TTIMES WORLD: Today's News Report

Friday, June 18, 2021
Washington, DC, USA


Surgeries Most Commonly Performed By Plastic Surgeons
Both Children and Adults

The work of plastic surgeons encompasses different parts of the body. They work with both children and adults.

1. Reconstructive surgery: It is the main job of a plastic surgery specialist and includes head & neck reconstruction, burns and trauma surgery, skin and soft tissue, breast reconstruction, cleft lip and palate surgery, and more.

2. Aesthetic Surgery: Aesthetic procedures are carried out on both men and women and much of this work is done privately. Some of the aesthetic surgeries include otoplasty, breast augmentation, eyelid surgery, liposuction and facelifts.

3. Augmentation Mammoplasty – Various surgical processes are adopted to give new shape to the breasts. The fat is transformed to breasts from different areas of the body.

4. Robot-Assisted Surgery – Robot-assisted surgery helps in performing complex surgeries with more flexibility, precision, and control. Results achieved are minimally invasive!!

5. Craniomaxillofacial Surgery – This type of surgery is used in treating diseases, injuries, and defects in the head, neck, face, and jaws. It is a globally acclaimed surgical specialty.

6. Liposuction – It is an attempt to transform the shape of the body. In such type of treatment excess fat is removed from the body with the help of surgery.

Do You Get Frequent Severe Shoulder Pains?
You May Have This Condition



Thoracic outlet syndrome is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed. This can cause pain in your shoulders and neck and numbness in your fingers.

TREATMENT – Treatment for thoracic outlet syndrome usually involves physical therapy and pain relief measures. Many people show signs of improvement with these approaches or improve completely. However, in some cases, the doctors might end up recommending a surgery.


Severe Shoulder Pain - Main symptom of this condition, often severe, may subside on its own.

WASTING IN THE THUMB – When the patient suffers from neurogenic thoracic outlet syndrome, often they experience wasting in the fleshy base of the thumb. 

NUMBNESS IN THE HANDS AND FINGERS – experience numbness in hands and fingers because of reduced blood flow to the extremities. 

DISCOLORATION OF THE ARMS N HANDS – When the arteries and veins of the shoulder get compressed, This poor circulation can also result in a weakened or even absent pulse in the arm.

Countries with Improved Healthcare System in Africa 2020
Countries with Improved Healthcare System in Africa 2020-Nigeria


Top 10 Countries with Improved Healthcare System in Africa 2020

African countries lose millions of US Dollars yearly in medical tourism.

Top 10 Countries with Improved Healthcare System in Africa 2020

Health Systems in India


Health systems in India


Report on the Health Survey and Development Committee, commonly referred to as the Bhore Committee Report, 1946, has been a landmark report for India, from which the current health policy and systems have evolved.1 The recommendation for three-tiered health-care system to provide preventive and curative health care in rural and urban areas placing health workers on government payrolls and limiting the need for private practitioners became the principles on which the current public health-care systems were founded. This was done to ensure that access to primary care is independent of individual socioeconomic conditions. However, lack of capacity of public health systems to provide access to quality care resulted in a simultaneous evolution of the private health-care systems with a constant and gradual expansion of private health-care services.2

Although the first national population program was announced in 1951, the first National Health Policy of India (NHP) got formulated only in 1983 with its main focus on provision of primary health care to all by 2000.3 It prioritized setting up a network of primary health-care services using health volunteers and simple technologies establishing well-functioning referral systems and an integrated network of specialty facilities. NHP 2002 further built on NHP 1983, with an objective of provision of health services to the general public through decentralization, use of private sector and increasing public expenditure on health care overall.4 It also emphasized on increasing the use of non-allopathic form of medicines such as ayurveda, unani and siddha, and a need for strengthening decision-making processes at decentralized state level.

Due to the India's federalized system of government, the areas of governance and operations of health system in India have been divided between the union and the state governments. The Union Ministry of Health & Family Welfare is responsible for implementation of various programs on a national scale (National AIDS Control Program, Revised National Tuberculosis Program, to name a few) in the areas of health and family welfare, prevention and control of major communicable diseases, and promotion of traditional and indigenous systems of medicines and setting standards and guidelines, which state governments can adapt. In addition, the Ministry assists states in preventing and controlling the spread of seasonal disease outbreaks and epidemics through technical assistance.5 On the other hand, the areas of public health, hospitals, sanitation and so on come under the purview of the state, making health a state subject. However, areas having wider ramification at the national level, such as family welfare and population control, medical education, prevention of food adulteration, quality control in manufacture of drugs, are governed jointly by the union and the state government.

Public health-care infrastructure in India

India has a mixed health-care system, inclusive of public and private health-care service providers.6 However, most of the private health-care providers are concentrated in urban India, providing secondary and tertiary care health-care services. The public health-care infrastructure in rural areas has been developed as a three-tier system based on the population norms and described below.7 The urban health system is discussed in the article on Urban Newborn.


A sub-center (SC) is established in a plain area with a population of 5000 people and in hilly/difficult to reach/tribal areas with a population of 3000, and it is the most peripheral and first contact point between the primary health-care system and the community. Each SC is required to be staffed by at least one auxiliary nurse midwife (ANM)/female health worker and one male health worker (for details see recommended staffing structure under the Indian Public Health Standards (IPHS)). Under National Rural Health Mission (NRHM), there is a provision for one additional ANM on a contract basis.

SCs are assigned tasks relating to interpersonal communication in order to bring about behavioral change and provide services in relation to maternal and child health, family welfare, nutrition, immunization, diarrhea control and control of communicable diseases programs. The Ministry of Health & Family Welfare is providing 100% central assistance to all the SCs in the country since April 2002 in the form of salaries, rent and contingencies in addition to drugs and equipment.

Primary health centers

A primary health center (PHC) is established in a plain area with a population of 30 000 people and in hilly/difficult to reach/tribal areas with a population of 20 000, and is the first contact point between the village community and the medical officer. PHCs were envisaged to provide integrated curative and preventive health care to the rural population with emphasis on the preventive and promotive aspects of health care. The PHCs are established and maintained by the State Governments under the Minimum Needs Program (MNP)/Basic Minimum Services (BMS) Program. As per minimum requirement, a PHC is to be staffed by a medical officer supported by 14 paramedical and other staff. Under NRHM, there is a provision for two additional staff nurses at PHCs on a contract basis. It acts as a referral unit for 5-6 SCs and has 4-6 beds for in-patients. The activities of PHCs involve health-care promotion and curative services.

Community health centers

Community health centers (CHCs) are established and maintained by the State Government under the MNP/BMS program in an area with a population of 120 000 people and in hilly/difficult to reach/tribal areas with a population of 80 000. As per minimum norms, a CHC is required to be staffed by four medical specialists, that is, surgeon, physician, gynecologist/obstetrician and pediatrician supported by 21 paramedical and other staff. It has 30 beds with an operating theater, X-ray, labor room and laboratory facilities. It serves as a referral center for PHCs within the block and also provides facilities for obstetric care and specialist consultations.

First referral units

An existing facility (district hospital, sub-divisional hospital, CHC) can be declared a fully operational first referral unit (FRU) only if it is equipped to provide round-the-clock services for emergency obstetric and newborn care, in addition to all emergencies that any hospital is required to provide. It should be noted that there are three critical determinants of a facility being declared as a FRU: (i) emergency obstetric care including surgical interventions such as caesarean sections; (ii) care for small and sick newborns; and (iii) blood storage facility on a 24-h basis.

Schematic diagram of the Indian Public Health Standard (IPHS) norms, which decides the distribution of health-care infrastructure as well the resources needed at each level of care is shown in Figure 1.

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Indian Public Health System. Reprinted with permission from National Rural Health Mission, Ministry of Health and Family Welfare, Government of India.21

On the basis of the distributional pyramid, currently there are 722 district hospitals, 4833 CHCs, 24  049 PHCs and 148 366 SCs in the country.

National rural health mission: strengthening of rural public health system

NRHM, launched in 2005, was a watershed for the health sector in India. With its core focus to reduce maternal and child mortality, it aimed at increased public expenditure on health care, decreased inequity, decentralization and community participation in operationalization of health-care facilities based on IPHS norms. It was also an articulation of the commitment of the government to raise public spending on health from 0.9% to 2-3% of GDP.8

Seeking to improve access of rural people, especially poor women and children, to equitable, affordable, accountable and effective primary health care, NRHM (2005-2012) aimed to provide effective health care to the rural population throughout the country with special focus on 18 states having weak public health indicators and/or weak infrastructure. Within the mission there are high-focused and low-focused states and districts based on the status of infant and maternal mortality rates, and these states are provided additional support, both financially and technically. Gradually it has emerged as a major financing and health sector reform strategy to strengthen the state health systems.

Major initiatives have been undertaken under NRHM for architectural correction of the rural health system—in terms of availability of human resources, program management, physical infrastructure, community participation, financing health care and use of information technology. Some of these activities are tabulated below (Table 1).

Table 1

Glimpse of activities under the National Rural Health Mission (2005–2013)
Human resources (new providers)931 239 Accredited social health activists
 27 421 Doctors at PHCs, 4078 specialists at CHCs*
 40 119 Staff nurses
 72 984 ANM
Human resources (program management)618 District Program Managers and 633 District Accounts Managers deployed
AmbulanceMore than 30 000 ambulances deployed nation wide
Community participation structure499 210 Village level Health Sanitation and Nutrition Committees (VHSNCs) created
 29 063 Patient Welfare Committees created at public facilities
Web-based mother and child tracking systemTracking 105 million mother–baby dyads
Finances providedA total of 21 billion USD invested (2005–2015) by the central government
OtherBetween 2009 and 2013, graduate medical capacity increased by 54% and post graduate medical seats by 74%

Abbreviations: ANM, auxiliary nurse midwives; CHC, community health centers; PHC, primary health center.

Source: Adapted from Quarterly NRHM MIS reports: National Executive Summary9 and Rural Health Statistics*.10

The mission emphasized on increasing health-care delivery points as well as facilities available at the health-care delivery points. It not only focused on increasing the number of physicians, specialists, staff nurses, as well as ANMs, but also gave importance to increasing the production capacity of medical colleges at graduate and post graduate levels. Physical infrastructure was enhanced by creating more health centers, newborn care units and renovating existing centers, which increased the capacity of health systems to treat more mothers and children. Special efforts were made to strengthen community participation through the formation of health committees at the village level and patient welfare committees at public health-care facilities. Information technology was used to track delivery of services to the mother and child. And all this has been an outcome of increased financial assistance by the central government and increased rates of utilization. During the period 2005-2013, the total investment by the central government equalled nearly 17 billion USD.

National programs and initiatives for newborn health

In India, major policies and national programs are planned and implemented during the 5-year planning phase. Despite the fact that no explicit programs on newborn care have been designed in the past, various programs and the 5-year plans in the country had focused on provision of services for mothers and children.111213141516171819 The launch of the CSSM program in 1992, for the first time included an essential newborn care component, and specifically integrated newborn care in the maternal and child health program. Thereafter, newborn care started receiving more attention and resources in the subsequent programs and initiatives.

Under NRHM, newborn health received unprecedented attention and resources with the launch of several new initiatives aimed at reducing the burden of maternal and newborn mortality and morbidity.

In February 2013, the government launched the strategic approach, reproductive, maternal, newborn, child and adolescent health (RMNCH+A),20 to accelerate actions for equity, harmonization and improved coverage of services. Although the RMNCH+A approach recognized that newborn health and survival is inextricably linked to women's health, across all life stages, it also clearly emphasized interlinkages between each of the five life stages with adolescent health as a distinct life stage, and connected community, outreach- and facility-based services. On the basis of this approach, the central government has taken vital policy decisions to combat major causes of newborn death, providing special attention to sick newborns, babies born too soon (premature) and too small (small for gestational age).

Specific interventions for the newborn included under the RMNCH+A strategy include:

  1. Delivery of antenatal care package and tracking of high-risk pregnancies;

  2. Skilled care at birth, emergency obstetric care and postpartum care for mother;

  3. Home-based newborn care and prompt referral;

  4. Facility-based care of the sick newborn;

  5. Integrated management of common childhood illnesses (diarrhea, pneumonia and malaria)

The strategy identifies the roles to be played at each level of care and the service provision and health systems requirement in terms of manpower and commodities for each of them. (Figure 1)212223 SCs and PHCs are designated as delivery points; CHCs (which are the FRUs) and district hospitals have been made functional 24 × 7 to provide basic and comprehensive obstetric and newborn-care services. Only those health facilities are designated as FRUs that have the facilities and manpower to conduct a caesarean section. Moreover, the strategic document identifies the required capacity building efforts for which NRHM has produced manuals. So far out of 116 capacity building manuals, 10 are dedicated to newborns. The document also has the guidance for reaching remote inaccessible areas to ensure maternal and child Health care.

One of the key aspects of the document and one that certainly contributes to its comprehensive nature is the involvement of various stakeholders in its development. Apart from the core drafting team of the Ministry of Health and Family Welfare, the technical support team is represented by the development partners, academic partners, practitioners, nationally and internationally. This has proved to be an important step for wider adaptation of processes and is crucial for implementation success.


India has been focussing on providing comprehensive care to mother and child. It has framed policies that allow the design and implementation of programs on newborn care in an inclusive manner. However, looking at the pace of achievements of the targets so far and future targets, it needs to focus more on framing of the policies in terms of building capacity of existing human resources, enhancing further allocation of finances dedicated toward newborn care, identifying areas through operational research, which can enhance quantity and quality of care for newborn care in India. The path is set and we need to operationalize and move forward.

Do You Suffer From Frequent Stomach Pains
You May Have Heart Burn - See Foods To Aviod

By Dan Austin MD
Internal Medicine

If you are the one who experiences heartburn occasionally, then you should avoid the below-mentioned foods as they can exacerbate the issue. Start avoiding these foods now if you don’t want to feel the pain of heartburn later:

1. FRIED FOOD – The biggest factor responsible for heartburn is fried food, both meat and vegetables. Fried foods aggravate your digestive system and lead to heartburn and acid reflux.

2• FAST FOOD – Fast food is full of fat, sugar and calories. So, along with this, there are many reasons why you should avoid fast food. It not only upsets your stomach but also it causes heartburn.

3• TOMATOES & TOMATO BASED SAUCE – Tomato based foods such as ketchup, marinara sauce and tomato-based soups are naturally acidic and they are not good for your stomach. Too much acid in the stomach may cause some to splash back into your esophagus.

4• CHOCOLATE – Chocolate does not mean only the chocolate bars, instead of all the decadent foods. Chocolate contains three things: cocoa, caffeine and fat. These three are the biggest responsible factor for heartburns.

5• FRUITS JUICES – The citric acid in the fruit relaxes your esophageal sphincter. Oranges and grapefruit, in particular, contribute to heartburn by making the symptoms worse.

If you pain persist and you need More Information, contact us at or visit to find an Internal Medicine or a Gastroenterology doctor in your area.

Helping Your Kids Avoid Backpack Injuries
Tips That Can Make A Difference - Dan E. Austin MD

Helping Your Kids Avoid Backpack Injuries
Children carry heavy load of backpack on their shoulders during school years. However, most parents and children are unaware of the potential injury caused by too-heavy packs.
While backpacks are considered the most efficient way to carry books and other items kids need for school, it's important they weigh less than 15 percent of a child's body weight. Children can experience back pain and soreness for carrying heavy bags. These problems can lead to more chronic problems that may require medical treatment.
Our orthopedic specialist in Fairfax, VA offers some advice to reduce the back and shoulder pain that as many as half of all school children experience each year.
• PACK ONLY WHAT IS REALLY NEEDED – Though this step requires few practice and reminders, and this becomes especially important once your child reaches middle school. Keep a check that your child daily carries the books and other items as prescribed in the timetable. Students have multiple textbooks and will be expected to tote them to and from class on a daily basis.
• LIMIT THE WEIGHT TO 15% OF BODY WEIGHT – Some kids decide to carry their entire curriculum books in the backpack. A child weighing 100 pounds should carry no more than 15 pounds. When you consider that the average book weighs 3-5 pounds, by the time your child has a few books, notebooks, and a water bottle, they’ve likely exceeded the safe zone. This is the reason why many schools maintain a daily timetable to reduce the number of books being carried to school each day.
• DISTRIBUTE THE WEIGHT EVENLY – Encourage your child to wear both straps of the backpack across the shoulders as it will minimize stress on the spine and back muscles. If ever it happens that the weight of the backpack exceeds the 15% rule, it is advisable to remove few books from the backpack and carry those in your hands to help more evenly distribute the weight.
• SELECT THE PROPER BACKPACK – You can enhance comfort and safety by purchasing a backpack that has multiple compartments so that the weight gets evenly distributed. Padded straps can also help prevent straps from cutting into shoulders. Newer backpacks with wheels are also an option, provided that the handle extends long enough to allow children to stand upright while pulling it. And at the same time, they should also be sturdy enough so that they do not topple over.
• LIFT PROPERLY & MINIMIZE BACK INJURIES – Whenever you are picking up the backpack and you know that it has ample of weight, make sure to bend at the knees and then lift it onto your shoulders.
Pain and injuries caused by backpack can be avoided. Always encourage your child to pay attention to these issues and take care of them. The backpack is a school supply item that has an important role in your child’s physical health. If you need advice on backpack-related problems or looking for back injury treatment for your child, you can schedule appointment with one of the renowned orthopedic specialists in Fairfax, VA or your local area at An orthopedic specialist is dedicated to the evaluation, diagnosis and treatment of orthopedic diseases, disorders and injuries. They treat children to help minimize back injury or strain so that they can stay focused on learning.

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Arthritis and Disability
What You Can Do to Improve Life Style

Arthritis Today
Time to Take Action!

Everyone knows someone with arthritis. It is a leading cause of disability, and causes pain, aching, stiffness, and swelling of the joints, but is not a normal part of aging. The most common types are osteoarthritis, rheumatoid arthritis, gout, lupus, and fibromyalgia. Arthritis costs at least $81 billion in direct medical costs annually. Many adults with arthritis are prescribed opioid medicines, yet other options for pain are safer. Physical activity can decrease pain and improve physical function by about 40% and may reduce healthcare costs. Still, 1 in 3 adults with arthritis are inactive. Adults with arthritis also can reduce their symptoms by participating in disease management education programs. Only 1 in 10 have taken part in these programs. Adults with arthritis are significantly more likely to attend an education program when recommended by a provider.

Healthcare providers can:

Urge patients with arthritis to be physically active and to strive for a healthier weight to ease joint pain.
Recommend patients attend proven educational programs about managing their condition.
Ask patients about any depression or anxiety, and offer care, treatment, and links to services.
Consult the guidelines of the American College of Rheumatology or other professional organizations for treatment options, including medicines.

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