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   2013| October-December  | Volume 2 | Issue 4  
    Online since December 31, 2013

 
 
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ORIGINAL ARTICLES
A study of prevalence and association of risk factors for diabetic vasculopathy in an urban area of Gujarat
Jayesh D Solanki, Amit H Makwana, Hemant B Mehta, Pradnya A Gokhale, Chinmay J Shah
October-December 2013, 2(4):360-364
DOI:10.4103/2249-4863.123906  
Background: Peripheral arterial disease (PAD) is an aftermath of type 2 diabetes posing a significant health problem in developing countries. Its silent progression warrants presymptomatic screening by ankle brachial index (ABI), which cannot be applied to the whole population. We tried to measure the burden of PAD in diabetics of this region correlating various risk factors for it quantitatively and qualitatively. Materials and Methods: From various out-patient departments, 110 known under treatment type 2 diabetics were recruited. They underwent thorough assessment for general, symptomatic, medical history and risk factor screening that included 11 well-known risk factors. ABI was measured by Versadop instrument using the standard protocol with ABI <0.9 being considered as abnormal. Results: There was a high prevalence of asymptomatism, hypertension, positive family history and age <52 years in the study group. Relative risk was highest for asymptomatism followed by high body mass index, hyperlipidemia, cardiovascular disease and smoking, but less significant for age, gender, fasting sugar level, family history. More adverse ABI profile was noticed with the increase in number of five modifiable risk factors cumulatively. Conclusion: There was a high prevalence of low ABI in our region that is an evidence of PAD mainly affected by risk factors many of which were modifiable. Defining those who are at risk to develop PAD in Diabetes, one can use ABI better in early screening and prompt treatment of this complication to stop its further progression and primary prevention can be served as felt the need for health-care effectively.
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Female literacy rate is a better predictor of birth rate and infant mortality rate in India
Suman Saurabh, Sonali Sarkar, Dhruv K Pandey
October-December 2013, 2(4):349-353
DOI:10.4103/2249-4863.123889  
Background: Educated women are known to take informed reproductive and healthcare decisions. These result in population stabilization and better infant care reflected by lower birth rates and infant mortality rates (IMRs), respectively. Materials and Methods: Our objective was to study the relationship of male and female literacy rates with crude birth rates (CBRs) and IMRs of the states and union territories (UTs) of India. The data were analyzed using linear regression. CBR and IMR were taken as the dependent variables; while the overall literacy rates, male, and female literacy rates were the independent variables. Results: CBRs were inversely related to literacy rates (slope parameter = -0.402, P < 0.001). On multiple linear regression with male and female literacy rates, a significant inverse relationship emerged between female literacy rate and CBR (slope = -0.363, P < 0.001), while male literacy rate was not significantly related to CBR (P = 0.674). IMR of the states were also inversely related to their literacy rates (slope = -1.254, P < 0.001). Multiple linear regression revealed a significant inverse relationship between IMR and female literacy (slope = -0.816, P = 0.031), whereas male literacy rate was not significantly related (P = 0.630). Conclusion: Female literacy is relatively highly important for both population stabilization and better infant health.
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REVIEW ARTICLE
The family and family structure classification redefined for the current times
Rahul Sharma
October-December 2013, 2(4):306-310
DOI:10.4103/2249-4863.123774  
The family is a basic unit of study in many medical and social science disciplines. Definitions of family have varied from country to country, and also within country. Because of this and the changing realities of the current times, there is a felt need for redefining the family and the common family structure types, for the purpose of study of the family as a factor in health and other variables of interest. A redefinition of a ''family'' has been proposed and various nuances of the definition are also discussed in detail. A classification scheme for the various types of family has also been put forward. A few exceptional case scenarios have been envisaged and their classification as per the new scheme is discussed, in a bid to clarify the classification scheme further. The proposed scheme should prove to be of use across various countries and cultures, for broadly classifying the family structure. The unique scenarios of particular cultures can be taken into account by defining region or culture-specific subtypes of the overall types of family structure.
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ORIGINAL ARTICLES
Increased utilization of primary health care centers for birthing care in Tamil Nadu, India: A visible impact of policies, initiatives, and innovations
Jayanthi Pandian, Saradha Suresh, BR Desikachari, P Padmanaban
October-December 2013, 2(4):329-333
DOI:10.4103/2249-4863.123781  
Background: Tamil Nadu has been showing an increasing trend in institutional deliveries since early 1990's and has now achieved near 100%. Among the institutional deliveries, a change was observed since 2006, wherein primary health centers (PHCs) showed a four-fold increase in deliveries, while other public and private health facilities showed a decline, despite equal access to all categories of health facilities. What led to this increased utilization of PHCs for birthing care? Material and Methods: Policies, documents, and published reports of the Government of Tamil Nadu (GoTN) were reviewed and interviews were conducted with the various stakeholders involved in providing birthing care in the PHCs. This study analyzes the impact of the policies and supply side initiatives and innovations which led to increase utilization of the PHCs for birthing care. Results: Scaling up of 24 × 7 services in all PHCs, upgrading PHCs with good infrastructure, human resources, and women friendly services have helped to boost the image of the PHCs. Pro-women policies like maternity benefit schemes, birth companionship, providing food, and compulsory stay for 48 h following delivery have attracted women towards PHC. Innovative strategies like maternity picnics and use of expected date of delivery (EDD) chart for follow-up have made women choose PHCs, while periodic reviews and support to staff has improved service delivery. Conclusion: Women centered policies, efficient managerial systems, quality care, and innovative marketing of services have together contributed to increased utilization of PHCs for birthing. Other states could explore the possibility of replicating this model to make optimal use the PHC facilities.
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Global cardiovascular risk assessment by family physicians in Suez canal university-family medicine centers-Egypt
Hebatallah Nour-Eldein, Shimaa A Abdelsalam, Gamila M Nasr, Hassan A Abdelwahed
October-December 2013, 2(4):365-370
DOI:10.4103/2249-4863.123919  
Background: The close sustained contact of family physician with their patients and local community makes preventive care an integral part of their routine work. Most cardiovascular diseases (CVD) can be prevented by addressing their risk factors. There are several guidelines that recommend different CV risk assessment tools to support CV prevention strategies. Aim: This study aimed to assess awareness and attitude of global CV risk assessment and use of their tools by family physicians; aiming to improve CV prevention service. Methods: The current study is a cross-sectional descriptive analytic. Sixty-five family physicians were asked to respond to, validated anonymous questionnaire to collect data about characteristics of family physicians, their awareness, attitude, current use, barriers, and recommendations of global CV risk assessment. Statistical Package for Social Sciences (SPSS) version 18 was used for data entry and analysis. Results: Awareness of guidelines of global CV risk assessment was relatively higher regarding the American guidelines (30.8%) than that recommended by World Health Organization (WHO) for Egypt (20.2%). 50.8% of participants had favorable attitude. There was statistical significant relationship between attitude scores and physician characteristics; age (P = 0.003), qualification (P = 0.001) and number of patients seen per week (P = 0.009). Routine use of global CV risk assessment tools was reported only (23%) by family physicians. Conclusion: Relative higher attitude scores than use of global CV risk assessment tools in practice. The most frequent barriers were related to lack of resources and shortage in training/skills and the raised suggestions were towards training.
  1 1,162 173
Determination of risk factors for pre-eclampsia and eclampsia in a tertiary hospital of India: A case control study
Punyatoya Bej, Pragti Chhabra, Arun Kumar Sharma, Kiran Guleria
October-December 2013, 2(4):371-375
DOI:10.4103/2249-4863.123924  
Background: Preeclampsia and eclampsia (PE) are pregnancy specific syndromes that contribute to maternal and fetal morbidity and mortality. The identification of its predisposing factors in the pre-pregnancy and initial stage of pregnancy will help in reducing the morbidity and mortality. Aim: The aim of this study is to determine the risk factors for PE among pregnant women in a tertiary level hospital. Materials and Methods: In this study, 122 women who delivered beyond 22 weeks of gestation and diagnosed as preeclampsia or eclampsia were selected. Simultaneously, 122 controls with no diagnosis of preeclampsia or eclampsia were selected from the post natal ward. Cases and controls were administered the same pre-tested questionnaire containing different risk factors. Results and Conclusion: Logistic regression was applied in the statistical analysis. The factors that were found to be significant predictors of risk for development of PE were family history of preeclampsia (adjusted odds ratio [OR] 18.57 [1.93-178.16], P = 0.011), higher calorie intake (adjusted OR 14.12 [6.41-43.23] body mass index (adjusted P < 0.001), employment (adjusted OR 6.35 [1.56-25.82] P = 0.010], less protein intake (adjusted OR 3.87 [1.97-8.01] P < 0.001), increased OR 5.86 [02.48-13.8] P < 0.001), mild physical activities (adjusted OR 3.46 [1.06-11.24] P = 0.039). Past history of hypertension and diabetes mellitus were also associated with development of PE.
  1 1,907 364
Knowledge and use of emergency contraceptive pill: An analysis of perception and practice among unmarried urban women
Neetu Purohit, Rakhi Mathur, Priyanka Bakhshi
October-December 2013, 2(4):376-380
DOI:10.4103/2249-4863.123926  
Objective: The objective of this study was to collect evidence with respect to perception and practice of unmarried women toward the use of emergency contraceptive pills (ECPs). Materials and Methods: Non-probability purposive sampling was used to select respondents. A total of 250 respondents were administered the tools for the study, of which 228 were considered for analysis. Results and Discussion: Descriptive statistics showed that nearly 87% of the respondents were aware of ECPs and there was a significant difference in the knowledge of ECP of the respondents by type of the institution they had studied. More than half of the (52%) respondents admitted to have boyfriends of which 16% were sexually involved and were using some form of contraception. Nearly 84% of the respondents used ECP, which superseded the use of other contraceptives. It was further found that around two-third respondents were using ECP regularly. The reason that "ECP did not hinder pleasure" and that it was handy in case of "unplanned contact" were the most cited reasons for using ECP as a regular contraceptive. Conclusion: The fact that ECPs was preferred over condom and was used regularly shows that the respondents were at a risk of sexually transmitted infection/human immunodeficiency virus. Health-care providers could be the most authentic source of information for orienting young women toward the use of safe sexual practices.
  1 1,590 235
Prevalence of anemia among tribal women of reproductive age in Udupi Taluk, Karnataka
Ramachandra Kamath, Jazeel Abdul Majeed, Varalakshmi Chandrasekaran, Sanjay M Pattanshetty
October-December 2013, 2(4):345-348
DOI:10.4103/2249-4863.123881  
Context: Anaemia is a major public health problem in India. Many studies have emphasized on prevalence of anaemia among general population. This study has focussed to address the prevalence of anaemia among the tribal population in Udupi taluk. Anaemia among women in the reproductive age group is one of the causes for maternal morbidity and mortality in India. Aim: To estimate the prevalence of anemia among tribal women (aged 15 to 49 years). Settings and Design: A Community based cross sectional study was conducted among tribal women aged 14-49 years in Udupi taluk, Udupi district, Karnataka. Methods and Material: A cross sectional study during July 2012 to August 2012 was conducted. A sample size of 170 was calculated taking into consideration a relative error of 15% and the prevalence of anemia in Karnataka as 51% (as per the NFHS-3). Statistical analysis used: Univariate and multivariate analysis was used to analyse the data using SPSS 15. Results: The study sample had a mean hemoglobin value of 11.3 g/dL with 95% CI of (11 - 11.6), with a standard deviation of 2g/dL. The study reveals that in the sample of tribal women in the age group of 15-49 years, the prevalence of anemia was 55.9%. Among the subjects, 6 (3.5%) were severely anemic, 33 (19.4%) were moderately anemic and 56 (32.9%) were mildly anemic. Conclusions: This study calls for an appropriate action and intervention in this tribal population to treat and prevent anaemia.
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CASE REPORTS
The vulnerable Indian one rupee coin
Arvind Krishnamurthy, Vijayalakshmi Ramshankar
October-December 2013, 2(4):381-383
DOI:10.4103/2249-4863.123927  
Coins are the most commonly ingested foreign body encountered in the pediatric population, with a peak incidence between 6 months and 3 years of age. Although some ingested coins may be aspirated, most coins pass through the alimentary tract without causing any complications. Coins in the esophagus causing symptoms require immediate removal. The management of asymptomatic coins has been a perplexing problem to the clinicians for decades. We recently managed an interesting case of an impacted Indian one rupee coin in the esophagus of a 13-year-old girl, by performing a simple yet novel technique, by using a conventional flexible endoscopic biopsy forceps. Further, reviewing the literature we inferred that the rounded, stainless steel Indian one rupee coin with a diameter of 25 mm, by itself seems to be vulnerable for impaction in the esophagus and therefore needs to be promptly addressed even if asymptomatic.
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Severe Vitamin D deficiency causing kyphoscoliosis
Abhishek Singhai, Subodh Banzal
October-December 2013, 2(4):384-386
DOI:10.4103/2249-4863.123930  
Vitamin D deficiency is common among Indian population. Women are especially at risk for severe vitamin D deficiency. The risk is higher for those who are multiparous and postmenopausal. Poor exposure to sunlight, higher latitude, winter season, inadequate diet, older age, obesity and malabsorption are also important risk factors. Symptoms of hypovitaminosis D, including diffuse or migratory pain affecting several sites (especially the shoulder, pelvis, ribcage and lower back) have also been misdiagnosed as musculoskeletal disorders, including fibromyalgia, polymyalgia rheumatica and ankylosing spondylitis. Here, we report two cases presented with kyphoscoliosis, diagnosed to have severe vitamin D deficiency.
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Consolidation in a child from tuberculosis endemic area - thinking apart from tuberculosis
George P Jacob, Ramakant Dixit, Rakesh C Gupta, Neeraj Gupta, Ankur Gupta
October-December 2013, 2(4):387-389
DOI:10.4103/2249-4863.123933  
Tuberculosis is endemic in South East Asian regions and hence a disease commonly over diagnosed in these parts of the country. Patients presenting with chest x ray shadows and vague symptoms are often started on Anti Tuberculosis Treatment - smear negative. However caution should be administered in prescribing ATT to patients who do not improve symptomatically, even after intensive phase. Congenital abnormalities such as sequestrated lung at times can also be rare causes of abnormal skiagram chest, especially in paediatric patients. A careful systematic approach with non invasive imaging such as CECT chest will often help to clinch the diagnosis in most cases.
  - 1,733 156
Clavicular fracture following uvulectomy and traditional hair barbing: A case report
Aliyu Ibrahim
October-December 2013, 2(4):390-392
DOI:10.4103/2249-4863.123935  
Activities of traditional barbers are an age-long practice in northern Nigerian. They are involved in conducting hair barbing and uvulectomy of newborn babies usually on the 7 th day of life. This procedure is often associated with complications like bleeding, infections, but its association with clavicular fracture is a rare event which had not been reported before now. Therefore, the case of a 10-day-old Nigerian girl is highlighted. She was managed conservatively with minimal handling of the involved limb.
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Purpura fulminans associated with hemiparesis following measles infection in a Nigerian girl: A case report
Aliyu Ibrahim
October-December 2013, 2(4):393-395
DOI:10.4103/2249-4863.123938  
Purpura fulminans is a life-threatening hematologic emergency characterized by extensive skin necrosis with hemorrhagic infarction, hypotension and gangrene which may arise from severe sepsis; mostly gram negative sepsis though also associated with some gram positive organisms, similarly viral infections like varicella and measles have been implicated; it may also arise from congenital deficiency of the anticoagulants protein C, S, and antithrombin III; and it may also be idiopathic. Its clinical manifestation may be quite extensive resulting in multiorgan failure. Treatment will require aggressive management with use of fresh frozen plasma, heparin, antibiotics, and surgical debridement of necrotic tissue.
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Xanthogranulomatous pyelonephritis: Unusual clinical presentation: A case report with literature review
Shirish S Chandanwale
October-December 2013, 2(4):396-398
DOI:10.4103/2249-4863.123942  
Xanthogranulomatous pyelonephritis (XGP) is rare and aggressive form of chronic infectious pyelonephritis. No single clinical or radiological feature is diagnostic of XGP. A 75-year-old man with prostatic enlargement presented with difficulty and burning micturition fever, abdominal and flank pain. X-ray, ultrasonography and computed tomography scan diagnosis was right kidney pyonephrosis. Intravenous urography revealed non-excretory right kidney. Right nephrectomy was done. Histological diagnosis of XGP was made. In all patients of prostatic enlargement, renal function must be assessed for the extent of damage. Surgery is the treatment choice in most cases. Pre- and post-operative antibiotics are key factors for successful management and better prognosis.
  - 1,764 183
Reprogramming of gastric motility with "pulse therapy" (metoclopramide and erythromycin) in severe gastroparesis
Shamik Shah, Dharmesh Kaswala, Nishith Patel, Sunita Sood, Zamir Brelvi
October-December 2013, 2(4):399-401
DOI:10.4103/2249-4863.123944  
Gastroparesis is a very common condition, however many times it becomes difficult to manage even after long-term treatment due to multiple etiologies or improper therapy. Patients with severe gastroparesis are considered candidates for gastric electrical stimulants. The "Pulse Therapy" using metoclopramide and erythromycin to reprogram gastric motility can delay or even avoid the need for gastric electrical stimulants. This case report focuses on a patient with severe gastroparesis, who was considered for a gastric pacemaker implantation and was instead treated successfully with "Pulse Therapy." As a part of this regimen, he was given metoclopramide continuously for 3 months along with pulses of erythromycin for 10 days a month for 3 months. Patient recovered dramatically that he no longer remained a candidate for gastric pacemaker implantation. This case study emphasizes on how the proper use of prokinetic agents based on symptoms and gastric emptying study can reprogram the stomach motility in these patients with severe gastroparesis.
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CLINICAL PRACTICE
Approach to Patient with a Generalized Rash
Lawrence Leung, Tony Soeyonggo
October-December 2013, 2(4):311-314
DOI:10.4103/2249-4863.123775  
Background: Generalized rash is amongst the most common conditions presented to practicing General Practitioners and common differentials include contact dermatitis, atopic eczema, sun-induced damage, drug eruption and general manifestations of systemic diseases or infections. Materials and Methods: We illustrate with differential diagnoses our clinical case of a generalized rash in a 55-year-old man with pathognomonic signs of a diagnosis, which has received increasing global concern. Conclusion: Despite the array of available laboratory tests, a detailed history and physical examination is still of paramount importance to arrive at the most likely diagnosis for any patient with a generalized skin rash.
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Practical approach for the prevention and management of vitamin d deficiency in adults
Faiza Abdulaziz Qari
October-December 2013, 2(4):315-318
DOI:10.4103/2249-4863.123776  
Context: Vitamin D inadequacy is a global problem and it is one of the most common endocrine diseases world-wide. In this review article, we covered the important practical clinical issues for screening, prevention and treatment of vitamin D deficiency in adults as well as during pregnancy and lactation.
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COMMENTARY
Family medicine at corporate clinics in India: Current scenario
R Bijayraj
October-December 2013, 2(4):323-325
Family medicine is undergoing a sudden revival in India. There is significant lack of clarity regarding the opportunities, advantages, and challenges available in family medicine, especially in the private sector. This article is addressed to young doctors aspiring to specialize in family medicine. It is an attempt to shed light on the present scenario of family medicine in the corporate sector in India and make young doctors aware of the prospects in this area.
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EDITORIAL
1 st National conference on family medicine and primary care: A journey toward stronger primary care in India
Raman Kumar
October-December 2013, 2(4):303-305
DOI:10.4103/2249-4863.123773  
Academy of Family Physicians of India organized the first National Conference on Family Medicine and Primary Care (FMPC) on 20-21 April 2013 at India International Centre New Delhi. The conference was a major success towards positioning of requirement for a distinct academic discipline (family medicine) within the medical and nursing education system as a means for strengthening of primary care in India. The event gained its prominence in the times when universal health coverage is being debated. A generalist approach in development of human resource prominently figured in the discussions. The deliberations and talks of the Indian as well as international experts were recorded and released as the report of national consultation on family medicine programme.
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ORIGINAL ARTICLES
A mixed outbreak of rubeola-rubella in district Kangra of Northern India
Surender N Gupta, Naveen Gupta, Shivani Gupta
October-December 2013, 2(4):354-359
DOI:10.4103/2249-4863.123904  
Background: On 14 th September 2006, a local community leader informed us about the sudden increase in number of cases of fever and rash in five villages of district Kangra. We investigated the suspected outbreak to confirm the diagnosis and recommend for prevention and control. Materials and Methods: We defined a case of rubeola as the occurrence of fever with rash in children from 3 rd September to 13 th January, 2007. We collected information on age, sex, date of onset, residence, signs, symptoms, vaccination and cold chain status. We described the outbreak by place, time and person characteristics. We conducted a retrospective cohort study to estimate vaccine efficacy (VE). We ascertained the measles immunization status by interviewing the mothers and reviewing immunization cards. We confirmed diagnosis clinically, epidemiologically and serologically. Results: We identified 60 case patients in five villages (41/60 rubeola and 11/60 confirmed epidemiologically linked unvaccinated rubella). The overall attack rate (AR) was 9%. Sex specific AR was 11% for male. Majorities of cases were >5 years of age. No death/minimal complications have occurred. Of 60 case-patients, 42 (70%) were vaccinated for rubeola. The AR of rubeola among unvaccinated children was 25.8% as compared to AR among vaccinated of 4.5% (relative risk: 5.75%; 95% confidence interval: 3.48-9.51 P < 0.001). We estimated general VE to be 83% while gender based VE for male was 84%. Eight case-patients were confirmed serologically for measles immunoglobin M antibodies, two nasopharyngeal swabs positive by polymerase chain reaction. Rubeola virus was genotyped D4. Only 30% (18/60) of the cases took the treatment from modern system of medicine. Conclusion: A mixed outbreak of rubeola/rubella was confirmed clinically, epidemiologically and serologically. We recommend measles and rubella (MR) vaccination at the age of 18-24 months and aggressive Information, Education and Communication (IEC) activities to modify help seeking behavior of the community, especially in the measles affected areas.
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Morbidity profile of inpatients in a secondary care center run by family physicians
Kirubah Vasandhi David, Ruby Angeline Pricilla, Sajitha Parveen MF Rahman, Prince RH Christopher, Moses Kirubairaj Amos Jegaraj, Rajaram Murugan
October-December 2013, 2(4):326-328
DOI:10.4103/2249-4863.123779  
Background: There is a scarcity of records of morbidity pattern in secondary care centers. Reliable morbidity data will help in proper allocation of human resources. Materials and Methods: A retrospective study of inpatient admission records of an urban secondary health center run by family physicians was done between April 2010 and March 2011. Results: Pneumonia and other respiratory illnesses (represented by ICD code J) was the most common diagnosis. This was followed by infectious and viral diseases, circulatory diseases like hypertension, ischemic heart disease and endocrine diseases like non-insulin dependent diabetes mellitus. Conclusion: Physicians working in secondary care centres need to be experts in managing respiratory diseases, viral diarrheal illnesses, hypertension, ischemic heart disease and diabetes mellitus and patients with co-morbidities. They also need to be able to manage common obstetrics and neonatal emergencies. As the discipline of family medicine specializes in management of common ailments and multiple co-morbidities with an attitude of patient centeredness, family physicians would be the best managers of such centers. Inclusion of family physicians as specialist in secondary care centers will help in covering the manpower shortage in such centers.
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Diet and physical activity among women in urban and rural areas in south India: A community based comparative survey
Violet Jayamani, Vijayaprasad Gopichandran, Premila Lee, Greeda Alexander, Solomon Christopher, Jasmin Helan Prasad
October-December 2013, 2(4):334-338
DOI:10.4103/2249-4863.123782  
Introduction: Noncommunicable diseases (NCDs) such as diabetes, hypertension, and heart diseases are increasing in India. There is a clear need to study risk factors for NCDs in various population groups in the country. Materials and Methods: This community based cross-sectional survey was conducted to study the diet and physical activity of women in urban and rural areas in Vellore district. Dietary data was collected using 24-h dietary recall and physical activity was collected using the International Physical Activity Questionnaire (IPAQ). Sociodemographic variables were collected to assess the risk factors for unfavorable diet and physical activity. Results: The odds of the rural women engaging in high physical activity are 3.61 times greater than urban women (95% confidence interval (CI) = 2.36-5.54). The odds of the urban women consuming a high calorie diet are 1.923 times that of the rural women (95% CI = 1.282-2.857). The odds of the urban women being overweight/obese are 5.555 times than that of the urban women (95% CI = 3.333-10). Women who were housewives and not doing household work were significantly less physically active, took higher calorie diet, and were more overweight and obese compared to women who were involved in active household work. Conclusions: Urban women had unfavorable diet and physical activity levels compared to rural women. They also had higher levels of overweight and obesity. There is a need for targeted NCD prevention interventions among urban women.
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Prenatal sex and other preferences for reproductive career of final year graduation girl students
Yugantara R Kadam, Prachi Nirmale, Alka D Gore
October-December 2013, 2(4):339-344
DOI:10.4103/2249-4863.123875  
Background: Marriage of girls just after graduation is common in Western Maharashtra. This study was planned to know the views of final year graduation student towards reproductive carrier. Aim: To interact with final year girl students of various streams to know their preferences on various aspects of reproductive carrier and contraceptive awareness. Material and Methods: Study-design: Cross-sectional. Study-setting: Academic institutes of Sangli-Miraj-Kupwad Corporation area. Study-subject: All willing final year Girl students. Exclusion Criteria: Married girls. Sample size: All final year girl students Sampling Technique: Cluster sample Study-Duration: 7 months. Study-tool: Pretested questionnaire. Statistical Analysis: Percentages, Chi-square test. Results: All girls who have responded prefer marrying and having first child at right age. All feel spacing is needed, at least of 2 years. Two children was the most common choice (52.3%). Forty-three percent girls feel male child is must and 52.3% of total girls will like to have sex determination done if required. Total 47.24% girls were unaware about any contraceptive methods but 88.2% girls knew the place of its availability. Most common source of information about contraceptive was school and friends. E-pill was known to 41.5% of girls. All girls felt the need for more information about reproductive health and according to 81.3% right age for it is 15-18 years. Conclusion: Girls have correct reproductive preferences except sex of child. Sex preference and Low contraceptive awareness needs strong intervention.
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PRACTICE MANAGEMENT
Referral letter with an attached structured reply form: Is it a solution for not getting replies
R. P. J. C. Ramanayake, DP Perera, A. H. W. de Silva, R. D. N. Sumanasekera, LR Jayasinghe, K. A. T. Fernando, L. A. C. L. Athukorala
October-December 2013, 2(4):319-322
DOI:10.4103/2249-4863.123777  
Background: Communication between primary care doctors and specialists/hospital doctors is vital for smooth functioning of a health care system. In many instances referral and reply letters are the sole means of communication between general practitioners and hospital doctors/specialists. Despite the obvious benefits to patient care, answers to referral letters are the exception worldwide. In Sri Lanka hand written conventional letters are used to refer patients and replies are scarce. Materials and Methods: This interventional study was designed to assess if attaching a structured reply form with the referral letter would increase the rate of replies/back-referrals. It was conducted at the Family Medicine Clinic of the Faculty of Medicine, University of Kelaniya. A structured referral letter (form) was designed based on guide lines and literature and it was used for referral of patients for a period of six months. Similarly a structured reply form was also designed and both the referral letter and the reply letter were printed on A4 papers side by side and these were used for the next six months for referrals. Both letters had headings and space underneath to write details pertaining to the patient. A register was maintained to document the number of referrals and replies received during both phases. Patents were asked to return the reply letters if specialists/hospital doctors obliged to reply. Results: Total of 90 patients were referred using the structured referral form during 1st phase. 80 letters (with reply form attached) were issued during the next six months. Patients were referred to eight different specialties. Not a single reply during the 1 st phase and there were six 6 (7.5%) replies during the 2 nd phase. Discussion: This was an attempt to improve communication between specialists/hospital doctors and primary care doctors. Even though there was some improvement it was not satisfactory. A multicenter island wide study should be conducted to assess the acceptability of the format to primary care doctors and specialists and its impact on reply rate.
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