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Myths & facts about depression

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Depression is not an illness, it is a state of mind- Depressive Disorders are caused by neurochemical disturbances in the brain which respond to antidepressant treatment. Like other bodily ailments, there is a physiological process involved in these disorders which disturbs the normal state of wellbeing. Just because there is no objective laboratory measure to identify these imbalances at present, doesn’t mean that depression is not an illness and that it should not be treated. There is enough empirical evidence to suggest mechanisms that cause depression and how effective treatment strategies are. Trust your doctor who is trained to handle these conditions rather than laypersons who air the myths regarding psychiatric disorders due to ignorance and distorted social belief systems.

Depression doesn’t happen if there is no stress or tension in the environment- Endogenous Depression can occur in the absence of a significant environmental stressor. There are hereditary and genetic factors involved in the causation of these disorders and psychosocial issues are often the triggers for the onset of depression and not the cause of it.

Depression can be controlled by willpower- Endogenous depression occurs due to a biological vulnerability to develop neurochemical imbalances which leads to a persistent state of sadness. During this phase, the patient isn’t able to use his willpower alone to get out of the state of depression. Negative thinking, lack of interest and inability to feel good are part and parcel of Depressive disorders. Understanding and support help the individual to open up about their inability to handle negative emotions and empathic treatment helps to guide them out of this sense of helplessness. Medicines help correct the neurochemical imbalance faster along with which psychological strategies help combat the issue in a professional setting.

There is no cure for Depression- Depressive disorders are treated with medication and psychotherapy and response to treatment modalities is generally good. When treated early, the response rate is even better and the patient is able to withdraw from medicines with a regular and rational treatment approach. With adequate treatment, depressed individuals are able to lead a normal life and carry on routine activities like any non-depressed individual.

Children have no business getting depressed as they have no stress- No age group is immune to depression. Children as young as 5 years of age have shown signs of depression and it need not always be a reaction to a major environmental stressor. Children often show more behavioural (crying/irritability/tantrums etc.)or physical symptoms (nausea, lack of appetite, stomach ache, headache etc.) than telling that they are feeling sad or have negative thoughts. If parents try to deny or ignore the symptoms due to their own fear of acknowledging that the child may have a psychological issue, timely intervention is impeded with long term negative consequences. 

Depression is normal for elderly people, lonely people or people with no one to talk to- Although loneliness increases the vulnerability to depression, it’s not a cause for it. Depression isn’t a normal state of mind for elderly people or people who are single or widowed. We all develop coping abilities to handle life situations and people vulnerable to develop depression often use ineffective coping strategies to handle situations like being old or alone. With corrective coping skills, reactive depression can be treated.

Depression is caused by evil spells (jaadu-tona)- Like hypertension and diabetes, Depressive disorders are caused by a chemical disturbance in a part of the body (in this case brain is the part of body affected). These disorders are not caused by black magic and don’t restrict treatments by spiritual healers ( ojha- tantrik/ jhaad- phoonk).

Antidepressants are only meant to sedate and are addictive- All antidepressants are not sedative. The goal of treatment is to help the individual lead a happy, healthy life and not to put him to sleep. Initial side effects of some antidepressants produce drowsiness and the effects vary from person to person. Treatment is thus individualised based on effects and side effects. Antidepressants are generally non-addictive if taken under supervision. Some drug companies have combination pills with antidepressants and sedatives which if continued without guidance can cause sleep-related issues upon sudden withdrawal. A rational approach to the treatment of Depression is to avoid combination formulas, to adequately educate patients about the effects and side effects of medicines, to maintain regular follow up with psychiatrist even during the asymptomatic maintenance phase and to introduce lifestyle measures and psychotherapy at the right time of treatment.

All psychiatric problems are called Depression- All psychiatric and psychological issues are not Depression. Depressive disorders are a specific, symptom-based category of mood disorders that require specialist intervention. Correct diagnosis and timely intervention alleviates suffering and reduces dysfunction associated with depression. Like any chronic illness, precautions are needed to avoid or handle relapses.

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PGIMER releases documentary titled ‘Front of Package Labeling: A Game Changer for Healthy India’

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A documentary titled ‘Front of Package Labeling: A Game Changer for Healthy India’, prepared by the Department of Community Medicine and School of Public Health (DCM & SPH), Post Graduate Institute of Medical Education and Research, Chandigarh.

This documentary is a part of a project being undertaken by the Institute in collaboration with Government of Punjab and Strategic Institute of Public Health Education and Research (SIPHER) and is supported by Global Health Advocacy Incubator, USA.

“A rapid rise in hypertensive cases is being observed in Punjab, which is worrisome. Through the project, we are collaborating with the Government of Punjab to prevent and better manage hypertension through sensitization of media and the general public regarding the risk factors like trans fats in food. We strongly feel that warning labels on food items are effective way of helping people to make nutritious food choices. The documentary drives home the importance of Front of Package Labeling (FOPL) for averting a cardiovascular health, obesity and diabetes crisis in India.” said Dr. Sonu Goel.

As per WHO, Non-communicable diseases (NCDs’) account for 70% of the global deaths. The state of Punjab has become a capital of hypertension with one out of three people suffering from this silent killer.

Excessive intake of fats, sugar and salt available in packaged foods such as cake, pizza, pastry, french fries, ice cream, etc. are the primary cause of NCDs. Under this project which started in 2019, PGIMER Chandigarh has signed a pact with Food and Drug Administration, Punjab to implement and regulate the trans-fat surveillance in Punjab.

The documentary highlights key features such as transition of food practices from traditional to modern, ways to making healthy food choices, identifying good and bad food, diseases associated with bad food. etc.

It was released at the juncture of festivals such as Diwali, aims to generate awareness among policymakers, implementers, and the general public about the importance of healthy and wholesome food to keep Non-Communicable Diseases (NCDs’) like hypertension at bay and to generate support for an intense Front-of-Pack Labelling (FOPL) policy to be developed by Government of India. It took around two months to prepare this documentary of approximately 7 minutes, which is a collaborative effort of the project team. The documentary has been conceptualized and narrated by Dr. Sonu Goel, Professor, Dept. of Community Medicine and School of Public Health, PGIMER, Chandigarh and Principal Investigator of the project.

Dr. Geeta Mehra, Head, Dept. of Food Sciences, MCM DAV College, Chandigarh emphasized the importance of reading food labels while purchasing any packaged food product. She stressed that “FOPL, if implemented in India, will allow the consumers to identify products containing excess sugars, trans-fats, oils, and sodium easily, quickly, and correctly and help them to make informed food choices.”

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STUDY SHOWS REGULAR MILLET CONSUMPTION CAN COMBAT ANAEMIA

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A new study has shown that regular consumption of millets can improve haemoglobin and serum ferritin levels to reduce iron deficiency anaemia, which is rising globally.

The findings of the study were published in the journal ‘Frontiers in Nutrition’. The research, a meta-analysis of 22 studies on humans and eight laboratory studies on millets consumption and anaemia, was undertaken by seven organisations across four countries and was led by the International Crops Research Institute for the Semi-Arid Tropics (ICRISAT).

“The study concluded that millets can provide all or most of the daily dietary iron requirements of an average person. Although the amount of iron provided depends on the millet variety and its form of processing, the research clearly shows that millets can play a promising role in preventing and reducing high levels of iron deficiency anaemia,” highlighted Dr S Anitha, the study’s lead author and Senior Nutritionist at ICRISAT.

The researchers found that millets increased haemoglobin levels by as much as 13.2 per cent. Four studies in the review also showed serum ferritin increasing by an average of 54.7 per cent. Ferritin is an iron-containing protein in the blood and is a clinical marker for iron deficiency.

The studies in the analysis involved nearly 1,000 children, adolescents and adults, and six different millet types – finger millet, pearl millet, sorghum and a mixture of kodo, foxtail and little millets. The participants in the studies were found to have consumed millets for anywhere between 21 days and 4.5 years. The findings were published on 14 October in Frontiers in Nutrition.

“1.74 billion people were anaemic in 2019. That number is rising,” said Dr Jacqueline Hughes, Director General, ICRISAT.

“It has been proven that iron deficiency anaemia affects cognitive and physical development in children and reduces productivity in adults. The need for a solution is critical, and therefore bringing millets into mainstream and government programs is highly recommended,” added Dr Hughes.

“Now that there is strong evidence of the value of millets in reducing or preventing iron deficiency anaemia, it is recommended that one major research study be undertaken on anaemia covering all the different types of millet, common varieties and all major forms of processing and cooking, using a uniform testing methodology. This will provide the detail required for designing interventions needed to have a major impact on reducing anaemia globally,” said Professor Ian Givens, a co-author of the study and Director at the University of Reading’s Institute of Food, Nutrition and Health (IFNH) in the UK.

“It has often been claimed that iron in millets is not highly bioavailable due to the supposed high levels of antinutrients. Our analysis proves this is a myth. Instead, millets were found to be comparable to typical iron bioavailability percentages for plants. Also, the levels of antinutrients in millets were identified to be similar or lower than common staples,” said Ms Joanna Kane-Potaka, former Assistant Director-General, ICRISAT, and Executive Director of the Smart Food initiative who is a co-author of the study.

The research also showed that processing can significantly increase the amount of iron bioavailable. For example, millet snacks made by expansion (extrusion) increased bioavailable iron 5.4 times, while fermentation, popping and malting more than tripled the iron bioavailable. Germination (sprouting) and decortication (dehulling) more than doubled the bioavailable iron.

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Benefits of eating nuts for breast cancer survivors

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Can eating nuts have health-protective effects for breast cancer survivors? A new study suggests that it might!

According to the study, nut consumption is associated with lower risks of breast cancer recurrence or death. The findings of the study were published in the ‘International Journal of Cancer’.

Among 3,449 breast cancer survivors from the Shanghai Breast Cancer Survival Study, who completed a dietary assessment 5 years after diagnosis, there were 374 deaths during a median follow-up of 8.27 years after the dietary assessment.

Among 3,274 survivors without a previous recurrence at the time of their dietary assessment, 209 developed breast cancer-specific events, including recurrence, metastasis, or breast cancer mortality.

There was a dose-response pattern in the relationship between nut consumption and risk of breast cancer recurrence or death, with those consuming the highest amounts having the lowest risks.

Also, the association was stronger for survivors who had earlier stages of breast cancer than for those who had later stages.

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Study finds orange juice helps fight inflammation, oxidative stress

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A new study has suggested 100 per cent orange juice has the potential to help fight inflammation and oxidative stress in adults.

The findings of the study were published in the journal ‘Advances in Nutrition’.

Though limited in scope, the study indicates drinking 100 per cent orange juice significantly reduces interleukin 6, a well-established marker of inflammation, in both healthy and high-risk adults. Two additional inflammatory and oxidative stress markers were also reduced; however, the results did not quite reach statistical significance.

The findings of this study, which was funded through an unrestricted grant by the Florida Department of Citrus, harmonise with a previously published FDOC-funded review that reported beneficial effects of hesperidin, the primary bioactive compound found in oranges and 100 per cent orange juice, on reducing some markers of inflammation and oxidative stress. Chronic inflammation may play a key role in causing or advancing some chronic diseases, including heart disease and diabetes.

“We know that 100 per cent orange juice contains a number of nutrients, like vitamin C, as well as beneficial bioactive compounds that have the potential to reduce inflammation and oxidative stress,” said Gail Rampersaud, Florida Department of Citrus registered dietitian.

“This review tells us that some studies find benefits with 100 per cent orange juice, but we need more data and large well-designed studies to make more definitive conclusions. This analysis is especially helpful as we and others plan future research related to orange juice,” added Rampersaud.

The review examined published studies relating to 100 per cent orange juice and markers of inflammation and oxidative stress. The review was conducted by the Think Healthy Group and researchers at Tufts University and George Mason University.

The analysis consisted of three parts: a qualitative scoping review of 21 studies with a total of 307 healthy adults and 327 adults at risk for disease; a systematic review of a subset of 16 studies that measured the six most reported biomarkers related to inflammation and oxidative stress in the body; and 10 studies that had sufficient data to conduct a meta-analysis. The researchers also examined the overall quality and potential bias in the studies.

The broad scoping and systematic reviews revealed that, in general, 100 per cent orange juice either had beneficial or null (no adverse) effects on oxidative stress or inflammation. The researchers cautioned that studies included a relatively small number of subjects, had a low strength of evidence, and had a moderate risk of bias; therefore, overall findings should be interpreted with caution.

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WHAT IS THE BONE DENSITY TEST? WHEN SHOULD ONE DO IT?

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Data suggests that 20% of women over the age of 50yrs are highly susceptible to Osteoporosis in India alone. Globally approximately 200 million people are estimated to be affected by the disease. Now you might wonder, what is this condition affecting millions worldwide and, more so, women significantly?

Osteoporosis, simply put, translates to porous and weak bones. This state also means the individual has less bone mass, thus making them more prone to frequent fractures. A person’s risk of the disease increases with age, i.e., 50 in most cases. In the case of women, menopause is a primary risk factor. Some other lifestyle choices which put you at the peril of Osteoporosis include smoking, excessive and frequent alcohol intake, sedentary lifestyle, no Calcium, Vitamin D and other necessary minerals, nutrients in your diet, protein deficient diet.

One can’t usually figure out whether they have Osteoporosis; it is only evident after high-impact painful fractures and through diagnostic tests. So which test must one undergo to understand whether they have Osteoporosis? The answer is Bone Density Test. Here, X-rays are utilised to measure the strength of bone and its fragility. Usually, the forearm, hip, thigh (femur) and spine are examined in a Bone Density Test (BDT). These are the most vulnerable areas for Osteoporosis.

Types of Bone Density Test: The most common and accepted test to diagnose Osteoporosis is the Central DXA (Dual-energy X-ray Absorptiometry), where pictures of the lumbar spine and hips are produced to determine bone loss. It can be used for other parts of the body as well. There is Quantitative Computed Tomography too, but it is less practised as it has higher amounts of radiation and is expensive.

Alternatives to DXA include: Peripheral Dual-energy X-ray Absorptiometry (pDXA) for the wrist and heel; Quantitative Ultrasound (QUS) to measure the bone density in the heels; Peripheral Quantitative Computed Tomography (pQCT) for the wrist.

WHY IS THE BONE DENSITY TEST DONE?

Diagnosing Osteoporosis

The test checks if the treatment of Osteoporosis is helping or improving the condition. The scan further helps to conclude whether the individual is going to develop fractures in the future.

WHEN SHOULD ONE GET CHECKED?

If you are past the age of 50yrs; the age group of 50-65yrs is a vulnerable one. You should get checked if your body structure is petite and thin, as low weight individuals are at a greater risk of Osteoporosis; If you are a postmenopausal woman; should you have Rheumatoid Arthritis; it is best to get a Bone Density Test done; family history of Osteoporosis, hip fracture, and smoking; have hyperthyroidism and have consumed Corticosteroid drugs for more than three months.

The DXA test is non-invasive and doesn’t cause any pain. However, repeated exposure to radiation is not recommended. Thus lead a healthy lifestyle, take adequate protein, calcium and vitamin D, do regular impact loading exercises and keep your bones strong.

The writer is a Director-Orthopedics & Joint Replacement Surgery, Fortis Hospital, Mulund

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Illness related messages significant motivators for exercise

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Fitness apps that emphasize illness- or death-related messaging are more likely to be effective in motivating participation than are social stigma, obesity, or financial cost messaging, according to a recent study led by researchers at the University of Waterloo.

The study, ‘The Relationship between Perceived Health Message Motivation and Social Cognitive Beliefs in Persuasive Health Communication’, was published in the journal MDPI (Multidisciplinary Digital Publishing Institute) and was authored by Oyibo, with Julita Vassileva, a Persuasive System Design professor at the University of Saskatchewan, assisting with the data collection.

Previous studies, especially on smoking cessation and risky sexual behaviour, found that messages related to mortality could be a barrier to acknowledging health risks, but the study found this is the opposite for fitness apps.

The study asked 669 research participants to indicate how persuasive these five types of messages were in terms of motivating them to work out at home with a fitness app, to uncover their effectiveness, connection with social-cognitive beliefs such as self-regulation (goal setting), self-efficacy, and outcome expectation, and seeing what role male/female gender played.

“I did not expect only illness- and death-related messages to be significant and motivational,” said Kiemute Oyibo, a postdoctoral fellow at the University of Waterloo’s School of Public Health Sciences.

Oyibo added, “Not only were illness- and death-related messages motivational, they had a significant relationship with self-regulatory belief and outcome expectation, and there was no significant difference between males and females.”

Oyibo said he had expected obesity-related messages (such as “one in four Canadians has clinical obesity”) to be motivational and have a significant relationship with self-regulatory belief, given that obesity is associated with the leading causes of global mortality.

“This study is important because it helps us – especially designers of health apps – understand the types of messages that individuals, regardless of gender, are likely to be motivated by in persuasive health communication, and that are likely to influence individuals’ social-cognitive beliefs about exercise,” Oyibo said.

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