Background: Multiple choice questions (MCQs) are frequently used to assess students in different educational streams for their objectivity and wide reach of coverage in less time. However, the MCQs to be used must be of quality which depends upon its difficulty index (DIF I), discrimination index (DI) and distracter efficiency (DE). Objective: To evaluate MCQs or items and develop a pool of valid items by assessing with DIF I, DI and DE and also to revise/ store or discard items based on obtained results. Settings: Study was conducted in a medical school of Ahmedabad. Materials and Methods: An internal examination in Community Medicine was conducted after 40 hours teaching during 1 ^st MBBS which was attended by 148 out of 150 students. Total 50 MCQs or items and 150 distractors were analyzed. Statistical Analysis: Data was entered and analyzed in MS Excel 2007 and simple proportions, mean, standard deviations, coefficient of variation were calculated and unpaired t test was applied. Results: Out of 50 items, 24 had "good to excellent" DIF I (31 - 60%) and 15 had "good to excellent" DI (> 0.25). Mean DE was 88.6% considered as ideal/ acceptable and non functional distractors (NFD) were only 11.4%. Mean DI was 0.14. Poor DI (< 0.15) with negative DI in 10 items indicates poor preparedness of students and some issues with framing of at least some of the MCQs. Increased proportion of NFDs (incorrect alternatives selected by < 5% students) in an item decrease DE and makes it easier. There were 15 items with 17 NFDs, while rest items did not have any NFD with mean DE of 100%. Conclusion: Study emphasizes the selection of quality MCQs which truly assess the knowledge and are able to differentiate the students of different abilities in correct manner.

Background: Violence against women is a universal phenomenon that persists in all communities and in all countries of the world and the perpetrator of that violence is often well-known to the victim. Domestic violence in particular continues to be frighteningly common and well-accepted as "normal" within too many societies. Objectives: (1) The primary aim of this study is to find out the extent of different type of domestic violence and to identify various risk factors for domestic violence against married women. (2) The secondary aim is to identify the various protective factors of domestic violence against married women. Materials and Methods: The present study was a population based cross-sectional study carried out in the urban area of Gwalior city for a period of one year. Stratified random sampling technique was used for the selection of the samples. The study participants were interviewed using a pretested semi-structured open-ended questionnaire. Proportion, Pearson's, chi-square test and odds ratio were calculated for the analysis of the study. Result: Of the 144 study participants, 68 participants reported some form of domestic violence, which was either physical, sexual or emotional. The most common type of violence reported was physical violence. The most important risk factor for domestic violence was alcoholism followed by literacy status. Majority of the abused women were dependent on their husbands for money, material assets and expenditure. Conclusion: The study hereby recommends that to prevent domestic violence government has to take stringent action for making women more self-reliant especially by making the women more literate and more financially independent.

Background: Harm ratings of substances help in understanding the perception toward substance use and formulating policies. Evidence of such harm ratings by substance users and their caregivers provides a clearer perspective of those who experience and observe such harm closely. Materials and Methods: Substance users and their caregivers were recruited from the Drug De-addiction and Treatment Centre of PGIMER, Chandigarh. Sociodemographic details of the subjects were noted. The subjects were then asked to rate a list of psychoactive preparations according to the harms they thought the preparation caused. The list of substances was developed taking into consideration substance commonly encountered in the geographical area. The harm ratings were transformed on a scale of 0­100. Results: All subjects were males and majority of them were educated above 10 ^th standard, were not employed and belonged to urban background. Most of them had taken psychoactive substances in their lifetimes but were currently abstinent. Most of the subjects endorsed intravenous drugs as the most harmful, followed by heroin. Beer and chewable tobacco considered the least harmful substances. Greater degree of education was associated with lower harm rankings for heroin, cannabis, dextropropoxyphene, and raw opium; while urban residence was associated with greater harm ratings for cannabis and raw opium. Differences in the harms were perceived for different preparations of the same active compound for alcohol and nicotine. Conclusion: Harm ratings of substances can be a useful guide while formulating policies and allocating resources. Need for further research extending this pilot study is emphasized.

Introduction: Expansion in road network, motorization, and urbanization in the country has been accompanied by a rise in road accidents leading to road traffic injuries (RTIs). Today RTIs are one of the leading causes of deaths, disabilities, and hospitalizations with severe socioeconomic costs across the world. Objectives: The following study analyses the:

1. Age and sex distribution of injured in road traffic accidents (RTAs).
2. Circumstances leading to RTA.
3. Pattern and severity of injuries sustained in RTAs cases.

Design: Retrospective record-based study. Materials and Methods: The aim of this study was to audit retrospectively the circumstances, severity, and pattern of injury sustained by vehicle occupants presenting to the Saraswathi Institute of Medical Sciences (SIMS) hospital Hapur, for a period of one year. Data were collected using the case sheets of 347 patients from the medical records section of hospital and analyzed using SPSS computer software version 16.0. Results are interpreted in terms of percentage, mean, chi-square, and z-test. Results: The pattern and severity of injuries sustained by 347 vehicle occupants admitted to the emergency department of SIMS, Hapur were retrospectively documented. Male victims 258 (74.35%) were more commonly involved than females 89 (25.65%) and majority of victims 141 (40.63%) were in age group of 20­30 years. Urban victims 222 (64.00%) outnumbered rural. The most frequently injured body regions were the extremities 499 (53.54%), followed by maxillofacial180(19.31%).. Out of total 802 external injuries, the most common type of injury was lacerations 307 (38.28%), abrasions 306 (38.15%)and followed by bruises 154 (19.20%). Multiple external injuries were more common on upper limb 216 (26.93%) , lower limbs 210 (26.18%) and face 170 (21.20%), while crush injuries were more predominently seen in both the limbs. While laceration were common on face 120 (38.83%). Injuries to the chest 19 (2.36%), abdomen13 (1.61%), and spine 11 (1.36%) were seen in roughy equal proprotion of victims. The bones on right side 55 (55.55%) were more commonly fractured which is statistically significant. Skull injuries were mostly found on frontal 77 (47.53%), followed by parietal bone 33 (20.37%), mostly on right side. Conclusion: RTAs constitute a major public health problem in our setting. Urgent preventive measures targeting at reducing the occurrence of RTAs are necessary to reduce the morbidity and mortality resulting from these injuries.

Context: Maternal mortality ratio (MMR) is an indicator of effectiveness of health care facilities for women of child bearing age group. Andaman and Nicobar (A&N) group of islands are unique as they are situated 1200 km from the mainland India. Healthcare delivery for the these islands is exclusively provided and controlled by only one authority, Directorate of Health Services, A&N Islands. GB Pant Hospital, Port Blair is the only referral hospital with round the clock specialists and surgical services. Aims: To estimate the MMR in A&N islands from 2001 to 2010, and study the causes of maternal mortality. Settings and Design: Retrospective. Materials and Methods: Data for the estimation of MMR were collected from office of Registrar of Births and Deaths, Hospital and Peripheral Health Centres. Case records of maternal deaths in GB Pant Hospital were reviewed to study the causes of death. Statistical analysis used: Proportions and Ratios. Results: Ten years average MMR for the entire island was 85.42. Analysis of 30 maternal deaths in GB Pant Hospital showed that 63.3% were due to direct obstetric causes (eclampsia 30%, hemorrhage 23.33%, sepsis 6.66%, and 3.33% amniotic fluid embolism). Of the indirect causes, anemia was the commonest (16.66%). Conclusions: The MMR of A&N islands is much lower than the national average of 250. Direct obstetric causes accounted for more than half of maternal deaths 63.33%.

Background: In India, the opportunities for professional education of the grass root level health workers are grossly inadequate. Capacity building of all categories of health workers is needed for enhancing health outcomes. Objectives: To plan and implement a professional development training program for all categories of allied health workers and to assess its outcomes in terms of knowledge and skills Materials and Method: We planned and organized a 'one week'(15 h) training program for 10 categories of allied health workers (1260) working in our hospital. The program included nine generic skills/topics: the prestige of AIIMS, sterilization & infection control, universal precaution, biomedical waste management, public health, life style & healthy nutrition, fire safety, communication skills and office procedure besides subject specific skills. Trainers were drawn from 12 departments. Training methodology included interactive lectures, narratives, demonstrations, videos, PPT slides, and informal discussions with participants. The effectiveness of the program was judged on the basis of participants' feedback, feedback from the supervisors, and our own observations post training. Results: Feedback from the participants and their supervisors after training was encouraging. The participants described training as a "life time experience". The supervisors reported improvement in confidence, communication skills, and awareness of workers. Conclusion: The success of the program was due to the use of interactive methods, involvement of multidisciplinary team, and commitment from leadership. We recommend that professional education should be linked with career advancement. Academic institutions can play a key role in taking such initiatives.

Background: Mental health is an important component of the total positive health and is interwoven closely with the physical and physiological dynamics of the human body. Worldwide, about 500 million people are believed to be suffering from neurotic, stress related and psychological problems. In India, surveys on mental morbidity in various parts of the country suggest a prevalence rate of 18-20 per 1000. Materials and Methods: A community-based, cross-sectional descriptive study was carried out amongst married women in the age group 18-45 years in an urban community of South Mumbai. Self-reporting questionnaire of 20 items (SRQ 20) developed by the WHO was administered. Statistical analysis was carried out to estimate the prevalence of psychiatric disturbance. Result: The prevalence of psychiatric disturbance was found to be 27.27% for the total sample. The study results indicate that somatic symptoms were reported more commonly which could be a manifestation of underlying/burgeoning mental disorders. Conclusions: The results imply a high prevalence of 27.27% of psychiatric disturbance in our community. However, defining mental disorder from a clinical standpoint necessitates identification of the dividing line between despair and depression. It is recommended that women be encouraged to approach counsellors and thus enable further diagnosis and management of Common Mental Disorders in the community.