.

Besides what good is growth if the people are not invited to the party? Poverty rates matter. Until recently, before inflation engulfed the country, there was a fierce debate on the number of poor. Economists are worse than politicians, so the debate quickly became arcane. Yet, for those who followed the debate, what was in dispute was the rate at which poverty was decreasing, not whether it was decreasing at all. So what is a good rate of decrease in poverty? The answer: it depends. It depends on how much you hate the general and love the poor and how you judge Musharraf for what he could have done against what he did do. Numbers are quickly engulfed by politics.

It’s all moot anyway now that inflation has shattered lives and dragged more people into poverty, some may argue. True — to an extent. Follow the new debate and it quickly becomes apparent that there is actually a consensus on what needs to be done to guide the country out of the economic crisis. If the present government fails to implement sound economic policies, can Musharraf be made to shoulder the entire blame? And will it undo his record over eight years? Yes, if you hate him; no, if you are more circumspect.

Whether Musharraf was good for Pakistan is also a relative assessment. And about overcoming stereotypes and simplifications. Take Messrs Sharif and Sharif. Nawaz is one of Pakistan’s most popular politicians but he has his fair share of detractors. He’s the military’s creation. There are charges of corruption against him. He is accused of breaking the law. Shahbaz, on the other hand, has no significant detractors. Even his worst critics acknowledge that he is a fearsome administrator and a tireless worker. Yet, by virtue of being Nawaz’s brother and Abbaji’s son, Shahbaz benefited from the same money and power that Nawaz is accused of having amassed illegitimately. But Shahbaz gets a free pass because he gets things done rather than make promises.

And take a look at ZAB, the country’s greatest populist. Was he not catapulted to stardom by being an obsequious young man who served in the cabinet of a dictator? Yet he is celebrated for using that springboard to do something else: awaken the countryside politically. The PPP is considered the country’s most liberal, secular party. It was and is. But ZAB’s law minister piloted a bill through parliament that amended the constitution to declare Ahmadis non-Muslims, shattering any notions of secularism. BB, derided as the ‘daughter of the West’ by critics, signed off on the Taliban policy in her second term in office.

The people know these shades of grey; it’s the politicians’ narratives that are devoid of grey. Dislodging Musharraf was a political act that of necessity was portrayed as a battle between good and bad. But the public knows that good people can make bad decisions and bad people can make good decisions. Which does the country need more: good decisions or good people? Both are a luxury the people know they cannot have. That complex matrix of decisions good and bad, right and wrong is the only space in which Musharraf can properly — and honestly — be assessed. And honesty demands we acknowledge that any assessment can never be objective because the issues are too important, the stakes are too high and we are too close to it all.

What is good is that Musharraf is gone. To a genuine democrat he was never welcome in the first place. But to assess him on the basis of that ideal is meaningless because the people themselves have rejected that touchstone. There is a more prosaic reason to welcome his departure though: Musharraf was the product of our system; his mistake was to believe that its constraints were not applicable to him.

Courtesy Daily Dawn Lahore / By By Cyril Almeida

Impeach the system

NOW that he has made his exit, Pervez Musharraf will surely fade into history. In Pakistan’s chequered 61 years, the ouster of all-powerful rulers from the top seat is nothing new.

These are games that the hard-core establishment has often played and will continue to play unless civil society asserts itself, and mainstream political parties transform themselves into well-organised, truly democratic and participatory organisations.

Remember what happened to powerful and ‘indispensable’ rulers like Ghulam Muhammad, Iskander Mirza, Ayub Khan and Ziaul Haq? They were thrown out ignominiously by the very establishment which had created them once they had served its purpose. With their departure nothing changed, and the mantra of the powerful vested interest remained ‘the king is dead. Long live the king!’

Currently, media hype has been created that with Musharraf’s departure everything will change in Pakistan. Of course his ouster from Army House will bring an end to the shenanigans he was indulging in, and will provide an opportunity to politicians to strengthen the process of change, presuming they want it. But should that be enough?

Starting from March 9, 2007 we have had indications that there is a strong desire at all levels that there should be basic changes in the country’s governance. But with Pervez Musharraf’s departure from the scene, we should not be lulled into believing that everything will be fine in the state of Denmark. Now our focus should be on impeaching the system. The system is like the proverbial dog in the village well. It will not be cleansed if we take out a few pots of water. We have to throw out the dog itself.

In order to elaborate this point, let us take three basic areas of our national life i.e. the structure and functioning of political parties, the administration of justice, and our economy, and see what needs to be done.

First, let’s take our electoral system. Most of our political parties are at best personalised institutions. Quite a few of them have been converted into family dynasties, where the mantle is passed from one generation to the next. Even if internal elections are held, they are nothing but a farce as the top leadership remains the same. A common ailment afflicts them all.

No party member dares to challenge the word of the leader, no internal debates are encouraged, and there is no merit-based system of promotion from the junior rungs of the ladder to the top echelons. The parties do not have any active think tanks to try and find solutions to problems like sustainable growth, social development, housing, health and education.

The MNAs and MPAs, once elected, are conspicuous by their absence from their constituencies. Instead of maintaining an active presence in their area, they are found mostly in Islamabad (when not travelling abroad). Most constituencies are family fiefdoms with members of the same family elected at the tehsil, district, provincial and federal levels, year after year. They resist any fundamental change that may threaten their power base. It is not surprising that they are supporters of the status quo, because it ensures their constant hold on power, and provides them with pelf and privilege.

Next, take the judiciary and the administration of criminal justice. The lawyers’ movement is commendable and we have hardly witnessed anything like this previously in Pakistan. Their cause — the independence of the judiciary and the rule of law — is lofty and noble.

However, hardly anyone is striving for the reform of the entire judicial system. No one is addressing the ailments that are hampering the process of the delivery of justice. No one is talking about how judges are appointed, how cases are fixed, how much money is to be paid to the staff at every step, why abnormal delays take place and whether the poor can afford to seek justice under the present system.

The current state of lower courts (the incapability of the civil judges to decide cases, the conditions in which they are forced to work, the paucity of staff and furniture) paints a dismal picture, but no one is paying attention.

This is not due to the shortage of money: $350m were spent on the Access to Justice programme but with what result? What is lacking is political will and priorities. Look at anything. It is in a shambles. After the much-touted devolution plan, billions were spent on police reforms. But has anything changed? Police stations, jails, the condition of the under-trial prisoners, all remain the same.

Last but not least, take a look at the economy. It is an admitted fact that we are in dire circumstances and millions of people are facing the scourge of runaway inflation and rising unemployment. This is not because Pakistan is a resource-poor country.The basic problem is that our conventional planning, development and distribution mould is deeply flawed. It has not worked in the past and will not work in the future. We have to impeach the current paradigm and look for alternative models which have worked in many countries and changed the lives of the people in one generation.

In Pakistan, governments come and governments go, but the economic managers keep on prescribing the same old policies which help the rich. During the last seven years as well, the beneficiaries of ‘growth’ have been banks, automobiles manufacturers, multinational companies (mainly in the IT and oil sector) and stock brokers while the poor have perished. Now they can’t afford even two square meals a day.

We must fix responsibility for this fiasco and Pervez Musharraf’s economic team must be put in the dock and asked to explain why policies advocated by them have consistently failed. Simultaneously there is need to change our fiscal policies, resource allocation and budget-making process if we want to bring about any improvement in the lives of the people.

Owing to continuous political instability caused by intermittent military interventions, the state of Pakistan has reached a stage where it cannot perform even its core functions as very aptly pointed out by columnist Ayesha Siddiqa in this paper recently. It is high time we realise that merely a change of face is not going to work.

Our ruling class must redefine the role of the state and the first priority must be to make its writ effective. At the same time, civil society must exert pressure on those who are in a position of power and make them accountable on a continuing basis.

Courtesy Daily Dawn Lahore / By Tasneem Siddiqui

The pleasures of ice cream

ICE cream does not need a season to be enjoyed; it only needs an excuse. However, Providence has been kind to this city in the sense that we enjoy warm weather for most of the year and hence get a greater chance to gorge on ice cream, though there are those among us who derive great pleasure in downing dollops of the cold, sweet stuff during the dead of Karachi’s (brief) winter. I, for one, am not one of them.

A wide variety of variations of the frozen dessert – beloved by countless faithful followers the world over – is available in the metropolis, from swish boutiques selling highly priced imported stuff in air-conditioned shopping malls to humble kulfi-wallahs peddling their product off a bicycle on the streets. No matter what your pocket size, God has given Karachians of every hue easy access to ice cream. Hallelujah.

Over the years, this writer has tried and tested ice cream of various varieties in this city – from the aforementioned shimmering malls to the thelay-wallas. Hereunder are listed some of the relevant experiences.

Perhaps a decade-and-a-half ago, when international fast food franchises landed on these shores, foreign ice cream vendors soon followed in their footsteps. To be precise, to my knowledge only one foreign franchise has come – a Swiss concern – while another up-market ice cream vendor claims to sell authentic Italian gelato, said to be a creamier version of good old ice cream.

One must call a spade, a spade: the stuff available at these places tastes heavenly. That said, the price, especially at the Swiss joint, is so high that no amount of ice cream can put out the fire raging inside the burning wallet of an average punter like yours truly after tasting a scoop or two at such places. Perhaps their product is flavoured with the milk of paradise. The Italian place, on the other hand, is priced a little lower.

But we are men of the people. Once or twice a year this high-end stuff might be okay, but where does everyman go for his/her ice cream fix? Well, for one there’s the stuff sold at corner stores and supermarkets manufactured by multi-national companies. But though these choc-bars, cones and other such delights may have their merits, just as I would not discuss a microwave dinner in a food column, ice cream sold out of a wrapper will have no place here.

Like fast food joints, there are countless ice cream parlours that dot the city, some very good, others average and some downright diabolical. Perhaps the most famous local chain is Baloch, with parlours from Kharadar to North Nazimabad and everywhere in between. One has to say that the special faluda at this place is a right treat on a sizzling summer day.

Not only does it quench one’s thirst, but the delicious mix of ice cream, rooh afza syrup, crunchy nuts and vermicelli is to die for. That goes for any well-made faluda. I say well-made as I’ve had my share of greasy, absolutely unpalatable faluda in this city.

Though flavours like chocolate, vanilla and strawberry can be had anywhere on earth, last summer I tried something terrific at a place on Burnes Road that specializes in kheer and rabri: rabri ice cream. What a truly glorious invention! It had the rich flavour of rabri with the smooth texture of well-made ice cream.

If you’re in the mood for something more traditional, perhaps Chaudhry Farzand Ali’s Spartan kulfi parlour might be the place to go. An absolutely no-frills establishment, customers are seated on marble benches here and served in tin plates that look like they date back to Partition. Located opposite the Empress Market in the heart of Saddar, this place retains something of the charm of old world Karachi in the simple delight it serves up.

Chaudhry Sahib’s offerings are as simple as the décor in his outlet: no tutti-frutti, frozen yogurt or foreign flavours here. Just plain old kulfi served up with plenty of vermicelli and a dash of rooh afza syrup and voila: a dessert fit for a king. Everyone from day labourers to cats in smart shirts line up to taste Chaudhry Sahib’s delightful kulfi.

But if you’ve had enough ice cream out of a cup or glass, you might want to try the cones available at two ice cream parlours just off Burnes Road, close to the old campus of the NED University. For the life of me, I’ve never had so much ice cream for so little money.

Starting at Rs15, these cats will make you a towering waffle cone with at least three flavours. However, be forewarned as unless you tell them exactly what you want, they are liable to give you the most bizarre mix of flavours you’ve ever tasted. I remember once ‘enjoying’ coffee, pistachio and mango in one cone. Quite an experience, to say the least.

If the swarming flies don’t bug you much, this is the place to get your money’s worth when it comes to ice cream.
Courtesy Daily Dawn Lahoe/ By Qasim A. Moini