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   Table of Contents - Current issue
October-December 2021
Volume 10 | Issue 4
Page Nos. 253-317

Online since Wednesday, November 17, 2021

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Ethical implications of the National Tuberculosis Elimination Programme in India: A framework-based analysis p. 253
S Ramesh Kumar, BM Shrinivasa, S Syed Hissar, M Rajasakthivel
Tuberculosis (TB), an infectious disease, is transmitted by inhalation of droplet nuclei discharged in the air. Revised National Tuberculosis Control Programme (RNTCP), now National Tuberculosis Elimination Program (NTEP) of India, has made significant gains in strengthening the support structures, program architecture, and implementation environment for TB control in India. Kass's framework for public health includes an analytic tool that consists of a step-by-step list of six questions for deciding how the burdens and benefits of an intervention can be fairly balanced. We have tried to apply each of the elements addressed in the framework with context to RNTCP/NTEP measures, reviewing relevant literature evidence and attempt to view from the “ receiver's” perspective instead of looking at from “ provider's” perspective. We feel the NTEP provides a sound delivery of ethical principles in the program. Involvement of private sectors into the program for TB control, which is a challenging task, is a requirement for a fair provision of uniform TB care across the nation.
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Prehospital emergency care model using short code access number for refining dispatching of ambulances and clinical communication for patient transfer–Insights from a Private Medical College and Hospital, Mysuru, India p. 257
Sathish Raju Nilakantam, Dayananda Melanahalli, Nisarg S Karanth, SB Adarsh, N Pradeep Kumar
BACKGROUND: In healthcare, effective communication is essential, particularly in emergency situations, it is critical and important. This article suggests a prehospital emergency care model using short code access number, through which method of communication from dispatching of ambulances to arrival and handover of patients to hospital is facilitated in emergency instances. We also attempted to elaborate the procedure, we followed for establishing this emergency access number for this private medical college in South India. Practical recommendations are also provided for policymakers who wish to initiate such facilities. OBJECTIVES: To strengthen our prehospital emergency care with ambulance short code, to guarantee that it is flawlessly incorporated into the healthcare system and to promote public responsiveness in prehospital Emergencies. PROJECT METHODS: Establishment of in-hospital ambulance command center, using a project management cycle framework in the phases of planning, designing, training, and implementation. A needs assessment was conducted and a committee was developed with a multidisciplinary team for planning and implementing out this initiative. RESULTS: It was possible to implement hospital emergency short code access number for hospital ambulance operations along with the establishment of ambulance command center with a trained interdisciplinary team and achieve best practices by participating on refining existing infrastructure and human resources. CONCLUSION: Timely arrival of an ambulance can make the difference between survival and death, in life-threatening emergency situations in which every second counts. Our prehospital emergency care model will respond to the patient needs from the initial emergency request of ambulance and its dispatching to arrival of patient and his/her admission to the emergency medicine department of the hospital. Data generated by the program will be used to guide and design appropriate interventions.
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Well-being indices: A role of mindfulness and social support p. 263
Meera Padhy, Prabhati Pati, Sandra Roshni Monteiro
BACKGROUND: Well-being is a desired and optimal state of functioning of individuals, which may be modified through various psychological factors. Mindfulness is a cultivable state of mind, which enhances experiential processing of stimuli. It is hypothesized that apart from mindfulness, the social environment of the individual vis-à-vis social support may help predict well-being. This study was done to examine mindfulness, social support, and well-being, their relationship and role in the Indian population. METHODS: Through purposive sampling, 375 men and women (mean age = 35.05 years; standard deviation = 12.82) were recruited into the study and were administered the cognitive and affective mindfulness scale-revised, interpersonal support evaluation list, and the brief inventory of thriving. The obtained quantitative data were analyzed using descriptive statistics, Pearson's product-moment correlation coefficient (Pearson's r), and multiple hierarchical regression analysis. RESULTS: The results showed a positive correlation among mindfulness, social support and its dimensions (tangible, appraisal, and belonging), and well-being. Regression analyses revealed that mindfulness and social support in combination contributed to well-being, where belonging support was seen to be a unique significant predictor. CONCLUSION: It can be concluded that both mindfulness and social support are significant indices of well-being, and this is especially useful in developing psychosocial interventions that would enhance well-being. Implications and limitations of the study have also been discussed.
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Breast cancer awareness and the prevalence of breast cancer risk factors and warning signs among women in Aleppo, Syria: A cross-sectional study p. 268
Ahmad Alhamid, Aya Zazo, Rima Salem, Dina Alfarra, Zain Douba, Haya Jawish, Zainab Zeino, Fatima Muzayek, Rama Zazo, Rayan Hamada, Hala Alayyoubi, Aya Haji Mohamad, Rand Massri, Joud Shiekhoni, Dania Khudro, Ayla Baghdadi, Tasnim Altenji, Rama Aldakhil, Ziad Aljarad, Anwar Chammout
BACKGROUND: Breast cancer (BC) is classified as the most prevalent cancer worldwide. The incidence and prevalence of BC in Syria are not determined but expected to be high. Lack of awareness toward BC leads to higher incidence and mortality. There are no studies measuring BC awareness in Syria. Our study aims to evaluate BC awareness and attitudes, the obstacles preventing women from receiving BC-related medical care, and the prevalence of BC warning signs and risk factors among women in Aleppo. METHODS: A cross-sectional, survey-based study was conducted during August 2019 in Aleppo, Syria. Participants were randomly recruited from multiple health-care and social facilities. We targeted adult females aged and avoided current or previous cancer patients and the visitor of oncology and pathology departments. The questionnaire had six main sections: (1) demographic characteristics; (2) knowledge of basic symptomatology and epidemiology of BC; (3) similar previous symptoms that the participant ever experienced; (4) attitude and behavior related to BC screening; (5) obstacles from seeking medical consultation related to BC, and (6) the prevalence of some BC risk factors among participants. RESULTS: BC awareness levels are disappointing. About 9.3% of the participants are confident that they have not ever heard of BC, and only 0.4% know the age-related risk of BC. About 8.7% of the respondents never or rarely self-examine their breasts, and only 10% of the 40 years or older participants screened for BC by the mammogram. Emotional barriers, especially feeling scared about what the doctor might find, were the main barriers preventing women from seeking medical help related to BC. Lack of enough physical activity and smoking headed the list of the prevalent risk factors. CONCLUSIONS: BC awareness levels in Aleppo-Syria are worrying. It is recommended to launch more awareness campaigns, with a concentration on the weak points in women's knowledge.
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Analysis of nutrients, phytochemicals, antioxidant and antimicrobial activity of corn silk extract (Zea mays L. Stigma) p. 275
H Rajeshwari, T Sivapriya
OBJECTIVE: The objective of the study is to estimate the nutrients, phytochemicals, antioxidant, and antimicrobial activity of Zea mays L. (Poaceae) Stigma maydis. MATERIALS AND METHODS: Aqueous extract of Zea mays L. (Poaceae) Stigma maydis was used for nutrient, phytochemical antioxidant, and antimicrobial analysis. Total carbohydrate, protein, fat, fiber, and energy were assessed according to British Pharmacopeia. Phytochemicals were screened by Trease and Evans method. Antioxidant assay was done by ferric reducing antioxidant power (FRAP) and 1, 1-diphenyl 2-picrylhydrazyl (DPPH) methods. Antimicrobial activity was determined by the agar well-diffusion method. RESULTS: The amount of carbohydrate, protein, fat, fiber, and energy present Zea mays L.(Poaceae) Stigma maydis was 6.12 g, 20.2 g, 0, 1.35 g, and 117.3 kilo calories, respectively. Preliminary phytochemical assay established the presence of phenols, flavonoids, tannins, alkaloids, saponins, terpenoids, glycosides, and steroids. The antioxidant activity was estimated as 76.75% at 700 nm by FRAP assay and 65.19% at 517 nm by DPPH assay. The zone of inhibition was found to be 1.5 mm against Escherichia coli. CONCLUSION: Zea mays L. (Poaceae) Stigma maydis can be used as a functional food to eradicate communicable as well as noncommunicable diseases due to its antioxidant and antimicrobial activity. It can be incorporated into food products for effective usage.
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Children as adherence enhancing agents in management of primary hypertension of adult family members p. 280
Sandra Roshni Monteiro, Meena Hariharan
BACKGROUND: Self-management of hypertension requires timely medication, prescribed diet, consistent exercise, and daily monitoring of health parameters to avoid its fatal consequences. Compliance is often difficult without family support, and this study aims to explore the agency of children in the mitigation of the disease. OBJECTIVES: To examine the effectiveness of children in their family member's hypertension management, an antihypertensive educational module was provided to them. METHODS: A sample of 43 children between 11 and 14 years of age, who had each identified a hypertensive family member, was provided with holistic information about hypertension through a video, information booklet, and interactive discussions reinforced at three intermissions over a span of 6 weeks. Children and adults were assessed for hypertension knowledge before and following intervention. Change in hypertension compliance and blood pressure (BP) was observed for the adults. RESULTS: The results showed that children had a significant improvement in overall hypertension knowledge test including its domains. The monitoring records reported to highlight the efforts put by the children during the course of the study. Assuming its intended effects, a significant reduction in the systolic and diastolic BP reading was observed with an overall improvement in compliance. Interestingly, the knowledge status in adult participants had not increased. CONCLUSION: The results have been discussed which highlight the role of children in influencing “their patients.” It unlocks a gateway of research involving children, especially in primary and tertiary approaches to secure chronic disease prevention and management.
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Knowledge of herbal medicines among pregnant women attending some antenatal clinics in Eastern Nigeria p. 287
Maureen Ogochukwu Akunne, Chigozie Gloria Anene-Okeke, Adaobi Uchenna Mosanya
BACKGROUND: There are no studies assessing the knowledge of herbal medicines among pregnant women in Eastern Nigeria despite a universal increase in herbal medicines used by this population who usually are at risk from their adverse effects. The purpose of this study was to investigate the knowledge of herbal medicines among expectant mothers in Eastern Nigeria in order to estimate any need for education on the safety and effectiveness of herbal medicines use in pregnancy. METHODS: A cross-sectional and descriptive method was adopted, and data were collected with a validated questionnaire between June and August 2018 in three health facilities in Nsukka among pregnant women who attended antenatal clinics. A total of 300 participants were conveniently sampled. Descriptive and inferential statistical analyses were performed using SPSS 23. For statistical significance, P < 0.05. RESULTS: Out of the 300 respondents who gave their consent, 93.3% were married, 89.9% were within the age range of 18–34 years old, and 82.8% of them had postprimary education. The mean percentage knowledge score of herbal medicine was 63.196%. More than half of the women scored below the mean score and were considered to have poor knowledge (57.9%). The respondents' sociodemographics had a nonsignificant statistical relationship with the level of knowledge of herbal medicines (P > 0.05). CONCLUSIONS: Most of the pregnant women assessed in this study had poor knowledge of herbal medicine and no association with their sociodemographic characteristics was observed.
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Birth preparedness and complication readiness among pregnant women visiting a government hospital in Delhi, India p. 293
Meenakshi Bhilwar, Poornima Tiwari, Pragyan Paramita Parija, Priyanka Sharma, Sunil Kumar Saha
BACKGROUND: According to the WHO, about 830 women die from pregnancy or childbirth-related complications globally and can be attributed to the three delays that influence the outcome of any pregnancy. Birth preparedness and complication readiness (BPCR) is one of the most conceptual and logical means of addressing these delays. OBJECTIVE: The objective was to study BPCR among pregnant women visiting ANC clinic at a tertiary care government hospital in Delhi. MATERIALS AND METHODS: It was a cross-sectional study conducted among 200 pregnant women, irrespective of gestational age visiting the hospital. Information was gathered using a pre-designed, pre-tested, semi-structured questionnaire by an interview about BPCR. Descriptive analysis was done and tests of significance were applied to determine association. RESULTS: Awareness about dangers signs during pregnancy and childbirth and symptoms indicating onset of labor were all found to be poor, none of subjects were aware of all the signs. About 76% believed they should identify an institution for delivery ahead of time, while 68.5% had identified one and 64 (32%) had arranged a mode of transport. One hundred sixteen women (58%) believed that they should save money for the incurring costs of pregnancy, while 105 (52.5%) were saving money for the same. Sixty-three women (31.5%) agreed that it is necessary to identify a blood donor; however, only 7.5% had identified one. The BPCR index for the current study was 37.12. CONCLUSION: Efforts should be targeted to increase the awareness about various components of BPCR along with increased involvement of community health workers and health-care providers.
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Cost of a unit of blood – An activity-based costing in a tertiary care teaching hospital p. 300
Shrinivasan Sowmmya, Melanahalli Dayananda, Jagiri Narotham Rao
CONTEXT: Costing enables administrators in planning for future expansion, evaluates cost-effectiveness, and helps in mobilization of resources. Costing of services like blood banking and transfusion is complex, more particularly in a service-oriented (not for profit) setup. Activity-based costing (ABC) helps in identifying all the resources involved at every step. AIM: The aim of the study was to analyze the cost of processing blood components in the blood transfusion services (BTS) department (blood center) of a private trust-funded tertiary care teaching hospital in South India. SETTINGS AND DESIGN: This was a retrospective study and an economic evaluation. METHODOLOGY: Cost an activities data was collected by observation and unstructured interviews of Blood Centre staff. The costing model was created based on the activities, cost heads and the costs were apportioned appropriately followed by calculation of the final costs. RESULTS: An ABC model with nine steps, which identified fifty substeps modeling the activities, was used to estimate the cost. The manpower cost (direct and indirect) was the highest cost driver followed by the direct material cost of the blood bag. ABC analysis revealed that component separation was the most expensive process step followed by cross-matching, specialized packed cells preparation, storage, and infection testing. CONCLUSIONS: Despite excluding fixed costs related to land, infrastructure, building, and equipment capital and depreciation, the ABC model costing was higher than the Government of India released costing. A homogenized ABC model helps in identifying and refining methods to adopt cost efficiency measures at the institutional level but also raises the question whether cost-efficiency requires a policy-level intervention. Additional data collected across the country and analyzed in a standardized manner can aid in the same.
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Adult Bacille Calmette-Guérin vaccination during the pandemic of COVID-19 in India p. 307
BM Shrinivasa, Padmapriyadarsini Chandrasekaran, Joshua Chadwick, Manoj V Murekhar
The pandemic of coronavirus disease 2019 (COVID-19) has impacted many health service systems including tuberculosis (TB) control in India. As of October 19, 2020, India has the second highest number of COVID cases globally, amounting to 7.55 million reported COVID-19 cases and 114,640 deaths. Indian Council of Medical Research's Bacille Calmette-Guérin vaccine study among elderly individuals in COVID-19 hotspots involves the following strategy such as COVID screening by antibody testing and real-time reverse-transcriptase-polymerized chain reaction, TB screening by symptom and chest X-ray, and those who are tested positive will be linked to the national tuberculosis elimination programme for the management, this could be a sustainable new strategy in combating the two pandemic diseases, especially in India with high TB and COVID-19 disease burden. To ensure no one is left behind, the paradigm shift of screening for TB and COVID should be in place to sustain the progress made toward TB elimination.
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The need for integrating social and behavioral sciences in the Indian medical curriculum p. 311
Z Zayapragassarazan
Behavior, social, psychological, and biological factors affect health and disease. It is widely recognized that behavioral and social sciences should become an integral part of medical training. Integrating behavioral and social science into the curriculum is a key issue emphasized in many research. Despite the critical role of behavior and social science in health-care performance, these have not been effectively incorporated in the medical and allied health sciences curriculum. This article emphasizes the role, purpose, and importance of social and behavioral science in the medical curriculum. It also discusses how effectively these domains can be integrated into the medical school curriculum to train future doctors in social and behavioral sciences relevant to medical practice. Such medical education and training will help future doctors to practice with a fully informed medical system.
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Understanding migrants' reaction to the COVID-19 pandemic from evolutionary psychology p. 316
Ishita Akula, M Kishor
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