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   2016| April-June  | Volume 60 | Issue 2  
    Online since June 23, 2016

 
 
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ORIGINAL ARTICLES
Prevalence and correlates of malnutrition among elderly in an urban area in Coimbatore
Anil Chankaramangalam Mathew, Darsana Das, Saranya Sampath, M Vijayakumar, N Ramakrishnan, SL Ravishankar
April-June 2016, 60(2):112-117
DOI:10.4103/0019-557X.184542  PMID:27350704
Background: Different studies in India have shown that more than 50% of elderly population of India are suffering from malnutrition and more than 90% have less than recommended intake. Objectives: The aim of this study is to estimate the prevalence and correlates of malnutrition among elderly aged 60 years and above in an urban area in Coimbatore using Mini Nutritional Assessment (MNA). Methods: A cross-sectional study was conducted on 154 households and 190 elderly were interviewed. Nutritional status was assessed using the MNA questionnaire. Results: Mean (standard deviation) age of the total population (n = 190) was 71.09 (7.93) years and 30% was male. In this population, 37 (19.47%) was malnourished (MNA <17.0) and 47 (24.73%) were at risk for malnutrition (MNA 17.0-23.5). No significant association was observed between smoking, current alcohol consumption, higher medication use, higher comorbidity, and use of walk aid with malnutrition. Among the social factors studied, lower socioeconomic status compared to higher socioeconomic status (adjusted odds ratio [OR] =5.031, P < 0.001), single/widowed/divorced compared to married (adjusted OR = 3.323, P < 0.05), and no pension compared to those having pension (adjusted OR = 3.239, P < 0.05) were significantly associated with malnutrition. Conclusion: The prevalence of malnutrition observed in the aged people is unacceptably high. The increasing total number of lifestyle, somatic, functional, and social factors was associated with lower MNA scores. The findings of the present study clearly indicate that malnutrition is a multifactorial condition associated with sociodemographic, somatic, and functional status. Hence, we recommend that the treatment of malnutrition should be multifactorial, and the treatment team should be multidisciplinary. Further research is needed to develop appropriate guidelines for nutritional screening and interventional programs among geriatric population.
  7 4,926 1,038
A study on utilization of Janani Suraksha Yojana and its association with institutional delivery in the state of West Bengal, India
Dipta K Mukhopadhyay, Sujishnu Mukhopadhyay, Sarmila Mallik, Susmita Nayak, Asit Kumar Biswas, Akhil Bandhu Biswas
April-June 2016, 60(2):118-123
DOI:10.4103/0019-557X.184543  PMID:27350705
Background: India launched the Janani Suraksha Yojana (JSY) on the principles of conditional cash transfer providing monetary incentive to needy women to improve access to institutional childbirth. Objectives: This study was conducted among JSY-eligible women who delivered between April 2012 and June 2012 to assess the utilization of cash incentives toward institutional delivery, along with other associated factors influencing institutional delivery. Methods: It was a cross-sectional, descriptive study conducted between July 2012 and May 2013 on 946 women selected through stratified random sampling of subcentres from better and worse performing districts of West Bengal. Results: 74.7% of the study population was JSY-eligible. 90.2% of those who took three antenatal check-ups (ANCs) and 36.8% JSY-noneligible women received cash. Government institutions were preferred for childbirth among all groups irrespective of JSY eligibility, receipt of cash, and number of antenatal visits. Overall, 78.8% opted for institutional delivery if they had received cash, which was significantly more than those who did not (64.5%). JSY-eligible women were 1.5 times more likely to deliver in government institutions compared to JSY-noneligible women. With no incentive, the likelihood of institutional delivery was halved. The distance of a 24 Χ 7 delivery hub beyond 5 km (74.8% vs. 81.8%), the religion of Islam (62.7% vs. 83.2%), and multiparity (63.9% vs. 83.6%) were significant deterring factors. Conclusion: Despite some inclusion and exclusion errors, cash incentive under JSY was associated with increased institutional delivery, especially in government institutions though there were other factors influencing the decision as well.
  3 3,167 576
BRIEF RESEARCH ARTICLES
Predictors and outcome of obstetric admissions to intensive care unit: A comparative study
Shruti Jain, Kiran Guleria, Neelam B Vaid, Amita Suneja, Sharmila Ahuja
April-June 2016, 60(2):159-163
DOI:10.4103/0019-557X.184575  PMID:27350713
This descriptive observational study was carried out in Guru Teg Bahadur Hospital to identify predictors and outcome of obstetric admission to Intensive Care Unit (ICU). Ninety consecutive pregnant patients or those up to 42 days of termination of pregnancy admitted to ICU from October 2010 to December 2011 were enrolled as study subjects with selection of a suitable comparison group. Qualitative statistics of both groups were compared using Pearson's Chi-square test and Fisher's exact test. Odds ratio was calculated for significant factors. Low socioeconomic status, duration of complaints more than 12 h, delay at intermediary facility, and peripartum hysterectomy increased probability of admission to ICU. High incidence of obstetric admissions to ICU as compared to other countries stresses on need for separate obstetric ICU. Availability of high dependency unit can decrease preload to ICU by 5%. Patients with hemorrhagic disorders and those undergoing peripartum hysterectomy need more intensive care.
  2 1,588 264
COMMENTARIES
Can Health Technology Assessment (HTA) provide a solution to tackle the increasing health-care expenditure in India?
Amit Dang, BN Vallish
April-June 2016, 60(2):138-141
DOI:10.4103/0019-557X.184570  PMID:27350708
The private health-care system in India is effective but expensive. Due to the absence of a comprehensive and well-penetrated insurance scheme that caters to the majority of the Indian population, most of the private health care consultations are out-of-pocket (OOP), and this is pushing many people to poverty. In this article, we describe the concept of health technology assessment (HTA), and review its possible role in improving the health-care system in India. We additionally comment on its present status and possible role of its implementation in the Indian context.
  2 1,640 290
AUTHORS REPLY
Emotional intelligence and stress in medical students performing surgical tasks
Nitin Joseph
April-June 2016, 60(2):166-166
DOI:10.4103/0019-557X.184577  PMID:27350715
  1 893 177
BRIEF RESEARCH ARTICLES
Association between oral health status and oral health-related quality of life among the prison inmate population of kanda model jail, Shimla, Himachal Pradesh, India
Shailee Fotedar, Atul Chauhan, Vinay Bhardwaj, Kavita Manchanda, Vikas Fotedar
April-June 2016, 60(2):150-153
DOI:10.4103/0019-557X.184573  PMID:27350711
The prison population is a challenging one with many health problems including oral health. In a country such as India, the information regarding the oral health status in prisoners is scant. So, a cross-sectional study was carried out among a 311 prison inmate population of Kanda model jail, Shimla, Himachal Pradesh, India, to assess the dental caries levels, periodontal health status, and oral health-related quality of life (OHRQoL). Dental caries was present among 71.8% of the population and the mean decayed missing and filled teeth index (DMFT) of the population was 5.1 ± 2.1. Calculus was seen among 54.9% of the population. The mean severity score, summed for the 14 items in the scale was 14.57. Dental caries, periodontal disease, the number of missing teeth were significantly associated with OHRQoL. The population had a higher level of oral diseases and one half of the population reported that their oral condition had negatively impacted them in some way, thereby affecting their quality of life.
  1 1,331 230
Methods to enhance capacity of medical teachers for research publications
Neelakandhan Asokan, Kunnukattil S Shaji
April-June 2016, 60(2):154-158
DOI:10.4103/0019-557X.184574  PMID:27350712
In 2009, the Medical Council of India (MCI) made a certain number of research publications mandatory for the promotion to higher posts of medical teachers. Responding to this, there was a series of workshops on research and scientific writing for faculty members of a medical college. We decided to explore the opinions and perceptions of the participants on the need and relevance of such efforts, using qualitative methods such as focus-group discussions (FGDs) and semi-structured interview. The main themes that emerged from the study were as follows: a) presently, there are several hurdles for research and publication; b) recent attempts to upgrade skills of research methodology and scientific writing are encouraging, but need to be sustained; c) the traditional role of clinician - teacher is being replaced with that of clinician-teacher-researcher. Suggestions for future included - a) combined workshops on research methodology and scientific writing skills, b) continuous institutional support system for research and publication, and c) effective mentorship.
  1 1,297 324
EDITORIAL
Attitude and communication module in medical curriculum: Rationality and challenges
Jayasri Mitra, Indranil Saha
April-June 2016, 60(2):95-98
DOI:10.4103/0019-557X.184537  PMID:27350701
  1 7,836 1,112
ORIGINAL ARTICLES
Evaluation of quality of multivariable logistic regression in Indian medical journals using multilevel modeling approach
Rajeev Kumar, Abhaya Indrayan, Pragti Chhabra
April-June 2016, 60(2):99-106
DOI:10.4103/0019-557X.184538  PMID:27350702
Background: Availability of user-friendly statistical software has increased the application of multivariable logistic regression (MLR) in the medical journal many fold. The reporting quality in terms of checking assumptions, model building strategies, proper coding, and report format need proper care and attention to communicate correct and reliable model results. Objective: The objective of this article is to evaluate the quality of MLR article based on 10-point well establish criteria and to study the factors that may influence the quality. Methods: Study included PubMed indexed Indian medical journals as on March 2010 and published at least ten original articles that applied MLR during 10 years was included in the study. Multilevel modeling was applied to assess the role of journal and article attributes on MLR quality. Results: Twelve out of 39 Indian PubMed indexed journals fulfilled the inclusion criterion. Of a total 5599 original articles in these journals, 262 (4.68%) applied MLR in their study. Conformity of linear gradient assumption for continuous covariate was the least fulfilled criterion. One-third of the MLR articles involved statistician or epidemiologist as co-author, and almost same number of MLR articles' first author was from outside India. The trend of 10-point criteria remained consistent although the number of MLR articles increased over the period. The average quality score was 3.78 (95% confidence interval: 2.97-4.60) out of a possible 10. Larger sample size, involvement of statistician as co-author, non-Indian as the first author, and use of SAS/STATA software increased the quality of MLR articles. Conclusions: The quality of MLR articles in Indian medical journals is lagging behind as compared to the quality of MLR articles published from the United States and Europe medical journals. Joint effort of editors, reviewers, and authors are required to improve the quality of MLR in Indian journals so that the reader gets the correct results.
  1 1,498 376
Compliance assessment of cigarette and other tobacco products act in public places of Alwar district of Rajasthan
ML Jain, Mamta Chauhan, Rajani Singh
April-June 2016, 60(2):107-111
DOI:10.4103/0019-557X.184540  PMID:27350703
Background: The Government of India has taken various initiatives for tobacco control by enacting comprehensive tobacco control legislation (Cigarette and Other Tobacco Products Act [COTPA], 2003). Objectives: The aim of this study was to assess the level of compliance of Sections 4, 5, 6-a, and 6-b, and 7, 8, and 9 of COTPA with respect to public places, educational institutes, point of sale (PoS), and warning on packaging (COTPA) in public places of Alwar District of Rajasthan. Methods: A cross-sectional observational study was conducted in 2014 in Alwar city and four blocks of the district. The study was done around 365 public places for observing the compliance of Section 4 of COTPA, 357 educational institutions for observing the compliance of Section 6-b of COTPA, and 357 tobacco retailers for observing the compliance of Sections 5 and 6-a of COTPA. Results: The criteria for the evaluation (the core indicators) and decision criteria for a district to qualify for the "Smoke free" status include six parameters. From the total of 365 places visited, 90% places displayed the "No-smoking" signage and out of total 328 places, 99% were as per the COTPA specification. Alwar city, Ramgarh, Thanagaji, and Alwar rural block followed the compliance of Section 4. The PoS visited Alwar district displayed 93% (332) signage and all the displayed signage followed the COTPA compliance. In Alwar city, Thanagaji, Ramgarh, and Alwar rural block, the compliance of Section 6-a was above 90%. The compliance of Section 6-b was above 90% in Alwar city, Ramgarh, Thanagaji, and Alwar rural block. Ninety-three percent (332) of the PoS did not display tobacco advertisement in Alwar district, which is a positive sign of COTPA compliance. Conclusion: This finding suggest a high level of compliance of Section 4, Section 5, Section 6-a, and Section 6-b of COTPA at Alwar district.
  1 2,255 476
Prevalence of mental retardation in urban and rural populations of the goiter zone in Northwest India
Shailja Sharma, Sunil Kumar Raina, Ashok Kumar Bhardwaj, Sanjeev Chaudhary, Vipasha Kashyap, Vishav Chander
April-June 2016, 60(2):131-137
DOI:10.4103/0019-557X.184545  PMID:27350707
Background: The existence of an endemic goiter belt along the southern slopes of the Himalayas has been known for a long time. Prevalence of neonatal hypothyroidism is high and there has been little work on the prevalence of mental retardation in this part of India. Objective: The study was conducted with the aim to know the prevalence of mental retardation in the urban and rural populations of Himachal Pradesh, India and to generate a hypothesis on the differential distribution (geographical) of mental retardation. Methods: This cross-sectional study was conducted in the rural and urban areas of the district of Kangra, Himachal Pradesh, India among children of 1-10 years of age. In the first phase, the children in the age group of 1-10 years were screened for mental retardation using the Ten Questions Screen, whereas in the second phase the suspects were evaluated clinically. Results: The prevalence of mental retardation was found to be 1.71% in the study population with higher prevalence (3.3%) in the 73-120 months age group. The prevalence was higher among the males in all study populations [rural: 1.9%, urban (nonslum): 1.6%, and urban slum: 7.14%). The prevalence was similar among the urban (nonslum) (1.75%) and rural (1.11%) populations, whereas it was higher (4%) in the urban slum population. A prevalence of 2% was seen in families from the lower middle class and 1.8% among families from the lower class in the rural population, whereas a prevalence of 2% was seen among lower middle class families of urban (nonslum) areas. Conclusion: The prevalence of mental retardation was higher in our study than in other parts of the country. The study concludes with the hypothesis that the prevalence of mental retardation is differentially distributed geographically with socioeconomic factors being important predictors.
  1 4,913 436
BRIEF RESEARCH ARTICLES
Estimates on state-specific Pneumococcal Conjugate Vaccines (PCV) coverage in the private sector in the year 2012: Evidence from PCV utilization data
Habib Hasan Farooqui, Sanjay Zodpey, Maulik Chokshi, Naveen Thacker
April-June 2016, 60(2):145-149
DOI:10.4103/0019-557X.184572  PMID:27350710
The pneumococcal conjugate vaccine (PCV) is not available through universal immunization programs but is available through private healthcare providers. Because the PCV coverage rates are unknown, we developed a Microsoft Excel-based coverage assessment model to estimate state-specific PCV coverage for the year 2012. Our findings suggest that in the private sector, the "overall PCV coverage" was around 0.33% that ranged between a minimum of 0.07% for Assam, India and a maximum of 2.38% for Delhi, India. Further, in major metropolitan areas, overall PCV coverage rates were: 2.28% for Delhi, India, 13.31% for Mumbai (Maharashtra), India 0.76% for Lucknow (Uttar Pradesh), India, 1.93% for Kolkata (West Bengal), India, and 4.92% for Chennai (Tamil Nadu), India highlighting that urban centers are major drivers for PCV utilization driver in the states with high PCV consumption. Hence, to improve PCV coverage, both demand side (increasing consumer awareness about pneumonia prevention) and supply side (controlling vaccine prices and indigenous vaccine production) interventions are required.
  - 1,432 180
COMMENTARIES
Selenium supplementation for the preterm Indian neonate
Geeta Gathwala, Rahul Aggarwal
April-June 2016, 60(2):142-144
DOI:10.4103/0019-557X.184571  PMID:27350709
Deficient antioxidant defenses in preterm infants have been implicated in diseases such as bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, periventricular leukomalacia, and intraventricular hemorrhage. The antioxidant properties of selenium make it important in the nutrition of very low-birth weight (VLBW) infants. Selenium is a component of glutathione peroxidase (GPX), an enzyme that prevents the production of free radicals. Preterm infants have low selenium stores and require supplementation by parenteral and enteral routes. This communiquι reviews the beneficial role that selenium supplementation might play in improving neonatal outcomes.
  - 1,348 210
LETTER TO THE EDITOR
Changes in the health care system of India have effects on management of human immunodeficiency virus infection and acquired immune deficiency syndrome epidemic
Aditya Shivram Nar, Despena Andrioti, Pranav Ganatra
April-June 2016, 60(2):167-168
DOI:10.4103/0019-557X.184578  PMID:27350716
  - 740 105
Comment on assessment and determinants of emotional intelligence and perceived stress among students of a medical college in South India
Jitendra Rohilla, Pinki Tak
April-June 2016, 60(2):164-165
DOI:10.4103/0019-557X.184576  PMID:27350714
  - 849 158
ORIGINAL ARTICLES
Evaluation of integrated Child Development Services program in Gujarat, India for the years 2012 to 2015
Rajesh K Chudasama, Umed V Patel, Amiruddin M Kadri, Arohi Mitra, Dhara Thakkar, Jasmin Oza
April-June 2016, 60(2):124-130
DOI:10.4103/0019-557X.184544  PMID:27350706
Background: The Integrated Child Development Services (ICDS) scheme has been operational for more than three decades in India. Objective: To evaluate the various aspects of the ICDS program in terms of inputs, process and outcome (coverage), utilization, and issues related to the ICDS program. Methods: A total of 130 Anganwadi centers (AWCs) were selected including 95 AWCs from rural areas and 35 AWCs from urban areas from April 2012 to March 2015, from 12 districts of Gujarat and the union territory of Diu. Information was collected for infrastructure, baseline characteristics of AWWs, provision, coverage and utilization of various ICDS services, and various issues related to program operation. Results: A majority of pregnant (94.7%) and lactating (74.4%) mothers, and adolescent girls (86.6%) were availing ICDS services. In 96.9% of the AWCs, a growth chart was available and 92.3% AWWs were using it accurately. A total of 14.9% children were underweight including 13.5% moderately and 1.4% severely malnourished children. Two-third (66.2%) children were covered by supplementary nutrition (SN). Only 14.6% of the AWCs reported 100% preschool education (PSE) coverage among children. More than half (55.4%) of the AWCs reported an interruption in supply during the last 6 months. Various issues were reported by AWWs related to the ICDS. Conclusion: The study has reported gaps in terms of infrastructure facility, different trainings, coverage, supply, and provision of SN, status of PSE activities in AWCs, and provision of different services to the beneficiaries.
  - 5,003 725
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