Letters to the Editor many hospitals meant specifically for operational requirements. The types of investigational parameters offered by different hospitals will also vary. In certain zonal hospitals, only a few super-specialists are posted but in some others, more superspecialists and even more specialists in the same general specialities are placed. In such circumstances, is there a yardstick to measure the OPD work load other than counting the total number? Measuring investigational load will also be equally difficult. Inspite of all the above difficulties, there is a strong need to develop such a yardstick to measure all functions of the hospital leading to the total work load in a simple way. Unless we do that, rationalisation of medical establishments will be a clerical exercise in futility. It may also help us to identify the type and number of
319 additional manpower requirement for an eventual revision of PE (Peace Establishment) of hospitals. A recent work done by Brig Sinha Committee (1) is a welcome step in this direction. It is suggested that institutions like Armed Forces Medical College, AMC Centre and School or interested individuals may undertake such studies. Till such time we may stay in the sulks. I have not recovered yet. Reference 1. Brig AK Sinha. A study report on redistribution of hospital beds in military hospitals, Mar 2002,18P. Col Tommy Varghese (Retd) Ex-Dir MS (OPP), DGMS (Army), Army HQ, New Delhi.
Tackling The Smoking Menace In The Army Dear Editor,
W
orld wide, tobacco use is the single most important preventable risk to human health, and probably is the single largest cause of premature death in adults [1]. Tobacco kills more than four million people every year, and is estimated to kill 8.4 million people every year by 2020 [2]. It is perceived that tobacco usage in the Army has not been adequately addressed or quantified. Hence, a cross sectional descriptive study aimed at eliciting information about usage and attitudes towards tobacco was carried out using a structured semi open ended questionnaire, based on standardized formats prepared by the World Health Organization [3], among officers attending training courses in a large cantonment (N = 50) in 1999. The study was intended to be a rapid epidemiological assessment to serve as a pointer for action in advocacy for change. The aim was to highlight the tobacco problem, and invoke introspection and debate on the actions that need to be taken by all responsible individuals to deal with the onslaught of tobacco. 26 officers (52%) were identified as ‘ever smokers’; of them tobacco was currently being smoked daily or used only occasionally by 7 (26.92%) and 9 (34.62%) participants respectively. All ‘ever smokers’ named cancers of various organs in the digestive and respiratory tract as the major disease caused by smoking. Despite this high level of awareness among the participants, continued usage of tobacco illustrates the gap between knowledge, attitude and practice. Most health consequences of smoking are not manifested until three to four decades after the onset of persistent smoking. Hence, efforts need to be made to encourage cessation activity irrespective of the age of the individual. Smoking cessation has immediate and substantial health benefits and dramatically reduces the risk of most smoking-related diseases [4]. More smokers in the younger service bracket were interested in quitting than those senior. While not statistically significant, it revealed the amenability to efforts directed at encouraging cessation of smoking. Of the participants in the study, those who smoked had invariably not been advised at any point of their service, by an AMC doctor to quit or cut down on use of tobacco. This is despite easy accessibility of health care facilities and an established system of compulsory Annual and Periodic Medical Examinations. This reveals an area where proactive efforts need to be initiated vigorously. Hence it is recommended that Authorized Medical Attendants must specifically screen all ranks for tobacco usage and provide advice to quit. MJAFI, Vol. 60, No. 3, 2004
Medical Officers must ask each of their patients whether they smoke, and provide proper information and counselling based on that history. Patients who are non-smokers should receive positive reinforcement for decreasing their risk of smoking-related disease. A smoking patient requires a more detailed history of why and how much he smokes, whether there have been efforts to quit, any respiratory symptoms or disease from smoking and a search for other risk factors which might increase the chance for that patient to develop cardiovascular disease, obstructive lung disease or lung cancer. Doctors should explain to every smoking patient the medical risks associated with smoking and the reduction in risk associated with smoking cessation [4]. Those who start to smoke in the teenage years are the most likely candidates for eventual nicotine dependence. Disease prevention thus may begin by educating soldiers and young officers in their formative years of service, before their views and outlook becomes well entrenched and rigid. On the issue of banning of usage / sale of tobacco products within the Army environment, 39 (78%) participants were of the opinion that a ban was justified. It was found that the younger officers were more favourably inclined to this ban. This identifies a target group which can be motivated to influence others behaviour, especially that of their subordinates. As a step in the correct direction from the public health perspective, all hospitals and medical establishments may be declared as ‘Non Smoking Zones’. A complete ban on smoking in other offices and workplaces may subsequently be enforced in the Army. This would need an enhanced effort at advocacy, targeting the officer cadre primarily. Smoking may further be banned in all air conditioned areas as also in common areas where other non smokers including those from the clerical staff are present. Awareness creation and encouraging social non acceptability are thus considered to be the keystones in the crusade against tobacco. References 1. Peto R, Lopez AD, Boreham J, Thun M. Mortality from tobacco in developed countries: Indirect estimation from national vital statistics. Lancet 1992;339:1268-78. 2. Murray CGL, Lopez AD. Alternative projections of mortality and disease by cause, 1990-2020: global burden of disease study. Lancet, 1997,349:1498-1504. 3. World Health Organization. Guidelines for controlling and
320
Letters to the Editor monitoring the tobacco epidemic. WHO Geneva 1998:1-190.
4. Smoking and Health: A Physician Responsibility. A Statement of the Joint Committee on Smoking and Health, American College of Chest Physicians, American Thoracic Society, Asia Pacific Society of Respirology, Canadian Thoracic Society, European Respiratory Society, International Union Against
Tuberculosis and Lung Disease. http://www.chestnet.org/ health.science.policy/smoking.html (Accessed on 31 May 2002). Maj MP Cariappa*, Lt Col Pushkar Singh+ * Deputy Assitant Director of Health, HQ 8 MTN Division (Med), C/o 56 APO, +Commanding Officer, SHO Jalandhar Cantt.
Events Calendar 9th-10th October, 2004 National Surgery Update 2004 Venue : Armed Forces Medical College Pune-411 040 Contact person : Col GL Tiwari Associate Professor Department of Surgery Armed Forces Medical College, Pune-411 040 Tel :- Mil : 6016
20th-25th November,2004 APCON-2004 Annual Conference of Pathologists and Microbiologists Venue : Armed Forces Medical College, Pune-411 040 Phone : 020-2630 6024, 020-2630 6025 E-mail : [email protected] Website : www.geocites.com / apcon_2004 Contact person : Col S K Nema Professor & Head, Department of Pathology, AFMC, Wannowori, Pune-411 040.
6th-7th November, 2004 National Anaesthesiology Conference & CME-2004 Venue : Armed Forces Medical College Pune-411 040 Contact person : Col AK Bhargava Professor & Head Department of Anaesthesiology & Critical Care Armed Forces Medical College Pune-411 040 Tel :- Mil: 6036,6232,6274 Mobile No: 020-31025726
27th-28th November, 2004 HOST-2004 ‘Haemorrhage in obstetrics’ and ‘Surgical techniques’ Contact : Organising Secretary Department of Obstetrics and Gynaecology Armed Forces Medical College Pune-411 040 Tel : 020-26306020, 020-26306021, Fax : 020-2687790 E-mail : [email protected]
MJAFI, Vol. 60, No. 3, 2004
319 additional manpower requirement for an eventual revision of PE (Peace Establishment) of hospitals. A recent work done by Brig Sinha Committee (1) is a welcome step in this direction. It is suggested that institutions like Armed Forces Medical College, AMC Centre and School or interested individuals may undertake such studies. Till such time we may stay in the sulks. I have not recovered yet. Reference 1. Brig AK Sinha. A study report on redistribution of hospital beds in military hospitals, Mar 2002,18P. Col Tommy Varghese (Retd) Ex-Dir MS (OPP), DGMS (Army), Army HQ, New Delhi.
Tackling The Smoking Menace In The Army Dear Editor,
W
orld wide, tobacco use is the single most important preventable risk to human health, and probably is the single largest cause of premature death in adults [1]. Tobacco kills more than four million people every year, and is estimated to kill 8.4 million people every year by 2020 [2]. It is perceived that tobacco usage in the Army has not been adequately addressed or quantified. Hence, a cross sectional descriptive study aimed at eliciting information about usage and attitudes towards tobacco was carried out using a structured semi open ended questionnaire, based on standardized formats prepared by the World Health Organization [3], among officers attending training courses in a large cantonment (N = 50) in 1999. The study was intended to be a rapid epidemiological assessment to serve as a pointer for action in advocacy for change. The aim was to highlight the tobacco problem, and invoke introspection and debate on the actions that need to be taken by all responsible individuals to deal with the onslaught of tobacco. 26 officers (52%) were identified as ‘ever smokers’; of them tobacco was currently being smoked daily or used only occasionally by 7 (26.92%) and 9 (34.62%) participants respectively. All ‘ever smokers’ named cancers of various organs in the digestive and respiratory tract as the major disease caused by smoking. Despite this high level of awareness among the participants, continued usage of tobacco illustrates the gap between knowledge, attitude and practice. Most health consequences of smoking are not manifested until three to four decades after the onset of persistent smoking. Hence, efforts need to be made to encourage cessation activity irrespective of the age of the individual. Smoking cessation has immediate and substantial health benefits and dramatically reduces the risk of most smoking-related diseases [4]. More smokers in the younger service bracket were interested in quitting than those senior. While not statistically significant, it revealed the amenability to efforts directed at encouraging cessation of smoking. Of the participants in the study, those who smoked had invariably not been advised at any point of their service, by an AMC doctor to quit or cut down on use of tobacco. This is despite easy accessibility of health care facilities and an established system of compulsory Annual and Periodic Medical Examinations. This reveals an area where proactive efforts need to be initiated vigorously. Hence it is recommended that Authorized Medical Attendants must specifically screen all ranks for tobacco usage and provide advice to quit. MJAFI, Vol. 60, No. 3, 2004
Medical Officers must ask each of their patients whether they smoke, and provide proper information and counselling based on that history. Patients who are non-smokers should receive positive reinforcement for decreasing their risk of smoking-related disease. A smoking patient requires a more detailed history of why and how much he smokes, whether there have been efforts to quit, any respiratory symptoms or disease from smoking and a search for other risk factors which might increase the chance for that patient to develop cardiovascular disease, obstructive lung disease or lung cancer. Doctors should explain to every smoking patient the medical risks associated with smoking and the reduction in risk associated with smoking cessation [4]. Those who start to smoke in the teenage years are the most likely candidates for eventual nicotine dependence. Disease prevention thus may begin by educating soldiers and young officers in their formative years of service, before their views and outlook becomes well entrenched and rigid. On the issue of banning of usage / sale of tobacco products within the Army environment, 39 (78%) participants were of the opinion that a ban was justified. It was found that the younger officers were more favourably inclined to this ban. This identifies a target group which can be motivated to influence others behaviour, especially that of their subordinates. As a step in the correct direction from the public health perspective, all hospitals and medical establishments may be declared as ‘Non Smoking Zones’. A complete ban on smoking in other offices and workplaces may subsequently be enforced in the Army. This would need an enhanced effort at advocacy, targeting the officer cadre primarily. Smoking may further be banned in all air conditioned areas as also in common areas where other non smokers including those from the clerical staff are present. Awareness creation and encouraging social non acceptability are thus considered to be the keystones in the crusade against tobacco. References 1. Peto R, Lopez AD, Boreham J, Thun M. Mortality from tobacco in developed countries: Indirect estimation from national vital statistics. Lancet 1992;339:1268-78. 2. Murray CGL, Lopez AD. Alternative projections of mortality and disease by cause, 1990-2020: global burden of disease study. Lancet, 1997,349:1498-1504. 3. World Health Organization. Guidelines for controlling and
320
Letters to the Editor monitoring the tobacco epidemic. WHO Geneva 1998:1-190.
4. Smoking and Health: A Physician Responsibility. A Statement of the Joint Committee on Smoking and Health, American College of Chest Physicians, American Thoracic Society, Asia Pacific Society of Respirology, Canadian Thoracic Society, European Respiratory Society, International Union Against
Tuberculosis and Lung Disease. http://www.chestnet.org/ health.science.policy/smoking.html (Accessed on 31 May 2002). Maj MP Cariappa*, Lt Col Pushkar Singh+ * Deputy Assitant Director of Health, HQ 8 MTN Division (Med), C/o 56 APO, +Commanding Officer, SHO Jalandhar Cantt.
Events Calendar 9th-10th October, 2004 National Surgery Update 2004 Venue : Armed Forces Medical College Pune-411 040 Contact person : Col GL Tiwari Associate Professor Department of Surgery Armed Forces Medical College, Pune-411 040 Tel :- Mil : 6016
20th-25th November,2004 APCON-2004 Annual Conference of Pathologists and Microbiologists Venue : Armed Forces Medical College, Pune-411 040 Phone : 020-2630 6024, 020-2630 6025 E-mail : [email protected] Website : www.geocites.com / apcon_2004 Contact person : Col S K Nema Professor & Head, Department of Pathology, AFMC, Wannowori, Pune-411 040.
6th-7th November, 2004 National Anaesthesiology Conference & CME-2004 Venue : Armed Forces Medical College Pune-411 040 Contact person : Col AK Bhargava Professor & Head Department of Anaesthesiology & Critical Care Armed Forces Medical College Pune-411 040 Tel :- Mil: 6036,6232,6274 Mobile No: 020-31025726
27th-28th November, 2004 HOST-2004 ‘Haemorrhage in obstetrics’ and ‘Surgical techniques’ Contact : Organising Secretary Department of Obstetrics and Gynaecology Armed Forces Medical College Pune-411 040 Tel : 020-26306020, 020-26306021, Fax : 020-2687790 E-mail : [email protected]
MJAFI, Vol. 60, No. 3, 2004
