Diabetes may increase cancer risk

Diabetes can increase the risk of developing a number of cancers, and may reduce the chances
of survival in cancer patients, a study has found.

Researchers from the Swedish National Diabetes Register (NDR) compared over 450,000
people with type 2 diabetes with more than 2 million matched controls over an average of 7
years.

For the most common cancers, individuals with diabetes face a 20 per cent greater risk of
developing colorectal cancer and a five per cent higher risk of breast cancer compared with
their diabetes-free counterparts.

People with diabetes already diagnosed with cancer also fare worse, with a 25 per cent and 29
per cent higher chance of dying following a breast and prostate cancer diagnosis respectively
than their peers without diabetes.

More than 415 million people are living with diabetes worldwide — equivalent to 1 in 11 of
the adult population — and this figure is expected to rise to 642 million by 2040.
Previous research has suggested a link between type 2 diabetes and an increased risk of cancer.
However, the relationship between diabetes and cancer remains poorly understood due to
limitations of previous studies.

To provide more evidence, researchers examined the incidence of a number of cancers and
post-cancer mortality in 457,473 individuals with type 2 diabetes from the NDR between 1998
and 2014, compared to 2,287,365 controls from the general population over an average of 7
years follow up.

A total of 227,505 people developed cancer over the follow-up period. Diabetes was associated
with 11 out of the 12 specific types of cancer investigated in the study.

Scientists found that people with diabetes were 231 per cent more likely to be diagnosed with
liver cancer than those without a history of diabetes over the study period.

Diabetes was also clearly linked with higher risk of cancers of the liver, pancreas (119 per
cent), uterus (78 per cent), penis (56 per cent), kidney (45 per cent), gallbladder and bile ducts
(32 per cent), stomach (21 per cent), and bladder (20 per cent).

There was evidence that those with diabetes were at a reduced risk of prostate cancer (18 per
cent) compared to their peers without diabetes.

The absolute 5-year risk of developing cancer for the cancer sites highlighted in the study
ranged from 0.02 per cent for penis cancer to 1.45 per cent for prostate cancer for people with
diabetes.

In addition, for individuals with diabetes, mortality was higher for prostate (29 per cent higher),
breast (25 per cent), and colon (9 per cent) cancer compared to their diabetes-free counterparts.
The researchers emphasise that although the relative risk of cancer is increased after diabetes,
the absolute risk increase is low.

"Our findings do not suggest that everyone who has diabetes will go on to develop cancer in
later life," said Bjornsdottir, who led the study.

"With the number of people with type 2 diabetes doubling over the past 30 years our findings
underscore the importance of improving diabetes care," she said.

Source: The Tribune

New law is the most progressive globally’

The Mental Health Care Act enshrines equality for mentally ill people with those who have
physical health problems in all matters related to health care.

India’s Mental Health Care Act is one of the most progressive legislations on mental health
globally, and should be read as a bill of rights for people with mental disorders. Fundamentally,
the Act enshrines equality for mentally ill people with those who have physical health problems
in all matters related to health care. Conceptually, it transforms the focus of mental health
legislations from supposedly protecting society and families by relegating people with mental
disorders to second-class citizens, to emphasising the provision of affordable care, aligned with
the preferences and needs of the affected person, financed by the government, through the
primary care system.

Involuntary treatment and confinement in mental hospitals, which have historically been
associated with profound depravity and abuse of human rights and which have been robustly
contested by the Convention for the Rights of Persons with Disabilities, has been greatly reined
in with stringent procedures to ensure that these are restricted to the rarest of circumstances
with systemic supports to enable the right of the person to make his/ her own decision.
However, it is hard to imagine these visionary ideals finding their way into the grim realities
of the lived experiences of the tens of millions of Indians living with a mental disorder and the
countless more of their familymembers and friends who are also affected. The National Mental
Health Survey of India (2016), the largest exercise to count the numbers of people affected by
mental disorders, reported that one of every ten adults experiences a clinically significant
condition. Nearly 90% of these people have received no care at all in the past year.

The recent observation that some of the victims of the horrific series of lynchings in our country
were people with mental disorders is a tragic reminder of their vulnerability. Indeed, no other
health condition in this country has such astonishing levels of unmet needs for care. Scarcity
is the mother of invention, and this is so true of health care innovations in India, a country
where the majority of people get too little of the care that they desperately need, while a few
get as much care, never mind if it is actually needed, that they can pay for. And the care that
many receive, whether too little or too much, is often not aligned with scientific evidence. In
the case of mental disorders, for example, only a tiny fraction of the population will have access
to brief psychosocial interventions, one of the most effective classes of treatments in medicine.
As with so many other formidable challenges facing our people, the community has been at the
heart of innovative solutions. A variety of community actions have illustrated paths to mental
health care which is affordable, evidencebased, empowering and equitable. Prominent amongst
these are the use of community based workers to deliver mental health care.

The community health worker, including cadre such as the ASHA worker and the Auxiliary
Nurse Midwife, are the foundation of our public health care system. Indeed, they have played
a central role in the success of our public health programmes which substantially reduced
maternal and child mortality. Even as they are slowly, but surely, winning these age-old battles,
they present a unique human resource to be deployed to helping people with mental disorders
to recovery.

Over the past decade, some national health care programmes (such as for adolescent health)
and NGOs have begun to task community-based workers to provide low intensity psychosocial
interventions. Sangath, an NGO I co-founded in Goa in 1996, has pioneered the design of an
entire suite of psycho social interventions for delivery by persons from the local community
with no prior professional training in mental health. These interventions have targeted a range
of conditions, from autism in childhood, emotional and behavioural problems in adolescents,
depression, drinking problems and psychosis in adults, to dementia in older people. Through
rigorous public health trials, we have demonstrated, time and again, that such interventions are
not only effective but, importantly, highly desired by people who are affected by these
disorders. There is no longer any doubt about whether community health workers can be trained
and supervised to deliver clinically effective psychosocial interventions. The challenge before
us now is how to go beyond pilots and research studies and scale these innovations up in routine
health care.

Sangath is currently embarking on a series of projects seeking to achieve these goals, by
embedding its proven interventions for delivery through existing community health workers
and counsellors of the public system, in partnership with state governments. In New Delhi, we
will train ASHA workers to deliver parent-mediated interventions for children with autism. In
Madhya Pradesh, we will design digital interventions to train and support ASHA workers to
deliver brief psychological therapies for depression. In Goa, we will train primary care based
counsellors and community based workers to reduce the burden of depression in the population.
Each of these models for scaling up could offer opportunities for wider adoption across the
country.

No NGO can ever match the mandate, reach and resources of the state for taking health care to
India’s vast and diverse population. For this to happen, we will need a structural rethink in how
we plan and implement mental health care. The doctor and hospital-centric approach which
dominates must be balanced with a robust investment in community based care, as was done
with such great results for maternal and child health.

The recent decision to rebrand the primary health care sub-centre as a Health and Wellness
centre, with a mid-level provider trained in community health, offers a major new opportunity.
Coordination between mental health professionals, primary care providers and community
workers is essential to address the longterm nature of many mental disorders and the need for
integrating clinical and social care. Only then will the creativity and science, which harnesses
civil society’s talent and instinct to care, be able to play its rightful role in realising the vision
of the National Mental Health Care Act.

The author is the Pershing Square Professor of Global Health at Harvard Medical School and
is affiliated with the Public Health Foundation of India and Sangath.

Source: Hindustan Times

WHO highlights ways to reduce cancer risk?

Tobacco and alcohol consumption, unhealthy diet, and physical inactivity are some major
factors’

With cancer emerging as the second leading cause of death globally, the World Health
Organisation (WHO) has listed ways to reduce cancer risk.

It advised not to consume any form of tobacco, to make one’s home smoke-free, to enjoy a
healthy diet, to vaccinate children against Hepatitis B and HPV, to use sun protections, to be
physically active, to limit alcohol intake and take part in organised screening programmes,
adding that breastfeeding reduces a mother’s cancer risk.

TheWHO said consumption of tobacco and alcohol, unhealthy diet, and physical inactivity are
major factors that increases cancer risk worldwide and are also the four shared risk factors for
other non-communicable diseases.

“Some chronic infections are risk factors for cancer and have major relevance in low and
middle-income countries. Approximately 15% of cancers diagnosed in 2012 were attributed to
carcinogenic infections, including Helicobacter pylori, Human papillomavirus (HPV),
Hepatitis B virus, Hepatitis C virus, and Epstein-Barr virus. Hepatitis B and C viruses and some
types of HPV increase the risk for liver and cervical cancer, respectively. Infection with HIV
substantially increases the risk of cancers such as cervical cancer,” the WHO said.

Dr. Pawan Gupta, additional director, Surgical Oncology, Jaypee Hospital, Noida said: “Cancer
is the uncontrolled multiplication of cells. Cancer can spread from where it started to another
part of the body. The original cancer is called the primary tumour. The cancer in another part
of the body is called metastatic or secondary cancer. Metastatic cancer has the same type of
cancer cells as the primary cancer. The term metastatic cancer is usually used to describe solid
tumours that have spread to another part of the body.”

Doctors have warned that prevalence of cancer cases are on the rise in India. The Indian
Council of Medical Research stated that approximately 12 to 13 lakh new cases of cancer are
being diagnosed every year along with an existing 25 to 30 lakh cancer cases at any given time
in India.

“The saddest part is that a vast majority of them are being diagnosed in advanced stages. On
the contrary, majority of cancer cases are diagnosed in the early stages in developed countries,
including Europe and the U.S.A., thanks to their effective screening programmes. Awareness
in general population about the big ‘C’ also helps in early cancer diagnosis,” added Dr. Pawan.

Source: The Hindu

Most babies not breastfed in their first hour

Report cites lack of supportive work environment, inadequate skills of health care providers
As many as 6 out of 10 babies born in the country are not able to begin breastfeeding within
one hour of birth despite an improvement in institutional deliveries due to a lack of
supportive work environment, inadequate skills of health care providers as well as caesarean
deliveries, according to a new report made public on Tuesday.

First milk
Mother’s breast milk within one hour of birth ensures that the infant receives the colostrum or
first milk, which is rich in protective factors. The WHO and UNICEF also recommend
exclusive breastfeeding for infants up to the age of six months and thereafter complementary
foods with continued breastfeeding up to 2 years of age or beyond.

The 5th Report of Assessment of India’s Policy and Programmes on Breastfeeding and Infant
and Young Child Feeding in 2018 also gives India a score of 45 out of 100 on 10 parameters
under the category of policy and programmes. However, India performs better in terms of
infant and young child feeding practices scoring 34 out of 50 on five parameters.

The report has been prepared by a national consortium of public health groups and agencies
including government departments, AIIMS and UNICEF, under the aegis of World
Breastfeeeding Trends Initiative (WBTI).

Early initiation of breastfeeding within one hour of birth is 41.5%, exclusive breastfeeding
for the first six months is 54.9%, inclusion of complementary feeding between 6-8 months is
42.7% and adequate complementary feeding and minimum acceptable diet among 6-23
months children is as low as 9.6%, the report cites data from NFHS-4.

Inching forward
India has made some progress over the years and between National Family Health Survey
(NFHS)-3 and NFHS-4, early initiation of breastfeeding has improved from 23.4% to 41.5%
children breastfed within one hour of birth.

This hasn’t kept pace with the stark increase in institutional deliveries which more than
doubled during the same period, from 38.7 % to 78.9%.

Source : The Hindu

Hypogonadism: A lesser-known cause of female infertility

Androgen deficiency in males has twice the chances of developing a condition known as
hypogonadism than in females.
People are unaware of a condition known as female hypogonadism and its symptoms can
seriously affect women's quality of life.
The condition refers to the deficiency in the production of estrogen and progesterone by the
ovaries. The symptoms include irregular or heavy periods, hair loss, depression and even
ovarian cysts.
"The condition allows the body to only synthesise very limited amount of gonadotropin, whose
low levels are associated with restricted secretion of testosterone thereby causing sperm
production abnormalities, low sex drive, erectile dysfunction and ultimately male infertility,”
said Dr. Sagarika Aggarwal, IVF Expert, New Delhi.
Though signs and symptoms defer depending on the severity of hypogonadism, it can begin
since foetal development, before puberty or even in the adulthood. During the foetal
development, if the body doesn't produce enough testosterone it can result in an impaired
growth of the external sex organs.
"Child genetically born as a male can develop female genitals, genitals that are neither clearly
male nor clearly female or underdeveloped male genitals. In males, hypogonadism can delay
puberty or even lack normal development. It can also lead to an impaired growth of body hair,
penis, testicles and breast tissue. Other symptoms include Infertility, erectile dysfunction,
decreased libido and fatigue,” said Dr. Amol Lunkad, IVF expert from Pune.
In females, menstruation and ovulation are triggered by hormones such as oestrogens,
luteinizing hormone, progesterone and follicle stimulating hormone. All the hormones are
controlled by gonadotropins.
The low level of gonadotropins will affect the menstruation and ovulation. Both are important
for the natural conceptions because, without egg produced during ovulation, it is not possible
to conceive a child Sex hormones also control the sex characteristics like breast development
in women, testicular development in men, and pubic hair growth. These hormones also play a
vital role in the menstrual cycle and sperm production.
A blood test is done to analyse the testosterone levels along with a sperm count test.
Testosterone replacement therapy (TRT) is done through gel and patch form and also available
in an injectable form.

Source: The Tribune

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
groups.

"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

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