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    Table of Contents - Current issue
Coverpage
October-December 2017
Volume 42 | Issue 4
Page Nos. 189-250

Online since Wednesday, October 25, 2017

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EDITORIAL COMMENTARY  

Reforming community medicine in line with the country's health priorities - Let's make it relevant and rational Highly accessed article p. 189
AM Kadri
DOI:10.4103/0970-0218.217237  
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ORIGINAL ARTICLE Top

Is there an association between the duration of stay in the medical colleges and the smoking behavior among medical students? A cross-sectional study Highly accessed article p. 193
JP Majra, KM Akshaya
DOI:10.4103/ijcm.IJCM_111_16  
Background: Health-care providers must be at the forefront of tobacco cessation to ensure a downward shift in tobacco use. Medical schools constitute an important site for education and cessation efforts. Health-care professionals play a substantial role in influencing patients' lifestyle choices including tobacco cessation. Objectives: To examine the association between the duration of stay in the medical colleges and the smoking behavior among the medical students in Karnataka, India. Materials and Methods: One government and four private medical colleges were selected using stratified random sampling technique for this cross-sectional study. Sample size was 3288 medical students. A pretested self-administered questionnaire was used to collect data. SPSS version 12.0 was used for data analysis. The statistical methods used were frequencies, proportions, and Chi-square test. Results: Mean age of the study participants was 20.68 ± 2.05 years for males and 20.20 ± 1.91 years for females. Number of smokers among medical students after joining medical college increased 2.7 times. The duration of stay in the medical colleges was positively associated with the smoking behavior (P < 0.0001) among medical students, and the increase in the number of smokers reached up to 259.6% during internship. Conclusion: Smoking among medical students increases along with their stay in medical college.
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ERRATUM Top

Erratum p. 196

DOI:10.4103/0970-0218.217220  
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ORIGINAL ARTICLES Top

Building evidence for coverage of fully vaccinated children of 12–23 months of age across Districts of North India, 2015 p. 197
Ashok Kumar Bhardwaj, Dinesh Kumar, Sushant Sharma, Anmol Gupta, Vishav Chander, Abhilash Sood
DOI:10.4103/ijcm.IJCM_126_16  
Context: Unprecedented low coverage (63%) of fully vaccinated (FV) children in the recent round of national survey district level household (HH) and facility survey 4 (DLHS-4) propelled health system of Himachal Pradesh for an independent rapid assessment of FV coverage. Aim: The aim of the study was to assess the FV coverage among 12–23-month old children in the state. Settings and Design: A community-based survey with an interviewer-administered questionnaire was carried out in all 12 districts of Himachal Pradesh from September 2015 to January 2016. Subject and Methods: WHO 30 × 7 cluster technique was used. Statistical Analysis Used: Chi-square and unpaired Student's t-test along with 95% confidence intervals. Results: A total of 2492 children across 35,551 HHs (2.4% of state share) were surveyed with FV coverage of 98.1% (95% confidence interval [CI]: 97.5–98.6) and 86% (95% CI: 84.6–87.3) based on history and card, respectively. Conclusions: The reported FV coverage in the current study was observed too high in the state as reported in earlier round of the national surveys (except DLHS-4).
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Linkages between hypertension and coronary heart disease in India: Evidence from India human development survey-2 (2011–2012) p. 200
Ayantika Biswas, Shri Kant Singh, Rakesh Kumar Singh
DOI:10.4103/ijcm.IJCM_168_16  
Background: Cardiovascular diseases (CVDs) are the leading causes of death globally (nearly 17.5 million deaths/year). Hypertension and coronary heart disease (CHD) are two of the most important CVDs. There is a dearth of studies at a large scale in India to ascertain the factors as well as social differentials in the prevalence of heart disease associated with hypertension. This paper attempts to bridge the gap in the relevant area. Methodology: Secondary analysis of the data obtained from India Human Development Survey (IHDS), conducted in two rounds in 2004–2005 and 2011–2012, was done (n = 147,201). Bivariate and logistic regression analyses have been used. Results: In India, the prevalence for CHD is 1.1% for 2011–2012. Findings showed that persons with hypertension are 11 times (odds ratio [OR] = 11.58, P < 0.01) more likely to be affected by CHD among adults (15 and above years) as compared to nonhypertensive adults. When the odds are adjusted for socioeconomic and demographic variables, hypertensives are found to be 5 times more likely (OR = 5.096, P < 0.01) to be having CHD as compared to nonhypertensives. Conclusions: The unadjusted odds of suffering from CHD when hypertension is a predictor are much higher than when the odds are adjusted for socioeconomic and demographic variables. Along with hypertension, age, education, and place of residence have also been found to be important determinants of CHD.
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A comparative study of depression and associated risk factors among elderly inmates of old age homes and community of Rajkot: A Gujarati version of the geriatric depression scale-short form (GDS-G) p. 204
Dipeshkumar D Zalavadiya, Anupam Banerjee, Ankit M Sheth, Matib Rangoonwala, Aarohi Mitra, Amiruddin M Kadri
DOI:10.4103/ijcm.IJCM_181_16  
Background: The prevalence of depression among elderly people varies across different setups such as old age homes (OAHs), community, and medical clinics. Aims: The aim of this study was to compare the epidemiological factors pertaining to depression among elderly residents of OAHs and community, using a new Gujarati version of the Geriatric Depression Scale-Short Form (GDS-G). Settings and Design: A cross-sectional, epidemiological study conducted in an urban setup of Western India. Materials and Methods: All the eligible 88 elderly residents of all the six OAHs and 180 elderly residents from the same city were administered a pretested semistructured questionnaire having the GDS-G form. Statistical Analysis: Descriptive statistics, odds ratio, Spearman's rank correlation test. Results: The elderly of OAHs were more depressed compared to those of community (odds ratio = 1.84; 95% confidence interval = 1.09–3.06). Older age, females, weaker family ties, economic maladies, poorer self-perception of health status, presence of chronic ailments, absence of recreational activity, lack of prayers, impaired sleep, history of addiction emerged as the predictors of depression in both the setups. More health complaints and a later self-perception of visit to a doctor were found among the depressed than the nondepressed in both the setups. Conclusions: Depressive symptoms were quite high among the elderly in both the setups. Special attention should be given toward health checkups of depressed persons in the OAH and improvement of family ties among depressed persons of the community.
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Neck circumference: Independent predictor for overweight and obesity in adult population p. 209
Madhur Verma, Meena Rajput, Soumya Swaroop Sahoo, Navjot Kaur
DOI:10.4103/ijcm.IJCM_196_16  
Background: Neck circumference (NC) measurement, an index of upper body fat (BF) distribution, seems promising as a community-based screening measure for overweight and obesity in want of evidence on its validity as a screener. Objective: The objective of this study was to determine the validity of NC as a screener for overweight and obesity in adults in community settings against BF percentage (BF%). Materials and Methods: This cross-sectional community-based study involved data collection on a predesigned, pretested, and semi-structured schedule that included the sociodemographic characteristics and anthropometric measurements of respondents. Results: NC correlated positively with body weight, waist circumference, and hip circumference. NC was found to have good discriminatory power with cutoff values of 36.55 cm for males and 34.05 cm for females, with maximum sensitivity and specificity to predict overweight and obesity in comparison to direct BF% estimation on receiver operating characteristic analysis. Conclusion: NC has a fair validity as a community-based screener for overweight and obese individuals in the study context. Further studies may be carried out to explore the generalizability of this observation.
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Rapid response to syphilis outbreak among female sex workers p. 214
Shaily B Surti, JK Kosambiya, Neeta Khokhar, Mohamedanas Mohamedfaruk Patni, Alpesh H Gohil, Zeel N Kamdar, Dipak Umrigar, Ragini Verma, Summaiya Mulla
DOI:10.4103/ijcm.IJCM_254_16  
Background: Outbreak of syphilis, i.e., 16 cases of rapid plasma reagin (RPR) reactive cases of syphilis was reported in Community Based Organization (CBO) Sahyog of Surat, India, from April to August 2014. The aim of the study was to find risk factors and take immediate actions to prevent spread. Materials and Methods: Outbreak investigation of 16 Female Sex Workers of CBO Sahyog in Surat who were found Rapid Plasma Reagin (RPR) and Treponema Pallidum Hemagglutination Assay (TPHA) positive from April to August 2014; was carried out. Clinico-epidemiological and laboratory-based evidence for different sexually transmitted infections (STIs) conducted at Government Medical College, New Civil Hospital, Surat. Root cause analysis (RCA) of index case was carried out. Results: Desk review for the past 3 years data of STI revealed total STI cases as 88 (2011), 95 (2012), and 130 (2013), of which 4, 2, and 2 found RPR reactive, respectively. Data from April to August 2014 revealed 16 RPR reactive cases and confirmed by TPHA. On examination, one had ulcerative cervical lesion, rest did not have any symptoms of syphilis. Eleven had vaginal/cervical discharge, 11 had lower abdominal pain. A total of 11 had unprotected sex, 7 encountered condom tear in the past 6 months, and 5 reported sexual violence. Seven had sexual activity under influence of alcohol. Laboratory investigation revealed two as HIV-positive. RPR reactivity reported highest (9 out of 16) from same area of hotspot. RCA of probable index case revealed factors responsible as violence and nonuse of condoms. Conclusions: Outbreak investigation revealed one probable index case. All 16 treated with injection Penidure. Violence or condom tear is responsible for the spread. Crisis management team should be strengthened.
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Situational analysis of sickle cell disease in Gujarat, India p. 218
Deepak Saxena, Sandul Yasobant, Mahaveer Golechha
DOI:10.4103/ijcm.IJCM_284_16  
Background: Sickle cell disease (SCD) is a major public health concern in tribal community not only in Gujarat but also globally. Gujarat, a western state of India, has 89.12 lakh tribal populations and is expected to have at least 9,00,000 sickle cell trait and 70,000 SCD patients. The aim of the present review is to document the prevalence of SCD in various communities and various screening methods adapted. Methodology: An in-depth literature review was carried out using available search engines such as Cochrane Library, PubMed, Scopus etc. and published articles, and government reports/policy documents with reference to SCD were gathered. Results: A total of 17 original research articles and 2 policy/program documents are included in this review. The review suggests a prevalence of 0.6%–35% studies conducted among medical students, tribal schoolchildren, and tribal adolescents, with diverse screening methodologies. Conclusion: A diverse prevalence is observed in this review. Various screening methods such as dithionite turbidity test/hemoglobin/high-performance liquid chromatography methods were used to estimate the prevalence, citing the need for standardization. It was also found that not only tribal population, but also nontribal population have the risk of getting SCD that needs to be further investigated properly. Qualitative studies with SCD patients are required to understand the quality of life and morbidity pattern.
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Stress and stressors among medical undergraduate students: A cross-sectional study in a private medical college in Tamil Nadu p. 222
R Anuradha, Ruma Dutta, J Dinesh Raja, P Sivaprakasam, Aruna B Patil
DOI:10.4103/ijcm.IJCM_287_16  
Background: Medical education is perceived as being stressful, and a high level of stress may have a negative effect on cognitive functioning and learning of students in a medical school. Objectives: To (a) assess the perceived stress among medical undergraduate students, (b) identify the sources of stress, and (c) find an association of perceived stress with sociodemographic characteristics and various stressors. Materials and Methods: A cross-sectional study was conducted among medical undergraduate students in a private medical college in Tamil Nadu. A total of 750 medical students from 1st year to final year were invited to participate in the study. Self-administered questionnaire was used to collect data regarding sociodemographic profile, perceived stress using perceived stress scale-14 and academic, psychosocial and environmental stressors. Descriptive statistics was used to describe the sociodemographic characteristics, sources of stress and perceived stress. Logistic regression analyses were carried out to assess determinants of stress. Results: The overall response rate was 93.33% (700 out of 750 students). The mean perceived stress score was 25.64 ± 5.44. Higher age-group, year of studying bachelor of medicine and bachelor of surgery, vastness of academic curriculum, fear of poor performance in examination, lack of recreation, loneliness, family problem, and accommodation away from home were important determinants of perceived stress. Conclusions: The perceived stress was higher among higher age group and final year medical students. Academic, psychosocial, and environmental stressors are associated with perceived stress. Reframing the academic curriculum and examination patterns, incorporating recreational and sports activities, and establishment of counseling cells in the institution is needed.
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Status of iodine nutrition among pregnant women attending antenatal clinic of a secondary care hospital: A cross-sectional study from Northern India p. 226
Shashi Kant, Partha Haldar, Ayush Lohiya, Kapil Yadav, Chandrakant S Pandav
DOI:10.4103/ijcm.IJCM_312_16  
Background: Daily requirement of iodine increases during pregnancy making pregnant women a high-risk group for iodine deficiency disorders. The limited available literature shows that even in iodine sufficient population, pregnant women are iodine deficient. Objective: The objective of this study is to assess the current iodine nutrition status among pregnant women in Ballabgarh, district Faridabad, Haryana. Materials and Methods: Pregnant women were recruited from antenatal clinic (ANC) of subdistrict hospital (SDH), Ballabgarh, Haryana. Consecutive sampling strategy was followed to recruit pregnant women, and women of all trimesters were included in the study. Urinary iodine estimation was done using simple microplate method, and salt iodine was estimated using iodometric titration. The study was approved by Institute Ethics Committee, All India Institute of Medical Sciences (AIIMS), New Delhi. Results: Out of the total 1031 pregnant women, 90.9% were using adequately iodized salt. Median (interquartile range [IQR]) salt consumption by the pregnant women was 8.3 (6.7, 11.1) g/day. Median (IQR) urinary iodine concentration (UIC) for the pregnant women was 260 (199, 323) μg/L. Only 13.5% of pregnant women had insufficient iodine intake (UIC <150 μg/L). There was no significant difference in median UIC values by household salt iodine content and across three trimesters of pregnancy. Conclusion: Iodine nutrition status of the pregnant women attending ANC clinic of SDH Ballabgarh was adequate with attainment of universal salt iodization goal of >90% adequately iodized salt coverage in the study population.
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A longitudinal study to assess the role of sanitary inspections in improving the hygiene and food safety of eating establishments in a tertiary care hospital of North India p. 230
Puja Dudeja, Amarjeet Singh
DOI:10.4103/ijcm.IJCM_365_16  
Introduction: Food safety inspections serve two purposes; determine compliance with the law and gather evidence for enforcement if there is noncompliance. The present study was conducted to assess the role of regular inspections on food safety in hospital premises. Methodology: This was an intervention based before and after study. A tool was prepared based on the Food Safety and Standards Regulations (FSSR) (in India) 2011. This included major, critical, and highly critical domains. Each item in the tool scored between 1 and 3 (poor, satisfactory, and good). Based on this, each eating establishment (EE) was given a score on conformance to FSSR 2011. Monthly inspection was made over a year and corrective actions were suggested. Results: The minimum preintervention score was (41.28%), and maximum was (77.25%). There was no significant association between type of meal services and score EE (P > 0.05). Higher proportion of EEs within the hospital building had a satisfactory and good score as compared to EEs outside the hospital building but within hospital premises (P < 0.05). Postintervention, there was a significant change (increase) in the scores of EEs. There was a significant increase in mean scores of EEs under major domains namely maintenance, layout of equipment, monitoring an detection, and elimination of food sources to the pests. Under critical and highly critical domains personal cleanliness, training, and self-inspection by food business operators improved significantly. Conclusion: Regular inspections can improve the food safety standards in EEs.
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SHORT COMMUNICATIONS Top

Mapping neonatal mortality in India: A closer look p. 234
Myron Anthony Godinho, Shruti Murthy, Theophilus Lakiang, Amitha Puranik, Sreekumaran N Nair
DOI:10.4103/ijcm.IJCM_327_16  
Introduction: Fifty-three percent of Indian under-5 deaths occur during the neonatal age group. Recognizing that there is a lack of illustrated district-level data on neonatal mortality in India, we mapped this to visually highlight districts where neonatal health issues require the most attention. Methods: District-level estimates of 596 Indian districts were used to generate maps and to illustrate neonatal mortality rates (NMRs), absolute numbers of neonatal deaths; the best and worst performing districts (positive and negative deviants) in each Indian state; the neonatal female/male death ratio; and district lag in NMR reductions. Results: The NMR ranged from 4.3 (Kannur, Kerala) to 65.1 (Datia, Madhya Pradesh), with the mean NMR being 29.8. Almost two-thirds of the districts (n = 380, 63.7%) had NMRs between 20 and 40. The top third of neonatal deaths could be accounted for by just 71 districts of a total of 596. Conclusion: There is an urgent need for up-to-date data on district-level neonatal mortality in India.
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Indicators to ensure treatment initiation of all diagnosed sputum positive pulmonary tuberculosis patients under tuberculosis control programme in India p. 238
Lavanya Jayabal, Asha Frederick, Sanjay Mehendale, Velayutham Banurekha
DOI:10.4103/ijcm.IJCM_361_16  
Background: Pretreatment loss to follow-up (PTLFU) is used as performance indicator of Revised National Tuberculosis Control Programme (RNTCP) of India. Objective: To document the PTLFU, identify additional indicators and examine documentation of all the diagnosed sputum positive pulmonary tuberculosis (PTB) patients under RNTCP. Methodology: Tuberculosis (TB) laboratory, referral for treatment registers, and referral forms were perused for information on sputum positive PTB patients diagnosed from January to June 2014, in 3 TB Units in Chennai. Results: PTLFU was 24% (572 out of 2361). However, in pursuance with the principle of ensuring that all diagnosed patients must be started on treatment following referral, it was inflated to 44% (1046 out of 2361). Conclusion: The existing PTLFU indicator does not reflect the proportion of treatment initiation of all diagnosed smear-positive PTB patients. We propose additional indicators for monitoring referral and treatment initiation of all diagnosed sputum positive PTB patients.
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LETTERS TO EDITOR Top

Changing trends in sexually transmitted infections at a rural-based tertiary health-care center in Gujarat: An 8-year study p. 242
Rita Vora, Rahulkrishna Sureshkumar Kota, Singhal Rochit
DOI:10.4103/ijcm.IJCM_144_16  
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Neonatal transport: The long drive has not even begun p. 244
Mamta Jajoo, Dipti Kumar, Vikas Dabas, Anup Mohta
DOI:10.4103/ijcm.IJCM_154_16  
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An integrated disease surveillance project concern for Kala-azar: Does the framework in nonendemic regions need an overhaul? p. 246
Madhumita Mukherjee, Swami Ekadevananda
DOI:10.4103/ijcm.IJCM_264_16  
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“Scratches/Abrasions without bleeding” cause rabies: A 7 years rabies death review from medical college Shimla, Himachal Pradesh, India p. 248
Omesh Kumar Bharti, Ramesh Chand, Anjali Chauhan, Rahul Rao, Hamender Sharma, Archana Phull
DOI:10.4103/ijcm.IJCM_37_17  
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BOOK REVIEW Top

Textbook of community medicine – Preventive and social medicine p. 250
Rashmi Sharma
DOI:10.4103/ijcm.IJCM_256_17  
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