Planning Commission of India-Access to Health systems including AYUSH

Working Group on


“Access to Health Systems including AYUSH”
Government of India

Planning Commission
D.O. No.G-20018/3/2006-P&E

July 31, 2006

Dear


Planning Commission has constituted a Working Group on “ Access to Health Systems including AYUSH” under the chairmanship of Secretary (AYUSH). Secretary (AYUSH) in turn had constituted Sub-Groups on following five issues:


(i) AYUSH Education.

(ii) Standardization and Quality Control of AYUSH drugs.

(iii) Research & Development.

(iv) Medicinal Plants.

(v) Mainstreaming of AYUSH.


The above Sub-Groups have submitted their reports which were discussed in the meeting of the Working Group chaired by Secretary (AYUSH) recently (Minutes enclosed). On the basis of a discussion in the Working Group and the Sub-Groups the Department has formulated its 11th Five Year Plan proposals. The change in priorities and schemes in the 11th Plan are reflected in the introduction chapter. The Department proposes to scale up Plan provision for Department of AYUSH from Rs.1057.26 crore (actual expenditure of first four years of the 10th Plan and B.E. of 2006 – 2007) to Rs.2473.45 crore in 11th Plan. The Department has been very cautious and realistic in making its Plan projections and it is hoped that by improving utilization of Plan funds and the quality of Plan expenditure the Department would be able to come back to the Planning Commission for raising its Plan provision midway during the 11th Plan.


Please find enclosed herewith the proposals of the Department of AYUSH for 11th Five Year Plan for AYUSH sector which have been duly approved by Secretary (AYUSH).


I am also enclosing the copies of the reports of the 5 Sub-Groups constituted by Secretary (AYUSH) on the above mentioned five subjects. The 11th Five Year Plan proposals alongwith the 5 reports of the Sub-Groups may be treated as report of the Working Group on “Access to Health Systems including AYUSH” constituted by the Planning Commission under the chairmanship of Secretary (AYUSH)..


With regards,


Yours sincerely,



( SHIV BASANT )

Prof. N.K. Sethi,

Adviser (Health), Planning Commission,

Yojana Bhawan,New Delhi.




INTRODUCTION


Department of Indian Systems of Medicine and Homoeopathy (ISM&H) was established in 1995 and renamed as Department of Ayurveda, Yoga & Naturopathy, Siddha, Unani and Homoeopathy (AYUSH) in November, 2003. There has been a three fold increase in the Plan budget of the Department in the 10th as compared as 9th Plan, most of which was on account of scaling up of the budget provision in the last two years of the 10th Five Year Plan i.e. 2004 – 2005 and 2005 – 2006 in line with the declared policy of the Central Government to increase the budgetary provision for AYUSH sector for mainstreaming it in the national health care delivery network.


Department has utilized the increased budget provisions in the 10th Plan for raising standards of AYUSH education, upgradation of national institutes set up by the Department to lay down benchmarks for teaching, research and clinical practices of different systems. With a view to prevent the mushroom growth of sub-standard colleges, the Indian Medicine Central Council and Homoeopathic Central Council Acts were amended in 2003 to provide for prior permission of the Central Government for establishing new colleges, starting new and higher courses, increase in the admission capacity in Ayurveda, Siddha, Unani and Homoeopathy colleges. The Centrally Sponsored Schemes of Strengthening of Institutions was effectively utilized for providing assistance to Government and Government aided colleges for ensuring conformity with the minimum infrastructural standards laid down by the statutory bodies. The Department would like to develop Government, Government aided and private but not for profit AYUSH colleges to the level of Centre of Excellence by providing enhanced scale of assistance on the basis of college specific upgradation plan which will clearly outline the responsibility of the college management and the State Governments for effective utilization of central assistance to be provided in the 11th Plan for the upgradation of these colleges.


Department of AYUSH attaches very high priority to laying down of pharmacopoeial standards for single and compound formulations, scientific validation of herbo-metallic compounds, standardization and quality control of AYUSH drugs. It is proposed to set up a Pharmacopoeial Commission for Indian Medicine in the 11th Plan which will be housed in the newly constructed building of the Pharmacopoeial Laboratory of Indian Medicine, Ghaziabad. The basic objective is to create an independent scientific body which will undertake laying down of pharmacopoeial standards and their revision from time to time on a more permanent footing. The Centrally Sponsored Scheme of Drugs Quality Control in the 10th Plan was utilized for providing financial assistance to the State Drug Testing Laboratories and State Pharmacies. The experience has not been a happy one as inspite of provision of financial assistance, State Drugs Testing Laboratories have been functioning at a sub-optimal level due to a variety of managerial problems. Offtake under the strengthening of enforcement mechanism component has also been very poor. The Department would like to shift the emphasis in the 11th Plan from strengthening of State Drug Testing Laboratories to utilization of a vast network of NABL accredited laboratories all over the country for random testing of Ayurveda, Siddha and Unani drugs and Homoeopathic mother tinctures for ensuring quality control of AYUSH medicines. It is proposed to modify the existing drug quality control scheme to provide financial assistance to States in terms of reimbursement of expenditure incurred by them on random testing of AYUSH medicine through NABL laboratories. The Department has enforced Good Manufacturing Practices and mandatory testing of heavy metals for export of purely herbal Ayurveda, Siddha and Unani medicines. Hon’ble Members of Parliament and informed sections of the public are also pressing for mandatory testing of AYUSH medicines for domestic consumption as well which would require in-house quality control laboratories in most of the AYUSH manufacturing units. A large number of AYUSH manufacturing units fall in the small and medium scale, it is felt that without a liberal financial assistance from the Government they would not be able to purchase costly equipments like Atomic Absorption Spectrometer for testing of heavy metals, TLC/HPTLC/GLC for testing of crude drugs. Therefore, it is proposed to provide backended subsidy of Rs.50.00 lakh or 50% of the project cost whichever is less to Ayurveda, Siddha and Unani drug manufacturing units for acquisition of requisite equipments and instruments for enabling them to test their ingredients, their raw materials and finished products inhouse. The subsidy would be released only through scheduled banks on the basis of a certificate to be issued by State Licensing Authority or any NABL Laboratories to the effect that the concerned manufacturing unit has obtained the requisite equipments and has started inhouse testing of raw materials and medicines. This assistance will be provided only to those units which has an annual turnover not exceeding Rs.25.00 crore. Units whose annual turnover exceeds Rs.25.00 crore should be able to avail of soft known facilities under the Pharma Development Fund which is administered by the Department of Science & Technology. As regards the State Drug Testing laboratories for which 1st instalment of upgradation grants has been released in the 10th Plan would be eligible for 2nd and 3rd instalment in the 11th Plan on proper utilization of funds.


Mainstreaming of AYUSH is one of the key strategies under the National Rural Health Mission (NRHM) under which it is envisaged that all PHCs/CHCs would be provided AYUSH facilities under the same roof. While the AYUSH manpower would be arranged either by relocation of AYUSH doctors from existing dispensaries or from contractual hiring of AYUSH doctors under NRHM funds. The other infrastructure and supply of medicines to PHCs/CHCs would be done through the Centrally Sponsored Scheme of Hospitals and Dispensaries which has received a very good response from States in the last two years of the 10th Plan. Hence, it is proposed to substantially increase the Plan provision for this scheme to Rs.625 crore in 11th Plan. A minor modification in the scheme for providing upgradation and assistance to existing AYUSH hospitals and dispensaries is also proposed.


The need for in-situ conservation and promotion of ex-situ of medicinal plants cannot be over emphasized. On the basis of the recommendations of the Task Force of Planning Commission the National Medicinal Plants Board (NMPB) was set up in the 10th Plan which is still grappling with infrastructural constraints. However, the National Medicinal Plants Board has been able to provide a strong impetus to medicinal plants sector through promotional and contractual farming schemes. Keeping in view the vast experience and constraints in the implementation of these two schemes, it is now proposed that the promotional and conservation scheme of the NMPB would be continued as Central Sector Scheme while the contractual farming scheme should be converted into a Centrally Sponsored Scheme for better monitoring and implementation by the State Medicinal Plants Board (SMPB). It has been felt that the States have not strengthened their Medicinal Plants Board as NMPB has been directly implementing the contractual farming scheme as a Central Sector Scheme. Conversion of this into Centrally Sponsored Scheme will provide the right impetus to the States to strengthen their SMPBs for better planning, implementation and monitoring of the contractual farming scheme which has a huge potential of generation of additional employment and income to the farmers through crop diversification. The Central Sector Scheme of the NMPB will concentrate on conservation/regeneration through joint forest management committees in forest areas, establishment of Gene Bank and community herbal gardens, etc. Whereas the Centrally Sponsored Scheme would encourage cultivation by farmers and provision of post harvest management and marketing support by State Medicinal Plants Boards and other State agencies in collaboration with National Medicinal Plants Board. Accordingly it is proposed to scale up the plan financing of the NMPB from approximately Rs.134.64 crore to Rs.465 crore in the 11th Plan.


AYUSH research councils have done a lot of research based on survey of medicinal plants and observatory clinical trials. Department has been emphasizing on focused, protocol based and peer reviewed research in a specified time frame and with specified outcomes. The major hindrance in the working of the AYUSH research councils has been non-implementation of the flexible complimentary scheme made applicable to other scientific institutions for in-situ Assured Career Progression as a result of which AYUSH councils are not able to attract talent. This matter has been taken up with the Department of Personnel & Training and Ministry of Finance on a number of occasions without much success. It is hope that the Sixth Pay Commission on the anvil will be able to address this anomaly. Another area of weaken of the AYUSH research councils has been lack of adequate equipments and good laboratories for standardization and quality control work. The Department has now entrusted the Pharmacopoeial work to the AYUSH research councils so that laying down of pharmacopoeial standards and SOPs can be attended to on a sustained basis in a scientific environment. Keeping in view the requirements for upgradation of various peripheral units of the research councils, it is proposed to scale up the Plan provisions** of Central Council for Research in Ayurveda and Siddha (CCRAS) from Rs.54.37 crore to Rs.100.00 crore in 11th Plan, for Central Council for Research in Unani Medicine (CCRUM) from Rs.59.45 crore to Rs.90.00 crore and for Central Council for Research in Homoeopathy (CCRH) from Rs.37.39 crore to Rs.77.50 crore.


** Plan Provision indicates actual Plan expenditure of that 1st four years of 10th Plan and Budget Estimates of 2006-07.

Suitable scaling up of Plan outlays for other Central Sector Schemes of the Department, namely, IEC and International Exchange is also proposed. The proposal for setting up of a National Ayurveda Hospital in Delhi and North-Eastern Institute of Ayurveda and Homoeopathy was conceived in the 10th Plan. Land has also been acquired for the National Ayurveda Hospital in Delhi and detailed project reports for these projects are being revised keeping in view the advice received from Expenditure Finance Committee. A Plan provision of Rs.75.00 crore for National Ayurveda Hospital in Delhi and another Rs.75.00 crore from out of that 10% NE corpus for North-Eastern Institute of Ayurveda and Homoeopathy is proposed in the 11th Plan.


The Department has showed in the last two years of the 10th Plan that it has the capacity to plan for and utilize higher Plan allocation in priority areas of strengthening of AYUSH institutions, standardization and quality control of AYUSH medicines, mainstreaming of AYUSH in national health care delivery network and focussed research for meeting national health goals. Keeping in view the enhanced Plan provisions a second post of Joint Secretary was sanctioned in the Department for strengthening planning, coordination and monitoring of various Central Sector and Centrally Sponsored Schemes. The posts of Directors, CCRUM/CCRAS/CCRH and the posts of Director of National Institutes were upgraded in the last two years of the 10th Plan and the proposal to upgrade the post of Director, PLIM to the Joint Secretary level is on the anvil. Due to sustained efforts, the Department has been able to find regular Directors for its research councils and autonomous institutions and fill up such vacancies timely. The Department of AYUSH has been maintaining a constant dialogue with all the stakeholders including the AYUSH industry. Successful launching of the Golden Triangle research initiative in collaboration with the ICMR, CSIR and creation of Traditional Knowledge Digital Library (TKDL) for defensive protection of ASU classical formulations from misappropriation are indicative of the fact that the Department of AYUSH has been providing effective leadership and momentum to the scientific validation and mainstreaming of AYUSH systems in the national health care delivery network. Keeping in view the tremendous potential of these systems for better health care for Indian citizens and for obtaining a better share of the world herbal market, these systems need to be supported by a quantum jump in Plan funding of the various Central Sector and Centrally Sponsored Schemes of the Department of AYUSH. Accordingly, it is proposed to scale up Plan provision for Department of AYUSH from Rs.1057.26 crore in the 10th Plan to Rs.2486.45 crore in the 11th Plan. The Department has been very cautious and realistic in making its Plan projections for 11th Plan and it is hoped that by improving utilization of Plan funds and the quality of Plan expenditure the Department would be able to come back to the Planning Commission for raising its Plan provision midway during the 11th Plan.


*****

Fibromyalgia

People with the condition can experience unbearable pain


Fibromyalgia is a condition which causes widespread pain and severe fatigue.
It cannot be treated, and people with the condition have to find ways of managing their symptoms.

What is fibromyalgia? The term combines "fibro" - which means fibrous, with "my" - muscles and "algia" - pain.

It is a collection of symptoms, rather than a specific disease.

As well as pain and fatigue, it can cause headaches or migraines, irritable bowel syndrome and can affect sleep.

Although other conditions, such as chronic fatigue syndrome, can lead to similar symptoms, fibromyalgia is defined as widespread pain for at least three months which is experienced in at least 11 specified points around the body.

If people are severely affected, it can limit their ability to work or have an active social life.

What causes the syndrome?

It appears that it is usually triggered by some kind of trauma, such as a car accident, a viral infection or an operation, although some cases develop without any obvious trigger.

Researchers are still investigating the actual cause of fibromyalgia.
However, scientists have suggested a deficiency in levels of the brain chemical serotonin, which helps deliver messages between cells in the brain.

This can lead to a problem in the way the brain processes messages about pain, meaning people feel pain where others might experience a slight ache or stiffness.

Are there treatments available?

Many people are offered drugs normally used to treat depression. Given at much lower doses, this class of drugs, called tricyclics, blunt pain messages to the brain.

Others use over-the-counter pain-relief medications, or receive treatment at a pain clinic.

Understanding how to relieve symptoms is crucial, experts say.

The Fibromyalgia Association recommends using relaxation techniques.
It also says that heat, from hot water bottles, baths or showers or even soaking hands and feet for a few minutes can relieve overnight symptoms.

Stretching and aerobic exercise can also help.
The association says the most important thing is for people to listen to their bodies, and to slow down when they need to.

Nutrional facts about Salt

Bread is a major source of salt


Campaigners say it is important for people to cut the amount of salt they eat in their diet.Too much salt is linked to high blood pressure, which is turn can increase the risk of heart attacks and strokes.

The government watchdog the Food Standards Agency announced targets for reducing salt in a range of food products in 2006.

Why do we need salt?

Salt is a commonly occuring mineral, the technical name of which is sodium chloride. It is the sodium part of salt that is important. The body needs a certain amount of sodium to function properly.

Sodium helps to maintain the concentration of body fluids at correct levels. It also plays a central role in the transmission of electrical impulses in the nerves, and helps cells to take up nutrients.

Why is too much salt bad?

In adults, when levels of sodium are too high, the body retains too much water and the volume of bodily fluids increases.

Many scientists, although not all, believe this process is linked to high blood pressure, or hypertension, which in turn is linked to a greater risk of coronary heart disease and stroke.

With high levels of fluid circulating through the brain there is a greater chance that weaknesses in the brain's blood vessels are exposed, and that they may burst, causing a stroke.

Similarly, a greater volume of fluid passing through the heart can place additional strain on the organ, increasing the possibility of coronary disease.

However, there are many potential causes of hypertension and coronary heart disease, and some scientists deny that salt plays any significant role at all.

An adult will be able to remove salt from the body through the kidneys into the urine.

However, very young babies do not have the capacity to process large quantities of salt as the kidneys are not yet developed.

If they are given adult food with a higher salt content before they are at least four months old, excess sodium can accumulate in the body, causing kidney, liver and brain damage, and in very occasional cases, death.

It is recommended that babies are given only milk, whether breast or formula, for the first four months of life.

Baby foods are supposed to contain lower levels of salt, and it is recommended that if adult foods are to be given, unprocessed foods should be used, and no salt added.

How much salt should we eat?

The government recommends that adults should eat 6g of salt a day. However, the average intake of salt is between 9g and 10g a day.

Experts estimate that if average consumption was cut to 6g a day it would prevent 70,000 heart attacks and strokes a year.

The main sources of salt in the diet are processed foods and salt added during cooking or at the table. Meat and meat products, and bread can also be high in salt.

Processed foods are thought to account for around 75% of the average person's salt intake.

However, research published in The Lancet medical journal suggested that most people could not tell the difference between loaves with markedly different salt content.

Salt is added to processed foods to aid preservation and to improve taste. Sodium is present in additives such as monosodium glutamate and sodium bicarbonate.

Small amounts of sodium can be found naturally in some foods such as eggs and fish.

The salt we sprinkle on our food from cellar accounts for only 10%-15% of our intake.

What action has the Food Standards Agency taken?
It drew up targets for the food industry to cut the salt content of a range of 85 products.

The aim was that if the targets were enforced, the average daily intake of salt would fall to the recommended level of 6g.

However, the targets were voluntary, and campaigners said they were not set at a sufficiently tough level. They argued that even if followed by the food industry they would result in an average daily intake of 8g, rather than 6g.

Professor Graham MacGregor, of Cash (Consensus Action on Salt and Health), said that would mean an extra 30,000 more strokes and heart attacks a year in the UK - 15,000 of which would be fatal.

What should we do?

Dr Wynnie Chan, a nutrition scientist for the British Nurtrition Foundation, says that everybody should look to reduce the amount of salt in their diet.

"It would have a significant effect on those people who need to reduce their salt levels because they are susceptible to hypertension, but it would also do no harm for the whole population to reduce its salt intake," she said.

Dr Chan said there were four main ways to reduce salt intake:


*Stop adding table salt to food once it is served

*Choose items with a reduced sodium content

*Carefully monitor the salt content of processed food

*Eat more fruit and vegetables - they contain potassium which balances the effect of salt on the body

Reading food labels can be confusing as they often give the sodium, rather than the salt content of food. To calculate the amount of salt in a product, multiply the sodium content by two-and-a-half times.

Motor neurone disease

Motor neurone disease is a progressive fatal condition that causes muscle wastage.
It is most common among people aged 50 to 70, and tends to affect men slightly more than women.

--------------------------------------------------------------------------------

What is motor neurone disease?

Motor Neurone Disease (MND) is a group of related diseases affecting the motor neurones in the brain and spinal cord.Motor neurones are the nerve cells along which the brain sends instructions, in the form of electrical impulses, to the muscles.

Degeneration of these cells leads to weakness and wasting of muscles.Some groups of muscles are more affected than others.

What are the symptoms?

The symptoms are usually first apparent in the arms or legs. Initially, they tend to be mild, and can include stumbling and difficulty holding objects.

Weakness and wasting in the muscles supplying the face and throat can also lead to problems with speech and difficulty chewing and swallowing.

In the advanced stages of the disease, a patient may become almost totally immobile. The rate of progression of the disease, however, varies enormously from patient to patient.

On average the disease takes three to four years to run its course.

Some surveys indicate that 50% of MND patients may be living three years after diagnosis, 10% after 10 years and some live for more than 20 years.

There are no remissions but people may experience a "plateau" lasting weeks or months while no deterioration occurs.

MND usually has no impact at all on intellect or memory.

The disease also has no impact on the five senses of sight, hearing, taste, smell and sensation.The bowels and bladder are not affected by the disease, but diet and exercise should be carefully monitored.

What causes MND?
The cause of the disease remains a mystery.

How is it diagnosed?

The disease is often difficult to diagnose.

It may be necessary to review patients for some time before diagnosis becomes relatively certain.

A GP may suspect the neurological problem, but confirmation of the diagnosis by a neurologist is necessary.

A range of tests are needed to rule out other conditions.

Often an Electromyograph (EMG) is used, in which a needle is inserted into various muscles to measure their electrical activity. Sometimes a muscle biopsy will be carried out so that a small sample of muscle can be examined under a microscope.

Can it be treated?

At present there is no cure.

However, a great deal can be done to improve the comfort and well being of people who have MND.

Watchdog warns over apricot seeds

Some claim apricot seeds can cure cancer.Apricot stones sold for health benefits could be fatal in high doses, the food safety watchdog has warned.

Apricot kernels are thought to contain high levels of vitamin B17, which is described as an immune system booster and even sold as a cancer treatment. But the Food Standards Agency said they also produce cyanide and can be poisonous in high doses.

It is now recommending that people consume no more than two bitter apricot kernels in a single day.

An FSA spokesman said there were reports from overseas of "very serious health effects" being associated with the consumption of 20 to 30 kernels in a short period of time.

He added: "They could be potentially lethal in high enough doses."

If simply eating apricot seeds could cure cancer, no one would be more delighted than us

Cancer Research UK
Natural food retailer Julian Graves was selling packs with a recommended daily dose of 10 kernels and has since pulled them from its shelves.

It said it had begun selling the apricot kernels due to customer demand and would do so again with a revised recommended dosage if the food watchdog gave it permission.

The seeds however are also available through specialist websites.

Cancer Research UK says of vitamin B17: "According to claims made on the Internet, this substance found in apricot pips is a highly active compound that can cure cancer.

"Unfortunately this is simply not true. The whole reason for the existence of Cancer Research UK is to find cures for cancers.

"If simply eating apricot seeds could cure cancer, no one would be more delighted than us."

Food chemicals 'may harm humans'

Scientists are divided over whether the chemicals can be harmful
Low levels of man-made chemicals in basic foods such as brown bread, butter and milk could combine to harm humans, a conservation charity has warned. WWF-UK said scientific tests link the chemicals to hormonal changes, cancers and immune deficiencies.

Dutch research suggests low levels of the chemicals are found in food from the environment or packaging.

However, some scientists have questioned whether the small quantities involved present a danger to health.

We should not be complacent about the presence of these chemicals in foods and should keep trying to reduce the levels

Professor Alan Boobis, of Imperial College London

The Dutch scientists found low levels of pesticides, flame retardants, non-stick chemicals, artificial musks used to scent products and phthalate chemical compounds used in plastics were present in food.

Further research at the London School of Pharmacy suggests low doses can work together to produce a significant combination.

Tests on animals and human cells show they might be a factor in various serious medical conditions.

Paul King, director of campaigns for WWF-UK, said: "While each item of food we tested is probably safe to eat on its own, taken together over long periods of time the food we eat contributes significantly to our body burden of chemicals."

The organisation is now calling for strict controls on the use of chemicals to be introduced by the European Parliament.

'Balanced view'

But Professor Alan Boobis, of Imperial College London, is among a number of toxicologists who have played down the research.

He said: "We should not be complacent about the presence of these chemicals in foods and should keep trying to reduce the levels.

"But we should also maintain a balanced view about whether these trace amounts represent a risk to the consumer and I don't believe that at these levels they represent a significant threat to human health"

And toxicologist Professor John Henry, of St Mary's Medical School, London, said WWF-UK was well intentioned but it had not demonstrated that the chemicals cause harm.

The Food Standards Agency and the chemical industry said levels of individual chemicals are not harmful but they are looking into how they add up in people's diets.

Steve Elliott, chief executive of the Chemical Industry Association, added the public should not be "overly concerned".

"I think there is a significant among of work that needs to be done to look at the additive effect in terms of how one substance might react with another and the ultimate product of that reaction."

Courtessy:BBC Health-Medical Notes

Hairspray linked to "Birth defect"

Hairspray exposure was linked to a condition called hypospadias
Boys born to women exposed to hairspray in the workplace may have a higher risk of being born with a genital defect.

Imperial College London scientists talked to women who had babies with hypospadias, where the urinary tract is found away from the penis.

They reported that hairspray exposure more than doubled the risk.

The study in the journal Environmental Health Perspectives, said it was too early to say for certain that hairspray was the cause.

Pregnant women will need to make their own choices about whether or not to avoid these kind of exposures

Professor Paul Elliott
Imperial College London

The incidence of hypospadias has risen sharply in recent decades, and some experts have pointed the finger of suspicion at chemicals called phthalates, found in some plastics, including those found in hairspray.

Phthalates have the ability to disrupt hormones, and have been banned in toys in the EU for some years.

Certain phthalates have also been banned from hairsprays and other cosmetic products since January 2005.

However, no study has found a convincing link between women exposed to them and problems in their children.

The latest study looks not at personal use of hairsprays, but at their use, potentially in higher doses, by workers such as hairdressers and beauty therapists.

A total of 471 women whose babies had been born with hypospadias were interviewed, as were a similar number of women with unaffected children.

The women gave birth in 1997 and 1998 and were interviewed between 2000 and 2003.

Roughly double the number of women in the "hypospadias" group revealed that they had been exposed to hairspray through their job compared with those with unaffected babies.

No proof

However, Professor Paul Elliott, who led the study, said that the finding did not prove that hairspray - or any phthalates it contained - was the cause of this.

He said: "Women shouldn't be alarmed. This study adds a bit more evidence to the general picture about these chemicals, but more research will be needed to demonstrate that the link exists.

"Pregnant women will need to make their own choices about whether or not to avoid these kind of exposures."

Professor Andreas Kortenkamp, the head of the Centre for Toxicology at the School of Pharmacy, University of London, said that it was "important research"

He said that the UK government should consider taking the approach used by the Danish authorities, which has issued advice to women about the evidence linking phthalates to health problems.

He said: "I don't think we can continue to leave women alone to make decisions about these things - they need a bit of guidance, to know where these chemicals are.

"Certainly, if this was the mother of my children who was pregnant, I would strongly advise her to stay away from these."

Leap of faith

Professor Richard Sharpe, from Edinburgh University, said it was a "big leap of faith" to conclude phthalates were to blame for birth defects.

He said research had shown phthalates could suppress production of the male sex hormone testosterone - which plays a role in penis development - in some animals, but evidence that it had the same effect in humans was inconclusive.

"My advice has long been that women who are planning a pregnancy should avoid (or at least minimise) use of cosmetics, body creams/lotions etc, especially in the first three months of pregnancy.

"This is not because we know that the ingredients can do harm to the baby, but because it can only do good for the baby to avoid unnecessary chemical exposures."

Another finding of the study provides further backing of the government's recommendation that pregnant women should take extra folate to prevent similar defects to hypospadias, which arise early in pregnancy.

Women who took folic acid in the first three months of pregnancy were a third less likely to have a baby with hypospadias, according to the study.

Preventive Medicine Update

The Importance of Breast health
-Kris Somol, ND

Breast health is an important component of a woman's overall wellness. Women frequently seek medical advice when they are concerned about breast discharge, lumps, size, pain and changes to the skin. While many changes in the breast are related to hormone shifts during menstruation, changes that are not cyclical deserve a conversation with your physician. The primary step a woman can take to maintain breast health is to take the time to understand the anatomy of the breast and schedule regular physical exams.

Women can help with the early detection and treatment of breast cancer by playing an active role in their own health care. While there are some different recommendations from medical organizations on the value of breast self-exams, all women's health organizations agree about the value of annual clinical breast exams, and the importance of regular mammograms after the age of 40.

Over the past three decades we have seen a reduction in breast cancer death in some populations from improved methods of early detection, primarily through the use of mammogram screening. However, there also has been a rise in breast cancer deaths among economically disadvantaged women, indicative of the reduced use and access to health-care resources.

In an effort to address this rise in cancer in some populations, the Washington Breast and Cervical Health Plan provides funding for women ages 40 to 64 to receive annual screening exams and mammograms. Each year, nearly 60,000 women are eligible for this program, which is available at Bastyr Center for Natural Health and other clinics throughout King County. Bringing questions and concerns to a doctor's attention, women can make informed decisions to improve their health.

-- Kris Somol, ND, resident in naturopathic medicine Bastyr Center for Natural Health

Nutrion Update

THE DIETARY MANAGEMENT of PEPTIC ULCER and ULCERATIVE COLITIS
STEWART WOLF M.D.
Department of Medicine, University of Oklahoma School of Medicine and the Oklahoma Medical Research Foundation, Oklahoma City, Okla



Evidence is presented which suggests that settings of anxiety and tension can nullify the beneficial effects of a high fat meal on gastric acidity and motility. One should not count very heavily on the inhibitory effects of diet in peptic ulcer when the stomach is under stimulation from stressful situations in the patient's daily life. There is also a great need to study the true effects of certain so-called irritating foods, condiments, and chemicals on the stomach. In a fistulous subject, the direct application of commonly accepted irritants produced fewer and lesser changes in the stomach than on the skin.

Similarly, the colon in ulcerative colitis responds more violently to certain situational stimuli than to foods and fecal contents.

Courtessy: American Journal of Clinical Nutrition

Malaysia's top Islamic body bans yoga for Muslims

Malaysia's top Islamic body bans yoga for Muslims
22 Nov 2008, 1007 hrs IST, AP


KUALA LUMPUR: Malaysia's top Islamic body on Saturday banned Muslims from practicing yoga, saying the Indian physical exercise contains elements of
Hinduism and could corrupt Muslims.

The National Fatwa Council, which has the authority to rule on how Muslims must conduct their faith, issued a fatwa, or edict, saying yoga involves not just physical exercise but also includes Hindu spiritual elements, chanting and worship.

Council chairman Abdul Shukor Husin told reporters that many Muslims who practice the globally popular yoga failed to understand that its ultimate aim was to be one with a god of a different religion.

``We are of the view that yoga, which originates from Hinduism, combines physical exercise, religious elements, chanting and worshipping for the purpose of achieving inner peace and ultimately to be one with god,'' he said.

``It is inappropriate. It can destroy the faith of a Muslim,'' he said.

The Fatwa Council's decisions are not legally binding on Muslims, who comprise nearly two-thirds of Malaysia's 27 million people, unless they are enshrined in national or Shariah laws.

However, many Muslims abide by the edicts out of deference, and the council does have the authority to ostracize an offending Muslim from society.

The fatwa reflects the growing strain of conservatism in Malaysia, which has always taken pride in its multiethnicity. About 25 per cent of Malaysians are ethnic Chinese and 8 per cent ethnic Indians, mostly Hindus.

Recently, the council issued an edict banning tomboys, ruling that girls who act like boys violate the tenets of Islam.

The issue of yoga came into the limelight last month when an Islamic scholar expressed an opinion at a seminar that it was un-Islamic, prompting the Fatwa Council to step in.

Local newspapers have received several letters from Muslims, expressing indignation at the scholar's view, saying yoga is simply a way to maintain health and has nothing to do with religion.

There are no figures for how many Muslims practice yoga, but many yoga classes have a sprinkling of Muslims attending.

In a recent blog, social activist Marina Mahathir criticized the council for even considering a yoga ban, calling it ``a classic case of reacting out of fear and ignorance.''

``Yoga may have spiritual roots but most of us do it for the exercise, both for the mind and body,'' Marina wrote.

Benefits of Sun salutations-Dynamic Yogic practice

Experiencing the All-round Benefits of the Sun Salutation Yoga Pose (Surya Namaskar)
Surya namaskara is a series of twelve physical postures. These alternating backward and forward bending postures flex and stretch the spinal column through their maximum range giving a profound stretch to the whole body.

Often, after a hard days work, we would just flop down on the couch apparently relaxing our bodies - but it is NOT so. The stagnant energies remain locked up and the organs remain de-oxygenated to a large extent. Surya Namaskar has a deep effect in detoxifying the organs through copius oxygenation and has a deeper relaxing effect.

To list some of the benefits of Suryanamaskar:

*Tones up the digestive system by the alternate stretching and compression of abdominal organs. It activates digestion and gets rid of constipation and dyspepsia.

*Strengthens abdominal muscles.

*Thoroughly ventilates the lungs, and oxygenates the blood.

*Acts as detoxifying agent, by getting rid of enormous quantity of carbon dioxide and other toxic gases.

*Tones up the nervous system and improves memory.

*Promotes sleep and calms anxiety.

*Normalizes the activity of the endocrine glands - especially the thyroid gland.

*Refreshes the skin. Prevents Skin disorders.

*Improves muscle flexibility.

*In women, stimulates the breasts to help firmness normally. Restores any lost elasticity, through stimulation of glands and the strengthening of pectoral muscles.

*Suppresses menstrual irregularity and assists in easy childbirth.

*Prevents loss of hair and graying.

*Helps reduce fat.

*Reduces abnormal prominence of the Adam's apple.

*Eliminates unpleasant smells from the body.

*Lends grace and ease of movements to the body.

*Revives and maintains the spirit of youthfulness.

*Broadens chest and beautifies arms.

*Makes the spine and waist flexible.

*Produces health, strength, efficiency and longevity.


Who should NOT do Surya Namaskar?

Pregnant women should not practice this after third month of pregnancy.
Patients of Hernia and high blood pressure are warned against this practice.
People suffering from back conditions should seek proper advice before commencing Surya Namaskar.
Women should avoid Surya Namaskar during menses.

How to do?

As mentioned Surya Namaskar is a flowing series of 12 yoga postures. These are described below.


Synchronizing the breath with the movements of the body is very important. The basic breathing principle is to inhale during backward bending postures and exhale during forward bending postures.

The Twelve Postures

1. Pranamasana (Salutation posture)
Stand erect with feet together. Join the palms together in front of the chest. Concentrate on standing straight, steady and in a prayerful attitude. This posture helps to induce a state of introversion, relaxation and calmness. It activates the anahata chakra. Exhale fully.

2. Hastauttanasana (Raised arm posture)
Inhaling stretch both arms above the head, palms facing upward. Arch the back and stretch the whole body. This posture stretches the chest and the abdomen and lifts the Prana (energy) upward to the upper parts of the body propelled by inhalation.

3. Padahastasana (Hand to foot posture)
Exhaling bend the body forward and down, keeping the spine straight. Avoid collapsing the chest or "over-rounding" the upper back. Keep the legs straight and perpendicular to the ground. The knees may be allowed to bend a little if needed. This posture massages the abdominal organs, especially the liver, kidneys, pancreas, adrenals, uterus and ovaries. The power of digestion increases and female disorders such as prolapse and menstrual irregularities are relieved. A healthy flow of blood is sent to the spinal nerves as they are stretched and toned. The hamstring muscles at the back of the thigh and calf muscles are stretched and toned. Inversion increases blood flow to the brain. The Prana is channeled to the lower regions of the body propelled by exhalation.

4. Ashwa Sanchalanasana (Equestrian posture)
On your next inhalation, extend the left leg back and drop the knee to the ground. The right knee is bent and kept between the hands and the right foot placed flat on the ground. Lift the spine and open the chest. Concentrate at the eyebrow center.

5. Parvatasana (Mountain posture)
On the exhalation bring the right leg back to join with the left leg. Simultaneously raise the buttocks and lower the head between the arms, so that the body forms a triangle with the floor. Try to place the heels flat on the ground. Focus awareness at the neck area. This posture strengthens the nerves and muscles in the arms and legs, stretches the calf muscles and Achilles' tendons and makes the spine straight and taut. It relieves varicose veins and tones spinal nerves. Maintaining the posture take a deep inhalation.

6. Ashtanga Namaskara (Salutation with eight limbs)
Exhaling gently drop both knees to the ground and slowly slide the body down at an angle as you bring the chest and chin to the ground. All eight limbs - toes, knees, chest, hands and chin - touch the floor. The buttocks are kept up. Hold the breath. This posture develops the chest and strengthens arms. It sends additional blood to this area helping to rejuvenate the nerves.

7. Bhujangasana (Cobra posture)
On the inhalation, lower the hips while pushing the chest forward and upward with the hands, until the spine is fully arched and the head is facing up. The knees and lower abdomen remain above the floor. Focus the awareness at the base of spine and feel the tension from the forward pull. This pose gives dynamic expansion to the organs of the chest and abdomen, relieving many ailments such as asthma, constipation, indigestion, kidney and liver problems. It is very helpful in relieving tension in the back muscles and spinal nerves.

8. Parvatasana (Mountain posture)
Exhale and get back to posture 5.

9. Ashwa Sanchalanasana (Equestrian posture)
Inhale and swing the right leg forward between the hands. The left leg remains back. Resume posture 4.

10. Padahastasana (Hand to foot posture)
Exhaling, bring the left foot forward. Join both legs and resume posture 3.

11. Hastauttanasana (Raised arm posture)
Inhale, raise the trunk up and bend backward. Resume posture 2.

12. Pranamasana (Salutation posture)
Straighten the body and bring the hands in front of the chest. Resume posture 1.

YOGA RESEARCH UPDATE

Yoga for Bronchial Asthma

A Controlled study by R. Nagarathna, H.R. Nagendra Vivekananda Kendra Yoga Research Foundation, Bangalore, India.

Abstract : Fifty three patients with asthma underwent training for two weeks in an integrated set of yoga exercises, including breathing exercises, suryanamaskar, yogasanas (physical postures), Pranayama (breath slowing techniques), dhyana (meditation), and a devotional session, and were told to practice these exercises for 65 minutes daily. They were then compared with a control group of 53 patients with asthma matched for age, sex, type and severity of asthma who continued to take their usual drugs. There was a significantly greater improvement in the group who practiced yoga in the weekly number of attacks of asthma, scores for drug treatment, and peak flow rate. This study shows the efficacy of yoga in the long term management of bronchial asthma, but the physiological basis for this beneficial effect needs to be examined in more detail.

Introduction : Yoga has been used to treat patients with asthma for over 50 years in yoga centers in India. Goyeche et al and several other workers have shown convincing evidence of the beneficial effects of yoga in patients with bronchial asthma. Most of these studies were short term, performed without controls, or qualitative but based on subjective judgments. Our earlier investigation clearly indicated the short term (two to four weeks) benefits of yoga, as established by standard controlled studies on large numbers of patients who underwent yogic training as outpatients. Prospective long term studies using standardized research procedures are however unavailable. It is well known that the clinical course of a disease like chronic bronchial asthma is highly variable, being subject to many known and unknown factors. We carried out this long term study with matched controls to ascertain whether yoga could have lasting influence on the course of the disease.

All Research Papers are published online courtesy http://www.vyasa.org/

CARDIOLOGY UPDATE

Heart failure patients have higher risk of fractures


Study highlights:



• Heart failure patients have four times the risk of fractures and 6.3 times the risk of hip fracture as other heart patients.• Heart failure patients should be screened and treated for osteoporosis if necessary, researchers said.


DALLAS, Oct. 21, 2008 — Heart failure patients are at higher risk for fractures, including debilitating hip fractures, than other heart patients and should be screened and treated for osteoporosis, Canadian researchers reported in Circulation: Journal of the American Heart Association.



One year after an emergency room visit, 4.6 percent of heart failure patients experienced a fracture compared to only 1 percent of other heart patients. The one-year rate for hip fractures was 1.3 percent for heart failure patients compared to only 0.1 percent for other heart patients.After researchers adjusted for other risk factors, heart failure patients had four times the risk of fracture and 6.3 times the risk of hip fracture as patients with heart attacks, chest pain or rhythm disturbances.“This is the first study to link heart failure patients to a higher risk of fractures,” said Justin A. Ezekowitz, M.D., senior author of the study and director of the Heart Function Clinic and assistant professor of medicine at the University of Alberta in Canada.



According to the study, heart failure is a leading cause of hospitalizations and death, occurring in 2.2 percent of the general population and 8.4 percent of those older than age 75. Osteoporosis occurs in about 25 percent of women and 12 percent of men older than 50 years. Heart failure and osteoporosis also share common risk factors such as older age, female sex, smoking and type-2 diabetes.The study included 16,294 patients with heart disease presenting at emergency rooms in Alberta, Canada from 1998 to 2001. Slightly more than 2,000 patients, average age 78, presented with a new diagnosis of heart failure. The primary outcome was fracture requiring hospital admission at one year follow-up that was not due to trauma or other disease.



Researchers excluded patients with hospitalization for heart failure two years prior to the ER visit and patients with conditions known to modify fracture or fall risk.Researchers ascertained prescription medication use based on database claims 60 days prior to and 60 days after the emergency room visit. The use of bisphosphonates and other osteoporosis medications was higher in the non-heart failure control group. But even when researchers excluded these patients, the risk of fracture was of similar magnitude. Even after adjusting for medications known to affect the bones, dosages and co-morbidities, heart failure patients had a fourfold higher risk of fracture, Ezekowitz said. Women have higher rates of osteoporosis, but when researchers controlled for gender with age-matched controls, heart failure patients still had higher fracture rates than other heart patients.The reasons for this remain unclear, Ezekowitz said. “It may be that heart failure patients aren’t getting enough calcium or vitamin D.”



Furthermore they noted, parathyroid hormone, which handles calcium and magnesium affecting bone growth and rebuilding, may elevate as heart failure worsens. Two other possible reasons are dietary intake and less exercise. “Most heart failure patients are placed on a strict diet, but some don’t adhere to the diet or are less inclined to eat,” Ezekowitz said.



“Additionally, people with heart failure exercise less due to fatigue and a lower exercise tolerance. Lack of exercise can weaken the bones.”Findings from the study identified important areas for immediate improvements, he said. “Most of these patients didn’t get adequate screening despite meeting the criteria for screening with a bone mineral density testing because of their age. And only a handful of heart failure patients were being treated for osteoporosis.”Fractures, especially hip fractures, can be devastating in older adults. “Hip fracture severely reduces mobility and increases the risk of lung infections and blood clots,” Ezekowitz said. “To make this worse, some patients with heart failure aren’t candidates for surgical intervention because of the underlying heart disease.



”Further study is needed to determine the mechanism linking heart failure and fractures, he said. “Until then, heart failure patients should be screened for osteoporosis and treated if necessary.”Co-authors are: Sean van Diepen, M.D.; Sumit R. Majumdar, M.D., M.P.H.; Jeffrey A. Bakal, Ph.D.; and Finlay A. McAlister, M.D. Individual author disclosures can be found on the manuscript.Randomized Controlled Trials program of the Canadian Institutes of Health Research funded the study. ###

RHEUMATOLOGY UPDATE.

Influence of age and gender on the 28-joint Disease Activity Score (DAS28) in rheumatoid arthritis
B J Radovits , J Fransen , P L C M van Riel , R F J M Laan Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

Correspondence to:Dr B J Radovits, Radboud University Nijmegen Medical Centre, Department of Rheumatology, PO Box 9101, HP 470, 6500 HB Nijmegen, The Netherlands B.Radovits@reuma.umcn.nl


Objectives:
To investigate the influence of age and gender on the components of the 28-joint Disease Activity Score (DAS28) in patients with rheumatoid arthritis (RA), and to clarify whether a high DAS28 can be equally interpreted in all age groups, independent of gender.

Methods:
A prospective cohort of 553 patients with RA was studied for approximately 20 years after diagnosis. The single measures of disease activity and the share of different components of the DAS28 (eg, erythrocyte sedimentation rate; ESR) were analysed and compared between three age groups (<45,>65 years) and per gender, using analysis of variance (ANOVA). The performance of the DAS28 and its components was explored in moderate to high and low DAS28 categories. Linear mixed model analysis was used to design the models best predicting ESR and the share of ESR.

Results:
ESR significantly increased with age, independent of other variables of disease activity. This increase was more pronounced in male than in female patients. Nevertheless, the share of ESR increased with age only in male patients with a low DAS28 (<3.2).>3.2, age and gender did not have a significant effect on any components of the DAS28. C-reactive protein (CRP) and DAS28(CRP) were not influenced by age.

Conclusions:
A high DAS28 was found to perform equally in all age groups, in men and women, despite the elevating effect of age on ESR. In elderly men with low disease activity, remission rate could be underestimated by an elevated ESR.

HOW MUCH EXERCISE IS GOOD FOR HEALTH?

TORONTO: What effect does exercise have on the cells and tissues of the body and how can we use the knowledge to combat conditions like arthritis, diabetes and heart disease? These are just some of the questions that the Canadian Institutes of Health Research's Institute of Musculoskeletal and Arthritis (IMHA) will tackle over the next five years through its strategic plan unveiled at the Saskatchewan University (SU). "As Canada's population ages and grows, the burden of arthritis, osteoporosis, and other musculoskeletal, oral and skin conditions on our health care system will increase," said Jane E. Aubin, IMHA's scientific director.

"We want to reduce this burden and improve the health and quality of life of Canadians of all ages by supporting research that increases our understanding of the relationship between physical activity, mobility and health," she added. Over the next five years, the Institute will work with its partners to fund peer-reviewed research and training projects in the area of physical activity and health, according to an IMHA release.

This research may range from the cellular behaviour of joint tissues to the psychosocial aspects of exercise, activity and sports on populations. Specific activities may include investigating the prevention or reversal of disease through physical activity and mobility, among others. The institute will also promote the application of the research results into new physical activity policies and programmes in collaboration with partners and communities. "I commend IMHA for choosing physical activity as a strategic research priority," said Karen Chad, acting vice-president research at SU. "As a physical activity researcher, I know first hand the positive effect of regular exercise on health and quality of life."

TREE-LINED STREETS CUT ASTHMA

Tree-lined streets 'cut asthma'

New York is currently planting more trees
Children who live in tree-lined streets have lower rates of asthma, a New York-based study suggests.

Columbia University researchers found that asthma rates among children aged four and five fell by 25% for every extra 343 trees per square kilometre. They believe more trees may aid air quality or simply encourage children to play outside, although they say the true reason for the finding is unclear. The study appears in the Journal of Epidemiology and Community Health. US rates of childhood asthma soared 50% between 1980 and 2000, with particularly high rates in poor, urban communities.

In New York City, asthma is the leading cause of admission to hospital among children under 15.
The researchers found the city had an average of 613 street trees per square kilometre, and 9% of young children had asthma. This is a positive first step into a new area of research linking the environment and asthma

Leanne Male Asthma UK
The link between numbers of trees and asthma cases held true even after taking into account sources of pollution, levels of affluence and population density, the researchers said.
However, once these factors were taken into account, the number of trees in a street did not appear to have any impact on the number of children whose asthma was so severe that they required hospital treatment.

Exposure theory
Some experts believe that children who are exposed to few microbes in early life are at an increased risk of asthma because their immune systems do not get the practice they need at fighting infection. Therefore, if a tree-lined street encourages outside play, it might help reduce the risk of asthma by maximising the odds that children will be exposed to microbes.
However, trees are also a source of pollen, which may potentially exacerbate asthma symptoms in vulnerable children.

Lead researcher Dr Gina Lovasi admitted the effect, if any, of trees was far from clear.
She said: "There may be something else healthful about the areas that had more trees.
"For example, trees could be more abundant in areas that are well maintained in other ways."
Leanne Male, assistant director of research at the charity Asthma UK, said: "Previous research looking at the influence of the environment on levels of asthma has focused on negative aspects, such as pollution and chemical exposure.

"This innovative report is the first to look specifically at the potentially beneficial effects of trees in urban areas and raises some interesting issues. "However, there are a number of other factors that have not been considered, for example whether the families involved have pets.
"Despite the need for further work, this is a positive first step into a new area of research linking the environment and asthma."
New York City is planning to plant 1 million extra trees by 2017.

GREEN SPACES REDUCE HEALTH GAP

Green spaces 'reduce health gap'

Nature may be good for health

A bit of greenery near our homes can cut the "health gap" between rich and poor, say researchers from two Scottish universities. Even small parks in the heart of our cities can protect us from strokes and heart disease, perhaps by cutting stress or boosting exercise.
Their study, in The Lancet, matched data about hundreds of thousands of deaths to green spaces in local areas. Councils should introduce more greenery to improve wellbeing, they said.
This study offers valuable evidence that green space does more than 'pretty up' the neighbourhood
Dr Terry HartigUppsala University, Sweden

Across the country, there are "health inequalities" related to income and social deprivation, which generally reflect differences in lifestyle, diet, and, to some extent, access to medical care.
This means that in general, people living in poorer areas are more likely to be unhealthy, and die earlier. However, the researchers found that living near parks, woodland or other open spaces helped reduce these inequalities, regardless of social class.

When the records of more than 366,000 people who died between 2001 and 2005 were analysed, it revealed that even tiny green spaces in the areas in which they lived made a big difference to their risk of fatal diseases.

Although the effect was greatest for those living surrounded by the most greenery, with the "health gap" roughly halved compared with those with the fewest green spaces around them, there was still a noticeable difference.

Stress buster
The change was particularly clear in areas such as heart disease and stroke, supporting the idea that the presence of green spaces encourages people to be more active.
However, the researchers, Dr Richard Mitchell from Glasgow University, and Dr Frank Popham, from the University of St Andrews, said that other studies had suggested that contact with green spaces also helped reduce blood pressure and stress levels, perhaps even promoting faster healing after surgery.

They wrote: "The implications of this study are clear - environments that promote good health might be crucial in the fight to reduce health inequalities." They called for planning authorities to consider making more green spaces available to improve the health and wellbeing of their residents. In an accompanying article in The Lancet, Dr Terry Hartig, from the Institute for Housing and Urban Research at Uppsala University in Sweden, wrote: "This study offers valuable evidence that green space does more than 'pretty up' the neighbourhood - it appears to have real effects on health inequality, of a kind that politicians and health authorities should take seriously."

David Tibbatts, from GreenSpace, a charity which promotes parks in urban areas, said that they were threatened by "decades of decline" in some areas. "The study confirms what we have been saying for many years - parks are important for health and everyone should have access to high quality, beautiful and vibrant green spaces. "Unfortunately, despite the benefits green spaces bring to communities, our research has shown a decline in park services that has spread across more than 30 years.

"Despite increase recognition of their role in areas such as improved health, far too many parks teams find their revenue budgets are still under continuous threat." Professor Barbara Maher from the Lancaster Environment Centre said her research had shown that roadside trees improve health by protecting people from pollution.

"Urban and roadside trees may be an under-used resource both in terms of acting as natural 'pollution monitors' and actively screening people, especially, children and the already ill, from the damaging health effects of particle pollution," she said.