Working towards Wellness- An Indian Perspective

People in low and middle-income countries tend to develop chronic diseases at younger ages, and suffer for a longer period as compared to their counterparts from the developed world.

Rajarshi Sengupta

As part of a study that PricewaterhouseCoop-ers (PwC) conducted in conjunction with the World Economic Forum's 'Working towards Wellness' initiative, it examined the challenges facing businesses as a consequence of the growing epidemic of chronic disease, which is the leading
cause of death and disability worldwide.

The purpose of the study was to act as a facilitator and stimulant of greater business engagement to help prevent chronic disease through employee wellness programmes. The goals of this initiative was to engage CEOs and business leaders to commit to improve employee health; help companies take practical steps to do this; and facilitate collaboration between stakeholders to help prevent chronic diseases.

Wellness is commonly defined as an organised set of activities designed to help individuals and their family members make and/or maintain voluntary behaviour change(s) that help reduce their health risks and/or enhance their ability to function.
Purpose

The current report draws heavily on the findings of the report highlighting the findings of the global study conducted by PwC and places the global report in an Indian context. The study conducted globally becomes even more critical for countries such as India; as such chronic diseases are increasingly affecting people in developing countries poised for growth.

In addition, two per cent of the capital spent on workforce is lost to disability, absenteeism and attendance arising from chronic diseases. Combined, these indirect costs are more than the additional direct medical claim costs that some employers incur.

The report, therefore, tries to set the context of how such global findings relate to India, and in particular take a look at case studies around the growing Information Technology (IT) and IT enabled services (ITeS) industry in India. Indian multinationals in this segment have been prominent in using the workplace to promote long-term health behavioral change to the measurable benefit of themselves, their employees and local communities.

Deriving from these experiences, and its experience worldwide, the current report first examines the nature of the problem in India, and then suggests a framework to corporations adopting wellness programmes, geared towards making these initiatives effective.

What is a Chronic Disease?

The US National Center for Health Statistics defines chronic disease as one that persists for a long time i.e. for three months or more. The major contributors to chronic diseases are health damaging behaviours ranging from tobacco use, lack of physical activity and poor eating habits. Chronic diseases such as cardiovascular diseases, cancer, diabetes, obesity are fast becoming the leading cause of death and disability in both the developed and developing world.

In particular, in regions such as India, with a growing urban population that is increasingly susceptible to such life-style diseases, chronic diseases are expected to cause a greater number of deaths than non-chronic diseases.

Chronic diseases, however, are among the most preventable diseases. Adoption of healthy behaviors such as eating nutritious foods, being physically active, and avoiding tobacco use can prevent or control the devastating effects of these diseases.

Who is Affected?

Traditionally, chronic diseases have been associated with the wealthy and elderly sections of society. However, it has now been proved that all sections of the society and people from different age groups including those who are in the working age are equally vulnerable to chronic diseases. The diseases cut across boundaries and people from both developed and developing nations are affected. In low and middle-income countries, approximately 80 per cent of all disability-adjusted life years (DALYs) are lost due to chronic disease before the age of 60. The impact of chronic diseases and related risk factors have far reaching implications ranging from consumption and saving decisions, labour-market performance, and human-capital accumulation. Evidence shows that chronic diseases have had a significant negative impact in terms of economic growth in high-income countries. There is a growing realisation among the policy makers in the developing countries that measures would have to taken to ensure that economic development does not get hampered due to the ill effects of chronic diseases.
source:www.expresshealthcaremgmt.com

The Two Faces Of Tuberculosis

The story of Andrew Speaker's infection with "extensively drug-resistant" tuberculosis -- with its weird improbabilities and misunderstood messages -- has provided a crash course in one of the 21st century's least recognized health threats.

The wandering, love-struck and tubercular lawyer accomplished in two weeks what a small army of epidemiologists and advocates has not in a decade: given drug-resistant TB a Paris-Hilton-like spot in the popular consciousness. He has added "XDR-TB" to the vocabulary of American households alongside pandemic flu, anthrax and SARS.
TB is a weapon of mass destruction, with 2 million deaths a year," said Henry M. Blumberg, a TB expert at Emory University School of Medicine in Atlanta. "It is a huge global public health problem, and it usually gets ignored."

Speaker's story has struck chords that will resonate long after its details are forgotten.

The case marks the latest revision of the world's evolving notion of health risk -- and what to do about it. It illustrates what may be necessary to fight epidemics that, unlike classical plagues of history, can take decades to develop. The federal government's first use of an "order of isolation" since 1963 also showed what a long arm in a white coat is willing to do to prevent infections that probably weren't going to happen anyway -- but would be catastrophic if they did.

Perhaps most important, the case shows what can happen when the affluent precincts of the global village ignore what is happening in the poorer ones.

That last point is the one that Richard E. Chaisson, an expert in drug-resistant tuberculosis at Johns Hopkins University's Bloomberg School of Public Health, hopes will not get lost.

The existence of XDR-TB in the lungs of a young, healthy Atlanta trial lawyer is evidence that the world needs to do a lot better at finding, treating and preventing tuberculosis in poor countries. That is where most of this year's 8.9 million new cases will occur -- 424,000 of them resistant to two drugs (multi-drug-resistant, or MDR) and 27,000 resistant to at least four (extensively drug-resistant, or XDR). They are the direct result of inadequate treatment.

"I am concerned that what will happen is that a lot of money and attention will be spent on homeland security issues, which have little to do with tuberculosis control," Chaisson said. "I am worried that the focus may be on biosecurity rather than on the problem itself."

What's urgently needed, he said, are tools for diagnosing TB and drug resistance that don't require fancy laboratories, as well as drugs both to treat the resistant cases and to make treatment of the regular cases quicker.

The subtleties and contradictions of Speaker's case underscore the challenge of tuberculosis.

The 31-year-old did not have any of the common risk factors for TB. He was not homeless or a recent immigrant. He had not been in prison. He was not poorly nourished or infected with the AIDS virus. Where he caught TB is a mystery. It's possible he was infected last year while visiting hospitals in Vietnam, where he did charity work with the Rotary Club.

Whatever the source, his illness is the result of the unwitting exposure of a healthy person to an ill one -- the very scenario that health authorities in Fulton County, Ga., sought to prevent when they told him not to fly to Europe for his long-planned wedding.

However, it was always a long shot that he would infect anyone else.

His case was "smear-negative" -- no organisms were visible when fluid from his lungs was examined under a microscope (although clearly they were in there because they grew out in lab culture). He felt well and wasn't coughing, which is the way the bacteria spreads in most "pulmonary," or lung-involved, cases. He had not infected his fiancee, family members or co-workers. His physician -- and apparently also the local health authorities -- did not think he needed to be isolated while awaiting treatment.

Nevertheless, people like Speaker aren't harmless. In a study of five years' worth of new TB cases in San Francisco, 17 percent were traced by DNA fingerprinting to a "smear-negative" infected person. The concern about air travel arose from studies in the 1990s showing that TB patients occasionally infect other passengers on long flights, with the people sitting within two rows of them at highest risk.

Despite the improbability of Speaker's infecting anyone else, the consequence of such an event would be extreme, especially when tests revealed his case was not only drug-resistant, but "extensively" so. Only one-third of XDR-TB patients are cured; the rest die.

Such "low-probability/high-consequence" scenarios are among the trickiest in medicine. It appears that Speaker concentrated on the probabilities; public health authorities were more concerned with the consequences.

The latter was dramatically clear when the federal Centers for Disease Control and Prevention tried to stop Speaker during his honeymoon in Italy.

A former CDC tuberculosis specialist working there notified Italian health officials and determined that Spallanzani Hospital in Rome, which has experience treating XDR-TB cases, had an isolation bed available. Simultaneously, a CDC quarantine officer in Atlanta tracked down Speaker and told him by phone to stay put.

Although Speaker's risk to others was almost certainly still small, transmission of the infection at this point would have been unforgivable. So unforgivable that the CDC didn't feel it was safe to send one of its airplanes to get him because none had air-filtering systems that would fully protect the crew.

"You can't be faulted if you take the most conservative approach. I saw this in the anthrax days," said Eddy A. Bresnitz, New Jersey's state epidemiologist, who helped direct the response to the 2001 bioterror attack that caused, among others, six cases of anthrax in New Jersey postal workers.

"CDC is always going to exercise the 'precautionary principle,' that you take protective measures even though you may not be certain how protective they will be, or how much further they may reduce risk," he said.

But extreme caution can have unintended consequences.

The prospect of being hospitalized in Italy for an indeterminate period clearly alarmed Speaker. He and his bride bolted -- back home, where he'd been told he would have the best shot at a cure.

Exactly what was said before they made this decision isn't known. CDC officials say they laid out options for getting him home. Nevertheless, Speaker's action highlights how much the perceptions of single patients can affect the public health.

"It may be that the most effective way to safeguard the health of the public at large is to assure the person who is sick -- or, in this case, the carrier -- that he will not be abandoned," said Johns Hopkins bioethicist Nancy Kass.

Whether it was necessary to slap a detention order on Speaker soon after he reentered the United States has become a subject of debate in public health circles.

Some believe the action violated a principle enunciated in another context by Louisiana State University legal scholar Edward P. Richards: that "the state demonstrate that the action ordered is intended to prevent harm in the future, not to punish for past actions, and that the action is reasonably related to the public health objective." They argue the detention order was punitive, as Speaker agreed to go straight to a New York City hospital when a CDC doctor reached him by phone soon after he reentered the United States via Canada.

Others believe the handling of someone who had twice defied medical advice was justified. Part of the reason, they argue, is that XDR-TB can only be fought one case at a time.

Unlike pandemic flu or SARS, XDR-TB does not emerge explosively. It cannot be stopped by halting or limiting the movement of whole populations. Moreover, there is no vaccine that can be given to masses of adults to prevent infection.

Instead, TB can be controlled only by the meticulous care of individuals, who must take medicine -- often a daily handful of pills -- for at least six months, and sometimes for as long as three years. Those who quit taking the medication once they started feeling better are responsible for the emergence of drug-resistant strains. Stopping a TB epidemic requires the prolonged cooperation -- either willing or enforced -- of every patient.
SOURCE:www.washingtonpost.com

LaCrosse virus reach under study

The Fort Wayne-Allen County Department of Health is set to receive $68,000 in federal money next year to help study a specific type of encephalitis among local teens.

Last year, health officials diagnosed two cases of a rare mosquito-borne illness called LaCrosse encephalitis. In one case, the illness caused neurological problems for the patient. But in August, 15-year-old Christopher James Doyle died of the illness.

About 70 cases of LaCrosse are reported to the Centers for Disease Control and Prevention a year.

But Dr. Deborah McMahan, the county’s health commissioner, wants to know for sure just how common the illness really is.

She hopes to take blood specimens from 1,000 area high school students to see whether they were ever exposed to LaCrosse.

She would also like to encourage doctors to consider testing for these types of illnesses, which can cause future learning problems and seizures for children with the diseases, McMahan said.

Detection can help clue parents and doctors into potential complications, she said.

Rep. Mark Souder, R-3rd, was able to secure the $68,000 for the study. The money will be available next year, McMahan said.

The study complements the health department’s shift in focus away from just the risk of West Nile virus, another mosquito-borne disease, to all arboviral diseases.

Previously, the health department had encouraged residents to wear insect repellent near dusk or dawn because West Nile-carrying mosquitoes are out at night. But LaCrosse-carrying mosquitoes are out during the day.

McMahan said anyone outdoors should wear repellent regardless of the time of day.

To help reinforce the message to wear repellent, Doyle’s parents, Jim and Sherry Doyle, are organizing a memorial softball benefit from 10 a.m. to 7 p.m. July 28 at the Indiana University-Purdue University Fort Wayne softball diamond. The event will also include a raffle, silent auction, food and other games.

Proceeds will go to the Ronald McDonald Family Room at Parkview Hospital, Sherry Doyle told the board of health during its meeting Monday.

Her son’s death was shocking and quick, she told the board.

And the Doyle family wants the community to be aware there are different kinds of mosquitoes and viruses and the need to wear repellent, Sherry Doyle said.

So far this year, health officials are investigating one human case of suspected West Nile virus. Test results that could verify whether the patient has West Nile could be available next week, McMahan said.

McMahan also reported nine patients have active tuberculosis. About half of those patients are immigrants or refugees and the other half are local cases, she told the board.

The number of TB cases is on a pace to surpass last year’s total of 10 cases, McMahan said.

In other news, the board received an update on the department’s efforts to enforce Allen County’s smoking ordinance.

As of Monday morning, the department had received a total of 59 calls from the public regarding the county’s ordinance and Fort Wayne’s smoking ban. Most of the calls pertained to Fort Wayne’s law, said Angelique Causey, the department’s smoking ordinance coordinator.

The department has investigated just one formal complaint, but no citations were issued, McMahan said.
SOURCE:www.fortwayne.com

Medication Errors and Syringe Safety are Top Concerns for Nurses According to New National Study

The American Nurses Association (ANA) announces the findings of the 2007 Study of Injectable Medication Errors, an independent nationwide survey of 1,039 nurses. According to the research, the overwhelming majority of nurses (97 percent) say they “worry” about medication errors, and more than two-thirds (68 percent) believe medication errors can be reduced with more consistent syringe labeling.

“Registered nurses play a critical role in the health care system. ANA’s Code of Ethics demands nurses take an active role in addressing the environmental system factors and human factors that present increased risk to patients,” says Rebecca M. Patton, MSN, RN, CNOR, president of the American Nurses Association. “Proper and consistent syringe labeling is one way to reduce risks associated with medication errors.”

The 2007 Study of Injectable Medication Errors was developed and co-sponsored by the ANA and Inviro Medical Devices. It was designed to capture opinions, concerns and experiences about challenges related to labeling on syringes, which has been a Joint Commission recommendation since 2006. Results of the study can be downloaded at www.nursingworld.org.

Injectable medication errors

When asked about the point in the process medication errors are most likely to occur, the majority of nurses say either during the preparation and administering of medication to patients (48 percent), or during the transcription of the initial order (47 percent).

To help reduce injectable medication errors, the vast majority of nurses (81 percent) believe their healthcare facility should ensure sufficient staff is available for timely and efficient administration.

Nurses indicate the most common factors contributing to injectable medication errors are:

Too rushed / busy environment (78 percent)

Poor / illegible handwriting (68 percent)

Missed or mistaken physician’s orders (62 percent)

Similar drug names or medication appearance (56 percent)

Working with too many medications (60 percent)

Frequency of syringe usage

Nearly half (44 percent) of nurses say they inject medicine via a syringe more than five times per shift, and more than one-third (37 percent) administer injectable medication at least one time per shift.

Labeling injectable medication

Slightly more than one-third (37 percent) of nurses claim injectable medications are always labeled. However, this study identified that as many as 28 percent of nurses nationwide do not label syringes when using them. Of the 72 percent who do, in fact, label syringes, they do so by:

Writing on self-adhesive labels then applying to syringe (54 percent)

Writing on pieces of tape and adhering to syringe (31 percent)

Using Sharpie® and writing directly on syringe (11 percent)

Writing on paper or sticky note and taping to syringe (4 percent)

While 62 percent are aware of The Joint Commission’s 2007 National Patient Safety Goals addressing the labeling of all medications and medication containers, only half (51 percent) of respondents are aware that The Joint Commission has determined that the pre-labeling of syringes does not meet labeling goals, since the label should be prepared only at the time the medication or solution is prepared.

Challenges of labeling

Challenges often arise when attempting to label a syringe. Labels covering measurement gradations on the syringe barrel pose the greatest problem (65 percent). Fifty-five percent of nurses consider the absence of a suitable label poses the greatest challenge, while 39 percent think a label impairs their ability to accurately check the dosage when comparing it to the order.

Benefits of a write-on stripe

When nurses were asked their opinions about a write-on stripe manufactured on the syringe, the vast majority (95 percent) believe the greatest benefit is the fact that it would not interfere with visibility of the syringe content or gradations on the syringe barrel. Ninety-three percent believe it will reduce the risk of error, while 92 percent of nurses say a write-on stripe also helps address The Joint Commission’s goal for medication labeling.

“This research confirms that our healthcare systems need new technology that simply and efficiently improves patient and employee safety,” says Gareth Clarke, chief executive officer of Inviro Medical Devices. “To help address the challenges associated with injectable medication errors and to comply with The Joint Commission’s goal for medication labeling, we are adding the InviroSTRIPE® feature -- an integral write-on stripe that allows for critical information to be recorded directly onto the syringe barrel -- to our full range of InviroSNAP!® safety syringes and our standard luer lock syringes.”

Nurses’ influence on selection of sharps devices

Eighty-one percent of nurses reveal that safety syringes are used in most or all departments within their healthcare facility. Even though the 2000 Needlestick Safety and Prevention Act – (NSPA), adopted as public law 106-430 by the 106th Congress, mandates that institutions conduct annual product reviews and that nurses be involved in the decision-making process, the majority of nurses (58 percent) say they do not have an opportunity to influence the selection of sharps safety devices used at their healthcare facility.

Additional health and safety concerns

According to 65 percent of nurses, health and safety concerns play a key role in determining the specific area in which they choose to work, as well as their decision to continue practicing.

The top four health and safety concerns for nurses nationwide are acute / chronic effects of stress and overwork (72 percent), back injuries (67 percent), infection of tuberculosis or other infectious disease (38 percent), and getting HIV or hepatitis from a needlestick injury (35 percent).

The study also reveals that 55 percent of nurses have experienced needlestick injuries from needles contaminated by blood or body fluids.

“We are honored to support ANA’s goal to continue bringing value to its members by addressing topical workplace issues with this survey,” says Jean McDowell, vice president of clinical affairs for Inviro Medical Devices. “Inviro Medical will apply the input secured from front-line nurses to further improve our safe medication delivery systems.”

“This study clearly indicates a need for the right safety equipment -- especially in regard to injectables -- to reduce the risk of medication errors and sharps-related injuries,” adds Patton.

Conducted in April, the 2007 Study of Injectable Medication Errors is based on an online, nationwide survey of nurses. The study is sponsored by the American Nurses Association, with support provided by Inviro Medical Devices. The survey’s margin of error is plus or minus 3 percent.
SOURCE:www.endonurse.com

New test to detect human growth hormone may catch doping athletes, experts say

Experts believe a new test to detect human growth hormone may bring sports authorities a step closer to catching doping athletes.

The blood test was recently developed by Dr. Ken Ho of Sydney’s Garvan Institute of Medical Research, and colleagues, with support from the World Anti–Doping Agency.

"This new test is more sensitive to human growth hormone than what we’ve had in the past," Ho said. "My message to athletes would be to train harder instead of cheating."

It has been notoriously difficult to identify athletes illegally using human growth hormone. Not only is the hormone naturally produced in the body – making it harder to detect synthetic versions – but the concentrations of it normally circulating in the body vary enormously and can disappear within minutes.

Human growth hormone is produced by the pituitary gland and helps cells regenerate. Synthetic versions of the hormone are routinely prescribed to children with growth problems, or tuberculosis and AIDS patients who need to maintain their body weight.

It is also widely taken among some anti–aging advocates since it can improve skin elasticity. But improper use of the hormone can lead to problems including the nerve disorder acute carpal tunnel syndrome, diabetes, and unnatural growth of the bones.

The new test works by finding proteins triggered by the hormone. "We’ve been able to identify markers that show abuse by measuring when other hormones and proteins released by human growth hormone reach certain levels," said Dr. Olivier Rabin, WADA’s science director. Rabin said that these biological markers are not affected by any other differences between athletes, such as ethnicity, gender, or physiology.

WADA has already introduced another test, which identifies the synthetic version of human growth hormone in the body, on a limited scale. That test was in place at the Athens and Turin Olympic Games. The agency hopes to use both tests together to maximize their chances of detection. But finding cheating athletes on a large scale will be difficult since the hormone can be detected only in blood – only trace amounts are present in urine. And blood tests are not used as regularly as urine tests.

While designing the new test, Ho and his colleagues also made another interesting discovery: Human growth hormone doesn’t work on its own.

In their research, Ho and colleagues looked at the effects produced by human growth hormone on its own and in combination with testosterone, in nearly 100 recreational athletes.

In the study, 64 men were given either a placebo, human growth hormone, testosterone, or a combination of the latter two, for eight weeks. In the other half of the study, 33 women were given a placebo or the growth hormone, for eight weeks. Their physical performances were then tested in various categories, including how much weight they could lift, how high they could jump and how fast they could sprint.

"We found that growth hormone does not increase muscle mass or improve performance," Ho said. "Only when you combine growth hormone with testosterone does it have an effect," he said. When taken together, the two substances have a synergistic effect, lowering the body’s fluid and fat levels while building muscle.

But the conclusions from Ho’s study are limited. Ho acknowledged that while study participants were given "high but safe" doses of human growth hormone and testosterone, professional athletes that are doping would probably use much higher levels for longer periods.

While Ho and colleagues concluded that the differences between athletes on various treatment regimens were not statistically significant, some experts think the differences cannot be altogether dismissed.

"In the laboratory, very small differences may not be significant for scientists," said Dr. Charles Yesalis, professor emeritus of health and human development at Pennsylvania State University. "But we can’t always measure small differences that are unbelievably important in sport." Yesalis was not connected to the study.

Experts also suspect that the vast majority of doping athletes already use a cocktail of banned substances. "Athletes taking human growth hormone probably take it in conjunction with a steroid," said Dr. Todd Schlifstein, a sports medicine rehabilitation physician at New York University Medical Center’s Rusk Institute. Human growth hormone is thought to prolong the effects of banned substances.

And because there is not yet any widespread test for human growth hormone, athletes can continue taking it even when they are being drug–tested. "This is possibly a way for athletes to maintain the effects of steroids without taking the chance of getting caught," Schlifstein said.

With the new tests however, WADA hopes that will no longer be the case. Rabin said WADA is now working to make the human growth hormone tests more widely available, and expect them to soon make a dramatic impact on professional sports.

Others, like Yesalis, are not so sure. "We have heard for years that a reliable test is coming soon," he said. "When I see athletes getting smaller and no Olympic or world records being broken, that’s when I’ll believe it."
SOURCE:www.caycompass.com

Foie Gras Could Cause Acceleration of Arthiritis, TB, Alzheimer's

Although many consider foie gras to be a tasty delicacy, a new study has found the risk of a dangerous protein found in the enlarged goose or duck liver may not be worth the indulgence.

The University of Tennessee Graduate School of Medicine study found a protein, related to diseases such as rheumatoid arthritis and tuberculosis, in laboratory mice after they were force-fed a protein extract from foie gras.

Amyloidosis is a disease process involving the deposit of normal or mutated proteins, called amyloids, that have become misfolded. In this unstable state, these proteins form hair-like fibers known as fibrils that are deposited into vital organs such as the heart, kidneys, liver, pancreas and brain. This process is related to many diseases, including rheumatoid arthritis, Alzheimer's, type 2 diabetes and Parkinson's.
This experiment, published in the Proceedings of the National Academy of Sciences, marks the first implication that mice — or people — could spread amyloidosis.

The mice, genetically altered to be susceptible to diseases with amyloidosis, were fed foie gras for eight weeks. Researchers found that 62 percent of the mice formed deposits on vital organs including the heart, kidney, liver, pancreas and intestines.

Altered mice that were not fed foie gras did not form deposits at all until after a span of eight months.

Researchers noted that even if the implications of the experiment hold true for humans, only those with a high risk for amyloid-related diseases would be affected by foie gras.

Alan Solomon, the lead author on the paper and a specialist in amyloid-related disorders at the University of Tennessee Graduate School of Medicine, explained that not everyone eating this delicacy is at risk.

"Eating foie gras probably won't cause a disease in someone who isn't genetically predisposed to it," Solomon said in a news release.

"People with a family history of Alzheimer's disease, diabetes, rheumatoid arthritis or other amyloid-associated diseases should avoid consuming foie gras and other foods that may be contaminated with fibrils," Solomon recommended.

Although the kind of amyloid that researchers found in the foie gras is not exactly the same as that found in the brains of Alzheimer's victims, Solomon said that it remains to be seen whether the particular amyloid found in foie gras could still trigger other types of amyloid proteins.
source:www.foxnews.com