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   2016| July-September  | Volume 41 | Issue 3  
    Online since June 7, 2016

 
 
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ORIGINAL ARTICLES
Evaluation of pharmacists' services for dispensing emergency contraceptive pills in Delhi, India: A mystery shopper study
Pikee Saxena, Archana Mishra, Aruna Nigam
July-September 2016, 41(3):198-202
DOI:10.4103/0970-0218.183595  PMID:27385872
Background: Although emergency contraceptive pills are available over the counter, the quality of consultation, including key areas of contraceptive counseling and prevention of sexually transmitted infections (STI), has not been well documented. Objective: To evaluate actual pharmacist services while dispensing emergency contraception through a mystery shopper technique. Material and Methods: This cross-sectional study was conducted in 81 pharmacies situated in Delhi by 4 trained mystery shoppers posed as customers over a period of 6 months. Results: None of the pharmacists asked about the time lapsed since last unprotected sexual intercourse or last menstrual period before deciding the eligibility of the customer. The majority were unclear about side effects associated with emergency contraception (78.57%) or with anticipated changes in menstrual flow (78.57%); 85.71% did not know whether subsequent unprotected intercourse would be protected. Only 15.71% counseled shoppers regarding risk of STI on asking leading questions and 88.5% did not provide any contraceptive advice. Conclusion: There is a huge gap in the technical knowledge and mindset of the pharmacists when it comes to checking for the eligibility of the client and providing advice regarding use of regular contraception and barrier for protection from STI, which needs to be addressed in order to realize the full benefit of making emergency contraceptive pills available over the counter.
  13,221 309 4
CME
Twin studies: A unique epidemiological tool
Monalisha Sahu, Josyula G Prasuna
July-September 2016, 41(3):177-182
DOI:10.4103/0970-0218.183593  PMID:27385869
Twin studies are a special type of epidemiological studies designed to measure the contribution of genetics as opposed to the environment, to a given trait. Despite the facts that the classical twin studies are still being guided by assumptions made back in the 1920s and that the inherent limitation lies in the study design itself, the results suggested by earlier twin studies have often been confirmed by molecular genetic studies later. Use of twin registries and various innovative yet complex software packages such as the (SAS) and their extensions (e.g., SAS PROC GENMOD and SAS PROC PHREG) has increased the potential of this epidemiological tool toward contributing significantly to the field of genetics and other life sciences.
  6,296 341 9
VIEW POINT
Doctors for tribal areas: Issues and solutions
Dileep Mavalankar
July-September 2016, 41(3):172-176
DOI:10.4103/0970-0218.183587  PMID:27385868
Health parameters of tribal population had always been a concern for India's march towards Millennium development Goals (MDG's). Tribal population contributes 8.6% of total population, in spite of efforts and commitment of Government of India towards MGD, India lagged far behind from achieving and optimal health of tribal population will be a concern for achieving Sustainable development Goals SDG's also. Some of the common health problems of the tribal population face are deficiency of essential components in diet like energy malnutrition, protein calorie malnutrition and micronutrient deficiencies. Goiter, Gastrointestinal disorders, particularly dysentery and parasitic infections are very common. High prevalence of genetic disorders like sickle cell anemia and others are endemic in few tribes of India. Tribal Health is further compounded issues by social issues like excessive consumption of alcohol, poor access to contraceptive, substance abuse and gender based violence. Besides other reasons, like poor budget allocation, difficult to reach, poor access to health care facility, severe shortage of qualified health workers and workforce led to poor governance of health sector in tribal areas. Present view point reflects on the issues of inadequacy of doctors in tribal area and suggests possible solutions.
  4,843 451 7
ORIGINAL ARTICLES
Adaptation of locally available portion sizes for food frequency questionnaires in nutritional epidemiological studies: How much difference does it make?
Neha Gupta, Sonika Verma, Abhishek Singh, Nikhil Tandon, Seema Puri, Narendra Kumar Arora
July-September 2016, 41(3):228-234
DOI:10.4103/0970-0218.183596  PMID:27385878
Introduction: There is need for employing strategies to minimize measurement errors while administering semi-quantitative FFQ. The current study was planned to adapt and standardize locally available portion sizes for semi-quantitative FFQ to improve its validity and document the process of standardization of portion sizes. Methodology: The study was conducted in 9 villages of the INCLEN-SOMAARTH DDESS (Demographic, Development and Environmental Surveillance Site), Palwal district, Haryana, India. The subjects in these nine villages are part of a cohort study to assess the interaction between societal and household factors with food intake and physical activity of children. Systematic utensil survey was undertaken in 3 randomly chosen households per village i.e. 27 households and the portion sizes were derived from a total of 74 serving utensils. The derived sizes were classified as small (240 ml), medium (320 ml) and large (600 ml). The semi-quantitative FFQ with locally derived portion sizes was then administered to 63 children in 6-12 year age group. Results: The volume of food measured by the reference portion sizes generally being employed in the national surveys, would have been underestimated the food consumed by the child by 55-60% as compared to what was being consumed by the children in the study area. The correlation between food intake assessed by 24-hr recall method and FFQ using derived (local) portion sizes was better as compared to that obtained with the semi-quantitative FFQ done with reference portions. Conclusion: In conclusion, local portion size adaptation of FFQ for semi-quantification is useful to mitigate measurement errors associated with this technique.
  3,671 310 3
EDITORIAL COMMENTARY
Pandemic of publications and predatory journals: Another nail in the coffin of academics
Pradeep Kumar, Deepak Saxena
July-September 2016, 41(3):169-171
DOI:10.4103/0970-0218.183586  PMID:27385867
  3,350 476 4
ORIGINAL ARTICLES
Dietary calcium intake, serum calcium level, and their association with preeclampsia in rural North India
Anant Gupta, Shashi Kant, Chandrakant S Pandav, Sanjeev K Gupta, Sanjay K Rai, Puneet Misra
July-September 2016, 41(3):223-227
DOI:10.4103/0970-0218.183591  PMID:27385877
Background: Preeclampsia in pregnancy has been shown to be associated with low serum calcium level. Though the evidence is abundant, it is equivocal. Objectives: The study aimed to estimate the dietary calcium intake and serum calcium status among pregnant women, and to document the association of the dietary calcium intake and serum calcium status with incidence of preeclampsia in the 3rd trimester of pregnancy. Materials and Methods: A community-based cross-sectional study was conducted in the Health and Demographic Surveillance System (HDSS) site, Ballabgarh, Haryana, India. All pregnant women between 28 weeks and 36 weeks of gestation were interviewed. A semi-structured interview schedule and a 24-h dietary recall questionnaire were administered to assess the dietary calcium intake. AutoAnalyser (Biolis 24i) was used for measuring serum calcium. Results: We enrolled 217 pregnant women. The mean [standard deviation (SD)] dietary calcium intake was 858 (377) mg/day. The mean (SD) serum calcium level was 9.6 mg/dL (0.56). Incidence of preeclampsia was 13.4%. Preeclampsia was not associated with hypocalcemia [odds ratio (OR) = 1.2 95% confidence interval (CI); 0.27-3.98]. Conclusion: The majority of pregnant women had inadequate dietary calcium intake. The prevalence of hypocalcemia was low. Low serum calcium level was not associated with preeclampsia. Calcium supplementation may not reduce preeclampsia in this population.
  3,383 362 1
Profiles and factors associated with poor glycemic control among inpatients with diabetes mellitus type 2 as a primary diagnosis in a teaching hospital
Aniza Ismail, Leny Suzana Suddin, Saperi Sulong, Zafar Ahmed, Nor Azmi Kamaruddin, Norlela Sukor
July-September 2016, 41(3):208-212
DOI:10.4103/0970-0218.183590  PMID:27385874
Context: Diabetes mellitus is a growing health problem in most countries. In Malaysia, there was an increase in prevalence over the years. This makes diabetes also a growing concern in Malaysia, which warrants strengthening of the prevention and control programme. Aims: This paper aims to describe the profiles of diabetes mellitus type 2 in tertiary setting and to identify the risk factors for high level of HbA1c among the study population. The findings will give a glimpse on current status of diabetes in our country and may reflect the achievement of the country in combating this disease. Settings and Design: A cross-sectional study was conducted in UKM Medical Centre. Methods and Material: Medical records of patient with E11 ICD-10 code were collected using Case Report Form. Statistical Analysis Used: Descriptive analysis done of mean and median while test of association were done using Spearman correlation and logistic regression. Results: The results showed that majority of inpatients of DMT2 showed mean age of 58.8 + 12.6 years and most were males (56.7%) with secondary level of education (41.7%). Median duration of disease was 12.0 + 11.0 years with median HbA1c level of 8.9 ± 4.4%. Only small proportion of patients achieved the desired level of HbA1c <6.5% (21.3%) and significant association was found with tertiary level of education [AOR=0.10, 95%CI=0.01-0.96] and with type of anti-diabetic therapy [AOR=15.90, 95%CI=2.03-124.30]. Conclusions: In conclusion, diabetes mellitus type 2 inpatients still showed unsatisfactory glycemic control and holistic approach using health education should be advocated continuously in the future in view of education being one of the predictors for the good HbA1c outcome.
  2,513 388 4
Correlates of the use of different tobacco cessation methods by smokers and smokeless tobacco users according to their socio-demographic characteristics: Global adult tobacco survey (GATS) India 2009-10
Rohini Ruhil
July-September 2016, 41(3):190-197
DOI:10.4103/0970-0218.183598  PMID:27385871
Background: Tobacco control has two aspects. One involves preventing non-tobacco users from using tobacco and the second involves tobacco cessation (quitting) by existing tobacco users. There are various methods of tobacco cessation. Pharmacotherapy [e.g., nicotine replacement therapy (NRT) and medications such as bupropion] and behavioral counselling are some of the internationally approved methods of tobacco cessation. Objective: This paper intends to study how age, gender, residence (rural/urban), education, and occupation influence the use of various tobacco cessation methods by smokers and smokeless tobacco users. Materials and Methods: The study was a cross-sectional secondary data analysis of the Global Adult Tobacco Survey (GATS) India 2009-2010. There were 3725 smokers and 6354 smokeless tobacco users included in the study who made attempts to quit in the 12 months prior to the survey by use of different cessation methods (NRT, drugs such as bupropion, counselling, and other methods). Results: A significant association was demonstrated between increasing educational attainment and use of cessation methods for all the methods among smokers. Being employed (Govt. or non-Govt.) was positively associated with the use of NRT as a cessation method by smokers. Students and homemakers had higher odds of using pharmacotherapy methods among smokers. A significant association was demonstrated for the gender and age of tobacco users with the use of counselling as a cessation method among smokeless tobacco users. Conclusion: The findings of this study have important implications for tobacco cessation service providers in view of supporting their decision of choosing a particular tobacco cessation method for tobacco users according to certain kinds of sociodemographic characteristics.
  2,426 437 3
Intimate partner violence: Associated factors and acceptability of contraception among the women
Rajlaxmi Mundhra, Nilanchali Singh, Somya Kaushik, Anita Mendiratta
July-September 2016, 41(3):203-207
DOI:10.4103/0970-0218.183589  PMID:27385873
Objective: To determine the prevalence of various types of domestic violence and to find out the impact of intimate partner violence (IPV) on adoption of contraceptive measures among the women who are victim to this. Materials and Methods: This questionnaire-based, cross-sectional study was conducted in the department of obstetrics and gynecology of a tertiary care hospital in Delhi. Four hundred and one postpartum females were randomly selected over a period of 5 months and were questioned about their age, parity, educational status, occupation, husband's education, monthly family income, and, if present, IPV in detail. These study participants were enquired about their contraceptive knowledge and use. Results: Sexual violence was seen in 38.4% of the cases, physical violence in 22.4% of the cases, and verbal abuse was seen in nearly 32.7% of the cases. In response to any of the three violence faced, only 23 women (11.79%) reacted by discussing with parents and friends. In 4.61% of the cases, the violence was so severe that she had to inform police. This study showed that higher percentage of women without IPV accepted immediate postpartum contraception methods as compared to those with IPV (35.9% vs. 25%, P = 0.023), but the overall frequency of using contraceptive methods was higher in those with IPV as compared to those without IPV (49% vs. 47%, P = 0.690). Conclusion: IPV is associated with increased contraceptive adoption.
  2,325 289 2
Evaluation of skill-oriented training on enhanced syndromic case management (ESCM) of reproductive tract infections / sexually transmitted infections (RTI/STIs) of care providers from three-tier health-care system of Gujarat
Rashmi Sharma, Shailesh Prajapati, Brijesh Patel, Pradeep Kumar
July-September 2016, 41(3):183-189
DOI:10.4103/0970-0218.183594  PMID:27385870
Background: Enhanced syndromic case management (ESCM) deals with reproductive tract and sexually transmitted infections. Capacity building of service providers not only boosts the program but also inputs from them improve the quality of services. Objectives: To (1) identify problem areas from providers' perspectives and the gaps in knowledge and application and (2) assess the gains (if any) through pre and post-training evaluation. Materials and Methods: A total of 121 participants (medical/para medical) from various medical colleges, district/sub-district hospitals/ community health centers, and urban dispensaries across Gujarat were trained at a teaching institute. Trainings were of 2-3 days duration involving different learning methodology. Pre- and post-training evaluation were done on a designed pro forma and data were entered in MS office Excel 2007. Gains in knowledge/skills if any were assessed by comparing pre-/post-evaluation responses and applying test of significance (x2 test). Observations: Out of total 121 participants, half (60) were doctors and the rest were paramedics [staff nurse (SN) and lab technicians (LT)]. Doctors revealed significant gain in basics of reproductive tract infections (RTI) and sexually transmitted infections (STI), syndrome identification, STI/HIV co-infection, and ESCM and less gain in asymptomatic STI/ complications, vulnerability, male reproductive organs, causes of vaginal/urethral discharge, STI complications, cervical cancer screening, and limitation of syndromic management. Gain was statistically significant in basics of RTI/STI amongst adolescent in paramedics; lab technicians showed significant gain in knowledge of laboratory-related areas. Conclusion: Assessment revealed (1) poor baseline knowledge and (2) gains following training sometimes significant and other times not significant even in core areas. Quality monitoring and contents/ methodologies modification are essential for robust trainings. Gains in skills could not be assessed through this evaluation.
  2,173 337 1
Evaluation of antenatal to neonatal continuum care services affecting neonatal health in a tertiary health-care setup
Jarina Begum, Syed Irfan Ali, Radha Madhab Tripathy
July-September 2016, 41(3):213-218
DOI:10.4103/0970-0218.183588  PMID:27385875
Background: Maternal and child mortality and morbidity continue to be high despite existence of various national health programmes in India. Annually 41% of all Under 5 mortality is comprised of neonates, 3/4 of who die within the first week of life. Even though effective programmes are existing, optimum utilization is still a question. So the present study was planned to assess utilisation of maternal and neonatal health services and its influence on neonatal health. Objectives: 1. To assess the utilization of MCH services before admission to SNCU. 2. To analyse the process of implementation of IMNCI before referral and during the admission. 3. To observe the impact on neonatal health and give necessary recommendations. Methodology: The information regarding utilization of MCH services was obtained by conducting in depth interviews with the responsible adults accompanying the sick neonate. The Pre-treatment and referral slips were verified and compared with that of the prescribed guidelines laid down by the IMNCI for young infants (0-2 months) at SNCU. Results and Discussion: Some of the important observations were mentioned here. 100% women had TT immunization whereas 72% had the full ANC, 58.7% had full course of IFA, 76% had utilized JSY benefits and 48.34% had their PNC. 84% neonates had required immunization, 59.01% were on exclusive breast feeding. 38.9% were paid home visits, only 42% had an idea about the danger signs of neonatal period. 23% sick babies were treated under IMNCI guideline. Among them 98% given initial treatment, only 34% given proper diagnosis/classification, 56% were given adequate advice.
  2,115 376 1
Seniors' recreation centers in rural India: Need of the hour
Sherin Susan Paul, Prashant Hanumanthappa Ramamurthy, Rakesh Kumar, Mathew Ashirvatham, Kamala Russel John, Rita Isaac
July-September 2016, 41(3):219-222
DOI:10.4103/0970-0218.183585  PMID:27385876
Aim: To empower and bring the underprivileged senior citizens in the rural areas to the mainstream of life through setting up of model “senior citizens' recreation centers” that can be replicated in the other parts of the country. Materials and Methods: Six senior citizens' recreation centers are run in six villages under a community health program of a leading Medical College in South India, which were started by looking into their perceived needs and in a location where organized self-help women groups (SHGs) showed willingness to take the role of caretakers. Together there are 140 members in 6 centers and the most deserving members were identified using a participatory rural appraisal (PRA) method. These centers are open for 5 days a week and the main attraction of the center has been provision of one good, wholesome, noon-meal a day, apart from several recreational activities. The members were also assessed for chronic energy deficiency (CED) and quality of life at the beginning of enrolment using body mass index (BMI) and WHO-BREF scale. Results: The attendance to these centers was nearly 90% of the enrolled beneficiaries. A statistically significant improvement was noticed in quality of life in the physical, psychological, social, and environmental domain (P < 0.05). There was also a significant increase in the average BMI after 1 year of the intervention (P < 0.05). Conclusion: Care of underprivileged senior citizens is a growing need in the rural areas and the “Recreation centers” proved to be a beneficial model that can be easily replicated.
  2,130 287 1
Patient safety in obstetrics and gynecology departments of two teaching hospitals in Delhi
Bindiya Gupta, Kiran Guleria, Renu Arora
July-September 2016, 41(3):235-240
DOI:10.4103/0970-0218.183592  PMID:27385879
Background: A healthy safety culture is integral to positive health care. A sound safety climate is required in Obstetrics and Gynecology to prevent adverse outcomes. Objective: The objective of this study was to assess and compare patient safety culture in two departments of Obstetrics and Gynecology. Materials and Methods: Using a closed-ended standard version of Hospital Survey on Patient Safety Culture (HSOPS), respondents were asked to answer 42 survey items, grouped into 10 dimensions and two outcome variables in two tertiary care teaching hospitals in Delhi. Qualitative data were compared using Fisher's exact test and chi-square test wherever applicable. Mean values were calculated and compared using unpaired t-test. Results: The overall survey response rate was 55%. A positive response rate of 57% was seen in the overall perception of patient safety that ranged from very good to acceptable. Sixty-four percent showed positive teamwork across hospital departments and units, while 36% gave an affirmative opinion with respect to interdepartmental handoffs. However, few adverse events (0-10) were reported in the last 12 months and only 38% of mistakes by doctors were reported. Half of the respondents agreed that their mistakes were held against them. There was no statistical difference in the safety culture between the two hospitals. Conclusions: Although the perception of patient safety and standards of patient safety were high in both the hospitals' departments, there is plenty of scope for improvement with respect to event reporting, positive feedback, and nonpunitive error.
  2,031 177 3
Why do patients in pre-anti retroviral therapy (ART) care default: A cross-sectional study
Jaya Chakravarty, Sangeeta Kansal, Narendra Tiwary, Shyam Sundar
July-September 2016, 41(3):241-244
DOI:10.4103/0970-0218.183584  PMID:27385880
Background and Objectives: Approximately, 40% of the patients registered in the National AIDS Control Program in India are not on antiretroviral therapy (ART), i.e., are in pre-ART care. However, there are scarce data regarding the retention of pre-ART patients under routine program conditions. The main objective of this study was to find out the reasons for default among patients in pre-ART care. Materials and Methods: Patients enrolled in the ART Centre, Banaras Hindu University (BHU) between January and December 2009 and in pre-ART care were included in the study. Defaulters were those pre-ART patients who missed their last appointment of CD4 count by more than 1 month. Defaulters were traced telephonically in 2011 and those who returned and gave their consent for the study were interviewed using a semi-structured questionnaire. Results: Out of 620 patients in pre-ART care, 384 (68.2%) were defaulters. One hundred forty-four of the defaulters were traced and only 83 reached the ART center for interview. Among defaulters who did not reach the ART center, illiterate and unmarried were significantly more and mean duration from registration to default was also significantly less as compared to those who came back for the interview. Most defaulters gave more than one reason for defaulting that were as follows: Inconvenient clinic timings (98%), need for multiple mode of transport (92%), perceived improved health (65%), distance of center from home (61%), lack of social support (62%), and financial difficulty (59%). Interpretation and Conclusion: Active tracing of pre-ART patients through outreach and strengthening of the Link ART centers will improve the retention of patients in the program.
  1,824 261 2
BOOK REVIEW
A handbook of rabies: A comprehensive update
Chandrakant Lahariya
July-September 2016, 41(3):245-245
DOI:10.4103/0970-0218.183597  
  1,023 239 -
ASSOCIATION UPDATES
Association news

July-September 2016, 41(3):246-247
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IAPSM world health day 2016 quiz report

July-September 2016, 41(3):248-248
PMID:27385881
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  564 169 -
Minutes of GBM held at Gandhinagar

July-September 2016, 41(3):249-252
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  2007 - Indian Journal of Community Medicine | Published by Wolters Kluwer - Medknow
  Online since 15th September, 2007