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UNIT1WelcometoInsidermedicineInDepth.I'mDr.SusanSharma.Focusingtimeandenergyonthemostpersonallymeaningfulaspectsoftheirworkmayhelpphysiciansavoidburnout,accordingtoasurveypublishedintheArchivesofInternalMedicine.Herearesomeconsequencesofphysicianburnout,publishedintheAnnalsofInternalMedicine:•Increasedriskforsubstanceabuse•Damagetopersonalrelationships,and•IncreasedriskfordevelopinginappropriateprescribingpatternsResearchersfromtheMayoClinicinRochestersurveyedover550physiciansinthedepartmentofinternalmedicineatalargeacademicmedicalcenter.Thesurveyincludedquestionsaboutjobsatisfaction,emotionalwell-being,andtheaspectsofthejobsthatwerethemostmeaningful.Asmanyas34%ofrespondentsmetthecriteriaforburnout,includingemotionalexhaustion,depersonalization,andalowsenseofpersonalaccomplishment.The88%whosaidtheyspentatleast20%oftheirworkingtimeonactivitiestheyfoundtobethemostmeaningfulhadabouthalftheburnoutrateofthosewhodidnot.Today'sresearchhighlightstheneedtooptimizecareerfitamongphysiciansinordertoreduceburnoutrates.ForInsidermedicineInDepth,I'mDr.SusanSharma.UNIT2EmergingeconomiessuchasChina,IndiaandSouthAfricaarediscoveringthereisadownsidetoprosperity.Asincomesrise,healthcandecline.OnMonday,theU.N.opensahigh-levelmeetingonnon-communicablediseasesthatusuallyhavebeenassociatedwithwesternnations.Inrecentyears,IndiaandChinahaveseenagrowingmiddleclass.Butwithgreateraffluencehascomeasurgeindiabetes,obesity,cardiovasculardiseaseandcancer.SouthAfricaisonasimilarpath.TheUnitedNationswilldebatewhatcanbedoneabouttheseillnesses.ProjectHOPEiscallingontheU.N.totakestrongaction–notonlyontreatment–butprevention.Thehealth-basedNGOhasprogramsin35countrieson5continents,manyofthemdealingwithnon-communicablediseasesorNCDs.Oneofthem–theHOPECenter–islocatedinJohannesburg,SouthAfrica.StefanLawson,countrydirectorforProjectHOPE,welcomestheU.N.meeting.It'sthefirsttimethatwe'vehadnon-communicablediseasesputonsuchahigh-levelforum.ThelasttimeaspecificdiseasewasdoneatthissortoflevelwasforHIVandAIDS.Andso,beingabletopushfornon-communicablediseasesupatthatministeriallevelIthinkwilldoalotofgood,hesaid.What'sfordinner?LawsonsaidamajorityofSouthAfricanmenandwomenarenowoverweight.Oneoftheresultsofprosperityisachangeinlifestyle,whichincludesachangeindiet.So,weseehereinashifttoamorewesterndiet–MacDonald's,KFC,fastfoods,moreprocessedmeat.Thingslikethatthatdefinitelyhaveanimpactonaperson'slifestyle,hesaid.Foodpriceshaverisensharplyinrecentyears,dealingamajorblowtothepoor.Thishasadirecteffectondietandhealth.Healthyfood–fruitsandvegetables,etc.–nowbecomesmoredifficulttopurchaseforsomeonewholivesinapoortownshipenvironment.So,they'reforcedtothenbuycheaper,lesshealthyfood,hesaid.FootingthebillAsdietschange,hesaid,whetherornotbychoice,theoverallhealthofacountrycandecline.That,hesays,canplaceagreatburdenonbudgets.SouthAfricahadawelldocumentedproblemwithHIVandTB.Andthatreallyputastrainonthepublichealthsystem.And(it)hascausedarealstraininjustthevolumeofpeoplethataregoingintotheclinicsnow.So,ifyouaddontopofthatnowmorepeoplegoingintotheclinicswiththingslikediabetesandhypertensionrelatedissues,it'sjustgoingtoincreasetheburdenevenmoreonanalreadyoverstrainedpublichealthsystem,hesaid.HeaddedhigherhealthcarecostscanbeadragonSouthAfrica'seconomicgrowth.ReachingoutTheHopeCenterprojectontheoutskirtsofJohannesburgprovidesservicestothosewithnon-communicablediseases.It'sapartnershipwiththelocalcommunity,theSouthAfricangovernmentanddonorEliLilly&Company.Theservicesincludeadiabetesclinicwiththelatestdiagnosticandtreatmentoptions.ProjectHOPETheHopeCenteroffersavarietyofhealthservicesThecenteralsohascreatedpeersupportgroupstohelppeoplemanagetheirdiseaseandmakehealthierlifestylechanges.GovernmenthealthworkersarealsobeingtrainedaboutNCDstohelpraisegeneralawareness.Teachingpeopleabouthealthymealoptions,teachingpeopleaboutportionsizes,teachingpeopleabouthowtocooktheirfoodinahealthierway.ThenIthinkalsothesecondpartofthatisbeingabletohelppeoplepurchasethosehealthierfoodoptions.Becausealotoftimessomepeopleknowthatanappleishealthierthanabagofchips,butabagofchipscostsalotlessthananapple,saidLawson.LawsonhopestheU.N.high-levelmeetingwillissueastrongstatementthatnon-communicablediseasesareanemergingthreatinthedevelopingworld.Inothercountries,ProjectHopesaidChinahasmorethan300-millionsmokersand30percentofthepopulationisoverweightwith12percentconsideredobese.InIndia,itsays50millionpeoplehavediabetes.IthasclinicsinbothcountriestohelpdealwiththeNCDs.UNIT3UNIT4Youknowthatoldadagethatlaughteristhebestmedicine.Well,studieshavelongshownthatlaughtercanhaveapositiveeffectbothphysicallyandemotionally.InSouthKorea,anationmoreusedtokeepingitsemotionsincheck,atleastonehospitalisencouragingpatientstoletlooseontheirregularbasis.Here’sourdigitalreporterJooheeCho.Laughing,forthesecancerpatientsandtheirfamilies,isaweeklyexercise.It’ssomethingthatdoesn’tcometooeasyforthem,butanhouroflaughterisallittakestofightdepressionthatoftenfollowschemotherapy.LimSongLi,atherapistatSeoulNationalUniversityhospital,wasonceadep