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

Kabita Barua, Madhur Borah, Chandana Deka, Rana Kakati

Journal of Family Medicine and Primary Care 2017 6(2):345-350

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

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Chasing viruses feverishly

Chandrakant Lahariya

Journal of Family Medicine and Primary Care 2017 6(2):196-197

A number of viral diseases have emerged and re-emerged in India and globally, in the last few years. Effective prevention and control of these diseases require, in addition to a functioning disease surveillance system, interventions both before and after disease occurrence, and a combination of personal and population services. However, the current efforts to control emerging viral diseases in India has major therapeutic focus (and attention on diagnostic and curative services) and there is limited attention on preventive and promotive components. It is proposed that for an effective and successful control, a systematic approach is adopted with an appropriate selection of personal and population health services, delivered by government through participation of private sector. This is possible through commitment and leadership of Government and other public health agencies, supplemented by multi agency coordination, sufficient funding and an accountability mechanism.

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Breastfeeding practice and knowledge among women attending primary health-care centers in Riyadh 2016

Norah Faleh Al-Mutairi, Yousef Abdullah Al-Omran, PJ Parameaswari

Journal of Family Medicine and Primary Care 2017 6(2):392-398

Introduction: Breast milk is the best natural essential nutrition to newborns and infants. However, the practice of breastfeeding (BF) has declined in Saudi Arabia. Objective: The objective of this study was to assess the knowledge and practice of BF with their determinants among mothers in Riyadh. Materials and Methods: In this cross-sectional study, 252 mothers attending the well-baby clinics in Riyadh from March 2016 to May 2017 were selected randomly with their consent and studied by a standardized questionnaire. Results: Of the 252 women, 69.4% were 25–35 years of age and 56.7% with a bachelor degree or higher education. Nearly 75% mothers had education on BF before our study. Mixed feeding was the most preferred method (51.6%) followed by artificial milk (29.4%). The most reported reason for discontinuing BF was breast milk insufficiency (37.3%) and of breastfeed continuation was their perceived benefit (36.6%). Excellent knowledge was observed among 12.7%, good knowledge in 57.1%, and unsatisfactory level in 30.2% mothers. The regression model shows that high school education improved the knowledge by 10.9 points (P = 0.024) and undergraduate by 18.7 points (P value = 0.001) when compared to women who were literate. Women with parity >5 improved knowledge score by 17.3 points (P < 0.001). Conclusion: We observed that majority (57.1%) of Saudi mothers had a moderate level of knowledge on BF benefits and 19% had practiced exclusive BF. There is a need for better educational programs to increase awareness on its benefits for the health situation in the country on the long term.

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Theory of scientific investigation by Hempel and a case of Semmelweis

Syed Ahsan Raza

Journal of Family Medicine and Primary Care 2017 6(2):198-200

Carl Gustav Hempel brought our attention to 19th century Hungarian physician Ignaz Semmelweis and his investigations in "systematic discovery" of solution to a "scientific problem." The historical account of Semmelweis provided an impetus for Hempel to ponder upon the role of "induction" in "scientific inquiry." By considering various conjectures, Hempel examined through this case, how a hypothesis once proposed is tested and rejected on the basis of test implication. Somewhere around this account lies the lesson for family practitioners of modern age in how to fight age-old-dogmatic beliefs with simple answers, but the ones that require appreciation from larger academia.

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In the dark even after a decade! A 10-year analysis of India's National Rural Health Mission: Is family medicine the answer to the shortage of specialist doctor in India?

Pavan Pandey, Sushrut Sharma

Journal of Family Medicine and Primary Care 2017 6(2):204-207

The National Rural Health Mission (NRHM) has been successful in reducing maternal, infant, and child mortality rates in India. In addition, it has tremendously improved the infrastructure of India's public health system. It has also placed at least one Accredited Social Health Activist worker in every village of India. However, the NRHM has not been able to overcome the shortage of specialist doctors at Community Health Centre (CHC) level. During 10 years of NRHM, only 81 gynecologists, 34 physicians, and 290 pediatricians have been added at the CHC level. Family medicine specialist can be a viable alternative to these specialist doctors, fill the existing gap, and drastically improve the quality of health care provided at CHC level.

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Level of tobacco dependence among tobacco users in an urban slum of Puducherry: A pilot study

Bijaya Nanda Naik, Marie Gilbert Majella, S Parthibane, Sitanshu Sekhar Kar

Journal of Family Medicine and Primary Care 2017 6(2):336-339

Context: Successful tobacco quit by the tobacco users can avoid millions of premature death. However, the physical dependence on tobacco use results in frequent relapse most commonly due to withdrawal symptoms. Aims: The aim of this study was to study the level of tobacco dependence among tobacco users in an urban slum of Puducherry. Materials and Methods: This facility-based descriptive pilot study was conducted among patients aged 15 years or above attending an urban health and training center in an urban slum of Puducherry. A total of 90 consecutive current tobacco users were included after obtaining verbal informed consent and interviewed using a pretested questionnaire. The information on tobacco dependence was collected using Fagerstrom Addiction Scale for smokers and smokeless tobacco users separately. Results: Of the 90 current tobacco users, 95% were daily tobacco users. Of the current tobacco users, 48.8%, 45.6%, and 5.6% were smokers, smokeless tobacco users, and dual users, respectively. Majority of the smokers (61%) and most of the smokeless tobacco users (41%) had medium dependence for tobacco use. However, physical dependence was much higher among smokeless tobacco users (41.3%) than smokers (20.4%). Conclusion: Proportionately high physical dependence on tobacco is a concern in the study population. Community-based interventions are required to curb the problem; however, study with representative sample should be carried out before that.

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Are our subcenters equipped enough to provide primary health care to the community: A study to explore the gaps in workforce and infrastructure in the subcenters from North India

MA Bashar, Sonu Goel

Journal of Family Medicine and Primary Care 2017 6(2):208-210

Background: A Sub-Centre (SC) is most peripheral and first point of contact between the primary healthcare system and the community in the rural areas. The success of any nationwide program largely depends on well-functioning SCs providing services of acceptable standards to people. Indian Public Health Standards (IPHS) for SCs was prepared keeping in view the minimum standards required to provide quality and need sensitive health care to the community. Materials and Methods: A cross-sectional study was conducted in Ambala District of Haryana to assess the availability of physical infrastructure, manpower, drugs and equipment in the SCs. A total of 30 SCs from a rural block was selected. The data was statistically analyzed using Microsoft Excel. The deficiencies in the availability of health workers male and female were found to be 66.6% and 50%, respectively. The residential facility for health workers was available only in 33.3% SCs but none being utilized. Although labour room with labour table was present in half of the Sub Centers, the deliveries were found to be conducted in none of those. Only 40% and 26.6% of SCs had stethoscope and functional B.P apparatus. The availability of essential drugs and equipment was also poor. Conclusion: The physical infrastructure and manpower availability at the SCs needs considerable improvement as per the Indian Public Health Standard (IPHS). Poor availability of essential drugs and equipment needs to be addressed at the earliest.

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

Kalaiselvi Selvaraj, R Jayalakshmy, Arjumand Yousuf, Arvind Kumar Singh, Gomathi Ramaswamy, C Palanivel

Journal of Family Medicine and Primary Care 2017 6(2):356-359

Introduction: Major proportion of the elderly with under nutrition is undetected in the community. One of the feasible ways to detect under nutrition among elderly would be screening in the field settings. in this study, we aimed to identify the utility of alternate anthropometric measures such as mid-upper arm circumference (MUAC), calf circumference, and skin fold thickness in identifying under nutrition among elderly. Materials and Methods: A community-based cross-sectional survey was done among elderly in one of the randomly selected subcenters. Anthropometric measures such as weight, arm span, MUAC, and triceps skinfold thickness were measured as per the standard measurement guidelines by a trained medical graduate. The elderly were identified as undernourished if body mass index (BMI) is <18.5 kg/m2. Utility of alternate anthropometric markers against BMI is represented by area under the curve (AUC) value from receiver operating characteristic curve and correlation coefficient (r). Results: Mean MUAC, calf circumference, and triceps skinfold thickness measured among 271 elderly were 25.6 cm ± 3.7 cm, 27.6 cm ± 3.7 cm, and 3.0 mm ± 1.3 mm, respectively. Among all three proxy anthropometric measures, MUAC had the highest AUC value (AUC = 0.88) Triceps skinfold thickness had the least AUC (AUC = 0.61). The correlation of anthropometric measurements such as MUAC, calf circumference, and triceps skinfold thickness with BMI was 0.74, –0.04, and 0.64, respectively. Conclusion: As MUAC and calf circumference are easy to measure and they are highly correlating with BMI, they can be used routinely by peripheral field workers to assess undernutrition in elderly during their regular house visits.

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

Anurag Minz, Monika Agarwal, JV Singh, VK Singh

Journal of Family Medicine and Primary Care 2017 6(2):211-217

Context: Globally, around 16% of under-five children die due to pneumonia. Childhood pneumonia, if identified early is a readily treatable through low-cost antibiotics. Access to timely and appropriate care is a key action to control pneumonia. Aims: The aim of the study was to understand the caregiver's care-seeking behavior for the management of childhood pneumonia among rural and urban poor communities in Lucknow. Settings and Design: Rural areas and urban slums of Lucknow district, from September 2014 to August 2015. Subjects and Methods: A community-based cross-sectional study. Total of 1065 under-five children were selected by multistage random sampling method. Caregivers of children (<5 years of age) were interviewed through pretested, semi-structured interview schedule. Information was gathered on episode of cough, difficult breathing, and or chest indrawing in child within 2 weeks preceding the survey, and caregiver's treatment seeking practices. Results: Out of total 1065 children, 52 (%) had pneumonia within 2 weeks preceding the survey. At the onset of illness, difficult/fast breathing was identified by 86.5% caregivers, but majority of them did not perceive it as a serious condition and resort to home remedies. Only 9.6% sought appropriate care at onset of illness. Appearance of chest indrawing in the child was identified by caregivers as a serious condition and sought treatment from outside. The mean time taken from onset of illness to the seeking care from health facility was around 2½ days (2.39 ± 0.75). Qualified private practitioners (70.5%) were the preferred choice and majority (87.0%) of the children received antibiotic for pneumonia. However, even after perception of seriousness of the illness, 26.8% and 11.1% caregivers in urban slums and rural areas, respectively sought inappropriate care at the first consultation. Conclusions: Caregivers were unable to perceive the severity of fast breathing leading to the delayed initiation of the appropriate treatment. There is a need of community mobilization through behavior change communication interventions to promote early symptom recognition and appropriate care seeking for pneumonia.

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Press release distribution, EDGAR filing, XBRL, regulatory filings

The report p... )--MBF Healthcare Partners announces that Michael J. Vaughan, Former COO of American Dental Partners , has joined MBF as an Operating Partner )--The "UV Disinfection Equipment Market: Global Industry Analysis, Trends, Market Size and Forecasts up to 2023" report has been added to Research and Markets' offering.

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Staff at Imogen Dental in Benson win at UK Dentistry Awards 2017

STAFF at an Oxfordshire dentist are flashing their pearly whites after they picked up a prize at the UK Dentistry Awards 2017. Neel Tank and his colleagues at Imogen Dental in Benson were crowned Best Team in the South East at the ceremony.

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Correction to: Long-term outcomes of patients with early gastric cancer found to have lesions for which endoscopic treatment is not indicated on histopathological evaluation after endoscopic submucosal dissection

Abstract

In Table 1, the second item in the right-hand column "Extra-indication" should be changed to "Out of indication". The correct version of Table 1 is displayed.

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Morbidity and mortality from a propensity score-matched, prospective cohort study of laparoscopic versus open total gastrectomy for gastric cancer: data from a nationwide web-based database

Abstract

Background

Controversy persists regarding the technical feasibility of laparoscopic total gastrectomy (LTG), and to our knowledge, no prospective study with a sample size sufficient to investigate its safety has been reported. We aimed to compare the postoperative morbidity and mortality rates in patients undergoing LTG and open total gastrectomy (OTG) for gastric cancer in prospectively enrolled cohort using nationwide web-based registry.

Methods

From August 2014 to July 2015, consecutive patients undergoing LTG or OTG (925 and 1569 patients, respectively) at the participating institutions were enrolled prospectively into the National Clinical Database registration system. We constructed propensity score (PS) models separately in four facility yearly case-volume groups, and evaluated the postoperative morbidity and mortality in PS-matched 1024 patients undergoing LTG or OTG.

Results

The incidence of overall morbidity were 84 (16.4%) in the OTG and 54 (10.3%) in the LTG groups (p = 0.01).The incidence of anastomotic leakage and pancreatic fistula grade B or above were not significantly different between the two groups (LTG 5.3% vs. OTG 6.1%, p = 0.59, LTG 2.7% vs. OTG 3.7%, p = 0.38, respectively). There were also no significant differences in the 30-day and in-hospital mortality rates between the two groups (LTG 0.2% vs. OTG 0.4%, p = 0.56; LTG 0.4% vs. OTG 0.4%, p = 1.00, respectively).

Conclusion

The results from our nationally representative data analysis showed that LTG could be a safe procedure to treat gastric cancer compared to OTG. The indication for LTG should be considered carefully in a clinical setting.

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Is an endoscopic or a microscopic approach optimal for management of attic cholesteatoma?

Dear Editors,

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Live cell imaging reveals different modes of cytotoxic action of extracts derived from commonly used luting cements

Publication date: February 2018
Source:Archives of Oral Biology, Volume 86
Author(s): Rita Trumpaitė-Vanagienė, Alina Čebatariūnienė, Virginijus Tunaitis, Alina Pūrienė, Augustas Pivoriūnas
ObjectiveTo compare cytotoxicity of extracts derived from commonly used luting cements: Hoffmann's Zinc Phosphate (ZPC), GC Fuji Plus Resin Modified Glass Ionomer (RMGIC) and 3M ESPE RelyX Unicem Resin Cement (RC) on primary human gingival fibroblasts (HGFs).DesignHGFs were exposed to different concentrations of the ZPC, RMGIC and RC extracts. The cytotoxicity was assessed with the PrestoBlue Cell Viability Reagent and viable cells were counted by a haemocytometer using the trypan blue exclusion test. In order to determine the primary mechanism of the cell death induced by extracts from different luting cements, the real-time monitoring of caspase-3/-7 activity and membrane integrity of cells was employed.ResultsThe extracts from the RMGIC and ZPC decreased the metabolic activity and numbers of viable cells. Unexpectedly, the extracts from the RC evoked only small effects on the metabolic activity of HGFs with a decreasing number of viable cells in a dose-and time-dependent manner. The live cell imaging revealed that the apoptosis was the primary mechanism of a cell death induced by the extracts derived from the RMGIC, whereas the extracts from the RC and ZPC induced a cell death through a necrotic and caspase-independent pathway.ConclusionsThe apoptosis was the primary mechanism of the cell death induced by the extracts derived from the RMGIC, whereas the extracts from the RC and ZPC induced a cell death via a necrotic pathway. We suggest that metabolic assays commonly used to assess the cytotoxicity of luting cements should be validated by alternative methods.



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Extensive phenotyping of the orofacial and dental complex in Crouzon syndrome

Publication date: February 2018
Source:Archives of Oral Biology, Volume 86
Author(s): Alexander Khominsky, Robin Yong, Sarbin Ranjitkar, Grant Townsend, Peter J. Anderson
ObjectivesFibroblast growth factor receptor 2 (FGFR2) ^C342Y/+ mutation is a known cause of Crouzon syndrome that is characterised by craniosynostosis and midfacial hypoplasia. Our aim was to conduct extensive phenotyping of the maxillary, mandibular and dental morphology associated with this mutation.Materials and methodsMorphometric data were obtained from 40 mice, representing two genotypes (Crouzon and wild-type) and two sexes (males and females) (n=10 in each group). Dental analysis further categorised the first molars into the two jaws (maxillary and mandibular) (n=20 in each group). Maxillary, mandibular and dental morphology was compared by analysing 23 linear landmark-based dimensions in three-dimensional micro-computed tomography reconstructions.ResultsCompared with wild-type, Crouzon (FGFR2^C342Y/+) maxillae were significantly shorter in maximum height, anterior and posterior lengths and middle width, but larger in posterior width (p<0.05 for height; p<0.001 for other comparisons). In the Crouzon mandible, the ascending and descending heights, effective and mandibular lengths, and intercoronoid and intercondylar widths were significantly shorter, whereas intergonial width was larger (p<0.01 for intercondylar width; p<0.001 for other comparisons). Crouzon teeth were significantly smaller mesiodistally, but larger in crown height (p<0.001 for each comparison). All Crouzon mice presented with bifid mandibular condyles and a quarter presented with expansive bone lesions in the mandibular incisor alveolus.ConclusionsOur findings of hypoplasia in all three planes in Crouzon maxillae and mandibles, together with the presence of bifid mandibular condyles and expansive bone lesions, may be relevant to maxillofacial surgery and orthodontics. Beyond skeletal effects, the FGFR2^C342Y/+ mutation is now implicated in affecting tooth development. This study's skeletal phenomics data also provides baseline data against which the effect of various treatments can now be assessed.



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Is an endoscopic or a microscopic approach optimal for management of attic cholesteatoma?

Dear Editors,

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Comparison of transcanal endoscopic tympanoplasty with sterile acellular dermal allograft to conventional endaural microscopic tympanoplasty with tragal perichondrium

This study aimed to compare the outcome of endoscopic tympanoplasty with sterile acellular dermal allograft (ADA) and conventional endaural microscopic tympanoplasty with tragal perichondrium.

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Is an endoscopic or a microscopic approach optimal for management of attic cholesteatoma?

Dear Editors,

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Comparison of transcanal endoscopic tympanoplasty with sterile acellular dermal allograft to conventional endaural microscopic tympanoplasty with tragal perichondrium

This study aimed to compare the outcome of endoscopic tympanoplasty with sterile acellular dermal allograft (ADA) and conventional endaural microscopic tympanoplasty with tragal perichondrium.

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