REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Basic Principles of Health Education

Basic Principles of Health Education

In this module, you will learn about the definition of health, health education, and health promotion. This will help you to understand then important components of health.

•  Physical
•  Psychological
•  Social

 Personal Views on Health

Think about your responses to the following questions:

• What does health mean to you?
• How important is health to you?
• What do you do (if anything) to stay healthy?

Health promotion and disease prevention programs focus on keeping people healthy. Health promotion programs aim to engage and empower individuals and communities to choose healthy behaviors, and make changes that reduce the risk of developing chronic diseases and other morbidities. Defined by the World Health Organization, health promotion:

Disease prevention differs from health promotion because it focuses on specific efforts aimed at reducing the development and severity of chronic diseases and other morbidities.

Wellness is related to health promotion and disease prevention. Wellness is described as the attitudes and active decisions made by an individual that contribute to positive health behaviors and outcomes.

Health promotion and disease prevention programs often address social determinants of health, which influence modifiable risk behaviors. Social determinants of health are the economic, social, cultural, and political conditions in which people are born, grow, and live that affect health status. Modifiable risk behaviors include, for example, tobacco use, poor eating habits, and lack of physical activity, which contribute to the development of chronic disease.

Typical activities for health promotion, disease prevention, and wellness programs include:

• Communication: Raising awareness about healthy behaviors for the general public. Examples of communication strategies include public service announcements, health fairs, mass media campaigns, and newsletters.
• Education: Empowering behavior change and actions through increased knowledge. Examples of health education strategies include courses, trainings, and support groups.
• Policy, Systems, and Environment: Making systematic changes – through improved laws, rules, and regulations (policy), functional organizational components (systems), and economic, social, or physical environment – to encourage, make available, and enable healthy choices.

Clearly health is not quite as simple as the definition implies.
The concept of health is wide, and the way we define health also depends on individual perception, religious beliefs, cultural values, norms, and social class. Generally, there are two different perspectives concerning people’s own definitions of health: a narrow perspective and a broader perspective.

1. Narrow Perspectives of Health

People with a narrow perspective consider health as the absence of disease, disability, or biological dysfunction. According to this view, to call someone unhealthy or sick means there should be evidence of a particular illness. Social, emotional, and psychological factors are not believed to cause unhealthy conditions. This view is narrow and limits the definition of health to the physical and physiological capabilities that are necessary to perform routine tasks.

According to this definition, the individual is healthy if all the body parts, cells, tissues, and organ systems are functioning well, and there is no apparent dysfunction of the body. Using this view, people view the human body in the same say as a computer or mechanical device. When something is wrong, the object is taken to experts who will maintain it. Hence, physicians often focus on treatment and clinical interventions with medication rather than health education to bring about behavior change.

Serena’s Story

• About two months ago Serena lost her six month old twins. She is grief stricken. She has always been slender, but now she looks very thin. She cannot sleep; she cannot eat, and she doesn’t want to talk to anyone.
• Do you think the view of health you have just read about applies to Serena?

This view of health ignores many of the social and psychological causes of ill health. Serena’s grief is not an illness, but it is certainly affecting her health.

2. Broader Perspectives of Health

In the previous section you read about a narrow definition of health. Now this section will help you understand the concept of health in a broader and more holistic way.

The most widely used broader definition of health is that within the constitution of the World Health Organization (1948), which defines health as: “Health is not only the absence of infirmity and disease but also a state of physical mental and social well-being.” This classic definition is important, as it identifies the vital components of health. To more fully understand the meaning of health, it is important to understand each of its individual components.

• Think back to Serena.
• Describe her state of health.
• Serena is mentally distressed. She does not by any means have mental and social well-being.

Physical Health

Physical health, which is one of the components of the definition of health, could be defined as the absence of diseases or disability of the body parts. Physical health could be defined as the ability to perform routine tasks without any physical restriction

To understand physical health, one needs to know what is considered to be physically unhealthy.

The following examples can help to understand someone who is physically unhealthy:

• A person who has been harmed due to a car accident
• A farmer infected by malaria and unable to do their farming duties
• A person infected by tuberculosis and unable to perform his or her tasks.

According to the WHO definition, do you see any of the above unhealthy examples as healthy? Also think about someone in your community who you would consider to be physically disabled.

While both of these people may be restricted in their movement and ability to do routine tasks, they may still be in a state of physical and mental well-being.

Psychological Health

Health is not limited to the biological integrity and the physiological functioning of the human body. Psychological health is also an important aspect of a health definition.

• Think about people in the community who are showing behavior that may indicate they are going through a period of mental distress in their lives.
• Or think about Serena again.
• Do you think that everyone in distress shows the same sorts of symptoms?

Sometimes it can be really difficult to tell if people are struggling with mental health issues, but at other times they may show symptoms that suggest a lack of self-awareness or personal identity, or an inability of rational and logical decision-making. At other times it might be apparent that they are not looking after themselves and are without a proper purpose in their lives. They may be drinking alcohol and have a non-logical response to any request. It may also be noticed that they have an inability to maintain their personal autonomy and are unable to maintain good relationships with people around them.

Social Health

The social component of health is considered to be the ability to make and maintain “acceptable” and “proper” interactions and to communicate with other people within the social environment. This component also includes being able to maintain satisfying interpersonal relationships and being able to fulfill a social role. Having a social role is the ability that people have to maintain their own identity while sharing, cooperating, communicating, and enjoying the company of others. This is really important when participating in friendships and taking a full part in family and community life.

Which of the following examples could be considered to contribute to social health? Explain and discuss your answers.

1. Mourning when a close family member dies
2. Going to a football game or involvement in a community meeting
3. Celebrating traditional cultural events within a community
4. Shopping in the market
5. Creating and maintaining friendships

In reality, all these events could have a social component and help towards building people’s social view of health. They all involve interacting with others and gaining support, friendship, and in many instances joy from being with other people.

The World Health Organization said that health promotion is defined as the process of enabling people to increase control over, and to improve, their health. The aim of health promotion is to reduce the underlying causes of ill-health so that there is a long-term reduction in many diseases.

Clearly health is not quite as simple as the definition implies.
The concept of health is wide, and the way we define health also depends on individual perception, religious beliefs, cultural values, norms, and social class. Generally, there are two different perspectives concerning people’s own definitions of health: a narrow perspective and a broader perspective.

1. Narrow Perspectives of Health

People with a narrow perspective consider health as the absence of disease, disability, or biological dysfunction. According to this view, to call someone unhealthy or sick means there should be evidence of a particular illness. Social, emotional, and psychological factors are not believed to cause unhealthy conditions. This view is narrow and limits the definition of health to the physical and physiological capabilities that are necessary to perform routine tasks.

According to this definition, the individual is healthy if all the body parts, cells, tissues, and organ systems are functioning well, and there is no apparent dysfunction of the body. Using this view, people view the human body in the same say as a computer or mechanical device. When something is wrong, the object is taken to experts who will maintain it. Hence, physicians often focus on treatment and clinical interventions with medication rather than health education to bring about behavior change.

Serena’s Story

• About two months ago Serena lost her six month old twins. She is grief stricken. She has always been slender, but now she looks very thin. She cannot sleep; she cannot eat, and she doesn’t want to talk to anyone.
• Do you think the view of health you have just read about applies to Serena?

This view of health ignores many of the social and psychological causes of ill health. Serena’s grief is not an illness, but it is certainly affecting her health.

2. Broader Perspectives of Health

In the previous section you read about a narrow definition of health. Now this section will help you understand the concept of health in a broader and more holistic way.

The most widely used broader definition of health is that within the constitution of the World Health Organization (1948), which defines health as: “Health is not only the absence of infirmity and disease but also a state of physical mental and social well-being.” This classic definition is important, as it identifies the vital components of health. To more fully understand the meaning of health, it is important to understand each of its individual components.

• Think back to Serena.
• Describe her state of health.
• Serena is mentally distressed. She does not by any means have mental and social well-being.

Physical Health

Physical health, which is one of the components of the definition of health, could be defined as the absence of diseases or disability of the body parts. Physical health could be defined as the ability to perform routine tasks without any physical restriction

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

To understand physical health, one needs to know what is considered to be physically unhealthy.

The following examples can help to understand someone who is physically unhealthy:

• A person who has been harmed due to a car accident
• A farmer infected by malaria and unable to do their farming duties
• A person infected by tuberculosis and unable to perform his or her tasks.

According to the WHO definition, do you see any of the above unhealthy examples as healthy? Also think about someone in your community who you would consider to be physically disabled.

While both of these people may be restricted in their movement and ability to do routine tasks, they may still be in a state of physical and mental well-being.

Psychological Health

Health is not limited to the biological integrity and the physiological functioning of the human body. Psychological health is also an important aspect of a health definition.

• Think about people in the community who are showing behavior that may indicate they are going through a period of mental distress in their lives.
• Or think about Serena again.
• Do you think that everyone in distress shows the same sorts of symptoms?

Sometimes it can be really difficult to tell if people are struggling with mental health issues, but at other times they may show symptoms that suggest a lack of self-awareness or personal identity, or an inability of rational and logical decision-making. At other times it might be apparent that they are not looking after themselves and are without a proper purpose in their lives. They may be drinking alcohol and have a non-logical response to any request. It may also be noticed that they have an inability to maintain their personal autonomy and are unable to maintain good relationships with people around them.

Social Health

The social component of health is considered to be the ability to make and maintain “acceptable” and “proper” interactions and to communicate with other people within the social environment. This component also includes being able to maintain satisfying interpersonal relationships and being able to fulfill a social role. Having a social role is the ability that people have to maintain their own identity while sharing, cooperating, communicating, and enjoying the company of others. This is really important when participating in friendships and taking a full part in family and community life.

Which of the following examples could be considered to contribute to social health? Explain and discuss your answers.

1. Mourning when a close family member dies
2. Going to a football game or involvement in a community meeting
3. Celebrating traditional cultural events within a community
4. Shopping in the market
5. Creating and maintaining friendships

In reality, all these events could have a social component and help towards building people’s social view of health. They all involve interacting with others and gaining support, friendship, and in many instances joy from being with other people.

The World Health Organization said that health promotion is defined as the process of enabling people to increase control over, and to improve, their health. The aim of health promotion is to reduce the underlying causes of ill-health so that there is a long-term reduction in many diseases.

The World Health Organization said that health promotion is defined as the process of enabling people to increase control over, and to improve, their health. The aim of health promotion is to reduce the underlying causes of ill-health so that there is a long-term reduction in many diseases.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Physiotherapy in mental health care and psychiatry is a recognized specialty within physiotherapy. It offers a rich variety of observational and evaluation tools as well as a range of interventions that are related to the patient’s physical and mental health problems based on evidence‐based literature and a 50‐year history. Physiotherapy in mental health care addresses human movement, function, physical activity and exercise in individual and group therapeutic settings. Additionally, it connects the physical and mental health needs of humans. This chapter offers general reflections on mental health, the scope of physiotherapy in mental health care and physiotherapy research. Physiotherapy in mental health care and psychiatry can offer added and beneficial value to the treatment of people with mental health problems.

Mental health is a topic of growing interest in society. Various mental health organizations are engaged in the prevention, treatment and rehabilitation of persons with mental health problems and disorders. Unfortunately, physiotherapy is not always considered to be a significant profession within mental health because the role and the added value it offers can remain unclear among patients and other health care providers. However, physiotherapy is a recognized conventional profession within health care and can offer an extensive range of physical approaches (physical activity, exercise, movement, relaxation techniques and body and movement awareness). These approaches are aimed at symptom relief, the enhancement of self‐confidence and the improvement of quality of life. Additionally, they are relevant to rehabilitation programmes in mental health care.

The goal of this chapter is to present an overview of why physiotherapy in mental health is necessary and what it can offer to fulfil requests for help and to increase the quality of life of persons with mental health problems. It describes physiotherapy methods and their applications in the fields of mental health and psychiatry.

Epidemiology

About half of the mental disorders begin before the age of 14. Similar types of disorders are being reported across cultures. Neuropsychiatric disorders are among the leading causes of worldwide disability in young people. About 23% of all years lost because of disability is caused by mental and substance use disorders. War and disasters have a large impact on mental health and psychosocial well-being. Rates of mental disorder tend to double after emergencies. Mental disorders increase the risk of getting ill from other diseases such as HIV, cardiovascular disease, diabetes, and vice-versa.

• 1 in 4 people will experience a mental health issue of some sort during their lifetime
• 1 in 6 people are likely to have had mental health issues in the past seven days
• people with mental health issues are more at risk of having poor physical health
• 70% of premature deaths in people with mental health issues are due to poor physical health
• mental health issues are one of the main causes of the overall disease burden worldwide.

The Relation of Physical Activity and Exercise to Mental Health

Mental disorders are of major public health significance. It has been claimed that vigorous physical activity has positive effects on mental health in both clinical and non-clinical populations.Mental health problems are the leading predictor of years lived with disability worldwide. Furthermore, without intensified prevention and management, the burden is estimated to increase to a greater extent. The consequences of mental health problems are devastating for the person and society as a whole and are compounded by physical health comorbidities with which most people with mental health problems are confronted. Physical health comorbidities are a major cause of the reduced life expectancy of 15–20 years in this population. The relationship between mental health and physical activity is supported by a growing number of articles. There is rigorous evidence now that physiotherapy improves mental and physical health in this vulnerable population.

Unfortunately, these efforts are becoming integrated into clinical practice at a slow pace. Physical activity is not always considered to be a worthwhile strategy. The benefits of physical activity are twofold, as people with mental health problems are also at an increased risk of a range of physical health problems, including cardiovascular diseases, endocrine disorders and obesity. Physical activity influences cognition and cardiorespiratory fitness and reduces dropout due to a wide range of mental health problems. The relationship between physical activity and mental health has been widely investigated.

The health benefits of regular exercise are:

• Improved cardiovascular fitness
• Improved sleep
• Better endurance
• A positive influence on metabolic syndrome and diabetes
• Stress relief
• Improved mood
• Increased energy and reduced tiredness.
• Exercise reduces anxiety, depression, negative mood and social isolation and improves self‐esteem, cognitive functions and quality of life.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

The Role of Physiotherapy in Improving Mental Health

Not all physiotherapists realize that mental health is all the business of physiotherapy. However, it is well illustrated in this quotation: ‘no health without mental health’. Physiotherapists are seen as experts in aspects of physical health care and can offer:

• Non-pharmacological management of pain
• Expertise in prescribing individualised exercise programs, which can improve mood, promote wellbeing and address co-morbidities associated with mental health diagnoses.
• Interventions to address physical issues of people with mental health diagnoses which hinder social participation and recovery, eg. minimising or counteracting the side-effects some of psychotropic medications
• Expertise in motivating, where appropriate, patients and promoting self-management in the context of mental and physical health issues.
• Management of falls and mobility issues for older people and developmental issues for children and young people.
• Expert advice and intervention to address impaired body awareness and reduce dissociation (disconnection from ‘thoughts, feelings, memories or sense of identity) associated with poor mental health.
• Development and delivery of individually-tailored lifestyle and weight management advice and programs.

Good mental health is fundamental to the well-being of individuals, families and communities. Poor mental health is identified as one of the biggest causes of disability, poor quality of life and reduced productivity. There is also a strong association between mental health conditions and people reporting multiple pain sites. It has been documented that physical activity can improve quality of life for people with serious mental illness. Improved physical health can alleviate psychiatric and social disability. A notable number of longitudinal and cross-sectional studies have proven the usefulness of physical activity as a preventative strategy and as adjunct treatment for mental illness. Several physiotherapy interventions are potentially effective in improving physical and mental health and health- related quality of life. The most commonly used forms of exercise are aerobic- and strength exercises. Aerobic exercises, such as walking, jogging, cycling, swimming, have been proven to reduce anxiety and depression

The burden of depression, anxiety and other mental disorders call for concerted, intersectoral response. Not only to raise public awareness but also to provide treatment and prevention strategies that can reduce this large and growing health problem, including the economic losses attributable to them. The correlations between poor mental health and an increased prevalence of musculoskeletal conditions, multiple areas of pain, chronic and preventable diseases, emphasizes the need for an effective and holistic multidisciplinary approach to the management of these conditions.

Physiotherapists have also a key role in the treatment of patients with schizophrenia and their interventions may have a broad spectrum of benefits for patients. In particular, physiotherapists are physical health experts providing an important bridge between physical and mental health in patients with schizophrenia. Promoting and encouraging physical activity is central to the physiotherapist’s role in treating individuals with schizophrenia.

Definition of Physiotherapy in Mental Health

Physiotherapists who were working in mental health and psychiatry applied in 2011 for recognition as a subgroup within the World Confederation of Physical Therapy. The main goal of this subgroup is to bring the different physiotherapy interventions in mental health and psychiatry together to clarify the role of physiotherapy in this field.

For that reason, the International Organization of Physical Therapy in Mental Health (IOPTMH) developed a definition that generally describes the field of physiotherapy in mental health that is recognizable among most colleagues across the world. Physiotherapy in mental health is a specialty within physiotherapy. It is implemented in different health and mental health settings: psychiatry and psychosomatic medicine. It is person-centered and provided for children, adolescents, adults and older people with common (mild, moderate) and severe, acute and chronic mental health problems, in primary and community care, inpatients and outpatients. Physiotherapists in mental health provide health promotion, preventive health care, treatment and rehabilitation for individuals, groups and in‐group therapeutic settings. They create a therapeutic relationship to provide assessment and services specifically related to the complexity of mental health within a supportive environment applying a model including biological and psychosocial aspects. Physiotherapy in mental health aims to optimize wellbeing and empower the individual by promoting functional movement, movement awareness, physical activity and exercises, bringing together physical and mental aspects. It is based on the available scientific and best clinical evidence. Physiotherapists in mental health contribute to the multidisciplinary team and interprofessional care.

Mental health and physiotherapy

The importance of the implementation of physiotherapy in both common and severe mental health disorders and psychiatry is underestimated, even if there is a tradition of more than 50 years in some countries (Belgium, Scandinavia, etc.), even if the attention to ‘the moving body’ increases in society and even if the moving body is an important issue that is integral to psychopathology. To overcome this problem, physiotherapists who were working in mental health and psychiatry applied in 2011 for recognition as a subgroup within the World Confederation of Physical Therapy. The main goal of this subgroup is to bring the different physiotherapy interventions in mental health and psychiatry together to clarify the role of physiotherapy in this field. For that reason, the International Organization of Physical Therapy in Mental Health (IOPTMH) adapted the recommendations of the WHO concerning mental health care using physiotherapy language.

Recommendation for mental health care of the World Health Organisation adapted by the IOPTMH.

1. To improve [physiotherapy] mental health care
2. To organize specific [physiotherapy] care for different ages including children, adolescents and elderly and risk‐related groups as persons with eating disorders, psychotic disorders, etc.
3. To ensure access to primary [physiotherapy] care for people with mental health problems
4. To provide treatment in ‘community‐based [physiotherapy] services for persons with severe mental health problems.

Mental health in physiotherapy

Not all physiotherapists realize that mental health is all the business of physiotherapy. However, it is well illustrated in the following quotation: ‘no health without mental health’.

As health care providers, physiotherapists are also involved in the prevention and promotion of health, including mental health. It is their responsibility to inform individuals adequately about mental health, eliminate misconceptions about mental illness and refer them when necessary to specialized professionals in mental health and psychiatry.

Consciously or unconsciously, colleagues will be confronted in their practice with individuals with frail mental health, chronic musculoskeletal disorders, chronic pain and psychosomatic disorders. In their stories, components of mental health are interwoven, and the patients deserve an appropriate physiotherapy intervention. In addition to these conditions, more severe physical diseases such as cardiovascular diseases, Parkinson’s disease, rheumatoid arthritis, hypertension, Diabetes mellitus, metabolic syndrome, asthma, asthma/chronic obstructive pulmonary disorder (COPD), cerebrovascular diseases (stroke), obesity, epilepsy, cancer and other diseases are frequently accompanied with a ‘rollercoaster’ of emotions, feelings of anxiety and pain. After all, individuals with mental disorders have numerous physical health complaints (cardiovascular diseases, metabolic syndrome, obesity, osteoporosis, etc.) due to medication, sedentary behaviour or inactivity and consult primary health services.

The scope of physiotherapy in mental health

Depending upon the problem, the story of the patient, and the results of the observation/evaluation, the patient’s treatment goals will be established, and the physiotherapist can choose a more health-related approach or psychotherapeutic physiotherapy. The physical health‐related approach aims to improve the global physical health of patients with psychiatric disorders. Physical activity can help to reduce cardiovascular disease and premature mortality in people with psychological problems. The psychosocial‐related approach emphasizes the acquisition of mental and physical proficiencies related to the body in motion and support of personal development to enhance people’s ability to function independently in society. The psychotherapeutic‐related approach uses the body in movement as a gateway to ameliorate the social affective functioning of an individual. When using this approach, the physiotherapist creates a setting that favours the initiation and development of a process in the patient by employing specific working methods that aim to help patients to access their inner workings.

In physiotherapy in mental health, a rationale for applying psychological models (e.g. cognitive behavioural therapy, acceptance and commitment therapy, etc.) is offered as a tool to strengthen physiotherapy interventions in the treatment of a wide variety of disorders in children, adolescents, adults and the elderly. The cognitive behavioural physiotherapy treatment approach consists of the identification of current and specific problems related to the moving human being. The physiotherapy goals are based on the SMART principles (Specific, measurable, acceptable/attainable, realistic/relevant and time bound). The treatment is I think it is patient-centered and the ultimate physiotherapy goal is to change unhealthy habits and promoting an active lifestyle and healthy posture. The focus lays on self‐management and relapse prevention. Different modalities such as cognitive techniques (cognitive restructuring, problem solving and cognitive functional training), behavioural (relaxation, pacing and graded exercise therapy and behavioural activation), supportive, educational and other techniques such as (bio‐) feedback, movement and body awareness and relapse prevention for children and adults are integrated into this treatment . The acceptance and commitment physiotherapy approach is supporting the patient to clarify his/her values and helping them to take the necessary steps towards living a meaningful life despite the discomfort .

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Immunization Programs

The Expanded Programme on Immunization (EPI), with recommended guidelines established by the World Health Organization, is a major international effort to increase the proportion of children covered by basic immunizations against childhood diseases. Because of Africa’s unusually high rates of child mortality from measles, the prevalence of tuberculosis, and in many places, substantial mortality due to neonatal tetanus, EPI plays a central role in the health strategy for Africa. In addition, the low levels of funding for health programs in Africa have forced many countries to focus their scarce resources on what are perceived as the most cost-effective interventions, which include EPI (Walsh and Warren, 1979).

Universal Immunisation Programme

Immunization Programme in India was introduced in 1978 as ‘Expanded Programme of Immunization’ (EPI) by the Ministry of Health and Family Welfare, Government of India. In 1985, the programme was modified as ‘Universal Immunization Programme’ (UIP) to be implemented in phased manner to cover all districts in the country by 1989-90 with the one of largest health programme in the world.

Ministry of Health and Family Welfare, Government of India provides several vaccines to infants, children and pregnant women through the Universal Immunisation Programme.

About immunization

Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. Vaccines are substances that stimulate the body’s own immune system to protect the person against subsequent infection or disease.

Vaccines provided under UIP:

BCG

• About-BCG stands for Bacillus Calmette-Guerin vaccine. It is given to infants to protect them from tubercular meningitis and disseminated TB.
• When to give – BCG vaccine is given at birth or as early as possible till 1year of
• Route and site- BCG is given as intradermal injection in left upper arm.

OPV

• About-OPV stands for Oral Polio Vaccine. It protects children from poliomylitis.
• When to give- OPV is given at birth called zero dose and three doses are given at 6, 10 and 14 weeks. A booster dose is given at 16-24 months of age.
• Route and site – OPV is given orally in the form of two drops.

Hepatitis B vaccine

• About – Hepatitis B vaccine protects from Hepatitis B virus infection.
• When to give- Hepatitis B vaccine is given at birth or as early as possible within 24 hours. Subsequently 3 dose are given at 6, 10 and 14 weeks in combination with DPT and Hib in the form of pentavalent vaccine.
• Route and site- Intramuscular injection is given at anterolateral side of mid thigh

Pentavalent Vaccine

• About-Pentavalent vaccine is a combined vaccine to protect children from five diseases Diptheria, Tetanus, Pertusis, Haemophilis influenza type b infection and Hepatitis B.
• When to give – Three doses are given at 6, 10 and 14 weeks of age (can be given till one year of age).
• Route and site-Pentavalent vaccine is given intramuscularly on anterolateral side of mid thigh

Rotavirus Vaccine

• About -RVV stands for Rotavirus vaccine. It gives protection to infants and children against rotavirus diarrhoea. It is given in select states.
• When to give – Three doses of vaccine are given at 6, 10, 14 weeks of age.
• Route and site-5 drops of vaccine are given orally.

PCV

• About- PCV stands for Pneumococcal Conjugate Vaccine. It protects infants and young children against disease caused by the bacterium Streptococcus pneumoniae. It is given in select states.
• When to give – The vaccine is given as two primary doses at 6 & 14 weeks of age followed by a booster dose at 9 months of age
• Route and site-  PCV is given as intramuscular (IM) injection in outer right upper thigh. It should be noted that pentavalent vaccine and PCV are given as two separate injections into opposite thighs.

fIPV

• About– fIPV stands for Fractional Inactivated Poliomylitis Vaccine. It is used to boost the protection against poliomylitis.
• When to give- Two fractional doses of IVP are given intradermally at 6 and 14 weeks of age.
• Route and site- It is given as intradermal injection at right upper arm.

Measles/ MR vaccine

• About-Measles vaccine is used to protect children from measles. In few states Measles and Rubella a combined vaccine is given to protect from Measles and Rubella infection.
• When to given- First dose of Measles or MR vaccine is given at 9 completed months to12 months (vaccine can be given up to 5 years if not given at 9-12 months age) and second dose is given at 16-24 months.
• Route and site – Measles Vaccine is given as subcutaneous injection in right upper arm.

JE vaccine

• About- JE stands for Japanese encephalitis vaccine. It gives protection against Japanese Encephalitis disease. JE vaccine is given in select districts endemic for JE.
• When to given- JE vaccine is given in two doses first dose is given at 9 completed months-12 months of age and second dose at 16-24 months of age.
• Route and site- It is given as subcutaneous injection.

DPT booster

• About-DPT is a combined vaccine; it protects children from Diphtheria, Tetanus and Pertussis.
• When to give -DPT vaccine is given at 16-24 months of age is called as DPT first booster and DPT 2^nd booster is given at 5-6 years of age.
• Route and site- DPT first booster is given as intramuscular injection in antero-lateral side of mid thigh in left leg. DPT second booster is given as intramuscular injection in left upper arm.

 TT

• About- Tetanus toxoid vaccine is used to provide protection against tetanus. 
• When to give– Tetanus toxoid vaccine is given at 10 years and 15 years of age when previous injections of pentavalent vaccine and DPT vaccine are given at scheduled age.
• Pregnant women-TT-1 is given early in pregnancy;  and TT-2 is given 4 weeks after TT-1.TT booster is given when two doses of TT are given in a pregnancy in last three years.
• Route and site– TT is given as Intramuscular injection in upper arm.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

INTRODUCTION-

Immunization saves 2 to 3 million lives each year. By protecting children against serious diseases, vaccines play a central role in ending preventable child deaths. UNICEF’s immunization programme helps identify children who have been left behind by health systems, and brings them life-saving care.

Vaccines now protect more children than ever before, but in 2019, approximately 14 million infants did not receive any vaccines. Low immunization levels among poor and marginalized children compromise gains made in all other areas of maternal and child health. Over 1.5 million people die annually from diseases that can be prevented by vaccination.

Vaccination is one of the great public health achievements of human history. Vaccines used in national immunization programmes (NIPs) are considered safe and effective when used correctly. Vaccines are, however, not risk-free and adverse events will occasionally occur following vaccination. Public trust in vaccine safety is key to the success of vaccination programmes.

Goal

This course aims to establish a shared understanding among professionals whose work is linked to vaccine safety issues. This may include nurses/midwives/community health workers, as well as pharmacists medical doctors and programme or technical officers.

Rationale

Professionals involved in vaccine safety come from different backgrounds. As their jobs are all interrelated and co-dependent, they need a ‘common language’ in order to ensure smooth collaboration.

The E-learning Course on Vaccine Safety Basics meets different starting points, learning needs and country contexts. It offers the learner options to work at the speed and depth he prefers, recognizing his prior knowledge. Accommodating the different mechanisms between regions and nations is a challenge to any global course. For this reason we ask you from time to time to shift your focus to your own local context and look how vaccine safety is ensured in your country.

WHO RESPONSE

MODULE 1

This module serves as an introduction to the whole course. You will learn about the importance of immunization programmes and how vaccines work. You will understand the relationship between vaccine coverage, adverse events and disease spread. You will also learn about the importance of vaccine regulations in ensuring the effectiveness of vaccine initiatives.

Module outcomes

By the end of this module you should be able to:

• 1Explain the importance of vaccinationVaccinationInoculation with a vaccine for the purpose of inducing immunity. in the control of infectious diseases,
• 2Describe the basic principles of vaccination,
• 3Explain how the public are less tolerant of the risksRiskThe probability that an individual will experience a certain event during a defined period of time. associated with vaccinesVaccineA material containing live attenuated or inactivated (killed) microorganisms, or constituents of microorganisms, capable of eliciting protection against infection. (although very low) than they are of those associated with drugsDrug (or medicine)Any substance in a pharmaceutical product that is used to modify or exploit physiological systems or pathological states for the benefit of the recipient. The term drug/medicinal product is used in a wider sense to include the whole formulated and registered product, including the presentation and packaging, and the accompanying information. Vaccines are drugs/medicines. used to treat disease,
• 4List the main types of vaccine and illustrate them with examples,
• 5Describe the importance of post marketing vaccine safety surveillance,
• 6Identify some vaccines that have been associated with adverse vaccine reactions.

MODULE 2

There are many types of vaccines. Different types or formulations affect how they are used, how they are stored, and how they are administered. If they are to be safe and effective, it is vital to be familiar with the different types and to know how to handle them.

Different vaccines can cause different adverse reactions, and it is important to recognize what these may be. Can you identify the contraindications for vaccination and know which present an additional risk? What special considerations should you make when immunizing pregnant women or immunocompromised clients?

This module will explain the different types of vaccine and the main routes of administration. You will learn about the main vaccine reactions and the importance of understanding contraindications – as ignoring these could lead to vaccine reactions. Finally, you will look at public concern over vaccines and consider some rumours about vaccine safety that have been disproved by research.

Module outcomes

By the end of this module you should be able to:

• 1Explain the modes of action of live attenuated vaccines, conjugate vaccines, subunit vaccines, and toxoid vaccines,
• 2List types of vaccine components, including adjuvants and preservatives, and explain their functions,
• 3Explain the difference between live attenuated and inactivated vaccines,
• 4Identify the contraindications for vaccination that may present an additional risk.

MODULE 3

Under recommended conditions, all vaccines used in national immunization programmes are safe and effective if used correctly. In practice, however, no vaccine is completely risk-free and adverse events can occasionally result after an immunization.

Adverse events can range from minor side-effects to more severe reactions. They can be a cause of public concerns about vaccine safety. To understand a specific event and to be able to respond appropriately, there are several questions that you need to answer:

• What caused the reaction?
• Was it related to the vaccine or the way it was administered, or was it unrelated?
• Are the reactions minor or severe?

This module will help you to answer these questions. You will look at the main types of adverse events and the situations in which they may occur. You will also be introduced to the challenges and opportunities of mass vaccination campaigns. Because of the nature of these campaigns, adverse events may be more noticeable.

Module outcomes

By the end of this module you should be able to:

• 1Define the main types of adverse events following immunization (AEFIs),

• 2Differentiate between a reaction related to the vaccine itself, to the vaccination procedure (immunization error), or to coincidental events that are not linked to the vaccine,

• 3Differentiate between minor and severe vaccine reactions,

• 4Describe potential underlying causes for each type of AEFI, and understand the link between the AEFI and its cause,

• 5Summarize the expected incidence of the different types of AEFI.

MODULE 4

Pharmacovigilance is the practice of detecting, assessing, understanding, responding and preventing adverse drug reactions, including reactions to vaccines. It is now an integral part of the regulation of drug and vaccine safety. Surveillance systems exist at national and international levels to ensure effective monitoring and prompt actions in response to AEFIs.

Pharmacovigilance requires that incidents of adverse events are followed up in the correct way. Some adverse events need to be reported and/or investigated, and you will need to know which to report, how and to whom. Causality assessment procedures also need to be carried out effectively.

This module introduces you to the concept of pharmacovigilance and describes national and international surveillance systems. It helps you to assess how to report an AEFI in the correct way and explains the procedure of causality assessment. Finally, you will look at the subject of risk/benefit assessment, including the factors that influence the balance between risks and benefits of vaccines, risk evaluation and options analysis.

Module outcomes

By the end of this module you should be able to:

• 1Describe the basic principles of pharmacovigilancePharmacovigilanceThe science and activities relating to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problem. and the special considerations that apply to vaccination programmes,
• 2Use AEFI case definitions to evaluate which AEFIs should be detected and reported to the National regulatory authority (NRA)National regulatory authority (NRA)The regulatory body that approves procedures to ensure that medicines, including vaccines, are of adequate safety and potency. The vaccine manufacturer is responsible for demonstrating that the vaccine batch produced meets the requirements, based on the test specifications given by the NRA. The NRA is also responsible both for the official vaccine lot release process, based on the data and information provided by the manufacturer and, eventually, for confirmatory testing. or its equivalent,
• 3Describe the principles of risk-benefit analysisRisk-benefit analysisEvaluation and assessment of the relative risks and benefits of an intervention, e.g. the potential benefit of protection from measles and its complications due to vaccination, relative to the potential risk of adverse reactions to the vaccine. relative to the protective effect of immunization and the importance of causality assessmentsCausality assessment (or causality association)The systematic review of data about an AEFI case to determine the likelihood of a causal association between the event and the vaccine(s) received. to evaluate possible links between AEFIs and a vaccine or vaccine lot,
• 4Explain how investigation of AEFI reports and vaccine testing can contribute to surveillanceSurveillanceThe systematic collection, analysis, interpretation, and dissemination of health data on an ongoing basis, to gain knowledge of the pattern of disease occurrence and potential in a community, in order to control and prevent disease in the community. that ensures vaccine safety.

MODULE 5

The general principles for the surveillance of adverse events following immunization (AEFIs) are similar in all countries. However, approaches may differ due to factors such as how immunization services are organized and the level of resources available.

The first half of the Module describes the central role of the national regulatory authority (NRA) and the national immunization programme (NIP) along with the role of the AEFI review committee; other participants are also briefly introduced.

In the second half of the Module you will look into the international services available to support vaccine safety in countries. You will understand how national and international agencies work together and how information flows between them and countries.

Module outcomes

By the end of this module you should be able to:

• 1List the main functions or services for vaccine safety, including national and international bodies, as well as manufacturers,
• 2Describe the relevant areas of responsibility and (if applicable) the areas of collaboration between the National regulatory authority and immunization programmes within your own country,
• 3Identify the mechanisms by which an AEFI seen in a clinic can be reported to the national regulatory authority,
• 4Summarize information flows between institutions at national level (immunization clinics, NRAs, etc.) and international bodies.

MODULE 6

Every year, billions of doses of vaccine are given in immunization programmes around the world. Vaccines are designed to provoke an immune response in the body, and it is inevitable that this reaction carries a small attributable risk to the health of a tiny minority of recipients. This risk is hugely outweighed by the very significant benefits of immunization in terms of protection from vaccine-preventable diseases and their wide-ranging consequences.

Explaining risks and benefits of vaccines clearly to parents, guardians and vaccine recipients requires effective communication and interpersonal skills from trained health professionals in immunization programmes and educators such as school teachers.

This module will help you to understand public fear and concerns, and how you can improve your communication skills on the subject of vaccine safety.

Module outcomes

By the end of this module you should be able to:

• 1Understand the need for improved communication on vaccine safety,
• 2Critically evaluate and assess new information about vaccines before communicating to the target audience,
• 3Gather information about the various target audiences, who they are, how they perceive vaccine risk and their knowledge about vaccines and safety,
• 4Outline the fears and concerns of different groups associated with, or likely to be affected by, an immunization programme,
• 5Design simple, clear and tailor-made messages to communicate information about vaccine safety to your target audience (e.g. parent, vaccinee, clinic staff, media, health professional, drug regulatory authority, health minister, etc.),
• 6Identify the most suitable means and channels of communication to convey information to different target groups,
• 7Understand the media as being an important ally in vaccine safety.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

UNICEF

UNICEF works with partners in governments, NGOs, other UN agencies and the private sector to provide immunization to the children who need it the most.

Vaccinating children in every community: Wherever children are not immunized, their lives and communities are at risk. UNICEF tailors new approaches to vaccinate every child in every community – no matter how remote or challenging.

The cold chain: UNICEF and partners harness solar power, mobile technology and telemetrics to make sure vaccines reach all children without losing their effectiveness from exposure to extreme heat or cold weather conditions.

Vaccine supply: With UNICEF efforts, the price of many essential childhood vaccines has reached all-time lows. This has facilitated the introduction of new vaccines to children living in the poorest countries.

Innovation: Working with private and public partners, UNICEF steers investment towards new vaccines, and diagnostic and health technologies.  

Disease eradication and elimination programmes: Thanks to steady progress on expanding vaccination, the world has never been in a better position to eradicate polio. Immunization against measles, rubella and tetanus are bringing the world closer to eliminating these devastating diseases.

Background note on Immunization :-

• Expanded Programme on Immunization was launched in 1978. It was renamed as Universal Immunization Programme in 1985 when its reach was expanded beyond urban areas. In 1992, it became part of Child Survival and Safe Motherhood Programme and in 1997 it was included in the ambit of National Reproductive and Child Health Programme. Since the launch of National Rural Health Mission in 2005, Universal Immunization Programme has always been an integral part of it.
• Universal Immunization Programme (UIP) is one of the largest public health programmes targeting close of 2.67 crore newborns and 2.9 crore pregnant women annually.
• It is one of the most cost-effective public health interventions and largely responsible for reduction of vaccine preventable under-5 mortality rate.
• Under UIP, immunization is providing free of cost against 12 vaccine preventable diseases:
• Nationally against 9 diseases – Diphtheria, Pertussis, Tetanus, Polio, Measles, Rubella, severe form of Childhood Tuberculosis, Hepatitis B and Meningitis & Pneumonia caused by Hemophilus Influenza type B
• Sub-nationally against 3 diseases – Rotavirus diarrhoea, Pneumococcal Pneumonia and Japanese Encephalitis; of which Rotavirus vaccine and Pneumococcal Conjugate vaccine are in process of expansion while JE vaccine is provided only in endemic districts.
• A child is said to be fully immunized if child receives all due vaccine as per national immunization schedule within 1st year age of child.
• The two major milestones of UIP have been the elimination of polio in 2014 and maternal and neonatal tetanus elimination in 2015.

New vaccines

• Inactivated Polio Vaccine (IPV): IPV has been introduced in UIP as part of Global Polio end-game strategy, to mitigate the risk associated with tOPV to bOPV switch. IPV was introduced in November 2015 initially in 6 states, which was expanded across the country by April 2016.
• Rotavirus vaccine (RVV): RVV has been introduced to reduce mortality and morbidity caused by Rotavirus diarrhoea in March 2016. It has been introduced in 11 states (Andhra Pradesh, Haryana, Himachal Pradesh, Jharkhand, Odisha, Assam, Tripura, Rajasthan, Tamil Nadu, Madhya Pradesh and Uttar Pradesh). The vaccine will be expanded across the country in 2019-20.
• Measles Rubella (MR) vaccine: India is committed to the goal of measles elimination and rubella control and to achieve the goal MR vaccine was introduced in the country through a campaign mode in a phased manner in 2017. MR campaign target around 41 crore children in the age group of 9 months to 15 years (covering ⅓ of the total population of the country) followed by 2 doses in routine immunization at 9-12 months and 16-24 months. Rubella component is now under routine immunization as MR vaccine.
• Pneumococcal Conjugate Vaccine (PCV): PCV has been launched in May 2017 for reducing Infant mortality and morbidity caused by pneumococcal pneumonia. It has been introduced in Bihar, Himachal Pradesh, Madhya Pradesh, 19 districts of Uttar Pradesh and 18 districts of Rajasthan.
• Tetanus and adult diphtheria (Td) vaccine: TT vaccine has been replaced with Td vaccine in UIP to limit the waning immunity against diphtheria in older age groups. Td vaccine to be administered to adolescents at 10 and 16 years of age and to pregnant women.

Mission Indradhanush

• Mission Indradhanush (MI) was launched in December 2014 and aims at increasing the full immunization coverage to children to 90%.
• Under this drive focus is given on pockets of low immunization coverage and hard to reach areas where the proportion of unvaccinated and partially vaccinated children is highest.
• A total of six phases of Mission Indradhanush have been completed covering 554 districts across the country.
• It was also identified as one of the flagship schemes under Gram Swaraj Abhiyan (16,850 villages across 541 districts) and Extended Gram Swaraj Abhiyan (48,929 villages across 117 aspirational districts).
• While the first two phases of Mission Indradhanush resulted in 6.7% increase in full immunization coverage in a year, a recent survey carried out in 190 districts covered in Intensified Mission Indradhanush (5th phase of Mission Indradhanush) shows 18.5% points increase in full immunization coverage as compared to NFHS-4 survey carried out in 2015-16.

New Initiatives in Vaccine Logistics & Cold Chain Management

1. Capacity building

• National Cold Chain Training Centre (NCCTE), Pune and National Cold Chain  & Vaccine Management Resource Centre (NCCVMRC) -NIHFW, New Delhi have been established to provide technical training to cold chain technicians in repair & maintenance of cold chain equipment

1. System strengthening

• Electronic Vaccine Intelligence Network (eVIN) rollout:
• The Government of India has rolled out an Electronic Vaccine Intelligence Network (eVIN)system that digitizes the entire vaccine stock management, their logistics and temperature tracking at all levels of vaccine storage – from national to the sub-district.
• This enables program managers to have real time view of the vaccine stock position and their storage temperature across all the cold chain points providing a detailed overview of the vaccine cold chain logistics system across the entire country.
• eVIN system has been completed in 12 states in the first phase – Assam, Bihar, Chhattisgarh, Himachal Pradesh Gujarat, Jharkhand, Madhya Pradesh, Manipur, Nagaland, Odisha, Rajasthan, and Uttar Pradesh.
• Second phase is ongoing in 9 states – Andhra Pradesh, Daman & Diu, Dadra & Nagar Haveli, Goa, Karnataka, Maharashtra, Telangana, Tripura and Uttarakhand.
• eVIN is to be scaled up to entire country.
• National Cold Chain Management Information System (NCCMIS)to track the cold chain equipment inventory, availability and functionality.

History of vaccine development

Although inoculationInoculationThe practice of intentionally exposing someone to matter from smallpox pustules in order to initiate a mild, protective response to the disease. against smallpox was practiced over 2000 years ago in China and India, a British physician, Edward Jenner, is generally credited with ushering in the modern concept of vaccination. In 1796 he used matter from cowpox pustules to inoculate patients successfully against smallpox, which is caused by a related virusVirusAn ultramicroscopic infectious agent that consists of genetic material surrounded by a protein coat. A virus can replicate themselves only within cells of living hosts..

By 1900, there were two human virus vaccines, against smallpox and rabiesRabiesA potentially fatal viral infection spread through the bite of certain warm-blooded animals. It attacks the central nervous system and, if left untreated, is highly fatal in animals., and three bacterial vaccines against typhoidTyphoid (typhoid fever)A serious disease caused by a bacteria called Salmonella Typhi. Typhoid causes a high fever, weakness, stomach pains, headache, loss of appetite, and sometimes a rash. If it is not treated, it can kill up to 30% of people who get it. There are different vaccines to prevent typhoid: inactivated vaccines that require injection, and live attenuated vaccines that are taken orally (by mouth)., choleraCholeraAn acute infectious disease of the small intestine, caused by the bacterium Vibrio cholerae and characterized by profuse watery diarrhea, vomiting, muscle cramps, severe dehydration, and depletion of electrolytes., and plaguePlagueA serious, potentially life-threatening infectious disease that is usually transmitted to humans by the bites of rodent fleas. It was one of the scourges of early human history..

A worldwide case detection and vaccination programme against smallpox gathered pace and, in 1979, the World Health Assembly officially declared smallpox eradicated — a feat that remains one of history’s greatest public health triumphs.

During the 20th century, other vaccines that protect against once commonly fatal infections such as pertussisPertussis (also known as whooping cough)An infectious bacterial disease caused by Bordetella pertussis that produces violent, spasmodic coughing; also called whooping cough., diphtheriaDiphtheriaA disease caused by toxigenic strains of Corynebacterium diphtheriae. Often marked by the formation of a false membrane in the throat, diphtheria is a serious vaccine-preventable disease that can cause death in unvaccinated children., tetanusTetanusA disease caused primarily by toxigenic C. tetani. The rare but often fatal disease affects the central nervous system by causing painful muscular contractions., polio, measlesMeaslesA contagious viral disease marked by fever, the eruption of red circular spots on the skin that can be deadly to young and weakened individuals., rubellaRubella (German measles)A viral infection that is usually milder than measles but can cause serious damage or death to a fetus when a pregnant woman is infected., and several other communicable diseases were developed. As these vaccines became available, high-income industrial nations began recommending routine vaccination of their children. There are now over 20 vaccine-preventable diseases.

REFERANCE-https://vaccine-safety-training.org/home.html

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

INTRODUCTION –

Mental health refers to cognitive, behavioral, and emotional well-being. It is all about how people think, feel, and behave. People sometimes use the term “mental health” to mean the absence of a mental disorder.

Mental health can affect daily living, relationships, and physical health.

However, this link also works in the other direction. Factors in people’s lives, interpersonal connections, and physical factors can all contribute to mental health disruptions.

Looking after mental health can preserve a person’s ability to enjoy life. Doing this involves reaching a balance between life activities, responsibilities, and efforts to achieve psychological resilience.

Conditions such as stress, depression, and anxiety can all affect mental health and disrupt a person’s routine.

Although the term mental health is in common use, many conditions that doctors recognize as psychological disorders have physical roots.

In this article, we explain what people mean by mental health and mental illness. We also describe the most common types of mental disorders, including their early signs and how to treat them.

Mental health is an integral and essential component of health. The WHO constitution states: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” An important implication of this definition is that mental health is more than just the absence of mental disorders or disabilities.

Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.

Mental health is fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living and enjoy life. On this basis, the promotion, protection and restoration of mental health can be regarded as a vital concern of individuals, communities and societies throughout the world.

Key facts

• Mental health is more than the absence of mental disorders.
• Mental health is an integral part of health; indeed, there is no health without mental health.
• Mental health is determined by a range of socioeconomic, biological and environmental factors.
• Cost-effective public health and intersectoral strategies and interventions exist to promote, protect and restore mental health.

Mental health is an integral and essential component of health. The WHO constitution states: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” An important implication of this definition is that mental health is more than just the absence of mental disorders or disabilities.

Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.

Mental health is fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living and enjoy life. On this basis, the promotion, protection and restoration of mental health can be regarded as a vital concern of individuals, communities and societies throughout the world.

Determinants of mental health

Multiple social, psychological, and biological factors determine the level of mental health of a person at any point of time. For example, violence and persistent socio-economic pressures are recognized risks to mental health. The clearest evidence is associated with sexual violence.

Poor mental health is also associated with rapid social change, stressful work conditions, gender discrimination, social exclusion, unhealthy lifestyle, physical ill-health and human rights violations.

There are specific psychological and personality factors that make people vulnerable to mental health problems. Biological risks include genetic factors.

Risk factors

Everyone has some risk of developing a mental health disorder, no matter their age, sex, income, or ethnicity.

In the U.S. and much of the developed world, mental disorders are one of the leading causes of disability.

Social and financial circumstances, biological factors, and lifestyle choices can all shape a person’s mental health.

A large proportion of people with a mental health disorder have more than one condition at a time.

It is important to note that good mental health depends on a delicate balance of factors and that several elements of life and the world at large can work together to contribute to disorders.

The following factors may contribute to mental health disruptions.

Continuous social and economic pressure

Having limited financial means or belonging to a marginalized or persecuted ethnic group can increase the risk of mental health disorders.

A 2015 study of 903 families in Iran identified several socioeconomic causes of mental health conditions, including poverty and living on the outskirts of a large city.

The researchers also explained the difference in the availability and quality of mental health treatment for certain groups in terms of modifiable factors, which can change over time, and nonmodifiable factors, which are permanent.

Modifiable factors for mental health disorders include:

• socioeconomic conditions, such whether work is available in the local area
• occupation
• a person’s level of social involvement
• education
• housing quality

Nonmodifiable factors include:

• gender
• age
• ethnicity

The study lists gender as both a modifiable and nonmodifiable factor. The researchers found that being female increased the risk of low mental health status by 3.96 times.

People with a “weak economic status” also scored highest for mental health conditions in this study.

Biological factors

The NIMH suggest that genetic family history can increase the likelihood of mental health conditions, as certain genes and gene variants put a person at higher risk.

However, many other factors contribute to the development of these disorders.

Having a gene with links to a mental health disorder, such as depression or schizophrenia, does not guarantee that a condition will develop. Likewise, people without related genes or a family history of mental illness can still have mental health issues.

Mental health conditions such as stress, depression, and anxiety may develop due to underlying, life-changing physical health problems, such as cancer, diabetes, and chronic pain.

Mental health promotion and protection

Mental health promotion involves actions that improve psychological well-being.  This may involve creating an environment that supports mental health.

An environment that respects and protects basic civil, political, socio-economic and cultural rights is fundamental to mental health. Without the security and freedom provided by these rights, it is difficult to maintain a high level of mental health.

National mental health policies should be concerned both with mental disorders and, with broader issues that promote mental health. Mental health promotion should be mainstreamed into governmental and nongovernmental policies and programmes. In addition to the health sector, it is essential to involve the education, labour, justice, transport, environment, housing, and welfare sectors.

Specific ways to promote mental health include:

• early childhood interventions (e.g. providing a stable environment that is sensitive to children’s health and nutritional needs, with protection from threats, opportunities for early learning, and interactions that are responsive, emotionally supportive and developmentally stimulating);
• support to children (e.g. life skills programmes, child and youth development programmes);
• socio-economic empowerment of women (e.g. improving access to education and microcredit schemes);
• social support for elderly populations (e.g. befriending initiatives, community and day centres for the aged);
• programmes targeted at vulnerable people, including minorities, indigenous people, migrants and people affected by conflicts and disasters (e.g. psycho-social interventions after disasters);
• mental health promotional activities in schools (e.g. programmes involving supportive ecological changes in schools);
• mental health interventions at work (e.g. stress prevention programmes);
• housing policies (e.g. housing improvement);
• ·violence prevention programmes (e.g. reducing availability of alcohol and access to arms);
• community development programmes (e.g. integrated rural development);
• poverty reduction and social protection for the poor;
• anti-discrimination laws and campaigns;
• promotion of the rights, opportunities and care of individuals with mental disorders.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Common mental health disorders

The most common types of mental illness are as follows:

• anxiety disorders
• mood disorders
• schizophrenia disorders

Anxiety disorders

According to the Anxiety and Depression Association of America, anxiety disorders are the most common type of mental illness.

People with these conditions have severe fear or anxiety, which relates to certain objects or situations. Most people with an anxiety disorder will try to avoid exposure to whatever triggers their anxiety.

Examples of anxiety disorders include:

Generalized anxiety disorder (GAD)

The American Psychiatric Association define GAD as disproportionate worry that disrupts everyday living.

People might also experience physical symptoms, including

• restlessness
• fatigue
• tense muscles
• interrupted sleep

A bout of anxiety symptoms does not necessarily need a specific trigger in people with GAD.

They may experience excessive anxiety on encountering everyday situations that do not present a direct danger, such as chores or keeping appointments. A person with GAD may sometimes feel anxiety with no trigger at all.

Panic disorders

People with a panic disorder experience regular panic attacks, which involve sudden, overwhelming terror or a sense of imminent disaster and death.

Phobias

There are different types of phobia:

• Simple phobias: These might involve a disproportionate fear of specific objects, scenarios, or animals. A fear of spiders is a common example.
• Social phobia: Sometimes known as social anxiety, this is a fear of being subject to the judgment of others. People with social phobia often restrict their exposure to social environments.
• Agoraphobia: This term refers to a fear of situations in which getting away may be difficult, such as being in an elevator or moving train. Many people misunderstand this phobia as a fear of being outside.
• Phobias are deeply personal, and doctors do not know every type. There could be thousands of phobias, and what might seem unusual to one person may be a severe problem that dominates daily life for another.

Obsessive-compulsive disorder (OCD)

People with OCD have obsessions and compulsions. In other words, they experience constant, stressful thoughts and a powerful urge to perform repetitive acts, such as hand washing.

Post-traumatic stress disorder (PTSD)

PTSD can occur after a person experiences or witnesses a deeply stressful or traumatic event.

During this type of event, the person thinks that their life or other people’s lives are in danger. They may feel afraid or that they have no control over what is happening.

These sensations of trauma and fear may then contribute to PTSD.

Mood disorders

People may also refer to mood disorders as affective disorders or depressive disorders.

People with these conditions have significant changes in mood, generally involving either mania, which is a period of high energy and elation, or depression. Examples of mood disorders include:

• Major depression: An individual with major depression experiences a constant low mood and loses interest in activities and events that they previously enjoyed. They can feel prolonged periods of sadness or extreme sadness.
• Bipolar disorder: A person with bipolar disorder experiences unusual changes in their mood, energy levels, levels of activity, and ability to continue with daily life. Periods of high mood are known as manic phases, while depressive phases bring on low mood.
• Seasonal affective disorder (SAD): Reduced daylight triggers during the fall, winter, and early spring months trigger this type of major depression. It is most common in countries far from the equator.

Schizophrenia disorders

Mental health authorities are still trying to determine whether schizophrenia is a single disorder or a group of related illnesses. It is a highly complex condition.

Signs of schizophrenia typically develop between the ages of 16 and 30 years, according to the NIMH. The individual will have thoughts that appear fragmented, and they may also find it hard to process information.

Schizophrenia has negative and positive symptoms. Positive symptoms include delusions, thought disorders, and hallucinations. Negative symptoms include withdrawal, lack of motivation, and a flat or inappropriate mood.

Common mental health disorders

The most common types of mental illness are as follows:

• anxiety disorders
• mood disorders
• schizophrenia disorders

Anxiety disorders

According to the Anxiety and Depression Association of America, anxiety disorders are the most common type of mental illness.

People with these conditions have severe fear or anxiety, which relates to certain objects or situations. Most people with an anxiety disorder will try to avoid exposure to whatever triggers their anxiety.

Examples of anxiety disorders include:

Generalized anxiety disorder (GAD)

The American Psychiatric Association define GAD as disproportionate worry that disrupts everyday living.

People might also experience physical symptoms, including

• restlessness
• fatigue
• tense muscles
• interrupted sleep

A bout of anxiety symptoms does not necessarily need a specific trigger in people with GAD.

They may experience excessive anxiety on encountering everyday situations that do not present a direct danger, such as chores or keeping appointments. A person with GAD may sometimes feel anxiety with no trigger at all.

Panic disorders

People with a panic disorder experience regular panic attacks, which involve sudden, overwhelming terror or a sense of imminent disaster and death.

Phobias

There are different types of phobia:

• Simple phobias: These might involve a disproportionate fear of specific objects, scenarios, or animals. A fear of spiders is a common example.
• Social phobia: Sometimes known as social anxiety, this is a fear of being subject to the judgment of others. People with social phobia often restrict their exposure to social environments.
• Agoraphobia: This term refers to a fear of situations in which getting away may be difficult, such as being in an elevator or moving train. Many people misunderstand this phobia as a fear of being outside.

Phobias are deeply personal, and doctors do not know every type. There could be thousands of phobias, and what might seem unusual to one person may be a severe problem that dominates daily life for another.

Obsessive-compulsive disorder (OCD)

People with OCD have obsessions and compulsions. In other words, they experience constant, stressful thoughts and a powerful urge to perform repetitive acts, such as hand washing.

Post-traumatic stress disorder (PTSD)

PTSD can occur after a person experiences or witnesses a deeply stressful or traumatic event.

During this type of event, the person thinks that their life or other people’s lives are in danger. They may feel afraid or that they have no control over what is happening.

These sensations of trauma and fear may then contribute to PTSD.

Mood disorders

People may also refer to mood disorders as affective disorders or depressive disorders.

People with these conditions have significant changes in mood, generally involving either mania, which is a period of high energy and elation, or depression. Examples of mood disorders include:

• Major depression: An individual with major depression experiences a constant low mood and loses interest in activities and events that they previously enjoyed. They can feel prolonged periods of sadness or extreme sadness.
• Bipolar disorder: A person with bipolar disorder experiences unusual changes in their mood, energy levels, levels of activity, and ability to continue with daily life. Periods of high mood are known as manic phases, while depressive phases bring on low mood.
• Seasonal affective disorder (SAD): Reduced daylight triggers during the fall, winter, and early spring months trigger this type of major depression. It is most common in countries far from the equator. Learn more about SAD here.

Schizophrenia disorders

Mental health authorities are still trying to determine whether schizophrenia is a single disorder or a group of related illnesses. It is a highly complex condition.

Signs of schizophrenia typically develop between the ages of 16 and 30 years, according to the NIMH. The individual will have thoughts that appear fragmented, and they may also find it hard to process information.

Schizophrenia has negative and positive symptoms. Positive symptoms include delusions, thought disorders, and hallucinations. Negative symptoms include withdrawal, lack of motivation, and a flat or inappropriate mood.

WHO response

WHO supports governments in the goal of strengthening and promoting mental health. WHO has evaluated evidence for promoting mental health and is working with governments to disseminate this information and to integrate effective strategies into policies and plans.

In 2013, the World Health Assembly approved a “Comprehensive Mental Health Action Plan for 2013-2020”. The Plan is a commitment by all WHO’s Member States to take specific actions to improve mental health and to contribute to the attainment of a set of global targets.

The Action Plan’s overall goal is to promote mental well-being, prevent mental disorders, provide care, enhance recovery, promote human rights and reduce the mortality, morbidity and disability for persons with mental disorders. It focuses on 4 key objectives to:

• strengthen effective leadership and governance for mental health;
• provide comprehensive, integrated and responsive mental health and social care services in community-based settings;
• implement strategies for promotion and prevention in mental health; and
• strengthen information systems, evidence and research for mental health.

Particular emphasis is given in the Action Plan to the protection and promotion of human rights, the strengthening and empowering of civil society and to the central place of community-based care.

In order to achieve its objectives, the Action Plan proposes and requires clear actions for governments, international partners and for WHO. Ministries of Health will need to take a leadership role, and WHO will work with them and with international and national partners, including civil society, to implement the plan. As there is no action that fits all countries, each government will need to adapt the Action Plan to its specific national circumstances.

Early signs

There is no physical test or scan that reliably indicates whether a person has developed a mental illness. However, people should look out for the following as possible signs of a mental health disorder:

• withdrawing from friends, family, and colleagues
• avoiding activities that they would normally enjoy
• sleeping too much or too little
• eating too much or too little
• feeling hopeless
• having consistently low energy
• using mood-altering substances, including alcohol and nicotine, more frequently
• displaying negative emotions
• being confused
• being unable to complete daily tasks, such as getting to work or cooking a meal
• having persistent thoughts or memories that reappear regularly
• thinking of causing physical harm to themselves or others
• hearing voices
• experiencing delusions

Treatment

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

There are various methods for managing mental health problems. Treatment is highly individual, and what works for one person may not work for another.

Some strategies or treatments are more successful in combination with others. A person living with a chronic mental disorder may choose different options at various stages in their life.

The individual needs to work closely with a doctor who can help them identify their needs and provide them with suitable treatment.

Treatments can include:

Psychotherapy, or talking therapies

This type of treatment takes a psychological approach to treating mental illness. Cognitive behavioral therapy, exposure therapy, and dialectical behavior therapy are examples.

Psychiatrists, psychologists, psychotherapists, and some primary care physicians carry out this type of treatment.

It can help people understand the root of their mental illness and start to work on more healthful thought patterns that support everyday living and reduce the risk of isolation and self-harm.

Medication

Some people take prescribed medications, such as antidepressants, antipsychotics, and anxiolytic drugs.

Although these cannot cure mental disorders, some medications can improve symptoms and help a person resume social interaction and a normal routine while they work on their mental health.

Some of these medications work by boosting the body’s absorption of feel-good chemicals, such as serotonin, from the brain. Other drugs either boost the overall levels of these chemicals or prevent their degradation or destruction.

Self-help

A person coping with mental health difficulties will usually need to make changes to their lifestyle to facilitate wellness.

Such changes might include reducing alcohol intake, sleeping more, and eating a balanced, nutritious diet. People may need to take time away from work or resolve issues with personal relationships that may be causing damage to their mental health.

People with conditions such as an anxiety or depressive disorder may benefit from relaxation techniques, which include deep breathing, meditation, and mindfulness.

Having a support network, whether via self-help groups or close friends and family, can also be essential to recovery from mental illness.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

• Ask the tough question: “Are you considering suicide?”
• Listen to the person without judgment.
• Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
• Stay with the person until professional help arrives.
• Try to remove any weapons, medications, or other potentially harmful objects.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Family Planning

India was the first country in the world to have launched a National Programme for Family Planning in 1952. Over the decades, the programme has undergone transformation in terms of policy and actual programme implementation and currently being repositioned to not only achieve population stabilization goals but also promote reproductive health and reduce maternal, infant & child mortality and morbidity.

The objectives, strategies and activities of the Family Planning division are designed and operated towards achieving the family welfare goals and objectives stated in various policy documents (NPP: National Population Policy 2000, NHP: National Health Policy 2017, and NHM: National Rural Health Mission) and to honour the commitments of the Government of India (including ICPD: International Conference on Population and Development, MDG: Millennium Development Goals, SDG: Sustainable Development Goals, and others).

National Programme for Family Planning

India was the first country in the world to have launched a National Programme for Family Planning in 1952. Over the decades, the programme has undergone transformation in terms of policy and actual programme implementation and currently being repositioned to not only achieve population stabilization goals but also promote reproductive health and reduce maternal, infant & child mortality and morbidity. Under the programme public health sector provides various family planning services at various levels of health system.

 “Mission Pariwar Vikas”

For improved access to contraceptives and family planning services in high fertility districts spreading over seven high focus states, the Ministry of Health and Family Welfare launched “Mission Pariwar Vikas”in 2016. Special focus has been given to 146 high fertility Districts of Bihar, Uttar Pradesh, Assam, Chhattisgarh, Madhya Pradesh, Rajasthan & Jharkhand, with an aim to ensure availability of contraceptive methods at all the levels of Health Systems.

Goal – Its overall goal is to reduce India’s overall fertility rate to 2.1 by the year 2025

Objective –The key strategic focus of this initiative is on improving access to contraceptives through delivering assured services, ensuring commodity security and accelerating access to high quality family planning services.

Key strategies include –

·         Providing more choices through newly introduced contraceptives: Injectable Contraceptive, MPA (Medroxyprogesterone acetate) under Antara program and Chaya (earlier marketed as Saheli) will be made freely available to all government hospitals.

·         Emphasis on Spacing methods like IUCD

·         Revitalizing Postpartum Family Planning including PPIUCD in order to capitalize on the opportunity provided by increased institutional deliveries. Appointment of counsellors at high institutional delivery facilities is a key activity.

·         Strengthening community-based distribution of contraceptives by involving ASHAs and Focused IEC/ BCC efforts for enhancing demand and creating awareness on family planning

·         Availability of Fixed Day Static Services at all facilities.

·         Emphasis on minilap tubectomy services because of its logistical simplicity and requirement of only MBBS doctors and not post graduate gynecologists/ surgeons.

·         A rational human resource development plan for IUCD, minilap and NSV be chalked up to empower the facilities (DH, CHC, PHC, SHC) with at least one provider each for each of the services and Sub Center’s with ANMs trained in IUD insertion

·         Ensuring quality care in Family Planning services by establishing Quality Assurance Committees at state and district levels Plan for accreditation of more private/ NGO facilities to increase the provider base for family planning services under PPP.

·         Increasing male participation and promoting Non-scalpel vasectomy.

·         Demand generation activities in the form of display of posters, billboards and other audio and video materials in the various facilities be planned and budgeted.

·         Strong Political Will and Advocacy at the highest level, especially in states with high fertility rates.

Family planning/contraception methods

Brief overview:

Ensuring access for all people to their preferred contraceptive methods advances several human rights including the right to life and liberty, freedom of opinion and expression and the right to work and education, as well as bringing significant health and other benefits. Use of contraception prevents pregnancy-related health risks for women, especially for adolescent girls, and when births are separated by less than two years, the infant mortality rate is 45% higher than it is when births are 2-3 years and 60% higher than it is when births are four or more years apart[1]. It offers a range of potential non-health benefits that encompass expanded education opportunities and empowerment for women, and sustainable population growth and economic development for countries.

Modern contraceptive prevalence among Married women of reproductive age (MWRA) increased worldwide between 2000 and 2019 by 2.1 percentage points from 55.0% (95% UI 53.7%–56.3%) to 57.1% (95% UI 54.6%–59.5%)1. Reasons for this slow increase include: limited choice of methods; limited access to services, particularly among young, poorer and unmarried people; fear or experience of side-effects; cultural or religious opposition; poor quality of available services; users’ and providers’ bias against some methods; and gender-based barriers to accessing services.

Contraceptive methods

Methods of contraception include oral contraceptive pills, implants, injectables, patches, vaginal rings, Intra uterine devices, condoms, male and female sterilization, lactational amenorrhea methods, withdrawal and fertility awareness based methods.  These methods have different mechanisms of action and effectiveness in preventing unintended pregnancy. Effectiveness of methods is measured by the number of pregnancies per 100 women using the method per year.  Methods are classified by their effectiveness as commonly used into:  Very effective (0–0.9 pregnancies per 100 women); Effective (1-9 pregnancies per 100 women); Moderately effective (10-19 pregnancies per 100 women); Less effective (20 or more pregnancies per 100 women)

Mechanisms of action and effectiveness of contraceptive methods 

Method	How it works	Effectiveness: pregnancies per 100 women per year with consistent and correct use	Effectiveness: pregnancies per 100 women per year as commonly used
Combined oral contraceptives (COCs) or “the pill”	Prevents the release of eggs from the ovaries (ovulation)	0.3	7
Progestogen-only pills (POPs) or “the minipill”	Thickens cervical mucous to block sperm and egg from meeting and prevents ovulation	0.3	7
Implants	Thickens cervical mucous to blocks sperm and egg from meeting and prevents ovulation	0.1	0.1
Progestogen only injectables	Thickens cervical mucous to block sperm and egg from meeting and prevents ovulation	0.2	4
Monthly injectables or combined injectable contraceptives (CIC)	Prevents the release of eggs from the ovaries (ovulation)	0.05	3
Combined contraceptive patch and combined contraceptive vaginal ring (CVR)	Prevents the release of eggs from the ovaries (ovulation)	0.3 (for patch)   0.3 (for vaginal ring)	7 (for patch)   7 (for contraceptive vaginal ring)
Intrauterine device (IUD): copper containing	Copper component damages sperm and prevents it from meeting the egg	0.6	0.8
Intrauterine device (IUD) levonorgestrel	Thickens cervical mucous to block sperm and egg from meeting	0.5	0.7
Male condoms	Forms a barrier to prevent sperm and egg from meeting	2	13
Female condoms	Forms a barrier to prevent sperm and egg from meeting	5	21
Male sterilization (Vasectomy)	Keeps sperm out of ejaculated semen	0.1	0.15
Female sterilization (tubal ligation)	Eggs are blocked from meeting sperm	0.5	0.5
Lactational amenorrhea method (LAM)	Prevents the release of eggs from the ovaries (ovulation)	0.9 (in six months)	2 (in six months)
Standard Days Method or SDM	Prevents pregnancy by avoiding unprotected vaginal sex during most fertile days.	5	12
Basal Body Temperature (BBT) Method	Prevents pregnancy by avoiding unprotected vaginal sex during fertile days	Reliable effectiveness rates are not available
TwoDay Method	Prevents pregnancy by avoiding unprotected vaginal sex during most fertile days,	4	14
Sympto-thermal Method	Prevents pregnancy by avoiding unprotected vaginal sex during most fertile	<1	2
Emergency contraception pills (ulipristal acetate 30 mg or levonorgestrel 1.5 mg)	Prevents or delays the release of eggs from the ovaries. Pills taken to prevent pregnancy up to 5 days after unprotected sex	< 1 for  ulipristal acetate ECPs  1 for progestin-only ECPs 2 for combined estrogen and progestin ECPs
Calendar method or rhythm method	The couple prevents pregnancy by avoiding unprotected vaginal sex during the 1st and last estimated fertile days, by abstaining or using a condom.	Reliable effectiveness rates are not available	15
Withdrawal (coitus interruptus)	Tries to keep sperm out of the woman’s body, preventing fertilization	4	20

Natural Family Planning: Advantages and Disadvantages

Advantages

NFP has many advantages which commend it to many couples who do not wish to rely on external methods:

• NFP can be quite effective in reducing the odds of pregnancy, to less than one per cent per year. However, since many couples do not use the method perfectly, the typical-use pregnancy rate is closer to 25 percent.
• These methods are almost cost-free except for a basal body thermometer and perhaps a menstrual calendar.
• They do not involve the use of any medication so no side-effects occur.
• They help women become more aware of their cycles and related physiological changes.
• Couples can either plan for achieving or avoiding a pregnancy using their awareness of the woman’s fertility pattern.
• Women are able to better recognize abnormalities in their menstrual cycles and reproductive systems as a result of greater awareness of their bodies.
• It promotes communication and responsibility-sharing within couples.
• It is acceptable within all cultures and religious groups.
• There are no medical contraindications as such.
• It does not require the input of a healthcare provider but leaves fertility within the couple’s control.

Disadvantages

NFP is a process which has its own negatives, if the couple considers them to be such:

• It is a couple-centered process so both partners need to agree to use these methods.
• They do not protect the couple against sexually transmitted infections (STIs). Where appropriate, couples must use condoms or other barrier methods as well.
• Couples require careful observation and training for accurate recording, for a few months, before they can be used reliably to predict fertile days. This is more difficult but still quite possible with irregular cycles.
• Time and effort must be invested to observe and accurately record fertility indicators, which may not be possible for busy women.
• The coitus interruptus method has a high failure rate and puts great stress upon the male partner to remember to remove the penis just before ejaculation. Viable sperm may be present in the fluid that escapes before ejaculation, and sperms may also swim up from just outside the vagina to cause fertilization.

RECENT STUDY

India, the second most populous country of the world, harbors 17.5% of the world’s population in only 2.4% of the global land mass. Coincidentally it also houses almost 17.3% of the world’s protected couples and 20% of world’s eligible couples with unmet need. Therefore, large population size of India not only impacts its own but also the global health indicators.

India became the first country in the world to initiate the family planning program in 1952 with the goal of lowering fertility and slowing the population growth rate.

Since October 1997, the services and interventions under the Family Welfare Program and the Child Survival and Safe Motherhood Program have been integrated with the Reproductive and Child Health (RCH) Program, addressing aspects such as client choice, service quality, gender issues and underserved groups, including adolescents.

In 2012 the ‘London Summit on Family Planning’ was held against this backdrop to bring back the focus on family planning globally. It further paved the way for increased investment (by countries, national/international agen­cies, academia, and the private sector) in expanding access to family planning services and knowledge mechanisms to an additional 120 million women and girls in the world’s poorest countries by 2020.

As a subsequent action, the Government of India adopted a new approach, which places a well-defined focus to the family planning efforts under a larger and more comprehensive umbrella of RMNCH+A (Reproductive, Maternal, Newborn and Child Health and Adolescents) program. This paradigm shift was adopted recognizing the need and long-term goal of addressing a target free approach (beyond the simple strategy of achieving population stabilization), under the larger purview of improving maternal and child (and adolescent) health in India.

Since then, the country has accelerated its interventions to focus on the rollout of new contraceptives, institutionalization of fixed day services with aggressive focus on quality in family planning, revitalizing Postpartum and Post Abortion Family Planning services, enhanced focus on male participation, and community based schemes through ASHAs, streamlining and strengthening commodity security, Public Private Partnership etc. The government is also harnessing the expertise of various partners in the field of advocacy, capacity building, IEC and BCC through a new focused communications campaign, programme management, quality improvement, evaluation and assessments, feasibility studies, development of resource material and E- learning modules, software development, social marketing, social franchising and provision of skilled human resource for successful implementation of the programme.

INTRODUCTION-

Natural family planning is a form of birth control that doesn’t involve pills or devices. As a result, you don’t have side effects.

With these methods, you track your fertility, which is when you are most likely to get pregnant.

Usually, a woman releases an egg from her ovaries at about the same time each month. That’s called ovulation. The egg moves through the fallopian tubes toward the uterus. An unfertilized egg can live up to 24 hours.

Most women are fertile for about 6 days each month — 5 before ovulation and the day of ovulation. Natural family planning uses different methods to pinpoint those fertility days.

According to the Centers for Disease Control and Prevention (CDC), family planning is one of the 10 great public health achievements of the twentieth century, on a par with such accomplishments as vaccination and advances in motor vehicle safety (CDC, 1999). The ability of individuals to determine their family size and the timing and spacing of their children has resulted in significant improvements in health and in social and economic well-being (IOM, 1995). Smaller families and increased child spacing have helped decrease rates of infant and child mortality, improve the social and economic conditions of women and their families, and improve maternal health. Contemporary family planning efforts in the United States began in the early part of the twentieth century. By 1960, modern contraceptive methods had been developed, and in 1970 federal funding for family planning was enacted through the Title X program, the focus of this report.

This chapter provides an overview of family planning in the United States. It begins by explaining the importance of family planning services and the crucial needs they serve. Next is a review of milestones in family planning, including its legislative history. The third section provides data on the use of family planning services. This is followed by a discussion of the changing context in which these services are provided, including changes in the populations served by Title X, changes in technology and costs, the growing evidence base for reproductive health services, and social and cultural factors. The fifth section addresses the financing of family planning. The final section presents conclusions.

TYPES-

You can use natural family planning to control pregnancy in several ways:

Rhythm method. One of the oldest ways of natural family planning, this is based simply on the calendar. A woman’s normal menstrual cycle lasts between 28 and 32 days. Ovulation usually happens around day 14. So you would avoid unprotected sex on days 8 through 19, since that’s when you’re most fertile.

Cervical mucus or ovulation method. Here, you track the mucus your cervix makes. When you’re ovulating, your mucus is clear, stretchy, and wet, like raw egg whites. You write down what your mucus is like each day so you know when you’re ovulating.

Basal body temperature (BBT) method. Your temperature can rise between 0.5 and 1 degree when you ovulate and stay there until your next period. With this method, you take your temperature before you get out of bed each morning, before you have anything to eat or drink. BBT by itself isn’t a good way to prevent pregnancy because charting your temperature tells you when ovulation has already happened.

Symptothermal method. With this, you combine several methods, usually BBT and cervical mucus. Using more than one method can give you a better idea what’s going on in your body

How Effective Is It?

Natural family planning isn’t as effective as other methods of birth control. According to the CDC, the failure rate is 24%. That means about 1 in 4 women who use natural family planning will get pregnant.

You need to be careful, diligent, and have plenty of self-control to practice natural family planning. You have to follow instructions completely to be successful.

Benefits

Natural family planning is free. There are also no side effects. You can stop anytime and it won’t have an impact on your body. It also meets most religious guidelines.

Apps can help you track your fertility, which can make things easier.

Once you’ve learned a method, you don’t have to keep going to a doctor for refills or follow-up appointments.

RISK-

Natural family planning requires you to keep track of your body and stick to a schedule. It may not be for you if you have irregular periods or if you are breastfeeding.

Talk to your doctor or gynecologist if you have questions about these methods or to see if natural family planning might work for you.

Social and Cultural Factors

The many guidelines identified above reflect the recognition that effective family planning requires more than the existence of effective biomedical interventions. Family planning by nature requires close attention to social and cultural factors as well. Women and men may experience a number of sociocultural barriers to accessing family planning services, including distance to a family planning provider, difficulty in arranging transportation, limited days and hours of service operation, costs to receive services, long waiting times either to schedule an appointment or to be seen by a provider, poor quality of care, concerns about confidentiality, language barriers for those with limited English proficiency, lack of awareness of the availability of services, and perceived or real cost barriers (discussed further below) (Bertrand et al., 1995; Brindis et al., 2003).

Women in rural areas may have particular difficulty finding and obtaining family planning services (Frost et al., 2001). Some special populations, such as homeless women (Wenzel et al., 2001) and those who are incarcerated, may be especially likely to face access and cost barriers. Among teenagers, concern about confidentiality is the most significant barrier to obtaining family planning services (NRC, 2008). Additional barriers for adolescents may include community disapproval of their use of family planning, stigma related to obtaining contraceptives, lack of knowledge about the existence of publicly funded clinics, a perceived lack of affordable services, ambivalence, a history of sexual abuse, and fears of side effects (Frost and Kaeser, 1995; Brindis et al., 2003).

Medical barriers can also inhibit the use of family planning services. These barriers include service providers basing care decisions on outdated information or contraindications (IUDs, for example, are underutilized in the United States in part because of outdated information regarding the risks of this contraceptive method [Morgan, 2006]); process or scheduling impediments, such as physical exams that clients must undergo before receiving contraceptives; service provider qualifications or regulations that unnecessarily limit the types of personnel who can provide a service; provider bias toward a particular method or procedure; inappropriate management of side effects; and regulatory barriers (Bertrand et al., 1995).

IMPORTANT-

For many women, a family planning clinic is their entry point into the health care system and one they consider their usual source of care. In 2015, publicly funded family planning services helped prevent 1.9 million unintended pregnancies, including 440,000 teen pregnancies.

Unintended pregnancies include pregnancies that are reported by women as being mistimed or unwanted. Almost half (45%) of the 6.1 million annual pregnancies in the United States are unintended. Unintended pregnancies are associated with many negative health and economic consequences. The public cost of births resulting from unintended pregnancies was estimated at $21 billion in 2010 (this figure includes costs for prenatal care, labor and delivery, post-partum care, and 1 year of infant care).

For women, negative outcomes associated with unintended pregnancy can include:

• Delays in initiating prenatal care
• Reduced likelihood of breastfeeding
• Increased risk of maternal depression
• Increased risk of physical violence during pregnancy

Births resulting from unintended pregnancies can have negative consequences including birth defects and low birth weight.Children from unintended pregnancies are more likely to experience poor mental and physical health during childhood, and have lower educational attainment and more behavioral issues in their teen years.

The negative consequences associated with unintended pregnancies are greater for teen parents and their children. Eighty-two percent of pregnancies to mothers ages 15 to 19 are unintended. Twenty percent of all unintended pregnancies occur among teens. Teen mothers:

• Are less likely to graduate from high school or attain a GED by the time they reach age 30
• Earn an average of approximately $3,500 less per year, when compared with those who delay childbearing until their 20s
• Receive nearly twice as much federal aid for nearly twice as long
• Similarly, early fatherhood is associated with lower educational attainment and lower income.The average annual cost of teen childbearing to U.S. taxpayers is estimated at $9.1 billion, or $1,430 for each teen mother per year. Moreover, children of teen parents are more likely to have lower cognitive attainment and exhibit more behavior problems.Sons of teen mothers are more likely to be incarcerated, and daughters are more likely to become adolescent mothers.

Emerging Issues in Family Planning

Many women of reproductive age can benefit from preconception care (care before pregnancy). Preconception care has been defined as a set of interventions designed to identify and reduce risks to a woman’s health and improve pregnancy outcomes through prevention and management of health conditions. Preconception care can significantly reduce birth defects and disorders caused by preterm birth.

Elements of preconception care should be integrated into every primary care visit for women of reproductive age. Preconception care must not be limited to a single visit to a health care provider, but should rather be a process of care designed to meet the needs of an individual. As part of comprehensive preconception care, providers should encourage patients to develop a reproductive life plan. A reproductive life plan is a set of goals and action steps based on personal values and resources about whether and when to become pregnant and have (or not have) children. Providers also must educate patients about how their reproductive life plan impacts contraceptive and medical decision-making.

Increased awareness of the importance of preconception care can be achieved through public outreach and improved collaboration between health care providers. Currently, only 30.3% of women report receiving pre-pregnancy health counseling. Future efforts should promote research to further define the evidence-based standards of preconception care, determine its cost-effectiveness, and improve tracking of the proportion of women obtaining these services.

Social and Cultural Factors

The many guidelines identified above reflect the recognition that effective family planning requires more than the existence of effective biomedical interventions. Family planning by nature requires close attention to social and cultural factors as well. Women and men may experience a number of sociocultural barriers to accessing family planning services, including distance to a family planning provider, difficulty in arranging transportation, limited days and hours of service operation, costs to receive services, long waiting times either to schedule an appointment or to be seen by a provider, poor quality of care, concerns about confidentiality, language barriers for those with limited English proficiency, lack of awareness of the availability of services, and perceived or real cost barriers (discussed further below) (Bertrand et al., 1995; Brindis et al., 2003).

Women in rural areas may have particular difficulty finding and obtaining family planning services (Frost et al., 2001). Some special populations, such as homeless women (Wenzel et al., 2001) and those who are incarcerated, may be especially likely to face access and cost barriers. Among teenagers, concern about confidentiality is the most significant barrier to obtaining family planning services (NRC, 2008). Additional barriers for adolescents may include community disapproval of their use of family planning, stigma related to obtaining contraceptives, lack of knowledge about the existence of publicly funded clinics, a perceived lack of affordable services, ambivalence, a history of sexual abuse, and fears of side effects (Frost and Kaeser, 1995; Brindis et al., 2003).

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

INTRODUCTION-

Ataxia describes a lack of muscle control or coordination of voluntary movements, such as walking or picking up objects. A sign of an underlying condition, ataxia can affect various movements and create difficulties with speech, eye movement and swallowing.

Persistent ataxia usually results from damage to the part of your brain that controls muscle coordination (cerebellum). Many conditions can cause ataxia, including alcohol misuse, certain medication, stroke, tumor, cerebral palsy, brain degeneration and multiple sclerosis. Inherited defective genes also can cause the condition.

Treatment for ataxia depends on the cause. Adaptive devices, such as walkers or canes, might help you maintain your independence. Physical therapy, occupational therapy, speech therapy and regular aerobic exercise also might help.

Ataxia is a movement disorder caused by problems in the brain. When you have ataxia, you have trouble moving parts of your body the way you want. Or the muscles in your arms and legs might move when you don’t want them to. The word ataxia actually means “without coordination.”

Ataxia isn’t a disorder or a disease itself — it’s a sign of other underlying disorders or diseases. Doctors have discovered anywhere from 50 to 100 different ataxias. They are grouped into categories based on what causes them, or based on which part of the body they affect.

Ataxia is typically defined as the presence of abnormal, uncoordinated movements. This usage describes signs & symptoms without reference to specific diseases. An unsteady, staggering gait is described as an ataxic gait because walking is uncoordinated and appears to be ‘not ordered’. Many motor activities may be described as ataxic if they appear to others, or are perceived by patients, as uncoordinated.

Ataxia can also refer to a group of neurological disorders in which motor behavior appears uncoordinated. Walking, speaking clearly, swallowing, writing, reading, and other activities that require fine motor control may be abnormal in patients with ataxia. Ataxia may result from abnormalities in different parts of the nervous system or different parts of the body, such as ataxic movements due to orthopedic injuries or pain from arthritis or muscle injury.

TYPES-

Ataxia is caused by damage to different areas of the central nervous system. Doctors categorize it by the specific part of the brain most affected, including:

• Cerebellar (brain)
• Sensory (nerves)
• Vestibular (ears)

Cerebellar Ataxia

Your cerebellum is the part of your brain that’s in charge of balance and coordination. If part of your cerebellum starts to wear away, you can develop cerebellar ataxia. Sometimes it can also affect your spinal cord. It’s the most common form of ataxia.

Symptoms of cerebellar ataxia include:

• Changes in your voice
• Dizziness
• Fatigue
• Headaches
• Muscle tremors
• Slurred speech
• Trouble walking
• Wide gait

Sensory Ataxia

Sensory ataxia is the result of damage to nerves in your spinal cord or your peripheral nervous system. That is the part of your nervous system outside of the brain and spinal cord.

When you have sensory ataxia, you have less sensation in your feet and legs from the nerve damage, so you have less feedback from your brain telling you where your body is in relation to the ground. It’s also called proprioceptive ataxia.

Symptoms of sensory ataxia include:

• Difficulty touching your finger to your nose with closed eyes
• Inability to sense vibrations
• Trouble walking in dim light
• Walking with a “heavy step,” or stomping when you walk

Vestibular Ataxia

Vestibular ataxia affects your vestibular system. This system is made up of your inner ear and ear canals, which contain fluid. They sense the movements of your head and help with your balance and spatial orientation.

When the nerves in your vestibular system are affected, you can have the following problems:

• Blurred vision and other eye issues
• Nausea and vomiting
• Problems standing and sitting
• Staggering when you walk
• Trouble walking in a straight line
• Vertigo, or dizziness

CAUSES-

Around 150,000 people in the U.S. deal with some form of ataxia. There are different causes for it. Some are genetic, some are acquired, like injuries, and some have no known clear cause.

Genetic. You can inherit a certain mutated, or changed, gene from one or both of your parents that causes ataxia. Or you may inherit a mutated gene that causes a disorder with ataxia as a symptom.

Some of the specific types of genetic ataxia include:

• Ataxia telangiectasia
• Ataxia with oculomotor apraxia
• Dominant spastic ataxias
• Dominant spinocerebellar ataxias (SCA)
• Episodic ataxia
• Friedreich’s ataxia
• Recessive spastic ataxias
• Wilson’s disease

Acquired. Acquired ataxia occurs when you have damage to your spinal cord or nerves. The damage might be from an injury or an illness.

Some of the causes of acquired ataxia could include:

• Brain tumors
• Brain hemorrhage (bleeding)
• Cerebral palsy
• Chickenpox
• Hydrocephalus, or too much fluid buildup in the brain
• Head trauma
• Multiple sclerosis
• Reactions to certain cancers
• Vitamin E or B12 deficiency

You can also get ataxia if you have a reaction to certain medications, from alcohol or drug use, or from exposure to poison.

Idiopathic. When you haven’t inherited a mutated gene or had an illness or injury that could have caused your ataxia, it’s called idiopathic ataxia. Your doctor will diagnose you with idiopathic ataxia if he can’t find a medical reason for your ataxia symptoms.

The most common idiopathic ataxia is called multiple system atrophy, or MSA. Doctors haven’t pinned down possible causes for this group of ataxias. They may come from a combination of environmental factors and genetic causes.

Damage, degeneration or loss of nerve cells in the part of your brain that controls muscle coordination (cerebellum), results in ataxia. Your cerebellum comprises two portions of folded tissue situated at the base of your brain near your brainstem. This area of the brain helps with balance as well as eye movements, swallowing and speech.

Diseases that damage the spinal cord and peripheral nerves that connect your cerebellum to your muscles also can cause ataxia. Ataxia causes include:

• Head trauma. Damage to your brain or spinal cord from a blow to your head, such as might occur in a car accident, can cause acute cerebellar ataxia, which comes on suddenly.
• Stroke. Either a blockage or bleeding in the brain can cause ataxia. When the blood supply to a part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients, brain cells die.
• Cerebral palsy. This is a general term for a group of disorders caused by damage to a child’s brain during early development — before, during or shortly after birth — that affects the child’s ability to coordinate body movements.
• Autoimmune diseases. Multiple sclerosis, sarcoidosis, celiac disease and other autoimmune conditions can cause ataxia.
• Infections. Ataxia can be an uncommon complication of chickenpox and other viral infections such as HIV and Lyme disease. It might appear in the healing stages of the infection and last for days or weeks. Normally, the ataxia resolves over time.
• Paraneoplastic syndromes. These are rare, degenerative disorders triggered by your immune system’s response to a cancerous tumor (neoplasm), most commonly from lung, ovarian, breast or lymphatic cancer. Ataxia can appear months or years before the cancer is diagnosed.
• Abnormalities in the brain. An infected area (abscess) in the brain may cause ataxia. A growth on the brain, cancerous (malignant) or noncancerous (benign), can damage the cerebellum.
• Toxic reaction. Ataxia is a potential side effect of certain medications, especially barbiturates, such as phenobarbital; sedatives, such as benzodiazepines; antiepileptic drugs, such as phenytoin; and some types of chemotherapy. Vitamin B-6 toxicity also may cause ataxia. These causes are important to identify because the effects are often reversible. Also, some medications you take can cause problems as you age, so you might need to reduce your dose or discontinue the medication. Alcohol and drug intoxication; heavy metal poisoning, such as from lead or mercury; and solvent poisoning, such as from paint thinner, also can cause ataxia.
• Vitamin E, vitamin B-12 or thiamine deficiency. Not getting enough of these nutrients, because of the inability to absorb enough, alcohol misuse or other reasons, can lead to ataxia.
• Thyroid problems. Hypothyroidism and hypoparathyroidism can cause ataxia.
• COVID-19 infection. This infection may cause ataxia, most commonly in very severe cases.

For some adults who develop sporadic ataxia, no specific cause can be found. Sporadic ataxia can take a number of forms, including multiple system atrophy, a progressive, degenerative disorder.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Hereditary ataxias

Some types of ataxia and some conditions that cause ataxia are hereditary. If you have one of these conditions, you were born with a defect in a certain gene that makes abnormal proteins.

The abnormal proteins hamper the function of nerve cells, primarily in your cerebellum and spinal cord, and cause them to degenerate. As the disease progresses, coordination problems worsen.

You can inherit a genetic ataxia from either a dominant gene from one parent (autosomal dominant disorder) or a recessive gene from each parent (autosomal recessive disorder). In the latter case, it’s possible neither parent has the disorder (silent mutation), so there might be no obvious family history.

Different gene defects cause different types of ataxia, most of which are progressive. Each type causes poor coordination, but each has specific signs and symptoms.

Autosomal dominant ataxias

These include:

• Spinocerebellar ataxias. Researchers have identified more than 40 autosomal dominant ataxia genes, and the number continues to grow. Cerebellar ataxia and cerebellar degeneration are common to all types, but other signs and symptoms, as well as age of onset, differ depending on the specific gene mutation.
• Episodic ataxia (EA). There are eight recognized types of ataxia that are episodic rather than progressive — EA1 through EA7, plus late-onset episodic ataxia. EA1 and EA2 are the most common. EA1 involves brief ataxic episodes that may last seconds or minutes. The episodes are triggered by stress, being startled or sudden movement, and often are associated with muscle twitching. EA2 involves longer episodes, usually lasting from 30 minutes to six hours, which also are triggered by stress. You might have dizziness (vertigo), fatigue and muscle weakness during your episodes. In some cases, symptoms resolve in later life. Episodic ataxia doesn’t shorten life span, and symptoms might respond to medication.

Autosomal recessive ataxias

These include:

• Friedreich’s ataxia. This common hereditary ataxia involves damage to your cerebellum, spinal cord and peripheral nerves. Peripheral nerves carry signals from your brain and spinal cord to your muscles. In most cases, signs and symptoms appear well before age 25. The rate of disease progression varies. The first indication generally is difficulty walking (gait ataxia). The condition typically progresses to the arms and trunk. Muscles weaken and waste away over time, causing deformities, particularly in your feet, lower legs and hands. Other signs and symptoms that might develop as the disease progresses include slow, slurred speech (dysarthria); fatigue; rapid, involuntary eye movements (nystagmus); spinal curvature (scoliosis); hearing loss; and heart disease, including heart enlargement (cardiomyopathy) and heart failure. Early treatment of heart problems can improve quality of life and survival.
• Ataxia-telangiectasia. This rare, progressive childhood disease causes degeneration in the brain and other body systems. The disease also causes immune system breakdown (immunodeficiency disease), which increases susceptibility to other diseases, including infections and tumors. It affects various organs. Telangiectasia is the formation of tiny red “spider” veins that might appear in the corners of your child’s eyes or on the ears and cheeks. Delayed motor skill development, poor balance and slurred speech are typically the first indications of the disease. Recurrent sinus and respiratory infections are common. Children with ataxia-telangiectasia are at high risk of developing cancer, particularly leukemia or lymphoma. Most people with the disease need a wheelchair by their teens and die before age 30, usually of cancer or lung (pulmonary) disease.
• Congenital cerebellar ataxia. This type of ataxia results from damage to the cerebellum that’s present at birth.
• Wilson’s disease. People with this condition accumulate copper in their brains, livers and other organs, which can cause neurological problems, including ataxia. Early identification of this disorder can lead to treatment that will slow progression.

SYMPTOM-

Ataxia can develop over time or come on suddenly. A sign of a number of neurological disorders, ataxia can cause:

• Poor coordination
• Unsteady walk and a tendency to stumble
• Difficulty with fine motor tasks, such as eating, writing or buttoning a shirt
• Change in speech
• Involuntary back-and-forth eye movements (nystagmus)
• Difficulty swallowing

When to see a doctor

If you aren’t aware of having a condition that causes ataxia, such as multiple sclerosis, see your doctor as soon as possible if you:

• Lose balance
• Lose muscle coordination in a hand, arm or leg
• Have difficulty walking
• Slur your speech
• Have difficulty swallowing

TREATMENT-

The best treatment for your ataxia symptoms depends on the type you have. There is no specific treatment for ataxia itself. If your ataxia is a symptom of another disorder, your doctor will treat that disorder.

If it’s due to a cause that you can avoid, like lack of vitamins or exposure to poison, your doctor will help you address the problem causing the ataxia.

In order to help you cope with your symptoms, your doctor may recommend:

• Counseling
• Physical or occupational therapy
• Speech therapy
• Support groups

Your doctor can also help you find tools so you can move around easier, such as a cane or a walker. There are also utensils to help you eat and speak more easily.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

INTRODUCTION –

Spinal muscular atrophy (SMA) most often affects babies and children and makes it hard for them to use their muscles. When your child has SMA, there’s a breakdown of the nerve cells in the brain and spinal cord. The brain stops sending messages that control muscle movement.

When that happens, your child’s muscles get weak and shrink, and children can have trouble controlling head movement, sitting without help, and even walking. In some cases, they can have trouble swallowing and breathing as the disease gets worse.

There are different types of SMA, and how serious it is depends on which type your child has. There’s no cure, but treatments can improve some symptoms and, in some cases, help your child live longer. Researchers are working to find new ways to fight the disease.

Keep in mind that every child or adult who has SMA will have a different experience. No matter how much your child’s movement is limited, the disease doesn’t affect their intelligence in any way. They will still be able to make friends and socialize.

Spinal muscular atrophy (SMA) is a genetic disease affecting the central nervous system, peripheral nervous system, and voluntary muscle movement (skeletal muscle).

Most of the nerve cells that control muscles are located in the spinal cord, which accounts for the word spinal in the name of the disease. SMA is muscular because its primary effect is on muscles, which don’t receive signals from these nerve cells. Atrophy is the medical term for getting smaller, which is what generally happens to muscles when they’re not stimulated by nerve cells.

SMA involves the loss of nerve cells called motor neurons in the spinal cord and is classified as a motor neuron disease.

In the most common form of SMA (chromosome 5 SMA, or SMN-related SMA), there is wide variability in age of onset, symptoms, and rate of progression. In order to account for these differences, chromosome 5-related SMA, which often is autosomal recessive, is classified into types 1 through 4.

The age at which SMA symptoms begin roughly correlates with the degree to which motor function is affected: The earlier the age of onset, the greater the impact on motor function. Children who display symptoms at birth or in infancy typically have the lowest level of functioning (type 1). Later-onset SMA with a less severe course (types 2 and 3, and in teens or adults, type 4) generally correlates with increasingly higher levels of motor function.

CAUSES-

Chromosome 5 SMA is caused by a deficiency of a motor neuron protein called SMN, for “survival of motor neuron.” This protein, as its name implies, seems to be necessary for normal motor neuron function. SMN plays a pivotal role in gene expression in motor neurons. Its deficiency is caused by genetic flaws (mutations) on chromosome 5 in a gene called SMN1. The most common mutation in the SMN1 gene within patients diagnosed with SMA is a deletion of a whole segment, called exon 7.Neighboring SMN2 genes can in part compensate for nonfunctional SMN1 genes as there is 99% identity between these two genes.

Other rare forms of SMA (non-chromosome 5) are caused by mutations in genes other than SMN1.

SMA is a disease that’s passed down through families. If your child has SMA, it’s because they have two copies of a broken gene, one from each parent.

When this happens, their body won’t be able to make a specific kind of protein. Without it, the cells that control muscles die.

If your child gets a faulty gene from just one of you, they won’t get SMA but will be a carrier of the disease. When your child grows up, they could pass the broken gene to their own child.

TYPES-

There are four different types of spinal muscular atrophy. The classification is determined by the developmental milestones the child has hit by the time of the disease onset. Types I and II are the most common.

The types of spinal muscular atrophy (SMA) are:

• Type 1 (severe) SMA: This type is also called Werdnig-Hoffmann Disease. It is the most severe and the most common type of SMA. It is usually evident at birth, or in the first few months afterwards (0-6 months). Symptoms include floppy limbs and weak trunk movement. Children with this type usually have very limited ability to move. They will also have a hard time feeding and swallowing, holding their head up, and breathing. Type 1 SMA progresses rapidly, with the weakening of muscles leading to frequent respiratory infections and usually death by the age of 2. Infants with SMA type 1 can never sit.
• Type 2 (intermediate) SMA: Symptoms usually appear between the ages of 7 to 18 months. The rate of progression can vary greatly. The disease affects the child’s legs more than his or her arms. Children with SMA type 2 can never stand. Respiratory infections are also common with this type of SMA. Life expectancy can range from early childhood to adulthood, depending on the severity of the patient’s condition.
• Type 3 (mild) SMA: This type of SMA is also called Kugelberg-Welander or Juvenile Spinal Muscular Atrophy. Symptoms can first appear during a wide range of years, from 18 months to early adulthood. Patients with Type 3 SMA can stand and walk, but may have trouble getting up from sitting position. They may also experience mild muscle weakness and are at greater risk for respiratory infections. Most patients with Type 3 SMA have a life expectancy close to normal.
• Type 4 (adult) SMA: Symptoms for this rare type of SMA do not usually emerge until the second or third decade of life. Patients with Type 4 SMA can walk during adulthood but will usually experience slowly progressive muscle weakness and other typical SMA symptoms.

SYMPTOM-

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

SMA symptoms cover a broad spectrum, ranging from mild to severe.

The primary symptom of chromosome 5-related (SMN-related) SMA is weakness of the voluntary muscles. The muscles most affected are those closest to the center of the body, such as those of the shoulders, hips, thighs, and upper back. The lower limbs seem to be affected more than the upper limbs, and deep tendon reflexes are decreased.

Special complications occur if the muscles used for breathing and swallowing are affected, resulting in abnormalities in these functions. If the muscles of the back weaken, spinal curvatures can develop.

There’s a great deal of variation in the age of onset and level of motor function achieved in chromosome 5-related SMA. These are roughly correlated with how much functional SMN protein is present in the motor neurons, which in turn correlates with how many copies of SMN2 genes a person has. Sensory, mental, and emotional functioning are entirely normal in chromosome-5 SMA.

Some forms of SMA are not linked to chromosome 5 or SMN deficiency. These forms vary greatly in severity and in the muscles most affected. While most forms, like the chromosome 5-related form, affect mostly the proximal muscles, other forms exist that affect mostly the distal muscles (those farther away from the body’s center) — at least in the beginning.

DIAGNOSIS-

Spinal muscular atrophy is usually diagnosed through a blood test to check for the presence of the SMN1 gene (genetic testing). This gene will be missing in about 95 percent of those with SMN-related SMA. In the other 5 percent, the gene will appear mutated. Your doctor will order this test if he or she suspects that your child might have SMA based on his or her symptoms and other diagnostic work up. Your doctor may order an electrical study called EMG (electromyography) or perform a muscle biopsy to confirm the diagnosis of SMA.

TREATMENT-

There is currently no cure for spinal muscular atrophy. Treatment for children affected with SMA is focused on treating their symptoms, preventing complications, and improving their quality of life. Your doctor will be able to determine the best treatment for your child based on the type of SMA, the severity of the condition, and his or her age.

For those with Type 1 SMA, treatments can include feeding tubes and ventilators and other forms of respiratory assistance. Physical therapy may also benefit patients with Type 1 SMA. Many patients with this type of spinal muscular atrophy may spend most of their lives in the hospital. At some point, parents may be asked to make very difficult decisions about the use of life-sustaining devices for their child.

Your doctor or the hospital’s social services department should be able to put you in touch with support groups such as Cure SMA for help in dealing with these extremely difficult decisions.

For those with Type 2 and Type 3 SMA, treatments may include orthopedic braces, wheelchairs, and physical and occupational therapies.

It is important to remember that the brains of those with spinal muscular atrophy develop normally. Many patients with SMA are highly intelligent and sociable. Talking to them, playing games, and providing other forms of mental stimulation can aid the emotional and physical lives of these children.

Spinal Muscular Atrophy Treatment

The FDA has approved two medications to treat SMA: nusinersen (Spinraza) and onasemnogene abeparvovec-xioi (Zolgensma). Both are forms of gene therapy that affect the genes involved in SMA. The SMN1 and SMN2 genes give your body instructions for making a protein that helps with controlling muscle movement.

• Nusinersen. This treatment adjusts the SMN2 gene and lets it make more protein. It’s used for both children and adults with SMA. Your child’s medical team will inject the drug into the fluid around their spinal cord. Including preparation and recovery time, this can take at least 2 hours and will need to be done several times, followed by another dose every 4 months. Studies show it helps about 40% of people who use it by making them stronger and slowing the disease.
• Onasemnogene abeparvovec-xioi. This involves replacing the problem SMN1 gene. It’s used for children under 2 years old. Your child’s medical team will put a tiny tube called a catheter directly into a vein in their arm or hand (an IV). Then, they’ll send a copy of the SMN gene through the tube into a specific group of motor neuron cells. This will need to be done only one time. In studies, onasemnogene abeparvovec-xioi helped children with SMA reach certain developmental milestones faster, like controlling their heads or sitting without support.

Besides gene therapy, your doctor may suggest a few other ways to help manage symptoms:

• Breathing. With SMA, especially types 1 and 2, weak muscles keep air from moving easily in and out of the lungs. If this happens to your child, they may need a special mask or mouthpiece. For severe problems, your child may use a machine that helps them breathe.
• Swallowing and nutrition. When muscles in the mouth and throat are weak, babies and children with SMA can have a hard time sucking and swallowing. In that situation, your child may not get good nutrition and may have trouble growing. Your doctor may suggest working with a nutritionist. Some babies may need a feeding tube.
• Movement. Physical and occupational therapy, which use exercises and regular daily activities, can help protect your child’s joints and keep muscles strong. A therapist may suggest leg braces, a walker, or an electric wheelchair. Special tools can control computers and phones and help with writing and drawing.
• Back issues. When SMA starts in childhood, children can get a curve in their spine. A doctor may suggest that your child wear a back brace while their spine is still growing. When they’ve stopped growing, they may have surgery to fix the problem.

Caring for Your Child With Spinal Muscular Atrophy

There’s a lot you can do as a family to help your child with some of the basic tasks of daily life. A team of doctors, therapists, and support groups can help you with your child’s care and let them keep up with friendships and activities with your family.

Your child will probably need lifelong care from different types of doctors. They may need to see:

• Pulmonologists, doctors who treat lungs
• Neurologists, specialists in nerve problems
• Orthopedists, doctors who treat bone problems
• Gastroenterologists, specialists in stomach disorders
• Nutritionists, experts in the way food affects your child’s health
• Physical therapists, people trained in using exercise to improve your child’s motion This team can help you make decisions about your child’s health. It’s important not to let yourself get overwhelmed by the task of managing care. Check for support groups that can let you share your experiences with others who are in similar situations.

PROGNOSIS-

Many scientists and clinicians are working hard to improve our understanding of this disease and improve the survival and quality of life of the SMA patient. Recent discoveries of the genes involved in SMA and the role(s) of these genes in maintaining the health of the motor neurons along with new developments in molecular medicine provide hope for better treatment strategies in this group of diseases. Research is now focused on strategies to enhance production of SMN protein through different approaches.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

INTRODUCTION-

Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (central nervous system).

In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause permanent damage or deterioration of the nerves.

Signs and symptoms of MS vary widely and depend on the amount of nerve damage and which nerves are affected. Some people with severe MS may lose the ability to walk independently or at all, while others may experience long periods of remission without any new symptoms.

There’s no cure for multiple sclerosis. However, treatments can help speed recovery from attacks, modify the course of the disease and manage symptoms.

Multiple sclerosis is a chronic disease that affects the central nervous system, especially the brain, spinal cord, and optic nerves. This can lead to a wide range of symptoms throughout the body.

It is not possible to predict how multiple sclerosis (MS) will progress in any individual.

Some people have mild symptoms, such as blurred vision and numbness and tingling in the limbs. In severe cases, a person may experience paralysis, vision loss, and mobility problems. However, this is rare.

It is difficult to know precisely how many people have MS. According to the National Institute for Neurological Disorders and Stroke (NINDS), 250,000–350,000 people in the United States are living with MS.

The National Multiple Sclerosis Society estimate the number could be closer to 1 million.

However, new treatments are proving effective at slowing the disease.

What is MS?

Scientists do not know exactly what causes MS, but they believe it is an autoimmune disorder that affects the central nervous system (CNS). When a person has an autoimmune disease, the immune system attacks healthy tissue, just as it might attack a virus or bacteria.

In the case of MS, the immune system attacks the myelin sheath that surrounds and protects the nerve fibers, causing inflammation. Myelin also helps the nerves conduct electrical signals quickly and efficiently.

Multiple sclerosis means “scar tissue in multiple areas.”

When the myelin sheath disappears or sustains damage in multiple areas, it leaves a scar, or sclerosis. Doctors also call these areas plaques or lesions. They mainly affect:

• the brain stem
• the cerebellum, which coordinates movement and controls balance
• the spinal cord
• the optic nerves
• white matter in some regions of the brain

As more lesions develop, nerve fibers can break or become damaged. As a result, the electrical impulses from the brain do not flow smoothly to the target nerve. This means that the body cannot carry out certain functions.

Types of MS

There are four types of MS:

Clinically isolated syndrome (CIS): This is a single, first episode, with symptoms lasting at least 24 hours. If another episode occurs at a later date, a doctor will diagnose relapse-remitting MS.

Relapse-remitting MS (RRMS): This is the most common form, affecting around 85% of people with MS. RRMS involves episodes of new or increasing symptoms, followed by periods of remission, during which symptoms go away partially or totally.

Primary progressive MS (PPMS): Symptoms worsen progressively, without early relapses or remissions. Some people may experience times of stability and periods when symptoms worsen and then get better. Around 15% of people with MS have PPMS.

Secondary progressive MS (SPMS): At first, people will experience episodes of relapse and remission, but then the disease will start to progress steadily.

SYMPTOM-

Because MS affects the CNS, which controls all the actions in the body, symptoms can affect any part of the body.

The most common symptoms of MS are:

Muscle weakness: People may develop weak muscles due to lack of use or stimulation due to nerve damage.

Numbness and tingling: A pins and needles-type sensation is one of the earliest symptoms of MS that can affect the face, body, or arms and legs.

Lhermitte’s sign: A person may experience a sensation like an electric shock when they move their neck, known as Lhermitte’s sign.

Bladder problems: A person may have difficulty emptying their bladder or need to urinate frequently or suddenly (urge incontinence). Loss of bladder control is an early sign of MS.

Bowel problems: Constipation can cause fecal impaction, which can lead to bowel incontinence.

Fatigue: This can undermine a person’s ability to function at work or at home. Fatigue is one of the most common symptoms of MS.

Dizziness and vertigo: These are common problems, along with balance and coordination issues.

Sexual dysfunction: Both males and females may lose interest in sex.

Spasticity and muscle spasms: This is an early sign of MS. Damaged nerve fibers in the spinal cord and brain can cause painful muscle spasms, particularly in the legs.

Tremor: Some people with MS may experience involuntary quivering movements.

Vision problems: Some people may experience double or blurred vision, a partial or total loss of vision, or red-green color distortion. This usually affects one eye at a time. Inflammation of the optic nerve can result in pain when the eye moves. Vision problems are an early sign of MS.

Gait and mobility changes: MS can change the way people walk, because of muscle weakness and problems with balance, dizziness, and fatigue.

Emotional changes and depression: Demyelination and nerve-fiber damage in the brain can trigger emotional changes.

Learning and memory problems: These can make it difficult to concentrate, plan, learn, prioritize, and multitask.

Pain: Pain is a common symptom in MS. Neuropathic pain is directly due to MS. Other types of pain occur because of weakness or stiffness of muscles.

Less common symptoms include:

• headache
• hearing loss
• itching
• respiratory or breathing problems
• seizures
• speech disorders
• swallowing problems

There is also a higher risk of:

• urinary tract infections
• reduced activity and loss of mobility

These can impact a person’s work and social life.

In the later stages, people may experience changes in perception and thinking and sensitivity to heat.

MS affects individuals differently. For some, it starts with a subtle sensation, and their symptoms do not progress for months or years. Sometimes, symptoms worsen rapidly, within weeks or months.

A few people will only have mild symptoms, and others will experience significant changes that lead to disability. However, most people will experience times when symptoms worsen and then get better.

Lhermitte’s sign is a common symptom of MS that happens when a person moves their head.

When to see a doctor

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

See a doctor if you experience any of the above symptoms for unknown reasons.

Disease course

Most people with MS have a relapsing-remitting disease course. They experience periods of new symptoms or relapses that develop over days or weeks and usually improve partially or completely. These relapses are followed by quiet periods of disease remission that can last months or even years.

Small increases in body temperature can temporarily worsen signs and symptoms of MS, but these aren’t considered true disease relapses.

At least 50% of those with relapsing-remitting MS eventually develop a steady progression of symptoms, with or without periods of remission, within 10 to 20 years from disease onset. This is known as secondary-progressive MS.

The worsening of symptoms usually includes problems with mobility and gait. The rate of disease progression varies greatly among people with secondary-progressive MS.

Some people with MS experience a gradual onset and steady progression of signs and symptoms without any relapses, known as primary-progressive MS

RISK FACTOR-

Scientists do not really know what causes MS, but risk factors include:

Age: Most people receive a diagnosis between the ages of 20 and 40 years.

Sex: Most forms of MS are twice as likely to affect women than men.

Genetic factors: Susceptibility may pass down in the genes, but scientists believe an environmental trigger is also necessary for MS to develop, even in people with specific genetic features.

Smoking: People who smoke appear to be more likely to develop MS. They tend to have more lesions and brain shrinkage than non-smokers.

Infections: Exposure to viruses, such as Epstein-Barr virus (EBV), or mononucleosis, may increase a person’s risk of developing MS, but research has not shown a definite link. Other viruses that may play a role include human herpes virus type 6 (HHV6) and mycoplasma pneumonia.

Vitamin D deficiency: MS is more common among people who have less exposure to bright sunlight, which is necessary for the body to create vitamin D. Some experts think that low levels of vitamin D may affect the way the immune system works.

Vitamin B12 deficiency: The body uses vitamin B when it produces myelin. A lack of this vitamin may increase the risk of neurological diseases, such as MS.

Previous theories have included exposure to canine distemper, physical trauma, or aspartame, an artificial sweetener, but there is no evidence to support these

There is probably no single trigger for MS, but multiple factors may contribute.

COMPLICATION-

People with multiple sclerosis may also develop:

• Muscle stiffness or spasms
• Paralysis, typically in the legs
• Problems with bladder, bowel or sexual function
• Mental changes, such as forgetfulness or mood swings
• Depression
• Epilepsy

DIAGNOSIS-

The doctor will carry out a physical and neurological examination, ask about symptoms, and consider the person’s medical history.

No single test can confirm a diagnosis, so a doctor will use several strategies when deciding whether a person meets the criteria for a diagnosis.

These include:

• MRI scans of the brain and spinal cord, which may reveal lesions
• spinal fluid analysis, which may identify antibodies that suggest a previous infection
• an evoked potential test, which measures electrical activity in response to stimuli

Other conditions have symptoms that are similar to those of MS, so a doctor may suggest other tests to assess for other possible causes.

If the doctor diagnoses MS, they will need to identify what type it is and whether it is active or not. The person may need more tests in the future to assess for further changes.

There is no cure for MS, but treatment is available that can:

• slow the progression and reduce the number and severity of relapses
• relieve symptoms

Some people also use complementary and alternative therapies, but research does not always confirm the usefulness of these.

Medications to slow progression

Several disease-modifying therapies (DMTs) have approval from the Food and Drug Administration (FDA) for the relapsing forms of MS. These work by changing the way the immune system functions.

A doctor may give some of these by mouth, some by injection, and some as an infusion. How often the person needs to take them and whether or not they can do this at home will depend on the drug.

The following DMTs currently have approval:

Injectable medications

• interferon beta 1-a (Avonex and Rebif)
• interferon beta-1b (Betaseron and Extavia)
• glatiramer acetate: (Copaxone and Glatopa)
• peginterferon beta-1a) (Plegridy)

Oral medications

• teriflunomide (Aubagio)
• fingolimod (Gilenya)
• dimethyl fumarate (Tecfidera)
• mavenclad (cladribine)
• mayzent (siponimod)

Infused medications

• alemtuzumab (Lemtrada)
• mitoxantrone (Novantrone)
• ocrelizumab (Ocrevus)
• natalizumab (Tysabri)

Current guidelines recommend using these drugs from the early stages, as there is a good chance that they can slow the progression of MS, especially if the person takes them when symptoms are not yet severe.

Some drugs are more useful at specific stages. For example, a doctor may prescribe mitoxantrone at a later, more severe stage of MS.

A doctor will monitor how well a drug is working, as there may be adverse effects, and the same drugs do not suit everyone. New drug options coming onto the market are proving to be safer and more effective than some existing ones.

Adverse effects of immunosuppressant drugs include a higher risk of infections. Some medications may also harm the liver.

If a person notices adverse effects or if their symptoms get worse, they should seek medical advice.

Medications for relieving symptoms during a flare

Other drugs are useful when a person experiences a worsening of symptoms, during a flare. They will not need these drugs all the time.

Corticosteroids: These reduce inflammation and suppress the immune system. They can treat an acute flare-up of symptoms in certain types of MS. Examples include Solu-Medrol (methylprednisolone) and Deltasone (prednisone). Steroids can have adverse effects if a person uses them too often, and they are not likely to provide any long-term benefit.

Behavioral changes: If vision problems occur, a doctor may recommend resting the eyes from time to time or limiting screen time. A person with MS may need to learn to rest when fatigue sets in and to pace themselves so they can complete activities.

Problems with mobility and balance: Physical therapy and walking devices, such as a cane, may help. The drug dalfampridine (Ampyra) may also prove useful.

Tremor: A person may use assistive devices or attach weights to the limbs to reduce shaking. Medications may also help with tremors.

Fatigue: Getting enough rest and avoiding heat can help. Physical and occupational therapy can help teach people more comfortable ways to do things. Assistive devices, such as a mobility scooter, can help conserve energy. Medication or counseling may help boost energy by improving sleep.

Pain: A doctor may prescribe anticonvulsant or antispasmodic drugs or alcohol injections to relieve trigeminal neuralgia, a sharp pain that affects the face. Pain relief medication, such as gabapentin, may help with body pain. There are also medications to relieve muscle pain and cramping in MS.

Bladder and bowel problems: Some medications and dietary changes can help resolve these.

Depression: A doctor may prescribe a selective serotonin reuptake inhibitor (SSRI), as these are less likely to cause fatigue than other antidepressant drugs.

Cognitive changes: Donepezil, a drug for Alzheimer’s, may help some people.

Complementary and alternative therapies

The following may help with different aspects of MS:

• heat and massage treatment for pain
• acupuncture for pain and gait
• stress management to boost mood
• exercise to maintain strength and flexibility, reduce stiffness, and boost mood
• a healthful diet with plenty of fresh fruits, vegetables, and fiber
• quitting or avoiding smoking

Medical marijuana

Studies have suggested that cannabis may help relieve pain, muscle stiffness, and insomnia. However, there is not enough evidence to confirm this.

People should also note that:

• There is a difference between using street cannabis and medical cannabis.
• Not all forms of cannabis are legal in all states.

A person should ask their doctor for advice before using cannabis, as some forms can have adverse effects. Smoking cannabis is unlikely to be beneficial, and it may make symptoms worse.

Rehabilitation and physical therapy

Physical therapy can help with strength and flexibility.

Rehabilitation can help improve or maintain a person’s ability to perform effectively at home and work.

Programs generally include:

Physical therapy: This aims to provide the skills to maintain and restore maximum movement and functional ability.

Occupational therapy: The therapeutic use of work, self-care, and play may help maintain mental and physical function.

Speech and swallowing therapy: A speech and language therapist will carry out specialized training for those who need it.

Cognitive rehabilitation: This helps people manage specific problems in thinking and perception.

Vocational rehabilitation: This helps a person whose life has changed with MS to make career plans, learn job skills, get and keep a job.

Plasma exchange

Plasma exchange involves withdrawing blood from the individual, removing the plasma, replacing it with new plasma, and transfusing it back into the person.

This process removes the antibodies in the blood that are attacking parts of the person’s body, but whether it can help people with MS is unclear. Studies have produced mixed results.

Plasma exchange is usually only suitable for severe MS attacks.

Stem cell therapy

Scientists are looking into the use of stem cell therapy to regenerate various body cells and restore function to those who have lost it due to a health condition.

Researchers hope that one day, stem cell therapy techniques may be able to reverse the damage done by MS and restore functionality in the nervous system.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com