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Home care for stroke patients ineffective, reveals new study

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Home care

[vc_row][vc_column][vc_column_text]~By Dinesh C Sharma

New Delhi, June 28 (India Science Wire): For years, doctors in Indian hospitals have been recommending home-based care for rehabilitation of stroke patients. But a new study – largest of its kind – has revealed that this does not work.

Stroke patients require continuous care including physiotherapy to recover and minimize life-long disability. In the absence of adequate professional and affordable rehabilitation facilities, doctors often recommend care at home by family members supplemented by physiotherapist visits. Hospital-based care is also offered in various centres but is costly.

In order to study if home-based care results in desired outcomes, a study was done at 14 public, private and district hospitals across the country. A total of 1250 stroke patients were followed up over six months. The study participants were divided in two groups – one received standard package of care given by respective hospital while the other group was given home-based care which included training to family members and weekly visits by physiotherapists for two months. The results revealed that there was no reduction in disability for patients who got care at home, compared to those who received the standard package.

The findings, published in medical journal The Lancet on Tuesday, have surprised medical community because earlier studies carried out in developed countries had indicated that community-based rehabilitation played significant role in recovery of stroke patients. The World Health Organisation (WHO) too recommends such an approach.

“We found that despite extensive training in hospital and during follow up visits in the home, there was no difference in the degree of recovery or quality of life of people who received this extra treatment,” explained Professor Richard Lindley of the George Institute for Global Health and the University of Sydney, who led the study.

The study, supported by the National Health and Medical Research Council (NMHRC) of Australia, was coordinated by Christian Medical College, Ludhiana. Patients in the intervention group had access to physiotherapists who taught the family techniques such as mobility training and communication practice.

“Professional help like training and visits by physiotherapists was provided for first two months only because the intervention needed to be cost effective and sustainable. If family members required more training, then the aspiration of routinely providing rehabilitation through family caregivers might not be feasible,” pointed out Jeyaraj Pandian, neurologist from Christian Medical College, Ludhiana who led the trial. “Our training programme might not have been sufficient (in time and content) to deliver effective family rehabilitation, as we observed only about 30 minutes of daily activities in the intervention group. Conventional western rehabilitation is usually associated with greater daily therapy time.” Accredited Social Health Activist (ASHA) might have been a more effective strategy, but probably more expensive.

Dr Vijaya Nath Mishra, a neurologist at the Sir Sunderlal Hospital at BHU, Varanasi, said the results of the study are surprising. “We will have to carefully examine the evidence because we have so far believed and also observed that caregivers and family members have a major role in outcome of stroke.” Dr Mishra was not associated with the study.

It is estimated that around 1.6 million people have a stroke in India each year, yet the vast majority receive no formal rehabilitation. The whole country has just 35 stroke units, and most are in the cities, despite stroke being the third commonest cause of death in the adult population.

Professor G V S Murthy of the Indian Institute of Public Health, the Co-Chair of the study, commented, “Task shifting is increasingly seen as a solution to targeting chronic diseases in many countries in the world. But our results show it may be ineffective for some conditions and waste already limited resources. We need more rigorous examinations of such family and community led programs before they become commonplace.”

The participating hospitals included Christian Medical College, Ludhiana; Apollo Gleneagles Hospitals, Kolkata; All India Institute of Medical Sciences, New Delhi; Baptist Christian Hospital, Tezpur; Christian Medical College and Hospital, Vellore;  GNRC Hospitals, Dispur; Lalitha Super Specialty Hospital, Guntur; Nizam Institute for Medical Sciences, Hyderabad; Postgraduate Institute for Medical Sciences and Research, Chandigarh; Sree Chitra Tirunal Institute for Medical Sciences and Technology; Global Hospitals, Chennai; BGS Global Hospitals, Bangalore; Amrita Institute of Medical Sciences, Kochi and St Stephen’s Hospital, New Delhi. (India Science Wire) [/vc_column_text][/vc_column][/vc_row]

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PM Modi assures no discrimination in women’s quota, delimitation debate intensifies in Parliament

PM Narendra Modi has assured that women’s reservation will be implemented without discrimination, amid a heated debate over delimitation in Parliament.

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Prime Minister Narendra Modi has assured that there will be no discrimination in the implementation of women’s reservation, as Parliament witnessed a sharp debate over the proposed linkage between the quota and delimitation exercise.

During the ongoing special session, the government reiterated its commitment to ensuring fair representation while addressing concerns raised by opposition parties regarding the timing and structure of the legislation.

The proposed framework aims to reserve 33 percent of seats for women in the Lok Sabha and state assemblies. However, its implementation is tied to a fresh delimitation exercise, which is expected after the next census.

Opposition questions timing and intent

Opposition leaders have raised concerns that linking the women’s quota to delimitation could delay its implementation. They argue that the process of redrawing constituencies may push the actual rollout further into the future.

The issue has triggered a broader political confrontation, with multiple parties questioning whether the move could alter representation across states.

Some critics have also alleged that the delimitation exercise could disproportionately benefit certain regions based on population, a charge the government has rejected.

Government reiterates commitment to fair implementation

Responding to these concerns, the Centre has maintained that the reforms are necessary to ensure accurate and updated representation based on population data.

Leaders from the ruling side have repeatedly emphasized that the process will be carried out transparently and without bias. The assurance that there will be “no discrimination” is aimed at addressing fears among states and opposition parties.

The debate marks a key moment in Parliament, with both sides engaging in intense exchanges over one of the most significant electoral reforms in recent years.

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Give all tickets to Muslim women, Amit Shah says, attacking Akhilesh Yadav on sub-quota demand

A sharp exchange between Amit Shah and Akhilesh Yadav in Parliament over sub-quota for Muslim women highlights key divisions on women’s reservation implementation.

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A heated exchange broke out in Parliament during discussions on the women’s reservation framework, with Union Home Minister Amit Shah and Samajwadi Party chief Akhilesh Yadav locking horns over the demand for a sub-quota for Muslim women.

The debate unfolded as the government pushed forward key legislative measures to implement 33% reservation for women in the Lok Sabha and state assemblies.

Akhilesh Yadav argued that the proposed reservation must ensure representation for women from marginalised communities, including Other Backward Classes (OBCs) and Muslim women. He said that without such provisions, large sections could remain excluded from political participation.

He also questioned the timing of the bill, alleging that the Centre was avoiding a caste census. According to him, a census would lead to renewed demands for caste-based reservations, which the government is reluctant to address.

Government rejects religion-based quota

Responding to the demand, Amit Shah made it clear that reservation based on religion is not permitted under the Constitution.

He stated that any proposal to provide quota to Muslims on religious grounds would be unconstitutional, firmly rejecting the idea of a separate sub-quota for Muslim women within the broader reservation framework.

The government has maintained that the existing framework already includes provisions for Scheduled Castes (SC) and Scheduled Tribes (ST) women within the overall reservation structure.

Wider political divide over implementation

The issue of sub-categorisation within the women’s quota has emerged as a major flashpoint, even as most opposition parties broadly support the idea of women’s reservation.

Samajwadi Party leaders reiterated that their support for the bill depends on inclusion of OBC and minority women, while the government continues to defend its constitutional position.

The debate is part of a broader discussion during the special Parliament session, where multiple bills linked to delimitation and implementation of the women’s quota are being taken up.

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No state will lose a seat, Centre assures as delimitation debate takes centre stage in Parliament

Parliament’s special session begins with key focus on implementing women’s reservation and delimitation, setting the stage for major electoral changes.

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Parliament

A special session of Parliament commenced on Thursday, with the Centre set to take up crucial legislation related to women’s reservation and delimitation of constituencies. The session, scheduled over three days, is expected to witness intense debate as the government pushes forward its legislative agenda.

At the centre of discussions is the proposal to operationalise the women’s reservation law, which seeks to allocate 33 percent of seats in the Lok Sabha and state assemblies to women. The law, passed earlier, requires enabling provisions before it can be implemented.

The rollout of the reservation is closely tied to the delimitation exercise — a process that redraws parliamentary constituencies based on updated population data. The implementation is expected only after the next census and delimitation process are completed.

The government is aiming to put in place the framework so that the reservation can be enforced in future elections, likely around 2029.

Delimitation and numbers at play

Delimitation is a key aspect of the proposed changes, as it will determine how seats are redistributed and which constituencies are reserved. The exercise is expected to reflect population shifts and may also involve an increase in the total number of Lok Sabha seats.

This linkage has made the issue politically sensitive, with several opposition parties backing women’s reservation in principle but raising concerns over how and when delimitation will be carried out.

Political reactions and expected debate

The session is likely to see sharp exchanges between the government and opposition. While there is broad agreement on increasing women’s representation, disagreements remain over the timing, process, and potential political implications of the delimitation exercise.

Some leaders have argued that delimitation could significantly alter the balance of representation among states, making it a contentious issue beyond the women’s quota itself.

The government, however, has framed the move as a step toward strengthening women’s participation in governance and ensuring more inclusive policymaking.

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