Showing papers in "Journal of family medicine and primary care in 2017"

Universal health coverage - There is more to it than meets the eye

Abstract: Dear Editor, We congratulate the Journal of Family Medicine and Primary Care for their continuing discourse and articles on Universal Health Coverage (UHC).[1-3] We were especially impressed by many pertinent issues raised by Kumar and Roy in the last issue of the journal.[1] While India depends on a flourishing private healthcare industry, one wonders whether public interest policies such as the UHC will be left alone without conceding to their interests. At a time, when there is a lot of ongoing debate on the continuance and budgeting of National Health System of the United Kingdom, when dilution of Universal Health Care is being discussed in developed nations, the ostensible push toward UHC in countries such as India may be because of the epidemiological transitions such as projected rise of noncommunicable diseases in India, signalling a potentially lucrative business opportunity for the global health industry.[1]

Prospective study on prevalence of anemia of pregnant women and its outcome: A community based study.

Abstract: Background: Anemia is one of the most common nutritional deficiency disorders affecting the pregnant women in the developing countries. Anemia during pregnancy is commonly associated with poor pregnancy outcome and can result in complications that threaten the life of both mother and fetus. Objective: The objective of the study was to estimate the prevalence of anemia among pregnant women and to determine its association with maternal and fetal outcomes. Settings and Design: This study design was a prospective, observational, community-based study. Subjects and Methods: Four hundred and forty-six pregnant women were included in the study from three primary health centers in Kolar district by multistage sampling technique and were followed up till 1 week after delivery. Statistical Analysis: The data were analyzed using SPSS version 22; correlation coefficient, Chi-square test, and logistic regression were used. Results: There was a significant overall improvement in the hemoglobin levels of pregnant during the follow-up (10.3–10.72 gm%). About 35.6% of the women had maternal or fetal morbidity. Anemia was one of the main pregnancy-related complications (62.3%), other complications include difficult labor (3%), postpartum hemorrhage, and preeclampsia 1.6% each abortions/stillbirths (3.5%). The fetal complications include low birth weight (25.5%) followed by premature delivery (0.2%) and birth asphyxia (0.5%). Conclusions: A high prevalence of anemia in pregnant women apparently increases the maternal and fetal risks. To improve maternal and fetal outcome, it is recommended that the primary health care has to be strengthened, prevention, early diagnosis, and treatment of anemia in pregnancy to be given priority.

Prevalence of Depression, Anxiety and Stress among school going adolescent in Chandigarh.

Abstract: Context: Depressive disorders often start at a young age. There is a need for early identification of depression, anxiety, and stress (DAS) and prevention. The present study was undertaken to find the magnitude of DAS among adolescents. Aims: To find the mental health status of school going adolescents in Chandigarh. The objectives were (i) to study the prevalence of DAS among school going adolescents and (ii) to study the correlates of DAS. Settings and Design: A Cross-sectional survey of students of four classes from 9th to 12th studying in government schools. Subjects and Methods: Ten government schools in Chandigarh were randomly selected through lottery method. In each school, for each of the four classes, a section was randomly selected again by the lottery method. Forty students were selected from each school reaching sample size of 470. DAS scale 21 questionnaires were used. Statistical Analysis Used: The data entry was done in MS Office Excel 2007. The analysis was done in the form of frequency tables, charts cross tables. For statistical significance, Chi-square test and correlation was found between various factors. Results: The prevalence of DAS was 65.53%, 80.85%, and 47.02%, respectively. Overall, comorbidity between depression and anxiety was 57.65%. Extremely severe depression was very less (3%). The prevalence of DAS was higher in females. For depression and anxiety, the peak age was 18 years. Conclusions: The prevalence of DAS was high among school going adolescents in Chandigarh. There is a need for early and effective identification of DAS that can prevent many psychiatric disorders at their nascent stage.

A descriptive cross-sectional study on menstrual hygiene and perceived reproductive morbidity among adolescent girls in a union territory, India.

Abstract: Introduction: Menstruation is a milestone event in a girl's life and the beginning of reproductive life. Lack of knowledge and poor sanitary practices during menstruation has been associated with serious ill-health ranging from genital tract infections, urinary tract infections, and bad odor. Aim: This study aims to explore the knowledge, attitude, and practices about menstrual hygiene and perceived reproductive morbidity among adolescent school girls in Puducherry. Materials and Methods: A school based cross-sectional study was conducted from June 2015 to July 2015 in Puducherry among 242 adolescent school girls in the age group of 12–18 years using multistage random sampling technique. Data were collected using a predesigned pretested, structured proforma by personal interview method after having informed written consent. Results: The mean age for menarche was 12.99 ± 0.9 years; 51.7% of respondents were not aware of menstruation before attaining menarche; 71.5% and 61.2% were not known about the cause and source of the menstrual bleeding, respectively; 78.1% used only sanitary pads whereas 21.9% used both old clothes and sanitary pads as the absorbents. Unsatisfactory cleaning of the external genitalia was practiced by 12% of respondents. Higher prevalence of dysmenorrhea (82.2%) was mentioned by the respondents; 25.2% reported excessive genital discharge. Statistically significant association was found between perceived reproductive morbidity and poor menstrual hygiene practices. About 88.4% of the study population reported any one of the reproductive morbidity, and only 37.4% sought for medical treatment from a health facility. Conclusion: The present study has underscored the necessity of adolescent girls to have adequate and precise knowledge about menstruation before menarche. Proper menstrual hygiene practices which could be imparted through appropriate interventions at earlier stages of life can prevent the girls and women from suffering reproductive morbidities.

Depression and its associated factors among people living with HIV/AIDS: Can it affect their quality of life?

Abstract: Introduction: Depression, being the most common neuropsychiatric complication of HIV, is also associated with increased health-care utilization, decreased quality of life (QOL), and poor adherence to antiretroviral therapy (ART). Depression is a multidimensional disorder affected by a variety of biological, psychological, and social determinants and this relation becomes more complicated in HIV patients. The current study therefore aimed to investigate the sociodemographic and clinical determinants of depression and assess difference in the QOL of HIV patients not having depression and those suffering from depression. Materials and Methods: A cross-sectional study was conducted at an ART center in a tertiary care hospital in HIV/AIDS patients of 18 years of age. Sociodemographic and clinical characteristics were studied, depression anxiety and stress scale-21 was used to assess depression, and QOL assessment was done using WHOQOL-HIV BREF questionnaire. Results and Conclusions: Out of 754 study subjects, 377, i.e., 50% suffered from depression and nearly 75.9% of them were in the age group of 25–44 years. The prevalence of depression was higher in females, illiterates, and unemployed HIV patients as compared to males, literates, and employed subjects, respectively. HIV patients who were depressed had significantly lower QOL than the subjects not suffering from depression, more so in the environment and social relationships domains.

Morbidity pattern and health-seeking behavior of elderly in urban slums: A cross-sectional study in Assam, India.

Abstract: Background: Elderly population in India is increasing fast which indicates a growing share of population with more special needs for health and support. Understanding the morbidities and health-seeking behavior of elderly is essential for strengthening geriatric health-care services delivery. Objectives: The objective of this study was to study the morbidity profile of elderly in urban slum areas and assess their health-seeking behavior. Methodology: A cross-sectional study was conducted in urban slums of Jorhat district of Assam, among 125 elderly selected by simple random sampling. Statistical Analysis Used: The statistical analysis was performed by Chi-square and proportions. Results: The most common morbidity found was arthritis (70.4%) followed by visual impairment (58%). Majority (83.7%) were seeking treatment for their health problems. Among those elderly who did not seek treatment, the most common reasons given were “lack of money” (81.2%) and “not feeling necessary to go to doctor as conditions were age related” (62.5%). Conclusions: More than two-third of slum-dwelling elderly in the present study were suffering from chronic morbidities; a few could not afford proper health care due to lack of money and self-medication practices were prevalent among some. This stresses the need to provide suitable health facilities and affordable health care to the elderly in slum areas to ensure their active aging. Living arrangement of the elderly was found to have significantly influenced their health-seeking behavior. Strategic implementation of policies focusing on the problems and beliefs of slum-dwelling elderly which prevent them from seeking healthcare is the need of the hour.

Diagnostic delay and associated factors among patients with pulmonary tuberculosis in Kerala.

Abstract: Introduction: Delay in the diagnosis of tuberculosis (TB) can lead to an increased infectivity period, delayed treatment, and increased severity of the disease. The objective of this study was to estimate the diagnostic delay and factors associated with the delay in diagnosis among the newly diagnosed smear-positive pulmonary TB patients in Kerala, India. Materials and Methods: A cross-sectional study was conducted among TB patients who were in the intensive phase of directly observed treatment short-course treatment in four randomly selected TB units in a district in Kerala during the years 2012–2013. Diagnostic delay was defined as the delay between the onset of symptoms and diagnosis. Data collection using a modified World Health Organization questionnaire was done by interviewing 302 participants. Results: Mean age of the participants was 48.6 ± 14.5 years. Males constituted 76.5% of the study population. The mean diagnostic delay was 43.5 ± 29.1 days (median: 37 days). The median patient and health system delays were 16 days and 15 days, respectively. Patient delay (55.6%) contributed more than health system delay (44.4%). Poor knowledge about TB, first consulting a private physician, and increased number of consultations were found to be significantly associated with diagnostic delay. Conclusion: The diagnostic delay in tuberculosis reported in this study was lower than other studies in India but it needs further reduction. Both patients and health providers play a role in a delay in diagnosis, and poor knowledge about the disease among the patients was one of the main risk factors. Interventions to improve knowledge and awareness of the disease and to increase the suspicion of chest symptomatic by health-care providers in the private sector are vital to reduce diagnostic delay.

Quality of life among elderly population residing in urban field practice area of a tertiary care institute of Ahmedabad city, Gujarat.

Abstract: Introduction: Overall improvement in the living standards of country's population is leading to longer life expectancy. To emphasize the medical and psychological difficulties faced by geriatric people is essential to know status of their quality of life (QOL). Methodology: A community-based cross-sectional study was carried out at urban field practice area of one of the teaching institutes of Ahmedabad, Gujarat. Considering the prevalence of about 7.5% of 60 years and above people sample size of 250 was calculated. A predesigned questionnaire related to the QOL of elderly people devised by the World Health Organization-QOL was used. Results: Mean age of the study population was 65.8 years with standard deviation of 5 years. Almost two-thirds of geriatrics were currently married and having spouse alive. List of common morbidities observed among study population was joint pain (42.8%), cataract (32.8%), hypertension (22.4%), diabetes mellitus (17.2%), and dental problems (12.4%). Scoring of QOL profile revealed that none of the geriatric had poor QOL, whereas 56% fall into category “good” and 50.8% had “excellent” QOL. QOL as per four different domains was significantly better among males as compared to females. Physical, environmental, and psychological domains were better in those who were educated and married individuals living with their spouse. Conclusion: Overall QOL was good to excellent. Social characteristics, such as education, marital status, and gender, all play role for the perceived QOL among the respondents.

Antibiotic prescribing knowledge, attitudes, and practice among physicians in teaching hospitals in South India.

Abstract: Background: Antibiotic overuse is a major public health challenge worldwide. Data from India related to physician antibiotic prescribing patterns are limited. Aims: We assessed antibiotic prescribing knowledge, attitudes, and practices among physicians in Mangalore, South India. Materials and Methods: Using a cross-sectional descriptive study design, physicians at academic tertiary hospitals completed an anonymous on-site survey. The survey items incorporated Likert scales, and data were analyzed using SPSS version 15.0. Results: Of the 350 physicians approached using a convenient sampling method, 230 (66%) consented and interviewed. The physician's knowledge of resistance patterns of common bacteria was related to receiving periodic updates on resistance patterns of bacteria (P = 0.019) and participation in courses on antibiotics (P = 0.026). Individuals with more number of years of experience (mean of 11 years) were less likely to justify antibiotic use for uncomplicated bronchitis (P = 0.015) and acute gastroenteritis (P = 0.001). Most respondents (n = 204, 89%) believed that physicians overprescribed antibiotics in routine clinical practice. Forty-five percent (n = 104) stated that their hospitals did not have an infection control policy in place. Conclusions: This study provides some understanding of physician's antibiotic prescribing patterns from teaching hospitals in India. Judicious antimicrobial use through educational and antimicrobial stewardship programs remains critical to control the spread of antibiotic resistance.

Exercise in patients with Type 2 diabetes: Facilitators and barriers - A qualitative study.

Abstract: Introduction: Diabetes is a major noncommunicable disease affecting more than 65 million Indians. Although treatment algorithms suggest lifestyle measures (diet and exercise) along with medications data regarding adherence to exercise as well as facilitators and barriers to the practice of physical activity in such patients are limited. Hence, this qualitative study was conducted. Objectives: The objective of this study is to describe the factors which (1) Facilitated and (2) hindered the practice of regular exercise in patients with Type 2 diabetes. Methodology: The study was conducted on 13 diabetic patients admitted to a tertiary care center in Bengaluru - St. John's Medical College Hospital, to explore factors that acted as facilitators and barriers to physical activity. Data saturation with the coded themes was achieved on interviewing 13 patients, after which, thematic analysis was done, and final themes reported. Results: The age of the study participants (7 males, 6 females) ranged from 40 to 80 years. Among those who did exercise, factors such as awareness regarding the benefits of exercise and complications linked with diabetes, positive family support, and emphasis by nursing staff emerged as facilitators. Lack of time, obligations to others, inability to link exercise with blood sugar control, lack of perception of obesity as a health issue, inadequate emphasis by physicians, social/cultural issues, lack of infrastructure, and physical restriction were the factors that acted as barriers to physical activity. In addition to the above, a clear lack of adherence to standard guidelines, while advising patients by physicians was also noted. Conclusion: A comprehensive approach by both doctors and nurses, based on standard guidelines, could help in implementing adherence to exercise in patients with diabetes.

Mohalla Clinics of Delhi, India: Could these become platform to strengthen primary healthcare?

Abstract: The mohalla or community clinics in Delhi, India aims to provide basic health services to underserved population in urban settings. This article reviews and analyzes the strengths & limitations of the concept and explores the role these clinics can play in (1) reforming urban health service delivery, (2) addressing health inequities, and (3) strengthening primary health care. These clinics provide basic healthcare services to people, in underserved areas, in a responsive manner, have brought health higher on the political agenda and the governments of a number of Indian states have shown interest in adoption (of a variant) of this concept. Strengths notwithstanding, the limitations of these clinics are: curative or personal health services focus and relatively less attention on public/population health services. It is proposed that while setting up these clinics, the government should built upon existing health system infrastructure such as dispensaries, addressing the existing challenges. The new initiative need not to be standalone infrastructure, rather should aimed at health system strengthening. These need to have a functional linkage with existing programs, such as Urban Primary Health Centres (U-PHCs) under national urban health mission (NUHM) and could be supplemented with overall efforts for innovations and other related reforms. The author proposes a checklist 'Score-100' or 'S-100', which can be used to assess the readiness and preparedness for such initiative, should other state governments and/or major city in India or other countries, plan to adopt and implement similar concept in their settings. In last 18 months, the key contribution of these clinics has been to bring health to public and political discourse. Author, following the experience in Delhi, envisions that these clinics have set the background to bring cleanliness-health-education-sanitation-social sectors (C-H-E-S-S or CHESS) as an alternative to Bijli-Sadak-Paani (B-S-P) as electoral agenda and political discourse in India. The article concludes that Mohalla Clinics, could prove an important trigger to initiate health reforms and to accelerate progress towards universal health coverage in India.

Addressing the escalating burden of chronic diseases in India: Need for strengthening primary care.

Abstract: The growing epidemic of noncommunicable diseases (NCDs) has impacted the national health systems, policies, and socioeconomic developments, thereby leading to increasing country level disparities. Despite substantial improvements in health indicators made in the past decade, the Indian health-care system continues to contribute disproportionately to the global disease burden, wherein NCDs holds significant prominence. Against this background, the present review analyzes the current NCD landscape from the perspective of India's health system preparedness toward meeting this growing challenge. Implementation and delivery of strategies and interventions are often impeded by existing grass root level challenges. Recognizing the importance of effective primary care, the review highlights the importance of implementing affordable, accessible, and comprehensive interventions, and delivering them at societal, a community and individual level. This simultaneously calls for strengthening of the primary care system through appropriate strategy and policy frameworks. Toward addressing India-specific needs in NCD prevention and management, concerted efforts on development of robust surveillance mechanisms, intersectoral and interdepartmental collaborations, integration of national programs, enhanced role of education and awareness should be made, to ensure effectivity, scale-up, and outreach of services in primary care.

Association of social anxiety disorder with depression and quality of life among medical undergraduate students.

Abstract: Objective: Social anxiety disorder (SAD), (also known as social phobia), is characterized by intense fear of social interaction and often associated with social avoidance and impairments. There is high risk for depression, substance use disorder, and suicide among them. Subjects and Methods: It is an observational, cross-sectional, single centered, questionnaire-based study assessing the frequency of SAD and depression and their possible association with quality of life among 290 consenting medical undergraduate students. Social Phobia Inventory (SPIN), Beck's Depression Inventory (BDI II), and the World Health Organization Quality of Life assessment scale (WHOQOL-BREF) were used to screen and assess severity of SAD, depression, and quality of life, respectively. The statistical analysis of proportions was done by Chi-square test, while the scores of SPIN, BDI II, and WHOQOL-BREF was compared using Mann–Whitney test or Kruskal–Wallis test followed by Dunn posttest multiple comparison, using GraphPad InStat version 3.06. Results: Frequency of SAD is 11.37%, and depression is 8.96%. Females are more likely to experience SAD. Participants with SAD are more likely to experience depression (P

Factors associated with childhood asthma control in a resource-poor center.

Abstract: Introduction: Optimal asthma control is a major aim of childhood asthma management. This study aimed to determine factors associated with suboptimal asthma control at the pediatric chest clinic of a resource-poor center. Methods: Over a 12-month study period, children aged 2–14 years with physician-diagnosed asthma attending the pediatric chest clinic of the Wesley Guild Hospital (WGH), Ilesa, Nigeria were consecutively recruited. Asthma control was assessed using childhood asthma control questionnaire. Partly and uncontrolled asthma was recorded as a suboptimal control. Relevant history and examinations findings were compared between children with good and suboptimal asthma control. Binary logistic regression analysis was used to determine the predictors of suboptimal asthma control. Results: A total of 106 children participated in the study with male:female ratio of 1.5:1, and majority (83.0%) had mild intermittent asthma. Suboptimal asthma control was observed in 19 (17.9%) of the children. Household smoke exposure, low socioeconomic class, unknown triggers, concomitant allergic rhinoconjunctivitis, and poor parental asthma knowledge, were significantly associated with suboptimal control (P

Determinants of menstrual hygiene among school going adolescent girls in a rural area of West Bengal.

Abstract: Background: Menstrual hygiene is a neglected issue in rural India. Lack of menstrual hygiene in adolescent girls can make them susceptible to various morbidities, for example, reproductive tract infection and urinary tract infection and their long-term consequences, for example, cervical cancer, infertility, and ectopic pregnancy. This study aims to find out the determinants of menstrual hygiene among the school going adolescent girls in a rural area of West Bengal. Objectives: To elicit the menstrual hygiene practices among the study population and to find out the association of poor menstrual hygiene practices with sociodemographic factors, such as age, occupation and education of the parents, housing, and presence of sanitary toilet. Materials and Methods: A descriptive, cross-sectional study was conducted among 307 school going adolescent girls of 12–17 years age group in a rural area of West Bengal. Results: Majority of the students in both schools (62.9%) were Hindu, general caste (54.1%) and belonged to nuclear family (69.7%). Most of the parents in both schools had completed their education up to primary level. Bivariate analyses were done, and the significant factors predicting good menstrual hygiene were entered into the multivariable logistic regression model. It revealed that good menstrual hygiene was more among those whose mothers were educated (adjusted odds ratios [AOR] 2.3 [1.06–5.01]), and who were homemakers (AOR 2.3 [1.06–5.01]). Conclusions: Menstrual hygiene among the study population was found to be poor. The improving education level of the mothers can go a long way in improving menstrual hygiene practice.

Knowledge, attitude, and practice of foot care in patients with diabetes at central rural India.

Abstract: Introduction: Diabetic foot syndrome is one of the common and most devastating preventable complications of diabetes mellitus (DM). It is associated with morbidity and premature mortality due to long-term complications affecting foot. The American Diabetes Association recommends that people with diabetes should have a comprehensive foot examination once per year. Most of the foot problems can be prevented with careful foot care. It may take effort and time to build up good foot care habits, but self-care is essential. Aim: The main aim of the study is to analyze the knowledge, attitude, and practice of foot care in patients with DM in central rural India. Methodology: This study was conducted at a rural educational hospital in central part of India over 200 patients who have Type 1 and Type 2 diabetes. They were evaluated for their knowledge about foot care and footwear practices. A structured and validated questionnaire was administered to cases. Results: Around 82.9% of the patients were aware of the disease and 23.2% were aware of the complications of the DM. In 63% of the patients, foot care examination and education regarding foot complications were not suggested by their treating physicians. Annual examination of feet by the physician and self-examination were not known facts to the diabetic population. Conclusion: It is necessary to firstly develop awareness of diabetes mellitus and the related complications, one amongst which is foot care. Certain educational strategies should be established for both the consultant physician and also the common man to create awareness for effective foot care.

Care seeking for childhood pneumonia by rural and poor urban communities in Lucknow: A community-based cross-sectional study

Abstract: Context: Globally, around 16% of under-five children die due to pneumonia. Childhood pneumonia, if identified early is a readily treatable through low-cost antibiotics. Access to timely and appropriate care is a key action to control pneumonia. Aims: The aim of the study was to understand the caregiver's care-seeking behavior for the management of childhood pneumonia among rural and urban poor communities in Lucknow. Settings and Design: Rural areas and urban slums of Lucknow district, from September 2014 to August 2015. Subjects and Methods: A community-based cross-sectional study. Total of 1065 under-five children were selected by multistage random sampling method. Caregivers of children (

Comparing depressive symptoms in teenage boys and girls.

Abstract: Introduction: Symptoms of depression vary between the males and females. Depressed men show behaviors such as irritability, restlessness, difficulty in concentrating, and instead of the usual behaviors. Sleep disturbance is a common symptom in depressed men. Men are less likely to go to doctors and unconsciously show other behaviors such as anger instead of the sadness. It seems that considering depression as “feminine” is a great injustice toward male patients whom their illness will not be diagnosed nor treated. Materials and Methods: The sample consisted of 191 depressed adolescents, 108 males and 83 females aged 13–19 years old. Data collected for 10 years from 2005 to 2015 and their depressive symptoms were evaluated by the Beck Depression Inventory-Second Edition. Results: Depressed girls felt sadness, guilt, punishment, worthlessness, low energy and fatigue, or more asthenia, whereas depressed boys have symptoms such as irritability, depression, suicidal thoughts, or desires to reduce their pleasure. The results of t-test showed that the difference between the total scores of boys and girls with depressive disorder (16.93) is significant at 0.001. F values for feeling sad (58.13), hatred of self (12.38), suicidal thoughts or desires (12.97), restlessness (17.35), and irritability (46. 41) were significant in the 0.001. Conclusion: Experiencing depression in boys and girls according to the role of gender was different. Gender can have an effective role in showing depression symptoms in adolescents.

Anemia in pregnancy and its associated factors among primary care clients in Sagamu, Southwest, Nigeria: A facility-based study.

Abstract: Introduction: In Nigeria, anemia in pregnancy is one of the leading causes of poor pregnancy outcomes. This study, therefore, determined the prevalence of anemia and its associated factors, among pregnant primary care clients in Sagamu, Nigeria. Materials and Methods: A cross-sectional descriptive study was carried out among 400 pregnant, primary care clients in Sagamu, selected through multi-stage sampling. Data were collected with the aid of an interviewer-administered, semi-structured questionnaire, a stadiometer, measuring tape, and a hemoglobinometer. Data were analyzed using SPSS version 17.00. Relevant descriptive and inferential statistics were calculated. Participation was fully voluntary. Results: The mean age of respondents was 25.4 ± 4.2 years. Most respondents (51.8%) were traders. About a third (32.5%) of respondents were anemic; of these, 72.1% were mildly anemic, while 27.1% were moderately anemic. Anemia was associated with household food security (P = 0.044) and level of food insecurity (P = 0.001) but not with age, occupation, educational status, household size, number of previous pregnancies, body mass index, mid-upper arm circumference, snacking, vegetable intake, and food avoidance (P > 0.05). Conclusion: Anemia in pregnancy is still high among respondents and associated with household food insecurity. Interventions targeted at improving household food security, dietary intake, and socioeconomic conditions will significantly reduce the prevalence and severity of anemia in pregnancy.

A study on awareness about breast carcinoma and practice of breast self-examination among basic sciences' college students, Bengaluru.

Abstract: Background: In India, the number of new breast cancer cases is about 115,000 per year and this is expected to rise to 250,000 new cases per year by 2015. It needs to be noted that breast cancer is leading in the age groups of 15–34 years which is a cause of concern as this denotes the need for educative and awareness programs targeting younger members of the society, to implement early practices of breast examination. This study was carried out with the intention of assessing the level of knowledge and awareness of carcinoma breast and breast self-examination (BSE) in female college students. Materials and Methods: This cross-sectional study was carried out in a well-known basic sciences college. After the pretest questionnaire was given, an awareness talk was given about breast cancer and BSE. A posttest questionnaire was administered. The data of pre- and post-test were collected and analyzed using SPSS. Results: Pretest and posttest were collected from 1030 students. The age of the study participants was ranged between 18 and 23 years. Most of them were aware of breast carcinoma, but half of them thought breast cancer affects the elderly. Regarding different aspects studied, 58% had a knowledge of at least one of the symptoms and 59% knew at least one of the risk factors for breast carcinoma. Only 185 (18%) women knew about BSE and 107 women practice it. Conclusions: This study concluded that the awareness of the breast cancer was good but the knowledge of signs and BSE was poor, which is utmost important for early detection and in reduction of mortality.

Diabetes and Ramadan: A concise and practical update.

Abstract: Despite the fact that the month of Ramadan includes 29-30 days and the duration of fasting for each day can last for between 12 and 16 h, it was estimated that a large number of individuals with diabetes do fast during Ramadan. In light of recent advancement of new pharmacological agents, drugs such as vildagliptin, sitagliptin, and liraglutide were found to be safe to use during this month of fasting. These therapeutic agents can also be used in combination with metformin. The use of sulfonylureas, in most of the recent guidelines about diabetes and Ramadan, seems not to gain much support due to the risk of hypoglycemia. In this review, we also addressed the use of insulin injection, insulin pump, and education before, during, and after Ramadan. Further research is needed to determine (i) the therapeutic benefit of new antidiabetic agents and (ii) the benefit of new technologies for the treatment of diabetes.

Correlation of Vitamin D with metabolic parameters in polycystic ovarian syndrome.

Abstract: Background: Polycystic ovarian syndrome (PCOS) and hypovitaminosis D are the two most common endocrine disorders in young women leading to many adverse metabolic consequences. We evaluated the correlation of 25-hydroxy Vitamin D (25OHD) with metabolic parameters and insulin resistance in PCOS. Materials and Methods: We included 100 PCOS patients (age 18–40 years, duration >6 months) serially, in this cross-sectional study. We excluded patients with past use of insulin sensitizers and hormone therapy. All patients underwent a physical examination, body fat estimation, and a single fasting blood sample was analyzed for the biochemical parameters. The patients were divided into 2 groups as per the 25OHD level: Group 1 (Deficient, 0.05). Conclusion: Hypovitaminosis D is very common in PCOS patients and exacerbates the metabolic abnormalities. It is essential to screen all the PCOS patients for 25OHD deficiency, and further large-scale studies are required to confirm our findings.

Seasonal variation in the prevalence of preeclampsia

Abstract: Introduction: Hypertension in pregnancy is one of the three factors of maternal mortality. Etiology of the disease is unknown, but the many factors contributing to the identification and control of it can be taken a step to prevent and reduce the symptoms of the disease. The purpose of this study was to determine the prevalence of preeclampsia (high-blood pressure) in different seasons of the year. Methods: The present retrospective cross-sectional study was conducted on more than 8,000 pregnant women visiting Assali specialized hospital from 2011 to 2013. Required data was collected through questionnaire checklist. The Chi-square test with multiple comparisons was used to compare the frequencies of pregnancy-induced hypertension (PIH) according to the month of year, and adjustment of multiplicity was conducted using Bonferroni's method. Student's t-test was used to compare the means of PIH prevalence rates. In all analyses, P

Bacteriological profile of neonatal sepsis in a secondary care hospital in rural Tamil Nadu, Southern India.

Abstract: Introduction: Neonatal sepsis is a leading cause of neonatal mortality and morbidity in the world. The objective of the current study was to detect the common causative microorganisms of neonatal sepsis and their antimicrobial resistance patterns in a rural secondary hospital in Tamil Nadu, India. Materials and Methods: Neonates (0–28 days) admitted to this newborn care unit from October 2013 to September 2015, with a diagnosis of probable sepsis were studied. All the enrolled babies had blood cultures taken and were followed up till final outcome, which was discharge or death, irrespective of culture result. Univariate analysis was performed for factors associated with culture positivity, generating odds ratios, and confidence intervals. Results: Among the 107 babies with a diagnosis of probable sepsis, 28 (26.2%) had shown bacteria in culture. The majority (94.4%) were of early-onset sepsis. The predominant organisms were Staphylococcus aureus (10/28) and Klebsiella (6/28). 100% of Gram-negative bacilli and 90% of Staphylococcus were resistant to Ampicillin. Gentamicin resistance among Gram-negative bacilli and Staphylococcus was 52.9% and 20%, respectively, while third-generation cephalosporin resistance was 31.2% and 20%, respectively. Among the neonates diagnosed as probable sepsis, idiopathic prematurity (P = 0.007) was found to have a statistically significant association with culture-positive sepsis. Conclusion: The culture positivity rate among the neonates with probable sepsis in the current study was 26%. An alarmingly high degree of antibiotic resistance observed calls for robust infection control practices and an urgent evaluation and development of individual and national antibiotic policies for neonatal sepsis.

Duchenne muscular dystrophy: Case report and review.

Abstract: Muscular dystrophies are a clinically and heterogeneous group of disorders that all share clinical characteristics of progressive muscular weakness. Duchenne muscular dystrophy (DMD) is the most common X-linked disorder muscular dystrophy in children, presenting in early childhood and characterized by proximal muscle weakness and calf hypertrophy in affected boys. There is usually delay in motor development and eventually wheelchair confinement followed by premature death from cardiac or respiratory complications. Treatment modalities such as corticosteroid therapy and use of intermittent positive pressure ventilation have provided improvements in function, ambulation, quality of life, and life expectancy, although novel therapies still aim to provide a cure for this devastating disorder. Here, we present a case of DMD in a 12-year-old male with remarkable clinical and oral manifestations.

Drug abuse: Uncovering the burden in rural Punjab.

Abstract: Introduction: Drug abuse is a global phenomenon, affecting almost every country, but its extent and characteristics differ from region to region. India too is caught in this vicious circle of drug abuse, and the numbers of drug addicts are increasing day by day. The bane of drug abuse in Punjab has acquired the proportions of a pestilence that has shaken the entire society in the state. It is observed that in Punjab “drug abuse” is a raging epidemic, especially among the young. Methodology: The present cross-sectional study was conducted on 400 adolescents and young adults (11–35 years) from 15 villages of Jalandhar District. Systematic sampling (probability proportionate to size) was used for the selection of study subjects. A preformed, semi-structured questionnaire was used to collect information on type and frequency of drugs abused and other sociodemographic variables. The statistical evaluation of the data was performed using SPSS software, version 21.0. Results: The prevalence of substance abuse among study group was 65.5% and most common substance abused was alcohol (41.8%), followed by tobacco (21.3%). A high prevalence of heroin abusers was noted among study subjects (20.8%). The prevalence of nonalcohol and nontobacco substance abuse was 34.8%. A significant association of drug abuse was observed with male gender, illiteracy, and age above 30 years. Conclusions: The problem of drug abuse in youth of Punjab is a matter of serious concern as every third person is hooked to drugs other than alcohol and tobacco. The other striking observations were the high prevalence of heroin and intravenous drug abuse.

Birth preparedness and complication readiness in pregnant women attending urban tertiary care hospital

Abstract: Background: Birth preparedness and complication readiness (BP/CR) is a strategy to promote the timely use of skilled maternal and neonatal care and is based on the theory that preparing for childbirth and being ready for complications reduce delay in obtaining care. Study Objective: The objective of this study was to evaluate the incidence and predictors of birth preparedness, knowledge on danger signs, and emergency readiness among pregnant women attending outpatient clinic of a tertiary care hospital. Patients and Methods: Six hundred pregnant women attending the outpatient department of a tertiary care hospital for the first time in an urban setting were interviewed using a tool adapted from the “Monitoring BP/CR-tools and indicators for maternal and new born health” of the “JHPIEGO.” The outcomes of the study were birth preparedness, knowledge of severe illness, and emergency readiness. Results: Six hundred pregnant women were in the study. Mean age of respondents was 25.2 (±4) years. The mean gestation at enrolment was 18.7 ± 8 weeks. Among the women who participated in the survey, 20% were illiterate, 70% were homemakers and nearly 70% had a monthly family income >Rs. 15,197 (n = 405). Three hundred and sixteen mothers (52%) were primigravida. As defined in the study, 71.5% were birth prepared. However, 59 women (9.8%) did not identify a place of delivery, 102 (17%) had not started saving money, and 99 mothers (16.5%) were not aware of purchasing materials needed for delivery. The predictors of birth preparedness are multiparity (odds ratio [OR]: 2.2, 95% confidence interval [CI]: 1.4–3.1), registration in the antenatal clinic in the first trimester (OR: 3.7, 95% CI: 2.2–6.1), educational status of women (OR: 1.9, 95% CI: 1.2–3.0), and pregnancy supervison by a doctor (OR: 5, 95% CI: 2.8–6.6). One hundred and sixty-four women (27%) made no arrangements in the event of an emergency, 376 women (63%) were not aware of their blood group, and 89% (n = 531) did not identify any blood donor. Only 20% (n = 120), 15.8% (n = 95), and 12% (n = 73) of the respondents had knowledge of at least 3 danger signs of pregnancy, labor, and severe illness in newborn, respectively. Conclusions: Nearly three-fourth pregnant women attending a tertiary care hospital in an urban area are birth prepared. However, emergency readiness and awareness of danger signs are very poor. Maternal education and early booking have an independent association with birth preparedness.

Regional variation in utilization of Antenatal care services in the state of Andhra Pradesh

Abstract: Background: Delivery of maternal health care services is a major challenge to the health system in developing countries. Provision of antenatal care (ANC) services is the major function of public health delivery system in India to improve maternal health outcomes and its impact on maternal morbidity and mortality. Studies are lack in documenting variation in utilization of ANC services between geographical regions of Andhra Pradesh (AP). Objective: The objective of this study is to assess variation in utilization of ANC services stratified by geographical region, type of delivery and determinants of utilization of ANC services in AP. Methodology: It is a cross-sectional study of District Level Household and Facility Survey-4 of the state of AP. Multistage, stratified and probability proportional to size sample with replacement was used. Around 3982 women who delivered after the year 2007 were considered for analysis. Binomial logistic regression was carried out to determine association of demographic, system level variables with adequate ANC. Results: Study reveals wide variation across four regions of AP in utilization of ANC services. Reception of adequate ANC was low in Rayalaseema region (27.9%) and high in North-coastal region (42.4%). The utilization of private health facilities for ANC services were highest in South-coastal region (73.2%) and lowest in North-coastal region (43.2%). Conclusion: Policy measures are to be adopted and implemented by government to address the demand-supply imbalance such as public health infrastructure and quality of services in underperforming districts of AP and to increase outreach of current programs by engaging communities.

Can mid-upper arm circumference and calf circumference be the proxy measures to detect undernutrition among elderly? Findings of a community-based survey in rural Puducherry, India.

Abstract: Introduction: Major proportion of the elderly with under nutrition is undetected in the community. One of the feasible ways to detect under nutrition among elderly would be screening in the field settings. in this study, we aimed to identify the utility of alternate anthropometric measures such as mid-upper arm circumference (MUAC), calf circumference, and skin fold thickness in identifying under nutrition among elderly. Materials and Methods: A community-based cross-sectional survey was done among elderly in one of the randomly selected subcenters. Anthropometric measures such as weight, arm span, MUAC, and triceps skinfold thickness were measured as per the standard measurement guidelines by a trained medical graduate. The elderly were identified as undernourished if body mass index (BMI) is