Dengue

30 new dengue cases but nos are still low over last year (Hindustan Times:20180911)

http://paper.hindustantimes.com/epaper/viewer.aspx

NEW DELHI: Thirty new cases of dengue were recorded by the municipal corporations of

Delhi (MCD) this week.

But even with the fresh cases, Delhi recorded just one-sixth the number of cases of dengue as

compared to figures last year till September first week.

So far, the MCD has recorded 137 cases of dengue among Delhi residents this season. In

2017, 829 cases had been registered during the same period. In 2015, Delhi saw its worst

dengue outbreak, with 1,160 cases of the disease being registered by the first week of

September.

“Although the number of cases is lesser in comparison to last year, the administration is

vigilant and is making all efforts to check the spread of the disease. The North Delhi

municipal corporation is leaving no stone unturned to ensure cleanliness is maintained and all

areas are fogged,” said Adesh Gupta, Mayor of the North corporation.

This monsoon, however, fewer cases have been recorded of all three mosquito-borne illnesses

that usually plague Delhi every year.

According to the weekly report released by the MCD, the city has recorded 195 cases of

malaria till September 8.

During the same period, 340 cases were recorded in 2017 and 264 cases were recorded in

2016 among Delhi residents.

DAILY NEWS BULLETINLEADING HEALTH, POPULATION AND FAMILY WELFARE STORIES OF THE DayTuesday 20180911

The corporations have also confirmed 47 cases of chikungunya as against 259 recorded the

previous year and 560 the year before during the same period.

However, officials expect that there could still be an increase in the numbers if the rains

become sporadic.

“Right now, Delhi is getting heavy rainfall constantly. However, once the rains become

sporadic, the environment would become conducive for breeding of mosquitoes. Over the last

two years too, the sporadic showers early on in the year resulted in higher number of cases

being registered,” said a municipal health official, on condition of anonymity.

Dengue (Dainik Jagran:20180911)

https://epaper.jagran.com/ePaperArticle/11-sep-2018-edition-Delhi-City-page_17-5193-

8744-4.html

Healthcare

‘No patients in 40 Rajasthan Ayurveda hospitals for 5 years’ (The Hindu:20180911)

https://www.thehindu.com/news/national/other-states/no-patients-in-40-rajasthan-ayurveda-

hospitals-for-5-years/article24922037.ece

CAG report tabled in House flags serious lapses in the Department of Ayurveda

As many as 40 Ayurveda hospitals in Rajasthan did not admit any patient for five consecutive

years since 2012, while no medical officer was posted in 645 dispensaries, according to a

Comptroller and Auditor General report.

Flagging serious lapses in the Department of Ayurveda, the CAG report said it incurred a

total expenditure of ₹2,655.89 crore during the five years between 2012 and 2017, of which a

huge component of up to 95.49% was spent on pay and allowances.

The CAG report, which was tabled in the Rajasthan Assembly during the monsoon session

last week, said no patient was admitted in 40 hospitals for five consecutive years, in 48

hospitals for four years in a row and in 49 hospitals for three straight years.

‘No review’

“Out of the 118 district hospitals, no patient was admitted in 60 hospitals during 2012-13,

which increased to 79 in 2016-17. In spite of this trend, no review to reduce/relocate the staff

was conducted,” the report said.

Manpower deployment

Scrutiny of deployment of manpower in healthcare centres in the State as of March 2017

revealed that deployment was disproportionate.

Out of the total 3,577 dispensaries, no medical officers was found posted in 645 dispensaries,

whereas two medical officers were posted in 40 dispensaries against the requirement of one

officer in each dispensary.

‘No medical officer’

No medical officer or nurse/compounder was posted in 195 dispensaries, the CAG report

said.

During 2012-17, the expenditure on pay and allowances was found very high, which ranged

between 87.97% and 95.49% of the total expenditure of Rs 2,655.89 crore, thereby leaving a

very small percentage for core activities of the department such as procuring equipment and

drugs and augmenting infrastructure.

There was no regulation to ensure the quality of drugs sold by retailers in the market.

Quality of drugs

The departmental pharmacies did not achieve the targets of production of drugs. The quality

of drugs manufactured in government pharmacies was also not maintained.

The government auditor, in its report, said that no new postgraduate course could be started

in the Government Ayurveda College, Udaipur, after 1986 due to non-availability of qualified

teachers.

‘No training’

Further, practical training in surgery and gynaecology was not being provided to students as

Ayurveda colleges did not have facilities for delivery and surgery cases.

Vibrating device

New device may help treat dizziness (The Hindu:20180911)

https://www.thehindu.com/sci-tech/science/new-device-may-help-treat-

dizziness/article24919361.ece

It analyses bone conduction sounds

Scientists have developed a new vibrating device that is placed behind a patient’s ear to

diagnose dizziness, and offers significant advantages over the current tests.

Researchers from Chalmers University of Technology in Sweden developed the testing

device using bone conduction sounds.

Issues with balancing

Hearing and balance have something in common. For patients with dizziness, this

relationship is used to diagnose issues with balance, according to the study published in the

journal Medical Devices: Evidence and Research.

Commonly, a ‘VEMP’ test (Vestibular Evoked Myogenic Potentials) needs to be performed.

A VEMP test uses loud sounds to evoke a muscle reflex contraction in the neck and eye

muscles, triggered by the vestibular system — the system responsible for our balance.

However, today’s VEMP methods have major shortcomings, and can cause hearing loss and

discomfort for patients.

“We have developed a new type of vibrating device that is placed behind the ear of the

patient during the test,” said Bo Hakansson, a Professor at Chalmers.

“The vibrating device is small and compact in size, and optimised to provide an adequate

sound level for triggering the reflex at frequencies as low as 250 Hz.

“Previously, no vibrating device has been available that was directly adapted for this type of

test of the balance system,” Mr. Hakansson said.

Air Pollution

Air you breathe in rarely ‘satisfactory’ (The Tribune:20180911)

https://www.tribuneindia.com/news/punjab/air-you-breathe-in-rarely-

satisfactory/650962.html

Found in ‘poor’ or ‘very poor’ category during first six months this year

For poor air quality in the state, farmers usually take the blame for causing it by resorting to

stubble-burning. However, a perusal of the data based on the monthly Air Quality Index,

collected from six air monitoring stations across the state, reveals a different story.

It shows that the air quality in the state was never in the “good” category and rarely in

“satisfactory”. It was rather “poor” or “very poor” during the first six months of this year.

There was no stubble-burning during this period, which usually takes place in October.

While 0-50 microgram per cubicmetre (µg/m³) RSPM (respirable suspended particulate

matter) is considered good, 51-100 satisfactory, 101-200 moderate, 201-300 poor, 301-400

very poor and 401-500 severe. The average air quality in the first six months of this year was

recorded between moderate to poor with sometimes reaching “very poor” category due to

dust storms and other factors.

Depleting forest cover in the state has further added to the woes. At present, the Punjab

Pollution Control Board records air quality at monitoring stations in Patiala, Amritsar, Mandi

Gobindgarh, Khanna, Jalandhar and Ludhiana.

Charanjit Singh, a senior PPCB official, said: “Usually the reading is above 100 RSPM on

most days, but goes on to alarming levels when farmers resort to stubble-burning or when we

have dust storms. The other major reason for the high pollutants in the air is the declining

forest cover in the state.”

“During winters, the burning of wood as fuel for cooking and crackers also add to pollution

in addition to low air velocity, while in summer months, dust storms are the major reason,”

he claimed.

In October and November last year, the air quality had turned “very poor” following farm

fires and bursting of crackers, with the RSPM reaching around 340 µg/m³, causing smoggy

conditions. Many schools in the districts were asked to shut down due to smog.

Another senior PPCB official said industrial and vehicular pollution and smoke emanating

from brick-kilns usually continued throughout the year and made the matters worse. “What is

now worrying is the flow of air laden with dust and other particles and less rain spells during

the pre-monsoon period. Further, pollens also worsen the air quality in addition to

construction-related activity,” he said.

What is particulate matter

Particulate matter (PM) is a complex mixture consisting of varying combinations of dry solid

fragments, solid cores with liquid coatings and small droplets of liquid. It may be divided into

many size fractions, measured in microns (a micron is one-millionth of a metre). ARB

regulates two size classes of particles - particles up to 10 microns (PM10) and particles up to

2.5 microns in size (PM2.5). PM2.5 particles are a subset of PM10

PPCB in denial mode

In May 2016, the PPCB had trashed as ‘dubious’ the WHO report showing four Punjab cities

— Ludhiana, Khanna, Amritsar and Mandi Gobindgarh — among the world’s 25 most-

polluted cities in terms of fine particulate matter-2.5 level in the air.

Again in May 2018, the PPCB had termed the figures quoted in a WHO report on 20 most-

polluted cities as “fudged and unscientific”. Patiala had figured at 13th spot on the list.

Medical Termination of Pregnancy Act

Can Indian women hope for a better abortion law? (Hindustan Times:20180911)

http://paper.hindustantimes.com/epaper/viewer.aspx

Legislations must not restrict or burden people. They must prevent tragedies. Amending the

law will be a crucial step

In July 2017, the Indian judiciary found itself faced with the heart breaking task of delivering

judgment on a young child’s abortion plea. The 10-year-old became pregnant after being

raped by her uncles. Too young to understand the unspeakable crime, her pregnancy was

discovered very late by her parents. From 26 weeks, when her parents first approached the

courts till well over 30 weeks, the lower and the Supreme Court, based on medical opinion,

ruled that she would have to carry the pregnancy to term. A few short weeks after, she

delivered the baby. I was horrified to see this case unfold.

SHUTTERSTOCK

The MTP Act does not account for those who may learn about foetal abnormalities only after

20 weeks or who may be rape survivors coming forward late due to stigma

Involving the judiciary, in what otherwise seems like a medical issue, is unfortunately on the

rise. An increasing number of women and young girls have approached the courts in recent

years to terminate pregnancies that have crossed the 20-week legal limit — usually in cases

of pregnancies resulting from rape or because of foetal abnormalities. Under the Medical

Termination of Pregnancy Act (MTP), 1971, a woman can get an abortion under certain

conditions within the legal gestation limit — if the pregnancy is a threat to her life, if the

foetus has abnormalities, if a pregnancy is a result of rape, or in case of con-

traceptive failure.

However, the MTP Act does not account for those who may learn about foetal abnormalities

only after 20 weeks, or who may be rape survivors (often minors) coming forward late due to

stigma and shame or because they did not know they were pregnant. It is also ambiguous for

unmarried women who conceive due to contraceptive failure. Additionally, the Act requires

consent from medical providers, one in the first and two in the second trimester, making it

particularly challenging for those in remote and underserved areas where there is a dearth of

providers.

Acknowledging the need for change, the ministry of health and family welfare (MoHFW) has

proposed amendments to the MTP Act that addressed the limitations mentioned above. Key

among these was increasing the gestation limit for rape survivors to 24 weeks and indefinitely

for cases of severe foetal abnormalities. These amendments, however, are yet to be

implemented.

Amending the MTP Act is a crucial step towards increasing access. I urge my fellow MPs,

the government and the leaders to come together and work to expedite the amendments,

freeing our girls and women from the barriers of the Act. Legislations must not restrict or

burden people. They must prevent tragedies. We have in the past taken truly progressive

stances for our girls and women, even when the rest of the world was a step behind us. It is

time we do so again.

Mental Health

New law can be a game-changer (Hindustan Times:20180911)

http://paper.hindustantimes.com/epaper/viewer.aspx

From stigma to lack of govt spending, mental healthcare faces many challenges. The success

of the Act lies in its implementation

Savitabai, 45, is a single mother living in a remote village in Ahmednagar district,

Maharashtra. She works as a daily wage earner on the farmland of a wealthy farmer.

Savitabai’s son Dhaval, 20, suffers from bipolar disorder (BPD), a severe mental health

condition which is characterised by extreme mood swings— long spells of manic behaviour

and bouts of depression. Dhaval’s condition causes severe disruption in his daily routine.

Given the severity of his condition, he requires medical care and support especially through

phases when his symptoms are most acute.

Savitabai is the sole earner and unable to provide care on a regular basis. Lack of awareness

about BPD and the stigma surrounding mental illness do not help matters, and other

community members are not forthcoming in their support either. The nearest community

health centre, which a psychiatrist attends once a week, is more than 50 km away. Travelling

to the centre means losing a day’s wages, something Savitabai can ill afford. The alternative,

as suggested by her community, is to get Dhaval treated by the local village faith healer. It is

less expensive but it does not assure a positive outcome for Dhaval’s mental health. His

symptoms recur despite numerous rituals and ceremonies. Dhaval needs a trained mental

health professional who can provide treatment and psycho-social support in the community,

but both these services are unavailable locally.

The World Health Organization (WHO) estimates India has only 0.3 psychiatrists, 0.07

psychologists and 0.12 nurses available per 1,00,000 people. The National Mental Health

Survey, 2016, estimated that over 85% of people with common mental disorders such as

depression or anxiety disorder and 73.6% of people with severe mental disorders such as

psychosis or bipolar disorder do not receive any mental healthcare and treatment. There is

also a wide variability in availability of mental health services — while urban areas have

some services, the situation is dire in rural areas, as the case of Dhaval illustrates. Since the

1980s, the National Mental Health Programme and the District Mental Health Programme

have sought to bridge this gap, by integrating mental healthcare at the primary level of the

public health system. However, this faces significant implementation challenges and resource

constraints. The public mental health system faces infrastructure gaps, financial deficits

(India spends less than 1% of its total health budget on mental health) and socio-cultural

barriers, such as the stigma that Dhaval’s mental illness carries which results in improper

psycho-social support.

Several cases of human rights violations of people with mental illness have been documented

over the years, including inappropriate or forced treatment, sub-human living conditions in

hospitals, inappropriate use of physical restraints and seclusion in care facilities. In this

landscape, the Mental Healthcare Act, 2017 (MHCA) is a historical intervention which, if

implemented well, can prove to be a game-changer. Two specific features stand out. First, the

act adopts a rightsbased approach. It places obligations on mental health services and

prescribes procedures that ensure that mental health professionals offer treatment in

accordance with a person’s will and preferences. The law provides for the right to make

advance directives— a person may state how they wish to be treated (or not) in the

eventuality that they have a mental illness and cannot make decisions for themselves at that

point. Additionally, the law recognises an entire gamut of rights relating to confidentiality,

access to medical records, protection from cruel treatment and non-discrimination based on

social markers, including sexual orientation. These rights are to be protected at all times when

a person is undergoing mental healthcare and treatment as an admitted patient or otherwise.

Any violation or deficiency in services can be reported before the Mental Health Review

Boards. Non-compliance with any of these provisions will result in punishment and

imposition of penalties.

Another significant aspect is that this is the first law in India which has man- dated universal

mental healthcare for all citizens. Indian legislation until now had not recognised a right to

healthcare as a universal right. Access to mental healthcare stresses on affordability, quality,

and non-discrimination. How does the law envision this? It offers a decentralised model,

placing obligations on the central and state governments to put infrastructure, resources and

budgets in place to bridge the deficit in mental health services and facilities. This includes

integrating mental healthcare at the primary, secondary and tertiary levels, setting up

community-based rehabilitative facilities, offering free mental healthcare to below poverty

line families, like Savitabai’s, and providing free essential medicines, among other things.

The act also places an obligation on insurance firms to provide health insurance to persons

with mental illness on the same basis as other physical illness.

The current mental health landscape in India is bleak, but there are many organisations and

individuals working to transform it. Take our experience: Since 2017, we have worked on a

project called Atmiyata, which is a community mental health intervention in Mehsana district

of Gujarat that trains community volunteers to provide lay counselling, referrals and linkages

with social benefits to individuals in distress. Today, our outreach extends to over one million

people. Involving the community through scaled-up grassroots-led approach is both an

opportunity and a challenge, but it is one way in which stakeholders like us can help actualise

the law’s mandate for universal mental healthcare.

Pathare is the director of Centre for Mental Health Law and Policy at Indian Law Society,

Pune, who assisted the Ministry of Health and Family Welfare in drafting the Mental

Healthcare Act, 2017. Kapoor is a lawyer and psychologist working at the Centre.

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Ovarian Cancer

Blocking ovarian cancer's energy supply helps curb spread (Medical News

Today:20180911)

https://www.medicalnewstoday.com/articles/323021.php

It is often the case that an ovarian cancer diagnosis reveals that the tumor has already spread

to nearby tissue. Now, scientists have discovered a potential way to cut off the energy supply

fueling this invasive stage of ovarian cancer.

Have scientists found a new way to stop the spread of ovarian cancer?

A new study, led by the University of Chicago in Illinois, has unraveled the role of glycogen

in fueling ovarian cancer spread.

It is the first to reveal how tumor cells interact with support cells called cancer-associated

fibroblasts to make this happen.

"No systematic study," says senior study author Ernst Lengyel, who is a professor of

obstetrics and gynecology at the university, "of the signaling pathways initiated by human

cancer cells and cancer-associated fibroblasts has been performed."

He and his colleagues report their recent findings in a paper that now features in the journal

Cell Metabolism.

"We think this could have significant clinical implications," claims Prof. Lengyel.

Ovarian cancer and metastasis

The ovaries are female hormone-producing glands that make eggs. Each woman has two

ovaries; one on either side of the uterus. About once per month, a mature egg carrying the

biological mother's genes travels through a fallopian tube to the uterus.

There, it is made ready for fertilization by sperm, which carries the biological father's genes.

A fertilized egg then becomes a fetus that has genes from both parents.

Ovarian cancer: Scientists find a way to launch dual attack

Aiming at two targets on the cancer cell could greatly enhance the power of antibody therapy

to kill ovarian cancer.

Ovarian cancer starts when cells in the ovaries or fallopian tubes grow out of control and

form a tumor.

The American Cancer Society (ACS) estimate that around "22,240 women" in the United

States will find that they have ovarian cancer and around 14,070 will die of the disease in

2018.

In nearly 4 out of 5 cases of ovarian cancer, the tumor has already invaded the omentum, a

curtain of fatty tissue that hangs over the intestines, at the time of diagnosis.

Once the cancer has penetrated this "energy-dense fat pad," it speeds up. The process of

spread, which begins with tissue invasion, is called metastasis and is complex and

multistaged.

The next stage is when tumor cells travel through the bloodstream and lymph system to set up

new tumors in other parts of the body.

Metastatic cancer is much harder to treat than cancer that is confined to the primary tumor,

and it is the main reason for cancer deaths.

Mobilizing energy supplies

In the case of ovarian cancer, as the tumor invades the omentum, it depletes its fat cells and

then recruits cells called cancer-associated fibroblasts to help it take the next step.

The fibroblasts speed up metastasis by helping cancer cells get the resources they need to

grow and proliferate, such as increasing blood supply to the tumor and mobilizing energy

supplies.

Prof. Lengyel and his colleagues investigated the signals that go back and forth between

human ovarian cancer cells and cancer-associated fibroblasts.

They did this by growing ovarian cancer cells and fibroblasts together in the laboratory and

then using a method called "quantitative phosphoproteomics" to monitor their "cellular

crosstalk."

The investigators found that chemical signals from the fibroblasts trigger the cancer cells to

metabolize their own stored glycogen into glucose.

This ready supply of glucose fuels the invasion of other tissues, which, in turn, leads to a

more aggressive tumor and rapid metastasis.

Blocking energy supply

The researchers suggest that there could be a way to halt or slow the invasion process. They

found that a signaling pathway called p38α MAPK activated glycogen mobilization in the

cancer-associated fibroblasts.

They also revealed that disrupting the enzymes involved in this pathway, or blocking the

signaling pathways that trigger glycogen metabolism in the cancer cells, "reduced

metastasis."

They suggest that this could be a "therapeutic strategy" for reducing "abdominally

metastasizing" tumors following surgery.

"This is the first time that the role of glycogen in cancer metastasis has been thoroughly

investigated."

Prof. Ernst Lengyel

Arthritis

Seven exercises for shoulder arthritis (Medical News Today:20180911)

https://www.medicalnewstoday.com/articles/322998.php

Seven exercises Tips for safety What to avoid Outlook

Arthritis can affect any joint in the body, including the shoulder joints. Performing specific

exercises on a regular basis can help relieve the symptoms of arthritis, which include pain and

swelling.

Approximately 54.4 million people in the United States receive an arthritis diagnosis every

year.

Arthritis causes flares of inflammation in the joints, leading to pain and stiffness. These

symptoms can have a significant impact on how much mobility people have in the affected

joints.

As a result, arthritis tends to make it more challenging to exercise. However, keeping the

joints active can have a powerful effect on the severity of arthritis symptoms.

The types of arthritis that commonly affect the shoulder include rheumatoid arthritis (RA)

and osteoarthritis.

In this article, we look at exercises that may reduce the damage that arthritis does to the

shoulder joints and help people manage pain.

Seven exercises for shoulder arthritis

Seniors stretching out their arms and exercising

Stretches are a beneficial exercise for shoulder arthritis.

The most beneficial types of exercise for arthritis include:

range-of-motion and flexibility exercises, such as stretches, which reduce stiffness

strength exercises that build muscle mass around the joints, which reduces the strain on them

aerobic activities, such as walking, swimming, and cycling, as these improve heart, lung, and

muscle function

The following exercises should stretch and strengthen the muscles around the shoulder joint:

1. Shoulder elevation stretch

This exercise improves the range of motion in the shoulder joints and stretches the muscles.

Doing this exercise regularly should facilitate daily activities, such as reaching for items on

shelves. To do this exercise:

Lie on your back.

Hold a broom handle or walking stick with both hands, keeping them shoulder-width apart.

Place the handle or stick gently on the thighs.

Slowly raise the pole up past the chest, then over the head so that it is almost touching the

floor above the head. Keep the arms as straight as possible throughout.

Lower the handle or stick slowly back down to the thighs.

Perform 3 sets of 10 repetitions once a day.

You should feel a gentle stretch in the shoulders, back, and chest as the arms move overhead.

2. Shoulder outward rotation stretch

This exercise also requires a broom handle or walking stick. It improves the flexibility in the

shoulder joints. Follow the steps below:

Lie on your back.

Keeping the upper arms by your sides, bend your elbows and hold the stick out above the

chest with your hands shoulder-width apart.

Slowly move the pole to the left until you feel a stretch in the left shoulder.

Return to the starting position.

Repeat on the right side of the body.

Perform 3 sets of 10 repetitions once a day.

3. Shoulder blade rotations

This rotation stretches the shoulders to promote increased range of movement. To do this

exercise:

Stand in a neutral position with your hands at your sides.

Raise your shoulders towards your ears and hold for 5 seconds.

Gently squeeze the shoulder blades together and hold for 5 seconds.

Pull the shoulder blades downward and hold for 5 seconds.

Repeat 10 times.

What are the causes and types of arthritis?

What are the causes and types of arthritis?

Learn more about the types and causes of arthritis as well as the remedies for this condition

here.

4. Pendulum exercise

The pendulum exercise helps relieve pain and relax the shoulder muscles. It involves the

following series of movements:

Bend forward and rest a hand on top of a chair or counter for support and balance. Use the

arm that is less sore to do this.

Allow the other hand to hang down.

Using motion from the legs and hips, gently swing the hanging hand back and forth and side

to side in a circular motion.

Repeat this 30 times in each direction once a day.

5. Door lean

The door lean can help stretch the muscles in the shoulders and improve resistance in the

joints. Perform the exercise as follows:

Stand facing toward a doorway and raise both hands above your head.

Place one hand on either side of the doorframe.

Gently lean forward until you feel a comfortable tension in your shoulders.

Hold this position for 15–30 seconds.

Repeat 3 times.

6. Door presses

Door press exercises can help build strength in the shoulder joints. To do these exercises:

Stand in a doorway and bend one elbow into a right angle with the thumb on that hand

pointing toward the ceiling.

Press the back of your wrist into the doorframe.

Hold for 5 seconds.

Repeat with the palm of your hand, using the other side of the doorframe.

Do 3 sets of 10 repetitions on each side.

7. Strengthen the postural muscles

Strengthening the postural muscles will improve overall posture, allowing the shoulders to

move more easily in all directions. These exercises require an exercise band, which it is

possible to buy in a sporting goods store or online.

To do these exercises:

Stand straight with your shoulders back.

Loop the exercise band behind a solid, vertical object and hold one end in either hand.

Relax your shoulders and bend your elbows at your sides.

Pull your elbows backward while squeezing the shoulder blades together. If the exercise band

does not provide any resistance, take a step back or loop the ends of the bands around your

hands.

Hold for 5 seconds.

Perform 3 sets of 10 repetitions once a day.

Tips for safety

Senior stretching before exercise

Warming up before exercise may include a brisk walk or light aerobic activity.

Arthritis can make exercising more challenging, so be sure to exercise with care to avoid

injury. Follow these tips to stay safe when exercising with arthritis.

Warm up before doing any exercise to stimulate blood flow around the body. A warmup

might include a brisk 10-minute walk or another light aerobic activity.

It should be possible to feel a stretch in the shoulders when doing these exercises, but they

should not be painful. If a particular motion hurts, stop doing it right away. If the pain persists

for several hours after the exercise, it may be necessary to see a doctor.

If the exercises cause any swelling in the shoulders, use an ice pack to reduce inflammation.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can also be beneficial.

What to avoid

It is crucial to avoid doing exercises that strain the shoulder muscles or put excessive pressure

on them, as this can result in injury.

Certain stretches may be painful or uncomfortable for some people and not others, so it is

vital to always listen to your body during exercise.

For some people, shoulder exercises such as pushups or lifting heavy weights can be too

intense for the shoulder joints. However, light exercise is necessary to build up the shoulder

muscles.

Aerobic exercise is also essential for physical health and mental well-being. People with

severe symptoms could try gentle alternatives to regular forms of exercise, for example,

replacing swimming with water therapy. This form of exercise offers many of the same

benefits as swimming but places less pressure on the shoulders.

Some people with milder symptoms may be able to continue with traditional forms of aerobic

exercise.

The most appropriate type or frequency of exercise will vary from person to person. It

depends on the severity of the person's arthritis symptoms and other factors, such as the

amount of muscle surrounding the affected joints.

A physical therapist should be able to work with an individual to create a tailored exercise

plan for them and explain any specific types of exercise that they should avoid.

Outlook

The outlook for arthritis in the shoulder joints is variable. In the early stages of the condition,

symptoms are generally mild and do not have a significant impact on the range of motion.

When arthritis is more advanced, people may experience severe pain and reduced movement

in the affected shoulder joints.

Regular exercise will keep the shoulder joints active, which can have a noticeable impact on

reducing pain and improving the range of motion in this area of the body. People should

exercise with care to avoid further damaging the joints or surrounding tissues.

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Insulin

Natural ways to improve insulin sensitivity (Medical News Today:20180911)

https://www.medicalnewstoday.com/articles/323027.php

Lifestyle Diet Dietary supplements Takeaway

Insulin sensitivity refers to how sensitive the body's cells are in response to insulin. Doctors

generally consider a high insulin sensitivity to be healthy. Some lifestyle and dietary changes

may help improve this sensitivity.

Insulin is a hormone that helps control the amount of sugar, or glucose, in the blood. The

body's cells respond to insulin by absorbing sugar from the blood.

Low insulin sensitivity is known as insulin resistance. This can cause blood sugar levels to

become too high and may lead to type 2 diabetes.

Insulin sensitivity varies between people and can change according to various lifestyle and

dietary factors. Improving insulin sensitivity may benefit people who have or are at risk of

type 2 diabetes.

In this article, we look at lifestyle and dietary factors that may help a person improve their

insulin sensitivity naturally.

Lifestyle

People who wish to increase their insulin sensitivity can try making the following lifestyle

changes:

Getting more exercise

Cycling fitness class

Doing more exercise may improve insulin sensitivity.

Getting more exercise may be one way to improve insulin sensitivity.

In a 2012 study, 55 healthy adults participated in a 16-week exercise program. The

researchers found an association between increased physical activity levels and improved

insulin sensitivity. This result was dose-dependent, meaning that the more the participants

exercised, the more their insulin sensitivity improved.

Combining different exercises

The findings of a 2013 review suggest that certain types of exercise may increase insulin

sensitivity more than others. The authors found that a combination of aerobic exercise and

strength training was particularly effective for people both with and without diabetes. Based

on their findings, the authors recommended that:

People without diabetes should do at least 30 minutes of exercise five times a week. This

exercise should include high-intensity aerobic exercise three times a week and strength

training in all major muscle groups twice a week.

People with type 2 diabetes should do at least 30 minutes of exercise five times a week. They

should perform long-duration, moderate-intensity aerobic exercise three times a week and

high-repetition resistance training in all major muscle groups twice a week.

People with type 2 diabetes and limited mobility should do as much exercise as they can

manage. They should aim to include low-intensity aerobic exercise combined with low-

intensity resistance training in all major muscle groups three times a week.

Getting more sleep

Getting more sleep may also improve a person's insulin sensitivity.

In a 2015 study, 16 healthy people who were not sleeping for long enough extended their

sleep by 1 hour per day for 6 weeks. This extra sleep led to increased insulin sensitivity.

Diet

Some research suggests that making certain dietary changes could increase insulin sensitivity.

These changes include:

Fewer carbohydrates, more unsaturated fats

Avocado salad with pine nuts

Eating foods rich in unsaturated fats, such as avocado and pine nuts, may increase insulin

sensitivity.

Recent research suggests that replacing carbohydrates with unsaturated fats may improve

insulin sensitivity in some people.

A 2012 study investigated the effects of different diets on insulin sensitivity in adults with

high blood pressure, which is a risk factor for type 2 diabetes. The researchers concluded that

eating a diet low in carbohydrates and high in unsaturated fats for 6 weeks may improve

insulin sensitivity.

The study also suggested that this diet was more effective at improving insulin sensitivity

than a diet high in carbohydrates or a diet that replaces some carbohydrates with proteins.

A 2016 systematic review of 102 studies concluded that replacing carbohydrate and saturated

fat with polyunsaturated fat may improve the body's blood sugar regulation.

More soluble fiber

Soluble fiber is a type of dietary fiber that comes from plants. Although this fiber is a type of

carbohydrate, the body cannot break it down properly. As a result, it does not contribute to

spikes in blood glucose levels.

Soluble fiber also delays gastric emptying, which is the time it takes for a meal to leave the

stomach and enter the small intestine. A small 2014 study suggests that this delay may help

lower blood glucose levels after meals in people with type 2 diabetes.

Another study suggests that eating more soluble fiber may help reduce insulin resistance in

healthy women.

Intermittent fasting

Intermittent fasting is a type of diet that focuses on the timing of eating rather than the

specific foods in the diet. It may improve insulin sensitivity and reduce the risk of type 2

diabetes for certain people.

A 2014 review investigated the effects of two types of intermittent fasting in overweight and

obese adults:

Restricting calorie intake for 1–3 days per week and eating freely on the remaining days.

Alternating between fast days and feed days. People reduce their regular calorie intake by 75

percent on fast days and do not restrict their diet on feed days.

As with a daily calorie-restricted diet, the researchers found that both types of intermittent

fasting reduced insulin resistance. However, this type of eating had no meaningful effect on

blood glucose levels. They concluded that more research is necessary.

Diet tips and strategies for weight loss with insulin resistance

Learn more about the relationship between insulin resistance and body weight here.

Dietary supplements

In addition to changing the foods in their diet, people looking to increase their insulin

sensitivity may benefit from taking some dietary supplements. According to research, the

following supplements could reduce insulin resistance:

Probiotics and omega-3 fatty acids

NAtural supplements

Probiotic supplements may increase insulin sensitivity.

Taking probiotics or omega-3 fatty acid supplements may improve insulin sensitivity in

overweight people.

A 2014 clinical trial investigated the effects of both omega-3 fatty acids and probiotics on

insulin sensitivity in 60 adults who were overweight but otherwise healthy.

The researchers reported that taking either a probiotic or omega-3 supplement for 6 weeks led

to significant improvements in insulin sensitivity compared to a placebo. The increase in

insulin sensitivity was greater still in people who took both supplements together.

Magnesium

Magnesium supplements may also be beneficial for people wanting to improve their insulin

sensitivity.

A 2016 systematic review found that taking magnesium supplements for more than 4 months

significantly improved insulin resistance in people with and without diabetes.

Resveratrol

Resveratrol is a natural compound that occurs in the skin of red grapes. It is also available as

a dietary supplement.

A 2014 meta-analysis of 11 studies found that taking resveratrol supplements significantly

improved glucose control and insulin sensitivity in people with diabetes. However, the

researchers did not observe the same effects in people without diabetes and concluded that

there is a need for more research on the effects of resveratrol supplementation in humans.

Takeaway

Low insulin sensitivity is a risk factor for developing type 2 diabetes. Exercising well, having

enough sleep, and eating a healthful diet high in unsaturated fats and soluble fiber may help

improve insulin sensitivity in people with and without diabetes.

Certain dietary supplements may also be beneficial. Many of these supplements are available

to purchase online:

probiotic supplements.

omega-3 supplements.

magnesium supplements.

resveratrol supplements.

We picked linked items based on the quality of products, and list the pros and cons of each to

help you determine which will work best for you. We partner with some of the companies

that sell these products, which means Healthline UK and our partners may receive a portion

of revenues if you make a purchase using a link(s) above.

Glucose Test

What is a random glucose test? (Medical News Today:20180911)

https://www.medicalnewstoday.com/articles/323022.php

What is random glucose testing? How and when is the test done? What do the results mean?

What can affect the result? Outlook

A random glucose test is one way a doctor can measure how much glucose or sugar a person

has circulating in their blood. Doctors use the result of random glucose testing to determine if

a person may have diabetes.

This article will look at what a random glucose test is, why a doctor may recommend it, and

what the results can mean.

What is random glucose testing?

glucose test

A random glucose test measures the amount of glucose or sugar in a person's blood.

Glucose is a form of sugar and comes from the foods people eat. It is the body's primary

energy source and fuels every cell, including those in the brain, heart, and muscles.

The body is continually working to keep the amount of glucose in the blood at optimum

levels. It does this by producing a hormone called insulin, which helps glucose get into the

cells that need it for energy.

People with type 1 diabetes do not produce insulin because their immune systems attack and

destroy the cells in the pancreas that make the insulin.

People with type 2 diabetes either do not produce enough insulin or their body does not

respond to it appropriately.

When a person does not make insulin correctly, glucose stays in their blood. Medical

professionals call too much sugar in the blood hyperglycemia, while they refer to too little

sugar in the blood as hypoglycemia.

Random glucose testing is one way of checking the levels of glucose in the blood. Doctors

may carry out a random glucose test at any time of the day.

If the result indicates that a person has higher than expected glucose levels, the doctor will

usually order a follow-up test to confirm the diagnosis. This may be another random glucose

test, or it may be a:

Fasting glucose test. This checks the levels of glucose in the blood after the person has had

nothing to eat or drink for 8 hours. Doctors usually perform this test in the morning, before

breakfast.

Oral glucose tolerance test (OGTT). People with diabetes can sometimes have a typically

normal fasting or random glucose test. If a doctor still suspects diabetes, they may

recommend an OGTT. This test also requires a person not to eat or drink for 8 hours. After

giving the first blood sample, the individual drinks a liquid containing glucose, and then more

blood samples are taken hourly over the course of the next 2 hours.

How and when is the test done?

A doctor may recommend a random blood glucose test if a person has symptoms of diabetes,

such as:

urinating more often

feeling extremely thirsty

feeling very hungry despite eating enough

unexplained weight loss

extreme fatigue or tiredness

blurred vision

slow healing of cuts and bruises

Type 2 diabetes can often develop slowly, which can make symptoms difficult to detect at

first.

People with diabetes may also experience a sensation of tingling or numbness in the hands or

feet, which is known as diabetic neuropathy. This is more likely to occur if a person's blood

glucose remains uncontrolled for extended periods.

A random glucose test is a quick test that a doctor or nurse can carry out at short notice in

their office or clinic. The person does not need to fast beforehand.

The test requires a small sample of blood that the doctor or nurse will take using a needle.

Which foods lower blood sugar?

One way to control blood sugar levels is to eat foods with a low glycemic index. Learn more

here.

What do the results mean?

salad weights and tape measure

Making dietary changes and losing weight can help people with prediabetes reduce their risk

of developing diabetes.

Doctors measure the amount of glucose in a person's blood in milligrams per deciliter or

mg/dL.

For a random glucose test, a result of 200 mg/dL or above indicates that a person may have

diabetes. However, for a more reliable diagnosis, the doctor will usually repeat the test on

another day.

To help confirm the diagnosis, the doctor may also order a different type of test, such as a

fasting glucose test or an OGTT.

For a fasting glucose test:

less than 100 mg/dL is normal

100 to 125 mg/dL indicates prediabetes

126 mg/dL or above indicates diabetes

For an OGTT:

less than 140 mg/dL is normal

140 to 199 mg/dL indicates prediabetes

200 mg/dL or above indicates diabetes

Prediabetes means that a person's blood glucose levels are higher than usual, but doctors do

not yet consider that they have diabetes. Doctors sometimes call this impaired glucose

tolerance (IGT) or impaired fasting glucose (IFG).

People with prediabetes are at increased risk of developing diabetes. Lifestyle modifications,

such as weight loss and exercise, and certain medications can help reduce this risk.

What can affect the result?

Blood glucose levels change throughout the day, depending on factors such as what a person

has eaten and how much exercise they have done that day. However, the blood glucose levels

of people without diabetes tends to stay within the normal range.

The following factors may increase a person's blood glucose levels:

eating too much food

low physical activity

medication side effects

illness

stress

pain

menstruation

dehydration

The following factors may decrease a person's blood glucose levels:

eating little or no food

drinking alcohol

medication side effects

intense physical activity or exercise

Outlook

woman having dental treatment

Untreated diabetes can lead to dental disease.

Diabetes is a chronic condition that, if left untreated, can lead to serious health problems and

complications, including:

heart disease

stroke

kidney disease

eye problems

dental disease

nerve damage

foot problems

However, with effective treatment and management, people with diabetes can enjoy a healthy

life.

Doctors usually diagnose type 1 diabetes in children and young adults. People with type 1

diabetes need to take insulin daily and regularly monitor their blood sugar levels for the rest

of their lives.

Type 2 diabetes often develops later in life. A person can sometimes manage type 2 diabetes

with just diet and exercise. Other people may need medication or even insulin so that they

can keep their blood sugar levels within healthy levels.

Anyone with symptoms of diabetes should see their doctor for an evaluation.