ICMR BULLETIN VOL. 26-No.-5-MAY-1996
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- ICMR BULLETIN VOL. 26-No.-5-MAY-1996
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ISSN 0377-4910
Vbl.26, No.5
May, 1996
HEALTH CARE FOR THE ELDERLY
The age structure of India's population shows an
unmistakable trend towards ageing. The population oflndia
in the age group of 60 years and above, is increasing more
rapidly than the population as a whole. The population of
India was 844.3 million as per the 1991 census, forming 16
per cent of the world's population. By the year 2001, India's
population is projected to reach 986.1 million. The number
of elderly persons has also been rising since 1961. The
population of India aged 60 years and above has increased
from 24.71 million in 1961 to 43.98 million in 1981 and was
projected to be 55.3 million in 1991. This is expected to go
叩 to 75.9 million by the year 2001*.
of persons surviving upto old age as a result of reduced
mortality and increased life expectancy is observed in sev
eral developing countries. By the year 2001, India will have
the highest population of elderly in the world. As people
survive dnd live longer into later years, non-communicable
diseases are more likely to increase. The diagnostic and
treatment procedures for these diseases are costly. As a
result, health care expenditure will rise. If the planning for
such eventualities is not started immediately, the country will
face a major crisis.
In India, persons aged 15-64 years, constitute 56.3 per
cent of the total population, and those aged 65 years and
above make-up 4 per cent of the population. It is expected
that by the year 2001, the proportion of population in the
age group of!5-64 years would increase to 63.3 per cent and
to 4.8 per cent in the age group of 65 years and above. The
expectation of life at birth has also increased from 41.9years
in 1961 to 54.1 years in 1981, and is expected to be 62 years
by the year 2001. This will alter the age structure of the aged
population and will influence their disease profile.
The National Sample Survey Organisation (NSSO) has
conducted a nation-wide survey wherein specific data related
to the elderly were collected. The health profile ofthe elderly
has been studied at the primary health centre level by the
Indian Council of Medical Research (ICMR). In addition,
some studies have been carried out by medical colleges/
institutions on the medical and social problems ofthe elderly.
By the year 2020, life expectancy at birth in India will
be close to 70 years — roughly the same as that of Europe's
in the late 1960s. Thus, India is right at the middle of an
extraordinary shift from being a young country with high
mortality and high fertility, to reach the final stage of the
demographic transition in a matter of a few decades.
An increase in tRe proportion of the elderly as a result
of declining fertility, and the increase in the actual number
HEALTH PROFILE OF THE ELDERLY
The National Sample Survey Organisation has studied
both the urban and rural populations2. The most common
chronic illnesses/symptoms reported were problems in the
joints followed by cough. Hypertension, heart diseases and
diabetes were reported more frequently by the urban popula
tion. In the ICMR supported study conducted at the primary
health centre area of Madurai, the most commonly reported
illnesses/symptoms were visual handicap, pain in the joints
and vague bodily pain. The commonly reported illnesses
amongst the elderly in out patient departments of large
referral hospitals are infections, cardiovascular diseases,
neurological and nutritional disorders.
Division of Publication & Information, ICMR, New Delhi - I 10 u'u
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COMMUNITY-BASED HEALTH SURVEYS IN
INDIA
National Survey in India
In 1986-87, a country-wide health survey was con
ducted by theNSSO on individuals aged 60 years and above.
The main objective was to study the socio-economic status
of the elderly. Fifty thousand households in 8312 villages
and 4546 urban blocks were surveyed. The survey con
ducted by non-medical field staff had a limitation in that
clinical morbidity in the aged was not always identified.
The rural population surveyed constituted 39.5 million
population, and 8.74 million lived in urban areas. The sex
ratio (no. of females per 1000 males) was 971 in rural area
and 1032 in urbaii area.
Chronic illness was reported by 45 per cent males and
44.8 per cent females, the numbers being nearly the same
for both rural and urban areas. Chronic diseases/symptoms
included problems of the joints and other disabilities, heart
diseases and blood pressure, cough, urinary problems and
piles. Amongst both the populations, the most common
chronic illness/symptom reported was problems in the joints
(35-50%), followed by cough (22-35%). Hypertension,
heart diseases and diabetes were reported more by the urban
population. Physical immobility was reported more among
women.
Wdowhood and unemployed status were more frequent
in women while economic independence, living alone and
social and managerial participation were more common in
men. With increasing age, employment and economic inde
pendence declined in both the sexes.
Primary Health Centre Survey
The ICMR, New Delhi, carried out a study on health
care ofthe rural aged at Madurai (Tamil Nadu) during 1981843. A total.of 1910 subjects (males,664; females, 1246)
were registered from an estimated number of 4656 aged
persons in the area of study. Nearly 80 per cent of the
subjects were between 60-70 years and 18 per cent between
70-80 years of age3. Subjects were screened for clinical
health status. The most commonly reported illnesses/symptoms were visual handicap (65%), pain in joints (34%),
vague bodily pain (15%), giddiness (15%), cough (10%),
sleeplessness (8%), and hearing deficit (6%).
34
SOME SPECIFIC HEALTH
AMONGST THE ELDERLY
PROBLEMS
The ICMR has, during the past decade, conducted
community-based studies for specific disease conditions
wherein the elderiy have been studied.
Cardiovascular Diseases amongst the Elderly
Coronary heart disease (CHD) has been studied through
an epidemiologic study (ICMR unpublished data). In an
urban surv取 in Delhi, the prevalence rate of CHD (using
the Minessotta coding) was observed to be 7.9 per cent
amongst persons aged 35-64 years. The per cent distribution
of high cholesterol levels (above 240mg/dl) showed an age
related trend in both males and females, being highest in the
55-64 years age group.
Blood pressure measurements were also taken in the
same population. An age related increase in mean systolic
and diastolic blood pressure levels was observed in both
males and females. The prevalence rate of hypertension also
showed an 军e related change, being highest in the age group
of55-59 years in males and 60-64 years in females in urban
areas. In rural areas also an age related increase was seen
in both sexes, beiijg highest in the age group of60-64 years.
Cancers amongst the Elderly
The ICMR's National Cancer Registry Project (NCRP)
is collecting on a continuous basis, year-wise incidence of
cancers in some selected cities and in one rural area. The data
have shown that nearly 5-6 per cent elderly suffer from
cancer eveiy year4. While tiie total number of elderly with
cancer by sheer numbers may be less than those with other
diseases such as cardiovascular diseases, die financial and
social support required for the management ofthese persons
is formidable. Since tobacco related cancers comprise nearly
a third of all cancers, a reduction in the tobacco habit would
go a long way in the reduction of the disease burden.
Mental Health Status of the Elderly
The commonly prevalent mental and psychological
problems facing the elderly are dementia, depression, alco
holism, drug abuse, anxiety disorders and schizophrenia.
The diagnosis of mental disorders associated with cognitive
impairement is complicated.
An ICMR study carried out at Madurai on 150 subjects
aged 60 years and above attending OPD, revealed that
psychiatric disorders in the elderly constituted two major
groups viz. affective disorders and psycho-organic syn
dromes5. Forty three per cent of the study subjects suffered
from dq)ressive illness.
Ophthalmic Problems amongst the Elderly
Eye diseases are common and occur in many diverse
forms. The magnitude of the problem of blindness in India
was obtained through an ICMR study on blindness during
1971-74. The study highlighted that ofan estimated 9 million
blind individuals, more than half were blind due to cataract6.
Another ICMR study on cataract estimated the prevalence
of cataract to be in the. range of 31 to 70 per cent amongst
the rural population above 40 years of age7. A total of 7.53
million eyes have been estimated to have mature or
hypermature cataract. An estimated 2.7 million eyes require
surgery annually to tackle the incoming load of cataract. At
present the country conducts about 1.1 million operations
annually.
from 17 villages, 510 were observed to utilise the existing
health care services.
Under the same study, the multipurpose woikers (para
medical stafi) at the primary health centre were trained to
inform the community about the functioning of a geriatric
clinic at the primary health centre. Thirty two per cent had
easy access to the PHC and 56 per cent coined the treatment
facilities to be adequate. Of the 134 patients taking treatment
at the PHC, about 70 per cent reported satis也ction while 17
per cent expressed otherwise. The reasons for not being
satisfied were inadequate availability of drugs including
injectables and lack of improvement even after treatment.
Seventy five per cent of the 453 subjects admitted having
benefitted by the MPW's services vdiile 13 per cent felt
otherwise.
This study provided guidelines for understanding the
scope and requirements for strengthening the existing health
care services so as to meet the future increasing demands.
HEALTH PROMOTION
ELDERLY
AMONGST
THE
The Government of India launched a National
Programme for the Control of Blindness in 1976. An impor
tant strategy of this Programme was the establishment of
mobile ophthalmic units to undertake safe cataract surgery
in eye camps.
Ageing is associated with health unless there is disease
or disability. It is important not to assume all ageing to be
the equivalent of disease and disability. The ultimate objec
tive of health promotion is to maintain older people in the
community with a high quality of life.
Health facilities in rural India are often not accessible
or effectively utilised. The mobile eye camps are identified
as the appropriate method for providing ophthalmic facilities
(including surgery) to the rural areas. The mobile eye camps
have a major role to play in clearing the backlog of cataract
surgery in the country.
Health promotion includes health education, health
maintenance and disease prevention in the backdrop of
socio-demographic changes. Health for all must include
equity and accessibility. In 1986 the Ottawa Charter for
health promotion recommended community participation,
redefining of the role of health professionals and a multi
sectoral approach towards care of the elderly8. At present
there is a wide variation in the population on the knowledge
of measures for health promotion.Adoption of preventive
measures in early life would result in a better health status
during adult life after 40 years.
RURAL HEALTH CARE SERVICES FOR THE
ELDERLY
The high prevalence of chronic conditions among the
elderly; and the functional limitations that result generate a
high demand on the health services. Often the health service
providers are ill equipped and ill trained to sustain adequate
diagnostic, therapeutic and. rehabilitative support to the
elderly. Further, the existing problems of maternal and
infant mortality and child morbidity demand the majority of
their time and efforts.
In the study carried out by the ICMR on the utilisation
of health services by the elderly at a rural primary health
centre near Madurai, of the 603 elderly subjects studied
Health programmes related to primary prevention which
includes nutrition, dietary advice, no-smoking programmes,
accident prevention, etc. need to be built into the primary
health care services. Evaluation of the needs of the elderly
and the alternate strategies that could be adopted by the
existing health system for health promotion need to be
considered. Attitudes to old people need to be changed
amongst the medical and para medical sta氐 social workers
and even the school-going children. Old age must not be
considered synonymous with ill-health and liability.
35
References:
1.
2.
Ageing in India — Demographic background and analysis
based on census materials. Occasional paper No 2. Office of
the Registrar General and Census Commissioner of India,
1992.
Socio-Economic and Health Characteristics ofthe Aged Persons
(42nd round). Rqx)rt ofthe National Sample Survey Organisation,
1986-87
3.
Venkoba Rao, A. Health Care cf the Rural Aged- Report of
a Taskforce Study. Indian Council of Medical Research, New
Delhi, 1990.
4.
National Cancer Registry Programme — Biennial Report
1988-89. Indian Council of Medical Research, New Delhi,
1992.
•5.
Venkoba Rao, A. National Task Force Study on Problems of
the Aged Seeking Psychiatric Help. Indian Council of Medical
Research, New Delhi, 1987.
6.
Collaborative Study on Blindness (1971-1974) _ A Report.
Indian Council of Medical Research, New Delhi, 1971.
7.
Collaborative Study on Prevalence of Cataract. Indian Coun
cil of Medical Research and National Programme for Control
of Blindness, New Delhi, 1990.
8
Kalache, A. Promoting health in old age. In: Public Health
Implications ofAgeing in India. Eds. C.R. Ramachandran and
Bela Shah. Indian Council of Medical Research, New Delhi,
p.7, 1993.
This write-up has been contributed by Dr. Bela Shah and
Dr. A.K. Prabhakar, Division of Non-communicable Dis
eases, ICMR Headquarters, New Delhi.
ABSTRACTS
Some Research. Projects Completed Recently
Role of cytostructural. alterations in cervical car
cinogenesis.
The study was carried out to find out the role of alter
ations in various cytoskeletal proteins during the process of ：
tumour progression in uterine cervix. The cytoskeletal pro
teins analysed included cytokeratins (CKs) 1,10,11,13,14,
16,18 and 19 as well as the terminal differentiation protein
involucrin. Tissue samples from a total of 180 subjects were
studied. This included 60 non-malignant cervical tissue
samples, 70 invasive carcinoma samples and 50
premalignant samples classified as cervical intraepithelial
neoplasia _ CINI (mild dysplasia), CINII (moderate dys
plasia) and CIN III (severe dysplasia). Non-malignant
samples were obtained from patients undergoing hysterec
tomy.
In non-malignant cervical epitheBumICKs 13,14,18 and
19 were.expressed in the basal cells while CKs 1, 10 and
11 in the spinal cells. CKs 18 and 19 were expressed
intensely in endocervical cells. In precancerous lesions (CIN
I, II and HI), there was no egression of CKs 13,16,1,10 and
11 in the basal cells. CK 19 showed intense expression in
basal cells of CIN I and no expression in CIN H and in. CK
14 was found to be intensely expressed in CIN IB. In
invasive carcinomas, 60 per cent or more of malignant cells
were positive for CKs 19, 18, 14 and 13, showing that
expression of these CKs are maintained during tumour
36
progression from non-malignant to invasive carcinoma. CKs
1,10,11,13 and 16, however, did not show intense expression
in the majority of patients analysed.
Involucrin showed intense expression in the upper spinal
layers ofnormal and inflammatoiy squamous epithelium. In
contrast, lesions with CIN I showed a mild staining pattern
in the spinal layers (both lower and upper), whereas CIN II
showed mild expression in the upper spinal layer, CIN HI
lesions did not express involucrin. In invasive carcinoma
expression of involucrin was found to be negative in 67 out
of 70 samples analysed.
It may thus be concluded that analysis of expression of
CKs and involucrin provides a very useful ccxnplemfent to
the established histologic procedures for understanding tis
sue pathology as well as various histogenetic pathways
involved in tumour development.
M. Radhakrishna Pillai
Regional Cancer Centre
Thiruvananthapuram.
Structural and functional alterations in liver during
fibrosis.
The study was carried out on adult male albino rats to
find put the alterations in liver functions during dimethylnitrosamine (DMN) induced hepatic fibrosis ；The rate of bio
synthesis and metabolic degradation and accumulation of
different types of collagen in hepatic fibrosis as also the role
of trace elements firing the progression of hepatic fibrosis
were .also studied.
Hqpatic fibrosis was induced by intraperitoneal injec
tions dfDMN (Igl/lOOg body wt) on 3 consecutive days of
each week for 21 days. Histopathological examination ofthe
fibrotic liver tissue showed intense neutrophilic infiltration,
bile duct hyperplasia, Mallory^s hyaline within cytoplasm,
apoptosis of hepatocytes, dysplasia, bridging necrosis and
extreme centrilobular necrosis and fibrosis. A four-fold
increase of collagen content was found in the liver tissue.
A significant increase of serum aspartate transaminase
(AST), alanine transaminase (ALT), y glutamyl
transpeptidase (y-GT), alkaline phosphatase (ALP) and lactate ddiydrogenase (LDH) was found. The serum albumin.
levels were remarkably lowered in DMN treated animals
while there was a significant increase in serum globulin
levels. While an induction in the biosynthesis of y-GT and
ALP in the liver was found, the.AST and ALT activities were
significantly reduced in the.hepatic tissue.The deterioration
of liver functions and modulating enzyme activities may be
contributing to an extent towards the development ofhepatic
fibrosis.
Study of the rate of biosynthesis and metabolic degra
dation of collagen in DMN induced fibrotic liver revealed
enhanced anabolism and catabolism of hepatic collagen. It
was also found that the balance between synthesis ana
degradation was almost maintained in the early stages of
DMN treatment as a self defence mechanism, but it was
totally impaired in the later stages with a net result of
accumulation of collagen in the liver.
Studies on the molecular characteristics of fibrotic liver
collagen( demonstrated a significant increase of B-chains
with a notable decrerase of oc/B ratio after DMN adminis
tration. Reduction with B>mercaptoethanol indicated the
presence of type m collagen in the electrophoretic field with
a.prominent increase in its level an day 21. An* increase in
the aldehyde content and enhanced rate of fibril formation
in DMN induced liver collagen indicated a higher d^ree of
cross linking.
Studies on minerals and trace elements during the pro
gression of hepatic fibrosis revealed significant decreae of
Ca, Mg, K, Na, Se and Zn in serum. The results indicate
that exacerbation of hepatic fibrosis with ascites plays a
major role in the alteration of essential elements which can
further aggravate the disease.
Joseph George
Gowri Chandrakasan
Department of Biochemistry
Central Leather Rescardi Institute
Madras.
85TH ANNIVERSARY CELEBRATIONS OF ICMR
Virus diseases (other than AIDS) was the theme selected
for the disseminaton of scientific information to various
groups of people in the month of March 1996.
The National Institute of Cholera and Enteric Diseases,
CMcutta, organised an awareness programme on the subject
for students of the National Medical College, Calcutta and
staffofthe NICED highlighting the activities of the ICMR's、
National Institute of Urology, Pune. The programme in
cluded. a lecture on viral diseases by Dr. Manish
Chakraborty, fbrmejr Director, Calcutta School of Tropical
Medicine, Calcutta, as well as a poster exhibition on the
subject.
The Centre for Research in Medical Entomologj
Madurai, celebrated the 85th Anniversary ofthe Council and
the National Science Day together on Febniary 28,1996 by
organising a symposium on viral diseases. Apart from the
lectures/discussions, the Centre also organised an exhibition
and a quiz competition for school children.
The Regional Medical Research Centre for Tribals,
Jabalpur, organised talks/discussions on common viral dis
eases at the Kundam Block of Jabalpur district. Approxi
mately 500 individuals including vfcmen and children par
ticipated in the programme.
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37
NATIONAL SCIENCE DAY CELEBRATIONS
The Indian Council ofMedical Research and its various
Institutes/Centres located in difibrent parts of the country
celebrated the National Science Day in February 1996 by
oi^anising various events like display/demonstrations, exhibitior s, open houses, lectures/discussions, quiz competi
tions, inter-school elocution competitions, etc. Many of the
Institutes combined these activities with those relating to the
85th Anniversary celebrations of the Council.
The National Institute of Nutrition, Hyderabad,
o吗 inised an inter-school elocution coi^ipetition "India can
doon February 29, 1996 in 询lich 50 students from 25
schools participated. Three best orators were given prizes
and certificates.
The National Institute of Virology, Pune, organised a
popular lecture on "Impact of poverty on public health —
What India can do about it?" by Dr. P.V Sukhatme.
The Institute for Research in Reproduction, Bombay,
organised an open house for students of various science
colleges of the city on February 25-26, 1996. The students
were taken to different departments/laboratories of the In
stitute and various activit es of the Institute and techniques
employed were explained to them with the help of posters
specially prepared for this occasion.
The Institute of Pathology, New Delhi, celebrated the
National Science Day by organising scientific lectures for
students from various Delhi schools and trainee nurses from
Safdaijang hospital. Dr. Uma Chaturvedi, Professor and
Head, Department of Pathology, Maulana Azad Medical
College, New Delhi, delivered a talk on "Importance of
laboratory services". Dr. Deepali Mukhegee and Dr. Bela
Shah, Dy. Directors-General, ICMR Headquarters, spoke
on "Malaria" and "Health hazards of tobacco consumption” respectively. The students were also given practical
briefing about different activities of the Institute and tech
niques employed.
The Regional Medical Research Centre, Dibrugarh,
celebrated the National Science Day at the Little Flower
School, Dibmgarh on February 28, 1996. The programme
included an exhibition on major health problems of the
north-eastern region of the country, a nutrition quiz and
screening of video films on malaria and nutrition. At the end
ofthe programme a debate was organised for school children
on ''Industrialisation and healthy nation".
Other ICMR Institutes/Centres which celebrated the
National Science Day include National Institute of Cholera
and Enteric 'Diseases, Calcutta; Centre for Research in
Medical Entomology, Madurai; Desert Medicine Research
Centre, Jodhpur, etc.
ICMR NEWS
f-9
Meetings:
A meeting ofthe Expert Group on PHC Level Planning
for Modified District Project on Integrated Reproductive
Health Care Package was held at New Delhi on May 9-11,
1996.
Participation of ICMR Scientists in Scientific Events:
Dr. K. Vjayaraghavan, Dy. Director, National Institute
ofNutrition, Hyderabad, visited Thailand to study commu
nity nutrition in the field of child development and nutrition
programmes (April 22-26, 1996).
38
Dr. Bhanu Iyengar, Director, Institute of Pathology,
New Delhi, participated in the II Locamo meeting on
Neuroendocrinoimmunology at Locamo (May 5-8, 1996).
L ectu res/Orations:
Dr. D.N. Rao, Addl. Professor, Department of Bio
chemistry, All India Institute of Medical Sciences, New
Delhi, delivered the Dr. B.K. Aikat Award (1993) Oration
ofthe ICMR on 叮 uftsin as a modulator of phagocytic and
microbial fiinctions of macrophage derived from leprosy
patients" at the ICMR Headquarters, New Delhi, on April
30, 1996.
COUNCIL'S TRAINING PROGRAMMES FOR 1996-97
Leprosy
Occupational Health
At the Central Jalma Institute for Leprosy, Agra:
At the National Institute of Occupational Health,
Ahmedabad:
•
Multidrug Therapy Orientation Course in Leprosy for
Medical Officers (September 9-20, 1996).
•
Virology
Medical Entomology
At the National Institute of Virology, Pune:
•
Diploma in Medical Virology (June 1996-May 1997).
At the Vector Control Research Centre, Pondicherry:
•
Reproductive Biology
At the Institute for Research in Reproduction, Bombay:
少
•
•
Laboratory Animal Technology
15, 1996).
At the National Centre for Laboratory Animal Science,
National Institute of Nutrition, Hyderabad:
Training Course on Current Trends in Management of
Infertility and Reproductive Disorders (September 213, 1996).
・ Training Course for Laboratory Animal Technicians
.(June 15-July 31, 1996).
•
At the National Institute of Nutrition, Hyderabad:
Annual Training Course on Endocrinological Tech
niques and their Applications (August 1- September
15, 1996).
Nutrition
At the National Institute of Nutrition, Hyderabad:
A)
M.Sc. in Medical Entomology (from August 1996; fbr
2 years).
Training Course on Immunoassay Techniques (June 3-
Endocrinology
•
Orientation Course on Occupational Health for Indus*
trial Medical Officers (September 17-29, 1996).
•
M.Sc. in Applied Nutrition (June 1, 1996-Februaiy
28, 1997).
•
Annual Training Course in Nutrition (December
1996-February 28, 1997).
1,
Training Course for Laboratory Animal Supervisors
(September 1-November 30, 1996.
Haematology
At the Institute of Immunohaematology, Bombay:
•
Training Course in Transfusion Medicine for Blood
Bank Medical O伍cers (August 5-October 4, 1996).
• Training Course in Blood Group Serology and Blood
Bank Methodology for Technicians (August 5September 4, 1996).
• Training Course in Advanced Haematology and
Immunohaematology (September 17-October 4,1996).
ICMR PUBLICATIONS
Price (Rs.)
Nutritive Value of Indian Foods (1985), by C. Gopalan, B.V. Ramasastri and
S.C. Balasubramaniam, Revised and Updated (1989), by B.S. Narasinga Rao, K.C. Pant
and Y.G. Deosthale (Reprinted 1995)
23.00
Growth & Physical Development of Indian Infants and Children (1972, Reprinted 1989)
10.00
Studies on Weaning & Supplementary Foods (1974, Reprinted 1996)
15.00
39
Studies on Pre-School Children (1974, Reprinted 1984)
6.00
A Manual of Nutrition (Second Edition 1974, Reprinted 1995)
6.00
Low Cost Nutritious Supplements (Second Edition 1975, Reprinted 1994)
4.00
Menus for Low Cost Balanced Diets and School Lunch Programmes Suitable for
North India (Second Edition 1977, Reprinted 1994)
4.50
Some Common Indian Recipes and their Nutritive Value (Fourth Edition 1977,
Reprinted 1995) by Swaran Pasricha &• L.M. Rebello
10.00
Nutrition for Mother & Child (Third Edition 1978, Reprinted 1994) by P.S.
Venkatachalam & L.M. Rebello
9.00
Japanese Encephalitis in India (Revised Edition 1980)
5.00
Some Therapeutic Diets (Fourth Edition 1988, Reprinted 1995) by Swaran Pasricha
4.50
Nutrient Requirements & Recommended Dietary. Allowances for Indians (1990, Reprinted 1995)
16.00
Count What You Eat (1989, Reprinted 1994) by Swaran Pasricha
9.00
Diet & Diabetes (Second Edition 1993) by T.C. Raghuram, Swaran Pasricha & R.D. Sharma
18.00
Dietary Tips for the Elderly (1992) by Swaran Pasricha & B.V.S. Thimmayamma
3.50
Diet and Heart Disease (1994, Reprinted 1996) by Ghafoorunissa and Kamala Krishnaswamy
26.00
♦Depressive Disease (1986) by A. Venkoba Rao
58.00
♦♦Medicinal Plants of India Vol.2 (1987)
136.00
* 10 per cent discount allowed to individuals.
** 25 per cent discount allowed to individuals.
These publications are available on prepayment of cost by cheque, bank draft or postal order (bank and postal charges
will be extra) in favour of the Director-General, Indian Council of Medical Research, New Delhi. Money orders are not
acceptable. All correspondence in this regard should be addressed to the Chief, Division of Publication and Information,
Indian Council of Medical Research, Post Box No.4911, Ansari Nagar, New Delhi-110029 (India).
EDITORIAL BOARD
Dr. G.V. Satyavati
...
Chairperson
Dr. Badri N. Saxena
...
Member
Dr. N. Medappa
...
Editor
-•
Printed and Published by Shri J.N. Mathur for the Indian Council of Medical Research, New Delhi
at the ICMR Offset Press, New Delhi-110029
R.N. 21813/71
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