Friday, 1 June 2018

World No Tobacco Day: India among top 4 users of tobacco

Tobacco is one of the most common and preferred forms of addiction. Even though scientific
evidences have revealed its harmful health effects, the use of tobacco in different forms has
seen a dramatic increase, especially in the developing countries.

This potentially lethal substance is responsible for more than 1 in 10 fatalities globally, with
India featuring among the top four users of tobacco. About 11.2 percent smokers worldwide
are Indian.

Despite decades of research and strong initiatives for controlling diabetes carried out
globally, the number of tobacco users in the world has not seen a declining trend.
Besides cancer, the use of tobacco in any form is also a leading cause of Type-2diabetes, the
most common type of the disease as seen in adults. Research shows that smokers are 30
percent to 40 percent more likely to develop diabetes as compared to non-smokers. This risk
doubled with the number of packs of cigarettes smoked per day.

"Naturally occurring tobacco does not have much sugar, the processed forms have added
sugars in high amounts. Hence, tobacco raises blood sugar levels and makes it more difficult
to manage diabetes. This was not the only problem. While nicotine may seem harmless, it
plays havoc on your body by changing the natural cell processes, thus affecting insulin
response leading to a condition called insulin resistance. People with insulin resistance need
larger and more frequent doses of insulin to control the blood sugar levels in their body," said
Sujata Sharma, Diabetes Educator, BeatO.

"Thus, smokers with diabetes are at a higher risk of developing serious complications such as
heart disease, neuropathy or nerve damage in extremities and poor blood circulation to limbs
and genitalia leading to gangrene, infections and possible disability and infertility.
Retinopathy leading to blindness is another common complication associated with diabetic
tobacco users," added Sharma.

A Global Adult Tobacco Survey (GATS-2) report shows that India is the second largest
consumer of tobacco products with 28.6 percent of the population addicted to it in any form.
Of this, 10.7 percent smoke, and 21.4 percent use SLT. Of the 346?million global SLT
consumers, India alone has 152.4?million consumers with a substantial increase across all age

"Many smokers tend to use Smokeless Tobacco when quitting cigarette addiction. Vaping, as
the use of e-cigarettes is called, is also considered as an alternative and at only 10 percent of
nicotine compared to a cigarette, it may seem relatively less harmful. But this is not so.
Smokeless tobacco poses just as many health risks," said Dr Ramananda Srikantiah Nadig,
Head of the Clinical Advisory Board, healthi.

Snuff and chewing tobacco also contain nicotine, which is responsible for tobaccoaddiction.
Though it is absorbed at a slower pace than that from cigarettes, the absorbed amount is three
to four times and remains in the bloodstream longer.

"Due to the presence of nicotine and other chemicals, prolonged use of SLT causes serious
health issues such as cancer and heart disease. It also increases the risk of oral and
oropharyngeal cancer. Sometimes, there may be white patches on the gums, tongue, or lining
of the mouth called leukoplakia. Though this is noncancerous, it could evolve into a fully
blown cancer of the mouth. Lung, stomach, bladder, pancreatic and oesophageal cancer are
some of the other cancers associated with smokeless tobaccoaddiction," added Dr Nadig.
Another form of tobacco, called smokeless tobacco and sheesha, release high levels of carbon
monoxide. By reducing the amount of oxygen circulating in the blood, these raise a person's
heart rate and blood pressure putting undue stress on the cardiovascular system.

"Apart from this, frequent tobacco users also stand the risk of cardiac arrests, elevated blood
pressure levels, strokes, hemorrhages, blood clots, and other heart-related ailments. It is
imperative for people who are at risk or those with a history of cardiac ailments to
discontinue using snuff or other smokeless tobacco products after an attack, failing which it
can become life threatening," said Dr Rajiv Agarwal, Cardiologist, Lybrate.

Quitting tobacco/smoking can be a great challenge and often requires professional help and
rehabilitation. Once on track, your body will definitely experience better overall health.
It is possible to overcome tobacco addiction through support systems, programmes, and
prescription medications.

Products such as the following can help wean the addict from SLT.
• Nicotine gum
• Nicotine patches
• Lozenges

Prescription medicines such as bupropion SR and varenicline tartrate can be used under
physician's guidance to quit nicotine addiction.

Source: The Tribune

Friday, 25 May 2018

India ranks 145th among 195 countries in healthcare, disparity among states

Goa and Kerala had the highest scores in 2016, both over 60, whereas Assam and Uttar
Pradesh had the lowest, both below 40.
While India has seen improvements since 1990, its HAQ score was lower than 50 for 23 of
the 32 causes of death.
India ranks a lowly 145th among 195 countries in terms of healthcare access and quality in
2016, as assessed in a Global Burden of Disease study published in The Lancet. The study
used an index based on 32 causes of death that should be preventable with effective medical
care. Each country was given a healthcare access and quality (HAQ) score between 0-100.
India’s HAQ score is 41.2, up from 24.7 in 1990.
For the first time, the study also analysed healthcare access and quality between regions of
seven countries including India. China and India had the widest disparities of 43.5 and 30.8
points, respectively, while Japan had the narrowest of 4.8 points. In India, the 30.8-point
difference marks an increase in disparity from 23.4 points in 1990. Goa and Kerala had the
highest scores in 2016, both over 60, whereas Assam and Uttar Pradesh had the lowest, both
below 40.
While India has seen improvements since 1990, its HAQ score was lower than 50 for 23 of
the 32 causes of death. Particularly low were scores like 12 for skin cancer, 24 for neonatal
deaths and adverse medical treatment, and 30 for tuberculosis and chronic kidney ailments.
“This is really disappointing – well behind BRICS countries,” Dr Madhukar Pai, Canada
Research Chair in Epidemiology and Global Health told The Indian Express.
About India’s low score in TB, Pai said: “This does not surprise me, since TB deaths should
be rare if quality care was available. We know India accounts for nearly 30 per cent of global
TB deaths… TB is often missed by practitioners, and MDR-TB is diagnosed very late. In the
public system, patients are lost along the entire care cascade, and this means only 1 in 2 TB
patients make it to the finish line. With MDR-TB, only 1 in 5 patients cross the finish line
and successfully complete therapy. All this makes for a poor HAQ score. The bottom line,
simply focusing on coverage of TB services is not enough. We need to also improve quality
of TB care, in both private and public sectors.”
Dr K Srinath Reddy, president of Public Health Foundation of India, felt that the reason for
India’s poor show is the low density of health workers in the poorly performing states. “For
instance the Janani Suraksha Yojana has registered a rise in the number of institutional
deliveries. However there is no demonstrable correlation with lowering of maternal mortality
in certain states,” Dr Reddy said.
This scorecard shows that the health system is weak and while centrally funded schemes have
provided health access in some areas, quality has not improved in certain states, he added.
The global average HAQ score was 54.4. Iceland and Norway top the list with a HAQ score
of 97 each.

Source : The Indian Express