Clinical practice with community health perspective makes community medicine a unique specialty. In their health centers, community physicians not only implement disease prevention programs, assess community health needs, manage healthcare teams and advocate for health promoting policies but also diagnose and treat diseases. However, participation of community medicine faculty in the delivery of clinical care varies from place to place due to administrative constraints. Health centers attached with medical college are not dependent on community medicine faculty for clinical service as these centers have their own medical and paramedical staff; whereas, other clinical departments in medical colleges depend on their faculty for delivery of clinical care in the hospital. Consequently, a perception is gaining ground that community medicine is a para-clinical specialty. Strategies for a fixed tenured rotation of faculty in the health centers should be evolved. All faculty members of community medicine must also provide clinical care in the health centers and the quantum of clinical services provided by each one of them should be reported widely to all stakeholders. Community medicine residency programs must ensure that trainee community physicians acquire competency to deliver comprehensive primary health care (promotive, preventive, curative, and rehabilitative) in a health center.

Violence on women has been present in our society since times immemorial. The ethics, the values, the morals, the culture of the society has been framed in such a way or we can say structured in such a way so as to promote exploitation of this segment which is in reality the root of the society. The concept of STRUCTURAL VIOLENCE was introduced by Johan Galtung in 1969. It refers to a form of violence wherein some http://www.studylecturenotes.com/social-sciences/sociology/370-social-institution-definitions-a-structure-of-social-institution social institution may harm people by preventing them from meeting their basic needs. Violence against women has taken the form of a global epidemic which has taken its toll on the physical, psychological, sexual and economic life of the female. Johan Galtung in “Violence, Peace and Peace Studies”, 1969 has rightly remarked “when one husband beats his wife, there is a clear case of personal violence, but when one million husbands keep one million wives in ignorance, there is structural violence”. India has been slow in its pace for action against violence on women, but the brutal gang- rape of a 23 year old Delhi girl on December 2012 aroused the Indians from their deep slumber on this issue. Structural violence is a demon against women that is devouring the society. The combined efforts of Government NGO's and most important, the sufferers of this violence, the women have to take a major step to fight this dragon.

Context: Disclosure of HIV-positive status to sex partners is viewed as a preventive measure and as a social and legal responsibility for HIV-infected individuals. Aims: The aim of this study is to determine the proportions and factors responsible for disclosure of HIV seropositivity among residents of Cross River State, Nigeria. Settings and Design: This was a cross-sectional comparative study. Subjects and Methods: It involved 320 HIV-positive individuals equally selected from the urban and rural settings of Cross River State and use questionnaires. Statistical Analysis Used: Data analysis used SPSS version 20.0. Chi-square test and logistic regression were used to identify determinants of HIV status disclosure. Results: Among urban respondents, 93.8% had disclosed compared with 79.4% among rural respondents, the difference was statistically significant (P < 0.001). There was a statistically significant association between HIV status disclosure and age (P = 0.008), marital status (P = 0.027), number of nonspousal sexual partner (P = 0.006), and area of residence (P < 0.001). There was no statistically significant association between HIV status disclosure and gender (P = 0.622), between occupation (P = 0.495) or income (P = 0.351 and head of household (P = 0.241). There was statistically significant association between HIV status disclosure and level of education (P = 0.015), house ownership (P = 0.008), time from diagnosis (P = 0.003), and duration of treatment (P = 0.002). Conclusions: This study has shown that HIV seropositive status disclosure was higher when compared with other local studies, and age, marital status, and area of residence were factors associated with HIV seropositive status disclosure.

Background: Tobacco use among adolescence is one of the important preventable causes of death as well as a leading public health problem all over the world. The present study was conducted with the objective of studying the effect of peer-led interventions on tobacco use among adolescents. Materials and Methods: Twenty schools were randomly selected and ten schools each were identified as cluster for intervention and control groups. A total of 402 students in intervention group and 422 in control group were studied. Results: About 48% and 41% of adolescents were consuming smokeless tobacco in any form in the intervention and control groups, respectively. Prevalence of consumption of smokeless tobacco was significantly high among boys as compared to girls. Pan masala was the most common form of consumption. After conducting A Stop Smoking in School Trial-like peer-led intervention, a significant reduction in tobacco consumption of any form was observed in the intervention group (48%–36%) during the follow-up (Z = 3.2, P < 0.01). A significant reduction in exposure to passive smoking in the intervention group (32%–29%) was also observed. All the students smoking initially had stopped smoking at the end of the follow-up in both the groups. Conclusion: It was found that peer-led intervention was effective in reducing the consumption of smokeless tobacco in any form. The rate of reduction was more in the first follow-up as compared to the end of the intervention. Sustained intervention in the form of retraining is needed for the long-term effect.

Background: Initially viewed as a human rights issue, partner violence is increasingly seen as an important public health problem of international concern. Objectives: To assess the extent of physical, sexual, psychological, and controlling behavior of intimate partners against women in an educated society and find the association with age, age of marriage, married years, educational status of the women and that of partner. Materials and Methods: A prevalence of 15% was taken and final sample was 200, after considering loss of follow-up. Statistical Methods: Proportion, Z-test, Chi-square test. Results: The prevalence of violence against intimate partner in educated society was found to be 40.5% in a South Indian city. Physical assault was high in 30–50 years and increased with duration of marriage from 5.5% at 5 years to 33.3% in 10–20 years of married life. Sexual and psychological assault also increased in <5 years of married life to 35% and 47.6% in 10–20 years duration of marriage, which was statistically significant. Sexual and psychological assault showed a bimodal presentation. Less educated women and their partners were found to report more violence, which was statistically significant. Conclusion: Violence against women is not uncommon in the educated society.

Objective: To develop and validate domains to assess attendee's gain at sexually transmitted infection (STI) clinic and their understanding after utilizing services at STI Clinic. Methods: Study was done in two phases. In-depth interviews were conducted to explore attendee's perception. Domains generated through the first phase were validated by conducting another 50 structured interviews. Results: Major domains developed were perceptions on STI, the source of information, treatment seeking behavior, understanding of treatment, laboratory test, and follow-up. Friends and counselor played an important role as the source of right information, while elder family female played a role in delayed seeking care. Conclusion: Developed domains can be used to assess STI clinic attendee's perspective on STI. Poor understanding of STI care component especially prevention, partner treatment, and referral was noted after the clinic visit.

Context: Amidst the uncertainty in childhood blood pressure (BP) thresholds, besides the ambiguity in levels and duration of BP elevation causing organ damage, hypertension is present in substantial number of asymptomatic children and adolescents with only a few studies disclosing the setup. With projection of deaths due to noncommunicable diseases in 2030 rising to 52 million, it is necessary to know about the knowledge of present adolescents about BP and its modifiable risk factors. Aims: (1) To assess the prevalence of elevated BP among adolescents and to ascertain the associated risk factors. (2) To assess adolescent's knowledge about BP and its modifiable factors. Settings and Design: A community-based cross-sectional study was conducted on school going adolescents of Lucknow, from September 2014 to August 2015. Subjects and Methods: BP, height, and weight were measured following standard protocols, Centers for Disease Control and Prevention charts for finding respective cut-off values and oral questionnaire for assessing lifestyle risk factors were used. Statistical Analysis: Chi-square, unpaired t-test, and logistic regression were used. Results: Of the 1041 participants, elevated BP (BP percentile ≥90) was prevalent in 24.2%. On regression, factors such as obesity (adjusted odds ratio [aOR] = 5.8, 95% confidence interval [CI] = 3.6–9.4), low fruit diet (aOR = 3.3, 95% CI = 2.1–5.4), and frequent junk food consumption (aOR = 1.9, 95% CI = 1.3–2.8) raised the odds of elevated BP while it was lowered by being physically active (aOR = 0.67, 95% CI = 0.46–0.97). Of 86.3% of children (n = 898) who were fathomed of BP, only less than third (33% and 21.9%) acquainted of BP raising and lowering practices, respectively. Conclusions: Prevalence of high BP is colossal with only a few children knowing its amendable nature. Strenuous efforts targeting detrimental behaviors and imparting the sense of healthy lifestyle enhancing practices are vital to control this epidemic.

Background: Considering the global and national level commitments in improving the maternal health as well as reducing the maternal mortality, assessment of factors influencing the delivery of antenatal healthcare services becomes essential. Objectives: The aim is to assess the utilization of antenatal health services and to identify the factors influencing their utilization among women of fishermen population in Kanchipuram district, Tamil Nadu. Materials and Methods: The cross-sectional study was carried out among the mothers in Kovalam area of Kanchipuram district. Details were collected using a pretested questionnaire and analyzed using statistical software. Results: The study included 284 mothers, of which 35% were illiterates. Nearly 60.21% have got registered with the Government sector, 59.51% of the mothers had three or more antenatal visits, 64.08% have received two doses of tetanus toxoid, and 73.24% have taken iron and folic acid tablets. Factors which were identified to have statistically significant association with better utilization of antenatal health services were age >30 years, higher educational status, skilled workers, those having their first child, and higher socioeconomic class. Conclusion: This study has reported the fact that antenatal healthcare services were not utilized fully by the community and the fishermen population being a special group has to be given the needed attention from the healthcare delivery system.

Introduction: All 26 antiretroviral treatment (ART) centers of Gujarat were monitored by Gujarat State AIDS Control Society under the National AIDS Control Program. A comprehensive tool is needed to identify gap in service delivery and to prioritize monitoring visits. Objectives: To supplement the existing monitoring system, identify strengths/weakness of ART centers, and give recommendations. Methodology: Scorecard was developed in spreadsheet format with 17 scoring indicators on monthly base from March 2014 onward. The centers were classified in three color zones: green (score ≥80%), yellow (score <80% and ≥50%), and red (score <50%). Visits were prioritized at centers with more indicators in yellow/red zone. The performance of centers was compared for March 2014 and March 2015. Results: The statistically significant improvement was observed in indicator “ART initiation within 2 months of eligibility,” while after removing red zone from analysis, four more indicators named “eligible patients transferred out before ART initiation, general clients started on ART, antenatal women started on ART, and pre-ART follow-up CD4 done” reflect statistically significant improvement. Quadrant analysis was done for some indicators, which provide insight that less number of eligible patients may be a reason for low initiation of ART at one center, and at four other centers, the possible reasons for low retention are high death rate and high lost to follow-up rate. Based on these findings, the recommendations were made to regular mentoring centers, improve coordination between ART center and care and support centers (CSCs), and conduct verbal autopsy. Conclusion: Scorecard is a simple and cost-effective tool for monitoring, and by highlighting low-performing indicators, it helps in improving quality of services provided at ART centers.

Background: Sickle cell disease is a common problem across central India, but its clinical features may differ from that in African populations. There is a need to define the features of sickle cell disease in India, and the current study addresses some features of the bone pain crisis. Objectives: The objective of the study was to describe the epidemiology of the bone pain crisis of sickle cell disease in Gujarat and explore the relationship with infection by Plasmodium vivax. Materials and Methods: This was a prospective review of all admissions in patients with sickle cell disease to a private pediatric institution in Bardoli, Gujarat, in the year 2015. Hemoglobin electrophoresis of all patients was consistent with homozygous sickle cell disease, but family studies indicated that at least seven cases had the severe sickle cell-beta + thalassemia presumed to be the common IVS1-5G>C mutation. Clinical, hematological, and parasitological features were recorded. Results: There were 914 admissions among 654 patients who had between one and seven admissions. The bone pain crisis accounted for 763 (83%) of admissions and increased between July and October coinciding with the monsoon period. Blood smears were examined for malarial parasites in 811 admissions and were positive for P. vivax in 73% patients. There was no evidence that P. vivax infections varied with the cause of admission or increased during the monsoon period. Conclusions: There was a high prevalence of P. vivax infection in hospital admissions of sickle cell patients, but the data did not support an etiological role in the bone pain crisis. A trial of malarial prophylaxis might determine its effect on the clinical features and outcome of sickle cell disease.

Background: In spite of enormous progress in cardiac care in India, rural communities lack access to even basic cardiac care. One possible solution to this problem is to employ telecardiology. Objectives: To demonstrate feasibility of telecardiology system to link rural clinics to a teaching hospital. Methods: Five rural clinics were linked to a teaching hospital, using an inexpensive system of cardiographs and tablet PCs to transmit ECGs to hospital and have them interpreted by cardiologist. Results: Three hundred eighty ECGs were acquired at clinics with 98.9% of them noise-free and transmitted to the hospital with 99.7% success on first attempt. Interpretation of ECG was provided to primary care physician at the clinic on the same day for 95.3% of ECGs. Abnormal ECG findings were seen on 22.6% of these ECGs. Conclusion: This system performed well with high success rate of acquisition and transmission. Staff at rural clinics successfully acquired quality ECGs and transmitted them and the staff at the hospital were able to provide timely interpretation of ECGs and advice to patients.

Background: Leprosy or Hansen's disease, a chronic infectious disease caused by Mycobacterium leprae is a serious public health concern because of associated case load, morbidity and stigma attached to it. India achieved elimination of leprosy as a public health problem (prevalence rate [PR]<1 case/10,000 population) at the national level on January 1, 2006, still 19% districts in the country report PR more than one. In Maharashtra, it is found that very few districts within the state or very few pockets within the district are actually having leprosy burden. Objectives: (1) Identification of region-wise actual “hot-spot” districts/pockets within state of Maharashtra.(2) Further drop-down below the district and block to tribal belt for understanding the actual high risk area/belt within the tribal districts. Methods: Secondary data analysis of leprosy patients registered in the State during the period 2008–2015. Results: PR per 10,000 was found more in Vidharbha region followed by rest of Maharashtra and then Marathwada. Analysis showed that, there are tribal districts and tribal area within tribal districts which are having higher leprosy burden as compared to the all other districts indicating need of allocation of programme funds and facilities to these tribal belts for the effective control and elimination of leprosy. Conclusion: National Leprosy Eradication Programme should focus on tribal belt for effective control. Without giving extra attention to these tribal areas within high risk district/pockets efforts of eradication of leprosy by 2018 would be unrealistic and impractical.

Background: Early detection and intervention seem to improve development in autistic children, and teachers form an important part of their early social environment. Objectives: The objective of this study was to assess baseline knowledge and misconceptions regarding autism among school teachers and evaluate factors influencing their knowledge. Materials and Methods: This is a cross-sectional survey enrolling primary school teachers using a self-administered questionnaire. Results: Seventy-three teachers (mean age of 34 years, 66% females) responded. Gaps in awareness and knowledge were found. About 52 (71.2%) teachers identified themselves as having some knowledge about autism, with 23 (44.2%) among this group understanding autism as a neurological/mental disorder. The majority (73.1%) believe that special education is a helpful intervention. The only significant factor that influenced knowledge among teachers was attendance of behavioral classes (P = 0.01). Conclusion: Results suggest that teachers have an inadequate understanding of autism due to several misconceptions. This calls for increased education of teachers with regard to autism and other childhood disorders.

Background: Studies from India on sputum conversion and tuberculosis (TB) treatment outcomes among TB patients with diabetes are limited. Objective: The objective of this study is to estimate the proportion of sputum smear conversion and successful treatment outcomes among diabetic–TB patients treated under Revised National TB Control Programme (RNTCP). Methodology: Information on TB disease, diabetes, sputum conversion, and treatment outcomes were collected from treatment cards of adult TB patients (age >18 years) treated in the District TB Centre TB Unit, Tiruchirapalli, Tamil Nadu from July 1, 2014, to October 31, 2015. Results: Diabetes was documented in 163 (14%) of 1131 TB patients. Sputum conversion was in 107 (94%) of 114 smear positive-TB patients. Successful TB treatment outcome was in 116 (85%) of 136 patients and 107 (86%) of 124 new TB patients. Conclusion: Sputum conversion was as per RNTCP target while treatment success rate among the new TB patients with diabetes was suboptimal.