The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

admission. This proportion could already be greater in some parts of the country and may increase if referrals of cases of self-poisoning increase faster than the facilities for their assessment and management. The provision of social work and psychiatric expertise in casualty departments may be one means of preventing unnecessary medical admissions without risk to the patients. Dr Blake's and Dr Bramble's figures do not demonstrate, however, that any advantage would attach to medical teams taking over assessment from psychiatrists except that, by implication, assessments would be completed sooner by staff working on the ward full time. What the figures actually suggest is that if assessment of overdoses were left to house doctors there would be an increase in admissions to psychiatric units (by 19°U), outpatients (by 5O°'), and referrals to social services (by 140o). So for house doctors to assess overdoses would provide no economy for the psychiatric or social services. The study does not tell us what the consequences would have been for the six patients who the psychiatrists would have admitted but to whom the house doctors would have offered outpatient appointments. E J SALTER

Vitamin D deficiency.

Meeting: International Seminar on Information and Communication Technology Statistics, Seoul, Republic of Korea, 19-21 July 2010

Ministry of Statistics and Programme Implementation

Background: Saudi Arabia has taken unprecedented and stringent preventive and precautionary measures against COVID-19 to control its spread, safeguard citizens and ensure their well-being. Public adherence to preventive measures is influenced by their knowledge and attitude towards COVID-19. This study investigated the knowledge, attitudes, and practices of the Saudi public, towards COVID-19, during the pandemic. Methods: This is a cross-sectional study, using data collected via an online self-reported questionnaire, from 3388 participants. To assess the differences in mean scores, and identify factors associated with knowledge, attitudes, and practices towards COVID-19, the data were run through univariate and multivariable regression analyses, respectively. Results: The majority of the study participants were knowledgeable about COVID-19. The mean COVID-19 knowledge score was 17.96 (SD = 2.24, range: 3–22), indicating a high level of knowledge. The mean score for attitude was 28.23 (SD = 2.76, range: 6–30), indicating optimistic attitudes. The mean score for practices was 4.34 (SD = 0.87, range: 0–5), indicating good practices. However, the results showed that men have less knowledge, less optimistic attitudes, and less good practice towards COVID-19, than women. We also found that older adults are likely to have better knowledge and practices, than younger people. Conclusions: Our finding suggests that targeted health education interventions should be directed to this particular vulnerable population, who may be at increased risk of contracting COVID-19. For example, COVID-19 knowledge may increase significantly if health education programs are specifically targeted at men.

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Knowledge, Attitude and Practice Toward COVID-19 Among the Public in the Kingdom of Saudi Arabia: A Cross-Sectional Study

Urinary incontinence in women

Telemedicine is the use of electronic information to communicate technologies to provide and support healthcare when distance separates the participants.(1)

“Tele” is a Greek word meaning “distance “and “mederi” is a Latin word meaning “to heal”. Time magazine called telemedicine “healing by wire”. Although initially considered “futuristic” and “experimental,” telemedicine is today a reality and has come to stay. Telemedicine has a variety of applications in patient care, education, research, administration and public health.(2) Worldwide, people living in rural and remote areas struggle to access timely, good-quality specialty medical care. Residents of these areas often have substandard access to specialty healthcare, primarily because specialist physicians are more likely to be located in areas of concentrated urban population. Telemedicine has the potential to bridge this distance and facilitate healthcare in these remote areas.(3,4)

Telemedicine: a new horizon in public health in India.

Good nutrition forms the basis for good health of a child. Nutrition is required for a child to grow, develop, stay active, and to reach adulthood as well.(1)

Exclusive breastfeeding (EBF) is recommended as the optimum method of feeding for the first 6 months of life and semi-solid foods are to be introduced after 6 months while continuing breastfeeding to meet the physiological requirements of the infants.(2)

Studies(3) have reported that the practices of early introduction of top feeds and late introduction of semi-solids are widely prevalent, more so in urban slums.

Studies by the Nutrition Foundation of India (NFI) in urban slums of three major cities (Mumbai, Kolkata, and Chennai) revealed serious erosion of breastfeeding practices. Other studies from urban slums repeatedly documented that exclusive breastfeeding was practiced in only 30-40% of infants, colostrum was discarded in upto 90%, use of prelacteal feeds was almost universal, use of feeding bottles, animal milk, and commercial milk formulae was very common. Also it was found that the introduction of complementary foods is markedly delayed and the foods lack the consistency, energy density and are fed in inadequate amounts and in unhygienic ways.(3)

With this background, the study had been conducted to assess the feeding practices of the children in an urban slum and to determine the factors influencing it, if any.

Feeding practices of children in an urban slum of kolkata.

Objectives: To find out the magnitude of malnutrition among the adolescents of an urban slum of Kolkata study population. To compare the middle upper arm circumference (MUAC) with that of body mass index (BMI) for determination of nutritional status of the study population. Materials and Methods: This was a school-based descriptive epidemiological study done among adolescent male students aged 10-19 years in the service area of Urban Health Centre, Chetla. The school is an all boy's government aided school and all the students reside in the Chetla slum, the largest slum of Kolkata. Anthropometric measurements of the students of one section selected from each class i.e. class V to XII were recorded. Results: Results showed 47.93% of study population as per BMI and 60.30% as per MUAC were malnourished. Evaluation of screening test showed MUAC as a marker was 94.6% sensitive and 71.2% specific. A correlation between measurements of MUAC and BMI was demonstrated (r=0.822; SE=0.035; 95% CI; P=0.000000; r2 =0.74).

Assessment of malnutrition among adolescents: can BMI be replaced by MUAC.

Background: Majority of the health problems affecting school children are preventable by promotion of hygienic practices through proper health education by the teachers, who are the first contacts. Objectives: The study was undertaken to find out the status of nutrition and personal hygiene among primary school children and their association with their varied morbidity profiles. Materials and Methods: A descriptive, observational, cross-sectional study was conducted in a primary school situated in the largest slum of Kolkata. Results: The participants included 103 boys and 81 girls, with a mean age of 6.2 years. The mean personal hygiene score of the girls (4.15 ± 0.98) was significantly higher than that of boys (3.2 ± 1.4) [ P P Conclusions: Care should be taken to improve the pitiable state of personal hygiene and poor sanitary practices of these school children through coordinated and concerted health education measures by teachers as well as parents.

Relationship of personal hygiene with nutrition and morbidity profile: a study among primary school children in South kolkata.

Though India is now considered a major power and is turning into a developed country from a developing country, a large section of its population still belong to the poorest of the poor. In developing countries, great efforts are directed towards the advancement of small-scale industries as these are considered the engine for their economic growth. According to WHO, over 1000 million people worldwide are employed in small-scale industries.(1) The ‘garment’ industry of India is one such industry. It is an unorganized sector, mostly run by private establishments. It provides employment for both men and women, mainly those from the lower socioeconomic classes.

The employees of this industry hardly ever benefit from occupational health-and-safety provisions. As a result their health suffers.(1) Studies show that musculoskeletal problems, diseases of the respiratory system and eye, accidents, injuries, skin diseases, stress, insomnia, etc. are all common among these workers. The ill health is compounded by various socioeconomic factors such as poverty, lack of education, poor working conditions, excess working hours, and poor diet.(2–4)

Against this background, and because no such study has been carried out in this part of the country to date, we conducted this study among workers employed in the ‘garment’ industry; we had the following objectives:



To find out the morbidity profile of the workers with special reference to musculoskeletal disorders.


To assess the relationship of socio-demographic and occupational factors with the musculoskeletal disorders.


To assess the felt needs of these workers.





Materials and Methods
This was a community-based cross-sectional study carried out in a slum area of Kolkata. The study was conducted from September 2008 - November 2008.

There are three main areas in the slum where almost all those engaged in the small-scale garment industry reside. One such area was chosen by simple random sampling. A complete enumeration of all workers in the chosen area was done. There were one hundred and twelve such workers who were identified and all of them consented to participate in the study. The subjects were then interviewed using a predesigned, pre-tested, semi structured questionnaire that had been translated into the local language; the questionnaire collected data on socioeconomic conditions, occupational history, health problems.

The felt needs of the workers were obtained from two Focus Group Discussions in each of which 9 workers participated. The researchers organized the group discussions after assuring confidentiality to the participants. Efforts were made to elicit the problems faced by them at their place of work, dealings with their employer and the changes they would like for a better and conducive working environment.

Aparajita Dasgupta

Papers

Telemedicine: a new horizon in public health in India.

Feeding practices of children in an urban slum of kolkata.

Assessment of malnutrition among adolescents: can BMI be replaced by MUAC.

Relationship of personal hygiene with nutrition and morbidity profile: a study among primary school children in South kolkata.

Health Status of Workers Engaged in the Small-scale Garment Industry: How Healthy are They?