New Delhi: Anuradha Mattoo's two sons, aged 5 years and one month respectively, were born on the same date – December 29. But that was no co-incidence. "When I realized that my second baby is also expected in the same timeframe as the first one, I prayed the delivery happens on the same date as well," says Motto. And when she was admitted with labor pains on the evening of December 29th last year, she has two options – either to wait for normal delivery which would have taken another day or get a caesarean section (C-sec) done on the same day. She chose the later.
Around the world, more an more women are going for C-sec over a normal delivery although the reasons may vary. Perhaps that is why a recent WHO report, which reviewed nearly 110,000 births across Asia in 2007 – 08, found that 27% were done under the knife, "partially motivated by the hospitals, business interests or by expectant mothers and their families." The survey found the world's highest C-sec rate in China, pegging it at 46%, a quarter of them not medically necessary. According to the report, which was published in the medical journal The Lance, the C-Sec rate in India was 18%.
"Nevertheless, C-sec is fast becoming the preferred mode of delivery in India as well, "say gynecologist Madhu Prakash. The reasons are many, she says. Some women opt for the surgery to choose their delivery day after consulting fortune tellers for "lucky" birthdays; others fear painful natural births or worry about damage to the vaginal region. Some women also prefer the operation because they mistakenly believe it is less risky. On special days, like New Year's Day, the number of C-sec deliveries rise abnormally says Prakash.
Last year, for instance, operation theatres turned into assembly lines for the Janmashtami baby boom, as it is believed that a baby born on this day is a reincarnation of Krishna. Although mothers can opt for C-sec once the baby has reached the 38th week, increase in this procedure is cause for alarm, since unnecessary C-sections are costlier and raise the risk of complications.
Vineeta Pandey, NEW DELHI
The Medical Council of India (MCI) has banned doctors from receiving gifts and sponsorships from pharma companies, allied healthcare industry and sales representatives. If doctors fail to abide by the rule their licenses will be cancelled. The MCI, which is the regulatory body for medical professionals and medical education in the country, has amended its Indian Medical Council (professional conduct, etiquette and ethics) rules to add a strict code of conduct for doctors.
It has been found that doctors prescribe expensive antibiotics and painkillers made by multinational companies even though generic alternatives are available. They also prescribe particular medicines and devices manufactured by specific companies and sold by specific shops. "It often transpires that these companies sponsor foreign trips for doctors, give them gifts or commission. This is an unhealthy practice that we want to stop," said health and family welfare minister Ghulam Nabi Azad.
Some doctors have welcomed the rules, but apprehensions about its proper implementation remain, especially since similar efforts in the past have failed. "There is fierce competition amount doctors and we believe the peer group would tip-off against any violations," said MCI president Ketan Desai.
New norms also ban doctors and their families from taking sponsorship from pharma companies to attend conferences, seminars and workshops. Free vacations have also been made illegal. Doctors have also been asked not to become advisor to any pharma company.
The MCI has also banned doctors from accepting any cash or grant from companies. Funding for medical research, study etc. can be received through approved institutions in accordance with rules laid down by them. This too has to be fully disclosed. In case of medical research , the papers will have to be passed by a proper ethics committee. Doctors will have the flexibility to get their correct research published without worrying about the interest of the pharma company that funded the research.
It is documented as the most difficult form of breast cancer to treat. But, most worryingly, Her-2 positive – as this aggressive form of breast cancer is known – is more common among Indian women than among their western counterparts. It is this scary susceptibility that two Indian doctors will study in great detail over the next two years. "We will study what are the risk factors among Indian women for developing Her-2 positive breast cancer," says Dr. Sudeep Gupta from Tata Memorial Hospital in Parel, who will conduct the Mumbai leg of the study.
His research partner, Dr. Shona Nag from Pune's Jehangir Hospital, says that the duo will study 1,000 women who for the firs time walk into breast cancer clinics at Tata Memorial and Jehangir hospitals in the next few months. " While two-thirds will be recruited at Parel, the rest will be recruited in Pune," she adds. These women will be put through a battery of tests to map their risk factors. One point would be to assess how much of a role does their ethnicity play in deciding the type of breast cancer.
There are three types of breast cancer – namely hormone – positive, Her-2 positive and triple negative. "In the West, hormone positive accounts for 60-65% of all breast cancer cases. In India, it accounts for only 40-50% of the cases," says Dr. Nag. The more aggressive and more difficult to treat types – Her 2 positive and triple - negative – account for 20% and 15% respectively in the West. Says Dr. Gupta, "But in India Her-2 positive account for 30% and triple-negative accounts for 25% of the cases."
He adds, "We will try to understand if the disease pattern among our urban women is mimicking the West. Moreover, we will also look at whether risk factors such as being a vegetarian or a non-vegetarian or an infection is a trigger." Incidentally, this study is sponsored by pharma major GSK as part of its Oncology International Ethnic Research Initiative. "Of the 3.2 billion women in the world, 90% are non – Caucasian.
In 2002, there were more than one million new cases of breast cancer in the world, making it the most common cancer among women, with around 40% of cases in developing countries," says a company spokesperson about the reason for instituting the global study.
Chicago: Genes in the mother and the foetus play a role in the risk of preterm labor, a leading cause of infant death and disability, US government researchers said on Thursday. They said gene variants in the mother and foetus can make them susceptible to an inflammatory response to infections inside the uterus, raising the risk that a baby will be born early before 37 weeks of gestation. A preterm baby has a 120 times greater risk of death than a baby born full term
Preterm birth is one of the most serious and significant challenges to medicine and society and one whose importance is not fully recognized," said Dr. Roberto Romero of the National Institutes of Health, who presented his findings at a meeting of the society for Material – Fetal Medicine in Chicago. Romero said the findings support the notion that preterm delivery is an evolutionary mechanism intended to protect baby and mother from infection. "We have established that one of every three premature babies is born to a mother who has an intra-amniotic infection an infection in the normally sterile amniotic fluid that surrounds the developing foetus, Romero said.
Because the response to infections is controlled by genes, Romero and colleagues set out to identify which are most likely to play a role in response to infections in the amniotic fluid. For the study, the team analyzed 190 genes and more than 700 DNA variants from 229 women and 179 premature infants in Chile. They compared these to genes from 600 women who delivered their babies full term. "What we found was there were some DNA variants in the foetus that were associated with the occurrence of premature labor and delivery and there were some genes in the mother that also increase the risk of premature labor and delivery, "Romero said.
In the foetus, the strongest gene influence was the interleukin 6 receptor, which is involved in the body's response to inflammation. In the mother, the team focused on one gene called tissue inhibitor of metalloproteinase 2, or TIMP2, which affects structures in the cervix and uterus that get broken down at the start of labor. Romero said when there is an infection, the combination of these two genetic profiles raises the risk of preterm labor as the body attempts to preserve the mother's and baby's lives.
New Delhi: The Consumer Protection Act (CPA) should not be a "halter round the neck" of doctors to make them fearful and apprehensive of taking professional decisions at crucial moments to explore the possibility of reviving patients hanging between life and death, the Supreme Court said on Wednesday. "Doctors in complicated cases have to take chance even if the rate of survival is low. A doctor faced with an emergency ordinarily tires his best to redeem the patient out of his suffering. He does not gain anything by acting with negligence or by omitting to do an act," said a bench of Justices Dalveer Bhandari and H S Bedi dismissing a CPA complaint against Batra Hospital and Medical Research Centre here.
Kusum Sharma had claimed Rs. 45 lakh compensation against the hospital for the death of her husband R.K. Sharma – a senior operations manager in the IOC. The national Consumer Disputes Redressal Commission had dismissed her complaint. Finding such CPA complaints against doctors on the rise and in many cases these being frivolous, the bench said, "Courts have to be extremely careful to ensure that unnecessarily professionals are not harassed and (or else) they will not be able to carry out their professional duties with fear."
Tracing the development of the law in major cases of medical negligence in India and other countries, especially the UK, the bench collated a 11-point guideline for courts to adjudicate complaints against doctors. They are:
Despite 42,000 Cr kept Aside for Rural Med Care, Rs.10,000 Cr. lying unspent. As the country awaits another Central Government Budget, there is a growing demand for more financial muscle on several fronts. But, is throwing money at complex problems really a solution? A look at the progress of crucial program of the government, the National Rural Health Mission (NRHM), indicates that money can't buy everything.
One of the biggest bottlenecks facing policy makers is that of medical personnel. Recently released data by the ministry of health and family welfare shows a shocking short fail of doctors, nurses, health assistants, radiographers, pharmacists and other personnel in the rural health delivery structure. This is despite over 822,000 new personnel being appointed under NRHM in the past four years and many villages getting to see a doctor for the first time.
The situation is worse for qualified doctors. Just 20% of required paediatricians and only about 26% of surgeons, obstetricians and gynaecologists, and general physicians are in place. They are needed at the Community Health Centres (CHC), each serving a population of 1.2 Lakh. Among technical personnel, only about 40% of laboratory technicians are in place to run diagnostic labs. There is a shortfall about 25% for pharmacists, and 16% for staff nurses. Even at the lower rungs of the medical service hierarchy, like the health sub-centres and primary health centres, many of the key personnel are not yet appointed. Nearly a quarter of 46,000 male and female health assistants are missing, while over 60% of health workers are not yet in place. The situation is much better for the auxiliary nurse and midwife (ANM) with about 90% appointments having taken place, but that still leaves nearly 16,000 ANM posts vacant. Two ANMs are required at the primary level in order that delivery cases are handled day and night. Just about one third of the PHCs are functioning with two ANMs.
Expenditure data shows that the problem is not of resources. Out of the Rs.42,000 crore released by the central government in the past four years for NRHM, nearly Rs.10,000 crore is lying unspent with state governments. In addition, all the state governments together have allocated an eye-popping Rs.1,06,388 crore for health and family welfare in their respective states.
Yet, progress under NRHM, has been uneven, and the country is still far from achieving goals set for various health indicators. "Spending money jazzing up an auto-rickshaw is not going to convert it into a going to convert it into a car", says public health expert Dr. Amit Sengupta. A thorough revamp of the infrastructure is needed and the government needs to think afresh about it, he says.
But why are medical personnel not in place? "An indifferent political leadership and bureaucracy, deficient medical education infrastructure, especially for technical and paramedical staff, low salaries for doctors, and frustration among them in rural postings as there are no drugs, no support staff and erratic infrastructure, are some of the problems," Sengupta said "Sadly, doctors prefer lucrative private incomes in urban areas or foreign lands, rather than serving people in the villages," he says.
The woman sent by government scientists visited the Queens apartment repeatedly before finding anyone home. And the person who finally answered the door – a 30 years-old Colombian – born waitress named Alejandra – was wary. Although Alejandra was exactly what the scientists were looking for – a pregnant woman – she was "a bit scared", she said, about giving herself and her unborn child to science for 21 years. Researchers would collect and analyze her vaginal fluid, toenail clippings, breast milk and other things and ask about everything from possible drug use to depression. At the birth, specimen collectors would scoop up her placenta and even her baby's first feces for scientific posterity.
Authorized by Congress in 2000, the National Children's Study began last January, its projected cost swelling to about $6.7 billion. With several hundred participants so far, it aims to enroll 100,000 pregnant women in 105 counties, then monitor their babies until they turn 21. It will examine how environment, genes and other factors affect children's health, tackling questions subject to heated debate and misinformation. Does pesticide exposure, for example, cause asthma ? Do particular diets or genetic mutations lead to autism ?
"This is a very important study for understanding the health of our nation's children," said Francis Collins, the director of the National Institutes of Health, which is overseeing the study.
participants in the study provide the names and phone numbers of relatives and friends, so researchers can find them if they move. As children grow, scientists, including outside experts, can cross–reference information about their medical conditions, behavioral development and school performance. Clues could emerge if, for example, disabled children in both rural Alabama and suburban California show similar genetic patterns or chemical exposure.
New Delhi : An Abysmally shameful ratio of one nurse for every 1,100 people in India has finally made the health ministry sit up. With the country facing an acute shortage of trained nurses, the ministry has now decided to let married women get admission to nursing courses. Nursing Council director T Dileep Kumar has shot off a letter to all stated directing them to allow married women to take admission in nursing colleges.
India has 2,000 nursing diploma school, 1,200 nursing degree schools and 281 MSc nursing colleges. Annually, the country produces around 60,000 nurses. "But majority of them work in the private sector. At present, we have a gap of 3.5 lakh nurses," Kumar told TOI. Officials say one reason why India is facing an acute shortage of trained nurses is the mass exodus of qualified nurses to Europe for better pay. "By the end of the 11th plan (2007-2012), India will require 10.43 lakh nurses. But with the existing infrastructure, the number would stand at just 6.84 lakh, short by 3.59 lakh nurses," an official said. India has a capacity to train 79,850 diploma nurses, 41,650 graduate nurses and 1,940 post-graduate nurses per year. However, over 20% of this number every year head to foreign shores. "For every 500 persons, there has to be one nurse," an official said. The ministry has now increased the retirement age of the faculty in nursing colleges to 70 years. At a meeting of the consultative committee of Parliament on health, held on Wednesday, it was decided to relax the qualification and experience of nursing teachers upto 2012. the eligibility criteria to admission for diploma and degree has been relaxed by 5%
Teacher student ratio for MSc programme has been relaxed from 1:5 to 1:10. Some of the other measures are sharing of teaching faculty for both diploma and graduate programme, establishment of centres of excellence at the state level at a cost of Rs.20 crore per institution and opening of 269 nursing school in high focus states.
The Medical Council of India (MCI) has finalized a code of conduct restraining doctors from getting influenced by drug makers through gifts and other disguised bribes to bring down costs for patients. "Our efforts of the past three years have finally borne fruits and we have been able to bring out an enforceable code of ethics for doctors", said Dr. Ketan Desai, President, MCI.
The MCI's code prohibits doctors from receiving gifts, travel facilities, hospitality, monetary grants, medical research, endorsements, etc. The notification on December 10, 2009, amended the 'Indian Medical Council (Professional Conduct, Etiquette and Ethics), Regulations 2002', stipulating guidelines to be followed by medical practitioners in the country.
The doctors self – regulatory body has been looking for ways to prevent corruption in the profession. This is probably the best step the body could have taken, although there is a belief that it may not be effective given that it won't be able to supervise lakhs of doctors spread throughout the country. MCI is an appellate body regulating the country's medical practitioners through various state medical councils. The council started working on the draft regulations in 2006.
With the code, medical practitioners are prohibited from receiving gifts, cash or monetary grants, accepting tours, paid vacations of any hospitality from any representatives of pharma or health care companies under any pretext. They will not be allowed to endorse any drug or product publicly and ensure that their professional autonomy is not compromised. They may, however, work for pharmaceutical and allied healthcare industries in advisory capacities, as consultants, as searchers, as treating doctors or in any other professional capacity.
Sydney : Women will soon be able to tell how many eggs they have in their ovaries in a simple hormone test that Australian researchers said on Sunday could revolutionise family planning and fertility treatment. Women are born with an average of one to two million eggs in their ovaries, which are shed monthly until menopause, with a 20 years old women typically having 200,.000 eggs. That number halves as she enters the 30s and dwindles to as low as 2,000 after the age of 40.
The so called "egg timer" blood test would be able to accurately predict ovum levels based on the concentration of a specific fertility hormone, said conception specialist Peter Illingworth. "I think this is a big step forward", said Illingworth, medical director of IVF Australia. "What the test will do is identify those younger women who may well be at serious risk of not having children easily when they're older", he told public broadcaster ABC. "It will identify women who are at risk of having a premature menopause for example and allow women to plan how active they should be about fertility treatment".
Women who had under gone treatment for cancer or endometriosis or had ovarian surgery would particularly benefit from the antimullerian hormone (AMH) test, he said, which would cost just $58. It could also save couples tens of thousands of dollars in expensive but ultimately futile in-vitro fertilization treatments.
"From my perspective as a doctor, this test gives us a basis of providing advice to women on how quickly they should get involved in active treatment. For example, it is a common situation for a couple to try for six or eight months and go to a fertility clinic to seek advice. If all the tests are normal at that point, then there's no rush for them to seek treatment", he said.
London : One of the world's largest studies of the contraceptive pill has found that women who have taken it live longer and are less likely to die from any cause, including cancer and hear disease. The new study by Royal College of General Physicians, involving 46,000 British women over 40 years, has revealed the birth – control pills are not linked to long-term health risks from cancer or heart disease, the London Times reported.
While younger women are at slightly higher risk of suffering heart attack, stroke or breast and cervical cancers while taking the pill, the scientists claim that this effect is negligible and outweighed by wider benefits. Any adverse effects of the pill disappear within ten years of stopping it, and could easily be counteracted by regular checks and a healthy lifestyle, they said. Philip Hannaford, a professor at the University of Aberdeen who led the study, said that over a lifetime, women who took the pill at any stage were less likely to die from any cause than those who did not. "Our best estimate is that if you took a group of 100,000 women and they used the pill for a year, on average you would have 52 fewer deaths in those women compared to those using other forms of contraception", he said.
However, according to the scientists, the beneficial effects may only be true for women who have taken older style pills – rather than those on newer drugs, having slightly different formulations. "Many women, especially those who used the first generation of oral contraceptives many years ago, are likely to be reassured by our results", Hannaford and Colleagues wrote in the study.
Earlier reports from the same study – known as the Royal College of General Practitioners" Oral Contraception Study and one of the world's largest ongoing investigations into the health effects of oral contraceptives – suggested the drugs may increase the risk of dying sooner, particularly in older women or those who smoked.
Indian Vice President Shri Mohd Hamid Ansari releasing the comprehensive abortion care guidelines in New Delhi on April 12, 2010, with Union Minister for Health and Family Welfare, Shri Ghulam Nabi Azad and the Ministers of State for Health and Family Welfare, Shri Dinesh Trivedi and Shri S. Gandhiselvan. Ipas India
Training and Service Delivery Guidelines, underlining the government's commitment toward increasing access to safe abortion services in the country.
The guidelines endorse a comprehensive approach to abortion care and aim to enhance the availability and quality of safe abortion services in the country. They are an updated consolidation of all aspects of service provision including safe technologies – manual vacuum aspiration (MVA) and medical methods of abortion – infrastructure requirements, legal information, counseling and pre- and postabortion care, for both first- and second-trimester abortions.
The guidelines also attempt to address the lack of trained providers in the country, and include a section on training protocols, including curriculum and other requirements to enable program managers, and public and private sector doctors to implement and participate in safe abortion trainings. The Ministry of Health and Family Welfare (MoHFW) believe this document will aid program managers and service providers in increasing access to high-quality, safe abortion services.
The MoHFW convened an expert group of partners and included representatives from professional organizations, nongovernmental organizations, multilateral organizations, academia, MoHFW and state health systems to draft the guidelines.
Vinoj Manning, Ipas India country director says, "Ipas is glad to have been a part of the expert group and played an active part in developing this document of national relevance. We look forward to working with the Ministry and other stakeholders in translating this commitment into action at all levels of the health system."
Ipas plans to facilitate wide dissemination of the guidelines to public and private sector providers, program managers and policymakers.
Going nuts in your diet can be good for your health, according to a new study, which shows that eating nuts helps to lower blood cholesterol levels.
People who ate an average of 67 grams of nuts a day saw a 5.1% fall in total cholesterol concentration and a 7.4% drop in low density lipoprotein cholesterol (LDL-C) – sometimes referred to as bad cholesterol – concentration compared to no-nut eaters, the study published on Monday showed.
People with high triglyceride levels who ate nuts saw a 10.2% fall in those blood lipid levels, said the study, which analyzed data from 25 trials conducted in 7 countries, involving 583 men and women aged 19-86 with high or normal cholesterol levels. All the trial data that were analyzed for the study compared nut-eaters to a control group that did not eat nuts. None of the participants were taking medication to lower their blood lipids.
Researchers led by Joan Sabate of Loma Linda University in California found in the study published Monday in the American Medical Association's Archives of Internal Medicine that the benefits to health were the same no matter what nut is eaten.
A person's weight and baseline LDL cholesterol levels did, however, influence whatever benefits might be derived from eating nuts. The higher the starting LDL-C, the greater the cholesterol-lowering effects of nuts, the study found. And the lower patient's body mass index the greater the effects of nuts on lowering cholesterol levels, the study found.
Researchers from University of North Carolina believe a blast of ultrasound to the testes can safely stop sperm production for six months.
The scientists, in fact, are beginning to conduct tests to see if ultrasound can be used as reversible male contraceptive, reports the BBC News website.
Lead researcher James Tsuruta said : "We think this could provide men with up to six months of reliable, low cost, non-hormonal contraception from a single round of treatment.
With a grant of $100,000 from the Bill & Melinda Gates Foundation the researchers hope to offer a new birth control option to couples throughout the world.
"Our long-term goal is to use ultrasound from therapeutic instruments that are commonly found in sports medicine or physical therapy clinics as an inexpensive, long-term, reversible male contraceptive suitable for use in developing to first world nations."
Once the testis has stopped producing sperm and all "sperm reserves" have been depleted, the man will be temporarily infertile. The effects of ultrasound waves would easily wear off and leave men with no adverse side effects, believe experts.
The search for a male "Pill" has intrigued researchers for decades. However, progress has proved extremely slow. Reasons include a lack of interest from pharmaceutical firms and a lingering behalf that many women would not entrust the job of preventing pregnancy to men.
Early research has suggested that the method could be successful. However, experts warned that the long-term effects were still unknown.
The idea of using ultrasound waves has been around since the 1970s, but had failed to attract much scientific support. Then in 2007 another North Carolina study suggested that it could be effective at the same time as researchers in Italy found that the technique worked on dogs. Raffaella Leoci, from the University of Bari, who led the animal study, said : "It's great that many people are working on ultrasound – it will make it easier to get the answers we need."
Expectant mothers pay more heed to their mother’s advice during pregnancy than to their doctors’ suggestions, researchers say.
A University of London team talked to women who gave birth in the 1970s, 1980s and the 2000s. Modern women were more likely to take a mixture of advice – but were still more likely to follow family wisdom, the BBC reported on Friday. One baby charity said family tips were useful; but medical advice should be sought if mothers-to-be had worries.
The researchers talked about pregnancy and childbirth advice to seven women who gave birth in the 1970s and 12 of their daughters who had babies in the 2000s. They then also analysed interviews on the same topic which had been carried out with 24 women in the 1980s. The 1970s women were most likely to take advice from family members.
But researchers found that women who had babies between 2000 and 2010 had to evaluate a wide range of information from doctors, midwives, books, magazines and the internet – as well as that from their families. In these women, it tended to be family advice that won out – particularly if a mother to be was dealing with a specific symptom, the BBS said.
One woman, Hetty from the 2000s generation, told the researchers she had tried to stop drinking tea because she had read on the internet that caffeine could cause miscarriages in the first few weeks of pregnancy.
But she then added she had taken her grandmother’s advice that tea could help relieve morning sickness. “She just used to stay in bed and have a cup of tea. And that did help actually.”
Professor Paula Nicolson from Royal Holloway, University of London, who led the study, told the BBC : “When it comes to the church – if women feel sock for example – they will take their mother’s or their grandmother’s advice.
“They wouldn’t necessarily recognize how important it was to them, but it would override the science.”
She added : “Taking all the guidelines too seriously leads to anxieties. Lack of self confidence also can lead to worry about ‘doing the wrong thing’ which is potentially more harmful than taking the odd glass of wine or eating soft cheese.”