Lifestyle Disorder Management Training
Lifestyle Disorder Management Training
on
Management of Life-style Disorders
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Training course on ‘Management of Life-style Disorders’
[Link]. Contents Page No.
1. Background document 1
2. Objectives 3
3. Course content 3
4. Methodology 4
5. Nature of participants 4
6. Number of participants 4
7. Session Objectives 5
8. Record of the proceedings 8
Day 1: 5th April, 2010 10
Day 2: 6th April, 2010 13
Day 3: 7th April, 2010 15
Day 4: 8th April, 2010 18
9. Evaluation of the training programme 21
10. Annexure-1: Programme 25
Annexure-2: List of Participants 29
Annexure-3a: List of External Resource Faculty 33
Annexure-3b: List of Resource faculty from 37
NIHFW
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Training course
on
During the 20th century, many diseases were eradicated or nearly eliminated
through advancement in medical science.1 Lifestyle diseases include atherosclerosis, heart
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disease and stroke, obesity, type 2 diabetes, and diseases associated with smoking, alcohol,
and drug abuse. These disease conditions usually attribute to dramatic shifts in the way
human beings live their lives, often due to advancements in a society due to scientific
progress.
Poor life-style includes, poor diet, lack of exercise, smoking, excess alcohol, poor
sleep, stress due to heavy workload. Several factors are resulting in the increasing burden
of lifestyle disease which include longer average life span, rising income, increasing tobacco
consumption, decreasing physical activity and increased consumption of unhealthy food.
The underlying attributable factors that cause these diseases are a complex web of social,
economic and cultural changes which are inevitable in this era of urbanization and
globalization. The urban people are having less physically active life-style, more exposure
to products and technologies that could be unhealthy for them.
Illnesses such as cancer of certain forms, most types of heart disease, high blood
pressure, obesity, and Type 2 diabetes are “contracted” from the way people live and are
caused by the life-style adopted by the individual, though there may be some exceptions.
All non-communicable diseases are not necessarily related to life-style. For instance,
conditions like enlarged prostate or prostate cancer and Alzheimer’s disease are related to
longevity or age. However, life-style diseases do refer to those conditions that could be
prevented by behavioural change.
Indian Scenario
In India, rapid urbanization and globalization mainly contribute towards increased
number of people suffering from life-style disorders. Despite strong evidence of the
magnitude of this burden to human health, national and global actions remain inadequate
to tackle the preventability of its causes, and the threat it poses. India is now home to the
largest population of diabetic cases in the world, where 30 million are affected. This
number is expected to grow to 57 million by 2025.
The burden of cardiovascular disease is rising in India. Compared to all other countries,
India suffers the highest loss in potentially productive years of life due to deaths from
cardiovascular disease in people aged 35-64 years (9.2 million years lost in 2000). By 2030,
this loss is expected to rise to 17.9 million years. Health Information of India, 2005 has
identified six key sets of “risk factors” responsible for a major share of adult non-
communicable disease morbidity and premature mortality. These are:
i. Cigarette use and other forms of tobacco use in various forms
ii. Alcohol abuse
iii. Failure or inability to obtain preventive health services
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iv. Life-style changes (easy dietary patterns, physical inactivity)
v. Environmental risk factors
vi. Stress factors
The levels of education and training of health care providers of diverse categories
were enhanced as relevant to chronic disease prevention, surveillance, and management.
Keeping this in view the training programme was organized to enhance the capacity of
health professionals in the management of life-style disorders.
2.0 General objective of the training programme was to sensitize and enhance the
capacity of the health personnel in the management of life-style disorders.
Following specific objectives were framed: At the end of the training programme, the
participants will be able to:
1. Describe the National Health Programmes (NPDCS and NCCP) related to non-
communicable diseases
2. Understand the risk factors associated with non-communicable diseases and life-
style disorders
3. Understand the concept of health promotion
4. Plan, implement, monitor and evaluate a health promotion programme
5. Management of life style disorders
6. Describe school health programme and relevance with life-style disorder
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11. Interventions for health promotion
4.0 Methodology
Orientation to concepts was done through lecture-discussion method. Participatory
approach was used for practical work and group exercises.
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7.0 Session Objectives
A brief overview of the sessional objectives planned for the training programme is as
follows:
Day-I
Day II
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Session 2: Physical Activity
Explain the importance of physical activity.
Describe the optimum level of physical activity that may be undertaken by
people of various age groups, and in the community.
Perform simple yoga exercise.
Suggest and develop a strategy for initiating physical activities.
Day III
Session 1: Management of tobacco, alcohol and drug abuse
Describe the health affects of tobacco abuse and its management by health
professionals in different settings.
Describe the management of alcohol and drug abuse.
Describe initiatives being undertaken for “Cessation activities” under
National Tobacco Control Programme.
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Session 2: Plan, implement, monitor and evaluate a health programme
How to plan, implement, monitor and evaluate a health programme for
prevention of NCDs/ life-style disorders.
Day IV
Session 1: Stress Management
Practice a few techniques of stress management.
Provide a few tips for stress management in general.
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Record of the Proceedings of the Training
Programme
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Training Course on “Management of Life-style Disorders”
(5th – 8th April 2010)
A brief Report of the Proceedings of the Training Programme
A four days training course was conducted from 5th to 8th April, 2010 on ‘Management of
life-style disorders’. The course was conducted to sensitize and enhance the capacity of the
health personnel in the management
of life-style disorders.
Inaugural session
Inaugural Address: Prof. Deoki Nandan, Director, NIHFW
Prof. Deoki Nandan mentioned that in India, rapid urbanization and globalization has
changed the life-style of people lending to increase number of people life-style related
suffering from diseases. Rapid urbanization has to increased cases of NCDs. He led briefed
about the training programmes which are being conducted throughout the year.
He hoped that this training programme would strengthen the capacity of the health
personnel in the states in the management of life-style disorders.
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Technical Sessions
Dr. J.S. Thakur discussed the Current Scenario of Non-communicable Diseases in India. He
gave a brief account of burden of disease globally and in India. He focused on risk factors,
level of prevention and management of non-communicable diseases.
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Disease Prevention for the High Risk, and
Surveillance of risk factors of Non-Communicable Diseases.
The participants discussed the strategies that have been adopted in their states and that
can be adopted at individual level, community level and policy level to prevent life-style
disorders.
Dr. Lalit Kumar started his session with global incidence, burden and common causes of
cancer. He elaborated on life-style factors like cigarette smoking, diet, alcohol, sun
exposure, environmental pollutants, infections, stress, obesity and physical inactivity that
can cause cancer. He discussed the National Cancer Control Programme.
Dr. Khattar briefed that the objective of this session is that participants would share the
data related to life-style disorders from their respective states and initiatives being
undertaken by the State Governments.
The participants from Chandigarh discussed NCD work done during the period 2009-2010
in their UT. They mentioned that one day training was organized for ANMs, LHVs, and
pharmacists. Modules have been prepared for health workers and pharmacists and diet
clinics have been started at the CHC level. NCD registers are being prepared for field
workers, distribution of blood pressure. apparatus measuring tapes to the workers. They
informed that celebrating world nutrition week. They are in process to employ 2 dieticians,
1 data entry operator, and 1 social health worker.
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The participants from Gujarat shared the results of the NCD risk factor survey conducted in
rural and urban areas Gandhinagar in the age group of 15-64 years. WHO STEPS approach
was followed up to 2 STEPS. Results showed that tobacco and cooking oil consumptions
was more in rural areas as compared to urban areas. Urban areas reported more cases of
hypertension and diabetes.
Session: Yoga
Resource Person: Dr. Shellindeshwari Malhotra, Consultant
Dr. Shellindeshwari Malhotra conducted an early morning yoga session in which she
discussed the importance of ‘asanas’. All the participants actively participated in the
sessions. They even discussed appropriate asanas for joint pains, constipation, and proper
digestion of foods.
Dr. Sudhir Gupta briefed about the NCDs and the risk factors associated with them. He also
discussed the health care delivery system (NRHM) in India and the approaches adopted
under this programme. He presented on overview of the NPDCS programme, its delivery
system, and achievements of this programme.
Dr. Gupta discussed key scientific recommendations for action in the area of diet and
physical activity for the prevention of NCDs. He mentioned other programmes like National
Mental Health Programme (NMHP), National Programme for Control of Blindness, National
Oral Health Programme, National Iodine Deficiency Disorders Control Programme (1992),
National Programme for Prevention and Control of Fluorosis (NPPCF), Tobacco control
strategies, Health Policy for Schools, and importance of Health and Physical Education.
His session generated the discussion on current policies and programmes of the
government in different states.
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Session: Management of tobacco, alcohol and drug abuse
Resource Person: Dr. Smita Deshpande, HOD, Ram Manohar Lohia Hospital
Dr. Smita Deshpande discussed on common drugs abuses like alcoholism, dependence on
opiates, cannabis, sedatives, hallucinogens and volatile substances. She discussed the
factors like society, individuals and other responsible for drug abuse. She briefed about the
physical, social and economic consequences of tobacco use and management of tobacco,
alcohol and drug abuse by the health professionals in different settings.
Dr. Deshpande also discussed the initiatives taken for “Cessation Activities” under the
National Tobacco Control Programme. She also emphasized on the setting up of tobacco
cessation services at different settings community, hospitals and other specialised settings.
She also mentioned about the behaviour change model.
She recommended interventions tailor made interventions, according to the stage of
change, incorporation of behavioral therapy if possible, phone counseling, and follow-up.
Prof. Rakesh Yadav discussed about the life-style diseases, nutrition and balanced diet. He
emphasized on the components of diet fat, cholesterol and fatty acid, carbohydrate and
proteins, fiber, salt, alcohol and other dietary aspects. He also mentioned dietary goals
given by ICMR, and importance of nutrition in different stages of life, in chronic diseases
like CHD, diabetes mellitus, obesity, hypertension and cancer.
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He also shared the experiences of his patients related to diet and cholesterol level. The
participants discussed about the commercial diets which are being used for prevention of
life-style disorders.
Dr. Neena Bhatia focused her session on ‘what is a healthy diet?’ What is the importance of
a healthy diet? How one can prepare a healthy diet. She mentioned about different
household measures and how they can be used while preparing food at home.
Dr. Bhatia demonstrated the preparation of diet using software prepared for calculating the
energy requirements and food availability. The participants prepared a weight reducing
diet chart for an adolescent girl suffering from obesity using the software.
Dr. Jagdish Kaur presented the framework of the school health programme and the current
situation of the programme in different states. She emphasized on adopting a participatory
approach and involving education department/school authorities and parent bodies in the
planning of health promotion activities in schools. She stressed that the capacity building
of school teachers and health workers to undertake planned activities is the need of the
hour. Participants discussed the status of school health programme in their states.
In National Mental Health Programme, Dr. Kaur mentioned the magnitude of mental
disorders; prevention, treatment, and rehabilitation tasks for mental health in India. She
concluded by saying that there is need to train and build the capacities of medical officers,
nurses, psychologists and social workers to meet the acute shortage of mental health
manpower.
Prof. Neera Dhar discussed various types of counseling, counsellling skills such as
attending, responding, personalizing and initiating skills. In attending skills, she
emphasized on sitting posture, eye contact and listening skills. Responding skills includes
empathizing with the individual. Personalizing skills include internalizing feelings, make
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helpee own the responsibility for feelings, and make help own the responsibility for
change. Initiating skills include identifying the goal together and joint choosing and
initiation of action towards the goal.
Prof. Dhar demonstrated the different skills of counselling through a skit with the active
participation of the participants.
Dr. P.L. Joshi focused on health planning for life-style disorders. He emphasized on strategic
planning which involves long term planning. He stated that it includes current situational
analysis, strategies to be adopted to achieve desired situational objectives. He explained
stages and elements of strategic planning.
Dr. Joshi explained the concept of planning with reference to the NRHM. He also mentioned
effective planning cycle which includes situational analysis, strategic planning, work plan
for implementation, monitoring and supervision and evaluation.
Session: Group work- “To design a health promotion programme for prevention of
lifestyle disorders for any of the risk factors”
Resource Person: Dr. Poonam Khattar, Reader, Department of Education and
Training, NIHFW
Dr. Khattar gave a brief introduction and objective of the session which was to design a
health promotion programme for prevention of life-style disorders for any of the risk
factors. The terms of reference for the group work are enclosed at Annexure__
The participants were randomly divided into two groups. The following topics were
selected by the groups:
1. Health promotion by preventing tobacco consumption
2. Sedentary lifestyle
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Day 4: 8th April, 2010
Group 1: Dr. Bhagyalaxmi gave the presentation on behalf of her group on “Health
promotion by preventing tobacco consumption”. The objective was to make schools free of
tobacco with following objectives:
1. To reduce the prevalence of tobacco consumption by less than 5% among school
going children in the next 5 years
2. Tobacco free zone in and around the schools
3. Rehabilitation of tobacco addicted children
Intervention would be done in 2 phases:
Phase1.
Training of the teachers to educate the children
Meetings with key persons of the education department for incorporating the
content in curriculum
Development of IEC material
Preparation of health card to assess the consumption of tobacco in the family
Phase 2.
Educating the children by trained
teachers
Peer education
Parents Teachers meeting to
educate the family members
The programme will be regularly
monitored and evaluated to determine the
impact of the programme.
Group 2: The presentation was made by Dr. Aman. This group focused on adolescents and
children as they are the ones who are involved in maximum television viewing, playing
computer and video games, and substance abuse. The objectives of the programme are as
follow:
• Reduce television viewing upto 1 hour per day
• One period of mandatory physical activity per day
• 1 hour physical exercise at home
• Rationalization of homework
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• Urban planning involvement
The interventions will be done by the means of mass media advertising, school workshop,
regular parents teacher meetings and public forums. The programme will be evaluated by
improvements in behavioural indicators, and comparison of pre and post indicator
parameters.
Prof. Neera Dhar started her session with a question to the participants on what is stress is
she explained that stress is not a personality trait. Stress does not indicate any
psychological problem. Stress is a physical and psychological condition of our body and
mind. Situations, events and people do not cause stress. Our perceptions, attitudes, values,
belief system and reactions to various situations lead to stress. She focused on
management of stress. Coping with stress involves realization that stress is a fact of life,
accept the responsibility of ones self, stop being perfectionist, involve oneself in yoga,
meditation, writing, listening to music, regular leisure activities, take healthy diet, try to
solve problems, indulge in humor and laughter, listen to one’s inner feelings, stress at times
may act as a motivator to achieve goals.
The participants took part in activities like laughter therapy and singing. Dr. Dhar ended
her session with a song “Aage bhi Jaane na tu…”
The participants discussed some of the relevant problems related to NCDs in their states.
Dr. Jain concluded by stating that NIHFW has taken the lead in the field of NCD by
organizing this training programme. He hoped that NIHFW would collaborate and support
the Ministry of Health and Family Welfare in this regard.
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Prof. Deoki Nandan congratulated the participants for completing the training course. He
appreciated Dr. D.C. Jain for encouraging NIHFW to conduct this training programme. He
assured that the institute will conduct more member of such training programmes
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Evaluation of the Training Programme by
the Participants
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Evaluation of the training programme by the participants
“Reaction Level Evaluation”
The participants were given a ‘reaction level evaluation’ proforma with an objective to
evaluate the following aspects of the training programme:
Goals/ objectives of the training
Training course
Training session
General organization of the training course
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Annexure-1 Programme
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Training course on ‘Management of Life-style Disorders’
(5-8 April, 2010)
Programme Schedule
11:00-11:30 Recap
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7th April, 2010 (Wednesday)
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Annexure-2 List of Participants
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List of Participants
[Link] Name Designation & Address Contact No. E-mail
Jaipur
1. Dr. Aman Kumar Dept of Community Medicine, 0141-2771777 aman1707@hot
Mahatma Gandhi Medical [Link]
College Hospital, Sitapura ,
Jaipur-302022
2. Dr. Sharad Daga Senior MBBS boys Hostel 09413268545 drsharaddaga@
Mahatma Gandhi Medical [Link]
College Hospital, Sitapura ,
Jaipur-302022
Chandigarh
3. Dr. Manjeet Singh Non Communicable Diseases 09814104609 manjeetsinghtre
Trehan CHC Manimajra han@[Link]
4. Mr. H.C Gera Integrated Disease 09988212139 hc_gera08@hot
Surveillance Project, [Link]
Additional Deluxe Building,
Sector-9D, Chandigarh
Bangalore
5. Dr . S.I. Bendigeri Training Officer 0944983154 sibendigeri@ya
Health and Family Welfare [Link]
Services, Anand Rao Circle,
Bangalore
Panchkula
6. Mr. Vikas Dubey, Consultant Management 09216234780 [Link]@gm
SIHFW, Panchkula [Link]
Patna
7. Ms. Geeta Kumari Regional Consultant 09386626152 geetaaiims@gm
Regional office for Health and [Link]
Family Welfare Patna
Ahemdabad
8. Dr S.R Avashia Deputy Director 09825286852 dydir-mediser-
Medical Services, Gandhinagar [email protected]
Commisionerate of Health [Link]
Services, Medical Section
Gandhinagar
9. Dr A. Bhagyalaxmi Associate Professor, B.J bhagya_mardi@
Medical College, Ahemdabad [Link]
Shillong
10. Dr. M.R. Basaiawmoit District Surveillance Officer 09436703964 dr_manojbasaia
IDSP, Shillong [email protected]
om
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[Link] Name Designation & Address Contact No. E-mail
Bhiwani
11. Mrs. Sudesh Kumari Public Health Nurse Tutor 09215562420 sudesh_kumari_
MPHW (F), Training School 2010@[Link]
General Hospital, Bhiwani m
Ambala
12. Mrs. Sushila Devi Public Health Nurse Tutor 09466308217 dsushila66@yah
MPHW (F), Training School [Link]
General Hospital, Ambala City
Jammu & Kashmir
13. Dr. Siddhartha ICMR Project, J&K 09968372112 relief2012@yah
J&K base hospital Sec –Poonch, [Link]
J&K
Ranchi
14. Dr. Mithilesh Kumar Tutor, Department of PSM, O947008647 mithilesh_neal@
RIMS Ranchi [Link]
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Annexure-3 a
List of External Resource Faculty
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List of Resource Faculty
1. Dr. D.C. Jain
DDG, LME
Ministry of Health and Family Welfare
Nirman Bhawan New Delhi-11001
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7. Dr. Neena Bhatia
Reader
Lady Irwin College, University of Delhi
New Delhi-110001
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Annexure-3b List of Resource Faculty from NIHFW
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List of Resource Faculty from NIHFW
1. Prof. Deoki Nandan
Director, NIHFW
91- 9971104666
Email: director@[Link] , dnandan51@[Link]
Fax: 26101623
Research Staff
1. Mr. Ramesh Gandotra
Assistant Research Officer
Dept. of Education & Training.
Email : gandotra_ramesh@[Link]
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