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THIRD JAB? SENDING THE WRONG MESSAGE

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Vaccine

Omicron ( B1.1.529) quickly evolved to become a VoC within a few months’ time, spreading from S Africa to several nations worldwide[1]. The Technical Advisory Group on SARS-CoV-2 Virus Evolution (TAG-VE) monitoring the evolution of SARS-CoV-2 was convened to assess this variant after it was first reported to WHO from South Africa on 24 November 2021 from a specimen collected on 9 November 2021. The detection of B1.1.529 quickly coincided with a surge in COVID19 cases establishing it as the dominant variant. By the time travel advisories and other restrictions could kick in, Omicron already spread to 89 countries (as of 18th Dec 2021) infecting millions. According to the Institute for Health Metrics and Evaluation (IHME), Washington, omicron infections are set to surge in the next two to three months and may infect 1-2 billion people globally. What makes B1.1.529 special is the sheer number of mutations it accumulated (32 vs 12) as compared to the delta(B1.617.2), plus the rapidness it is spreading with an estimated Ro of 2.69 (vs 1.69 for the delta variant). For a populous country like India with over 8 lakh active cases[2], and a positivity of ~10-15%, the stakes are higher. The healthcare system that is already stretched beyond its capacity has seen a further dent with several HCW exposed and quarantined. Amidst the rising cases, the administration has to enforce lockdown, containment zones, and travel restrictions which may, in turn, affect the economy. However, it seems during this crisis, the public is getting influenced by a different set of narratives, derived from an overall short term observation, poor understanding of the full nature & scale of this variant, inadequate testing, surveillance, genome sequencing, as well as overlooking the long term health consequences of Omicron on adults as well as in children and pregnant women. This lack of our knowledge is giving rise to numerous misleading statements[3] even by the professionals, labeling Omicron to be a mild, benign variant, a variant of least concern, a variant that needs nearly no hospitalization or is associated with very low mortality. Taken to the public domain, this may create callousness and a sense of anarchy in following COVID-appropriate behavior like social distancing, double masking, or getting tested and vaccinated. This also falsely justifies hosting super-spreader events like religious and political rallies, ignoring the law and order, and downsizing the potential risk. We need to accept from all our past experiences that our understanding of the overall COVID pandemic is still very naïve and almost nil for this new variant. Still, a vast majority of the PCR/NAAT-based detection is not targeted to B1.1.529. SGTF(S Gene Target failure) is rarely used in diagnostic labs. With India’s sequencing agency, The Indian SARS-CoV-2 Genomics Consortium(INSACOG), sequencing a minuscule 2-3% of all positive cases, we are still in an ocean of uncertainties to comment on the real number of genuine Omicron cases[4]. Going by the average consensus worldwide, even if 60-80% is Omicron, that still implies that Delta and other variants are out there and may retaliate any time. Moreover we don’t know if B1.1.529 is just a transient quasi-species on its evolutionary trajectory in the process of evolving to a more virulent form. We also don’t know if Omicron will make us permissive for co-infection by another variants that are perhaps mutating at some corner of the world. The rapid spread of B1.1.529 with its extremely high transmissibility could in theory wipe out COVID-specific memory B/T cells, that many of us might be banking on, making them ineffective and futile. Worst, if it blunts the effect of the COVID-19 vaccine, acting as a “decoy virus” exhausting the pool of effector immune cells before another lethal variant steps in. With all these possibilities, labeling omicron as a harmless variant and taking the guard off is the last thing one should ever do. Further, the decision for a booster dose needs some serious thoughts following the philosophy that “more is not always the best”. Serology testing has shown a lesser efficiency in vaccine-induced neutralization against the new variant. Under these conditions, there is no credible evidence to show that a 3rd jab will make things all right. We need to consider that sometimes a higher dose of antibodies produced may in fact facilitate virus infection by the process of ADE(antibody-dependent enhancement)[5]. Though well observed in Dengue virus infection and not yet in SARS-CoV2, the probability how-so-ever small still remains. We have already seen a massive breakthrough re-infection amongst those fully vaccinated making it apparent that the vaccines are not capable enough to prevent new infection or virus transmission. Whether adding a booster dose to ramp the antibody level will do any benefit is highly uncertain and should be only considered based on solid science and rigorous clinical trials, rather than speculation. Also drawing parallels between Ab titers with disease protection can not only be misleading but also erroneous[6]. For a country as large and populous as India with just 64% fully vaccinated with a double dose (as of December 30th, 2021), demand for a 3rd booster dose is highly ambitious. Making the right choices and sending the right messages, more so in pandemic times might hold the key to overcoming the ongoing crisis. Sending the wrong message may do more harm than the virus itself.

Subhradip Karmakar, Additional Professor, All India Institute of Medical Sciences.

References:

1. https://www.who.int/news/item/26-11-2021-classification-of-omicron-(b.1.1.529)-sars-cov-2-variant-of-concern

2. India COVID cases . URL : https://www.mohfw.gov.in/

3. https://indianexpress.com/article/opinion/columns/its-dangerous-to-take-omicron-lightly-7710469/

4. https://scroll.in/article/1013438/lack-of-genome-sequencing-capacity-hampers-indias-efforts-to-track-the-spread-of-omicron

5. Narayan R, Tripathi S. Intrinsic ADE: The Dark Side of Antibody Dependent Enhancement During Dengue Infection. Front Cell Infect Microbiol. 2020 Oct 2;10:580096. doi: 10.3389/fcimb.2020.580096. PMID: 33123500; PMCID: PMC7573563.

6. Lisboa Bastos M, Tavaziva G, Abidi SK, Campbell JR, Haraoui LP, Johnston JC, Lan Z, Law S, MacLean E, Trajman A, Menzies D, Benedetti A, Ahmad Khan F. Diagnostic accuracy of serological tests for covid-19: systematic review and meta-analysis. BMJ. 2020 Jul 1;370:m2516. doi: 10.1136/bmj.m2516. PMID: 32611558; PMCID: PMC7327913.

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Medically Speaking

Better mobility in frail older people linked to regular exercise with dietary advice

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A programme of regular exercise along with expert dietary advice is linked to a reduction in mobility problems among frail older people living in the community, finds a trial.

The findings were published in The BMJ. The combination of aerobic (walking), strength, flexibility, and balance exercises alongside personalised nutritional counselling reduced mobility disability by 22 per cent over three years.

US and EU data indicate that about 13 per cent of adults aged 70 years and older living in the community have mobility disability, which is linked to poor quality of life, admission to hospital or residential care, and death, as well as greater healthcare costs.

It is therefore important to find safe and effective ways to preserve mobility in older people at risk of further decline.

So researchers designed the SPRINTT trial to find out whether a combined intervention of physical activity with technological support and nutritional counselling prevents mobility disability in frail older adults compared with education on healthy ageing.

Their findings are based on 1,519 men and women (average age 79 years) with physical frailty and sarcopenia (a combination of reduced physical function and low muscle mass) recruited from 16 clinical sites across 11 European countries between 2016 and 2019.

Physical frailty and sarcopenia was defined as having a physical performance battery (SPPB) score of 3 to 9 points (score range 0 to 12, with lower scores indicating poorer physical function) and low levels of muscle mass, but able to independently walk 400 metres in 15 minutes.

In all, 760 participants were randomised to the intervention, 759 received education on healthy ageing (controls), and all were monitored for up to 36 months.

The intervention group received twice weekly moderate intensity physical activity sessions at a centre and up to four times weekly at home alongside personalised nutritional counselling. Activity was measured by an actimeter worn on the thigh.

Controls received education on healthy ageing once a month and a brief instructor led programme of upper body stretching exercises or relaxation techniques.

Among participants with SPPB scores of 3-7 at the start of the trial, mobility disability occurred in 47 per cent assigned to the intervention and 53 per cent controls.

Persistent mobility disability (inability to walk 400 m on two consecutive occasions) occurred in 21 per cent of intervention participants compared with 25 per cent of controls. SPPB scores increased more in the intervention group than in controls at both 24 months and 36 months (average differences of 0.8 and 1 point, respectively).

Women in the intervention group lost less muscle strength (0.9 kg at 24 months) and less muscle mass (0.24 kg and 0.49 kg at 24 months and 36 months, respectively) than control women, but no significant group differences were seen in men.

The risk of adverse events was, however, greater among intervention participants (56 per cent) than controls (50 per cent).

In a separate analysis of participants with better mobility (SPPB scores of 8 or 9 at the start of the trial), the intervention did not affect the risk of developing mobility disability and had marginal effects on physical performance.

The researchers acknowledge some limitations. For example, older adults with important cognitive deficits were not included, and almost all participants were white, so findings may not apply to other ethnic groups.

However, retention and adherence to interventions were high compared with other similar trials, and their use of validated tests in a geographically and culturally diverse group of frail older people across Europe, suggests that results are solid.

As such, they conclude that such an intervention “may be proposed as a strategy to preserve mobility in older people at risk of disability.”

This fresh evidence confirms the benefits of structured physical activity in community living older adults, says Thomas Gill at Yale School of Medicine in a linked editorial.

He acknowledges that translating even the best designed trial findings into clinical practice can be challenging, but says these findings, along with those from another large US trial (the LIFE Study), “provide compelling evidence that mobility in the community can be preserved among vulnerable older people through structured physical activity, with walking as the primary modality.”

He notes that the cost effectiveness of the LIFE programme “was found to be comparable to that of many commonly recommended medical treatments.”

Confirming these findings in SPRINTT “would further strengthen the case for developing, implementing, and supporting community based physical activity programmes to preserve independent mobility among vulnerable older people,” he concludes. (ANI)

US and EU data indicate that about 13 per cent of adults aged 70 years and older living in the community have mobility disability, which is linked to poor quality of life, admission to hospital or residential care, and death, as well as greater healthcare costs.

It is therefore important to find safe and effective ways to preserve mobility in older people at risk of further decline.

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Medically Speaking

50% of brain’s cells execute new functions

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In a new study at Tufts University, researchers came across a previously unknown function performed by a cell type that contains almost half of all cells in the brain.

The findings of the research were published in the journal ‘Nature Neuroscience’. The scientists say this discovery in mice of a new function by cells known as astrocytes opens a whole new direction for neuroscience research that might one day lead to treatments for many disorders ranging from epilepsy to Alzheimer’s to traumatic brain injury.

It comes down to how astrocytes interact with neurons, which are fundamental cells of the brain and nervous system that receive input from the outside world. Through a complex set of electrical and chemical signaling, neurons transmit information between different areas of the brain and between the brain and the rest of the nervous system.

Until now, scientists believed astrocytes were important, but lesser cast members in this activity. Astrocytes guide the growth of axons, the long, slender projection of a neuron that conducts electrical impulses. They also control neurotransmitters, chemicals that enable the transfer of electrical signals throughout the brain and nervous system.

In addition, astrocytes build the blood-brain barrier and react to an injury. But they did not seem to be electrically active like the all-important neurons–until now. “The electrical activity of astrocytes changes how neurons function,” said Chris Dulla, associate professor of neuroscience at the School of Medicine and Graduate School of Biomedical Sciences.

“We have discovered a new way that two of the most important cells in the brain talk to each other. Because there is so much unknown about how the brain works, discovering new fundamental processes that control brain function is key to developing novel treatments for neurological diseases.”

In addition to Dulla and lead author Moritz Armbruster, the study’s other authors include Saptarnab Naskar, Mary Sommer, Elliot Kim, and Philip G. Haydon from Tufts University School of Medicine; Jacqueline P. Garcia from the Cell, Molecular and Developmental Biology program at Tufts Graduate School of Biomedical Sciences; and researchers from other institutions.

To make the discovery, the team used brand new technology to devise a technique that enables them to see and study the electrical properties of brain cell interactions, which could not be observed previously.

“With these new tools, we’ve essentially uncovered completely novel aspects of biology,” said Armbruster, research assistant professor of neuroscience at the School of Medicine.

“As better tools come along–for example, new fluorescent sensors are being developed constantly–we’ll get a better understanding of things we didn’t even think about before.”

“The new technology images electrical activity with light,” Dulla explained. “Neurons are very electrically active, and the new technology allows us to see that astrocytes are electrically active, as well.”

Dulla describes astrocytes as “making sure everything is copacetic in the brain, and if something goes wrong, if there’s an injury or viral infection, they detect it, try to respond, and then try to protect the brain from insult. What we want to do next is determine how astrocytes change when these insults happen.”

Neuron-to-neuron communication occurs through the release of packets of chemicals called neurotransmitters.

Scientists knew that Neuron-to-neuron communication helps to make sure that neurons stay healthy and active.

But the new study reveals that neurons also release potassium ions.

which change the electrical activity of the astrocyte and how it controls the neurotransmitters.

“So the neuron is controlling what the astrocyte is doing, and they are communicating back and forth.

Through a complex set of electrical and chemical signalling, neurons transmit information between different areas of the brain.

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Medically Speaking

HOW SLEEP HELPS IN PROCESSING EMOTIONS

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Researchers at the Department of Neurology of the University of Bern and University Hospital Bern identified how the brain triages emotions during dream sleep to consolidate the storage of positive emotions while dampening the consolidation of negative ones.

The work expands the importance of sleep in mental health and opens new ways of therapeutic strategies. Their findings were published in the journal Science. Rapid eye movement (REM or paradoxical) sleep is a unique and mysterious sleep state during which most of the dreams occur together with intense emotional content. How and why these emotions are reactivated is unclear. The prefrontal cortex integrates many of these emotions during wakefulness but appears paradoxically quiescent during REM sleep. “Our goal was to understand the underlying mechanism and the functions of such a surprising phenomenon”, says Prof. Antoine Adamantidis from the Department of Biomedical Research (DBMR) at the University of Bern and the Department of Neurology at the Inselspital, University Hospital of Bern.

Processing emotions, particularly distinguishing between danger and safety, is critical for the survival of animals. In humans, excessively negative emotions, such as fear reactions and states of anxiety, lead to pathological states like Post-Traumatic Stress Disorders (PTSD). In Europe, roughly 15 percent of the population is affected by persistent anxiety and severe mental illness. The research group headed by Antoine Adamantidis is now providing insights into how the brain helps to reinforce positive emotions and weaken strongly negative or traumatic emotions during REM sleep. This study was published in the journal Science.

A DUAL MECHANISM

The researchers first conditioned mice to recognize auditory stimuli associated with safety and others associated with danger (aversive stimuli). The activity of neurons in the brain of mice was then recorded during sleep-wake cycles. In this way, the researchers were able to map different areas of a cell and determine how emotional memories are transformed during REM sleep.

Neurons are composed of a cell body (soma) that integrates information coming from the dendrites (inputs) and send signals to other neurons via their axons (outputs). The results obtained showed that cell somas are kept silent while their dendrites are activated. “This means a decoupling of the two cellular compartments, in other words, soma wide asleep and dendrites wide awake”, explains Adamantidis. This decoupling is important because the strong activity of the dendrites allows the encoding of both danger and safety emotions, while the inhibitions of the soma completely block the output of the circuit during REM sleep. In other words, the brain favours the discrimination of safety versus danger in the dendrites, but blocks the over-reaction to emotion, in particular danger.

A SURVIVAL ADVANTAGE

According to the researchers, the coexistence of both mechanisms is beneficial to the stability and survival of the organisms: “This bi-directional mechanism is essential to optimize the discrimination between dangerous and safe signals”, says Mattia Aime from the DBMR, first author of the study. If this discrimination is missing in humans and excessive fear reactions are generated, this can lead to anxiety disorders. The findings are particularly relevant to pathological conditions such as post-traumatic stress disorders, in which trauma is over-consolidated in the prefrontal cortex, day after day during sleep.

BREAKTHROUGH FOR SLEEP MEDICINE

These findings pave the way to a better understanding of the processing of emotions during sleep in humans and open new perspectives for therapeutic targets to treat maladaptive processing of traumatic memories, such as Post Traumatic Stress Disorders (PTSD) and their early sleep-dependent consolidation. Additional acute or chronic mental health issues that may implicate this somatodendritic decoupling during sleep include acute and chronic stress, anxiety, depression, panic, or even anhedonia, the inability to feel pleasure. Sleep research and sleep medicine have long been a research focus of the University of Bern and the Inselspital, Bern University Hospital. “We hope that our findings will not only be of interest to the patients but also to the broad public”, says Adamantidis.

The work expands the importance of sleep in mental health and opens new ways of therapeutic strategies.

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Health & Wellness

ABHA WILL ENHANCE DIGITAL HEALTHCARE SYSTEM IN THE COUNTRY

The health insurance sector in India is expecting a growth at a rate of 10.1% in the years between 2021 and 2027. Distribution and affordability are two keywords to get a large number of people insured, said experts.

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Introducing the challenges and the need for new policies in health insurance in India, a conference on ‘Health Insurance 2042- Let us Plan for Ambitious Target for 2042’ was organised in Vigyan Bhawan, New Delhi. The conference organised by the PHD Chamber of Commerce and Industry (PHDCCI) highlighted the need to boost the digital healthcare system in the country.

Speaking about the Ayushman Bharat Digital Mission (ABDM), Dr. Malti Jaswal, a Senior Consultant, World Bank and Advisor with the National Health Authority, said, “ABDM plans to create a healthcare infrastructure that will bridge the existing gap amongst different stakeholders in the healthcare ecosystem through digital highways.” A health id for all Indian citizens-ABHA (Ayushman Bharat Health Account) will help maintain personal health records digitally and easily accessible.

The Ayushman Bharat scheme has also been able to cover the bottom 50% and several voluntary schemes cover almost 20%. The government must focus on the remaining 30%. Pradeep Multani, President, PHDCCI, said, “The health insurance sector has undergone a lot of change in the last two years of the pandemic, with people realising its importance.” He also focussed on the need for customising products as per the customers.

Also, while discussing the growth of digital healthcare, Dr. Harsh Mahajan, Chair, Hospital & Diagnostics Committee, PHDCCI and Founder & Chief Radiologist, said, “The digital healthcare market, valued at $116 billion in the year 2018 is expected to touch $485 billion by the year 2024, a growth of 3.5 times. The spurt in growth is primarily due to the pandemic, which accelerated the diagnostics sector to grow at a rate of 20.5 percent. It is valued at $32 billion now, up from just $5 billion in the year 2012.”

Mr. S K Sethi, Co-Chair, Banking, Financial Services and Insurance (BFSI) Committee, PHDCCI & Founder & CEO, Insurance Foundation of India, stated that from Rs 690 crore in 2001 to Rs 73,300 crores in 2022, the sector has grown approximately 106 times. He stated that blockchain technology would help in eliminating the fraud taking place in the insurance sector

Although the pandemic taught us the significance of mental health, health insurance policies exclude the challenges of mental health. According to Deepak Singh, CEO and Co-founder of Tatsam, insurance companies have developed plans but, except for psychiatrists, have yet to recognise counselors and therapists. Most people have often faced a treatment gap while claiming their insurance. Dr. Steward Doss, Professor, National Insurance Academy, Pune, stated that there is a significant treatment gap in India. A lot of these issues can be resolved with insurance cover.

The knowledge paper on Health Insurance 2042 was also released at the event. Other members who participated in the event were Kanya Saraswathy C, Head Commercial and Reinsurance Practice, Insurance Advisory Group & Lead – US West Accounts, BFSI, Tata Consultancy Services Limited, Ashish Agrawal, Co-Chair, BFSI Committee, PHDCCI, Ravi Bhati During the seminar, Teena Jain Kaushal, Senior Editor of Business Today, and so on.

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Medically Speaking

Taking a break from social media improves mental health

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Section 144 CrPC order on social media

According to new research, a social media break for just a week improves an individual’s overall level of well-being, as well as reduced symptoms of depression and anxiety, which helps people manage their mental health.

The findings of the research were published in the journal Cyber psychology Behavior and Social Networking. The study, carried out by a team of researchers at the University of Bath, studied the mental health effects of a weeklong social media break. For some participants in the study, this meant freeing up around nine hours of their week, which would otherwise have been spent scrolling Instagram, Facebook, Twitter, and TikTok.

For the study, the researcher’s randomly allocated 154 individuals aged 18 to 72 who used social media every day into either an intervention group, where they were asked to stop using all social media for one week, or a control group, where they could continue scrolling as normal. At the beginning of the study, baseline scores for anxiety, depression, and wellbeing were taken.

Participants reported spending an average of 8 hours per week on social media at the start of the study. One week later, the participants who were asked to take the one-week break had significant improvements in wellbeing, depression, and anxiety than those who continued to use social media, suggesting a short-term benefit.

Participants asked to take a one-week break reported using social media for an average of 21 minutes compared to an average of seven hours for those in the control group. Screen usage stats were provided to check that individuals had adhered to the break. Lead researcher from Bath’s Department for Health, Dr. Jeff Lambert explained: “Scrolling social media is so ubiquitous that many of us do it almost without thinking from the moment we wake up to when we close our eyes at night.

“We know that social media usage is huge and that there are increasing concerns about its mental health effects, so with this study, we wanted to see whether simply asking people to take a week’s break could yield mental health benefits.”

“Many of our participants reported positive effects from being off social media with improved mood and less anxiety overall. This suggests that even just a small break can have an impact.”

“Of course, social media is a part of life and for many people; it’s an indispensable part of who they are and how they interact with others. But if you are spending hours each week scrolling and you feel it is negatively impacting you, it could be worth cutting down on your usage to see if it helps.”

The team now wants to build on the study to see whether taking a short break can help different populations (e.g., younger people or people with physical and mental health conditions).

The team also wants to follow people up for longer than one week, to see if the benefits last over time. If so, in the future, they speculate that this could form part of the suite of clinical options used to help manage mental health.

Over the past 15 years, social media has revolutionised how we communicate, underscored by the huge growth the main platforms have observed.

In the UK the number of adults using social media increased from 45 percent in 2011 to 71 percent in 2021. Among 16 to 44-year-olds, as many as 97 percent of us use social media and scrolling is the most frequent online activity we perform.

Feeling ‘low’ and losing pleasure are core characteristics of depression, whereas anxiety is characterised by excessive and out-of-control worry. Well-being refers to an individual’s level of positive affect, life satisfaction, and sense of purpose.

According to the Mind, one in six of us experience a common mental health problem like anxiety and depression in any given week.

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Medically Speaking

ATTENTION & CARE OF VERY ELDERLY SENIOR CITIZENS

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Since I am an Orthopaedic Surgeon and dealing with the Geriatric problem of Post-Menopausal / Andropause osteoporotic problems and fragility fractures, I would like to bring to the notice, a very important and crucial socio-emotional and socio-economic issue for the entire generation of present and future elderly and very elderly senior citizens and Kudos to the networking of many dedicated and sincere Social Service workers for bringing up the same serious issue of Society of coming generations i.e Lonely senior citizens going in a stage of loneliness and then depression after staying far away from their children, Who are mostly settled abroad. The problem has worsened many folds during covid times.

In their young days, the same parents encourage their children to study abroad, supporting them financially. Over some time, children take up lucrative jobs and settle down abroad permanently. The excited proud parents in their hay days make frequent trips to visit them and to be with them and later mostly for baby-sitting. But later, the same parents are reluctant to visit their children due to the tiring long air travel and children also do not encourage their elderly parents to visit them due to unaffordable medical expenses. At such times, children visit their parents for short periods.

Everyone is happy with this arrangement until they (parents) are physically and medically fit.

Once their health starts deteriorating, the parents start feeling the necessity of being near their children. Then it is too late to make a compromise from either side. The irony of the situation is, that the same parents who looked after their elderly parents sincerely, do not have the same kind of support from their children.

Unfortunately, most of the parents when they become very elderly senior citizens with comorbidities, they are left to tend to themselves mostly in old age homes.

Western trends are replacing a Rich culture of high moral values.

How do we solve the problem of migrating diaspora?

Doesn’t the present generation owe some moral responsibility towards their parents?

Emotions, attachment, and sense of responsibility are taking a back seat in today’s materialistic world?

Can long-distance video calls kill Parents’ loneliness?

Is the empty nest syndrome a permanent reality in the life of the elderly?

Should the parents be selfish enough to refuse to fund, or discourage their children in settling down foreign countries?

Should the government of India make certain laws ( like in China ) to ensure Indian citizens return home after a stipulated period and serve their native country as well as their proud parents, when they are in need, indeed?

The problem is very complex and needs quick solutions at the end of the hour before one entire generation of senior Citizens became mentally unstable. A strong debate, discussion, and the ultimate decision are required and the whole generation of present and future senior citizens needs a platform for this controversial but important issue.

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