Application of compressional optical coherence elastography (OCE) for delineation of tumor and peri-tumoral tissue with simultaneous assessment of morphological/molecular subtypes of breast cancer is reported. The approach is based on the ability of OCE to quantitatively visualize stiffness of studied samples and then to perform a kind of OCE-based biopsy by analyzing elastographic B-scans that have sizes ~several millimeters similarly to bioptates used for “gold-standard” histological examinations. The method relies on identification of several main tissue constituents differing in their stiffness in the OCE scans. Initially the specific stiffness ranges for the analyzed tissue components (adipose tissue, fibrous and hyalinized tumor stroma, lymphocytic infiltrate and agglomerates of tumor cells) are determined via comparison of OCE and morphological/molecular data. Then assessment of non-tumor/tumor regions and tumor subtypes is made based on percentage of pixels with different characteristic stiffness (“stiffness spectrum”) in the OCE image, also taking into account spatial localization of different-stiffness regions. Examples of high contrast among benign (or non-invasive) and several subtypes of invasive breast tumors in terms of their stiffness spectra are given.

OCT-elastography-based optical biopsy for breast cancer delineation and express assessment of morphological/molecular subtypes

Background: With the availability of low-cost mobile devices and the ease of internet access, mobile health (mHealth) is digitally revolutionizing the health sector even in resource-constrained settings. It is however necessary to assess end-user perceptions before deploying potential interventions. Objective: This study aimed to assess the mobile phone usage patterns and the acceptability of mobile phone support during care and treatment in patients with tuberculosis (TB) in South India. Methods: This exploratory study was conducted at an urban private tertiary care teaching hospital and nearby public primary-level health care facilities in Bangalore, South India. We recruited 185 patients with TB through consecutive sampling. Subsequent to written informed consent, participants responded to an interviewer-administered pretested questionnaire. The questionnaire included questions on demographics, phone usage patterns, and the benefits of using of mobile phone technology to improve health outcomes and treatment adherence. Frequency, mean, median, and SD or interquartile range were used to describe the data. Bivariate associations were assessed between demographics, clinical details, phone usage, and mHealth communication preferences using the chi-square test and odds ratios. Associations with a P value ≤.20 were included in a logistic regression model. A P value of <.05 was considered significant. Results: Of the 185 participants, 151 (81.6%) used a mobile phone, and half of them owned a smartphone. The primary use of the mobile phone was to communicate over voice calls (147/151, 97.4%). The short message service (SMS) text messaging feature was used by only 66/151 (43.7%) mobile phone users. A total of 87 of the 151 mobile phone users (57.6%) knew how to use the camera. Only 41/151 (27.2%) mobile phone users had used their mobile phones to communicate with their health care providers. Although receiving medication reminders via mobile phones was acceptable to all participants, 2 participants considered repeated reminders as an intrusion of their privacy. A majority of the participants (137/185, 74.1%) preferred health communications via voice calls. Of the total participants, 123/185 (66.5%) requested reminders to be sent only at specific times during the day, 22/185 (11.9%) suggested reminders should synchronize with their prescribed medication schedule, whereas 40/185 (21.6%) did not have any time preferences. English literacy was associated with a preference for SMS in comparison with voice calls. Most participants (142/185, 76.8%) preferred video-based directly observed treatment when compared with in-person directly observed treatment. Conclusions: Although mobile phones for supporting health and treatment adherence were acceptable to patients with TB, mHealth interventions should consider language, mode of communication, and preferred timing for communication to improve uptake.

Mobile Health for Tuberculosis Management in South India: Is Video-Based Directly Observed Treatment an Acceptable Alternative?

This client-centered handbook provides state-of-the-art information for health care professionals on the complete range of family planning methods. The information is based on international consensus regarding critical medical epidemiologic and clinical research findings and their implications for method choice and service delivery. The handbook is consistent with the reproductive health approach developed at the 1994 International Conference on Population and Development and addresses changes in contraceptive needs across the life cycle. Its 16 chapters cover counseling clinic guidelines for determining pregnancy and preventing infection oral contraceptives Depo-Provera Norplant implants female sterilization and vasectomy condoms IUDs vaginal methods natural family planning lactational amenorrhea method and sexually transmitted diseases. Decision tables interspersed with the chapters identify a client condition or problem and recommend an appropriate response. An appendix presents the World Health Organization medical eligibility criteria for starting contraceptive methods. This material can be used as a resource in work with individual clients and community groups in training courses for health workers and as a basis for the preparation of educational materials. It is available free of charge to health care providers and programs in developing countries.

[The essentials of contraceptive technology: a handbook for clinic staff. Chinese version.]

This thesis consists of three papers on the economics and structure of Swedish familiesPaper [I] examines the determinants of children’s educational achievement in Sweden Special attention is giv 

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The phase-out of the nuclear family? : empirical studies on the economics and structure of modern Swedish families

Background: Injuries are an important public health problem worldwide, accounting for 5 million deaths, of which unintentional injuries account for 0.8 million deaths in children. Though there are many factors responsible for injury in the home, the environment plays an important role. Objectives: The objectives were to study the magnitude and pattern of home injuries in children aged 0–14 years and to assess the environmental risk associated with home injuries. Methods: A community-based, cross-sectional study was conducted in 2015 in a ward of Mehrauli containing 20,800 households, and the total sample of children was selected from 400 households by systematic random sampling, with sampling interval being 52. Information was taken using a predesigned, semi-structured, pretested proforma from both the parents and children. The data collected were analyzed using SPSS version 12. Results: The prevalence of home injury was found to be 39.7% in the last 1 year, significantly higher in the age group of 1–3 years (54.3%) followed by 5–10 years (45.1%) (P = 0.000). The total number of injuries and the average number of injuries in girls were significantly higher than those of boys. The most common type of home injury was falls (59.5%) followed by injury with sharps and burn injury. The environmental risk was assessed using standard and working definitions and found unsafe electrical points (95.3%), unsafe stairs (100%), unsafe kitchen with access to sharps (29.3%), access to active fire (19.3%), and unsafe furniture and objects (22.8%). Conclusion: Though home injury did not occur in 60% of the children during the study period, the risk of injury in the future is high. Educating the parents and the children at schools and environmental modification are important strategies for prevention of home injury.

An epidemiological study on home injuries among children of 0–14 years in South Delhi

Breast cancer is the most common cancer among women both in developed and developing countries. The current study was conducted to correlate the molecular sub-typing of breast cancer with the Histological typing, Bloom Richardson grading and TNM staging. A cross sectional study was conducted on 70 invasive breast carcinoma samples from November 2012 to October 2014. Cases were sub-classified using immunohistochemical staining for ER, PR, Her- 2/neu, Ki-67, CK 5/6 into following subtypes luminal A, luminal B, Her-2/neu positive, basal-like and normal-like. Most common molecular subtype was Luminal A representing 27.1% of total cases, and least common subtype was normal- like comprising 5.7% of total cases. Luminal B, Her-2/ neu positive, Basal-like molecular subtypes belonged to 25.7%, 25.7%, 15.7% cases respectively. The following variables were significantly associated with IHC subtypes: number of lymph node involved, Bloom-Richardson grading and TNM staging with p value < 0.05. Luminal B, Her-2/neu positive and basal-like phenotype are found to be more associated with Large tumor size, high Nottingham modification of

Breast Cancer: Correlation of Molecular Classification with Clinicohistopathology

BACKGROUND: Family is where our roots take hold and from there we grow. In India, the joint family system has been in existence since ancient times. However, with the passage of time, the joint family system has disintegrated, giving rise to the nuclear family system. AIMS & OBJECTIVE: To Study socio demographic pattern of different types of family of Indian society, to know the attitude of members of different family type towards their family composition and to know whether current family pattern has any effect on their health status. SETTINGS AND DESIGN: A cross sectional study was conducted in urban area of Indore district. MATERIAL & METHOD: A cross sectional study with written informed consent was conducted in 100 families (50 joint families and 50 nuclear families) an urban area of Indore city. Families were selected using sequential sampling method. All the married members of family were included in study. A predesigned semi structured questionnaire was used to interview the respondent members of family at the time of visit. The questions included demographic profile, satisfaction with current family pattern, opinions about changing trends of family system and overall health status of members of family. Statistical Analysis: The data was analyzed using Microsoft office excel and SPSS version 20. Chi square Test and Mann Whitney U Test were applied. RESULTS: In the nuclear families 35 males and 30 female members and in joint families 126 males and 110 females participated in the study. 68% male and 50% females in nuclear families and 18% males and 67% females in joint families were heavily loaded with work responsibility. In Nuclear family 38% males and 42% females had poor health status. 47% and 39% males of nuclear families had alcohol and smoking habits respectively. 96% of females of nuclear families had awareness of Antenatal care. CONCLUSION: The overall health status of members of nuclear families was poor as compared to members of joint families. Awareness about health care facilities is more in nuclear families.

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A study to compare various aspects of members of joint and nuclear family.

Background: Domestic accidents are emerging as a new epidemic. They result in significant mortality and morbidity. Majority of the domestic accidents are preventable.

Objective: To study the occurrence of domestic accident and awareness on its prevention in an urban community. 

Materials and Methods: A community-based cross-sectional study was conducted on 300 members residing in an urban area. Complete information was collected through a semi-structured, pretested questionnaire. Domestic accident was considered when any of these individuals had met with an accident inside the house or in the immediate surroundings of the house. The data were analyzed using appropriate statistical software (MS Excel and SPSS, version 20).

Results: This study on the assessment of the level of awareness on preventive measures revealed that 40% respondents used apron while working in kitchen, 58% did not have a first-aid kit in the kitchen; 84% respondents said that subdue fire caused by electricity should be dealt with pouring water on fire; and 56% respondents were unaware that keeping the handle of the pan toward oneself may lead to tipping on contents on them and cause injury. Sixty-eight percent respondents were unaware about the storage of medicines in cool and dry places.

Conclusions: The most common accident reported was cuts. The level of awareness regarding domestic accidents was not high among the residents and hence there is a serious need to address the problem through public health education.

Domestic accidents: an emerging threat to community -

Background: Safe maternity with improved neonatal outcomes is predicated on proper antenatal care services. Exercise has become a fundamental aspect of women's lives and an important constituent of antenatal care.
Objective: To find out effectiveness of antenatal exercise in facilitating normal labor and also other benefits associated with antenatal exercise during pregnancy.
Methodology: A cross-sectional study was conducted in urban area (private clinic and government institution) of Indore district where antenatal exercise facility was available. Samples were selected using sequential sampling method. Sample size included 200 females (100 performing antenatal exercise and 100 non exercising females). Inclusion Criteria included all the recently delivered females practice exercise or not during their pregnancy, stand in age group of 20 to 35 years, not had any history of medical condition like Asthma, Diabetes, Hypertension, Bad obstetric history, Cephalo-pelvic disproportion and Twin pregnancy, and gave informed consent to participate in study. A semi structured questionnaire was used as study tool for interview. Chi square test was applied for significance association between variable.
Result: In this study, only 36% group B females were delivered normally, as compared to 74% group A females who delivered normally. In group A only 9% females had urinary incontinence after delivery and 30% females had complain of backache. Major source of information (87%) for females were gynecologist. Main reason for not doing antenatal exercise was not having enough time (42%) followed by not having enough knowledge (31%).
Conclusion: Females practiced antenatal exercise had less chances of caesarean section, back ache and urinary incontinence. Gynecologists were major source of information for antenatal exercise.

Effect of Antenatal Exercise on Outcome of Labor

Background: An effective contraception is the only way to stop this population explosion. There are too advantages and side effects associated with the IUCD, But most of side effects are effectively controlled by proper selection of clients and counseling process. Objective: To know the pattern of side effects and reason for removal among beneficiaries. Methods: A cross sectional study was conducted in 400 beneficiaries selected using systematic random sampling. Study sites included both urban and rural area. Data was entered and analyzed using MS excel sheet. Results: In this study maximum client 348 (87%) belonged to age group of 21 to 30 years. 47 (11.8%) clients were illiterate and 285 (71.3%) clients were unemployed/housewife. Most common side effect was pain with heavy bleeding in 30.6% clients, pain in 23.8% clients and pain with light spotting in 18.4% clients. Most common reasons for removal were pain with heavy bleeding in 42.6% clients while 10 (12.8%) clients removed due to husband’s insistence. Conclusions: After ICUD insertion 36.8% clients had side effect. Pain with heavy bleeding, pain with light spotting and only pain are the most common type of side effects. Removal of ICUD was 19.25%. Most common reason for removal was pain with heavy bleeding.

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Dhruvendra Pandey

Papers

Breast Cancer: Correlation of Molecular Classification with Clinicohistopathology

A study to compare various aspects of members of joint and nuclear family.

Domestic accidents: an emerging threat to community -

Effect of Antenatal Exercise on Outcome of Labor

Study of pattern related to side effects and removal of IUCD usage