Chronic Disease And Injury Control Ma3 - Research Paper Example

?Chronic Disease And Injury Control Ma3 This paper is divided into three parts each examining iatrogenic illness, road traffic accident injuries and alcohol consumption induced disease burden respectively. Iatrogenic illness commonly known as doctor-generated is still out of control. However, measures such as interventions by geriatric care, pharmacist consultation and acute care for elderly patients are promising ones to reduce iatrogenesis. Road traffic accidents cause 1.30 million deaths each year and WHO has cautioned that this type of injury which is the tenth leading cause of death will graduate to fifth leading cause by 2050, if the present trend is not stopped. Lastly, the alcohol consumption led disease is one of the five major causes of deaths and accounts for 25 % total deaths. These aspects have been explained in greater detail. Part A Discuss the risk for injury due to iatrogenic illness for people with chronic disease including the impact of co-morbidity. Iatrogenic illness is a ‘doctor-generated’ disease though unintended resulting from his handling of mental or bodily disorders or symptoms. This medical harm is rather paradoxical to the belief that medicine is meant for improvement of health. It is also called medical mishap. Ivan Illich was the first to talk about this medical harm as iatrogenesis as early as in 1970s. He categorised the illness as clinical, social and cultural phenomenon. Clinical iatrogenesis covers doctor-inflicted injuries, surgeries that are not essential, treatments with no use such as antibiotic therapy for viral infections. He claims that morbidity due to medical harm far exceeds morbidity due to traffic, industrial accidents and even war-related mishaps (Milligan & Robinson, 2003). It can happen under the situations of “conscious risk, unexpected complications, over-zealous care, and inept care” (Kane, 1978, p. no page no). Kane (1978) argues that iatrogenesis is a part of every step of medical care and hence focus should be on how it can be identified or minimised rather than enquiring how it occurs and how it can be avoided since it is thought to be a production of morbidity through treatment. There is yet another view of iatrogenesis as an unnatural consequence of the disease due to” medication, diagnostic or therapeutic procedures, noscomial infections or environmental hazards” (Capezuti, Siegler, & Mezey, 2008, p. no page number). In a broader view, it is said to occur due to environmental events such as falls, under-diagnosis, under-treatment or negligence. Restricted mobility and bed-rest in older patients are iatrogenic events resulting in functional decline and the older patients are prone to iatrogenic illness for the reasons of reduced homeostatic reserves, heightened co-morbidity and polypharmacy (Capezuti, Siegler, & Mezey, 2008). Bipolar disorder Bipolar disorder patients are both subject to co-morbidities and risk for injury as the illness is a chronic one requiring life-long treatment beginning from early adulthood. It is incurable but treatable (Duckworth, 2006). It has been found that patients with bipolar disorder are at higher risk for several co-morbidities than those (patients) without mental illnesses such as bipolar disorder. They are trauma or iatrogenic conditions, neurological episodes, female reproduction system affected by conditions such as dysfunctional bleeding and breast cancer, musculoskeletal disorders such as back pain, bone fractures and osteoarthritis, and ear, nose and throat conditions which include sinusitis and pharyngitis, poisonings, adverse drug reactions, injuries, and lastly endocrine diseases such as type 2 diabetes and hypothyroidism. Of all these co-morbidities, trauma and iatrogenic episode were found in patients with bipolar disorder in greater proportion of 3.13 times than in those without such a disorder. They are likely to have at least one injury episode. The related study found injuries involving open wounds, blunt trauma to the abdomen or trunk 2.99 times more in bipolar patients than in other patients. In respect craniocerebral injury, it was 3.53 times more and in thoracic and spinal cord injuries 2.08 times more (ThomsonReuters, 2009). Elderly patients with chronic disease conditions prescribed with Benzodiazepines are reported to have suffered injurious falls. They were administered with the drug despite their predisposition to adverse effects with resultant falls. This was due to indispensability of the drug especially in patients already on anti-depressants. The related study has concluded that patients having the risk of injurious falls have to be given Benzodiazepine despite adverse side effects (Bartlett, Abrahamowicz, Grad, Silvestre, & Tamblyn, 2009). The issue of iatrogenesis seems to elude solution as the recent study indicates that elderly patients suffer from iatrogenic disease due to drug-induced iatrogenic disease, multiple chronic diseases, multiple physicians, hospitalisation and medical or surgical procedures. The study concludes that iatrogenic diseases are preventable with the intervention of “geriatric interdisciplinary team, pharmacist consultation and acute care for the elderly patients.” (Permpongosol, 2011, p. no page no). Part B Global burden Traffic Accidents injuries. prevalence, morbidity and mortality, trends over time, financial burden, and QALYs and/or DALYs. Road traffic accident injuries are currently the tenth leading cause of mortality at global level and are predicted to worsen as the fifth leading cause by 2050 (Kishore & Michelow, 2011). Road traffic accidents cause 1.3 million deaths each year. That is, 3000 deaths daily. Less than half these people travel by car. Fatalities apart, 20 to 50 million people suffer non-fatal injuries each year and such injuries are one of the important causes of disabilities the world over. The paradox is that low and middle income countries having less than half the fleet worldwide report ninety percent of road traffic fatalities at the global level. This means 90 percent of 1.3 million deaths stated above are from low and middle income countries. The road traffic accidents are one of the three leading causes of deaths among people aged between 5 and 44 years. If this trend is not arrested, this type of injury will be the fifth leading cause of death as stated above with 2.4 million deaths each year, nearly twice the current trend of fatalities. The increasing rate road accidents is attributed to increased motorization without proportionate increase in safety measures and land use. The financial burden due to motor vehicle crashes is estimated to be between 1 % to 3 % of the GNP of the respective countries of the world. This amounts to $ 500 billion The U.N has announced a decade plan “ Decade of Action for Road Safety 2011-2020 exhorting member countries to implement road safety measures in terms of “road safety management, road infrastructure, vehicle safety, road user behaviour, road safety education and post crash response” The United Nations strategy underpins the importance of designing of road transport system keeping in view the kinetic energy human body is capable of withstanding and conceding to the inevitable human errors which cannot be altogether avoided. The reduction in fatalities by 2020 has been planned to be achieved by the countries by fully implementing the UN’s road safety related agreements and conventions, sustainable road safety strategies and programmes, and setting targets of reduction of fatalities by 2020 along with related measures. Countries are expected to implement five pillars at their national level. Pillar 1 Road safety management, Pillar 2 Safer roads and mobility, Pillar 3 Safer vehicles, Pillar 4 Safer road users and Pillar 5 Post crash response. Each pillar has a number of activities to be carried out by the countries. (WHO, 2011) For the European region, proportion of death due to road accident injuries was 1.3 percent for the year 2002 and proportion of DALYs for road accident injuries was 2.4. (Racioppi, Eriksson, Tingwall, & Villaveces, 2004). 2. Describe two public health programs in place that aim to minimise this type of injury in U.K. and their evaluation WHO has characterised road traffic injury as a public health problem. Accordingly, WHO has laid down seven components as parts of public health functionality. They are injury surveillance, research, prevention and control, advocacy, services , policy and evaluation (WHO, 2004). Although road safety is the primary function of the transport sector, its function is limited to infrastructure building and controlling traffic growth. As it has become a serious health problem due to road crashes, public health has assumed an important role to play as stated by the WHO report 2004 above (Quimby & Davis, 2004). Pursuant to the WHO’s World Report on violence and Health for programmes for prevention of violence and injury, each member state had to designate a national focal point for violence and injury prevention. Public health initiated interventions to prevent road traffic accidents that can be evidenced for the U.K. are “adapting the environment, safety education and skills training, addressing drunken driving, multi-component interventions, enforcement of legislation’. The U.K. has achieved significant improvement in road safety and vehicle design in the past few years. Yet, number of injuries has not reduced. In the U.K. there were 230,000 deaths or injuries due to RTA in 2008. Out of these, 133,000 were males. Drivers and passengers of motor vehicles account for the highest number of casualties per kilometre amongst all types of vehicles. A road traffic casualty is estimated to cost ? 52,600 that includes medical expenses and lost output. Majority of RTAs and casualties have occurred at the speed limit of 30 mph. Drunken driving accounted for 8,640 accidents and 13,020 casualties during 2008. As many RTAs can be prevented and the Department of Transport has also proposed in its consultation document “ A Safer Way “ to reduce road deaths and injuries by 33 % by 2020, a range of interventions stated above are already being implemented (Wood, Bellis, & Watkins, 2010). Two of the programmes are discussed below. a) Adapting the environment: In order to reduce traffic volumes and speeds, cyclists are segregated from other vehicles in the traffic flow. This along with improvement in pedestrian safety will lower RTAs and injuries. Different solutions are required due to tackle diverse nature of environmental and social characteristics of traffic in urban, suburban and rural areas. Traffic calming solutions such as speed humps, 20 mph zones and road closures have resulted in traffic speeds and injuries among children between 12-15 years of age. 115 zones of 20 mph reviewed in 2003 showed that the average speed was maintained at 17 mph. Mean traffic speeds came down by an average of 9 mph while traffic flows reduced by an average of 15 %. Frequency of accident injuries reduced by 42 % in the said zones and serious and fatal injuries reduced by 53 %. 20 mph zones in residential areas and areas frequented by pedestrians and cyclists have been recommended as part of “A Safer Way” consultation. Red light cameras which can identify vehicles crossing while traffic signal is red are to be used. These cameras can help reduce right-angled collisions though they have been found to increase rear end collisions. There are marked pathways for cyclists on roads. School crossing patrols have been found to reduce accidents to child pedestrians. Initiatives for safe routes to schools include improved pathways, traffic calming systems, safe crossings for both pedestrians and cyclists. Creation of pedestrian zones by diversion of traffic and safety education for children has also been initiated. Though the safe routes to school programmes are a common feature in the U.K., not much research has been done for their results. But international evidence suggests that programmes of this nature focussing on environmental measures have yielded results through reduction of incidence of accidents to child pedestrians or cyclists in California (Gutierrez, 2008), (Wood, Bellis, & Watkins, 2010). Apart from focus on urban areas, some measures are attributable to rural areas. They are creation of by-passes to avoid traffic into towns and villages. Betterment of rural routes for the benefit of pedestrians and cyclists. Monitoring traffic speeds on country lanes for the purpose of reducing traffic speeds. Speed regulators at junctions or locations which pose problems by fixing vehicle activated signs or rough road surfaces. Narrow roads are to be free of central white lines. And creation of quiet zones with roads dedicated for walking, cycling and horse riding (Christy, Dale, & Lowe, n.d) , (DepartmentForTransport, n.d.) and (Hamilton & Kennedy, n. d.) b) Safety education and skills training Safety equipments such as helmets for motorcyclists, seatbelts and child car seats (seat boosters) meant for drivers and passengers are recommended for reduction in road traffic injury and death. If cyclists also wear helmets, it can help prevent or minimise injury to the head, brain by 63 % and 88 % though the findings are still under debate. Educational and promotional methods for use of helmets and other safety equipments are in place though there is not much research on their positive impact on injuries. However, a positive finding of increased helmet use and decreased accidents as a result of a hospital-led helmet promotional campaign targeting five to fifteen year olds has been reported. Educational and promotional campaigns have always been accompanied by discount or free offer to acquire safety equipment. The campaigns target parents and children along with lessons and information. Media publicity would include statements about the importance of using the safety equipment. Even clinicians would participate in the campaigns for health promotion. These programmes have resulted in increased use of safety equipments such as cycle helmet used by children and booster seats in cars. Though there is limited research as to the results on injury incidence, certain evaluations have found that use of car seats for children have led to significant reductions in injury to vehicle occupants ranging from 33 % to 55 %. Apart from safety equipment provisioning, ‘safety education programmes for pedestrians’,’driver training/education programmes’, and ‘media education campaigns’ are in place and they are also subject to evaluation (Turner, 2005)and (Wood, Bellis, & Watkins, 2010). Part C 1) Summarise the global burden of disease attributable to alcohol and comment on the distribution of this burden Alcohol use has been one of the five major causes for twenty five percent of deaths all over the world and twenty percent of all DALYs, the others being childhood low weight, unprotected sex, unprotected water and high blood pressure. Life expectancy can be increased by five years if these causes are reduced. Alcohol is one of the eight causes for 61 % of cardiovascular deaths, the rest being tobacco consumption, hypertension, high body mass index, high cholesterol, high blood sugar level, low fruit and vegetable consumption and lack of physical activity. All these combined are responsible for over 75 percent of ischemic heart disease which is the major cause of death worldwide. 84 per cent of global burden of disease comes from the low and middle -income countries. Geographically, Africa, American middle income countries and some high-income countries account for the largest number of deaths in men due to alcohol use. Alcohol causes 60 types of disease and injury. Eastern European countries account for high levels of consumption by 2.5 times the global average consumption of 8.2 litres. And alcohol related deaths in Eastern Europe are in the proportion of more than 1 in every 10 deaths. The proportion in Latin America is 1 in every 12 deaths. Males are more affected than females by alcohol consumption globally i.e 6 % of deaths and 7.4 % of DALYs. Besides this direct of loss of health due to addiction, the substance accounts for 20 % deaths due to road traffic accidents, 30 % due to oesophageal cancer, liver cancer, epilepsy and homicide and 50 % due to liver cirrhosis. At the global level, alcohol use has been the cause for 69 million (4.5%) DALYs. Among the low-income countries, it is 18 million (2.1 %) DALYs. Middle income countries account for 44 million (7.6 %) DALYs and high income countries account for 8 million (6.7 %) (WHO, 2009). Comment: The fact that alcohol related deaths occur in higher proportion in low and middle income countries points to the prevailing poor literacy and lack of efforts in curbing alcohol consumption by the Governmental authorities in those regions where alcohol consumption is a good source of tax revenue for the States. 2. Discuss how the misuse of alcohol relates to the following: Road traffic injuries in UK It has been already seen that road traffic related injuries are one of the top ten causes of deaths globally. As per the WHO estimate, 1.2 million people die and 50 million people are injured every year due to road traffic accidents. Further 85 % of road accident deaths occur in low and middle income countries. The people affected happen to be pedestrians, passengers, cyclists, two-wheeler riders and those who travel by buses and minibuses. Urban poor are more affected as they belong to the said group of people who are high risk groups being pedestrians, cyclists, bus passengers and pavement dwellers (Gibbons, Bali, & Wickramasinghe, 2010). The psycho-motor and cognitive effects as a result of alcohol consumption while driving impact ‘on reaction times, cognitive processing, coordination, vigilance, vision and hearing.’ The impairment begins even from the low blood-alcohol levels. Vision impairment or blurring begins at ‘blood alcohol concentrations of 30 mg %. The impairment of psychomotor skills begins at 40 mg %. In the U.K., blood alcohol limit legally allowed for drivers is 80 mg %. Risk of accident remains even after some time of drinking since the sensory skills and faculties are not restored immediately after alcohol is excreted from the body. It was found in a simulation study that 10 % airline pilots could not operate all operations correctly even before alcohol ingestion. 89 % of them could not operate all correctly after their blood alcohol level reached 100mg/dl. 68 % of them could still not operate even after 14 hours after the full excretion of alcohol from their systems. The blood alcohol concentration (BAC) on reaching 30 mg %, causes impairment of cognitive function, motor coordination and sensory perception. At 50 mg % of BAC, mood and behaviour begin to change especially euphoria. With increased levels of BAC, ‘slurring of speech, unsteadiness, drowsiness, impaired reasoning and memory, reduced perception and decreased concentration’ occur. With a BAC of 30 mg %, the alcohol drinker cannot focus and follow objects with his eyes. He cannot gauge breadth of visual fields. He cannot discriminate between lights of varying intensity. During 2007, 460 deaths occurred due to drivers’ exceeding the legal alcohol limit. Accidents have occurred even with BAC below the legal limit. Together with the accidents caused by drunken pedestrians, alcohol turns out to be a factor responsible for one in five of all road accident fatalities. Please see table below estimates of total casualties in accidents due to illegal BAC in Great Britain for the years from 2000 to 2008. (InstituteOfAlcholStudies, 2010 ). (InstituteOfAlcholStudies, 2010 ). References Bartlett, G., Abrahamowicz, M., Grad, R., Silvestre, M.-P., & Tamblyn, R. (2009). Association between risk factors for injurious falls and new benodiazepine prescribing in elderly patients. BMC Family Practice , 10 (1), no page numbers . Capezuti, L., Siegler, E. L., & Mezey, M. D. (2008). Encylopedia of Elder Care : The Comprehensive Resource on Geriatric and Social Care (2nd ed.). New York: Springer Publishing Company. Christy, N., Dale, M., & Lowe, C. (n.d). Road Safety Research Reeport No 32: Child Road Safety in rural areas - a critical review of literature and commentary. accessed < www.dft.gov.uk/rmd/project.asp?intProjectID==10071>23 July 2010 in Wood, S., Bellis, M., & Watkins, S. (2010). Road Traffic Accidents ; A review of evidence for prevention. Liverppol: Centre for Public Health. DepartmentForTransport. (n.d.). Rural road safety demonstration project. accessed 23 July 2010 in Wood, S., Bellis, M., & Watkins, S. (2010). Road Traffic Accidents ; A review of evidence for prevention. Liverppol: Centre for Public Health. Duckworth, K. (. (2006). Mental Illnesses, Bipolar Diorder . National Alliance on Mental Illness : Accessed 30 Oct 2011 Gibbons, M. C., Bali, R., & Wickramasinghe, N. (2010). Urban Health Knowledge Management. New York: Springer. Gutierrez, N. et al . (2008). Pedestrian and bicyclist safety effects of the California safe routes to school programme. U.C Berkely in Wood, S., Bellis, M., & Watkins, S. (2010). Road Traffic Accidents ; A review of evidence for prevention. Liverppol: Centre for Public Health.: Safe Transportation Research and Education Centre, Institute of Transport Studies. Hamilton, K., & Kennedy, J. (n. d.). Rural Road Safety. Retrieved July 23, 2010, from www.scotland.gov.uk/Resource/Doc/55971/0015841.pdf. in Wood, S., Bellis, M., & Watkins, S. (2010). Road Traffic Accidents ; A review of evidence for prevention. Liverppol: Centre for Public Health. InstituteOfAlcholStudies. (2010 ). Alcohol and Accidents; Fact Sheet. accessed 30 Oct 2011. Kane, L. R. (1978). Iatrogenesis : just what the doctor ordered. Rand Corp. Kishore, S. P., & Michelow, M. D. (2011). The Global Burden of Disease, Chapter 1 in Finkel Madelon Lubin Public Health in the 21st Century. Santa Barbara, Calif: Praeger. Milligan, F., & Robinson, K. (2003). Limiting harm in health care; a nursing perspective . Oxford: Wiley-Blackwell. Permpongosol, S. (2011). Iatrogenic disease in the elderly: risk factors, consequences, and prevention. Clinical Interventions in Aging , 6, 77-82. Quimby, A., & Davis, A. (2004). Chapter 6.4 Road Safety as a Health Problem in Guidelines for Condcuting Community Road Safety Education Programmes in Developing Countries. Berkshire , UK: TRL lTd. Racioppi, F., Eriksson, L., Tingwall, C., & Villaveces, A. (2004). Preventing Road Traffic Injury : A Public Helath Perspective fofr Europe. Copenhangen, Denmark .Accessed 30 Oct 2011: ThomsonReuters. (2009). Patients with bipolar disorder at higher risk for wide range of physical comorbidities. Retrieved Oct 30, 2011 Turner, C. et al . (2005). Community-based programs to promote car seat restraints in children 0-16 years- a systematic review. Accidents Analysis Prevention , 37 (1), 77-83 in Wood, S., Bellis, M., & Watkins, S. (2010). Road Traffic Accidents ; A review of evidence for prevention. Liverppol: Centre for Public Health. WHO. (2009). Global Health Risks : Mortality and burden of disease attributed to selecetd major risks. World Health Organization Accessed 30 October 2011. WHO. (2011). Global Plan for the Decade of Action for Road Safety 2011-2020. Wolrd Health Organzation . WHO. (2004). World Report on Road Traffic Injury Prevention. Washington D.C.: World Bank. Wood, S., Bellis, M., & Watkins, S. (2010). Road Traffic Accidents ; A review of evidence for prevention. Liverppol: Centre for Public Health. Read More