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    Table of Contents - Current issue
Coverpage
October-December 2016
Volume 41 | Issue 4
Page Nos. 253-309

Online since Thursday, November 03, 2016

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EDITORIAL  

A dedicated public health cadre: Urgent and critical to improve health in India Highly accessed article p. 253
Sanjiv Kumar, Vinay Bothra, Dilip Singh Mairembam
DOI:10.4103/0970-0218.193336  PMID:27890973
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ORIGINAL ARTICLES Top

Senior friendly hospitals: Development and application of criteria: A descriptive study p. 256
MR Rashmi, Arvind Kasthuri, Rashmi J Rodrigues
DOI:10.4103/0970-0218.193334  PMID:27890974
Background: The world's population is rapidly aging. Between 2000 and 2050, the proportion of the world's population over the age of 60 will double from about 11% to 22%; more so in the developing countries. The prevalence of frailty and morbidity among the elderly is high. There is a need to assess the “preparedness” of the health care system including hospitals to respond to the needs of the elderly. Aim: 1. To develop criteria for a senior friendly hospital and 2. To assess the feasibility of application of these criteria. Materials and Methods: A descriptive study was done at Bangalore, India, involving 100 subjects sampled by purposive sampling. Study population consisted of senior citizens, their caretakers, physicians, hospital support staff, nurses, geriatricians, hospital administrators, and architects. They were interviewed using a validated translated interview schedule. The study consisted of two phases; Phase 1: Developing a checklist to assess senior friendliness of a hospital by using modified Delphi technique. Phase 2: Application of the checklist thus developed to selected hospitals in order to assess the feasibility of administration. The data was then analyzed using Statistical Package for the Social Sciences (SPSS) for frequencies, proportions, central tendency and dispersion, interclass reliability, intraclass reliability, and Cronbach's alpha. Results: A checklist containing 44 items to assess the senior friendliness of a hospital was developed. The checklist was found feasible and easy to administer. Conclusions: The checklist thus developed to assess senior friendliness of a hospital has wider application as it has a potential to be considered for framing senior friendly hospital guidelines/ policies.
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Prevalence of type 2 diabetes mellitus among urban sikh population of Amritsar p. 263
Amrinder Singh, Shweta Shenoy, Jaspal Singh Sandhu
DOI:10.4103/0970-0218.193338  PMID:27890975
Context: Type 2 Diabetes Mellitus (T2DM) refers to a group of common metabolic disorders that share the phenotype of Hyperglycemia. More than 60% of the world’s population with diabetes comes from Asia. Aim: To study the prevalence of Type 2 Diabetes Mellitus among Sikh individuals living in the urban localities of Amritsar. Settings and Design: The study was designed in the Faculty of Sports Medicine & Physiotherapy, Guru Nanak Dev University ,Amritsar , Punjab, India. The data collection was carried out in various urban localities of Amritsar. Blood samples were analyzed in the Biochemistry laboratory, whereas data analysis and article preparation was carried out in the Faculty of Sports Medicine and Physiotherapy. Materials and Methods: Multi-stage random sampling was done with a sample size of 1089 patients. Statistical Analysis: The data was analyzed in Stata 11.2 software. Various tests used in the study are Mean± SD, Pearson Chi Square Test, Students’ t test and multiple logistic regression test. Results: Our study showed that the prevalence rate of Type 2 Diabetes Mellitus is 23.2% with the confidence interval of 20.7–25.7. Proportionately more patients with T2DM had hypertension (46.6%). Likewise proportionately more patients, 67.5% had hypertrigylerdemia, 67.6% had low HDL levels, 59.2 % had hypercholesterolemia and 73.1% suffered from metabolic syndrome. Conclusions: Our study clearly indicates that the young Sikh adults below 40 years of age have similar high BMI, WC and WHR to that of the older adults above 40 years of age. It is necessary to adopt appropriate preventive strategies and interventions in high-risk individuals to curb the growing epidemic of diabetes. Innovative community outreach programs need to be designed and implemented to create awareness and early screening and treatment of diabetes, especially in the urban population.
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Study frequency of hypertension and obesity and their relationship with lifestyle factors (nutritional habits, physical activity, cigarette consumption) in Ardabil city physicians, 2012-13 p. 268
Afshin Fathi, Saeid Sadeghieh Ahari, Firouz Amani, Mohammad Reza Nikneghad
DOI:10.4103/0970-0218.193332  PMID:27890976
Background and Objective: Few studies have been done on lifestyle of Iranian physicians. As physicians have important role in health promotion, the main goal of the study was to assess the lifestyle of this influential group. Materials and Methods: A cross-sectional descriptive study was conducted on lifestyle of all registered physicians of Ardabil hospitals, Iran, 2012–13. In this research, 225 physicians were selected, by using simple random sampling. Demographic and lifestyle data were obtained by self-report using standard questionnaires, physical activity by official Iranian short-version of the international physical activity questionnaire, and dietary intake by food frequency questionnaire. Weight and height was performed according to standard protocols by using standardized and zero calibrated instruments. Data were analyzed by inferential statistics using Statistical Package for the Social Sciences.16 software. Results: Findings showed that 8% of participants were hypertensive, 21.3% smoker, 40%–47% inactive, 51.1% overweight, and 18.2% obese. There was a significant relationship between blood pressure and self-reported lifestyle habits (P < 0.05). And 70.7% of males and 74.1% of females had regular 10-min walking each day and moderate activity of males was significantly higher than females (P < 0.05). Food frequency weekly consumption of overweight and obese physicians were significantly higher than normal weight physicians (P < 0.05). Conclusion: Few doctors follow a healthy lifestyle; this may have a negative effect on society attitude about health.
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Health and socioeconomic status of the elderly people living in Hilly areas of Pakhribas, Kosi Zone, Nepal p. 273
Ankit Amar Gupta, Amrit Kumar Lall, Aditi Das, Anshu Saurav, Abnish Nandan, Deepa Shah, Anand Agrahari, Deepak Kumar Yadav
DOI:10.4103/0970-0218.193333  PMID:27890977
Background: The rising geriatric population is facing significant health and social problems in the developing world that are impacting the quality of their lives. Objective: The study describes the general health status and the socioeconomic characteristics of the elderly people of Pakhribas village development committee (VDC) of Eastern Nepal. Materials and Methods: Descriptive cross-sectional study was carried out targeting the people aged 60 years and above in the sample area using a semi-structured questionnaire and convenient sampling to get the required sample size. A total of 189 elderly people who consented were interviewed in May 2010. Result: The major part of the elderly population was in the age group of 60-69 years. Seventy-two percent were illiterate and 75% were still earning with the majority involved in farming. Nine out of ten were living with their families and still made decisions for the household, Eighty-two percent did not feel lonely and 88.4% did not report any misbehavior by the house members. Regarding health, 69% had some diagnosed health issue with 36% suffering from gastritis and 20.4% from chronic lung disease. Using the ICD 10 criteria, depression was found among 18%. The most prevalent geriatric problem was a dental problem as found in 61% even though 87% claimed to brush their teeth regularly. More than half were suffering from visual difficulty and the proportions suffering from memory and hearing issues were also substantive. Smoking habit was found in 60%, and the relation between smoking and chronic respiratory diseases had a statistical association (P = <0.05). The geriatric cases who were misbehaved with felt depressed or neglected in the family (P = <0.0001). Conclusions: The results of the study show that employment, family support, and pension schemes have a positive impact on the social status of the elderly. Health screening clinics should be established in the community to detect health-related disorders. Elderly populations need health education to emphasize the importance of personal and dental hygiene and to abstain from smoking and alcohol.
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Patterns of use and perceptions of harm of smokeless tobacco in Navi Mumbai, India and Dhaka, Bangladesh p. 280
Seema Mutti, Jessica L Reid, Prakash C Gupta, Mangesh S Pednekar, Gauri Dhumal, Nigar Nargis, AKM Ghulam Hussain, David Hammond
DOI:10.4103/0970-0218.193337  PMID:27890978
Background: Globally, smokeless tobacco use is disproportionately concentrated in low-income and middle-income countries like India and Bangladesh. Objectives: The current study examined comparative patterns of use and perceptions of harm for different smokeless tobacco products among adults and youth in Navi Mumbai, India, and Dhaka, Bangladesh. Methods: Face-to-face interviews were conducted on tablets with adult (19 years and older) smokeless tobacco users and youth (16–18 years) users and non-users in Navi Mumbai (n = 1002), and Dhaka (n = 1081). Results: A majority (88.9%) of smokeless tobacco users reported daily use. Approximately one-fifth (20.4%) of the sample were mixed-users (used both smoked and smokeless tobacco), of which about half (54.4%) reported that they primarily used smokeless over smoked forms like cigarettes or bidis. The proportion of users planning to quit was higher in India than in Bangladesh (75.7% vs. 49.8%p “ 0.001). Gutkha was the most commonly used smokeless product in India, and pan masala in Bangladesh. Among users in Bangladesh, the most commonly reported reason for using their usual product was the belief that it was “less harmful” than other types. Perceptions of harm also differed with respect to a respondent’s usual product. Bangladeshi respondents reported more negative attitudes toward smokeless tobacco compared to Indian respondents. Conclusions: The findings highlight the high daily use of smokeless tobacco, and the high prevalence of false beliefs about its harms. This set of findings reinforces the need to implement effective tobacco control strategies in low and middle-income countries like India and Bangladesh.
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Comprehensive index for community health assessment of typical district administrative units in Maharashtra State, India p. 288
Prakash Prabhakarrao Doke
DOI:10.4103/0970-0218.193339  PMID:27890979
Background: Health administrators require status of health of different administrative units under them. Use of large number of indicators may create confusion and uncertainty about health status. Availability of a comprehensive index is certainly useful.Objective: To evolve one comprehensive health index for a district as unit and measure district wise disparity.Materials and Methods: Ten indicators from categories of health outcomes, health system, determinants of health, and utilization of services were considered. Data for districts in Maharashtra State were obtained from different sources.For each indicator the best performing district was given score of 100 and other districts were given marks proportionately.Results: The comprehensive index for the state was 0.52. The district scoring lowest value of 0.36 was a tribal district and scoring highest value of 0.66 was a nontribal district.Conclusion: Computing such index of districts for monitoring and allocation of resources may be useful managerial tool.
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BMI is a better indicator of cardiac risk factors, as against elevated blood pressure in apparently healthy female adolescents and young adult students: Results from a cross-sectional study in Tripura p. 292
Surajit Debnath
DOI:10.4103/0970-0218.193340  PMID:27890980
Background: Anthropometric measures are used as indicators of elevated blood pressure, but reported to have variable sensitivity among populations. This study was undertaken to identify the better indicator of Cardiac-risk factors by statistical comparison of BMI, Waist circumference, and Waist to Height (WtHr) ratio in apparently healthy adolescents and young adult female students of Tripura. Materials and Methods: A cross-sectional study was conducted in a resource limited setup on 210 apparently healthy female adolescents and young adult students in Tripura. Mean (±SD) of all parameters were compared (ANOVA) to recognize significant independent (anthropometric measures) and dependent factors (blood pressure indices and so on). Correlation (r) analysis was used to identify the better (p) indicator of blood pressure indices (dependent variable) and its impact was assessed by Multiple Regression analysis. Results: blood pressure indices are comparatively higher in obese and overweight participants with statistically significant (95.5% confidence) mean differences. Significant correlation with dependent factors is observed with BMI followed by WtHr and Waist Circumference. Impact of anthropometric measures with blood pressure Indices is most significant for BMI (P ≤ 0.020) followed by WtHr (P ≤ 0.500) and waist circumference (P ≤ 0.520). Conclusion: BMI is a superior indicator of blood pressure indices and can identify participants at risk even in apparently healthy adolescent and young adult females.
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Neonatal cholestasis - Single centre experience in Central India p. 299
Mayank Jain, Sagar Adkar, Chandrashekhar Waghmare, Jenisha Jain, Shikhar Jain, Kamna Jain, Gouri Rao Passi, Rashmi Shad Vinay, MK Soni
DOI:10.4103/0970-0218.193331  PMID:27890981
Background: Neonatal cholestasis syndrome (NCS) is a major cause of morbidity and mortality in infants. The disorder has rarely been studied in centers from Central India. Objectives: To study the prevalence, clinical presentation and etiology of NCS at a tertiary referral center in Central India. Materials and Methods: The study was carried out at a tertiary referral center in Central India. The study is a descriptive study. The records of all patients with suspected NCS treated in the Department of Pediatrics from 2007−2012 were analyzed. Results: One hundred and sixty-eight children had a provisional diagnosis of NCS. The complete records of 100 children were available for the study. The median age of presentation was 78 days (range 15−270 days). The male: female ratio was 1.17:1. The clinical features noted were- jaundice (100/100,100%), failure to thrive (73,73%), organomegaly (68, 68%), acholic stools (38,38%), abdominal distention (52,52%) and poor feeding (29, 29%). The etiology as confirmed by investigations is as follows- neonatal hepatitis (20,20%), idiopathic neonatal hepatitis (18,18%), biliary atresia (41,41%), sepsis (14,14%) and others (7,7%). Conclusions: The proportion of NCS in our group of patients was 1.2 per 1000 patients. Jaundice, organomegaly and failure to thrive are the common presentations. Biliary atresia, neonatal hepatitis and idiopathic neonatal hepatitis were the common etiological factors at our center.
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SHORT COMMUNICATION Top

Towards a better health care delivery system: The Tamil Nadu model p. 302
R Parthasarathi, SP Sinha
DOI:10.4103/0970-0218.193344  PMID:27890982
The Tamil Nadu model of public health is renowned for its success in providing quality health services at an affordable cost especially to the rural people. Tamil Nadu is the only state with a distinctive public health cadre in the district level and also the first state to enact a Public Health Act in 1939. Tamil Nadu has gained significant ground in the various aspects of health in the last few decades largely because of the significant reforms in its health sector which dates back to 1980s which saw rigorous expansion of rural health infrastructure in the state besides deployment of thousands of multipurpose health workers as village health nurses in rural areas. Effective implementation of Universal Immunization Programme, formation of Tamil Nadu Medical Services Corporation for regulating the drug procurement and promoting generic drugs, early incorporation of indigenous system of medicine into health care service, formulation of a health policy in 2003 by the state with special emphasis on low-income, disadvantaged communities alongside efficient implementation of The Tamil Nadu Health Systems Project (TNHSP) are the major factors which contributed for the success of the state. The importance of good political commitment and leadership in the health gains of the state warrants special mention. Moreover, the economic growth of the state, improved literacy rate, gender equality, and lowered fertility rate in the last few decades and contributions from the private sector have their share in the public health success of the state. In spite of some flaws and challenges, the Tamil Nadu Model remains the prototype health care delivery system in resource-limited settings which can be emulated by other states also toward a better health care delivery system.
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LETTER TO THE EDITOR Top

Child marriage in rural Gujarat p. 305
Manas Pratim Roy
DOI:10.4103/0970-0218.193335  PMID:27890983
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BOOK REVIEWS Top

Patient safety - Protect yourself from medical errors p. 307
Mohua Moitra
DOI:10.4103/0970-0218.193342  
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Visionary leadership in health - Delivering superior value p. 308
B Unnikrishnan
DOI:10.4103/0970-0218.193343  
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NOTICE OF RETRACTION Top

Child rearing practices amongst brothel-based commercial sex workers p. 309

DOI:10.4103/0970-0218.191094  PMID:27890984
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