2015| July-September | Volume 4 | Issue 3
Perception of stigma toward mental illness in South India
Bhumika T Venkatesh, Teddy Andrews, Sreemathi S Mayya, Mannat M Singh, Shradha S Parsekar
Background: Stigma associated with mental illnesses is one of the principal causes for mentally ill people not receiving adequate mental health care and treatment. The study was conducted to assess the extent of stigma associated with mental illness and knowledge of mental illness among the community. Materials and Methods: Community-based, cross-sectional study was conducted among 445 respondents from Udupi district; the community attitude toward the mentally ill (CAMI) scale was used to assess stigma. The probability proportional to sampling size technique was adopted to select the wards/blocks. Household from blocks/wards were selected using convenience sampling. Self- administered semi-structured questionnaire was used to collect the information. Data was analyzed using the software SPSS version 15. Results: Of the total 445 respondents, the prevalence of stigma toward mentally ill people was 74.61% (95% confidence interval, 0.7057, 0.7866). The prevalence of stigma was high under all the four domains of CAMI scale. High prevalence of stigma was seen among females and people with higher income. Conclusions: The overall prevalence of stigma toward PWMI was found to be high. The stigma toward PWMI was associated with gender with respect to AU, BE and CMHI. Hence, the study suggests that there is a strong need to eliminate stigma associated with mental illness to improve the mental health status of the region.
Prevalence of diabetes and pre-diabetes and assessments of their risk factors in urban slums of Bangalore
Hemavathi Dasappa, Farah Naaz Fathima, Rugmani Prabhakar, Sanjay Sarin
Background: To determine the prevalence of diabetes and pre-diabetes and to assess the risk factors associated with diabetes and pre-diabetes in the urban slums of Bangalore. Materials and Methods: A cross-sectional study was conducted in four slums of Bangalore in the age group of 35 years and above comprising of total 2013 subjects. Risk factors like age, sex, family history, behavior, physical activity, BMI, waist hip ration, diet habits were assessed to find their association with diabetes. Results: Prevalence of diabetes was 12.33% and of pre-diabetes was 11.57%. Prevalence was more among the females compared to males. Increasing age, over weight and obesity, sedentary life style, tobacco consumption, diet habits showed statistically significant association with prevalence of diabetes and pre-diabetes. Conclusion: Physical activity like regular exercises both at the office and at home, fibers-rich diet, blood sugar estimation after 35 years are some of the recommendations which can control diabetes.
Maternal and neonatal outcomes of gestational diabetes: A retrospective cohort study from Southern India
PR Sreelakshmi, Sanjeev Nair, Biju Soman, Rani Alex, K Vijayakumar, V Raman Kutty
Background: The prevalence of gestational diabetes is on the rise. Understanding the various outcomes of it is necessary to face this challenge. Objectives: To study the frequency of occurrence of various maternal and fetal outcomes among gestational diabetes patients. Methods: This is a retrospective cohort study conducted in rural Kerala, a southern state of India. The study participants were followed up for a period of 4 years, from 2007 to 2011. The participants included 60 women with gestational diabetes and 120 women without gestational diabetes. Gestational diabetes was the major exposure variable. The frequencies of various outcomes were computed. Multivariable logistic regression was done to compute the risk for various outcomes in gestational diabetes. Results: The major outcomes included termination of pregnancy by caesarean section, long-term progression to type 2 diabetes, in-born nursery (IBN) admissions and increased neonatal birth weight. The maximum adjusted RR [13.2 (1.5-116.03)] was for the development of type 2 DM later. Conclusion: Gestational diabetes can result in significant feto-maternal outcomes; so better facilities are needed to manage gestational diabetes.
Knowledge and practice of Accredited Social Health Activists for maternal healthcare delivery in Delhi
Charu Kohli, Jugal Kishore, Shantanu Sharma, Harsavsardhan Nayak
Introduction: The role of community health workers in healthcare delivery system is considered inevitable to meet the goal of universal healthcare provision. The study was planned to assess the knowledge and practices for maternal health care delivery among Accredited Social Health Activist (ASHA) workers in North-East district of Delhi, India. Materials and Methods: A descriptive cross-sectional study was conducted in North-East district of Delhi among 55 ASHA workers after taking written informed consent. Data were collected using a pretested semi-structured questionnaire consisted of items on sociodemographic profile of ASHA workers, knowledge, and practices about maternal health. The data was analyzed by using SPSS software version 17. Qualitative data were expressed in percentages and quantitative data were expressed in mean ± standard deviation (SD). Results: Mean age (±SD) of ASHAs was 31.84 ± 7.2 years. Most of the ASHAs workers were aware of their role in provision of maternal health services. Most of the ASHAs workers were aware of their work of bringing mothers for antenatal check-up (94.5%), counseling for family planning (96.4%), and accompanying them for hospital for delivery (89.1%). 87% of ASHAs knew that iron tablets have to be taken for minimum 100 days during pregnancy. 51 (92.7%) ASHAs reported that they used to maintain antenatal register. Some problems reported by ASHAs while working in community were shortage of staff at health center (16.4%), no transportation facility available (14.5%), no money for emergency, and opposition from local dais (12.7% each). Conclusion: Present study showed that ASHAs knowledge is good but their practices are poor due to number of problems faced by them which need to be addressed through skill based training in terms of good communication and problem solving. Monitoring should be made an integral part of ASHA working in the field to ensure that knowledge is converted into practices as well.
Scar formation and tuberculin conversion following BCG vaccination in infants: A prospective cohort study
Sara S Dhanawade, Suhas G Kumbhar, Alka D Gore, Vijay N Patil
Background: There is considerable variation in BCG scar failure rate on available data and correlation between BCG scar and tuberculin conversion remains controversial. Through this study we aimed to determine the scar failure rate and tuberculin conversion in term infants vaccinated with BCG within the first month. Materials and Methods: A prospective cohort study was conducted among 85 consecutive infants weighing >2 kg attending the immunization clinic of a medical college hospital. Fifteen subjects who could not complete the follow up were excluded. Total of 70 cases were analyzed. All babies were administered 0.1 ml of BCG and examined at 3 months (+1 week) for scar. Tuberculin test was done with 5TU PPD. An induration of >5 mm was considered positive. Statistical analysis was done using Microsoft Excel and SPSS-22. Results: Out of the 70 infants, 41 (58.6%) were males. Although majority (72.9%) of infants were vaccinated within 7 days, only 18 (25.7%) received BCG within 48 hours of birth. Sixty-four (91.4%) had a visible scar at 12 weeks post vaccination representing a scar failure rate of 8.6%. Tuberculin test was positive in 50 (71.4%). The mean ± s.d. for scar and tuberculin skin test (TST) reaction size was 4.93 ± 2.01 mm and 6.01 ± 3.22 mm, respectively. The association between scar formation and tuberculin positivity was highly significant (P < 0.001). There was significant correlation between scar size and TST size (r = 0.401, P = 0.001) Conclusions: Less than 10% of infants fail to develop a scar following BCG vaccination. There is good correlation between scar positivity and tuberculin conversion.
Risk factors associated with default among tuberculosis patients in Darjeeling district of West Bengal, India
Nirmalya Roy, Mausumi Basu, Sibasis Das, Amitava Mandal, Debashis Dutt, Samir Dasgupta
Background: The treatment outcome "default" under Revised National Tuberculosis Control Program (RNTCP) is a patient who after treatment initiation has interrupted treatment consecutively for more than 2 months. Aims: To assess the timing, characteristics and distribution of the reasons for default with relation to some sociodemographic variables among new sputum-positive (NSP) tuberculosis (TB) patients in Darjeeling District, West Bengal. Settings and Design: A case-control study was conducted in three tuberculosis units (TUs) of Darjeeling from August'2011 to December'2011 among NSP TB patients enrolled for treatment in the TB register from 1 st Qtr'09 to 2 nd Qtr'10. Patients defaulted from treatment were considered as "cases" and those completed treatment as "controls" (79 cases and 79 controls). Materials and Methods: The enrolled cases and controls were interviewed by the health workers using a predesigned structured pro-forma. Statistical Analysis Used: Logistic regression analysis, odds ratios (OR), adjusted odds ratios (AOR). Results: 75% of the default occurred in the intensive phase (IP); 54.24% retrieval action was done within 1 day during IP and 75% within 1 week during continuation phase (CP); cent percent of the documented retrieval actions were undertaken by the contractual TB program staffs. Most commonly cited reasons for default were alcohol consumption (29.11%), adverse effects of drugs (25.32%), and long distance of DOT center (21.52%). In the logistic regression analysis, the factors independently associated were consumption of alcohol, inadequate knowledge about TB, inadequate patient provider interaction, instances of missed doses, adverse reactions of anti-TB drugs, Government Directly Observed Treatment (DOT) provider and smoking. Conclusions: Most defaults occurred in the intensive phase; pre-treatment counseling and initial home visit play very important role in this regard. Proper counseling by health care workers in patient provider meeting is needed.
Orofacial tuberculosis: Clinical manifestations, diagnosis and management
Ramta Bansal, Aditya Jain, Sunandan Mittal
Orofacial tuberculosis (TB) is an uncommon form of extrapulmonary TB and is nonspecific in its clinical presentation. It can be misdiagnosed especially when oral lesions are present before systemic symptoms become apparent. Doctors especially attending dentist who generally is the first among clinicians to come across such pathological entity should be aware of the orofacial lesions of TB and consider them in the differential diagnosis of suspicious oral lesions to ensure early diagnosis of TB and its treatment. In this review, we have discussed in detail the clinical presentation of various forms of orofacial TB, diagnosis, and management of patients. Also, an update is provided about recent anti-TB drug development.
Dietary pattern and nutritional deficiencies among urban adolescents
Mrigen Kr. Deka, Anil Kumar Malhotra, Rashmi Yadav, Shubhanshu Gupta
Introduction: Adolescents are considered to be a nutritionally vulnerable segment of the population. There is a greater need to look into the nutritional status of adolescents but unfortunately, precise estimates of their dietary intake, dietary practices as well as nutritional deficiencies have been the least explored area. The general objective for conducting this study was to assess the dietary pattern and nutritional deficiencies among adolescents. Materials and Methods: A cross-sectional study was conducted among adolescents in schools and colleges in the urban areas of Jhansi district in Uttar Pradesh. The study sample consisted of 400 school children in the age group of 10-19 years. Food consumption of the subjects was assessed using a 3-day food intake recall method. Results: Mean age of the adolescents was 14.16 years. More than half of the children studied had malnutrition (53.5%). Mean intake of calorie, protein, fat, iron, and vitamins A and C were lower than the Recommended Dietary Allowances (RDAs). The habitual dietary pattern indicated poor consumption of milk, liver, and leafy vegetables. In comparison to boys (31.5%), more girls (46%) were underweight. On seeing the association, nutritional status of these adolescents within the normal limits were found to be significantly higher in those from nuclear families (P < 0.001), those with better educated parents (P < 0.000), and those from families of higher socioeconomic status (P < 0.000). Conclusion: Overall, among the participants, there were both macro- and micronutrients deficiencies. Therefore, there is a need to encourage people to adopt small family norms, and a need for the sensitization of both adolescents and their parents through health and nutrition education (HNE) to improve the health and nutritional status of the adolescents.
Mortality in newborns referred to tertiary hospital: An introspection
Kailash Chandra Aggarwal, Ratan Gupta, Shobha Sharma, Rachna Sehgal, Manas Pratim Roy
Background: India is one of the largest contributors in the pool of neonatal death in the world. However, there are inadequate data on newborns referred to tertiary care centers. The present study aimed to find out predictors of mortality among newborns delivered elsewhere and admitted in a tertiary hospital in New Delhi between February and September 2014. Materials and Methods: Hospital data for were retrieved and analyzed for determining predictors for mortality of the newborns. Time of admission, referral and presenting clinical features were considered. Results: Out of 1496 newborns included in the study, there were 300 deaths. About 43% deaths took place in first 24 hours of life. Asphyxia and low birth weight were the main causes of death in early neonatal period, whereas sepsis had maximum contribution in deaths during late neonatal period. Severe hypothermia, severe respiratory distress, admission within first 24 hours of life, absence of health personnel during transport and referral from any hospital had significant correlation with mortality. Conclusions: There is need for ensure thermoregulation, respiratory sufficiency and presence of health personnel during transport.
Dietary calcium intake and physical activity levels among urban South Indian postmenopausal women
Jeffrey Pradeep Raj, Anu Mary Oommen, Thomas V Paul
Introduction: Calcium is the most abundant mineral in our body with varied functions and its dietary deficiency leads to osteoporosis, besides playing a significant role in the pathogenesis of other diseases. The data regarding dietary calcium intake (DCI) among postmenopausal women in urban areas of South India is limited. Objectives: This study was aimed to assess DCI and physical activity among postmenopausal women. The risk factors for a low intake of dietary calcium were also assessed. Materials and Methods: A cross-sectional study was done among 106 postmenopausal women selected by systematic random sampling from the city of Erode, Tamil Nadu, India. DCI and physical activity were measured using validated questionnaires. Results: The mean DCI was 632.72 ± 28.23 mg/day. The proportion of women consuming less than 800 mg/day of dietary calcium was 74.5%. Only 10.4% of the women studied (11 out of 106) were on calcium supplements while 55% had low physical activity. A low knowledge score [adjusted odds ratio (OR): 5.17; 95% confidence interval (CI): 1.31-20.42] and a low socioeconomic status (SES) score of the family (adjusted OR: 4.00; 95% CI: 1.32-12.11) were significantly associated with low DCI after adjusting the age, dietary preferences, and educational and occupational statuses. Conclusions: DCI was below the Recommended Dietary Allowance (RDA) and the majority of postmenopausal women were physically inactive, indicating the need for better education regarding DCI and the need for calcium supplements and physical activity, all of which can contribute to the prevention of the consequences of osteoporosis.
Low uptake of periodic health examinations in the Kingdom of Saudi Arabia, 2013
Charbel El Bcheraoui, Marwa Tuffaha, Farah Daoud, Mohammad A AlMazroa, Mohammad Al Saeedi, Ziad A Memish, Mohammed Basulaiman, Abdullah A Al Rabeeah, Ali H Mokdad
Introduction: It is unknown whether Saudis receive health examinations periodically. To inform health authorities on the health-seeking behavior of the Saudi population, we investigated patterns of periodic health examination (PHE) use by Saudis. Materials and Methods: We conducted a nationally representative multistage survey of individuals aged 15 years or older on sociodemographic characteristics, healthcare utilization, and self-reported chronic conditions. We used a backward elimination multivariate logistic regression model to measure associations between PHE and sociodemographic, behavioral, and health characteristics. Results: Between April and June 2013, a total of 12,000 households were contacted, and 10,735 participants completed the survey (response rate of 89.4%). Among participants, 2542 (22.9%), representing more than 2.7 million Saudis aged 15 years or older, received a PHE during the past 2 years. Moreover, 7463 (73.5%) participants, representing 9.1 million Saudis, visited a healthcare setting in the past 2 years due to illness or injury. The likelihood of receiving a PHE in the past 2 years increased with age, education, being married, consumption of five servings of fruits and vegetables per day, diagnoses of prediabetes, diabetes, or hypercholesterolemia, and a visit to a healthcare setting within the last 2 years due to an illness or an injury. Discussion: This is the first national study to investigate the use of PHE in Kingdom of Saudi Arabia (KSA) where healthcare is freely available. Few Saudis seek preventive healthcare and most healthcare visits are for injuries or sickness. KSA may reduce its health expenditures by routinizing PHE and detecting chronic conditions at early stages.
Clinical and laboratory profile of dengue in the elderly
Rahul Unnikrishnan, Baiju P Faizal, Priya Vijayakumar, George Paul, RN Sharma
Background: Dengue is the most rapidly spreading mosquito-borne viral disease in the world with a 30-fold increase in incidence in the last 50 years. Approximately, 50 million dengue infections occur annually. Aim: To study the various clinical and laboratory manifestations of dengue in the elderly and observe for any variations in IgM titer elevation with progression of age. Design: Retrospective observational study. Subjects and Methods: Medical charts of all patients admitted to the Division of Geriatrics of the institute during study period were reviewed for collection of demographic, clinical, and laboratory information. The diagnosis of dengue was made based on positive dengue IgM ELISA. An elderly patient referred to one whose age was ≥60 years. Results: Fever and myalgia were noted to be the most common clinical manifestation with only four patients presenting with overt bleeding manifestations. Only one patient presented in delirium and there was no case fatality. Thrombocytopenia was the single most common hematological abnormality noted. Hyponatremia was found to be prevalent in a majority of the patients and were symptomatic in more than half of them. There have been very few studies done worldwide on the varied clinical manifestations of dengue in the elderly.
Pneumoperitoneum: What to look for in a radiograph?
Binit Sureka, Kalpana Bansal, Ankur Arora
Knowledge about diabetes and relationship between compliance to the management among the diabetic patients from Rural Area of Sangli District, Maharashtra, India
Girish M Chavan, Vivek B Waghachavare, Alka D Gore, Vishwajeet M Chavan, Randhir V Dhobale, Girish B Dhumale
Introduction: Diabetes is an important public health problem of India. Studies have shown that increase in patients' knowledge regarding the disease results in better compliance to treatment and decrease in complications. This study was planned to assess the knowledge about diabetes and its correlation with pharmacological and non-pharmacological compliance, among the diabetic patients attending rural health center from Sangli District, Maharashtra (India). Materials and Methods: The study was conducted during September to November 2014. The study subjects were all willing adult patients with type II diabetes mellitus attending a selected rural hospital. The study tool was pretested and self-administered questionnaire. Analysis was done using Microsoft Excel and SPSS-22. Results: Total study participants were 307 in number, with the mean age of 55.6 years. The mean morbidity with diabetes was 10.7 years. Only 23.8% had good knowledge regarding diabetes, while 19.2% participants had poor knowledge. Knowledge was significantly associated with the compliance to the pharmacological and non-pharmacological management. Conclusion: Although most of the patients were suffering with diabetes for many years there is lack of knowledge regarding the disease and self care. The compliance to the management of diabetes was better in patients with good knowledge. Seminars, counseling sessions and workshop should be arranged periodically for diabetic patients to increase their awareness.
Contaminated tooth brushes-potential threat to oral and general health
Rashmi Naik, BR Ahmed Mujib, Neethu Telagi, BS Anil, BR Spoorthi
Background: Tooth brushing is most common method of maintaining oral hygiene. In removing plaque and other soft debris from the teeth, tooth brushes become contaminated with bacteria, blood, saliva and oral debris. These contaminated tooth brushes can be a source of infection. Aims and objectives: The aim of the present study was to evaluate the presence of microorganisms in the tooth brushes and to investigate the effect of disinfectants such as chlorhexidine gluconate, sodium hypochlorite and water to decontaminate them. Materials and Methods: Twenty-one children were asked to brush their teeth for 5 days with a tooth brush. The tooth brushes were put in Robertson's Cooked Meat broth and were observed for growth of Streptococcal microorganisms. These tooth brushes were then placed in disinfectants such as 0.2% chlorhexidine gluconate (Group I), 1% sodium hypochlorite (Group II) and water (Group III) for 24 hrs and then cultured again. Reduction of growth of microorganisms was seen in Group I, Group II and remnants of growth seen in Group III. Conclusion: We conclude that the use of disinfectant for a tooth brush is a must for every individual at least at regular intervals.
Perceptions of teachers about learning disorder in a northern city of India
Susanta Kumar Padhy, Sonu Goel, Shyam Sunder Das, Siddharth Sarkar, Vijaylaxmi Sharma, Mahima Panigrahi
Background: Teachers are perhaps the closest observers of child's academic performance and can be instrumental in detecting learning disorder (LD) early. Objectives: The present study aimed to assess the teachers' perceptions about LD. Materials and Methods: This is a cross-sectional questionnaire-based study in the public schools located in the urban, rural and slum areas of Chandigarh. Teachers were recruited from 20 randomly selected schools out of a total of 103 schools in the Union Territory by proportionate sampling. The sample size required for α of 0.05 and power of 0.80 to detect a difference of 15% from base rate of 35% was 80. Eighty teachers of 3 rd and 4 th grades of these schools were recruited using purposive sampling. Teachers were briefed for 5 minutes about the symptoms of LD. They were asked questions using a structured questionnaire about their socio-demographic status, methods of teaching, and students' progress and their perception about LD. Descriptive statistics was mainly used to represent nominal and ordinal data using frequency and percentages. Non-parametric statistical tests were used to assess relationship between the variables. Results: Eighty teachers were recruited, 87.5% were females, 57.5% had more than 5 years teaching experience; 56.3% of teachers thought that they were aware of LD, 67.5% of teachers perceived that they do encounter children with LD in the school, 43.8% endorsed educating such children in special schools, while 36.3% endorsed integration to regular schools. Interestingly, more than three fifth of teachers were willing to undergo special training for LD intervention. Conclusion: Teachers acknowledge that there is a need for further steps to be taken to help children with LD. They perceive opening special cells or sending such children to special schools for appropriate intervention which may not tally with the perception of clinician who may wish to provide LD intervention in hospital setting.
Women exposed to second-hand smoke more at home than at workplace: An analysis of GATS Report, India, 2009-10
Deepika Agrawal, Arun Kumar Aggarwal, Sonu Goel
Background: Tobacco smoke has adverse health effects on women of the reproductive age group with serious health implications for the next generation. Objectives: This study assessed the prevalence of current active smoking, second-hand smoke (SHS) exposure and the factors influencing smoke exposure in females of the reproductive age group. Materials and Methods: Data from the nationally representative Global Adult Tobacco Survey-India (GATS 2009) was analyzed for socio demographic variables, tobacco-related variables and knowledge variables. Results: 50.4% of the women in the reproductive age group had been exposed to SHS at home, though only 2.6% of the women were current active smokers. This was more than the SHS exposure at work (21.7%) and elsewhere (32.6%). SHS exposure of the women at home did not vary significantly with knowledge of adverse effects of smoking but was affected by the place of dwelling as the smoke exposure was found to be more among rural women. Conclusion: SHS exposure is more prevalent than current active smoking in women of the reproductive age group and that too at home. Thus, policies need to be framed in order to curb this menace which is a vicious one as women don't really have an alternative as far as this exposure is concerned.
WONCA YOUNG DOCTORS MOVEMENT
Family medicine 360°: Global exchanges in family medicine
Ana N Barata, Sara Rigon
Objective: The global world of the 21 st century has created communities and cultures that are interconnected, thanks to the development both in the field of transportation and technology. In this global intercultural community, future physicians, and even more so future general practitioners (GPs)/family physicians (FPs), need to be clinically competent and culturally sensitive and flexible in order to adapt to different social settings while delivering holistic care in multiethnic teams and environments with professionalism. As such, exchange programs are exceptional opportunities for international collaboration and the development of personal and professional competencies of these health care professionals. Materials and Methods: This article presents a review of the literature on the value of exchanges as well as the results of exchange programs with educational content that are aimed at junior GPs/FPs. Results: Exchange programs have been growing in popularity, especially among junior GPs/FPs. Since its launch in 2013, The "Family Medicine 360° (FM360°) program has been receiving up to 163 inquires till date, promoting global cooperation among the World Organization of family Doctors (WONCA)'s Young Doctors' Movementd (YDMs). Conclusions: By participating in an exchange program, future GPs/FPs are given the chance to experience intercultural communication and peer collaboration. They also develop personal and professional skills and thus, actively contribute to the growth and development of primary care all over the world.
Are interventions to reduce sitting at workplace effective?
Nipun Shrestha, Soumyadeep Bhaumik
Clinical Scenario It is common for family physicians in developing nations like India to encounter patients whose profession demands sedentary lifestyle. Such patients present with back problems, obesity, cardiovascular diseases and diabetes and ask doctors for advice on how to decrease sitting. Workplaces need to address this issue by inculcating strategies to decrease sitting and improve health of their employees. Occupational physicians too need to suggest evidence-based strategies to employers. This article provides an evidence based summary about what interventions are actually effective for decreasing sitting at workplace.
Clinical profile of non-traumatic acute abdominal pain presenting to an adult emergency department
Lakshay Chanana, Moses A. K. Jegaraj, Kimmin Kalyaniwala, Bijesh Yadav, Kundavaram Abilash
Background: Abdominal pain is one of the most common reasons for presenting to the emergency depatment (ED) and the etiology is varied. Materials and Methods: This prospective observational study was conducted in a large ED of a tertiary care center in India. All patients older than 15 years and presenting with non-traumatic abdominal pain to the ED from May 2012 to October 2012 were recruited and the demographic characteristics, diagnosis and outcome were analyzed. Results: The study cohort included 264 patients over a 6 month period. More than half (55.6%) were aged between 15 and 40 years. There was a male predominance (56.8%). Majority of the patients (76.9%) presented with abdominal pain of less than 72 hour duration. The pain was sudden in onset in 54.9% of patients. Dull type was the most common character of pain (36%) followed by colicky type (22.3%). The most common site of pain was the lower abdomen (45.8%). Upper abdominal pain was seen in 26.9% and the pain was generalized in 27.3% of patients. The common causes were uretericcolic (16.3%), urinary tract infection (12.5%), acute pancreatitis (11%), acute appendicitis (10.6%) and acute gastritis (8%). More than half (51.9%) discharged from ED and 37% of cases were managed by the emergency physicians. Surgical intervention was required in 25.8% of patients. The mortality rate was 2.3%. Conclusions: Abdominal pain is a common ED symptom and clinicians must consider multiple diagnoses, especially those that require immediate intervention to limit morbidity and mortality.
The prediction of postpartum depression: The role of the PRECEDE model and health locus of control
Mahdi Moshki, Akram Kharazmi, Khadijeh Cheravi, Tahereh Baloochi Beydokhti
Background: The main purpose of this study was to investigate the effect of the PRECEDE model and health locus of control (HLC) on postpartum depression. This study used the path analysis to test the pattern of causal relations through the correlation coefficients. Materials and Method: The participants included 230 pregnant women in the north-east of Iran who were selected by convenience sampling. To analyze data, Pearson correlation and path analysis were applied to examine the relationships between variables using SPSS 20 and LISREL 8.50software. Results: The result of path analysis showed that a positive correlation exists between predisposing (knowledge, internal HLC, powerful others HLC, chance HLC) enabling and reinforcing factors with postpartum depression by GHQ score (GFI = 1, RSMEA = 000). Conclusion: The current study supported the application of the PRECEDE model and HLC in understanding the promoting behaviors in mental health and demonstrated their relationships with postpartum depression.
An interesting case of characteristic methanol toxicity through inhalational exposure
Pratyush Kumar, Atul Gogia, Atul Kakar, Pratyush Miglani
Methanol poisoning is rare but carries high risk of morbidity and mortality. Most of the cases witnessed in emergency are due to consumption of adulterated alcohol. Here we are reporting a very rare case of methanol poisoning through inhalational exposure leading to putamen necrosis and decreased visual acuity. He had dyselectrolytemia and metabolic acidosis which was successfully managed with early intervention. Its importance lies in the fact that inhalational methanol poisoning is an entity which if picked up early can prevent long-term neurological sequelae.
Generic drugs: Review and experiences from South India
Philip Mathew
The cost of pharmaceuticals, as a percentage of total healthcare spending, has been rising worldwide. This has resulted in strained national budgets and a high proportion of people without access to essential medications. Though India has become a global hub of generic drug manufacturing, the expected benefits of cheaper drugs are not translating into savings for ordinary people. This is in part due to the rise of branded generics, which are marketed at a price point close to the innovator brands. Unbranded generic medicines are not finding their way into prescriptions due to issues of confidence and perception, though they are proven to be much cheaper and comparable in efficacy to branded medicines. The drug inventory of unbranded generic manufacturers fares reasonably when reviewed using the World Health Organization-Health Action International (WHO-HAI) tool for analysing drug availability. Also, unbranded generic medicines are much cheaper when compared to the most selling brands and they can bring down the treatment costs in primary care and family practice. We share our experience in running a community pharmacy for an urban health center in the Pathanamthitta district of Kerala State, which is run solely on generic medicines. The drug availability at the community pharmacy was 73.3% when analyzed using WHO-HAI tool and the savings for the final consumers were up to 93.1%, when compared with most-selling brand of the same formulation.
The leadership crisis of medical profession in India: Ongoing impact on the health system
Rita Sood
Evaluation of input and process components of quality of child health services provided at 24 × 7 primary health centers of a district in Central Gujarat
Paragkumar Chavda, Shobha Misra
Context: With the critical Indian challenge on child survival and health, time is ripe to initiate focus on quality of services apart from measuring coverage, to bring about improvements. Aims: To assess the quality of child health services provided at 24 × 7 Primary Health Centers of Vadodara District in Gujarat in terms of Input and Process Indicators. Settings and Design: The study was carried out in 12 randomly chosen 24 × 7 Primary Health Centers (PHCs) of Vadodara district using a modified quality assessment checklist of the Program on District Quality Assurance for Reproductive and Child Health (RCH) services with use of scores from May 2010 to June 2011. Subjects and Methods: Inputs assessment was done by facility survey. Process assessment for the four child health service components used actual observation of service, review of records and interview of service providers and clients. Results: The mean obtained score for facilities in Input section was 65%. Highest score was obtained for Drugs and Consumables (86%) followed by Equipments and Supplies (74%). The score obtained for Infrastructure facility was 65%, Personnel and training was 56% and Essential protocols and guidelines scored 43%. The mean obtained score in the process section was 55%. Highest scores were obtained for immunization at 76%. This was followed by newborn care (52%), growth monitoring (52%). management of sick child (41%). Conclusion: Quality improvement efforts should focus not only on resource-intensive structural improvements, but also on cost-effective measures at improving service delivery process, especially adherence to service guidelines by providers.
Morbidity status of low birth weight babies in rural areas of Assam: A prospective longitudinal study
Madhur Borah, Rupali Baruah
Introduction: Low birth weight (LBW) infants suffer more episodes of common childhood diseases and the spells of illness are more prolonged and serious. Longitudinal studies are useful to observe the health and disease pattern of LBW babies over time. Aims: This study was carried out in rural areas of Assam to assess the morbidity pattern of LBW babies during their first 6 months of life and to compare them with normal birth weight (NBW) counterparts. Materials and Methods: Total 30 LBW babies (0-2 months) and equal numbers of NBW babies from three subcenters under Boko Primary Health Centre of Assam were followed up in monthly intervals till 6 months of age in a prospective fashion. Results: More than two thirds of LBW babies (77%) were suffering from moderate or severe under-nutrition during the follow up. Acute respiratory tract infection (ARI) was the predominant morbidity suffered by LBW infants. The other illnesses suffered by the LBW infants during the follow up were diarrhea, skin disorders, fever and ear disorders. LBW infants had more episodes of hospitalization (65%) than the NBW infants (35%). Incidence rate of episodes of morbidity was found to be higher among those LBW infants who remained underweight at 6 months of age (Incidence rate of 49.3 per 100 infant months) and those who were not exclusively breast fed till 6 months of age (Incidence rate of 66.7 per 100 infant months). Conclusion: The study revealed that during the follow up, incidence of morbidities were higher among the LBW babies compared to NBW babies. It was also observed that ARI was the predominant morbidity in the LBW infants during first 6 months of age.
Assessment of morbidity pattern, quality of life and awareness of government facilities among elderly population in South India
Nitin Joseph, Maria Nelliyanil, Sriraksha R Nayak, Vyom Agarwal, Arjun Kumar, Harsh Yadav, Gourav Ramuka, Kshirabdhi Tanaya Mohapatra
Background: This study was done to assess the determinants of morbidity pattern, quality of life (QoL) and awareness of elderly about various government schemes and social security legislations. Materials and Methods: Data was collected by house to house survey among participants aged 60 years and above using a structured interview schedule. The QoL was assessed using Kannada version of WHOQOL-BREF instrument following language validation. Results: Mean age of 206 participants was 69.6±6.7 years. Half of them were males and majority were graduates 54 (26.2%). Morbidity was present among 194 (94.2%) participants (95% CI 89.5-98.9%), most common being hypertension 96 (46.6%). Morbid conditions were seen more among less educated (P = 0.007). Only 68 (33%) were under medical insurance coverage, 17 (8.3%) were under old age government pension and 74 (35.9%) were under retirement pension scheme. Social relationships, psychological health and environmental domain scores were associated with socio-economic status. Social relationship domain score was significantly better among well educated participants and those without morbidities. Level of ambulation was significantly associated with QoL scores in all domains (P < 0.001). Majority of the participants 132 (64.1%) had moderate level of awareness about government facilities for senior citizens. Awareness level was significantly better among males (P < 0.001), well educated (P < 0.001), better socio-economic status respondents (P < 0.001) and those currently working (P = 0.026). Conclusion: Health status of elderly needs improvement which would also improve their QoL. Awareness about various government schemes needs to be enhanced to improve its utilization. The results of this study are expected to help policy makers in planning comprehensive services for elderly residing in this area.
India's draft National Health Policy, 2015: Improving policy to implementation effectiveness
Nata Menabde, Chandrakant Lahariya
As the Government of India is working on drafting a new National Health Policy, developing national health accounts, and planning for a "health assurance mission," this opportunity has the potential to transform health status of millions of Indians and achieve universal health coverage. The draft of new National Health Policy of India was put in public domain for comments in early 2015. This editorial reviews the draft National Health Policy 2015 and proposes a few steps to improve implementation effectiveness.
Can routine screening and iron supplementation for iron deficiency anemia in nonsymptomatic pregnant women improve maternal and infant health outcomes?
Anoosh Moin, Zohra S Lassi
Clinical Scenario Pregnant women have an increased need for iron that might not be met with diet alone. Due to physiologic anemia and population differences, no set criteria for defining iron deficiency anemia (IDA) are available globally. Serum ferritin and transferrin levels are often used to guide therapy by clinicians. Studies have reported an association between poor iron status and negative health outcomes such as low birth weight, premature birth, and perinatal death for women and their infants, although the evidence is weak.
Health and beyond...strategies for a better India: using the "prison window" to reach disadvantaged groups in primary care
Soumyadeep Bhaumik, Rebecca J Mathew
As of 2013, the latest statistics available, more than 400,000 individuals are lodged in Indian prisons. Prisoners represent a heterogeneous population, belonging to socially diverse and economically disadvantaged sections of society with limited knowledge about health and healthy lifestyles. There is considerable evidence to show that prisoners in India have an increased risk of mental disorders including self-harm and are highly susceptible to various communicable diseases. Coupled together with abysmal living conditions and poor quality of medical services, health in prisons is a matter of immense human rights concern. However, the concept and the subsequent need to view prison health as an essential part of public health and as a strategic investment to reach persons and communities out of the primary health system ambit is poorly recognized in India. This article discusses the current status of prison healthcare in India and explores various potential opportunities the "prison window" provides. It also briefly deliberates on the various systematic barriers in the Indian prison health system and how these might be overcome to make primary healthcare truly available for all.
Clinical audit and lifelong reflective practice as game changers to integrate medical education and practice
Rakesh Biswas
Prevalence and patterns of coexistence of multiple chronic conditions: A study from Indian urban outpatient setting
Rajnish Joshi, John A Santoshi, Nirendra Rai, Abhijit Pakhare
Background: Chronic diseases are a common cause for seeking care in a hospital, however little is known about prevalence and spectrum of multiple chronic conditions (MCC) in Indian context. Estimates for coexistence of MCC range from one-fourth of all primary care attendees in Spain to two-thirds of all medicare attendees in the United States. This study was designed to estimate the similar prevalence and patterns in an Indian outpatient setting. Materials and Methods: This study was performed at All India Institute of Medical Sciences Bhopal between May and June 2013, a hospital which had just started outpatient services in this period. All consecutive patients that presented to Medicine, Neurology, and Orthopedics clinics were sought to be included in the study, and information about their current diagnoses was abstracted from their outpatient records. All patients with one or more chronic disease diagnosis were asked about their monthly out-of-pocket expenditure. We performed a descriptive analysis of the demographic, medical diagnoses, and out-of-pocket expenditure variables. Results: A total of 785 patients were included in the study, and 286 (36%) of them had one or more chronic disease diagnosis. Of these, 103 (13%) had a single chronic disease, while 183 (23%) had more than one chronic disease diagnosis. Among those with MCCs, chronic vascular diseases in combination, followed by combinations of chronic vascular and immunological diseases were common patterns. There was a significant rising trend in average out-of-pocket expenditure with increasing number of chronic disease diagnoses. Conclusion: Co-existence of multiple chronic diseases is common in those who seek hospital-based care. This fact has important implications for education and clinical decision making in primary care.
An audit of the completion of radiology request forms and the request practice
Akintunde O Akintomide, Anthonia A Ikpeme, Affiong I Ngaji, Nchiewe E Ani, Appolline T Udofia
Objective: To assess the degree of utilization of the radiology request form (RRF), the extent of completion each form, the frequency of filling the fields in all the forms, and its effectiveness as a communication tool between the referring clinicians and radiologists. Materials and Methods: All the RRFs for conventional radiographic examinations were audited over a 3-month period. A database containing all the fields in the form, type of request paper used, and legibility of the physician's handwriting was created. A few resident radiologists in the plain film reporting unit were recruited to join in collecting the data daily. We used simple statistical methods to analyze the extent of completion of each form, frequency of completion of the fields in all the request forms, frequency of use of the appropriate form, and frequency of legibility of the physician's handwriting. The results are expressed in percentages. Results: Five hundred eighty (580) requests were analyzed, consisting of 180 for males and 400 for females. The most-completed request form was 86.67% filled, while the least-completed was 26.67%. The most frequently filled field was the requested examination (99.66%). Of the clinicians, 28% did not use the RRF for their referrals, while 7.37% had illegible handwriting. Conclusion: A significant number of the referring clinicians did not make the best use of the radiology department by not using the institution's approved RRF as an effective means of communication with the radiologists, mainly due to the inadequate completion of the forms.
Hyperglycemia associated dissociative fugue (organic dissociative disorder) in an elderly
Dushad Ram, HG Ashoka, Basavnna Gowdappa
Inadequate glycemic control in patients with diabetes is known to be associated with psychiatric disorders such as depression, anxiety disorder, and cognitive impairment. However, dissociative syndrome has not been reported so far. Here we are reporting a case of repeated dissociative fugue associated with hyperglycemia, in an elderly with type II diabetes. Possible neurobiological mechanism has been discussed.
An uncommon cause for hip pain and limping
Sahana Shetty, Samantha Sathyakumar, Nitin Kapoor, Thomas Vizhalil Paul
Slipped capital femoral epiphysis (SCFE) is characterized by displacement of the capital femoral epiphysis from the femoral neck. An 18-year-old male presented with left hip pain and a limping gait, following a trivial trauma. Radiological examination revealed bilateral SCFE. Clinically and biochemically, he had features of hypopituitarism. His prolactin levels were high and magnetic resonance imaging (MRI) scan showed a pituitary macroadenoma, suggesting a diagnosis of macroprolactinoma causing hypopituitarism and presenting as SCFE. He was started on dopamine agonist cabergoline as well as thyroxine and glucocorticoid replacement treatment. He was also scheduled for an orthopedic surgical procedure for his SCFE.
What individual doctors can do to counter the leadership crises in medical profession?
Rohan Bhoil, Sanshrita Jhingan, Sabina Jagdevan, Rohit Bhoil
Knowledge and awareness of Consumer Protection Act among private dentists in Tricity, Punjab
Ramandeep Singh Gambhir, Jagjit Singh Dhaliwal, Samir Anand, Arvind Bhardwaj
Background: Consumer Protection Act (CPA) aims to protect the interests of the patients in case of any unethical treatment rendered by a medical or a dental health professional. The present study was conducted to assess knowledge and awareness of CPA among dental professionals in a Tricity in India. Materials and Methods: A cross-sectional study was conducted among 265 private dental practitioners in Tricity. A close-ended self-structured questionnaire was administered which contained 15 questions on knowledge and awareness regarding CPA. Categorization of knowledge scores was done at three levels-low, medium and high. Statistical analysis was done using ANOVA and Student t-test. Results: 54.7% (145) of subjects were having low knowledge scores, 23.3% (62) had a medium score and 21.8% (58) had a high score. Mean knowledge score according to educational level was statistically significant (P<0.05), whereas there was no significant difference in case of gender and type of practice (P > 0.05). Conclusion: The results of the present study showed that majority of the subjects were aware of the existence of CPA but knowledge regarding basic rules and regulations was lacking in few studies. Therefore, dental professionals need to keep them updated of various rules and latest amendments to save themselves from any litigation.
The effects of anti-depressants on depression symptom scores at 12 months follow-up in patients with cardiometabolic disease: Results from a large primary care cohort
Bhautesh Dinesh Jani, David Purves, Sarah J. E. Barry, Colin McCowan, Jonathan Cavanagh, Frances S Mair
Background: Evidence on the long-term usefulness of anti-depressants in managing depression in cardiometabolic disease is limited. Aim: We examined the effects of anti-depressant prescribing on depressive symptoms at 12 months follow-up in patients with cardiometabolic disease and a positive depression screening result at baseline. Design and Setting: We retrospectively reviewed routine UK primary care data for patients with coronary heart disease, diabetes and previous stroke for the year 2008-2009. 35,537 patients with one of the three above diseases underwent depression screening using the Hospital Anxiety and Depression Scale (HADS-D). Of 7080 patients with a positive screening result (HADS-D ≥ 8), 3933 (55.5%) patients had a repeat HADS-D recorded at 12 months follow-up. Methods: We compared the change in HADS-D at follow-up and remission rate in those who were prescribed anti-depressants (n = 223) against those who were not (n = 3710). Results: The mean change in HADS-D from baseline, for the nonprescribed group was similar to the reduction observed in patients who were continuously prescribed (n = 93) with anti-depressants during follow-up. Patients who were prescribed intermittently (n = 72) or only one (n = 58) prescription during follow-up had a lower reduction in HADS-D compared to the nonprescribed group. There was no difference in remission rates between continuously prescribed and the nonprescribed group, but remission was lower in patients prescribed intermittently and single prescription. Conclusion: Improvement in depressive symptoms in patients with cardiometabolic disease at 12 months was not any better in patients prescribed with anti-depressants compared to the nonprescribed group. The role of anti-depressants in the management of depression in cardiometabolic disease merits further investigation.
Visual dynamic e-module as a tool to fulfill informational needs and care continuum for diabetic patients
Mohan Shinde, Ankur Joshi, Vishwanath Arutagi, Daneshwar Singh, Vidhu Shekhar Khare, Pulkit Pandey
Introduction: Diabetes can be envisaged as a lifelong phenomenon having the ominous odds for multisystemic involvement in the duration of disease. The probabilities of the occurrence of these events are influenced by the adopted lifestyle. Hence, information about the disease and lifestyle modification are vital from the perspective of prognostics. This study attempts to explore the potential of a "visual dynamic tool" for imparting knowledge and consequently received acumen by diabetic patients. Objectives: To appraise the effectiveness of a constructed visual dynamic module (encompassing the various dimensions related to and affected by diabetes) by capturing the opinions, perceptions, and experiences of the diabetic patients who underwent intervention through the module. Materials and Methods: A visual e-module with dynamically imposed and animated images in the vernacular (Hindi) was prepared. This module was instituted among the diabetic patients in a logical sequence for consecutive 3 days. All the diabetic patients who underwent this intervention were interviewed in depth in order to ascertain the effectiveness of the module. These interviews were analyzed by thematic and framework analyses. Result: The visual module was perceived by the diabetic patients as an optically engaging tool for receiving, connecting, and synthesizing information about diabetes. They sensed and expressed the ease to connect with the images and labeled the received information as inclusive. Conclusion: Initial evidences suggest that visual e-module is an effective and efficient tool for knowledge management in diabetes. This issue may be further explored at diverse academic and clinical settings for gathering more information for efficacy.
Preparedness of frontline health workers for tobacco cessation: An exploratory study from two states of India
Rajmohan Panda, Swati Srivastava, Divya Persai, Manu Raj Mathur, Bhavesh Modi, Paresh Dave, Monika Arora
Background: The 5As approach is a clinic-based approach and has been developed for primary health care providers who are uniquely positioned to interact with tobacco users. The 5As stands for: Ask about tobacco use at every visit, advise tobacco users to quit, assess readiness to quit, assist quit attempts through counseling and pharmacotherapy and arrange follow-up to prevent relapse. The present study explores whether auxiliary nurse midwives (ANMs) adhere to the 3As from the recommended 5As model for tobacco cessation. Materials and Methods: The study was a cross-sectional study conducted among 501 ANMs in the state of Gujarat and Andhra Pradesh. Descriptive analysis and chi-square test were employed to test the differences in knowledge levels and practices of ANMs. Bivariate logistic regression was used to examine the association between each predictor variable separately and the outcome variables after adjusting for age and location. Data was analyzed using SPSS version 17 software. Results: Majority of ANMs reported that they were aware of respiratory illnesses, tuberculosis, lung and oral cancer as conditions caused due to tobacco consumption. Awareness of adverse reproductive and child health effects associated with tobacco use was very low. Only about one third of respondents informed all patients about harmful effects. Only 16% of ANMs reported having ever received any on-job training related to tobacco control. ANMs who reported receiving training in tobacco control were about two times more likely to provide information on health effects of tobacco as compared to those who reported not being trained in tobacco control in the state of Gujarat. Conclusions: A majority of ANMs ask patients about tobacco use but provide advice only to patients suffering from specific diseases. A context-specific capacity building package needs to be designed to equip ANMs in recommended 5As approach in tobacco cessation.