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   2017| January-March  | Volume 6 | Issue 1  
    Online since September 18, 2017

 
 
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ORIGINAL ARTICLES
Correlation of Vitamin D with metabolic parameters in polycystic ovarian syndrome
Arun Kumar, Satish Barki, Vinod Raghav, Ashutosh Chaturvedi, K. V. S. Hari Kumar
January-March 2017, 6(1):115-119
DOI:10.4103/2249-4863.214985  PMID:29026762
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, <30 ng/mL) and Group 2 (normal). The data were analyzed using appropriate statistical methods, and aP< 0.05 was considered statistically significant. Results: The study population had a mean age of 28.6 ± 6.3 years, body mass index (BMI) 30.4 ± 6.1 kg/m2 and body fat of 39.1 ± 13%. A total of 90 women had 25OHD deficiency, and hypovitaminosis D was observed more in younger, obese patients. Patients with hypovitaminosis D had a higher BMI (P = 0.0124), low- high-density lipoprotein (P = 0.0094), calcium (P ≤ 0.0001), and elevated testosterone (P = 0.0412) in comparison with normal 25OHD patients. None of the metabolic parameters showed significant correlation with 25OHD (P > 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.
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EDITORIAL
Mohalla Clinics of Delhi, India: Could these become platform to strengthen primary healthcare?
Chandrakant Lahariya
January-March 2017, 6(1):1-10
DOI:10.4103/jfmpc.jfmpc_29_17  PMID:29026739
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.
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ORIGINAL ARTICLES
Comparative evaluation of Indian Diabetes Risk Score and Finnish Diabetes Risk Score for predicting risk of diabetes mellitus type II: A teaching hospital-based survey in Maharashtra
Shivshakti D Pawar, Jayashri D Naik, Priya Prabhu, Gajanan M Jatti, Sachin B Jadhav, BK Radhe
January-March 2017, 6(1):120-125
DOI:10.4103/2249-4863.214957  PMID:29026763
Context: India is currently becoming capital for diabetes mellitus. This significantly increasing incidence of diabetes putting an additional burden on health care in India. Unfortunately, half of diabetic individuals are unknown about their diabetic status. Hence, there is an emergent need of effective screening instrument to identify “diabetes risk” individuals. Aims: The aim is to evaluate and compare the diagnostic accuracy and clinical utility of Indian Diabetes Risk Score (IDRS) and Finnish Diabetes Risk Score (FINDRISC). Settings and Design: This is retrospective, record-based study of diabetes detection camp organized by a teaching hospital. Out of 780 people attended this camp voluntarily only 763 fulfilled inclusion criteria of the study. Subjects and Methods: In this camp, pro forma included the World Health Organization STEP guidelines for surveillance of noncommunicable diseases. Included primary sociodemographic characters, physical measurements, and clinical examination. After that followed the random blood glucose estimation of each individual. Statistical Analysis Used: Diagnostic accuracy of IDRS and FINDRISC compared by using receiver operative characteristic curve (ROC). Sensitivity, specificity, likelihood ratio, positive predictive and negative predictive values were compared. Clinical utility index (CUI) of each score also compared. SPSS version 22, Stata 13, R3.2.9 used. Results: Out of 763 individuals, 38 were new diabetics. By IDRS 347 and by FINDRISC 96 people were included in high-risk category for diabetes. Odds ratio for high-risk people in FINDRISC for getting affected by diabetes was 10.70. Similarly, it was 4.79 for IDRS. Area under curves of ROCs of both scores were indifferent (P = 0.98). Sensitivity and specificity of IDRS was 78.95% and 56.14%; whereas for FINDRISC it was 55.26% and 89.66%, respectively. CUI was excellent (0.86) for FINDRISC while IDRS it was “satisfactory” (0.54). Bland-Altman plot and Cohen's Kappa suggested fair agreement between these score in measuring diabetes risk. Conclusions: Diagnostic accuracy and clinical utility of FINDRISC is fairly good than IDRS.
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Psychometric properties of the Trust in Physician Scale in Tamil Nadu, India
Maria Jusler Kalsingh, Geetha Veliah, Vijayaprasad Gopichandran
January-March 2017, 6(1):34-38
DOI:10.4103/2249-4863.214966  PMID:29026745
Context: Trust in health care is of high intrinsic value. It also leads to positive outcomes such as better treatment adherence and disclosure of sensitive information. Therefore, there is a need to measure trust in health care objectively. Aims: To assess the psychometric properties of the Trust in Physician Scale in Tamil Nadu, India. Settings and Design: The study was conducted in a private tertiary hospital setting in Tamil Nadu by a cross-sectional survey design. Methods: The Trust in Physician Scale and General Trust Scale were administered to 288 participants in the waiting area of a tertiary care hospital in Tamil Nadu. Statistical Analysis: Descriptive statistics, exploratory factor analysis, and Cronbach's alpha statistics were used to assess the validity and reliability of the scale. Results: The respondents were predominantly men from rural areas, older than 35 years of age, and with lesser than 8 years of schooling. The questionnaire had acceptable internal consistency with Cronbach's alpha of 0.707 (95% confidence interval 0.654–0.755). Exploratory factor analysis divided the questionnaire into four domains. Seven items loaded into factor 1 which explained dependability and competence of the physician, two items loaded on factor 2, and one each in factors 3 and 4. The latter four items had very low item to total correlations and hence did not contribute much to the questionnaire. Conclusions: The Trust in Physician questionnaire needs to be modified to accurately measure the domains of trust in the context of the study area. More qualitative studies are required to understand the domains of trust in this cultural and social context.
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REVIEW ARTICLE
Diabetes and Ramadan: A concise and practical update
Mohamed H Ahmed, Nazik Elmalaika Husain, Wadie M Elmadhoun, Sufian K Noor, Abbas A Khalil, Ahmed O Almobarak
January-March 2017, 6(1):11-18
DOI:10.4103/2249-4863.214964  PMID:29026740
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.
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CASE REPORTS
Macroglossia as a presenting feature of multiple myeloma
Serkan Demirkan, Ekin Şavk, Alper Alp, Firuzan Kacar Doger, Gurhan Kadikoylu, Ozgur Gunduz
January-March 2017, 6(1):146-147
DOI:10.4103/2249-4863.214968  PMID:29026768
Macroglossia has been very rarely reported as a first clinical sign of multiple myeloma.
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Lateral medullary syndrome after a scorpion sting
Vineeth Varghese Thomas, Tina George, Ajay Kumar Mishra, Pavithra Mannam, I Ramya
January-March 2017, 6(1):155-157
DOI:10.4103/2249-4863.214988  PMID:29026772
Scorpion bites are a common problem in Southern parts of India. The sting of Mesobuthus tamulus belonging to the Buthidae family is known for being fatal. The toxidrome of scorpion sting is known for its effect on the cardiovascular system, and there have been rare reports of cerebrovascular accidents as well. We describe a case of lateral medullary syndrome secondary to scorpion sting. As per the knowledge of the authors, this is the first case report of the same.
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Atypical Kleine–Levin syndrome: An elusive entity?
Swarndeep Singh, Saurabh Kumar, Rohit Verma, Nand Kumar
January-March 2017, 6(1):161-163
DOI:10.4103/2249-4863.214963  PMID:29026774
Kleine–Levin syndrome (KLS) is a rare disorder (around 1.5 cases per million population), often presenting with triad of recurrent episodes of hypersomnia, hyperphagia, and hypersexuality. However, cases of atypical KLS with features opposite to that being commonly reported are often misdiagnosed as psychosis and present as a diagnostic challenge for the physicians, psychiatrists, and neurologists. We describe a case of atypical KLS which was misdiagnosed as unspecified nonorganic psychosis previously, highlighting the various points which would be helpful in identifying and diagnosing cases of atypical KLS in future.
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ORIGINAL ARTICLES
Contraceptive behavior of couples undergoing sterilization in an Eastern State of India
Venkatarao Epari, Lipilekha Patnaik, Deepa Prasad, Trilochan Sahu, Arunkiran Soodireddy, Arabinda Acharya
January-March 2017, 6(1):21-24
DOI:10.4103/2249-4863.214991  PMID:29026742
Background: As a part of a larger study for evaluating the effectiveness of a community-based family welfare program, this study assessed the contraceptive behavior of couples preceding sterilization and termination of pregnancies, if any during the interim period. Methods: During May–June 2013, a cross-sectional study was undertaken in three districts of Odisha, an eastern state of India with poor maternal health indicators. Using a 15 × 14 cluster design with probability proportionate to size sampling 15 village clusters from each district were selected. Seven beneficiaries from the catchment area of two Accredited Social Health Activist of the selected villages were interviewed (14 respondents from each village) using a pretested predesigned questionnaire. Results: A total of 630 clients with either of the partner having undergone sterilization were interviewed. Male partner having undergone vasectomy was <1% (n = 3). The mean age (standard error mean [SEM]) of the respondent women was 34.54 ± 0.26 years. The mean age of the women at the time of sterilization was 27.12 (standard deviation [SD], 3.8, SEM 0.15 and median 26.83 years) years. Women as young as 22 years had undergone sterilization. Average family size was 2.81 with about 29 respondents (4.5%) having 5 or more children. The average duration between the last childbirth (LCB) to the date of sterilization was 18.37 months (range: 1–142 months, SD: 24 months, SE: 10 months). Seventy-two percent of the respondents did not use any method of contraception during this period. Methods adopted for contraception among the users was pill (20%) followed by condom (7%), and intrauterine contraceptive device (IUCD) was least used (0.2%). Ten percent of the women had undergone abortion before sterilization either once (7.9%) or more than once (2.1%). Conclusion: There was a gross delay in sterilization after LCB. Postpartum sterilization or IUCD were also not used frequently.
  1 1,433 207
Profile of drug-resistant tuberculosis in Western Maharashtra
Sudhakar W More, Malangori Abdulgani Parande, Sanjeev W Kamble, Manjunath S Kamble
January-March 2017, 6(1):29-33
DOI:10.4103/2249-4863.214954  PMID:29026744
Context: Drug-resistant tuberculosis (TB) strains have evolved mainly due to incomplete or improper treatment of TB patients and are one of the hurdles in controlling TB problem. It is better to understand the magnitude and comorbidities associated with drug-resistant TB. Aim and Objectives: (1) To study some of the sociodemographic profile and history of TB treatment of drug-resistant TB cases. (2) To study their drug-resistance pattern and their comorbidity profile. Settings and Design: It was a record-based study descriptive, cross-sectional study of drug-resistant TB cases that were referred to State TB Training and Demonstration Centre (STDC). Materials and Methods: The data were collected by means of use of TB patient treatment register of those tested at STDC during first two quarters of the year 2012 (from January to June 2012). Sputum samples of all the cases were subjected to concentrated microscopy, and all positive samples were tested by GeneXpert and Line Probe Assay for drug susceptibility testing (DST) for isoniazid and rifampicin. Statistical Analysis: The findings were analyzed with Epi info7, using the mean, standard deviation, Chi-square test. Results: The mean age of the patients was 35.65 ± 13.59 years, majority 71.87% were males. The majority of patients 72.91% had the previous history of TB. A majority 68.75% of the patients had acquired drug resistance, and 73.95% of cases were suffering from multidrug-resistant TB. A total of 28.13% patients had self-reported comorbidity. A majority 62.5% had failure as the treatment outcome for the current episode of TB and mortality was seen in 12.5% cases. Conclusions: Majority had failure as a treatment outcome due to advanced disease status or late diagnosis. Rapid diagnosis and DST for first- and second-line drugs will greatly improve the clinical outcome.
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Effectiveness of first-aid training on school students in Singur Block of Hooghly District, West Bengal
Lina Bandyopadhyay, M Manjula, Bobby Paul, Aparajita Dasgupta
January-March 2017, 6(1):39-42
DOI:10.4103/2249-4863.214960  PMID:29026746
Objective: First aid is the helping behavior and initial care provided for an acute illness or injury. Students have the potential for changing the health scenario of the society if properly groomed and educated. The objective of the study is to evaluate the effectiveness of educational intervention on the first aid among middle school students of a rural school in West Bengal. Materials and Methods: A total of 230, 6th and 7th standard students were given a self-administered questionnaire for assessing their baseline knowledge about management of common injuries followed by educational intervention with a systematically devised teaching module during February to March 2016. Post intervention evaluation of their knowledge acquisition was done after 2 weeks with same questionnaire. Results: The baseline knowledge on the management of selected injuries was found to be insufficient among the study subjects. Paired t-test was performed to compare the pre- and post-test scores of knowledge and attitude of the students about first aid, and there was a significant change in knowledge from pretest score (mean = 1.50, standard deviation [SD] =0.47) to posttest score (mean = 6.53, SD = 1.30). To quantify the effectiveness of health education, effect size (Cohen's d) was derived. For knowledge score, Cohen's d was 5.14 with large effect size indicating highly effective impact of the training program. Significant change was also noticed regarding attitude regarding first aid as evident from increase in pretest score (mean = 1.19, SD = 0.96) to posttest score (mean = 3.17, SD = 1.03); Cohen's d was 1.88 with medium effect size. Conclusion: Inculcating first-aid training in the school curriculum can be a fruitful investment in ensuring proper and timely management of illnesses and injuries not only for the school children but also for the community at large.
  1 1,032 170
Acanthosis nigricans: A screening test for insulin resistance – An important risk factor for diabetes mellitus type-2
Meera Bhagyanathan, Deepak Dhayanithy, Vijayan Ampaya Parambath, R Bijayraj
January-March 2017, 6(1):43-46
DOI:10.4103/2249-4863.214961  PMID:29026747
Background: Acanthosis nigricans (AN) is one of the signs suggestive of high insulin resistance (IR). IR is one of the mechanisms involved in pathogenesis of diabetes mellitus type-2 (DM Type-2). Thus, early detection of IR in children may allow us time to intervene well before the development of DM Type-2. In this study, 62% of children having AN had high IR. In children having both, AN and high body mass index (BMI), the incidence of IR was about 80%. This suggests that these easily detectable parameters alone can be useful in screening children at high risk of developing DM Type-2 in future. These simple criteria thus hold promise for use in high throughput screening programs for diabetes. Context: A pilot study conducted by the authors showed that children with AN have a high incidence of IR. The detection of IR in children may allow us time to intervene well before the development of DM Type-2. Detection of DM Type-2 by hyperglycemia may be too late to prevent the onset of microvascular changes. Aims: This study aims to determine whether easily observable presence of AN can be used to screen for increased IR in children, and thereby to detect this important risk factor for DM Type-2. Settings and Design: Cross-sectional, observational study. Two schools, one with children belonging to average economic background and the other, a residential school with children of affluent parents. Selection of children was done randomly. Subjects and Methods: The study was conducted among 507 children in the age group of 10–18 years. Physical examination for the detection of AN, height and weight measurements, waist circumference, fasting plasma glucose, fasting plasma insulin, and lipid profile was done. Homeostatic model assessment of insulin resistance was calculated. Statistical Analysis Used: Data analysis was performed using descriptive statistics and inferential statistical methods. The association between categorical variables was done by Chi-square test. Results: The presence of AN positively correlated with high IR, and when combined with increased BMI, the incidence rate of IR is 80%. Conclusions: AN can be used as a screening method to identify children at risk of DM Type-2-since those who have high IR have a high possibility of having DM Type-2 in future. Hence, early screening and simple, but effective interventional strategies can be instituted at this age, which may prevent or delay diabetes in the long run.
  1 1,377 226
Medication discrepancies and potentially inadequate prescriptions in elderly adults with polypharmacy in ambulatory care
Juan Víctor Ariel Franco, Sergio Adrián Terrasa, Karin Silvana Kopitowski
January-March 2017, 6(1):78-82
DOI:10.4103/2249-4863.214962  PMID:29026754
Objectives: The objective of this study is to describe the frequency and type of medication discrepancies (MD) through medication reconciliation and to describe the frequency of potentially inadequate prescription (PIP) medications using screening tool of older persons' prescriptions criteria. Design: Cross-sectional comparison of electronic medical record (EMR) medication lists and patient's self-report of their comprehensive medication histories obtained through telephone interviews. Inclusion criteria: Elderly individuals (>65 years old) with more than ten medications recorded in their EMR, who had not been hospitalized in the past year and were not under domiciliary care, affiliated to a private community hospital. Outcome Measures: The primary outcomes were the proportion of patients with MD and PIP. Secondary outcomes were the proportion of types of discrepancies and PIP. We analyzed possible associations between these variables and other demographic and clinical variables. Results: Out of 214 randomly selected individuals, 150 accepted to participate (70%). The mean number of medications referred to be consumed by patients was 9.1 (95% confidence interval [CI] =8.6–9.6), and the mean number of prescribed medications in their EMR was 13.9 (95% CI = 13.3–14.5). Ninety-nine percent had at least one discrepancy (total 1252 discrepancies); 46% consumed at least one prescription not documented in their EMR and 93% did not consume at least one of the prescriptions documented in their EMR. In 77% of the patients, a PIP was detected (total 186), 87% of them were at least within one of the following categories: Prolonged used of benzodiazepines or proton pump inhibitors and the use of aspirin for the primary prevention of cardiovascular disease. Conclusions: There was a high prevalence of MD and PIP within the community of elderly adults affiliated to a Private University Hospital. Future interventions should be aimed at reducing the number of PIP to prevent adverse drug events and improve EMR accuracy by lowering medications discrepancies.
  1 1,142 195
Hand hygiene knowledge of primary health care workers in Abha city, South Western Saudi Arabia
Ahmed A Mahfouz, Ahmed Abolyazid, Hasan M Al-Musa, Nabil J Awadallah, Aesha Faraheen, Shamsunhar Khalil, Mohammad N El-Gamal, Khalid M Al-Musa
January-March 2017, 6(1):136-140
DOI:10.4103/2249-4863.214971  PMID:29026766
Purpose: The aim of this is to find out the hand hygiene (HH) knowledge among primary health care workers (PHCWs) in Abha health district, southwestern Saudi Arabia. Methods: Data were collected through an anonymous self-administered questionnaire. The questionnaire was based on a WHO “Knowledge Questionnaire for Health Care Workers.” Results: The study included 478 PHCWs (239 males and 239 females). The sample included 186 physicians, 212 nurses, and 80 technicians. The highest proportion receiving formal training was nurses (82.1%). Females (77.4%) received significantly more training than males (70.3%). Only 59.2% (283) of the HCWs properly identified unclean hands of HCWs as the main route of the cross. Only 26.4% (126) of the HCWs properly identified germs already present on or within the patient as the most frequent source of pathogens in a health-care facility. Only 54.8% (262) of HCWs properly identified 20 s as the minimal time needed for alcohol-based hand rub to kill most germs on hands. Conclusion: The study revealed gaps in the knowledge regarding HH. To promote HH at primary health care setting, WHO bundle of multimodal strategies should be adopted including system change; training/education; evaluation and feedback; reminders in the workplace; and institutional safety climate.
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Association of thyroid peroxidase antibody and dyslipidemia in subclinical hypothyroidism
Vikas Kumar Srivastava, Harkaran Singh
January-March 2017, 6(1):63-68
DOI:10.4103/2249-4863.214958  PMID:29026751
Context: Subclinical hypothyroidism (SCH) is stated as mild thyroid failure, is more common as compared to overt hypothyroidism, is associated with different biochemical abnormalities such as dyslipidemia, and is also having high conversion rate into overt hypothyroidism in patients having thyroid peroxidase (TPO) antibody positive. Lipid abnormalities are controversial in SCH and there is lack of Indian studies showing correlation between lipid abnormalities and TPO positivity in SCH. Hence, we did this study to find the TPO positivity and associated dyslipidemia in SCH patients. Materials and Methods: It was a prospective observational study from January 2015 to December 2015 including fifty adult diagnosed SCH patients presented in outpatient department of Sri Balaji Action Medical Institute, Paschim Vihar, New Delhi. TPO positivity and different lipid abnormalities were studied in those fifty diagnosed SCH patients, and finally, association between TPO antibody and dyslipidemia was calculated. Results: Females were predominant (86%). TPO was positive in 56% SCH patients. Dyslipidemia was found in 100% of SCH patients with positive TPO antibody. In overall, TPO positive patients as well as TPO positive females, total cholesterol, triglyceride, and low-density lipoprotein were significantly high while high-density lipoprotein was insignificant. In males, no significant association was found. Conclusion: In SCH patients, dyslipidemia is significantly associated with TPO positivity, especially in females. Hence, early screening, diagnosis, and treatment of SCH patients are recommended to prevent further risks.
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HWA: Hypoferritinemia without anemia a hidden hematology disorder
Hassan A Al-Jafar
January-March 2017, 6(1):69-72
DOI:10.4103/2249-4863.214986  PMID:29026752
Introduction: Anemia is a condition, in which the number of red blood cells (RBC) and the hemoglobin (Hb) is insufficient to meet the body's physiologic needs. Hypoferritinemia without anemia (HWA) could cause masked clinical manifestations as general weakness, easy fatigability, depressed mode, and hair loss but with normal complete blood count (CBC) parameters. HWA is deferent from iron deficiency anemia (IDA) because there is no reduction in the RBC, Hb, or any of the other parameters of the CBC. In HWA, the hypoferritinemia could be missed because serum ferritin not always requested by general practitioners. Materials and Methods: A retrospective study conducted on 6993 patients of hypoferritinemia patients from our computerized database from 2010 to 2016. The parameters investigated to detect HWA disorder were serum ferritin, RBC, Hb, hematocrit, mean corpuscular volume, and mean corpuscular hemoglobin. Results: HWA is found in 130 (0.018%) hypoferritinemia patients, in a ratio 1.7–1 females to male. Conclusion: HWA is a masked hematology disorder which needs new nomenclature to distinguish it from IDA because they are two deferent disorders although both of them have low serum ferritin. HWA is not a latent IDA because it could happen in patients whom will not get anemia as in polycythemia patients on recurrent veinesection treatement.
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CASE REPORTS
Neuroleptic malignant syndrome in a patient with stable dose of olanzapine
Manoj Kumar Sahoo, Sangita Kamath, Abhijeet Sharan
January-March 2017, 6(1):158-160
DOI:10.4103/2249-4863.214969  PMID:29026773
Neuroleptic malignant syndrome (NMS), a potentially fatal consequence due to typical neuroleptics, has been described so far. In the past few years, there has been increased use of atypical antipsychotic drugs. Cases of NMS related to atypical neuroleptics, such as olanzapine, are less common in spite of increasing cases reported in literatures. Here, we report a case of NMS in a patient with bipolar affective disorder on maintenance treatment with 5 mg olanzapine for the last 7 year. He was successfully treated with bromocriptine and discharged in stable condition in 10 days.
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Increasing awareness of physicians against severe leptospirosis: A treatable but potentially fatal zoonotic infection
Konstantinos Kritikos, Panagiotis Mililis, Aikaterini Mpahara, Georgios Kouvariotis, Nikolaos Kritikos, Georgios Chaliotis
January-March 2017, 6(1):148-150
DOI:10.4103/2249-4863.214955  PMID:29026769
Leptospirosis is a worldwide, often severe and potentially fatal zoonotic infection. Here, we present the case of a 35-year-old man with severe leptospirosis infection that was identified early and was treated effectively, with a quite impressive complete recovery. Delaying of early diagnosis and treatment is crucial for the development of an unfavorable clinical course and increases the risk of a lethal outcome.
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Coxsackie encephalitis in a child in Western India
Ira Shah, Hemant Ambulkar
January-March 2017, 6(1):151-152
DOI:10.4103/2249-4863.214976  PMID:29026770
Enteroviral encephalitis in children has been rarely described from Western India. We describe a 5½-year-old child with Coxsackie encephalitis.
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Aortoarteritis with tuberculosis
Anmol Goyal, Ira Shah
January-March 2017, 6(1):153-154
DOI:10.4103/2249-4863.214978  PMID:29026771
Aortoarteritis is an inflammatory condition of the aorta, which has been rarely reported due to tuberculous infection. We report two cases of children who had aortoarteritis along with tuberculosis (TB), of which one had collapse consolidation and the other had latent TB. Both patients were treated with anti-TB therapy and steroids.
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Hydatid disease: A rare cause of fracture nonunion
Divya Aggarwal, Vaibhav Girotra, Neelam Wadhwa, Manish Chadha
January-March 2017, 6(1):164-166
DOI:10.4103/2249-4863.214979  PMID:29026775
Hydatid disease is an infrequent parasitic infestation caused by cestode, most commonly, Echinococcus granulosus. Bone involvement is distinctly uncommon. We would like to share our experience of a rare case of hydatid disease of femur in a 24-year-old male who presented with nonunion of subtrochanteric fracture. Histopathology showed typical lamellated wall and dagger-shaped hooklets. In view of its rarity, hydatid disease often remains an unsuspected infection of the bone.
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EVIDENCE-BASED SUMMARY
Salt reduction strategy at population level
Madhavi Bhargava
January-March 2017, 6(1):19-20
DOI:10.4103/2249-4863.214984  PMID:29026741
World is facing a huge burden of noncommunicable diseases such as hypertension, ischemic health diseases, and stroke. Moreover, the developing countries have had a relatively speedy rise of the problem, with noncommunicable diseases occurring at much lower age as compared to the developed world. The World Health Organization, therefore, recommends reduction in salt intake at population level to <5 g/day. Not all researchers and public health physicians agree to it, leading to conflicting information for a primary care physician. This evidence based summary documents this polarization of the recommendations regarding salt reduction and acknowledges the ongoing challenge primary care physicians face when following such evidence based guidelines.
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LETTERS TO EDITOR
Antiepileptic therapy, osteomalacia, and synchronous fractures: Don't lose looser zones
Ganesh Singh Dharmshaktu
January-March 2017, 6(1):167-168
DOI:10.4103/2249-4863.214989  PMID:29026776
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Universal health coverage - There is more to it than meets the eye
Nafis Faizi, Shahwar Kazmi
January-March 2017, 6(1):169-170
DOI:10.4103/jfmpc.jfmpc_13_17  PMID:29026777
  - 854 94
Methods for estimating medication adherence to antiretroviral therapy: Response to Mehta et al. (2016)
Saurav Basu, Suneela Garg
January-March 2017, 6(1):171-172
DOI:10.4103/jfmpc.jfmpc_9_17  PMID:29026778
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Oral rehydration solution in infantile diarrhea: Make sure it is given properly!
Rohit Anand, Anirban Mandal, Amitabh Singh
January-March 2017, 6(1):173-174
DOI:10.4103/jfmpc.jfmpc_49_17  PMID:29026779
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ORIGINAL ARTICLES
Management of diabetic ketosis and ketoacidosis with intramuscular regular insulin in a low-resource family medicine setting
Sudhakar Basetty, GS Yeshvanth Kumar, Martina Shalini, Ruby Pricilla Angeline, Kirubah Vasandhi David, Sunil Abraham
January-March 2017, 6(1):25-28
DOI:10.4103/2249-4863.214992  PMID:29026743
Background: India is facing an epidemic of diabetes mellitus (DM). Effective management of complications of DM is a challenge in resource-poor areas of India. This study addresses the need to explore low-cost methods to manage diabetic ketosis (DK) and diabetic ketoacidosis (DKA). Objectives: To demonstrate the use of intramuscular (IM) regular insulin as a safe alternative method to control DK and DKA in a family practice setting. Materials and Methods: A retrospective chart review was done for 34 patients admitted with DK and DKA in a family medicine unit for the urban poor over 5 years. Data on age, sex, precipitating factors, blood pressure, number of days of hospitalization, amount of insulin, and time required to control blood glucose (BG) and to correct acidosis were entered into EpiData version 3.1 and analyzed using SPSS software version 17. Results: Administration of IM regular insulin was effective in reducing the BG to <250 mg/dL in patients with DK and DKA. The mean time required for this in the ketosis group was 3.8 h and in the ketoacidosis group was 3.9 h. The mean amount of insulin required for correction of acidosis in the ketoacidosis group was 72.3 units and the mean time to achieve this was 33 h. Of the 34 patients, only one in the ketoacidosis group had hypoglycemia. There was no fatality or referral of any patient. Conclusion: This study demonstrates that IM regular insulin is a safe alternative method in managing DK and DKA in a family medicine setting.
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Attitude toward learning of community medicine: A cross-sectional study among medical school students
Japhereena Murugavel, Vinoth Gnana Chellaiyan, Dhivyatharani Krishnamoorthy
January-March 2017, 6(1):83-87
DOI:10.4103/2249-4863.214974  PMID:29026755
Background: Community medicine strives to protect and promote the health and well-being of the community through primary health care approach. However the preference of community medicine as career among medical school students and curriculum of community medicine is pivotal. Aim: The study intended to find the attitude towards learning of community medicine and also to assess the preference of post graduation specialty among medical school students. Materials and Methods: A cross sectional study conducted at a teaching hospital located in Tamil Nadu, South India. The study questionnaire was administered to a total of 500 study participants and the data collected were analyzed using SPSS IBM version 21.0. Results: Almost 97% were of the opinion that community medicine subject is mandatory. Eighty three percent were interested in learning the principles. Only 21.8% students wanted to pursue post graduation in community medicine. Lack of attraction in terms of scientific technical interest, workplace conditions, and research potential has been reported for being not interested. Conclusion: Majority enjoyed to learn principles of community medicine at undergraduate curriculum but only few preferred to opt community medicine as post graduate specialty. Therefore there is a room to influence the medical students positively towards learning community medicine in curriculum.
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Gynecological complaints and their associated factors among women in a family health-care clinic
Mateus de Paula von Glehn, Linconl Uchôa Sidon, Eleuza Rodrigues Machado
January-March 2017, 6(1):88-92
DOI:10.4103/2249-4863.214982  PMID:29026756
Aim: The aim of this study was to describe the most common gynecological complaints and possible associated factors among women of reproductive age attended at a family health-care clinic. Methodology: A transversal study conducted with a sample of an outpatient population consisting of women of reproductive age. Pregnant women and minors were excluded. The final sample consisted of women between 18 and 49 years of age. The participants answered a questionnaire in which the complaints of the last 4 weeks were registered. They were examined, had the vaginal pH assessed, and secretion was tested using a 10% potassium hydroxide solution to verify the presence of amine odor (whiff test). Results: Most participants were black or of mixed races. Considering the frequency of complaints, there were no significant differences between white and nonwhite women. There was an association between vaginal pH and discharge complaints as well as unpleasant odor, positive test of amines, smoking, and performing vaginal douches. Conclusions: Vaginal complaints were common among participants; the practice of vaginal douches was also frequent and was associated with higher pH values. The use of hormonal contraceptives was associated with lower pH values. There was no significant association between condom use and gynecological complaints, vaginal pH, or the whiff test.
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Socio-clinical profile of married women with history of induced abortion: A community-based cross-sectional study in a rural area
Sumitra Pattanaik, Lipilekha Patnaik, Arpita Subhadarshini, Trilochan Sahu
January-March 2017, 6(1):93-96
DOI:10.4103/2249-4863.214967  PMID:29026757
Background: Induced abortion contributes significantly to maternal mortality in developing countries yet women still seek repeat induced abortion in spite of the availability of contraceptive services. Objectives: (1) To study the sociodemographic profile of abortion seekers. (2) To study the reasons for procuring abortions by married women of reproductive age group. Materials and Methods: It was a cross-sectional community-based study. All the married women of reproductive age group (15–49 years) with a history of induced abortion were selected as the subjects. Results: The most common reason for seeking an abortion was poverty (39.4%), followed by girl child and husband's insistence, which accounted for 17.2% each. More complications were noted in women undergoing an abortion in places other than government hospitals and also who did it in the second trimester. Conclusions: To reduce maternal deaths from unsafe abortion, several broad activities require strengthening such as decreasing unwanted pregnancies, increasing geographic accessibility and affordability, upgrading facilities that offers medical termination of pregnancy (MTP) services, increasing awareness among the reproductive age about the legal and safe abortion facilities, the consequences of unsafe abortion, ensuring appropriate referral facilities, increasing access to safe abortion services and increasing the quality of abortion care, including postabortion care.
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Impact of school health education program on personal hygiene among school children of Lucknow district
Ruby Khatoon, Beena Sachan, Mohsin Ali Khan, JP Srivastava
January-March 2017, 6(1):97-100
DOI:10.4103/2249-4863.214973  PMID:29026758
Background: Personal hygiene plays a major role to promote healthy life. This study was performed to assess the current level of knowledge and practicing behavior in regard to hand washing, bathing, tooth brushing, and taking care of nail and hair. Materials and Methods: A cross-sectional descriptive study was conducted on 800 students of Lucknow district. All the students were interviewed with a structured questionnaire (pretest). A visual display of good and bad personal hygiene was shown on projector and explained the benefits of good personal hygiene behavior. Again, structured questionnaire was given (posttest). Results: Most of the students belonged to the 10–12 years age group. The knowledge of the students regarding general body cleanliness was 87.5% in posttest as compared to 53.8% in pretest. Keeping the hair well-trimmed was considered as a part of personal hygiene by 38.0% of students. Knowledge about eating less food in diarrhea was positive in 80% of students. Only 12.5% of students accepted that diarrhea can kill children (pretest) while 100% (posttest) children were aware of this fact. Practice regarding change of clothes was on alternate day in 79.5% of students. Most of the students were found washing their hair once a week (72.5%) and 70% students were washing hands before meal. Conclusion: Overall trend of knowledge and practice about personal hygiene was in poor condition among students at the time of pretest. Posttest results were highly satisfactory.
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Knowledge and awareness regarding menstruation and HIV/AIDS among schoolgoing adolescent girls
Rakhi Jain, Puneet Anand, Anuj Dhyani, Deshant Bansal
January-March 2017, 6(1):47-51
DOI:10.4103/2249-4863.214970  PMID:29026748
Introduction: Menstruation in our country is associated with various myths and restrictions leading to lack of awareness among adolescent girls. Insufficient menstrual hygiene practices are the cause of stress associated with menstruation and reproductive tract infections. Sexually transmitted infections and HIV/AIDS are not openly discussed in our society making adolescents vulnerable to them. Aim: To assess the knowledge of school going adolescent girls regarding menstrual hygiene and HIV/AIDS. Materials and Methods: Girls studying in class 8th-12th standard and who have attained menarche were included in the study. A predesigned questionnaire, which consisted of questions related to menstrual awareness and knowledge about HIV/AIDS was used for data collection. Data was analysed using SPSS software and results were interpreted into percentages. Results: 282 girls took part in the study. Mean age of girls was 14.70 ± 1.5 years. Median age of girls was 15 years. Knowledge regarding menstrual hygiene and HIV/AIDS was found to be only satisfactory leaving a scope of improvement. Mother was the main source of information regarding both menstruation and HIV/AIDS. Conclusion: A comprehensive health education programme involving mothers is required to remove various misconceptions and taboos associated with menstruation and make it a pleasant experience for adolescent girls. Information, education and awareness programmes need to be strengthened to spread awareness regarding HIV/AIDS.
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Implementation of a Schedule II patient agreement for opioids and stimulants in an adult primary care practice
Erin Downey, Wei Pan, Jan Harrison, Esther Poza-Juncal, Paula Tanabe
January-March 2017, 6(1):52-57
DOI:10.4103/2249-4863.214959  PMID:29026749
Background: The consumption of controlled substances in North Carolina and the nation has created a health crisis with epidemic levels of medication diversion, abuse, overdose and death. Primary care providers are the principal prescribers of controlled substances and at greatest risk of encountering patients that abuse medications. Guidelines recommend patient agreements with monitoring requirements when prescribing opioids and stimulants. Studies have focused on opioids and excluded stimulants. Adherence to recommended monitoring requirements has not been fully evaluated. Methodology: This was a quality improvement project using the Plan-Do-Check-Act procedure. The following outcome measures were evaluated: signed agreement on file, prescription monitoring program (pmp) checks, urine screens, and prescriptions written without a mandatory visit. Implementation: Who: patients aged 19 and over prescribed a long-term Schedule II medication for the chronic conditions of pain and/or attention deficit hyperactivity disorder. What: implemented a patient agreement and measured fidelity to components of the agreement. When: seven months pre- to seven months post-implementation. Where: in an adult primary care practice with approximately 2,500 patients. How: an agreement was implemented with monthly feedback provided. Results: Post-implementation, 94% of patients meeting criteria had a signed agreement in their medical record. Adherence to urine screening improved from 5.3% to 71.1%. Guideline adherence to pmp checks improved from 11.3% to 99.0%. Guideline deviation for prescriptions written without a visit improved from 20.6% to 0%. All improvements were statistically significant (P < .001). Conclusion: A Schedule II controlled substance patient agreement was successfully implemented in a primary care practice reducing risk for both the patient and provider.
  - 841 115
Visual impairment among 10–14-year school children in Puducherry: A cross-sectional study
R Vishnuprasad, Joy Bazroy, K Madhanraj, Hannah Ranjee Prashanth, Zile Singh, Abel K Samuel, T Muthukumar
January-March 2017, 6(1):58-62
DOI:10.4103/2249-4863.214983  PMID:29026750
Introduction: According to the 2010 estimates by the World Health Organization, nearly 285 million (4.24% of total population) people of all ages worldwide are visually impaired. Almost 18.9 million children under 15 years of age are visually impaired globally. In developing countries, 7%–31% of childhood blindness and visual impairment is avoidable. Materials and Methods: The study was conducted as a cross-sectional study among 1884 school students in Puducherry, in the age group of 10–14 years. A child with presenting maximum vision ≤6/12 Snellen equivalent in the better eye is considered visually impaired. Data were entered in Microsoft Excel 2013 and analyzed using the statistical software SPSS version 21.0. Chi-square test was applied for testing difference in proportion and a P< 0.05 was considered statistically significant. Results: The overall prevalence of visual impairment (vision ≤6/12) among the study participants was 6.37% (95% confidence interval = 5.27–7.47). The prevalence of visual impairment increased with age and it was found to be high among male students (6.6%) when compared to female students (6%). Presenting vision of 6/6 was observed in 79.8% of the children while with pinhole correction, the proportion increased to 94.6%. Conclusion: The prevalence of visual impairment in our study population was found to be 6.37% and the prevalence was even higher among children who belonged to schools of urban region or private schools. Children with a positive family history of spectacle use were more likely to have visual impairment.
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Socioeconomic determinants affecting the quality of life among diabetic and hypertensive patients in a rural area, Egypt
Hewaida M ElShazly, Nagwa Nashat Hegazy
January-March 2017, 6(1):141-145
DOI:10.4103/jfmpc.jfmpc_31_17  PMID:29026767
Background: Diabetes mellitus and hypertension have a high prevalence of growth in all countries threatening to become a global epidemic risk, thus the quality of life this category of patients is extremely important. The aim of this study was to assess the socioeconomic determinants affecting the quality of life among diabetic and hypertensive patients. Patient and Methods: A descriptive cross-sectional study was conducted in a rural family health care center in El-Batanon village, in the delta region of Menoufia, Egypt. The recruited sample population was 401 participants over six month's context time frame (diabetic and hypertensive participants were 224 and 117 respectively). All participants were interviewed using a questionnaire to assess the demographic characteristics, socioeconomic status, type, duration and treatments of illness and the 36-Item Short Form Health Survey. Results: Patients with Diabetes presented a poorer health related quality of life than those with hypertension in perceived health in the areas of role-physical (RP) (P < 0.05), bodily pain (BP) (P < 0.001), general health (GH) (P < 0.05), vitality (VT) (P < 0.05), social functioning (SF) (P < 0.001) and role-emotional (RE) (P < 0.001). Age, Sex, Family size, socioeconomic score and occupation were the main Socioeconomic Determinants affecting the quality of life among diabetic and hypertensive patients. Conclusion: Diabetes and hypertension seem to comparably impair the health-related quality of life. There is a need to develop and implement effective targeted intervention to help the patients to cope with their life in a better way.
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Postherpetic neuralgia, diabetic neuropathy, and trigeminal neuralgia – Chronic peripheral neuropathic pain in 58,480 rural Italian primary care patients
Nicola Buono, Hans Thulesius, Ferdinando Petrazzuoli, Elena Castelli, Marco Cambielli
January-March 2017, 6(1):110-114
DOI:10.4103/2249-4863.214980  PMID:29026761
Introduction: Chronic peripheral neuropathic pain (CPNP) is a condition due to peripheral nervous system diseases or injury, but its prevalence is unknown in Italian primary care. Aim: The aim of this study is to assess the prevalence of CPNP in a rural primary care area in Northern Italy. Materials and Methods: A multicenter audit study was carried out in a rural area in Northern Italy with 113 participating general practitioners (GPs) seeing 58,480 patients >18 years during 3 months. Patients who for any reason attended GPs' surgeries and had symptoms suggestive of neuropathic pain (NP) were given the NP diagnostic questionnaire “Douleur Neuropathique en 4 Questions” (DN4) and recorded their pain level on a visual analog scale (VAS). Results: Chronic NP was established by a DN4 score of ≥4 and a VAS pain score of ≥40 mm for >6 months together with a clinical diagnosis in 448 (254 women and 194 men) out of 58,480 patients giving a prevalence of 0.77%. 179 patients (0.31%) had diabetes neuropathy, 142 (0.24%) had postherpetic pain, 41 (0.07%) had trigeminal neuralgia, 27 (0.05%) had NP postinjury, 27 (0.05%) had NP caused by nerve entrapments, 11 (0.02%) had NP triggered by systemic diseases, and 21 (0.04%) had NP of unknown etiology. Conclusions: The prevalence of CPNP in this population of primary care attenders in a rural area in Northern Italy was 0.77%. Diabetes neuropathy (0.31%) and postherpetic pain (0.24%) were the two most common subgroups of NP, followed by trigeminal neuralgia (0.07%).
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Quality of life among elderly population residing in urban field practice area of a tertiary care institute of Ahmedabad city, Gujarat
Venu R Shah, Donald S Christian, Arpit C Prajapati, Mansi M Patel, KN Sonaliya
January-March 2017, 6(1):101-105
DOI:10.4103/2249-4863.214965  PMID:29026759
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.
  - 1,003 167
Etiological and clinicopathological study of secondary small vessel vasculitis in elderly: A case series of 12 patients
Ajay Kumar Mishra, Ramya Iyadurai, Anu Anna George, Ebenezer Rajdurai, V Surekha
January-March 2017, 6(1):106-109
DOI:10.4103/2249-4863.214977  PMID:29026760
Background: Inflammation involving the postcapillary venular wall is defined as small vessel vasculitis. Small vessel vasculitis has various clinical manifestations. Etiologically, it can be primary or secondary. Literature regarding secondary vasculitis in elderly is scanty. Aim and Objectives: In this case series, we aimed to assess the clinical features and etiologies of biopsy-proven secondary small vessel vasculitis in the elderly. Methodology: Twelve elderly patients with biopsy-proven small vessel vasculitis were included in this study. All patients were thoroughly evaluated to assess the etiology and presence of major organ involvement. Results: Secondary small vessel vasculitis involved both the sexes equally. Constitutional symptoms including fever and weight loss were noticed by most of the (70%) patients. Neurological deficits were present in 83% of the study population. The most common finding in an electromyographic examination was an asymmetric sensory motor distal predominant polyradiculopathy. Fifty percent of the patients did fulfill the criteria for a definite autoimmune disease. More than 30% of the vasculitis was secondary to malignancies. Conclusions: Neurological manifestations are the most common systemic involvement in elderly patients with secondary vasculitis. Meticulous search for underlying malignancies is mandatory in elderly patients with secondary small vessel vasculitis.
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A case–control study on environmental and biological risk factors for renal calculi persisting in a coastal Union Territory, India
Prakash Mathiyalagen, Anand Neelakantan, Karthik Balusamy, Kavita Vasudevan, Johnson Cherian, Bhuvaneswary Sunderamurthy
January-March 2017, 6(1):126-130
DOI:10.4103/2249-4863.214981  PMID:29026764
Background and Objectives: Renal stone disease is a common disorder of the urinary tract and also a significant problem because of incidence, recurrence, and severe consequences. The complex pathogenetic mechanisms of renal stone formation involve both biologic and environmental risk factors. The present study was performed to identify the role of these parameters among renal stone patients and normal individuals from a coastal union territory region in South India. Methods: The authors conducted a case–control study of renal stone disease among outpatient department patients more than 30 years of age using systematic random sampling procedure with 100 study participants (50 subjects for each group). A questionnaire to explore some relevant history as well as to note general examination findings was used along with a house visit to collect a sample of water. Analysis was undertaken using appropriate statistical techniques. Results: The study showed statistically significant association for renal stones with female sex, illiteracy, body mass index (BMI) (>25 kg/m2), sodium (>50 mg/L), water consumption (<1.5 L/day), water source being borewell, consuming soft drink, sedentary work, and family history of renal stones. The adjusted odds ratios (ORs) were significantly higher for consuming soft drink (OR: 8.19; 95% confidence interval: 1.99–33.69), sedentary work (10.01; 1.27–78.91), and water consumption <1.5 L/day (7.73; 2.24–26.69). Interpretation and Conclusions: We conclude that in this part of India, female gender, illiteracy, high BMI, high sodium in drinking water, inadequate water consumption, borewell drinking water, soft-drink consumption, sedentary work, and family history of renal stones can lead to a significant increase in the risk of renal stone disease.
  - 938 136
Screening antenatal anxiety: Predicting its effect on fetal growth
Kaushik Sarkar, Goutam Das, Ranadip Chowdhury, Bhaskar Shahbabu, Ishita Sarkar, Santu Maiti, Aparajita Dasgupta
January-March 2017, 6(1):131-135
DOI:10.4103/2249-4863.214956  PMID:29026765
Context: Maternal anxiety has an association with low birth weight. However, studies are scarce to determine any association between maternal anxiety and fetal growth. Aims: This study aims to determine the effect of maternal anxiety on fetal growth, measured by gestational age-dependent increase in fetal abdominal circumference (AC). The secondary objective is to determine the effect of maternal anxiety on other fetal parameters (biparietal diameter [BPD], head circumference [HC], femur length [FL]). Settings and Design: This cross-sectional study was conducted in a tertiary care hospital, Kolkata. Materials and Methods: Four hundred and ten pregnant mothers, between 14 and 40 weeks of gestation, were interviewed with socioeconomic and obstetric profile questionnaire and examined for anthropometric profile and presence and severity of pallor. Anxiety was assessed using Generalized Anxiety Disorder-7 (GAD) questionnaire. HC, AC, BPD, and FL were measured by ultrasound biometry. Analysis Used: A multivariable logistic regression analysis was done to determine the predictors of small-for-gestational-age (SGA). A robust mediation analysis was done to determine mediating effect of anxiety on gestational age-dependent increase in fetal AC. Results: Mild (odds ratio [OR]Adjusted = 6.23, [2.41, 16.15]) and moderate (ORAdjusted = 22.42, [5.00, 100.57]) anxiety was significantly associated with SGA fetus. Anxiety increased with the progression of gestation (βGAD: 0.011 [0.007–0.015]) and it had a negative effect on fetal growth (standardized indirect effect of gestational age-mediated by anxiety on AC: −0.037 [−0.059, −0.022]). Anxiety also attenuated gestational age-dependent increment of HC. Conclusion: Mother's anxiety has a gestational age-dependent temporally incremental negative effect on fetal growth and brain development.
  - 1,081 149
Does violence affect the use of contraception? Identifying the hidden factors from rural India
Nishikant Singh, Sudheer Kumar Shukla
January-March 2017, 6(1):73-77
DOI:10.4103/2249-4863.214987  PMID:29026753
Purpose: The objective of this study is to investigates the relationship between domestic violence and use of contraception among married women in rural India. Data: Third round of National Family Health Survey (NFHS-III). Methodology: Cross tabulation as bivariate analysis and Binary Logistic Regression as multivariate analysis has been employed to fulfill the objective. Findings: The result shows that there are several hidden factors. between physical violence and contraception use. Alternate explanatory variables are significantly affected the use of contraception. With physical violence which reflects that there is a relationship between physical violence and socioeconomic status such as education, awareness, empowerment of women and subsequently the use of contraception. Originality/value: The paper throws light on the hidden factors which are obstacle in use of contraception with physical violence. Results of this study have potentially important implications for programs aimed at preventing violence and promoting family planning programs.
  - 1,198 113
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