June 2024

June 15,2024 There is a common belief that food cooked at home is not processed & healthier and that food cooked in an industrial kitchen is processed and unhealthy. This is not true. As the food cooked in an industrial kitchen is made in bulk quantity, with standardised recipes as per food standards issued by food regulatory authorities (like FSSAI, Tea Board, Spice Board, DAHD etc.) and adhering to stricter health and safety norms during the preparation. What is Food Processing? Food processing which refers to transforming food ingredients like grains, meat, vegetables, fruits, etc. with minimal waste into a value-added and convenient processed product can be done in a home kitchen or in a large-scale kitchen usually known as an industrial manufacturing unit. The technique, ingredients, food additives , packaging, and transportation are almost similar and vary only in the case of size and volume. The process of oil-preserved pickle made by our granny at home is similar to manufacturing the same at the industrial level which includes sorting, cleaning, pickling, and packing. It is not incorrect to say that large-scale food processing has eased our fast-paced and hustled lives and made more space and time for interaction with our loved ones. Does processing decreases nutritional value of the food? The most common myth prevalent for processed foods is that it will decrease the nutritional value of the food but it is not always true. In fact, some foods must be necessarily processed prior to consumption to remove harmful / toxins naturally present e.g. Milk must be boiled or pasteurised to kill harmful bacteria to make it safe for human consumption, Most of the anti-nutritional compounds of the pulses that are present in the seed coat are sensitive to heat and can be substantially reduced by milling, cooking, germination, fermentation, and heat processing. Germination induces enzymes to split up carbohydrates, lipids, and proteins into basic methods and stimulates proteases involved in destroying proteins, thus enhancing the bioavailability of nutrients. Vitamin C and the B complex vitamins increase dramatically and encourage the production and productivity of seedlings. During fermentation, lactic acid bacteria synthesise vitamins and minerals, produce biologically active peptides with ensymes such as proteinase and peptidase, and remove some non-nutrients. Fermented foods provide many health benefits such as anti-oxidant, anti-microbial, anti-fungal, anti-inflammatory, anti-diabetic, and anti-atherosclerotic activity. Juicing helps in breaking down complex carbohydrates to simpler forms for easy digestion and assimilation by the body. Another way in which food processing enhances nutritive value of foods is fortification with essential nutrients like vitamins, minerals, omega-3, dietary fiber etc. Some examples are: Milk is fortified with Vitamin A and D to address nation-wide associated deficiencies. Common Edible Salt is fortified with Iodine to address nation-wide associated deficiencies. Non-carbonated waters are fortified with certain minerals like Calcium, Potassium, Magnesium, etc. to replenish lost minerals during exercise or sports activity. Fruit Juices are fortified with certain minerals and vitamins like Vitamin C, D, K, B complex, E, Iron, Calcium etc. to enhance nutritive value of the juices. Edible oils are fortified with omega-3, Vitamin A to enhance its nutritive value. Biscuits and other bakery items are fortified with vitamins, minerals, and dietary fiber to enhance its nutritive value and avoid digestive issues related to cereals. Source: Healthworld

NEW MASTER CIRCULAR issued by IRDAI repeals 55 previous circulars. Major reforms FOR health insurance policies – especially beneficial for Sr Citizens. Insurers have been advised to move to 100 % cashless claim settlements – and empanel all categories of hospitals considering affordability for all population segments. Stricter time limits for portability. CIS – Customer Information Sheet to be provided with every policy document giving complete details of the medical insurance policy. These are MAJOR LANDMARK reforms in the health insurance sector that come into effect immediately.

June 12,2024 New Delhi: Exposure to heat was found to stress the heart of adults by increasing the blood flow to the organ’s walls, according to a new study. The researchers also found evidence of obstructed blood flow induced because of the heat in some of the adult participants with heart disease, even though they did not display symptoms externally. The researchers, including those from Canada’s Montreal Heart Institute, said these adults may benefit by staying cool to counter the heat’s stress on their hearts. For the study, published in the journal Annals of Internal Medicine, the team recruited 61 adults — 20 healthy young adults, 21 healthy older adults and 20 older adults with coronary artery disease (CAD) — to see how exposure to extreme heat impacted the heart. CAD is a condition in which blood vessels supplying to the heart are narrowed because of plaque buildup, thereby limiting blood flow. The researchers artificially raised the core body temperature of the participants by 1.5 degrees Celsius and measured their myocardial blood flow (MBF) – blood reaching muscles of the heart wall – before exposure and also at every increase of 0.5 degrees Celsius to their core temperature. The authors found that blood flow to the heart muscles increased in all participants when their body temperature increased by 1.5 degrees Celsius. Using imaging techniques, the authors further observed that seven of the participants with CAD experienced heat-induced myocardial ischemia in which blood flow to the heart is obstructed due to blockage in vessels. The participants, however, did not outwardly show symptoms of the condition. In an accompanying editorial from Annals of Internal Medicine and the University of Pennsylvania Perelman School of Medicine (US), the researchers said that exposure to heat can significantly stress the heart by inducing a supply-demand mismatch in vessels. With temperatures around the world on the rise, identifying vulnerable people with conditions of the heart and blood vessels is imperative, it said. Repeated exposures can result in a “symptomatic or silent” blood flow problems, which could partly explain the increased risk for adverse cardiovascular events observed because of heat exposure in population studies, it said. Source: Healthworld

June 12,2024 Copenhagen: The WHO on Wednesday blamed four major industries — tobacco, ultra-processed foods (UPFs), fossil fuel and alcohol — for 2.7 million deaths a year in Europe, accusing them of obstructing public policies that could hurt their profits. These “four industries kill at least 7,000 people in our region every day,” Hans Kluge, the director of the World Health Organization Europe region which counts 53 countries including Central Asia, said in a statement. The consolidation of these industry sectors into a small number of multinationals “has enabled them to wield significant power over the political and legal contexts in which they operate, and to obstruct public interest regulations which could impact their profit margins,” the WHO said as it released a report. Industry tactics included exploiting vulnerable people through targeted marketing strategies, misleading consumers, and making false claims about the benefits of their products or their environmental credentials, it argued. “These tactics threaten public health gains of the past century and prevent countries from reaching their health targets,” it added. Industry lobbying was hampering efforts to tackle non-communicable illnesses such as cardiovascular disease, cancer and diabetes, said the WHO. Almost 60 percent of adults and a third of children in Europe are overweight or obese, according to the WHO. The most recent data, from 2017, showed that one death in five attributed to cardiovascular disease and cancer in Europe was the result of unhealthy eating habits. The WHO urged countries to fight back by enforcing stronger regulations on the marketing of unhealthy products, monopolistic practices and lobbying. “People must take precedence before profit, always,” Kluge said. The report, “Commercial determinants of noncommunicable diseases in the WHO European Region”, is available at the WHO website. Source: Healthworld

June 11,2024 New Delhi: Researchers from the George Institute for Global Health India in collaboration with researchers from Indira Gandhi Government Medical College (Nagpur), and the London School of Hygiene and Tropical Medicine (UK) have conducted a survey shedding light on the staggering financial burden faced by Tuberculosis (TB) patients in India. Their findings underscore the urgent need for both policy and public interventions to alleviate this burden on patients and the nation. The study was led by Dr Susmita Chatterjee, Senior Health Economist, George Institute for Global Health, New Delhi, along with Palash Das, Research Fellow, George Institute for Global Health, New Delhi; Gayatri Bhambure, Research Assistant, George Institute for Global Health, New Delhi; Dr Radha Munje, Department of Respiratory Medicine, Indira Gandhi Government Medical College, Nagpur; Anna Vassall, Professor, Health Economics, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London. The study conducted against the backdrop of the World Health Organisation’s End TB strategy, which serves as a blueprint for countries to achieve zero catastrophic costs for TB-affected households, reveals concerning statistics about the economic toll of the disease in India. With the nation bearing the highest TB burden globally, the reported incidence reached 2.42 million cases in 2022. The George Institute researchers followed a cohort of 1,482 drug-susceptible TB patients across four states in India: Assam, Maharashtra, Tamil Nadu, and West Bengal. Employing World Health Organisation guidelines, the study calculated treatment costs, incorporating both direct (ie actual money spent) and indirect costs such as time, productivity, and income loss. Speaking about the research, Dr Chatterjee said, “Following the largest cohort of drug-susceptible TB patients till date, our study concluded that a significant proportion of study participants faced catastrophic cost and the proportion was much higher when income loss because of TB treatment was considered in total cost calculation method. Therefore, ensuring uninterrupted livelihood during TB treatment is an absolute necessity.” She also added, “Our study showed significant delay from symptom onset to diagnosis and our study participants spent more than half of total treatment cost even before starting the treatment. Further, during this period they also propagated the disease. Therefore, reducing the pre-diagnosis delay should be the policy priority.” Shockingly, depending on the method of indirect cost calculation, between 30 per cent to 61 per cent of study participants faced catastrophic costs. Defined as out-of-pocket expenses exceeding 20 per cent of pre-TB annual household income, catastrophic costs pose a significant threat to the financial stability of millions of TB-affected households in the country. Of particular concern was the fact that for over half of the participants who faced catastrophic cost, costs became catastrophic even before commencing TB treatment due to delays in diagnosis. The average delay of 7-9 weeks from symptom onset to treatment initiation, twice the accepted delay period, resulted in substantial financial burdens from repeated consultations, tests, and travel expenses. The study’s implications are profound, calling for immediate action at both policy and community levels. Supply-side interventions such as intensifying private sector engagement and rapid diagnosis are crucial, alongside demand-side initiatives like community awareness campaigns. Addressing the delay in diagnosis through early case detection and active community engagement is paramount to reducing economic burdens. The study also advocates for the reimbursement of pre-treatment expenses through health insurance, emphasising the need for improved coverage and utilisation. Policies safeguarding TB patients from unemployment and income loss are also imperative to mitigate financial hardships associated with the disease. The findings of this study serve as a clarion call for concerted efforts from policymakers, healthcare providers, and communities to alleviate the economic burden of TB treatment in India. By implementing comprehensive strategies, we can not only reduce financial hardships on patients but also move closer to achieving the ambitious targets set forth by the End TB strategy. The results of the study have been published in PLOS Global Public Health. Source: Healthworld

June 11,2024 New Delhi: Sildenafil, commonly known by its brand name Viagra, the wonder drug for men suffering from erectile dysfunction, can also help people prevent problems related to memory. A recent study has found that the drug increases cerebral blood flow and enhances the function of blood vessels in individuals who are at risk of developing vascular dementia. Vascular dementia is a condition that affects cognitive functions, such as memory, reasoning, planning, and judgement. This type of dementia occurs due to reduced blood supply to the brain, resulting in damage to brain tissue. The research conducted by scientists at the University of Oxford, the results of which appeared in journal Circulation Research, represents a significant advancement in the battle against dementia. The findings could provide a crucial turning point in the efforts to combat the disease, said city doctors. Dr Praveen Gupta, principal director, neurology, Fortis Gurgaon, distinguished between vascular and Alzheimer’s disease dementia, noting that while the end result was comparable, the underlying pathophysiology differed. “In Alzheimer’s, dementia occurs due to deposition of Amyloid beta plaques in the brain, which prevents connectivity of neurons causing cognitive or brain dysfunction,” he explained. “In vascular dementia, the damage to brain cells occurs due to the obstructions in blood vessels.” The underlying processes leading to these two types of dementia are distinct, despite their similar outcomes in terms of cognitive impairment. According to a study titled ‘Vascular cognitive impairment in India’, the burden of vascular contribution to cognitive impairment and dementia is substantially high in India. There are approximately 5.3 million dementia patients in India and nearly 40 per cent are estimated to be sufferers of vascular dementia. Gupta said the Oxford studies provide promising early results that could pave the way for treatment. However, larger studies were needed to demonstrate the efficiency of sildenafil before it could be considered standard treatment. Dr Manjari Tripathi, head of AIIMS’ neurology department, explained that the primary risk factors for vascular dementia included blood pressure, smoking, diabetes, hypertension, obesity, obstructive sleep apnea and atherosclerosis. She said that vascular dementia could manifest in different forms. One type is multi-infarct dementia (MID), which develops as a consequence of multiple small strokes that lead to brain damage. Another type is strategic infarct dementia, where a single infarct occurs in a crucial region of the brain, such as the anterior nucleus of the thalamus, resulting in dementia even with a solitary infarct. “Strokes can affect individuals of all ages. The cognitive impairments resulting from a stroke, such as diminished reasoning, logical thinking, attention and judgment, are often more severe compared to those observed in Alzheimer’s dementia,” said Tripathi. “The onset of these cognitive deficits can be sudden and profound, regardless of the patient’s age. While Alzheimer’s dementia typically progresses gradually, the impact of a stroke on cognitive functions can be immediate and substantial.” Agreeing that the Oxford research was groundbreaking in linking sildenafil with improvement in vascular dementia, Dr Rajeev Mehta, senior psychiatrist, Sir Ganga Ram Hospital, added, “It is important to note that in vascular dementia, memory deficiency or forgetfulness occurs in steps.” However, further comprehensive multi-centric trials were needed to substantiate these findings, said Dr Jitendra Nagpal, chairman, Institute of Mental Health, Moolchand Hospital. That said, any benefit to chronic sufferers was a welcome step in cognitive recovery, he added. Source: Healthworld

June 12,2024 New Delhi: Observing that the state has to exercise its parens patriae jurisdiction in cases concerning those with mental health issues and without family support, Madras high court directed the state to take into custody a 20-year-old youth with mental health issues, house him in appropriate accommodation and provide him “lifelong medicare”, reports K Kaushik. The court was hearing a plea filed by parents of a man whose has serious mental health issues. He was admitted to Tirunelveli Medical College and Hospital’s psychiatry ward on May 5, 2022 and discharged on June 6, 2022. He has been diagnosed with bipolar affective disorder and has current episodic mania with psychotic symptoms. Unable to support their son, the petitioners, daily wage labourers, wanted govt to take over his upbringing. Justice G R Swaminathan, allowing the plea, said: “The moot question that arises for consideration is whether the state can be saddled with liability in such cases. My answer is yes.” He said the state must exercise its parens patriae jurisdiction in the case of the mentally disabled who are without family support. When the state fails to exercise its duty, the constitutional court, exercising jurisdiction under Article 226 of Constitution, will direct the authorities to discharge the aforesaid function. The judge observed that the state is obliged to set up residential homes for the mentally disabled in every district. This alone will reduce overcrowding. There are NGOs who have set up such shelter homes, the state should liberally support them financially. Source: Healthworld

June 12,2024 New Delhi: BJP president JP Nadda, who took charge of the health ministry on Tuesday, held a brief meeting with senior officials and asked them to focus on the agenda for the first 100 days. Ministers of state for health Anupriya Patel and Prataprao Jadhav also attended the meeting. Extending coverage under the Ayushman Bharat scheme to people aged 70 years and above, and the launch of a vaccine portal, U-Win, are among the top items on 100-day plan. “The Ministry of Health and Family Welfare plays a crucial role in the nation’s progress and the well-being of its people. As the backbone of the country, the health sector not only promotes public health but also stands as a strong force in addressing and overcoming health challenges,” the minister posted on X after taking charge. Nadda also assumed charge of chemicals and fertilisers ministry. Source: Healthworld

June 12,2024 Bangor: It is becoming increasingly clear that spending time in nature can benefit our mental health and wellbeing. But a new study by my colleagues and me shows that you don’t have to actually be in nature to reap the rewards. Simply directing your gaze towards natural elements, even in the middle of a city, can enhance wellbeing. Our paper, published in the journal People and Nature, used eye-tracking technology to explore how focusing on natural versus man-made elements affects mental health. Urban living, with its fast pace and high levels of stress, has been linked to numerous mental health issues, including anxiety and depression. Our research team, which was led by me and consisting of my colleagues Brian Rizowy and Assaf Shwartz, recruited 117 adults for the study. Participants were randomly assigned to one of three groups: one that focused on natural elements such as trees (green group), one that focused on man-made elements such as buildings (grey group) and a third group that focused on a mix of both (mixed group). Each participant wore specialised eye-tracking glasses during a 45-minute guided walk around town and the campus. The route included ten designated stopping points designed to emphasise either natural or man-made elements, depending on the group. Before and after the walk, participants completed surveys assessing their mood, anxiety levels and the restorative quality of the walk. The surveys included standardised measures such as the positive and negative affect schedule (Panas) and the state-trait anxiety inventory (Stai). The eye-tracking glasses recorded where participants were looking throughout the walk, allowing researchers to quantify the amount of time spent focusing on green (natural) or grey (man-made) elements. In fact, our technique offered a precise and objective measure of visual engagement, strengthening the link between nature exposure and improved wellbeing. The data confirmed that each group really did spend more time looking at the scenery we had asked them to focus on. The results were striking. Participants who focused more on green elements reported significant improvements in mood and reductions in anxiety compared to those who focused on grey elements. And they showed higher levels of positive emotions and lower levels of anxiety after the walk. They also reported feeling more refreshed and rejuvenated. In contrast, the grey group did not show these improvements, and the mixed group had intermediate results, suggesting that even a partial focus on nature can be beneficial. Implications for urban planning These findings have important implications for urban planning and mental health practices. Designing urban spaces that incorporate natural elements and encourage visual engagement with nature could help reduce the mental health burden of city living. For instance, planners could prioritise green spaces, tree-lined streets, parks and ponds that invite people to pause and take in the natural beauty. The findings could also be useful for mental health professionals. For example, they may want to incorporate guided attention exercises into therapy, encouraging patients to specifically focus on natural elements during walks or other outdoor activities. This simple, cost-effective strategy could enhance traditional treatments for anxiety and depression. The study highlights the importance of visual engagement with nature, providing robust evidence that the mental health benefits of nature are closely tied to where we focus our attention. For the average person, this study suggests an easy way to boost mental health: spend more time looking at trees, flowers and other natural elements. Whether during a daily commute, a walk in the park or a weekend hike, consciously directing your gaze towards nature could make a significant difference in how you feel. Our research underscores the potential for simple, everyday actions to have a profound impact on mental health. As urban areas continue to grow, c into cityscapes and encouraging people to engage visually with these elements could play a crucial role in enhancing public wellbeing. Source: Healthworld

June 12,2024 Mumbai: Of late, the weight loss drugs market has been booming, and it has created a ripple effect globally. These drugs were developed for diabetes management, but they have created a lot of buzz not only in managing diabetes but also in helping with weight loss, benefits in heart, kidney, and liver diseases, and more. Such is the demand for these so-called blockbuster drugs, which have become the most sought-after drugs globally. Since late, style disorders and diseases have posed a significant challenge; obesity being one of the major concerns, there is a need to address it. According to a recent study published in the Lancet, 70 per cent of India’s urban population is classified as obese or overweight, placing the country amid an obesity crisis. It also states 30 million adults in India are either overweight or obese, and 62 million diabetic Indians exhibit obesity-related characteristics such as excess body fat, abdominal adiposity, and fat deposition in ectopic sites. Currently, Abbott’s Leptos (sibutramine hydrochloride) is approved for obesity medication in India; the same drug branded as Meridia in 2010 was withdrawn in the US for its increased risk of heart attack and stroke. Eli Lilly’s Zepbound (tirzepatide) and Novo Nordisk’s Wegovy (semaglutideinjection), are expected to make their entry by 2025 and 2026, respectively, in India. As the frenzy for these weight-loss drugs catches on in India, so does the interest in these therapies, as there are limited options in the country: (Source: GlobalData). Indian doctors have been prescribing these weight-loss drugs even though they aren’t yet commercially sold in India. To better understand this scenario, ETHealthworld interacted with leading diabetologists on how these drugs are procured and administered if they are not available in the Indian market, and there is a global shortfall as well due to high demands. Sharing his opinion, Dr Rajiv Kovil, Head of Diabetology, Zandra Healthcare, and Co-Founder, Rang De Neela Initiative, shared, “Oral semaglutide has approval in India. Injectable semaglutide at a higher dose has approval in India for obesity. Oral semaglutide which goes by the brand name Rybelsus, has been marketed in India, and its approval is for diabetes, it can be prescribed by doctors in India. Injectable semaglutide is not marketed in India, and injectable semaglutide with a higher dose, which has the brand name Wegovy, has DCGI approval but has not yet been launched and marketed in India. Hence, doctors in India cannot prescribe injectable semaglutide as it has not been marketed in India.” Dr V Mohan, Chairman and Chief of Diabetology, Dr Mohan’s Diabetes Specialities Centre, added, “Semaglutide is available in both oral (tablet) form, which is known as Rybelsus, as well as injectable form, which is known as Ozempic and Wegovy. Rybelsus has already been available in India for the last few years, and that is being used (prescribed) by all of us. While it is effective, it is not as effective as the injectable forms, namely Ozempic and Wegovy. Wegovy was approved earlier this year by the Drug Controller General of India (DCGI), and the company has been permitted to market it in India. However, the fact is that despite the injectable form, both Ozempic and Wegovy are much more effective in weight reduction and controlling diabetes, but they are unable to bring them to India immediately because of the heavy demand for their production. They have been struggling to produce enough to sell in Europe, the US, the Middle East, and other countries where the drug is available. Inquiring about how Indian medical practitioners prescribe these drugs for weight loss in non-diabetic patients, Dr Kovil said, “Indian prescriptions cannot be used to obtain these drugs from overseas markets, but whichever country semaglutide has been launched in, whether it is the UAE, Saudi Arabia, the UK, or the US, the healthcare practitioner based in the country is required to prescribe this drug as this is not an over-the-counter medication. The medication has to be prescribed only by experts in the field. Semaglutide injectable has been approved for diabetes as well as weight loss. Though injectable semaglutide has been approved in India, it has not been marketed. Oral semaglutide which is approved, marketed, and available in India, has received approval only for the management of type 2 diabetes and cannot be used for the treatment of obesity in people without diabetes. There are a lot of people with diabetes who are fighting obesity, and breaking the obesity pandemic in people with diabetes is itself a challenge. So, semaglutide oral, which goes by the brand name Rybelsus, is the drug of choice or pill for diabetics who want to lose weight or who don’t want to gain weight.” Dr Mohan mentioned that since it is not available in the Indian market, some Indians are procuring these drugs from Dubai or other sources and using them. He stated, “The problem if the drugs are used without being available in India is that if any side effects develop, then the question of who is responsible will arise. Will the current company still be held responsible if the patient has illegally obtained the drug from some other country? If a legal issue like this arises, it could lead to complications. Hence, in my view, until it is officially available through proper sources, that is, through hospitals, clinics, or pharmacies in India, people shouldn’t import the drugs and use them on their own.” The side effects that are seen are mostly gastrointestinal, nausea, vomiting, and diarrhoea being the most common. Very rarely, they can lead to a condition called paralysis of the stomach and intestine. Even more rarely, pancreatitis and medullary carcinoma of the thyroid have been reported. However, these are more common in animal models when higher doses are used, and they are very uncommon in human trials. If the patients start using these drugs, they lose weight, and the sugars get under control. However, they have to be on it long term because if they stop it, they tend