Self - Medication: A pill for every ill Health Times May 201… · Global data suggests that medicines account for 30–40% of health expenditure in developing countries. Most payments

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Introduction-Global data suggests that medicines account for 30–40% of health expenditure in developing countries. Most payments are made by individuals for self medication and rarely on prescription. Understanding the basis of this is the first step to ensure that these resources are optimally and safely utilized. Based on this knowledge, it is possible for policy-makers to design interventions that are sensitive to the particular practices and needs of the community.

Aim-To understand the behaviour of people towards self-medication on antibiotics and its implications in public health.

Objective-To create awareness about the tendency to self-medicate on antibiotics due to frequent use in sub-optimal dosages wherein bacteria become drug-resistant and cause adverse health effects. These later can exceed the therapeutic window and even cause toxicity.

Scope-Antibiotics are important drugs, but they are over-prescribed and overused in self medication for the treatment of minor disorders such as simple diarrhoea, coughs and colds. When antibiotics are used too often in sub-optimal dosages, bacteria become resistant to them. Hence, a serious problem to public health policy makers.So the scope of the study is to create awareness level in the population and understanding the behaviour of people towards self-medication on antibiotics.

MethodsThe methods used in conducting the research were –

Questionnaire (a 150-respondent survey). Statistical tools, viz. Variance analysis, cross-tabulation, correlation. Charts and graphs.

Findings And Result- As age increases, the tendencies of people to self medicate with antibiotics decreases.

Occupation is a contributing factor to self medication. The tendency of people to self medicate on antibiotics is influenced by ongoing trends of antibiotics in the market.

Discussion-During a Conference, UN said that, with the continuous rise in the use of Antibiotics as a means of self medication, the day is not far when majority of the people will become resistant to the best of the effective Antibiotics. In fact, it was implicated that the era of Preliminary Antibiotics have already started since, majority of the Antibiotics have become resistant in the human body due to excessive self medication. This is a major threat in the society as this type of behaviour is devastatingly affecting the Society since majority of the Pharmaceutical Companies have started investing the money in Generic drugs, rather than the Research on new drugs for treating the old diseases.Hence, an awareness regarding the implications and the behaviour pattern of people is to be addressed so as to help the society in dealing with this problem.

Conclusion-This study shows that age, occupation and the tendency to self medicate based on the recommendations of parents/ relatives and market tends are the major contributing factors for self medication on antibiotics. This study draws attention to the major problem of self medication with antibiotics that leads to resistance of highly potent drugs towards various diseases.

Self - Medication: A pill for every ill

Dr (Col). V.B. DeshpandeAssociate Professor

Symbiosis Institute of Health Science Pune

Ms. Madhulika RawatMBA(HHM)Symbiosis Institute of Health SciencePune

Symbiosis Health Times 2015

References-

1. Abramson JH, Abramson ZH (1999). Survey methods in community medicine, 5th ed. Edinburgh, Churchill Livingstone.

2. Debus M (1986). Methodological review: a handbook for excellence in focus group research. Washington,

3. DC, Academy for Educational Development, HEALTHCOM. (To re quest a free copy write to: BASICS, In formation Center, l600 Wilson Blvd., Suite 300, Arlington, VA 22209, e-mail [email protected]).

4. Hardon A (1991). Confronting ill health: medicines, self-care and the poor in Manila.Quezon-City, Health Action Information Network.

5. Hardon A et al (2001). Analysis of qualitative data. In: Applied health research manual: Anthropology of health care. Amsterdam, Het Spinhuis. hudelson PM (1994). Qualitative research for health programmes. Geneva, World Health

6. Organization.WHO/MNH/PSF/94.3.Rev.l.Varkevisser, CM, Pathmanathan I, Brownlee A. (1992). Designing and implementing health systems research projects. Volume 2. Geneva, Health Sciences Division of the International Development Research Centre and the World Health Organization.

7. Scrimshaw SCM, Hurtado E (1987). Rapid assessment procedures for nutrition and primary health care. Tokyo, United Nations University/Los Angeles, University of California.

37Symbiosis Health Times 2015

IntroductionThe concept of a polyclinic in government sector in India is to provide a basic comprehensive medical care by a team of dedicated healthcare professionals on a 24 hour basis. Preventive healthcare ensures minimal breakdown of physical and mental health and whenever required a specialist treatment could be readily available.

Organization/ResourcesThe primary care centre comprises of the following(a) 10 or 20 bedded dieted primary care centre (including family beds)(b) Family Welfare Centre (c) Maternal and Child Welfare Centre and peripheral Medical Aid Unit

Human ResourcesThe medical team is headed by a medical specialist or a senior GDMO(general duty medical officer) who is supported by one community medicine specialist and four general duty medical officers including one or two lady medical officers. The paramedical staff consists of 40 to 50 medical or nursing assistants, part time lady attendant, nursing officer/part time nurse is also usually available. Class-IV staff comprises of one ward Sahayika, Safaiwalas and Lascars. Family Welfare Centre consists of lady health visitor and storekeeper cum clerk is available who also functions as Family Planning motivator.

Services Provided The polyclinic provides promotive, preventive, curative and rehabilitative health care services. They can be

divided as (a) Emergency care – available 2 hours with 2 medical assistants at around the clock. Duty medical officer is

available on call. Both DMA and DMO have been provided with a mobile phone.(i). Defibrillator with Cardiac monitor(ii). Endotracheal intubation(iii). Nebulizer(iv). 6 channel self-interpreted ECG machine(v). Suction Apparatus(vi). Scoop stretcher(vii). Spinal board(viii). Oxygen concentrator(ix). Fingertip pulse oximeter(x). Pneumatic splint(xi). Multiparameter monitor and (xii). Emergency support equipment.

Emergency Room Emergency room is usually well equipped and air conditioned with life saving equipment and treatment protocols for easy reference.OPD services are provided on all days including holidays. The timing of OPD services is from 0715h to 1430h on working days and 0800 to 1200h on holidays. Evening clinic is conducted by the DMO of the day from 1600h to 1800h. Outpatient clinic is conducted by all available MOs to reduce the waiting period for patients. Special clinics like obesity clinic for long term treatment cases are held at 1300h on specified days. A civilian lady doctor is available at SMC from 0930h to 1300h on all working days. Antenatal clinic is conducted every Wednesday at the

Review article on facilities of Primary Health Polyclinic in Government Sector in India versus International Standard of a Polyclinic – Lacunae and Recommendations

Wing Cdr S YazdaniIndian Air Force


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Family wing and immunisation clinic on every Friday. The waiting rooms are well ventilated and air-conditioned with television sets and magazines for patients to relax while awaiting their turn.

Table – 1: Family OPD

Specialist Cover It is provided by nearby service hospitals which may be 10 to 100 km away from Specialists available are

(i) Medicine(ii) Surgery(iii) Dermatology(iv) Paediatrics(v) Pathology(vi) Radiology(vii) Gynaecology(viii) ENT(ix) Ophthalmology

ECHS Clinic for the Ex-Servicemen is established as colocated unit. Dental services are provided by Dental Care Centre adjacent to the polyclinic.

WardIn-Patient ServicesThe average bed occupancy is approximately six to seven patients in otherwise healthy soldier clientele.. The family ward has three beds for day care where patients are kept under observation. These beds are also used in conduct of various health camps.

LaboratoryLaboratory ServicesThe laboratory at the polyclinics is well equipped to carry out routine haematological and biochemical examinations. Availability of a binocular microscope has made screening of the slides more accurate. A semi-auto analyser is being used for biochemical investigations.

(a) The routine investigations carried out at the laboratory are (i) Blood Hb%, TLC, DLC, ESR, AEC, MP, MF, Blood grouping, BT and CT.(ii) Urine, RE, ME, BS, BP & Pregnancy tests.(iii) Stool RE.(iv) Sputum, AFB at satellite MI room under RNTCP.

(b) Biochemistry investigations carried out are(i) Blood sugar - fasting, PP and random.(ii) Blood urea, Creatinine


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(iii) Blood uric acid, RA factor(iv) Lipid profile(v) Widal test and rapid test for typhoid (vi) Rapid test for malaria

The laboratory is linked up with Christian Medical College, Vellore (EQAS scheme) to test the accuracy of biochemical tests and the results have been reported very well in VIS (Value Index Score) for ten parameters for this quarter ending. The laboratory is also acting as blood collection centre for specialized investigations like HIV, TSH and VDRL which are carried out at MH Agra.

Rehabilitative Healthcare

Physiotherapy DepartmentThe Physiotherapy department is available with the following equipment to help curative treatment and early rehabilitation of patients. Approximately five – six patients avail of these services daily. The facilities available are

(a) Short wave diathermy(b) Infra-red lamp(c) IFT machine(d) Portable TENS(e) Nautical Wheel(f) Cervical cum lumbral tractor(g) Cycles(h) Rowing machines(i) Wax bath(j) Supination/Pronation machine

Promotive Healthcare

Annual Medical Examinations and Health Checkups: for families are carried out from time to time which enables early detection of disease and its prompt treatment. Various health events (national & international) viz. World Health Day, World Diabetes Day, Suicide Prevention Week, Road Safety Week etc. are conducted round the year. Health education of personnel and their families on lifestyle diseases, communicable diseases, first aid etc. is carried out during health talks and display of informative charts and poster.

Maternity and Child Welfare Activities

Well woman and well-baby clinic are conducted every well baby clinic are conducted every Wednesday at polyclinic and the satellite first aid room. Attendance at these clinics ranges from 30-40 per session. Other activities conducted are(a) Medical examinations of school children carried out regularly with special focus on screening for poor oral

and ear hygiene, dental caries and anemia.(b) Antenatal clinic is conducted every Wednesday with an average attendance of 16-17 cases per clinic.(c) Post natal and immunisation clinic is carried out every Friday and immunization of infants is carried out as per

guidelines laid out in the IAP. Mothers are educated in parenting and the importance of breast feeding.

Psychological Counselling ActivitiesThe polyclinics have a dedicated counselling centreand two qualified psychologists along with trained non-medical personnel who are called “mentors” who conduct counselling sessions over weekends routinely and on other days when required.

Alcoholics AnonymousAn alcoholic anonymous helpline too has been established to help alcoholics cut down and curb their alcohol dependence in the case of chronic cases along with smokers quitting aid group.


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Suicide PreventionNon-medical personnel from various units in the station have been indoctrinated towards stress management and suicide prevention programmes. Several cells have been setup as the first line for afflicted individuals to address their problems with confidentially and report to the doctors in polyclinic as and when required.A 24 hour e-helpline has been setup to facilitate aggrieved and potentially suicidal personnel to come forward and seek timely assistance in all confidentiality with the nodal centre at the SM

Preventive HealthcareExercise and Fitness: The SMC is a part of all station level PT, parade, games & yoga activities where a paramedical personnel along with ambulance is detailed to monitor the events and render first aid if required.Anti-Malarial Measures: Regular medical activity with respect to anti-malarial measures is carried out at the station.(a) Three rounds of residual spraying is done in all domestic and technical area buildings alongwith impregnation of mosquito nets, window/door curtains and portable fogging machine.(b) Anti-larval measures are undertaken by the SHO by breeding larvivorous fish in static water tanks hich controls mosquito larvae (Gambusia fish)

Water Supply: OPD and indoor services in polyclinic are supplied by the RO water plant which also supplies station. Monitoring of safeguards of this plant is done by assessing:- (a) Total dissolved solids (b) Bacteriological analysis (c) Annual chemical analysis.

Hospital Waste Disposal The polyclinic is an authorised centre for operating a facility of collection, reception, treatment, storage, transport and disposal of biomedical waste. This authorization complies with the provisions of the Environment Protection Act 1986 and the rules made thereunder.

A brief description of the method of treatment and disposal of hospital waste is given below:


Medical Stores Management

Expendables & Non-expendablesThe polyclinic is authorised medical store for the emergency room dispensary physiotherapy room and prevention programmes, apart from motor ambulance. The government supply of medicines is from the Armed Forces Depot . The deficiency is fulfilled by the local purchase of medicines and laboratory reagents. Non-expendable medical stores like electro-medical equipment are procured both locally and centrally.

Ambulance StateThere are heavy and light vehicles available for ambulance role.. The ambulances are fitted with emergency equipment like, stretcher, oxygen, suction apparatus and doctors' bag on board. The polyclinics also conducts dedicated runs to the dependent service hospitals every morning for patients who are referred to specialists for opinions/further management by a dedicated bus.

Constraints and Limitations

Supply of Medical StoresThe supply of medical stores from the government supply agencies is grossly inadequate and the local vendor authorised for the purchase of medicines is able to deliver the demands only in the evening or subsequent working day. This leads to inconvenience to patients who have to make an additional visit to the polyclinic for collection of their prescribed medicines.

Manning

Reduction in the number of available doctors due to courses, leaves and temporary duties and non-availability of specialist doctors at the polyclinic is another cause of inconvenience to the clientele population. On referral to secondary and tertiary care centres, the man hours wasted in terms of time and energy is a major hurdle for the smooth disposal of cases in a polyclinicNon availability of a part-time nurse or a nursing officer at the polyclinics often causes inconvenience to female patients. Due non availability of female attendant at the polyclinic, female patients cannot be detained or admitted for observation or further management after working hours.A large number of patients are referred to specialists on a daily basis for opinions and evaluation at service hospitals. Disposal of such cases takes time and lot of precious man hours are wasted. There are certain specialties like psychiatry and orthopaedics where no specialists are available in remote hospitals . This handicap greatly affects the morale of the clientele. Disposal of cases requiring such specialist opinion or intervention and their management in polyclinics may be full of risks. This acts as a major determinant of patient outcome at polyclinics.

Equipment

The serviceability of electro medical equipment like semi-autoanalysers, short wave diathermy, Doppler machine, Oxygen concentrator, defibrillator, ECG machines etc. is an area of concern. These equipment are repaired by dependent EME workshop which are faraway and ignorant about design circuits of the machines. The transportation involved and the non-availability of trained manpower causes delay in repair of these necessary electro medical equipment.Replacement of worn out equipment is a long drawn process and at times it even takes two to three years for replacement of these equipment from the concerned government agencies especially if the electro medical equipments are not in Annual Maintenance contract. With no dedicated logistic support for their maintenance.Non availability of trained manpower can increase the downtime of any equipment. For e.g. An X-ray machine of 160MA is available in polyclinic but no technician is trained to use it at the clinic. Hence no X-rays can be taken and hence the patient needs to be routed to hospitals.Misuse/mishandling of equipment like thermometers, BP apparatus, torches, stethoscopes and auroscopes. The eye testing charts are old and need to be replaced with newer electronic charts. Unlike a private setup, the service


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equipment are public property and the personnel handling these equipment fail to exercise adequate and necessary caution in handling of the same.

Space Constraints

There is an urgent need to upgrade the existing infrastructures by providing a screen and comfortable gowns for female patients for ECG and private examinations in our government set ups.. Availability of standby power supply at all such peripheral set ups and 12 lead ECG machine (one standby ECG machine) at all times is an absolute necessity. No space for an audiometry room is available at the clinic. No separate room has been booked for the same, no room for Pulmonary Function Test or Spirometry exists .The present physiotherapy room is non-air-conditioned non carpeted and deficient in SWD machine, TENS and USG therapy machines. The laboratory at the SMC does not have a waiting room leading to overcrowding in the corridors. There is an urgent need for a haematological cell counter and a well lit room for microscopy.The ward at the polyclinic has a dining room without a pantry and food for the patients is brought from the neighbouring messes. The recreational room for the patients is very small and poorly ventilated.The Emergency room is well equipped but is capable of accommodating only two beds and there is no separate day care room to monitor detained patients. The treatment room and the dressing room coexist and separated only by a collapsible partition, leading to constrained areas.The dispensary of polyclinics lack adequate standard storage facilities and no separate LP cell exists. The drugs are dispensed through one single window; hence only one person can be entertained at any given time.

Comparison with the National Health Services At Great Britain

The British NHS was launched in 1948 after the end of the second world war. Many new hospitals have been built over the last half century. With advancement in medical technology and increasing life span, the NHS has alleviated suffering of all age groups. The regular annual health boards of the country gave more responsibility to NHS and in 2002, the NHS hospitals had the additional responsibility of healthcare at the grass root level. This need for clinical audit, demanded additional resources from the government, leading to NHS hospitals having dual governance viz. corporate governance and clinical governance. This safeguards the clinical acumen of the medical team of NHS hospitals. Publishing annual performance ratings for all NHS organisations and producing annual reports for quality assurance of the state of healthcare. The government sector polyclinics have no such annual performance reports or clinical audits in the existing scenario although NABH accreditation is a step towards the same.

Comparison with Health Care In Canada

Its delivered through a publicly funded health care system, which is mostly free at the point of use and has most services provided by private entities. It is guided by the provisions of the Canada Health Act of 1984.The government assures the quality of care through federal standards. The government does not participate in day-to-day care or collect any information about an individual's health, which remains confidential between a person and

]his or her physician. Canada's provincially based Medicare systems are cost-effective partly because of their administrative simplicity. In each province, each doctor handles the insurance claim against the provincial insurer. There is no need for the person who accesses health care to be involved in billing and reclaim. Private health expenditure accounts for 30% of health care financing. The Canada Health Act does not cover prescription drugs, home care or long-term care, prescription glasses or dental care, which means most Canadians pay out-of-pocket for these services or rely on private insurance. Provinces provide partial coverage for some of these items for vulnerable populations (children, those living in poverty and seniors). Limited coverage is provided for mental health care.

Competitive practices such as advertising are kept to a minimum, thus maximizing the percentage of revenues that go directly towards care. In general, costs are paid through funding from income taxes. In British Columbia, taxation-based funding is supplemented by a fixed monthly premium which is waived or reduced for those on low incomes. There are no deductibles on basic health care and co-pays are extremely low or non-existent . In general, user fees are not permitted by the Canada Health Act, though some physicians get around this by charging annual


fees for services which include non-essential health options, or items which are not covered by the public plan, such [4]

as doctors notes, prescription refills over the phone.

A health card is issued by the Provincial Ministry of Health to each individual who enrolls for the program and everyone receives the same level of care. There is no need for a variety of plans because virtually all essential basic care is covered, including maternity. In some provinces, private supplemental plans are available for those who desire private rooms if they are hospitalized. Cosmetic surgery and some forms of elective surgery are not considered essential care and are generally not covered. These can be paid out-of-pocket or through private insurers. Health coverage is not affected by loss or change of jobs, health care cannot be denied due to unpaid premiums (in BC), and there are no lifetime limits or exclusions for pre-existing conditions. The Canada Health Act deems that essential physician and hospital care be covered by the publicly funded system, but each province has some license to determine what is considered essential, and where, how and who should provide the services. The result is that there is a wide variance in what is covered across the country by the public health system, particularly in more

[4]controversial areas, such as midwifery or autism treatments.

Canada is the only country with a universal healthcare system that does not include coverage of prescription medication. Pharmaceutical medications are covered by public funds in some provinces for the elderly or indigentior through employment-based private insurance or paid for out-of-pocket. Family physicians (often known as general practitioners or GPs in Canada) are chosen by individuals. If a patient wishes to see a specialist or is counseled to see a specialist, a referral can be made by a GP. Preventive care and early detection are considered important and yearly checkups are encouraged .Recent reports indicate that Canada may be heading toward an excess of doctors, though communities in rural, remote and northern regions, and some specialities, may still experience a shortage.

Primary Health Organisations (PHOs), in New Zealand, are health care providers that are funded on a capitation basis by the New Zealand Government via District Health Boards. They are usually set up as not-for-profit trusts, and have as their goal the improvement of their population's health. n the early 1990s, general practitioners (GPs) were joining together to form independent practitioner associations (IPAs). They did this to better negotiate with the purchasers of healthcare at that time.Prior to the introduction of PHOs, general practitioners were paid using a fee-for-service model. For every person that went through their door, the GP received a set amount of money from the state. For some time, the Government had been trying to introduce a capitation model, that is, give practices a set amount of money depending on the population they served. The formation of the voluntary IPAs gave the Government an important stepping stone to introduce capitation-based funding

Perceived advantages of PHOBenefits for individual patients

Overall lower fees Wider range of services

Benefits for the population as a whole Encouragement of rural practice Increased emphasis on preventative measures Services tailored to the needs of the communities PHOs serve

Benefits for general practices Steady and predictable stream of income Better use of nurses (previously, a doctor had to see a patient for a practice to get paid by the Government)

Recommendations as Per International StandardsThese polyclinics of the Armed Forces acts as a primary health care echelon providing free medical care to the armed forces personnel and their families. As per international standards, the recommendations for modernisation


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of polyclinics in terms of equipment and health professionals and their expertise is far from the international desired standards..

WHO recommendations for a polyclinicThe acronym GOBIFFF recommended for primary healthcare is followed by our polyclinics as well. . It consists of growth monitoring, oral rehydration therapy, breast feeding, immunisation, family planning and growth spacing, female education and food supplementation (iron and folic acid fortification for pregnant women.These primary care setups is equivalent to a PHC and is essentially a provider of Out Patient services, basic indoor facilities and round the clock emergency medical care to its clientele. They are funded by the public sector and work under the Ministry of Health and Family Welfare. This model of healthcare is based on Alma Ata conference of 1978 with core concept of health for all – the goal of the WHO.

Mental Health Clinic and Geriatric ClinicsPolyclinics many a times also have co located ex-serviceman health clinics which provide care to the senior citizens but do not have exclusive Geriatric Clinics or Pain Clinics for the rapidly aging society with high risk of cancers and prevailing non communicable diseases like diabetes, osteoporosis and cardiac ailments. It is recommended that outsourcing of trained professionals and specialists will enable the medical officers at grass root levels to deal with the increasing menace of lifestyle diseases even affecting our armed forces.. Diagnosis and treatment of common mental health conditions locally at poly clinics and referral of more complicated ones to appropriate mental health care is strongly recommended. A case has been taken up to hire psychologists, speech therapists and physiotherapists for spastics and differently abled children of the armed forces personnel from public funds.

ConclusionISO 9001:2000 has its origin in military standards, starting from American military standards which encourages the managers to achieve their objective of quality control. An integrated approach to the issues of health will reaffirm the commitment of the healthcare personnel towards their clientele. The ultimate goal of primary health care is better health for all. The WHO has identified five key elements to achieving that goal.

reducing exclusion and social disparities in health (universal coverage reforms); organizing health services around people's needs and expectations (service delivery reforms); integrating health into all sectors (public policy reforms); pursuing collaborative models of policy dialogue (leadership reforms); and increasing stakeholder participation.

Behind these elements lies a series of basic principles identified in the Alma Ata Declaration that should be formulated in national policies in order to launch and sustain PHC as part of a comprehensive health system and

[1]in coordination with other sectors: Equitable distribution of health care - according this principle, primary care and other services to meet the

main health problems in a community must be provided equally to all individuals irrespective of their gender, age, caste, color, urban/rural location and social class.

Community participation - in order to make the fullest use of local, national and other available resources. Health workforce development - comprehensive health care relies on adequate numbers and distribution of

trained physicians, nurses, allied health professions, community health workers and others working as a health team and supported at the local and referral levels.

Use of appropriate technology - medical technology should be provided that is accessible, affordable, feasible and culturally acceptable to the community (e.g. the use of refrigerators for vaccine cold storage).

Multi-sectional approach - recognition that health cannot be improved by intervention within just the formal health sector; other sectors are equally important in promoting the health and self-reliance of communities. These sectors include, at least: agriculture (e.g. food security); education; communication (e.g. concerning prevailing health problems and the methods of preventing and controlling them); housing; public works (e.g. ensuring an adequate supply of safe water and basic sanitation); rural development; industry; community organizations (including Panchayats or local governments, voluntary organizations, etc.).


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References1. http://www.civilization.ca/cmc/exhibitions/hist/medicare/medic-5h23e.shtml2. Public vs. private health care CBC, December 1, 2006.3. "Overview of the Canada Health Act".4. http://www.theglobeandmail.com/globe-debate/five-things-canadians-get-wrong-about-the-health-

system/WHO (1978). "Alma Ata 1978: Primary Health Care". HFA Sr. (1).5. WHO (2008). The World Health Report 2008: Primary Health Care, Now More Than Ever.

6. McGilvray, James C. (1981). The Quest for Health and Wholeness.Tübingen: German Institute for Medical Missions. ISBN 0728900149.

7. Socrates Litsios (2002). "The Long and Difficult Road to Alma-Ata: A Personal Reflection". International Journal of Health Services32 (4): 709–732. doi:10.2190/RP8C-L5UB-4RAF-NRH2. article20360452/

8. Socrates Litsios (November 1994). "The Christian Medical Commission and the Development of WHO's Primary Health Care Approach". American Journal of Public Health94 (11): 1884–1893. doi:10.2105/AJPH.94.11.1884. PMC 1448555.PMID 15514223.

9. Julia A. Walsh and Kenneths. Warren. "Selective Primary Health Care: An Interim Strategy for Disease Control in Developing Countries*".SW. S'i. & Md.14C.: 145–163.

10. Gatrell, A.C. (2002) Geographies of Health: an Introduction, Oxford: Blackwell.11 Ministry of Health. Primary Health Organisations (PHOs). Retrieved 16 January 201112. "Push to merge Primary Health Organisations". Stuff. 4 February 2010. Retrieved 16 January 2011.


KnowledgeBytes

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1. India bets on mobiles in battle on maternal, child deaths

[http://in.reuters.com/article/2015/03/17/india-health-mobilephone-idINKBN0MD0M320150317] Tue Mar 17, 2015 1:45pm IST

NEW DELHI | BY ADITYA KALRA

(Reuters) - India is betting on cheap mobile phones to cut some of the world's highest rates of maternal and child deaths, as it rolls out a campaign of voice messages delivering health advice to pregnant women and mothers.

Amid a scarcity of doctors and public hospitals, India is relying on its mobile telephone network, the second largest in the world with 950 million connections, to reach places where health workers rarely go.

"It's a huge priority for us," health ministry official Manoj Jhalani told Reuters, adding that the service, advising on vaccinations and vitamin supplements, will launch in eight of the country's Hindi-speaking states by Aug. 15.

"These are the most cost-effective health interventions," said Jhalani, the supervisor of the project, named 'Kilkari,' or "Baby's Gurgle", which will tailor its recorded messages to individual stages of pregnancy or the age of a newborn.

Poor sanitary conditions and stark poverty prevail in many villages in India, which recorded 50,000 maternal deaths in 2013, when 1.3 million children died before turning five.

Preventable hazards such as pneumonia, or poor nutrition, cause most deaths of mothers and babies. Many women give birth at home without access to clean water and toilets, while public medical clinics remain dilapidated and overcrowded.

Over the last 18 months, almost 100,000 rural families have signed up for the voice message project, first piloted by the government of the impoverished, but resource-rich, eastern state of Bihar.

With India's health services starved for funds, the mobile phone messages are a cheaper way to spread basic tips on health.

Payment delays have led to months of disruption in the traditional system of home visits by health workers to encourage pregnant women to take medicine and follow safety measures. (Read this exclusive here)

The new project, backed by the Bill and Melinda Gates Foundation and the charity arm of British broadcaster BBC, will make use of a national database to track pregnant women.

Another service, Mobile Academy, will also use recorded messages to help train India's millions of health workers.

Health experts welcome the initiatives, but warn such mobile phone campaigns will not be enough to cut mortality rates unless India ramps up health services, particularly in rural areas.

"This (mobile services) will have a very marginal effect," said DileepMavalankar, director of the Indian Institute of Public Health in the western state of Gujarat, adding that the health system needed to be strengthened in remote areas.

2. Bar code on drug packaging to help track and trace authenticity

Under the system, the primary , secondary and tertiary packs of medicines will carry a unique bar code, which will be allotted to each manufacturer. SushmiDey | 14 March 2015, 12:35 PM IST

[http://health.economictimes.indiatimes.com/news/pharma/bar-code-on-drug-packaging-to-help-track-and-trace-authenticity/46563107]

Knowledge Bytes


NEW DELHI: To ensure medicines sold are genuine products, the health ministry has developed a ̀ Track and Trace' mechanism which will enable consumers to check safety and authenticity of a drug through the internet.Under the system, the primary , secondary and tertiary packs of medicines will carry a unique bar code, which will be allotted to each manufacturer. Consumers, buying medicines from retail pharmacy store, can use the bar code on the pack on internet to check information about the source of manufacturing of the product, whether it is an approved drug, it's date of expiry as well as price fixed by the government etc.

The move is significant because of the highly fragmented Indian pharmaceutical market, pegged at around Rs 89,000 crore annually. The huge size of the market makes it difficult for regulators and monitoring agencies to track medicines, mainly in rural areas and distant villages. This leads to a potential risk of spurious, inefficacious and low quality medicines being sold in the market.

The government is yet to finalize a date for launching the 'Track and Trace' system in the local market. "Rules for implementing the Track and Trace mechanism will be framed and will be operationalized after allowing a reasonable period for transition," Union health minister J P Nadda said. He added, compliance will be mandatory for all drug manufacturers.

Following allegations from some international markets that spurious medicines are making their way from India, the commerce ministry in 2012 had made it mandatory for pharmaceuticals exporters to have barcoding for secondary and tertiary packaging on their export consignments.

Now, the government is also working to create an integrated database with all details of a product, which will enable tracking and monitoring of these products.

3. Stent re-labelling scam: How price pushed up

Cardiac stents of different brands from the same company are priced differently. On what basis then do cardiologists make claims about the relative superiority of one brand over another? Are they misled by claims made by company representatives or – worse -- are they willing partners in misleading patients?TNN | 14 March 2015, 6:56 AM IST

[http://health.economictimes.indiatimes.com/news/medical-devices/stent-re-labelling-scam-how-price-pushed-up/46561069]

NEW DELHI: Different brands of cardiac stents from the same company are priced differently, leading patients to believe that there are qualitative differences between them. However, documents submitted by a company with the Drug Controller General of India (DCGI) have stated that its different brands are identical and are merely "rebranding or relabelling" of the brand already available in the market.

Abbot Healthcare's Xience Pro is being sold for over Rs 29,000, Xience V for over 57,000 and Xience Prime for over Rs 74,000 in some of the leading hospitals in the Capital. The rate contract for stents given by Abbot Healthcare to the Maharashtra government quoted Rs 23,625 as the price of the Xience PRO drug eluting stent.Doctors often claim superiority of one brand over another of the same company, claiming that the superior one is `next generation' or higher quality and persuade patients to pay more for the so-called superior brand. However, in an affidavit filed with the DCGI to get approval for its brand Xience PRO, Abbot Healthcare, the company manufacturing this stent, has stated that the Xience Pro brand of DES was just "rebranding (relabelling)" of the commercially approved XienceV and the Xience Prime LL drug eluting stents.

The company has also filed detailed tables giving head-to head comparison showing how they are absolutely identical.It also stated in the affidavit: "The Xience PRO brand is identical in design, manufacturing process and specification, intended use, indications and instructions for use to the currently approved product. The Xience PRO brand will have new part numbers and new labelling."



"The Xience PRO and the Xience PRO LL everolimus eluting coronary stent system (EECSS) is a rebranding (relabelling) of the commercially approved Xience V EECSS and the Xience Prime LL EECSS," stated the company affidavit.

On what basis then do cardiologists make claims about the relative superiority of one brand over another? Are they misled by claims made by company representatives or - worse -- are they willing partners in misleading patients?

4. Wearable device helps visually impaired avoid collision

Researchers have developed a wearable device for the visually-challenged people that can help them avoid a collision. IANS | 27 March 2015, 3:12 PM IST

[http://health.economictimes.indiatimes.com/news/medical-devices/wearable-device-helps-visually-impaired-avoid-collision/46714349]

NEW YORK, Researchers have developed a wearable device for the visually-challenged people that can help them avoid a collision.

People who have lost some of their peripheral vision, such as those with glaucoma, or brain injury that causes half visual field loss, often face mobility challenges and increased likelihood of falls and collisions."We developed this pocket-sized collision warning device, which can predict impending collisions based on time to collision rather than proximity," said paper co-author Shrinivas Pundlik. The findings are published in Investigative Ophthalmology and Visual Science (IOVS).

"It gives warnings only when the users approach obstacles, not when users stand close to objects and not when moving objects just pass by," said senior author Gang Luo, associate scientist at Massachusetts Eye and Ear."The auditory collision warnings given by the device are simple and intuitively understandable," Luo explained.Compared to walking without the device, collisions were reduced significantly by about 37 percent with the device and walking speed barely changed.

“We are excited about the device's potential value for helping visually impaired and completely blind people walk around safely," Luo said.

5. Satellite tech to scan human skin for cancer

The European Space Agency has announced that doctors will be adapting its Proba-V vegetation-scanning satellite camera for a decidedly non-vegetative purposeGizmodo | 19 March 2015, 2:13 PM IST

[http://health.economictimes.indiatimes.com/news/health-it/satellite-tech-to-scan-human-skin-for-cancer/46620245]

The European Space Agency has announced that doctors will be adapting its Proba-V vegetation-scanning satellite camera for a decidedly non-vegetative purpose: Monitoring human skin cells. The hardware within this satellite may, in a few years, form the core of a new medical device that doctors can use to scan human skin for disease.

Proba-V is a mini satellite that uses state-of-the-art digital infrared sensors, coupled with a high speed camera, to monitor changes to Earth's vegetation from orbit. According to the space agency, the camera's unique wide field of view allows it to construct a fresh picture of earth's flora every two days.

From thousands of miles above the planet's surface, it can resolve small differences in the colour of neighbouring trees that would appear identical to the human eye. This feature allows scientists to monitor the health of Earth's ecosystems over time with unparalleled precision.

Apparently, Proba-V's ability to see shortwave radiation our eyes cannot detect makes it an ideal tool for monitoring the health of humans, as well. Researchers discovered that if you mount Proba-V's camera on a medical scanner, doctors can use the camera here on earth, to stare deeper into human tissues than previous scanners, and perhaps detect signs of skin diseases such as cancer earlier on.

Perhaps in the future, in addition to using satellite cameras to map earth's climate, we'll be using them to map our very own bodies.

6. 'Smart' bandage detects bedsores early

This new bandage can detect bedsores before they can be seen by human eyes, thereby making timely treatment possible.IANS | 18 March 2015, 3:30 PM IST

[http://health.economictimes.indiatimes.com/news/health-it/smart-bandage-detects-bedsores-early/46608716]

WASHINGTON, This new bandage can detect bedsores before they can be seen by human eyes, thereby making timely treatment possible.

Pressure ulcers, or bedsores, are injuries that can result after prolonged pressure cuts off adequate blood supply to the skin.

Engineers at the University of California, Berkeley, have created a new 'smart bandage' that uses electrical currents to detect early tissue damage from pressure ulcers, or bedsores, before they can be detected with the naked eye."We set out to create a type of bandage that could detect bedsores as they are forming, before the damage reaches the surface of the skin," said Michel Maharbiz, head of the smart bandage project.

Bedsores are associated with deadly septic infections, and the growing prevalence of diabetes and obesity has increased the risk factors for bedsores.

"We can imagine this being carried by a nurse for spot-checking target areas on a patient, or it could be incorporated into a wound dressing to regularly monitor how it's healing," Maharbiz explained.

The researchers exploited the electrical changes that occur when a healthy cell starts dying.They tested the thin, non-invasive bandage on the skin of rats and found that the device was able to detect varying degrees of tissue damage consistently across multiple animals.

The invention, described in the journal Nature Communications, could provide a major boost to efforts to stem a health problem that affects an estimated 2.5 million people in the US alone.

"This bandage could provide an easy early warning system that would allow intervention before the injury is permanent. If you can detect bedsores early on, the solution is easy," said Michael Harrison, a professor of surgery at UC San Francisco and a co-investigator of the study.

7. Chronic kidney disease more prevalent in northern states: Government

PTI | Aug 5, 2014, 06.09PM IST

[http://timesofindia.indiatimes.com/india/Chronic-kidney-disease-more-prevalent-in-northern-states-Government/articleshow/39692539.cms]

NEW DELHI: Small population-based studies have shown that chronic kidney diseases (CKD), which is a cause of kidney failure, are five times more prevalent in north Indian states that their southern counterparts, Health Minister Harsh Vardhan told Rajya Sabha on Tuesday.



"CKD has been studied in India by small population based studies. It was found to be 0.79 per cent in north India and 0.16 per cent in south India," he said, adding that state-wise data was not available.

The data on numbers of cases of persons suffering from kidney diseases and deaths due to the ailment was also not available, he said in a written reply.

8. Hepatitis C 'could become a rare disease by 2036’

[http://www.medicalnewstoday.com/articles/280635.php]

In the US, 1 in every 100 people has chronic hepatitis C. But according to a new study published in the Annals of Internal Medicine, current screening and treatments for the disease will make it "rare" by the year 2036, affecting only 1 in every 1,500 people. They note this could even happen 10 years earlier if treatment and screening methods are further improved.

Researchers estimate that by the year 2036, only 1 in 1,500 people will have hepatitis C.

These findings come from a predictive computer model created by researchers at the University of Pittsburgh Graduate School of Public Health, PA, in collaboration with investigators from the University of Texas MD Anderson Cancer Center.

Hepatitis C is an infection caused by the hepatitis C virus (HCV). Mainly spread through contact with blood from an HCV-infected individual, hepatitis C is the leading cause of chronic liver disease in the US and is accountable for more than 15,000 deaths each year.

Around 70-80% of individuals with HCV, however, do not experience any symptoms, meaning many people are not aware they have it until they undergo blood screening.

Because of this, in 2012, the Centers for Disease Control and Prevention (CDC) and the US Preventive Services Task Force recommended that everyone born between 1945 and 1965 - deemed "baby boomers," a population that incorporates around 81% of people with chronic HCV infection - should undergo a one-time screening for HCV.

As well as improved screening recommendations, treatment for hepatitis C has come a long way. Up until 2 years ago, there were only two drugs approved by the Food and Drug Administration (FDA) to treat the virus - pegylated interferon, which can be used alone, and ribavirin, which is used in combination with pegylated interferon.

But earlier this year came the first drug regimens for hepatitis C that could be taken orally. Sofosbuvir - brand name sovaldi - is a once-daily pill approved to treat HCV genotypes 1, 2, 3 and 4. It is used in combination with ribavirin or both ribavirin and pegylated interferon. Such regimens have demonstrated high effectiveness, making the virus undetectable in the blood of some patients.

Current screening recommendations effective, but more can be done

In this latest study - led by Mina Kabiri, a doctoral student of the Department of Health Policy and Management at the University of Pittsburgh Graduate School of Public Health - the team accounted for recent improvements in HCV screening and treatment to create their predictive model of HCV prevalence in the US, using data from the National Health and Nutrition Examination Survey (NHANES) and an array of clinical studies.

Fast facts about HCV

Approximately 75-85% of people who become infected with HCV develop chronic infection

Although HCV can be asymptomatic, some people will develop symptoms, such as fever,fatigue, abdominal pain and nausea

HCV symptoms occur, on average, 6-7 weeks after infection.

Their model, they say, uses the data to predict the number of people in the US with HCV infection at any given time between 2001 and 2050, while taking into account a range of different scenarios.


To validate the model, the team used it to predict HCV prevalence in the US between 2003-10. It reported 2.7 million cases - the same number reported by NHANES.

Using the model to predict long-term prevalence of HCV, the researchers estimate that the one-time screening of baby boomers currently in action can help identify 487,000 HCV cases in the next decade.

From this, they say that current screening guidelines, along with the highly effective treatments available, could make hepatitis C a rare disease in the next 22 years - with only 1 in 1,500 people becoming infected.

But the team calculated that if one-time screening was offered to all Americans - allowing more individuals to receive earlier treatment - 933,700 cases could be identified in the next 12 years, meaning hepatitis C could become a rare disease 10 years earlier than with current screening recommendations.

Furthermore, they estimate that universal HCV screening would further prevent 161,500 liver-related deaths, 13,900 liver transplants and 96,300 cases of hepatocellular carcinoma - the most common form of liver cancer.

"Although recent screening recommendations are helpful in decreasing the chronic HCV infection rates, more aggressive screening recommendations and ongoing therapeutic advances are essential to reducing the burden, preventing liver-related deaths and eventually eradicating HCV," says senior author JagpreetChhatwal, PhD, assistant professor of health services research at the University of Texas MD Anderson Cancer Center.

9. Health care jobs lift less-educated workers

Paul Davidson, USA Today5:38 a.m. CDT July 24, 2014

[http://www.ksdk.com/story/news/health/2014/07/24/health-care-jobs-less-educated-workers-boom/13084721/]

The boom in health care jobs is skewed toward positions requiring less education, providing lower-paid workers a potential pathway to better careers, a new Brookings Institution report says.

From 2000 to 2011, the number of workers in 10 large health care occupations who had less than a bachelor's degree surged 46%, vs. 39% growth for all health care jobs, the study says.

Health care workers with less than a four-year degree make up 61% of the industry's 12.1 million employees. Their growth can partly be traced to the need to more quickly turn out health workers to serve an aging population, says Brookings fellow and study co-author Martha Ross.

The findings have significant implications for a U.S. labor force that has grown increasingly polarized between high-wage and low-wage jobs, with the number of middle-income jobs shrinking in recent years. A sizable share of employment growth during the recovery has been in low-wage sectors, such as fast food and retail, whose workers have staged protests to demand higher pay and more consistent hours.

The health care industry can help bridge the divide between low- and high-paying jobs.

"It can provide people with lower levels of education a career ladder and a path toward upward mobility," Ross says. For example, nursing assistants can rise to become registered nurses.

Education and earnings levels for health care jobs vary widely. About half of diagnostic technicians and registered nurses have either associate degrees or some college, and their median annual salaries are the highest, at $52,000 to $60,000.

Licensed practical nurses, emergency medical technicians, paramedics and dental assistants typically have some college and earn $30,000 to $40,000.

Personal care aides and home health aides generally have high school diplomas and the lowest salaries — $21,000 to $25,000.

The bulk of the job gains for less educated health care workers has been among positions paying $30,000 or less, such as personal care aides, nursing aides and medical assistants.


The study recommends that such workers be utilized to a far greater extent, especially under a new health care law designed to increase efficiency and lower costs. For example, home health aides can be trained to monitor patients' conditions, enter electronic medical data and even do some health coaching, Ross says. The added duties, she says, would bring higher pay.

Similarly, medical providers and states should promote more team-based care that hands a bigger role to lower-level health workers and allows doctors to focus on specialized services.

Metro areas with the highest share of health care jobs filled by less educated workers — 58% to 72% — include: Modesto, Calif.; Lakeland, Fla.; Dayton, Ohio; and El Paso. Such areas typically have fewer medical schools and teaching hospitals and require a less educated and specialized workforce, the report says.

10. A novel cholera vaccine developed in India provides more protection

Updated: July 27, 2014 12:55 IST

[http://www.thehindu.com/sci-tech/health/medicine-and-research/scientists-in-india-develop-live-oral-cholera-vaccine-which-is-more-efficacious-and-protective/article6249606.ece]

An Indian cholera vaccine now available produces only 53 per cent protection after two doses.

Using a novel approach, scientists in India have developed a live oral cholera vaccine that is not only more efficacious and hence more protective than the currently available ones but also able to elicit better protection with just one dose. The results of the human clinical trial of the vaccine have been published in July this year in the journal PLOS ONE.

“We were able to achieve 65.9 per cent sero-conversion using only one dose of the vaccine,” said Amit Ghosh who is currently an Emeritus Scientist at the National Institute of Cholera and Enteric Diseases (NICED) in Kolkata. An Indian cholera vaccine now available produces only 53 per cent protection after two doses.

The difference between the existing three vaccines and the candidate vaccine — VA1.4 — being tested goes beyond the level of protection achieved. The most important one from the public health perspective is that the higher protection was achieved using only one dose of the vaccine.

'Shanchol', marketed by Hyderabad-based Shantha Biotech requires two doses to achieve 53 per cent protection, with the second dose given 14 days after the first. The other two vaccines too need to be given in two doses.

But the biggest public health challenge when a vaccine is given as two doses is to make sure that people come back for the second dose. In reality, there could be a significant number of people not turning up for the second dose; this greatly impacts the achievement of the primary objective of preventive vaccination, especially during cholera outbreaks.

“It is difficult to say” whether it was the use of a live cholera strain (unlike the killed ones used in the other three cholera vaccines) in the vaccine that produced better protection Dr. Ghosh noted. “It's a speculation that if some antigen that may induceprotective immunity is made by the Vibrio bug only when it is in the intestine, then this protective antigen is absent in the killed bug [used in other vaccines],” he explained.

But the biggest differentiating factor is that unlike the other three vaccines, the strain used in the VA1.4 vaccine does not have the gene that produces the cholera toxin.

“It does happen in nature that due to various reasons one bug may not have the gene responsible for producing cholera toxin,” he said. “NICED [National Institute of Cholera & Enteric Diseases, Kolkatta] screened 1,000s of cholera strains. They identified one and sent it to me at IMTECH [Institute of Microbial Technology, Chandigarh] in mid 1990s to genetically engineer the bug.”

While the general trend at that time was to take a live virulent cholera strain and remove the cholera toxin gene thereby preventing the strain from causing cholera (when the vaccine containing the live bacteria is given), the vaccine still causedsome adverse effects.

“When they remove the toxin gene, other secondary virulent factors present in the cholera bacteria whose adverse effects are normally masked by the presence of the cholera toxin gene emerge,” Dr. Ghosh explained. “These [secondary virulent factors] cause diarrhoea.”

“So we wanted to take a Vibrio bug which is completely devoid of all virulent factors and then manipulate it so the bug has only the immunogenic subunit of the cholera toxin,” he said. The live oral vaccine VA 1.4 was developed by isolating a 'Vibrio cholerae O1 El Tor' strain.

The cholera toxin gene is a combination of two different subunits. Subunit A of the toxin gene is the one that causes cholera disease, while subunit B is the immunogenic subunit that is necessary for the virus to produce antigen. The human immune system produces antibodies in response to the antigen produced by a bacteria/virus; antibodies so produced are responsible for killing the bacteria. “We genetically engineered the strain to produce the subunit B,” he said.

“We were probably lucky the approach worked,” he said. “We got a U.S. patent in 10 months of filing it.”

A human clinical trial conducted last year had 44 subjects on whom the vaccine was tested; 43 got a placebo. Two doses were given — the second dose was given 14 days after the first one. The sero-conversion was about 66 per cent on day seven after the first dose was given, and it did not increase further after the second dose was administered. The trial was done in collaboration with the Society for Applied Sciences, Kolkatta.

“The trial was beyond Phase I,” Dr. Ghosh said, “because it looked at sero-conversion [efficacy] and not just safety.” The main objective of Phase I trials is to check for the safety of a candidate drug/vaccine. A larger trial involving more human subjects is being planned.

The vaccine was developed by a collaborative effort of three institutes in India — IMTECH, NICED the Indian Institute of Chemical Biology (IICB), Kolkata. DBT funded the project.

11. Blood test predicts suicide risk, study suggests

[http://www.foxnews.com/health/2014/07/31/blood-test-predicts-suicide-risk-study-suggests/]

A new gene linked to suicide risk has been discovered, and researchers say the finding could lead to a blood test that predicts a person's risk of attempting suicide.

In the study, researchers scanned the genes of brain tissue samples from people who had died by suicide, and compared these genes with those of people who died of other causes. The scientists found that a genetic mutation, in a gene called SKA2, was more common among the people who died by suicide. The researchers also found a chemical change, called an epigenetic change, on that same gene that was more common among people who committed suicide than in those who died from other causes.

"We have found a gene that we think could be really important for consistently identifying a range of behaviors" having to do with suicide, said study researcher Zachary Kaminsky, an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.

Next, the researchers examined whether these genetic changes could predict a person's risk of having suicidal thoughts or attempting suicide. Using blood samples from 325 people, the scientists created a model that took into account whether a person had the SKA2 genetic mutation and the epigenetic change, as well as the person's age, sex, and stress and anxiety levels. The researchers tested this model on 22 people ages 15 to 24, and about 50 pregnant women, who all gave blood samples. Scientists then followed up with these individuals to see whether they had experienced suicidal thoughts or attempted suicide. [5 Myths About Suicide, Debunked]

The model correctly identified 80 percent to 96 percent of people who experienced suicidal thoughts or attempted suicide. It was more accurate among people at severe risk for suicide.

The researchers said they suspect that the genetic changes in SKA2 may be involved in shutting down the body's



response to stress. Kaminsky likened the genetic changes to faulty brakes on a car: Without stress, it's like having a parked car with bad brakes, but once stress occurs, having brakes that work is important, or else the car can get out of control.

Because the study was small, the results are preliminary and more research is needed to confirm the findings, the researchers said.If the findings are confirmed and lead to a blood test for suicide risk, such a test might be used to screen people in psychiatric emergency rooms or to determine how closely a person needs to be monitored for suicide risk, the researcher said.

The study was published online Tuesday (July 29) in the American Journal of Psychiatry. Kaminsky and one of his colleagues hold a patent on evaluating people's risk of suicidal behavior using genetic changes in SKA2.Last year, another group of researchers found certain markers in the blood were linked to suicidal thoughts in people with bipolar disorder.

12. Portea Medical to invest $20 million to enter 32 cities by 2015 end

PTI Aug 3, 2014, 10.52AM IST

[http://articles.economictimes.indiatimes.com/2014-08-03/news/52385749_1_accel-partners-and-ventureast-home-healthcare-market-portea-medical]

NEW DELHI: Home healthcare services provider Portea Medical plans to invest $ 20 million (over Rs 120 crore) to expand its footprint in India across 32 new cities by the end of 2015.

The Bangalore-based firm is at present in 18 cities, including Chennai, Delhi and NCR, Mumbai, Pune, Hyderabad and Kolkata. It is looking to hire 5,000 people during the period.

"We would be investing $ 20 million for expansion in 32 cities by end of 2015. Our aim is to be present in 50 cities in India that have a population of more then 10 lakh," Portea Medical Co-Founder & Chairman K Ganesh told PTI.

Asked how the company plans to raise funds for the expansion, Ganesh sad: "It will be through private equity."

The company at present has 1,000 employees and will add another 5,000 more people to its workforce.

"We would be employing 5,000 more people as we expand by end of 2015. We would also impart training to them so that patients get highest quality of medical care," he added.

About the long term vision for the company, Ganesh said: "We are confident about the growth of home healthcare market. We will be looking to list the company in seven years time."

He didn't share the revenue of the firm stating it's a privately held firm at the moment.

For growth, the company would focus on four key areas -- geriatric care, chronic diseases, post operative care and in- home primary care, he added.

Bangalore based Portea Medical had last week raised an undisclosed amount from Qualcomm Ventures. It had earlier raised $ 8 million from Accel Partners and Ventureast.

13. How An Advisor Can Help Cut Your Healthcare Costs

By Leslie Kramer | August 04, 2014

[http://www.investopedia.com/articles/investing/080414/how-advisor-can-help-cut-your-healthcare-costs.asp]

Healthcare costs are on the rise, but few people are adequately planning for how these costs will impact their overall retirement plan budget. Until recently, many financial advisorslacked the ability to help clients realistically forecast their future Medicare and healthcare costs, and plan for likely expenses. But today new tools are being developed


that can aid retirees in assessing those costs and in figuring out ways to reduce them.

To help individuals do a better job of calculating their average retirement healthcare costs, the Insured Retirement Institute, an association for the retirement income industry, recently teamed up with HealthView Services, a provider of retirement health care cost data, to make the HealthView Prime cost planning tool available to IRI's members. (For related reading, see: 5 Questions To Ask Before Hiring A Financial Advisor.)

Preparing for Retirement Healthcare Costs

With retirement healthcare costs expected to exceed Social Security benefits for many retirees, financial advisors should be taking steps now to help clients better prepare for and deal with what could become a difficult situation later on.

The inflation rate for basic healthcare is 5-7% per year, according to HealthView's data. That means that the majority of retirees living on a fixed income will not be able to keep up with their healthcare costs. (For related reading, see: What Does Medicare Cover.)

The HealthView paper entitled “Addressing the Retirement Health Care Cost Crisis: Cost Management Strategies,” noted that a 65-year-old couple living in Massachusetts today pays about $7,020 for one year of health care coverage spread over their Medicare Parts A, which covers lab tests and surgeries; Part B, which covers doctors' visits and out-patient services; Part D, which pays for prescription drug coverage, and a supplemental Medigap policy. In ten years time, those premiums are projected to increase by 64% to reach $11,536. So as a retiree continues to age, those costs will continue to rise. In fact, a 55-year-old couple today should see their health care costs almost double from $11,536 during their first year in retirement to $22,981 a decade later, the paper notes. (For related reading, see: Medicare 101: Do You Need All 4 Parts?.)

Advisers Can Help Retirees Lower Healthcare Costs

So how can a financial advisor better help their clients plan for and alleviate some of these rising costs? First and foremost, advisors need to point out to their clients that Medicare premiums are means-tested. That means that higher-income retirees will pay larger monthly premiums for Medicare Part B and Medicare Part D than lower income earners.

Secondly, advisors should be assessing their clients modified adjusted gross income (MAGI), which is used to calculate the higher surcharges. The MAGI takes into account the taxable portion of Social Security benefits and interest on municipal bonds, which are not subject to federal income tax. By contract, income generated by using the loan provision of a cash-value life insurance policy, and any Roth IRA distributions, as well as distributions from a health savings account, are not included in the MAGI income calculation. (For related reading, see: Shopping For a Financial Advisor.)

Based on the MAGI income brackets, those individuals whose income exceeds $85,000, and married couple's who's income exceeds $170,000, will pay higher monthly premiums for Medicare Parts B and D, than those whose income falls into a lesser bracket. There are a total of four income brackets used to define the MAGI thresholds.

Based on these figures, over one-third of advisory clients will likely have to pay higher Medicare premiums than the majority of Medicare beneficiaries, who will pay the standard $104.90 per month for Medicare Part B, according to the Healthview study. (For related reading, see: How To Find The Financial Advisor Of Your Dreams.)

Reducing Withdrawals May Hurt You

Financial advisors need to explain these nuances to their clients, so that they can better plan their retirement budget or make adjustments to improve it. For instance, the strategy of claiming reduced Social Security benefits before the age of 67, or allowing a retirement account, such as a regular IRA account to continue to grow tax-deferred, while withdrawing income from an investment account instead, may in fact increase one's healthcare costs later down the line in retirement.

That's because the required minimum distribution age from a regular IRA account is 70.5 years old, and if the amount being withdrawn is large, it could land some retirees in a higher Medicare premium bracket, which, by the way, is not indexed for inflation. Additionally, if a spouse passes away, the surviving spouse could find him or herself paying even higher premiums, while their income remains unchanged, as premiums are based on the lower


income brackets used for singles. (For related reading, see: Find The Right Financial Advisor.)

The Bottom Line

Financial advisors would be wise to alert their clients — especially their wealthier ones — who are moving toward retirement how to better optimize Social Security benefits and IRA accounts to mitigate rising healthcare costs.

14. Indian Healthcare Industry - At the Cross-Roads

[http://www.siliconindia.com/magazine-articles

-in/Indian_Healthcare_Industry_%E2%80%93_At_the_CrossRoads-BBNV864624544.html]

ALTEN Calsoft Labs is a 1992 founded technology consulting and engineering services company. Based out of California, the company offers software product development, cloud enablement and engineering services in verticals like telecom & networking, semiconductor and others.

The usage of IT solutions for healthcare industry in India is much lower compared to developed countries. Large private hospitals in India spend under 1 percent of their operating budget on IT, which is much lower than 3 percent spent in the west, this is even lower in case of Government hospitals. According to research firm Gartner Inc., Indian health care providers are expected to spend $1.08 billion on IT products and services in 2014, a moderate increase of 4 percent over 2013. Internal services, like salaries & benefits paid to the internal IT staffs, are projected to grow fastest at 18.5 percent in 2014. Fueled by the increasing demand in Clinical & Care Management applications, HIT software segment is projected to grow at a rate of 6 percent in 2014 to reach $101 million in 2014, up from $95 million in 2013.

The health care delivery environment in India has distinctive challenges. Currently, the Indian Healthcare sector faces the challenges of accessibility, infrastructure and quality.

Some other challenges faced by Indian CIOs in adopting IT into the Indian health care system include:>> Lack of standards :- Health care service providers have to face several problems while designing and implementing health care management systems as there is not standard like HIPAA in India>> Lack of in-house IT domain knowledge : - Most of the hospitals focus on care delivery and have low investment in IT

>> Reluctance of medical, nursing and other staff to adjust to change

>> Apprehensions around technology failures (paper systems appear more reliable)

Many of these challenges can be solved by increasing the automation of diagnostic, care and collaboration processes. Though the usage of IT solutions for healthcare industry in India is not very high, the help of private sector investments in Healthcare sector and due to the increase in the use of modern diagnostic and treatment solutions, we see that care providers and associated service providers like health insurers are adopting information technology as a much faster pace than earlier. Indian technology solution providers need to develop innovative solutions to seize this opportunity and create a strong healthcare technology industry. Few areas which have a higher potential of IT investment related to Automation are:

>> Hospital Management Systems, customized to meet the needs of Indian hospitals

>> Telemedicine systems for providing care to remote hospitals and primary health centers where trained or

specialized doctors are not available

>> Patient health record portals for storing and sharing patient health record among different stakeholders like patients, hospitals, clinics and physicians

>> Laboratory information management system for pharmaceutical and biotechnology companies for accelerating R&D activities


>> Remote patient monitoring solutions to support patients with chronic illness

>>mHealth solutions for improving collaboration among patients, physicians, hospitals, and payersIndian technology solutions providers, big and small, have an opportunity to use the disruptive technologies like Cloud & Mobility and change the way healthcare is provided in our country and create a sustainable competitive advantage in the market place. To understand how these technologies can change the healthcare landscape, let us understand the two primary challenges in healthcare - one in providing healthcare solution to all and other to grow the industry faster enough. These two challenges are two sides of the coin and cannot be solved independently. At a macro level these challenges are caused by:

>> Absence of access to healthcare to a major part of the population due to unavailable infrastructure, skilled doctors, care providers, and basic medicines

>> Resource constraints, financial and workforce, to create infrastructure required to provide healthcare for all>> Inefficiencies in healthcare operations due to low automation and isolated systemsHealthcare providers can use cloud computing effectively to solve many of these challenges. A cloud based telemedicine system that can be accessed over a low cost tablet can go a long way in increasing the access to healthcare as this can enable people in remote areas to reach out to expert doctors in a much lower cost. Since cloud based solutions are generally delivered on a 'pay-per-use' model, it creates less strain on existing financial resources, at the same time optimize the use of skilled human resources. Similarly, a cloud based patient health record portal, accessible through a tablet, can increase operational efficiencies and reduce the diagnostic costs. A cloud based healthcare information system integrated with patient health record portal can increase operational efficiencies in any hospital manifolds without creating a big dent on financial resources of the hospitals. Likewise, a cloud based Laboratory Information System can reduce the cost of drug discovery which can result in low cost medicines for our country. We are already seeing many Indian technology companies taking right step towards this and launching cloud and mobility based innovative solutions for enabling healthcare providers to solve above mentioned challenges.

Another big opportunity that lies in front of Indian technology companies is to come out with low cost indigenous medical devices that meet the requirements of Indian healthcare industry. Companies should focus on the ruggedness, simplicity, easy accessibility, usability and specific needs of Indian healthcare industry while developing these systems. A new bottom of the pyramid approach can help the manufacturers here as they can offset the loss of profit margin through economy of scale.

It is clear that the disrupting technologies like cloud & mobility will be a major driver in changing the face of Indian healthcare industry and making India a healthy nation. It is imperative that both healthcare providers and technology providers need to show agility, and out of-the-box thinking capability to come out with innovative solutions to contribute to this growth journey.

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WellnessQuotes

59

When 'I' Is Replaced By 'We' Even Illness Becomes Wellness!

With Good Health Comes Happiness, With Happiness comes Positive Attitude, With Positive Attitude comes A Great Society.

So �Stay Healthy, Be Happy�, Make This A Wonderful World.

A Healthy Outside Starts From The Inside.

Health Is The food for our mind And Body So, Think wisely. Work Actively And exercise regularly.

Its not that You Have Stopped Playing Because U Have Grown Old...it Is You Grow Old Because You Have Stopped Playing.

Positive Attitude Is The Biggest Asset One Can Have In Life .

You Can Choose To Subsidize Your Illness Or Invest On Your Wellness.

Money Cannot Buy Health. What Is The Use Of Sitting On A Diamond-studded Wheelchair ?

When It Comes To Eating Right And Exercising, One Can't Say That � I Will Start Tomorrow�. Tomorrow Is The Starting Day Of Your Ending.

Life Is Waking Up An Hour Early To Live An Hour More.

�Health Is Not Forbidden, The Keys Are In Our Hands To Unlock� .

If You Think Wellness Is Expensive, Then Try Illness

Health Is Like Money, We Never Have A True Idea Of Its Value Until We Lose It

Wellness Is An Asset & Illness A Liability.

Be ill, Be Expensive! be Well, Be Rich !!!

Nurture Your Body To Strengthen Your Soul

Wellness Quotes



�Healthy Isn't The Look, its A Way Of Being�

Health Is The Physical Fitness Of A Person But Wellness Is Having A Healthy Soul As Well.

Laughter Is The Best Medicine without Side Effects.

Exercise Is Almost Like Music In A Way; There's No End To It.

If You Think You Do Not Have Time For Exercise, Sooner Or Later You Will Have Time For Illness.

A Healthy Attitude Is Contagious, Don't Wait To Catch It From Others, Be A Carrier, Start An Epidemic!�

�A Good Laugh And A Long Sleep Are The Best Cures In The Doctor's Book.�

�Health Comes From Peace Of Mind, Heart And Soul, So Feed Your Mind With Good Thoughts, Your Heart With Love And Your Soul With Eternal Happiness.�

A Man's Health Can Be Judged By Which He Takes Two At A Time-pills Or Stairs.

Healthy' Is Not A Duty But A Lifestyle After All It Starts With 'heal' And Ends With 'thy' i.e. 'you'.

Documents

Self - Medication: A pill for every ill Health Times May 201… · Global data suggests that medicines account for 30–40% of health expenditure in developing countries. Most payments