1. Triangulation surveys are carried out for locating





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MCQ-> Throughout human history the leading causes of death have been infection and trauma, Modem medicine has scored significant victories against both, and the major causes of ill health and death are now the chronic degenerative diseases, such as coronary artery disease, arthritis, osteoporosis, Alzheimer’s, macular degeneration, cataract and cancer. These have a long latency period before symptoms appear and a diagnosis is made. It follows that the majority of apparently healthy people are pre-ill.But are these conditions inevitably degenerative? A truly preventive medicine that focused on the pre-ill, analyzing the metabolic errors which lead to clinical illness, might be able to correct them before the first symptom. Genetic risk factors are known for all the chronic degenerative diseases, and are important to the individuals who possess them. At the population level, however, migration studies confirm that these illnesses are linked for the most part to lifestyle factors — exercise, smoking and nutrition. Nutrition is the easiest of these to change, and the most versatile tool for affecting the metabolic changes needed to tilt the balance away from disease.Many national surveys reveal that malnutrition is common in developed countries. This is not the calorie and/or micronutrient deficiency associated with developing nations (type A malnutrition); but multiple micronutrient depletion, usually combined with calorific balance or excess (Type B malnutrition). The incidence and severity of Type B malnutrition will be shown to be worse if newer micronutrient groups such as the essential fatty acids, xanthophylls and falconoid are included in the surveys. Commonly ingested levels of these micronutrients seem to be far too low in many developed countries.There is now considerable evidence that Type B malnutrition is a major cause of chronic degenerative diseases. If this is the case, then t is logical to treat such diseases not with drugs but with multiple micronutrient repletion, or pharmaco-nutrition’. This can take the form of pills and capsules — ‘nutraceuticals’, or food formats known as ‘functional foods’, This approach has been neglected hitherto because it is relatively unprofitable for drug companies — the products are hard to patent — and it is a strategy which does not sit easily with modem medical interventionism. Over the last 100 years, the drug industry has invested huge sums in developing a range of subtle and powerful drugs to treat the many diseases we are subject to. Medical training is couched in pharmaceutical terms and this approach has provided us with an exceptional range of therapeutic tools in the treatment of disease and in acute medical emergencies. However, the pharmaceutical model has also created an unhealthy dependency culture, in which relatively few of us accept responsibility for maintaining our own health. Instead, we have handed over this responsibility to health professionals who know very little about health maintenance, or disease prevention.One problem for supporters of this argument is lack of the right kind of hard evidence. We have a wealth of epidemiological data linking dietary factors to health profiles/ disease risks, and a great deal of information on mechanism: how food factors interact with our biochemistry. But almost all intervention studies with micronutrients, with the notable exception of the omega 3 fatty acids, have so far produced conflicting or negative results. In other words, our science appears to have no predictive value. Does this invalidate the science? Or are we simply asking the wrong questions?Based on pharmaceutical thinking, most intervention studies have attempted to measure the impact of a single micronutrient on the incidence of disease. The classical approach says that if you give a compound formula to test subjects and obtain positive results, you cannot know which ingredient is exerting the benefit, so you must test each ingredient individually. But in the field of nutrition, this does not work. Each intervention on its own will hardly make enough difference to be measured. The best therapeutic response must therefore combine micronutrients to normalise our internal physiology. So do we need to analyse each individual’s nutritional status and then tailor a formula specifically for him or her? While we do not have the resources to analyze millions of individual cases, there is no need to do so. The vast majority of people are consuming suboptimal amounts of most micronutrients, and most of the micronutrients concerned are very safe. Accordingly, a comprehensive and universal program of micronutrient support is probably the most cost-effective and safest way of improving the general health of the nation.The author recommends micronutrient-repletion for large-scale treatment of chronic degenerative diseases because
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MCQ-> Read the following case-let and answer the questions that follow Rajinder Singh was 32 years old from the small town of Bhathinda, Punjab. Most of the families living there had middle class incomes, with about 10% of the population living below the poverty level. The population consisted of 10 percent small traders, 30 percent farmers, besides others. Rajinder liked growing up in Bhathinda, where people knew and cared about each other. Even as a youngster it was clear that Rajinder was smart and ambitious. Neighbors would often say, “Someday you’re going to make us proud!” He always had a job growing up at Singh’s General Store - Uncle Balwant’s store. Balwant was a well-intentioned person. Rajinder loved being at the store and not just because Balwant paid him well. He liked helping customers, most of who were known by the nicknames. Setting up displays and changing the merchandise for different seasons and holidays was always exciting. Uncle Balwant had one child and off late, his interest in business had declined. But he had taught Rajinder ‘the ins and outs of retailing’. He had taught Rajinder everything, including ordering merchandise, putting on a sale, customer relations, and keeping the books. The best part about working at the store was Balwant himself. Balwant loved the store as much as Rajinder did. Balwant had set up the store with a mission to make sure his neighbors got everything they needed at a fair price. He carried a wide variety of goods, based on the needs of the community. If you needed a snow shovel or piece of jewelry for your wife, it was no problem - Singh’s had it all. Rajinder was impressed by Balwant’s way of handling and caring for customers. If somebody was going through “hard times”, Balwant somehow knew it. When they came into the store, Balwant would make them feel comfortable, and say something like, “you know Jaswant, let’s put everything on credit today”. This kind of generosity made it easy to understand why Balwant was loved and respected throughout the community. Rajinder grew up and went to school and college in Bhathinda. Later on, he made it to an MBA program in Delhi. Rajinder did well in the MBA course and was goal oriented. After first year of his MBA, the career advisor and Balwant advised Rajinder for an internship at Bigmart. That summer, Rajinder was amazed by the breadth and comprehensiveness of the internship experience. Rajinder got inspired by the life story of the founder of Bigmart, and the value the founder held. Bigmart was one of the best companies in the world. The people that Rajinder worked for at Bigmart during the internship noticed Rajinder’s work ethic, knowledge, and enthusiasm for the business. Before the summer ended, Rajinder had been offered a job as a Management Trainee by Bigmart, to start upon graduation. Balwant was happy to see Rajinder succeed. Even for Rajinder, this was a dream job - holding the opportunity to move up the ranks in a big company. Rajinder did indeed move up the ranks quickly, from management trainee, to assistant store manager, to supervising manager of three stores, to the present position - Real Estate Manager, North India. This job involved locating new sites within targeted locations and community relations. One day Rajinder was eagerly looking forward to the next assignment. When he received email for the same, his world came crashing down. He was asked to identify next site in Bhathinda. It was not that Rajinder didn’t believe in Bigmart’s explanation. What was printed in the popular press,especially the business press, only reinforced Rajinder’s belief in Bigmart. An executive viewed as one of the wisest business persons in the world was quoted as saying, “Bigmart had been a major force in improving the quality of life for the average consumer around the world offering great prices on good, giving them one stop solution for almost everything.” Many big farmers also benefitted through low prices, as middlemen were removed. At the same time, Rajinder knew that opening a new Bigmart could disrupt small business in Bhathinda. Some local stores in small towns went out of business within a year of the Bigmart’s opening. In Bhathinda, one of the local stores Singh’s,now run by Balwant’s son, although Balwant still came in every day to “straighten out the merchandise.” As Rajinder thought about this assignment, depression set in, and the nightmares followed. Rajinder was frozen in time and space. Rajinder’s nightmares involved Balwant screaming something- although Rajinder could not make out what Balwant was saying. This especially troubled Rajinder, since Balwant never raised his voice. Rajinder didn’t know what to do - who might be helpful? Rajinder’s spouse, who was a housewife? Maybe talking it through could lead to some positive course of action. Rajinder’s boss?Would Bigmart understand? Could Rajinder really disclose the conflict without fear? Uncle Balwant? Should Rajinder really disclose the situation and ask for advise? He wanted a solution that would make all satkeholders happy.Who is the best person for Rajinder to talk to?
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