Tobacco use and smoking can be discouraged with a more positive approach

Health Care, Heart Care Foundation of India, Social Health Community Comments Off

These habits can cause, among other things, heart diseases and eventually death

New Delhi, 06 December 2017: Tobacco use among children and teenagers claims about one million lives in India, indicate statistics. There is also a huge economic burden among people due to tobacco use. One of the major causes for continued tobacco consumption in India is the fact that it is a part of the country’s social culture. However, a recent study has also indicated that there have been many benefits due to the large pictorial warnings on product packs, higher taxes and an intensive awareness campaign against tobacco consumption.

Tobacco use is associated with many adverse health effects and is a major preventable cause of morbidity and mortality. As per the CDC, smoking increases the risk of coronary heart disease by 2 to 4 times, for stroke by 2 to 4 times, lung cancer by about 25 times. In addition, it reduces quality of life, and increases health care utilization and cost.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “India has a ‘National Tobacco Control Programme’ in place to make the public aware about the harmful effects of tobacco use, control tobacco consumption and minimize the deaths. ‘Smoking kills’ has been the message that has been conveyed in the campaigns on tobacco control with the expectation that highlighting the potentially life-threatening health consequences would deter people from smoking or using tobacco products. It’s time to alter the tone of such public health campaigns, from negative to positive. Quite often, we may rebuke a patient for failing in his efforts to quit smoking and say, ‘If you do not quit, you may die’. A statement worded as this may inadvertently sound discouraging to the patient. While it is important that people know the dangers of smoking or using tobacco products, a positive communication approach may have a more fruitful impact than a critical approach.

Kids start to smoke before they’re old enough to think about the risks; after starting they rapidly become addicted to smoking and then regret it later.

Adding further, Dr Aggarwal, said, “The chances that a patient would adhere to the lifestyle modifications are higher if communicated in an empathetic and supportive manner. IMA is committed to working closely with all National Health Programs alongside the government. As individual doctors, we too can contribute to the success of National Tobacco Control Program. Counsel your patients who smoke about quitting smoking but with a difference… Turn a negative situation to a more positive action.”

Some tips to help such people cope with and quit the habit are as follows.

  • Avoid violent communication. Do not condemn, criticize and complaint, the 3Cs of violent communication.
  • Use a nonviolent communication approach to help and support your patient in his efforts to give up smoking.
  • Tell your patient, who is trying to quit smoking, or other tobacco products, “Thank you for not smoking”.
  • Appreciate the hard work put in and their perseverance. This way the patient knows that he has your support and will have trust and faith in you.

Air pollution causes millions of CKD cases globally each year

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The estimated global burden of chronic kidney disease CKD attributable to air pollution fine particulate matter PM less than 2.5 m is significant amounting to more than 10.7 million cases per year. The researchers used the Global Burden of Disease study methodologies to estimate the burden of CKD attributable to air pollution. Epidemiologic measures of the burden of CKD attributable to air pollution included years living with disability YLD meaning years living with kidney disease years of life lost YLL meaning early death attributable to kidney disease and disability adjusted life years DALY a measure that combines the burden of living with the disease and the early death caused by the disease . The global annual burden of incident CKD attributable to high PM2.5 levels was 10 784 514 95 Uncertainty Interval 7 821 109 13 857 623 . YLD YLL and DALYs of CKD attributable to high PM2.5 were 2 185 317 1 418 442 3 061 477 7 897 941 5 471 081 10 514 433 and 10 083 258 7 064 399 13 323 685 respectively. The study also found that burden of disease varies greatly by geography. India along with Nigeria Bangladesh and Pakistan had the high attributable burden of disease exceeding 200 incident cases of CKD per 100 000 population. India was also amongst the countries that reported highest DALYs that included Mexico Central America Southeast Asia and Northern Africa. DALYs per 100 000 were 366.71 251.05 498.01 in Nicaragua and 353.93 260.05 449.24 in Mexico compared to 44.59 24.07 65.74 in the United States. These findings were presented at the recently concluded ASN Kidney Week 2017 in New Orleans Louisiana USA. Keeping BP cholesterol body weight blood sugar within healthy limits avoiding overuse of OTC painkillers smoking eating a healthy diet and exercising regularly are some of the ways to protect kidney health. Air pollution has become a major threat to society today. Air pollution has been at an extremely high level particularly in the Delhi NCR region and continues to remain the hazardous category. Studies have shown that air pollution can damage the kidneys. A significant association between exposure to PM2.5 and risk of incident CKD decrease in estimated glomerular filtration rate eGFR and progression to end stage renal disease was reported online September 2 2017 in the Journal of the American Society of Nephrology. It s now time perhaps to add air pollution PM2.5 to the list of risk factors for chronic kidney disease and recommend avoiding or limiting air pollution exposure to the list of measures generally advised to prevent delay chronic kidney disease. It has become important to also note the air pollution levels in different areas in your city before venturing out to avoid exposure to pollution. Source American Society of Nephrology News Release November 4 2017

PTSD is a systemic disorder with comorbidities

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Post-traumatic stress disorder (PTSD) has been traditionally regarded as a psychological disorder. However, the findings of a new study suggest that PTSD should be considered a systemic disorder and not just a psychological disorder as it is associated with several comorbidities independent of exposure to trauma.
Researchers analysed the health status of 298 Australian veterans aged between 60 and 88 years who had fought in the Vietnam War between February 2014 and July 2015. Of these, 108 had confirmed PTSD, while 106 acted as trauma-exposed controls.

Compared to trauma-exposed controls, patients with PTSD had higher frequency (14.1% vs 17.7%, respectively) of comorbid conditions of the gastrointestinal, hepatic, cardiovascular and respiratory systems. It was also associated with sleep disorders. Comorbid depression was found in 22% of subjects with PTSD.
These patients also had a higher prevalence of risk factors such as smoking, alcohol dependence and higher BMI.

Hence, not just psychological health, but physical health including control of risk factors should also be part of management of patient with PTSD to improve their quality of life and survival.
The study is published April 3, 2017 in the Medical Journal of Australia.
(Source: Med J Aust. 2017 Apr 3;206(6):251-257)

Dr KK Aggarwal
National President IMA & HCFI

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