By Z. Ur-Gosh. Texas Southern University. 2019.

Almost 38-65% of adult urban Indians in Delhi fulfill the 93 criteria for either overweight/obesity or abdominal obesity colchicine 0.5 mg cheap. India shows that children aged 4 and 8 years who were born small and later showed accelerated growth had a propensity to abdominal obesity buy colchicine 0.5mg free shipping. In 1995 order 0.5mg colchicine mastercard, there were an estimated 200 million obese adults worldwide but as of 2000 cheap 0.5mg colchicine fast delivery, the number of obese adults has increased to over 300 million. In developing countries it is estimated that over 115 million people suffer from obesity-related problems. Obesity is a complex condition, one with serious social and psychological dimensions, that affects virtually all age and socioeconomic groups. In the analyses carried out for World Health Report 2002, approximately 58% of diabetes and 21% of heart disorders and 8-42% of certain cancers globally were attributable to excess weight. While a third of Indian population still falls below the poverty line, there has been a steady growth of the relatively affluent urban middle class now estimated to number over 200 million. The prevalence of 94 abdominal obesity is 29 per cent among middle-class men and 46 per cent among women. Obesity is positively associated to many chronic disorders such as hypertension, dyslipidemia, type 2 diabetes mellitus, coronary heart disease, pregnancy, bone metabolism and certain 96,97 cancers. Obesity Hypertension and Cardiovascular Diseases Adipose tissue has a central role in lipid and glucose metabolism and produces a large number of hormones and cytokines, e. These are closely associated with abdominal obesity and can often be controlled by dietary changes and weight reduction. Obesity and Pregnancy Overweight and obesity during pregnancy raises the risk of gestational diabetes and complications during delivery. Lifestyle factors like physical activity may ameliorate many of 101 these risks through its beneficial effects on the glucose homeostasis. As obesity is associated with chronic inflammation, excessive fat accumulation is detrimental to bone mass. Further, high-fat intake may interfere with intestinal calcium absorption and therefore decrease calcium availability for bone formation. The decreased bone mass with obesity may be due to increased marrow adipogenesis at the expense of osteoblastogenesis, and/or increased osteoclastogenesis because of up-regulated production of pro-inflammatory cytokines Obesity and Cancer Obesity has been linked to cancer which has been shown by some recent studies. Alcohol Alcohol consumption has both health and social consequences via intoxication and alcohol dependence. Overall there is a causal relationship between alcohol consumption and more than 60 types of diseases and injury. Alcohol is a risk factor for oesophageal cancer, liver cancer, cirrhosis of the liver, homicide, stroke, psychiatric illness and motor vehicle accidents 106 worldwide. According to South-East Asia Regional Information System on Alcohol and Health, 25% of road accidents in India are alcohol-related, and 20% of accident-related head injury victims seen in emergency rooms of hospitals have consumed alcohol prior to the 107 accident. Further, the prevalence of alcohol use disorders among people who committed suicide in the city of Chennai was as high as 34%. The per capita consumption of alcohol per year in India is estimated to be of two litres per adult. Community based studies have reported that alcohol use ranges between 25% and 40% in north India and 33% and 50% in south India, with a higher prevalence among the less educated and the poor. The proportion of frequent heavy drinkers, who consume five or more standard drinks in 13 four or more days per week is estimated to be 1. Punjab, Andhra Pradesh, Goa and north- 108 eastern states have the highest consumption figures. The prevalence of alcohol is reported to be lowest in Gujarat (7%) and the highest is in the north-eastern state of Arunachal Pradesh (75%). Low prevalence in Gujarat is likely to be due to underreporting due to the prevailing ban on alcohol in the state. For example a study carried out in the villages around Navsari town in 109 Gujarat has shown that 60% of the healthy men were using alcohol. The prevalence of alcohol use among women has been less than five percent in India. About 80% of alcohol consumption is in the form of hard liquor with high concentrations of alcohol. Furthermore, country liquor accounts for 60% of alcohol consumption with the poor being the predominant consumers. Although moderate consumption of alcohol appears to be protective for heart attacks in western 111 populations it appears to be either neutral or conferring higher risk among South Asians. Unsafe Health Care Unsafe health care is becoming a serious global public health issue. Waste disposal was found to be unsatisfactory at the health facilities (53%) at the terminal level for plastic syringes and disposable needles and was found to be least at 66 immunisation clinics (49%). Burden of unsafe Surgical care: Globally, about 234 million major surgical operations are conducted a year. Half of these events are preventable if standards of care are adhered to and safety tools, such as checklists, are used. Surgical site infections are the most frequent in developing countries with rates of up to 25% of all surgical procedures. Approximately 20% of hospital waste is biomedical waste, which is hazardous /infectious in nature. Infections are the most common health hazard associated with poor waste management. Many States in the country are lagging behind in implementation of the Safe waste management practices and lack systems for development. National Health Pogrammes being implemented during the 11 Plan, their th current status and allocation during the 11 Plan are summarized below: Allocation Year of th S. Being implemented in 42 districts in 21 5 2007 National Tobacco Control Program states; 9 states have cells, 5 testing & one 471. Biomaterial __ centre for tissue being established 73 th Progress and achievements during 4 years of the 11 Plan for each program is given below: 1. Later the programme was modified in the year 1984-85 with emphasis on primary prevention and early detection of cancer. The District Cancer Control Programme was introduced during 1990-91 and later modified in 2000-01. As per Atomic Energy Regulatory Board there are 250 institutions having radiotherapy facilities with 450 Radiotherapy machines (50% Pvt. To financial support the poor and the needy cancer patients a Health Ministers cancer fund have been started. The Palliative care services in the Tertiary facilities of the country were evaluated and it was found that more than 60 percentage of cancer patients registering at Regional Cancer Centers are in need of palliative care.

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The late stage generic 0.5 mg colchicine with mastercard, with destructive lesions of skin and bone cheap colchicine 0.5 mg with amex, occurs in about 10%–20% of untreated patients best 0.5mg colchicine, usually 5 or more years after infection order 0.5 mg colchicine visa. Unlike what happens in syphilis, the brain, eyes, heart, aorta and abdom- inal organs are not involved. Congenital transmission does not occur; the infection is rarely if ever fatal, but can be very disfiguring and disabling. Occurrence—Predominantly a disease of children living in rural humid tropical areas; more frequent in males. Mass penicillin treatment campaigns in the 1950s and 1960s dramatically decreased worldwide prevalence but yaws has re-emerged in parts of equatorial and western Africa, with scattered foci of infection persisting in Latin America, the Caribbean islands, India, southeastern Asia and some South Pacific islands. Mode of transmission—Principally through direct contact with exudates of early skin lesions of infected people. Indirect transmission through contamination from scratching, skin-piercing articles and flies on open wounds is probable but of unknown importance. Climate influences the morphology, distribution and infectiousness of the early lesions. Period of communicability—Variable; may extend intermittently over several years when moist lesions are present. Infec- tion results in immunity to reinfection and may offer some protection against infection by other pathogenic treponemes. Preventive measures: The following apply to yaws and other nonvenereal treponematoses. Although present techniques can- not differentiate the infectious agents, differences observed among clinical syndromes are unlikely to result from epidemio- logical or environmental factors alone. Periodic clinical resurveys and continuous surveillance are essential for success. Differentiation of venereal and nonvenereal treponema- toses, with proper reporting of each, has particular impor- tance in the evaluation and consolidation of mass campaigns. In low-prevalence areas, treat all active cases, all children and close contacts of infectious cases. For patients 10 years or older with active disease and contacts, a single injection of benza- thine penicillin G, 1. Essential features are: 1) examining a high percentage of the population through field surveys; 2) extending treatment of active cases to family and community contacts based on the demonstrated prevalence of active yaws; 3) surveys at yearly intervals for 1–3 years, as part of the established rural public health activities of the country. Disaster implications: None observed, but potentially a risk in refugee or displaced populations in endemic areas without hygienic facilities. International measures: To protect countries against risk of reinfection where active mass treatment programs are in progress, adjacent countries in the endemic area should institute suitable measures against yaws. Movement of infected people across frontiers may require supervision (see Syphilis, section I, 9E). Identification—Acute infectious viral disease of short duration and varying severity. The mildest cases may be clinically indeterminate; typical attacks are characterized by sudden onset, fever, chills, headache, back- ache, generalized muscle pain, prostration, nausea and vomiting. The pulse may be slow and weak out of proportion to the elevated tempera- ture (Faget sign). Some cases progress after a brief remission of hours to a day into the ominous stage of intoxication manifested by hemorrhagic symptoms including epistaxis, gingival bleeding, hemateme- sis (coffee-ground or black), melaena, and liver and renal failure; 20%–50% of jaundiced cases are fatal. The overall case-fatality rate among indigenous populations in endemic regions is 5% but may reach 20%–40% in individual outbreaks. Serological diagnosis includes demonstrating specific IgM in early sera or a rise in titre of specific antibodies in paired acute and convalescent sera. Recent infections can often be distinguished from vaccine immunity by comple- ment fixation testing. Infectious agent—The virus of yellow fever, of the genus Flavivirus and family Flaviviridae. Occurrence—Yellow fever exists in nature in 2 transmission cycles, a sylvatic or jungle cycle that involves Aedes or Haemagogus mosquitoes and nonhuman primates, and an urban cycle involving humans and mainly Aedes aegypti mosquitoes. Sylvatic transmission is restricted to tropical regions of Africa and Latin America, where a few hundred cases occur annually, most often among occupationally exposed young adult males in forested or transitional areas of Bolivia, Brazil, Colombia, Ecuador and Peru (70%–90% of cases reported from Bolivia and Peru). Historically, urban yellow fever occurred in many cities of the Americas; no outbreak of urban yellow fever has occurred for 50 years in North America. There is no evidence that yellow fever has ever been present in Asia; in western Kenya, sylvatic yellow fever was reported in 1992–1993. Reservoir—In urban areas, humans and Aedes mosquitoes; in forest areas, vertebrates other than humans, mainly monkeys and possibly marsupials, and forest mosquitoes. Transovarian transmission in mosqui- toes may contribute to maintenance of infection. Humans have no essential role in transmission of jungle yellow fever, but are the primary amplifying host in the urban cycle. Mode of transmission—In urban and certain rural areas, the bite of infective Aedes mosquitoes. In South American forests, the bite of several species of forest mosquitoes of the genus Haemagogus. Period of communicability—Blood of patients is infective for mosquitoes shortly before onset of fever and for the first 3–5 days of illness. The disease is highly communicable where many susceptible people and abundant vector mosquitoes coexist; it is not communicable through contact or common vehicles. Susceptibility—Recovery from yellow fever is followed by lasting immunity; second attacks are unknown. Transient passive immunity in infants born to immune mothers may persist for up to 6 months. Preventive measures: 1) Institute a program for active immunization of all people 9 months or older who are exposed to infection because of residence, occupation or travel. Antibodies appear 7–10 days after immunization and may persist for at least 30–35 years, probably much longer, though immunization or reim- munization within 10 years is required by the International Health Regulations for travel from endemic areas. The vaccine can be given any time after 6 months of age and can be administered with other antigens such as measles vaccine. The vaccine is contraindicated in the first 4 months of life and should be considered for those aged 4–9 months only if the risk of exposure is judged to exceed the risk of vaccine-associated encephalitis, the main complication in this age group. The vaccine is not recommended in the first trimester of pregnancy unless the risk of disease is believed to be higher than the theoretical risk to the pregnancy. There is no evidence of fetal damage from the vaccine, but lower rates of maternal seroconversion have been observed, an indication for reimmunization after delivery or termina- tion. Protective clothing, bednets and repellents are ad- vised for those not immunized. Control of patient, contacts and the immediate environment: 1) Report to local health authority: Case report universally required by International Health Regulations; Class 1 (see Reporting). Prevent access of mosquitoes to patient for at least 5 days after onset by screening the sickroom, by spraying quarters with residual insecticide, and by using insecticide-treated bednets. Search patient’s premises and places of work or visits over the preceding several days for mosquitoes capable of transmitting infec- tion; apply effective insecticide. Investigate mild febrile illnesses and unexplained deaths suggesting yellow fever.

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The infection rate is a proportion that expresses the incidence of all identified infections discount colchicine 0.5 mg fast delivery, manifest or inapparent (the latter identified by seroepidemiology) purchase colchicine 0.5 mg with mastercard. Incubation period—The time interval between initial contact with an infectious agent and the first appearance of symptoms associated with the infection purchase 0.5 mg colchicine otc. In a vector cheap colchicine 0.5mg with mastercard, it is the time between entrance of an organism into the vector and the time when that vector can transmit the infection (extrinsic incubation period). The period between the time of exposure to an infectious agent and the time when the agent can be detected in blood or stool is called the prepatent period. Infected individual—A person or animal that harbours an infec- tious agent and who has either manifest disease or inapparent infection (see Carrier). An infectious person or animal is one from whom the infectious agent can be naturally acquired. Infection—The entry and development or multiplication of an infectious agent in the body of persons or animals. Infection is not synonymous with infectious disease; the result may be inapparent (see Inapparent infection) or manifest (see Infectious disease). The presence of living infectious agents on exterior surfaces of the body, or on articles of apparel or soiled articles, is not infection, but represents contamination of such surfaces and articles. Infectious agent—An organism (virus, rickettsia, bacteria, fungus, protozoan or helminth) that is capable of producing infection or infectious disease. Infectivity expresses the ability of the infectious agent to enter, survive and multiply in the host. Infectiousness indicates the relative ease with which an infectious agent is transmitted to other hosts. Infectious disease—A clinically manifest disease of humans or animals resulting from an infection. Infestation—For persons or animals, the lodgement, development and reproduction of arthropods on the surface of the body or in the clothing. Infested articles or premises are those that harbour or give shelter to animal forms, especially arthropods and rodents. Insecticide—Any chemical substance used for the destruction of insects; can be applied as powder, liquid, atomized liquid, aerosol or “paint” spray; an insecticide may or may not have residual action. The term larvicide is generally used to designate insecticides applied specifically for the destruction of immature stages of arthropods; adulticide or imagocide, to those destroying mature or adult forms. The term insecticide is used broadly to encompass substances for the destruction of all arthropods; acaricide is more properly used for agents against ticks and mites. Isolation—As applied to patients, isolation represents separation, for a period at least equal to the period of communicability,of infected persons or animals from others, in such places and under such conditions as to prevent or limit the direct or indirect transmission of the infectious agent from those infected to those who are susceptible to infection or who may spread the agent to others. Universal precautions should be used consistently for all patients (in hospital settings as well as outpatient settings) regard- less of their bloodborne infection status. Protective barriers include gloves, gowns, masks and protec- tive eyewear or face shields. Two basic requirements are common for the care of all potentially infectious cases: i) hands must be washed after contact with the patient or poten- tially contaminated articles and before taking care of another patient; ii) articles contaminated with infectious material must be appropri- ately discarded or bagged and labelled before being sent for decontamination and reprocessing. Recommendations made for isolation of cases in section 9B2 of each disease may allude to the methods that had been recom- mended as category-specific isolation precautions, based on the mode of transmission of the specific disease, in addition to univer- sal precautions. These categories are as follows: ● Strict isolation: To prevent transmission of highly contagious or virulent infections that may be spread by both air and contact. The specifications, in addition to those above, include a private room and the use of masks, gowns and gloves for all persons entering the room. Special ventilation requirements with the room at negative pressure to surrounding areas are desirable. In addition to the 2 basic requirements, a private room is indicated, but patients infected with the same pathogen may share a room. Masks are indicated for those who come close to the patient, gowns if soiling is likely and gloves for touching infectious material. In addition to the basic requirements, masks are indicated for those who come in close contact with the patient; gowns and gloves are not indicated. Specifications include use of a private room with special ventilation and closed door. In addition to the basic requirements, those entering the room must use respirator-type masks. In addition to the basic require- ments, specifications include use of a private room if patient hygiene is poor. Masks are not indicated; gowns should be used if soiling is likely and gloves used when touching contaminated materials. In addition to the basic requirements, gowns should be used if soiling is likely and gloves used when touching contaminated materials. Molluscicide—A chemical substance used for the destruction of snails and other molluscs. Mortality rate—A rate calculated in the same way as an incidence rate, by dividing the number of deaths occurring in the population during the stated period of time, usually a year, by the number of persons at risk of dying during the period or by the mid-period population. A total or crude mortality rate refers to deaths from all causes and is usually expressed as deaths per 1000. A disease- specific mortality rate refers to deaths due to a single disease and is often reported for a denominator of 100 000 persons. The mortality rate must not be confused with the case-fatality rate (Synonym: death rate). Nosocomial infection—An infection occurring in a patient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission; or the residual of an infection acquired during a previous admission. Includes infections acquired in the hospital but appearing after discharge, and also such infections among the staff of the facility. Pathogenicity—The property of an infectious agent that deter- mines the extent to which overt disease is produced in an infected population, or the power of an organism to produce disease. Measured by the ratio of the number of persons developing clinical illness to the number of persons exposed to infection. Period of communicability/Communicable period—The time during which an infectious agent may be transferred directly or indirectly from an infected person to another person, from an infected animal to humans, or from an infected person to animals, including arthropods. In diseases such as tuberculosis, leprosy, syphilis, gonorrhoea and some of the salmonelloses, the communicable state may persist—sometimes intermittently—over a long period with dis- charge of infectious agents from the surface of the skin or through the body orifices. For diseases transmitted by arthropods, such as malaria and yellow fever, the periods of communicability (or infectivity) are those during which the infectious agent occurs in the blood or other tissues of the infected person in sufficient numbers to permit infection of the vector. For the arthropod vector, a period of communicability (transmissibility) is also to be noted, during which the agent is present in the tissues of the arthropod in such form and locus as to be transmissible (infective state). Personal hygiene—In the field of infectious disease control, those protective measures, primarily within the responsibility of the individual, that promote health and limit the spread of infectious diseases, chiefly those transmitted by direct contact. Such measures encompass: ● washing hands in soap and water immediately after evacuating bowel or bladder and always before handling food or eating; ● keeping hands and unclean articles, or articles that have been used for toilet purposes by others, away from the mouth, nose, eyes, ears, genitalia and wounds; ● avoiding the use of common or unclean eating utensils, drinking cups, towels, handkerchiefs, combs, hairbrushes and pipes; ● avoiding exposure of other persons to droplets from the nose and mouth as in coughing, sneezing, laughing or talking; ● washing hands thoroughly after handling a patient or the pa- tient’s belongings and keeping the body clean by frequent soap and water washing.

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Out of 113 purchase colchicine 0.5 mg free shipping, in 16 Government hospitals trauma center are partial operational for Trauma Care facilities buy 0.5mg colchicine with visa. Recently buy colchicine 0.5 mg free shipping, Ministry of Road Transport & Highways one Advance Life support Ambulance to be deployed in 70 identified hospitals in various states generic colchicine 0.5mg visa. National Program for Prevention and Control of Fluorosis (2007-08) National Programme for Prevention and Control of Fluorosis was approved in the year 2007-08 for 100 districts with an amount of Rs. The following strategies are adopted for implementing the programme::- • Training:- Impart training to health personnel for prevention, health promotion, early diagnosis and prompt intervention, deformity correction and rehabilitation. The objectives of the pilot project were to model the impact of providing preventive, promotive and treatment services at peripheral centres to reduce therisk of developing these chronic diseases and appropriate management. It was started in 10 states with one district each namely, Assam (Kamrup), Punjab (Jalandhar), Rajasthan (Bhilwara), Madhya Pradesh (Jabalpur), Karnataka (Shimoga), Tamilnadu (Kancheepruam), Kerala (Thiruvananthapuram), Andhra Pradesh (Nellore), Madhya Pradesh (Jabalpur), Sikkim (East Sikkim). Opportunistic Screening for diabetes and high blood pressure will be provided to all persons above 30 years including pregnant women of all age groups at the point of primary contact with any health care facility. Funds have been released to 30 districts taken up during 2010-11 and will be released to 70 districts taken up during 2011-12. National Program for Health Care of the Elderly (2010-11) The existing health care facilities for older people in our country in terms of infrastructure, skilled manpower are almost none existing. Dedicated and separate health infrastructure is available only in a few medical colleges/institution. Major components of the programme are to establish geriatric department in 8 regional medical institutions of the country and strengthening health care facilities for elderly at various levels of 100 identified districts of the country. Funds have been released to 30 districts during 2010-11 and will be released to 70 districts during 2011-12. Assam, Haryana and Himachal Pradesh covering one Medical College and 2 district hospitals each as below. Components- ƒ Preventive Programme:This component is being implemented through Central Health Education Bureau and Awareness Programme in School for generating awareness. In Medical College, Rohtak and District Hospital, Panipat, construction plan has been finalized and construction work taken up. However in Rohtak, the Trauma Centre building where burn unit was to be located temporarily is not yet ready and will take some more time. In District nd Hospital, Gurgaon, the agreed space on 2 floor terrace could not be used. Hence, inspection visit needs to be conducted for alternative site in the hospital campus. Medical College, Tanda, District Hospital, Mandi and District Hospital, Hamirpur the Construction work has been taken up on the identified land/space. Pending construction, space has also been earmarked for burns unit & beds have been provided to the patients. However, as the District Hospital, Dhubri has been declared as a Medical College by the State govt. As establishment of new burns unit will take time, the states have been requested to start providing burn services at the earliest by identifying space for temporary locating the unit and earmarking 2-4 beds for burn cases. The 6 days training programme schedule for Surgeons/Medical Officers to be trained under the programme have been prepared. Burn Injury Management protocol which will be distributed as part of the training programme is being prepared by experts. In all, 21 medical colleges have been identified for establishing / up-gradation of P. The scheme involves signing of memorandum of understanding with State Governments for providing adequate space and logistic support in medical colleges and designation of Nodal Officer and grant for financial assistance for procurement of equipment and engagement of manpower on contractual basis as shown in the table below: 1 Silchar Med. Despite the above constraints, the challenge for building up capacity for providing quality in rehabilitation services will have to be carried forward vigorously in the years to come as anticipated as it may take number of years or considerable time to harness such services which are different from other types of health services in the Health Care System. Patient Safety Programme There have been some initiatives for safety of patients seeking health care services in the Public Sector as given below: • Patient Safety committees have been formed in three central government institutions in Delhi namely Dr Ram Manohar Lohia Hospital, Safdarjung Hospital and Lady Harding Medical College & associated Hospitals. The committee is headed by Medical Superintendent / Additional Medical Superintendent. Beside Hospital experts, the members of committee also include representative of a Non Govt. These hospitals conduct meetings of their patient safety committees to review the various patient safety issues, adverse events reported, actions taken and maintain records of all the meetings of their patient safety committees. Self learning modules in the area of Health Care Waste Management for doctors, nurses and paramedical and Group D employees have been developed. Sofar more than 60 medical colleges and tertiary care hospitals in public as well as private sector have been trained in these workshops. Till now more than 400 healthcare professionals from these institutes including doctors (surgeon, physician, anaesthetist and microbiologist), administrators and nurses have participated in these workshops. Lessons Learnt: Broadly, across programmes, following experiences were observed and lessons learnt in th implementation of programmes, which need to be addressed during the 12 Plan: 1. Convergence and integration would be critical in implementation of large number of interventions which would require unified management structure at various levels. Costs borne by the affected individuals and families may be catastrophic as treatment is long term and expensive. Investments during the 11 Plan and earlier plans have been more on provision of medical services which have not been adequate in the public sector. Private sector has grown particularly in urban settings but is beyond the reach of the poor and middle sections of the society. While Government of India’s role will be policy formulation, population based multi-setoral interventions, technical and financial th support, the onus of implementation will be with the States. To ensure convergence and integration with public health services, a decentralized approach is proposed with District as the management unit for programs. Hereditary Blood Disorders (Sickle Cell Anaemia, Thalassemia, Haemophilia) (b) Programmes for Disability Prevention and Rehabilitation 13. To ensure universal coverage including rural population and underprivileged urban poor, the schemes will beimplemented through Public Sector Health System. Primary Health Care: Health promotion, screening , basic medical care, home based care & referral system 2. Tertiary Care for advanced treatment of complicated cases, radiotherapy for cancer, cardiac emergency including cardiac surgery, neurosurgery, organ transplantation etc. Health Promotion & Prevention: Legislation, Population based interventions, Behaviour Change Communication using mass media, mid-media and interpersonal counselling and public awareness programmes in different settings (Schools, Colleges, Work Places and Industry). To ensure convergence, common districts will be selected for all three major programmes. The schemes would be flexible to meet local requirements as there would be variation in prevalence and availability of existing health infrastructure. Cancer Cancer pattern is varied in different parts of the country with increasing urbanization, sedentary habits & life style behavior it is becoming a major life style problem. At this juncture the country is equipped with only 450 radiotherapy machines in 250 institutes, where as the requirement is 1160 (1 per million population). The experts felt that Cancer should be a notifiable disease for the whole country like the State of West Bengal. It is essential that at all levels of the health facilities there is availability and accessibility of facilities for prevention, early detection, diagnosis, treatment and follow up of common cancers.

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