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   2013| January-March  | Volume 38 | Issue 1  
    Online since January 31, 2013

 
 
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EDITORIAL
Open access ensures effective information retrieval of medical literature in e-databases
NC Jain
January-March 2013, 38(1):1-3
DOI:10.4103/0970-0218.106615  PMID:23559695
  1 2,181 303
LETTERS TO EDITOR
Self-reported chronic diseases and occupational health risks among bank employees of southern Karnataka city, India
S Ganesh Kumar, B Unnikrishnan, K Nagaraj
January-March 2013, 38(1):61-62
DOI:10.4103/0970-0218.106633  PMID:23559708
  1 1,516 253
ORIGINAL ARTICLES
Equipment errors: A prevalent cause for fallacy in blood pressure recording - A point prevalence estimate from an indian health university
Badrinarayan Mishra, Nidhi Dinesh Sinha, Hitesh Gidwani, Sushil Kumar Shukla, Abhishek Kawatra, SC Mehta
January-March 2013, 38(1):15-21
DOI:10.4103/0970-0218.106622  PMID:23559698
Background: Blood pressure (BP) recording is the most commonly measured clinical parameter. Standing mercury sphygmomanometer is the most widely used equipment to record this. However, recording by sphygmomanometer is subject to observer and instrumental error. The different sources of equipment error are faulty manometer tube calibration, baseline deviations and improper arm bladder cuff dimensions. This is further compounded by a high prevalence of arm bladder miss-cuffing in the target population. Objectives: The study was designed to assess the presence of equipment malcalibrations, cuff miss-matching and their effect on BP recording. Materials and Methods: A cross-sectional check of all operational sphygmomanometers in a health university was carried out for the length of the manometer tube, deviation of resting mercury column from "0" level, the width and length of arm bladder cuff and extent of bladder cuff-mismatch with respect to outpatient attending population. Results: From the total of 50 apparatus selected, 39 (78%) were from hospital setups and 11 (22%) from pre-clinical departments. A manometer height deficit of 13 mm was recorded in 36 (92.23%) of the equipment in hospital and 11 (100%) from pre-clinical departments. Instruments from both settings showed significant deviation from recommended dimensions in cuff bladder length, width and length to width ratio (P < 0.001). Significant number of apparatus from hospital setups showed presence of mercury manometer baseline deviation either below or above 0 mmHg at the resting state (χ2 = 5.61, D. F. = 1, P = 0.02). Positive corelationship was observed between manometer height deficit, baseline deviation and width of arm cuff bladder (Pearson correlation, P < 0.05). Bladder cuff mismatching in response to the target population was found at 48.52% for males and 36.76% for females. The cumulative effect of these factors can lead to an error in the range of 10-12 mmHg. Conclusion : Faulty equipments and prevalent arm bladder cuff-mismatching can be important barriers to accurate BP measurement.
  1 2,885 320
Validity and reliability of MOS short form health survey (SF-36) for use in India
Richa Sinha, Wim J A van den Heuvel, Perianayagam Arokiasamy
January-March 2013, 38(1):22-26
DOI:10.4103/0970-0218.106623  PMID:23559699
Background: Health is defined as the state of complete physical, mental and social well-being than just the absence of disease or infirmity. In order to measure health in the community, a reliable and validated instrument is required. Objectives: To adapt and translate the Medical Outcomes Study Short-Form Health Survey (SF-36) for use in India, to study its validity and reliability and to explore its higher order factor structure. Materials and Methods: Face-to-face interviews were conducted in 184 adult subjects by two trained interviewers. Statistical analyses for establishing item-level validity, scale-level validity and reliability and tests of known group comparison were performed. The higher order factor structure was investigated using principal component analysis with varimax rotation. Results: The questionnaire was well understood by the respondents. Item-level validity was established using tests of item internal consistency, equality of item-scale correlations and item-discriminant validity. Tests of scale-level validity and reliability performed well as all the scales met the required internal consistency criteria. Tests of known group comparison discriminated well across groups differing in socio-demographic and clinical variables. The higher order factor structure was found to comprise of two factors, with factor loadings being similar to those observed in other Asian countries. Conclusion: The item-and scale-level statistical analyses supported the validity and reliability of SF-36 for use in India.
  1 5,390 506
Attracting doctors to rural areas: A case study of the post-graduate seat reservation scheme in Andhra Pradesh
Zubin C Shroff, Seema Murthy, Krishna D Rao
January-March 2013, 38(1):27-32
DOI:10.4103/0970-0218.106624  PMID:23559700
Background: Attracting doctors to rural posts is an ongoing challenge for health departments across different states in India. One strategy adopted by several states to make rural service attractive for medical graduates is to reserve post-graduate (PG) seats in medical colleges for doctors serving in the public sector. Objective: This study examines the PG reservation scheme in Andhra Pradesh to understand its role in improving rural recruitment of doctors and specialists, the challenges faced by the scheme and how it can be strengthened. Materials and Methods: Qualitative case study methodology was adopted in which a variety of stakeholders such as government officials, health systems managers and serving Medical Officers were interviewed. This was supplemented with quantitative data on the scheme obtained from the Health, Medical and Family Welfare Department in Andhra Pradesh. Results: The PG reservation scheme appears to have been one of the factors responsible in attracting doctors to the public sector and to rural posts, with a reduction in vacancies at both the Primary Health Centre and Community Health Centre levels. Expectedly, in-service candidates have a better chance of getting a PG seat than general candidates. However, problems such as the mismatch of the demand and supply of certain types of specialist doctors, poor academic performance of in-service candidates as well as quality of services and enforcement of the post-PG bond need to be resolved. Conclusion: The PG reservation scheme is a powerful incentive to attract doctors to rural areas. However, better monitoring of service quality, strategically aligning PG training through the scheme with the demand for specialists as well as stricter enforcement of the financial bond are required to improve the scheme's effectiveness.
  1 6,352 393
Metabolic syndrome in the rural population of Wardha, Central India: An exploratory factor analysis
Pradeep R Deshmukh, Pranita Kamble, Kalyan Goswami, Neelam Garg
January-March 2013, 38(1):33-38
DOI:10.4103/0970-0218.106625  PMID:23559701
Background and Objectives: Metabolic syndrome - a plausible precondition for type II diabetes and cardiovascular diseases is also on rise. To understand the mechanistic complexity of metabolic syndrome it is imperative to study the specific contribution of the determinants of metabolic syndrome. Such study can help to identify the most significant factor which may be of use in early detection as well as prevention efforts. Such information is scarcely available from India and especially from rural India. Hence, the present study was undertaken to explore for such factor which might be considered crucial for development of such pathogenesis particularly in rural population of Wardha. Methods: A cross-sectional study comprising of 300 subjects was carried out in rural area of Primary Health Center, attached to medical college with approximate 31,000 populations. The anthropometric parameters such as height, weight, waist circumference were measured. Overnight fasting samples were collected for lipid profile (total cholesterol, triglyceride, high density lipoproteins, low density lipoproteins, very low density lipoproteins) and fasting blood glucose levels. The National Cholesterol Education Programme Adult Treatment Panel, ATP-III guidelines were used to categorize the study subjects. As many of the variables are highly intercorrelated, exploratory factor analysis was carried out to reduce the data to a smaller number of independent factors that accounts for the most of the variances in the data. Principal component analysis was used as a method of extraction. Results: For both sexes, three factors were extracted accounting for about 71% variance in the measured variables. An adiposity factor which accounted for highest explained variance (28%), was the initial factor extracted. It was loaded positively by waist circumference, triglyceride, and very low density lipoprotein and negatively loaded by high density lipoprotein. Second factor extracted was a cholesterol factor which explained about 20% variance. It was positively loaded by total cholesterol and low density lipoprotein. Blood pressure factor was third to be extracted which again explained about 20% variance. It was positively loaded by systolic and diastolic blood pressure. Interpretation and Conclusion: The results clearly indicate the significance of visceral adiposity over the obesity in general or simple abdominal obesity measured anthropometrically as a pathogenic determinant of the metabolic syndrome. The most consistent factor has been found to be dyslipidemia which explained major share of the observed variance and the most significant load of this factor being rested on triglyceride and the VLDL level. Hence, we conclude measurement of triglyceride might be a rewarding screening parameter for assessment of cardio-metabolic risk in general populace and warrants a large scale study focusing into this issue.
  1 2,204 420
SHORT COMMUNICATIONS
Prevalence of anemia and role of βE -Globin gene as an associating factor among college students of Assam: A preliminary report
SK Sharma, Lipika Chaliha, Beauty Mahanta
January-March 2013, 38(1):53-55
DOI:10.4103/0970-0218.106629  PMID:23559705
  1 1,615 195
CME
"Air pollution in Delhi: Its Magnitude and Effects on Health"
SA Rizwan, Baridalyne Nongkynrih, Sanjeev Kumar Gupta
January-March 2013, 38(1):4-8
DOI:10.4103/0970-0218.106617  PMID:23559696
Air pollution is responsible for many health problems in the urban areas. Of late, the air pollution status in Delhi has undergone many changes in terms of the levels of pollutants and the control measures taken to reduce them. This paper provides an evidence-based insight into the status of air pollution in Delhi and its effects on health and control measures instituted. The urban air database released by the World Health Organization in September 2011 reported that Delhi has exceeded the maximum PM10 limit by almost 10-times at 198 μg/m3. Vehicular emissions and industrial activities were found to be associated with indoor as well as outdoor air pollution in Delhi. Studies on air pollution and mortality from Delhi found that all-natural-cause mortality and morbidity increased with increased air pollution. Delhi has taken several steps to reduce the level of air pollution in the city during the last 10 years. However, more still needs to be done to further reduce the levels of air pollution.
  - 18,961 613
LETTERS TO EDITOR
"All is not well" with medical tourism
Rajesh Garg
January-March 2013, 38(1):59-61
DOI:10.4103/0970-0218.106631  PMID:23559707
  - 2,021 220
ORIGINAL ARTICLES
Effect of community-based behavior change communication on delivery and newborn health care practices in a resettlement colony of Delhi
Mamta Parashar, SV Singh, Jugal Kishore, Ajay Kumar, Milan Bhardwaj
January-March 2013, 38(1):42-48
DOI:10.4103/0970-0218.106627  PMID:23559703
Background: Neonatal morbidity and mortality in India continue to be high. Among other reasons, newborn care practices are major contributors for such high rates. Objective: To assess the effect of behavior change communication (BCC) package among pregnant women regarding neonatal care. Materials and Methods: Semistructured and pretested schedule was used to interview 200 multigravidas on various aspects of neonatal care. Based on the preliminary data, BCC package was designed and implemented in intervention block in the community. Follow-up was done to find out change in their behavior. Statistical Analysis: Data were analyzed using Epi info and Fischer exact test and chi - square test were applied in the baseline data. A P value of less than 0.05 was considered significant. Effect of the BCC package is given in terms of relative risk. Results: BCC package increased 1.76 times higher number of deliveries conducted by trained dais in intervention group. There was significant improvement in using sterile cord tie (P = 0.01), applied nothing to the cord (P < 0.0001) and giving bath to their baby within 6 h of birth (P = 0.02) in intervention group as compared to nonintervention group. Significant difference was found between the two groups with regard to breastfeeding practices of baby. Harmful practices were reduced in the intervention group. Significant improvement was found in intervention group as compared to nonintervention group with regard to knowledge of danger signals, physiological variants, management of breastfeeding-related problems, and awareness of skin-to-skin technique for the management of hypothermic baby. Conclusion: Inadequate knowledge and adverse practices regarding neonatal care among mothers in study areas were found. BCC package had favorable impact on behavior of mothers for neonatal care in intervention group.
  - 2,885 600
Influence of socioeconomic status on in-hospital mortality and morbidity after stroke in India: Retrospective hospital-based cohort study
Ravi Yadav, Kameshwar Prasad, Vasantha M Padma, Achal Kumar Srivastava, Manjari Tripathi, Rohit Bhatia
January-March 2013, 38(1):39-41
DOI:10.4103/0970-0218.106626  PMID:23559702
Objectives : To determine an association between socioeconomic status and in-hospital outcome in Indian patients with stroke. Materials and Methods : Retrospective hospital-based cohort study. The hospital stroke register was used for this study. The independent variables were demographic job status, education, cardiovascular risk factors, comorbidities and the score on the Glasgow Coma Scale (GCS). The outcome variables were mortality and Barthel's index (BI) score at discharge. Results : Data of 599 consecutive patients comprising 370 men (54.3%) and 229 women (33.6%) was available for analysis. Their mean age was 55.63±15.36 years. Age, diagnosis (ischemic or hemorrhagic), midline shift, smoking and GCS were significantly associated with mortality and BI score (P<0.05). There was a statistically significant association between employment status and BI at discharge (P=0.03) in univariate analysis. In multivariate analysis, joblessness was associated with lower BI at discharge (P=0.02) after adjustment for GCS motor score and stroke subtype. Conclusion : Our study shows that in patients with stroke, lower employment status is associated with poor outcome at discharge from the hospital. The association is independent of other prognostic factors.
  - 2,066 361
SHORT COMMUNICATIONS
Mortality trend and pattern in tertiary care hospital of Solapur in Maharashtra
Lata Godale, Sanjay Mulaje
January-March 2013, 38(1):49-52
DOI:10.4103/0970-0218.106628  PMID:23559704
  - 3,524 243
R-software: A newer tool in epidemiological data analysis
Amir Maroof Khan
January-March 2013, 38(1):56-58
DOI:10.4103/0970-0218.106630  PMID:23559706
  - 1,699 291
VIEW POINT
Missing Midwifery: Relevance for Contemporary Challenges in Maternal Health
Rupa Prasad, Rajib Dasgupta
January-March 2013, 38(1):9-14
DOI:10.4103/0970-0218.106619  PMID:23559697
Midwifery is rooted in public health, and most of its history has been community oriented. In India, midwifery evolved during the British rule; but over the years with changes in political and program priorities, the role and the capacity of midwives has changed substantially. The verticalization of national health programs has obscured the midwives' community focus and inhibited its contribution to the wider public health. There is a global acceptance and recognition of the midwifery model of care and skilled delivery for ensuring effective maternal health outcomes. The approaches are in line with local needs and have proved its effectiveness in resource-constrained settings. It is important to recognize the substantial contribution they make to public health, working to promote the long-term well-being of women, their babies and families, by offering information and advice on nutrition, supplementation, breastfeeding, and immunization. There is considerable scope for developing the midwifery model through enhancing the extent of their involvement in assessing health needs of local populations, designing, managing and evaluating maternal and health services, making timely and effective referrals and developing family-centered care.
  - 4,022 392
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  2007 - Indian Journal of Community Medicine | Published by Wolters Kluwer - Medknow
  Online since 15th September, 2007