Lip News
International Conference: Cardio-Ankle-Vascular-Index (CAVI) a Novel Indicator for Vascular Function – Tokyo Japan
On 2nd December 2009, at an international conference in Tokyo, Japan Dr Tsering Norboo, the founder of Ladakh Institute of Prevention (LIP) presented the findings of the study on application of CAVI machine on 1239 individuals in the Ladakh region of India.
This epidemiological research survey by LIP on non-communicable diseases in Ladakh through applicability of CAVI helped explain the correlation of CAVI with risk factors, such as tobacco smoking, alcohol, sedentary lifestyle and diet. Some of the key findings include, a direct correlation of CAVI with number of abnormalities component of metabolic syndrome, although the overall prevalence of metabolic syndrome in Ladakh is fewer than 4%. Furthermore, the survey showed that CAVI has a good correlation with blood pressure (BP) and lipid profiles, including a strong correlation with age, when applied with senior citizens. The findings of the study showed that CAVI is a useful indicator for arteriosclerosis.
The findings of the survey complemented the overall aim of the conference; one of the key outcomes from the conference to LIP would the possibility of applying CAVI to a wider population in the Ladakh region, and helps benefit the population in identifying neuron-cardio-vascular risk factors. Furthermore, it will facilitate in educating the population to adopt a healthy lifestyle. Concurrently, it will encourage study the adaptation of communities in the high altitude regions, like Ladakh.
The conference discussed increasing the scope of CAVI in prevention of lifestyle related diseases among communities living in high altitude regions. It was also highlighted during the conference that the application of CAVI at high altitude and the results would lead to fruitful inferences even among sea-level population.
Invitation to Dr Tsering Norboo in Japan
Dr Norboo’s contribution into the field of high altitude research, understanding of occupational and environmental health problems is widely recognized by scientific communities worldwide. More recently, the founder of LIP was invited by the ‘Fakuda Denshi Company of Japan at their annual conference on CAVI in Tokyo. During the five day trip he attended a series of conferences, and it was imperative to showcase the best practices of LIP and share some of the vital findings from researches carried out by LIP in the Ladakh region of India.
Dr Norboo presented the findings from a significant survey research at the International conference on Cardio-ankle-vascular-index (CAVI) as a novel indicator for Vascular Function.
This was followed by another thought provoking seminar with international experts to discuss the changes in global environment and lifestyle, and its impact on human adaptation among highland population and the ageing process. At the seminar Dr Norboo shared the experiences of a joint project between LIP and Ladakh Ecological Group (LeDeG) and gave a talk on “high altitude human adaptation, ageing and life style related diseases”. The joint project is being carried out in Ladakh and is funded by the Japanese Government through its "research institute of humanity and nature."
On 5th December, Dr Norboo gave a talk at the Annual Meeting of Psychosomatic Disorders at the Tokyo University Medical School and was well received by the audience. Professor Kuniaki Otsuka, Director of Tokyo women's university hospital chaired the session, who shared his experience of a visit to LIP projects in Ladakh and appreciated the contribution LIP is making to the region though innovative projects on key issues, such as, occupational health "Silicosis in Ladakh", High altitude human adaptation" and identifying prevalence of cancer in Ladakh.
Dr Keith Percy Ball, doctor and campaigner, born December 8 1915; died January 10 2008
As a consultant at the Middlesex Hospital in the postwar years, Keith Ball became increasingly concerned about the damaging effects of tobacco on his
patients, not widely understood at that time. As the evidence showing the
alarming extent of the problem accrued, he combined with like-minded people
to raise awareness about the magnitude of the harm tobacco was doing,
enlisting the help of MPs of all persuasions as well as ministers - though
the might of the tobacco industry ensured that some of them did not retain
their ministerial positions for long.
The fight was a vigorous one on many fronts but he and his colleagues managed to get the seemingly immobile Royal College of Physicians to take a position and then to produce in 1962 what was hailed as a highly influential keynote report on Smoking and Health.
This report in turn led to the foundation of Action on Smoking and Health: he became its first honorary secretary and he remained intimately involved with it for the rest of his life. ASH campaigned relentlessly for measures, including legislation, to curb the deleterious effects of tobacco, campaigns which culminated most recently in the ban on smoking in public places.
Keith Ball was born in 1915 and graduated from the Middlesex Hospital Medical School in 1938. He held house appointments there before becoming a medical registrar at Stoke Mandeville Hospital. War was looming ominously, but having been rejected for military service on medical grounds, he became senior registrar in Medicine at the Middlesex Hospital where he remained through the Blitz.
In 1944, restless to help to rebuild a shattered Europe, he volunteered to join the recently established United Nations Relief and Rehabilitation Authority. His experiences in working with this organisation to provide medical and other help for people who had been displaced in forced labour camps, concentration camps and those who were refugees, imprinted indelibly on him the social sources of disease.
On returning to Britain, he was appointed in due course a consultant physician to the Central Middlesex Hospital, where he was to remain for the rest of his professional life. Many medical luminaries were working there including Dr (later Sir) Francis Avery Jones and Dr (later Professor Sir) Richard Doll. He was influenced and greatly supported by Dr Horace Joules. It was an exciting time with the inception of National Health Service and all the potential that this brought with it. He built up a department not only with a strong interest in clinical care but also with an interest in research into heart and lung disease.
He attracted many young doctors for training as well as a continuing stream of medical students from the Middlesex Hospital Medical School. He was the sub-dean for the medical school, a responsibility he took seriously, taking a personal interest in everyone who worked for him, particularly junior doctors from abroad who came to Britain for training. Aware of the problems they faced in getting training both in their own countries as well as here in the UK, he made it a responsibility to encourage and support them. Many became lifelong friends.
As a cardiologist, he was aware of the role of smoking in the inexorable rise in coronary heart disease and other vascular disease. At a time when cardiologists were more concerned with other forms of heart disease, he took what was then the unpopular path of proselytising for the need for coronary prevention. Once again he harnessed the Royal College of Physicians and the British Cardiac Society to jointly produce another highly influential report, now recognised as the starting point for coronary prevention in the UK.
Nowadays it is strange to learn that the British Heart Foundation was initially reluctant to become involved in coronary prevention, but Ball eventually persuaded the BHF to join in. He and his friends founded the Coronary Prevention Group to focus the efforts of many diverse organisations on the common task of prevention, thereby raising greatly awareness of the extent of the problem and what could be done about it. Later much of this work was absorbed by the National Heart Forum, of which Ball was an ardent supporter. These organisations extended their influence to fruitful collaborations elsewhere in the EU.
When he reached 60, Ball retired from clinical work, becoming an academic in public health and community medicine. This gave him an opportunity to forge increasing links overseas. He travelled to many countries in Africa, Asia and the Middle East where he was able to encourage doctors working in those countries to engage in the prevention of diseases at that time more prevalent in the affluent nations. He developed a particular affection for Ladakh - an Indian community high in the mountains in a disputed territory adjacent to Pakistan and China. Immense social changes were going on in this isolated, pastoral community as a result of it becoming the epicentre for a military stand-off - and also as it opened up to Western tourism. With his friends working there, Ball identified the importance of starting preventive measures and developed with them the means to do so.
Dust storms in China and Central Asia, arising because a combination of industrialisation and climatic change, and causing pulmonary silicosis and modulating tuberculosis, proved an unexpected problem. Again, Ball drew international attention to the issue as well as seeking local measures to counter it. His efforts, both intellectual and material, were central to the foundation of the Ladakh Institute of Prevention where, once again, he brought together people with seemingly disparate interests united in a common aim.
As a child Ball had a rascally sense of humour which never really left him. In his career he had frequent heated battles, which he often won, but he was always chivalrous about his opponents, however misguided he may have found their views. It gave him great satisfaction see the ban on smoking in public places, to know that the increase in coronary heart disease had been stemmed, and to learn of the efforts in developing nations to curb the growth of diseases of Western, industrialised nations.
Ball is survived by his wife, Francesca, and three daughters; a son predeceased him.
This Obitury is published in THE TIMES, London - February 8th 2008, and written by Brian J Kirby