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.

What is GBD and why is it important?





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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The leading risk factors

Disease burden can be reduced by addressing the risk factors for major diseases.
The findings of the study reveal that three types of risks – undernutritionair 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 Pollution:  Air Pollution levels in India are among the highest in the world, making it the second leading risk factor in 2016, responsible for 10% of the total disease burdenin the country.
  • 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 undernutritionair 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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This new knowledge base and the annual updates planned by the India State-Level Disease Burden Initiative will provide important inputs for the data-driven and decentralised health planning and monitoring recommended by the National Health Policy 2017 and the NITI Aayog Action Agenda 2017-2020.

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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

Re: Traditional community resources for mental health: a report of temple healing from India

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 

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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,[] 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.[] 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.[] It is considered that regular practice of yogic exercise reduces psychological tension, as well as reduces the decline in physical health.[] In recent times, yoga and meditation have received wide acceptance and popularity all over the world.[]

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.[] 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.[] Under these circumstances, the boundaries between “me” and “not-me” tend to get blurred, and for Indians, “we” rather than “I” becomes important.[] 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.[] 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).[] 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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