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    Table of Contents - Current issue
January-March 2021
Volume 46 | Issue 1
Page Nos. 1-170

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A strengths, weaknesses, opportunities, and threats analysis of public health in India in the context of COVID-19 pandemic Highly accessed article p. 1
Harshad Thakur
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Is it the right time to introduce the hepatitis B booster vaccine in national immunization schedule? An analysis from the available evidence Highly accessed article p. 4
Sudip Bhattacharya, Ozden Gokdemir, Md Abu Bashar, Arulmani Thiyagarajan, Amarjeet Singh
Hepatitis B virus (HBV) infection is a global health concern, and it is considered one of the deadliest infections in the world, having nearly 1.2 million deaths annually. Around 75% of all global HBV carriers live in the Asia-Pacific region. In this regard, India has a prevalence ranging between 2% and 7% with exposure rates of 10%–60%. Hepatitis B is a vaccine-preventable disease. In India, the World Health Organization protocol for hepatitis B vaccination has been followed, and it is given free of cost in public health facilities under the National Immunization Schedule. Despite the free hepatitis vaccination program in India, coverage and awareness are low. Low awareness, followed by low coverage of hepatitis vaccination, can prove dangerous for the Indian population in the long run. A majority of chronic hepatitis cases progress silently to end-stage liver disease without having many signs and symptoms. Once occurred, a complete cure is not possible with currently available drugs. The studies from neighboring countries such as China and Taiwan documented that the impact of single-dose booster for children of 10 years has made a significant difference from the cost-effectiveness perspective. They have also included the booster dose in their national vaccination program. Considering the low level of vaccination awareness, small coverage, high disease burden, and high treatment cost, now, it is high time for India to introduce hepatitis B booster vaccine.
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Demystifying R naught: Understanding what does it hide? Highly accessed article p. 7
Arun Kumar Yadav, Surinder Kumar, Gurpreet Singh, Nikunj Kumar Kansara
Since the onset of the pandemic in Wuhan city, China, forecasting and projections of the pandemic are the areas of interest for the investigators, and the basic reproduction rate R0 always stayed the favorite tool. The basic reproduction number (R0) is either ratio or rate or the basic reproductive rate. This dimensionless number was calculated in the past to describe the contagiousness or transmissibility of infectious agents for many communicable diseases. Its importance in the context of COVID-19 is not less, it tells us about the public health measures to be undertaken for disease prevention, and how the transmission of COVID-19 will be affected or eliminated. R0 is affected by several biological, sociobehavioral, and environmental factors which decide agent transmission. R0 is estimated by using complex mathematical models, the results of which are easily distorted, misjudged, and misused. R0 is not a biological constant for an agent or pathogen, it is a rate over time. It can measure the disease severity and also gives an estimate about the herd immunity required for the reversal of epidemic. R0 cannot be altered through vaccination campaigns though it can tell us about the relationship between the population's immune status and epidemic curve. Modeled R0 values are dependent on the model structures and assumptions made. Some R0 values reported in the scientific literature are likely outdated as assumptions are frequently changing in the current pandemic. R0 must be predicted and applied with great caution as this basic metric is far from simple.
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Challenges of the deaf and hearing impaired in the masked world of COVID-19 Highly accessed article p. 11
Suneela Garg, Chetana Prakash Deshmukh, Meghachandra M Singh, Amod Borle, Blake S Wilson
Difficulties of the hearing impaired have increased due to COVID-19, leading to lack of inclusiveness along with the breakdown of their mental, physical, and social health. The study objective was to assess the challenges faced by the deaf and hearing-impaired people during COVID-19 by a literature review. Literature search was done using keywords such as “challenges” OR “barriers” and “COVID-19” OR “Deaf” OR “Hearing Impaired” OR “Communication” on PubMed and Google Scholar from November 2019 to June 2020. The challenges faced were lack of information, face mask making communication difficult, social distancing affecting their physical, mental health, stigma and barriers related to the health-care system. Strategies included use of technology, help from sign language instructors, and preparedness of health-care settings for the hearing disabled. System strengthening, tele-medicine, and policy amendments can be the pillars to build up the support system for the hearing impaired to protect them from COVID-19.
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Cost of outpatient department services at a community health center of Bankura, West Bengal p. 15
Sumana Samanta, Dibakar Haldar, Daliya Biswas, Sourav Lo, Indrajit Saha
Background: Changing trends of privatization and globalization of health care compel the hospitals to practice cost accounting for providing accurate information about the cost of patient care. Objectives: The objectives were to determine unit cost and to identify major cost areas of outpatient department (OPD) services provided by the community health center (CHC) of Bankura district, West Bengal. Materials and Methods: A cross-sectional study was conducted at Amarkanan CHC in 2016. Work sampling (WS) and time motion (TM) study were conducted for assessing the workforce cost, otherwise complete enumeration was done to assess the cost of different service areas such as medicine, logistic, maintenance, transport, electricity, building, equipment, and furniture. A predesigned pro forma and a questionnaire were used for WS and TM study and for interviewing the key informants for collection of information pertaining to different costs. Unit cost of different services as well as overall unit cost was estimated. Results: If a patient received injection, undergone dressing, and had electrocardiogram and X-ray both done in a day, then the total cost of OPD services for workforce was Rs. 85.33/. Cost of logistics per patient per day was maximum in X-ray room. Manpower exerted the maximum cost incurred by the government to conduct OPD in Amarkanan CHC. Overall, the unit cost in OPD incurred by the government was Rs. 44.53/-. Conclusion: Close monitoring is required by aligning the staffing pattern and patient activities and having adequate number of staff with right skill at right place and time for efficiency, productivity, and cost-effectiveness.
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Analyzing the changes in certain infectious and parasitic diseases in urban population of India by using medical certification of cause of death data p. 20
Bal Kishan Gulati, Saurabh Sharma, MV Vardhana Rao
Background: Infectious diseases are important causes of morbidity and mortality globally. At least 25% of about 60 million deaths that occur worldwide each year are estimated to be due to infectious diseases. In India, the burden of infectious diseases is enormous; although it has decreased as a result of overall socioeconomic progress and use of vaccines and antimicrobials, it is still a major health-care burden. Studying a disease trend over a certain time period is important in a country's public health system as it guides agencies to prioritize funds and other measures for its control. Objectives: The present study tries to understand its transition in an urban population of India. Materials and Methods: “Medical Certification of Cause of Death” data for the period from 1989 to 2015 have been used. Deaths under the head “age not stated” have been distributed in all age groups in proportion to total deaths at those age groups for all the years, and the percentage of the cause of death to total deaths has been calculated. Three years' moving average of these percentages have been calculated. Results: The overall age group analysis showed a downward trend in both males and females. However, age-segregated analysis showed that mortality is declining among children and youth population, specifically showing a steep decline among infants and under-five population. Conclusion: Infectious diseases are still a major public health problem in India.
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Pediatric asthma: Prevalence and socio-cultural factors affecting asthma management in a rural area of Northern Karnataka p. 24
BM Rashmi, Shailaja S Patil, BM Sindhu, SV Patil
Context: Asthma prevalence and severity is increasing among Indian children. There is the paucity of data on pediatric asthma in rural India and treatment received by asthmatics is not up-to-standard treatment guidelines. Aim: The aim is to estimate asthma prevalence and factors influencing access to standard asthmatic care among 5–15 years aged children. Settings and Design: Cross-sectional study conducted in rural north-Karnataka for 1 year. Subjects and Methods: The International Study of Asthma and Allergies in Childhood questionnaire was administered to participants followed by clinical examination. A child was considered as asthmatic if there was affirmative response to: (a) History of wheeze in the past 12 months, (b) Physician diagnosed/ever asthma, (c ) history of taking inhaled/oral bronchodilators. Statistical Analysis: All characteristics were summarized descriptively. Results: Prevalence of Current-wheeze, Ever-asthma, and wheeze on exertion were 4%, 2%, and 3.7%, respectively. About 63.9% of asthmatics had severe-asthma and 44.4% reported severe attack of wheezing limiting speech. About 89% of current-wheezers used only oral medications for wheeze/asthma, 50% did not take medicines as per doctors' advice. None availed regular follow-up. Financial constraints and ignorance were major reasons cited. Conclusions: Illiteracy, poverty, lack of proper guidelines, and non-availability of inhalational medications have affected treatment adherence resulting in severe asthma.
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Validation of Indian Diabetes Risk Score for screening prediabetes in west Tripura district of India p. 30
Bitan Sengupta, Himadri Bhattacharjya
Background: Viswanathan Mohan and his team have developed “Indian Diabetes Risk Score” (IDRS) for identifying the Indians at risk for developing diabetes and prediabetes. Due to heterogeneity of Indian population, this risk score needs further validation in different parts across the country. Objectives: The objective is to estimate the sensitivity, specificity, positive, and negative predictive values of IDRS for screening prediabetes in West Tripura District. Methodology: It was a community-based cross-sectional study conducted in West Tripura district during January 1, 2018–December 31, 2019 among 325 self-declared nondiabetic individuals, selected by multistage sampling. Fasting blood sugar value was used as the gold standard to validate IDRS. Data were collected using a validated and pretested interview schedule. Data entry and analysis were performed in computer using SPSS-24. Receiver operating characteristic (ROC) curve was constructed to validate IDRS. Results: Among the study individuals, 19% and 6.5% were identified as prediabetic and diabetics, respectively. Optimum sensitivity of 83.13% and specificity of 82.64%, with positive and negative predictive values 62.16% and 93.45%, respectively, were observed at an IDRS score of ≥60 for identifying prediabetes and diabetes in this study population. IDRS showed good accuracy with an area under ROC curve of 0.832 (95% confidence interval: 0.77–0.88). Conclusion: IDRS is found to be a valid tool for screening prediabetes at community level in West Tripura district of India.
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Maternal near miss: Unraveling our experience in the tertiary care hospital of Andaman and Nicobar Islands p. 35
Charu Sharma, Anita Yadav, Manju Mehrotra, Mrinmoy Kumar Saha, Rupali R Tambe
Context: Women who survive life-threatening complications related to pregnancy and delivery have many common aspects with those who die of such complications. This similarity brought forward the near miss concept in maternal health. Analysis of the similarities, differences, and the relationship between these two groups of women provide a complete assessment of quality of maternal health care. Aims: The aim of this study is to assess the baseline indices of maternal near miss (MNM) and analyze the quality of care at a tertiary care center in Andaman and Nicobar Islands. Settings and Design: Facility-based, cross-sectional study. Subjects and Methods: The study was conducted for a period of 18 months from January 1, 2015, to August 31, 2016. Cases, who met the World Health Organization (WHO) criteria of severe obstetric morbidity, were included and followed up during their hospital stay and till their discharge or death. Quality of maternal health care was assessed through the WHO near-miss criteria and criterion-based clinical audit methodology. Statistical Analysis Used: Descriptive statistics using mean and percentages and Student's t-test were used. Results: Among 4720 women who delivered in our hospital, there were 4677 live births, 52 patients were near miss, and there were 9 maternal deaths. The MNM incidence ratio was 11.11%, the MNM mortality ratio was 5.77, and the mortality index 14.75%. The most common cause of maternal morbidity was hemorrhage followed by hypertensive disorders. Conclusions: Improving referral systems, effective use of critical care, and evidence-based interventions can potentially reduce severe maternal outcomes.
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Translation, reliability, and validity test of Gujarati version of menopause rating scale in postmenopausal women for menopause-related symptoms p. 40
Khushali Ajani, Dhvani Nimavat, Monika Vidja, Anjali Moradiya, Dharti Panchasara, Sonali Bhalodiya, Krupali Miyatra, Krupa Dharmeshkumar Tank
Background: Women's health has been a global concern for many decades. As menopause is midway between the challenges of adulthood and despair of old age, comes the changes of menopause in women. The menopause rating scale (MRS) is widely used to assess menopause-related symptoms. The MRS was first published in 1990 for assessing menopause symptoms. However, no reliable and valid tools are available in the Gujarati language to assess the individuals with menopause symptoms. Aim: The aim of the study was to translate and find out reliability and validity of the Gujarati version of MRS in postmenopausal women. Methods: The study was carried out in three phases: The first phase was the translation of scale into the Gujarati language; the second phase was a pilot study on 30 postmenopausal women age assesses the comprehensibility of the prefinal version; and the third phase was to find out the reliability and validity of the final version of scale. Results: The total value of intraclass correlation coefficient of test–retest reliability was 0.88, with the all items having individual intraclass correlation coefficients score ranging from 0.74 to 0.92. Reliability estimated by internal consistency reached a Cronbach's alpha of 0.94 and ranging from 0.85 to 0.95 test–retest. Conclusion: The Gujarati version of MRS is a reliable and valid tool for assessing the menopausal symptoms and health-related quality of life in Guajarati-speaking populations.
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A qualitative study to identify the perceptions of adherence to antiretroviral therapy among people living with HIV p. 45
Arjunahalli Eshwarachar Paramesha, Leena Kunnath Chacko
Background: Primary health care for marginalized population group such as people living with HIV (PLHIV) is challenging as evidenced by the alarming magnitude of nonadherence to freely available antiretroviral therapy (ART). Successful viral suppression depends on optimum adherence to ART which in turn depends on the client's perceptions toward adherence and ART. Objectives: This study aims at identifying the prevailing perceptions of PLHIV toward adherence to ART. Materials and Methods: A qualitative research was conducted through 7 focused group interviews and 5 in-depth interviews among 44 PLHIV across 3 ART centers of different organizational characteristics. Interviews were transcribed and analyzed through a thematic content analysis approach. Unique perceptions and thoughts identified from each interview were listed and regrouped according to related themes. Data were triangulated across different sources of information such as key informant interview and review of the literature. Results: The median age of PLHIV was 36 years, and the mean duration of ART was 3.53 years. A qualitative analysis of transcribed data yielded stigma, cost, distance, type of health-care setting, and desire for living longer as dominant themes in perceptions of PLHIV toward ART. Conclusion: Overall 70% of perceptual expressions and 15 themes out of 30 themes were related to person related factors that determine the adherence to ART.
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Electricity access, sources, and reliability at primary health centers in India and effect on service provision: Evidence from two nation-wide surveys p. 51
Sunil Mani, Sasmita Patnaik, Chandrakant Lahariya
Background: A large number of government primary health-care facilities (GPHCFs) in India do not have access to the regular electricity supply. Objectives: To assess the status and change in electricity access, sources, and reliability at primary health centers (PHCs) in India; and to understand the effect of regular electricity supply on health services provision and on workforce availability and retention. Materials and Methods: Secondary analysis of data from the lastest two rounds of district-level household survey (DLHS) in India, conducted in 2007–2008 and 2012–2013. Results: Data of 8619 PHCs from DLHS-3 and 8540 PHCs from DLHS-4 were analyzed. The proportion of PHCs with access to electricity increased from 87% to 91%. However, regular electricity supply was available at only 50% of PHCs in 2012–2013, which was an increase from 36% such PHCs in 2007–2008. PHCs with regular electricity supply provided services to 50% more beneficiaries (deliveries and vaccination) than PHCs without regular or no electricity (P ≤ 0.001). Increased access to regular electricity was associated with improved availability and retention of health staff (P = 0.001). Conclusion: Government policies should aim to ensure access to regular electricity-supply-beyond just connection from grid-at all GPHCFs, including health sub-centers, PHCs, and community health centers. Indicators on electricity access at GPHCFs could be standardized and integrated into regular health and facility-related surveys as well as in the existing dashboards for real-time data collection. Health policy interventions should be informed by regular data collection and analysis. Improving access to regular electricity supply at GPHCFs can contribute to achieve the goals of National Health Policy of India. This will also help to advance universal health coverage in the country. There are lessons from this study, for other low and middle income countries, on improving health service provision at government health care facilities.
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Development and validation of a menstruation-related activity restriction questionnaire among adolescent girls in urban resettlement colonies of Delhi p. 57
Suneela Garg, Yamini Marimuthu, Nidhi Bhatnagar, M Megha Chandra Singh, Amod Borle, Saurav Basu, Falak Azmi, Yomri Dabi, Indu Bala
Introduction: Menstruation, a physiological phenomenon, till date is associated with myths, taboos, and malpractices. These interfere with the emotional, physical, and mental health of adolescent girls. This study attempts to draft a validated questionnaire to measure menstruation-related activity restriction. Objective: The objective was to study activities restricted during menstruation among adolescent girls residing in urban resettlement colonies of Delhi and to develop and validate a questionnaire for menstruation-related activity restriction. Materials and Methods: A community-based cross-sectional study was conducted among adolescent girls residing in urban resettlement colonies of Delhi during 2019. A multistage random sampling technique was used to select 1100 girls across four districts of Delhi. A 15-item questionnaire was developed by an expert committee and validated with principal component analysis (PCA). Results: In total, 1100 adolescent girls were included in the study whose mean age was 15.8 (±2.1) years. School/college/work was missed due to menstruation in 60% of the adolescent girls, 66% were not comfortable during menstruation, and 92% were restricted from entering religious places. In exploratory factor analysis using PCA, 6 principal components were identified which had eigenvalues more than 1. Conclusion: Religious restrictions during menstruation (94%) were highly prevalent among adolescent girls, followed by restriction of routine activity (69%) and work/academically related activity (60%). Construct validity has identified a six-factor structure for the menstruation-related activity restriction questionnaire. This was identified as a valid and internally consistent tool to assess activities restricted during menstruation among Indian adolescent girls.
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Teleophthalmology as a model for detecting ocular diseases in tribal areas of a North West state in India p. 62
Gaurav Sharma, Anil Chauhan, Rajeev Tuli, Sunil Kumar Raina, Rattan Kumar Sharma
Background: Lahaul and Spiti district of Himachal Pradesh, a high altitude tribal district, situated at altitudes varying from 10,000 to 15, 000 ft. above mean sea level is cut off from the rest of the country for nearly 6 months due to heavy snowfall in the mountain passes. In the absence of any ophthalmologist and ophthalmic technician, the provision of eye care is virtually absent. The current study (part of a research project funded by the Indian Council of Medical Research) was conducted with the aim to explore teleophthalmology as a model for detecting posterior segment eye diseases in tribal and inaccessible areas. Materials and Methods: Fundus images (taken through fundus photography) of 1000 individuals above 5 years of age with no improvement in vision to 6/6 on refraction and individuals with known history of diabetes mellitus, systemic hypertension, or long standing headache with features of raised intracranial tension irrespective of whether their vision improved to 6/6 or not were sent to tertiary care center (base hospital) from regional hospital (field hospital). Transmitted images (through internet after attaching the details and patient particulars on the excel sheet) were analyzed by the ophthalmologists and the final diagnosis along with the line of management if any was transmitted back. Results: Eighty-five percent of the images transmitted were of good quality. Retinal, vitreous, optic nerve head, and choroidal diseases could be detected. Conclusions: In the present situation, where trained workforce is unavailable in these areas, teleophthamology is an appropriate tool by which a number of eye diseases can be detected at early stages. Most of them can be treated in these early stages by lifestyle modification and medical management.
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Motivators and barriers for physical activity among health-care professionals: A qualitative study p. 66
Leyanna Susan George, Harsha Lais, Maya Chacko, Charutha Retnakumar, Vijayakumar Krishnapillai
Background: Physical inactivity is one of the critical risk factors for lifestyle-related diseases. In Kerala, the life expectancy of doctors who are considered the gatekeepers of health was found to be 13 years lower than the general population. Objective: The objective was to identify the motivators and barriers for physical activity among doctors and nurses belonging to public and private health-care sectors in Ernakulam district. Methodology: Qualitative study was conducted using a grounded theory approach. A total of 30 in-depth interviews and 8 focus group discussions were conducted among doctors and nurses, respectively. The audio-recorded data were transcribed, coded, and thematically analyzed. Results: The main themes identified were motivators, barriers, and future considerations for physical activity. The factors motivating doctors were the fear of noncommunicable diseases and to stay fit, while the nurses were more concerned about their body image. The common barriers were gender, lack of time, laziness, bad climate, and safety issues. Overreliance on medication and prioritizing their patients' health over their own were additional barriers. Conclusion: Physical activity among doctors and nurses is severely compromised. Provision of a favorable environment and behavior change is needed to combat the silent epidemic of physical inactivity.
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Validation and reliability assessment of the mini-nutritional assessment–short form questionnaire among older adults in South India p. 70
Yuvaraj Krishnamoorthy, M Vijayageetha, Ganesh Kumar Saya
Background: Nutrition of the elderly affects immunity and functional ability and leads to increased morbidity and mortality. Validation of a short-form (SF) scale will make the assessment easier for primary care physicians. Hence, the study was done to assess the validity and reliability of Mini-Nutritional Assessment–SF (MNA-SF) Questionnaire among elderly in Puducherry. Methods: A cross-sectional study among 279 elderly was conducted in four villages of rural Puducherry. We have used three forms of MNA questionnaire. Diagnostic accuracy of the MNA-SF was assessed and internal consistency was interpreted using Cronbach's alpha. Results: The prevalence of malnutrition by the MNA full-form scale was 17.9%. Similar prevalence was reported by the body mass index (BMI) MNA-SF (16.5%), but calf-circumference (CC) MNA-SF overestimated the prevalence (38%). Sensitivity was higher in CC-MNA-SF (92%) when compared to BMI-MNA-SF (72%), while specificity was higher in BMI-MNA-SF (95.6%) when compared to CC-MNA-SF (73.8%). The positive predictive value was higher in BMI-MNA-SF (78.3%) when compared to CC-MNA-SF (43.4%), while the negative predictive value almost similar in both the scales. Reliability of the questionnaire showed the highest value for MNA full form (alpha = 0.71). Conclusion: This shows that both the forms of MNA-SF (BMI-based, CC-based) were valid and can be recommended as a screening tool for the assessment of nutritional status of the elderly.
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Establishing performance indicators of telemedicine-based “On-Consultation Training” of primary care doctors: An innovation to integrate psychiatry at primary care p. 75
Narayana Manjunatha, Kamaldeep Sadh, Harihara N Shashidhara, BR Manjunatha, HP Shashank, K Puttaswamy Ashwatha, Rajani Parthasarathy, Channaveerachari Naveen Kumar, Suresh Bada Math, Jagadisha Thirthalli
Background: A “functional treatment gap” exists in primary care of India despite the higher prevalence of psychiatric disorders at primary care. Traditional classroom training for primary care doctors (PCDs) fails to translate into adequate clinical skills to provide basic psychiatric treatment. An innovative telepsychiatric on-consultation training (Tele-OCT) is designed exclusively for practicing PCDs where a telepsychiatrist trains PCDs in live video streaming of their own real-time general consultations of primary health centres. The aim of this study is to establish performance indicators of Tele-OCT for its effective implementation. Methodology: The data collected using a file review method from a naturalistic design of the implementation of Tele-OCT for 73 PCDs from August-2016 to October-2018 across Mandya district, Karnataka, India. Results: Flexibility in the scheduling of Tele-OCT sessions is key to success. Personal smartphones of PCDs with available videoconference applications are the popular choice. Four consecutive Tele-OCT sessions are planned for each PCD with a gap of 2–4 weeks over two months. The first three sessions are considered the “optimum Tele-OCT training package” for each PCD, followed by the fourth one as a 'Tele-OCT impact evaluation session' in a live, real-time general consultation. Each Tele-OCT is conducted in an average ten general patients in about two hours per session, totalling about 30 patients in 6 hours of Tele-OCT training package per PCD. Patient's profiles especially common mental disorders are reflective of a true picture of Indian primary care. Conclusions: Performance indicators of Tele-OCT for future implementation are established. Tele-OCT appears to be a path-breaking training model for PCDs to integrate psychiatric care in their general practice.
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Are village health, sanitation, and nutrition committees functional? Evidence from Chhattisgarh and Madhya Pradesh p. 80
E P. Abdul Azeez, P Subramania Siva, A P. Senthil Kumar, Dandub Palzor Negi
Background: The Village Health, Sanitation, and Nutrition Committee (VHSNC) is a participatory effort aimed to strengthen the village-level agencies and to provide better health and sanitation services. However, there is a lack of evidence on the functionality of VHSNCs. Objectives: The present study aimed to explore the functionality of VHSNCs in the selected localities. Materials and Methods: The study was conducted in five districts of Chhattisgarh and Madhya Pradesh states. Using a multistage sampling method, a total of 508 VHSNCs were studied. The VHSNCs were considered as the unit of study. From each VHSNC, some key functionaries and its members were interviewed using a semi-structured interview schedule to understand the nature and effectiveness of its functioning. The researchers closely observed the meetings of VHSNCs and their records. Data were analyzed using descriptive statistical methods along with the impressions from the field notes. Results: The result of the study indicates that the functionality of the majority of the VHSNCs is not promising. Inadequate participation and improper implementation of key tasks are evident. Conclusion: The functionality of the VHSNC can be improved through the active involvement of Panchayati Raj Institutions and local communities.
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Comprehension of prescriptions and errors in taking prescribed medicines by veterans – Polypharmacy a problem underrated p. 85
Anuj Singhal, Arun Kumar Yadav, Shankar Subramanian, Basant Kumar Pathak, Aakriti Gupta, Vivek Aggarwal
Background: Polypharmacy is a significant problem in the elderly. The veteran population is unique in terms of better access to health-care services and higher educational qualifications. However, the studies to assess the burden and effects of polypharmacy in this cohort are rare. Hence, the research was done to find the prevalence of polypharmacy in the veteran population. Methods: In this cross-sectional observational study, we included veterans with more than 35 years visiting the medical outpatient department. All participants were interviewed about polypharmacy after taking informed consent. Results: Out of 394 patients included in the study, 110 were prescribed five or more medicines for their illnesses (27.91%: 95% confidence interval [CI] 21.1%–30%). More than 95% (377/394) of the study participants were unaware of the concept of polypharmacy. There was high compliance to treatment in veterans (97.46%, 95% CI 95.1%–98.6%). Conclusion: This study shows that the prevalence of polypharmacy is significant in veterans, including patients in their fourth and fifth decades of life, despite fewer morbidities.
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Smartphone use and its addiction among adolescents in the age group of 16–19 years Highly accessed article p. 88
Dinesh J Bhanderi, Yogita P Pandya, Deepak B Sharma
Background: Smartphone use is escalating among adolescents, thereby increasing the risk of its addiction among them. Objective: The objective of this study was to estimate the prevalence of smartphone use and its addiction among adolescents in 16–19 years of age group. Materials and Methods: An observational cross-sectional study was conducted among 496 students in the age group of 16–19 years. Relevant information was collected using a self-administered questionnaire and the Smartphone Addiction (SA) Scale. Chi-square test and logistic regression were applied to study the association between independent and dependent variables. Results: Smartphone use was found to be 83.9%. It was associated with age, area of residence, discipline, use of hands-free kit, and parents' education and income. The smartphone addiction rate was reported to be 37%. It was found to be associated with age, area of residence, place of education, duration of smartphone use, daily hours of use, perception that cellphone use is harmful to health, and parents' education and income. Conclusion: A high rate of SA among adolescents warrants effective strategies at local, state, and national level to address this growing health problem in this population.
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Cost analysis of different antibiotic brands available in indian market with reference to National List of Essential Medicines p. 93
Dinesh Kumar Meena, Mathaiyan Jayanthi
Background: About 60%–90% of healthcare spending in India is on medicine which is mainly out of pocket. Almost all the drugs including antibiotics are available as brands with variable cost. Indian government formulated National List of Essential Medicines (NLEM) to ensure availability of affordable medicines to the population. Prescribing drugs from NLEM and considering the cost of drug, especially antibiotics in practice, can reduce cost of treatment and patient's out-of-pocket expenditure. Objective: The objective of the study is to analyze cost variation of different antibiotic brands available in Indian market with reference to NLEM. Materials and Methods: List of antibiotics listed in the NLEM 2015, India, was prepared. Percentage cost variation and cost ratio of different brands of these antibiotics were calculated and compared. Results: We found 17 antibiotics listed in NLEM 2015. The number of brands varied from 2 to 102. We found wide cost variations among different brands of same antibiotics. Minimum cost variation was 7.34% (for ciprofloxacin 200 mg/100 ml vial) while maximum 1049.82% (for azithromycin 500 mg tablet). Conclusion: There is wide cost variation in different brands of same antibiotics listed in the NLEM. Prescribers should prescribe cheaper brands of antibiotics to ensure that patients complete the course of treatment and thus reduce development of resistance to antibiotics.
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What is stopping primary health centers to go digital? Findings of a mixed-method study at a district level health system in Southern India p. 97
Ravi Barigela, Prakash Babu Kodali, Sibasis Hense
Introduction: Electronic medical records (EMRs) are computerized medical information systems that collect, store, and display patient information and essential for the achievement of primary health-care goals. This study explores the availability and utilization of EMR and analyzed the barriers inhibiting their implementation at primary health centers (PHCs) in Nalgonda district of Telangana, India. Methods: The research employed a sequential mixed-method design. Quantitative data were collected using a questionnaire by conducting facility surveys across 75 PHCs and in-depth interviews with district health authorities were conducted using a predesigned guide. Quantitative data were analyzed using descriptive statistics and thematic analysis of interviews resulted in four themes focusing on the factors inhibiting PHCs to use EMR. Results: The availability of EMR facility was low (19.14%) and they are routinely used for maintaining immunization data in 83% of the PHCs. In contrast, none of the PHCs used EMR for prescribing medications to patients. Budgetary constraints, unavailability of dedicated information technology staff, gaps in technical knowledge, and perceptions about EMR as a time-consuming system were the commonly reported barriers inhibiting PHCs to go digital. Conclusion: The availability and utilization of EMR keeping was low across PHCs of Nalgonda district.The study identified multiple barriers which hinder the implementation of EMR facilities at PHCs. Addressing these barriers is crucial for the successful implementation of EMR.
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Secondhand smoke exposure during pregnancy and its effect on birth outcomes: Evidence from a retrospective cohort study in a tertiary care hospital in Bengaluru p. 102
Priya Mary Prince, Marciya Umman, Farah Naaz Fathima, Avita Rose Johnson
Context: The effect of maternal smoking on birth outcomes is well-established, but the effect of maternal secondhand smoke (SHS) exposure is less clear, especially among Indian women. Aim: To evaluate the effect of SHS exposure during pregnancy on birth outcomes such as gestational age at birth, neonatal anthropometry, and Apgar score. Setting and Design: Retrospective cohort study at a tertiary hospital in Bengaluru. Methods: 208 postnatal mothers: 104 each in “exposed” and “nonexposed” group, based on the history of SHS exposure during pregnancy. Sociodemographic and obstetric details were obtained by interview schedule and birth outcomes were obtained from patient charts. Statistical Analysis: Association of SHS exposure with birth outcomes was analyzed using inferential statistics such as Chi-square, t-test, and Mann–Whitney U-test, whereas the strength of association was expressed as relative risk with 95% confidence intervals. P < 0.05 was considered statistically significant. Results: SHS exposed and nonexposed groups were comparable with regard to potentially confounding socioeconomic and obstetric covariates. Babies born to SHS-exposed mothers had significantly lower mean birth weight, mean birth length, and mean birth head circumference by 172.5 g (P = 0.027), 1.6 cm (P = 0.001), and 1.1 cm (P = 0.001), respectively. Conclusion: Mothers exposed to SHS during pregnancy were twice likely to deliver low birth weight babies (relative risk [RR] = 1.9 [1.0–3.6], P = 0.02) and babies of low birth length (RR = 2.64 [1.4–4.6], P = 0.001) than unexposed mothers. With a significant risk of adverse birth outcomes found among mothers exposed to SHS during pregnancy, it is important that a “no tobacco smoke” environment at home should be recommended for pregnant women and their families.
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Predictors of stroke subtype and severity in patients of a tertiary care hospital, Dehradun p. 107
Megha Luthra, Puneet Ohri, Priyanka V Kashyap, Sonam Maheshwari
Context: Stroke caused 6.7 million deaths worldwide in 2013. In India, the cumulated incidence of stroke was 105–152/100,000 persons per year in last decade. Dearth of data on predictors of stroke subtype and severity in India lead to this study. Aims: (1) To categorize presenting stroke patients by subtype and severity. (2) To establish association of risk factors with above. (3) To predict subtype and severity by risk factors. Settings and Design: Hospital-based cross-sectional analytic, retrospective study. Subjects and Methods: A predesigned, pretested, semi-structured questionnaire with standard tool (National Institute of Health Stroke Scale Score), informed consent after prior approval of institutional ethics and research committees. Statistical Analysis Used: Percentages, proportions, Chi-square trends, linear regression, independent t-test, and analysis of variance (ANOVA). Results: Mean age of 102 patients was 62.1 (±12.8 years). Stroke subtype associated with socioeconomic status (χ2 = 6.38775, P = 0.0115) and stroke severity (χ2 = 18.98, P = 0) and stroke severity associated with stroke subtype (χ2 = 9.79366, P = 0.0018). Stroke subtype could be predicted by stroke severity and stroke severity by subtype, sex, and dyslipidemia (regression models). Independent t-test revealed excessive alcohol intake was a significant predictor and one-way ANOVA revealed education was a significant predictor of severe stroke. Conclusions: Stroke subtype is significantly associated with higher socioeconomic status and severe stroke. Stroke severity is significantly associated with hemorrhagic stroke. Stroke subtype, sex, dyslipidemia, alcohol intake, and education may act as predictors of stroke severity.
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Effect of 12 weeks of yoga training on neurocognitive variables: A quasi-experimental study p. 112
Sridip Chatterjee, Samiran Mondal, Deepeswar Singh
Background: Neurocognitive abilities are the brain-mind skills needed to initiate any task from the simplest to the most complex, decreases with advancing age. Attention, alertness, and memory are the basic neurocognitive functions most affected by age. There are potential benefits of yoga on neurocognitive functions because this ancient Indian technique positively nurtures the mind-body systems. Aim of the Study: The present study was aimed to evaluate the effect of 12 weeks of yogic training on neurocognitive abilities in a middle-aged group. Methods: A total of 86 volunteers (46 male and 40 females, age group of 35–55 years), with no prior experience of yoga were participated in this study. Five male and 4 female participants were excluded from the study. All participants divided into yoga training group (male = 21 and female = 18) and control group (male = 20 and female = 18). The yoga training group underwent yoga practices, including kriya, surya namaskar, asana, pranayama, and dhyana daily in the morning, for 6 days/week, for 12 weeks. Standing height, body weight, body mass index, visual reaction time (RT), auditory RT (attention and alertness), and short-term memory were assessed day 1 (pre), 6th week (mid), and 12th weeks (post) of intervention. Results: Repeated-measures analysis of variance showed that a statistically significant increased (P < 0.05) in attention-alertness and short-term memory after 12 weeks of yogic practices. Conclusion: Integrated approach of yogic intervention may have promising effect on neurocognitive abilities that concomitantly promote successful aging.
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Tackling the menace of anemia and hemoglobinopathies among young adults – Conceptualizing university-level screening p. 117
Geetika Madan Patel, Ankita Parmar, Dhara Zalavadiya, Kandarp Talati
Background: National family health survey-4 data suggests alarmingly high prevalence of anemia among adult population. Hemoglobinopathies such as thalassemias and structural hemoglobin (Hb) variants are the commonly seen autosomal, recessively inherited, monogenic disorders of Hb production, and pose a significant health burden in India. Premarriage screening for thalassemia would help to prevent such marriage, reduce health and financial burdens. Objectives: To assess the burden of anemia and hemoglobinopathies, among newly admitted college students through a University-level screening program. Methodology: A cross-sectional study was conducted among college students of the University. The study was part of regular health check-up of all new admissions. Sample frame included all the 4197 students who appeared for health screening and were screened for anemia and hemoglobinopathies. Results: Out of 4197 students, 73.2% were male and a total of 19.5%were anemic. Gender-wise prevalence among males and females was 13.6% and 35.7%, respectively. Among anemic, the proportion of mild, moderate, and severe anemia was 69%, 29%, and 2%. Prevalence of typical beta thal minor and sickle cell trait was found to be 2.6% and 1.4%. Conclusions: Anemia and hemoglobinopathies are significant public health challenges. University setup offers a unique opportunity for modeling and pilot testing integrated interventions for screening and management.
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Heterogeneity and confinement of HIV prevalence among pregnant women calls for decentralized HIV interventions: Analysis of data from three rounds of HIV sentinel surveillance in Karnataka: 2013–2017 p. 121
Santhakumar Aridoss, Malathi Mathiyazhakan, Nagaraj Jaganathasamy, Ganesh Balsubramanian, Manikandan Natesan, VM Padmapriya, Joseph K David, Pradeep Kumar, Elangovan Arumugam
Background: The HIV sentinel surveillance (HSS) serves to estimate the levels and trend of HIV prevalence among high-risk, bridge, and general population and monitors HIV management at national, state, and district levels. Data from HSS are valuable in understanding the risk factors associated with HIV transmission with particular demographic characteristics. Objectives: The objective was to analyze the sociodemographic profile of the pregnant mothers attending the antenatal care (ANC) clinics in Karnataka, in order to understand the dynamics of HIV within the general population in Karnataka. Materials and Methods: Study design: this was a cross-sectional study conducted using consecutive sampling method. Study setting: the surveillance was conducted at select antenatal clinics, in Karnataka, India, between January and March, in the years 2013, 2015, and 2017. Methodology: in total, 74,278 eligible pregnant women aged between 15 and 49 years, attending the sentinel sites for the first time during the surveillance period, were included in the study. Information on their sociodemographic characteristics and blood samples was collected. Results: HIV prevalence among the ANC clinic attendees has significantly declined, reaching a recent stabilization. The risk factors significantly associated with HIV among pregnant women were age, education, occupation, and marital status. HIV is highly concentrated in the northern and southern districts of Karnataka. Conclusion: Despite the declining trends of HIV prevalence in Karnataka, the epidemic is heterogeneous and concentrated within the state, calling for decentralized region-specific interventions.
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Utilization of postnatal care among rural women in Punjab p. 126
Niharika Mahajan, Baljit Kaur
Background: The postchildbirth period presents considerable challenges in the form of health risks for the mother and the newborn, yet postnatal care (PNC) remains seldom utilized maternal and newborn health intervention. Objectives: The present study aims to study the coverage of PNC among rural women in Punjab and understand the factors that determine the utilization of PNC services. Materials and Methods: From rural areas of seven districts of Punjab, a total of 420 respondents were questioned using semi-structured interview schedule. Binary logistic regression is employed to understand the factors that influence the utilization of complete PNC. Results: The utilization of complete PNC has remained mere 25.9% in the present study. The results of multivariate logistic regression reveal that variables district, caste, birth order, and type of delivery significantly influence the utilization of complete PNC. Conclusion: The utilization of PNC component is found to be abysmal as compared to antenatal component and institutional delivery among the study group. There is a need to create awareness regarding the necessity of PNC among the women.
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Are primary health centers prepared for noncommunicable disease management? A facility-based mapping of gaps in coastal Karnataka, India p. 130
Utsav Raj, Kibballi Madhukeshwar Akshaya, Madhavi Bhargava
Background: India is in the middle of epidemiological and demographic transitions, with an estimated 63% of the deaths attributed to noncommunicable diseases (NCDs). Primary health centers (PHCs) can deliver a package of services to prevent and control NCDs. Objective: The aim of this sudy is to assess the status of health promotion activities and availability of resources for screening and the treatment of NCDs in PHCs of Dakshina Kannada district, Karnataka. Materials and Methods: A cross-sectional facility-based assessment of all the 65 functioning PHCs (2016-2017) was conducted for the status of health promotion activities, and availability of resources using a checklist evolved from the World Health Organization Package of Essential NCD Interventions framework and Indian Public Health Standards. Results: Forty-eight (74%) PHCs had displayed materials on the intake of healthy foods and avoiding junk food. Warning signs of cancer were displayed at 43 (66%) PHCs. The availability of drugs for the management of hypertension (Atenolol and Amlodepine) and diabetes mellitus (Metformin) were seen in all the PHCs. Insulin was available in 64 (98%) PHCs. Sorbitrate and Nifedefine were found in 11 (17%) and 7 (11%) PHCs. More than a quarter of the PHCs were not having the medical officer and other health-care professionals to manage NCDs. Conclusions: Preparedness of the PHCs in the health promotion domain was good. The availability of human resources, laboratory support and emergency drugs for the management of NCDs needs improvement.
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Diet and dialogue skills: An innovative approach to diet demonstration by medical students of lady hardinge medical college p. 134
Archana Thakur, Ananya Ray Laskar, Anita Shankar Acharya, Sanjeev Kumar Rasania, Aparna Jain
Background: Nutrition' is a very essential component of undergraduate teaching in MBBS curriculum. In this age of growing diet-consciousness and fitness, skill development of medical graduates in designing healthy and culturally appropriate diet is imperative. Objective: To demonstrate the effectiveness of Diet Demonstration Training technique in improving the knowledge about basic principles of nutrition in medical undergraduates. Methodology: A pilot pretest-posttest study was conducted among 16 undergraduate medical students participated in a pre-conference workshop. Steps of diet demonstration for Under-graduate students were performed and a pretest - posttest was conducted using a self designed self administered questionnaire. Results: The mean marks received by the students were 8.69 & 10.31 out of 15 in the pretest & post-test respectively (p value <0.017). Overall 56.3% & 93.6% students performed well in pre-test and post-test respectively. Conclusion: There was significant improvement in nutrition education of participated undergraduates.
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Coping strategies and perception toward drugs, electronic gadgets, and media in relation to stress: A cross-sectional study among residents of a suburban area p. 137
Manisha Arora, Archana Singh, Ajit Kumar Singh, Vishal Sharma, Atul Kotwal
Background and Objectives: Stress is an indispensable part of modern-day living. The study deals with coping strategies by the participants and their perception toward drugs, electronic gadgets, and media as stress creators, busters, or relievers. Materials and Methods: A cross-sectional study was conducted among 400 community dwellers in a suburban area of Delhi. A structured questionnaire with Likert scale was used to assess coping strategies to stress and perception of use of electronic gadgets, media, and substance abuse as stress creators, busters, and relievers. Results: For coping strategies, 52.8% (95% confidence interval: 47.73–57.73) of the participants wanted to discuss problems with their families, but others considered mobile phones (51.5%, 46.48, 56.50), television (70.5%, 65.77, 74.93), and social networking sites (33.5%, 28.89, 38.36) to be their stress busters than creators. An age-associated statistically significant difference in perception about stress creator and buster scores between younger versus older was observed (P = 0.000), whereas gender-wise males perceived substance abuse to be a stress reliever in contrast to females (P = 0.000). Conclusion: Family plays an important role in the mitigation of stress. However, excess reliance on social media by younger people and substance abuse by males in stressful situations need to be addressed adequately.
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Childlessness among muthuvan tribes of Tamil Nadu, India: An exploratory study p. 141
S Mageswari, H Magesh Rajan, M Balusamy, G Elavarasu, R Vijayaprabha, V Ramachandran, J John Britto, Yuvaraj Jayaraman
Introduction: Childlessness is a global concern and it has serious demographic, social, and health implications. The declining Muthuvan child population may reduce their population on the whole. Objective: The study explored the prevalence of childlessness and its underlying reasons in the Muthuvan tribes of Tamil Nadu. Subjects and Methods: The study applied the mixed-method design, and the snowball technique was adopted to identify eight Muthuvan hamlets. Descriptive and thematic analysis was done for the collected quantitative and qualitative information. Results: The study found the prevalence of childlessness among Muthuvan couples as 30.65%. The underlying reasons were their cultural practices of confinement during menstruation and restriction on engaging in productive work and family care, which gave them the idea of regular intake of oral contraceptive pills and lessen their desire to have children. Conclusion: The study concludes that the comfort of their daily life has taken over more important than the consequences of objects used for comfort, to their health and future generations.
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What do women in rural Tamil Nadu think about postmenopausal bleeding? A mixed-method study p. 145
R Sindhuri, Amol R Dongre
Introduction: Perception of women about postmenopausal bleeding (PMB) may have a greater influence on their treatment-seeking behavior. Objectives: The objective was to explore the perceptions of causes and treatment of PMB among menopausal women and to quantify its perceived reasons. Materials and Methods: It was a sequential exploratory mixed-method study design, with two group interviews (qualitative phase), followed by a survey among 1530 postmenopausal women (quantitative phase). The qualitative data were analyzed by thematic analysis and quantitative data using descriptive statistics. Results: Lack of seriousness about PMB and stigma were stated as barriers for the treatment of PMB. Among 1530 women, 40.8% of them did not know the cause for PMB. The problem in the uterus, cancer, and improved nutrition were stated as reasons by 17.6%, 16.8%, and 15.8% of women, respectively. Conclusion: Most of the women did not know the reason for PMB and its awareness is crucial for better uptake of screening and detection of pathology at an early stage.
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Primary health-care innovations with superior allusion to family health centers p. 149
G Ajai Krishnan, Athira K Nair
The present case study discusses about the Primary Health Care system of Kerala and the Government's innovative step to promote the Primary Health Centres to Family Health Centres. The case study also deliberates about the FHC working model and its superiority over the current PHCs in the areas of manpower, OP time, lab services, nursing services, social security projects etc. and the transformation of PHCs to a well-functioning PHC, thereby it can become a model for other states.
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Prevalence of psychiatric disturbances among school going children in North Karnataka p. 153
Archana Basavaraj Byahatti, Azizahmed I Arbar, Rohit Rajendra Natekar, Sindhu N Reddy, Ghansham Jadhav
Context: Psychic Disturbances are the most common problems encountered in children. Aims: To study the prevalence of Psychic Disturbances like anxiety and depression among high school going adolescents. Settings and Design: This is cross-sectional survey study conducted among 522 children (13-15 years). Methods and Material: Anxiety and Depression were measured using Hamilton anxiety rating scale and Kutcher adolescent depression scale respectively. Statistical analysis used: The collected data were analyzed using Statistical Package for Social Science(SPSS statistics 20 License Authorization Wizard.Ink).Results were expressed as proportions using appropriate tables. Prevalence rate was calculated using point prevalence formula. Results: The response rate of study being 91.7%, Among total samples of 522, 403 samples (77.2%) had only mild anxiety,14.17 % participants had possible depression another 14.17 % of participants having both anxiety and depression. Conclusions: Prevalence of Anxiety was higher compared to Depression among the study participants, females had higher prevalence rate of depression were as males had higher rate of anxiety.
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Snakebite envenoming and associated factors in an indian context p. 155
Ansuman Swain, Manisha Gore
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Effectiveness of nutrition interventions on World Health Organization global nutrition targets: An evidence summary p. 157
Ritu Rana, Dileep V Mavalankar
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Students' perspective and feedback on foundation course 2019 in a medical college of North India p. 159
Saurabh Sharma, Surabhi Gupta, Rahul Bansal
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Fireworks-related legislatures: Are they actually followed? - An ophthalmological perspective p. 161
Naresh Babu, Piyush Kohli, Dhipak Arthur, Chitaranjan Mishra, Kim Ramasamy
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Comparing balance among elderly fallers and nonfallers using modified romberg test: A case–control study p. 163
Pinky Surendrakumar Jain, Suroshree Mitra, Rachana P Dabadghav
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The feasibility of opportunistic screening for detecting noise-induced hearing loss in factory workers in a rural area of Delhi, India p. 165
Akashdeep Sharma, Saurav Basu, Suneela Garg
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Problematic use of the internet and its correlates with psychological well-being among undergraduate dental students p. 167
Bhavya Nidhi Sharma, Padmavathi Nagarajan, Balaji Bharadwaj, Shivanand Kattimani
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Erratum: Software intervention in smoking cessation among engineering students in Bhubaneswar City: A randomized controlled trial p. 170

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Erratum: Association of Vitamin D levels in coal miners: A case–control study p. 170

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  2007 - Indian Journal of Community Medicine | Published by Wolters Kluwer - Medknow
  Online since 15th September, 2007