Clinical Establishment Act Update (Part 1)

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In the 8th Meeting of National Council for Clinical Establishment, which was chaired by Dr Jagdish Prasad, DGHS, the Indian Medical Association (IMA) submitted a list of issues and objections related to Clinical Establishment Acts and Rules and persuaded the Council to discuss these issues separately in a special meeting under the Chairmanship of DGHS, which followed and IMA has been able to make following points/recommendations.

1. MA has demanded that the District Appropriate Authority must be headed by a medical person. DGHS informed the IMA members that as District Collector is the administrative head of the District, the change may not be necessary. (not agreed)

2. Exclusion of the police officer from the District Registering Committee has been agreed by the inter-ministerial Committee

3. It was recommended that single doctor clinical establishment (Husband & Wife should be taken as one unit/OAE Own Account Entrepreneur) who are providing only consultation services, may be exempted from the purview of Clinical Establishment Act. The IMA argued that single doctors are already covered under the Medical Council of India Act and are regulated by the Medical Council of India or State Medical Council.

4. Allowing Medical Establishment, which has entry level accreditation or above under NABH, need only registration under the Act and should automatically be registered under CEA without any other formalities has been referred to Ministry for decision whether this is permissible under the Act.

5. IMA raised objections to the other conditions of registration as included in Rule 9 of Central Govt. Rules, 2012. It was agreed that these conditions may be reviewed by DGHS and suggestions in this regard sent to Ministry for further action.

Service to the society and country is the best way to give back

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Dr KK Aggarwal, Editor in Chief eMedinewS and IMA News in conversation with Prof Dr C V Harinarayan, Director, Institute of Endocrinology, Diabetes, Thyroid and Osteoporosis Disorders, Sakra World Hospitals, Bangalore, Karnataka.

Dr CV Harinarayan has been honored with Dr BC Roy National Award for the year 2009 under the category of ‘Oration’’.

How does it feel being conferred one of the most prestigious awards in the medical field?

I feel humbled and the society expects more dedicated work from me.

Tell us about your journey so far.

I was the first to document low vitamin D status in Indian population as a part of my DM (endocrinology) project thesis. Our studies showed that low vitamin D status of Indian population is the cause of bone disease in patients with primary hyperparathyroidism. This work on primary hyperparathyroidism is quoted in many textbooks of metabolic bone disease. It is hard to believe that in a sun drenched country like India we have vitamin D deficiency. Later this fact was confirmed by many scientific workers across the country.

Our landmark population study from south India is the FIRST and ONLY study till date to document the low dietary calcium intake and low vitamin D status in agricultural laborers residing in villages. Subsequently we documented by in vitro studies on ampoule model of previtamin D synthesis and showed that we as Indians can synthesize enough vitamin D on exposure to sunlight from 11 am to 2 pm, by exposing 10 to 15% of body surface area for 15 to 30 minutes. Our studies documented that correction of vitamin D deficiency and calcium supplementation can improve the pancreatic beta cell secretory function.

Our work was the first to show that renal tubular damage is the major cause of metabolic bone diseases in patients with fluorosis (Ranked top 10 publications – year 2006 by Internet). The work with BARC, Mumbai helped to indigenously develop intact IRMA radioimmunoassay for parathyroid hormone in India (make in India concept).

With all this background, we were instrumental in developing the “Clinical Practice Guidelines on management of Postmenopausal osteoporosis (2012-13) – Executive summary and Recommendations” for Indian Menopause society. We developed the Department of Endocrinology, SVIMS, Tirupati, (for nearly two decades) with a good dedicated endocrine laboratory infrastructure and now we have MCI recognized seats (two) for DM endocrinology.

What were the early challenges faced by you in your career? How did you manage to overcome them?

To convince the scientific community about low vitamin D status in Indian population was a major challenge. We conducted population studies in villages in and around Tirupati (Tirupati is nearer the equator and sun drenched most of the year) and showed low dietary calcium intake along with low vitamin D status in agricultural population. It is the first and only study (till date) of dietary calcium intake and vitamin D status from rural India. It would not have been possible but for the dedicated team work of students and staff of the department of Endocrinology, and support of the administration of SVIMS, Tirupati, Andhra Pradesh.

Tell us about your family. How important has been the role of your family in your journey?

Family has been always supportive and encouraging in my academic work.

What would be your message to the community?

Service to society and community should be kept in mind of all health care professionals, so that it benefits a larger segment of the society.

Given a chance, what changes would you like to bring about in health policies?

India being a vast country with diverse cultural habits and limited resources, I would aim to provide adequate dietary calcium and vitamin D to all ages groups and both genders using available resources.

What advice would you give to youngsters?

Society and our country has given you the opportunity to get knowledge, the best way to return that is service to the society and county.

Study links health Benefits from nature to frequency and duration of visits to green spaces

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Yet another study has corroborated the positive health outcomes of communing with nature.

Researchers from Australia have shown that people who made long visits to green spaces had lower rates of depression and high blood pressure, and those who visited more frequently had greater social cohesion. Higher levels of physical activity were linked to both duration and frequency of green space visits.

The results further suggested that up to a further 7% of depression cases and 9% of high blood pressure cases could be prevented if all city residents were to visit green spaces at least once a week for an average duration of 30 minutes or more.

For the first time, the researchers quantified the link between health outcomes and experiences of nature, as measured by intensity (i.e. the quality or quantity of nature itself), and the frequency and duration of a city resident’s experiences.

The participants’ experiences of nature were measured by three factors: The average frequency of visits to outdoor ‘green spaces’ during a year, the average duration of visits to these spaces across a week and the intensity of nature in these spaces – measured by the amount and complexity of greenery in that space.

The researchers concluded that higher levels of physical activity were linked to both duration and frequency of visits to green spaces.

The study is published online June 23, 2016 in the journal Scientific Reports

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