Presentation on theme: "Disease Informatics: ICD-11 at the doorstep By: RP Deolankar Presentation for 4 th Nutraceutical Summit, WTC, Mumbai, India Feb. 21-23, 2008 Bill and Narayana."— Presentation transcript:
Disease Informatics: ICD-11 at the doorstep By: RP Deolankar Presentation for 4 th Nutraceutical Summit, WTC, Mumbai, India Feb. 21-23, 2008 Bill and Narayana
WHO World Health Organization (WHO) provides a service which is designated as a Family of International Classifications (WHO-FIC) 10th version of ICD (ICD-10) has a Chapter entitled “Endocrine nutritional and metabolic diseases”
ICD One of such service is International Classification of Diseases (ICD) Application of Statistics and Information Science to establish causes of morbidity The activity is being described as a part of “Disease Informatics”
Disease Definition The ICD has become the international standard diagnostic classification for all general epidemiological and many health management purposes. In turn, ICD provided Diseases definitions "Let your food be your medicine and your medicine be your food" Hippocrates In short, most of the diseases could be linked to food and lifestyle.
ICD-10 Endorsed by the Forty-third World Health Assembly (WHA) in May 1990 Disease Definitions are quantal Domain of handpicked experts as described by media Severity of the disease triggered by the virus may be determined by the type of food had been eaten by the subject.
Scope for improvement Severity of Disease: Diseases are quantitative Holistic approach: Multiple morbidities interact Throwing open portal to Doctors, Health Workers, Educationists and Spiritualists Dr. T. B. Ustun
Scope for improvement in clinical research Multiple morbidity ► Multiple hypotheses Bayesian applications What can be done? As most of the functional foods serve as multiple remedy and also could reduce side effects of drugs, create task force for statistical methods in this area
Objectives of the presentation Discuss: How to use platform provided by ICD-11 for Defining the diseases with least error so that those are understood, prevented and reversed Identifying most of the targets to combat a cluster of diseases, understand spatial continuum through working on Disease Causal Chains and Designing a holistic solution to the disease problem
Health of an individual = % Wellbeing + % Disease Loosing the wellbeing is proportionally gaining the disease Wellbeing guards Good food Superb lifestyle Complementary Nutraceuticals
Medical check-up Revealing certain events in the health history of an individual Three aspects of Medical Check-up Attempt to hunt priors (Backend events) Understand present (Current event) Predict posteriors (Frontend events)
Disease Causal Chain or Web Events linked together Chain could be reversed due to intervention Pruning the Frontends could stimulate branching in the chain Event
Factors (Components) Drive events from backend to frontend Proxy, Overlapping, Independent, Mediators and Moderators Events could be modulated through altering factors Cause Effect Diagram Event Factors are shown by arrows Prof. HC Kraemer
Components working together It is not A + B It is A + B + AB Point to ponder: Why certain probiotics reverse viral diarrhea? Genes load the gun, the environment pulls the trigger Prof. Kenneth Olden
Ancient Indian Model of Human Body Computer Human = Somatic body + Vitality + Mind + Intellect + Bliss (Panchakosha) Intellect (Central Processing Unit) + Self/ Ego (Software) + Memory (Free space, Pen Drive/ Hard Disk) + Mind/ senses (Program) + Life history (Data)
Human Microbial Organs Gut Associated, Vagina Associated, Skin Associated etc (Eco-organs) Being described as Human Microbiome Prof. Stig Bengmark Prebiotics Probiotics Synbiotics
Clinical Research To understand the disease of an individual, one has to understand human and his body computer and his associated organs also
ICD-10 classification Infectious and Parasitic Diseases Cancers Endocrine, nutritional or metabolic diseases etc.
Triviality Infectious disease is not a nutritional disease Nutritional disease is not an endocrine disease One may have Infectious Disease + Nutritional Disease + Endocrine disease i.e. Multiple morbidities but not the complex disease
Reality Infection can happen due to endocrine abnormality and endocrine abnormality can happen due to malnutrition Some component may occur as prior some component may occur as posterior (Keshan disease: Selenium Deficiency + coxsackie virus B4)
What is neglected in ICD-10 Disease Causal Chain Most of the traditionally established remedies (TER) alter disease causal chain TER could alter some component of a sufficient cause of the disease Disease definition might not regard that component
Rothman and Greenland Sufficient and component cause model (Button is not sufficient cause to switch on or switch off the bulb) Sufficient causal mechanisms > 1 Three sufficient causes of disease.
To summarize the background Diseases are complex Needs group effort to understand Needs modern tools of information science to study Yet can have simple solutions
ICD-11 Membership is open to all who are willing to register Members can back their suggestions with appropriate evidence Members can participate in online debate over proposed changes in disease definition What can be done? Register as a member, Form Disease Informatics Groups
Systematic reviews: Basis of ICD-11 Practice of combining the results of a number of studies (scientific, clinical and public health) that address a set of related research hypothesis What can be done? Participate in Cochrane collaboration
What is Cochrane Collaboration? It is a global network of dedicated volunteers for providing reliable source of evidence in health care. Evidence is in the form of Systematic reviews based on meta-analysis What can be done? Register our interest in nutraceuticals and functional foods, form Cochrane review group Professor Archibald Leman Cochrane
Field testing of ICD-11 Draft version of ICD-11 shall be field tested What can be done? Participate in the field testing
Standardization of terminology ICD-11 website shall provide linkage for standardization of terminology What can be done? Find out methodology so that world understands our terminology
Examples of Indian terms Simple term: Ama = Dysbiotics (Products of dysbiosis) Complex term: Vata = Body constitution described as Low density of the body + Ectomorphy + More gaseous + Less muscle + High body motility + Linear body shape etc Traditional Knowledge Digital Library should be made available to ICD-11
Confusion due to local dialect Kanjika (Indian functional food, also abbreviated as Kanji), a probiotic food, is a lactic fermented product where lactic fermentation is the terminal step in food processing and is prepared from raw material of plant origin and devoid of dairy product Kanji is also used for porridge that is confusing
Confusing terms (Continued) Umbil is similar to kanjika but contains lactic fermented milk as an ingredient or cooked plant material may be combined with lactic fermented dairy product Umbil is also used in place of Kanjika by some people
MeSH, Medical Subject Headings of NLM, NIH, USA Based on UMLS (Unified Medical Language System) Metathesaurus Standard Terminology
Standardization of Data Processing ICD-11 website shall provide linkage for standardization of Data Processing More and more Bayesian Approach would appear in Disease Informatics What can be done? Develop user friendly software
Standardization of Research ICD-11 website shall provide linkage for standardization of research More and more Good Practice Protocols would be asked for What can be done? Develop standard courses in Health Research, Project Management Software, Infrastructure and Equipment Management, Store and Inventory Management, Archive Management, Document Management and GLP, GCP, GCLP, GMP etc
Example of Disease Causal Chain; …follows Phytase (germinated grains) + Calcium + Vitamin D + Sun Exposure for Influenza prevention? Sania in Sun
Calcium deficiency as the front-end event due to Chelation by Phytic acid
Front end events of Reduced availability of Calcium Front end eventsBackend event No deficiency in subjects taking calcium sufficient diet Calcium deficiency (reduced availability of Calcium due to IP6) Sub-clinical deficiency in subjects taking calcium deficient diets Rickets in children where component cause is calcium deficiency Osteomalacia / osteoporosis in elderly where component cause is calcium deficiency Degradation of vitamin D in the liver due to calcium deficiency
Front end events of Degradation of vitamin D in the liver John M Pettifor. Nutritional rickets: deficiency of vitamin D, calcium, or both? Am J Clin Nutr 2004; 80(suppl): 1725S–9S.
Front end events of Vitamin D deficiency (Avitaminosis D syndrome, I) D: Finally, a vitamin makes the grade. Several new studies suggest that the so-called sunshine vitamin (because it’s produced in skin exposed to sunlight) may protect against cancer. One study showed that as blood levels of vitamin D go up, women’s breast cancer risk goes down. Another found that fairly large amounts of vitamin D lowered the risk for pancreatic cancer by about 40%. The Top 10 health stories of 2006, from the Harvard Health Letter
Dr.Narayana Kochupillai Founder faculty member of the Department of Endocrinology, Metabolism & Diabetes at the AIIMS, INDIA "Based on our clinical experience and limited studies, we believe vitamin D deficiency is widespread in northern India," http://www.bmj.com/cgi/content/full/326 /7379/12/b?etoc
Front end events of Vitamin D deficiency (Avitaminosis D syndrome, II) Front end eventsBackend event Autoimmune diseases Vitamin D deficiency Type 1 diabetes Heart Disease Osteoporosis
The UV Advantage: The Medical Breakthrough That Shows How to Harness the Power of the Sun for Your Health by Michael F. Holick. I Books /Marvel, New York Prof. Michael Holick Boston University
Front-end events of Vitamin D deficiency (Avitaminosis D syndrome, III) Front-end eventBack-end event Epidemic Influenza (Driving factors to be investigated) Vitamin D deficiency Cannell JJ, Vieth R, Umhau JC, Holick MF, Grant WB, Madronich S, Garland CF, Giovannucci E. Epidemic influenza and vitamin D. Epidemiol Infect. 2006 Dec;134(6):1129-40 Aloia JF, Li-Ng M. Re: epidemic influenza and vitamin D. Epidemiol Infect. 2007 Oct;135(7):1095-6; author reply 1097-8.
Epidemic influenza and vitamin D. Epidemiol Infect. 2006 Dec;134(6):1129-40 1. Cannell JJ, Atascadero State Hospital, CA 2. Vieth R, Mount Sinai Hospital, Canada 3. Umhau JC, NIH 4. Holick MF, Boston University 5. Grant WB, SUNARC, CA 6. Madronich S, National Center for Atmospheric Research, CO 7. Garland CF, University of California San Diego 8. Giovannucci E., Harvard School of Public Health, Boston All authors are from different institutes
Disease definition challenged Author’s remark in the conclusion section: Is influenza infection a sign of vitamin D deficiency as much as Pneumocystis carinii pneumonia is a sign of AIDS? J. J. Cannell
Nutraceutical for Influenza Prevention on the basis of the DiCC Calcium Irrigated, UV Irradiated Mushrooms Rich in Calcium Rich in Vitamin D Rich in Protein Useful in lead detoxification
Indian Government Institute National Centre for Disease Informatics and Research at Bangalore, India Multi-disciplinary Multi-centric Surveillance Healthcare: Eleventh Five Year Plan (2007-2012) by Ministry of Health and Family Welfare, Government of India, New Delhi
Proposed Title-adjuncts for Nutraceutical Journals Disease Path Speed Breakers Causal Chain Quenchers Sufficient Cause Crackers Reversal of Disease Chronicle Simple Solutions to Disease Clusters Back-End Targets for Nutraceuticals Disease Informatics for Nutraceutical Development
Learn more about DiCC Supercourse : Epidemiology, the Internet and Global Health, Lecture no. 30331 Disease informatics for setting up Disease definition, drawing Disease Causal Chain / Web, marking Risk Events, Backend and Frontend Events, and Health Problem Solutions Rajendra P Deolankar BMJ.COM, 30 May 2006 Disease Informatics: Phytates driving from the back-end to Influenza, Encephalitis, Hepatitis, Anemia at the front-end
Read the Basics of Disease Informatics DIG for Disease Informatics Group. Part I Part II Disease Informatics: Host factors simplified Supercourse : Epidemiology, the Internet and Global Health, Lecture no. 25371, 25381 and 28921
Your consent to our cookies if you continue to use this website.