bluuebunny/crossref_metadata_2025 huggingface dataset:
Utilization of antenatal care services in a rural area of Nalgonda district, Telangana state, India
Authors: Jahnavi K. , Nagaraj Kondagunta , Nirgude Abhay Subhashrao
Published: August 2020

Background: Majority of maternal deaths can be prevented through appropriate maternal health services during antenatal, natal and post natal period Reasons for non-utilization of Antenatal health services could be due to various social, cultural and economic factors. Therefore, keeping this in view, this study was conducted to assess the utilization pattern of antenatal services by mothers, the facilitators of utilization of services.Methods: It is a Community based cross sectional study conducted in Cherlapally and villages around, which constitute the rural field practice area of Department of SPM, Kamineni Institute of Medical Sciences, Narketpally telangana. This study was conducted from September 2012-October 2014. A pre-designed and pre-tested questionaire was used to collect the data. The data was compiled and analyzed using SPSS version 19.Results: Majority (91.5%) of the mothers had three or more than three antenatal visits. Antenatal visits less than 3 was seen in only 8.5% of mothers. Mothers who took minimum of 2 tetanus toxoid injections were 93.6%.  But only 37.7% of the mothers consumed 100 IFA tablets. Majority (68.6%) of the mothers received antenatal care from doctor and 22.9% of mothers from both doctor and ANM.Conclusions: Majority of the mothers received antenatal care from private health facility followed by government health facilities. Better care and advice from health staff was the prime determinant for utilization.
Clinical indications of penetrating keratoplasty in a tertiary care centre of North India
Authors: Dahiya Monika , Chugh J. P. , Chauhan R. S. , Rathi Ashok
Published: August 2020

Background: Corneal diseases are one of the major causes of blindness and visual impairment in developing countries. Penetrating keratoplasty is a surgical procedure where a damaged or diseased cornea is replaced by donor corneal tissue. Aim was to determine the indications of penetrating keratoplasty (PK) in a tertiary health care centre of North India.Methods: A retrospective analysis of the records of 288 patients, who underwent penetrating keratoplasty (PK) from January 2016 to December 2018 at Regional Institute of Ophthalmology, PGIMS Rohtak were included in this study.  All patients who underwent PK during this time period were included in our study except those who underwent regrafting.Results: A total of 288 patients who underwent penetrating keratoplasty (PK) surgery were included in our study. Out of 288, 184 (63.88%) were males and 104 (36.11%) were females. In our study, 162 (56.25%) patients underwent optical PK, 76 (26.38%) had tectonic PK and 50 (17.36%) underwent therapeutic PK. Most common indication for optical PK was bullous keratopathy followed by corneal opacity. Most common reason for tectonic PK was found to be corneal perforation while for therapeutic PK was sloughing corneal ulcer followed by recalcitrant fungal keratitis.Conclusions: Though bullous keratopathy (BK) was the most common indication for penetrating keratoplasty in North India, but in our study 27% patients had tectonic PK and 17% patients underwent therapeutic PK which is significantly higher than documented data from South India and developed countries. It can be because of low literacy level, lack of awareness and late presentation to ophthalmologist in North India.
Assessment of nicotine dependence among tobacco chewers attending dental outpatient department in a tertiary care hospital
Authors: Shekhar Saket , Nehulkar Prachi N. , Holambe Vimal M.
Published: August 2020

Background: Smokeless tobacco is most common form of tobacco addiction. Nicotine dependence plays important role in tobacco addiction. In the present study we try to study sociodemographic factors, type of smokeless tobacco use and its pattern and smokeless tobacco chewers and nicotine dependence among them.Methods: A cross sectional study was conducted for six months and responses from 854 smokeless tobacco chewers were collected from dental OPD of Government Medical College and Hospital, Latur, Maharashtra. A structured questionnaire was designed and filled by face to face interview and responses were analysed.Results: Out of 854 study participants more than 50% i.e. 468 (54.80%) were in age group of 25-44 years. Illiterates compromised 27.87% of study participants. Almost one third (31.14%) of study participants started using smokeless tobacco before age of 18 years. Khaini or tobacco mixed with slaked lime is preferred type of smokeless tobacco by most of the smokeless tobacco users. Most common i.e. 51.87% of study participants consumed smokeless tobacco 5-9 times a day. Almost 50% of study participants i.e. 421 (49.30%) spent Rs 100-300 on smokeless tobacco per month. Nicotine dependence is seen in 38.20% of study participants.Conclusions: Smokeless tobacco use is prevalent before age of maturity among teenagers. Nicotine dependence is seen in almost one third of smokeless tobacco users. Determining nicotine dependence is an important step in tackling nicotine dependence.
Epidemiological study on admission of infectious diseases in pediatrics department of a tertiary care hospital, Jharkhand, India
Authors: Murmu Nisha , . Pushpa , Kujur Anit , Sagar Vidya , Kashyap Vivek
Published: August 2020

Background: Infectious diseases have a major contribution in the mortality and morbidity among children in India. The aim of our study was to assess the infectious diseases and the sociodemographic characteristics along with the assessment of awareness on mode of transmission of these diseases among the family members.Methods: This was a cross-sectional study done in Department of Pediatrics, RIMS, Ranchi, for a period of 6 months by consecutive sampling. Pre-tested, semi structured questionnaire was used for data collection and analysed in SPSS version 20.Results: A total of 220 children were included in the study. Majority of patients (60%) comprised of under 5 age group with male predominance (55%), with 84.1% children fully immunized, among which 54.1% were institutional deliveries and approx. 85.9% children were breast fed for more than 6 months. Malaria, being an endemic disease of Jharkhand affected maximum children (38.2%). Sanitation, (toilet facilities) was about 27% and hand hygiene was only 5% in the family members of the patients admitted. Thus lack of awareness and poor hand hygiene was an important finding in our result.Conclusions: Health education among the community should be the prime concern for the reduction of the diseases.
A cross sectional study on early initiation of breastfeeding among mothers in Chennai city
Authors: Jeyakumar Anaiappan , Deivasigamani Kuberan
Published: August 2020

Background: The practice of breast feeding is the best intervention in promoting child survival. The success depends on early initiation of breast feeding soon after birth. Globally a three fifth of new born wait for more than one hour to begin breast feeding, despite the fact that the practice will extremely reduce neonatal infections and maternal postpartum complications. In this context, the objectives of the study was to estimate the prevalence of early initiation of breastfeeding and barriers in non-initiation of early breast feeding among recently delivered mothers at Chennai.Methods: This cross sectional study was conducted in Zone VI of Chennai. Four hundred and fifty (450) delivered a term, live baby with in past 1 year were selected by using simple random technique. Pre-tested structured interview schedule was used to collect data.Results: Among the study group, 54.4% mothers initiated breast feeding within first one hour after delivery. Delay in handing over the baby to the mother (43.9%), maternal complications (19%), neonatal complications (14.1%), Caesarean section (17.6%), and misconception of insufficiency of milk secretion (5.4%) were barriers in non-initiation of early breast feeding.Conclusions: The study explains the prevalence and importance of early initiation of breast feeding. Avoidance of pre lacteal feeds. Promotions of breast milk substitutes and commercial products should be restricted. Co-ordination between the health care providers and mothers must be strengthened. Maternal education plays a vital role in clarifying the ignorance and misconceptions. Emotional and social support influences mothers to initiate it early.
Biofilm production and its effects on virulence of MRSA: a study in tertiary care hospital, Delhi
Authors: Khan Amir , Tewari Rachna , . Neetusree , Dudeja Mridu
Published: August 2020

Background: The aim of this study was to study the prevalence of biofilm formation in MRSA and its effect on virulence and the antimicrobial resistance pattern on MRSA strains from different clinical samples.Methods: A total of 221 isolates of S. aureus isolates were selected from various clinical specimens. Prevalence was estimated according to age, sex, and location.  The antibiotic susceptibility test was conducted according to the guidelines of CLSI by the VITEK 2 automated system. 113 strains were identified as MRSA by cefoxitin disc methods which were then subjected to Microtiter plate assay method to confirm phenotypic biofilm formation.Results: 51.13% isolates were resistant to methicillin, and 48.86% isolates were methicillin sensitive. The most common source of MRSA isolation was blood. MRSA isolates were mostly isolated from male. 33.63% MRSA and 19.44% MSSA isolates were strong biofilm producers while 12.38% MRSA and 14.81% were low biofilm producers. The resistance for commonly used antibiotics like benzyle penicillin, ciprofloxacin, cotrimoxazole, and erythromycin was more in MRSA strains and MIC was higher in biofilm producers.Conclusion: Statistical difference was observed between MSSA and MRSA regarding biofilm formation and antimicrobial resistance. A Biofilm producer shows resistance to many antibiotics and also make host immunity in effective. In hospitals Biofilm production should be checked regularly before giving treatment. And research should be done to find out other effective drugs to eradicate biofilms.
Epidemiological profile of cancer patients attending tertiary care teaching hospital: a record based retrospective study
Authors: Antony Aji , K. Sujatha , K. Senthil Kumar S. , R. Sree Supria P. , V. Palaniappan
Published: August 2020

Background: Cancer, the second leading cause of death worldwide is one of the most dreaded non-communicable diseases. Cancer incidence and demographic data form an important basis for cancer prevention. However, the data available through cancer registries are limited. Thus, the present study aimed to describe the epidemiological profile of cancer patients registered in our hospital.Methods: A record based retrospective study was done assessing the records of the cancer patients, admitted during the year 2017 at Coimbatore Medical College Hospital. The data collected included the epidemiological information like demographic details, place distribution and the type of cancer.Results: A total of 1192 confirmed cases of cancer were studied. Among the study subjects, 1014 (50.9%) patients were male and the age group of 50-69 had the maximum percentage of cancer cases (1121 cases, 56.3%). Most cases came from western Tamil Nadu (1138 cases, 95.5%) and majority of them belonged either to lower (560 cases, 46.6%) or upper lower class (548 cases, 45.9%). The lip, oral cavity and pharynx was the type of cancer having the maximum number of cases (429 cases, 36%) and had high proportion in comparison with world level and national statistics. Nearly 57% cases presented with regional extent of disease.Conclusions: The epidemiological factors leading to high incidence of cancer should be analysed and steps towards cancer prevention should be initiated by altering the associated risk factors.
Effectiveness of mindfulness based stress reduction program (MBSR) on stress among nursing students- a mixed method study
Authors: Gautam Anamika , Palanivelu Srinivasan , Kaur Gurvinder
Published: August 2020

Background: Stress is not always avoidable but learning techniques to manage stress can develop overall wellbeing by decreasing the physical, psychological, spiritual, and social effects of stress. Learning to manage stress through holistic self-care with MBSR techniques could help to decrease the negative effects of stress.Methods: Mixed method research approach and concurrent dominant (QUAN+qual) design was selected. Total 120 nursing students was included in the study with identical sampling approach. Data was collected by using sample characteristics proforma, DASS-42 (14 items of stress) and structured open-ended questionnaire. Total 7 sessions of MBSR was administrated in the experimental group for 40 minutes.Results: Finding of the study showed that the mean score in the experimental group was lower than the comparison group (12.02 versus 21.82: t=10.12, p=0.001). The major themes emerged were stress and quality of life, body and mind.Conclusions: The study concluded quantitatively that MBSR was effective in reducing stress among nursing students and improved their daily living as well as mental health. Qualitatively the study revealed that stress influence their academic performance and personal life negatively and some student able to fight in stressful situation where as some prefer to flight by using negative defence mechanism.
Breast cancer knowledge, attitude and self-examination practices of physiotherapy students in India: a cross-sectional study
Authors: Parle Jyoti , Gupta Shivangi
Published: August 2020

Background: Breast cancer is a major cause of cancer in Indian females. Breast self-examination (BSE) being a low-cost, effortless, and efficient procedure can help early detection in developing countries. Physiotherapists play an active role in community rehabilitation and this study aims to assess their knowledge about breast cancer, BSE as well as explore attitude and self-examination practice among physiotherapy students.Methods: This cross-sectional study was conducted among 380 students in various physiotherapy colleges of Navi Mumbai, using a pre-validated questionnaire. The data collected were analyzed using Statistical Package for the Social Sciences (SPSS) version 24. A chi-square test was applied to find an association between variables. Correlation analysis was used to test the strength of the relationship between numeric variables.  Results: The study reported students had moderate knowledge about breast cancer (59.5%) and breast self-examination (BSE) (62.6%). Attitude towards self-examination practice was excellent (94.2%), but only (25.8%) of the respondents reported to perform BSE monthly. There was a significant association between the overall knowledge and practice of BSE (p=0.000). Also, a significant association was found between overall knowledge and attitude towards BSE (p=0.000).Conclusions: Health education strategies and awareness programs are necessary to keep in view the current status of breast cancer, BSE knowledge among health care professionals.
Perspectives of Indian medical students on e-learning as a tool for medical education in the country: a quantitative study
Authors: Lawande Neel N. , Kenkre Trusha D. , Mendes Nuala A. , Dias Lydia M. , Dias Amit S.
Published: August 2020

Background: In view of the COVID-19 pandemic, medical colleges resorted to e-learning to continue teaching; giving us a unique opportunity to explore the potential of this tool, understand the student perspective, help improve its structure and assess its scope for future use.Methods: A quantitative cross-sectional study was conducted across Indian medical colleges using Google forms. The questionnaire consisted of sections on e-learning experience, technological readiness, effects of COVID-19 on education and attitude towards e-learning.Results: From 32 medical colleges in India, 556 undergraduate medical students participated in the study. The results showed that 93.3% students were exposed to e-learning, from which 99% were introduced to it following the COVID-19 pandemic-imposed lockdown. The study reported the pros and cons of e-learning for medical education. E-learning methods were deemed fit for theory lectures, but wasn’t preferred for clinics and demonstrations. Students believed that e-learning- preferably short live online classes, together with efficient portals, provision of offline videos and discussion of clinical cases- had great scope to support the traditional methods of teaching.Conclusions: According to the students, e-learning has immense potential and is an irreplaceable ally to the traditional method of medical education, even beyond the COVID-19 pandemic.
A study to evaluate risk factors and factors associated with non-adherence to the prescribed treatment among essential hypertensive patients attending tertiary care hospital
Authors: Bommishetty Venkat Sunil , Kumbhar Suresh Keshav
Published: August 2020

Background: Prevalence of hypertension is on rising trend with rise in life style and behavioral changes. It is also a major risk factor for most of the dreadful conditions like coronary artery disease, stroke, etc. Medication adherence would help in reducing the chance of occurrence of such complications. Thus objectives of study are 1) to evaluate the risk factors of hypertension among the diagnosed essential hypertensive patients; and 2) to assess the magnitude and the factors associated with non-adherence to the prescribed treatment.Methods: A hospital based cross-sectional study among 71 participants was conducted, using a pre-structured questionnaire and physical examination to assess risk factors of hypertension and CULIG’s 16 questionnaire medication adherence scale to assess the non-adherence. Data analysed with proportions and Chi square test.Results: Out of 71 participants, 60 (84.5%) were found to be non-adherent to their anti-hypertensive medication and factors like being male (p=0.0055), alcohol consumption (p=0.0485) and paid medication (p=0.0091) were found to be significantly affecting the medication non-adherence. Positive family history, sedentary life style, preference of extra salt and smoking/tobacco products usage were the most common risk factors of essential hypertension observed along with others.Conclusions: The participants who experienced the complications/ill effects of hypertension were more adherent as compared to others. Factors which are responsible for non -adherence need to be addressed and appropriate interventions required to improve adherence by educating the people about its importance in prevention of complications.
Evaluation of community outreach program for detection of prevalence and causes of visual impairment in East Uttar Pradesh region
Authors: Dixit Kuldeep Kumar , Sharma Sandeep , Bharadwaj Rahul
Published: August 2020

Background: The purpose of this study was to find out the prevalence and the causes of visual impairments in rural areas of east Uttar Pradesh where peoples are still deprived of the spectacles and other corrective measures.Methods: In this retrospective study eye camps were conducted in 6 districts in east Uttar Pradesh over a period of 2 years from April 2016 to March 2018, we have conducted 893 camps and total 123597 patients were examined and following parameters were used- measure distance and near vision with Snellen’s vision drum, refraction, I. O. P., torchlight examination and dilated fundus examination.Results: About 36.15% patients were having refractive error problems, about 37.10% patients were found to have cataract, 3.20% patients were retina problems, 1.67% patients were cornea problems, 1.31% patients were oculoplastic problems, 1.21% patients were having glaucoma and 19.35% patients had other ocular problems as itching, watering and some of them were referred to base hospital for confirm the diagnosis. Those patients having refractive errors included myopia, hypermetropia and presbyopia glasses were dispensed at eye camp site. The patient require ocular surgery were immediately transferred to base hospital by hospital bus.Conclusions: The study showing outreach camps really helpful the people those suffering from visually impairment and not able to reach the hospital.
Clinical and epidemiological profile of patients admitted with dengue fever in a tertiary care hospital, Thrissur, Kerala, India
Authors: George Tania , Mankara Valsan Sruthi
Published: August 2020

Background: Dengue is a fast emerging mosquito borne pandemic prone viral disease affecting many parts of the world. The elucidation of the exact clinical profile is important for patient management and thus crucial for saving life. Dengue is widespread throughout the tropics, with risk factors influenced by local spatial variations of rainfall, temperature, relative humidity, degree of urbanization and quality of vector control.Methods: A descriptive study was undertaken and data was collected by reviewing the records of patients admitted with dengue fever over a period from January 2019 to August 2019. Total 100 records of confirmed cases of dengue were included in the study. The information regarding demographic details, clinical symptoms and complications, and epidemiological details were collected from the records using a questionnaire. Results: Out of 100 patients admitted with dengue, 61% were males and 54% of the total were admitted during June and July month. Most common symptoms reported were fever (99%), headache (91%), muscle & joint pain (71%). The bleeding manifestation was reported in 11% and the most common site of bleeding was gastrointestinal tract.Conclusions: The present study concludes that dengue confirmed cases are seen more among males, and the incidence of disease is more in age groups of less than 30 years. Most of them were residing in the Northern part of Thrissur (56%) and the most common clinical symptoms were fever and headache.
COVID-19 infection fatality rate: a new approach
Authors: S. Seshadri M. , R. Ranganathan C.
Published: August 2020

Infection fatality rate (IFR) in COVID 19 is a useful parameter for health-care planning during the current COVID-19 pandemic. The sensitivity of the reverse transcription polymerase chain reaction (RT-PCR) test, the rate of mortality reporting (MRR) in a country and the number of RT-PCR tests done per million population are the factors that influence the true infection fatality rate. In this article we present a ready reckoner for estimating the infection fatality rate for COVID-19, for a given RT PCR test sensitivity and mortality reporting rate for use in middle and low-income countries with resource constraints. We further demonstrate the inverse relationship between infection fatality rate and the number of tests done.
Daily activities of teenagers with autism at home: a case report study
Authors: Jiu Cau Kim , Gusmiah Tisa , Erwhani Indri , Febriyanti Indriani
Published: August 2020

Parents have an important role in supervising and directing their autistic teenagers while carrying out daily routines at home so they can become independent teens. The purpose of this case study is to provide an overview of how teenagers with autism carry out their daily activities and what their daily activities are at home. Data collection methods used in this study were in-depth interviews and observations. The results of this study indicate that teenagers with autism are involved by parent in carrying out daily activities at home such as folding clothes, cleaning the kitchen floor, and washing rice and vegetables while at the same time parent accompany, supervise and guide her daughter. Very important for mother to teaches and trains her autistic teenager in daily living activities at home to be independent.
A case report on necrotizing fasciitis in a hemiplegic patient following an intra-muscular injection
Authors: Mendem Sowjanya , Faraz M. Aqib Ali , Rao K. Lankeswar
Published: August 2020

Necrotizing fasciitis (NF) can be defined as a surgical emergency causing the necrosis of the skin, subcutaneous fat, and superficial fascia. It spreads along the fascial planes with or without the presence of cellulitis. It is characterized by the destruction of tissue, systemic toxicity, and may even lead to morbidity and mortality. Higher rates of prevalence were observed in the obese, diabetic, alcoholic, patients with peripheral vascular diseases and immunocompromised populations. There are no definite diagnostic criteria for NF and the laboratory findings may lead to misdiagnosis as cellulitis or abscess. It is usually developed from an injury to the skin, which may occur during trauma, IV drug use, drug administration (via injection), skin infections, ulcer, insect bites, visceral-cutaneous fistulas, surgical complications, percutaneous catheter insertion, abscesses and can even have idiopathic causes. Early diagnosis of the condition, surgical debridement, and optimal antibiotic therapy leads to the improvement in the condition and desired outcomes in the patient. The present study is focused on the successful treatment of necrotizing fasciitis in a hypertensive and hemiplegic patient, following an IM injection of an analgesic, which caused an ulcer and rapidly progressed, leading to necrosis of the affected regions.
Factors associated with depression among young people globally: a narrative review
Authors: Amaltinga Awuni Prosper Mandela , Mbinta James Fenibe
Published: August 2020

Although depression is a major concern for global health, understanding of this phenomenon has been limited since most of the empirical studies address personal characteristics without much consideration to larger environmental contexts for adolescents globally. The objective was to review factors associated with depression among young people. The researchers adopted a narrative review of selected peer reviewed articles on depression with a focus on the factors associated with depression among young people. The papers were selected according to the six World Health Organization (WHO) regions. The results show that females were at greater risk of depression compared to their male counterparts. Also, genetic predisposition as a result of maternal rumination was a factor for depression among young people in all WHO regions. Past history of depressive symptoms, uncontrollable negative life events, and family-related stressful events contributed significantly to depression among young people. Finally, the study recommends that mental health services at primary healthcare level be prioritized in all Low and Middle-Income countries (LMICs) to help identify and handle early cases of mental health in young people.
Neoliberalismo, biocomunicabilidad y la producción de ciudadanos salubres e insalubres. Un análisis a partir de las políticas contra la anemia vistas desde la Amazonía Peruana.
Authors: Palma Helen
Published: August 2020

A partir de un trabajo etnográfico, se realiza una reflexión crítica sobre los procesos de biocomunicabilidad (Briggs y Nichter, 2009) vinculados con las políticas para combatir la anemia, vistos desde una sociedad multiétnica de la Amazonía Peruana con población mayoritariamente awajún y wampis. En ese sentido, se destaca la inserción de estos procesos en una trama de tensiones inter e intraétnicas que los antecede. 

El acompañamiento cercano y prolongado de estos procesos permitió identificar aspectos ideológicos y morales, expresados en una visión medicalizante de la anemia, así como la reproducción de un sentido de ciudadanía basado en el rendimiento individualista y funcional a una lógica neoliberal.

Con esto, se espera contribuir al análisis de las políticas oficiales de atención a la población indígena, lo cual se hace relevante en un momento en el que existe una clara demanda del enfoque intercultural y cuando es necesario estar atentos a los posibles procesos de medicalización de la salud indígena.
«VIH/sida awajún: nociones y experiencias de enfermedad y daño en un contexto de epidemia en la Amazonía Peruana
Authors: Flores Rojas María Ximena
Published: August 2020

Desde el año 2002, de acuerdo con los relatos de algunas familias awajún, empezarona correr los rumores sobre una nueva enfermedad llamada «sida» en el distrito de El Cenepa. Esta condición de origen apách o no indígena se incorporó en la cotidianidad de la población awajún como parte de sus experiencias de enfermedad (jata) y brujería (waweamu), generando las nociones de «jata sida» y “waweamu con síntoma de sida”.  La mayoría de los estudios sobre VIH/sida en pueblos indígenas suelen abordar esta condición desde enfoques biomédicos o epidemiológicos. Este artículo presenta otras dimensiones posibles para pensar el VIH/sida en contextos indígenas. Partiendo del complejo conocimiento awajún sobre el cuerpo amazónico y las fuerzas que lo afectan, este artículo busca entender las nociones y experiencias de «enfermedad» y «brujería» que la población awajún usa al hablar de VIH/sida.
Challenges in Machine Translation For Teaching Arabic Language/ الترجمة الحاسوبية والتحديات في التعليم اللغة العربية
Authors: Khan Dr. Lubna Farah
Published: August 2020

The study aims to search for syntax errors in machine translation. The study focuses on challenges in English Arabic Machine translation, types of errors in translation software, the most developed technologies in machine translation, and arbitrary Arabic text generating problems generally and in the Arabic language. This study use qualitative research design, qualitative data, drawn from our pragmatic analysis are presented, from perceptions of language learners and tutors in relation of Machine translation. The article discusses the disappointing fact that most intelligent machines are built to produce woodenly literal or paraphrased translations, but in Arabic, the errors are in high numbers. The paper results show an urgent need to build the machine language infrastructure in the Arabic language field to help people achieve accurate translation. To overcome the problems of machine translation, we recommend that we enter enough vocabulary and linguistic texts in the machine.
Coronavírus e Lei de Saúde Mental: Novos Desafios, Problemas Antigos
Authors: Carvalheiro Ana Mafalda , Martinho Sérgio
Published: August 2020

N/a.
An exploration of the experiences of GP registrar supervisors in small rural communities: a qualitative study
Authors: Couch Danielle Lobena , O’Sullivan Belinda , Russell Deborah , McGrail Matthew , Wallace Glen , Bentley Michael
Published: August 2020

Background:
In Australia registrar training to become a general practitioner (GP) involves three to four years of supervised learning with at least 50% of GP registrars training wholly in rural areas. In particular rural over regional GP placements are important for developing future GPs with broader skills because the rural scope of practice is wider. Having enough GP supervisors in smaller rural communities is essential such training. We aimed to explore what makes rural GPs’ based outside of major regional centres, participate in supervising or not, their experiences of supervising, and impact of their practice context.
Methods:
Semi-structured interviews were undertaken with 25 GPs based in rural Tasmania (outside of major regions - Hobart and Launceston), in towns of <25,000 population, to explore the GPs’ professional backgrounds, their experiences of supervising GP registrars, their practice context and their decisions about supervising GP registrars or not. Thematic analysis was undertaken; key ideas, concepts and experiences were identified and then reviewed and further refined to core themes.
Results:
Supervising was perceived to positively impact on quality of clinical care, reduce busy-ness and improve patient access to primary care. It was energising for GPs working in rural contexts. Rural GPs noted business factors impacted the decision to participate in supervision and the experience of participating: including uncertainty and discontinuity of registrar supply (rotational training systems), registrar competence and generating income.
Conclusions:
Supervising is strongly positive for rural GPs and related to job satisfaction but increasing supervision capacity in rural areas may depend on better policies to assure continuity of rural registrars as well as policies and systems that enable viable supervision models tailored to the context.
Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study
Authors: Jin Yinzi , Xu Jin , Zhu Weiming , Zhang Yaoguang , Xu Ling , Meng Qingyue
Published: August 2020

Background: People bypass primary healthcare (PHC) institutions to seek expensive healthcare at high-level hospitals, leading to escalating medical costs and inefficient use of resources. In 2009, China launched nationwide synergic policies on primary care strengthening, to tackle access to healthcare and financial protection. This study aimed to assess the impact of the two policy areas, health insurance and health workforce, on healthcare seeking behavior.
Methods: Drawing on national survey data before (2008) and after (2013) the policies, we linked individual-level data on healthcare-seeking behavior with county-level data on health workforce and health insurance. We constructed a multilevel zero-inflated negative binomial regression to examine the impacts of average reimbursement rate (ARR) of health insurance and the density of registered physicians on outpatient/inpatient visits, and multilevel multinomial logistic regression for the impacts on choice of outpatient/inpatient care providers.
Results : Although the increase in health insurance ARR and physician density have positive impacts on individuals’ healthcare use, their impacts might be weakened during 2008 and 2013, and the negative impacts of investment of those in PHC institutions on likelihood of visiting hospitals was larger. The negative impacts of ARR at PHC institutions on likelihood of visiting county-, municipal- and higher-level hospitals in 2013 was 28 percentage points, 66 percentage points and 33 percentage points larger than these in 2008.
Conclusions: Primary care strengthening requires synergic policies. Effective mechanisms for coordination across multisectoral actions are necessities for deepening those policies to ensure efficient delivery of healthcare without experiencing financial risks.
Transtheoretical model-based nutritional interventions in adolescents: a systematic review
Authors: Langamer Jennifer Nakabayashi , Melo Giselle Rha-isa , Toral Natacha
Published: August 2020

Background: Literature has shown a tendency of inadequate dietary intake among youth, consequently, nutritional interventions are required. The transtheoretical model (TTM) classifies individuals based on their readiness to change. This model is widely used for health education interventions with proven efficacy. Purpose: This review aimed to weigh the strength of evidence about the TTM usage in nutritional interventions for adolescents and its effectiveness regarding dietary intake.Methods: This study followed the PRISMA guidelines. Eligible studies were input into Mendeley software. The Adolec, Google Scholar, LILACS, PsycINFO, PubMed, Science Direct and Web of Science databases were searched. Only full original articles written in English, Spanish or Portuguese on randomized controlled trials and quasi-experimental designs that applied the TTM in the design of nutritional interventions targeting adolescents were included, with no restrictions on publication date. The quality and risk of bias was evaluated with the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies.Results: The initial search yielded 3779 results. Three studies were rated as strong, six as moderate and five as weak. The final sample of 14 articles included adolescents that were mostly recruited from schools, with interventions ranging from one month to three years. The TTM was used alone or combined with other behavior-change theories and most of the interventions involved digital technology. The nutritional topics covered included fruit and vegetable consumption, low-fat diet, and cooking skills. Four studies presented improvement in fruit and vegetable consumption and four progressed through stages of change. Participants from two interventions reduced fat intake. At the end of one intervention, all the participants were in action and maintenance stages. Conclusion: The TTM seems to be a successful strategy for nutritional intervention aiming at improving dietary intake in adolescents. Its application in different contexts shows that the TTM is flexible and possible to be implemented in many settings. The use of the model is shown to be restricted to the stage of change’ construct. Further studies should use all constructs of the TTM in the design and compare the TTM with other behavior-change theories to better understand its effectiveness.
Effectiveness and Tolerability of Repetitive Transcranial Magnetic Stimulation for Preventive Treatment of Episodic Migraine: A Single Centre, Randomised, Double-Blind, Sham-Controlled Phase 2 Trial (Magnet-EM).
Authors: Safiai Nabil Izzaatie Mohamad , Amir Nur Ain , Basri Hamidon bin , Mat Liyana Najwa Inche , Hoo Fan Kee , Khan Abdul Hanif Khan Yusof , Loh Wei Chao , Chia Peck Kee , Ramachandran Vasudevan , Din Hazwan Mat , Samsudin Intan Nureslyna , Fernandez Aaron , Mohamed Mohd Hazmi , Ching Siew Mooi , Hashim Hasnur Zaman , Sulaiman Wan Aliaa Wan
Published: August 2020

Background: This is a phase II randomised, double-blind, sham-controlled trial to evaluate the effectiveness and tolerability of repetitive transcranial magnetic stimulation for preventive treatment of episodic migraine among migraine subjects. Methods: Subjects age 18 to 60 years will undergo a baseline evaluation to establish the diagnosis of migraine based on International Classification of Headache Disorder 3rd Edition (ICHD-3). Those who fulfil the ICHD-3 criteria for episodic migraine and compliant to the headache diary during a month run-in period will be enrolled. A total of 76 subjects will be randomised to receive either transcranial magnetic stimulation or sham stimulation for 5 sessions within 2 weeks duration. Follow-up sessions will be conducted monthly for three consecutive months. Prior to treatment, subjects will be required to fill up questionnaires and undergo few procedures such as electroencephalography, transcranial doppler ultrasound and biochemical analysis for serum serotonin, serum calcitonin-gene related peptide and serum beta-endorphin. These procedures will be repeated at month 3 after receiving last treatment. The primary outcome measure of this study is the difference in mean monthly migraine days at baseline and at month 1, 2 and 3 after treatment sessions. Discussion: Following evidence from previous studies showing restoration of dorsolateral prefrontal cortex (DLPFC) activation to almost normal level, the rTMS intervention will target left DLPFC in this study. Meanwhile, the least number of treatment sessions reported which proved to be effective in reducing migraine days was three session of rTMS given in alternate days. Hence, an intermediate duration of treatment sessions is selected for this study. It is set to five treatment sessions given within 2 weeks duration. Trial registration: NCT03556722. Transcranial Magnetic Stimulation in Episodic Migraine (Magnet-EM) was registered on 27th April 2018. https://clinicaltrials.gov/ct2/show/NCT03556722.
Association between long-term exposure to air pollutants and cardiopulmonary mortality rates in South Korea
Authors: Hwang Jeongeun , Kwon Jinhee , Yi Hahn , Bae Hyun-Jin , Jang Miso , Kim Namkug
Published: August 2020

Background: The association between long-term exposure to air pollutants, including nitrogen dioxide (NO2), carbon monoxide (CO), sulfur dioxide (SO2), ozone (O3), and particulate matter 10 μm or less in diameter (PM10), and mortality by ischemic heart disease (IHD), cerebrovascular disease (CVD), pneumonia (PN), and chronic lower respiratory disease (CLRD) is unclear. We investigated whether living in an administrative district with heavy air pollution is associated with an increased risk of mortality by the diseases through an ecological study using South Korean administrative data over 19 years. Methods: A total of 249 Si-Gun-Gus, unit of administrative districts in South Korea were studied. In each district, the daily concentrations of CO, SO2, NO2, O3, and PM10 were averaged over 19 years (2001–2018). Age-adjusted mortality rates by IHD, CVD, PN and CLRD for each district were averaged for the same study period. Multivariate beta-regression analysis was performed to estimate the associations between air pollutant concentrations and mortality rates, after adjusting for confounding factors including altitude, population density, higher education rate, smoking rate, obesity rate, and gross regional domestic product per capita. Associations were also estimated for two subgrouping schema: Capital and non-Capital areas (77:172 districts) and urban and rural areas (168:81 districts). Results: For IHD, higher SO2 concentrations were significantly associated with a higher mortality rate, whereas other air pollutants had null associations. For CVD, SO2 and PM10 concentrations were significantly associated with a higher mortality rate. For PN, O3 concentrations had significant positive associations with a higher mortality rate, while SO2, NO2, and PM10 concentrations had significant negative associations. For CLRD, O3 concentrations were associated with an increased mortality rate, while CO, NO2, and PM10 concentrations had negative associations. In the subgroup analysis, positive associations between SO2 concentrations and IHD mortality were consistently observed in all subgroups, while other pollutant-disease pairs showed null, or mixed associations.Conclusion: Long-term exposure to high SO2 concentration was significantly and consistently associated with a high mortality rate nationwide and in Capital and non-Capital areas, and in urban and rural areas. Associations between other air pollutants and disease-related mortalities need to be investigated in further studies.
Anxiety Disorders and PTSD in Palestine: Litreture review
Authors: Marie Mohammad Mohammad-Zeyad , SaadAdeen Sana , Battat Maher
Published: August 2020

Background The WHO reports that anxiety disorders are the most common mental disorders worldwide. Most people who experience such events recover from them, but people with post-traumatic stress disorder (PTSD) continue to be severely depressed and anxious for months or even years following the event. Palestinians are especially at a higher risk for developing anxiety disorders and PTSD due to their chronic exposure to political violence, prolonged displacement, and others as a limited professional, educational, financial opportunities, and mental health services. This paper aims to provide a systematic review of the literature and established studies concerning Anxiety disorders besides PTSD in Palestine.Methods PubMed, Science Direct, Google Scholar was used to search for materials, for the critical analysis of empirical articles, the following aspects were considered: study type, sample, and the key findings.Results Twenty-four studies from Palestine (West Bank and Gaza) were included in this review. Five studies related to children, five related to Adolescent, three related to women, three related to physical diseases and four related to gender and age differences . Results showed that anxiety disorders and PTSD were one of the most common mental disorders in Palestine. Anxiety and PTSD develop from a complex set of risk factors, including genetics, personality, and life events. They are highly associated with poor quality of life and disability. The results indicate that a significant proportion of Palestinian experiencing serious psychological distress especially anxiety and PTSD. Therefore, a mental health policy for Palestinians must deal with several challenges. Distinct barriers including inconsistent availability of medications, absence of multidisciplinary teamwork, insufficient specialists, fragmented mental health system, and occupation need to be addressed.Conclusion As a primary prevention, occupation has to be considered as a main source of the anxiety and other mental health disorders in Palestine. Besides, there is a need to implement mental health care system through the multidisciplinary work and raising awareness regarding prevalent of mental disorders.
Preparedness of outpatient health facilities for ambulatory treatment with all-oral short DR-TB treatment regimens in Zhytomyr, Ukraine: A cross-sectional study
Authors: Gils Tinne , Laxmeshwar Chinmay , Duka Marve , Malakyan Khachatur , Siomak Olga Valentinovna , Didik Vitaly Stephanovich , Lytvynenko Natalia , Terleeva Yana , Donchuk Dimitri , Isaakidis Petros
Published: August 2020

Background: Ukraine has a high burden of drug-resistant tuberculosis (DR-TB). Mental health problems, including alcohol use disorder, are common comorbidities. One in five DR-TB patients has human immunodeficiency virus (HIV). As part of health reform, the country is moving from inpatient-care to ambulatory primary care for tuberculosis (TB). In Zhytomyr oblast, Médecins Sans Frontières (MSF) is supporting care for DR-TB patients on all-oral short DR-TB regimens. This study describes the preparedness of ambulatory care facilities in Zhytomyr oblast, Ukraine to provide good quality ambulatory care.
Methods: This is a retrospective analysis of routinely collected programme data. Before discharge of every patient from the hospital, MSF teams assess service available at outpatient facilities using a standardised questionnaire. The assessment evaluates access, human-resources, availability of medicines, infection control measures, laboratory and diagnostic services, and psychosocial support.
Results: We visited 68 outpatient facilities in 22 districts between June 2018 and September 2019. Twenty-seven health posts, 24 TB-units, 13 ambulatories, two family doctors and one polyclinic, serving 30% of DR-TB patients in the oblast by September 2019, were included. All facilities provided directly observed treatment, but only seven (10%) provided weekend-services. All facilities had at least one medical staff member, but TB-training was insufficient and mostly limited to TB-doctors. Anti-TB-medicines and adequate storage space were available in all facilities, but only five (8%) had ancillary medicines. HIV-positive patients had to visit a separate facility to access HIV-care. Personal protective equipment was unavailable in 32 (55%) facilities. Basic laboratory services were available in TB-units, but only four (17%) performed audiometry. Only ten (42%) TB-units had psychosocial support available, and nine (38%) offered psychiatric support.
Conclusion: Outpatient facilities in Zhytomyr oblast are not yet prepared to provide comprehensive care for DR-TB patients. Capacity of all facilities needs strengthening with trainings, infection control measures and infrastructure. Integration of psychosocial services, treatment of co-morbidities and adverse events at the same facility are essential for successful decentralisation. The health reform is an opportunity to establish quality, patient-centred care.