Dainik Jagaran: 30 November 017
Wednesday 29 November 2017
Tuesday 28 November 2017
A toolkit to think local : ‘India State Level Disease Burden’ report
A toolkit to think local
November 27, 2017 00:15 IST
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The ‘India State Level Disease Burden’
report, prepared as part of the Global Burden of Disease (GBD) Study
2016, and published in Lancet, has found that every State in India has a
higher burden from non-communicable diseases and injuries than from
infectious diseases. The study used multiple data sources to map
State-level disease burden from 333 disease conditions and injuries, and
83 risk factors for each State from 1990 to 2016. It was released by
Vice-President.
The estimates are based on analysis of all identifiable epidemiological data from India over 25 years. The
report, which provides the first comprehensive set of state-level
disease burden data, risk factors estimates, and trends for each state
in India, is expected to inform health planning with a view toward reducing health inequalities among States.
The Global Burden of Diseases,
Injuries, and Risk Factors Study (GBD) is the single largest and most
detailed scientific effort ever conducted to quantify levels and trends in health. Led by the Institute for Health Metrics and Evaluation (IHME)
at the University of Washington, it is truly a global effort, with over
1,000 researchers from more than 100 countries, including 26 low- and
middle-income countries, participating in the most recent update.
GBD creates a unique platform to compare the magnitude of diseases, injuries, and risk factors across age groups, sexes, countries, regions, and time.
For
decision-makers, health sector leaders, researchers, and informed
citizens, the GBD approach provides an opportunity to compare their
countries’ health progress to that of other countries, and to understand the leading causes of health loss that could potentially be avoided, like high blood pressure, smoking, and household air pollution.
IHME
provides GBD results in visualization tools, allowing people to
interact with the vast amounts of data and the trends they identify. These
unique tools are beneficial when trying to identify specific
information for age groups, sexes, causes, risks, and comparison to
other regions.
for more : http://www.insightsonindia.com/2017/11/28/insights-editorial-toolkit-think-local/
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Disease burden can be reduced by addressing the risk factors for major diseases.
The findings of the study reveal that three types of risks – undernutrition, air pollution, and a group of risks causing cardiovascular disease and diabetes
– are akin to national emergencies as these have the potential to
significantly blunt the rapid social and economic progress to which
India aspires.
Under Nutrition: It is remarkable that even though there is a declining trend in child and maternal under nutrition, this is still the single largest risk factor in India, responsible for 15% of the total disease burdenin 2016.
- Under nutrition increases the risk of neonatal disorders, nutritional deficiencies, diarrhoeal diseases, and lower respiratory and other common infections.
- This burden is 12 times higher per person in India than in China.
- While this risk factor is relatively worse in the major northern poor States and Assam, it is amazingly the leading risk in over three-fourths of the States across India.
- Air pollutionincreases the risk of cardiovascular diseases, chronic respiratory diseases, respiratory infections, and cancer.
- The burden of outdoor air pollutionhas increased in every part of India since 1990 because of pollutants from power production, industry, vehicles, construction, dust and waste burning.
- Air pollutionis higher in the northern States, but is considerable even in the southern States.
The unacceptably high disease burden due to undernutrition and air pollution in most of India must be brought to an end through systematic large-scale interventions with robust short- and long-term goals.
Non Communicable Diseases:
A group of risks that include unhealthy diet, high blood pressure, high
blood sugar, high cholesterol and overweight, which increase the risk
of ischaemic heart disease, stroke and diabetes, contributed a tenth of the total disease burden in India in 1990, but increased to a quarter of the total burden in 2016.
- While these risks are currently higher in the relatively more developed States, their phenomenal increase in every State over the past quarter of a century poses a grave threat.
Unless serious attempts are made soon to address this surge through massive up scaling of interventions in the health, food, agriculture, housing and urban development sectors, these risks can result in major deterioration in the health status across all States, rich and poor.
An important point to note related to undernutrition, air pollution,
and the risks causing cardiovascular disease and diabetes is that the
interventions needed to address them have to involve extensive
collaborations between the health sector and other relevant sectors.
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How India deals with mental disorders
Following a Supreme Court request of 1997, the National Human Rights
Commission (NHRC) has been regularly inspecting and reviewing the
activities of all mental health institutions since 1999. India also came
up with a National Mental Health Policy in 2014. The Mental Healthcare
Bill 2013 was proposed in Parliament in 2013. Still, abuse and rights
violations - both by family members and by hospitals cannot be ruled
out. The rehabilitation of patients poses a further challenge.
Voices in their heads: How India deals with mental disorders
Deepika Padukone recently came clean on her struggles with depression. Among non-celebrities, however, any sign of deviating from the expected and usual, emotionally and behaviourally, is viewed with a sense of horror. And so the condition festers unheeded till it spirals out of control.
http://www.hindustantimes.com/health-and-fitness/voices-in-their-heads-how-india-deals-with-mental-disorders/story-a64Jhyk4o72k6SV1Ke7WdJ.html
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Traditional community resources for mental health: a report of temple healing from India
https://www.researchgate.net/publication/11276845_Traditional_community_resources_for_mental_health_A_report_of_temple_healing_from_India
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123553/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123553/
Attached is an Abstract of a study that I have conducted on
patients with psychotic disorders undergoing treatment in the
traditional healers centers in Sudan:
Background: Alternative and traditional healings methods are common and popular especially for treating people with mental disorders, but only little information is available about the outcome of theses traditional healing approaches.
Objectives: To study the outcome of treating patients with psychotic disorders by traditional healers, and to understand the type of services, interventions procedures, treatments methods used by traditional healers to manage patients with psychotic disorders.
Method: Prospective follow up quantitative study of cohort of inpatients with psychotic disorders from admission until discharged from traditional healers Centres in Central Sudan. Subjects are the people with psychotic disorders undergoing treatment in the traditional healers Centers in Central Sudan. Outcome Measures: we used The Mini International Neuropsychiatric Interview (MINI) for the diagnosis of the psychotic disorders, and the Positive and Negative Syndrome Scale (PANSS) for assessing the patient’s severity of psychotic symptoms on admission and discharge from the traditional healer centres.
Results: we interviewed 129 inpatients with psychotic disorders on admission and discharge from the traditional healers centres. There was significance reduction in the PANSS score (P= 0.0001) after a mean period of stay of 4.5 months. The mean for the overall PANSS score was 118.36 on admission and 69.36 on discharge from the traditional healers centres.
Conclusion: Although traditional healing approaches produce significant improvement in the signs and symptoms of psychotic disorders measured on the PANSS scale, still the traditional healing approaches need to be more investigated, assessed and studied.
Ref:
Sorketti, E. A., Zainal, N. Z., & Habil, M. H. The treatment outcome of psychotic disorders by traditional healers in central Sudan. International Journal of Social Psychiatry.isp.sagepub.com DOI: 10.1177/0020764012437651
Background: Alternative and traditional healings methods are common and popular especially for treating people with mental disorders, but only little information is available about the outcome of theses traditional healing approaches.
Objectives: To study the outcome of treating patients with psychotic disorders by traditional healers, and to understand the type of services, interventions procedures, treatments methods used by traditional healers to manage patients with psychotic disorders.
Method: Prospective follow up quantitative study of cohort of inpatients with psychotic disorders from admission until discharged from traditional healers Centres in Central Sudan. Subjects are the people with psychotic disorders undergoing treatment in the traditional healers Centers in Central Sudan. Outcome Measures: we used The Mini International Neuropsychiatric Interview (MINI) for the diagnosis of the psychotic disorders, and the Positive and Negative Syndrome Scale (PANSS) for assessing the patient’s severity of psychotic symptoms on admission and discharge from the traditional healer centres.
Results: we interviewed 129 inpatients with psychotic disorders on admission and discharge from the traditional healers centres. There was significance reduction in the PANSS score (P= 0.0001) after a mean period of stay of 4.5 months. The mean for the overall PANSS score was 118.36 on admission and 69.36 on discharge from the traditional healers centres.
Conclusion: Although traditional healing approaches produce significant improvement in the signs and symptoms of psychotic disorders measured on the PANSS scale, still the traditional healing approaches need to be more investigated, assessed and studied.
Ref:
Sorketti, E. A., Zainal, N. Z., & Habil, M. H. The treatment outcome of psychotic disorders by traditional healers in central Sudan. International Journal of Social Psychiatry.isp.sagepub.com DOI: 10.1177/0020764012437651
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Relevance to modern psychiatry
SOURCE: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146223/
In
the recent past there has been lot of research on use of many eastern
techniques of healing in health sciences. Lot of emphasis is being laid
on life style and health. Modern era and its increasing stresses call
for stress management techniques and medicines devoid of side effects
which increase the importance of alternative methods of medicine.
Scientific
research on transcendental meditation programme has shown effectiveness
of meditation on reducing neuroticism (Ander Tjoa) improving learning
(Miskiman), improving academic achievements, prevention of alcohol
(Shafii) and drug abuse (David Katz) There have been several reports on
effect of transcendental meditation on reduction of anxiety, neuroticism
(Jean Ross). Alexander and Schnieder reported comprehensive effects on
neuroendocrine, psychological, social and spiritual factors related to
substance abuse. Role of yoga in stress and sleep management, improving
performance in sports and executives is being stressed recently.
Prekshyadhyan a combination of meditation and relaxation technique has
been found useful in improvement of concentration, memory and anxiety
reduction in a study conducted at Jaipur by the author. Effectiveness of
vipassana meditation as a therapeutic tool in psychological and
psychosomatic illnesses has been reported by lyer and Flechman.
Some
Ayurvedic combinations have been used as anti-anxiety and
anti-depressants, reports of which are available from National Institute
of Ayurveda, Jaipur. Vacha (Acorus calamus) and Jyotishmati (Celastrus Panniculatus)
were found useful in treatment of depression (Bahetra). Unmad Bhanjan
Ras a combination of 24 compounds was found to have anti-psychotic
effect equivalent to chlorpromazine.
While communicating with cancer patients it was found by Gautam and Nijhawan,[30]
that Indian patients tend to accept the diagnosis of cancer rather
easily. The concept of death prevalent in Indian culture based on
philosophy of Gita where soul is accepted as immortal and it is believed
to transfer through death from one to another human/species plays a
significant role in the easy acceptance of the diagnosis and the
planning for the rest of the life.
The understanding of
human psyche in vedantic model is more acceptable to Indian patients
because of transfer of attitudes from generation to generation.
Anecdotes from Bhagwat Gita as a psychotherapy of dying patient is
virtually a tradition in Indian culture. Even now in many families when
death is anticipated preaching of Lord Krishna stating that thoughts at
the time of death determine the species of next birth help the
individual to accept the death in a more gracious manner. The concept of
“sthit pragna”
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Traditional methods of controlling mind: Yoga and meditation
SOURCE: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705672/
Yoga
is a discipline, which has evolved in India several thousand years ago
with the basic aim of growth, development and evolution of mind. The
ultimate goal of yoga is to control one's own body, to handle the bodily
senses, and to tame seemingly endless internal demand.[7]
It offers a world view, a lifestyle and a series of techniques by which
changes in human awareness can be brought about which can help in
realizing the human potential. There are various systems of yoga.
However, all aim to achieve the same, i.e., bringing about altered
states of consciousness, which is known as the cosmic consciousness,
transcendental illumination, or samadhi. It is said that correct
practice of yogic techniques gives rise to certain types of reactions
within the person, which facilitate qualitative and quantitative changes
in awareness.[1]
It is considered that regular practice of yogic exercise reduces
psychological tension, as well as reduces the decline in physical
health.[7] In recent times, yoga and meditation have received wide acceptance and popularity all over the world.[2]
Indian psyche
When
one tries to define Indian personality in general, it is proposed that
the inner self of an average Indian is lodged in a “circle of intimacy”
or the family.[8]
Unlike the western man whose self-hood is confined to his own body, the
Indian self diffuses into the intimate circle, with bond, bondship, and
kinship becoming the fulfilling elements of life. Within these close
ties, Indians can communicate without the fear of rejection, depend on
sympathy, comfort, and support without considering them as charity. From
childhood, social relationships in Indians are spread over several
people like grandparents, uncles, aunts and siblings, and hence, parents
are not the sole guardians or regulators of the child. With the growth
of the individual, a series of similar relationships of varying
intensity and duration develop and at no point of time do Indians assume
full individual responsibility. Even marriage marks the development of a
new set of relationship instead of independence. Hence, unlike the
singularity, self-sufficiency and independence of western self-hood, the
core Indian psyche is based on intimacy, family security, and
stability.[7]
Under these circumstances, the boundaries between “me” and “not-me”
tend to get blurred, and for Indians, “we” rather than “I” becomes
important.[9]
As discussed earlier, Indian psyche is also influenced a lot by the
Hindu philosophical beliefs of transmigration of soul, re-birth, and
fatalism. The inner self of Indians has been enriched through the ages
by the integration of different religions, languages and cultures, as
the various invaders who came to India sooner or later mingled and
became one with the Indians. Therefore, it was only at the time of
British colonialism that the greatest challenge to the Indian self was
posed by an “invader”, who, for the first time in Indian history, made
no efforts to integrate with the ever expanding Indian psyche. Under
these circumstances, instead of undergoing a radical change in the inner
self, Indians sought to resolve the conflict by postponement and
avoidance. Identity models were compartmentalized and behaviors
conformed to the demands of the situation. The other model used to
resolve the identity crisis was identification with the victor by
internalizing them, in this case the western belief of self. However,
the original Indian self-remained as before, making its presence felt
time and again. Until date, this fragmented, multifaceted representation
of the Indian self persists without creating any significant inner
turmoil or crisis.[8]
Understanding this dualism is useful not only in conceptualizing
mental-health problems and their management in the Indian context but
also to throw light upon the coping, resilience, attitude toward
mental-illness, and treatment seeking behavior of Indians.
Use of yoga and meditation in management of psychiatric disorders
With
the worldwide recognition of yoga in management of stress and positive
mental-health, studies from India and the west have evaluated its
usefulness in various psychiatric disorders. A recent meta-analysis
included studies which have evaluated Hatha yoga, Iyengar's yoga, Sudarshan Kriya yoga,
and different types of meditative yoga for management of various
psychiatric disorders. This meta-analysis demonstrated that yoga therapy
is an effective adjunct treatment for depression, anxiety, PTSD, and
schizophrenia, with a significant pooled mean effect size of 3.25 (P = 0.002).[47]
Yoga-based practices may provide relief for symptoms left untreated
through common treatments such as psychopharmacology and psychotherapy.
Yoga breathing can be extremely useful in the treatment of anxiety and
PTSD. Considering the usefulness of yoga and acceptance of the same by
many patients, advising the patients to practice the same under the
guidance of an expert may be very useful as an adjunct to other
modalities of treatment.
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Wednesday 19 April 2017
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