A population-based study, published in the Journal of the American Medical Association (JAMA), has found flu vaccination during pregnancy does not lead to an increased risk of adverse early childhood health outcomes.
Although pregnant people are not more susceptible to acquiring influenza infection, they are at an increased risk of severe illness and complications if they get the flu during pregnancy. For this reason, all pregnant people are advised to receive a flu shot each year, yet only 36% received it according to a study monitoring four flu seasons in Nova Scotia. Safety concerns are reportedly a leading reason women may not receive influenza vaccination in pregnancy.
Dr Deshayne Fell, an Associate Professor of Epidemiology in the Faculty of Medicine at the University of Ottawa and a Scientist at the CHEO Research Institute, a pediatric healthcare and research centre, led the study along with researchers in Ontario and at Dalhousie University in Nova Scotia. The study followed over 28,000 children from birth up to an average age of 3.5 years, with the results suggesting that maternal influenza vaccination during pregnancy was not associated with:
– Immune-related health conditions, such as asthma, ear infections or other types of infection.
– Non-immune-related health problems like neoplasms, sensory impairment.
– Nonspecific health needs such as Emergency Department visits and hospitalisations did not increase.
“This study adds to what we know from other recent studies showing no harmful effects of flu vaccination during pregnancy on the long-term health of children,” says Dr Fell, whose other recent work includes studying the effectiveness and safety of Covid-19 vaccines during pregnancy.
She added, “This is important because we know that getting the flu shot during pregnancy not only protects the pregnant person but has the added bonus of protecting newborn babies from getting the flu during their first few months of life, which is when they are most susceptible to respiratory infections but still too young to get the flu shot themselves.”
The study, Association of Maternal Influenza Vaccination During Pregnancy with Early Childhood Health Outcomes, is published in JAMA.
With ANI inputs
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EXPOSURE TO NATURE DURING LOCKDOWN BENEFICIAL FOR MENTAL HEALTH
Exposure to nature during the Covid-related lockdown is beneficial for a person’s mental health. A new study has found that exposure to natural spaces during the first Covid-19 lockdown in 2020 was beneficial for the mental health of Spanish and Portuguese citizens. The findings of the study were published in the journal Environment International.
The study was carried out by the Institute of Environmental Science and Technology of the Universitat Autonoma de Barcelona (ICTA-UAB) and the Instituto de Saude Publica of the University of Porto (ISPUP).
The research showed that, in Portugal, during the first confinement, people who maintained or increased contact with natural public spaces, such as parks and coastal areas, or who could contemplate these spaces from their homes, presented lower levels of stress, psychological distress and psychosomatic symptoms.
In Spain, those who maintained or increased contact with private natural spaces, such as indoor plants or community green areas, presented lower levels of stress and psychosomatic symptoms. This could be due to the fact that Spain adopted more restrictive measures for foreign circulation during the period analysed.
The research on the effects of nature on mental health during the Covid-19 lockdown was conducted between March and May 2020.
Dr Ana Isabel Ribeiro, researcher at the ISPUP and first author of the work together with Margarita Triguero-Mas from the ICTA-UAB said that “we decided to study whether natural, public and private spaces had a beneficial effect on the mental health of Portuguese and Spanish citizens, helping them to better cope with the negative effects of lockdown”. For her part, Margarita Triguero-Mas adds that “people around us and ourselves talked about how we missed the park we crossed when we went to the office or the walk on the beach with our dogs, so we wanted to check to what extent contact with natural spaces was an important factor during confinement.”
Several previous articles have also shown the positive impact of exposure to natural spaces on mental health, that is, in reducing stress, anxiety and improving psychological well-being as a whole. “Taking into account what is described in the literature, we wanted to evaluate whether people who enjoyed greater exposure to natural spaces during the first Covid-19 lockdown had better mental health indicators than those who had no contact with natural areas”, explained Dr Ribeiro.
MINDING YOUR MIND IN PANDEMIC TIMES
Mind and body go hand in hand. This is one lesson that the Covid-19 pandemic has taught us. The battle is as much about your body fighting the China-born virus as it is about your mind dealing with it positively. In the end, only those with a strong mind and healthy body with as few comorbidities as possible survive.
My own tryst with the virus taught me the importance of mental health, an area we Indians mostly ignore and disregard. Thankfully, there is a massive change in the mindset from the era when anyone visiting a psychiatrist was regarded as “pagal”. But still the kind of importance we must give to our mental health is still missing. Covid is a stark reminder of how the mind really matters for our overall well-being.
This article isn’t a mental expert’s Covid-19 survival guide. For, I don’t really qualify for that, despite having a university degree in psychology. It’s about my own survival experience vis-à-vis the virus. The first thing that hits you when you are down with Covid, is that you are all alone in this battle. You are isolated, no one can come and hug you, console you. You yourself become a virus. To make things worse, there’s so much information — or should I say, misinformation? — in the social media that at the end of it all you are more confused than ever before. Once you google anything about Covid-19, you are automatically bombarded with all sorts of virus-related information. And believe me, all this ends up making you more depressed than before.
So, based on my experiences, here’s some of the golden rules for fighting the pandemic. Read on:
1. Keep your mobile away: The first thing you should do is keep your mobile away from you, especially when you are truly down with the virus. For, trust me, it will only make you more depressed. You will find information, information and information, but there won’t be any solution in sight. In those precarious moments, all you need is a me-time. Be yourself, explore yourself. Meditate. And yes, if you have the strength, pick a book and read. It’s therapeutic.
2. Slow down, look within: Just be calm, have a cup of tea in silence, spend time with your plants. Plan your day, talk to yourself to be a better person than you were yesterday. Your silence for an hour will bring mental poise, happiness, confidence and inner strength. Do things that make you happy; look back at the life you are leading. Do you like your job? Your relationship? Are you on the right track? Make adjustments for inner peace, as that’s most important. Always have goals as they help you keep moving in life.
3. Take a laughter pill: Laughter is an excellent antidote for stress and releases hormones that help you relax. Try practising to have some laughter with friends, family or watch some laughter shows. Be in the company of people who make you laugh.
4. Monitor your thoughts: We have somewhere between 40,000 and 75,000 thoughts per day, out of which 88% are random “nonsense”. Try to live in the present by not worrying about the past and future. Keep reminding yourself not to overthink.
5. Exercise and sleep: This is very important, especially for those who are just recovering from Covid-19. Remember, post-Covid phase is equally critical and can be quite distressing for many. A walk for 30-45 minutes and 8-hour sleep can make your mind calm and composed. However, there’s an advice here: Don’t jump into a rigorous exercise mode soon after the recovery. Go slow, let your body come to terms with the ‘new normal’.
6. Balance diet & regular health check-ups: Your diet with complete nutrients keeps your body and mind in place. Regular health check-ups highlight the areas you need to work on and change your perspective for yourself as it brings a lot of self-confidence.
The pandemic has changed how we live, work, learn and interact as social distancing guidelines have led us to a more virtual existence, both personally and professionally. This new phase requires us to maintain “social distancing” but the challenge is not to distance ourselves from society, especially our near and dear ones. The change has been so sudden and drastic that as per a report, 60% of those in the age bracket of 16 to 35 years, have been reporting mental health issues due to stress, anxiety, depression and loneliness or isolation. This is an alarming situation as we are still not out of the Covid woods and if the anticipated third wave hits us in the next few months, it’s the younger ones who could be impacted the most. So, brace for the impact. Brace up physically — and also mentally!
Coronavirus can lead to cognitive, behavioural problems in patients
Issues with memory, spatial awareness and information processing problems were identified as possible overhangs from the virus in post-Covid-19 patients.
Covid-19 patients suffer from cognitive and behavioural problems two months after being discharged from hospital, a new study presented at the 7th Congress of the European Academy of Neurology (EAN) has found.
Issues with memory, spatial awareness and information processing problems were identified as possible overhangs from the virus in post-Covid-19 patients who were followed up within eight weeks. The research also found that one in 5 patients reported post-traumatic stress disorder (PTSD), with 16 per cent presenting depressive symptoms.
The study, conducted in Italy, involved testing neurocognitive abilities and taking MRI brain scans of patients two months after experiencing Covid-19 symptoms. More than 50 per cent of patients experienced cognitive disturbances; 16 per cent had problems with executive function (governing working memory, flexible thinking, and information processing), 6 per cent experienced visuospatial problems (difficulties judging depth and seeing contrast), 6 per cent had impaired memory, and 25 per cent manifested a combination of all these symptoms.
Cognitive and psychopathological problems were much worse in younger people, with the majority of patients aged under 50 demonstrating issues with executive functions. In the whole sample, the greater severity of Covid-19 acute respiratory symptoms during hospital admission was associated with low executive function performance.
Additionally, longitudinal observation of the same cohort at 10 months from Covid-19, showed a reduction of cognitive disturbances from 53 to 36 per cent, but a persisting presence of PTSD and depressive symptoms.
The lead author of the study, Prof. Massimo Filippi, from the Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy, explained, “Our study has confirmed significant cognitive and behavioural problems are associated with COVID-19 and persist several months after remission of the disease.”
“A particularly alarming finding is the changes to executive function we found, which can make it difficult for people to concentrate, plan, think flexibly and remember things. These symptoms affected three in 4 younger patients who were of working age”.
No significant relationship was observed between cognitive performance and brain volume within the study. “Larger studies and longer-term follow up are both needed, but this study suggests that COVID-19 is associated with significant cognitive and psychopathological problems”, concluded Dr Canu, Researcher at the San Raffaele Hospital of Milan and first author of the study. “Appropriate follow-up and treatments are crucial to ensure these previously hospitalised patients are given adequate support to help to alleviate these symptoms.”
With ANI inputs
COVID THIRD WAVE: NEED FOR COMMON APPROACH AND STRATEGY
Situation may worsen if the ongoing accelerated vaccination drive is not maintained with Central procurement and timely supplies.
The second wave of Covid-19 has ravaged vast sections of the population with a record number of cases and casualties, aggravating further the challenges and ill-health of families.
Confirmed reports of 3.90 lakh deaths (Maharashtra leading and Delhi not lagging behind) vis-à-vis three crore registered cases have come to light. These are mere statistics for people who have suffered or those likely to suffer. There are reports that the death figures have been suppressed in eight states. Further, in a span of 10 days, Bihar with a rise of 73% deaths in 24 hours, as reported to the Patna High Court, and 1,97,000 “excess” deaths in U.P., as per the Article 14 website, could be termed as phenomenal examples of under-reporting.
Such a statistical inconsistency is likely to prevail during the third wave as well, when the Delta variant is going to be more transmissible. Individuals who died under miserable circumstances all had their hopes, dreams and aspirations.
KUMBH FAKE CERTIFICATES
As if this were not bad enough, the disturbing news about fake certificates numbering about one lakh, issued during the Mahakumbh has surfaced (I too was a victim of such cheating). Consequently, cases pertaining to negligence, spreading disease, cheating, etc, have been filed against three laboratories with regard to Rapid Antigen tests. In the midst of this raging pandemic, a certain percentage of the labour force has rejoined work when unlocking began. They have no option but to survive and sustain. In the event of fresh infection, general health deteriorates, either for want of proper guidance at home or it is bed or oxygen which generally becomes the determining factor.
The situation may worsen, however, if the ongoing phase of accelerated vaccination drive (with a record of 8.5 million doses on the first day which dipped to 4.5 million on day two) is not maintained with Central procurement and timely supplies. Can anyone guarantee this? The fact of the matter in the present scenario, however, looks just the opposite. How to remedy such a ticklish situation?
INEVITABLE THIRD WAVE
A recent statement of the Director, AIIMS, pertaining to an inevitable third wave in the next six to eight weeks, has unfortunately bolstered the level of anxiety, apart from much guesswork. Even then, Covid-19 norms are being flouted. Though many have learnt lessons from the immediate past, instead of expressing regret, a majority don’t mind paying fines.
BRITISH SCIENTIST’S OPINION
In addition, Prof Adam Finn, a British scientist, too, has subscribed to a similar stand due to what he claims “Delta variant of coronavirus being first identified in India.” He further adds that for the time being, the surge in infections may not appear much, yet the same will show an upward swing, especially in the age group 16 to 25 years. Be that as it may, the process of hospital admissions, both in India and England, shall have to be closely monitored from day one to get periodic clarity and in chalking out a plan of pre-emptive action, based on past performance.
Reverting to the domestic scene, keeping in view the vulnerability of Maharashtra and Delhi, the Maharashtra government and the Delhi HC have already warned of the “devastating” third wave, thus: “If flouting of norms continues, expect the third wave to hasten its pace.”
One may remind that the worst outbreak so far between 5 April to 10 May 2021, compelled helpless citizens to scramble from hospital to hospital, which was, in a way, facilitated by irresponsible media utterances.
While the “free for all” Mahakumbh and thousands of fake tests conducted by three private agencies therein, have come to the fore, “prediction” of 37,000 daily cases likely to go up to an extent of 45,000 in Delhi, has unnecessarily added to the state of depression and fear concerning the third wave.
Can’t we be more positive on health, education and social welfare fronts? Also, is it proper for the Government of India to tell the states “now” not to rush to unlock, after having given arguments in favour of losses being suffered time and again by industrialists and businessmen and rising unemployment all over?
FACTOR OF EFFICACY
In the meanwhile, efficacy reported to the extent of 96% with regards to Pfizer, 92% with regard to AstraZeneca and 76% of Covaxin after two doses, probably may give some respite. Also, the disclosure that fatalities drop in places having high vaccination rates and that male fertility is not hurt by vaccination and finding of another study that Covid hits cognition, need to be seriously looked into.
However, a warning from some other experts that the coronavirus may continue to evolve for a few years more, certainly disturbs all sections. As such, according to emerging trends, vaccines are unlikely to protect fully against infection or may be, relapse. It may sound pessimistic, but this is how it is.
The writer is the ex-Chief Secretary, the Government of Sikkim. The views expressed are personal.
A case of sudden cardiac arrest
It was 1 June 2021 at 6.10 pm, I had just returned from hospital and was pondering over today’s work while taking my dog Jerry out for his evening walk. As I reached society gate, my phone rang, which broke my thoughts. There was an unknown number, but somehow, I decided to pick it up.
A lady in a sheer panic called me on the other side, asking me if I am Dr Chandra, without even waiting for my answer, she told me her husband had collapsed in the home at Utopia. I rushed back, took my stethoscope, and found my way towards the said address.
The flat was on the 7th floor. As I reached the lifts, the guard was already alert and showed me to the 7th floor flat. I was taken straight to the bedroom, where a young gentleman was lying on the floor, and our energetic and ever helpful Vice President of the society Sayema and her team of guards were busy doing CPR. But there was no pulse, no breathing movements and the pupils were dilated and fixed (the ultimate sign of irreversible brain damage). No cardiac activity on listening thru the stethoscope. My worst fears proved correct. A young life was gone. Too prematurely. Could we have saved his life? This was what Sayema asked me with sadness. I was feeling guilty for not being able to save a young life.
Every now and then, we listen to such news of a young person, previously hale and hearty, dying suddenly, due to Sudden Cardiac Death (SCD). The most common cause of which is Ventricular Fibrillation. This is a medical term denoting, chaotic, very fast and ineffective cardiac activity, leading to the cessation of blood flow to the vital organs, including the brain, and if not restored in the next five to eight minutes, leads to irreversible brain damage and ultimately death.
According to World Health Organisation, nearly 5.8 lakh people are dying due to heart attack in the world in a year. Nearly 1.15 lakh people die due to cardiac arrest every day in the world.
Sudden Cardiac Arrest (SCA) is the number one killer in India, killing approximately 25 lakh people every year. As per the data revealed by the Delhi Economic Survey about 150 to 250 deaths happen in the city of Delhi every single day and out of these deaths, 25 to 45 deaths occurred due to Sudden Cardiac Arrest (SCA).
So, what could be done in five minutes, in a residential tower on the 7th floor with the nearest heart hospital at least 2 km away? If we wait for an ambulance or a doctor to arrive it takes at least 30 minutes, even if you are very near to a hospital. With each passing minute after a cardiac arrest, the chance of survival goes down by 10%. That means after 10 minutes of cardiac arrest, there are negligible chances of survival.
Thankfully, with the great strides in medical technology, we now have a small portable device, called AED (Automated External Defibrillator), that can be used by a layperson/bystander, to jumpstart the heart from the cardiac arrest.
So what is an AED? Let me answer this in Q&A format:
1.What actually is an AED?
AED are small portable battery-powered devices, which are designed to detect ventricular fibrillation (Cardiac Arrest), and are able to deliver a shock, to correct it. AED uses sophisticated software to analyze the victim’s heart rhythm and determine if a shock is required to restart the heart. The electrodes which attach to the victim’s chest relay information to a computer inside the AED that analyses whether a shock is necessary. A shock is only delivered by the AED if deemed to be needed (a sudden cardiac arrest event is detected) and the “shock” button is pressed by the rescuer. The electrodes will deliver a shock to the body which stuns the heart allowing it to reset to a normal heart rhythm. It’s important to back away from the victim if the AED indicates it’s about to deliver a shock. Receiving this shock to restart the heart is essential to survival as there is only a three to five minute window before most individuals begin to experience brain damage.
2.Do I need any training to use an AED?
AED is designed to be used by a layperson. A very short training of only 10 to 15 minutes, only which is required to use an AED. Even a 5th class student can learn to use AED, and it is safe. Most AEDs give voice-based step by step instructions on how to operate it.
3.I know CPR – that’s enough.
CPR is very important, but CPR alone is not enough. The odds of survival reduce by as much as 10% every minute the heart is not beating after a sudden cardiac arrest or cardiac event. The use of an AED along with CPR actually increases a person’s chances of survival by 75%. After 10 minutes without defibrillation, very few people survive. Every minute counts!
4: How safe is it to use AED. Could I get a shock?
AEDs are designed to be very safe. There are zero chances of getting a shock while using it. An AED cannot shock a person whose heart is in a normal rhythm. Most AEDs will clearly tell you something along the lines of: “Stay clear of the patient” and will warn you not to touch the patient before pressing the shock button and administering the shock.
Should you happen to have a hand on the patient while a shock is administered, you may feel a slight tingle. Proper placement of AED pads is unlikely to cause any harm. All you have to do is follow the prompts and you will be safe. If a person does not have a “shockable” rhythm, the AED will not allow the delivery of a shock.
5: Should I wait for medical personnel to arrive before I use an AED?
Remember, you only have minutes to act! If you wait for a doctor to arrive, in five to ten minutes of a cardiac arrest, that is practically impossible in the Indian scenario. Your best bet of saving the person is to give a shock as early as possible.
6: I can only use my AED once.
Most AEDs can administer a range of 100 to 200 shocks in their useable lifetime and a maximum of four shocks can be delivered during a rescue. Pads should be replaced every 2 years to ensure they are sticky enough to be adhesive on virtually anyone’s chest. Batteries should be changed every five years and AEDs should be replaced every seven to ten years.
7: Can AED be used in children?
Latest generation AEDs can be modified to be safe for use on small children under the age of 8. It is recommended that you use specialised pads child keys which lower the amount of charge released by the AED. Purchasing an infant/child AED kit is a must for schools or daycares.
8: Can an AED shock a victim, when it is not needed?
It is nearly impossible because of the excellent diagnostic algorithm these machines have. They deliver a shock, only when needed.
9: AEDs are expensive to purchase and difficult to maintain.
AED prices have reduced over the years. In India, it is available from Rs 80000 to 1 lakh that can be shared amongst a large number of residents, bringing the individual price to an affordable level. AEDs are very easy to maintain, the battery needs replacement every five years.
I jolted by the above incident at our society, our BOM led by P.K. Misra, and ably supported by Sayema, decided to acquire an AED for the Utopia family. And I am happy to inform, that as I am writing this article, a brand new AED has been procured, making Eldeco Utopia the first society in Noida to get this life-saving machine. We have organised a training session for all the guards and few interested residents. We sincerely hope that the need for AED never arises but just like a fire extinguisher, it gives us confidence.
The writer is a Resident of Eldeco Utopia, Noida & Director, Interventional Cardiology, Fortis Escorts Heart Institute, New Delhi.
WHY PARENTS SHOULD OPT FOR HOME VACCINATION FOR CHILDREN
Vaccinations are crucial during the first year for the child to stay healthy and infection-free and the availability of home-based care is no more an option, it is rather a necessity.
This is the first pandemic, this generation has faced. Unlike the previous pandemics, we now have many vaccines to prevent vaccine-preventable diseases (VPD). Since the Covid-19 was discovered, the world has waited for a vaccine that would help our lives return to some level of normalcy. Unlike in the past, it took less than a year from lab to jab (vaccine development in case of Covid-19). And now that that vaccine distribution has begun especially for the age group from 18 years and above what will this “new normal” look like for our children? As a neonatologist, I often come across parents who have been asking the question — Is it okay to delay routine vaccinations for our children amidst pandemic? If not, how do we take these vaccinations? Is visiting the hospital safe with infants and toddlers for vaccination? The WHO and UNICEF were concerned when the pandemic struck — as the “primary vaccinations” for children against VPD was getting missed or delayed leading to the possible emergence of these diseases taking a toll on children. Throughout the world, the lockdowns, and “the fear of contracting the disease” made parents “miss their children’s vaccinations”. My simple response to these parents is home vaccination — which is the new normal.
Unsurprisingly, the Covid-19 pandemic resulted in dramatic changes in hospital inpatient volumes at the onset and the hospital inpatient volumes dropped drastically. As the situation continued to evolve, there was a need to have a home care solution. The pandemic has clearly proven itself as a healthcare innovation catalyst, reinforcing the benefits and growth potential of the home healthcare industry.
HOME VACCINATION FOR CHILDREN
Vaccinations are crucial during the first year for the child to stay healthy and infection-free and the availability of home-based care is no more an option, it is rather a necessity and a responsibility to protect children. Why should parents opt for home vaccinations for children? Here are the reasons:
• Home vaccination ensures safety first
• It helps in avoiding risks
• It helps to save time
• Parents can teleconsult and secure a digital prescription at home that will explain the vaccinations and possible common side effects of missing them
The pandemic has made us adapt to newer ways of doing things. Many things that were hitherto thought not possible or not the first option is now being seen as normal and comfortable. The pandemic also made the country and the fraternity realise that many healthcare issues can be solved at home and do not require a visit to the clinic or hospital most of the time. Healthcare digitisation is driving the ecosystem of healthcare and bringing effective care to home with convenience and comfort.
Home healthcare is beneficial as a doctor is readily available for a home visit or teleconsultation on video. Telehealth is a great way to get in touch with the clinician and avoid unnecessary travel. Nurses can visit patient homes for vaccinations and clinical procedures that are smaller in scale. Patients need not postpone their physiotherapy or speech therapy sessions as the clinicians can travel to their home or be available for video sessions. Vaccinations can be administered at home under the combined care of doctors and nurses.
In my view, home vaccination has become so popular that parents are happy to have their child vaccinated without the fear of visiting the hospital for the same and the fear of getting infected in the hospital. Within the last year, my unpublished data suggest that we have done more than 20,000 home vaccinations for the children of India and the initiative has received even Karnata deputy Chief Minister’s approval.
Earlier home healthcare was unorganised and run by bureaus with a lack of quality control and customer-centricity. But with the home healthcare sector becoming organised and institutionalised with the advent of trusted players, the scenario has changed. Expert and experienced clinicians are recruited with various background checks. Training and clinical protocols are institutionalised. Audits, quality controls, and tech involvement aid in high-quality clinical services with safety have benefited the community at large. Hence, quality clinical services at home is a prudent investment that people have been making for the management of their health.
HEALTHCARE IS BEING REDEFINED AND MOVING STEADILY INTO THE HOME
With Zoom, texting, and more, technology has transformed our everyday human interactions and what we define as “interpersonal communication.” Between value-based care models and these advancements in technology, healthcare is also being redefined and moving steadily into the home. Covid-19 has accelerated that trend and become a catalyst for virtual and remote care. The year 2021 looks to be the year of the home and after children, senior citizens will be the next set who will be more comfortable than ever with moving healthcare visits to their living rooms and caregivers are more comfortable incorporating time-saving technology into their workflows. In these challenging times, home-based care, remote patient monitoring, and telemedicine services and solutions are helping bridge the gap and prepare for the prevalent needs of healthcare delivery.
The writer is Founder Chairman & Senior Neonatologist, Cloudnine Group of Hospitals, Bengaluru. He is also a healthcare delivery graduate from Harvard Business School.
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