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«India needs to generate new health system models' TOI EXCLUSIVE - `India needs to generate new health system models'The Times of India: 20150814) ...»

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Friday 20150814

India needs to generate new health system models'

TOI EXCLUSIVE - `India needs to generate new health system

models'The Times of India: 20150814)

http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=TOI-EXCLUSIVEIndia-needs-to-generate-new-health-14082015013025 There's No Magic Number For Health Spending But It's Not Possible To Maintain An Adequate System With Inadequate Financing There are many ways to tell India's story of progress over the past generation. Prime Minister Narendra Modi will tell one version when he addresses the nation at the Red Fort.My favourite ve r s i o n i s this: In 1990, 3.3 million Indian chil dren died before they turned five.

Since then, the population has gone up by 48%, so you'd expect that 4.9 million Indian children died last year. In fact, the number was 1.3 million.That's 3.5 million children who would have died last year but who lived because the Indian government prioritized health.

The next task is to get from 1.3 million to as close to zero child deaths as possible, that means studying the progress of the past, learning from it, and improving upon it.

India's success in saving children's lives so far, means that it hasn't just met but surpassed the UN's ambitious Millennium Development Goal (MDG) on child mortality. In 2000, UN agreed to a sweeping plan to improve the lives of the poorest people in the world, including specific targets in eight key areas of development, with a deadline of 2015. The MDGs helped countries and development organizations set priorities, measure progress, and continually get better.

Now, the deadline for the MDGs is near. The MDGs are being replaced by a new set of goals, the Sustainable Devel opment Goals (SDG), which run from 2015 to 2030. The SDGs provide an opportunity to consolidate all the lessons you've learned in the past 15 years and chart your next course. You get to ask yourselves, “What kind of country do we want to have in 2030, and what do we need to do to get there?“ When it comes to health, the area I follow most closely, I see two big needs: More resources and using those resources as effectively as possible.

The SDGs are backed by a bold vision of the future, but to put it bluntly, that vision costs money that is not yet available. In India, public spending on health amounts to just 1.1% of GDP, compared to 2.9% and 4.1% in China and Brazil, respectively. Many countries spend even more. There is no magic number for the percentage a government needs to spend on health, but it is not possible to maintain an adequate public health system with inadequate financing.

Resources matter, but how they are used is just as important. India is immense -and immensely complex. There is no existing health system model that can simply be applied to India. You need to generate new models. How can you provide high-quality care in vast rural areas where there are very few doctors?

Given that so many Indians use private health providers, how can the government work with the private sector to improve care? How can such a sprawling health system produce and use data in real time to respond to what is happening on the ground? These are challenges India is wrestling with. You have the creativity and intellect to solve them, and I believe you also have the political commitment.

In 2014, India developed a strategy to save the lives of infants, added vaccines to the routine immunization schedule, and created the Indradhanush and Swachh Bharat missions to promote universal immunization coverage and better sanitation. That's an impressive record for just a single year.

But it's not enough for these plans and missions to exist. They must perform. If you look at the statistics about quality of life in India, the first thing that jumps out at you is how much better it has gotten.But the second thing is how uneven it still is from state to state. The child mortality rate in the worst-performing states is three times higher than it is in the best states.

More than anything else, we should make sure that primary health systems in every state reach every single person with high-quality services. It is possible because we have seen it in many places.We have also seen that it takes long-term attention and investment.

India's record on child survival is impressive. But to maximize the impact those children will have in the future, India needs to make sure that they not only survive but thrive. So, this Independence Day, in the new era of the SDGs, I hope Indians focus on an ambitious goal that is good for India and good for Indians: Creating a society where every citizen has access to healthcare, education, and nutrition they need to fulfill their potential.

Call it a new social compact. If the government can ensure that the Indian people have access to these services, the Indian people will build a strong future for the country.

Bill Gates is founder & co-chair of the Bill and Melinda Gates Foundation Diet(The Asian Age:20150814) http://onlineepaper.asianage.com/articledetailpage.aspx?id=3459286 Therapy for psychiatric disorders Brain scans may help predict success of therapy for psychiatric

disorders(Medical News Today:

http://www.medicalnewstoday.com/articles/298072.php Brain scans that look at biomarkers of brain connectivity may help predict which patients with psychiatric disorders are likely to benefit from therapy.

anxious woman People with social anxiety disorder are also at higher risk of depression and substance abuse.

So conclude researchers from the Massachusetts Institute of Technology (MIT) who analyzed brain scans of patients receiving cognitive behavioral therapy (CBT) for the treatment of social anxiety disorder.

CBT is a talking therapy that aims to help people change the way they think and behave.

While it can be a useful treatment for a range of mental and physical health problems, it is most commonly used to treat anxiety and depression.

Around 15 million Americans are affected by social anxiety disorder or social phobia - a condition where the fear of being judged and of being embarrassed is so strong it can get in the way of going to work or school and doing everyday things.

According to the National Institutes of Mental Health, social anxiety disorder is the third most common mental health disorder in the US.

Patients with social anxiety disorder are also at higher risk of other psychiatric disorders, such as depression and substance abuse.

Currently, even after weeks of therapy, only around half of patients with social anxiety disorder find their symptoms improve, leaving the other half having to start again with something else. The lack of effective treatment selection tools means trial and error is the only avenue open to patients, many of whom give up because it is so time consuming and expensive.

Susan Whitfield-Gabrieli, a research scientist at MIT's McGovern Institute for Brain

Research and first author of the new study, says:

"Choice of therapy is like a wheel of chance. We're hoping to use brain imaging to help provide more reliable predictors of treatment response."

She and her colleagues report their findings in the journal Molecular Psychiatry.

Study uses resting-state as opposed to task-based scans The team analyzed brain scans of 38 patients with social anxiety disorder and found they could be used to predict - with 80% accuracy - which patients would most benefit from CBT.

Using scans improved prediction accuracy five-fold compared with clinician assessment on its own.

After undergoing brain-scanning, the patients took part in 12 weeks of group-based CBT.

An important aspect of the study is the type of brain scan that the researchers used. They used "resting-state" scans as opposed to "task-based" scans. Resting state scans are taken when the patient is at rest, not thinking or paying attention to anything in particular. Task-based scans are taken when the patient is focusing on a given task.

In previous work, some of the authors had found that task-based scans, where patients responded to angry or neutral faces as they underwent their brain scans, could also be used to predict CBT outcomes.

But task-based scans are not ideal, because behavioral differences among patients can affect performance. In addition, they can only be used on patients who can follow the instructions, which rules out the very young and some of the very old or very ill.

The appeal of resting-state imaging is that it can be done reliably and quickly - in about 15 minutes - without the patient having to follow instructions. The patient just lies there and lets their mind drift. This makes resting-state scans ideal for doctors to use in clinical settings to help select the best treatments for their patients.

Resting-state scans give an idea of the brain's connectivity - or what the researchers call its "connectomics" - a functional and structural map of its connections.

The functional view can be seen in resting-state functional magnetic resonance imaging (fMRI). This shows which parts of the brain work together during rest.

Clinicians can see the structural view with the help of diffusion-weighted magnetic resonance imaging (dMRI), which reveals the physical white matter connections between distant brain regions.

Three types of brain-scan analysis predicted CBT outcomes Building on earlier research, the team first used resting-state fMRI to look at connections to the amygdala - the part of the brain that deals with fear.

They found patients with higher connectivity to the amygdala from certain other parts of the brain were more likely to have lower symptoms of anxiety after CBT.

A second analysis of the same scans - this time looking at connectivity across the whole brain

- revealed more markers that were predictive of treatment outcomes.

When they examined dMRI scans, the researchers found the more robust connectivity between tracts that connect visual cues with emotional responses was also predictive of better CBT outcomes.

The patients were assessed before and after their CBT treatment with a behavioral assessment tool called the Liebowitz Social Anxiety Scale (LSAS). Higher LSAS scores indicate more severe social anxiety, and usually correlate modestly with better improvements following CBT.

However, the study shows that each brain scan analysis had predictive value beyond the LSAS, and the three together led to a five-fold improvement in predictive power over the LSAS alone.

The team now plans to validate the predictive tool on hundreds, and possibly thousands, of patients. Such a large-scale study is possible because, unlike task-based scans, you can compare resting-state scans even when they are performed in different labs or by different researchers.

Greg Siegle, an associate professor of psychiatry at the University of Pittsburgh School of

Medicine who was not involved with the study, comments on its potential implications:

"Knowing who to give which therapy to upfront would save time, money, and health care resources. This ability would be staggering to have at our disposal for the health care system."

Earlier this year, Medical News Today reported a world-first MRI study that found babies experience pain like adults. In the journal eLife, researchers from Oxford University in the UK show how many of the brain regions in the adult brain that are active in response to pain are also active in the brains of babies.

Low-Sodium, Low-Sodium, Wheat-Free Alternatives(Med India:20150814) http://www.medindia.net/patients/lifestyleandwellness/low-sodium-wheat-freealternatives.htm Did you know that most of the sodium you eat comes from whole wheat bread products? Yes, American Heart Association and CDC claim that one slice of bread can give you almost 200 mg of sodium based on the type of bread product you eat.

Why do you need to look for Low Sodium and Wheat Free Bun Alternatives?

Scientists have reported that whole grain bread has the ability to increase the glucose levels in the blood.

Low-Sodium, Wheat-Free Alternatives The glycemic index of whole wheat bread is higher. Bread has high sugar content.

Wheat has gluten which is harmful for health.

The quantity of essential nutrients present in whole grain bread is extremely low.

In addition, consumption of bread reduces the absorption of other food items with high nutritive value.

Increased intake of whole grain bread can also lead to increased chances of heart diseases as it has the ability to raise the low density lipid cholesterol.

With an increased sodium intake, fluid volume increases which exerts burden on the heart thereby increases the risk of heart diseases and heart failure. An increased amount of salt can also leave damaging effects on the heart, aorta, and the kidneys. In some cases, it may also have a bad effect on bones.

Bread is one of the highest used products and hence it is imperative to find a low sodium and wheat free bread alternative.

Wheat Free Cereals There are various gluten free foods, which you can choose to lead a gluten free lifestyle.

Some of the gluten free cereals include amaranth, arrowroot, cornmeal, corn tortillas, sago, sorghum, millet meal, poppadum, polenta, psyllium, maple buckwheat flake cereal, rice cereal, rice cereal with quinoa, and oats and oat products.

Wheat Free Cereals Certain other wheat free flour options include chestnut flour, coconut flour, corn flour, lentil flour, soy flour, tapioca and potato flour.

Recent research has also genetically engineered wheat free cereals to prepare gluten free foods.

Gluten Free Foods for Breakfast and Snacks There are certain gluten free products which are commercially prepared. These include biscuits, bread, breadcrumbs, wheat free breakfast cereals, and baking mixes. Some wheat free snacks are also available such as cakes, muesli bars, other wheat free snack bars and pastries.

Choose from these Wheat Free Bun Alternatives You can choose from a plethora of gluten free vegetarian foods and low sodium alternatives to make your hot dogs and burgers.

Go Green!

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