Health Watch

Non-Communicable Diseases - healthy workplace key to prevention

Suharshi Perera

Maintaining healthy activity levels

Promote a minimum of 30 minutes continuous brisk physical activity a day

-Brisk walking from bus stop to work place

-Walking around the workplace after a meal

-cycling to work

- Taking the stairs instead of the lift

Employers to arrange sport facilities within the work place Volley ball/ badminton courts/ tennis courts Gymnasium

Facilities for mental sports ( carom, chess, sudoku)

Maintaining activity record book

-Employers can assist by providing a printing record book where the type of activity and the time spent can be recorded.

Courtesy: The Health Ministry, ILO
 

Chronic NCDs Percentage
Cardiovascular diseases 34
(Including hypertension, strokes)
Respiratory diseases 11
Cancer 15
Diabetes 4
Other NCDs 14

Global warming, economic recession, and for Sri Lanka it will be either dengue or resettling IDPs. Non-communicable diseases (NCDs) is another challenge that needs immediate attention as Sri Lanka is experiencing a slow epidemic of non-infectious diseases, health authorities warn.

"Most premature deaths in Sri Lanka occur due to non-communicable diseases and unfortunately many die of heart diseases and strokes which are largely preventable", Healthcare and Nutrition Ministry Secretary Dr. Athula Kahadaliyanage says.

Promoting and protecting health in workplace can largely contribute to prevent non- communicable diseases especially the cardiovascular diseases. Such initiatives can achieve many benefits including an increased productivity, reducing absenteeism, improved working capacity, high morale of the staff and also can reduce the expenses spent on medical insurance, he said.

He was speaking at a workshop organized by the International Labour Organization, WHO and the Ministries of Healthcare and Nutrition, Labour Relations and Manpower and Public Administration and Home Affairs in Colombo Friday to mark World Heart Day which fell yesterday. This year's theme was 'work with heart' which focused on preventing heart diseases by creating a healthy environment at workplace.

What are NCDs?

Non-communicable diseases (NCDs) include cardiovascular diseases affecting heart and brain, diabetes, chronic respiratory diseases, cancer and other (like kidney diseases).

Why should NCDs be prevented?

According to health reports 58 million deaths occur annually across the globe. Of that about 30 million are due to chronic diseases and 50 percent of that, are deaths due to ischemic heart diseases.

In Sri Lanka too the leading cause of death is ischemic heart diseases. The above non-communicable diseases account for 75 percent deaths in Sri Lanka.

About 600 deaths are reported in Sri Lanka a day of which 400 are deaths due to non-communicable diseases. The percentage of deaths due to some of the non-communicable diseases is given below:

There is huge underreporting of diabetes cases and diabetes is an underlying cause or cardiovascular diseases, Consultant Community Physician of the Health Ministry's Non-communicable Diseases Unit Dr. Palitha Karunapema said.

Apart from deaths a considerable number of cases of disability also occur due to NCDs. The Government spends a colossal amount on treating NCD affected patients and it spent Rs. 600 million to treat cardiovascular diseases in 2005, he said. By investing on prevention the country can save a huge amount of money spent on treatment.

The economic cost of the NCDs results in due to loss of productivity. The social cost is reduction of quality of life, disruption of family life and the cost of healthcare could be an enormous burden to the family. Therefore serious attention should be paid to prevent heart and other non-communicable diseases to minimize the healthcare cost, economic cost and social cost by investing more on prevention. Identifying the risk factors of non-communicable diseases is also vital in prevention, Dr. Karunapema said.

Risk factors

The common risk factors and non-communicable diseases are unhealthy diet, tobacco and alcohol consumption and lack of physical activity. Prevalence of unhealthy diet is a main cause of NCDs, the Consultant said. Around 80 percent of the population in Sri Lanka does not consume a healthy diet. A person needs to include five portions of vegetables and fruits in his/her daily diet.

Avoid consuming alcohol and smoking is also helpful to keep diseases at bay.

Physical activity is far higher among Sri Lankans compared to the West due to cultural reasons. However, regular working out and exercising is more prevalent in the West. It is important to note that the deaths due to cardiovascular diseases have reduced over the past 30 years in rich countries where as there is a considerable rise in Sri Lanka, he noted.

Misconceptions

A popular misconception about non-communicable diseases is older people die of these diseases. According to reports half of the people dying of chronic NCDs are less than 70 years. Mortality rate due to non-communicable diseases are higher in Sri Lanka and some Asian countries than the Western countries. Countries like Sri Lanka and

India report a relatively high number of premature deaths due to NCDs, he said.

How to prevent?

Addressing the risk factors and acting accordingly may help in preventing NCDs in Sri Lanka. That is why promoting and protecting health at workplace is important. Many of us spend most of our time in workplace during the day. Therefore health and safety at work place largely contribute to combat diseases.

Creating awareness among employers and employees also helps preventing the diseases. Implementing cost-effective NCD screening programs is another way to prevent NCDs.

This includes integrated risk screening. By diagnosing the diseases early, damage and treatment costs can be minimized by controlling the disease at early stages.

A problem commonly prevalent in Sri Lanka is even after being screened and at risk, people do not change their lifestyle and behaviour to prevent the disease, the consultant said.

Healthy diet and nutrition promotion in workplace

Availability of healthy diet in canteens and maintaining standards on safe and healthy food. Such canteens can be designated as 'healthy canteens'. Nutrition and food safety promoting environment for staff. Access to information on good nutrition and food safety.

The diet

It should be a broad classification of food based on permissible levels. Should be readily available as part of regular diet. E.g.: Yellow and green vegetables, green leaves of many varieties, fruits, yams and tubers. Within limits E.g.: Red meat once a week, limiting salt (total 5g a person), sweets (one tsp sugar per cup of coffee/tea), fat (total 5g a person to be used in a work setting 20ml/person/day) Not recommended E.g.: addition of monosodium glutamate to food, consumption of frizzy drinks, fast foods and snacks.

The four food groups that should be included in all menus Cereals especially red rice, rice flour, yams and tubers Fats and oils preferably polyunsaturated fats such as soya oil, corn oil and sunflower oil.

Legumes and animal protein such as fish, chicken and eggs (red meat with limitations)

Fruits, vegetables and greens When preparing menus consider target groups. If the workplace has staff doing more physical work, the weight of food in total per person should be higher compared to desk workers (guidelines should be given by the Health Ministry)

-Menu plan should be displayed together with nutritive value and cost

- Food preparation areas should be seen, clean surfaces should be maintained.

A schedule for cleaning utensils should be maintained, cross contamination should be avoided, ingredients should be of good quality and stored properly, food should be cleaned thoroughly, cooked and processed optimally and cooked food stored properly and served cleanly.

- Food handlers must be clean, with correct protective gear worn and undergo regular health check-ups

-There should be regular contact between the Canteen Manager, Public Health Inspectors and workplace management.

-Labels and expiry dates of food should be well noted during procurement and storage.

Promoting nutrition and healthy environment

-Promoting healthy snacks during workshops and meetings(E.g.: fruits, fresh milk)

-conducting awareness programs

Courtesy: The Health Ministry, ILO

Singapore Cardiologist commends

Medical Crossword Feature

Edward Arambewala

A leading Cardiothoracic Surgeon from the Mount Elizabeth Medical Centre, Singapore Dr. Saw Huat Seong on Thursday commended the Daily News Medical Page for introducing the crossword feature for health education which appears to be the first time that this has been done in a newspaper in this region.

Dr. Seong was in Colombo as a special invitee at the annual sessions of the College of Physicians, Sri Lanka held at the Ceylon Intercontinental. Dr. Seong was meeting the press to talk on preventive health to control and combat heart disease and reduce the incidence of heart operations when he refered to the Medical Crossword. Dr. Seong also drew a consolation prize winner in Medical Crossword No. 38. The winner he picked was Thamali Kariyawasam 22 yrs. of No. 289/3, Temple Road, Dalugama, Kelaniya an undergraduate of the Kelaniya University.

Parkway Health Office in Colombo will offer the prize to Thamali at the official prize draw of Crossword No. 39 to be held early October.

Spanish Government approves controversial abortion reforms

Spain's Socialist government Saturday approved controversial reforms to the country's abortion law which would allow women as young as 16 to undergo the procedure without parental consent.

The proposal was passed at a cabinet meeting despite strong opposition from the Roman Catholic Church, the conservative opposition Popular Party and even many supporters of Prime Minister Jose Luis Rodriguez Zapatero's Socialist Party.

The measure now will to go to parliament for approval, Deputy Prime Minister Maria Teresa Fernandez de la Vega told a news conference.

Under the proposed reforms, abortions would be allowed for women of 16 and over on demand up to the 14th week of pregnancy, and up to 22 weeks if there is a risk to the mother's health or if the foetus is deformed.

Women can also undergo the procedure after 22 weeks if the foetus has a serious or incurable illness.

"We want to offer minors as much protection as possible and the most respect for their basic rights," said de la Vega.

MADRID, AFP

Chlorine in swimming pools linked to allergy risks

Swimming in a chlorinated pool may boost the odds that a child susceptible to asthma and allergies will develop these problems, a study released on Monday indicates.

"These new data clearly show that by irritating the airways of swimmers, chlorination products in water and air of swimming pools exert a strong additive effect on the development of asthma and respiratory allergies such as hay fever and allergic rhinitis, Dr.Alfred Bernard, a toxicologist at the Catholic University of Louvain in Brussels, said in an email.

"The impact of these chemicals on the respiratory health of children and adolescents appears to be much more important at least by a factor of five than that associated with secondhand smoke, "Bernard noted.

Taken together with his team's prior studies, he added, "There is little doubt that pool chlorine is an important factor implicated in the epidemic of allergic diseases affecting the westernized world."

In the current study, Bernard and colleagues compared the health of 733 adolescents, 13 to 18 years old, who swam in chlorinated outdoor and indoor pools for various amounts of time with that of 114 "control" adolescents who swam mostly in pools sanitized with a concentration of copper and silver.

In children with allergic sensitivities, swimming in chlorinated pools significantly increased the likelihood of asthma and respiratory allergies, the researchers report in the journal Pediatrics.

Among "sensitive" adolescents, the odds for hay fever were between 3.3- and 6.6 - fold higher in those who swam in chlorinated pools for greater than 100 hours and the odds of allergic rhinitis were increased 2.2- to 3.5 - fold among those who logged more than 1,000 hours of chlorinated pool time.

For example, among children and teens who swam in chlorinated pools for 100-500 lifetime hours, 22 children out of 369(6.0percent) had current asthma, compared with those who had spent less than 100 hours (2 of 144,1.8 percent). The proportions with asthma rose with longer exposure, to 14 out of 221 (6.4percent) who had been swimming for 500- 1,000 hours, and 17 out of 143 (11.9percent) who swam for more than 1,000 hours. The risk of asthma and allergy was not influenced by swimming in copper- silver sanitized pools and children without allergic tendencies were not at increased risk of developing allergies.

Megan Brooks, Reuters

Practising MUALSV

Patients are generally reluctant to give publicity to their ailments and even to successful treatment to their medical or surgical matters.

"But, I have decided to give publicity to my bitter experiences I had to face for four years in England, for the benefit of many patients who are tortured unnecessarily as a result of delayed diagnosis, prolonged ineffective treatment using drugs, and exposure to unnecessary expensive and dangerous modern investigations.

The MRI scans of the vertebral column which are justifiable only before surgery for cases of back-pain and sciatica, pain in the leg and the buttocks, arising from pressure on the sciatic nerve by a pressure caused by prolapsed disc."

Purvana Katheeswaran, who lived in London for a considerable period of time and returned to Sri Lanka to seek remedy for her prolonged illness which was almost killing her, said.

Purvana, from Batticaloa went to UK in July 2004 to get married to a citizen of UK. She said that she developed a pain on her neck and while in UK the pain spread to her left arm and the fingers swelled.

Doctors in UK attributed the neck pain to my occupation in Sri Lanka as a computer operator and the swellings on my fingers to arthritis. Although four MRI scans on the neck bones were done, no abnormality was detected. All treatments were ineffective and I suffered severe pain. My movements were restricted when I developed pain in my left shoulder as well. My worst suffering began with the intolerable pain, numbness and muscle cramps spread to my right thigh, calf and my right toes and the soles of the feet. I sought the assistance of nearly fifteen doctors," she said.

Puvana told the Daily News that, "Specialists treated me with heavy doses of drugs, and a tolerable back ache became intolerable. Unbearable pain and suffering, both physical and mental, forced me and my husband to return to Sri Lanka for confirmation of diagnosis treatment.

We wanted to go to Apollo Hospital, Colombo. But I wished to see my friends and relatives in Batticaloa before getting admitted to the hospital in Colombo.

"It was in Batticaloa, that my husband heard of the successful treatment of sciatica and severe pains without surgery through a procedure called 'Manipulation of the Lumbo-Sacral Vertibrae under anaesthesia or (MUA-LSV) performed by a senior resident surgeon with a team of trained assistants at the Siloam Vincent Hospital, Batticaloa.

"I consulted the doctor with my husband, and the doctor without any x-ray, told us that I was having three problems, a cervical fisc prolapse causing pain radiating to my left arm, a left frozen shoulder, and a severe right lumber disc prolapse causing wasting of muscles, muscle spasms, and numbness of the right leg, toes and the sole of the foot. The doctor (Xavier) assured me that within three or four days my neck pain and frozen shoulder problem will disappear and that the sciatica pain will be relieved."

"I underwent a manipulation under anaesthesia and on that night I had peaceful sleep after seven months of agony in UK. My neck pain and the problems of the frozen shoulder are cured. 80 percent of my other illnesses are also cured. Many medical students in the University visited me to study my case history.