Disease Informatics

Assessment of Holistic (Wholistic) Health and Fitness http://www.wordinfo.info/words/index/info/view_unit/1/?letter=B&spage=3 Disease Informatics By R. P. Deolankar Not to repeat story of blind men examining the elephant Not to perform unnecessary procedures on patients for better income but to provide simple solutions!

Disease is a deviation from Health • Health is a process of gaining of physical, mental, social, emotional or spiritual wellbeing • The regular complete health checkup provides the right assessment • The deviation in the process of health is a progression towards disease • WHO states: Promoting and protecting health and respecting, protecting and fulfilling human rights are inextricably linked

Health policy is a guiding principle(Applies to the public health rather than family or individual) • Principle of Policy: Holistic or Isolated / Fragmented • Program Policy: Time Bound, Phased Manner or Random • Economics and Finance Policy: distribution of funds among research, service, training and extension • Personnel Policy: who shall perform the task, of what kind and for whom • Communication Policy: Language, Mode of Communication and What to Communicate etc

Setting Health Goals: Depends on the Health Policy Examples: • Earth: Health and the Millennium Development Goals provided by WHO • National: Nutritional goal like 5+ a day, achieving clean air and water as per standard, media propaganda for clean hands, tobacco control etc • Community: Vaccination, special foods and supplements, mosquito control • Family and Individual: Provided through family doctor, barefoot doctor, health worker or family head

No Solution Without Appropriate Training • 1st : Capability of health worker to provide solution through his or her expertise could be Upgraded • 2nd : Continuing education and refresher courses could be provided • 3rd : Ability of a Health Worker to have perfect communication with specialists i.e. translating the correct problem from land to lab and feasible and sustainable solution from bench to bedside / field could be improved

Realization by a Health Worker • Health worker could provide self assessment tools to the people through health education thereafter observe horizontally or vertically the processes in individuals, families or groups • Fixes the health goals for target populace of a health worker as per the health policy • How to fill the gap between the health goal and the actuality is a health problem • "A problem shared is a problem halved”. Help could be sought for a difficult problem

Health Worker is a Translator • Translating problem from land to lab • “Simple problem – complex solution” model is to consider a single morbidity separately and develop solution for each • “Complex problem – simple solution” model is to consider disease as a whole and find a feasible solution • The later model matches with the policy word “Translation” • Sometimes solution is provided but the science is not understood. However, “Translation” is achieved

From Bench to Bedside • Problem based learning” (PBL) at the “problem location” (PL) facilitated by the problem solvers and complimentary facilitators is required for research worker • Only feasible solutions developed in the labs could be translated to the hospitals or individuals through health worker • The solution also needs to be sustainable • Public funded research institutes trapped by the fragmented policy and lack of holistic view fail to provide feasible and sustainable solutions

Dilemma: Super-Specialists • Companies and high-tech labs employ specialists to work on profitable diseases • Likely to be pushed by their dreams or profit rather than actual problem (Risk of performing caesarean when normal delivery is possible) • Public funded research labs publish isolated work in specialized journals and produce impact on similar labs rather than public health • “Science... never solves a problem without creating ten more.” …George Bernard Shaw

Human Rights and Health Violations or lack of attention to human rights can have serious health consequences • Harmful traditional practices, slavery and torture, inhuman and degrading treatment, violence against women Health policies and programs can promote or violate human rights in their design or implementation • Freedom from Discrimination, Rights to Participation, Privacy and Information

Health Promotion Vulnerability to ill health can be reduced by taking steps to respect, protect and fulfill human rights • Freedom from discrimination on account of ethnicity, sex and social status • The rights to food and nutrition, water, education, adequate housing (and sex-life) Dr. B. R. Ambedkar

Assessment of Health • The result of an interaction between the assessors (A) and subject (S) • Self assessment means A and S are same • Otherwise, when A and S work together towards the assessment the product is not A + S but it is A + S + AS • Assessment SOP / questionnaires cannot be rigid with all close ends; it must have open ends, bias of assessor needs to be checked • To manage these open ends is a challenge for Disease Informatics

Will more doctors or super-specialists mean better health for all? • Quality of health information depends on the level of education of a community member • Education: Food and nutrition, sports and exercise, hygiene, toxins and pollution, stress and natural feeling • It has been realized that better health education for all rather than more doctors or scientists would result in better health for the community • Know the elephant as a whole and not to repeat story of blind men examining the elephant

Skills required for Health Assessment-I: Spiritual • “Laughter composed of peace, joy and compassion is the best medicine” and hence “Laughing man” is the symbol of spiritual health • Case file begins here; with a short remark on spirituality • Spiritual test Ξ assessment performed by the subject himself + spiritual master • Interaction of man with self

Spiritual: Meaningful living by human form of life • Real spirituality improves quality of life • Spirituality: Ordinary → Motivated → Seeker of truth → Spiritually uplifted man • Inspired health worker or organization guided by scientific temper and actual self experience provides practical, wise and prudent solution (attempt to perform normal delivery and avoid caesarean)

Spiritual: Pointers in the life of a human being • Morality (Dharma) • Prosperity (Artha) • Instincts (Kama) • Freedom (Moksha)

Spiritual: Traditional Spiritual Protocols(Mythologies and superstitions are regretted) Example: RishiPanchamiVrata(one of the spiritual module for motivated individuals, a general prescription by ancient sages) • Rishis (Ancient sages) in India lived longer by sustaining on Paleolithic diet and lifestyle • RishiPanchami is the day when motivated Indian individuals, particularly women, live like Rishis • Rituals: Take prolonged bath in the river or lake, expose to Sun, clean the teeth with the stick of a herb Aghada (Achyranthesaspera Linn), do not eat agricultural produce but eat food gathered from forest • Health benefits are seen particularly in gynecological problems in women

Spiritual advice to the person having problem (Vaikalya) • Priest / Sage learns the problem of an individual • Recommends regimen of fasting or special food, nature worships, pilgrimage etc. • Health outcome depends on knowledge of an advisor

Spiritual: Religious Festivals • Festivals are local and seasonal • Points to seasonal changes in food and lifestyle or pre-seasonal detoxification to prevent seasonal diseases • Migrants need to match festivals to the season rather than calendar else adopt new local culture for certain health benefits

Spiritual: Harmful Superstitions • While certain religious and spiritual traditions are beneficial, certain superstitions are harmful • Example: Menstruating women are regarded unclean and are isolated. They cannot enter the kitchen or temple till they are ‘clean’ again

Skills required for Health Assessment-II: Social • Social exam Ξ assessment of a subject performed by the anthroposociologist (Trained teachers and social workers) • Socioeconomic status of an individual is recorded in the case file • The interaction of the individual with the environment, with the members of society, with respect to social structure, language, law, politics, religion, magic, art, and technology • Social causes of a particular human behavior and thoughts relating to the health and disease

Social: Appraisal of a domestic environment • Health of a person depends on an environment • Availability of sunlight, clean air, clean water, clear mind and happy thoughts • This environment is of a very small residential area • Called as micro-environment

Social: Appraisal of a toxic exposure • Living in a world composed of toxic air, water and food • Exposure to the toxin can occur at home, at work place or during transit • Vices and habits

Social: Food, Nutrition and Agriculture • Availability of 5+ a day (more than 5 servings of fruits, salads and vegetables) • Food help during draught and calamities is mostly of cereal grains causing diet deficient in vitamins, minerals and protein • Excessive and aggressive agriculture causing mineral deficient soils, susceptible crops, toxic foods

Social: Habits and Habitat • Physical habits e.g. impotence associated with cycling • Pornography and health • Cell phone towers and mobile phone radiation, radio frequency radiation from TV and radio transmitters

Social: Migration • The associations between disease, travel and migration have historical roots • Health disparities between a place of origin and its destination • May import a disease that was never seen in local population

Skills Required for Health Assessment III: Mental and emotional • Mental and emotional exam Ξ clinical assessment of a subject performed by the psychiatrist • Human is considered more than an animal • Reveals endogenous backend e.g. faulty interpersonal relationships resulting in psychosomatic process • Records interaction between psychological processes and the nervous and immune systems of the human body

Mental and Emotional: Types and Tests • Addiction to Internet, sex, vices • Anxiety, Depression, Self Esteem, Assertiveness • Disorders pertaining to Attention deficit, mood, obsessive compulsion, personality and sex

Mental and Emotional: Stigma • Mental and emotional disorders are stigmatized • Dignity of a patient suffering from a mental problem is denied that unable them to mix in the society • Patient as well as relatives may not cooperate during assessment unless health worker gains confidence of the family and patient

Mental and Emotional: Perfectionist, EQ and IQ • Perfectionists are displeased with anything that is not perfect or does not meet extremely high standards • He or she may have high IQ but may not have tact and skill in managing delicate situations and handling people, provide limited output and likely to suffer from emotional issues • Family members or acquaintances of a perfectionist may turn rebellious spoiling family environment and health • Hence assessment of Emotional Intelligence is better determinant of health

Mental and Emotional: Stress in the Modern World • Stress is harmful when it is beyond the coping capability of an individual • Stress in the modern world is being recognized as a killer • Measurement and management of stress are important issues of health

Skills Required for Health Assessment IV: Physical • Physical exam Ξ clinical exam of a subject performed by the doctor without reading the case file to begin with • Sign is an objective evidence of disease especially as observed and interpreted by the physician rather than by the patient or lay observer • Symptom is a subjective evidence of disease or physical disturbance observed by the patient • Test is a proof or disproof for the clinical diagnosis

Physical: Tests and Examinations • Laboratory tests are performed by medical laboratory technicians and pathologists • Physical examinations are performed by physiotherapists and physicians • Fitness tests are performed by physiotherapists, physicians and sports people • Fitness tests for laborer and farmer are required but rarely performed

Physical: If health is wealth then fitness is money Fitness is measured in terms of • Body composition, cardiovascular fitness, flexibility, muscular endurance, and muscle strength • Agility, balance, coordination, power, reaction time, and speed • Job specific requirement for fitness

Physical: Popular Anthropometry • It is easy to perform, cheap but sometimes time consuming • Useful in determining size, shape, somatotype, strength, working capacity and body composition • Advances in 3-D imaging technology has replaced traditional anthropometry • Equipment: Bone Calipers, Measuring Rods, Skinfold Calipers, Tapes, Scales, Segmometer, Stadiometer, Steel Rulers, Surgical Skin Marker, or 3-D image scanner

Physical: Aerobic Endurance Tests • Markers of healthy heart • Markers of healthy lungs • Tests: run, walk, cycle, step etc • Equipment: Tapes for measuring distance and stop watches

Physical: Flexibility Assessment • Trunk and lower body flexibility • Upper body flexibility • Equiment: Goniometer or flexometer, sit and reach boxes

Physical: Muscular Endurance and Strength • The ability of the muscle to perform heavy work (strength) and continue to perform without fatigue (endurance) • Different tests for different groups of muscles • Weights, pushups, sit ups

Physical: Agility, Balance and Co-ordination • Agility is the ability to perform a series of explosive power movements in rapid succession in opposing directions assessed by ZigZag running or cutting movements • Balance is the ability to control the body's position, either stationary or while moving • Co-ordination is the ability to integrate so that effective movements are achieved

What about time? • Too many parameters! Won’t assessment become clumsy? What about time? • Application of statistics and Information Science (Disease Informatics) is required to reduce the parameters without loosing the truth • Upgrade wisdom provided by Holistic Ancient Medicine to perform assessment with a few parameters

Family doctor as a Source of Information • Knows subject in the context of the family and the community: contacted by each family member at regular interval irrespective of occurrence of sickness • Keeps record of a family and their members by performing spiritual, social, mental and emotional, and physical assessment of a patient • He or she understands the disease process before the disease event occurs i.e. disease causal chain: Should be worthy in keeping touch with epidemiologist for exchange of information

Features of a Good Family Doctor • Specialist in family medicine: comprehensive health care to people of all ages including immunizations and screening tests, routine checkups and assessment of risk to the health, personalized counseling on sex-libido and other confidential issues at affordable cost • Wide knowledge and multiple skill set to treat individuals and family as a whole; Provides guidance on diet, exercise and change in lifestyle modalities , manages chronic illness and coordinates specialists • Respect for human rights and love for human relations • Bears administrative load, spends lot of time with people

Family Doctor and Health Problem • Modern doctor is focused more on disease rather than health • Few doctors monitor exercise and lifestyle but tend to prescribe drugs • Traditional doctor is focused more on health -- diet, native herbal and environmental resources and physical-mental and spiritual exercises

Family Health Aides or Part-time Health Workers • Health Aides are supposed to be persons complementing skill-set of a family doctor • Could be focused on diet, exercise and lifestyle factors and concerned with needs and availability of health services • Social workers, educationist and spiritual workers could be groomed as health aides • Should have good communication with family doctor to form a team under the leadership of the doctor (Health Team)

Ideal Reward and Punishment of a Health Team • The amount of money one might have spent on fees for specialists and super-specialists, drugs and medicines, tortures of medical procedures and surgeries, hospitalizations will be saved because of the activities of a health team and will act as their reward (say A) • If he or she fails then the cost of medical treatment should be recovered from his reward or he or she should bear the burden of expenditure (say B) • Earnings = A - B

Is there a reward policy for a health team? • No. Providing simple solutions to the disease problem fetches less income and performing procedures on a patient fetches better income (Compare vaginal vs. caesarean delivery) • Subspecialties generally are considered more glamorous — and lucrative in terms of wealth; shift from wealth to health is problematic • Many a times, admissions to a medical college is competitive and not dependent on talent and motivation but on money power and corruption • Reward of health aides is meager

What is the result of lack of reward policy? • Matter of health is getting commercialized and only rich can afford it; mushrooming super-specialized research institutes rather than solution providers • Number of family doctors is going down day by day • Family doctor is an important source of information for epidemiologist hence collection of information would be difficult with a few family doctors • The challenge is to shift the role of family doctor to community health aides or barefoot doctors and reward them properly

What is so special about Mahatma Gandhi? • The greatest public health scientist • Gandhian approach: The health plans should suit the poorest of poor • Be your own doctor: a complementary policy to barefoot doctor • How to live naturally in the artifact world • How you can help your body ‘stay healthy’ and cure it naturally if you are currently ill etc

Aarogyaswaraj (Self-ruling the health) -- SEARCH model • Model developed by Drs. Abhay and Rani Bang • Save yourself from predatory practices of super-specialists and pseudo-scientists, form your own policy, set your own health goals, and find appropriate means to stay healthy • Targeting Tuberculosis, Malaria, HIV, Acute Respiratory Illnesses, Diarrhea and other vaccine preventable diseases does not require very high clinical expertise, or expensive and high-tech diagnostic aids

Thanks • Lecture no. 36261: Disease Informatics: Living in the Toxic World, November 6, 2009 • Lecture no. 35791: Disease Informatics: The burden of disease, September 11, 2009 • Lecture no. 34141: Disease Informatics: Brush up the terms describing techniques and resources, February 19, 2009 • Lecture no. 34011: Disease Informatics: Terms and Jargon to begin with, February 1, 2009 • Lecture number -31981: Disease Informatics: ICD-11 at the doorstep, February 26, 2008 • Lecture number-30331: Disease Informatics: Phytates driving from the back-end to Influenza, Encephalitis, Hepatitis, Anemia at the front-end, July 10, 2007 • Lecture number-28921: Disease Informatics: Host factors simplified, February 07, 2007 • Lecture number-25381: DIG for Disease Informatics group; Part-II, November 07, 2006 • Lecture number-25371: DIG for Disease Informatics group; Part-I, November 07, 2006

Disease Informatics