InnoHEALTH magazine - Volume 3 Issue 2 - April to June 2018 by innohealthmagazine

An Initiative of An Initiative of

India’s First Magazine of Healthcare Innovations India’s First Magazine of Healthcare Innovations

VOLUME 3 ISSUE 2 APRIL-JUNE 2018 me 2 | Issue 4 | Oct-Dec 2017

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EXECUTIVE OPINION

Improvisation, Jugaad, New India, Digital India,Innovation, Indovation and Invention, what it means Make India, Innovate India Iin making a ‘Healthy’ India

Innovation has become buzz To make everyone aware what word and being used by many innovation means if they need without even knowing its meaning to work on it either by start-up and difference in improvisation, or otherwise we have created a Jugaad, innovation, indovation and knowledge platform InnovatioCuris Invention. It would be appropriate (IC) to delineate innovations in Dear Friends, to explain these terms for benefit of healthcare to reduce healthcare many. ndia is a country of diversity with 1.3 billion population of which 70 per cent delivery cost and yet keep quality. resides in villages and have access to 30 per cent of medical assets of the The dissemination of knowledge Improvisation: Processissueofof the country, despite having one of the is done through International country. Poverty is a significant devising a solution to a requirement conference and fastest-growing economies in the world, clocked at an economic growth of 7.6 InnoHEALTH by making-do, despite absence of registered magazine with same per cent in 2015. It is estimated that 23.6 per cent of Indian population, or resources that might belive expected about 276 million people, below $1.25 per day. As Health is a state sub- name, complimentary webinars, to produce a solution. ject-there is lot of mismatch in states like Kerala and Punjab have best health training and Innovators’ club. In fact, indicators, Uttar Pradesh is the poorest as per the NITI Aayog report. this issue gives post conference Jugaad:while A colloquial Hindi-Urdu Indian government spends 1.5 per cent of its GDP on health sector and and club glimpses, which included word that can mean an approx. innovative plans it 2.5 per cent which is much less than many developing coun- young innovators award and nine fix ortoamake simple work-around, used tries while the USA dedicated 16 aper cent of its GDP. India is riddled with companies of European Union for solutions that has bend rules, or participated to Dr bring healthcare very basic public health issuesas leading VK Singh resource that can be used such,to disease burden. Keeping this in mind, innovations suiting Indian needs. Prime Minister Narendra Modi has launched six initiatives: Open Defecation or a person who can solve a complicated issue Editor were in Chief & MD, B2B meetings in Delhi and Bangalore organized, free country by 2019, Swachh Bharat Mission, National Health Policy 2017, InnovatioCuris Innovation: The process of translating an idea to learn from each other’s experiences. In case you Digital India with ehealth, medical device manufacturing and door-to-door into a good or service that create value for which missed conference or wish to refresh moments this screening of chronic diseases. vksingh@innovatiocuris.com customer will be ready to pay and replicate at issue will update you. We are also encouraging grass The healthcare needs holistic approach which depends on multiple factors. economic There are various typespositive of innovations root innovations The presentcost. government has taken many steps including launching offrom far and wide. The next paragraph like process and product innovations, frugal explains National Health Policy 2017 after the gap of 12 years. It has announcedhow manydeveloped countries take Indian Innovation, reverse Innovation, disruptive innovation, innovations. initiatives like health insurance of people who cannot afford basic healthcare IndovationandInnovation Excellence The regulation of medical devices have and upgrading of health infrastructure. Alexander Blass, CEO of Innovation Institute of beenIndovation: brought out and is applicable w.e.f January 2018 ending uncertainty of winner of Top Innovator of the Year It is an abbreviation of 1,Indian America, Inc. and medical device manufacturersinhaving market of 220award billionstates, US dollar. innovation, conceptualised 2009global by Navi Radjou, “It is no secret that many of the world’s Challenges bring opportunities such asfor Indian healthcare is around US$ the executive director of the Centre India & Globalmarket top innovators come from India. Within the past few 100 billion at while it is expected grow US$ 280 billion 2020. The India health-has embarked upon an incredible Business Judge BusinesstoSchool, University of by decades, care IT market is US$ one billion and is expected to grow 1.5 times by 2020. Cambridge transformation from an agrarian-based society to a There is requirement of 7 lakh hospital beds which need investment oppor- economy. Along with the population knowledge-based Invention: New scientific or technical idea, and the tunities of 25-30 billion US dollar. We need to bring innovations incame hospital survival instincts and the need to be means of its embodiment or accomplishment. To be growth planning,devices, diagnostics, drugs and use of technology to reducebetter health-and unique. One can see innovation different, patentable, must be novel, have utility, care delivery an costinvention and yet quality. everywhere in India, whether in large game changing and be non-obvious. To be called an2000, invention, an idea We failed targets of Health for All by National Rural Health Mission,that and garner lots of publicity, or in less innovations only needsDevelopment to be provenGoals as workable. Millennium and now launched Universalobvious Health Coverage; yet important incremental fashions” its success on providing healthcare facilities Every would persondepend interested in innovation need to and strict accountjoin in many initiatives of IC a knowledge and ability. We need to internet focus on primary health care and customiseHence our healthcare know that what age provides... “Just about hand holding platform to take innovation in healthcare delivery by an learning from experiences of other countries. The concept anyone system can have idea at breakfast, design it with forward which of Diagnosis Group (DRG)amaking financial for group of dis-is need and national movement of online CAD Related software, produce prototype on apackage 3D country, buzz word eases which is known to patients, providers and third party payors should be of innovation is to be converted into printer, receive financing and market analysis from reality for benefit of community through participation considered by improving deficiency found in its execution a crowd funding site, rent supercomputer time from by the USA. of all stakeholders. The various schemes of present government are appreciable but success Amazon, contract a manufacturer and be done by would depend on strict monitoring, corporate hospitals have high cost and lunch without even leaving the table”. many unethical practices are reported every day in media. Public hospitals to www.innovationexcellence.com/blog/2014/05/18/5-thingsNational Rural Health Mission have not delivered as required because of corDr VK Singh managers-should-know-about-the-big-data-economy/ ruption, lack of resources and application of management practices. The need Editor in Chief & MD, InnovatioCuris is not old wine in new bottle but strict control in implementation of various schemes launched.

Published in January 2018 Order your copy at CRC Press or Amazon website! The planning and design of healthcare facilities have evolved during the previous decades from "Function follows design" to "Design follows function". Rapid changes and burgeoning technologies are now major considerations in facility design, so without ﬂexibility, hospitals face quicker obsolescence if designs are not forward-thinking. The book explains new concepts to reduce healthcare delivery cost yet keep quality. It is eﬃciency and economy of scale in operations of healthcare facilities.

For queries, email: vksingh@innovatiocuris.com

Volume 2 | Issue 4 | Oct-Dec 2017

Volume 3 | Issue 2 | April-June 2018

The Message AMAZING! TEN CRORE POOR PEOPLE TO GET HEALTH INSURANCE Dear Readers,

big ticket announcement of medical insurance cover for ten crore poor people in India recently has triggered a major debate whether the world’s largest healthcare scheme, being billed by many as Modicare on lines of Obamacare can be a runaway success or just an another show? Skepticism apart, any such initiative has to be religiously adopted by well-intentioned governments. Such steps though pose massive burden on exchequer on one side but vaulting aspirations and dire need of health protection of huge chunk of populace on the other side of scale cannot be rubbished either. So, sooner the better! Now only option left is to implement the initiative in right spirit at the earliest. Union Health Minister Jagat Prakash Nadda hogged limelight after the announcement in the Budget 201819. Prime Minister Narendra Modi addressing party’s law makers on the budget day directed Mr. Nadda to get on the job immediately in close rapport with his two ministerial colleagues and others to ensure its successful implementation. Official machinery is working on full gear to unspool the mega initiative. Our magazine contacted the minister and he firmly reiterated that the government was committed to its implementation and the resource details are being worked while addressing intricate nifty gritty. The Health Minister also has given a bird eye view of India’s Healthcare scenario and government plans to meet the challenges. To keep our readers abreast of researches being done world over on health related problems, we are carrying various studies for benefit of readers. We have also highlighted innovative practices adopted in various zoos to save endangered animals. In this issue, we are carrying acknowledged good work done by the erstwhile Allen Forest Zoological Garden. The magazine is striving hard to highlight innovations in the health sector while focusing its binoculars on latest developments in the health sphere. The magazine salutes a doctor who ensured safe delivery of a baby on Air France flight (mid air) recently. Interestingly, a study by PEW offers a new insight of science issues coverage. It says Americans offer a mixed evaluation of how well the news media cover science, but more say that overall they do a good, rather than a bad job. When delving more deeply, however, Americans show skepticism in the accuracy of general news outlets, instead placing more trust in specialty information sources. And, while many see problems in coverage of scientific research stemming from a range of players, when asked to choose, most Americans say the bigger problem stems from how reporters cover scientific research than from the way researchers publish their findings. The situation is no different in other countries, and mostly people prefer trusted information from niche brands, and we are sure that we will be able to provide trusted information with support of all stakeholders. Thanks.

Neeraj Bajpai Consulting Editor

Volume 3 | Issue 2 | April-June 2018

TRENDS Latest Innovations!

30 min of sunbath a week can make infants’ vitamin-D sufficient

Iron and zinc deficiencies can be addressed through simple measures 20

ISSUES World's Largest Health Scheme Unspooled in India

Software as Medical Device?

Health Card of Indian States

WELL BEING Infertility no more a curse; scientists develop new artificial ovary prototype

IIT Kanpur braces up to thwart cyber attacks in India 34

Caution! Energy drinks not safe for kids

Kanpur Zoo adopts innovative methods for animal health management 36

Insurance needs to go global: Expert

RESEARCH

Why head & face pain keeps you furious?

Insomnia – A Short Communication Study Skin patch to detect ‘silent’ heart attacks

40 42

Meet world’s first cloned monkeys-Zhong Zhong & Hua Hua

High Blood Pressure : 130 mm Hg is the new reading

Rotating night shifts may trigger Type 2 diabetes

PERSONA A Right Gesture Saves Life!

Minds of Medalists behind their Medals!

WOMEN’S CORNER Workplace harassment has adverse consequences

Arunachalam Muruganantham: A Tale of Menstrual Hygiene Movement

NEWSCOPE

How crucial are business models for the healthcare organisations? 68

Volume 3 | Issue 2 | April-June 2018

Consulting Editor Sr. Designer

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

Major General (Retd) A K Singh, Advisor, Telemedicine and Health Informatics, Rajasthan, India

Dr. Sarita Jaiswal, Ex-Research officer at University of Saskatchewan, Saskatoon, Canada and now in Delhi, India Printed and Published by Sachin Gaur on behalf of InnovatioCuris Private Limited. Printed at Lippe Scan Private Limited 89, DSIDC, Okhla I, Okhla Industrial Area, New Delhi, Delhi 110020. Editor: Sachin Gaur. DCP Licensing number: F.2.(I-10) Press/2016 © 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.

Disclaimer: 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 advertiser’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. 8

Volume 3 | Issue 2 | April-June 2018

Dear Editors, I recently purchased my first copy of InnoHealth and I was impressed with the content and the information. Congratulations! I understand that you are interested for writers to contribute to your magazine. I am writing to you in this context to express my interest. I am a scientist by education and an entrepreneur by choice. I also write for various platforms. Regular columns on StartUps for NRDC's Invention Intelligence & NanoDigest on one hand; and scientific articles & features for India Science Wire, on the other, through which my work has been published in various platforms like Hindu

TRENDS

Volume 3 | Issue 1 | Jan-Mar 2018

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;

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.

Business Line, Outlook India, Down to Earth, Biotech News, Scroll, Biospectrum etc. I have also written for Indian Express, and Indiabioscience. Dr. Swati Subodh, Consultant, India

I really enjoyed reading InnoHealth. It gave a great insight on various topics. It is not only meant for healthcare professionals but anyone and everyone as it covers vast topics. I personally liked the Well-Being and the Trends section; it is indeed one of its kind magazine on healthcare innovations in India. I look forward for the next issue. Vishal Singh, General Manager, Hyatt Regency, Pune, India

InnoHealth has been instrumental in bringing out the various new ideas in the field of healthcare and wellness; the magazine in itself helps new innovators come in the limelight, catch the fancy of investors who have tough time marketing their ideas and finding the right kind of people to back them. The healthcare experts also find wonderful new ideas to implement through this. It is indeed a path breaking in its idea, concept and design and a great platform that helps connects all like minded people as well. Divya Joshi Senior Manager HRD, ITDC, Delhi, India

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

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

Volume 3 | Issue 1 | Jan-Mar 2018

WOMEN'S CORNER

Advisors Konda Vishweshwar Reddy, Member of Parliament, India

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.

ISSUES

Suraj Sharma, Ritu Versha

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

PERSONA

Neeraj Bajpai

Do you have any innovative idea?

WELL BEING

Nimisha Singh Verma

y congratulations to you and your excellent team for an outstanding program. I really enjoyed the talk by Prof. Paul and Sachin. The concept of the Business Canvas Model was beautifully illustrated. I wonder as to whether the use of the business canvas model can be expanded to do a test run of all projects (for profit and the non-profit ones). For e.g my wife runs a program for children of class eight and nine of various schools in Nagpur, private and govt. on emotional intelligence and emotional sobriety. My father, on the other hand, is a part of a team of senior citizens, called Jan Akrosh, who stand in the blistering sun at mid-day at traffic lights at various places in Nagpur, requesting motorists and two-wheeler drivers to follow traffic rules politely. I would also like to express my deep gratitude and thanks to you and your team for giving me the opportunity to this network and interact to people interested in this field like Prof Venkat, Prof Dash, Sachin, Harsh Desai, Abhinav Singhal, Ankit and of course, the very knowledgeable, Professor Paul Lillrank and his colleague Paulus Torkii. Dr. Nirbhay Karandikar, Nagpur, India

POLICY

Dr. Avantika Batish

TRENDS

Alok Chaudhary

POLICY

Editors:

A Brief Review on InnoHEALTH WELL BEING

Sachin Gaur

PERSONA

Executive Editor:

ISSUES

Dr. V. K. Singh

Readers Feedback

WOMEN'S CORNER

Editor-In-Chief:

It's heartening to note that India's khichdi has also made a foray in health magazine. We khichdi eaters are relishing history of this food item. Hope such articles will be seen routinely in the magazine which I had bought from a bookshop in Delhi. Arun Agnihotri Bareilly, India

I appreciate your magazine for highlighting medical aspect of smart phones impact on brain. Such revealing research really opens our eyes. We should be regular to highlight such studies which hardly get much exposure in routine mill media platforms. I think even one worth reading item pays back us the subscription cost. We hope to get magazine every month rather than after a long wait of three months. P K Pandey Ghaziabad, India It was great to go through an article about your IC club meeting that gave a bird eye view of fair tricks while seeking funds for dream projects from international funding agencies. The article was worth reading and very informative for aspiring first generation entrepreneurs. We will try to be part of the IC and hope the next issue must be having another meeting detail. Dr. Neha Dhami, London, UK Volume 3 | Issue 2 | April-June 2018

trends

NEWSCOPE

WOMEN’S CORNER

PERSONA

WELL BEING

RESEARCH

ISSUES

TRENDS

Volume 3 | Issue 2 | April-June 2018

Intraocular lenses (IOLs) replace the natural eye lenses after cataract surgery for enhanced vision. Previously through conventional multifocal lenses, the quality of vision would get reduced due to division of light. These lenses reportedly caused high incidences of halos and glare, which are bright rings and sharp light which interferes with vision, and the frequent need of wearing glasses did not completely fulfill the purpose of getting the lenses implanted In recent times, technological advancement made significant improvement making it possible for

patients to resume a completely normal life post cataract surgery with nearly perfect vision. On the other hand, a new technology known as ERV IOL commended as the next revolution in eye care gives a perfect balance of contrast, light, near, far and even intermediate vision. Doctors are constantly underlining the utter need for awareness around eye care. Regular checkups, especially for diabetic patients are imperative. ERV IOL promises to be the next revolution in eye care and providing respite from eye ailments.

category at the seventh edition of the Entrepreneur India Awards 2017 for their efforts in preventive healthcare. Their endeavour is to conveniently provide community an access to the

he Startup raises $ 3.1 million to boost applications that empowers people to take control of their health Healthi is a 2014 found technologybacked preventive healthcare platform that uses analytics and machine learning to help users make smart choices about their health to avoid chronic diseases. This Predictive analysis-based healthcare Startup has recently raised funding of $3.1 million led by VC fund Montane Ventures, which it intends to use to boost applications that empowers it’s users to understand, engage with and take control of their health. Co-Founders RekuramVaradharaj and Krishna Ulagaratchagan ofHealthi have been accorded the ‘Entrepreneur of the Year in Product - Healthcare’

Volume 3 | Issue 2 | April-June 2018

NEWSCOPE

A new technology that promises enhanced vision clarity An increasing number of studies and toxicological evidence shows that burning of solid fossil fuels is associated with cataract formation. Harmful environmental toxic compounds cause “ocular irritation” or irritation in the eyes. Unrefined cooking oil when burned under high temperature emits benzene and formaldehyde. The toxic air results in trachoma, glaucoma and cataract.But various viable and effective technological alternatives are now available for cataract patients.

best healthcare practitioners and raise awareness about the prevention and management of lifestyle diseases. Healthi is proving to be India’s fastest growing digital preventive health startup and is revolutionising the preventive healthcare market by combining scientifically validated predictive analytics, machine learning technology, contemporary design, strong partnerships with healthcare majors and cutting-edge research. It has made significant strides within a short span of time and now serves users in over 130 Indian cities. For its health check offering, it has tied up with most of the leading diagnostic and imaging laboratories, clinics and hospitals in India, thus offering 400+ high-quality venue options for users.

HEALTHI HELPS USERS TO AVOID CHRONIC DISEASES

WOMEN’S CORNER

EXTENDED RANGE OF VISION INTRAOCULAR LENSES

guided and standardized examination procedures helps perform routine MRI exams from day one. DuraDiagnost F30 Digital X-ray provides ease-of entry into the world of digital radiography with a price to performance ratio that’s hard to beat. It also helps simplify the path to clinical decision-making, improves patients’ outcomes and reduces the radiodiagnosis department’s burden.

PERSONA

biological child through fertility preservation. Unfortunately, fertility preservation services are rarely offered or even discussed with the patient before starting cancer therapy.

own unique features. Access CT offers flexibility, exceptional image quality, and diagnostic accuracy with lower total cost of ownership. Ingenia Prodiva MR is built on proven dStream digital broadband technology, present in over 2000 installations worldwide which can accelerate patient throughput with a simplified Breeze Workflow. It has an intuitive user interface enhanced by

WELL BEING

vation is a procedure to secure fertile eggs, ovarian tissue, or sperm before a patient undergoes cancer therapy. These can enable the patient to reproduce when they have overcome cancer. The success rate of these methods is about 30% to 40% in younger men and women. In those above the age of 30 and 35, fertility potential of the eggs and sperm may decrease thereby lowering the success rate. It is important to consult a doctor as soon as they are diagnosed with cancer and find out the possibilities of treatment. Many cancers are detected very early in life often in the prime years for fertility. Cancer survivors can now produce their own

RESEARCH

bout 50% of the cancer patients in India are under the age of 50. Apart from other things, this alarming rate of young cancer victims has also created concerns about preservation of their fertility. Cancer treatment can affect fertility in both men and women. In young women, cancer treatment including chemotherapy and radiation can cause infertility. In men, exposure of the pelvis to radiation and use of chemotherapy drugs can lead to DNA damage in the sperms. However, experts indicate that the recent technologies and advancements in the IVF sector like egg freezing, embryo freezing, donor eggs, donor embryos, donor sperms, sperm freezing etc. can help cancer patients to keep their fertility window open for a longer time. With the use of these techniques, cancer victims not only have a better rate of survival but can also think about raising a child and starting a family. Fertility preser-

ISSUES

A RAY OF HOPE FOR YOUNG CANCER SURVIVORS A

s healthcare organizations continue to move toward value-based care, there is a growing need for intelligent solutions to help address the biggest challenges radiologists face in improving outcomes, simplifying data and insights gathering, lowering the cost of healthcare delivery, and enhancing patient and staff satisfaction. Philips India Ltd, a leading health technology company,never fails to bring something new for the medical fraternity and so it recently announced the launch of its new range of next generation imaging solutions namely Access CT 32 Slice, Ingenia Prodiva 1.5T MRI and Dura Diagnost F30 Digital X-ray which are customised products supported by artificial intelligence to help radiologists bring about better and faster diagnosis with more accuracy and also improved and better patient care and experience. These imaging solutions have user-friendly interfaces which areeasy to operate and take lesser preparation time for patients. Their other positives are high image quality, streamline workflow and reduce variability thus providing better diagnostic outcomes for radiologists.All these Imaging System solutions have their

TRENDS

LATEST INNOVATIONS!

INNOVATIVE IMAGING SOLUTIONS BY PHILIPS A

TRENDS WELL BEING PERSONA WOMEN’S CORNER

BABYGOGO

t allows parents to connect with paediatricians Babygogo, a Delhibased child healthcare startup founded by Siddharth Ahluwalia, Sowrabh N.R.S. and Satyadeep Karnatiin 2016,

offers childcare help and medical advice to mothers. The startup provides advice, across a range of child care issues, from experienced moms and medical practitioners through its mobile app.

PORTABLE BIONIC HAND

t mimics the sense of touch in case of an amputate hand Europe based scientists have developed the first portable bionic hand that mimics the sense of touch in case of an amputate hand. The pros-

thetic hand has sensors to detect whether an object is soft or hard. The computerprocessed information is relayed to the brain via electrodes implanted in the upper arm.

Volume 3 | Issue 2 | April-June 2018

NEWSCOPE

Volume 3 | Issue 2 | April-June 2018

tient’s doctor, the app also allows patients to track symptoms proactively, sync their data with their clinic at any time, and view their transmission history without having to contact their clinic to confirm successful data transfers. Patients can also record their symptoms such as fainting spells or heart palpitations in the app on their smart phones, to complement the information being monitored by the device. The device has already received the CE Mark and USFDA approvals and is available in the EU, U.S.A and Australia. The insertable cardiac monitor is extremely useful as it provides early diagnosis and timely treatment to events which could be catastrophic in nature if left unattended. This device for sure is taking cardiac monitoring to a whole new level.

WOMEN’S CORNER

effective management of patients by diagnosing patients having infrequent but potentially fatal episodes of cardiac arrhythmias while enhancing patient compliance through smartphone connectivity. For patients it provides a new way to get monitored for abnormal heart rythms while staying connected to their doctors remotely and engaged in their healthcare. Once implanted just under the skin in the chest during a quick, minimally-invasive outpatient procedure this ICM continuously monitors heart rhythms to detect a range of cardiac arrhythmias. It is also the slimmest ICM available today. It is the size of two paper clips, stacked on top of each other. While the ICM continuously monitors for abnormal heart rhythms and transmits data to a pa-

that real-time threat and mitigation updates can be made expeditiously, before cybercriminals take advantage of any weaknesses in connected IoT devices or the critical services they provide. An organisation needs to ensure that their security posture is up-to-date with prevention and detection measures as well as develop and maintain good network hygiene which includes systematic patching and updating of vulnerable systems and replacing outdated technologies that are no longer supported.

PERSONA

bbott, one of India’s leading healthcare companies recently launched the latest Insertable Cardiac Monitor (ICM) across the country which is also the world’s first smartphone compatible ICM to aid physicians who can remotely monitor their patients for even the most difficult to detect cardiac arrhythmias including irregular heartbeats, atrial fibrillation etc. It is designed to continuously monitor a patient’s heart rhythm and proactively transmit information via Bluetooth to Abbott’s dedicated mobile app for this, allowing physicians to follow their patients remotely and accurately diagnose arrhythmias that may require further treatment. This device provides a win-win situation for both the doctor and the patient. For doctors the device allows for

overall downtime, incident response and legal fees, as well as long-term reputational damage can cost hospitals millions and keep them from providing high-quality care to patients. The best course of action is to ensure every hospital has a robust and integrated security strategy. Keeping this in mind Fortinet offers certain strategies for healthcare organizations to prepare against imminent IoMT cyber-threats: A dedicated team needs to be put into place to uncover the latest threat intelligence so

WELL BEING

nternet of Medical Things (IoMT) is a collection of medical devices and applications that connect to healthcare IT systems through online computer networks. These include medical devices equipped with Wi-Fi that allow machine-to-machine communication. Though the rise of the IoMT has improved processes and patient care but has also resulted in an increased number of vulnerabilities. Healthcare IT security teams in India must be prepared to face possible cyber-attacks on connected medical devices in healthcare facilities, as well as home health devices. These devices have not been designed with security as its top concern since developers are primarily focused on its functionality and ease of use. According to Allied Market Research, the global Internet of Things (IoT) healthcare market is expected to reach US$136.8 billion by 2021, registering a CAGR of 12.5 percent between 2015 and 2021, driven by easy availability of wearable smart devices and decreasing cost of sensor technology. Cyber-attacks will continue to be a threat for healthcare providers and likely in greater volumes going forward. The resulting

RESEARCH

ISSUES

NEWSCOPE

IoMT: PROTECTION AGAINST CYBER-THREATS

TRENDS

INDIA’S FIRST SMARTPHONE COMPATIBLE INSERTABLE CARDIAC MONITOR

Volume 3 | Issue 2 | April-June 2018

cility streamlines the process of doctors appearing in courts in response to summons and saving their time not only for patient care but also for medical education and research. The project is operational in Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh since March 2014.

TRENDS POLICY WELL BEING PERSONA

To forecast dengue spread

Dr. Shikha T. Malik

University of Liverpool.

Scientists have reached this conclusion after evaluating the relationship of climatic factors in the spread of dengue in different climatic zones in the country – Punjab, Haryana, Rajasthan, Gujarat and Kerala. They focused on changes in a factor called ‘extrinsic incubation period (EIP) of the dengue virus by taking into account daily and monthly mean temperatures in these areas.

lives by donating vital organs. The activities of the Centre will include coordination for tissue procurement and distribution, donor tissue screening, removal of tissues and storage, preservations of tissue, laboratory screening of tissues, tissue tracking, sterilization,

SOMNOX—A SLEEP ROBOT

The extrinsic incubation period (EIP) is the time taken for incubation of the virus in the mosquito. During this period, after the mosquito draws virus rich blood meal, the virus escapes the gut and passes through the mosquito’s body and reaches it salivary glands. Once this happens, the mosquito is infectious and capable of transmitting the virus to a human host. It has been found that climatic conditions play an important role in EIP. Lower temperatures (17–18 °C) result in longer EIPs thereby leading to decreased virus transmission. With increasing temperatures, feeding he Startup can improve a user’s increases because of enhanced sleep through its breathing metabolism of the mosquito, leading to shorter EIPs. Even decrease rhythm. A sleep robota 5-day has been dein the incubation period can hike veloped by a Netherlands –based transmission rate by three times, and startup it claims from can with anSomnox, increasewhich in temperature improve a user’s sleep through its 17 to 30 °C, dengue transmission increases rhythm. fourfold. However, a further breathing The technology increase in temperature beyond 35 °C makes the pillow-like device fall and is detrimental to the mosquito survival.

rise which provides the user with a 18

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| Issue 4 | Oct-Dec 2017

The researchers observed that except for Gujarat which comprises of arid regions, there was a strong correlation between rainfall and dengue disease burden. The study found that Kerala being warm (temperature range 23.5-30 °C) and wet and with short EIPs (9-14 days) experiences the highest number of dengue cases.It has been found that EIP is the shortest during the monsoon season in most states and therefore there is an enhanced risk of dengue during this time. This climate-based dengue forecasting model could help in planning effective and efficient disease control operations well in advance and optimize the use of resources meticulously.

breathing sensation. The device can changes in temperature helpWith one fall asleep effortlessly, get affecting the extrinsic incubation back to of sleep if onefuture wakeschanges up inthe period the virus, in middle of the night anda substantial helps one the climate might have effect on while dengue and other feel safe sleeping. Thevectorappborne disease burden in India. “Though connected device can also play the such methods are in vogue for disease sound ofoperations, heartbeats we andare music control still which in the automatically off after the user initial stages ofturns implementation of such strategic falls asleep.control methods,” Dr Rao

records maintenance, data protection and confidentiality, quality management in tissues, patient information on tissues, development of guidelines, protocols and standard operating procedures, trainings and assisting as per requirement in registration of other tissue banks.

SUPERMEAT

he Startup raises $ 3 million Supermeat is developing lab-made told Indiameat Science Factors on such chicken andWire. is working the as population density and migration meat-making process which involves also need to be included for future extracting cells from a chicken and risk assessment studies. The study feeding right nutrient to produce muswas published in journal Emerging Microbes & Infections. cle and fat. The start up has recently raised $Article 3 million in from seed‘India funding. shared Science 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.

Volume 3 | Issue 2 | April-June 2018

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network backbone, all available and future networks. So far,10 states have been financially supported. Ministry of Health & Family Welfare (MoHFW) in collaboration with Department of Space has setup Telemedicine nodes at some pilgrim places for health awareness, screening of noncommunicable disease (NCD) and for providing specialty consultation to the devotees visiting holy places like Maa Vindhyavasini Mandir, Vindhyachal Dham, Mirzapur (UP), Sheshnag, Amarnath Pilgrimage (J&K), Pampa Hospital, Ayyappa Temple at Sabrimala (Kerala) and Kashi Vishwanath Temple, Varanasi, Uttar Pradesh Tele-Evidence: The tele-evidence fa-

NEW METHOD DEVELOPED

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ill date, the Indian Government has taken various steps to strengthen the telemedicine network to provide healthcare services in the country especially rural India. Some of the efforts in this direction which need a mention are : National Medical College Network (NMCN): With the purpose of e-Education and e-Healthcare delivery, 50 Government Medical Colleges have been selected to interconnect, riding over NKN (National Knowledge Network). For this purpose, one National Resource Centre (NRC) with required centralized infrastructure and 7 Regional Resource Centres (RRCs) have been established. State Telemedicine Network (STN): The States/UTs have been supported under National Health Mission (NHM) under Program Implementation Plan (PIP) for strengthening State Telemedicine initiatives under STN & to create reliable, ubiquitous and high speed

n India, it is mainly the living donors who are donating organs and only about 23% of the organ transplant is being done with organs obtained from the cadavers. There is a need to promote cadaver or deceased organ donation rather than relying on living donors in order to avoid the risk of organ trading and also to avoid the inherent risk to the health of the living donor. In view of this, National Biomaiven its close link with both terial Centre (National Tissue Bank) temperature and rainfall, was inaugurated in February at the it is possible to forecast National Organ Tissue Transplant outbreak of and dengue. But for such Organization (NOTTO)towith objec-it disease forecasting be the effective should be based specific tive of filling up theon gapmodels between ‘defor different climatic zones in the mand’ and ‘supply’ as well as ‘quality country, a new study has shown. The assurance’ in the availability of varistudy has been jointly done by the ous tissues.There is a need to spread Hyderabad-based Indian Institute of awareness in the community large, Chemical Technology (IICT),at National that a living person can saveEducation the life Institute of Pharmaceutical of and onlyResearch one person but a deceased (NIPER), Guwahati,orin collaboration with can scientists cadaver organ donor save upattothe 9

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TELE-MEDICINE SYSTEM TO STRENGTHEN HEALTHCARE SERVICES IN INDIA T

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ture perforation. This procedure is intended to facilitate weight loss in obese and adult patients. The outpatient procedure usually takes less time, also the recovery time is less since there’s no inci-

WOMEN’S CORNER

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besity continues to be a challenge in all parts of the world, an epidemic which is spreading with an immense pace. Many procedures have been in vogue to tackle this issue in the past decade. Lately Global Hospitals, a multi super specialty tertiary care hospital has successfully performed first of its kind, procedure on a 45-year-old who was almost 30 kilos overweight as per the body mass index count. This process involves reduction in the size of stomach using an endoscopic suturing device. The Food and Drug Administration (FDA) has approved the use of a device commonly termed as ‘over stitch’ which is meant for su-

WELL BEING

sion involved, in most of the cases the patients are discharged on the same day. The device does not alter the stomach’s natural anatomy in any way, however; patients are advised to follow medically supervised diet and exercises in future. While this procedure does not guarantee to replace the conventional method, however; it can be treated as an option while discussing to perform it on the patient. Since bariatric surgery is expensive and needs post surgery maintenance, this new procedure can be a good option. The benefit being that this procedure is primarily performed through an oral cavity rather than through the abdomen like in the case of bariatric surgeries. It’s absolutely safe and effective to the patients in order to lead a healthier life.

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A PROCEDURE FOR WEIGHT LOSS IN INDIA

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NATIONAL BIOMATERIAL CENTRE INAUGURATED

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OVER STITCH

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Startup Ideas

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RESEARCH

By Bhavya Khullar

t used to be a routine practice in India to massage infants and give them a sunbath. But changing lifestyles in recent decades have confined kids to indoors. This has led to emergence of Vitamin D deficiency as a major problem among infants. A study from Delhi has suggested an estimate for the minimum duration for which infants need to be exposed to sunlight every day to achieve sufficient levels of vitamin-D in their body. Doctors at the University College of Medical Sciences, New Delhi enrolled 100 infants and asked their mothers to record the time, duration, and the body area exposed during sunbath every day starting 6 weeks of age. The study found that an exposure of as low as about 30 minutes of sunlight per week with about 40% of the child’s body exposed to the sunlight can help achieve adequate vitamin-D status at 6 months of age. The researchers also found that the ideal time to give the sunbath is between10 AM and 3 PM. “This small intervention can help improve levels of vitamin D in infants without the need for supplements or formula feed, and can possibly benefit more than 16 million babies born in the country every year,” Dheeraj Shah, professor of pediatrics at the University College of Medicine Sciences, New Delhi, who is a co-author of the study said. The study took into account fac18

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The study found that an exposure of as low as about 30 minutes of sunlight per week with about 40% of the child’s body exposed to the sunlight can help achieve adequate vitamin-D status at 6 months of age. tors like skin colour of infants and season of sunbath. About 90% of the mothers in the study were themselves vitamin D deficient. Mothers who were on vitamin D supplements were excluded so that the study results remained unaffected, researchers explained. The study has been published in journal Indian Pediatrics. “We are planning further studies with a larger group of infants to test it as an intervention therapy”, said Piyush Gupta, corresponding author of the paper. Vitamin D is synthesized in the skin when ultraviolet rays from the sun convert a molecule,7-dehydrocholesterol, on the skin into an inactive form of the vitamin. This enters the blood circulation and is converted to its active form in the liver and kidney. Several studies over the years have shown that more than 50% of the Indian population is vitamin D deficient. This is a matter of concern especially for infants because Vitamin D is important for calcium absorption, normal growth and development, and maintenance of bone health and hair follicles. Insufficient vitamin D levels cause

lethargy, irritability, and a predisposition to infections. Extreme Deficiency of vitamin D can cause rickets which results in malformation of leg bones. Umesh Kapil, professor of Gastroenterology at the All India Institute of Medical Sciences (AIIMS), New Delhi, who is not connected to the study, felt that the proposed strategy may not be feasible in winters when the temperature remains low. While agreeing with Kapil, Shah said, “We have reported that for the winter months if the child is fully clothed with only face and hands are exposed, the required sunbath is calculated to be two hours per week or approximately 17 minutes per day.” Ramesh Agarwal, professor of Pediatrics AIIMS New Delhi, suggested that randomized control trials must be done to test this intervention as a therapy. He also highlights the need to evaluate the safety of sun exposure in relation to hyperthermia, burns and skin cancer in infants. (Shared from India Science Wire)

InnoHEALTH magazine is launching a new section from the next issue. If you have any question regarding your startup journey, email our experts for reply with your question and contact details at magazine@innovatiocuris.com

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30 min of sunbath a week can make infants’ vitamin-D sufficient

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A recent study has found that it could be because cereals, tubers and legumes, which are the major constituents of a staple diet, contained a class of substances called phytates in high amounts.

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Iron and zinc deficiencies can be addressed through simple measures

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By Monika Kundu Srivastava

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But, one should not eliminate the phytates from the diet. Phytates help in fighting off cancer and age-related changes in the body.

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unavailable to the body for its use. This low ‘bioavailability’ is the main cause of deficiency of iron and zinc in the Indian population.

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ndia is one of the leading exporters of cereals. It is the second largest producer of rice and fruits in the world. Overall, the country is self sufficient in food production. Yet iron and zinc deficiencies are widespread even amongst well-nourished children. A recent study has found that it could be because cereals, tubers and legumes, which are the major constituents of a staple diet, contained a class of substances called phytates in high amounts. Phytates are considered ‘anti-nutrient’ as they attach themselves to the iron and zinc in the food and make them

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The researchers have recommended modifying eating habits and cooking practices. South Indian cooking, for instance, follows a process of fermentation, soaking and germination which reduces the phytate content. Likewise, a simple intervention such as taking a piece of guava or Indian gooseberry (amla) fruit after food or while taking iron tablets would double the availability of iron and zinc in the body. In addition, they suggest, measures like minimal milling, intake of vitamin C, heating, and enzymatic treatment of grains with phytates enzyme and consuming curds, yogurts and pro-biotic cultures to maintain acid environment in the gut as well as genetic improvement of food crops may enhance bioavailability of iron and zinc. Further, non-vegetarian foods can also make available more iron and zinc to the body. The study, conducted by researchers at Indian Institute of Horticultural Research, Bengaluru, has found that the country as a whole requires 8,170 tonnes of iron and 4,412 tonnes of zinc in the food to meet nutritional iron and zinc requirements of the entire population. Availability of iron from plant and animal food sources is estimated at 10,939 tonnes per year and that of zinc at 6,335 tonnes per year. In other words, there is enough supply of iron and zinc through food sources in the country. The intake of the two micronutrients is also adequate. Agricultural crops such as cereals, pulses, oilseeds and sugar contribute the major share of the requirements, at 82.8% for iron and 78.6% for zinc. This is followed by the animal husbandry sector, including milk and milk products, meat, mutton, beef, pork, chicken and eggs, which account for 3.9% iron and 11.7% zinc. The horticultural sector (including fruits, vegetables and nuts) contributes 12.9% iron and 9.1% zinc to national production. The fisheries sector is at the tail end, providing 0.42% iron and 0.62% zinc. The researchers have published a 22

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Dr. A.N. Ganeshamurthy, leader of the research team, said, “There was a need for research efforts to focus on methods to reduce phytate content of Indian foods to enhance bioavailability. report on the study in a recent issue of journal Current Science. Dr. A.N. Ganeshamurthy, leader of the research team, said, “There was a need for research efforts to focus on methods to reduce phytate content of Indian foods to enhance bioavailability. This should be at the forefront of nutritional programmes rather than trying to improve the quality or yield of crops. “Before a new variety is released for cultivation by a breeder, the Institute/State/National-level variety release committees must take into account the issue of absorption of iron and zinc. Efforts to improve the quality and yield of crops or the ‘biofortification programmes’ will prove to be a failure, if they do not address the issue of bioavailability of nutrients. Further, we must do all we can to ensure a healthy soil and

a healthy production environment, with good agricultural practices,” he added. Iron deficiency, which may or may not result in anaemia, leads to substantial loss in physical productivity in adults. Iron deficiency during pregnancy is associated with maternal mortality, pre-term labour, low birth weight and infant mortality. In children it affects development and increases the likelihood of sickness. Highest prevalence of anaemia is seen in children around 15 years of age, in pregnant women and elderly people. Zinc deficiency, in turn, may cause hair loss, affect the taste and smell, among other things. Dr. Ganeshamurthy conducted the study in collaboration with his colleagues, Dr. D. Kalaivanan and Dr. B. L. Manjunath. (Shared from India Science Wire)

Policy

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Q. What challenges you aimed to achieve next year? Provisioning UHC and to restrict the growing burden of Non – Communicable diseases. We have iniVolume 3 | Issue 2 | April-June 2018

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Breast & Cervical) represents a massive step in identifying and addressing the risk factors at the community level itself. More than 150 Districts are being taken up in 2017-18. There have been global achievements in terms of India being declared Infective Trachoma free. The MoHFW has also signed MoUs with Italy, Morocco and Cuba.

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To provide comprehensive primary care, the Government has announced of transforming 1.5 lakh sub-health centres to Health and Wellness centres i.e. MoHFW is now moving towards provision of comprehensive primary care through the Health and Wellness Centres. The MoHFW has initiated universal screening of common Non Communicable Diseases (NCDs) such as diabetes, hypertension and common cancers at the sub-centre and Primary Health Centre (PHC), which will enable the strengthening of preventive and promotive health, improve patient referral and access to secondary care.

services of primary care to make it comprehensive. The HWCs are expected to provide preventive, promotive, rehabilitative and curative care for a package of services related to reproductive, maternal, newborn, child, and adolescent health (RMNCH+A), communicable diseases, noncommunicable diseases, ophthalmology, ENT, dental, mental, geriatric care, treatment for acute simple medical conditions and emergency and trauma services. In addition, the recently launched population-based Screening of Diabetes, Hypertension and Common Cancers (Oral,

PERSONA

WHO’s definition of UHC — one of the goals of sustainable development — includes financial risk protection (against medical expenses), access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. The National Health Policy 2017 approved last year envisages the attainment of the highest possible level of health without anyone having to face financial hardship as a consequence. The Ministry of Health & Family Welfare (MoHFW) has taken concrete steps to reduce the Out of Pocket Expenditure (OOPE). Mission Indradhanush, one of the largest global public health initiatives, was launched in 2014. In its four phases till date, Mass Immunisation (MI) has successfully reached over 25 million children in over 528 Districts. The focus is also on increasing the basket of vaccines. Since 2014, Rotavirus vaccine, Pneumococcal Conjugate Vaccine (PCV), and the Measles-Rubella (MR) vaccine, and also the JE vaccine for adults have been launched. Under Pradhan Mantri Dialysis Program (PMDP) 1.43 lakh patients have availed free services from 1,069 Dialysis Units and also under Free Drugs and Diagnostics Program; Affordable Medicine and Reliable Implants for Treatment (AMRIT) outlets nearly 47 lakh patients have benefitted and through purchase of subsidized medicines from AMRIT Pharmacies

Besides these policy and legislature decisions, the MoHFW launched some major health initiatives, starting with the most recent National Nutrition Mission 2017 with Ministry of Women and Child Development (WCD), the intensified Mission Indradhanush.

WELL BEING

In an interaction with InnoHEALTH magazine, the Minister asserts that the government would herald a new era of healthcare and the plan announced in the Union Budget would be implemented with full sincerity. It will take a few months to roll out all nitty-gritty’s of implementation. He dismisses apprehensions of those sceptical of the plan in wake of massive funds required for the implementation of the world’s largest healthcare plan. There would be no laxity in the successful implementation of the scheme and it had nothing to do with elections but it is a well-thought out plan to ensure holistic healthcare to common people. Massive machinery has started churning out plans to bring the scheme to the ground reality. Informatively, a plan to provide health cover to 50 crore people has been proposed in the current budget 2018-19 and is being viewed as precursor to the UHC.

RESEARCH

pparently bracing up to showcase India’s achievements in Health Sector management during general elections due within a year and a half, Union Health and Family Welfare Minister Jagat Prakash Nadda, who recently hogged limelight during mega health plan announced in the Union Budget 2018-19, and also played prominent role in the ruling party activities at the national and states’ level, says the NDA government is committed to advancing Universal Health Coverage (UHC) agenda. World Health Organisation Director-General Dr Tedros Adhanom Ghebreyesus has recently said that India should have UHC.

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By Neeraj Bajpai

Q. Please share some major highlights of 2017 in promoting health initiatives? I am proud to say that there have been several achievements. Few on top of my mind are--Release of the new National Health Policy 2017 after a gap of 15 years, the Passing of HIV & AIDS (Prevention & Control) Act, 2017, the Mental Healthcare Act 2017, and the most recent National Medical Commission Bill, 2017 being approved by the Cabinet. Besides these policy and legislature decisions, the MoHFW launched some major health initiatives, starting with the most recent National Nutrition Mission 2017 with Ministry of Women and Child Development (WCD), the intensified Mission Indradhanush. After the success of MI, the annual rate of increase of full immunisation coverage has increased from 1% to 6.7 % during the two rounds. We increased the basket of Universal Immunization Programme (UIP) with introduction of new vaccines i.e. Rotavirus vaccine, MR vaccine and the PCV. The PMSMA (Pradhan Mantri Surakshit Matritva Abhiyan) has helped detect more than 5 lakh high risk pregnancies. Similarly, MoHFWs Rashtriya Bal Swasthya Karyakram (RBSK) has screened 11.7 crore children, 43.4 lakh children were referred to secondary tertiary facilities, 27.8 lakh children availed services in secondary tertiary facilities. The MoHFW also launched the Mission Parivar Vikas (MPV) in 146 Districts of 7 states for substantially increasing the access to contraceptives and family planning services in Districts with Total Fertility Rate (TFR) of 3 and above. The MoHFW announced transformation of sub-health centres to Health and Wellness Centres (HWCs) to expand the basket of

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World's Largest Health Scheme Unspooled in India

EXCERPTS:

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WOMEN’S CORNER

Volume 3 | Issue 2 | April-June 2018

Q. What message you want to share with community in their fight against dengue and chikungunya? I want to focus solely on prevention viz. preventing water logging around house and other measures

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• Population-based screening for Diabetes, Hypertension and Common Cancer (Oral, Breast & Cervical)---The recently launched Population-based Screening of Diabetes, Hypertension and Common Cancers represents a massive step in identifying and addressing the risk factors at the community level itself. More than 150 Districts are being taken up during 2017-18. As on September 2017, approvals given for about

Q. Pl throw light on MoU signed with Morocco. What will be the major gains? The main areas of cooperation include the following: a. Non-communicable diseases, including child cardiovascular diseases and cancer b. Drug Regulation and Pharmaceutical quality control c. Communicable Diseases d. Maternal, child and neonatal health e. Hospital twinning for exchange of good practices f. Training in administration and management of health services and Hospitals

Q. What has been the status on new AIIMS being constructed across the country? The Government has been at the forefront to strengthen the tertiary care and as such six new AIIMS are functioning and six will come up in due course.

WELL BEING

Q. Your comments on private sector role in healthcare? Are you satisfied with their contribution? Private sector engagement is a part of new National Health Policy 2017 for a reason. They have a very significant and important contribution to the country’s health services landscape. In terms of real time support, we are satisfied with their contribution to the Pradhan Mantri Swasthya Matritva Abhiyan (PMSMA) and provisioning dialysis services through PPP under the Pradhan

Q. Pl throw light on Universal Health Coverage initiatives? There are several, however, I can list a few:• In 2017-18, the MoHFW announced transformation of subhealth Centres to Health and Wellness Centres (HWCs) to expand the basket of services of primary care to make it comprehensive. The HWCs are expected to provide Preventive, Promotive, Rehabilitative and Curative Care for a package of services related to RMNCH+A, Communicable diseases, Non-Communicable diseases, Ophthalmology, ENT, Dental, Mental, Geriatric Care, treatment for acute simple medical conditions and emergency and trauma services. The indicative package of services envisaged is: a. Care in pregnancy and childbirth

b. Neonatal and infant health care services c. Childhood and adolescent health care services d. Family planning, contraceptive services and other Reproductive Health care services e. Management of Communicable diseases: National Health Programmes f. Management of Common Communicable Diseases and General Out-Patient care for acute simple illnesses and minor ailments g. Screening and management of Non-Communicable diseases h. Screening and basic management of mental health ailments i. Care for common Ophthalmic and ENT problems j. Provision of basic dental health care k. Geriatric and palliative health care services l. Trauma Care (that can be managed at this level) and Emergency Medical Services

a. Janani Suraksha Yojana (JSY) b. Janani Shishu Surakha Karyakram (JSSK) c. HBNC/HBIC (Home Based Neonatal Care/Infant Care) d. National Ambulance Service (108/104) e. Tribal Birthing/Waiting Homes f. Pradhan Mantri Swasthya Matritva Abhiyan (PMSMA)

Q. How the Ministry ensures safe pregnancy in rural/remote and tribal areas where access to hospitals is not that easy? Our entire Reproductive Child Health (RCH) programme and National Health Mission is focused around this issue. To list a few viz.-

RESEARCH

Q. How to address the fund crunch issue? There is no fund crunch. In 2017-18 Union Budget, the health allocation was increased by 27.7% and the MoHFW is committed to 2.5% of GDP to healthcare in a phased manner under the National Heath Policy 2017. So I don’t foresee any fund crunch.

Mantri Dialysis Program.

which we keep reiterating through our regular Information, Education, and Communication (IEC) campaigns. This requires community partnership and ownership.

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tiatives in place to manage both.

• National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS)---In order to prevent and control major NCDs, the MoHFW is implementing the NPCDCS in all states across the country with the focus on strengthening infrastructure, human resource development, health promotion, early diagnosis, management and referral. As on date, the programme is under implementation in total 436 Districts, with setting up of NCD clinics in 435 District Hospitals, and 2145 Community Health Centres. Cardiac Care Units have been set up in total 138 Districts and Day Care Centres for Cancer Chemotherapy have been set up in 84 Districts. Provision has been made under the programme to provide free diagnostic facilities and free drugs for NCD patients attending the clinics at the District and CHC levels.

170 Districts in 16309 sub -centres and screening has been initiated in about 60 Districts, 12 states, 2 UTs and 20,15,474 people have been screened.

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The Health and Wellness Centre (H&WC) will deliver comprehensive primary healthcare using a team based approach and would be led by a mid-level service provider with a primary healthcare team including ANMs, ASHAs, and AWWs, of the sub-centre area. Altogether, 4000 sub-centres are targeted to be transformed to HWCs by March 2018 and 1.25 lakh HWCs by March 2022. So far approval has already been given for 3871 HWCs.

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Q. Doctors’ shortage: What measures should be put in place to address the concern? • The MoHFW has granted permission for establishment of 83 new medical colleges in the last 3 years including 31 in government sector. The country has today 479 medical colleges with more than 67,000 MBBS seats. • The Ministry has taken various measures to facilitate the setting up of new colleges viz. a. norms for medical colleges have been rationalized b. requirement of minimum area of land has been dispensed with in notified urban areas. c. Companies have been allowed to set up medical colleges. • The MoHFW is implementing a Centrally Sponsored Scheme namely “Establishment of new

THE INITIATIVES ARE AS FOLLOWS:(i) Health and Wellness Centre:- The National Health Policy, 2017 has envisioned Health and Wellness Centres as the foundation of India’s health system. Under this 1.5 lakh centres will bring healthcare system closer to the homes of people. These centres will provide comprehensive healthcare, including for non-communicable diseases and maternal and child health services. These centres will also provide free essential drugs and diagnostic services. The Budget has allocated Rs. 1200 crore for this flagship programme. Contribution of private sector through CSR and philanthropic institutions in adopting these centres is also envisaged. (ii) National Health Protection Scheme:- The second flagship programme under Ayushman Bharat is National Health Protection Scheme, which will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization. This will be the world’s largest government funded healthcare programme. Adequate funds will be provided for smooth implementation of this programme. In order to further enhance accessibility of quality medical education and healthcare, 24 new Government Medical Colleges and Hospitals will be set up, by upgrading existing district hospitals in the country. This would ensure that there is at least 1 Medical College for every 3 Parliamentary Constituencies and at least 1 Government Medical College in each state of the country. Volume 3 | Issue 2 | April-June 2018

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disorders available through various schemes. It has also launched several programmes to make free drugs and diagnostics available under the National Health Mission. Also our AMRIT stores provision generic drugs. 105 pharmacies have been set up across 19 states for providing medicines for Diabetes, CVDs, Cancer and other disease at discounted prices to the patients. A total of more than 5000 drugs and other consumables are being sold at upto 50% discounts. As on 15th November 2017, 44.54 lakh patients benefitted from AMRIT pharmacies. The value of drug dispensed at MRP is Rs 417.73 crore and savings of Rs. 231.34 crore from AMRIT stores thereby reducing their out of pocket expenditure.

Finance Minister Arun Jaitley recently has announced two major initiatives in health sector, as part of Ayushman Bharat programme. This is aimed at making path breaking interventions to address health holistically in primary, secondary and tertiary care systems, covering both prevention and health promotion.

WOMEN’S CORNER

The ministry has sought public comments on the draft, after which it is likely to become part of the drug law.

PERSONA

Q. Generic medicines: How to address availability issue? The MoHFW recently issued a draft gazette notification making it mandatory for Pharma companies to carry generic name of drugs on packs that is at least two fonts larger than the brand name. This clause will be a legal provision as a rule under the existing Drugs and Cosmetics Act and any violation will be punishable under the provisions of the law. The Ministry has sought public comments on the draft, after which it is likely to become part of the drug law. Also, issued orders to the Medical Council of India (MCI), state governments and all central government hospitals asking them to ensure that doctors write prescriptions with generic names of medicines in legible hand writing. In last three years, the government has capped prices of around 700 essential medicines. It has also capped prices of stents and is working to make drugs for critical diseases like cancer and heart

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•

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• •

Q. Please throw light on Mental Healthcare Act which was passed in 2016. What steps the government planned to create awareness on this? • The Act adopts a rights-based statutory framework for mental health in India and strengthens equality and equity in provision of mental healthcare services in order to protect the rights of people with mental health problem to ensure that they are able to receive optimum care and are able to live a life of dignity and respect. • The Act strengthens the institutional mechanisms for improv-

ing access quality and appropriate mental healthcare services. • The Act increases accountability of both government and private sectors in delivery of mental healthcare with representation of persons with mental health problem and their care-givers in statutory authorities such as Central and State Mental Health Authority. • The most progressive features of the Act are provision of advance directive, nominated representative, special clause for women and children related to admission, treatment, sanitation and personal hygiene; restriction on use of Electro-Convulsive Therapy and Psychosurgery. • Decriminalization of suicide is another significant facet of the Act, which will ensure proper management of severe stress as a precursor for suicide attempts.

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•

Act. Combined with increase of DNB seats, the ministry could achieve an increase of nearly 5800 PG seats in 2017. • The country has today around 38,000 PG seats including Diplomate of National Board (DNB).

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•

medical colleges attached with existing district/referral hospitals” 58 Districts in 20 States/UT have been identified under this Scheme to establish new Medical Colleges attached with existing district/referral hospitals. Out of these, 56 have been approved till date. Out of 56 approved medical colleges, 8 are functional and 29 have applied for MCI’s permission to start new medical colleges from the academic year 2018-19. Increase of PG seats: In January, 2017 the teacher student ratio was revised in government medical colleges in clinical subjects and consequently around 3,000 PG seats were added as a one-time measure. 700 seats were added in normal course of permission under IMC

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(The author is a qualified lawyer who takes a keen interest in how tectonic shifts in technology is impacting healthcare delivery. The intersection of law, innovation, interaction with man and machine excites him. Manas works with NovoJuris Legal deeply in AI, IOT, health-tech, med-tech, devices and more in the healthcare segment)

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Volume 3 | Issue 2 | April-June 2018

Software as Medical Device (SaMD) A broadly accepted definition of a SaMD is the one issued by the International Medical Devices Regulation Forum (“IMDRF”); currently Australia, Brazil, Canada, China, Europe, Japan, Russia, Singapore and the United States of America are member countries to this Forum. This definition has been adopted by the Food and Drugs Administration (FDA) in the United States, The Medical Device Directive adopted in the European Union in 2010, and in major countries such as Australia, Canada and Japan. The term “Software as a Medical Device” is defined as software intended to be

used for one or more medical purposes that perform these purposes without being part of a hardware medical device. It includes an in vitro diagnostic medical device. It must be capable or running on a computer platform that is not of a medical purpose, and should not need a hardware medical device to achieve its purpose. It can be interfaced or used in a combination with other devices, but cannot be used to drive a hardware device. Mobile applications meeting this definition are also considered as SaMDs. The medical purpose‟ that it must intend to serve can be diagnostic, preventive, investigative, life sustaining, for treatment of disease or injury, disinfection, control of conception or purely informative. In some jurisdictions, aids for persons with disabilities, devices for assisted reproduction and devices incorporating animal and/or human tissues are also recognized. A SaMD

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is not a medical device and hence outside the purview of regulations usually applicable for medical devices. Can we ignore the risks? If so, should software be treated as a medical device?

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he tectonic shifts in technology are transforming human life in ways unfathomable just a few years ago. Health-tech and medtech are touching our lives continuously through a number of ways - from simple wearable devices to complex invasive devices; simple AI software which can predict and sense to complex AI software which can diagnose; sensors and other hardware devices including the mobile phone with ever increasing computing power. Some of these have made human lives so dependable on these devices, gadgets, software and in some cases these are dumping human intelligence. We witnessed software wherein by looking at a camera on the mobile phone, the software can predict the heart rate and many other vitals. What if human intelligence gave way in believing the reading as true? The software or the camera

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By Manas Ingle

Putting them to use SaMDs are now available in abundance in the Indian market. Both foreign manufacturers as well as Indian manufacturers are introducing so many forms of SaMDs. This includes use of artificial intelligence, IoT, general software etc. Interesting, many SaMDs are enjoying high adoption rates not only by early users but continued users. The glaring point is that there is no legislative framework or guidance policy which works as a guiding principle for the SaMD manufacturers or at least as a self-regulating piece of legislation, in India. The Medical Devices Rules, 2017 which has come into effect from January 1, 2018 has now defined medical devices and has made a clear distinction between drugs and medical devices, but still this definition does not include SaMDs or software as a medical device. Interestingly, the draft Medical Devices Rules, 2016 on basis of which the Medical Devices Rules, 2017 have been formalized included software in the definition of medical device. With the market being flooded with AI, IoT, general software, wearable, and wellness and customized medical devices, software as a medical device as a whole should be considered with equal importance in the sector. Curiously, the definition of medical devices under Foreign Direct Investment policy includes software.

statement should clearly state that this app or product is not intended to be used in a diagnosis, monitoring, management or treatment of any disease. Keeping all the innovation in health-tech space, India should provide guidance on SaMDs. The regulatory framework in India for medical devices is by the Central Drugs Standards Organization widely known as CDSCO. The new Medical Devices Rules, 2017 are comprehensive and now extensively covers almost 351 medical devices and about 247 in-vitro medical devices it still does not cover SaMDs. Given the increased use of mobile technology and awareness, guidelines on SaMDs could contribute to improving the affordability and availability of healthcare, including rural India, which has a huge user base. Gradual rigour in legislation will allow India to meet increased need, according to when resources for monitoring and enforcement become more available. India already follows the IMDRF regulations with respect to clinical trials and the clinical evaluation of medical devices, with respect to documents, licensing and safety standards. It is important for the legislation to allow the industry to grow and achieve its potential, especially in country like India where there is a need for better point of care medical solutions but at the same time provide unambiguous guidance. A good starting point would be a selfregulating mechanism with a set of standards, methods and procedures, clinical evaluation process. Such guidance would help improve innovation as well and guide the nascent Indian SaMD industry.

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Software as Medical Device?

REGULATIONS The IMDRF has worked extensively in setting guiding principles for governing SaMD and has put in place a regulatory structure for how the SaMDs shall be governed, regulated, clinically evaluated and how the data shall be evaluated and then used by the SaMD. While India has not yet included any software or apps in its regulation purview, countries like U.S.A, Singapore, Australia, EU and Japan has issued guidance documents to make the app developers aware of what might be subjected to regulation. The common theme that determines the classification is the level of risk that these apps pose to the consumers. For example, let’s take an app which allows a user to take ECG test by putting their fingers on an external device which is connected wirelessly to the smartphone. It checks the electrical activity of the heart. Such apps may be considered as risky and be subject to regulation, since the belief is that any incorrect analysis may hamper a user’s treatment. However, the Government authorities need to strike a balance while assessing these risks so that not all apps need to be certified under law, so that innovation is not hampered. It is indeed a very fine balance. General wellness apps or products such as apps tracking and assisting in maintaining healthy body weight, or products are generally kept out of the purview of law versus apps which tracks and assists in say monitoring blood sugar or other vitals or treats specific health issues or provides guidance for treatment of specific illnesses. The whole purpose to bring these apps under regulation is that there is a certain amount of rigour before the apps are released to the market and there is onus and responsibility on these makers. It should enable the app developers to be mindful of how is the product or app is advertised, claims as well. To protect consumers, certain jurisdictions, like Singapore, have mandated the manufacturers/ app developers to put a clarification statement on their product or on their apps. This

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can also be a means to suggest mitigation of a disease or provide aid to diagnosis. There are further guidelines on the definition of changes to SaMDs- they can be adaptive, corrective or preventive in nature. The manufacturer of SaMD would be a natural or legal person who has the intention for the software to be used under his/its name. It would not include a distributor or the manufacturer of an accessory. The final legal responsibility lies with the manufacturer unless it is specifically imposed on another party by the country’s regulatory authority.

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Rate (U5MR) and replacement level fertility, leaving limited space for any further improvements. However, the incremental measurement reveals that about onethird of the States have registered a decline in their performance in 2016 as compared to 2015, stressing the need to pursue domain-specific, targeted interventions. Common challenges for most States and UTs include the need to focus on addressing vacancies in key staff, establishment of functional district Cardiac Care Units (CCUs), quality accreditation of public health facilities and institutionalization of Human Resources Management Information System (HRMIS). Additionally, almost all Larger States need to focus on improving the Sex Ratio at Birth (SRB). Volume 3 | Issue 2 | April-June 2018

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showed the highest improvement in indicators such as institutional deliveries, tuberculosis (TB) treatment success rate, and transfer of National Health Mission (NHM) funds from State Treasury to implementation agency. The Health Index report notes that while States and UTs that start at lower levels of development are generally at an advantage in notching up incremental progress over States with high Health Index scores, it is a challenge for States with high Index scores to even maintain their performance levels. For example, Kerala ranks on top in terms of overall performance but sees the least incremental change as it had already achieved a low level of Neonatal Mortality Rate (NMR) and Under-five Mortality

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It would also serve as an instrument for “nudging” States & Union Territories (UTs) and the Central Ministries to a much greater focus on output and outcome based measurement of annual performance than is currently the practice.

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in three categories namely, Larger States, Smaller States, and Union Territories (UTs), to ensure comparison among similar entities. The Health Index is a weighted composite Index, which for the larger States, is based on indicators in three domains: (a) Health Outcomes (70%); (b) Governance and Information (12%); and (c) Key Inputs and Processes (18%), with each domain assigned a weight based on its importance. Among the among Smaller States, Mizoram ranked first followed by Manipur on overall performance, while Manipur followed by Goa were the top ranked States in terms of annual incremental performance. Manipur registered maximum incremental progress on indicators such as PLHIV on ART, first trimester antenatal care (ANC) registration, grading quality parameters of Community Health Centres (CHCs), average occupancy of key Statelevel officers and good reporting on the Integrated Disease Surveillance Programme (IDSP). Among UTs, Lakshadweep showed both the best overall performance as well as the highest annual incremental performance. Lakshadweep

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Among the among Smaller States, Mizoram ranked first followed by Manipur on overall performance, while Manipur followed by Goa were the top ranked States in terms of annual incremental performance.

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Government report on comprehensive health index in India states that larger States like Kerala, Punjab, and Tamil Nadu have been ranked on top in terms of overall performance, while Jharkhand, Jammu & Kashmir, and Uttar Pradesh are the top three ranking States in terms of annual incremental performance. Jharkhand, Jammu & Kashmir, and Uttar Pradesh showed the maximum gains in improvement of health outcomes from base to reference year in indicators such as Neonatal Mortality Rate (NMR), Under-five Mortality Rate (U5MR), full immunization coverage, institutional deliveries, and People Living with HIV (PLHIV) on Anti-Retrovi-

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Health Card of Indian States

ral Therapy (ART). NITI Aayog recently unveiled the comprehensive Health Index report titled, “Healthy States, Progressive India”. The report ranks states and Union territories innovatively on their year-on-year incremental change in health outcomes, as well as, their overall performance with respect to each other. Health Index has been developed as a tool to leverage co-operative and competitive federalism to accelerate the pace of achieving health outcomes. It would also serve as an instrument for “nudging” States & Union Territories (UTs) and the Central Ministries to a much greater focus on output and outcome based measurement of annual performance than is currently the practice. With the annual publication of the Index and its availability on public domain on a dynamic basis, it is expected to keep every stakeholder alert to the achievement of Sustainable Development Goals (SDGs) Goal number 3. States and UTs have been ranked

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In October 2016, as many as 32 lakh credit cards from different Indian banks were compromised, according to National Payments Corporation of India. There were a number of cyber security attacks post demonetization, according to TAC Security, a cyber‐ security solutions provider. In 2016 and early 2017, cyberattacks disabled the power delivery to large number of customers in Ukraine. Turkey's banking infrastructure was attacked by denial of service attack bringing all banking activities to a halt last year. Bangladesh Central Bank lost equivalent of 80 million dollars through cyber-attacks. Volume 3 | Issue 2 | April-June 2018

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Investigator for the center. IIT Kanpur Director Dr. Indranil Manna says, “Cyber security is a major thrust area in this institute considering contemporary national need and opportunity for technological innovation where IITK can make a significant impact.”

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for Cyber Security and Cyber Defence of Critical Infrastructures

along with development of technology to protect them. “We recognized the need for developing a research and education program in cyber security ‐‐ especially in the sector of critical infrastructures such as power grid, manufacturing automation, electricity generation facilities, building automation, railway signaling etc. and went to DST with a compelling proposal to establish a national test bed for experimenting with cyber security of such systems, and carry out research to develop defence techniques. Through many rounds of presentations, and revisions we were able to convince multiple panels of experts and external reviewers that we have the interdisciplinary expertise at IIT Kanpur. Our center has experts in cyber security, cryptography, machine learning, formal methods, program analysis, electrical engineering, networking and computer systems ‐‐ a convergence of which is essential to build cyber security of critical infrastructure. We are very confident that we can build a world class facility and research/ education/training program,” said Prof. Sandeep Shukla, Co‐Principal

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IIT Kanpur has taken a number of initiatives in the field of cyber security research. They recently signed a MoU with New York University Tandon School of Engineering, with whom they also hosted the Cyber Security Awareness Week in November 2016. They also signed a MoU with the Interdisciplinary Center for Cyber Security at Tel Aviv University in Israel, and MoU with Bombay Stock Exchange to cooperate on cyber security.

would work closely with researchers from IIT Bombay, IIT Kharagpur, ISI Kolkata, IIT Delhi and MNIT Jaipur. “Working with various industry and government bodies we are convinced that cyber security research, training and man power development are national imperatives. We are very pleased that DST has decided to fund our center and help us build the capabilities to carry out cutting edge research and training in the field of cyber security, in particular with the goal to protect our critical infrastructures. We look forward to the journey in the next five years to the development of world class capabilities here at IIT Kanpur,” said Prof. Manindra Agrawal, Principal Investigator for

the upcoming center. The Cyber Security and Defence Center at IITK plans not only to engage faculty in cutting edge research in the domain of cyber security of critical industrial systems (water treatment plants, nuclear power plants, power distribution infrastructure) but also to engage in training through courses with an emphasis on cyber security. They also plan to have summer courses and internships for students from other institutes as well as custom training courses for government and industry executives. Consulting to the government and the critical infrastructure sector by the faculty and researchers at the Center will also be one of the focus areas. One of the major components of the centre will be an Industrial Systems Cyber Security Test Bed – a first of its kind in India – similar to the test beds at the Idaho National Labs, Sandia National Labs, and National Institute of Standards and Technology in the U.S. It will take about a year to build this facility where research on cyber vulnerabilities of critical industrial systems will be carried out

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mid lurking threats of cyber-attacks on all sectors including hospitals storing medical records and its long term dangerous implications on country’s’ economy and individual’s personal data, Indian Institute of technology (IIT) Kanpur is all set to open a cyber security center. Department of Science & Technology, Government of India, has recently sanctioned a grant of INR 14.43 crore to IIT Kanpur in response to a proposal by the institute to set up the Interdisciplinary Center for Cyber Security and Cyber Defence of Critical Infrastructures. The grant has been sanctioned for a period of five years and covers expenditures for the setting up of the center such as infrastructure, equipment etc. Cyber Security has become a pressing need the world over, with major cyber‐attacks coming to light every few months. Large number of countries is working on strengthening their cyber security technology to protect their national security as infrastructure disabling cyberattacks is a threat to national security. In India though, the work in this field is still in its nascent stages. A consolidated effort from the cyber security expertise present in the country is the need of the hour and the new center coming up at IIT‐K plans to work specifically towards this. To achieve this goal, the Interdisciplinary Center

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IIT Kanpur braces up to thwart cyber attacks in India

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Kanpur Zoo adopts innovative methods for animal health management

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Cosmetic surgery of a python, barking deer, distant pus cleaning device for squirming rhino, gangrene in Saddam’s tail! Sound bizarre but that’s reality…

ired by successful cosmetic surgery of human beings, a team of vets in the Kanpur zoo (erstwhile Allen Forest Zoo) in Uttar Pradesh had carried out a successful cosmetic surgery of a badly thrashed 15-feet long massive python. The mammoth reptile was kept in an iron barred cage of hospital. The appearance of the python showed that it had recently in36

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gested medium-sized animal. On examination, all rows of the teeth and the tongue were damaged. On 35th day, he began exhibiting normal activities. The python was released after three months. The case had hit the headlines three years ago. Recently, a barking deer writhed in pain for days after its lower jaw dropped perilously was shifted to the hospital. Its cosmetic surgery

was carried out so that his jaws work in perfect unison to chew food. Buoyed by a slew of such accomplishments, vets are embarking upon innovative initiatives to protect the zoo’s wildlife. A rhino developed pus in one of its legs and its dressing was a huge task, but because of pain, the bulky animal squirmed. A new surgical device was designed for the remote wound cleaning. The

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The leopard was treated with antibiotics and other prescribed methods but the recurrence of the disease could not be prevented due to leopard’s tendency to keep its tail on surface. Owing to continuous rubbing of the tail and wild animal managerial constraints it was not possible to dress the tail daily and the only possible successful treatment advocated for the tail gangrene is said to be the amputation from one uninfected coccygeal vertebrae above the gangrene.

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A unique method was devised by the zoo veterinarians by using a half horse power water lifting pump, thick walled PVC/Rubber tube, tube with nozzle and a large container of around fifty litre capacities. Tube with nozzle was connected at outlet end of the water lifting pump and on other end i.e. inlet end a thick walled PVC/Rubber tube was connected. technique clicked and provided instant relief in pain for mega herbivores. The technique got international acclamation. It was displayed on website by Rhino Resource Centre sponsored by the WWF. Usually, the mating among rhinoceros is violent and female is chased by male before mounting with frequent infighting and biting. The act may last for hours before coitus which is also a long process and sometimes takes more than an hour. A unique method was devised by the zoo veterinarians by using a half horse power water lifting pump, thick walled PVC/Rubber tube, tube with nozzle and a large container of around fifty litre capacities. Tube with nozzle was connected at outlet end of the water lifting pump and on other end i.e. inlet end a thick walled PVC/Rubber tube was connected. The other end of inlet tube was submerged into a large container containing 2 per cent potassium permanganate and 4 per cent povidoneiodine solution. The rhino was taken into his night house and the wounds were washed with the solution daily for two days and then alternatively for three more occasions. The zoo is presently housing 12 leopards; many of them are zoo born. Among them leopard named Saddam, born to dam Mona and Wild Sire, is very ferocious and have well-built 38

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body. The animal was quite healthy up to the age of nine but then got its tail tip injured which slowly developed into gangrene. Sastry (1983) defined gangrene as ‘necrosis of the tissue with putrefaction by saprophytic bacteria’. The leopard was treated with antibiotics and other prescribed methods but the recurrence of the disease could not be prevented due to leopard’s tendency to keep its tail on surface. Owing to continuous rubbing of the tail and wild animal managerial constraints it was not possible to dress the tail daily and the only possible successful treatment advocated for the tail gangrene is said to be the amputation from one uninfected coccygeal vertebrae above the gangrene. According to doctors, the possible reasons behind successful treatment of Saddam was prevention of infection by confinement of the animal and by making a coating of turmeric and ayurvedic antimicrobial agent which further prevented residual infection and helped in healing of the tissue. After a thorough and efficient monitoring, leopard was again released in the enclosure after a long period and has not shown any sign of infection in tail in last more than one year. Now, a new operation theatre with modern machines is being established in the zoo in order to facilitate the more complicated surgeries.

A trio of vets – Dr. R.K. Singh, Dr. U.C. Srivastava and Dr. Mohd. Nasir have been working not only to save the wild animals but also helped to develop the zoo as one of the best managed zoo of the country with respect to animal health management. The trio has applied innovative ideas of treatment. Efforts were also made by vets in attracting corporate word to not only adopt the animals but were also encouraged to make adoptions in wild animal health field and leading pathology of Kanpur began to analyse the pathological samples free of cost. New surgical technics were developed to surgically treat the animals. These vets got their several papers published in several international journals and Kanpur zoo became first zoo in India to receive ISO 14001:2004 to “conserve, breed and provide alternate home for fauna of national importance”. Apart from above, another feather has been put in their caps by coining a new English word ‘WILDOMESTIC’ for the wild animals in captivity. This has been widely recognized and accepted by wild lifers and print and electronic media and it has been recommended by all for inclusion in several dictionaries such as oxford and chambers few to name.

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II. The sleep disturbance clinically significant distress or impairment in social, occupational, educational, academic, behavioral or other important areas of functioning.

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IV. The sleep difficulty is present at least for 3 months.

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VI. The insomnia is not better explained by and does not exclusively during the course of another sleep related disorder.

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Resulting in disease-Insomnia

By Dr. Tinni Dutta

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dividualized counseling is urgently needed. As we find in DSM V (Diagnostic Criteria) sleep wake disorders is intended for use by general mental health and medical clinicians. It encompass 10 disorders or disorder groups: insomnia disorder, hypersomnolence disorder, narcolepsy, breathing related sleep disorder, circa din rhythm sleep wake disorders, non-rapid eye movement (NREM), sleep arousal disorders, restless leg syndrome, and substance/medication induced sleep disorder. In this

article we would limit our discussion only on Insomnia. Pathways between stress and disease I. A predominant complaint of dissatisfaction with sleep quantity and quality, associated with one of the following symptoms: • Difficulty initiating sleep • Difficulty maintain sleep, characterized by frequent awakening • Early – morning awakening with

Dr. Dutta at Asutosh College, Kolkata, is eminent Psychologist and a famous educationist. Her research work has been greatly appreciated in India and aboard. She has visited U.S.A, U.K, Switzerland, France, Germany, Thailand, Singapore and Indonesia. She is recipient of many awards and fellowship. Volume 3 | Issue 2 | April-June 2018

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he impact of stress on physical health varies between diseases. Chronic or severe stress can lead to variety of mental health problems-post traumatic stress disorder, anxiety, depression, insomnia and different types of psychosomatic disorder. The field of sleep disorder medicine has progressed to a great extent. Sedatives, Hypnotics and Anxiolytics are used for ameliorating these symptoms. But medicine alone cannot do much. Yoga, meditations coupled with in-

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Insomnia – A Short Communication Study

Premorbid Personality Vulnerability to stress. Vulnerability to stress.

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Stress exposure Emotional, social occupational stress

frequent or prolonged awakenings throughout night. Late insomnia involves early – morning awakening with an inability to return to sleep. Insomnia is related to sleep physiological and cognitive arousal which interferes with sleep. The more an individual strives to sleep, the more frustration builds. The more impairs sleep. It is also associated with other psychological complaints like fatigue, boredom decreased energy and mood disturbances.

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VII. The insomnia is not attributable to the physiological effects of a substance

VIII. Coexisting mental disorder and medical conditions do not adequately explain the predomi nant complaints of insomnia. Different manifestations of insomnia can occur at different times of sleep period. Sleep onset insomnia involves difficulty initiating sleep at bed times. Sleep maintenance insomnia refers

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V. The sleep difficulty occurs despite adequate opportunity for sleep.

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III. The sleep difficulty occurs at least 3 nights per week.

The field of sleep disorder medicine has progressed to a great extent. Sedatives, Hypnotics and Anxiolytics are used for ameliorating these symptoms. But medicine alone cannot do much. Yoga, meditations coupled with individualized counseling is urgently needed. As we find in DSM V sleep wake disorders is intended for use by general mental health and medical clinicians.

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inability to return to sleep.

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pain and shortness of breath that is indicative of heart attack is not felt. Akash aims to study cardiology at the country’s premier All India Institute of Medical Sciences in Delhi.

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charged electrical impulse to draw negatively charged ---protein to the surface; If the amount of FABP3 is high, then the person would need immediate medical attention; People who are at risk are recommended to use the de-

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FABP3 biomarker in the bloodstream. ABP3 is a lightweight protein released quickly from heart muscle into the bloodstream during a heart attack, and therefore, it is an optimal cardiac diagnostic marker. According to him, doctors may test a patient's blood for FABP3 if he or she experiences characteristic symptoms like chest pain. However, not all heart attacks make themselves known through easily noticeable signs. Silent heart attacks, which are becoming increasingly common, are asymptomatic, making them more dangerous than conven-

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hour away from his hometown. He could not afford expensive books and journals so the library visit was the only option left for this enterprising adolescent who had an extra knack to comprehend complexities of cardiology just because of his penchant for the heart diseases studies. He was chosen for the President’s Innovation Scholar’s In-Residence Programme at Rashtrapati Bhavan. The 16-year-old says that he investigated a novel concept that could potentially allow patients to detect silent heart attacks by non-invasively sensing the

vice twice a day -- in the morning and at night, before going to bed; The product can soon be seen in the market and would cost around R 900, cheaper than a glucometer symptoms at all. Diabetes, high blood pressure, high cholesterol levels all put you at risk of a silent heart attack, experts say. Having a silent heart attack puts people at a greater risk of having another heart attack, which could be fatal. Having another heart attack also increases risk of complications, such as heart failure. Experts say a silent heart attack a heart attack is characterized by chest pain, pain in the left arm or shortness is when of breath. A person who has a silent heart attack may not show these the symptoms like chest

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he death of his grandfather due to heart attack led Manoj Akash, a class 10th student of Ashok Leyland School in Hosur, Karnataka, to invent skin patch which has to be attached to the wrist or the back of the ear and it will release a small ‘positive’ electrical impulse, which will attract the negatively charged protein released by the heart to signal a heart attack. If the quantity of this protein – FABP3 -- is high, the person must seek immediate medical attention. Since class eight he started visiting library of the Indian Institute of Science in Bengaluru – an

Internet gave him lot of insight, he admits Clinical trials for the medical device are on and it could be approved for a human trial. The product would be fit to be launched in the market after two months of human trial, assuming nothing goes wrong. “I have already filed for a patent and I would tie up with department of biotechnology for the trial. I would want the Government of India to take the project instead of selling it to a private company because it is for the public good,” he says on his website. A small silicon patch stuck to your wrist or back of your ear can be used regularly to monitor whether there has been a heart attack instead of waiting for a doctor to prescribe a test. The patch uses a positively

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Skin patch to detect ‘silent’ heart attacks

tional heart attacks. Patients often "drop dead" while feeling completely normal. This collapse happened to my grandfather on July 3rd 2015 which served as an impetus for me to find a solution to this problem. In these "silent" cases, doctors are unlikely to administer the crucial FABP3 blood test because there is no visible presentation of symptoms to warrant a diagnostic test. As a result, silent heart attacks go unnoticed. “I realized that, if at-risk patients could test themselves daily for the presence of FABP3 in their blood, they would have higher chances of detecting silent heart attacks as they occur. A method that allows daily selftesting would have to be non-invasive, safe, and easy to use. Ultimately, it would have to involve a transcutaneous blood analysis, which examines the contents of one's blood without penetrating the skin. In searching for ways to tackle this challenging prospect, I examined the various distinguishing characteristics of blood proteins that would allow them to be identified transcutaneously. I found that proteins have distinctive masses and electric charges in blood. So, I used a model to test whether different magnitudes of charged electricity, when applied to a thin area of skin, would isolate FABP3 from the other blood proteins and attract FABP3 to the capillary walls. My results showed that this is true. This means that the technique that I investigated can potentially be coupled with transcutaneous UV-protein quantification to non-invasively measure the amount of FABP3 in a patient's blood and alert him or her of a silent heart attack.” Help Million Hearts Stay Healthy! Is his web page that narrates his vision. He was frequenting scientific conventions to further his knowledge in the science field.

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Meet world’s first cloned monkeys--Zhong Zhong & Hua Hua

he first primate clones made by somatic cell nuclear transfer are two geneticallyidentical long-tailed macaques born recently at the Institute of Neuroscience of Chinese Academy of Sciences in Shanghai. Researchers named the newborns ZhongZhong and Hua Hua—born six and eight weeks ago, respectively—after the Chinese adjective “Zhōnghuá,” which means Chinese nation or people. The technical milestone, presented on January 25 in the journal Cell, makes it a realistic possibility for labs to conduct research with customizable populations of genetically uniform monkeys. The academy in a news statement on its website said. “There are a lot of questions about primate biology that can be studied by having this additional model,” says senior author Qiang Sun, Director of the Nonhuman Primate Research Facility at the Chinese Academy of Sciences Institute of Neuroscience. “You can produce cloned monkeys with the same genetic background except the gene you manipulated. This will generate real models not just for genetically based brain diseases, but also cancer, immune or metabolic disorders, and allow us to test the efficacy of the drugs for these conditions before clinical use.” Zhong Zhong and Hua Hua are not the first primate clones—the title goes to Tetra, a rhesus monkey made in 1999 by a simpler method called embryo splitting (Science, v. 287, no. 5451, pp. 317-319). This approach is how twins are made, but can only generate up to 4 offspring at a time. 44

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Zhong Zhong and Hua Hua are the product of somatic cell nuclear transfer (SCNT), the technique used to create Dolly the sheep over 20 years ago, in which researchers remove the nucleus from an egg cell and replace it with another nucleus from differentiated body cells. This reconstructed egg then develops into a clone of whatever donated the replacement nucleus. Differentiated monkey cell nuclei, compared to other mammals such as mice or dogs, have proven resistant to SCNT. Sun and his colleagues overcame this challenge primarily by introducing epigenetic modulators after the nuclear transfer that switch on or off the genes that are inhibiting the embryo development. The researchers found their success rate increased by transferring nuclei taken from fetal differentiated

cells, such as fibroblasts, a cell type in the connective tissue. Zhong Zhong and Hua Hua are clones of the same macaque fetal fibroblasts. Cells from adult donor cells were also used, but those babies only lived for a few hours after birth. “We tried several different methods but only one worked,” says Sun. “There was much failure before we found a way to successfully clone a monkey.” The researchers plan to continue improving the technique, which will also benefit from future work in other labs, and monitoring Zhong Zhong and Hua Hua for their physical and intellectual development. The babies are currently bottle fed and are growing normally compared to monkeys their age. The group is also expecting more macaque clones to be born over the coming months.

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leans. “If you’re only going to focus on events that ignores the process when it’s beginning. Risk is already going up as you get into your 40s.” The guidelines stress the importance of home blood pressure monitoring using validated devices and appropriate training of healthcare providers to reveal “white-coat hypertension,” which occurs when pressure is elevated in a medical setting but not in everyday life. Home readings can also identify “masked hypertension,” when pressure is normal in a medical setting but elevated at home, thus necessitating treatment with lifestyle and possibly medications. “People with white-coat hypertension do not seem to have the same elevation in risk as someone with true sustained high blood pressure,” Whelton said. “Masked hypertension is more sinister and very important to recognize because these people seem to have a similar risk as those with sustained high blood pressure.”

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a top number (systolic) between 120-139 mm Hg or a bottom number (diastolic) between 80-89 mm Hg. People with those readings now will be categorized as having either Elevated (120-129 and less than 80) or Stage I hypertension (130-139 or 80-89). Previous guidelines classified 140/90 mm Hg as Stage 1 hypertension. This level is classified as Stage 2 hypertension under the new guidelines. The impact of the new guidelines is expected to be greatest among younger people. The prevalence of high blood pressure is expected to triple among men under age 45, and double among women under 45 according to the report. Damage to blood vessels begins soon after blood pressure is elevated, said Whelton, who is the Show Chwan professor of global public health at Tulane University School of Public Health and Tropical Medicine and School of Medicine in New Or-

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The guidelines stress the importance of home blood pressure monitoring using validated devices and appropriate training of healthcare providers to reveal “white-coat hypertension,” which occurs when pressure is elevated in a medical setting but not in everyday life.

WELL BEING

cardiovascular science for researchers and clinicians. Rather than 1 in 3 U.S. adults having high blood pressure (32 percent) with the previous definition, the new guidelines will result in nearly half of the U.S. adult population (46 percent) having high blood pressure, or hypertension. However, there will only be a small increase in the number of U.S. adults who will require antihypertensive medication, authors said. These guidelines, the first update to offer comprehensive guidance to doctors on managing adults with high blood pressure since 2003, are designed to help people address the potentially deadly condition much earlier.

RESEARCH

High blood pressure should be

treated earlier with lifestyle changes and in some patients with medication – at 130/80 mm Hg rather than 140/90 – according to the first comprehensive new high blood pressure guidelines in more than a decade. The guidelines are being published by the American Heart Association (AHA) and the American College of Cardiology (ACC) for detection, prevention, management and treatment of high blood pressure. The guidelines were presented on November 13, 2017 at the Association’s 2017 Scientific Sessions conference in Anaheim, the premier global cardiovascular science meeting for the exchange of the latest advances in

ISSUES

ccording to American Heart Association/American College of Cardiology Guidelines the high blood pressure is now defined as readings of 130 mm Hg and higher for the systolic blood pressure measurement, or readings of 80 and higher for the diastolic measurement. That is a change from the old definition of 140/90 and higher, reflecting complications that can occur at those lower numbers. In the first update to comprehensive U.S. guidelines on blood pressure detection and treatment since 2003, the category of prehypertension is eliminated.

• Normal: Less than 120/80 mm Hg; • Elevated: Top number (systolic) between 120-129 and bottom number (diastolic) less than 80; • Stage 1: Systolic between 130139 or diastolic between 80-89; • Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg; • Hypertensive crisis: Top number over 180 and/or bottom number over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage. The new guidelines eliminate the category of prehypertension, whichwas used for blood pressures with

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High Blood Pressure : 130 mm Hg is the new reading

The new guidelines stress the importance of using proper technique to measure blood pressure. Blood pressure levels should be based on an average of two to three readings on at least two different occasions, the authors said. High blood pressure accounts for the second largest number of preventable heart disease and stroke deaths, second only to smoking. It’s known as the “silent killer” because often there are no symptoms, despite its role in significantly increasing the risk for heart disease and stroke. Paul K. Whelton, M.B., M.D., M.Sc., lead author of the guidelines published in the American Heart Association journal, Hypertension and the Journal of the American College of Cardiology, noted the dangers of blood pressure levels between 130139/80-89 mm Hg. “You’ve already doubled your risk of cardiovascular complications compared to those with a normal level of blood pressure,” he said. “We want to be straight with people – if you already have a doubling of risk, you need to know about it. It doesn’t mean you need medication, but it’s a yellow light that you need to be lowering your blood pressure, mainly with non-drug approaches.” Blood pressure categories in the new guideline are:

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Rotating night shifts may trigger Type 2 diabetes If you work periodically on night shifts, it is more likely that you may develop Type 2 diabetics than those who only work during days.

study of more than 270,000 people, published online recently in the journal Diabetes Care, also found that the more nights employees work, the greater their odds of having the disease, whether they are genetically predisposed to it or not.Healthcare workers, security guards and other employees who periodically work the night shift are significantly more likely to have Type 2 diabetes than workers who work only days, according to a sweeping new study by researchers from CU Boulder and Brigham and Women’s Hospital (BWH) in Boston. “Work, particularly night shifts, disrupts social and biological rhythms, as well as sleep, and has been suggested to increase the risk of metabolic disorders, including Type 2 diabetes,” said co-first author Celine Vetter, Director of the Circadian and Sleep Epidemiology Laboratory ( CASEL) at CU Boulder. “Our study is one of the first to show a dose-response relationship, where the more often people work nights, the greater their likelihood of having the disease.” About 15 million Americans work permanent night shifts, rotating shifts or shifts with irregular schedules. Recent studies have found associations between such shift work and cardiovascular disease, diabetes and cancer, but few have looked specifically at how different work schedule characteris48

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tics impact risk. For the study, Vetter worked along with co-first author Hassan S. Dashti and collaborators at BWH, the Broad Institute of MIT and Harvard, and Manchester University, to examine data from participants 38 to 71 years old in the UK Biobank. Participants had provided detailed information on lifestyle, health status and present work schedule; 77,000 also provided in-depth lifetime employment information, and a subgroup of 44,000 provided genetic information. Participants also provided information about their “chronotype,” or whether they were a morning person or night person. Nearly 7,000 people had Type 2 diabetes. The researchers found that those who worked irregular or rotating shifts that included night shifts were 44 percent more likely overall to have Type 2 diabetes than those who never worked nights. The odds of a person having diabetes rose with nights worked. For instance, those who worked eight or more night shifts per month were 36 percent more likely to have diabetes than day workers. Notably, those who in their current schedule worked only at night showed no increased incidence of diabetes. This could be because those who tolerate nightshift work better tend to gravitate toward night jobs (permanent night-shift workers were twice as likely to have a “night owl” chronotype). But

Vetter also notes that over time, some people may partially adapt to working nights. “If you rotate through a schedule that is always changing between day and night shifts it makes it hard to adapt and you can end up with a chronic misalignment between your lightdark cycle, your sleep-wake schedule, your meal timing, and your physical activity timing.” Previous research at CU Boulder and by corresponding co-senior author Dr. Frank Scheer, director of the Medical Chronobiology Program and associate professor of medicine at Harvard Medical School, has shown that both sleepdebt and body-clock misalignment can impair glucose tolerance and insulin sensitivity—a precursor to diabetes. Vetter notes that while people may not be able to avoid working nights, maintaining a healthy weight and diet, and taking care to get enough exercise and sleep, is likely to mitigate its health risks. This was the first study to look at the genetic predisposition to Type 2 diabetes and its potential modification by shift work, and more studies are needed to replicate those findings. The authors hope that the research will also inform efforts by employers to help their workers be as healthy as possible. “Our study findings represent another puzzle piece in this quest towards healthier work schedule design,” they conclude.

Well Being

vestment in awareness and educational resources highlighting the potential adverse effects and safe use of energy drinks is required. Significant efforts should be made to educate consumers regarding the clear and present differences between soda, coffee, sports drinks and energy drinks. Energy drink education also should be a priority in school-based curricula related to nutrition, health and wellness. A research agenda must be developed to prioritize key questions about the acute and chronic effects of energy drink use. At a minimum, standard safety and efficacy studies should be performed and submitted to the FDA by manufacturers. Well-designed and controlled research is required to examine the increasing frequency of adverse events being reported by emergency departments. Healthcare providers must talk to their patients about energy drink use, and report adverse events to watchdog agencies, like the Poison Control Centers, Consumer Product Safety Commission and the FDA. A national registry should be set up to specifically track energy drink side effects with mandated reporting requirements. Volume 3 | Issue 2 | April-June 2018

NEWSCOPE

Protecting children at risk: Children and adolescents appear to be at particularly high risk of complications from energy drinks due to their small body size, being relatively caffeine naïve. The message that these beverages are not intended for children needs to be re-enforced and widely disseminated. Stop marketing to at-risk groups, especially children: Marketing should not appeal to vulnerable populations. Currently, manufacturers of energy drinks advertise on websites, social media and television channels that are highly appealing to both children and adolescents. Target marketing to sporting and other events involving children and adolescents should not be permitted. Do not use energy drinks before/during/after strenuous exercise: Regardless of health and fitness levels and until such time that proper safety and efficacy data are available, energy drinks should be avoided before, during or after strenuous activities. Some of the deaths allegedly due to energy drinks have occurred when a person consumed energy drinks before and/or after performing strenuous activities. More education and data needed: In-

WOMEN’S CORNER

TRENDS ISSUES RESEARCH WELL BEING PERSONA WOMEN’S CORNER

ACSM’s primary recommendations focus on four key areas:

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NEWSCOPE

ence and the promotion of participant safety, ACSM is focused on facilitating high performance, while protecting those who compete in athletics or engage in other forms of physical activity. By publishing the new recommendations, ACSM is helping consumers to understand the risks associated with rapid and excessive consumption of energy drinks. “When used safely and with moderation, energy drinks may have some short-term, performance-enhancing effects. However, users are generally unaware of the many potential adverse reactions that could have long-term effects, some of which are quite serious,” said Higgins. We highly encourage consumers, parents, physicians, athletic trainers, personal trainers and coaches to follow these recommendations.

WELL BEING

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Biopsies taken from three women of child-bearing age were analyzed using scanning electron microscopy. The thickness of the layers and characteristics such as the stiffness of the tissue were compared with that of four different concentrations of fibrin. “This was done to identify the fibrin formulation that best resembles the natural milieu of the human ovary in terms of architecture, porosity and rigidity,” says Chiti. The research team tested different fibrin matrix concentrations. One - which is called F50/T50 - emerged as the combination of choice in terms of ultrastructure and rigidity, as well as the way in which it closely resembles the outer layer of the human ovary. “These combinations may mimic the physiological environment of human follicles more closely, making them good candidates for the artificial ovary prototype,” says Chiti. “Such findings are essential to help us standardize fibrin matrix architecture.”

lar and concerns about their consumption are coming from every sector of society, which is why we’ve published these recommendations,” said John Higgins, MD, FACSM. “Our review of the available science showed that excessive levels of caffeine found in energy drinks can have adverse effects on cardiovascular, neurological, gastrointestinal, renal and endocrine systems, as well as psychiatric symptoms. More needs to be done to protect children and adolescents, as well as adults with cardiovascular or other medical conditions”, the statement said. Energy drinks are highly caffeinated beverages that often contain a myriad of vitamins, minerals, amino acids and herbal mixtures. As the global authority for sports medicine, exercise sci-

RESEARCH

follicles (producers of hormones such as oestrogen and the precursors of mature female egg cells) are isolated from the ovarian tissue and encapsulated within a scaffold made of fibrin that is grafted to the patient. This hopefully restores the patient’s hormonal and reproductive functions. In previous studies, Dolmans’ research team used a type of filamentous protein around which blood clots form called fibrin to construct the necessary artificial ovary tissue scaffolding or matrixes. “The ideal is that these matrixes should mimic the structure and physical properties of the human ovary in such a way that it could ideally support the growth of follicles within which the egg cell resides,” explains co-author Maria Costanza Chiti. Dolmans and her team have so far performed tests using mice tissue and follicles. But in this study, the research team turned their attention to the minute characteristics of human tissue.

latest study has warned that the excessive levels of caffeine found in energy drinks can have adverse effects on cardiovascular, neurological, gastrointestinal, renal and endocrine systems, as well as psychiatric symptoms. The American College of Sports Medicine (ACSM) recently released an official statement about the beverages. Regarding energy drinks, published in the college’s clinical review journal, Current Sports Medicine Reports. “Energy Drinks: A Contemporary Issues Paper” provides helpful guidance and warnings regarding these beverages because of the dangers they present to at-risk populations, primarily children who are the most vulnerable and the target of marketing efforts. “Energy drinks are extremely popu-

ISSUES

protein formulation based on fibrin resembles the architecture and rigidity of human ovarian tissue, and could be used for ovary transplant: Researchers Belgian researchers have taken important steps towards creating transplantable artificial ovaries. Once successful, these could be of value to women struggling with infertility or cancer patients who cannot conceive after undergoing radiation or chemotherapy. The research team has identified a protein formulation that closely resembles the structure and rigidity of the natural tissue lining a woman’s ovaries, says Marie-Madeleine Dolmans of the Université Catholique de Louvain in Belgium, in an article in Springer’s Journal of Assisted Reproduction and Genetics. Through cryopreservation, it is already possible to store a cancer patient’s ovarian tissue and to transplant it back into her body once her cancer treatment has been completed and she has gone into remission. The technique has already helped 130 mothers who survived cancer to conceive and give birth. Such treatment is, however, not advisable for patients who have a risk of malignant cells in their frozen ovarian tissue. In that case, ovarian tissue cannot be reimplanted because of the chances that their cancer could return. Developing a transplantable artificial ovary with isolated follicles from their tissue could therefore offer these women more possibilities for them to conceive. The first step in the process is to remove and freeze some ovarian tissue before a woman starts cancer treatment. When needed,

Caution! Energy drinks not safe for kids

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Infertility no more a curse; scientists develop new artificial ovary prototype

TRENDS ISSUES RESEARCH WELL BEING PERSONA WOMEN’S CORNER

Will my health insurance coverage Clinical Trials?

We feel that if treatment is; 1. Part of hospitalization in a reputed hospital like AIIMS, capable of conducting clinical trials under controlled conditions. 2. Under supervision of a reputed doctor 3. Clinical trials are approved by Medical Council (Ministry of Health) Then it will be payable. If it does not fulfill these conditions, then you may

have difficulty in getting it paid as the issue is around treatment as well as the price of the medicine. I own a pet and my vet bills are sky-high. Is there such a thing as health insurance for animals? It depends on pet. But definitely it is not part of Health Insurance policy which is for human beings only. Cow, buffalo are covered under Cattle Insurance. Should I pay my premiums through the agent? If he is ready to provide you the service – yes. It is your duty that cheques should reach the insurance company well in time. Not picking up of the

cheques by the agent is no excuse. If your cheque has not reached the insurance company on time, your policy may have a break and you may lose the benefits. You can also pay the premium online. I already have a health insurance policy. Should I still buy a life insurance policy with the riders? Health Insurance Policy covers your hospitalization needs. Life insurance covers your retirement needs. Adding of critical illness rider will take care of incidence of you getting critical illness like cancer. Every product is different and fulfills different needs. Study it carefully and make a decision.

Are the new clinical and pathological tests, not available in India and done abroad covered under the mediclaim rules of the country? If no, are efforts being made to do? You are only permitted by some insurance companies to take eopinion. Your suggestion is very good, and we feel Insurance companies will start offering the same. If Textile industry is permitted to get flammability tests done on garments in Hong Kong then why Insurance companies should not permit clinical and pathological tests (not available in India), which are to be conducted in foreign country.

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I might be laid off soon. Should I see my doctor before I lose my insurance? No purpose will be served by seeing your doctor. You should consult an Insurance Brokerage Firm and buy a health insurance policy which should be issued at least 30 days before your last day in your present company. This protects your interest.

WOMEN’S CORNER

My employer provides me with health insurance coverage. Is it advisable to take another policy on my own? If the sum assured is good and the company is doing fine then you should think positive and do not go in for additional sum. When you plan to leave the organization then you must verify from the new employer whether they have suitable sum assured available for you as part of compensation package. If no health insurance is available, then you must buy Health Insurance immediately so that 30 days cooling off period of new policy (purchased by you) is matching with last 30 days with your employer. Try to have this health insurance from the same Insurance Company. Will the agent be helpful in settling of claims in future? Yes, your agent will be helpful, but he is getting 100% of his income from the insurance company and he may be getting .001 % of his income from you. If he has to make a choice, it is natural that he will favour Insurance Company. You are the best person to

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lished by the insurance company.

How much should you invest in health insurance? You have to invest according to your health requirements and the resources you have. You can invest by deciding about your budget for health insurance or if budget is not a constraint, you can invest by deciding about the sum assured and services required by you.

WELL BEING

decide whether to buy directly from the company or through an agent. Theoretically the agent is supposed to help you in claim settlement, but time will tell when the claim is to be lodged. Be positive and buy it through agent but better buy through an Insurance Brokerage Firm as it offers wider choice and is large enough to protect your interests

RESEARCH

EXCERPTS How is the premium determined in Health Insurance? It depends on the age, sum assured, whether person to be insured has any pre-existing disease or adverse health conditions. The rates are fixed (approved by IRDA) and are available in the brochure pub-

ISSUES

f textile industry is permitted to get flammability tests done on garments in Hong Kong then why Insurance companies should not permit clinical and pathological tests (not available in India), which are to be conducted in foreign country? asks S.K Sethi, an Insurance Expert. For a hawk of health insurance business, convolutedness of the insurance cover is not a hard nut to crack but for a gullible buyer, it is not a facile task to comprehend its intricacies. Amid growing awareness for the insurance cover due to high cost involved in medical treatment at super specialty hospitals, InnoHEALTH magazine interviewed seasoned player of the insurance discipline Mr. Sethi, Vice President Insurance Foundation of India and sought answers for simple queries by people. Mr. Sethi, who is closely following recently announced National Health Protection scheme by the Union government for ten crore poor people and enthusiastically await roll out of the full scheme, said it would herald a new era in the health sector as the country has pan India facilities to implement the plan, but “ only little bit intelligent planning” is warranted.

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Insurance needs to go global: Expert

TRENDS ISSUES RESEARCH WELL BEING PERSONA WOMEN’S CORNER NEWSCOPE

Why head & face pain keeps you furious?

eople consistently rate pain of the head, face, eyeballs, ears and teeth as more disruptive, and more emotionally draining, than pain elsewhere in the body. The Duke University scientists have discovered how the brain's wiring makes us suffer more from head and face pain. The answer may lie not just in what is reported to us by the five senses, but in how that sensation makes us feel emotionally. The team found that sensory neurons that serve the head and face are wired directly into one of the brain’s principal emotional signaling hubs. Sensory neurons elsewhere in the body are also connected to this hub, but only indirectly. The results may pave the way toward more effective treatments for pain mediated by the craniofacial nerve, such as chronic headaches and neuropathic face pain. “Usually doctors focus on treating the sensation of pain, but this shows that we really need to treat the emotional aspects of pain as well,” says Fan Wang, a professor of neurobiology and cell biology at Duke, and senior author of the study. Pain signals from the head versus those from the body are carried to the brain through two different groups of sensory neurons, and it is possible that neurons from the head are simply more sensitive to pain than neurons from the body. But differences in sensitivity would not explain the greater fear and emo54

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tional suffering that patients experience in response to head-face pain than body pain, Wang said. Personal accounts of greater fear and suffering are backed up by functional Magnetic Resonance Imaging (fMRI), which shows greater activity in the amygdale -- a region of the brain involved in emotional experiences -- in response to head pain than in response to body pain. “There has been this observation in human studies that pain in the head and face seems to activate the emotional system more extensively,” Wang said. “But the underlying mechanisms remained unclear.” To examine the neural circuitry underlying the two types of pain, Wang and her team tracked brain activity in mice after irritating either a paw or the face. They found that irritating the face led to higher activity in the brain’s parabrachial nucleus (PBL), a region that is directly wired into the brain’s instinctive and emotional centers. Then they used methods based on a novel technology recently pioneered by Wang’s group, called CANE, to pinpoint the sources of neurons that caused this elevated PBL activity. “It was eureka moment because the body neurons only have this indirect pathway to the PBL, whereas the head and face neurons, in addition to this indirect pathway, also have a direct input,” Wang said. “This could explain why you have stronger activation in the amygdale and the brain’s emotional centers from head and face pain.”

Further experiments showed that activating this pathway prompted face pain, while silencing the pathway reduced it. “We have the first biological explanation for why this type of pain can be so much more emotionally taxing than others,” said Wolfgang Liedtke, a professor of neurology at Duke University Medical Center and a co-author on Wang’s paper, who is also treating patients with head- and face-pain. “This will open the door toward not only a more profound understanding of chronic head and face pain, but also toward translating this insight into treatments that will benefit people.” Chronic head-face pain such cluster headaches and trigeminal neuralgia can become so severe that patients seek surgical solutions, including severing the known neural pathways that carry pain signals from the head and face to the hindbrain. But a substantial number of patients continue to suffer, even after these invasive measures. “Some of the most debilitating forms of pain occur in the head regions, such as migraine,” said Qiufu Ma, a professor of neurobiology at Harvard Medical School, who was not involved in the study. “The discovery of this direct pain pathway might provide an explanation why facial pain is more severe and more unpleasant.” Liedtke said targeting the neural pathway identified here can be a new approach toward developing innovative treatments for this devastating head and face pain.

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The writer is an accomplished Plant Scientist with +15 years of R&D experience with specialization in cereal & pulse crop biochemistry and genomics. An ex-Research officer at University of Saskatchewan, Saskatoon, Canada and served in different capacities for eight years. She has been awarded twice for the category ‘Young Scientist (Indian Society of Plant Physiology &amp; KK Nanda Foundation for Advancement of Plant Sciences). She also serves as an Honorary Advisor to various reputed firms and reviewer of multiple Journals of International repute.

WOMEN’S CORNER

er like a prayer and tilting their head forward in respect to other person which is referred as ‘Wai’ in Thailand, ‘Sampeah’ in Cambodia and ‘Namasté’ in India. Similar gesture is followed in Sri Lanka, Nepal, Bhutan, Laos, Burma and Indonesia. Namasté reflects not only recognition of another’s physical presence, but also of their spiritual presence. Namasté is a greeting of another’s spirit, or reverence. Namah means “bow”, “adoration” and te means “you”. In other words,” I bow to you.” Flexing hands in Namasté pose releases the tension that activities like typing creates in the tendons in the

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Dr. Sarita Jaiswal

WELL BEING

represents intimacy and accepted as cultural norm in European countries and Latin America. The right-left-right alternate cheek kiss thrice is common in Russia, Poland, Slovenia, Serbia, Macedonia, Montenegro, the Netherlands, Iran and Egypt while twice in Bosnia, Herzegovina, Italy, Hungary and Rome. In Mexico and Belgium only one kiss is required. In Galapagos, women restrict kiss on the right cheek only. French people kiss twice or even five times depending upon the region. Two kisses and back slap is famous in Greece. Kiss goes always with a hug if you are in Argentina. One of the common practices is ‘pecking’ or brushing each other’s cheek with a sound of kiss. In Greenland, they often press their nose and upper lip against the cheek or forehead and take deep breath (Kunik), similar to a mother embracing her child. Saudi Arabia, UAE, Oman and various gulf countrymen show their welcome respect by ‘touching their noses’ as greeting gesture. In New Zealand, it takes another variation of in form of ‘forehead touching’. In South Asian countries, people do ‘Añjali Mudra’ in which they show their humility by placing palm togeth-

RESEARCH

reeting gestures, a language of paying honor, respect, love, adoration, graciousness, empathy towards each other. It is a global custom and has multiple variations. Each country has its own customized version and ritual.The most popular version i.e. hand-shake, probably has its roots in Great Britain. Men in the United States will usually shake hands when greeting each other, but it’s not usual for them to kiss when greeting. Americans in addition to handshaking also do fist bump, wave and hug. For English people, handshake is the formal way of greeting when meeting someone new. In informal situations, a quick kiss on the cheek is used between both men and women, and for women who know each other well. Handshake works universally as professional way to greet, though it is little firm in Germany, more extended (3-step handshake) in Botswana and for Malays it extends to touching each other’s fingertip followed by their hearts. Filipinos take hand of their elders and press it to their foreheads called as ‘Mano’. The second most common way to greet is kiss (or cheek kiss) which also

each other. An idea of handshake free zones in hospitals have encouraged awareness but also questioned how a doctor will take physical examination without touching a patient. On the other hand, we cannot ignore the fact that microbes like Acinetobacter calcoaceticus, Enterococcus faecalis, E. faecium, and Shigella dysenteriae type 1 can sustain on hand surface upto one hour while Pseudomonas aeruginosa and Burkholderia cepacia survive upto 30 minutes. Rota virus might survive for 20 min while viability of human parainfluenza virus is nearly 60 min. Studies indicate that a contaminated hand can transfer its viable contamination to seven different subjects or surfaces. One of two common items is clean paper towel and soap dispenser with average transfer rate ranges between 0.01% to 0.64% and 12.4% to 13.1% respectively. We touch our face nearly 2-5 times a minute i.e., 2000 to 3000 times a day. In fact whatever contamination we have on our hands is also getting transferred to our face. We may wonder whether our hand soap is capable of killing all the potentially pathogenic microbes. Are we washing our hands correctly and

ISSUES

By Dr. Sarita Jaiswal

wrists. It also calms the mind, helping to reduce stress and anxiety.Being a polite gesture of love and respect; it can be said to anybody. Indians take blessing from elders by complete bowing while touching feet of elders referred as ‘pranam mudra’. Bowing with no physical contact is standard greeting practice of Japanese and Chinese. Tibetan monks stick their tongue out to greet people. They also press the hands together and place them in front of their chest to show that they “come in peace”. In South Asian, various Muslims often greet through ‘adaab’ gesture, involves raising the right hand towards the face with palm inwards such that it is in front of the eyes and the finger tips are almost touching the forehead, as the upper torso is bent forward. The other countries of the world have also evolved their special ways to greet people as per their culture. One of the major health and environmental challenge we face today is rapid emergence of novel pathogens. The spread of these pathogens especially of nosocomial origin (hospital based) is often linked to cross contamination by healthcare workers and ways of greeting gestures while meeting

does it really help? We often use hand wash, sanitizers without giving attention to their content and standards. Do they qualify for antimicrobial purpose? Moreover, our greeting gestures further contribute in the spread of the germs. For healthcare workers the protected physical contact is non-avoidable choice. Healthcare workers and doctors should change their gloves while switching from one patient to another. Avoiding greetings which involve physical contacts especially during outbreaks can provide a preventive approach in managing outbreaks. Hospitals need to improve compliance with hand hygiene. Handshake free zone can be one alternative in hospitals, but they aren't designed to replace hand washing but to complement it. Creating handshake free zone will also bring attention to the hands as vectors for disease as well as improve compliance with hand hygiene. It is an easy and inexpensive way to reduce infections. It is rude to not to shake hand if a person extends its hand towards you in the name of trust and honor.We can’t be rude to others but why not to adopt ‘Anjali Mudra’, Wai, Namasté, Wave, Bowing or Adaab to greet. This respectable way of greeting with no physical contact should specially be adopted in the healthcare settings. In India, by adopting our age old greeting method especially in healthcare setting can shield us from many invisible microbial infections. We just need to adopt, practice and re-practice these gestures to decrease spread of infections.

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A Right Gesture Saves Life!

Two kisses and back slap is famous in Greece. Kiss goes always with a hug if you are in Argentina. One of the common practices is ‘pecking’ or brushing each other’s cheek with a sound of kiss.

WOMEN’S CORNER

TRENDS ISSUES RESEARCH WELL BEING PERSONA WOMEN’S CORNER

PERSONA

brain makes decisions by weighing information coming in from the various senses. He knows elite athletes are making these choices faster and more accurately – at least when it comes to decisions related to their sport. Take an Olympic skier-- They’re flying down the slope and see a gate. Do they go left or right? It’s a seemingly easy choice, but a very tough computational challenge for the brain. The skier must evaluate what they see ahead as they move, the feel of the snow pack, their speed, the tilt of their body. But because they’ve skied slopes

NEWSCOPE

WELL BEING

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Take an Olympic skier-- They’re flying down the slope and see a gate. Do they go left or right? It’s a seemingly easy choice, but a very tough computational challenge for the brain.

RESEARCH

Hopkins and a researcher in the university's Zanvyl Krieger Mind/ Brain Institute studies how the

fix it. “Think of a snowboarder doing a double McTwist or some daring maneuver that gives us all the chills,” Cullen says. “What they’ve done is they’ve practiced that maneuver over and over and over again so that they’ve built a very sophisticated model of the sensory flow they expect during that routine. And what’s also very unique about these athletes is when there’s a mismatch between what they expect and what actually occurred, rather than panicking, they can recalibrate on the fly to deal with the new constraints.” Next, the brains of Olympians have learned to ignore sensory signals that make regular people dizzy. Dizziness happens after spinning because the inner ear sends an incorrect signal to the brain. In everyday life, the inner ear sensors responsible for this error

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onsider: When 100ths of seconds count, an Olympian’s brain connections allow for faster decision-making. Though ordinary folks get dizzy just watching skaters and skiers spin and flip, the brains of these athletes have adapted in surprising ways to handle the disorientation. And while stakes are high at the Olympics, the brain activity of the contenders will reveal almost every time that will choke under pressure. Christopher Fetsch, an assistant professor of neuroscience at Johns

pull them off because of two fundamental improvements in the way their brains work. First, their brains have built intricate models for the sensory input that comes in during a proper triple Salchow or Lutz. Everyone’s brain builds models – typically for ordinary tasks like walking down the street or climbing stairs. But years and years of practicing elaborate, disorienting moves has forged considerably more complex models in the brains of elite athletes, Cullen says. While an Olympian is rotating or upsidedown, their brain is crunching data coming in from the eyes with what the inner ear knows about motion and spatial orientation and combining it with even more information from the nerves and muscles. If the flip is on point, the brain knows. If it’s not, the brain knows how to

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Minds of Medalists behind their Medals!

like this thousands of times, by the time they’re on an Olympic course, at that gate, their brains know just how to merge this disparate sensory information. Though the brain of someone who’s never skied would be at a loss, the Olympian’s brain has expertise at this precise equation of speed and snow. In about the time it takes to blink, the skier has settled on an informed plan. The entire run is a sequence of these decisions. “What set elite athletes apart from us is not necessarily their body, their strength or their agility, Fetsch says. “What really sets apart the gold medalists from just the also-rans is the quickness and flexibility with which their brains are converting input from their senses into commands to move their muscles. These rapid-fire decisions that a skier has to make going down the slope will determine whether that extra hundredth of a second is gained.” Kathleen Cullen, a professor of Biomedical Engineering and co-Director of the Johns Hopkins Center for Hearing and Balance says when Olympic figure skaters, snowboarders and ski jumpers execute breathtaking spins and flips; they

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TRENDS ISSUES RESEARCH WELL BEING PERSONA WOMEN’S CORNER NEWSCOPE

provide our perception of rotation and generate eye movements that help keep the world looking stable as we move through it. But when we stop spinning, inner ear fluid keeps moving due to inertia and also makes the eyes continue to move. We feel like the world is still whirling. But Olympians, skaters in particular, do not. Their brains have changed to quash the feeling. If you look at athletes who do a lot of spinning in training, what they’ve learned to do is suppress this false input,” Cullen says. “Over time their brain develops this ability.” According to Vikram Chib, assistant professor of biomedical engineering-Take two Olympians who are equally trained, equally fit, equally talented. If Chib could compare their brain scans, he’d have a good idea about which one is most likely 60

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to choke under pressure during the games: it’s whoever is most excited about winning gold, and all the pride, glory and potential cash that comes with it. Chib studies how incentives motivate performance. He’s found that when people are playing for high stakes, those likely to choke have wild swings of activity in an area deep in the brain that encodes value. In these people, the bigger the incentive, the more the area lights up. But once they start the activity where money is on the line, that activity plummets, the same way it would when someone thinks about losing. That neural deactivation can affect the player’s motor skills – and they choke. “Think of a hockey player taking a penalty shot,” Chib says. “They might think to themselves, I’m going to score. But when they actually take the shot, they become worried about the

possibility of failure and they miss. We think that the areas of the brain that are responsible for encoding reward and potential gains and losses are what’s coming online and interfering with their motor performance. Even a hockey player that’s trained thousands upon thousands of hours, these worries about loss or gain can interfere with their performance.” The athletes most likely to bring home a medal, Chib says, are either hard-wired to keep their cool when the stakes are high, or they’ve found a way to get mentally in the zone. “We found when you frame things appropriately; your neural activity stays pretty constant. You don’t get really amped up for high gains or really depressed for losses,” he says. “The people that can maintain very stable reward activity tend to be the ones that don’t choke under pressure.”

WOMEN’S CORNER

TRENDS ISSUES RESEARCH WELL BEING PERSONA WOMEN’S CORNER

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Alisha Thapa

cades have already passed by in public awareness and selling of sanitary pads in our country. However, various surveys report that only 12% of women population use sanitary pads and the remaining 88% rely on other unhygienic alternatives. As an answer to overcome all the aforementioned complexities, a common man from the southern part of India struggled for many years and finally in the year 2006, he succeeded

in innovating a machine that changed the game of menstrual hygiene in our country. The man behind a thoughtful initiative in women’s menstrual hygiene in India did not initially begin his remarkable journey with an intent to lead a full-fledged movement. He once had a simple and decent lifestyle in the beginning years of his life. Born in 1962, Arunachalam as a young boy grew in poverty in a small village of Coimbatore, Tamil Nadu, India. His father’s early death and his mother’s single-handed hardships eventually left him with no option but to drop out of school. From the age of fourteen, he was involved in various jobs such as tool operator, farm labourer, welder and many more to support his family. Today, he is a social entrepreneur who has designed a low cost sanitary pad making machine. An awardee of Padma Shri, he is credited for innovating grassroots mechanisms for generating awareness about traditional unhy-

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ow that the entire nation knows the unsung hero, let’s learn about how his uncomfortable journey actually began. Silence on Menstruation in our country remained extreme, until ad commercials on sanitary pads started erupting one after the other along with a revolution of Television industry in 1990s. That’s how women in urban India developed an interest to replace the cloth with a sanitary pad during menstruation days. The availability of the product became prominent in nearby stores. Sadly, situation wasn’t the same in rural India. For a very long era, women in villages and small towns relied on dirty rags and leaves and horrifyingly even used ashes and sand. Certain customs made their lives more difficult such as hiding menstrual cloth in dark areas which did not allow sterilisation of cloth from sunlight, living in a separate room during menstrual days and restriction from doing many activities. Girls dropped out of the school once the period would start or remained absent for those five days due to the lack of toilets in school. The multinational companies had entered India, but failed to pitch the rural market due to lack of three As--Awareness, Affordability and Accessibility. The biggest hurdle that was deeply rooted above all other disadvantages in India was menstrual taboos that differed with every different region. Irrespective of rural or urban society, certain customs still prevail in large amount that are followed during menstrual days such as not entering the temple, skipping religious ceremonies at home, not allowed to enter the kitchen and many more. Three de-

RESEARCH

consequences and should not be normalized or ignored. In this study we found that sexual harassment from clients or customers, which is more prevalent than harassment from other employees, is associated with an increased level of depressive symptoms. This is important as some workplaces, for example in personrelated work like care work or social work, may have an attitude that dealing with sexual harassment by clients or customers is ‘part of the job’.” The researchers found that compared to employees not exposed to sexual harassment, employees harassed by clients or customers scored 2.05 points higher on the Major Depression Inventory (MDI) – a self-report mood questionnaire that generates a diagnosis of depression together with an estimate of symptom severity. Scores on the MDI range from 20 for minor depression to 30 or more for major depression. Employees harassed by a colleague, supervisor or subordinate scored 2.45 points higher compared to employees who had experienced sexual harassment by clients or customers. When looking at clinical depression

By Alisha Thapa

ISSUES

mployees who experience sexual harassment by supervisors, colleagues or subordinates in the workplace may develop more severe symptoms of depression than employees who experience harassment by clients or customers. The research which involved 7603 employees from across 1041 organizations in Denmark was published in the open access journal BMC Public Health. Dr. Ida Elisabeth Huitfeldt Madsen, National Research Centre for the Working Environment, Denmark, the corresponding author said: “We were surprised to see the differences between the effects of harassment by clients or customers compared to harassment by other employees. This is not something that has been shown before. Previous research showed an increased risk of long term sickness absence for employees exposed to sexual harassment by a colleague, supervisor or subordinate but an increased risk was not always found in association with sexual harassment by clients or customers.” Dr. Madsen added: “Our findings suggest that sexual harassment from clients or customers have adverse

only, the researchers found no increased risk among those harassed by clients or customers compared to those not exposed to harassment, whereas those harassed by colleagues, supervisors or subordinates had a significantly higher risk of clinical depression. Out of the 7603 employees who participated in this study, 2.4% (180) were exposed to sexual harassment by clients or customers, while 1.0% (79) was exposed to harassment by colleagues. Women were more likely to be exposed than men, with 169 out of 4116 women reporting sexual harassment by clients or customers compared to 11 out of 3487 men, and 48 women reporting sexual harassment by colleagues compared to 31 men. Participants employed in care work were more often exposed to sexual harassment by clients or customers – 152 out of 2191 (6.9%) – than participants employed in other occupational groups such as education, service or industrial work. The authors note that as the number of exposed individuals in this study was relatively low, this increases the uncertainty of the reported estimates, especially for men. The observed associations may thus largely be reflective of women’s experiences. The crosssectional observational design of this study does not allow for conclusions about cause and effect. Also, the use of self-reported data that relied on participant recall may have led to sexual harassment being under- or over-reported. Despite these limitations, the authors suggest that it is important to investigate sexual harassment from clients or customers and sexual harassment by colleagues, supervisors or subordinates as distinct types of harassment and to identify methods to prevent sexual harassment and the development of depressive symptoms.

Arunachalam Muruganantham: A Tale of Menstrual Hygiene Movement

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Workplace harassment has adverse consequences

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TRENDS ISSUES RESEARCH WELL BEING PERSONA WOMEN’S CORNER

Volume 3 | Issue 2 | April-June 2018

At times, even women living in urban areas or metropolitan cities are unaware of basic hygiene that are important to follow during periods. Lack of limited education on the subject, hesitance against free flow of communication and taboos are some of the barriers that overshadow the basic hygiene knowledge of menstruation. Take a look below and see if you knew them before: n n n n n

You should change your sanitary pad once in every six hours. During heavy flow, you could change in shorter time. Wearing same pad for longer duration could lead to problems such as skin rashes and infections. Wash yourself regularly to avoid bad odour and spread of germs. Once you have decided to throw a used pad, do it properly. Refrain from flushing the pad down the toilet as it may cause blockage. Wrap it well before you discard it. Then wash your hands properly. Apply an ointment after a bath if you suffer from a pad rash. In case if it doesn’t heal, visit a doctor. While travelling, always carry extra pads stored in a clean bag or a pouch. Carrying some tissues and a hand sanitizer will be useful as well as a bottle of water will keep you hydrated. Volume 3 | Issue 2 | April-June 2018

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USEFUL TIPS AND INFORMATION ON MENSTRUAL HYGIENE WOMEN’S CORNER

(The writer works as a community manager in MixORG, New Delhi. Also generates content and strategy for brands. She runs campaigns for brands' engagement and presence on online media channels)

He showed his innovation to the Indian Institute of Technology in Madras where scientists were doubtful as they did not see any potential in the machine to compete with other innovations.

PERSONA

dollars. Therefore, Arunachalam came up with an idea to design a machine and it took four years for him to prepare the machine. He showed his innovation to the Indian Institute of Technology in Madras where scientists were doubtful as they did not see any potential in the machine to compete with other innovations. Nonetheless, IIT entered his machine in a competition for a national innovation award. Arunachalam’s machine stood first out of nine hundred forty three entries. He was presented an award by the then President of India Pratibha Patil. His next big move is to reach the wider world and he plans to expand to as many countries such as Kenya, Nigeria, Bangladesh and many more. Inspired from his breakthrough innovation, the film Industry in India initiated a film on February, 2018 titled as ‘PadMan’.

WELL BEING

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RESEARCH

He was left all alone in the world, but nothing could stop him or weaken his determination. However, the cotton pad he had managed to design couldn’t produce an output like any other branded sanitary pad. Lack of knowledge and resources and inability to speak or understand english were some of the first hurdles in his method of research. He would send those branded pads for laboratory analysis and everytime cotton would be detected as the main material, whereas his own cotton creation was failing. With the help of a college professor, he started writing and asking the big manufacturing companies. In reply, he was being asked about the kind of plant he owned and to which he had no clue of what the companies were asking. Subsequently, he started saying that he was a textile mill owner in Coimbatore and he was interested in setting up a business in sanitary pads. Therefore, he required few samples to start with. That statement did work in his favour. It took him more than two years to discover the material used in a sanitary pad and it was cellulose extracted from the bark of a tree. Very soon he realised the requirement of a machine to break down the material. Buying a machine meant expenditure of thousands of

ISSUES

his honest and small attempt which we know today as a worldwide phenomenon. In his first attempt, he made a pad completely made out of cotton. After he faced series of unwillingness to wear and test the pad for feedback from his wife, sisters and the medical college girls, he decided to wear and test the product on himself. That is how he officially became ‘the man who wore a sanitary pad’. Interestingly, he created an artificial uterus from a football bladder and filled goat’s blood in it. He then attached a pipe in the bladder and directed it towards the pad he wore. He walked, cycled and ran as he pumped the blood from the bladder and everytime sensed a foul smell of the blood. Day by day, his involvement in the research deepened. On the other side, his activities were wrongly judged by the village people and he was even addressed as a mad man. Some avoided him and some declared him to be suffering from sexual disease as he washed his blood stained clothes in a public well. Bigger problems awaited him. Within the eighteen months of his research, his wife left him with a divorce notice being slapped on his face as well as his mother left the house. With the ever-growing superstitious beliefs of the villagers, it eventually became tough for him to live and he was finally ostracized from his village.

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gienic practices around menstruation in rural India. So, what made Arunachalam think deeply about menstrual hygiene? How did he come across the idea of designing sanitary napkins for women? Well, his marriage with Shanti and the aftermath gave birth to a genius that developed within him. In the late 90s shortly after his marriage, one day Arunachalam noticed that his wife was hiding something on her back. She showed him the dirty cloth stained with blood and Arunachalam was shocked to discover that the dirty cloth was used during menstruation days by his wife. He himself felt that he would never consider using that dirty cloth to even clean his scooter. On wife’s part, it was the other household budget that made her discard the usage of sanitary pads. As a gesture to impress his wife and take care of her personal hygiene, Arunachalam travelled to the town and bought a pack of sanitary pads for his wife. As he touched the pad for the first time, he knew that the cotton was the primary material needed for a pad. He could also make out the serious amount of price being charged for a 10 gram cotton-made pad. With a hope to design affordable pads for his wife as well as the women around his village area, he started off

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NEET’S QUALIFICATION MANDATORY FOR FOREIGN MEDICAL COURSE

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WOMEN’S CORNER

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WELL BEING

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admission to all medical courses in the country. Indian students can also pursue medical education abroad and have to qualify a Screening Test called Foreign Medical Graduates Exam (FMGE), for registration to practice in India after obtaining primary medical qualification (MBBS) overseas.

ENCOURAGEMENT OF AYUSH MEDICINES C entral Council for Research in Homoeopathy, an autonomous body under the Ministry of AYUSH has signed a Memorandum of Understanding (MoU) with Royal London Hospital for Integrated Medicine, United Kingdom on Cooperation in the field of Research and Education in Homoeopathic Medicine. The MoU aims at strengthening & developing co-operation in the field of Research & Education in Homoeopathic Medicine at International level. This encompasses joint research projects; exchange of information; organisation of seminars/workshops etc, stated by Minister of State (Independent Charge) for AYUSH, Shripad Yesso Naik.

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he government would set up 15 new biotechnology incubators and another 15 new technology business incubators in this financial year. The new initiatives spelt out in the budget is designed to help translate new technologies developed by biotech and other companies into products of use to society, said Minister for Science and Technology and Earth Sciences Dr. Harsh Vardhan. Apart from the incubators, the Biotechnology Industry Research Assistance Council (BIRAC) will support setting up of 3,000 additional Start-ups in different parts of the country. (The article is shared from India Science Wire)

the Eligibility Certificate for such persons, provided that such persons fulfils the eligibility criteria for admission to the MBBS course prescribed in the Regulations on Graduate Medical Education, 1997. A common National Entrance Exam viz. National Eligibility-cum-Entrance Test has been made mandatory for

WOMEN’S CORNER

he Indian Citizens / Overseas Citizen of India intending to obtain primary medical qualification from any medical institution outside India, on or after May 2018, shall have to mandatorily qualify the NEET for admission to MBBS courses abroad. The result of NEET shall be deemed to be treated as

PERSONA

NEW INITIATIVES TO BOOST TECHNOLOGY INCUBATORS

WELL BEING

las! A sparkling peg of Champagne eluded him for a while. So what? A bucket full of joy was waiting for 27-year-old second-year urology resident Dr Sij Hemal who works at Cleveland Clinic’s Glickman Urological and Kidney Institute. After attending a wedding in Delhi and travelling in the main cabin, Dr Hemal had just begun his Paris to New York segment in luxurious executive class, relaxing up his strained and jet lagged body and waiting for a champagne glass while browsing

cian working for Alliance for International Medical Action. Very soon, however, their activities heightened. Within the course of an hour, Toyin’s contractions accelerated; they occurred seven, then five and finally two minutes apart. “That’s when we knew we were after about 30 minutes of pushing, Toyin gave birth to a boy, whom she named Jake. Dr. Hemal safely removed the placenta, used a surgical clamp (and a shoestring) to tie off the umbilical cord, and then cut it off with a pair of scissors. Dr. Shepherd assessed Jake’s health, which appeared to be normal. Soon, Dr. Hemal began nursing on Jake’s mother although his practice area is urology; he had delivered seven babies during medical school – although never on the floor of a jetliner. A beaming Toyin recalls being rather composed throughout the delivery, thanks to the calm manner of the two doctors and the professional treatment they provided: “I was relaxed because I knew I was in safe hands. They did everything a doctor or midwife would have done if I was in the labor room in the hospital. …”

RESEARCH

on TV screen for an absorbing movie. Next to him, by happen chance, was a pediatrician Dr. Susan Shepherd. He, too, was in a relaxed mood. But then, suddenly whole scene underwent a dramatic change.That’s because a fellow passenger – 41-year-old Toyin Ogundipe, a banker in Nigeria – went into labor about midway into the flight. An emergency landing would require a two-hour diversion to a U.S. military base in the Azores Islands. “Her contractions were about 10 minutes apart, so the pediatrician (Dr. Susan Shepherd) and he began to monitor her vital signs and keep her comfortable, Dr. Hemal explained later. The doctors used instruments and supplies in the flight’s scanty medical kit to routinely check her vital signs, including blood pressure, Oxygen rate and pulse. Dr. Shepherd is a US pediatri-

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BABY ON JETLINER

How crucial are business models for the healthcare organisations?

AVE YOU EVER THOUGHT, long and hard about what can be key to your success in a business startup? You might be having all ideas to accomplish your dream but you donâ&#x20AC;&#x2122;t have any clue how to jot down the proposal to clinch the deal. Sitting thousands miles away from comforts of his home in Finland, A Finnish Professor Paul Lillrank, with one hand in his trousers ,adjusts his specks on a crispy winter morning recently in posh Lutyen

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zone of Indiaâ&#x20AC;&#x2122;s national capital to address a select select group of professionals, aspiring entrepreneurs and experts from prestigious business and management institutes. A clam composure of the professor, writer of many books on healthcare, was infectious as he along with another expert Sachin Gaur started presenting a threadbare account of points to be highlighted in the business proposal before it is thrown to the practice and before financers and other stake holders.

In the third IC Innovators Club meeting, Prof Paul Lillrank of Aalto University, Finland and Sachin Gaur, Director, IC deliberated with club members on the business models. The workshop was named as the business model canvas. The participants from successful health ventures as far as Nagpur participated. Many of the businesses do not experiment with their business model, hence they are not able to maximize the revenues, profits or impact! Alexander Osterwalder has

Sachin Gaur further added to the workshop on the practical side by running the business model and value proposition canvases by asking two volunteers among the IC Club participants to share their business cases. examined the business models and designed a canvas on which a business model workshop can be run as a simulation and new adjustments for the betterment of businesses can be made. Ever since its creation business model canvas has seen fifty million plus downloads. This IC Club meeting used the business model canvas as a tool. Prof Paul Lillrank has been studying the topic already for more than a decade and brings the academic rigor in understanding the dynamics of healthcare businesses. He not only shared the underlying constructs for efficient and robust

healthcare models but also the understanding of what makes the most successful models like that of Arvind Eye Care work. He also shared how a desire to copy Arvind Eye Care in Finland resulted in creation of a mega dental clinic. Which clearly illustrates that the fundamentals of good business models are universal cutting geographies and specializations. Sachin Gaur further added to the workshop on the practical side by running the business model and value proposition canvases by asking two volunteers among the IC Club participants to share their

business cases. The participation of the audience in sourcing the business model for the two business cases was an enriching exercise not just for the volunteers but for the entire room. As the transaction cost for soliciting relevant feedback from an accomplished crowd of forty plus diverse set of people would have taken the two example businesses more than a month, which the club as a platform could solicit in a matter of few hours for them! This remains as the core motto of the IC Club which is to act as a force multiplier for new and innovative businesses by connecting them with a diverse set of health experts. Who are constructive and see themselves as a change agent for good! If you want to run a business model canvas workshop for your organization or institution, donâ&#x20AC;&#x2122;t hesitate to contact us at info@innovatiocuris.com Volume 3 | Issue 2 | April-June 2018

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