Geetha Mani

Probiotics as Dietary Supplements in Maintaining Health

Probiotics as Dietary Supplements in Maintaining Health Probiotics are micro-organisms that provide health benefits when consumed. Lactic acid bacteria and bifidobacteria are the most common types of microbes used as probiotics, but certain yeasts and bacilli may also be used.

Perceived levels of stress and its correlates among residents of old age home in Kanchipuram District, Tamil Nadu

Introduction: Elderly are vulnerable to stress from various causes. The elderly in old age homes are a distinct population with lack of family and social support contributing to an increased prevalence of stress. This study was carried out to assess the perceived stress among inmates of an old age home in Kanchipuram District, Tamil Nadu. Materials and Methods: A descriptive, cross-sectional study was conducted among 100 inmates of an old age home in Kanchipuram District, Tamil Nadu between May and July 2012, using a semi-structured questionnaire. Perceived levels of Stress among elderly were assessed using the perceived stress scale-10. Results: Nearly 18% of the participants had high stress scores and 60% had moderate stress scores. Gender, co-living status with spouse was found to be significantly associated with stress scores. Conclusion: The perceived stress was high among inmates of old age homes. There is a need for organized family and social support to improve the physical and psychological health of elderly. Exploratory research studies are necessary to identify the problems among elderly, especially those in old age homes.

Elimination of Maternal and Neonatal Tetanus in India: A Triumph Tale

In 1993, from the review of child survival and safe motherhood program, districts were classified for area‐specific action‐oriented intervention measures to eliminate tetanus. Districts were classified into three categories depending on TT immunization coverage among pregnant women, NT incidence rates, and proportion of clean deliveries by trained personnel [Table 1]. Taking into account the gender bias as male children were brought to the health facilities than female children, the total caseload of NT for a district was considered two times the reported male NT cases. Preventive measures were accelerated in high‐risk areas and further strengthening of surveillance system was ensured in low‐risk areas to reduce underreporting of cases.[6]

Nutritional psychiatry: An evolving concept

| 2017 | 1 its influence on mental health are inseparable and inevitable.[1] As nutrition is one of the important predictors of both mental health and other noncommunicable diseases (NCD), it acts as direct and indirect link for mental health outcome. Moreover, NCD such as diabetes and other chronic diseases are associated with comorbid mental ill‐health. Thus, by addressing the nutritional issues, one can achieve the betterment in both NCD control and mental health disorders. Even a minimal change in the dietary pattern of the community will have major effect on the distribution of common mental disorders as well as NCDs in the population, and it can even reverse the current trend of the disease.[3]

Preconception care: A pragmatic approach for planned pregnancy

Counseling of women regarding possible teratogenic effects of certain drugs, toxins, chemicals, and health consequences of tobacco use, alcohol and substance abuse on the fetus should be carried out. Screening should be done for diseases with direct impact on fetal health such as periodontal diseases, urogenital and sexually transmitted infection and also for mental health to detect anxiety, depression, domestic violence, and other psychosocial stressors which will enable the mother to take care of pregnancy in a qualitative manner. Laboratory testing includes complete blood count, blood grouping and typing, urine analysis, screening for diabetes, thyroid disorders, HIV, gonorrhea, and syphilis.[3,4]

Controlled temperature chain: Reaching the unreached in resource-limited settings

Geographical distance from health centre and the costs and constraints involved in cold chain maintenance are important factors influencing poor immunization coverage in remote areas of resource-limited countries. Controlled temperature chain (CTC) is an approach which uses the innate heat stability specific to certain vaccines, to reduce the dependency on cold chain and has been accepted for potential use in situations where cold chain maintenance is not feasible and limits immunization programme effectiveness. In 2012, MenAfriVac, Meningitis A conjugate vaccine became the first vaccine to be pre-qualified by World Health Organization for use under CTC. Various existing vaccines are being approved for CTC use in low-resource settings. Proper CTC labelling and effective temperature monitoring are important considerations. While cold chain is critical and should be maintained as always, CTC is a useful alternate option which needs to be explored to reach the unreached in limited-resource settings. Bangladesh Journal of Medical Science Vol.16(3) 2017 p.477-479

Road map to organ donation in Tamil Nadu: an excellent model for India.

DEAR EDITOR, Organ shortage is a huge public health concern worldwide. While Spain tops the list of organ donation rate with 35.3 per million population (pmp), India lags far behind with 0.26 pmp. In a country like India, which needs informed consent for organ donation, it is difficult to meet the organ demands as contrast to countries like Spain, where it is presumed consent, which makes easier to get adequate organs for donation. Tamil Nadu is one of the well-developed states of India with organ donation rate of 1.8 pmp, which is seven times higher than the national average, Chennai in Tamil Nadu fairs even better with 14 pmp, which is on par with developed countries like Germany.[1,2] Even though, the country had passed “The Transplantation of Human Organ Act” in 1994, it was “The Hithendran effect” in 2008 which brought paradigm shift in the attitude of Tamil Nadus people toward organ donation. Hithendrans organs were donated by his parents after he was announced brain death. Multi Organ Harvesting Aid Network (MOHAN) Foundation, a non-governmental organization, had taken a major effort in the initiation and promotion of organ donation program in Tamil Nadu.[3] In 2008, Government of Tamil Nadu had started Cadaver Transplant program (CTP), the first of its kind with the best organ-sharing network in the country. CTP is the backbone of organ donation that integrates government hospitals, private hospitals, NGO, donors, recipients, police and social workers. This is an excellent example for a successful public-private partnership program.[4] According to “The Transplantation of Human Organ Act,” commercial organ donation is illegal in India. The motive for organ donation should be purely altruistic and in case of donation from non-relatives, clearance should be obtained from government authorization committee. The organ cost involved in deceased donor is nil apart from the cost incurred for perfusion fluids and intensive care costs in maintaining the donor. Tamil Nadu Chief Ministers Comprehensive Health Insurance Scheme covers transplantation cost for poor recipient patients. For the recipients, the average cost of the transplantation surgery varies from `200,000 to `25,00,000 depends upon the type of transplantation.[5] Government of Tamil Nadu had passed several government orders to promote organ donation which includes procedure to be adopted for cadaver transplant, criteria for nontransplant centers to retrieve organs, mandatory declaration of brain deaths, postmortem procedures and a counseling department for all registered hospitals. Organs obtained from hospitals are distributed to required patients through common waiting list registered in Tamil Nadu Network for Organ Sharing. Tamil Nadu has been divided into three zones namely, north, south and west to minimize the time of ischemia of organ and to ease organ distribution.[1] Cadaveric organ donors in Tamil Nadu have increased from seven in 2008 to 131 in 2013.[4,6] The general guidelines for allocation of organs is that the retrieving hospital has the right over the retrieved heart, liver and one kidney and the other kidney will go to the common waiting list. The Tamil Nadu model has been possible only through strong political commitment together with the participation of NGOs like MOHAN foundation and the presence of a well-coordinated committee consisted of transplant coordinator, transplant team from both retrieval and transplant hospitals, grief counselor; even there is a nodal officer for green corridors (an open route without blocks or traffics, where all traffic signals are green) in the traffic police department for coordinating the transport of retrieved organ to the respective hospitals for transplantation. Above all the public attitude for organ donation in Tamil Nadu, as evident from a recent study, 75.3%, was in favor of donating their organs.[7] Other initiatives are “Organ Protection and Donation Initiative” and use of mobile applications. Former focuses on the reduction of demand of organs for diabetic patients by appropriate strategy to protect their kidneys and other organs. Later was launched for motivating people to sign up for organ donation. This includes e-donor card and pledging cornea donation through social network.[8] Moreover, Toll free 24 × 7 helpline number has been introduced for organ donation. Since eye donation has been widely practiced in India, a protocol named “Sri Ramachandra protocol for organ donation,” has been used during emotionally difficult situation in the event of brain death; according to the protocol, the family members will be counseled initially for eye donation if they are willing, further counseling will be done for other organs, if the family members are not willing even for eye donation, further efforts will be abandoned.[9] Within a short span of time, Tamil Nadu state of India has achieved a tremendous success in organ donation rate; this successful implementation is possible only through strong political commitment, public-private partnership, positive public attitude along with well-established program and its strategies which should be taken as a role model not only for other states of India but also for other countries where organ donation rate is still low. To conclude, with growing demands for organs worldwide, it needs further thrust from remaining part of the under developed and developing nations of the world to keep in par with other developed countries in organ donation.

Recurring tragedy of road traffic accidents in India: Challenges and opportunities

Sir, Road traffic accident (RTA) is an emerging epidemic; it is the eighth leading cause of death and most important cause of death among young people (15–29 years) globally. Every year, 1.24 million people die prematurely in RTA and moreover, 20–50 million people suffer from nonfatal injuries worldwide.[1] India recorded more number of deaths from RTA than any other countries in the world. According to National Crime Records Bureau Report, there was 17.6% increase in deaths due to RTA from 2008 to 2012.[2] Without immediate action, this tragedy will continue to increase, posing a major threat to the country. RTA poses a major burden in health care system in terms of prehospital care, emergency care, and rehabilitation. India spends 12.5 billion dollars on average, toward RTA, which excludes the economic burden of accident survivors with a permanent disability.[2] It is estimated that 3% gross domestic product lost due to RTA in India.[3] India differs from developed countries in road use patterns, with mixed traffic of slow and fast-moving vehicles, pedestrians and animals sharing the same roads.[4] India is currently experiencing a rapid increase in vehicles especially two-wheelers. As of 2009, combined two and three wheelers constitute about 71.6% of total registered vehicles in India.[3] Risk factors are broadly classified as human and environmental factors. Human risk factors are younger age (15–29 years), male sex, drunken driving, fatigue, nonobservance of traffic rules, inadequate use of helmets and safety belts, medical conditions (sudden illness, myocardial infarction, impaired vision), psychological factors (risk taking, impulsiveness), defective judgment, delayed decisions, aggressiveness, poor perceptions, family dysfunction, and distraction while driving (using mobile phones). Environmental risk factors may be related to roads (defective and narrow roads, defective layout of crossroads, poor lighting, and lack of familiarity) and vehicles (excessive speed, poorly maintained vehicles, large number of vehicles, low driving standards and overloaded buses).[4,5] Even though, there are laws and policy regulating RTA, it has been found that the enforcement of regulations is weak [Table 1].[3] According to World Health Organization report on India, enforcement of speed limit and drink law both scored 3 on a scale of 0–10. Enforcement of wearing seat belts for car occupants and helmet law enforcement both scored 2 on a scale of 0–10.[3] Factors that need to be addressed are road safety infrastructure development, appropriate vehicle designs for Indian roads, setting vehicles standard, regular inspection of vehicles, minimizing exposure by segregation of vulnerable road users such as pedestrians and cyclist, removal of encroachments on footpath, strict enforcement of legislation, adequate training of drivers, educating public about road safety, improving postcrash emergency care for the victims and better rehabilitation services, strengthening of accident research and injury surveillance system for accurate database on RTA.[4,5] Table 1 Status of road safety measures in India To reduce the alarming trend of RTA, legal reforms are necessary, it includes adoption of newer regulation regarding child restraint, apply blood alcohol concentration limits of 0.02 g/dl or less among young and novice drivers, reducing speed limit for newer and younger drivers, disqualification and cancellation of license for repeat offenders. Setting a national target to reduce the incidence of accidents proved to be successful in improving the road safety.[5] So far, India has not set a target, such national target should be set and revised at regular interval. Since there is no program, there is an urgent need for appropriate and exclusive national program to combat RTA. To conclude, RTAs are easily predictable and preventable. It requires strong political commitment and multipronged strategies to address the current demands and needs of six Es of road safety such as education, engineering (roads), engineering (vehicles), enforcement, emergency care and enactment. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Growing concern about maternal mental health disorders

Received: April 20, 2015; Accepted: May 19, 2015; Published: May 22, 2015 Globally one in three women of developing countries and one in ten women of developed countries are suffering from some form of mental health problem either during pregnancy or after childbirth [1]. Depression and anxiety are the major mental health disorders seen among the mothers and numbers of suicides among severe cases are increasing day by day. Mental health problem among the mother adversely affects the child’s growth and development as well. Maternal mental health disorders are preventable and also easily treatable if identified early. And, most of these problems can be easily managed even by non-specialist healthcare providers who are properly trained. In order to achieve the Millennium Development Goal (MDG) 5 of improving maternal health, efforts should include measures for prevention and management of maternal mental health disorders [2].

Bystander cardiopulmonary resuscitation in out of hospital cardiac arrest: need of the hour.

Sir, An out of hospital cardiac arrest (OHCA) is defined as cessation of cardiac mechanical activity, confirmed by the absence of signs of circulation and that which occurs outside the hospital setting.1 About 70–85% of these events have a cardiac cause.1 Published literature identifies Acute coronary syndrome (ACS) as the most frequent cause of OHCA, particularly among elderly and coronary vasospasm as a considerable cause among young healthy individuals.2 It can also occur from non-cardiac causes such as trauma, drowning, drug overdose, asphyxia, electrocution and primary respiratory arrests.3 OHCA is a major public health problem because though the process is potentially reversible, the probability of recovery is small. Every year, more than 300,000 individuals experience an OHCA in the United States.1 Nearly 88% of the cardiac arrests occur at home.4 The survival rate varies between 6.7% and 8.4% and this statistic has remained unchanged for nearly three decades.1,3 Reliable statistics are lacking in most developing countries. Early cardiopulmonary resuscitation (CPR), therapeutic hypothermia and early advanced care have a crucial role in management of OHCA. Every minute lost in initiating CPR leads to 10% decrease in survival rates of the victim.5 Since members of the community are the first to witness OHCA, there is an increasing recognition of the need to coordinate with the community in providing emergency medical care to optimize patient survival after an OHCA. American Heart Association (AHA) guidelines for cardiopulmonary resuscitation and emergency cardiovascular care describes a “chain of survival” to reduce mortality and improve survival. The “chain of survival” comprises of five elements, namely, immediate recognition and rapid access, rapid CPR, rapid defibrillation, effective advanced care and integrated post cardiac arrest care.6 The chain of survival should be initiated as soon as possible for effective outcomes.6 In developing countries with low resource settings, the early initiation of chain of survival could best be achieved by training the community in early identification and initiation of CPR for effective outcomes. Bystander assisted CPR is the real need of the hour. Bystander CPR is a concept, rapidly gaining approval in many parts of the world. Bystander initiated basic life support can increase survival chances by 2–3 times.7 The lesser the interval between collapse to bystander CPR, the more favourable is the outcome.8,9 Wissenberg et al examined the temporal trends in bystander CPR rates and the survival outcomes between 2001 to 2010 in Denmark during which period various national initiatives were launched to improve bystander resuscitation rates and advanced care. There was a considerable increase in bystander CPR rates from 22.1% (2001) to 44.9% (2010) and the increase in bystander CPR rates was significantly associated with survival on arrival at hospital, 30-day survival and 1-year survival in OHCA patients.10 CPR is generally considered a skill to be acquired by doctors and other health care staff involved in active patient care. Various studies in India and across the world show poor knowledge of resuscitation among health care staff.11 The awareness among common people is even lesser. Nielsen et al reported that fear of harming the patient further, fear of inadequate knowledge about the technique, fear of liability and concerns about transmission of infectious diseases by mouth-mouth ventilation were the commonest reasons for reluctance to act when faced with OHCA.7 It is necessary that CPR knowledge and adequate training be imparted to the common man. This is even more important in developing and underdeveloped countries with inadequate human and material health care resources. In such a scenario, bystander CPR would play an effective role in saving the patient through the golden hour. In adult OHCAs, bystanders performing chest compression only CPR is considered to be as effective as conventional CPR. Compression only CPR can be easily performed even by non trained bystanders.12 Registries should be maintained to record all occurrences of OHCA, identify the neighbourhood characteristics of the affected and measures taken by bystanders. All hospitals and practitioners should be encouraged to notify cases of OHCA to a common database. Telephone based emergency medical services should provide a dispatcher service to advice the bystander in initiating CPR. School based training on basic life services including CPR is a useful step in promotion of bystander CPR. Web based interactive applications have been found to be useful in mapping and application of CPR with assistance. In the era of communication revolution, smart phone user friendly applications should be developed. Widespread media campaigns and health education programmes can increase the rate of early identification of OHCA and improve willingness and confidence among public to perform CPR. Professional organisations should actively be engaged in organising training programmes for public and refresher programmes for health professionals.