bluuebunny/crossref_metadata_2025 huggingface dataset:
Barriers and Facilitators to Cervical Cancer Screening, Diagnosis, Follow-Up Care and Treatment: Perspectives of Human Immunodeficiency Virus-Positive Women and Health Care Practitioners in Tanzania
Authors: Bateman Lori Brand , Blakemore Shaundra , Koneru Alaya , Mtesigwa Thereza , McCree Renicha , Lisovicz Nedra F. , Aris Eric A. , Yuma Safina , Mwaiselage Julius D. , Jolly Pauline E.
Published: June 2018

Background

This study was conducted to identify barriers and facilitators to cervical cancer screening, diagnosis, follow-up care, and treatment among human immunodeficiency virus (HIV)-infected women and clinicians and to explore the acceptability of patient navigators in Tanzania.

Materials and Methods

In 2012, we conducted four focus groups, two with HIV-positive women and two with clinicians who perform cervical cancer screening, diagnosis, follow-up care, and treatment. Transcriptions were analyzed using thematic analysis.

Results

Findings from the patient focus groups indicate the prevalence of fear and stigma surrounding cervical cancer as well as a lack of information and access to screening and treatment. The clinician focus groups identified numerous barriers to screening, diagnosis, follow-up care, and treatment. Participants in both types of groups agreed that a patient navigation program would be an effective way to help women navigate across the cancer continuum of care including screening, diagnosis, follow-up care, and treatment.

Conclusion

Given the fear, stigma, misinformation, and lack of resources surrounding cervical cancer, it is not surprising that patient navigation would be welcomed by patients and providers.

Implications for Practice

This article identifies specific barriers to cervical cancer screening and treatment from the perspectives of both clinicians and patients in Tanzania and describes the acceptability of the concept of patient navigation.
Influence of calcium content on structure and strength of MSWI bottom ash-based geopolymer
Authors: Huang Guodong , Ji Yongsheng , Zhang Linglei , Hou Zhihui , Zhang Li , Wu Shourong
Published: June 2018

This study explored the strength limitations of municipal solid waste incineration (MSWI) bottom ash-based geopolymer, which can limit its use in building materials. The calcium content in MSWI bottom ash was increased by the addition of varying amounts of granulated blast furnace slag (GBFS) and calcium-containing chemicals. The results showed that the low calcium content of MSWI bottom ash in geopolymer was the main cause of insufficient polymerisation. Both GBFS and calcium-containing chemicals improved geopolymer microstructure and enhanced the degree of polymerisation, which clearly improved the compressive strength. However, further increases in geopolymer compressive strength were not significant when the GBFS content was greater than 40%, and the compressive strength decreased sharply when hydrated Ca(OH)2content was greater than 5%.
Geospatial and temporal data mining to combine railway low adhesion and rail defect data
Authors: Arnall Andrew D. , Fletcher David I. , Lewis Roger
Published: June 2018

Rolling contact fatigue (RCF) damage to rails and low adhesion at the rail–wheel interface remain significant problems in maintaining railway performance, fully utilising network capacity and reducing running costs. A novel approach has been developed to understand these problems through analysis of data on RCF and low-adhesion incidents from the UK rail network. This augments understanding of specific mechanisms such as the roles of rail plasticity in crack initiation and environmental moisture levels in low adhesion, which have not given sufficient information to prevent these problems to date. A moving-window filtering technique and temporal and geospatial approaches were used to identify correlations between sites of low rail–wheel adhesion subject to transient sliding contact, crack initiation and underbridge locations where vertical and lateral track stiffness typically change rapidly. The analysis showed that a high density of otherwise unexpected RCF defects occurred close to underbridges and that there was a strong correlation between momentary slides during braking and RCF sites. The temporal analysis indicated that, although concentrated in the autumn period, 55–60% of transient low-adhesion incidents occur outside that period, with the highest risk in the very early morning.
Nothing is Certain Except Death and Taxes: The Lack of Policy Uncertainty from Expiring "Temporary" Taxes
Authors: Chang Andrew C.
Published: June 2018

What is the policy uncertainty surrounding expiring taxes? How uncertain are the approvals of routine extensions of temporary tax policies? To answer these questions, I use event studies to measure cumulative abnormal returns (CARs) for firms that claimed the U.S. research and development (R&D) tax credit from 1996-2015. In 1996, the U.S. R&D tax credit was statutorily temporary but was routinely extended ten times until 2015, when it was made permanent. I take the event dates as both when these ten extensions of the R&D tax credit were introduced into committee and when the extensions were signed by the U.S. president into law. On average, I find no statistically significant CARs on these dates, which suggests that the market anticipated these extensions to become law. My results support the fact that a routine extension of a temporary tax policy is not a generator of policy uncertainty and, therefore, that a routine extension of temporary tax policy is not a fiscal shock.
Hayvan Odaklı Turizm Faaliyetlerine Meta Eleştirel Bakış: Türkiye Örneği
Authors: DİLEK Emre , GÜNLÜ KÜÇÜKALTAN Ebru
Published: June 2018

Çalışmanın konusu, turizm sektöründe hayvanların metalaştırıldığı alanları ortaya koyarak, eleştirel bir tahlil yapmaktadır. Bu bağlamda çalışmanın amacı, turizmin hayvanlara yönelik ahlaki sorumluluğunu tartışmaya açarak, öneriler geliştirmektir. Bu tür bir çalışma, Türkiye’de turizm yazınında bulunmamakta olup, bu yönüyle ilk olma özelliğini taşımaktadır. Çalışmada, turizmin hem arz hem de talep boyutunda hayvanlara yönelik nasıl bir ahlaki sorumluluğa sahip olması gerektiği üzerinde bir tartışma yürütülmektedir. Türkiye’de yer alan toplam 23 hayvan odaklı turizm işletmesinin tamamına ulaşılmış ancak 17’sinin yöneticileri ile yarı yapılandırılmış görüşme formu aracılığıyla yüz yüze görüşmeler gerçekleştirilmiştir. Söz konusu işletmelere gelen ziyaretçiler ise kolayda örneklem yöntemi ile seçilmiş olup katılımcılara uygulanan anketlerden toplam 406 adet geri dönüş sağlanmış ve 388’i analize dâhil edilmiştir. Yüz yüze görüşmeler yoluyla elde edilen veriler betimsel analiz ile anket yoluyla elde edilen veriler ise betimleyici istatistik ve yapısal eşitlik modeli (YEM) ile analiz edilmiş ve sonuçları değerlendirilmiştir. Analizler neticesinde hayvan odaklı turizm işletmelerini ziyaret edenlerin demografik özellikleri, verdikleri yanıtların YEM aracılığıyla oluşturulan modellemesi ile işletme yöneticilerinin hayvanların metalaştırılmasına ilişkin verdikleri yanıtlar karşılaştırmalı olarak ele alınmıştır. Ziyaretçiler kendilerini daha çok ekosentrik olarak ifade etseler de hayvan odaklı çekiciliklere katılım amaçlarını “doğa turizmine bir alternatif”, “eğitim aracı” ve “aile odaklı deneyim” şeklinde belirterek antroposentrik bir duruş ortaya koymaktadırlar. İşletme yöneticilerinin verdikleri yanıtlar ise (1) mevcut durum, (2) etik durum, (3) dış çevre ana temaları altında toplanmış olup, genel olarak hayvanlara yönelik ahlaki ve yasal sorumluluktan uzak oldukları sonucuna varılmıştır. Bu yönüyle hem arz hem de talep boyutunda, hayvanların turizm sektörü içinde ahlaki statüden uzak birer meta olarak var oldukları çıkarımı yapılmıştır.
Destinasyon Deneyimi Bileşenleri: Antalya ve İstanbul Destinasyonları Üzerinde Karşılaştırmalı Bir Araştırma
Authors: ŞAHİN İlker , GÜZEL F. Özlem
Published: June 2018

Destinasyon DNA’larının yapı taşlarını oluşturan ve birbiriyle bağlantılı bütünsel bir yapı haline gelen, mimari, gastronomi, altyapı gibi çeşitli destinasyon deneyimi bileşenleri, turistlerin davranışlarını ve tatil boyunca edindikleri tecrübeleri etkileyebilmektedir. Bu bağlamda destinasyonların deneyimsel bileşenleri konusunda destinasyon yöneticileri ve turizm paydaşları arasında farkındalık yaratarak farklı bakış açıları geliştirmek büyük önem arz etmektedir. Bu araştırmanın temel amacı; (a) destinasyon deneyimini bileşenlerini sahil ve kültür destinasyonları üzerinde karşılaştırmalı ortaya koymak ve (b) bu deneyim bileşenlerine yönelik milliyetler bazında farklılıkları değerlendirmektir. İstanbul ve Antalya destinasyonlarında gerçekleştirilen bu çalışma kapsamında, veri toplama aracı olarak anket tekniğinden faydalanılmıştır. Toplam 1281 yabancı turistin katılımcı olarak yer aldığı araştırmada elde edilen bulgulara göre, destinasyon deneyimi bileşenleri olarak; yerel kültür, aktiviteler, misafirperverlik, altyapı, yenilik fırsatları, hizmet kalitesi, üstyapı estetiği, gastronomi, ulaşılabilirlik, fiziki coğrafya, ekonomik değer ve duygular boyutları ortaya çıkmıştır. Bu boyutlardan fiziki coğrafya boyutu İstanbul’da, ulaşım boyutu ise Antalya’da faktörleşmemiştir. İstanbul’un altyapı, hizmet kalitesi ve ulaşım özellikleri, Antalya’nın ise duygular ve ekonomik değer özellikleri konularında Alman turistlere ilişkin algıların İngiliz ve Ruslara göre daha negatif yönlü olduğunu ortaya çıkarmıştır.
High quality DNA extraction from Sycon capricorn for MinION long read sequencing v1
Authors: Vaughn Erin
Published: June 2018

Long-read sequencing (e.g. Nanopore's MinION or PacBio) has the potential to dramatically improve genome assembly but the quality of the reads is critically dependent upon the quality of the input gDNA. Here I describe the extraction of high molecular weight DNA from the calcareous sponge, Sycon capricorn. I choose to use Qiagen RLT buffer in the initial lysis step as this solution results in higher molecular weight DNA compared to alternatives. I suspect that RLT is deactivating endogenous DNases that would otherwise digest the gDNA.
Doğum Ağrısı ve Bazı Psikiyatrik Özellikler Arasındaki İlişki
Authors: ÖZSOY Filiz , YILDIZ Mesut , GÜLÜCÜ Selim , KULU Müberra
Published: June 2018

Amaç:
Doğum ağrısının algılanmasında ve ağrıya verilen cevapta etkili
olan pek çok faktör vardır. Bunlar arasında; prenatal eğitim, kültür, annenin
kaygı düzeyi ve kişilik yapısı sayılabilir. Biz bu çalışmada; normal
doğum yapacak kadınların hissettikleri ağrı düzeyi ile kişilik yapıları ve
anksiyete düzeyleri arasındaki ilişkiyi araştırmayı amaçladık.

Gereç
ve Yöntemler: Çalışmaya normal
doğum ile doğum yapması planlanan, doğum eylemi başlayıp doğumhaneye yatırılan
101 hamile bayan dahil edildi. Hastalara Sosyodemografik ve Klinik Veri Formu,
Vizüel Ağrı Skalası (VAS), Anksiyete Duyarlılığı İndeksi-3 (ADİ-3), Leiden
Depresyona Duyarlılık İndeksi (LDDİ) ve Türkçe Büyük beşli ölçeği uygulandı.

Bulgular: Çalışmamızda VAS ile diğer
hiçbir ölçek arasında anlamlı ilişki saptanmadı (P>0,05). ADİ-3 toplam puanı
ile Türkçe büyük beşli ölçeği dışa dönüklük (r=0,228) ve açıklık alt boyutları
(r=0,201) arasında zayıf bir ilişki saptandı (P<0,05). Türkçe büyük beşli
ölçeği dışa dönüklük alt boyutu ile ADİ-3 bilişsel (r=0,210) ve fiziksel
(r=0,225) alt boyutları arasında da yine zayıf bir ilişki saptandı (P<0,05)

Sonuç: Doğum eyleminde hissedilen
ağrının boyutu pek çok faktöre bağlıdır. Biz çalışmamızda; doğum ağrısı ile kişilik özellikleri, anksiyete düzeyleri
ve depresyon ölçeği parametreleri arasında herhangi bir anlamlı ilişki
saptamadık. Fakat doğum ağrısı ve kişilik özellikleri arasındaki ilişkiyi
ortaya koyabilmek için daha fazla sayıda ve daha büyük örneklem
gruplarında yapılacak çalışmaya
gereksinim vardır.
¿Qué significa integrarse en una sociedad liberal? La integración social vista desde el prisma de la discapacidad
Authors: Merklen Denis
Published: June 2018

¿Cómo abordar el tema de la discapacidad desde el ángulo de la integración social? ¿En qué medida el problema de la discapacidad permite desplegar nuevos interrogantes sobre la problemática de la integración social? En este artículo intentaremos articular esas dos preguntas con el propósito de ubicar el problema que nos ocupa en una coyuntura precisa. En el marco de sociedades liberales, que sitúan al individuo en el centro de lo social, tanto las regulaciones y las protecciones sociales como las relaciones del trabajo pasan a un segundo plano. ¿Pero qué ocurre con el individuo discapacitado? ¿Qué lugar ocupan aquellos sujetos a quienes se les reconoce una forma de invalidez en la economía de la integración social de nuestras democracias liberales? ¿Y qué nos dice el lugar que se reserva a estos individuos en las formaciones sociales contemporáneas a propósito del régimen general de la integración social?  Proponemos una “comparación en la historia”, siguiendo las recomendaciones de Robert Castel. Prestaremos una atención particular al tipo de política social que se promueve hoy en relación con el rol que se les atribuyó en el pasado.
Discapacidad intelectual y violencia de género: un análisis transnacional
Authors: Morcillo Martínez Juana María , Pérez Villar Juana
Published: June 2018

Dentro de los múltiples factores que pueden originar situaciones de discriminación, la discapacidad se configura como un factor importante a tener en cuenta, problema que se ve agravado en función de los  factores discriminatorios añadidos que puedan ir sumándosele.  De este modo, si a dificultades intrínsecas que afrontan las personas con discapacidad le unimos la cuestión de  género, nos encontramos con que las  mujeres con discapacidad sufren una doble discriminación que las situará en una posición desigual con respecto a la población en general y  hombres con discapacidad en particular. Por otro lado, la violencia de género, entendida como la manifestación de las relaciones sociales, económicas y culturales, que históricamente se han mantenido de forma desigual entre mujeres y hombres, se convierte por tanto, en un fenómeno de enorme calado que afecta, no sólo a la integridad física de las mujeres, sino al reconocimiento de su dignidad, donde se socava el principio básico de igualdad entre hombres y mujeres consagradas en la Constitución española. Por ello, el objetivo fundamental de este trabajo es analizar desde una perspectiva de género la situación actual de la mujer con discapacidad intelectual que sufre violencia de género, tanto españolas como de otras nacionalidades, poniendo de manifiesto que la característica más notable a destacar, es su sustentación en las desigualdades de género.
REASONABLE ACCOMMODATION BASED ON RELIGIOUS BELIEFS OR PRACTICES. A COMPARATIVE PERSPECTIVE BETWEEN THE AMERICAN, CANADIAN AND EUROPEAN APPROACHES
Authors: Pérez de la Fuente Oscar
Published: June 2018

In certain situations, religious minority members ask for an exception to general rules because they could be discriminatory for this collective. These exceptions are called reasonable accomodations and have been recognised in different legal systems, but always conditioned not to the presence of certain circumstances (costs, safety, third-party rights, etc.). In this article, the regulations and case law on reasonable accommodation in Canada, United States and Europe are analysed.
Authoritarian Norms in a Changing International System
Authors: Ambrosio Thomas
Published: June 2018

The normative structure of the international system is changing, driven by the logics of effectiveness and appropriateness. Whereas the balance between democracy and autocracy had clearly favored the former, this appears to no longer be the case. Not only are authoritarian methods spreading because they have been found to be successful, but democracy’s very legitimacy has been eroded from self-doubt and as a consequence of rising and increasingly confident authoritarian great powers. This commentary provides an overview of these trends.
Current methods of patellar instability imaging in children. Selection of the best treatment approach
Authors: Sautenko Alexander A. , Ogarev Egor V. , Eltsin Alexander G. , Merkulov Vladimir N. , Mininkov Dmitry S.
Published: June 2018

Background. Patellar instability is a common problem in pediatric patients. Up to 2%–3% of all knee injuries are associated with acute patellar dislocation. According to the data in the literature, patients aged 10–17 years are at the highest risk of patellar dislocation and subsequent instability. These patients must be evaluated according to the proposed algorithm to select the optimal treatment method.
Aim. To diagnose patellar instability in children and subsequently select the optimal treatment method based on acquired data.
Materials and methods. The study is based on data acquired through the examination and treatment of 147 patients at the 9th Department of Pediatric Traumatology and Orthopedics. Great emphasis was put on computed tomography (CT) data, its essential parameters, which require the most thorough analysis, and assessment methods. These parameters include patellar tilt, dysplasia of the distal metaepiphysis of the femur, the tibial tubercle–trochlear groove index, and the rotational relation of the femur and tibia.
Results. A novel algorithm for patient examination using CT is proposed. Data obtained by multislice CT (MSCT) had a significant influence on the selection of the surgical method for treating patients with patellar instability.
Conclusion. The examination of patients with patellar instability using MSCT in adherence to the proposed diagnostic algorithm allows the selection of the optimal treatment method, which will increase the likelihood of rapid recovery of patients and their return to the level of activity similar to that before injury.
Restoration of elbow active flexion via latissimus dorsii transfer in patients with arthrogryposis
Authors: Agranovich Olga E. , Kochenova Evgeniya A. , Trofimova Svetlana I. , Petrova Ekaterina V. , Buklaev Dmitriy S.
Published: June 2018

Background. Severe hypoplasia (or aplasia) of the biceps brachii is a primary cause of restriction in activities of daily living in patients with arthrogryposis.
Aim. To estimate the possibility of restoring elbow active flexion via a latissimus dorsii transfer in patients with arthrogryposis.
Materials and methods. From 2011 to 2018, we restored active flexion of the elbow via a latissimus dorsi transfer to the biceps brachii in 30 patients with arthrogryposis (44 upper limbs). We used different regimes including clinical examinations, EMG donor and recipient sites, and CT of the chest wall and shoulder.
Results. The mean age of the patients was 4.0 ± 2.4 years, and the follow-up period was 3.2 ± 1.9 months. Follow-up results were available for 26 patients (30 upper limbs). The active postoperative elbow motion was 90.5 ± 14.9°. Elbow extension limitation occurred in 51% of cases (12.8 ± 4.3°) without any problems in activities of daily living. In total, 55.6% of patients had good results, 33.3% had satisfactory results, and 11.1% had poor results.
Discussion. Our latissimus dorsi transfer results were comparable with those of other authors. Transposition of the latissimus dorsi to the biceps brachii restores sufficient flexion of the elbow without severe elbow flexion contractures.
Conclusions. We suggest pedicle monopolar latissimus dorsi transfer as a reliable therapeutic option to restore active elbow flexion in patients with arthrogryposis having passive elbow flexion of 90° or higher before operation and donor muscle strain grade 4 or higher.
Drug utilization pattern in orthopaedic outpatient department of a tertiary care hospital in Kerala: a geriatric perspective
Authors: K. Sini , Basheer Mohammed , Iqbal Daud Shaikh Ubedulla Shaikh , Krishnan Divya G.
Published: June 2018

Background: Geriatric population due to the age related changes in pharmacokinetics and pharmacodynamics and the presence of comorbidities is vulnerable to drug interactions, adverse effects and high cost of therapy. This necessitates a periodic review of DU pattern in the geriatric population to ensure safe and effective treatment for them. The present study was undertaken to evaluate the DU pattern for medical conditions among the geriatric population in the Orthopaedic outpatient department (OPD) of a tertiary care hospital in Kerala.Methods: In this cross sectional observational study conducted in the Orthopaedics OPD of a tertiary care hospital, prescriptions were collected from patients attending the Orthopaedics OPD randomly over a period of 6 months. Out of these, prescriptions of male and female patients of age more than 60 years were sorted and analysed using World Health Organization drug prescribing indicators as well as additional parameters and the data was presented in the form of frequency and percentages using tables and charts.Results: A total of 800 prescriptions were collected and studied of which 76 (9.5%) belonged to patients from the geriatric population. Majority of the patients were in the age group of 61-70years (52.63%). Spondylosis (42.10%) was the most common indication for patients attending Orthopaedics OPD. Average number of drugs per prescription was 3.05 with a range between 1 and 5. Only 5.17% drugs were prescribed using generic name. Utilization from the essential drug list was 39.65%. The percentage of encounters in which an antibiotic and injection prescribed was 0% and 10.34% respectively. Of the total drugs prescribed 35% were FDCs. The most routinely prescribed drugs among the various classes were NSAIDs 34% followed by gastroprotectives (25%). The assessment of prescriptions with regard to completion and legibility was satisfactory.Conclusions: Current study pointed out deficiencies like polypharmacy, low prescribing of drugs by generic names, low prescribing of drugs from the essential drug list and higher use of FDCs. Use of antibiotics and injections was satisfactory and acceptable. Legibility and completion of prescription format was largely satisfactory. Proper strategies to rectify these deficiencies can ensure safe and effective treatment for geriatric patients.
Spectrum of adverse drug reactions and implicated drugs in a tertiary care centre: a prospective study
Authors: K. Kabilan , V. Sathyanarayanan , Rani R. Jammuna
Published: June 2018

Background: Adverse Drug Reaction(ADR) is the major limitation in providing health care to patients at a global level. It affects patient’s recovery and is an important cause of mortality and morbidity in both hospitalized and ambulatory patients. ADR can occur with any class of drugs. Early detection and evaluation of ADR is essential to reduce harm to the patients. Thus, the present study was aimed to estimate the number of ADR’s reported, analyze its spectrum and the drugs attributed to it.Methods: This was a prospective study conducted in a tertiary care teaching hospital for a period of 3 months from March 2016 to May 2016 in SRM Medical College and Hospital, Potheri. Adverse drug reactions were collected by spontaneous reporting by active and passive methods. The causality assessment of the reported ADR’s was done using Naranjo causality assessment scale.Results: A total of 38 ADR’s were reported during the study period with male predominance (58%). Most of the ADR’s (42%) were common in patients in the age group 19-39 years. More number of ADR’s were from Medicine (29%) followed by Surgery (16%) and OG (16%) departments. Most commonly affected organ systems were skin (45%) followed by GIT (24%). The drugs mostly accounted were antibiotics (55%) especially Cephalosporins (33%). Most of the reactions were type A (68%) rather than type B (32%) and thus predictable. According to Naranjo’s causality assessment, 63% of reactions were probable, 26% were possible and 11% were definite. No reactions were unlikely. Severity assessment by Modified Hartwig and Seigel scale revealed 45% ADRs to be moderate, 42% were mild and 13% were severe and life threatening.Conclusions: The study concluded that Adverse Drug Reactions are common and some of them resulted in increased healthcare cost due to need of some interventions and increased length of hospital stay. As majority of ADR is predictable (Type A), so preventable. The health system should promote the spontaneous reporting of Adverse Drug Reactions (May be done mandatory). The proper documentation and periodic reporting to regional pharmacovigilance centres to ensure drug safety.
The comparisons of the efficacy of two fixed dose combinations, i.e. Salmeterol and Fluticasone vs. Formoterol and Tiotropium bromide in moderate to severe COPD patients
Authors: B. Dharmaraj , G. Prashanth , S. Basavaraj
Published: June 2018

Background: Bronchodilators are essential for symptomatic management of all stages of chronic obstructive pulmonary disease (COPD). For patients whose COPD is not sufficiently controlled by monotherapy, combining a ß2-agonist with either inhaled steroid or anticholinergic drug is a convenient way of delivering treatment. Currently, there is no documentation to say that one drug is superior to other or the contrary, but a combination of two drugs is more effective than giving single drug alone in patients suffering from COPD.Methods: The study was prospective, open labelled, randomized, comparative interventional clinical study conducted by the Departments of Pharmacology and Medicine, Basaveshwara Medical College and Hospital, Chitradurga in 60 moderates to severe COPD patients.Results: Both the treatments i.e. Salmeterol/Fluticasone and Tiotropium/Formoterol were equally effective as far as the improvement of the lung functions and Borg dyspnoea score are concerned. The difference in improvement with the combination of Salmeterol/Fluticasone was not statistically significant (p>0.05) compared to the combination of Tiotropium/Formoterol. However, Salmeterol/Fluticasone was found to be better than Tiotropium/Formoterol in improving the lung function of moderate to severe COPD patients.Conclusions: Salmeterol/Fluticasone is efficacious and better than Tiotropium /Formoterol combination for maintenance therapy in moderate to severe COPD patients.
Educational stress and coping strategies in school going adolescents
Authors: Kaushal Yashovardhan , Koreti Sunita , Gaur Ajay
Published: June 2018

Background: Academic pressure are one of the main causes of stress for young people and this stress is a significant catalyst and precursor to depression. This research uses to assist the teaching units in understanding the related problems of stress of students of modern teaching technology, thereby proceeding to provide assistance and preventive measures. Current study was aimed to find out prevalence of educational stress among school going adolescents and associated factors. In addition to study the use of stress coping strategies.Methods: It was Cross-sectional study carried out during 2016-2017 at Government and Private Schools of Gwalior. 1400 students were selected randomly. Prepared questionnaire in Hindi and English language adapted from. Educational Stress Scale for Adolescent (ESSA) and Academic Stress Scale (ASC). Scales are modified according to our settings.Results: We found that 43% children have minimal stress, 56.6% moderate stress, 0.4% have highly stress. Female adolescents have more stress than male. 63% adolescents of government school have moderate stress as compared to private school which has 50.9% moderate stress. 11th and 12th standard students have more stress than 9th and 10th standard which is highly significant (p value <0.01). 20.4% adolescents use occasionally coping and 55.3% adolescents used sometimes coping and 23.5% used frequently coping strategies.Conclusions: The present study reveals that the school going adolescents are having educational stress and which is affected by age, gender, socioeconomic status, examinations, parents expectation and peer and also found that adolescents uses different coping strategies to cope up with educational stress.
Bacterial contamination of nasogastric feeding tube and development of neonatal sepsis in premature newborns: a prospective observational research at a tertiary care center in Gujarat, India
Authors: Thaddanee Rekha , Morbiwala Shamim , Chauhan Hasmukh , Gusani Jigar , Dalal Parima
Published: June 2018

Background: The objective of the present study is to observe the effect of frequency of changing nasogastric feeding tube (NG-FT) on microbial growth in relation to development of neonatal sepsis in premature newborns. The study is prospective observational study in its nature. Neonatal intensive care unit (NICU) of a tertiary care teaching hospital of western Gujarat, India, from December 2016 to November 2017.Methods: Eighty-five preterm newborns admitted to NICU for feeding support were randomly divided into three groups depending on frequency of changing nasogastric feeding tubes (Group I, II and III with NG-FT changed every 12, 24 and 48 hourly respectively). In Groups I, II and III, the first NG-FT cultures were sent at the end of 12, 24, 48 hours of NG-FT insertion respectively. The second and third NG-FT cultures were sent after 7 and 14 days respectively. Microbial growth pattern was observed and correlated with development of necrotizing enterocolitis (NEC), neonatal sepsis and mortality.Results: Microbial growth on first NG-FT culture significantly increased when frequency of changing nasogastric feeding tube was reduced from every 12 to 24 or 48 hours {p = 0.0432 (Group I vs II) and 0.0001 (Group I vs III)}. Microbial growth increased on second (24.1%, 87% and 85% in groups I, II and III respectively) and third NG-FT culture (44% in group I and 100% in groups II and III); this was significantly high in group II and III as compared to group I (p = 0.0001). Common organisms isolated were Klebsiella pneumonia (63.28%), Pseudomonas aeruginosa (32%) and Escherichia coli (21%). No significant difference was noted in incidences of feeding intolerance, necrotizing enterocolitis (NEC), neonatal sepsis and mortality among the three groups.Conclusions: Organism growth in nasogastric feeding tube culture increases significantly when frequency of changing NG-FT is beyond 12 hours. However, there is no increase in episodes of feeding intolerance, necrotizing enterocolitis (NEC), neonatal sepsis and mortality.
Time of initiation of breastfeeding in various modes of delivery and to observe the effect of low birth weight and period of gestation on initiation of breastfeeding
Authors: Badaya Navneet , Jain Sanjiv , Kumar Nayan
Published: June 2018

Background: There are certain factors influencing early initiation of breastfeeding, most of them can be corrected by paying little attention and by making certain strategies for the other factors. Study the difference between the time of initiation of breastfeeding in vaginally delivered and caesarean born deliveries, evaluate the effect of low birth weight and period of gestation on initiation of breastfeeding and to promote and encourage the breastfeeding.Methods: This observational prospective study was conducted on 500 newborns delivered at Department of RMC, Ajmer and outborn section of Department of Pediatrics, JLN MC, Ajmer. The study group was divided two groups, group- I 250 newborn delivered vaginally and group-II 250 newborn delivered by caesarean section.Results: Among birth weight >2500gm, in 146 (41.83%) cases breastfeeding was started in 0-1 hr, in 172 (49.28%) cases in 1-4 hours. Thus 91.11% initiated breastfeeding in first 8 hours (p value <0.00002), showing early initiation of breastfeeding in >2500g newborn. Among term babies, out of 398 (79.6%) babies with period of gestation 37-41 weeks, in 162 (40.70%) cases breastfeeding was initiated in 0-1 hour, in 185 (46.48%) cases in 1-4hr (p value <0.0391). Thus, 347(81.18%) initiated breastfeeding in first 8 hours.Conclusions: Term gestation is positively associated while low birth weight and prematurity of baby has negative impact on early initiation of breastfeeding.
One-year prospective study of pediatric cutaneous leishmaniasis: a neglected tropical disease in sub Himalayan region, India
Authors: Kumar Pancham , Garg Ashok , Kumari Sandhya , Negi Ajeet , Tegta G. R.
Published: June 2018

Background: Satluj Valley of Himachal Pradesh is a newly identified focus of Cutaneous Leishmaniasis (CL) and here disease is still in emerging phase. Although children are most commonly affected victims by CL but till date no such study has been done on childhood CL in this region.Methods: All newly diagnosed cases of CL were registered and detailed clinico-epidemiological parameters of children between 0-18 years were recorded. Imprint smears for LD bodies and biopsies for histopathology were done in atypical cases to confirm clinical diagnosis.Results: Over a period of one year 337 cases of CL were registered, out of them 115 children (0-18 years) were enrolled for this study. School going (6-18 years) population was predominantly affected age group. Males outnumbered the females with a ratio of 1.88. Face was most commonly affected site and most (65.21%) cases presented with single lesion. Nodules (40.87%), plaques (24.35%) and papules (7.39%) were commonly observed morphologies although mixed patterns and atypical forms were also found. Most (62.60%) cases presented within 1-3 months of lesion onset. All cases responded well to treatment with antimonials. Lesional pain, swelling, bleeding, pigmentation and scarring were minor post treatment side effects.Conclusions: Pediatric CL is an emerging infection along the Satluj valley of Himachal Pradesh (HP). Although clinical diagnosis is simple, and all cases respond well to antimonials. But, availability of diagnostic tests is essential to diagnose atypical cases. Further annual record keeping, and reporting is recommended to know the exact disease burden so as to promote the effective treatment and preventive measures.
Clinical profile and outcome of diphtheria in central India: a retrospective observational study
Authors: Meshram Rajkumar M. , Patil Ashwini
Published: June 2018

Background: Although, diphtheria is eliminated by many developed countries by effective immunization, still diphtheria   continues to be endemic in India and leading cause of morbidity and mortality, especially in areas in the border of the two states. The objective of the present study was to recognize the clinical profile, morbidity and mortality pattern of diphtheria and to study their immunization status as a retrospective observational study performed in pediatric wards and paediatric intensive care unit.Methods: The medical records were recovered from the case files, searching for cases diagnosed as diphtheria from the Medical Record Section and Statistical Service of the institute.  A pre-established protocol was formed after approval from institutional ethical committee. Case study   included suspected, probable and confirmed cases of diphtheria as per the WHO definition guidelines. All the relevant data and information regarding age, gender, residence, socioeconomic status, immunization status, clinical details, laboratory investigation, complications, and treatment provided, and outcome were recorded.Results: Amongst 47 patients, 55.32% were >5years and mean age was 6.46±3.08 years with no difference in sex distribution.  2(4.25%) patients were completely immunized, 27(57.45%) were partially immunized and 18(38.30%) were not immunized. An immunization rate was less in females as compared to males. All patients presented with fever and membrane in throat followed by throat pain 95.74%, enlarged/congested tonsils 80.85%, respiratory difficulty 68.08%, dysphagia 59.57% bull neck 48.94% and voice change 36.17%. Myocarditis was the commonest (42.55%) complication followed by palatal palsy (14.89%), polyneuropathy (8.51%), acute renal failure (4.25%) and DIC & shock (4.25%) were observed. Case fatality rate was 21.28%. Maximum numbers of cases were noted during the rainy season.Conclusions: Shifting of occurrence of diphtheria in the age group of 5-15 years suggest the need to improve and strengthen the immunization activity specially booster doses in the border districts as most of the cases were from areas at the border of two states.
Case reports of a typical extrafollicular adenomatoid odontogenic tumor of maxilla
Authors: Kumar Annem Sudarshan , Sameera Ayesha , Reddy Sridhar Erugula , Roja Karri Lakshmi , Nelakurthi Hasini , Haritha Pothuraju
Published: June 2018

Adenomatoid odontogenic tumor is a rare benign odontogenic tumor comprising of 3% to 7% of all Odontogenic tumors. It is usually asymptomatic, well circumscribed, slow growing tumor associated often with impacted canine and discovered on routine radiographs. Microscopically this lesion shows a variety of patterns forming sheets, strands, nest or rosette-like structures with ductal pattern with central space surrounded by single layer of cuboidal to columnar epithelial cells with a rim of eosinophilic coagulum which is the characteristic feature of these tumors. In this article we present two extrafollicular cases of this rare tumor occurring in a male and a female patient in the maxillary anterior region with both symptomatic and asymptomatic presentation. Both the tumors were not associated with any impacted tooth. Adenomatiod Odontogenic tumor was confirmed based on histopathology.
Cutis vertices gyrate: a case report
Authors: Narang Gursharn Singh , Jasleen Jasleen , Kaur Jaskeen , Kaur Tanreet
Published: June 2018

Cutis verticis gyrata is a rare condition characterized by excessive growth of skin of the scalp, resulting in furrows and folds similar to gyri of the cortex of brain. It can be classified into two forms: primary (essential and non-essential) and secondary. We report a case of 18-year-old male patient with primary essential cutis verticis gyrata with rugosities over forehead and scalp and coarse facial features.
Moyamoya disease: a case report
Authors: Sehgal Parul , Wasim Sanober
Published: June 2018

Moyamoya disease is a chronic, progressive occlusion of the circle of Willis arteries that leads to the development of characteristic collateral vessels seen on cerebral angiography. The appearance of these small, multiple vessels at the base of the brain resembles “puff of smoke”. The disease may develop in children and adults, but the clinical features differ. Children are likely to suffer with ischemic or haemorrhagic stroke. In the present report, authors describe a 7-year-old female with history of recurrent stroke apraxia and atrophy of left side with facial nerve palsy and was later on diagnosed with Moyamoya disease at HIMS Dehradun. Conclusion: Child with Moyamoya disease presents with recurrent episodes of sudden hemiplegia that might occur on alternate sides. The disease is progressive and dynamic in children.  MRA clinches the diagnosis and neurosurgical intervention may be required as a part of definitive management.
A cross sectional study to evaluate the prevalence of cardiovascular risk factors among college students aged 18-25 years in and around Calicut
Authors: Premlal K. S. , Bhanushali Vasantkumar V. , Nagalingam Saranya
Published: June 2018

Background: Cardiovascular disease (CVD) has a major impact on both developed and developing nations as it has become as a leading cause of death all over the World. In recent years an increasingly robust body of epidemiological evidence has highlighted the proliferation of CVD risk factors worldwide. The westernization of dietary habits, decreased levels of physical activity, increased childhood obesity and increased tobacco consumption accelerated by industrialization, globalization now threaten once low risk regions. The project aims to establish the need for screening, risk assessment, education and management in young adults. Objective of the study was to assess the risk behaviours in relation to smoking habits, alcohol use, sexual promiscuity among college going youth populace in southern part of Calicut.Methods: A cross-sectional study was conducted among college students aged 18-25 years around Calicut city.  Study was conducted during the months of June 1st and July 30th 2016. The colleges were selected using simple random sampling method and the partakers were interviewed after getting assent from the concerned institutions. The sample size was calculated as 200 from WHO Global health observatory data prevalence of tobacco usage as 51%.Results: Mean (SD) age of study population is 20.90 (±2.11). Majority of the study population were females (78.5%) and males were 21.5%. Prevalence of smoking found to be 4% and alcohol consumption was found to be 2.5% among study population. BMI of the study population is 21.04 (±3.73).Conclusions: The results of this survey are alarming that the college going youth population fail to understand the devastating consequences of risky behaviours. Hence, interventions must be designed to prevent high-risk behaviours among the vulnerable population.
Projection of population of stunted children under five years and anaemic women of reproductive age in thirteen low, upper and high income 100 million+ countries around the world up to 2050
Authors: Raut Manoj Kumar , Sahu Ananta Basudev
Published: June 2018

Background: In 2012, the World Health Assembly Resolution 65.6 endorsed a comprehensive implementation plan on maternal, infant and young child nutrition, which specified a set of six global nutrition targets that by 2025. The goals were aimed at reducing stunting, anaemia, low birth weight, no increase in childhood overweight, increase rates of exclusive breastfeeding and reduce and maintain wasting. Out of these an average annual rate of reduction (AARR) of 3.9% for a 40% reduction in reduction in the number of children under five years of age who are stunted and an average annual rate of reduction of 5.2% has been estimated for a 50% reduction in anaemia among women of reproductive age.Methods: This paper uses demographic techniques to project the number of stunted children under five years and anaemic women for the thirteen 100 million plus countries as of UN population projections, 2017 of Philippines, Ethiopia, Japan, Mexico, Russian Federation, Bangladesh, Nigeria, Pakistan, Brazil, Indonesia, United States of America, India and China using average annual rate of reduction recommended in the world health assembly.Results: The number of stunted children under five years of age is estimated to be reduced by 27% by 2025, 40% by 2030 and 72% by 2050. The number of anaemic women of reproductive age is estimated to be reduced by 32% by 2025, 46% by 2030 and 85% by 2050.Conclusions: There is a dire need for accelerating the progress of reduction in stunting prevalence among children under five years and anaemia among women of reproductive age to achieve the global targets in selected high burden countries of India and Nigeria.
A study on the ocular findings and management of differently abled persons: North-East India
Authors: Hazarika Himanto N. , Hazarika Suranjana C.
Published: June 2018

Background: The study of the objective was to evaluate the different ocular problems and proper management in differently abled persons (DAP).Methods: A randomised analysis of 530 DAP were done by a team of Ophthalmologists, Optometrists, Social workers and Psychologist, covering a few districts in North-East India, between August 2013 to July 2016 were included. Patients without parents’ consent were excluded. History was taken and IQ tested by Clinical Psychologist. Utmost care was taken during ocular examinations to obtain the best results. External ocular examination was done by slit lamp, ocular motility was tested, fundus examined by direct Ophthalmoscope, visual acuity tested by Cardiff cards and E-charts and refractive status determined by auto-refractometer.Results: Of the 530 persons examined, 304 (57.36%) male and 226 (42.64%) female; 144 (27.17%) were below and 386(72.83%) above 10 years. Mean IQ level was 44. A total number of 248 (46.8%) DAP had ocular problems. Most common being refractive error 115 (21.7%), squint 46 (8.68%), congenital ocular anomalies 34 (6.42%), cataract 28 (5.28%), Vitamin-A deficiency 15 (2.83%) and conjunctivitis 10 (1.89%).Among the 248 patients with ocular problems- 65 (26.21%) had down's syndrome, 6 (2.42%) maternal infections and drug exposures, 42 (16.94%) postnatal infections, 9 (3.63%) head trauma. 115 cases were prescribed spectacles; 21 cataract cases undergone operation; Vitamin-A deficiency, conjunctivitis and other ocular problems were properly managed.Conclusions: Regular and periodic eye examination of these DAP and providing them with visual aid, proper treatment along with intensive training and counselling can help them to function in the society as a normal person.
A study on prevalence of anaemia among reproductive age group females attending urban health center of Anakaputhur area of Kancheepuram district
Authors: Aljin V. , Umadevi R. , Hariharan S.
Published: June 2018

Background: Anaemia, a major public health threat and real challenge for the health care professionals, for the past several decades. The burden of anaemia is high especially among females of reproductive age group, who are a vulnerable population undergoing pregnancy and child birth at this stage of their life. Thus this study was aimed to find the prevalence of anaemia among the reproductive age group females attending an urban health center in Tamil Nadu.Methods: A hospital based, cross sectional study was conducted among reproductive age group females, attending Urban Health Training Center. 292 patients, who gave written consent were included and interviewed using a questionnaire followed by haemoglobin assessment with venous blood sample.Results: The mean age of the study participants were 34.6±12.4 years with 9.6% uneducated and 7.2% graduate females. 26% gave history of symptoms of anaemia and prevalence of anaemia was reported to be 42.12% with 24.31%, 12.32% and 5.5% of mild anaemia, moderate anaemia and severe anaemia, respectively.Conclusions: With immense efforts, prevalence of anaemia is still high, in this study. Prevention and treatment of anaemia in women is much essential at this point and therefore programmes and policies should be implemented based on the needs of the community and health education should be imparted with respect to measures that can prevent and helps in early diagnosis of anaemia.
Study of hygiene practices among school going children in a government school in Kolkata
Authors: Meher Sabita , Nimonkar Ravi
Published: June 2018

Background: A majority of morbidity and mortality in developing countries is attributed to communicable diseases. 31% of all deaths in Southeast Asia, are caused by infectious disease. Poor health among school children is results from lack of awareness of the health benefits of personal hygiene.Methods: The present cross sectional study was conducted among 440 school children in Government school in Kolkata (WB) over a period of 6 months.Results: We tried to assess the hygiene practices among the school children. Majority of children responded that there were sources of clean water at their houses (94%) and school (84%).Conclusions: The percentage of hygiene practices among school children was found to be satisfactory, however when asked to demonstrate correct hand washing procedure, 86.1% demonstrated the same in an incorrect manner.