Study Finds Nuts To Be Key in Improving Brain Health
Our brain is arguably the most important organ, as it not only controls and coordinates actions and reactions, it also allows us to think, feel, have memories and emotions, and do a lot more. Therefore, keeping your brain healthy is as important as maintaining a healthy and fit body. According to new research, a healthy habit of eating nuts could be the key to better cognitive health as we grow older.
 
In a study conducted by the University of South Australia, researchers found that consuming more than 10gm (grams) of nuts a day is positively associated with better mental functioning, including improved thinking, reasoning and memory. Dr Ming Li led this new study which is the first to report an association between cognition and nut intake in older adults. This new research has provided important insights into increasing mental health issues (including dementia) faced by an ageing population.
 
“Population ageing is one of the most substantial challenges of the twenty-first century. Not only are people living longer, but as they age, they require additional health support which is placing unprecedented pressure on aged-care and health services,” Dr Li said. “Improved and preventative health care, including dietary modifications, can help address the challenges that an aging population presents.”
 
Researchers gathered data from 4,822 Chinese adult participants aged 55+and found that eating more than 10gm (or two teaspoons) of nuts per day improved their cognitive function by up to 60%, compared to those not eating nuts. The research team suggested that such an eating habit could effectively ward off what would normally be experienced as a natural two-year cognition decline. 
 
For the study, researchers analysed nine waves of China Health Nutrition Survey data collected over 22 years, finding that 17% of participants were regular consumers of nuts (mostly peanuts). Peanuts are known to have specific anti-inflammatory and antioxidant effects which can alleviate and reduce cognitive decline. Dr Li says, “Nuts are known to be high in healthy fats, protein and fibre with nutritional properties that can lower cholesterol and improve cognitive health. While there is no cure for age-related cognition decline and neuro-generative disease, variations in what people eat are delivering improvements for older people.”
 
According to the World Health Organisation (WHO), by 2020, the number of people aged 60 years and older will outnumber children younger than five years old. WHO also estimates that, globally, the number of people currently living with dementia is 47 million. By 2030, this number is projected to rise to 75 million and, by 2050, global dementia cases are estimated to almost triple. This study, therefore, has major implications for improved and preventive healthcare in nations where people are living far longer and experiencing cognitive decline.
 
“As people age, they naturally experience changes to conceptual reasoning, memory and processing speed. This is all part of the normal aging process. But age is also the strongest known risk factor for cognitive disease, if we can find ways to help older people retain their cognitive health and independence for longer, even by modifying their diet, then this is absolutely worth the effort,” said Dr Li.
 
In other words, if you are looking to justify your nut obsession, rest assured that adding some nuts to your day is really doing something good for your health. So go ahead and go nuts!
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    What Does the Law Say on Medical Negligence and Issues of Diagnosis, Treatment, Informed Consent, Interference and Damages?
    Everyone falls sick one time or other and needs to go to a doctor for medical attention. A misdiagnosis, an inaccurate treatment or a tragedy leads to disputes we classify in law as medical negligence. Patients worry if they are getting the best care while doctors worry about the legal implications. These worries are a result of lack of proper understanding of the law on medical negligence. 
     
    The law on medical negligence is affected by developments across the world. It creates a few dos and don’ts for the patients and doctors alike. With the help of significant court judgements from India and across the world, this article aims to acquaint the patients, doctors and medical practitioners with some basic guidelines to prevent litigation. 
     
    Diagnosis and Treatment
    The law on the acceptability of diagnosis and treatment is well developed. In short, the doctors are required to be prudent when it comes to diagnosis and treatment. Practically, it means that a general body of experts should concur with the doctor’s action.
     
    Doctors and hospitals are legally responsible for the standard of care. The standard of care has two parameters—first the standard should be acceptable to a general body of experts. The standard of care should also be up to date considering developments in the field of medicine. Thus, doctors and hospitals are required to keep abreast of new practices in medicine. Further, all the medical professionals involved in providing the treatment procedure are required to possess the necessary skills.
     
    Second, the standard of care should also meet the common-sense test. Related examples of cases are blood transfusion of the wrong type, employing unqualified nurses, empty oxygen cylinders etc. From my personal experience, I could add some more—such as quack medical supervisors, over-worked resident doctors, improper medical records, hospitals and nursing homes not having appropriate permissions from the Medical Council of India and local authorities, open/exposed medical waste in patient area, etc.
     
    As clarified in Balram Prasad case, the liability of the hospital is residuary and therefore in many cases maximum. The responsibility of the hospitals is two-fold. First is the substantive responsibility. The hospitals are required to ensure efficient and effective diagnosis and treatment. They need to ensure that the doctors are qualified, that they have tools and techniques available at their disposal for the best possible patient care. Second, the hospitals also have procedural responsibility. Any shortfall in either of these two duties creates a liability. The hospitals need to ensure that the standards on these two aspects meet the requirement. 
     
    Information
    Legally, the decision with respect to diagnosis rests exclusively with the doctor. Whether the diagnosis is correct can only be determined by a doctor or a body of expert doctors. But the decision with respect to treatment is taken jointly between the doctor, patient, patients’ family and other stake-holders. The interests of the patient are paramount in this decision. To arrive at both these decisions we need information.
     
    The law expects the patients to supply the information about their conditions to the doctor. This information covers symptoms, allergies, etc. but also much more. 
     
    Court decisions indicate that a patient should also highlight her concerns and apprehensions that help her decide—i.e. her decision parameters. Thus, “incessant questioning” was held as an indicator of patient’s apprehension about possible complications arising from an operation. An explicit comment about not wanting to lose her voice was found to be a relevant concern raised by the patient. Thus, the law expects patients to be curious about the risks involved at all stages - diagnosis, treatment and possible side-effects or possible complications. The patients, therefore, should also seek information about the diagnosis, treatment and the risks involved in all the procedures.
     
    Doctors must understand that informing the patient is absolutely critical. The information must be complete and easily understandable. In general, it is absolutely essential to discuss the possible outcomes, possible risks and potential complications arising from the procedure. 
     
    Various decisions indicate that the doctors must be vigilant about understanding the patients’ decision-making process as well. They must glean from patient interaction as to what sort of risks the patient is accepting and what risks the patient does not wish to take. Using this information, the doctors must determine the kinds of risks they should inform the patient about. If it is unclear, they must directly point out the risks and seek the patients’ consent. The information, in the words of Lady Hale is “enough information [is] given so that the doctor is not acting negligently and is giving due protection to the patient's right of autonomy.”
     
    Even in the matter of getting information from the patient, substantial responsibility rests with hospitals and clinics who deal in out-patient care. Many hospitals have separate professionals, junior doctors usually, who get detailed information from the patients based on predesigned forms. While the intent is salutary, such over-reliance on forms is also not good. Hospitals must aim for materiality and relevance and allow for judicious departure from norms.
     
    Informed Consent
    The question of informed consent in important in the Indian context. Firstly, Indian hospitals and doctors tend to get blanket consent that the common law jurisprudence rejects. Secondly, the concept of informed consent, while accepted in Indian jurisprudence, has not been rigorously tested.
     
    We find that the Indian law does not approve of the term “informed consent” and favours “real consent”, a legacy of English law. However, both are practically the same. Thus, in the Samira Kohli case, the court, while using the term “real consent” has described various principles associated with it. The principles enlisted are quite illuminating and should be read entirely in the case description. 
     
    The courts states that the consent should be “prior consent” before undertaking the procedure. The consent should be obtained after providing “adequate information” but not overburden the patient with remote risks. The court has clarified it as “the doctor should disclose (a) nature and procedure of the treatment and its purpose, benefits and effect; (b) alternatives if any available; (c) an outline of the substantial risks; and (d) adverse consequences of refusing treatment.” The court further states that the consent for diagnostic procedure cannot be extended to treatment and a separate consent is required for that. However, in certain cases consent for both may be taken together but the same must be clearly explained to the patient.
     
    Many hospitals have specialists who inform the patients of the risks related to the diagnosis and treatment. The process is iterative, and more information must be sought and given to meet the high standard of consent required by law. The standard of consent globally established is quite high and Indian law is expected to progress rapidly towards that standard.
     
    There are two additional complications when it comes to informed consent in India. First, in many cases you have patients who are illiterate and do not comprehend the kinds of risks they are undertaking. Second, Indian doctors are still seen in their paternalistic role when it comes to general patient. Thus, I venture, the patient has to demonstrate a clear preference for knowing all the risks before the onus can be shifted to the doctor. Further, the patient needs to actively protect herself from the judicial presumption that sees doctors in a paternalistic role. Nevertheless, I expect we shall soon see developments with respect to “informed consent” in Indian law.
     
    Therapeutic Privilege
    The law recognises that there are cases of emergency where a doctor has to make a choice in the absence of information or consent. The law allows for the doctor to take any and all actions in the interest of the patient’s health and safety. There are two conditions: the doctor’s action should be in good faith and there has to be an emergency. In the Samira Kohli case, the Supreme Court established that the consent had not been proper though it concluded that the action of the doctor was in good faith and in the interest of the patient. There is another condition in which the doctor is allowed to withhold information – if she determines that it will affect the patient’s mental health.
     
    Interference by Patient and Kin
    Unfortunately, this aspect has no parallel in the international jurisprudence. While a paternalistic role is attributed to the doctors generally, it is not always the case. Therefore, Indian law also allows for defence of a non-cooperating patient and interference from the patients’ kin. In the Martin Dsouza case, the court concluded that the doctor was faced with a non-cooperative patient with multiple maladies and it therefore justified the deployment of extraordinary measures by the doctor.
     
    However, the courts are careful in ascribing interference to the patient or patient’s kin and strong evidence is required for the same. Thus, in the Malaykumar Ganguly case, faced with the doctor’s incompetent handling of the patient, the patient’s husband (who was also a doctor) “interfered” with the treatment but it was held to be acceptable.
     
    Patients and their kin should not interfere in the diagnosis and treatment. However, the patient and their kin are not restrained from making inquiries, making suggestions and indicating their views on the diagnosis or treatment. 
     
    Doctors should also note that what is “interference” is determined by a post-facto judicial scrutiny. Thus, if the patient is reasonable in her inquiry, suggestions or views on the diagnosis or treatment, then the burden on the doctors increases. The consequences of ignoring just and reasonable suggestions of the patients and their kin are quite drastic. 
     
    We can infer that consulting doctors need to keep a record of interference by the patient herself or by their kin, along with the case files and record the inquiries, suggestions and views in the said file along with the opinion of the relevant doctor. It is in the interest of the treating doctors and the hospitals that such instances be recorded and maintained properly.
     
    Damages
    Indian jurisprudence is compensatory and does not usually award exemplary damages. However, Indian jurisprudence is progressing rapidly in the case of award of damages. In this regard two landmark cases, Nizam Institute and Balram Prasad, have laid new ground rules. The Indian courts have transitioned from relying on multiplier method to more ad hoc damages that are closer to appropriate compensation for the loss suffered.
     
    There are two areas where, in the future, there may be further enhancement. First, computation of legal costs. In Balram Prasad, we have seen some costs awarded for legal expenses. However, the determination of these costs is arbitrary and not in keeping with the actuals. This may change. Second, award of exemplary damages may be around the corner. The jurisprudence with respect to damages is affected from various quarters - motor vehicles, civil suits on contracts and those on other forms of negligence too. Since this particular element is a kind of tort law, as the tort law develops, we will see further development in the computation of damages.
     
    Conclusion
    Thus, as seen above, the law on medical negligence is keeping up with the changes in the society. These changes cast a duty on patients, doctors and hospitals to improve the standard of care in every aspect of medical practice. I believe the doctors and hospitals need to continuously review their procedures and ensure that the provided care meets the ever-stricter standards laid down by the courts.
     
    (Rahul Prakash Deodhar, Advocate, Bombay High Court, has counselled Fortune 500 companies, public and private sector banks, hedge funds and private equity funds. He has previously worked with Aditya Birla Group, CRISIL and Morgan Stanley. He is the author of two books – Subverting Capitalism and Democracy and Understanding Firms. He can be reached at [email protected], on twitter at @rahuldeodhar or at his website www.rahuldeodhar.com.) 
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    COMMENTS

    Paragsinha Gahelot

    5 months ago

    Hi All!

    My family is also a victim of medical negligence. I’ve started a petition “Medical Council of India, Lilavati Hospital: Cancel License, expel Corrupt Nephrologist Hemant Mehta, Prashant Rajput who killed my Mom” on change.org

    Request you to go through the petition and please sign the petition, it will only take you 30 seconds to sign it. Here’s the link:

    http://www.change.org/p/medical-council-of-india-lilavati-hospital-cancel-license-expel-corrupt-nephrologist-hemant-mehta-prashant-rajput-who-killed-my-mom

    Thanks!
    Parag

    AVINASH BHOSALE

    5 months ago

    Good article. Sorry but I did not get the line which says ... the hospitals also have procedural responsibility...paragraph before information . Can u please explain it ?

    Good Breakfast, Less Screen Time May Boost Heart Health, Says Study
    The role of lifestyle changes for primary prevention of heart attack or other cardiovascular diseases cannot be undermined. Small lifestyle changes, over a period, can make a lot of difference and pay rich dividends when it comes to heart health. In line with this hypothesis, people who spend less time watching TV and regularly eat a healthy breakfast may have a lower risk of developing heart disease or suffering a stroke, a new study suggests. 
     
    This new two-part study is being presented at the American College of Cardiology’s 68th Annual Scientific Session on 16th March. The study found that those who watched TV for less time and ate a healthy breakfast showed significantly less plaque and stiffness in their arteries. These observations emphasise the benefits of lifestyles that incorporate balanced eating and less sedentary time. 
     
    “Environmental and lifestyle factors are important but underestimated risk factors for cardiovascular disease,” said Dr Sotirios Tsalamandris, a cardiologist at the National and Kapodistrian University of Athens (Greece). He added that the study emphasises the many factors that impact heart disease and the need for holistic preventive approaches.  
     
    Researchers assessed markers of heart health, along with a variety of environmental exposures and lifestyle factors, in 2,000 people living in Corinthia (Greece). Participants ranged from the ages of 40 to 99 years, with an average age of 63 years, and represented a broad spectrum of the general population. The group included healthy people as well as those with cardiovascular risk factors and established heart disease. 
     
    Detailed questionnaires were used to assess participants’ physical activity levels and eating habits, while two non-invasive tests were used to assess the condition of participants’ arteries. The first test, carotid femoral pulse wave velocity, measured the speed of pressure waves that move along the arteries to detect stiffening of the arteries or atherosclerosis. The second test used ultrasound imaging to measure the thickness of the inner part of the arterial wall. Thickening of the arterial walls reflects plaque build-up and is associated with an increased risk of stroke.
     
    In the first segment of the study, researchers divided participants into three groups according to the number of hours spent watching television or videos each week: a low amount (seven hours or fewer), a moderate amount (seven to 21 hours) or a high amount (more than 21 hours). After accounting for cardiovascular risk factors and heart disease status, researchers found those watching the most TV per week were almost twice as likely to have plaque build-up in the arteries compared with those watching the least. 
     
    “Our results emphasize the importance of avoiding prolonged periods of sedentary behaviour,” Dr Tsalamandris said. “These findings suggest a clear message to hit the off button on your TV and abandon your sofa. Even activities of low energy expenditure, such as socialising with friends or housekeeping activities, may have a substantial benefit to your health compared to time spent sitting and watching TV.”
     
    Researchers also concluded that watching more TV was associated with an increased risk of other cardiovascular risk factors, including high blood pressure and diabetes. Compared to those watching less than seven hours of TV per week, those watching more than 21 hours per week were 68% more likely to have high blood pressure and 50% more likely to have diabetes.
    In the second part of the study, participants were divided into three groups based on how much of their daily caloric intake came from breakfast: high-energy (breakfast contributing more than 20% of daily calories), low-energy (5%-20% of daily calories) or skipped breakfast (less than 5% of daily calories). In total, about 240 people reported a high-energy breakfast; nearly 900 ate a low-energy breakfast; and about 680 skipped breakfast.
     
    Breakfast foods commonly eaten by those in the high-energy group included milk, cheese, cereals, bread and honey. Breakfast for those in the low-energy group, typically, included coffee or low-fat milk along with bread & butter, honey, olives or fruit. Researchers found that those who ate a high-energy breakfast tended to have significantly healthier arteries than those who ate little or no breakfast. Even after accounting for cardiovascular risk factors, pulse wave velocity as well as arterial thickness were, on average, highest in those skipping breakfast and lowest in those eating a high-energy breakfast. 
     
    “A high-energy breakfast should be part of a healthy lifestyle,” Dr. Tsalamandris said. “Eating a breakfast constituting more than 20% of the total caloric intake may be of equal or even greater importance than a person’s specific dietary pattern, such as whether they follow the Mediterranean diet, a low-fat diet or other dietary pattern.”
    However, Dr Tsalamandris also indicated that because most study participants followed a Mediterranean diet overall, it is unknown how the findings translate for people following different dietary patterns. 
     
    It is important to note that this research was strictly observational and that the study does not prove cause & effect. The reason for the association between a high-energy breakfast and better heart health is unclear. However researchers have offered two possible explanations, based on previous studies. One is that people who eat breakfast tend to eat healthier food overall and have fewer unhealthy lifestyle patterns such as smoking and sedentary behaviour than those who skip breakfast. Another is that the specific breakfast foods consumed in the high-energy group, such as dairy products, may benefit heart health. The research team plans to continue tracking health outcomes in the participants for at least 10 years, with a primary focus on assessing potential impact of environmental exposures.
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