Health and beyond… strategies for a better India: Concept paper on primary health care in India

India is one of the fastest growing economies of the world, and is posed to overtake China in terms of being the most populous nation of the world. The very essential components of primary health care – promotion of food supply, proper nutrition, safe water and basic sanitation and provision for quality health information concerning the prevailing health problems – is largely ignored. Access to healthcare services, provision of essential medicines and scarcity of doctors are other bottlenecks in the primary health care scenario. Complete absence of evidence-based guidelines on clinical scenarios and treatment plans in the primary health care sector, together with overburdening of the secondary and tertiary care sectors, has substantially lowered the quality of care in the nation.
The paper by Dr. Soumyadeep B published in the Journal of Family Medicine and Primary Care , of the Academy of Family Physicians of India is a concept note that suggests a triad of strategies (technology, accountability and ink-blot strategy) that can be adapted to various problems in the primary healthcare scenario . Read the full paper here (Open Access ): http://www.jfmpc.com/text.asp?2014/3/2/94/137608

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What are the benefits and harms of different intravenous fluid regimens in people with acute bacterial meningitis?

Along with Dr Ian K Maconochie Department of Paediatrics A&E, St Mary’s Hospital, London, UK – Dr Soumyadeep Bhaumik has completed a Cochrane  systematic review and meta-analysis titled “Fluid therapy for acute bacterial meningites”.

The extensive review has data of 415 patients in total and “no significant differences in death rates or overall effects on neurological function, either immediately or later. There was also some evidence favouring maintenance fluid therapy over restricted fluids for chronic severe neurological events at three months follow-up.”Capture

However the available evidence is limited and not of high  quality (GRADE) and there is an immense need to conduct more research on the issue . It is indeed sad that trials on intravenous fluids for bacterial meningites,one of the most importance interventions are not happening. This is probably because unlike antibiotics from which “big and small pharma “can make huge profites – research on intravenous fluids is not profitable. There is a need for charities as well as government funding for sponsorinf trials on these kind of interventions.

Read full Cochrane Review here . (Click : Open access in India vide ICMR funding)

Read Cochrane Clinical Answer on this topic here . (Click : needs subscription)

About half of chronic pain research remains unreported

Results from more than half of clinical trials for common chronic pain disorders are not readily available on global registries, according to a new paper in the journal PAIN [1]. The survey included 15 major registries accessible through the World Health Organisation’s International Clinical Trials Registry Platform. Of the 447 unique trials identified, only 46% had results available. Dr Michael Rowbotham, Scientific Director of the California Pacific Medical Center Research Institute and lead study author:

Many patients enter clinical trials with the belief that by taking part in research, they will help other patients in the future. For that to happen, the results of this research must be transparent and fully available.

AllTrials co-founder Dr Ben Goldacre:

Once again we see that half of all trial results for currently used treatments are missing. While industry groups like the ABPI give false reassurance, and try to pretend that this problem has gone away, patients are being unnecessarily harmed. Industry, regulators, patient groups, professional bodies and the research community need to take action, show leadership, and address this problem urgently.

Capture The same is true for research on all domains. It’s time all clinical trial results are reported. Patients, researchers, pharmacists, doctors and regulators everywhere will benefit from publication of clinical trial results. Wherever you are in the world please sign the petition: Thousands of clinical trials have not reported their results; some have not even been registered. Information on what was done and what was found in these trials could be lost forever to doctors and researchers, leading to bad treatment decisions, missed opportunities for good medicine, and trials being repeated.   All trials past and present should be registered, and the full methods and the results reported. Join the AllTrials Campaing to call on governments, regulators and research bodies to implement measures to achieve this by signing the petition here.

[1] “RReACT Goes Global: Perils andPitfalls of Constructing a Global Open-Access Database of Registered Analgesic Clinical Trials and Trial Results,” by Troels Munch; Faustine L. Dufka; Kaitlin Greene; Shannon M. Smith; Robert H. Dworkin; Michael C. Rowbotham (DOI: http://dx.doi.org/10.1016/j.pain.2014.04.007). It appears online ahead of PAIN®, Volume 155, Issue 8 (August 2014) published by Elsevier.

CDC Releases Guidelines About Medications to Prevent HIV Infection

Originally posted on news@JAMA:

The CDC has released its first set of comprehensive guidelines for preexposure prophylaxis (taking a daily pill that contains 2 anti-HIV drugs) for the prevention of HIV infection in high-risk individuals. Image: Gilead.

Physicians should consider prescribing antiretroviral medication to individuals who are not infected with HIV but are at high risk of infection, according to a new set of comprehensive guidelines released this week by the US Centers for Disease Control and Prevention (CDC).

This approach, called preexposure prophylaxis, involves individuals who are not infected with HIV taking daily antiretroviral (anti-HIV) medications to prevent infection. Numerous clinical studies have shown this approach to dramatically reduce the chance of HIV infection in certain high-risk groups, such as men who have sex with men, people who are HIV negative but are in an ongoing relationship with a partner who is HIV positive, and people who use injection drugs.

In July…

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Expert Group Consultation demands for a Comprehensive National Alcohol Control Policy

New Delhi , 9th April 2014 : The Public Health Foundation of India (PHFI) in collaboration with Ministry of Health and Family Welfare, (MoHFW) Govt. of India organised an expert group consultation titled “Alcohol Control: Public Health Perspective – Moving forward towards a comprehensive national alcohol control policy”. The consultation was organised with an aim to raise the discourse with key relevant government departments and ministries, government alcohol monopolies, civil society organizations, media and other important stakeholders. The consultation was attended by Shri CK Mishra, Additional Health Secretary, MoHFW; Mr. Harald Sandberg, Hon’ble Swedish Ambassador to India,; Dr. Vivek Bengal, Psychiatrist from NIMHANS, representatives from the World Health Organisation and civil society members.

Alcohol_desgraciaSpeaking at the event, Shri C. K Mishra, Additional Secretary (Health) said “It is important to think of a coherent strategy and put together overall policy framework for control of NCDs where alcohol and tobacco form the basis of a policy formulation.” “There is a need to address the problem of alcohol use from public health perspective with multi-stakeholder involvement from government, civil society and like-minded organisations” added Shri Mishra

In India, Alcohol is a state subject and States/ Union territories have the power to frame policies and guidelines on issues relating to movement, possession, marketing, availability, consumption, sale and state excise rates of alcohol. Similarly, the provisions of the state excise policies differ widely from state to state with regards to advertising, promotion and sponsorships as well the minimum legal drinking age. The differential policies of the states are exploited by the industry to promote and induce new initiates as well keep the initiated addicted to alcohol. To address the above and pave the way for the development of a comprehensive programme and policy response, the consultation was organised.

“The consultation aims at sharing of global and national best practices to create a conducive environment to address alcohol problem in India from a public health perspective. The consultation also discussed a draft White Paper on Alcohol Control in India enlisting the public health interventions and programs needed to overcome the burden of alcohol in India” said Dr. Monika Arora, Director-Health Promotion, PHFI. “The inputs of state officials from excise and health department at this consultation will further inform this white paper as an outcome and a final white paper on Alcohol Control from this consultation will be presented to Government of India” added Dr. Arora

India is the dominant producer of alcohol (65%) in the South East Asia region and contributes to about 7% of total alcohol beverage imports into the region. Alcohol use in India has registered a steady growth rate of 10% to 15% each year during the past decade with greater expansion seen in southern parts of the country. The per capita consumption of alcohol, among adults, (over) 15 years in India, has increased by 106.7% between 1970‐72 and 1994‐1996. India is now one of the key markets for the global spirits industry.

To address the issue, PHFI had also released a report titled “Alcohol Marketing and Regulatory Policy Environment in India” which highlights the various characteristics of the alcohol industry. It draws attention to the key alcohol players in India and the types of alcohol products and brands available in the market. It also discusses the production and distribution of alcohol under different names. The second part of the report reviews policies that regulate alcohol in different states. The third section focuses on the advertising and promotion of alcohol products across India and how the industry circumvents laws regulating and prohibiting alcohol advertising. In conclusion, the report recommends strategies and interventions for policymakers and other key stakeholders to consider as part of a comprehensive alcohol control policy in India.

Reproduced from the Press Release of  PHFI on an  as-it-is basis with kind permission.

Image file  is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported, 2.5 Generic, 2.0 Generic and 1.0 Generic license. http://commons.wikimedia.org/wiki/File:Alcohol_desgracia.jpg

What is Research Priority setting?

Originally posted on Flying Evidence:

Research priority setting is a term used by lots of people, however, many of them have a different understanding what this term means. Research priority setting has been defined as part of a research cycle starting from the identification of a research questions (based on scoping the context and/or engaging with stakeholders) to ranking the questions, implementing them and finally evaluating the process. Others would see only the step “ranking the questions” as research priority setting. Some researchers believe that research priority setting should be accountable and systematic. Others accept a consensus of a few people behind the doors adequate to prioritise research. We had recently an international workshop on agenda setting and research priority setting methods on 1-2 June in Plymouth University, UK. A question that was raised again and again in the workshop was “what are values underpinning the decisions that we make in setting a research agenda…

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Role of Trade Union Leaders in workplace HIV/AIDS program

It is essential for the Worker/Trade Union Leader to help the Company management in helping it fight against HIV/AIDS .Several years of research clearly indicate that the early investments in education, prevention campaigns and health care provision may be initially costly, but they will have long-term cost benefits. Inaction, on the other hand, will result in increased production costs related to the rising of HIV rates.

A trade union leader/worker hold an important key in the entire HIV/AIDS prevention dynamics. Owing to his/her stature and the fact that workers will often find it easier to confide to a fellow worker rather than a Health Educator or a doctor or even the management staff whom he has never even earlier seen or even heard about. Thus they are indispensable and are to be help the management to “break the ice” during the initial period of Education and prevention campaign when workers or even some management staff may refuse to attend any such programmes.

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Trade Union Workers/leaders should themselves start promoting safe sex practices and help/motivate/coordinate with government health workers and also the company management regarding safe sex practices. An informed progressive workplace can manage the impact and costs of the epidemic by providing care and support to help infected workers live longer and to work more productively rather than downgrading workers because of their HIV status.

One essential considerations for Trade Union leaders involved in workplace HIV/AIDS program is that  he/ she cannot disclose the union friends HIV /AIDS status to anyone (even to the employer or to his own family or even the union friend’s family) without explicit consent from your friend. Trade union leaders need to be trained on how to deal with such scenarios so that he can counsel his/her union friend to break the stigma and reveal the status to his/her spouse or sexual partner so that they don’t remain in the dark. The trade union leader should also make it a point to see that the HIV/AIDS affected union friend visits the physician and ensure and encourage the friend to avail the benefits as per your company norms.

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Key Message for Labour /Trade Union Leaders

  • It affects fundamental rights at work
  • Causes suffering to individuals and their families
  • Stigma, discrimination and victimisation of HIV+ workers is still undesirable
  • Loss of jobs and  income is an issue that falls well within the trade union responsiblity.
  • Being supportive to the union brother /sister is the moral/social/political obligation of all trade union workers/leaders.
  • Worker rights protections are a major benefit to the workplace policies.
  • Components of workplace policies can become part of collective bargaining agreements
  • An HIV/AIDS policy of the union can be used as a recruitment tool
  • Workers need education to address stigma

 

 

 

 

 

 

 

 

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