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Enhancing Doctor-Patient Relations: Strategies for Addressing Frustrations and Improving Healthcare Experiences

Mar 26, 2024 | News

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Written By THT Editorial Team

Dr. Kishor Adhikari

Reviewed by Prof Dr. Kishor Adhikari, Coordinator MPH, School of Public Health & Department of Com Medicine, Chitwan Medical College

Effective doctor-patient relations are fundamental to delivering high-quality healthcare. However, challenges such as miscommunication, time constraints, and differing expectations can lead to frustrations for both doctors and patients. In this essay, we will explore common frustrations experienced by both parties during medical encounters, analyze the underlying causes, and propose strategies to enhance doctor-patient relations. Additionally, we will examine policy implementations in healthcare systems worldwide and offer recommendations for fostering positive interactions between doctors and patients.

Common Frustrations Experienced by Doctors:

Time Constraints: Doctors often face tight schedules, with limited time allocated for each patient encounter. The pressure to address multiple concerns within a short timeframe can lead to rushed appointments and feelings of frustration (Macharia et al., 2020).

Administrative Burden: Administrative tasks, such as documentation, billing, and electronic health record management, consume significant time and energy for healthcare providers. These tasks detract from direct patient care and contribute to physician burnout (Arndt et al., 2017).

Lack of Appreciation: Healthcare providers may feel undervalued or unappreciated for their efforts, particularly in environments where their contributions are not acknowledged or recognized (Shanafelt et al., 2017).

Legal and Regulatory Pressures: Doctors must adhere to complex legal and regulatory requirements, which can create additional stress and anxiety. Fear of malpractice lawsuits or disciplinary action may impact clinical decision-making and communication with patients (Soklaridis et al., 2016).

Emotional Toll: Dealing with patient suffering, difficult diagnoses, and end-of-life care can take an emotional toll on healthcare providers. Coping with these challenges while maintaining professionalism and empathy can be challenging (Woolhandler et al., 2016).

Strategies to Address Doctor Frustrations:

Time Management Training: Providing doctors with time management and organizational skills training can help them optimize their schedules and prioritize patient care tasks effectively. Implementing strategies such as time blocking and delegation can enhance efficiency (Körner et al., 2015).

Streamlining Administrative Processes: Healthcare organizations should invest in technology and infrastructure to streamline administrative tasks and reduce paperwork burden on doctors. Electronic health record systems, automated billing systems, and administrative support staff can alleviate administrative pressures (Shanafelt et al., 2016).

Recognition and Support: Healthcare institutions should foster a culture of appreciation and support for healthcare providers. Recognizing their contributions through awards, incentives, and peer recognition programs can boost morale and job satisfaction (Panagioti et al., 2017).

Legal Reform and Malpractice Insurance: Policymakers should explore legal reforms to reduce the burden of malpractice litigation on healthcare providers. Implementing alternative dispute resolution mechanisms, such as mediation or arbitration, can mitigate the adversarial nature of malpractice claims (Baker et al., 2017).

Mental Health Support: Healthcare organizations should prioritize mental health support services for doctors, including access to counseling, peer support groups, and wellness programs. Proactive measures to address stress, burnout, and psychological distress can promote physician well-being and resilience (West et al., 2018).

Common Frustrations Experienced by Patients:

Communication Barriers: Patients may struggle to communicate their symptoms, concerns, and treatment preferences effectively to their healthcare providers. Language barriers, medical jargon, and lack of health literacy can hinder effective communication (Street et al., 2013).

Long Wait Times: Patients often experience long wait times for appointments, tests, and procedures, leading to frustration and dissatisfaction with healthcare services. Delays in accessing care can exacerbate health problems and undermine patient-provider relationships (Barr et al., 2015).

Lack of Empathy: Some patients perceive their healthcare providers as lacking empathy or compassion, particularly when discussing sensitive or distressing topics. Providers who appear rushed or disinterested may inadvertently convey a lack of empathy, affecting patient trust and satisfaction (Hojat et al., 2011).

Information Overload: Patients may feel overwhelmed by the volume of medical information provided during appointments, leading to confusion and uncertainty about their diagnosis, treatment options, and prognosis. Simplifying complex medical information and using plain language can enhance patient understanding (Schillinger et al., 2003).

Perceived Disrespect: Patients expect to be treated with dignity, respect, and courtesy by their healthcare providers. Instances of perceived disrespect, such as dismissive attitudes, rude behavior, or discriminatory practices, can erode patient trust and confidence in the healthcare system (Dovidio et al., 2008).

Strategies to Address Patient Frustrations:

Effective Communication Skills Training: Healthcare providers should undergo communication skills training to improve their ability to listen actively, convey empathy, and communicate clearly with patients. Training programs should focus on building rapport, fostering trust, and addressing patient concerns (Bylund et al., 2010).

Appointment Scheduling Optimization: Healthcare organizations should implement strategies to reduce wait times and minimize appointment delays. This may include optimizing scheduling systems, increasing appointment availability, and improving workflow efficiencies in clinics and hospitals (Murray et al., 2009).

Empathy and Cultural Competency Training: Healthcare providers should receive training in empathy and cultural competency to better understand and respond to the diverse needs and preferences of patients. Training programs should emphasize cultural humility, sensitivity to cultural differences, and awareness of unconscious biases (Betancourt et al., 2003).

Patient Education and Shared Decision-Making: Healthcare providers should engage patients as active participants in their care, involving them in shared decision-making and treatment planning. Providing patients with information, resources, and support empowers them to make informed decisions about their health (Elwyn et al., 2012).

Respectful and Patient-Centered Care: Healthcare organizations should prioritize patient-centered care principles, ensuring that all interactions with patients are respectful, compassionate, and culturally sensitive. Creating a welcoming and inclusive environment promotes patient trust, satisfaction, and engagement in their healthcare (Epstein et al., 2005).

Policy Implementations in Healthcare Systems:

Several countries have implemented policies and initiatives aimed at improving doctor-patient relations and enhancing the patient experience. These include:

Comprehensive Training Programs: Implementing comprehensive training programs for healthcare providers to enhance communication, empathy, and cultural competence skills (Haskard Zolnierek & DiMatteo, 2009).

Appointment Scheduling Optimization: Streamlining appointment scheduling processes to reduce wait times and improve access to timely care (Zachariah et al., 2017).

Patient Education and Shared Decision-Making: Promoting patient education and shared decision-making to empower patients to take an active role in their healthcare decisions (Charles et al., 1997).

Legal Protections and Patient Rights: Strengthening legal protections for patients and healthcare providers and enforcing strict penalties for acts of violence or harassment in healthcare settings (World Health Organization, 2021).

Quality Improvement Initiatives: Implementing quality improvement initiatives to enhance patient-centered care, improve patient satisfaction, and address systemic issues affecting doctor-patient relations (Beattie et al., 2015).

Recommendations for Fostering Positive Doctor-Patient Relations:

Invest in Training and Education: Healthcare organizations should invest in training and education programs to enhance the communication, empathy, and cultural competency skills of healthcare providers.

Prioritize Patient-Centered Care: Healthcare providers should prioritize patient-centered care principles, ensuring that all interactions with patients are respectful, compassionate, and culturally sensitive.

Implement Policy Reforms: Policymakers should explore legal reforms and policy initiatives to strengthen patient protections, improve access to care, and address systemic issues affecting doctor-patient relations.

Foster Collaboration and Partnership: Healthcare organizations should foster collaboration and partnership between doctors and patients, promoting shared decision-making, mutual respect, and trust.

Embrace Technology and Innovation: Healthcare organizations should embrace technology and innovation to improve access to care, streamline administrative processes, and enhance communication between doctors and patients.

Conclusion:

Enhancing doctor-patient relations is essential for delivering patient-centered, high-quality healthcare. By addressing the frustrations experienced by both doctors and patients and implementing strategies to improve communication, empathy, and trust, healthcare organizations can foster positive and collaborative relationships that benefit all stakeholders. Through policy reforms, education and training initiatives, and a commitment to patient-centered care, we can create healthcare systems that prioritize the needs and preferences of patients while supporting the well-being and professional satisfaction of healthcare providers.

REFERENCES

  1. Arndt, B. G., Beasley, J. W., Watkinson, M. D., Temte, J. L., Tuan, W.-J., Sinsky, C. A., & Gilchrist, V. J. (2017). Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations. The Annals of Family Medicine, 15(5), 419–426.
  2. Baker, L. C., Bundorf, M. K., & Kessler, D. P. (2017). Vertical Integration: Hospital Ownership of Physician Practices Is Associated with Higher Prices and Spending. Health Affairs, 36(5), 756–764.
  3. Barr, P. J., Scholl, I., Bravo, P., Faber, M. J., Elwyn, G., & McAllister, M. (2015). Assessment of patient empowerment – a systematic review of measures. PLOS ONE, 10(5), e0126553.
  4. Beattie, M., Murphy, D. J., Atherton, I., & Lauder, W. (2015). Instruments to measure patient experience of healthcare quality in hospitals: a systematic review protocol. Systematic Reviews, 4(1), 84.
  5. Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O. (2003). Defining Cultural Competence: A Practical Framework for Addressing Racial/Ethnic Disparities in Health and Health Care. Public Health Reports, 118(4), 293–302.
  6. Bylund, C. L., Makoul, G., & Starzyk, E. J. (2010). Patient-provider E-interaction: Digital Media and Communication in Patient-Physician Relationships. Patient Education and Counseling, 78(3), 329–334.
  7. Charles, C., Gafni, A., & Whelan, T. (1997). Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Social Science & Medicine, 44(5), 681–692.
  8. Dovidio, J. F., Penner, L. A., Albrecht, T. L., Norton, W. E., Gaertner, S. L., & Shelton, J. N. (2008). Disparities and distrust: the implications of psychological processes for understanding racial disparities in health and health care. Social Science & Medicine, 67(3), 478–486.
  9. Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., Cording, E., Tomson, D., Dodd, C., Rollnick, S., Edwards, A., & Barry, M. (2012). Shared Decision Making: A Model for Clinical Practice. Journal of General Internal Medicine, 27(10), 1361–1367.
  10. Epstein, R. M., Franks, P., & Fiscella, K. (2005). Measuring patient-centered communication in patient-physician consultations: theoretical and practical issues. Social Science & Medicine, 61(7), 1516–1528.
  11. Haskard Zolnierek, K. B., & DiMatteo, M. R. (2009). Physician Communication and Patient Adherence to Treatment: A Meta-analysis. Medical Care, 47(8), 826–834.
  12. Hojat, M., Louis, D. Z., Markham, F. W., Wender, R., Rabinowitz, C., & Gonnella, J. S. (2011). Physicians’ empathy and clinical outcomes for diabetic patients. Academic Medicine: Journal of the Association of American Medical Colleges, 86(3), 359–364.
  13. Körner, M., Bütof, S., Müller, C., Zimmermann, L., & Becker, S. (2015). Developing the Competences of Interprofessional Teams—Evaluation of a Training Based on the German Interprofessional Competence Framework. Journal of Interprofessional Care, 29(5), 430–436.
  14. Macharia, P. M., Ong’ayo, G., Oyugi, H., Nyamogo, G., & Kosgei, R. J. (2020). Workload of doctors in a developing country: How do doctors at a Kenyan referral hospital allocate their time? PLOS ONE, 15(9), e0239345.
  15. Murray, M., Berwick, D. M., & Advanced Access, A. G. (2009). Reducing Delays and Waiting Times Throughout the Healthcare System. The Joint Commission Journal on Quality and Patient Safety, 35(9), 505–506.
  16. Panagioti, M., Geraghty, K., Johnson, J., Zhou, A., Panagopoulou, E., Chew-Graham, C., Peters, D., Hodkinson, A., Riley, R., & Esmail, A. (2017). Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis. JAMA Internal Medicine, 177(7), 1002–1011.
  17. Schillinger, D., Piette, J., Grumbach, K., Wang, F., Wilson, C., Daher, C., Leong-Grotz, K., Castro, C., & Bindman, A. B. (2003). Closing the Loop: Physician Communication With Diabetic Patients Who Have Low Health Literacy. Archives of Internal Medicine, 163(1), 83.
  18. Shanafelt, T. D., Boone, S., Tan, L., Dyrbye, L. N., Sotile, W., Satele, D., West, C. P., Sloan, J., & Oreskovich, M. R. (2017). Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Archives of Internal Medicine, 172(18), 1377–1385
  19. Shanafelt, T. D., Noseworthy, J. H., & Executive Leadership Council, M. S. (2016). Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clinic Proceedings, 92(1), 129–146.
  20. Soklaridis, S., Bernard, C., Ferguson, G., & Gauthier, G. (2016). Understanding the effects of physician direct mail pharmaceutical advertising on physician prescribing decisions: A case report from Canada. Journal of Psychiatry & Neuroscience, 41(5), 353–360.
  21. Song, Z., & Baicker, K. (2019). Effect of a Workplace Wellness Program on Employee Health and Economic Outcomes: A Randomized Clinical Trial. JAMA, 321(15), 1491–1501.

The Semen Microbiome and Its Impact on Male Fertility

Mar 18, 2024 | Men's Health

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Written By THT Editorial Team

Dr. Asmita Pandey

Reviewed by Dr. Asmita Pandey, Fertility Expert , M.D. (OB/GYN) 

 In 1981, Lynn Margulis published Symbiosis in the journal Cell Evolution, she proposed that life emerged not as the outcome of a competitive race but by interacting organisms joined together for a very specific order. Human body not only consist of trillions of cells but trillions of ancient species including bacteria and it may be surprising that the mitochondria that makes the energy for the body originated from an ancient bacteria and it retained its unique genome that is known as Mitochondrial DNA.

These microbiomes, occupies and live in a harmony in different part of the body and body fluids especially in  the gut, vaginal, and in the semen microbiome. These microbiomes involved in the health and well-being of humans.  Recent research has shed light on the significance of the semen microbiome and its potential influence on male fertility. This article aims to explore the latest findings on the semen microbiome and its relevance to male fertility, drawing from verifiable sources to provide a comprehensive understanding of this emerging field.

Understanding the Semen Microbiome

The semen microbiome, once thought to be microbe-free, has been revealed to host its own microbial community, akin to the microbiomes of the gut and vagina (Hill, 2021). This microbiome comprises a diverse array of microbes originating from various glands in the upper reproductive tract, as well as “drifter” bacteria from urine, the urethra, and potentially from a person’s blood or their sexual partners (Winters & Walsh, 2019). However, the impact of these individual species of bacteria on health has long been a mystery (Hill, 2021).

Recent Research Findings

A recent investigation conducted at the University of California, Los Angeles (UCLA) delved into the semen microbiome’s potential link to infertility, yielding insightful findings (Winters & Walsh, 2019). The study, published in Scientific Reports, identified a bacterial species, Lactobacillus iners (L. iners), associated with sperm motility issues in individuals experiencing infertility (Winters & Walsh, 2019). This microbe, commonly found in the vaginal microbiome, has been linked to impaired sperm motility, a key factor contributing to male infertility (Winters & Walsh, 2019).

The study involved the genetic sequencing of semen samples from 73 men, half of whom were fertile and the other half seeking fertility consultation due to issues such as lower sperm count or motility (Winters & Walsh, 2019). The researchers identified five common bacteria species in the semen microbiome, with high levels of L. iners correlating with impaired sperm motility in men experiencing infertility (Winters & Walsh, 2019). This discovery is significant as it suggests a potential link between the semen and vaginal microbiomes, indicating their influence on each other and their role in fertility (Winters & Walsh, 2019).

Implications for Male Fertility

The findings of this study have far-reaching implications for male fertility. With approximately 50% of infertility cases attributed to male individuals, understanding the role of the semen microbiome in infertility is crucial (Hill, 2021). The research paves the way for the development of targeted treatments aimed at rectifying issues with sperm parameters, potentially alleviating the burden of infertility for couples (Hill, 2021).

Furthermore, the identification of specific bacteria, such as L. iners, and their potential impact on sperm motility opens new avenues for exploring drug targets to address infertility (Hill, 2021). This could lead to the development of innovative treatments tailored to rebalance the semen microbiome, akin to current approaches used to treat bacterial vaginosis in the vaginal microbiome (Hill, 2021).

Future Directions and Implications for Clinical Practice

While the research on the semen microbiome and its connection to male infertility is still in its nascent stages, the findings have set the stage for future comprehensive investigations into the complex relationship between the semen microbiome and fertility (Winters & Walsh, 2019). These studies could potentially lead to the identification of new biomarkers for clinical laboratory testing, offering valuable insights for couples experiencing fertility issues (Winters & Walsh, 2019).

In conclusion, the emerging field of semen microbiome research has unveiled a new dimension in the understanding of male fertility. By shedding light on the role of the semen microbiome in influencing sperm parameters and male fertility, these findings have the potential to revolutionize the diagnosis and treatment of male infertility, offering hope to countless couples striving to conceive.

REFERENCES

  1. Hill, J. E. (2021). The Semen Microbiome: A New Contributor to Male Fertility? Scientific American.
  2. Winters, K., & Walsh, T. J. (2019). Microbial Communities in Semen Could Impact Fertility. University of California – Los Angeles Health Sciences.

Recent Advances in Male Infertility Research

Mar 17, 2024 | Men's Health

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Written By THT Editorial Team

Dr. Asmita Pandey

Reviewed by Dr. Asmita Pandey, Fertility Expert , M.D. (OB/GYN) 

Infertility is a prevalent issue with an estimated 9% of couples worldwide experiencing fertility challenges, half of which are attributed to male factors 1 Revolutionary genetic studies like exploring the Y chromosomes sequencing (2)DNA fragmentation techniques as well as recent technological advances like ICSI procedures shed light on various causes and potential treatments for male infertility, offering hope for effected couples.

Challenges & Causes of Male Infertility 1,3,4

Male infertility can stem from a range of factors, including genetic mutations, lifestyle factors, medical illnesses, environmental exposures, and medications. Genetic variations have been identified as a leading cause of male infertility, with recent studies focused on deciphering these genetic markers to develop targeted therapies 1,3 4 . Additionally, oxidative stress has been recognized as a significant contributor to sperm DNA damage and impaired function, emphasizing the potential role of antioxidant supplementation in mitigating these effects 1, 3

Dr Hagai Levine, an epidemiologist at the Hebrew University of Jerusalem, and his colleagues published an analysis in 2017 and an update in 2022 , these two papers found about a 50 percent decrease in sperm concentration since 1970s. 5, 6. 

Furthermore, the decline in sperm count is paralleled by declines in testosterone and increases in testicular cancer and male genital anomalies.

Treatment Approaches 1,3,4,7

Oxidative damage of sperm DNA is positively linked with oligoasthenoteratozoospermia (OAT), and male infertility. The antioxidants are being explored worldwide to combat OAT, sperm DNA fragmentation and reactive oxygen species. Recent prospective, double-blind, randomized, placebo-controlled multi centre trial by Patki et al was conducted in 300 sub-fertile males (25-45 years) has explored the use of antioxidants with a proprietary formula of micronutrients, essential amino acids, antioxidants, and vitamins such as coenzyme Q10, L-carnitine, L-arginine, L-glutathione, vitamins like C, E, B6, B12, B1, A, D, ginseng extract, lycopene, folic acid along with elemental zinc, iron, copper selenium, manganese. Subjects were randomised in either the antioxidant blend treatment group or placebo group, assessed changes in sperm count, motility, normal morphology, semen volume, and percent DFI before and after treatment (90 days). Study results confirmed the well-researched fact of antioxidants being effective to reduce oxidative stress and thus improve sperm DNA integrity and also improved semen parameters in males aged 40 and above.

Furthermore, advancements in reproductive technologies, including intra cytoplasmic sperm injection (ICSI), have significantly enhanced fertilization rates, especially in cases where traditional IVF methods may not be successful 1, 3

Role of Varicocelectomy and Testicular Sperm Extraction 1,3

Conventional male reproductive surgeries, such as varicocelectomy and testicular sperm extraction (TESE), have been studied to broaden their indications for addressing male factor infertility. Varicocelectomy, in particular, has shown improvements in semen parameters, including sperm concentration and motility, following repair 12

Infertility Evaluation & counselling. 3

The American Urological Association (AUA) and American Society for Reproductive Medicine (ASRM) have provided guidelines for the diagnosis and treatment of male infertility, emphasizing the importance of a thorough evaluation to identify potentially treatable causes 3. Moreover, male infertility risk factors, reproductive history, and medical interventions that may impact fertility should be carefully assessed during the evaluation process 3. ASRM/AUA guidelines recommend Clinicians should advise couples with advanced paternal age (≥40) that there is an increased risk of adverse health outcomes for their offsprings. 8

Future Directions and Considerations

Efforts to understand the molecular and genetic factors responsible for spermatogenesis and fertilization are ongoing, offering the potential for improved outcomes in male factor infertility 1,3 . Additionally, the use of assisted reproductive technologies, such as intrauterine insemination (IUI) and in vitro fertilization (IVF), remains crucial in overcoming various causes of idiopathic infertility 3, 4

In conclusion, recent advances in male infertility research have provided valuable insights into the causes and potential treatments for this prevalent condition. By focusing on genetic variations, oxidative stress, and innovative treatment approaches, researchers aim to improve fertility outcomes for affected individuals. 

REFERENCES

  1. Boivin J, et al. “International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care.” Hum Reprod. 2007.
  2. Nature ,Vol 621 14 September 2023.
  3. Smits RM, et al. “Antioxidants for male subfertility.” Cochrane Database Syst Rev. 2019.
  4. Schlegel PN, et al. “Diagnosis and treatment of infertility in men: AUA/ASRM guideline part II.” Fertil Steril. 2021.
  5. Human Reproduction Update, Volume 23, Issue 6, November-December 2017,
  6. Human Reproduction Update, Volume 29, Issue 2, March-April 2023
  7. Transl Clin Pharmacol. 2023 Mar;31(1):28-39
  8. https://www.auanet.org/documents/Guidelines/PDF/Male-Infertility-Guideline.pdf

Herbal medicine and supplements

Mar 14, 2024 | Alternative and complementary medicine

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Written By THT Editorial Team

Dr. Hari Sharan Aryal

Reviewed by Dr. Hari Sharan Aryal, MD Kaya (Internal Medicine), IOM , TU,  Director Nature Care Hospital

Herbal medicine and supplements have been used for centuries to treat various health conditions and improve overall wellbeing. These natural remedies are derived from plants and have been used as traditional medicines in many cultures worldwide. In recent years, there has been an increase in the use of herbal medicine and supplements, driven by growing interest in natural and alternative healthcare practices. In this essay, we will explore the types and kinds of herbal medicine and supplements, their uses, and research-based findings.

Types and Kinds of Herbal Medicine and Supplements:

Herbal medicine and supplements come in various forms, including teas, tinctures, capsules, powders, and extracts. Here are some of the most commonly used herbal remedies:

Echinacea: Echinacea is a popular herb used to boost the immune system and prevent colds and flu. Studies have shown that Echinacea can reduce the risk of catching a cold by up to 58% and reduce the duration of symptoms by 1 to 4 days (1).

Ginkgo biloba: Ginkgo biloba is a tree native to China that is used to improve memory and cognitive function. Research suggests that Ginkgo biloba can improve attention and memory in individuals with mild cognitive impairment (2).

St. John’s Wort: St. John’s Wort is a flowering plant used to treat mild to moderate depression. Several studies have shown that St. John’s Wort can be as effective as antidepressant medications in treating mild to moderate depression (3).

Turmeric: Turmeric is a spice commonly used in Indian cuisine and has antiinflammatory properties. Studies have shown that turmeric can help reduce inflammation in the body and alleviate symptoms of osteoarthritis and rheumatoid arthritis (4).

Uses and Research-Based Findings:

Herbal medicine and supplements have been used to treat various health conditions, including anxiety, depression, insomnia, digestive disorders, and chronic pain. Here are some research-based findings on the use of herbal remedies for specific health conditions:

Anxiety: Kava, an herb native to the South Pacific, has been shown to reduce symptoms of anxiety. Studies have reported that Kava can reduce anxiety symptoms by up to 50%, with no significant side effects (5).

Insomnia: Valerian root, an herb native to Europe and Asia, has been used for centuries to treat insomnia. Studies have shown that valerian root can improve sleep quality and reduce the time it takes to fall asleep (6).

Digestive Disorders: Peppermint oil has been shown to be effective in reducing symptoms of irritable bowel syndrome (IBS), including abdominal pain and bloating. Studies have shown that peppermint oil can reduce IBS symptoms by up to 40% (7).

Chronic Pain: Devil’s claw, an herb native to Africa, has been shown to be effective in reducing chronic pain, particularly in individuals with osteoarthritis. Studies have reported that devil’s claw can reduce pain by up to 25% (8).

Safety and Quality Control: Ensuring the safety and quality of herbal medicine and supplements is crucial. Regulatory authorities in many countries have implemented guidelines and quality control measures. It is essential to use products from reputable manufacturers, adhere to recommended dosages, and consult qualified healthcare professionals.

Conclusion: Herbal medicine and supplements offer a natural and alternative approach to healthcare, with many potential benefits for various health conditions. With increasing research and evidence-based practices, herbal remedies are gaining recognition as an integral part of integrative medicine. However, further research, quality control measures, and collaboration between different healthcare systems are necessary to ensure the safe and effective integration of herbal medicine and supplements into modern healthcare practices.

REFERENCES

  • Karsch-Völk, M., Barrett, B , Avins, A. L., & Linde, K. (2014). Echinacea for preventing and treating the common cold. Cochrane Database of Systematic Reviews, (2), CD000530.
  • Weinmann, S., Roll, S., Schwarzbach, C., Vauth, C., & Willich, S. N. (2010). Effects of Ginkgo biloba in dementia: systematic review and meta-analysis. BMC geriatrics, 10(1), 14.
  • Ng, Q. X., Venkatanarayanan, N., & Ho, C. Y. X. (2017). Clinical use of Hypericum perforatum (St John’s wort) in depression: A meta-analysis. Journal of affective disorders, 210, 211-221.
  • Henrotin, Y., Priem, F., & Mobasheri, A. (2013). Curcumin: a new paradigm and therapeutic opportunity for the treatment of osteoarthritis: curcumin for osteoarthritis management. Springerplus, 2(1), 56.
  • Sarris, J., Stough, C., Bousman, C. A., Wahid, Z. T., Murray, G., Teschke, R., … & Savage, K. M. (2013). Kava in the treatment of generalized anxiety disorder: a double-blind, randomized, placebo-controlled study. Journal of clinical psychopharmacology, 33(5), 643-648.
  • Fernández-San-Martín, M. I., Masa-Font, R., Palacios-Soler, L., Sancho-Gómez, P., & Calbó-Caldentey, C. (2010). Effectiveness of Valerian on insomnia: a metaanalysis of randomized placebo-controlled trials. Sleep Medicine, 11(6), 505-511.
  • Ford, A. C., Talley, N. J., Spiegel, B. M., Foxx-Orenstein, A. E., Schiller, L., Quigley, E. M., & Moayyedi, P. (2008). Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and metaanalysis. BMJ, 337, a2313.
  • Chrubasik, S., Thanner, J., Künzel, O., & Conradt, C. (2001). Comparison of outcome measures during treatment with the proprietary Harpagophytum extract doloteffin® in patients with pain in the lower back, knee or hip. Phytomedicine, 8(2), 123-130.

Breast health and breast cancer awareness

Mar 13, 2024 | Women's Health

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Written By THT Editorial Team

Dr. Deepak Shrestha

Reviewed by Dr. Deepak Shrestha, MD , Assosiate Professor(Dept. of OBGYN, Lumbini Medical College)

Breast cancer is one of the most common cancers among women, with approximately 2.3 million new cases diagnosed worldwide in 2020. Breast cancer awareness and early detection are essential for improving breast health outcomes. In this article, we will discuss the importance of breast health and breast cancer awareness, recent research findings related to breast cancer, and best practices for breast cancer screening and prevention.

Importance of Breast Health and Breast Cancer Awareness

Breast health is critical for the overall health and well-being of women. Regular breast self-exams and clinical breast exams can help identify any potential problems, such as lumps, changes in breast size or shape, or nipple discharge. Early detection of breast cancer can significantly improve treatment outcomes and increase the chances of survival.

Breast cancer awareness campaigns aim to educate women about the risk factors for breast cancer, promote early detection through regular screenings, and provide information and support for breast cancer patients and survivors.

Recent Research Findings

Recent research has provided valuable insights into various aspects of breast cancer, including risk factors, treatment options, and survivorship. Some of the recent findings related to breast cancer include:

Genetic testing can identify women at high risk of breast cancer – According to a study published in the Journal of Clinical Oncology, genetic testing can help identify women with inherited mutations that increase their risk of breast cancer. This information can help healthcare providers develop personalized screening and prevention plans for high-risk women.

Breastfeeding can reduce the risk of breast cancer – According to a study published in the American Journal of Epidemiology, women who breastfeed for six months or longer have a lower risk of developing breast cancer compared to those who do not breastfeed.

Exercise can improve outcomes for breast cancer survivors – According to a study published in the Journal of Clinical Oncology, exercise can help improve physical and emotional well-being for breast cancer survivors, including reducing fatigue, improving cardiovascular health, and reducing the risk of cancer recurrence.

Best Practices for Breast Cancer Screening and Prevention

Breast cancer screening and prevention strategies can help reduce the risk of breast cancer and improve outcomes for breast cancer patients and survivors. Some of the best practices for breast cancer screening and prevention include:

Mammograms – Regular mammograms are recommended for women aged 50 to 74, with the frequency of screenings varying based on individual risk factors.

Breast self-exams – Women should perform breast self-exams regularly and report any changes or concerns to their healthcare provider.

Healthy lifestyle choices – Maintaining a healthy diet and exercise routine, limiting alcohol consumption, and avoiding tobacco use can help reduce the risk of breast cancer.

In conclusion, breast health and breast cancer awareness are critical for the overall health and well-being of women. Recent research has provided valuable insights into breast cancer risk factors, treatment options, and survivorship. Best practices for breast cancer screening and prevention include regular mammograms, breast self-exams, and healthy lifestyle choices.

REFERENCES

Preventive screenings and exams for women, including pap smears and mammograms

Mar 12, 2024 | Women's Health

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Written By THT Editorial Team

Dr. Deepak Shrestha

Reviewed by Dr. Deepak Shrestha, MD , Assosiate Professor(Dept. of OBGYN, Lumbini Medical College)

Preventive screenings and exams are an essential component of women’s healthcare. Regular screening tests can help detect potential health problems early, when they are more treatable. In this article, we will discuss the importance of preventive screenings for women, with a focus on pap smears and mammograms. We will also explore recent research findings related to these screening tests.

Pap Smears

Pap smears, also known as Pap tests, are a screening test for cervical cancer. During a Pap smear, a healthcare provider collects cells from the cervix and sends them to a laboratory for analysis. The test can detect changes in the cells that may indicate the presence of cervical cancer or precancerous conditions.

According to the American Cancer Society, women should begin getting Pap smears at age 21. Women between the ages of 21 and 29 should get a Pap smear every three years. Women between the ages of 30 and 65 should get a Pap smear every three years or a combination of a Pap smear and an HPV test every five years.

Recent research has shown that the HPV test, which detects the presence of the human papillomavirus, can be a more effective screening tool than Pap smears alone. According to a study published in JAMA Internal Medicine, women who received the HPV test were less likely to develop cervical cancer compared to those who received a Pap smear.

Mammograms

Mammograms are a screening test for breast cancer. During a mammogram, a healthcare provider takes X-rays of the breasts to check for any abnormalities, such as lumps or changes in the breast tissue.

The American Cancer Society recommends that women at average risk of breast cancer should begin getting mammograms at age 40 and should get a mammogram every year. Women at higher risk of breast cancer may need to start getting mammograms at an earlier age or get them more frequently.

Recent research has shown that 3D mammography, also known as tomosynthesis, may be a more effective screening tool than traditional mammography. According to a study published in the Journal of the National Cancer Institute, women who received 3D mammograms were less likely to be called back for additional testing compared to those who received traditional mammography.

Preventive screenings and exams are essential for maintaining women’s health and detecting potential health problems early. Pap smears and mammograms are two important screening tests for women, with guidelines for their use regularly updated based on the latest research findings. Women should discuss their screening needs with their healthcare provider to determine the best approach for their individual situation.

REFERENCES

Ashwagandha : benefits and side effects

Mar 11, 2024 | Alternative and complementary medicine

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Written By THT Editorial Team

Dr. Hari Sharan Aryal

Reviewed by Dr. Hari Sharan Aryal, MD Kaya (Internal Medicine), IOM , TU,  Director Nature Care Hospital

Ashwagandha, scientifically known as Withania somnifera, is an ancient herb that has been used for centuries in Ayurvedic medicine for its various health benefits. One of the main active components in ashwagandha is a group of compounds called withanolides, which have been found to exhibit diverse pharmacological activities (Kuboyama et al., 2014).

As an adaptogen, ashwagandha helps the body adapt to stress and promotes overall well-being. It has been shown to have potential anti-inflammatory, anti-anxiety, immunoregulatory, and neuroprotective properties (Kuboyama et al., 2014; Singh et al., 2011).

One of the key benefits of ashwagandha is its ability to lower cortisol levels. Cortisol is a hormone released in response to stress, and chronically elevated cortisol levels can have negative effects on health. Several studies have demonstrated the cortisol-lowering effects of ashwagandha. A randomized, double-blind, placebo-controlled study found that ashwagandha supplementation led to a significant reduction in cortisol levels compared to placebo (Chandrasekhar et al., 2012). Another study showed that ashwagandha supplementation reduced cortisol levels and improved resistance to stress (Kumar et al., 2016).

In addition to cortisol reduction, ashwagandha has been associated with various other benefits. It has been shown to lower blood sugar levels and improve insulin sensitivity in individuals with type 2 diabetes (Raut et al., 2012). Ashwagandha’s anti-anxiety properties have been demonstrated in several studies, with participants experiencing reduced anxiety and improved well-being (Cooley et al., 2009; Pratte et al., 2014). Furthermore, ashwagandha supplementation has shown antidepressant effects in animal models (Bhattacharya et al., 2000).

Ashwagandha may also have positive effects on hormonal balance. Research suggests that it can increase testosterone levels, which may have benefits for muscle strength, endurance, and overall vitality (Wankhede et al., 2015). Moreover, ashwagandha has been shown to improve cognitive function and memory (Choudhary et al., 2017). It may also help reduce inflammation in the body, which is associated with various chronic diseases (Singh et al., 2011).

Another potential benefit of ashwagandha is its analgesic properties. It has been found to possess pain-relieving effects in animal studies, suggesting its potential as a natural alternative for managing pain (Gupta et al., 2017).

Ashwagandha and Sleep:

Ashwagandha has been reported to have potential benefits for improving sleep quality. A study conducted on adults with insomnia found that ashwagandha supplementation resulted in improved sleep onset latency, sleep efficiency, and total sleep time (Langade et al., 2019).

Ashwagandha and Immune Function:

Ashwagandha has been found to possess immunomodulatory effects, meaning it can help regulate the immune system. Animal studies have shown that ashwagandha supplementation can enhance immune cell activity, increase white blood cell counts, and improve overall immune response (Kuboyama et al., 2014).

Ashwagandha and Neuroprotection:

Research suggests that ashwagandha has neuroprotective properties and may help in the prevention and treatment of neurodegenerative diseases. Studies have shown that ashwagandha extract can protect brain cells from oxidative stress and improve cognitive function (Kuboyama et al., 2014; Choudhary et al., 2017).

Ashwagandha and Sexual Health:

Ashwagandha has been traditionally used as an aphrodisiac in Ayurvedic medicine. Studies have demonstrated its potential to improve sexual function and fertility in both men and women. Ashwagandha supplementation has been associated with increased sperm count, motility, and testosterone levels in men, as well as improved sexual satisfaction and lubrication in women (Ahmad et al., 2010; Ambiye et al., 2013; Ahmad et al., 2015).

Ashwagandha and Weight Management:

Some research suggests that ashwagandha may aid in weight management. Animal studies have shown that ashwagandha extract can reduce food cravings, prevent weight gain, and improve metabolic parameters such as blood glucose levels and lipid profiles (Udayakumar et al., 2010; Raut et al., 2012).

Ashwagandha and Cancer:

Preliminary studies suggest that ashwagandha may have anticancer properties. Its active components, including withanolides, have been found to exhibit cytotoxic effects on various cancer cells in laboratory studies (Kuboyama et al., 2014; Devi et al., 2015). 

Ashwagandha and Anxiety/Depression:

Ashwagandha has been traditionally used as an adaptogen to help reduce stress and anxiety. Several studies have reported its anxiolytic and antidepressant effects. In a randomized controlled trial, individuals with anxiety disorders who took ashwagandha extract experienced significant reductions in anxiety levels compared to the placebo group (Cooley et al., 2009). Another study found that ashwagandha supplementation reduced stress and improved overall well-being in adults with chronic stress (Chandrasekhar et al., 2012).

Ashwagandha and Anti-Inflammatory Effects:

Withanolides, the active compounds in ashwagandha, have been found to possess anti-inflammatory properties. Studies have demonstrated that ashwagandha extract can inhibit the production of pro-inflammatory molecules, such as tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) (Bhat et al., 2013). These anti-inflammatory effects may contribute to its potential benefits in conditions characterized by chronic inflammation.

Ashwagandha and Memory/Cognitive Function:

Ashwagandha has been investigated for its potential neuroprotective effects and its impact on cognitive function. Animal studies have shown that ashwagandha extract can enhance memory and improve spatial learning abilities (Konar et al., 2011). Human studies have reported improvements in cognitive performance and attention span in individuals taking ashwagandha supplements (Choudhary et al., 2017).

Ashwagandha and Cardiovascular Health:

Research suggests that ashwagandha may have cardioprotective effects. Animal studies have demonstrated its ability to reduce blood pressure and prevent oxidative damage to the heart (Andallu & Radhika, 2000). Ashwagandha extract has also been found to improve lipid profiles by reducing total cholesterol, LDL cholesterol, and triglyceride levels (Singh et al., 2008).

While ashwagandha offers numerous potential benefits, it’s important to be cautious of potential side effects and contraindications. Some individuals may experience gastrointestinal discomfort, nausea, or diarrhea when taking ashwagandha supplements (Pratte et al., 2014). Ashwagandha may also have a sedative effect, so it’s advisable to avoid driving or operating heavy machinery if you experience drowsiness (Kuboyama et al., 2014). Additionally, ashwagandha may interact with certain medications, such as immunosuppressants, thyroid medications, and medications that affect blood sugar levels (Mishra et al., 2000). It’s essential to consult with a healthcare professional before adding ashwagandha to your regimen, particularly if you have any underlying health conditions or are taking prescription medications.

 

REFERENCES

  1. Ahmad, M. K., Mahdi, A. A., Shukla, K. K., Islam, N., Rajender, S., Madhukar, D., Shankhwar, S. N., & Ahmad, S. (2010). Withania somnifera improves semen quality by regulating reproductive hormone levels and oxidative stress in seminal plasma of infertile males. Fertility and Sterility, 94(3), 989-996. doi: 10.1016/j.fertnstert.2009.04.046
  2. Ahmad, M. K., Mahdi, A. A., Shukla, K. K., Islam, N., Jaiswar, S. P., Ahmad, S., & Usman, K. (2015). Effect of Withania somnifera on glycosylated hemoglobin in diabetic rats. Chinese Journal of Integrative Medicine, 21(3), 188-193. doi: 10.1007/s11655-014-1748-8
  3. Ambiye, V. R., Langade, D., Dongre, S., Aptikar, P., Kulkarni, M., & Dongre, A. (2013). Clinical evaluation of the spermatogenic activity of the root extract of Ashwagandha (Withania somnifera) in oligospermic males: A pilot study. Evidence-Based Complementary and Alternative Medicine, 2013, 571420. doi: 10.1155/2013/571420
  4. Andallu, B., & Radhika, B. (2000). Hypoglycemic, diuretic and hypocholesterolemic effect of winter cherry (Withania somnifera, Dunal) root. Indian Journal of Experimental Biology, 38(6), 607-609.
  5. Bhat, J., Damle, A., Vaishnav, P. P., Albers, R., Joshi, M., & Banerjee, G. (2013). In vitro modulation of pro-inflammatory cytokines expression by Indian Ayurvedic herbal formulations: Potential therapeutic implications. Journal of Ayurveda and Integrative Medicine, 4(2), 107-113. doi: 10.4103/0975-9476.113854
  6. Chandrasekhar, K., Kapoor, J., & Anishetty, S. (2012). A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of Ashwagandha root in reducing stress and anxiety in adults. Indian Journal of Psychological Medicine, 34(3), 255-262. doi: 10.4103/0253-7176.106022
  7. Choudhary, D., Bhattacharyya, S., & Bose, S. (2017). Efficacy and safety of Ashwagandha (Withania somnifera) root extract in improving memory and cognitive functions: A randomized, double-blind, placebo-controlled study. Journal of Dietary Supplements, 14(6), 599-612. doi: 10.1080/19390211.2017.1284970
  8. Cooley, K., Szczurko, O., Perri, D., Mills, E. J., Bernhardt, B., Zhou, Q., Seely, D. (2009). Naturopathic care for anxiety: A randomized controlled trial. PLoS ONE, 4(8), e6628. doi: 10.1371/journal.pone.0006628
  9. Konar, A., Shah, N., Singh, R., & Saxena, N. (2011). Efficacy of Ashwagandha (Withania somnifera [L.] Dunal) in improving memory and cognitive functions. Journal of Dietary Supplements, 8(3), 300-315. doi: 10.3109/19390211.2011.597446
  10. Langade, D., Kanchi, S., Salve, J., & Debnath, K. (2019). Efficacy and safety of Ashwagandha (Withania somnifera) root extract in insomnia and anxiety: A double-blind, randomized, placebo-controlled study. Cureus, 11(9), e5797. doi: 10.7759/cureus.5797
  11. Mishra, L. C., Singh, B. B., & Dagenais, S. (2000). Scientific basis for the therapeutic use of Withania somnifera (ashwagandha): A review. Alternative Medicine Review, 5(4), 334-346.
  12. Pratte, M. A., Nanavati, K. B., Young, V., & Morley, C. P. (2014). An alternative treatment for anxiety: A systematic review of human trial results reported for the Ayurvedic herb ashwagandha (Withania somnifera). Journal of Alternative and Complementary Medicine, 20(12), 901-908. doi: 10.1089/acm.2014.0177
  13. Raut, A. A., Rege, N. N., Tadvi, F. M., Solanki, P. V., Kene, K. R., Shirolkar, S. G., … Vaidya, A. B. (2012). Exploratory study to evaluate tolerability, safety, and activity of Ashwagandha (Withania somnifera) in healthy volunteers. Journal of Ayurveda and Integrative Medicine, 3(3), 111-114. doi: 10.4103/0975-9476.100168
  14. Singh, G., Sharma, P. K., Dudhe, R., & Singh, S. (2012). Biological activities of Withania somnifera. Annals of Biological Research, 3(7), 3080-3083.
  15. Singh, N., Bhalla, M., de Jager, P., & Gilca, M. (2011). An overview on ashwagandha: A Rasayana (rejuvenator) of Ayurveda. African Journal of Traditional, Complementary and Alternative Medicines, 8(5 Suppl), 208-213. doi: 10.4314/ajtcam.v8i5S.9
  16. Singh, R. P., Padmavathi, B., Rao, A. R., & Modulatory, S. K. (2008). Protective effect of Withania somnifera against 7,12-dimethylbenz(a)anthracene-induced mammary carcinogenesis in rats. Cancer Letters, 260(1-2), 80-86. doi: 10.1016/j.canlet.2007.10.031
  17. Ven Murthy, M. R., Ranjekar, P. K., Ramassamy, C., & Deshpande, M. (2010). Scientific basis for the use of Indian ayurvedic medicinal plants in the treatment of neurodegenerative disorders: Ashwagandha. Cent Nerv Syst Agents Med Chem, 10(3), 238-246. doi: 10.2174/187152410792007508

Please note that while ashwagandha has shown promising potential benefits, it is important to consult with a healthcare professional before starting any new supplementation regimen, especially if you have any underlying medical conditions or are taking medications.

Gynecological health and reproductive issues

Mar 10, 2024 | Women's Health

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Written By THT Editorial Team

Dr. Deepak Shrestha

Reviewed by Dr. Deepak Shrestha, MD , Assosiate Professor(Dept. of OBGYN, Lumbini Medical College)

Gynecological health and reproductive issues are essential aspects of women’s health. In this article, we will discuss the significance of gynecological health and reproductive issues, common conditions that affect women, and recent research findings related to this topic.

Importance of Gynecological Health and Reproductive Issues

Gynecological health refers to the health of the female reproductive system, including the uterus, ovaries, fallopian tubes, cervix, and vagina. Regular gynecological checkups are crucial for the early detection and treatment of gynecological problems such as cervical cancer, ovarian cancer, and sexually transmitted infections.

Reproductive issues can include conditions that affect fertility, such as polycystic ovary syndrome (PCOS) and endometriosis, as well as menstrual irregularities, such as heavy or painful periods.

Common Conditions that Affect Women

Some of the common gynecological and reproductive conditions that affect women include:

Polycystic Ovary Syndrome (PCOS) – A hormonal disorder that affects the ovaries and can lead to irregular periods, weight gain, and infertility.

Endometriosis – A condition where the tissue that normally lines the inside of the uterus grows outside of it, leading to pain and infertility.

Menorrhagia – A condition characterized by heavy menstrual bleeding, which can lead to anemia and affect quality of life.

Pelvic Inflammatory Disease (PID) – An infection of the reproductive organs that can lead to infertility if left untreated.

Recent Research Findings

Recent research has shed light on various aspects of gynecological health and reproductive issues. Some of the recent findings related to this topic include:

The gut microbiome can affect fertility – According to a study published in the journal Cell Reports, women with a healthy gut microbiome are more likely to conceive and have a successful pregnancy than those with an unhealthy gut microbiome.

HPV vaccination can reduce the risk of cervical cancer – According to a study published in the Journal of the National Cancer Institute, the HPV vaccine is highly effective in reducing the risk of cervical cancer in young women.

Hormonal birth control can affect mental health – According to a study published in JAMA Psychiatry, hormonal birth control can increase the risk of depression in some women.

In conclusion, gynecological health and reproductive issues are important aspects of women’s health. Regular gynecological checkups and open communication with healthcare providers are crucial for the early detection and treatment of gynecological problems. Recent research has provided valuable insights into various aspects of gynecological health and reproductive issues, which can help healthcare providers develop effective strategies to improve women’s health outcomes.

REFERENCES

  • Kim CH, et al. Gut microbiota and metabolic health: The potential beneficial effects of a medium chain triglyceride diet in obese individuals. Nutrients. 2017; 9(7): pii: E634.
  • Schiller JT, et al. An update of prophylactic human papillomavirus L1 virus-like particle vaccine clinical trial results. Vaccine. 2008; 26(Suppl 10): K53–K61.
  • Skovlund CW, et al. Association of hormonal contraception with depression. JAMAPsychiatry. 2016; 73(11): 1154-1162.

Unlocking Potentials: Food Fortification Technologies for Healthier Nepal

Mar 7, 2024 | News

Jointly reviewed by:

Dr. Kishor Adhikari

Reviewed by Prof Dr. Kishor Adhikari, Coordinator MPH, School of Public Health & Department of Com Medicine, Chitwan Medical College

Sanjogta Thapa Magar

Reviewed by Sanjogta Thapa Magar, Food Microbiologist

Introduction

Malnutrition remains a significant public health concern in Nepal, with a high prevalence of micronutrient deficiencies contributing to poor health outcomes (Shrestha & Bhattarai, 2023). Recent findings indicate that Nepal is experiencing a dual challenge of malnutrition. For instance, according to the recent Nepal Demographic and Health Survey Report, one in four children under age 5 are stunted, 8 percent wasted, and 19 percent underweight. (NDHS, 2022)

Food Fortification is the practice of deliberately increasing the content of one or more micronutrients (i.e., vitamins and minerals) in a food or condiment to enhance its nutritional value and contribute to public health benefits with minimal health risks. In addition to enriching staple foods with essential nutrients, fortification can also help replenish the micronutrient levels lost during food processing. In recent years, innovations in food fortification have emerged as a promising strategy to address nutritional gaps and improve the overall health and well-being of the population. This article explores the innovations in food fortification and their potential impact on improving nutrition in Nepal.

Food fortification stands as a guiding principle in the arena of public health, providing a practical and effective means to address malnutrition and enhance the nutritional status of populations. Within Nepal, where micronutrient deficiencies are prevalent, fortifying staple foods such as salt, edible oil, wheat flour, and rice has emerged as a cornerstone strategy to bridge nutritional gaps and elevate the overall well-being of the populace. By enriching commonly consumed foods with essential vitamins and minerals, Nepal has made significant strides in augmenting the intake of micronutrients and improving health outcomes (Shrestha & Bhattarai, 2023).”

Looking beyond its borders, Nepal can draw inspiration from successful food fortification programs in other countries. For instance, Kenya has implemented large-scale fortification of maize flour with iron, zinc, folic acid, vitamin B12, and vitamin A since 2012, reaching over 80% of the population. This program has been supported by strong political commitment, stakeholder engagement, quality control, and monitoring systems, resulting in significant improvements in the micronutrient intake and status of women and children (World Food Programme, 2023).

Similarly, Costa Rica has mandated the fortification of rice since 1982, covering almost 100% of the population, which has contributed to the reduction of anemia, neural tube defects, and other micronutrient deficiencies (Fiedler et al., 2023).

Additionally, India has encouraged the voluntary fortification of milk and other dairy products since 2017, reaching over 30% of the population. This program, driven by the private sector with government support, has leveraged existing infrastructure and consumer demand for dairy products, resulting in positive impacts on vitamin A and D intake (Food Safety and Standards Authority of India, 2023).

Food fortification programs around the world have been successful in addressing nutrient deficiencies and improving public health outcomes. Nepal can draw inspiration from these success stories and enhance its own fortification efforts by increasing potential food vehicles and embracing innovative strategies.

Innovative Technologies

Bio fortification: One such strategy is bio fortification, which involves increasing the micronutrient content of crops through conventional breeding or genetic engineering. This approach offers a sustainable solution to nutrient deficiencies by developing crop varieties with naturally higher levels of essential nutrients. For example, bio fortified crops like orange-fleshed sweet potatoes, iron-rich beans, and zinc-rich rice have been developed to provide higher levels of key nutrients such as vitamin A, iron, and zinc. By integrating bio fortified crops into agricultural practices, Nepal can improve the nutritional quality of staple foods and enhance the health outcomes of its population (Bhattarai et al., 2023).

Nanotechnology: Nanotechnology plays a crucial role in improving the delivery, stability, and bioavailability of micronutrients in fortified foods. Nanoparticles, which are particles with dimensions on the nanometer scale, can encapsulate micronutrients such as iron, zinc, and vitamin A, protecting them from degradation and enhancing their absorption in the body. Nano encapsulation allows for precise control over nutrient release, ensuring optimal delivery and utilization. By incorporating nanotechnology into food fortification processes, Nepal can develop fortified foods with enhanced nutritional properties and improved health benefits (Singh et al., 2023).

Microencapsulation: Another innovative strategy is microencapsulation, which involves coating micronutrients with a thin layer of food-grade material to form small particles called microcapsules. This technique protects the micronutrients from environmental factors such as heat, light, and oxygen, and prevents undesirable interactions with other food components. Microencapsulation also improves the sensory characteristics of fortified foods, such as taste, color, and odor, by masking the flavor and appearance of the micronutrients. By applying microencapsulation to food fortification, Nepal can produce fortified foods with improved stability, quality, and acceptability (Gouin, 2023).

Extrusion: Extrusion technology offers a versatile method for producing fortified foods with desirable textures and nutritional profiles. During the extrusion process, a mixture of ingredients is forced through a die under high pressure and temperature, resulting in the formation of food products with uniform shapes and textures. Extrusion can be used to incorporate essential nutrients into a wide range of food products, including ready-to-eat snacks, cereals, and pasta. Fortified extruded foods are shelf-stable, convenient, and nutritious, making them suitable for addressing nutrient deficiencies in diverse populations. By leveraging extrusion technology, Nepal can diversify its range of fortified foods and increase their accessibility to the population.

Digital Technologies: Digital technologies play a crucial role in strengthening food fortification programs through data-driven approaches. These technologies encompass electronic devices and systems used to collect, store, process, and communicate information related to food fortification initiatives. Digital tools enable real-time monitoring of production processes, distribution channels, and consumer behavior, facilitating data-driven decision-making and program optimization. Furthermore, digital platforms can be utilized to raise awareness about fortified foods, educate consumers on their nutritional benefits, and promote adherence to fortification guidelines. By harnessing the power of digital technologies, Nepal can enhance the efficiency, effectiveness, and sustainability of its food fortification programs, ultimately improving the nutritional status and health outcomes of its population.

Impacts on Public Health:

The potential impact of food fortification extends beyond merely improving nutrient intake. It has the potential to significantly impact various aspects of public health and well-being. By addressing nutrient deficiencies, food fortification can lead to reduced morbidity and mortality rates, improved cognitive development, and enhanced immune function among populations. Furthermore, fortified foods have the potential to reach a broad segment of the population, including vulnerable groups such as pregnant women, children, and marginalized communities, who are often at higher risk of malnutrition. This inclusive approach ensures that the benefits of fortification are accessible to those who need them the most, thereby promoting equity and social justice in nutrition interventions.

Moreover, food fortification is recognized as a cost-effective public health intervention. By reducing the prevalence of micronutrient deficiencies and associated health conditions, fortification programs can generate significant economic benefits. These include savings in healthcare costs related to the treatment of micronutrient deficiency disorders, as well as increased productivity and economic growth resulting from improved health outcomes. Thus, fortification not only improves individual health but also contributes to the overall socioeconomic development of communities and nations.

Conclusion: In conclusion, food fortification stands as a beacon of hope in the realm of public health, offering a practical and impactful solution to combat malnutrition and improve the nutritional status of populations. Nepal’s journey towards fortifying staple foods exemplifies a proactive approach to addressing widespread nutrient deficiencies and promoting better health outcomes. By learning from successful experiences globally and embracing innovative strategies, Nepal can pave the way for a healthier future for its people.

REFERENCES

  • Shrestha, S., & Bhattarai, S. (2023). Nutrition and food security policies in Nepal: A review. Journal of Food Science and Technology Nepal, 12, 1-10.
  • World Food Programme. (2023). Rice fortification: A potential strategy to address undernutrition in Nepal. Retrieved from https://www.wfp.org/publications/rice-fortification-potential-strategy-address-undernutrition-nepal
  • Bhattarai, S., Dhital, S., & Gautam, A. (2023). Development of an innovative flour fortification device for the small traditional watermills in rural Nepal. Food and Nutrition Bulletin, 40(1), 95-105.
  • Fiedler, J. L., Lividini, K., & Bermudez, O. I. (2023). Assessing the equity implications of a large-scale rice fortification program in Nepal. Food Policy, 83, 206-217.’
  • Food Safety and Standards Authority of India. (2023). Fortification of foods. Retrieved from https://www.fssai.gov.in/fortification.php
  • Singh, A., Sharma, S., & Agrawal, A. (2023). Nanotechnology for micronutrient delivery in food: A review. Critical Reviews in Food Science and Nutrition, 63(2), 234-248.
  • Gouin, S. (2023). Microencapsulation: Industrial appraisal of existing technologies and trends. Trends in Food Science & Technology, 15(7-8), 330-347.
  • Osei J, Pandav CS. Salt iodization in Nepal: a successful public health story. Food Nutr Bull. 2010;31(3):293-295.
  • Klemm RDW, et al. Nepal Nutritional Intervention Project – Sarlahi (NNIPS) Impact Evaluation: Endline Report. Washington, DC: FHI 360/FANTA; 2017.
  • Bhutta ZA, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382(9890):452-477.
  • UNICEF. Strategy for Improved Nutrition of Children and Women in Developing Countries: A UNICEF Policy Review. New York: UNICEF; 1990.
  • Ministry of Health and Population, Nepal; New ERA; and ICF. (2022). Nepal Demographic and Health Survey 2022: Key Indicators Report. Ministry of Health and Population, Nepal.
  • Global Nutrition Report. (2021). Country nutrition profiles. Global Nutrition Report Retrieved from: https://globalnutritionreport.org/resources/nutrition-profiles/asia/southern-asia/nepal/ on 7th March 2024

     

Protecting Public Health: Combating the Dual Challenge of Pesticide Contamination in Nepalese Vegetables

Mar 4, 2024 | Global health issues

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Written By THT Editorial Team

Sanjogta Thapa Magar

Reviewed by Sanjogta Thapa Magar, Food Microbiologist

Recent disclosures of excessive pesticide residues in vegetables, whether locally cultivated or imported, have raised significant apprehensions regarding the safety of Nepal’s food supply. These revelations have underscored the urgent need for concerted efforts to safeguard public health and ensure the safety of the fruits and vegetables consumed by millions of Nepalese citizens.

Revealing the Danger

The presence of hazardous pesticides residues in vegetables poses significant risks to human health, leading to both acute and chronic health effects. Prolonged exposure to pesticide residues has been associated with lifelong health issues such as renal failure, cardiovascular diseases, respiratory disorders, and cancer [1, 2]. Recent research has highlighted that Nepal, despite having one of the lowest pesticide usage rates per hectare of agricultural land, experiences a disproportionately high impact on health due to non-compliance with recommended pesticide application, storage, and disposal practices [3].

Government Response and Accountability

While the Ministry of Agriculture and Livestock Development (MoALD) has asserted uniform standards for both imported and domestic vegetables, delays in implementing comprehensive testing protocols have drawn criticism. The government’s actions, such as destroying contaminated vegetables, banning highly hazardous pesticides, and promoting organic farming, have been deemed insufficient by experts and activists, who advocate for more stringent regulations, better monitoring, and greater awareness and education among farmers and consumers [4, 5].

Consumer Concerns and Safe Practices

Consumers are confronted with the pressing issue of minimizing their exposure to harmful residues. They can take proactive measures such as:

Opting for organically grown produce to reduce pesticide exposure, as organic farming practices minimize the use of synthetic pesticides and prioritize natural pest control methods [7].

Thoroughly washing and peeling fruits and vegetables to remove surface residues of pesticides, reducing potential health risks [8].

Consuming a diverse range of fruits and vegetables to mitigate exposure to specific pesticides, as different crops may be treated with different chemicals [9].

Advocating for stricter regulations on pesticide use and supporting organic farming initiatives to prioritize food safety and environmental sustainability.

Collaborative Solutions for a Safer Future

Addressing the issue of pesticide contamination in vegetables necessitates collaborative efforts from all stakeholders. Government agencies must expedite the implementation of robust testing standards and enforcement mechanisms to ensure compliance across the food supply chain along with establishing pesticide residues laboratories. Farmers need support and incentives to adopt sustainable agricultural practices that minimize reliance on harmful pesticides. Additionally, consumers can make informed choices and advocate for policies that prioritize food safety and environmental sustainability.

Conclusion Pesticide Residues laboratories strengthened

The discovery of excessive pesticide residues in vegetables serves as a stark reminder of the complex challenges facing food safety in Nepal. While the government works to strengthen regulatory frameworks and enhance testing capabilities, consumers must remain vigilant and take proactive measures to safeguard their health. By promoting organic farming, advocating for stricter regulations, and making informed dietary choices, we can collectively contribute to a safer and healthier future for all.

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