InnoHEALTH magazine volume 3 issue 1 - January to March 2018 by innohealthmagazine

An Initiative of An Initiative of

India’s First Magazine of Healthcare Innovations

VOLUME 3 ISSUE 1 JAN-MARCH 2018 e 2 | Issue 4 | Oct-Dec 2017

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Lifestyle diseases

Issue 4 | Oct-Dec 2017

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s e t a t s d r a w k c a b o A threat t Exclusive Report

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NNOVATIVE

Special Report on InnoHEALTH 2017

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EXECUTIVE OPINION

Improvisation, Jugaad, Innovation, Transforming Indovation and Invention, what it means Healthcare Through I Innovations Innovation has become buzz word and being used by many without even knowing its meaning and difference in improvisation, Jugaad, innovation, indovation and Invention. It would be appropriate Dear Friends, to explain these terms for benefit of many.

To make everyone aware what innovation means if they need to work on it either by start-up or otherwise we have created a knowledge platform InnovatioCuris (IC) to delineate innovations in healthcare to reduce healthcare delivery cost and yet keep quality. t the outset, I wish all our innovator community best wishes and exciting New The dissemination of knowledge Improvisation: Process Year 2018. At our end, we continueofto add value through our knowledge activi- is done through International devising a solution to a requirement conference and ties of InnovatioCuris (IC). An international conference will be organised on October InnoHEALTH by despite 5 & making-do, 6 2018. We also continueabsence to arrangeofwebinars, training, IC club meetings, maga- registered magazine with same resources thatand might zine publication launchbeof expected new initiatives like security audit of healthcare facili- name, complimentary webinars, to produce a solution. ties. We have already published two books in the U.S.A. First being “Innovations in training and Innovators’ club. In fact, this issue gives post conference Jugaad: A colloquial Hindi-Urdu Healthcare Management: Cost-Effective and Sustainable Solutions” in 2015 which has and club glimpses, which included word that can meanInstitutes an innovative been adopted by Indian of Management (IIMs) and University in UK as a young innovators award and nine fix or a book. simple work-around, usededition as well. The second is “Planning and reference It has now special Indian companies of European Union for solutions that bend rules, or aInnovative, and Evidence-Based Approach” Designing Healthcare Facilities: A Lean, participated toDrbring healthcare VK Singh resource that can be used as such, published in October 2017. We bring global leaders to our platform and share experi- innovations suiting Indian needs. or a person who can solve a complicated issue Editor inwere Chief & MD, ences to benefit all. We thank our members for continuous support to meetings take all initiaB2B in Delhi and Bangalore organized, Innovation: The process of translating an idea InnovatioCuris to learn from each other’s experiences. In case you tives to the next level. We have already partnered with many credible organisations into a good or service that create value for which missed conference or wish to refresh moments this to work together. customer will be ready pay of and replicate at issue will update are also encouraging grass As developed economies enterto a period slower growth, emerging economies such you. We vksingh@innovatiocuris.com economic cost. There are various types of innovations as India have become prime examples of how more can be achievedroot withinnovations less. We needfrom far and wide. The next paragraph like process and product innovations, frugal explains how developed countries take Indian to share best global practices to optimise healthcare delivery cost and can reduce conInnovation, reverse Innovation, disruptive innovation, innovations. cerns of patients and yet keep high degree of quality. We impart knowledge through IndovationandInnovation Excellence Alexander Blass, CEO of Innovation Institute of various medium and presents new concepts, methods and tools to achieve low cost, It that is improve an abbreviation of care Indian America, Inc. and highIndovation: volume solutions access to patient by better understanding of winner of Top Innovator of the Year innovation, conceptualised in 2009 by Navi Radjou, award states, “It transforming healthcare through innovations. Our focus is grass root innovation to is no secret that many of the world’s the executive of the Centreand for flow Indiato&achieve Globalwithtop innovators come from India. Within the past few benefit have notsdirector by organising resources available resources. Business at Judge Business School, University of decades, India has embarked upon an incredible It also covers non-traditional ecosystems of innovation outside of pure technology, Cambridge transformation from an agrarian-based society to a such as social persuasion, rural health delivery, exploitation of economies of scale, knowledge-based economy. Along with the population Invention: Newprimary scientific technical idea, and prevention oriented care,ormedical education, and the hospital design. growth came survival instincts and the need to be means of its embodiment or accomplishment. To now, be with The ecosystem is very conducive for innovations right growing num- and unique. One can see innovation different, better patentable, an and invention must be ber of start-ups open mindset. Wenovel, shouldhave take utility, advantageeverywhere of the new initiain India, whether in large game changing and be non-obvious. To be called an invention, an idea tives launched by the government like Startup India, Make in innovations India, Standupthat In- garner lots of publicity, or in less only needs to be proven as workable. dia, Skill India and many more to take innovations to logical conclusion. The obvious yet important incremental fashions” Every person interested innovation need to government has created enough infunds to support. Innovators should take adHence join in many initiatives of IC a knowledge and know what internet agefulfil provides... “Just about vantagethat of these schemes to their mission. To makehand members aware holding platform to take innovation in healthcare anyone canopportunities, have an ideaa at breakfast, it with of funding workshop wasdesign conducted in the last club meetforward which is need and national movement of online CAD software, a prototype on very a 3Dvibrant ing by experts evaluatingproduce such proposals. We have website; it has printer, receive financing and market analysis from country, buzz word of innovation is to be converted into videos, webinars, conference and magazine articles. It would bereality worth for visiting our of community through participation benefit a crowd funding site, rent supercomputer time from website at www.innovatiocuris.com and magazine website is http://innohealthmagof all stakeholders. Amazon, contract a manufacturer and be done by azine.com lunch without even leaving the table”.

We would be happy to get your views and feedback. The healthcare delivwww.innovationexcellence.com/blog/2014/05/18/5-thingsery is a holistic approach, which requires integrating all stakeholders of varied Dr VK Singh managers-should-know-about-the-big-data-economy/ fields and discipline. It is a team work to develop and scale up new innovations Editor in Chief & MD, InnovatioCuris and we are committed to bring best global resource under one roof to benefit the community. Volume 2 | Issue 4 | Oct-Dec 2017

Volume 2 | Issue 4 | Oct-Dec 2017 Volume 3 | Issue 1 | Jan-Mar 2018

7 3

Dear Readers,

The Message

Happy New Year 2018!

n New Year, generally most of the people take a resolution that they will shun old habits assailing their health, but as days pass by, the resolution fades. They gloss over the time tested fact- Health is Wealth, a golden rule for centuries without an iota of doubt. We bogged down in daily clutter and treat health on the lowest priority, but such an attitude only compounds health problems. The world is full of information about the health sector developments, but we hardly find adequate coverage of those issues in media, primarily because of reason that the media platforms are overflowing with hard news related to geo-political and economic developments. Almost every day there is researches, major surgical operations, and new light on health issues, but many of such developments hardly see light of the day. We are trying to cover a slew of health issues in order to highlight researches, medical conferences, policies, interviews of health experts with prime focus on innovations in the sector. We will continue to cover all formats of therapies so that our readers get holistic view of treatments available to them. In the current issue, we have highlighted various studies, inside of a newly launched book on hospitalsâ&#x20AC;&#x2122; planning, innovations in the health sector, latest researches across the world etc. Other articles include a study on alcohol addiction; digital pill; opening of a childhood neuro disorder center at AIIMS; an exhaustive study on the prospects of Medical tourism; obesity among women; first humanitarian drone for emergency purpose being developed by IIT Kanpur; why doing exercise in large parks is beneficial for health, addiction to smart phones and many more. I hope with every edition, our coverage of the sector will increase and provide additional knowledge for medical professionals, common public and policy makers.

Best Wishes,

Neeraj Bajpai Consulting Editor

Volume 3 | Issue 1 | Jan-Mar 2018

CONTENTS TRENDS

POLICY

10 Multi Medicine Facility 13 Practo Ray Tab 14 IBM Reveals Five

24 Matters of Good Health

Innovations

19 Smart Mirror and Kiomatik

20 Artificial Retinas

TRENDS

Digital tracking system: Pill to determine medication ingestion WELL Latest Innovations! BEING Big parks can reduce depression! Know how?

12 14 20

New Year- New Gift 22 30 Sweet smell of Find out and how different houses and lifestyles health affect which bugs live with us?

well-being

MedicalBack TourismTo needs systematic structural overhaul 38 Going Yoga

PERSONA

It’s good to have dogs!

Genetic link to heart disease in40 Indian population The Nobel Prize

PERSONA

30 36

The Future of Healthcare

India aims to eliminate Tuberculosis by 2025

42 Alcohol baby 43 Tete-Tete With

Do you have any innovative idea? Unreported Angels

34 Medical Tourism POLICY

to the rescue Hospitals designing bats for a fresh look

Khichdi comes out of kitchen; enters Guinness World Records

A Jovial Gp

62 66

ISSUES Lifestyle diseases: A threat to backward states

Smart City: Areas selected for development are heat islands

Regulatory Alignment - Play catch up 42

Smartphone addiction creates imbalance in brain

Menace of Non-Communicable Disease: A far

Indian scientists detect new strain of dengue virus

reaching impact 44

Alcohol addiction: Counselling can be of great help

WELL BEING

WOMEN’S CORNER

ISSUES Rural Healthcare: Solutions lie in Innovations Healthy ageing promises Healthy gut 46 How to Save at

Regular consumption of fruits, vegetables and dals cuts National Level risk of death

50 Healthcare Innovations in India

6 54 Weighing on 3Fat Facts Volume | Issue 1 | Jan-Mar 2018

48 50 52

WOMEN Stressful events can increase women’s odds of obesity CORNER Center for Childhood Neuro developmental Disorders at AIIMS Global nutrition ‘at odds’; needs swift efforts

90 92

56 Kiss Guilt Goodbye forever

Dr. V.K.Singh, Managing Director, InnovatioCuris and Lt. Gen P.K.Singh, Director, United Service Institution of India (USI) signs MoU to work with world class academic institute, government organisation, industry and NGOs in order to create a collaborative ecosystem for piloting new interventions (system & process) and to improve the cyber security know how in the society. Editor-In-Chief: Dr. V. K. Singh

Executive Editor: Sachin Gaur

Editors: Alok Chaudhary Dr. Avantika Batish Nimisha Singh Verma Consulting Editor Neeraj Bajpai Sr. Designer Suraj Sharma

Advisors Konda Vishweshwar Reddy, Member of Parliament, India Amir Dan Rubin, Executive Vice President, United Health Group, USA Thumbay Moideen, Founder President,

THUMBAY Group, UAE Prof Prabhat Ranjan, Executive Director, Technology Information Forecasting and Assessment Council, India

Global Editorial Board Dr Shailja Dixit, Chief Medical Officer, Scientific Commercialization, Fellow of Health Innovation & Technology Lab, USA Ronald James Heslegrave, Chief of Research, William Osler Health System, Canada Dr Ogan Gurel, Chief Innovation Officer, Campus D, South Korea Dr Chandy Abraham, CEO and Head of Medical Services, the Health City, Cayman Islands Dr Sharon Vasuthevan, Group Nursing & Quality Executive at Life Healthcare Group, South Africa Dr Kate Lazarenko, Founder and Director, Health Industry Matters Pte. Ltd, Australia Disclaimer:

Major General (Retd) A K Singh, Advisor, Telemedicine and Health Informatics, Rajasthan, India Printed and Published by Sachin Gaur on behalf of InnovatioCuris Private Limited. Printed at Poonam Printers, C-145, Back side Naraina Ind. Area, Phase I, New Delhi. Published at E-2/9, First Floor, Malviya Nagar New Delhi 110017. Editor: Sachin Gaur. DCP Licensing number: F.2.(I-10) Press/2016

ÂŠ InnovatioCuris Private Limited. All rights reserved. Neither this publication nor any part of it maybe reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission from InnovatioCuris Private Limited.

Readers are requested to verify and make appropriate enquires to satisfy themselves about the veracity of the advertisements before responding to any published in this magazine. Sachin Gaur, the Publisher, Printer and Editor of this magazine, does not vouch for the authenticity of any advertisement or advertiser or for any the advertiserâ&#x20AC;&#x2122;s products and/or services. In no event can the Publisher, Printer and Editor of this magazine/ company be held responsible/liable in any manner whatsoever for any claims and / or damage for advertisements in this magazine. Authors will be solely responsible for any issues arising due to copyright infringements and authenticity of the facts and figures mentioned in their articles. InnoHEALTH magazine is not liable for any damages/copyright infringements.

Volume 3 | Issue 1 | Jan-Mar 2018

trends

companies to understand how technology might benefit patients and prescribers.” It is important to note that AbilifyMyCite’s prescribing information (labeling) notes that the ability of the product to improve patient compliance with their treatment regimen has not been

shown. AbilifyMyCite should not be used to track drug ingestion in “real-time” or during an emergency because detection may be delayed or may not occur. Schizophrenia is a chronic, severe and disabling brain disorder. About 1 percent of Americans have this illness. Typically, symp-

WOMEN'S CORNER

TRENDS POLICY WELL BEING PERSONA ISSUES WOMEN'S CORNER

ISSUES

Volume 3 | Issue 1 | Jan-Mar 2018

PERSONA

WELL BEING

bilifyMyCite (aripiprazole tablets with sensor) has an ingestible sensor embedded in the pill that records that the medication was taken. The product is approved for the treatment of schizophrenia, acute treatment of manic and mixed episodes associated with bipolar I disorder and for use as an add-on treatment for depression in adults. The system works by sending a message from the pill’s sensor to a wearable patch. The patch transmits the information to a mobile application so that patients can track the ingestion of the medication on their smart phone. Patients can also permit their caregivers and physician to access the information through a web-based portal. “Being able to track ingestion of medications prescribed for mental illness may be useful for some patients,” said Mitchell Mathis, M.D., director of the Division of Psychiatry Products in the FDA’s Center for Drug Evaluation and Research. “The FDA supports the development and use of new technology in prescription drugs and is committed to working with

treated with antipsychotic drugs are at an increased risk of death. AbilifyMyCite is not approved to treat patients with dementia-related psychosis. The Boxed Warning also warns about an increased risk of suicidal thinking and behavior in children, adolescents and young adults taking antidepressants. The safety and effectiveness of Abilify-

MyCite have not been established in pediatric patients. Patients should be monitored for worsening and emergence of suicidal thoughts and behaviors. AbilifyMyCite must be dispensed with a patient Medication Guide that describes important information about the drug’s uses and risks. In the clinical trials for Abilify, the most common side effects reported by adults were nausea, vomiting, constipation, headache, dizziness, uncontrollable limb and body movements (akathisia), anxiety, insomnia, and restlessness. Skin irritation at the site of the MyCite patch placement may occur in some patients. Prior to initial patient use of the product, the patient’s health care professional should facilitate use of the drug, patch and app to ensure the patient is capable and willing to use the system.

POLICY

The U.S. Food and Drug Administration has recently approved a pill with sensor that digitally tracks if patients have ingested their medication

Prior to initial patient use of the product, the patient’s health care professional should facilitate use of the drug, patch and app to ensure the patient is capable and willing to use the system.

TRENDS

DIGITAL TRACKING SYSTEM: PILL TO DETERMINE MEDICATION INGESTION

toms are first seen in adults younger than 30 years of age. Symptoms of those with schizophrenia include hearing voices, believing other people are reading their minds or controlling their thoughts, and being suspicious or withdrawn. Bipolar disorder, also known as manic-depressive illness, is another brain disorder that causes unusual shifts in mood, energy, activity levels and the ability to carry out day-to-day tasks. The symptoms of bipolar disorder include alternating periods of depression and high or irritable mood, increased activity and restlessness, racing thoughts, talking fast, impulsive behavior and a decreased need for sleep. AbilifyMyCite contains a Boxed Warning alerting health care professionals that elderly patients with dementia-related psychosis

Volume 3 | Issue 1 | Jan-Mar 2018

TRENDS POLICY WELL BEING PERSONA ISSUES WOMEN'S CORNER

It is believed that by 2030, India alone will account for 60 percent of the world’s cardiac patients, nearly four times its share of the world’s population. The major reason for these alarming statistics is lack of awareness towards ‘healthy’ lifestyle and the lack of knowledge of few simple steps that can be taken during emergency or before reaching the hospital. Out of the people who die from heart

attack, about 50 percent die within an hour of their initial symptoms before they reach the hospital. The chances of survival of the victim can increase significantly if he is provided Cardiopulmonary resuscitation (CPR) immediately. Hence, people present at the scene can help avert the risk of death by proving CPR promptly to the victim. Providing BLS and CPR during the golden hour can help in preventing pre-hos-

Volume 3 | Issue 1 | Jan-Mar 2018

We often hear of people dying in sleep. But, do we have an understanding of what can cause this sudden death? In most cases, the cause is sudden cardiac arrest due to an undetected heart rhythm disorder, or an underlying coronary artery disease. In India, however, there is limited awareness both among people and healthcare providers about mechanisms needed to be adopted to reduce risk of sudden cardiac death and save lives. There is a need to talk about the importance of timely identifying and treating patients at high risk of sudden cardiac death. Sudden cardiac death (SCD) is defined as death which occurs within one hour of onset of symptoms due to cardiac causes. In USA about 350,000 deaths occur every year which are sudden. While we do not have consolidated statistics for India, clinical evidence suggests the numbers of people dying a sudden death due to heart ailments is high. Most important cause of sudden death in India is coronary heart disease or artery blockage but very few people understand the concept of sudden cardiac death or do anything to mitigate their risks. In many cases, especially in smaller towns patients do not report fainting episodes, and carry on with their lives after regaining consciousness. There could be several reasons for a person passing out including a heart rhythm disorder coming from lower chambers of heart which can turn fatal if ignored. If the predictors are detected on time, the sudden cardiac arrest can be prevented by implanting a pacemaker-like device called ICD (Implantable Cardioverter Defibrillator) under the skin (usually below the collarbone) to send life-saving electrical signals that bring the heart back to a normal rhythm whenever abnormal heart rhythm is detected. If you have a history of coronary artery disease, a record of high blood pressure or cholesterol, or a tendency towards diabetes or obesity, you are at a higher risk of sudden cardiac arrest. People who smoke, have family history of irregular heart rhythm or sudden cardiac death are other groups who have higher chance of sudden cardiac death. Also, chances of sudden cardiac arrest are higher in people whose ejection fraction is less than 35% or who have history of fainting intermittently. Ejection fraction is a measure of the heart’s pumping power. A healthy person’s ejection fraction ranges between 60-70%. This is diagnosed on performing ECHO. A sudden cardiac arrest occurs when the electrical impulse system of the heart malfunctions, disrupting regular heartbeat. It is more dangerous that heart attack because the rate of survival

in case of sudden cardiac arrest is very low. Implanting an ICD in persons at high risk of sudden cardiac arrest can save lives. The key lies in improving identification of persons at high risk and recommending them for ICD implantation in time. Another important aspect of prevention is preventing coronary artery disease. The single most important and cost-effective way to prevent sudden cardiac death is to prevent damage to heart which occurs due to heart attacks caused by blockages in the arteries. Cardiovascular disease is a huge health burden in India, magnified by the changing lifestyles, increase in sedentary jobs and lack of physical activity. How to Reduce the Risk of Sudden Cardiac Arrest: Control your weight: People who are over overweight especially at the abdomen have high risk of cardiovascular disease. Control diabetes, hypertension and LDL. Diabetes, hypertension and bad cholesterol magnify risk of both coronary artery disease and sudden cardiac arrest. Exercise: 45 minutes of moderate daily exercise, at least 5 days a week, performing yoga or meditation, will go a long way to prevent heart attacks & sudden cardiac death. Avoid Smoking: Smoking increases risk of coronary heart disease by narrowing arteries over a sustained period of time. Quitting immediately cuts the risk. Managing heart health: People who already have suffered damage to their left ventricle (Ejection Fraction 35 % or less) can prevent sudden death by implantation of small pacemaker like device called ICD. ICD is highly effective device which can revive more than 95% of victims who suffer from cardiac arrest. Volume 3 | Issue 1 | Jan-Mar 2018

WOMEN'S CORNER

Research Society for the Study of Diabetes in India (RSSDI) recently announced the launch of DiaHELP. The toll-free helpline, managed by Lifeincontrol, is a first of its kind digital diabetes management platform. It will aid millions of diabetes patients and their caregivers to get education related to managing this chronic disease effectively. Women who are at high risk of gestational diabetes will be given special service. Toll free number 180030022935 will provide any information and queries.

Knowledge of BLS and CPR goes a long way DiaHelp – India’s first toll free diabetes in dealing with emergency cardiac patients helpline service

Sudden Cardiac Arrest More Dangerous Than Heart Attack; Awareness Abysmally Low

ISSUES

all areas of laboratory medicine. Neuberg will combine conventional pathology testing, new generation laboratory techniques and basic Radiology & imaging techniques for enhanced patient outcomes. The aim of the partnership is to develop a new shared services model for the provision of pathology services in the Middle East, Africa including west and South India. Neuberg Diagnostics is built on the vision to provide modern, innovative and sustainable services that deliver world-class lab facilities with the focus on high-end technology and services like Genomics and Proteomics to doctors and patients alike. Indian healthcare delivery is growing by leaps and bounds. A global consortium is, therefore set to be a major platform, to introduce new generation pathology services to the sector, thereby increasing the quality and affordability of the country’s healthcare services.

PERSONA

Minerva Labs, which have already made their presence in their respective countries and states such as Karnataka, Gujarat, Tamil Nadu, South Africa & UAE. Neuberg will have three world class global reference laboratories located in Bangalore, Ahmedabad, and Durban (South Africa) carrying out advanced range of testing using new generation In vitro diagnostics techniques along with total lab automation & big data analytics tools supported by robust world-class laboratory information system. With full throttle growth expected to take up Indian diagnostics in the near term, the new generation consortium will pool in cutting-edge advanced diagnostics technology and actively perform 5000 plus variety of pathological tests, promoting prevention and early diagnosis, thereby empowering the Indian healthcare consumer. In conjunction with providing comprehensive laboratory services, covering

WELL BEING

Aggregating the fragmented diagnostic sector of the country, four nations joined forces to launch India’s first global Pathology Laboratory Consortium- Neuberg Diagnostics in Bangalore. Founded by the renowned healthcare entrepreneur, Dr. G.S.K.Velu, the international alliance brings together leading laboratories from India, Sri Lanka, South Africa and UAE under one umbrella, making it one among the top laboratory chains of the country from the day one of its inception, both in footprints and revenue. Neuberg Diagnostics was conceived with the goal to erase geographical borders and make the world of healthcare one, bringing advanced diagnostics affordable to people across the globe. The conglomerate, which has a combined diagnostic expertise of over two centuries, is an alliance of top laboratories like Anand Diagnostic Laboratory, Supratech Micropath, Ehrlich lab, Global labs and

that irreversible brain damage is common if circulation is not restored within 5 minutes of cardiac arrest. The need of the hour is to train common people to do CPR and BLS before the victim reaches the hospital. This training will help them to learn special skills required to deal with heart related emergencies. Skills to perform CPR through chest compressions, maintaining victims breathing by providing appropriate rescue breaths, can greatly improve the chances of survival of these unfortunate people. You too can save a life. And for this you don’t need a medical degree.

POLICY

India’s First Global Consortium to Unveil Collective Diagnostic Strength of Four Countries

these lifesaving steps. Therefore, CPR and BLS should be made mandatory in secondary level of education and to all public service job holders as the chances of survival of the victim increase double fold if appropriate emergency medical care is provided immediately. Time is the essence while treating a heart attack and cardiac arrest victims. “When the heart stops beating, blood flow to the body organs ceases. Of all the organs, brain is affected first. People become unconscious within 15 -20 seconds after the heart stops and chances of brain recovery decreases with time so much so

TRENDS

LATEST INNOVATIONS!

pital deaths from injuries as well as heart attack if there is a delay in receiving hospital treatment or medical care. Mostly, the steps we take in haste while attending to an emergency, makes a deep-rooted impact in saving the life of the patient. Thus, it is vital for all to learn the BLS and CPR techniques, so that we can take the right measures when required. These are simple steps like early recognition and initiating chest compression in cardiac arrest or protecting cervical spine with c-collar in road traffic accident victims and for this you don’t need to be an expert in medicine to take

Volume 3 | Issue 1 | Jan-Mar 2018

TRENDS POLICY WELL BEING PERSONA ISSUES WOMEN'S CORNER

Midmark (India), a leader in the area of patient positioning equipment, has announced the launch of their new motorised bed ‘Electra’, designed and positioned to capture a new market in India’s tertiary care sector at an affordable price. The new bed aims to revolutionize the traditional hospital bed and transform it into an accelerator in a patient’s recovery process. The new bed has been designed and built to enhance patient comfort and caregiver efficiency and also is priced between the range of INR 1,30,000 to INR 1,50,000 and engineered incorporating the most modern technological configurations. Manufactured and designed entirely in India, the bed matches world class standards from a quality, efficiency and safety point of view. The company is looking to increase sales of motorised beds by 20% overall. Electra looks forward to meet the growing demand of quality motorised beds in India and enter competitive global markets like Africa, Latin America and East Europe over the next 2 years. Advance positions like the Cardiac Chair are achieved swiftly with help of its embedded panels, elevating patient from a down right position to a sedentary position without any complexity. Bravo can also be configured with X-ray Permeable Backrest and X-ray Permeable Cassette holder so that the patient doesn’t have to be repositioned, which makes it more convenient for the staff to handle with precision.

WOMEN'S CORNER

fections. Other less well established but actively under research benefits of Vitamin D includes protection against heart disease, high blood pressure and Autoimmune Disorders. Vitamin D supplementation is a no-brainer. Supplementation is extremely easy and after an initial weekly dose can be consumed once a month. However, you can obtain it naturally; the only problem lies in the consistency of sun exposure. To obtain a day of sufficient vitamin D supply, you have to spend time in direct sunlight, approximately between 60 and 120 minutes with 30% body surface exposed.

‘ELECTRA’ best-in-class motorised bed for Indian hospitals at affordable prices

ISSUES

Breast Cancer. People with deficiency have been shown to have significantly higher incidences of various neurological disorders like Dementia, Depression, Multiple sclerosis, Psychosis and even Schizophrenia. The biggest plus point is that people who have good vitamin D levels have a much lower risk of developing Type 2 Diabetes, which is another epidemic we are facing in urban India. Vitamin D plays another important role; boosting the immune system. Multiple studies have shown that people with high vitamin D levels are less likely to get Influenza and Flu like in-

Vitamin D deficiency- A ‘Silent Epidemic’

treats the condition at an intracellular level whereas the other available drugs in the country are immunosuppressant. It is an oral therapy which can be self-administered unlike some of the currently available injectable therapies which have to be administered by paramedics. Further, Apremilast is a safer drug having no effects on other organs like the liver and kidney and does not require routine laboratory diagnostic tests like CBC, liver and Kidney test or TB screening as required in the case of other therapies used currently. India has now become one of the largest patient pools in the world and is estimated to have around 33 million psoriasis patients. As per a study on psoriasis in India, based on data collected across various medical colleges located in Lucknow, Dibrugarh, Kolkata, Patna, Darbhanga, New Delhi and Amritsar. It was found that the incidence of psoriasis among total skin patients ranged between 0.44 and 2.2%. It was also found that the ratio of male to female (2.46:1) was very high and the highest incidence was noted in the age group of 20-39 years.

PERSONA

Due to adoption of urban lifestyles, vitamin D deficiency has reached epidemic proportions; 90% of patients we see are severely vitamin D deficient. The issue with Vitamin D deficiency is that patient complaints are extremely vague and possible to be missed by most doctors and sometimes even patients may not report them putting them down to the general wear and tear of life. Some can, however, get severe symptoms including stress fractures as well as neurological symptoms. Studies have shown that vitamin D decreases the risk by half in certain forms of Cancer like Colon and

PHILIPS LIGHTING RESEARCH

• While 49% adults in Mumbai agree that light quality affects their eye sight, only one in five (21%) will opt for lighting that is comfortable for their eyes • Almost half of adults in Mumbai consider durability (47%) andprice (45%) of bulbs over comfort for their eyes, while making purchase decisions • More than half (53%) of adults in the city don’t regularly get their eyes checked; eye care does not rank at par with other perceived health metrics such as managing weight, fitness levels and skin care

Globally, about 3% of the world population has some form of psoriasis. Another study reveals that the prevalence of psoriasis in countries ranges between 0.09% and 11.43%, making psoriasis as one of the serious issues. Glenmark Pharmaceuticals Limited, a research-led global integrated pharmaceutical company which has been in the field of dermatology for more than four decades, now has announced the launch of Apremilast under the brand name ‘APREZO’, the first advanced Oral Systemic treatment for psoriasis in India which is also DCGI approved. Apremilast is a phosphodiesterase4 (PDE4) inhibitor which is indicated for the treatment of moderate to severe psoriasis. The launch of Apremilast will revolutionize the treatment of psoriasis impacting close to 33 million Indians suffering from the condition. Apremilast is an advanced oral treatment for psoriasis which addresses the limitations of the current available therapies in India. It acts in a targeted manner at an early stage of the disease progression and is also an immunomodulator which

WELL BEING

visit an eye specialist on a regular basis while about three fourths on an average use weight (73%) and fitness (60%) as overall indicators of health. Clearly, eye care does not rank at par with other perceived health metrics. Quality lighting is not only related to longevity, but is also incredibly important when it comes to ensuring our eyes aren’t strained and feel comfortable. people should choose high quality lamps that are comfortable for their eyes.

In Mumbai, durability of the bulb emerged as the highest priority while making purchase decision for light bulbs, with almost 47% of adults choosing it over other factors like price and eye comfort. While 49% of adults in the city agree that light quality affects eyesight, only 21% will opt for lighting that is comfortable for their eyes. The study conducted amongst 9,000 adults across twelve countries including India, also revealed uncomfortably entrenched mindsets with about half of the Indian population compromising on their eyesight by prioritising price (50%) and durability (48%) of bulbs over eye comfort, while making purchase decisions for light bulbs. The situation is quite alarming considering the invasion of digital technol-

ogy in our lives translating into longer screen exposure times, with almost 70% of Indians surveyed spending more than 6 hours a day in front of a screen and a similar number complaining of eyestrain! This also comes at a time as myopia hits record levels globally, with the World Health Organization predicting that one in two people will be short sighted by 2050, a vision emergency of sorts, in the not too distant future! Ophthalmologists understand the gravity of the situation and are pulling out all stops to sensitise the general population to step up on their eye care quotient. They highlight a continued need to educate the public about eye care. In response to this situation the All India Ophthalmological Society has developed a number of proactive community oriented programs, guidelines and resources to enhance ophthalmic education amongst the public. The study of over 9,000 adults across twelve countries – India, China, USA, Czech Republic, France, Germany, Indonesia, Poland, Spain, Sweden, Thailand and Turkey– becomes even more relevant given the dire situation. It was commissioned to explore how quality LED lighting can help ameliorate the eye comfort problem amongst consumers. As per the findings of the study, 44% of Indians don’t

POLICY

Philips Lighting (Euronext Amsterdam ticker: LIGHT), the world leader in lighting, has released findings that reveal that almost two third of Indians agree that poor light quality is detrimental to eyesight but just one fifth (21%) will actually take corrective measures such as buying light bulbs that are comfortable for their eyes. The survey also highlighted that for most Indians, eyecare is not treated at par with skincare and other health issues such as managing one’s weight and fitness levels.

Glenmark Launches ‘Apremilast’ – A Revolutionary Advanced Oral Treatment for Psoriasis

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Two-third of Indian adults agree that light quality affects their eyesight

Volume 3 | Issue 1 | Jan-Mar 2018

O NEW METHOD DEVELOPED To forecast dengue spread

Dr. Shikha T. Malik

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ral health is a window to your overall health. It is medically proven that prevention and looking after your teeth will save you from many medical problems such as heart disease, sleeping disorders, pre-term iven its close link with both delivery, etc. So, clove dental has come temperature and rainfall, up with a planit keeping in mind how is possible to forecast preventive dentistry play a key roleforin such outbreak of dengue. But maintaining your overall health. disease forecasting to be effective it based on models specific Clove should Dental,be the largest dental different climatic by zones chain for in India promoted Starin the shown. The Dentalcountry, Centrea new Pvt. study Ltd. has recently study has been jointly done by the launched the first of its kind ‘PlatiHyderabad-based Indian Institute of num Dental Membership Chemical TechnologyPlan’, (IICT),pan National India which is a complete annual Institute of Pharmaceutical Education dentaland health plan (NIPER), for the Guwahati, entire in Research scientists at the family collaboration that includeswith a complemenUniversity Liverpool. tary oral care of kit, with required Scientists reached this toothpaste, brushes,have mouthwash, conclusion after evaluating floss, etc., delivered to your door- the relationship of climatic factors in step every few months. Members the American Dental Association the spread of dengue in different get Clove vouchers up to Rs. 5000 for climatic zones in the country – Punjab, (ADA) recommends visits to the denHaryana,in Rajasthan, Gujarat any treatment Clove clinics. Also and tist at regular intervals determined Kerala. They focused on treatchanges in by a dentist. These practices are deincluded are many preventive a factor called ‘extrinsic incubation The researchers observed that ments at no cost and on virus all by signed to ensure that our teeth stay period (EIP) of discounts the dengue except for Gujarat which comprises other treatments. clean, strong, andthere white. taking into account daily and monthly of arid regions, was Children a strong meanDental temperatures in thesePlan areas. correlation between rainfall and Platinum Membership should be taught proper oral hygiene dengue disease burden. tooth decay. is offered The to individuals, couples and at an early age to prevent extrinsic incubation period is theThe timeplan taken for incubation The study found can that help Keralaavoid being families(EIP) of four. offers Clove of Preventive dentistry the virus in the mosquito. During this warmdisease, (temperature range Vouchers, 4 complementary kits, bidental protecting our23.5-30 smile period, after the mosquito draws virus °C) and wet and with short EIPs (9-14 annual rich scaling polishing, saving us from the expensive dental bloodand meal, the virus Dental escapes the and days) experiences highest number X-rays, gut and treatment for procedures. andfluoride passes through the mosquito’s of dengue cases.It has been found that andfamily. reaches it salivary glands. Clove EIP is Dental the shortest monsoon a childbody of the The Platinum has during set anthe ambitious Once this happens, the mosquito is season in most states and therefore members can also avail 10 % discount target to launch 200 Clinics by the infectious and capable of transmitting there is an enhanced risk of dengue on all treatments, discount endduring of this the virus to a5% human host.on Imthisyear. time.For the next phase, plants, and priority consultation with they will launch 600 clinics over the It has been found that climatic This climate-based dengue specialist doctorsplay fromanClove. This isrole in next 3-4 years.model The company has soin conditions important forecasting could help one of EIP. its kind membership plan(17–18 that °C) farplanning made aneffective investment of $25M and Lower temperatures and efficient disease result in longer EIPs thereby leading plans control operations well in advance no other dentist or dental chain ofto invest another $25-30M, till to decreased virus transmission. With and optimize the use of resources fers. Another first from Clove Dental, they reach the 600-clinic target. increasing temperatures, feeding meticulously. which is India’s largest dentalofchain increases because enhanced Clove Dental is the only player in the With changes in temperature Preventive dentistry is the practice metabolism of the mosquito, leading Oral Care space in the country who affecting the extrinsic incubation to shorter Even 5-day decrease holds a membership of the prestigious of caring for yourEIPs. teeth to akeep them period of the virus, future changes in period can hike healthyinto the avoidincubation cavities, gum disease, Royal Medicine, Backed the Society climate of might have aUK. substantial transmission rate by three times, and effect on dengue and other vectorenamelwith wear, and other dental probby advanced technologies the Clove an increase in temperature from borne disease burden in India. “Though lems. Preventive dentistry 17 to 30 °C, dengue includes transmission clinics offer International Standards such methods are in vogue for disease fourfold. However, a further of Dental Care to the patients. Clove regularincreases dental care routine at home control operations, we are still in the increase in temperature beyond 35 °C like brushing twice a day, flossing etc. hasinitial introduced transparent, ethical, stages of implementation of such is detrimental to the mosquito survival. strategic control methods,” Rao Also, to maintain optimal oral health, patient friendly delivery withDrfocus

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Clove Dental launches first of its kind ‘Platinum Dental Membership' Plan’

INNOVATIOCURIS AT EVENTS

18 Volume 2 | Issue 4 | Oct-Dec 2017 Volume 3 | Issue 1 | Jan-Mar 2018

on Global standards of sterilization, treatment protocols across all disciplines of Dentistry. Clove Dental plans to build community awareness told India Science Wire. Factors such programs to improve appreciation as population density and migration towards and also need Oral to beHygiene included forPreventive future risk studies.other The study Oralassessment Care to ensure diseases was published journal linked to poorinoral healthEmerging like DiabeMicrobes & Infections. tes, Heart ailments, Pre-term birth Article shared from ‘India Science etc. are eliminated.

Surgeon R Admiral V K Singh, VSM (Retd) Managing Director, IC participates as guest speaker at Army Medical Corps Centre & College in Lucknow in a conference on Healthcare Strategy for Indian Army

Wire’

Compiled by: Dr. Avantika Batish is working as Director Strategy and Healthcare at International Health Emergency Learning and Preparedness. Also, guest faculty for MBA (HR) and MBA Healthcare Management at various B-Schools and is a soft skills trainer.

Dr. V. K. Singh, MD of InnovatioCuris signs MoU with Dr K M Chacko, Director, Shriram Institute – Technology Business Incubator of Shriram Institute for Industrial Research Volume 2 | Issue 4 | Oct-Dec 2017

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ISSUES in the SMART Cities Mission. Allocating municipal land for large urban parks should have a high priority,” adds Dr. Prabhakaran. Altogether, 11 scientists from India, America and United Kingdom contributed to this study. Participating institutions include Centre for Control of Chronic Conditions, Public Health Foundation of India, All India Institute of Medical Sciences, National Institute of Mental Health and Neurosciences, Rollins School of Public Health USA, London School of Hygiene and Tropical Medicine UK. The findings were recently published in journal Health and Place.

Volume 3 | Issue 1 | Jan-Mar 2018

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THOSE WHO EXERCISE IN LARGE PARKS IN CITIES ARE LESS PRONE TO DEPRESSION

green spaces due to rapid socio-economic development in metropolitan cities has not been studied, stressing the need for more studies on the matter. In addition to health benefits, urban green spaces reduce air and noise pollution. They also function as an important habitat islands for urban wildlife. Certain neighborhoods may enable behaviours that promote mental health, while other residents may find it more restrictive to follow a healthy and happy lifestyle. Dr. Mukherjee says, “Our study provides the first empirical evidence of the benefits of availability of parks in the Indian context. It highlights the importance of having large parks near people’s living quarters”. The study could be a model for similar studies in other cities across the country. The scientists also recommend inclusion of urban green spaces in city planning to increase overall health of people. Their findings come at an important time whena largescale development in major cities is being undertaken in the country. “This is an opportune moment given that development of sustainable cities is ongoing in 109 cities selected

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BIG PARKS CAN REDUCE DEPRESSION! KNOW HOW?

vailability of large neighbourhood parks encourages people to increase their physical activity, and those suffering from chronic conditions who regularly exercise in these parks are less prone to major depression, a new study has found. Besides increasing physical activity, regular exposure to outdoor green spaces improves cognitive functioning and lowers mortality risks. This is significant for those with chronic conditions like arthritis, diabetes, asthma and heart diseases as they are the most vulnerable to depression. The study was done in Delhi, which has several public parks in residential areas. “Large parks in Delhi have diverse landscapes and are more likely to receive regular and frequent visitors, providing an opportunity for regular socialization,” say researchers. People who used large-sized neighbourhood parks walked for more than 150 minutes per week, the study found. For overall health, fitness and cognitive maintenance, the World Health Organization recommends adults to engage in 150 minutes of physical activity per week. Dr. Debarati Mukherjee, lead author of the study says,” High levels of exercise encourage birth of new neurons which aid memory functions and learning.” Researchers measured the association between park availability and major depression in 1208 adult park-users in Delhi. Major depression was measured using a structured clinical interview. Compared to residents exposed to large parks, major depression was 3.1 times higher among those exposed to small parks. They also showed that large-sized parks reduced stress and increased satisfaction with the immediate living environment. “There are several mechanisms by which mental health is enhanced by physical activity. This is largely by increasing levels of endorphins in the brain” said Dr Dorairaj Prabhakaran of Public Health Foundation of India and one of the researchers. Endorphins are a group of chemicals that are natural mood elevators. Dr. Mukherjee says that high levels of exercise encourage birth of new neurons which aid memory functions and learning. Physical activity is also thought to reverse cell and tissue damage as seen in Parkinson’s and Alzheimer’s. Researchers point out that negative impact of shrinking

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FIRST HUMANITARIAN DRONE PUT INTO USE FOR MEDICINE DELIVERY AT MALAWI, AFRICA

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NEW YEARNEW GIFT

f you are trapped in an inaccessible area during a natural crisis and need medicines, Midair Rescue Helicopters will instantly supply required medicine packets through a drone. The

tion of drone with a focus on humanitarian and developmental purpose. The joint application of IIT Kanpur with EndureAir (sponsor and partner of IITK team for this activity) is approved by the Malawi Civil Aviation Authority (CAA) for first

of Aerospace Engineering. The current Rotary Wing Unmanned Air Vehicle (RUAV) developed at IIT Kanpur is capable of lifting 3 kg of useful payload and fly for over 2 hours. The best range speed of the RUAV is 75 km/hr and

first humanitarian drone has been developed at IIT Kanpur in association with EndureAir.

humanitarian drone testing activity. The solution based on Autonomous Helicopter has been developed by the students of Aerospace Engineering Department: Mr. Nidhish Raj (PhD), Mr. SagarSetu (PhD), Mr. Ankur Duhoon (Research Engineer, IITK alumni) and Mr. JoydeepBhowmik (PhD) under the guidance of Prof. Abhishek and Prof. Mangal Kothari, Department

the top speed can easily reach 120 km/hr. The UAV uses regular petrol as its fuel, which enables it to achieve better performance than battery powered drones. The autopilot which is â&#x20AC;&#x153;brainsâ&#x20AC;? of the RUAV for fully autonomous operations has been fully developed by the students. The IIT Kanpur team would visit Malawi for trials and demonstration in February.

The Government of Malawi and UNICEF has launched an air corridor for potential humanitarian use of unmanned aerial vehicles (UAVs), commonly known as drones. This is the first of its kind in Africa and unique in the world for the applica22

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A survey of urban households reveals how room layout and indoor lifestyle impacts the diversity of our tiniest roommates.

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this age-old coexistence, and how it may impact our physical and mental well-being.” Humans spend most of their time indoors. Aside from pests, most life within the home—be it bacteria, fungi, or arthropods (a group that includes insects and their close relatives like spiders and millipedes)—has rarely been studied. The scientific team surveyed 50 urban homes in Raleigh, North Carolina to see what it is about a home that

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umans have lived under the same roof with bugs since we first began building shelters 20,000 years ago. Now, scientists are studying how physical factors of our homes— from the floor plan and the number of windows to even how tidy we are—may play a role in the diversity of the multi-legged communities populating the indoor environment. Researchers from the California Academy of Sciences, North Carolina State University, and the Natural History Museum of Denmark published findings recently in Scientific Reports revealing that a greater number of bug species can be found in high-traffic, groundlevel, carpeted rooms with many windows and doors. (And a word of comfort for pet owners with messy habits: don’t worry, bugs don’t really care.) “We are just beginning to realize— and study—how the home we create for ourselves also builds a complex, indoor habitat for bugs and other life,” says Dr. Misha Leong, lead author and postdoctoral researcher at the Academy. “We’re hoping to better understand

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Find out how different houses and lifestyles affect which bugs live with us?

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Next time you climb the stairs, remember that insects, too, prefer lower levels. Survey findings revealed that as floor numbers increase, fewer types of insects thrive. Larger rooms, especially on the ground floor (or even below ground), harbored more insect diversity. More varied types of insects were also observed in carpeted rooms versus those with bare floors as well as “airier” rooms with more windows and doors offering greater accessibility to the outdoors. Species diversity within the home tends to mirror the life thriving outside, with neighborhood affluence playing an important and recently studied role. “While the idea of uninvited insect roommates sounds unappealing, bugs in houses may contribute to health in a roundabout way,” says Dr. Michelle Trautwein, senior author and the Acad26

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emy’s Schlinger Chair of Diptera. “A growing body of evidence suggests some modern ailments are connected with our lack of exposure to wider biological diversity, particularly microorganisms—and insects may play a role in hosting and spreading that microbial diversity indoors.”

ROOM TO ROOM

Bugs can also vary from room to room. An analysis of core representative species—like booklice, fruit flies, and ladybugs—revealed how common areas like living rooms hosted more diverse communities when compared to bathrooms, kitchens, and bedrooms. Basements also proved unique: these dark, damp, and cavernous spaces lent to diverse communities of cavedwelling insects like spiders, mites, millipedes, camel crickets, and ground beetles. Every room within the home revealed a complex ecological structure of predator and prey— with scavenger species, strays from the outdoors, and transient go-betweens all playing critical

roles. The study also noted how indoor The presence of cats or dogs, “We are just beginning to ecology is much like island ecology—a houseplants, pesticides, and scientific discipline that examines what realize—and study—how dust bunnies revealed no siglives where, and why. Once species pernificant impact, suggesting that the home we create for meate inside, they tend to colonize their our indoor communities are new “island” habitat and disperse across more strongly influenced by the ourselves also builds a the household. environment outside the wincomplex, indoor habitat “We’re beginning to see how houses dow than how tidily we live incan be a passive go-between for insects side with Fido and Kitty. for bugs and other life,” traveling through the surrounding landthough we like to think says Dr. Misha Leong, lead of “Even scape,” says Trautwein. “The more nuour homes as shielded from merous the entry points of windows and the outdoors, wild ecological author and postdoctoral doors, the more diverse the community may be unfolding right researcher at the Academy. dramas that thrives inside.” beside us as we go about our No need to de-clutter; cats and pups daily lives,” says Leong. “We’re are a-ok For the messy among us, rest assured: learning more and more about these sometimesstudy findings revealed that tidiness does not play invisible relationships and how the homes we a significant role in insect diversity except for the choose for ourselves also foster indoor ecosystems presence of cellar spiders—delicate, long-legged all their own.” critters of the family Pholcidae typically spotted This study is part of a seven-continent exin damp crawl spaces. While more cluttered areas ploration to understand overlooked life in the hosted a greater number of these web-spinners, home: how our tiniest roommates arrive and overall human behavior played a minimal role in thrive, and the unknown impacts—both harmdetermining the composition of bug communities ful and benign—that stem from living together in in the survey. close quarters. Volume 3 | Issue 1 | Jan-Mar 2018

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FROM THE ATTIC TO THE BASEMENT

Every room within the home revealed a complex ecological structure of predator and prey—with scavenger species, strays from the outdoors, and transient go-betweens all playing critical roles.

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might lead to a buggier abode.

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Dr. V. K. Singh

Prof. Paul Lillrank

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With more natural light and better air quality, green buildings contribute to improved health, comfort, and productivity. The LEED 2009 for Healthcare Green Building Rating System is a set of performance standards for certifying healthcare facilities. In ‘Designing a Patient-centric Healthcare Facility Using Lean Methodology’, Mr. John Gallagher, Kim Chaney and Ron Kwon say 2P (Process Preparation) is a Lean design tool that helps to organize the flow of activity in a way that results in the least amount of waste. This chapter details how it worked when Concord Hillside Medical Associates, a multi-specialty group practice part of Harvard Vanguard Medical Associates near Boston, applied it in a major facility design project. Likewise, in an article on ‘Creating safer healthcare environments using an evidence-based design process, Dr. Anjali Joseph, Ellen Taylor and Xiaobo Quan say a growing body of research shows that the

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The first was ‘functions follow design’, as services had to be adapted to whatever structures were available. Next came ‘design follows functions’. Various professional groups lined out their requirements in terms of floor space and layout. More recently, the concept ‘Design follows first patients, then functions’ has been adopted. The emphasis now is on integrating the needs of patients, hospital functions, and functionaries in hospital design. In a chapter, ‘Green Hospitals and Sustainable solution to Healthcare Facility’, Mr. Rajeev Boudhankar says as important parts of the modern urban landscape, hospitals must adopt environmentally friendly and sustainable designs and technologies. Green hospitals use energy, water, materials and land more efficiently than conventional buildings.

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k o o l h s e r f a r o f designing bats

itting newsstands in the United States of America and India simultaneously, A New Book–Planning and Designing Healthcare Facilities: A Lean, Innovative and Evidence based approach by Dr V.K. Singh and Prof. Paul Lillrank call for a fresh approach in designing new age hospitals in the wake of emerging new normal in the healthcare sector. Authors say modern medicine is founded on the scientific pursuit for knowledge about the human body and its pathologies. Science builds theories and tests them against evidence. The scientific method should now be applied to the design of hospitals and health service systems. This is the rationale for evidence – based design. According to authors, lean and innovation complement each other. Lean means creating more value for customers with fewer resources. Innovation is a process of translating an idea into goods or services that create value for which customer is ready to pay. The General Hospital is still a valid concept and is not going to disappear anytime soon, particularly in parts of the world where public health is poor, resources are scarce, and a majority of people is underserved. While visions are always welcome, the task at hand, and the theme of this book, is to improve on the Dominant Design, the standard General Hospital. Evidence-based design (EBD) emphasizes credible evidence to influence design. It works on well-defined problems, applies a multidisciplinary perspective, involves users and customers, establishes quantitative performance measures for critical variables, and uses tests and simulations throughout the design process. Prof. Lillrank along with Riikka-Leena Leskelä and Olli Tolkki say the hospital has traditionally been seen as a production site like a factory where flows of material, people, energy and information combine with fixed assets. In modern manufacturing, the factory has evolved into supply networks. In a similar vein, the modern hospital is seen as a node in a regional service system. A hospital design initiative should therefore begin with a master plan that defines the hospital’s place and role in a broader health service system. Dr. Singh in a chapter on ‘Patient First, Functions Next and Design Later’ along with Mr. S K Biswas says the evolution of hospital design principles has gone through stages.

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Hospitals

A book written by Dr. V. K. Singh & Prof. Paul Lillrank

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Health System’, Matthew Saunders said Singapore is an advanced country of small size with a single party dominated political system. This has made it agile and able to respond quickly to changing circumstance in ways that differ from larger and more complex polities. Singapore faces the same challenges as other developing countries, including ageing society, non-communicable diseases and healthcare cost inflation, while it is well positioned to implement advanced technologies, such as electronic patient records and smart solutions. Singapore highlights the systemic nature of healthcare, where service production, facility design, finance, and regulation require innovative approaches to integration. Dr. B. R. Shetty, Founder and Chairman, NMC Healthcare, Abu Dhabi, United Arab Emirates in his foreword said, “The book is a timely effort to discuss various concepts and tools to reduce delivery costs and maintain high quality by the means of planning a hospital with an eye on operations. It details experiences from around the globe. The authors strive to integrate several strains of thought: Lean, Innovation, Patient Centricity, and Evidence–based designs. This is what the healthcare industry needs. Volume 3 | Issue 1 | Jan-Mar 2018

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In a chapter on ‘Planning Safe Hospitals’, Ms. Sushma Guleria says that the Hyogo Framework for Action 20052015 (HFA) spells out the challenge to substantially reduce the impact of disasters and to make risk reduction an essential component of development policies and programs. Risk reduction planning should be integrated into the health sector to make hospitals safe from disasters and strengthen their capacity to remain functional in disaster situations. Hospitals need to have disaster management plans and to evaluate their performance by implementing the Hospital Safety Index used widely to gather information for sound decision making. In an article on ‘Designing Innovative Facilities: Contamination & Security Hazards at Hospitals’, Dr. Singh along with Dr. Raman Chawala emphasis on the danger of chemical, biological, radiological, nuclear and explosive (CBRNE) related terrorism which pose a contamination threat to healthcare institutions. Designing innovative resilience can provide long term and effective solutions by establishing a rigorous framework that can accelerate adaptation and ability to recover from any known and unknown contamination security and safety hazards. ‘Adapt or Obsolesce: The evolution of the Singapore

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healthcare built environment impacts safety outcomes such as infections, medication errors, falls, and staff injuries. Latent conditions that adversely impact patient safety are built into the physical environment during the planning, design, and construction phases. Design decisions should be proactively evaluated by engaging users from different disciplines such as infection control, nursing, risk managers, and environmental services. Emerging tools such as the Safety Risk Assessment (SRA) toolkit provide a structured way to apply evidencebased design to improve patient safety. Dr. Singh and Dr. Biswas in another chapter on ‘Evidence Based Design in Hospitals - Theory to Implementation’ opine that the principles of Lean Healthcare support Evidence Based Design. Lean calls for the identification of all major stakeholders and specifying what they consider valuable. Stakeholder value can be grouped into the basic categories tangibility, reliability, responsiveness, assurance and empathy. When these requirements are not met, processes create waste. EBD ana-

lyze the constraints that need to be addressed. The design process covers several stages, initial hypothetical design, process design, service design, and empirical design. These principles are detailed in a case in a hospital in Kolkata. On Virtual Hospitals of Future, IT expert Sachin Gaur says the Information and Communication Technologies (ICT), particularly smart and wearable devices, have the potential to break constraints of time and location. Physical installations may turn virtual, and centralized services may be decentralized. Assessing the potential of new technologies, the CIMO -methodology of Evaluation Science can be employed. It asks the questions, what is the context in which technology is applied through what kinds of interventions, and which mechanisms are activated to produce which outcomes? On ‘Redefining Healthcare of Tomorrow in Smart City’, Dr Singh and Ms. Nimisha Singh say the three pillars of the smart city are-people, process, technology, and the information flows that bind them together as an optimized whole. The Smart Cities Mission under the leadership of Prime Minister Narendra Modi is an initiative towards urbanization. Smart cities require smart healthcare. With the Internet of things (IoT), layers of smartness are being added to the hospitals, such as remote monitoring, chronic disease management, medication management, patient self-management, and workflow management. In a Chapter titled ‘Delivering Inclusive Intelligent Healthcare’ by Innovative and Comprehensive e-Health System, Dr. Kuo Shou-Jen and Lai ChienWen aver that the chapter is based on a case study of Changhua Christian Healthcare System (CCH), Taiwan. CCH has been a pioneer in implementing sophisticated new technologies. The case emphasizes the importance of the combination of high tech with human touch.

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In a Chapter titled ‘Delivering Inclusive Intelligent Healthcare’ by Innovative and Comprehensive e-Health System, Dr. Kuo Shou-Jen and Lai Chien-Wen aver that the chapter is based on a case study of Changhua Christian Healthcare System (CCH), Taiwan. CCH has been a pioneer in implementing sophisticated new technologies.

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Endorsements for the Book:

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MR. SANDIPAN GANGOPADHYAY, President and COO, Galaxy Systems, U.S.A.

said, “It is an established fact that well designed hospitals in terms of architecture, operational processes and protocols have a significant impact to patient health outcomes. One example is modelling processes based on Patient Flow Analysis (PaFA). Recent advances in Big Data solutions and Machine Learning have enabled evidence and data driven decision making that would guide innovations in the planning and design of healthcare facilities. There are significant opportunities for further enhancement of efficiency in healthcare operations. This book is timely in addressing those opportunities and provides guidance to the practitioner in the various approaches they might want to explore and pursue towards this noble goal of a better patient experience and outcome”.

Lucknow, said, “This Book is a comprehensive one and covering planning, design and control of healthcare facilities which is a major aspect of cost of healthcare delivery. It has drawn various lessons on how management science and innovations can help in delivering quality care at low cost.”

BRIG (HONY) DR. ARVIND LAL, PADMASHRI, Chairman & Managing Director, Dr Lal PathLabs, India,

says, “This book could not have been launched at a better moment. India is reeling under the pressure of providing more hospitals, which are also matching quality standards internationally, for its masses. I urge all players in the healthcare industry to study this book so that Indian hospitals can increase the service levels that have not been achieved so far”.

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(The book titled ‘Bad Medicine’ by Professor David Wootton makes the case that Western medicine from Hippocrates to the late 19th century did more harm than good. The turning point came in 1865, when Joseph Lister performed the first surgical intervention involving antiseptics. Soon the idea of aseptic followed, meaning that instead of the surgeon cleaning the scalpel on his coat between patients, instruments were sterilized through boiling. In effect, modern medicine could seriously claim its capacity to save lives only after 1942 when antibiotics were introduced.)

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ogy, Raipur, opines that “This book is very much needed to catalyse the innovations and growth in health sector in developing nations. The spectrum of content and the background of contributors are very impressive. It will give readers the new and global insights to improve the existing healthcare conditions locally. The mix of basic ideas in the futuristic framework covers the whole continuum of putting together the best practices in planning and designing healthcare facilities across the world. The suggestions in the book can be looked upon by various stakeholders of healthcare system in developing nations which could help them to jump over the current challenges and be at par (or better) with developed nations in Healthcare facilities.”

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DR. VENKATARAMANAIAH, Associate Professor in Operations Management, Indian Institute of Management,

DR. SAURABH GUPTA, Assistant Professor, Department of Biomedical Engineering, National Institute of Technol-

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ting extra burden to the care infrastructure and environment. In one hand, the changing way to practice medicine dictates the need for contemporary innovations in planning and design of the physical infrastructure, but perhaps points even more importantly to the quest for dynamic and rapidly adjustable virtual groundwork to support efficient care. Therefore, the current book edited by distinguished pundits in healthcare innovation Prof V.K. Singh and Prof Paul Lillrank, proves to be timely and needed. Without doubt, this book will serve as a useful tool to the rapidly evolving healthcare systems in South and South-East Asia, in particular.

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DR. JAANUS PIKANI, Chairman, ScanBalt, Denmark said Supersonic speed developing health technologies are put-

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The Medical Tourism Industry, poised to be a whooping USD 8-9 Billion Industry in India by the year 2020, is highly unorganized & unstructured. According to various reports of Industrial bodies, Indian Medical Travel Industry or Healthcare services is growing at a compounded rate of 20-25 per cent. By Neeraj Bajpai, Consulting Editor

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Medical Tourism, also known as Health & Wellness tourism, in recent years, has been coined as a term to represent the movement of people from one place to another for their medical treatment care, and wellness needs. People from across the world travel to other countries for their surgical, medical, dental requirements, etc. etc. And at the same time make some time for family vacations, tours & travels to experience the local attractions of the destinations. Such movement has in itself evolved as one of the most rapidly growing industry integrating travel & tourism sector with healthcare and wellness sector; both being the most revenue generating sectors for an economy. India, Thailand, Singapore, Malaysia, Greece, Peru, to name a few are some of the major Medical Travel destinations. This phenomenon has been actively prevalent in the healthcare sector across the globe for last one and half decade and is growing tremendously. With high cost of treatment in the West, to the long

waiting time for treatment in the EU Countries, the people from developed and industrialized nations are looking for destinations that have a ready availability for treatments with the facilities that are at par with their own country. The countries like Africa, Oman, Afghanistan, etc. are also looking for better healthcare infrastructure as compared to their own. India can serve as an enormous potential destination for all the international medical travelers owing to its healthcare facilities that match the best in the world, along with a vast number of West trained medical practitioners. Another major factor is the cost effectiveness the Indian Healthcare sector provides viz-a-viz the International healthcare costs. People travelling for medical processes can get the treatment readily available and that too with a 5-Star Hospitality (in a fraction of the cost they incur in their own countries). Travelers also have an option to explore the country with amazing picturesque destinations, backed with rich heritage culture. This exceptional combination has already made the Medical Tourism Industry worth 2.5 Billion USD in India, growing at a compounded rate of 20-25 per cent, as per various reports of Industrial Bodies. Volume 3 | Issue 1 | Jan-Mar 2018

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showcased for the medical travelers as a lot of difficulty is faced by them due to lack of awareness. According to him, the payment security for service providers as well as medical travelers needs to Jitin Kapoor be developed through a dedicated digital payment platform. A common or ganizing platform, integrating all the medical service providers, along with the related service providers is highly desirable. They are required to be brought on single digital platform which will assist in providing transparent and conducive environment leading to a positive feedback and in turn help the industry to flourish. Medical Tourism, also known as Health & Wellness tourism, in recent years, has been coined as a term to represent the movement of people from one place to another for their medical treatment care, and wellness needs. People from across the world travel to other countries for their surgical, medical, dental requirements,

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he Medical and Wellness Industry in India, being a highly unorganized and unstructured industry, is currently driven by limited market players and requires a systematic structural presentation, according to an in-depth study titled “Medical Tourism Opportunities and Challenges”. The study, conducted in Delhi and National Capital Region (NCR), found if structural development of the sector is ensured, it will facilitate creation of a level playing field for the medical & ancillary service providers which in turn will put the country as one of the most premier Medical Travel destination in the world. Jitin Kapoor, Joint Secretary at International India Medical Tourism Congress (IIMTC), who spearheaded the study along with a team of researchers, told “Inno Health” in an exclusive interview that the Medical Tourism Industry is undoubtedly one of the most promising sector for the country’s economy, and shall be one of the major source of revenue generation, as well as job creation in near future. The study finds positioning India in the world market as a bigger and valued prospect for medical travelers from around the world. Mr Kapoor, also a chartered accountant, recommended that there is a dire need to improve the local travel and accommodation facilities for the medical tourists. The available ancillary services need to be adequately marketed and

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Medical Tourism needs systematic structural overhaul

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Followings are the some of the key challenges that remain to improve healthcare: • Investment – Compared to the other countries, very small % of Indian GDP is spent on developing healthcare which is about 100 times less than the United States. • Geography – A wide gap remains between rural and urban healthcare. Most of our healthcare resources are concentrated in big cities leaving the rural areas with no or almost no resources to meet the growing healthcare need. • Infrastructure - The number of hospitals and health centers in India are far less than what is required. Except for a few super specialty hospitals, most of the hospitals and health centers in India do not have

Figure 1 Benefits of Cloud based healthcare solutions

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magine a world where patient information is accurate, accessible, reliable, and safe. The opportunities and benefits are endless: availability, accuracy, portability and privacy of patient information, confidence on the information in an emergency, ease in searching and finding patterns, medical and post ops management with proactive reminders influencing patient behavior, and minimizing insurance and substance abuse. In recent times, we have seen tremendous progress in the evolution of cloud technology. Cloud enables easy access to shared configurable technology resources that can be utilized to rapidly create and deploy new services.

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Digital Health: Giving Birth to New Delivery Models and Fostering Innovations

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The Future of Healthcare

proper infrastructure to provide quality services. It makes sense then that in India where there is always a huge gap between demand and availability of quality healthcare that cloud technology can play a huge role. Cloud based technology solutions can be leveraged to provide efficient and high-quality services in healthcare at an affordable price for remote locations with little to no infrastructure.With the advancement of technology, cloud is becoming more and more secured and compliant with regulations. Adopting cloud based technology solutions will alloworganizations engaged in healthcareto focus more on their core activities and reduce utilization of resources that manage technology. Key research tells us that with digitization of medical data, medical knowledge has increased by 2 times or more in past 3 to 5 years. The way cloud is being adopted more and more by the industry globally and with the growing need for collaboration, flexibility and improved patient care, we can say that cloud will eventually become a commonplace in the industry. As seen in countries that have developed healthcare systems, these capabilities were key in the development of healthcare to a point where no avenue is left unexplored in the strive towards improvement of healthcare for its citizens. While the road to these advances may have been littered with challenges, impediments, false starts and hurdles, technologies today and the lessons learned therein will allow developing nations to avoid such pitfalls and leapfrog their healthcare eco-system into the future! (Contributors: Kausik Bhattacharya, Johnson & Johnson, Sandipan Gangopadhyay, President and COO, Galaxe Solutions. Dheeraj Misra and Anusha Panduga also from Galaxe Solutions.) Volume 3 | Issue 1 | Jan-Mar 2018

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INDIA AIMS TO ELIMINATE TUBERCULOSIS BY 2025

ndia’s National Health Policy recognizes the key role that research plays in the development of a nation’s health. The India TB Research Consortium brings together diverse stakeholders to develop new tools – diagnostics, vaccines and drugs – to enable the country to take a leadership role in fast-tracking translational TB research and find solutions for the world. Dr. Soumya Swaminathan (Secretary, Department of Health Research, Ministry of Health & Family Welfare and Director General, ICMR) recently at the second International Scientific Advisory Group (ISAG) meeting, states India has the highest number of TB cases in the world. It is widely recognised that the field needs new tools to make a greater impact on this disease, including more sensitive diagnosis, preventive vaccines and new drugs to treat MDR-TB. The India Tuberculosis Research Consortium (ITRC), formed by the Indian Council of Medical Research (ICMR), Delhi convened its second International Scientific Advisory Group (ISAG) meeting. The ISAG comprises global experts in the areas of TB research and has been formed to advise the ITRC on developing and translating, research & development leads across four key thematic areas – diagnostics, vaccines, therapeutics and implementation research – taking into account the research leads in each area, available both nationally and internationally. Dr. Barry R. Bloom (Distinguished Service Professor, Harvard University and Chair, ISAG) addressing the meeting states, “TB is now the largest single cause of death in the world from an infectious disease. Hence, the Government of India has made a significant commitment to support research to prevent and control the disease in India.” India’s National Strategic Plan 2017 for TB elimination aims to achieve and maintain a cure rate of >85% in new sputum positive patients for TB and reduce incidence of new cases, to reach elimination status by the year 2025.

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Dr. Soumya Swaminanthan needs no introduction. The 58-year-old pediatrician and clinical scientist has been recently nominated as Deputy Director General of the World Health Organisation. Ms. Swaminanthan, the pioneer in Tuberculosis research, advocates the role of research to root out the disease as the country has the highest number of cases in the world.

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Telemedicine is no longer a form of medicine to be practiced in the future; it is very much prevalent now and has seen a very rapid increase in its take up in this millennium. By Sapna Singh

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consent from individuals to collect data. The other changes with massive repercussions for businesses doing business within or with the UK and EU will be in regards to automated decision making tools; right to access and portability; penalties; accountability and privacy notices. (The writer is a lawyer with a Diploma in Hospital Administration from India; Masters of Law in Intellectual Property Rights from the U.S.A, Masters of Science in Telemedicine & ehealth from the UK and years of experience in Telehealth law research.)

GDPR PRINCIPLES:

• Information to be processed fairly and lawfully. • The personal data must be collected for specified, explicit and legitimate purposes. • It should be adequate, relevant and not excessive for those purposes. • It should be accurate and up to date. • It should be kept no longer than is necessary for the purposes it is being processed for. • Maintain integrity and confidentiality. • There will be accountability. Volume 3 | Issue 1 | Jan-Mar 2018

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This includes the non-clinical applications like administration and provider education which makes telehealth the preferred modern terminology. There has been an exponential increase in practice of telehealth which has meant that the legal and regulatory environment has not progressed as swiftly, for example the Data Protection Act, 1998 (DPA) in the UK has been in effect since March 2000 but has lacked the teeth to actually address the need of the hour. This is set to change with a new regulation. From May 25, 2018, the new regulation will come into force, which is being called, General Data Protection Regulation (GDPR).

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Department of Health and Human Services) distinguishes telehealth from telemedicine in its scope. According to HRSA, telemedicine only describes remote clinical services; such as diagnosis and monitoring, while telehealth includes preventative, promotive and curative care delivery. This includes the nonclinical applications like administration and provider education which makes telehealth the preferred modern terminology. There has been an exponential increase in practice of telehealth which has meant that the legal and regulatory environment has not progressed as swiftly, for example the Data Protection Act, 1998 (DPA) in the UK has been in effect since March 2000 but has lacked the teeth to actually address the need of the hour. This is set to change with a new regulation. From May 25, 2018, the new regulation will come into force, which is being called, General Data Protection Regulation (GDPR). This is a regulation of the European Union Parliament and has a direct effect. It is also believed that the inculcation of GDPR will go ahead despite Brexit i.e. Britain (UK) leaving the European Union. GDPR will have certain principles which are strong and stringent, though further clarity on each of these will be over time and by judicial decisions, it is certainly set to have more power. Consent has always been considered of great importance, however, it has been more implicit under the DPA but under the new GDPR there will be a need for a clear explicit

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TELEMEDICINE IS ONE WAY OF practicing medicine, which may provide opportunities and increase possibilities to effectively use available human and material resources. The possibilities offered by telemedicine must be open to all doctors over geographical borders. I, however, prefer to advance to Telehealth, which involves the distribution of health-related services and information via electronic information and telecommunication technologies. The Health Resources and Services Administration (HRSA - an agency of the U.S.

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Regulatory AlignmentPlay catch up

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on-communicable diseases (NCDs) represent a major peril to the economic growth and development and human health of any nation. The economic loss to India is pegged at $4.58 trillion before 2030 due to NCDs and mental health. The vicious cycle of high out-of-pocket expenditure on health, poor economic growth, workforce productivity loss and rising disease burden are intricately linked to the rising menace of NCDs. 44

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The South Asian region─with a population of more than 1.7 billion─is experiencing a marked demographic transition─characterised by declining birth and death rates and an increasingly aging population. This increase in longevity has also been accompanied by a rise in the prevalence of NCDslike diabetes (78 million cases in 2015). India has the second highest number of diabetic patients in the world, at about 69 million, after China, and this ﬁgure

is likely to reach 140 million by 2040 and almost half of them remain undiagnosed. A recent study showed that seven out of ten diabetics in India - especially those in the 20-24 age group - do not take enough steps to control their blood sugar level - even after diagnosis. The Economic Impact of Diabetes As per a study conducted by the Indian Institute of Public Health, the number of diabetes patients in the country is likely to go up to 120

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which can be an added advantage for time-constrained clinicians. Intelligent e-learning management systems also adapt and learn from the learners’ aptitude and change and deliver a personalised learning experience. The right mix of video, audio, and text content formats help to ensure that delivery of content is mapped to the medium most appropriate & relevant to concept development. Keeping in mind these perspectives, a Six Months Certification Course in Diabetes in partnership with Fortis C-DOC Hospital was launched by BMJ in South Asia. This course is endorsed by the Royal College of Physicians. This is a six months online learning course offered in two formats: with hands-on training and online-only – to cater to the learning needs of clinicians in South Asia. Courses such as these will go a long way in knowledge & skill upgradation for clinicians in areas which the country faces a high disease burden. Such courses are clinician-centric and learner-led, and have been developed keeping in mind the real and on-ground challenges faced by doctors in South Asia.

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By Prashant Mishra, Managing Director-India & S Asia, BMJ

better diabetes management options to their patients. A Possible Solution: E-Learning Courses e-Learning programs can help clinicians in acquiring skills required to address the growing complex management of diseases. E-learning courses can be tailored to fit the clinicians schedule, delivering content right at the moment when it is demanded by the doctor. Interactive e-learning programs also offer peer to peer learning, thus enabling clinicians to discuss learnings from key cases. Those elearning programs which also offer the opportunity of contact classes, offer a richer and immersive learning experience. An effective e-learning program will incorporate guidelines for determining the correct and appropriate blend of instructional strategies, including on-line learning, face-to-face instruction, and skill demonstrations, thus facilitating the learning of a clinician far beyond than traditional learning materials. Unlike traditional CMEs, e-learning can be designed to be selfpaced, and research has indicated that e-learning reduces the learning time by at least 25-60% when compared to traditional learning,

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Menace of NonCommunicable diseases: A far reaching impact

million in next 20 years as against the current 70 million2. On an average a diabetic patient spends about INR 25,000 annually to manage the disease and its associated complications2.Beyond placing a financial strain on the patient due to treatment expenditures, poor management of diabetes significantly impacts the patients’ quality of life: it may lead to loss of productivity due to multiple hospital visits, elevating rates of absenteeism, diminishing the energy and focus of a productive workforce, and depleting critical workplace skills ultimately leading to reduced mobility and span of life1. Diabetes related complications like kidney failure, nerve damage along with obesity, dyslipidemia and hypertension make diabetes management quite complex for clinicians. In this context, it becomes important that healthcare professionals have access to more educational resources to remain updated about how to tackle the diabetes epidemic. But due to scarcity of time and high patient load in South Asian healthcare facilities, medical practitioners find it very difficult to update their knowledge. Remaining updated can help clinicians offer

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Well Being

iKure CHW, Hubli, Karnataka

(Author: Dr. Tirumala Santra Mandal is a research and communication analyst at iKure. With a doctorate degree in corporate communication from IIT Kharagpur, she has worked in diverse fields of communications such as lie detection, multimedia communication, communicative English. Prior to working with iKure, she has worked as an editor and authored several publications in referred and business journals both at national and international levels.)

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Gayathri Acharya

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remain a huge constrain. WHIMS is accompanied with low-cost portable instruments to measure basic statistics and loaded on a tablet is carried by the CHWs in the remotest villages to diagnose patients. The patients pay an affordable rate for basic diagnostics and consultations, through which they earn additional income. Unlike the Accredited Social Health Activists (ASHA workers) who work as community mobilizer and not authorized to deliver clinical services, these CHWs meet both the ends. Equipped with a medical kit that consists of devices including BP machine, stethoscope, pulse oximeter, thermometer, first aid kit, weight machine, Height measuring scale and gloves, they carry medicines for basic common ailments, non-invasive hemoglobin meter, haemoglobin kit, mobile phone based sphygmomanometer, urine analyzer, calorimeter, ECG, flipcharts/ Hoardings & registers.

“Initially when I used to visit pregnant women, they were apprehensive and reserved. But repeated visits have given them confidence to open up. They ask many questions, show doctor’s report and ask for medicines. I have a joint family and few among them are pregnant, even they are educated, but they would consult me and ask for my opinion. I feel valued and found a voice through iKure”.

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For the next few days, Jayashree monitored and screened her closely and counselled her and family about different preventive measures pertaining to her health conditions. Soon after, Pushpa recovered and gave birth to a healthy child. In the context of rural settings, it is never possible to create doctors or health clinics as required. To bridge the gap, the grassroots community members are empowered to provide clinical careenabled through WHIMS. The technology application is designed with an intuitive graphics user interface that can be efficiently used by a health worker even with a basic education. For instance, WHIMS screen has a complete photograph of a human body. When a health worker clicks on the head, WHIMS gives options of potential symptoms of the head, such as ache, dizziness, seeing dark spots, and so on. Usually with the standard diagnostic tool, low accessibility and portability

Dr. Ajay Agrawal, Medical Director-iKure

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here are over 330 CHWs who are trained and strategically deployed across six states in rural India and have been rendering services under iKure’shealthcare delivery system. Jayashree is one the CHW who works relentlessly in her village Hubli (Karnataka). One day, she visited a woman named Pushpa who was in her first trimester and looked quite unwell. On enquiring, Pushpa was found to suffer from Epilepsy. Her family also revealed that she has been prescribed with medicines by a local doctor, but she didn’t take them regularly. Epilepsy is a disorder of the nervous system and such patients during pregnancy have major concerns. Jayashree felt the need and promptly captured her vitals on her smartphone loaded with Wireless Health Incident Monitoring Systems, (WHIMS), and pushed the patient’s vitals on to the cloud for a quick doctor reference.

“For a basic diagnostic long distance travel time, high cost of services and prolonged waiting hours at the local PHCs was a huge burden for these rural residents. Use of P-O-C devices is extremely portable, affordable with high accuracy rate and can be used by any health worker with a short training. This has been a critical step in rural healthcare delivery with a positive outcome on prevention, curative care and treatment procedures”.

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It has become imperative to make rural and remote areas healthy and free of diseases and infections to make ‘National Health Mission’ a success. There are still many parts of the country where medical services are still not accessible. With the iKure’shealthcare delivery system, the dream of providing minimum health service to the rural parts of the country has become true. Armed with Wireless Health Incident Monitoring Systems, Community Health Workers have been at forefront to provide doorstep solutions at minimal cost. iKure’shealthcare has become a new frontier to drive innovations in rural healthcare delivery.

mobilize patients at different levels. They are also attuned to provide nutritional counselling, and spectacle services based on the community needs. Further, WHIMS is upgraded with robust supply chain management framework, innovative algorithm, and Data Warehousing solutions. Driven by its CHWs, iKure aims to bring efficiency in public system & programe and improve lives. The CHW model of empowering the women community and gender mainstreaming represents transformational change in rural healthcare delivery. As they champion tech-savvy cultural values in otherwise austere facilities, and limited supply of doctors, such effort has established inspirational leaders driving catalyst change in sustainable rural development.

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Rural Healthcare: Solutions lie in Innovations

Through these CHWs, every patient is also provisioned with Digital Health Card (DTH) encrypted with a QR (Quick Response) code and during home visits. DTH gets updated with latest clinical indicators. The health data obtained from the health cards is synced to a cloud for effective utilization in the upward heath chain at both secondary and tertiary levels. CHW’s contact and familiarity within the community drive effective community mobilization measures. As they become an integral part of the healthcare delivery model, CHWs act as a catalyst to drive behavioral change. While they interacts and communicates the necessity on the ground and identifies appropriate health needs, it is through street plays, hoardings and message dissemination on mobile phones, they

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Healthy ageing promises Healthy gut If you are ridiculously healthy at 90-years, your gut microbiota is not that different from a healthy 30-year-old in the same population: Study

n one of the largest microbiota studies conducted in humans, researchers at University, Lawson and Tianyi Health Science Institute in Zhenjiang, Jiangsu, China have shown a potential link between healthy aging and a healthy gut. With the establishment of the China-Canada Institute, the researchers studied the gut bacteria in a cohort of more than 1,000 Chinese individuals in a variety of age-ranges from 3 to over 100-years-old who were self-selected to be extremely healthy with no known health issues and no family history of disease. The results showed a direct correlation between health and the microbes in the intestine. “The aim is to bring novel microbiome diagnostic systems to populations, then use food and probiotics to try and improve biomarkers of health,” said Gregor Reid, PhD, professor at Western’s Schulich School of Medicine & Dentistry and Scientist at Lawson Health Research Institute. “It begs the question – if you can stay active and eat well, will you age better, or is healthy aging predicated by the bacteria in your gut?” The study, published in the journal mSphere, showed that the overall microbiota composition of the healthy elderly group was like that of people decades younger, and that the gut microbiota differed little between individuals from the ages of 30 to over 100. “The main conclusion is that if you are ridiculously healthy and 90-years-old, your gut microbiota is not that different from a healthy 30-yearold in the same population,” said Greg Gloor, PhD, the principal investigator on the study and also a professor at Western’s Schulich School of Medicine & Dentistry and Scientist at Lawson Health Research Institute. Whether this is cause or effect is unknown, but the study authors point out that it is the diversity of the gut microbiota that remained the same through their study group. 50

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“This demonstrates that maintaining diversity of your gut as you age is a biomarker of healthy aging, just like low-cholesterol is a biomarker of a healthy circulatory system,” Gloor said. The researchers suggest that resetting an elderly microbiota to that of a 30-year-old might help promote health. “By studying healthy people, we hope to know what we are striving for when people get sick,” said Reid. The study also found a distinct anomaly in the group aged 19 to 24 that has not been observed in large-scale analyses of other populations and they suspect may be unique to this healthy cohort in China. The distinct gut microbiota of this group was a surprising finding and requires further study.

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partment of Nutrition of the Harvard School of Public Health, Boston, USA, who is not connected to the study,“Increased consumption of fruits and vegetables should beat the expense of reducing other foods and drinks, such as sugar sweetened beverages, red and processed meat, saturated and trans fat, refined cereals, and sugar rich desserts”. She added that consuming more plant-based foods helps replace detrimental foods, which benefits the overall dietary pattern.

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hile World Health Organization (WHO) recommends 800 grams or 5-9 servings of fruit or vegetables per day, the new study has shown that it takes just half – that is, 375 grams to get the desired health benefits. This is important for people living in countries who cannot afford a lot of fruits and vegetables. Potatoes and other tubers were not included and fruit juices were not considered as fruits while calculating the intake. Legumes included beans, black beans, lentils, peas, chickpeas, and black-eyed peas. The researchers attribute beneficial effects of consuming fruits and vegetables to presence of antioxidants like vitamin C, vitamin E and carotenoids, and fiber in them, which reduces bad cholesterol, improves insulin response, lowers the blood pressure, prevents fat deposition in blood vessels, and improves cellular function in the body. “Although there is a popular belief that fruits, and vegetables are healthy, there was nolong-term study data to support this and hence our findings are new and significant,” said Dr.V Mohan of the Dr. Mohan’s Diabetes Specialties Centre in Chennai, who contributed to the study. The decade-long research was done in 18 countries with 135,335 participantsaged 35 to 70 years. Healthy individuals with no reported diseases and complications were enrolled for the study. They were given questionnaires to record daily diet, lifestyle habits like smoking, physical activity and alcohol intake, and their socioeconomic status like education, income, and employment. At the end of the study, researchers recorded the number of deaths, cases of cardiovascular diseases, heart attack, and stroke. Then the data was analyzed to seeifconsuming higher amounts of fruits, vegetables, and dal is related to the number of deaths and adverse outcomes on health. “We found that regular consumption of vegetables, fruits and

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People who consume around 375 to 500 grams of fruits, vegetables and dal per day are at a reduced risk of death by nearly 23 per cent, a new study published in The Lancethas found.

legumes protectedpeople from cardiovascular disease and death”, states Dr. Mohan. “This study does not distinguish between cooked vegetables and raw ones, although it is common knowledge that cooking destroys some of the vitamins and minerals, hence as far as possible we should use raw vegetables like tomato, cucumber, carrot and green leafy vegetables which can be consumed raw”, pointed out Dr.Mohan. According to Estefania Toledo, professor at the De-

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Regular consumption of fruits, vegetables and dals cuts risk of death

The decade-long research was done in 18 countries with 135,335 participantsaged 35 to 70 years. Healthy individuals with no reported diseases and complications were enrolled for the study. They were given questionnaires to record daily diet, lifestyle habits like smoking, physical activity and alcohol intake, and their socioeconomic status like education, income, and employment.

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Khichdi Comes Out of Kitchen; Enters Guinness World Records

GLIMPSES OF INNOVATIOCURIS

During ancient times, it remained a favourite food in ashrams and even now it is being served as ‘prasad’ at religious places.

ndia created the world record on November 4, 2017 by cooking total 918kg Khichdi at the World Food India event. A team led by popular chef Sanjeev Kapoor cooked this traditional dishto enter the Guinness World Records and promote the dish as Brand India superfood. “Khichdi is healthy and superfood. It is good for those depending on food supplements. It is rich in all nutrition,” Yoga Guru Baba Ramdev said. It is a good step towards promoting healthy superfood not only in the domestic but also in the international market says the Yoga Guru who used to cook and eat khichdi in Gurukul. Food Processing MinisterHarsimrat Kaur Badal said, “It is a wholesome food as it contains most of the nutrients. It also symbolizes the country’s unity in diversity. ”The dish was prepared using multigrains like rice, pulses, coarse cereals and vegetables. The night-long preparation was supervised by chef Sanjeev Kapoor.It was distributed among orphans by the Akshaya Patra Foundation and Gurudwara to about 60,000 people. 54

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Dr. V. K .Singh (sitting in first row from left side) at jury for awards of Pan Indian Institutes of Management Conference, Lucknow

The Moroccan traveller, Ibn Battuta mentions khichdi as a dish in India composed of rice and beans. Records mention the dish is described in the writings of Afanasy Nikitin,a Russian adventurer who travelled to the South Asia in the 15th century. Khichdi was very popular with the Mughals, especially Jahangir. Aini-Akbari, a 16th-century document, mentions the recipe for khichdi, which has several variations. There is a story featuring Akbar, Birbal and khichdi titled as “birbal ke khichdi kab pakegi” (as how long will it take to cook the Khichdi). This a reference to a folk tale where Birbal in a battle of wits with King Akbar, was challenged to cook khichdi in a pot which was placed 20 metres above the flame, so as to illustrate the amount of time it would take for someone to “complete a task”. The story is still is being quoted as an idiom.

"Mr. Sachin Gaur (in first row from right side) from InnovatioCuris presents a business model canvas at a workshop which hosts five Danish companies

Dr. V. K. Singh inaugurates Healthcare Course at Indian Institute of Management, Sirmour, Himachal Pradesh. Also present was Prof. S Venkataramanaiah who developed the course.

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could protect from cardiovascular disease. We know that dog owners in general have a higher level of physical activity, which could be one explanation to the observed results. Other explanations include an increased well-being and social contacts or effects of the dog on the bacterial microbiome in the owner,” says Tove Fall, senior author of the study and Associate Professor in Epidemiology at the Department of Medical Sciences and the Science for Life Laboratory, Uppsala University. “There might also be differences between owners and non-owners already before buying a dog, which could have influenced our results, such as those people choosing to get a dog tending to be more active and of better health. Thanks to the population-based design, our results are generalisable to the Swedish population, and probably also to other European populations with similar culture regarding dog ownership,” says Fall. The study was conducted by researchers at Uppsala University, Karolinska Institutet, Stanford University and the Swedish University of Agricultural Sciences.

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total of more than 3.4 million individuals without any prior cardiovascular disease in 2001 were included in the researchers’ study linking together seven different national data sources, including two dog ownership registers. The results are being published for the first time in Scientific Reports. The goal was to determine whether dog owners had a different risk of cardiovascular disease and death than non-dog owners. “A very interesting finding in our study was that dog ownership was especially prominent as a protective factor in persons living alone, which is a group reported previously to be at higher risk of cardiovascular disease and death than those living in a multi-person household. Perhaps a dog may stand in as an important family member in the single households. The results showed that single dog owners had a 33% reduction in risk of death and 11% reduction in risk of myocardial infarction during follow-up compared to single non-owners. Another interesting finding was that owners to dogs from breed groups originally bred for hunting were most protected,” says Mwenya Mubanga, lead junior author of the study and PhD student at the Department of Medical Sciences and the Science for Life Laboratory, Uppsala University. In Sweden, every person carries a unique personal identity number. Every visit to a hospital is recorded in national databases, accessible to researchers after de-identification of data. Even dog ownership registration has been mandatory in Sweden since 2001. These scientists studied whether being registered as a dog-owner was associated with later diagnosis of cardiovascular disease or death from any cause. “These kind of epidemiological studies look for associations in large populations but do not provide answers on whether and how dogs

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A team of Swedish scientists have used national registries of more than 3.4 million Swedes aged 40 to 80 to study the association between dog ownership and cardiovascular health. Their study shows that dog owners had a lower risk of death due to cardiovascular disease or to other causes during the 12-year follow-up.

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Owning a dog lowers risk of death due to cardiovascular disease or to other causes, a latest study reveals.

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IT’S GOOD TO HAVE DOGS!

In Sweden, every person carries a unique personal identity number. Every visit to a hospital is recorded in national databases, accessible to researchers after de-identification of data.

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GENETIC LINK TO HEART DISEASE IN INDIAN POPULATION By Ratneshwar Thakur

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Research team at IIT Madras “Basic research in cardiovascular biology is in a very nascent stage in India with only a handful of researchers working in this field. This new study significantly contributes towards understanding molecular basis of cardiovascular and metabolic diseases. This is a fast emerging area with tremendous therapeutic and diagnostic potential,” commented Dr Shyamal

K. Goswami, a professor at School of Life Science, JNU, who is not connected with the study. The study was led by Dr. Mahapatra in a collaborative effort with Dr. Ajit S. Mullasari at Madras Medical Mission, Chennaiand Dr. Madhu Khullar at PGIMER, Chandigarh. (Article shared from India Science Wire)

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populations, it occurs more frequently in population of South Asian ancestry. “It is a protein of neuroendocrine origin and is secreted along with hormones like catecholamines. Earlier studies had suggest edits role in regulation of cardiovascular and metabolic diseases but there was no data

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genetic variant. The study is based on analysis of genomic DNA samples from over 750 individuals from Indian population. The research findings have been published in the Journal of Biological Chemistry. Though the CHGA promoter haplotypeis present in other ethnic

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team of Indian researchers have discovered that carriers of a set of genetic variants in the Chromogranin A (CHGA) gene called‘CHGA promoter haplotype2’ may be at higher risk for cardiovascular and metabolic disorders. An estimated 35 to 40 percent of Indian population may carry this

aboutit in South Asian population,” said Lakshmi Subramanian, first author of this paper. “Westudied genomic DNA of Indians and discovereda specific set of changes in the CHGA genesequence called Haplotype2 which contributed to increased CHGA gene expression, and ultimately increasedCHGA protein levels in plasma. When the clinical parameters of those in the study were compared, Haplotype2 carriers displayed higher levels of metabolic and cardiovascular traits like plasma glucose, blood pressure and body mass index,” explained Dr. Nitish R. Mahapatra, Professor at IIT Madras. However, he said, these results need further validation in animal models as well as largescale studies in individuals with metabolic syndrome. “We hope these findings would help unravel biological pathways and mechanisms underlying these complex diseases and would help in the development of therapeutic as well aspreventive strategies,” said Dr. Mahapatra.

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no new sets of facts and figures for same projects with different bodies; and no lobbying were among many during his opening remarks. Dr. Shirshendu Mukherjee, Mission Director of Program Management Unit, jointly supported by the Department of Bio Technology, Bio Technology Industry Research Assistance Council (BIRAC) –BMGF(BILL & MELINDA GATES) Foundation and Wellcome Trust unveiled points which play crucial role in attracting funds from various bodies.

The agenda of IC Innovator Club’s second meeting was to share the views and knowledge on how to write a research or a grant proposal so that the innovator is successful in bringing his innovation to real world by implementing ideas. once upon a time to a happily lived ever after. By this what he meant was, it is important to narrate the beginning, ending and all the important milestones to the funding agency very clearly and in chronological order with a proper flow of events to take place for the innovation to happen. Dr. Mukherjee beautifully divided the prospective challenges

of innovation broadly under three stages: Discovery, Development and Delivery. Major challenges under the discovery stage being to understand the problem, limited market pull and push in non-commercial indications and lack of local research infrastructure. Under the development stage, he told the major challenge faced by an innovator could be the translation of the idea to the product. Adding to it, lack of local development infrastructure, complex IP and regulatory pathway also contribute to the challenges faced during the development stage of an innovation. Dr Mukherjee also told “One should keep in mind the unmet need of the market and the funding space available for area of interest”. About the dedicated experts and advisors being appointed in the funding agencies, he advised participants to seek advice on the funding space relevance of their

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Glued to a widescreen where slides were scrolled for thumb rules while applying to such bodies for funding, innovators lent ears to Mission Director who at an ease rolled out drill for a successful applicant. Batting with a straight blade, he minced no words to articulate the harsh reality that there was no scope to dodge funders to siphon money from them on bogus facts and figures. No cutting of corners; no double play with different funders; no concealment of facts;

In life of a researcher or innovator one important pillar for the success of his idea is getting the right funding. Innovation is not only about ideas.It’s about making the ideas happen and sometimes difficult to convert a good idea on to a paper. The agenda of IC Innovator Club’s second meeting was to share the views and knowledge on how to write a research or a grant proposal so that the innovator is successful in bringing his innovation to real world by implementing ideas. Dr. Mukherjee insisted that art of communication is trick of the trade as in the world of tearing hurry ambience and cut-throat competition no one has time to flip through bulky dossiers. According to Dr Mukherjee, “Winning a grant is how compelling story (of your idea) you tell”. He said writing a grant application is like narrating a story with

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t was a crisp winter morning when a motely crowd of innovators assembled quietly in a conference hall of the national capital’s prestigious India International Center to learn craft of presenting their case before government bodies, philanthropists and other agencies for funding. With a promise to give an encouraging platform to innovators and aspiring Startups, InnovatioCuris had organised the second IC Innovator Club meeting on November 26, 2017. A medium height simpleton emerged on the scene and occupied center stage of the Sunday morning show, but patient listeners within split of seconds shed off doubts whether spending a precious Sunday morning in such a meet was rewarding or a mere waste. The club meeting brought some big names of healthcare including PHFI, INMAS (DRDO), Amity University, IIHMR to name a few, under a single roof including experts from investing agencies, Startups, policy makers, academia and many more. The members quickly envisioned pots of money for their dream projects mainly strategized to fulfill unmet needs of common people and the industry.

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Pots of Money available for innovative projects, but Caution! No can lay hands on them without knack for saleable idea

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Do you have any innovative idea?

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$ Putting two different applications at the same time to same funder. $

Doubling the funder (two funders for the same proposal).

$ Diverse and varied application should be avoided, instead thematic calls are better. visiting their respective websites, noticing what they have funded in last two years and others. Best approach for applying a grant is ‘Two funder approach’. Approach is also a crucial factor in determining the progress of the application says Dr. Mukherjee. Benefit of doubt always rests in court of applicant, meaning if one of the reviewers is in favor the application and rest are not then also the applicant would get a chance to defend his application at first. Further discussing about the

ideas and points to be taken care of while drafting the proposal application, views were discussed on how one can write a comprehensive application with a suitable title and an impactful abstract. Budgeting is very important in every aspect of life and so is the case while writing a grant application. The budget should be exhaustive and self-explanatory says Dr. Mukherjee. One should be realistic in quoting the budget and should avoid any kind of hidden costs or inflation in costing.

Dr. Mukherjee holds Ph.D. in Microbiology, Degree in Law, Advance Course in Strategy Management from IIM Kolkata, Management and Leadership course from Business School University of Oxford. He has devised and formulated strategies for mitigating challenges and bridging gaps through impact funding. Before joining Wellcome Trust as Senior Strategic Advisor (India), Dr.Mukherjee was staff scientist at International Centre for Genetic Engineering and Biotechnology (ICGEB). Dr. Mukherjee manages the R&D for Affordable Healthcare in India, a £30 million initiative of Wellcome Trust in India. The initiative funds translation research leading to affordable healthcare solution in India and beyond.

Parthvee Jain is an engineering graduate with her post-graduation and specialization in Food Processing and Nutraceuticals. Her interest fields include Biotechnology, Healthcare, Food Processing and Nutraceuticals. Connecting European Healthcare innovation leaders with the Indian healthcare system and pioneers, she is working with InnovatioCuris as analytical and resultdriven marketing professional having experience impacting organizational performance through expert research, analysis and evaluating market and competitive conditions, current and emerging trends, and industry-specific solutions to ensure optimal position in the marketplace. Volume 3 | Issue 1 | Jan-Mar 2018

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ONE SHOULD AVOID THE FOLLOWING FOR A POSITIVE OUTCOME:

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proposal through these experts. According to the expert, few of the challenges that one can expect during his project/work could be regulatory, IP or IT related, business plan development challenges, challenges in developing business exit plan etc. Dr. Mukherjee encouraged the participants by saying “A successful proposal is 60% science and rest 40% is the foresightedness” that is how accurately down the line one can see and plan. Sharing about Program Related investments, Dr. Mukherjee made a bold statement which could make an enormous impact in the applicant’s life. He said, “The applicant should also do due diligence on the funder, it is not only the right of a funder to do due diligence on the applicant, but also the applicant should do due diligence on the funder”. He also discussed few points on how one can perform the above said task, like

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A revelation to us but an everyday fact to their world is that about 20 percent of all kids suffer some form of mental stress which usually go untreated. Since their actions and conduct are within the tolerance level of students and teachers, the condition goes undetected. Which explains, probably, why some precocious children face burn out later in life – their psychological resilience being underdeveloped. It is, perhaps, some of these buried childhood traits that make for difficult adults. We have all had one or two very unreasonable bosses or colleagues. God knows I forgive them today. It was not their fault. While the kids and their parents face untold challenges as their lives only certainty was an onerous task with doubtful out comes, the teachers in this field bear the brunt. Very young girls, yes mostly females, have offered themselves to teach this category of children voluntarily, despite moderate pay. On 9th December 17’, about 200 children from such schools participated in the ‘Special and intellectually challenged students Sports’ at Navi Mumbai. Whatever inspired these teachers is not clearly known, but their stupendous involvement in bringing the challenged pupils to this event, spending hours under a blazing sun, was utterly admirable. Not one

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the organization providing care. For mainstream students and teachers, it would be unthinkable to converse in ‘love’ and this is a medium of instruction employed here to teach basic skills like lifting an empty mug. Fertile atmosphere for interaction with other students of similar disabilities enhances interest among students. They wish for greater interest in these children from ‘normal’ children. Young teachers Manisha and Suman strongly believe the government could help in establishing modern tutoring tailormade for these children in mainstream schools and not just having them admitted under RTE. These very young teachers realise that being with fully developed kids is what might help her students achieve milestones earlier. She wished that the world and society were more sensitive and patient to these kids. Sanketa, another internationally experienced faculty member, finds it commonplace for these kids to be gifted in some skill or other. Of course, there are few who may never be able to fend for themselves due to irrecoverable birth defects. But a majority could be assets to the society had the world been more patient. Every child here has vast possibilities hidden in his untapped energies. If only we the normal knew to communicate.

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(The Writer is Chief Correspondent India, for an American Channel)

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xpected only bedlam when I first entered their tiny premises in a municipal building at Mulund (Mumbai) with “There is no great genius without a touch of madness” (Aristotle) ringing in my head. Indian Council of Mental Health set up in 1953 within the iconic Eros theatre building in Mumbai, is witness to the innate ability of pupils termed ‘Mad’ by the society. The power of that word can be so severe, practitioners in the field of mental health shun it like plague. Born out of philanthropy of one Dr. Masani, who none of the current active managers have ever met, ICMH brews a near impossible concoction of therapy, counselling and education for children with psychological imbalance. ICMH today runs schools for children with limited development of faculties at two centres in Mumbai suburbs. Unlike the rarefied conclave of eccentric wealthy, this is an organisation that dealt purely with imparting minimum social skills to this ultra-marginalized group. But why would people in their senses ever employ themselves in betterment of those who had none? Not a simple answer here. Every day, the lovely people who provide leadership to this organisation, live kind-hearted lives, shunning perfunctory act of kindness.The managing trustee, Zarir Merchant is one such kind soul who got hooked to this journey when after few cursory visits, students here came forward to hug him. For a globe trotter, Zarir never got such an innocent and loving welcome anywhere else in the world. That child and others who may have merely waved out to him touched him in unimaginable forms. With people of high stature like finance wizard TNV Ayyar, who joined in later, ICMH today has evolved into the best school for students with developmental issues. Educationist like Reshma Mathew and Neetal along with a bevy of ladies run

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teacher (and there were about fifty teachers from various such schools of Mumbai) was impatient with the kids. They were stern but not once rude. Speaking to me, parent of a dyslexic teenager attributed her own sanity to her sons’ teachers. Other parents I spoke to, on that day had only words of effusive praise for the teachers. None of the instructors and educationist for mental health may ever rise to be celebrated. None of them will receive a bouquet, years later, on Guru Poornima from the President or a Nobel laureate. They know not one from their class will ever make it to that height. Yet not a slight ever for any kid however difficult they were, never a sense of despair repeating a small lesson on holding a pencil for weeks to the same child or even toilet training them through their only medium of instruction – compassion. One can only imagine the tall intellectual ability of these teachers. Aristotle only spoke of productive geniuses. A higher degree of endearing madness exists in the teachers here. We hear of people in their senses who deploy themselves in service of those without? In this world, we call them ‘angels’.

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Lifestyle diseases like chronic respiratory and heart diseases are killing more people in India than communicable ailments like Tuberculosis (TB) or Diarrhea in every states, including most backward belts, says the India State-Level Disease Burden Initiative's Report.

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mong the leading non-communicable diseases, the largest disease burden or Disability-Adjusted Life Year (DALY) rate increase from the period of 1990 to 2016 was observed for diabetes at 80 per cent, and ischaemic heart disease at 34 per cent. In 2016, three of the five leading individual causes of disease burden in India were non-communicable, with ischaemic heart disease and chronic obstructive pulmonary disease as the top two causes and stroke as the fifth leading cause. The range of disease burden or DALY rate among the states in 2016 was nine-fold for ischaemic heart disease, four-fold for chronic obstructive pulmonary disease, and six-fold for stroke, and fourfold for diabetes across the country. The key metric used in the study is DALYs, which is the sum of the number of years of life lost due to premature death and a weighted measure of the years lived with disability due to a disease or injury. The use of DALYs to track disease burden is recommended by India’s National Health Policy of 2017. While ischaemic heart disease and diabetes gen-

erally had higher DALY rates in states that are at a more advanced epidemiological transition stage toward non-communicable diseases, the DALY rates of chronic obstructive pulmonary disease were generally higher in the Empowered Action Group (EAG) states that are at a relatively less advanced epidemiological transition stage. The report shows that communicable diseases constitute almost two-thirds of the disease burden in India from a little over a third in 1990. Despite the transition, which is associated with development, malnutrition remains the single top risk for health loss. All states have thus made what's called the 'epidemiological transition' there remain wide variations in their disease profiles with some having made that transition as early as 1986, and others as recently as 2010. The first group to make the transition in 1986 included Kerala, Tamil Nadu, Goa, Himachal Pradesh and Punjab. The last group to do so, accounting for the highest number of people (588 million), made the transition almost a quarter of a century later, in 2010. This group included Bihar, Uttar Pradesh, Madhya Pradesh, Chhattisgarh, Jharkhand, Rajasthan and Odisha. India as a country made the transition in 2003. The Report’s executive summary says with almost one-fifth of the world’s population living in India, the health status and the drivers of health loss are expected to vary between different parts of the country and between the states. Accordingly, effective efforts to improve popula-

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Lifestyle diseases: A threat to backward states

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The contribution of most of the major non-communicable disease groups to the total disease burden has

Rising burden of non-communicable diseases in all states

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Infectious and associated diseases made up the majority of disease burden in most of the states in 1990, but this was less than half in all states

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While the disease burden rate in India has improved since 1990, it was 72% higher per person than in Sri Lanka or China in 2016. The under-5 mortality rate has reduced substantially from 1990 in all states, but there was a four-fold difference in this rate between the highest in Assam and Uttar Pradesh as compared with the lowest in Kerala in 2016, highlighting the vast health inequalities between the states. Large differences between states in the changing disease profile of the total disease burden in India measured as DALYs, 61% was due to communicable, maternal, neonatal, and nutritional diseases (termed infectious and associated diseases in this summary for simplicity) in 1990, which dropped to 33% in 2016. There was a corresponding increase in the contribution of non-communicable diseases from 30% of the total disease burden in 1990 to 55% in 2016, and of injuries 18 %.

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tion health in each state require systematic knowledge of the local health status and trends. While state-level trends for some important health indicators have been available in India, a comprehensive assessment of the diseases causing the most premature deaths and disability in each state, the risk factors responsible for this burden, and their time trends have not been available in a single standardised framework. The Report finds that the Health status improving, but major inequalities between states Life expectancy at birth improved in India from 59.7 years in 1990 to 70.3 years in 2016 for females, and from 58.3 years to 66.9 years for males. There were, however, continuing inequalities between states, with a range of 66.8 years in Uttar Pradesh to 78.7 years in Kerala for females, and from 63.6 years in Assam to 73.8 years in Kerala for males in 2016. The per person disease burden measured as DALYs rate dropped by 36% from 1990 to 2016 in India, after adjusting for the changes in the population age structure during this period. But there was an almost twofold difference in this disease burden rate between the states in 2016, with Assam, Uttar Pradesh, and Chhattisgarh having the highest rates, and Kerala and Goa the lowest rates.

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increased all over India since 1990, including cardiovascular diseases, diabetes, chronic respiratory diseases, mental health and neurological disorders, cancers, musculoskeletal disorders and chronic kidney disease. On the other hand, the DALY rates of stroke varied across the states without any consistent pattern in relation to the stage of epidemiological transition. This variety of trends of the different major noncommunicable diseases indicates that policy and health system interventions to tackle their increasing burden have to be informed by the specific trends in each state. Increasing but variable burden of injuries among states The contribution of injuries to the total disease burden has increased in most states since 1990. The highest proportion of disease burden due to injuries is in young adults. Road injuries and self-harm, which includes suicides and non-fatal outcomes of self-harm, are the leading contributors to the injury burden in India. The range of disease burden or DALY rate varied 3 fold for road injuries and 6 fold for selfharm among the states of India in 2016. There was no consistent relationship between the DALY rates of road injuries or self-harm versus the stage of epidemiological transition of the states. The burden due to road injuries was much higher in males than in females. The DALY rate for self-harm for India as a whole was 1.8 times higher than the average globally for other geographies at a similar level of development in 2016. The report says the disease burden due to child and maternal malnutrition has dropped in India substantially since 1990; this is still the single largest risk factor, responsible for 15% of the total disease burden in India in 2016. This burden is highest in the major EAG states

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India: Health of the Nation’s States from 9% to 12%

in 2016. However, the year when infectious and associated diseases transitioned to less than half of the total disease burden ranged from 1986 to 2010 for the various state groups in different stages of this transition. The wide variations between the states in this epidemiological transition are reflected in the range of the contribution of major disease groups to the total disease burden in 2016: 48% to 75% for non-communicable diseases, 14% to 43% for infectious and associated diseases, and 9% to 14% for injuries. Kerala, Goa, and Tamil Nadu have the largest dominance of non-communicable diseases and injuries over infectious and associated diseases, whereas this dominance is present but relatively the lowest in Bihar, Jharkhand, Uttar Pradesh, and Rajasthan. Infectious and associated diseases are reducing, but still high in many states. The burden of most infectious and associated diseases reduced in India from 1990 to 2016, but five of the ten individual leading causes of disease burden in India in 2016 still belonged to this group: diarrheal diseases, lower respiratory infections, iron-deficiency anemia, preterm birth complications, and tuberculosis. The burden caused by these conditions generally continues to be much higher in the Empowered Action Group (EAG) and North-East state groups than in the other states, but there were notable variations between the states within these groups as well. The range of disease burden or DALY rate among the states of India was nine fold for diarrheal disease, seven fold for lower respiratory infections, and nine fold for tuberculosis in 2016, highlighting the need for targeted efforts based on the specific trends in each state. The burden also differed between the sexes, with diarrheal disease, iron-deficiency anemia, and lower respiratory infections higher among females, and tuberculosis higher among males. The proportion of total disease burden caused by infectious and associated diseases was highest among children, which contributed to the disproportionately higher overall disease burden suffered by the under-5 year’s age group. The report said for India as whole, the disease burden or DALY rate for diarrheal diseases, iron-deficiency anemia, and tuberculosis was 2.5 to 3.5 times higher than the average globally for other geographies at a similar level of development, indicating that this burden can be brought down substantially.

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Rising risks for cardiovascular diseases and diabetes

Importance of understanding the specific health situation of each state

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from stroke. The cardiovascular risks were generally higher in Madhya Pradesh, and the unsafe water and sanitation risk was relatively higher in Uttar Pradesh. The two North-East India states of Manipur and Tripura are both at a lower-middle stage of epidemiological transition but have quite different disease burden rates from specific leading diseases. Tripura had 49% higher per person burden from ischaemic heart disease, 52% higher from stroke, 64% higher from chronic obstructive pulmonary disease, 159% higher from iron-deficiency anaemia, 59% higher from lower respiratory infections, and 56% higher from neonatal disorders. Manipur, on the other hand, had 88% higher per person burden from tuberculosis and 38% higher from road injuries. Regarding the level of risks, child and maternal malnutrition, air pollution, and several of the cardiovascular risks were higher in Tripura. The two adjoining north Indian states of Himachal Pradesh and Punjab both have a relatively higher level of development indicators and are at a similar more advanced epidemiological transition stage. However, there were striking differences between them in the level of burden from specific leading diseases. Punjab had 157% higher per person burden from diabetes, 134% higher burden from ischaemic heart disease, 49% higher burden from stroke, and 56% higher burden from road injuries.

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Understanding the health and disease trends in groups of states at a similar level of development or epidemiological transition is an important intermediate step in teasing apart the heterogeneity of disease and risk factor epidemiology in India. However, effective action to improve health must finally be based on the specific health situation of each state. This point is elucidated by significant variations in the burden from leading diseases and risk factors in 2016 between the following pairs of states that have physical proximity and are at similar levels of development and epidemiological transition. The major EAG states of Madhya Pradesh and Uttar Pradesh both have a relatively lower level of development indicators and are at a similar less advanced epidemiological transition stage. However, Uttar Pradesh had 50% higher disease burden per person from chronic obstructive pulmonary disease, 54% higher burden from tuberculosis, and 30% higher burden from diarrheal diseases, whereas Madhya Pradesh had 76% higher disease burden per person

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Of the total disease burden in India in 1990, a tenth was caused by a group of risks including unhealthy diet, high blood pressure, high blood sugar, high cholesterol, and overweight, which mainly contribute to ischaemic heart disease, stroke and diabetes. The contribution of this group of risks increased massively to a quarter of the total disease burden in India in 2016. The combination of these risks was highest in Punjab, Tamil Nadu, Kerala, Andhra Pradesh, and Maharashtra in 2016, but importantly, the contribution of these risks has increased in every state of the country since 1990. The other significant contributor to cardiovascular diseases and diabetes, as well as to cancers and some other diseases, is tobacco use, which was responsible for 6% of the total disease burden in India in 2016. All of these risks are generally higher in males than in females. The sweeping increase of the burden due to this combination of risks in every part of the country indicates emphatically that major efforts need to be put in place to control their impact in every state before the situation gets totally out of control.

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air pollution is highest in a mix of northern states, including Haryana, Uttar Pradesh, Punjab, Rajasthan, Bihar, and West Bengal. Control of air pollution has to be ramped up through inter-sectoral collaborations based on the specific situation of each state.

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rapid improvements. Remarkably, the per person disease burden due to unsafe water and sanitation was 40 times higher in India than in China in 2016. The massive effort of the ongoing Swachh Bharat Abhiyan has the potential to improve this situation. Improvement was notice in household air pollution. Outdoor pollution worsened air pollution and remained high in India between 1990 and 2016, with levels of exposure among the highest in the world. It causes burden through a mix of non-communicable and infectious diseases, mainly cardiovascular diseases, chronic respiratory diseases, and lower respiratory infections. The burden of household air pollution decreased during this period due to decreasing use of solid fuels for cooking, and that of outdoor air pollution increased due to a variety of pollutants from power production, industry, vehicles, construction, and waste burning. Household air pollution was responsible for 5% of the total disease burden in India in 2016, and outdoor air pollution for 6%. The burden due to household air pollution is highest in the EAG states, where its improvement since 1990 has also been the slowest. On the other hand, the burden due to outdoor

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and Assam, and is higher in females than in males. Child and maternal malnutrition contributes to disease burden mainly through increasing the risk of neonatal disorders, nutritional deficiencies, diarrhoeal diseases, lower respiratory infections, and other common infections. As a stark contrast, the disease burden due to child and maternal malnutrition in India was 12 times higher per person than in China in 2016. Kerala had the lowest burden due to this risk among the Indian states, but even this was 2.7 times higher per person than in China. This situation after decades of nutritional interventions in the country must be rectified as one of the highest priorities for health improvement in India. Unsafe water and sanitation improving, but not enough yet Unsafe water and sanitation was the second leading risk responsible for disease burden in India in 1990, but dropped to the seventh leading risk in 2016, contributing 5% of the total disease burden, mainly through diarrheal diseases and other infections. The burden due to this risk is also highest in several EAG states and Assam, and higher in females than in males. The improvement in exposure to this risk from 1990 to 2016 was least in the EAG states, indicating that higher focus is needed in these states for more

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ing impact of large-scale interventions based on time trends of disease burden, and forecasting population health under various scenarios in each state. Future plans of the India State-level Disease Burden Initiative include annual updates of the estimates based on newly available data, and more disaggregated findings such as the rural-urban estimates planned for next year and sub-state level estimates subsequently when adequate data become available.

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The chances of achieving the overall health targets set by India would be much higher if the biggest health problems and risks in each state are tackled on priority than with a more generic approach that does not take into account the specific disease burden trends in each state.

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On the other hand, Himachal Pradesh had 63% higher per person burden from chronic obstructive pulmonary disease. Consistent with these findings, Punjab had substantially higher levels of cardiovascular risks than Himachal Pradesh. The Executive summary says these examples highlight why it is necessary to understand the specific disease burden trends in each state, over and above the useful broad insights provided by trends common for groups of states at similar levels of epidemiological transition, if health action has to be planned for the specific context of each state. The chances of achieving the overall health targets set by India would be much higher if the biggest health problems and risks in each state are tackled on priority than with a more generic approach that does not take into account the specific disease burden trends in each state. Application of the state-level disease burden findings and future work The findings in this report of the India Statelevel Disease Burden Initiative can be used for planning of state health budgets, prioritisation of interventions relevant to each state, informing the governmentâ&#x20AC;&#x2122;s Health Assurance Mission in each state, monitoring of health-related Sustainable Development Goals targets in each state, assess-

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water demands, the study said. “While urban areas have experienced increased number of heat waves and temperature extremes in recent past, urban heat island effect driven by rapid urbanization can further worsen extreme hot conditions in cities,” pointed out Dr Vimal Mishra, a scientist at the Water and Climate Lab of Indian Institute of Technology, Gandhinagar, which did the study. The results of the study appeared in journal Scientific Reports on Wednesday. The development of smart cities

will result in rapid growth in urban infrastructure and population, leading to increases in UHI intensity. “Our results can provide policy insights for development of smart cities,” Dr Mishra said. “Considering night-time heating which could be significant during heat waves, measures such as passive cooling should be used. Building materials that absorb less heat and are sustainable can reduce the amount of heating caused by stored heat.” The presence of water bodies and vegetation in cities can also help reduce additional night-

time heating in urban heat islands.

(Article shared from India Science Wire)

The study team included Rahul Kumar and Vimal Mishra (IIT Gandhinagar); Jonathan Buzan and Matthew Huber (Purdue University, USA); Rohini Kumar (UFZ-Helmholtz Centre for Environmental Research, Leipzig, Germany ); and Drew Shindel (Duke University, USA).

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oisture from irrigation canals UHI effect during day time is mainly driven by agriculture and and agriculture fields play a irrigation. However, in the night-time, cities are significantly key role in keeping rural areas warmer than surroundings in both winter and summer seasurrounding cities much cooler sons. Night time urban heat is mainly driven by the amount of that urban areas, resulting cit- heat stored in buildings and other impervious surfaces. ies becoming heat islands. In a Urban areas located in highly irrigated regions - Indoheat island, temperature could Gangetic Plain and north-west India (Haryana and Punjab) be 1 to 6 degrees higher than show UHI intensity of 3 to 5 degrees. During summer season surrounding areas. Remote sensing data and climate model- (April and May), when air temperature is at the peak, land ling were used to evaluate UHI across the country. surface temperature becomes is higher than that of the postWhen the surrounding of non-urban areas have no agri- monsoon season in absence of agricultural operations. Moreculture during summer, cities are relatively cooler during over, amount of moisture and vegetation in non-urban areas daytime. However, if the non-urban areas are under irrigated are also limited as crops are largely harvested by the end of agriculture, cities are warmer than surroundings. This means March and soil moisture is depleted due to high atmospheric

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M By Dinesh C Sharma

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Areas selected for development are heat islands

The phenomenon of urban heat islands, in which concrete and built areas experience higher temperatures than surrounding rural areas, may get accentuated with rapid urbanisation. This is the conclusion of a new study of urban areas selected for development of smart cities. The study, which covered 89 of 100 areas selected for development of smart cities, has found that agriculture and irrigation are two dominant drivers of urban heat islands or UHI in India. In addition, significant presence of atmospheric aerosols – mainly pollutants - over urban areas can influence UHI.

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Researchers have found an imbalance in the brain chemistry of young people addicted to smartphones and the internet.

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SMARTPHONE ADDICTION CREATES IMBALANCE IN BRAIN

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with internet or smartphone addiction and 19 gender- and age-matched healthy controls. Twelve of the addicted youth received nine weeks of cognitive behavioral therapy, modified from a cognitive therapy program for gaming addiction, as part of the study. Researchers used standardized internet and smartphone addiction tests to measure the severity of internet addiction. Questions focused on the extent to which internet and smartphone use affects daily routines, social life, productivity, sleeping patterns and feelings. “The higher the score, the more severe the addiction,” Dr. Seo said. Dr. Seo reported that the addicted teenagers had significantly higher scores in depression, anxiety, insomnia severity and impulsivity. The researchers performed MRS exams on the addicted youth prior to and following behavioral therapy and a single MRS study on the control patients to measure levels of gamma aminobutyric acid, or GABA, a neurotransmitter in the brain that inhibits or slows down brain signals, and glutamateglutamine (Glx), a neurotransmitter that causes neurons to become more electrically excited. Previous studies have found GABA to be involved in vision and motor control and the regulation of various brain

functions, including anxiety. The results of the MRS revealed that, compared to the healthy controls, the ratio of GABA to Glx was significantly increased in the anterior cingulate cortex of smartphone- and internet-addicted youth prior to therapy. Dr. Seo said the ratios of GABA to creatine and GABA to glutamate were significantly correlated to clinical scales of internet and smartphone addictions, depression and anxiety. Having too much GABA can result in a number of side effects, including drowsiness and anxiety. More study is needed to understand the clinical implications of the findings, but Dr. Seo believes that increased GABA in the anterior cingulate gyrus in internet and smartphone addiction may be related to the functional loss of integration and regulation of processing in the cognitive and emotional neural network. The good news is GABA to Glx ratios in the addicted youth significantly decreased or normalized after cognitive behavioral therapy. “The increased GABA levels and disrupted balance between GABA and glutamate in the anterior cingulate cortex may contribute to our understanding the pathophysiology of and treatment for addictions,” Dr. Seo said.

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ccording to a recent Pew Research Center study, 46 percent of Americans say they could not live without their smartphones. While this sentiment is clearly hyperbole, more and more people are becoming increasingly dependent on smartphones and other portable electronic devices for news, information, games, and even the occasional phone call. Along with a growing concern that young people, in particular, may be spending too much time staring into their phones instead of interacting with others, come questions as to the immediate effects on the brain and the possible long-term consequences of such habits. Hyung Suk Seo, M.D., professor of neuroradiology at Korea University in Seoul, South Korea, and colleagues used magnetic resonance spectroscopy (MRS) to gain unique insight into the brains of smartphone- and internet-addicted teenagers. MRS is a type of MRI that measures the brain’s chemical composition. The study, presented recently at the annual meeting of the Radiological Society of North America (RSNA) in Chicago, involved 19 young people (mean age 15.5, 9 males) diagnosed

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Volume 3 | Issue 1 | Jan-Mar 2018

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Volume 3 | Issue 1 | Jan-Mar 2018

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Volume 3 | Issue 1 | Jan-Mar 2018

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Dengue virus

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DETECT NEW STRAIN OF

cientists at Pune-based National Institute of Virology (NIV) have found a new genotype of dengue virus in patients who suffered due to one of the worst epidemics in recent years in Tamil Nadu. The study shows that the strain originated in Singapore and emerged in Tamil Nadu in 2012 and Kerala in 2013. Even a single cell bacterium has not only DNA but also cell organelles. But viruses are just bits of DNA material in a wrap, and they use cellular mechanism of the host to multiply themselves. In doing so they damage the infected cells. The immune system of the body responds with production of specific antibodies, which destroy specific viruses. Dengue virus comes in different types and each with different flavours. There are four serotypes of dengue virus - DENV-1 to 4. Each of them has multiple genotypes. The genotype variation can be subtle either in DNA material or the envelope. For example, DENV-1 comes in as many as five genotypes - Asia, South Pacific, Thailand, Malaysia and AM/AF. When infected first time, the patient developed a life time immunity for that serotype due to presence of antibodies produced earlier. However, if the secondary infection is by another serotype, the immune system is confused, and the infection

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Indian Scientists

By Dr. T V Venkateswaran

can become life threatening. “Dengue virus has four antigenically defined serotypes and each serotype has multiple genotypes with several clades based on phylogenetic analysis of envelope or whole genome sequences” says D Cecilia of the Dengue Group at ICMR-NIV, Pune, who is the lead author of the new study. This makes developing an effective vaccine a major challenge. During the last five years, the National Vector Borne Disease Control Programme (NVBDCP) reported 80,725 cases of dengue per year with a fatality rate of about 0.24%. The ten-year data for Tamil Nadu, 2007–2016 show an average of 2539 cases per year with fatality of 0.21%. This is less than the national average. However, during 2012 the cases spiked to 12,826 and deaths rose to 66, which implied fatality of 0.51%. This was a clear signature of a dengue epidemic. Epidemiological studies indicated that Tirunelveli in Tamil Nadu was the epicentre of the epidemic. Past research had shown that the emergence of new genotype was the cause of the major dengue outbreak in late 1980s in India. Taking a cue, scientists led by Dr Cecilia collected blood samples from patients in South India during the 2012 outbreak with the help of Vellore-based Christian Medical College. The genome sequence of the virus collected from the samples were compared against the GenBank library which hosts all known dengue virus samples from 1943 to 2015. The study revealed that DENV-1 Asian genotype had replaced the AF-AM type that was hitherto dominant in Tamil Nadu. “All four serotypes were circulating but DENV-1 was dominant, present in 52% of the serotyped samples” says Cecilia. Further, the study showed that the DENV-1 Asian genotype had also developed a new phenotype in the E gene. “This is the first time after 20 years we are observing change in genotype in India,” the scientist added. DENV-1 originated in US and Japan during 1932. However, the Asian genotype of DENV-1 that emerged in Thailand. The Indian strains that caused havoc during the 2012-15 emerged in Singapore sometime in 2005. The same strain caused an epidemic in Singapore in 2005 and later in 2009 in Sri Lanka. “Phylogenetic analysis revealed that the Asian genotype was introduced from Singapore and shared 99% similarity with viruses, associated with large outbreaks in Singapore and Sri Lanka. The movement of DENV can affect dengue outbreaks and underscores the need for close molecular monitoring of DENV,” says Dr Cecilia. The findings are published in journal Virology. The research team included D. Cecilia, J.A. Patil, M.B. Kakade, A. Walimbe, K. Alagarasu, B. Anukumar, from National Institute of Virology and A. Abraham from Christian Medical College, Vellore. (Article shared from India Science Wire)

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ver the years, several measures have been launched to overcome the problem including imposition of ban on alcohol sale and setting up of de-addiction centres to help the drinkers. A group of researchers drawn from several national and international institutions have now found that it is possible to address the issue in a significantly effective manner at low costs. They have found that lot of benefit can be derived by merely equipping public health workers with different counselling techniques. The study was conducted at 10 public primary healthcare centres in Goa. A total of 377 heavy drinkers in the age group of 18 to 65 years were enrolled. They were randomized into two groups- one receiving just the routine care and the other who also received counselling for two months. Their alcohol use was measured after 12 months. In the group that received counseling, as much as 68 per cent of the men were found to have reduced their consumption to the safe level, as against 40 per cent in the case of the group that received only the routine care. The counselling programme was also not too intense. It consisted of just one to three sessions. The counselors were also just non-specialist health

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By Bhavya Khullar

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(Article shared from India Science Wire)

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cluded Abhijit Nadkarni, Helen A Weiss, Benedict Weobong, David McDaid, Daisy R Singla, A-La Park, Bhargav Bhat, Basavaraj Katti, Jim McCambridge, Pratima Murthy, Michael King, G Terence Wilson,

Betty Kirkwood, Christopher G Fairburn, and Richard Velleman. National Institute of Mental Health and Neurosciences (NIMHANS) in Bengaluru and Sangath, a NGO in Goa participated in the study. They collaborated with the London School of Hygiene and Tropical Medicine, University of Oxford, University of Bath, University of York, University College London and London School of Economics and Political Science in United Kingdom, University of Toronto in Canada, Rutgers University in New Jersey, and Harvard Medical School in United States of America. The Indian Council of Medical Research gave the ethical approval for conducting the trial.

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Alcohol abuse contributes to illness and premature deaths in a big way. It is also associated with several socio-economic consequences such loss of earnings and domestic violence.

They had no prior professional training or qualification in the field of mental health. However, they were given rigorous training on various aspects of counselling and they gave advice on how to deal with craving and motivated patients to quit drinking.

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Alcohol addiction: Counselling can be of great help

workers. They had no prior professional training or qualification in the field of mental health. However, they were given rigorous training on various aspects of counselling and they gave advice on how to deal with craving and motivated patients to quit drinking. Speaking to India Science Wire, Vikram Patel, professor at the Department of Global Health and Social Medicine of the Harvard Medical School, Boston, Massachusetts in USA, who was the corresponding author for the study, said, â&#x20AC;&#x153;Given the great social and health harms associated with heavy drinking in India, and the effectiveness of this relatively brief and cheap treatment to reduce drinking levels,the government needs to scale up this treatment by training primary care health workers across the countryâ&#x20AC;?. Besides Dr. Patel, the study team in-

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Volume 3 | Issue 1 | Jan-Mar 2018

Global Nutrition Report’s Independent Expert Group and Director of the Centre for Food Policy at City, University London. “We will not achieve any of the Global Goals for Sustainable Development (SDGs) by the 2030 deadline unless there is a critical step change in our response to malnutrition in all its forms. Equally, we need action throughout the goals to tackle the many causes of malnutrition.” The Report calls for nutrition to be placed at the heart of efforts to end poverty, fight disease, raise educational standards and tackle climate change. "We know that a well-nourished child is one-third more likely to escape poverty,” said Jessica Fanzo, Bloomberg Distinguished Professor of Global Food and Agriculture Policy & Ethics at Johns Hopkins University and Global Nutrition Report CoChair.

l 155 million under-fives are stunted; Africa is the only region where absolute numbers are rising, due to population growth. l 52 million children worldwide are defined as wasted, meaning they do not weigh enough for their height.

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2015. While more women worldwide are affected by obesity, the case for diabetes and hypertension is mixed. There is more diabetes among men than women in Asia, Europe, Northern America and Oceania, and more hypertension among men than women in all regions except Africa. The world now faces a serious nutrition-related challenge, whether stemming from undernutrition or obesity, states Global Nutrition Report 2017. The report found the vast majority (88%) of countries studied face a serious burden of two or three of these forms of malnutrition. It highlights the damaging impact this burden is having on broader global development efforts. “The world can’t afford not to act on nutrition or we risk putting the brakes on human development as a whole,” said Corinna Hawkes, Co-Chair of the

everywhere in the world. That’s why governments and their partners need to tackle them holistically, not as distinct problems.”Donor funding for nutrition rose by just two per cent in 2015, to US$867 million, representing a slight fall in the overall percentage of global aid. The report says funding needs to be ‘turbo charged’ and calls for a tripling of global investments in nutrition, to $70bn for over next 10 years to tackle childhood stunting, wasting and anemia and to increase breastfeeding rates. Crucially, donors are only spending 0.01 per cent of official development assistance on diet related Non-Communicable Diseases, a ‘disturbingly low’ level. Pledges to invest in nutrition must be ‘concrete’ and ‘acted upon’, not ‘empty rhetoric’, the report said. Of the 203 commitments made at the Nutrition for Growth Summit in 2013 those most likely to be classified as ‘on course’ are the UN agencies’ at 86 per cent, followed by ‘other organisations’ at 75 per cent and NGO policy commitments at 73 per cent. The report found there is a critical need for better data on nutrition - many countries don’t have enough data to track the nutrition targets they signed up to and to identify who is being left behind.

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omen’s health in India has emerged as a major nutritional challenge with the country wrestling largest number of anemic women in the world and the other having to tackle diseases related with obesity –that is on the rise, warns the latestGlobal Nutrition Report, 2017. It says there is malnutrition among adults globally.A total of 614 million women aged between 15–49 years were affected by anemia. India had the largest number of women impacted, followed by China, Pakistan, Nigeria and Indonesia.In India and Pakistan, more than half of all women of reproductive age have anemia. It is a global issue that many women in high-income countries also suffer from; prevalence rates may be as high as 18% in countries such as France and Switzerland.Obesity (body mass index (BMI) ≥30) is most common among North American men (33%) and women (34%), and lowest among Asian and African men (6%) and Asian women (9%). Overweight and obesity are increasing in almost every country and are a real concern for many low and middleincome countries, not just high-income ones.The problem affects more women than men in all the world’s regions, reflecting a wider global gender disparity. Hypertension is most common (28%) among African women and European men, and lowest (11%) among North American women. A quarter of Asian and Latin American men suffered from raised blood pressure in

“They will learn better in school, be healthier and grow into productive contributors to their economies. Good nutrition provides the brainpower, the ‘grey matter infrastructure’ to build the economies of the future.” Rates of undernutrition in children are decreasing, the report said, with recent gains in some countries. But global progress is not fast enough to meet internationally agreed nutrition goals, including the Sustainable Development Goals (SDG) target 2.2 to end all forms of malnutrition by 2030. EmornUdomkesmalee, Co-Chair of the Global Nutrition Report’s Independent Expert Group and Senior Advisor, Institute of Nutrition, Mahidol University, Thailand, said, “It’s not just about more money – although that is important - it’s also about breaking down silos and addressing malnutrition in a more joined-up way alongside all the other drivers of development. There’s a powerful multiplier effect here that we have to harness.” The report found that overweight and obesity are on the rise in almost every country.With 2 billion of the world’s 7 billion people are now overweight or obese and a less than 1 per cent chance of meeting the global target of halting the rise in obesity and diabetes by 2025. Rising rates of anemiaamong women of reproductive age are also cited as a concern with almost one in three women affected worldwide and no country on track to meet global targets.“Historically, maternal anemia and child undernutrition have been separate problems to obesity and noncommunicable diseases,” said MsFanzo. “The reality is they are intimately connected and driven by inequalities

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Global nutrition crisis threatens human development, demands ‘critical step change’ in response - Report

In all 140 countries studied, the report found ‘significant burdens’ of three important forms of malnutrition used as an indicator of broader trends: 1) childhood stunting-children too short for their age due to lack of nutrients, suffering irreversible damage to brain capacity, 2) anemia in women of reproductive age-a serious condition that can have long term health impacts for mother and child, and 3) overweight adult women-a rising concern as women are disproportionately affected by the global obesity epidemic.

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Global nutrition ‘at odds’; needs swift efforts

l At least 41 million children under five are overweight, with the problem affecting high and lower income countries alike l At least 10 million children in Africa are now classified as overweight l One-third of North American men (33%) and women (34%) are obese

Report says the world consumes too much salt. Intake varies by region, but no region had intakes within the WHO-recommended limits of 2 g/day of sodium. Asia has the highest intake (4.3 g/day of sodium), followed by Europe (4.0 g/day of sodium). At national level, only seven countries (Burundi, Comoros, Gabon, Jamaica, Kenya, Malawi and Rwanda) have sodium intakes within desirable limit) Volume 3 | Issue 1 | Jan-Mar 2018

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Volume 3 | Issue 1 | Jan-Mar 2018

“Our findings suggest that psychological stress in the form of negative and traumatic life events might represent an important risk factor for weight changes and, therefore, we should consider including assessment and treatment of psychosocial stress in approaches to weight management,” Albert said. Because the study looks at the association between stressful events and obesity in a snapshot of time, future studies should look at the relationship longitudinally, following people for weight gain over time after life events have occurred, according to Albert. “This is important work because women are living longer and are more at risk for chronic illnesses, such as cardiovascular disease. The potential public health impact is large, as obesity is related to increased risks of heart attack, stroke, diabetes and cancer, and contributes to spiraling healthcare costs,” Albert said. Volume 3 | Issue 1 | Jan-Mar 2018

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Women who experienced one or more traumatic lifetime events or several negative events in recent years had higher odds of being obese than women who didn’t report such stress, according to preliminary research presented at the American Heart Association’s Scientific Sessions 2017, a premier global exchange of the latest advances in cardiovascular science for researchers and clinicians.

Women who reported greater than one traumatic life event versus no traumatic life events had 11 percent increased odds of obesity; The higher the number of negative life events reported by women in the last five years, the higher the tendency for increased odds of obesity. Specifically, women who reported four or more negative life events had a 36 percent higher risk of obesity, compared to women who reported no such events; Among women who had higher levels of physical activity, there was a stronger association between increasing cumulative/chronic stress and obesity, though the reason for this finding remains uncertain.

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NEARLY A QUARTER (23 PERCENT) OF THE WOMEN STUDIED WERE OBESE

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Sleep deprivation may increase risk of cardiovascular disease in older women Older women who don’t get enough sleep were more likely to have poor cardiovascular health, according to preliminary research presented at the American Heart Association’s Scientific Sessions 2017. In the new study, researchers considered sleeping at least two hours more during the weekend than on the weekday as a sign of being in state debt. Among the roughly 21,500 female health professionals between ages of 60 and 84 the research team followed, women who were in sleep debt were more likely to be obese and have hypertension. When taking into account socioeconomic status and sources of stress, such as negative life events and work-related stress that could also influence cardiovascular health, quality of sleep was still an important factor for good overall cardiovascular health. The results suggest that not getting enough sleep during the week might throw the body off and may increase risk of cardiovascular disease in older women.

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CAN INCREASE WOMEN’S ODDS OF OBESITY

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STRESSFUL EVENTS

“Little is known about how negative and traumatic life events affect obesity in women. We know that stress affects behaviour, including whether people under- or overeat, as well as neuro-hormonal activity by in part increasing cortisol production, which is related to weight gain,” said study senior author Michelle A. Albert, M.D., M.P.H., professor of medicine, cardiology, and founding director of the Center for the Study of Adversity and Cardiovascular Disease, at University of California, San Francisco. Obesity, a preventable risk factor for cardiovascular and other diseases, impacts more than one-third of U.S. adults. According to the American Heart Association, nearly 70 percent of American adults are either overweight or obese. Women tend to live longer than men, putting especially obese, aging women at greater risk for disease, said study author Eva M. Durazo, Ph.D., a post-doctoral scholar at the NURTURE Center, Division of Cardiology, and UCSF said. The researchers studied the relationship between major life events and obesity in a group of 21,904 middle-aged and older women, focusing on women with the highest obesity prevalence. They defined obesity as having a body mass index (BMI) of 30 kg/m2 or higher. And, they measured the impacts of two types of stress: traumatic events, which could occur anytime in a woman’s life and includes events as death of a child or being a victim of a serious physical attack, as well as negative life events that had occurred in the previous five years of a woman’s life. Negative events included wanting employment but being unemployed for longer than three months or being burglarized.

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Volume 3 | Issue 1 | Jan-Mar 2018

The genetic tests would help in antenatal counselling preventing further birth of affected children in families and unveiling of newer pathogenic and therapeutic pathways.

of its kind in the country paving the way for meaningful research, policy making and advocacy for childhood neurodevelopment disorders. A standardised list of investigations for diagnosis of neurodevelopmental disorders would be developed including advanced genetic investigations in collaboration with Institute of Genomics and Integrative Biology. The genetic tests would help in antenatal counselling preventing further birth of affected children in families and unveiling of newer pathogenic and therapeutic pathways. The Centre will focus on use of technology-aided rehabilitation strategies for children with neurodevelopmental disorders. This will be done in collaboration with IIT Delhi utilising textile technology and biomedical engineering. It will provide reliable and round the clock toll-free telephonic guidance. The India Infrastructure Finance Company Limited as part of its CSR activities has collaborated for the purpose. Volume 3 | Issue 1 | Jan-Mar 2018

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--Creation of a National Registry, National Knowledge and Training Centre, Advanced Diagnostics, Advanced Therapeutics& Rehabilitation and a helpline for Tele-consultation. The National Registry will be the first

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he All India Institute of Medical Sciences will soon establish the Centre for Advanced Research and Excellence for Childhood Neurodevelopmental Disorders. The Centre of Excellence will come up at the Mother and Child Block at an approved amount of Rs 14.3 crore. The broad category of Neuro developmental disorders to be covered by the CoE would be Neuromotor impairments, Motor, language and cognitive delay and epilepsy. Vision and hearing impairments will be covered as comorbidities According to AIIMS Deputy Director Administration V. Srinivas, the proposal for establishing the CoE was conceptualised by a team of senior faculty led by Prof V. K. Paul and Prof Sheffali Gulati. The state-of-the-art Centre will provide high quality affordable care, perform high end diagnostic and therapeutic research and act as an education and training hub. The five key elements of the CoEare

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Centre for Childhood Neuro developmental Disorders at AIIMS