Eating more fruits & vegetables improves well-being

Eating more fruits & vegetables improves well-being
The beneficial effects of fruits and vegetables on physical health are well-recognized. And, several studies have established the advantages of eating a fruit and vegetable-rich diet. A new study published online February 3, 2017 in PLos One (PLoS One. 2017 Feb 3;12(2):e0171206) has further added to the repertoire of health benefits of fruits and vegetables by demonstrating the psychological benefits of eating more fruits and vegetables. 
The study participants included 171 young adults aged 18-25 years. They were grouped into two: one group was assigned into a diet-as-usual control condition. They took their normal diets and were sent regular text-reminders to increase their intake of fruits and vegetables and were also given a voucher to purchase fruits and vegetables. In the second group, or a fruit and vegetable intervention condition, the study participants were given two additional daily servings of fresh fruits and vegetables along with their normal diet.
The researchers found that only those young adults who were provided with high-quality fruits and vegetables showed improvements to their psychological well-being with increases in vitality, flourishing and motivation across the study duration of two weeks. The strongest effects were found for motivation. However, no changes in symptoms of depression and anxiety were observed.
The researchers state that “our research suggests that simply educating people about fruits and vegetables and reminding them to eat their recommended daily intake may not be sufficient in ensuring the wider population reaps the psychological benefits of fruits and vegetables consumption. Perhaps greater emphasis needs to be placed on actually providing people with fresh fruits and vegetables (stocking more fruits and vegetables in dorms, cafeterias, workplaces, substituting fruit for dessert, and offering free fruit for people when they shop)”.
Follow these tips for a healthy meal • Eat less and enjoy your food by eating slowly • Fill half your plate with fruit and vegetables. • Avoid oversized portions which can cause weight gain. • At least half of your grains should be whole grains. • Limit consumption of food high in trans fats and sugar. • Choose healthy fats. Use fat–free or low fat milk and/or dairy products. • Drink plenty of water. Avoid sugary drinks. • Avoid foods that have high sodium levels such as snacks, processed foods. • Above all, balance your food choices with your activity level. Dr KK Aggarwal National President IMA & HCFI

Compulsory columns in a medical prescription

Compulsory columns in a medical prescription A prescription is an integral part of a consultation as it summarizes the instructions of the doctor to the patient. The Free Dictionary has defined a prescription as “a written directive, as for the compounding or dispensing and administration of drugs, or for other service to a particular patient” (http://medical-dictionary.thefreedictionary.com/prescription). Handing over of the prescription by the doctor to the patient marks the conclusion of every consultation, be it a new consultation or a follow up visit. A medical prescription traditionally enumerates the drugs that have been prescribed, along with directions for the patient to follow when taking the drug and the diagnosis. Some significant clinical findings may also be mentioned. There are four parts of a typical prescription • Superscription: Indicated by the sign Rx meaning recipe, take • Inscription: This is the main part of the prescription, contains the names, doses and dosage forms of drugs ordered. • Subscription: Directions for compounding of drugs • Signature: Instructs the patient about how to take the drugs prescribed and is preceded by the symbol S or Sig (signature - Latin) Noncommunicable diseases (NCDs) such as heart disease, stroke, cancer, diabetes and chronic lung disease are a major public health problem now incurring significant costs in their management. The Global Status Report on Noncommunicable Diseases 2010 by the WHO states that “NCDs are caused, to a large extent, by four behavioral risk factors that are pervasive aspects of economic transition, rapid urbanization and 21st-century lifestyles: tobacco use, unhealthy diet, insufficient physical activity and the harmful use of alcohol”. Given the alarmingly high prevalence of lifestyle diseases worldwide, including India, it’s now time to move beyond the confines of the traditional way of writing a prescription. In addition to the demographic data and drugs, a prescription should have some ‘compulsory columns’. • Hygiene • Vaccines • Addictions • Noise pollution • Standard Lifestyle • Rehabilitation: Exercise, job, vacation • Counselling: Diet, mental health, exercise • Point of Care Investigations: ECG, blood sugar, pocket spirometry, urine spot test, hemoglobin, blood counts, coagulation etc. • Noise pollution check • Air pollution check: PM 2.5, PM 10 • Important phone numbers: Police, hospitals, ambulance, fire department, emergency number (Similar to 911 in US, the single national emergency number in India is 112) Adding these components to a prescription is an intervention towards ‘preventive healthcare’, primary prevention or secondary prevention and check the rising prevalence of chronic lifestyle diseases. This way doctors can motivate their patients and support them to make healthier lifestyle choices. Dr KK Aggarwal National President IMA & HCFI

IMA So far

IMA So far Greetings from IMA HQs! Since the Team Digital IMA took over, we have achieved the following in the past 40 days: • In the PCPNDT Act, IMA is pursuing the Ministry to exclude clerical errors under Penal Provisions. • IMA is pursuing Ministry of Health to exclude single doctor establishment out of Clinical Establishment Act (CEA). • IMA has been able to pursue the Govt. of India to write to all States to enact special Laws, where absent, in their respective states to tackle violence against medical profession and medical establishments and requested their strict implementation, where present. • On IMA’s persuasion the government will recommend to Consumer Ministry to cap medical compensation. • IMA 1 Voice Satyagraha, IMA 1 Voice Solidarity day and IMA 1 Voice Action Day was a great success • IMA is in process of starting certifying IMA Clinics involving all national health programs. • IMA has finalized IMA Prayer. • Kerala State government has included noise and health as a Chapter in 8th standard syllabus on IMA’s recommendations. • On IMA’s intervention, 304-B was converted into 304-A in Pune case. • On IMA’s intervention, the 3 attempts for UG MBBS admission were shifted from retrospective to prospective. The Ministry of Tourism, Govt of India has been persuaded by IMA for the following: • Duration of e-medical visa to be 6 months, with double entry. • Attendants traveling with patients to be made eligible for e-medical visa on automatic route with a simplified online application procedure. • Hospitals to be responsible for reporting of personal details of patients to FRRO (Foreign Regional Registration Office) in lieu of present system of personal reporting. • Requirement of referral letter from local doctor may be dropped. • Visa fee for e-medical visa to be rationalized. • Concerned agencies to expedite accreditation process and issue of accreditation letters with respect to treatment at Ayurveda and Wellness centers. • Clear indication of the broad cost of various treatments readily available for the patients; hospitals should have all inclusive packages advertised within a band. • Under the purpose of visit for e-TV category, a separate check box to be included for Medical Attendant and that this could then be linked with documentation of the original applicant for the e-Medical Visa so that it could be clearly established who is coming in as the attendant. • e-Medical Visa on the basis of invitation letters from NABH-accredited hospitals. • Separate immigration counters at major international airports for e-Medical Visas • A facilitation counter for such tourists outside the immigration area under the aegis of the Ministry of Health and Family Welfare (MoHFW) and the Hospital Association with interpreters for Russian and Arabic languages. • NABH may set up such counters. The counter could also be connected to the MoT Helpline number 1363 for multi-language assistance, which is 24X7 service for tourists. • The cost of e-Medical Visa should be on par with that of the Tourist Visa. • MHA may be requested to include at least one Medical Attendant who could accompany the patient on the e- Medical Visa and that the visa application for the attendant be linked with that of the patient (e-Medical Visa applicant) The aim of every State of IMA should be to act locally and think nationally. Let’s all join hands together with IMA HQs and solve all national issues in the coming months.

Jaroorat Bhi Hai Kya? Rationalization of clinical practice

Jaroorat Bhi Hai Kya? Rationalization of clinical practice The practice of medicine today relies a lot on diagnostic investigations as an aid to diagnosis and management. The fact that the medical profession was placed under the purview of the Consumer Protection Act, may certainly have contributed to this trend. But, practicing ‘defensive’ medicine by overinvestigating a patient may not help the patient as they could lead to false positive results. The number of tests may make the patients more anxious. They also add to the healthcare costs, which should be a matter of concern for a country like ours, where patients pay most of their medical expenses out of their own pockets. Prescribing too many and at times unnecessary tests overburdens the healthcare system translating into an inefficient healthcare system. The Choosing Wisely campaign launched in 2012 was a step forward to avoid medical tests, treatments and procedures. The campaign aims “to promote conversations between clinicians and patients by helping patients choose care that is: Supported by evidence, not duplicative of other tests or procedures already received, free from harm and truly necessary (www.choosingwisely.org)”. Non-maleficence (do no harm) and beneficence (do good) are the pillars of medical ethics. As clinicians, it is our duty to provide the safest, cheapest but quality drug to our patients and prescribe the right investigation to the right patient. “Jaroorat Bhi Hai Kya” is a campaign of the Indian Medical Association (IMA) to promote rational use of drugs and/or rational ordering of investigations and hospitalizations. This will help avoid litigations. Rational use of drugs assumes importance particularly in view of the widely prevalent problem of antibiotic resistance globally. Extensive and injudicious use of antibiotics has been a major factor driving this public health crisis. Be cautious about off-label use of drugs, procedures. This may be considered a trial and need approval of Ethics Committee. Before you prescribe any drug or order investigations, ask yourself the following questions: • Is it necessary? • Will it benefit my patient? • Is it safe? Remember, Think before you Ink …Use Wisely and not widely…

Updated ACIP Immunization Schedule for Adults

Updated ACIP Immunization Schedule for Adults The Advisory Committee on Immunization Practices (ACIP) has released updated immunization schedule for adults aged 19 years or older, United States, which have been published February 7, 2017 in the Annals of Internal Medicine. • ACIP recommends against live attenuated influenza vaccine (LAIV) during the 2016–2017 influenza season. • Adults with a history of egg allergy who have only hives after exposure to egg should receive age-appropriate inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV). • Healthy adolescents who start their human papillomavirus vaccine (HPV) series before age 15 years are recommended to receive 2 doses of HPV. But, for adults and adolescents who did not start their vaccination series before age 15 years, 3 doses are recommended. • Hepatitis B vaccine is recommended for adults with chronic liver disease, including, but not limited to, hepatitis C virus infection, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and an alanine aminotransferase (ALT) or aspartate aminotransferase (AST) level greater than twice the upper limit of normal. • A 2-dose primary series of serogroups A, C, W, and Y meningococcal conjugate vaccine is recommended for adults with HIV infection. • Three doses of MenB-FHbp are recommended for adults at increased risk for meningococcal disease and for use during serogroup B meningococcal disease outbreaks, while 2 doses have been recommended for healthy adolescents and young adults who are not at increased risk for meningococcal disease. (Source: Ann Intern Med. 2017;166(3):209-219)

New guideline for preventive care in inflammatory bowel disease

New guideline for preventive care in inflammatory bowel disease A new clinical guideline from the American College of Gastroenterology has said that the primary care physician should also be involved in the management of a patient with inflammatory bowel disease (IBD), especially with regard to preventive health maintenance such as vaccinations. The guideline published in the February 2017 issue of the American Journal of Gastroenterology says, “To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. It is equally important to educate the primary care clinician to the unique health maintenance needs of the IBD patient, especially those on immunomodulators and biologic agents.” The guideline includes 14 recommendations to address the preventive care needs of these patients. • Guideline recommends appropriate vaccinations including influenza, pneumococcal, herpes zoster, varicella, Tdap (tetanus toxoid, reduced diphtheria toxoid and acellular pertussis), hepatitis A and B and HPV, as per guidelines. • Consult an infectious disease specialist prior to travel to endemic areas for yellow fever. • Household members of immunosuppressed patients can receive live vaccines with certain precautions. • Women on immunosuppressive therapy should be evaluated for cervical cancer annually. • All patients should be screened for depression and anxiety. • Evaluate these patients for melanoma independent of the use of biologic therapy; patients on immunomodulators should be screened for non-melanoma squamous cell cancer. • Screen for osteoporosis at the time of diagnosis as well as at regular intervals in at-risk patients. • Crohn’s disease patients who smoke should be counselled to quit. (Source: Am J Gastroenterol. 2017;112:241-58)

Timing and meal planning affect heart health, says AHA

Timing and meal planning affect heart health, says AHA A new scientific statement from the American Heart Association (AHA) has highlighted the role of meal timing and frequency in prevention of cardiovascular diseases. According to it, planning when to eat meals and snacks and not skipping breakfast are patterns associated with healthier diets, which could reduce risk of cardiovascular disease. The statement reviews the cardiometabolic health effects of specific eating patterns: skipping breakfast, intermittent fasting, meal frequency and timing of eating occasions. It recommends that “intentional eating with mindful attention to the timing and frequency of eating occasions could lead to healthier lifestyle and cardiometabolic risk factor management”. As clinicians, we stress upon eating a healthy diet, one that is rich in fruits, vegetables, whole grains, low-fat dairy products, poultry and fish and limiting red meat, salt and foods high in added sugars. Now, we should also educate our patients that “when and how often a person eats” are also important in promoting heart health - a more intentional approach to eating. Irregular patterns of eating have adverse impact on cardiometabolic health such as obesity, high blood pressure, cholesterol, blood glucose levels, insulin resistance. The statement titled “Meal Timing and Frequency: Implications for Cardiovascular Disease Prevention” is published online January 30, 2017 in the journal Circulation. (Source: AHA News Release, Circulation) Dr KK Aggarwal National President IMA & HCFI