Mid-level health cadre to prescribe drugs

Mid-level health cadre to prescribe drugs (The Tribune: 201805040)

http://www.tribuneindia.com/news/nation/mid-level-health-cadre-to-prescribe-

drugs/584059.html

New provision in National Medical Commission Bill for practice licence to non-MBBS

practitioners

The government has moved quietly to create a new cadre of non-MBBS medical

professionals with rights to practise and prescribe medicine in specified areas and under

specified conditions.

The move comes after the Parliamentary Standing Committee on Health rejected the National

Medical Commission Bill provision enabling Ayush practitioners to prescribe a listed set of

medicines after taking a bridge course.

Taking a cue from the committee’s recommendations to consider giving limited drug-

prescription rights to nursing practitioners or pharmacists instead of Ayush experts, the

DAILY NEWS BULLETINLEADING HEALTH, POPULATION AND FAMILY WELFARE STORIES OF THE Day

Friday 20180504

Ministry of Health drafted a new provision in the Bill to grant limited licence to practise

medicine to non-MBBS medical practitioners.

The amended provision recently cleared the Cabinet hurdle and will now be part of the

official amendments the government will move to the NMC Bill in the next session of

Parliament.

The new provision coins a new term, “mid-level medical practitioners”, who will get limited

licence from the NMC to practise medicine.

“Mid-level medical practitioners will get limited licence to practise specified medicines in

primary and preventive healthcare settings and in other settings under the supervision of a

medical doctor,” says the new section in the Bill. The Bill also provides for a separate register

to list such mid-level medical practitioners with limited drug prescription rights. This register

will be maintained by the Board of Ethics under the NMC, which will replace the Medical

Council of India once the law is passed by Parliament and assented to by the President. So far

under the Indian laws, only MCI-licensed and registered medical doctors can practise

medicine and prescribe them.

Once through, the new cadre of mid-level medical practitioners will get to prescribe specified

medicines independently in settings specified by the NMC and in hospital settings such as

ICUs under medical doctors’ supervision.

Those who qualify as mid-level medical practitioners include non-MBBS medical

professionals such as a nursing practitioner who has done a specific nursing course like

tertiary nursing care; pharmacists, physician assistants, optometrists, among others, ministry

sources said. These practitioners will be specifically listed by the NMC.

So now under the amended NMC Bill there’s a provision to maintain two registers — one of

licensed MBBS doctors and the other of specified mid-level medical practitioners with

limited medicine prescription and practising licence. The idea is to tide over the crisis of

dearth of doctors in rural areas. India’s doctor-patient ratio is a dismal 1:1600 as against the

WHO mandated 1:1000.

Impaired pulmonary function

Impaired pulmonary function in 53% of tested area population’ (The

Hindu: 201805040)

http://www.thehindu.com/news/cities/Delhi/impaired-pulmonary-function-in-53-of-tested-

area-population/article23765033.ece

180 men, 107 women participated in study; ‘females 5.57 times more prone to it’

Impaired pulmonary function was seen in 53% of the tested population in south Delhi,

reveals a study conducted by Safdarjung Hospital. The hospital looked at prevalence of

pulmonary function impairment among the residents of urban village Aliganj, located behind

INA.

The study also found that of the total 180 male participants, 74 or 41.1% had impaired

pulmonary function, whereas of the total 107 female participants, 78 or 72.9% had impaired

pulmonary function.

It noted that females were 5.57 times more likely to have impaired pulmonary function. The

study was conducted by Anirudh Saxena of the Department of Community Medicine under

Anita Khokhar, Professor, Community Medicine, and Head of Department, Respiratory

Medicine, Safdarjung Hospital.

The study was aimed at understanding the prevalence of pulmonary impairment in the

general population of Delhi, the pattern of impaired pulmonary function and factors

associated with it. The study found that out of all participants, 42 or 14.6% reported having

symptoms related to wheezing or tightness in the chest.

The symptoms related to shortness of breath were reported by 75 or 26.1%, while 22 or 7.7%

reported symptoms related to cough and phlegm, and 27 or 9.4% had a history of difficulty in

breathing. Respiratory problems due to exposure to dust, animal dander, etc., were reported

by 9 or 3.1% participants.

Also, 39 or 13.6% had a positive history of allergies/atopy either individually or in the

family. Frequent difficulty in breathing which resolved spontaneously was seen in 19 or

6.6%, while 8 or 2.8% complained of constant breathing problems.

Screening programme

High prevalence of impaired pulmonary function, the study said, suggests the need for a

screening programme not just for high-risk population but also for the general population.

“Women in particular should be sensitised to get screened and also educated about the need

for a separate kitchen from the respiratory health point of view. Regular physical activity

should be promoted for all in order to curb obesity, as it is an associated factor for impaired

pulmonary function. The population needs to be made aware about the protective effects of

physical activity carried out indoors in well-ventilated areas for better pulmonary function

outcomes as compared to outdoors,” noted the study.

Sauna bathing

Sauna bathing may reduce risk of stroke (The Tribune: 201805040)

http://www.tribuneindia.com/news/health/sauna-bathing-may-reduce-risk-of-

stroke/583582.html

Frequent sauna bathing may significantly reduce the risk of stroke, according to a long-term

study.

In the 15-year follow-up study published in the journal Neurology, people taking a sauna four

to seven times a week were 61 per cent less likely to suffer a stroke than those taking a sauna

once a week.

"The findings are very significant and highlight the multiple health benefits of taking frequent

sauna baths," said Setor Kunutsor from the University of Bristol in the UK.

Stroke is one of the leading causes of disability worldwide, placing a heavy human and

economic burden on societies.

The findings by researchers, including those from the Cambridge University, involved 1,628

men and women aged 53 to 74 years living in the eastern part of Finland.

Based on their frequency of taking traditional Finnish sauna baths (relative humidity 10-20

per cent), the study participants were divided into three groups: those taking a sauna once a

week, those taking a sauna two to three times a week, and those taking a sauna four to seven

times a week.

The more frequently saunas were taken, the lower was the risk of stroke, researchers said.

Compared to people taking one sauna session per week, the risk was decreased by 14 per cent

among those with two to three sessions and 61 per cent among those with four to seven

sessions.

The association persisted even when taking into account conventional stroke risk factors,

such as age, sex, diabetes, body mass index, blood lipids, alcohol consumption, physical

activity and socio-economic status.

The strength of association was similar in men and women, researchers said.

The mechanisms driving the association of sauna bathing with reduced stroke may include a

reduction in blood pressure, stimulation of immune system, a positive impact on the

autonomic nervous system, and an improved cardiovascular function, they said.

In a recent experimental study, the same group of scientists also showed that sauna bathing

has acute effects on the stiffness of the arterial wall, hence influencing blood pressure and

cardiac function parameters. PTI

Infant mortality

Karnataka elections 2018: In Anganwadis, hot meals for new mothers, and

hope for Congress (The Indian Express: 20180504)

http://indianexpress.com/elections/karnataka-assembly-elections-in-anganwadis-hot-meals-

for-new-mothers-and-hope-for-congress-5162586/

Among the southern states, Karnataka has the worst figures for both infant mortality (24 per

100 live births) and maternal mortality (133 deaths per 100,000 live births).

Karnataka elections 2018: In anganwadis, hot meals for new mothers, and hope for Congress

Karnataka Assembly elections 2018: Mathru Poorna lunch being served at an anganwadi in

Belladamudugu village, Madhugiri. (Amrita Dutta)

Karnataka Assembly Elections 2018 LIVE UPDATES: Rahul Gandhi to address three rallies;

BJP to release manifesto todayKarnataka Assembly Elections 2018 LIVE UPDATES: Rahul

Gandhi to address three rallies; BJP to release manifesto today

A bright yellow giraffe painted on its wall announces that the small building in Lingenahalli

village, off a busy road in Tumkur’s Madhugiri constituency, is an anganwadi. The children,

having had their milk and lunch, are playing outside. Anganwadi worker S D Parvathiamma

awaits the group of pregnant and lactating women who will have their bisi oota, or hot

cooked meal: rice and sambhar, a glass of milk, a boiled egg, and a peanut chikki.

Parvathiamma does not expect any Lingayat or Brahmin women in the group. “They don’t

even send their children. They won’t eat with people from other castes,” says the 52-year-old,

herself a Madiga Dalit.

For a year now, this anganwadi, without electricity or a toilet, has been serving meals under

the state’s Mathru Poorna scheme. Nutrition and food security are a thrust of the “Karnataka

welfare model” on which the Congress is banking in the elections. The flagship programme,

Anna Bhagya, makes rice and dal available to families below the poverty line (BPL); the

anganwadi is at the centre of efforts to address challenges of hunger, low birth-weight and

malnutrition — by focusing on the health of children and women.

Among the southern states, Karnataka has the worst figures for both infant mortality (24 per

100 live births) and maternal mortality (133 deaths per 100,000 live births). All children are

entitled to eggs twice a week, and a glass of whole milk every day under the Motte Bhagya

and Ksheera Bhagya schemes. The Siddaramaiah administration has pushed for consumption

of eggs to deal with stunting and malnourishment.

The government says 8.3 lakh women have benefited from Mathru Poorna. “Earlier, take-

home rations given to pregnant women were used in the family kitchen,” says Kempa

Hanumaiah, child development project officer (CDPO) of Tumkur district.

The Mathru Poorna programme began in February 2017 with four pilot schemes including

Madhugiri, and was scaled up across the state in October last year. According to the state

government’s human development report 2014, the taluk is an outlier in south Karnataka,

with “very poor” health indicators, comparable to the most backward regions of the state.

“Women in our rural areas work hard but eat the last, and never get adequate food. This one

meal is for them,” says Hanumaiah.

But whether that will lead women to vote for the ruling party might depend on, among other

things, their place in the social and caste hierarchy. Anitalakshmi, 38, a Vokkaliga woman

from the village, praises the Anna Bhagya scheme but is unhappy with local Congress MLA,

K T Rajanna. “He only listens to Congress supporters. We might give the JD(S) candidate a

chance,” she says. “Of course, everyone has benefited from the rice and the anganwadi meals,

but look how much we have to pay for electricity.”

Jayamma, 45, a Dalit woman in Lingenahalli who gets a destitute widows’ pension of Rs 500,

and works on landowners’ fields for Rs 150 a day is, however, emphatic that “Because of this

government, we have not gone hungry this year”. Standing with her is 23-year-old Kamala,

who uses a free bus pass for girl students to travel to Tumkur, 40 km away, for B.Ed classes.

“Earlier, if children asked for food, women struggled, or gave them leftovers from the

previous night,” continues Jayamma. “But now they can get good food at the anganwadi.”

But there is wide disparity in the state of the anganwadis across Karnataka, and many report

pilferage. In Mallabad village in Gulbarga, children and women were being given half an egg

twice a week, and in Lad Chincholi, villagers say one of three anganwadis rarely function.

“The scheme is good, but unlike in Anna Bhagya, there is a lot of corruption in the

implementation,” says Vithal Chikani, an activist of the Samajika Parivartana Janandolana,

which has worked on nutrition issues in the Hyderabad-Karnataka region for a decade now.

In Shetanahalli village in Yadgir district, the anganwadi is a dark, airless room, into which

15-odd children are packed. Supervisor Mallamma says it is difficult to persuade women to

come for meals because they leave for work early in the morning. “They work in the fields

until they are nine months pregnant. Sometimes, we manage to pack the meals for them, but

not always.”

Women and Child Development Minister Umashree, a lawmaker from Terdal in Bagalkote

district, says the Mathru Poorna scheme “was not devised keeping in mind electoral gains,

but because it was necessary for the health of women”. However, she says, “It is one of many

welfare schemes that will influence people while voting.”

In an anganwadi in Belladamudugu village in Madhugiri, baby Trisha sleeps in her mother

Manjula’s lap. She was 3 kg at birth and, two months later, weighs double that. “We don’t get

to eat this nutritious food at home,” says 20-year-old Manjula. Another new mother,

Thimirajani, 25, says: “At home, the food has to be shared by all. But this is meant only for

us.”Is that something that will be on their mind when they go to vote? “I really don’t know,”

says Manjula, with a smile.

Indian Drugs (The Asian Age: 20180504)

http://onlineepaper.asianage.com/articledetailpage.aspx?id=10594556

Peanut Allergy (The Asian Age: 20180504)

http://onlineepaper.asianage.com/articledetailpage.aspx?id=10592267

Atherosclerosis ((The Asian Age: 20180504)

http://onlineepaper.asianage.com/articledetailpage.aspx?id=10592264

Embryo without egg or sperm

Scientists craft embryo without egg or sperm (The Times of India:

20180504)

https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/

Scientists have for the first time created embryo-like structures in the lab from stem cells,

without recourse to eggs or sperm, they reported on Wednesday.

In experiments, bundles of mouse stems cells — one type corresponding to the placenta,

another to the embryo — self-organised into proto-embryos and initiated pregnancies when

implanted into mouse wombs.

The procedure was not expected to create a viable embryo and did not do so, but could yield

important insights into fertility and the earliest phases of life, according to a study published

in the journal ‘Nature’.

“This breakthrough has opened up the black box of early pregnancy,” said lead author

Nicolas Rivron, a researcher at MERLN and Hubrecht Institutes in Utrecht, The Netherlands.

“These early embryos have all the cell types required to form a whole organism,” said

Rivron. “They will help us better understand the hidden processes at the start of life, to find

solutions for fertility problems, and to develop new drugs without using lab animals.”

A few days after a mammal egg has been fertilised, it develops into a so-called blastocyst, a

hollow sphere formed by less than 100 cells divided into an outer layer — the future placenta

— and a small cluster in the middle, the future embryo.

Individual stem cell lines corresponding to both these sub-types have been cultivated

separately in the lab for decades. Using engineering technologies, Rivron and his team

assembled them for the first time in such a way as to trigger self-organisation, resulting in the

formation of what they called ‘blastoids’. “In a natural embryo, those same stem cells are in

three dimensions talking to each other in a language we barely understand,” Rivron said.

The experiments mimicked that process, and the cells spontaneously began to arrange

themselves as they might in the womb.

“The embryonic cells were the chatty ones — they instructed the placental stem cells to

multiply, organise and implant into the uterus.” The findings could shed light on adult

conditions that originate from small flaws in the embryo, including forms of diabetes or

cardiovascular disease, the research said.

“This research opens the path to a new biomedical discipline,” said co-author Clemens van

Blitterswijk, a pioneer in tissue engineering and regenerative medicine at Maastricht

University. AFP

Nutrition policy

The bipolarity in India’s nutrition policy must end (Hindustan Times:

20180504)

http://paper.hindustantimes.com/epaper/viewer.aspx

The hot cooked food versus nutrient packets debate should be solved on the basis of context

and demand

WHAT WOULD WORK IN ONE STATE, MAY NOT WORK IN ANOTHER. TESTS

MUST BE CONDUCTED FOR ALTERNATIVES LIKE NUTRIENT PACKS BUT THE

CHOICE HAS TO BE CONTINGENT UPON THE DATA FINDINGS

Union minister Maneka Gandhi’s comment on providing “energydense nutrient packets” as

takehome ration for all pregnant women and lactating mothers as well as children between

the age of six months and three years as part of the supplementary nutrition programme

(SNP) of the Integrated Child Development Scheme (ICDS), has set off a debate. This time,

the debate appears to be driven more by ideology than by the idea itself.

The debate got intensified with the minister and the Women and Child Development (WCD)

officials charting out a separate set of nutrition guidelines, with the latter supporting the

traditional non-processed hot food option. With the inter-ministerial Nutrition Council

overruling the minister’s decision, the proposal is now on hold. But it has raised questions

over the design choices for the nutrition programme. Supplementary nutrition programmes in

India have traditionally focused on hot cooked meals and take home rations. The Integrated

Child Development Services (ICDS) programme was introduced in 1975. But more than four

decades after being backed by a legal entitlement, its task is largely unfinished. It has to

contend with India’s reputation of being home to the largest number of malnourished children

in the world.

The Niti Aayog, in its National Nutrition Strategy, has questioned the efficacy of the take-

home ration scheme and the quality of food supplements provided under the ICDS. Does the

model need a rethink in terms of product choice, delivery mechanisms or implementation

protocols? Activists, while vouching for some programmes, are willing to give them decades

to reach fruition, but their surprising impatience to see results overnight for new government

schemes strikes a jarring note. The proposal to alter the ICDS’s portfolio was subjected to

similar scrutiny and judged by summary outcomes.

And then there is the political economy. Whether it is the Public Distribution System, mid-

day meals or the SNP, our food policy has been primarily driven by the anticipation of

political dividends. Any reforms to the programmes if perceived by media and political

organisations as compromising on entitlements, would be a no-go area.

Notwithstanding the safety net elements of the SNP and the political expediency surrounding

it, the debate over delivery of hot cooked meals versus nutrition packets should do well to

keep in mind a few important points. To begin with, the performance of the current system

has been subpar. It is difficult to pretend it is working fine. Second, there is a fine line

separating bad policy from bad implementation. Finally, and most crucially, one State policy

can’t suit everybody. Take the case of Ready to Use Therapeutic Food (RUTF). Evidence

shows that RUTF has been tough to introduce in tribal areas because of taste/preferences in

food choices. What would work in one state, may not work in another setting. We propose

that tests be conducted for the newer alternatives such as nutrient packs and let the choice be

contingent upon the findings. The solution to this bipolarity in policy could be to take the

cluster approach. Given that the nutrition programmes are prone to leakages, the integrity of

nutrient composition in terms of their provisions is another marker that would need to be

monitored.

In the food-versus-nutrition debate — whether with respect to dietary supplementation or

fortification — taste, accessibility, trust and pricing issues need to be looked at closely. Are

the entitlements of the community in sync with the overall consumption patterns? Based on

the patterns, can there be a basis for altering the commodity portfolio? Assessing the demand

of the beneficiaries for safety net programmes (within the context and feasibility of the

programme) will go a long way in the uptake of these programmes and contribute to better

nutritional outcomes.

Whether hot cooked food or as nutrient packets, if the programme were to be effective only

as nutritional insurance, the most cost-effective way of delivering it, needs to be assessed.

Which alternative serves the purpose better would depend on the context and ultimately on

the quality of implementation and the customisation of the programme to the local context. In

the end, it calls for robust systems of demand assessment and monitoring and evaluation.

Mamata Pradhan is doctoral scholar, University of East Anglia and Devesh Roy is research

fellow, International Food Policy Research Institute

Heart Diseases (Dainik Gagaran: 20180504)

http://epaper.jagran.com/ePaperArticle/04-may-2018-edition-Delhi-City-page_4-937-8458-

4.html

Intestine Bacteria (Dainik Gagaran: 20180504)

http://epaper.jagran.com/ePaperArticle/04-may-2018-edition-Delhi-City-page_21-911-6235-

4.html

Stevia (Navbharat Times: 20180504)

http://epaper.navbharattimes.com/details/71872-50820-1.html

Dangerous Chemicals (Navbharat Times: 20180504)

http://epaper.navbharattimes.com/details/71876-64231-1.html

Food and Nutrition (Hindustan: 20180504)

http://epaper.livehindustan.com/imageview_13966_90887566_4_1_04-05-

2018_i_13.pagezoomsinwindows.php