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Tuesday, August 8, 2017

It’s near the end of the “summer” holidays, known in my time as August holidays or mango, fly and gastro season. Now it’s “summer” and we all go away to Disneyland to forget about eating “roady”, pretend we are in the 1% and talk about our “grades”. I know it as marks. What mark yuh get, boy? Now if you call someone “boy” they accusing you of race.

Medically in the States, September mean the start of the “flu” season so as good little patriots we now have a “flu” season complete with flu shots even though the flu immunisation is by far the least effective of all the vaccines, giving at the most 66 per cent protection and last year it barely made it to 40 per cent, really only useful for old folks and young children with chronic disease, asthma, diabetes, sickle cell disease and the like.

More importantly for us, September is the start of the respiratory allergy season, asthma and “sinus”, which may be related to the “flu”, but then “flu” in T&T, as diagnosed by our GPs, could be anything from dengue to a “cold” to swine flu to “sinus”. Then you have the people who watch a lot of CNN or Fox who come in talking about “stomach flu”, all of which added to the “gas” pains in their stomach (from drinking too much milk) plus the gas in their elbow and knee at night, well all that could real confuse even Confucius.

“Sinus” is also known as “hay fever” and, since we in the Caribbean do not know hay and, since most people with “hay fever” do not have fever, one understands the quandary we find ourselves in each September.

To further the bobol, the treatment of choice in T&T for the “flu” is antibiotics down the line and if one doesn’t work, it’s on to the next. Because as all red-blooded Trini doctors know “itis” means infection and fever means infection and infection means antibiotics.

However, the thing is that what we call “sinus”, is really allergic rhinitis, from the Greek “rhino” meaning nose and “itis” meaning inflammation, allergic inflammation of the nose. It’s a problem every September and one of the major reasons why, is that school also starts in September and allergic rhinitis specifically affects school performance.

“Sinus” affects at least 10 per cent of any population and higher in children and is related, at least in Western countries, to the levels of pollen in the air. Whether that is true or not is T&T is uncertain and we wait with breathless anxiety for our researchers at UWI to say something on the matter.

The most obvious signs are runny, itchy nose and sneezing. Add heavy snoring to this mix and a hacking cough that keeps waking up the child and all this can disrupt sleep, leading to day-time sleepiness and lack of learning. Antihistamine medications can worsen the problem during the day by inducing sleepiness.

In September last year the Journal of Health Economics published a paper from Norway, titled, “You Sneeze, You Lose” that showed that when pollen levels rise, students’ test scores fall. The study used data from nearly 70,000 high school exit exams, the usual exit exam that everyone must pass to graduate, and get into a university. Higher pollen counts correlate with a slightly lower likelihood of enrolling in a university and this is in a country where the final exam only counts for 15 per cent of university entrance requirements.

In Britain, students take this exit exam in the spring or summer, when pollen counts are high. They also take a practice test the prior winter. Frighteningly, compared with those with no allergy symptoms, British students who report allergies or take allergy medications during their secondary education exit exams are 40 per cent to 70 per cent more likely to score a full grade lower than they did on their practice test.

In the United States a doubling of the pollen count is associated with about one or two per cent drop in the proportion of third graders passing English and math achievement tests. That is standard one, right?

These specific studies have to be superimposed on to the results of other studies examining the cognitive effects of allergic rhinitis more directly. People with hay fever experience slower speeds of mental processing during ragweed season than at other times of year. If you expose allergic people to pollen they exhibit slower mental function, decreased memory, and poorer reasoning and computation abilities compared with nonallergic test subjects.

This is quite apart from the general link between air pollution and school absences as well as labour supply and worker productivity, not that our hard-working unions (“highest worker productivity in the world said one labour union leader last Friday and he must be suffering from long-nose or Pinnochio disease), would care about that, at the start of one of their long weekends.

Worse, air quality can cause or worsen respiratory problems, like asthma, especially cough-asthma, so incredibly underdiagnosed in T&T today, reducing some children’s ability to attend school and adults’ entry into the work force. It can also harm job performance.

Higher concentrations of air pollutants also hurt test scores of students and the chances of passing a high school exam necessary for higher education.

Individually, we may not be able to do much about air pollution (except keep talking), but we can try to reduce the impact of “sinus” on school performance. Check out your local GP and good luck.


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