Assessment of functioning of public health facilities in a North Indian state

Background: This study was conducted to assess the current status of functioning of health facilities in Punjab.Methods: A checklist based on six building blocks of health system proposed by WHO and the IPHS was developed, validated and pretested. District hospital (DH), one sub district hospital (SDH) and two Community Health Centres or Block Primary Health Centres (CHCs/BPHCs) were randomly selected from each of 22 districts of Punjab and evaluated against checklist. Total score was thus assigned to each facility. Additionally, workload of healthcare workforce, presence of health functionaries as against total posted strength and feedback from administrators of these facilities were also recorded.Results: Health services are concentrated at the DH and SDH. Functional equipment like ECG, oxygen, mask, ambubag etc. are deficient at all levels of health facilities. Nearly 50% of expected medicines were in stock at the DH and SDH and 66% at CHC/BPHC level. Patient to doctor ratio is highest at SDH in outpatient department and CHC/BPHC in emergency section. Number of lab tests per lab technician are highest at CHC/BPHC level. Administrators express the need for reducing staff shortage, more intensive training in the financial and administrative processes and simplification of procedures for management of equipment.Conclusions: Strengthening CHC/BPHC level institutions may improve utilization of public health system and reduce referrals. Lifesaving drugs and equipment need to be available and operational at all levels of facilities. Content of training to administrators needs to be tailored to the felt needs.

Oromotor Stimulation for Transition from Gavage to Full Oral Feeding in Preterm Neonates: A Randomized controlled trial.

Objective: To assess the effect of additional oromotor stimulation along with routine care on transition from gavage to full oral feeding in preterm neonates. Method: 51 neonates (28-34 weeks) randomized to receive either oromotor stimulation along with routine care (n=25, intervention), or routine care alone (n=26, control) (which included Kangaroo mother care and non-nutritive sucking). Results: Median (IQR) days to reach partial and full spoon feed were significantly lesser [5(3-9.5) vs 10(5-15) P=0.006; and 7(5-14.5) vs 12.5(7-21); P=0.03] in intervention than in control group, respectively. A significantly higher number (56%) in intervention group as compared to control group (31%) achieved partial direct breast feeding at discharge (P=0.01). Conclusion: Oromotor stimulation along with routine care reduces the duration of gavage feeding in preterm neonates.

Potbelly--the most powerful predictor of metabolic syndrome and premature morbidity and mortality.

BACKGROUND: We evaluated the hospital population for the prevalence of the metabolic syndrome with the help of clinical variables, such as abdominal waist circumference, biochemical variables and ultrasonic variables. The aim was to define the most sensitive and powerful predictor of the syndrome, as also of premature morbidity and mortality. METHODS: We used clinical and biochemical data from our prospective study: "To Evaluate the Scenario of Metabolic Syndrome in the Hospital-Based Community". The criteria used for the definition of the syndrome were those laid down by the National Cholesterol Eradication Program Adult Treatment Panel III. The modified criteria for Asian Indians, that is, an abdominal waist circumference of greater than 90 cm in men, and above 80 cm in women, were also included. A total of 200 patients (100 males and 100 females) between the ages of 20 and 85 years were clinically and biochemically evaluated for the study. RESULTS: The results using the National Cholesterol Eradication Program Adult Treatment Panel III criteria as well as the modified criteria showed that abdominal waist circumference is the single most accurate (79% and 86.5%, respectively) predictor for determining the metabolic status of an individual (p-value <0.001). The waist circumference cut-off of the modified criteria proved to be a more accurate predictor for males as well as females (69% vs. 84%, and 89% vs. 85%, respectively for the two definitions; p-value <0.001). CONCLUSIONS: An abdominal girth of above 90 cm in males and above 80 cm in females is a far more powerful clinical predictor of the metabolic syndrome than other clinical, biochemical and ultrasonic variables (p-value <0.001). This may be considered in the context of premature morbidity and mortality.

A historical perspective on menopause and menopausal age.

Earliest known references to menopause have been very scarce. Aristotle referred to age at menopause being 40 years. A French physician coined the term menopause in 1821. Medical interest in menopause increased considerably in mid 19th century. In 1930s people started describing it as a deficiency disease. Consequently, various replenishment therapies were advocated eg. testicular juice, crushed ovaries of animals.In 1970s medicalization of menopause was complete. Menopausal symptoms were ascribed to estrogen deficiency and estrogen (hormone) replacement therapy was exhorted as the ultimate liberation of middle aged women. Synthetic estrogen was developed in 1938. Medical industry (Pharmaceuticals) entered the scenario of menopause in a big way and dominated the center stage. In 1970s International Menopause Society was established. First International Congress on Menopause was also organized in Paris, France in 1976. Various countries have formed national societies on menopause. Symptomatology of menopause differs in different ares of the world e.g In West - hot flush, in Japan shoulder pain and in India low vision are the hallmarks of menopause. HRT use rate is high in West while it is low or negligible in countries like India. Age at menopause is also higher in West as compared to the range of 45-47 years in developing countries like India. Historically also a lower age at menopause was range documented in earlier times. This rose to the range of 50-51 years in the present era.Overall, women in western countries view menopause negatively. This is contrasted with a positive outlook towards menopause in a developing country like India.