After a year since the pandemic began, the entire world continues to deal with cascading effects on human lives. As a big relief, the moment we have all been waiting for is here. India kicked off the world’s largest vaccination drive for Covid-19 on January 16, 2021. Healthcare and frontline workers will be a priority for vaccination and initially, nearly three crore doctors, healthcare and frontline workers would be inoculated. Vaccine administration to 1.3 billion people in India is a mammoth task and digital platforms can play an integral part in the entire process of its implementation.
To start with, digital support would be required for registration, vaccination centre selection, slot booking, beneficiary profile, vaccination certification, and recording e-Health records. Through digital interventions, we would also be able to manage adverse effects, feedback, and grievance redressal mechanism. Artificial Intelligence and Machine Learning would be helpful in mining real-time data to assess the safety and efficacy of Covid-19 vaccines and adverse patient monitoring.
Realising the importance of digital disruption for the smooth function of the vaccination programme, India had developed an Electronic Vaccine Intelligence Network (eVIN) in 2015. The network was initially deployed in 12 states. Now, for Covid vaccine, the Centre has launched CO-WIN, another digital platform, to plan, implement, and monitor the drive. The digital platform would facilitate real-time information of vaccine stocks, storage temperature, and individualised tracing of beneficiaries. CO-WIN is an extension of the government’s eVIN and it digitises vaccine stocks and monitors the temperature of the cold chain through a smartphone application. It supports better vaccine logistics management at cold chain points.
The CO-WIN is an app designed by the Government of India, to enable citizens to self-register for the Covid-19 vaccination processes, initially will be accessible to healthcare workers and frontline warriors alone and will be open to usage for the general public within a month. Along with healthcare providers and the Covid warriors, the app will be effectively used by Central and State Governments to implement the inoculation drive. It provides much-needed information in bulk for healthcare workers. CO-WIN app would provide beneficiary details and update vaccination status. Digital interventions in the world’s largest vaccination campaign would surely be replicated globally.
Digital platforms are also geared up to support providers to manage post-vaccination adverse events in a better way. Hence, not only vaccination but digital platforms would strengthen the entire continuum of care in post Covid period. Healthtech service providers are ready to provide support as the vaccination for Covid-19 would be a long term event. As per the official schedule, Phase II of the vaccination would continue till December 2022, when the rest of the adult population nearly 50 crore would be covered. Healthtech companies such as DayToDay Health (DTDHI) and many more are all set to collaborate with the government and expecting the issuance of guidelines for leveraging CO-WIN app which would enable them to build on and build around the app. Healthtech service providers would invest in a strong analytics engine for not only tracking purposes, but also for planning and predictive analytics related to prioritisation of beneficiaries, areas to be targeted, reduce drop-outs, and improve vaccine efficacy across target segments.
The writer is CEO and founder of DaytoDay Health.
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SKINCARE MISTAKES THAT HASTEN AGEING
While skin ageing is a natural process that occurs through a combination of physiological and environmental factors, several ill-informed skincare practices may contribute to premature ageing. Often, out of disregard or lack of awareness, we adopt skincare or lifestyle practices that hasten the breakdown of collagen or cause irritation of the skin which eventually leads to the appearance of signs of ageing such as fine lines, blemishes, or enlarged pores.
If you are experiencing signs of premature ageing, here are some common skincare and lifestyle mistakes that may be the cause:
Don’t get it wrong. Scrubbing and exfoliating is a good practice for the skin as it helps get rid of dead cells and dirt crowing the topmost layer of the skin. However, it can do more harm than good if done excessively. Exfoliating too harshly or scrubbing the face too aggressively can cause severe skin irritation. Excessive scrubbing over a period,will lead to prolonged inflammation and the appearance of fine lines and wrinkles. If you are using a facial scrub, use it gently on your face rather than rubbing it hard. Also, scrubbing is sufficient 2-3 times a week.
Skipping moisturiser and sunscreen
When it comes to slowing down the ageing process, moisturisers and sunscreens are more important than most of us believe them to be. Lack of moisture or hydration is a leading cause of premature ageing. Often, many people who do not have dry skin tend to skip using a moisturiser every day believing they do not need it. This is where they make a mistake. Moisturiser is essential for the skin. You may use a water-based or light moisturiser if you have normal or oily skin. But use it nevertheless. Similarly, skipping sunscreen is a major factor in premature ageing since exposure to UV radiation accelerates the breakdown of collagen. Your daily skincare routine must include washing your face gently followed by a layer of moisturiser and sunscreen. Using hyaluronic acid-based products including creams, serums, and injectables such as Profhilo can also help prevent premature ageing and even address the signs of ageing.
Using products with fragrance and synthetic colours
Fragrances of scented products abound in the market. However, you must be wary of any added fragrances or synthetic colours in your skincare products. A series of potentially harmful ingredients are clubbed in the bracket called ‘fragrance’. Fragrances and synthetic colours are major causes of skin irritation and breakouts. They not only irritate sensitive skin but are harmful to all skin types. In fact, certain ingredients used in fragrances and synthetic colours are also potential carcinogens with effects stretching beyond skin irritation. Go scentless for safer skincare.
Not using products as per your skin type
While most people know that skin types are classified into normal, dry, oily, and sensitive, not many use skincare products as per their skin type. Not using products as per your skin type may cause irritation and breakouts. People who have sensitive or acne-prone skin need to adopt a highly cautious approach before picking up skincare products. A basic rule to follow is to immediately stop using a product that causes a burning sensation on the skin. Skin irritation because of using inappropriate skincare products are a major cause of the onset of premature ageing.
Consuming too much sugar
This might not be a direct skincare practice but excessive intake of sugar is associated with premature ageing. Sugar unleashes a process in the body that produces harmful free radicals called advanced glycation end products (AGEs). These AGEs are responsible for breaking down the skin’s scaffolding proteins such as collagen resulting in signs of ageing. A low-on-sugar diet is not just good for the body but also for the skin.
The writer is a Celebrity Cosmetic Dermatologist, working in Mumbai.
CHILDHOOD OBESITY AND ITS IMPACT ON THYROID IN LATER YEARS
Childhood obesity is a growing health concern these days and its prevalence is increasing all over the world. According to experts, children who are overweight or obese are at more risk of developing health issues in the future as compared to children having normal weight.
WHAT ARE THE CAUSES OF CHILDHOOD OBESITY?
Genetics and lifestyle are the two main causes of childhood obesity. If one or both of the parents are overweight or obese, their kids are more likely to be obese. Lifestyle factors such as overeating, less physical activity, too much time spent in front of the television, mobiles or laptops and consumption of unhealthy foods such as fries, cakes, aerated drinks, or other oily and sugary foods can significantly lead to obesity.
OBESITY AND THYROID DYSFUNCTION
Obesity can lead to thyroid dysfunction. Some studies have suggested that childhood obesity can affect thyroid function and structure. Hence, as the child grows older, there is more amount of stress on the thyroid gland thus leading to decreased production of thyroid hormones like T4 and TSH. This in turn leads to difficulty in losing weight because the rate of metabolism is lowered. It has been observed that thyroid function can come back to normal if there is significant weight loss as it can lead to normalisation of the TSH production. Interleukins and inflammatory cytokines play an important role in thyroid autoimmunity. In obese or overweight children, there is enhanced secretion of cytokines and interleukins, thus leading to an under-functional thyroid.
HOW TO DIAGNOSE THYROID ISSUES?
Thyroid imbalances can be diagnosed by:
• Medical history and physical examination- The doctor takes a complete history of the patient and their family. A thorough physical examination is done to understand whether the patient is having any other health issues.
• Blood check-up- A complete blood check-up is done to evaluate the hormone levels and identify any other conditions.
Besides thyroid imbalances, childhood obesity is linked to diabetes, high blood pressure, cholesterol, fatigue, joint problems, muscle cramps, breathing issues such as shortness of breath, asthma or sleep apnea, liver disorders, and psychological conditions such as anxiety or depression.
HOW TO PREVENT CHILDHOOD OBESITY?
• Avoid over-feeding the child.
• Portion control is important.
• Incorporate healthy snacks as between-the-meals options. This will prevent them from reaching out to a bowl of chips or fries.
• Keep a check on hydration levels. Fluids in any form- water, fresh juices, and fruit infused water are some of the options. Avoid tea, coffee, and aerated drinks.
• Get creative and incorporate healthy foods such as whole wheat bread, nuts, fruit salads, and other items in meals.
• A minimum of 60 minutes of physical activity is important as it benefits their physical as well as mental health.
• Limit screen time, and encourage them to start running, cycling, swimming, football etc.
Childhood obesity, if not kept under control, can lead to very serious health problems later in life. It is important to take proper medical guidance at early stages. In addition to this, efforts must be made to bring about lifestyle changes to prevent further weight gain.
The writer is Chief Endocrinologist, Aster RV Hospital.
HOW ONLINE PERSONALISED LIFESTYLE COACHING IS IMPROVING OVERALL FITNESS
The digitalisation of health and fitness services has caved in to the ecosystem with an extremely gradual yet visible shift. Most lifestyle coaching spaces now either have both physical and virtual funnels or have gone entirely virtual with respect to their mode of engagement. Indeed, gyms are always going to be crucial simply because of the vast range of machinery and equipment they have to offer, nevertheless, the approach towards all coaching and training related services is now taking a ‘digital’ turn – more so now because of the pandemic. Over the years, the focus of lifestyle service providers has evolved from extremely generic consumer services to personalised ones. This gradual shift in the quality of service can be attributed to the increasing consciousness and self-awareness among users.
Online health platforms are progressively taking the forefront in the industry because of their ‘personalised’ style of customer service. Given the benefits of this approach, users are developing a more sustainable attitude towards health and hence ascribing to the increasing demand for customised health and nutrition plans. Let us understand why online health platforms are vouching for personalised lifestyle coaching over generic fitness training.
HOLISTIC IN NATURE
While traditional dieticians and gym trainers mostly focus on just one aspect of health, i.e. training and diet, online coaching integrates all aspects of health to foster a sustainable transformation. The focus on nutrition, exercise, lifestyle modification, and behavioural aspect covers an individual’s health with a holistic approach.
The basic premise of online coaching is to start with whatever you have, in terms of time, equipment, and situation. These platforms inculcate the same fundamentals in their customised plans, thereby providing the flexibility to users where they can start and progress with whatever resources they have. This structure promotes home-workouts, cost-effective diets, and time-saving. For example, it is easier for a new mother to spare 30 minutes for a routine walk when her kid is sleeping instead of taking time to move-out for a gym workout.
MAINTAINS HIGHER ACCOUNTABILITY
Most people who start their fitness journey under a coach fail because of the huge baggage of bad habits or past failures that they have and hence the process needs a lot of handholding through the initial three to four weeks. An online coach can connect with the client almost daily and sometimes even multiple times in a day – the daily check-ins makes sure that the clients stay on track. In fact, in the event of a cheating activity, the coach has the access to bring the client back on track without any further delay as they both are constantly connected through phone or WhatsApp. In the traditional approach, a cheat meal can easily become a cheat day, a cheat week, or even a cheat month.
SETTING RIGHT EXPECTATION
Most people who start on their fitness journey either have unrealistic goals or give up too soon. An online coach (through the close contact model) can always set the right goals for their clients and always remind them about the journey being a ‘long-run’. This type of paradigm shift for clients requires a lot of communication and is possible only in a remote/online setup.
REAL-TIME QUERY RESOLUTION
It is often that individuals end up undergoing guilt phases due to a series of cheat meals. In situations where a client might end up eating extra because of a spontaneous dinner plan, he/she would require real-time help by a coach to go about his/her following meals and exercise. This kind of accessibility to quick guidance is another advantage of personalised coaching as the client can be guided closely through WhatsApp/phone etc.
Personalised coaching is all about building deep and meaningful connections. Since the frequency and intensity of client-coach conversations is at par with that of two close friends, it is likely for a coach to teach the client valuable lessons about goal setting, accountability, discipline, and habit formation. These values taught and incorporated during the process of health transformation turn out essential for success and sustainability.
The writer is Founder & CEO, MyHealthBuddy
THE LONG-TERM IMPACT OF WORK FROM HOME ON SPINAL HEALTH
The Covid-19 pandemic has been a testing time for everyone around the world. In the new normal, while some offices have started functioning fully, others still have part of their organisation working from home. Most people without a proper home office set up may therefore need to make do their beds, tables, and couches to work from. Although this may sound like a welcome change at first, it can be a pain over time – literally! Working in wrong postures and an uncomfortable setting could mean an increase in the incidence of neck and back pain with lasting effects on spinal health. This is especially seen among those who need to sit on their laptops for a long time or in people who are constantly on their mobiles. For women, in particular, household chores can add to the burden. Some of the primary reasons for back pain are as follows:
Many people are unaware of how they sit when they are working. One of the common mistakes they make is that of holding the mobile between the ear and shoulder to speak while typing on the laptop. Since the neck is tilted, over time, this can hamper the muscles leading to spasms and pain. Then there are also those who lie down, slouch on the sofa or chair during work. When this posture is not corrected for a long time, it can lead to muscle fatigue and hamper the spine.
Lack of good ergonomics
At home, people tend to work in whatever way they want to. It is not a common practice to ensure that the ergonomic conditions match our work including a comfortable chair, table that is adjusted to the height suitable, and lighting, etc. Many also continue to sit and work for long durations in the same posture without any physical activity. This can lead to muscle and joint pain over time.
Stress and addiction
The pandemic has caused a lot of changes in the way we work and live. However, extreme work stress can lead to aggravation of physical ailments and pain. This is one of the major causes of joint
pain as well. Some people also tend to resort to addictions such as smoking and alcohol to ease away their worry. Research suggests that nicotine causes the blood vessels to narrow, thus decreasing blood supply to the muscles. This can lead to fatigue and spasms.
Some tips that can help prevent pain and avoid harm to one’s spinal health:
Correct your posture: Do not slouch or lounge while working. Use a chair and table and adjust the height according to the position of the laptop. In case you want to work on a sofa, make sure you sit upright. Make sure you have a dedicated space where you can work. Support your back and do not bend your neck while typing. The keyboard and mouse should be kept closer so that the paraspinal muscles of the neck are offloaded and there is no fatigue.
Change position and move around: Avoid sitting in the same position for a long time. Take a break for a small walk once in every hour or so. Make sure that you get adequate physical activity for at least 30 minutes every day. You must stretch and flex your muscles every now and then to avoid fatigue.
Use headphones or earphones: Do not multitask especially when taking work calls. Avoid adjusting the phone between your neck and shoulder and working on your computer together. Instead, you could make use of your speaker or plug-in earphones to avoid the awkward position of the neck cradle.
Rest your feet: If your feet don’t reach the floor, make sure to use something underneath that does not let them dangle in air. In case they are not touching the floor, it can put pressure under the thighs restricting blood flow.
Destress: Find ways to reduce mental stress. You can opt for relaxation techniques, meditation or even yoga. Once in a while indulge in your hobby, listen to music or just spend time with family and friends to reduce mental fatigue. Stay hydrated.
When we are put in a situation with limited resources and options, it is important to work our way around what is available. This includes adjusting your schedule and other aspects to ensure minimal impact to your mental and physical health. Make sure to follow these tips and in case you experience any recurrent pain in the muscles or joints, consult a specialist.
The writer is Medical Director at Portea Medical
HOW TO MANAGE STUBBORN DANDRUFF
Dandruff is a skin condition that is localised on the scalp and can happen occasionally on different areas of the face like the sides of nose, eyebrows, ears and eyelids. The medical name for dandruff is seborrheic dermatitis and consists of small patches of scaly skin. Some FAQs about the condition:
What causes dandruff?
Dandruff is caused by a yeast-like fungus called Malassezia that feeds on the oils on the scalp. The fungus is naturally found on the scalp. Due to increased sebum production, Malassezia tends to feed off the oils, breaking them down into byproducts, one of which is oleic acid. Some people tend to be sensitive to this byproduct and thereby experience dandruff.
Is dandruff caused by poor hygiene?
No, but sometimes infrequent shampooing can make dandruff more apparent. Some hair colour and styling products can also leave behind flaky skin or dry skin on the scalp, which can trigger dandruff.
What triggers dandruff?
Most commonly, the condition is related to stress. However, certain medical conditions like Parkinsonism can predispose the person to dandruff. Certain medications can also trigger stubborn dandruff like the kinds used to treat seizures.
Will shampooing cause more dandruff?
No, shampooing will actually cut down on the amount of oil in the scalp and can improve dandruff.
Does gender affect dandruff?
Yes, both men and women get dandruff but men develop the condition more frequently than women possibly because of the male hormones which play a role in the life cycle of the skin cells on the scalp.
Is dry scalp different from dandruff?
Dry scalp is usually seen in winter and it gets better as summer approaches. However, if one develops dandruff, it must be treated by increasing the humidity of their living environment and moisturising the scalp by applying extra conditioner.
What are the shampoos I can use for dandruff?
Use anti-dandruff shampoos that have ingredients like salicylic acid, selenium sulphide, and zinc parathion. Occasionally, you may use sulphur-based shampoos. Make sure to follow the instructions on the bottle when using anti-dandruff shampoos. Make sure you use the shampoo on the scalp as these ingredients have a tendency to dry the hair shaft. Do not use these shampoos for regular washing of hair.
Can I use coal tar shampoo for stubborn dandruff?
Coal tar shampoos are safe but can discolour or lighten hair colour and turn hair blonde, grey or white. It also makes your scalp sensitive to the sun. It can also be carcinogenic in higher doses.
What are some natural remedies for treating dandruff?
Some research supports using aloe vera, tea tree oil and lemongrass shampoo as they cause less itching on the scalp and reduce scaling.
What should my first approach be if I have dandruff?
Your first approach should be to see a healthcare professional or a dermatologist for evaluation and management because certain skin conditions can mimic dandruff.
How to get rid of dandruff without washing your hair?
One can use dry shampoo on the scalp to get the flakes off. Alternatively, you can use coconut oil, olive oil or neem oil on the scalp to get rid of flakes.
Can I use oil on the scalp if I have dandruff?
Yes, one can but if you are someone who uses a lot of oil, make sure that you are removing it with a gentle shampoo. Otherwise, it could be problematic and lead to persistent dandruff. Do not use heavy or thick oils if you have dandruff as it will use more shampoo to remove the oiliness and lead to drier scalp and hair. Alternatively, one can use mineral oils like baby oil to treat dandruff as it does not contain saturated fatty acids and makes it difficult for the fungus to thrive.
The writer is a well-known dermatologist and cosmetologist working in Noida.
WHAT YOU NEED TO KNOW ABOUT HEART FAILURE
Health experts discuss causes, treatment and ways to reduce the risk of heart failure on Heart Failure Awareness Week.
Heart failure is a serious public health concern, therefore it becomes important to know what it is, how to prevent, diagnose, and manage it. Heart failure is a condition which is caused either by ineffective pumping or inadequate relaxation of the heart. It is the culmination of various other diseases, says Dr Sunil Kumar, consultant, Interventional Cardiology, Columbia Asia Hospital Hebbal. “Heart failure does not mean that the heart has completely stopped working, but that its capabilities have reduced. Left unaddressed, it can lead to decreased quality of life and complications like irregular heart rhythm (arrhythmias), recurrent hospitalisations, and sudden cardiac death. There are different stages of heart failure and treatment is focussed on slowing its progression into advanced heart failure,” mentions Dr Divya Marina Fernandes, Interventional Cardiologist, Aster RV Hospital, Bengaluru.
“Heart Failure has a 50% mortality rate in five years. 30% of deaths in the US and 33% of deaths in India are due to heart failure alone. Majorly, there are two types of heart failure, preserved ejection fraction and reduced ejection fraction. In India growing cases of heart failure is of preserved ejection fraction. The reason for rising heart failure in India is due to increased hypertension. Earlier there was a myth, weak heart leads to heart failure which isn’t correct,” says Dr Sai Ravi Shankar, Consultant Cardiologist, Apollo TeleHealth.
Dr Kumar points out, “There are various reasons for heart failure but the most common cause is heart becoming weak due to a previous heart attack. Other causes are the development of blocks inside the heart which causes weakness of the heart without causing any heart attack, viral infections which affect the heart muscles, nutritional problems like thiamin and selenium deficiency, uncontrolled diabetes, thyroid problems, excessive alcohol intake, persisting cardiac rhythm disturbance, and uncontrolled hypertension for a long time. Rarely heart failure can also occur due to stress, which is called stress cardiomyopathy.”
“Heart failure is often connected to lifestyle factors, therefore it is important to follow a healthy diet and lifestyle from a young age. Management of diabetes, obesity, and hypertension is of utmost importance. A healthy diet with lots of vegetables, grains, pulses, lean meat, sufficient hydration, supported by cardio exercises such as walking, jogging, swimming, playing sports, etc, basically any activity that gets the heart rate up is good to maintain a healthy heart. Fluid and salt restriction is usually advised for these patients. Unhealthy fats, salty and oily foods, excessive consumption of sugar, alcohol and smoking among others can all damage the heart over the long run, so it’s best to quit these as soon as possible, adds Dr Fernandes.
TREATMENT OPTIONS FOR HEART FAILURE
Dr Shankar says, “The treatment for heart failure has stages. First is identifying and treating the cause. The major cause for health failure is heart blockage which is treated by CABC, angioplasty with stent and valve replacement. The new drugs that are proven helpful for heart failure are ARNI, SGLT2 and Beta-Blockers that have been available in India as well. The non-surgical treatments that are available in India are New Assist Device i.e ICD, CRT, LVAD, TAH (total artificial heart). These are called the bridge to transplant. If the heart patient has reduced ejection fraction we take help of non-surgical treatments before going for the surgical options. But the cost is Rs 25 lacs approximately so lots of people can’t afford it.”
Dr Ashish Agarwal, Head & Senior Consultant, Department of Cardiology, Aakash Healthcare suggests some non-transplant surgical options in heart failure:
Coronary revascularisation: This treats ischemic cardiomyopathy, the most common cause of heart failure across the world, and events it may cause, such as myocardial hibernation, myocardial stunning, and myocardial cell death. For patients with ischemic cardiomyopathy, coronary revascularization should be the first treatment modality.
Mitral reconstruction: This treats mitral regurgitation (MR), a common event in heart failure patients. Along with another surgical intervention termed percutaneous mitral valve repair system, MR can better restore left ventricular remodeling, and gives patients a better quality of life.
Stem-cell regeneration of myocardium: The process replaces myocytes lost from the injured cardiac region and is a viable nontransplant treatment for heart failure. The myocardium could be regenerated by injecting stem cells such as peripheral blood stem cells, skeletal myoblasts, and bone marrow stem cells, into the damaged heart.
Geometric ventricular reconstruction: This is another nontransplant surgical means to treat heart failure.
PRE-EXISTING CVD, COVID-19 AND RISK OF HEART FAILURE
Are patients with pre-existing cardiovascular disease infected with Covid-19 at higher risk of heart failure? Dr Shankar replies, “Patients with Covid-19 and pre-existing heart disease can lead to more heart muscle damage which eventually weakens the heart, the virus can lead to more blockage in the heart, heart rate irregularity, and sudden cardiac deaths. The people with heart disease should take utmost care, that is wearing a mask, sanitising, and social distancing followed by regular medications and immediate consultations with the doctor in the case of an emergency. Also, Covid-19 vaccine is proven to be safe for heart disease patients.”
Dr Agarwal opines, “People with pre-existing cardiovascular disease (CVD) are more likely to have a more severe form of the infection. It may lead to heart failure as their hearts are weaker than normal. However, not all CVD patients who contracted Covid-19 have died, many have recovered as well.” He suggests one should take precautions to not get infected by Covid-19 such as wearing a mask, maintaining the medicine schedule, avoiding outside exposure unless mandatory, washing hands, and maintaining social distancing.
Ways to lower the risk of heart failure
Heart failure risk can be reduced if we address and treat the risk factors effectively. Since the most common cause of heart failure is heart attack, reducing the risk of heart attack will help in reducing the risk of heart failure. Some of the measures to do so: · Having a healthy diet (low calorie and low-fat diet) · Regular exercise · Effective management and treatment of the risk factors such as diabetes, hypertension, and high cholesterol levels · Taking medications and regular check-ups · Nutritional deficiency can be treated with a healthy diet. If there is any cardiac rhythm disturbance, consulting the cardiologist and treating them would reduce the risk of heart failure.—By Dr Sunil Kumar, consultant, Interventional Cardiology, Columbia Asia Hospital Hebbal
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