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Medico-legal issues in orthopaedic practice are increasing day by day. With the tremendous metamorphosis in the healthcare sector, incidents of lawsuits against orthopaedic surgeons and hospitals, in the name of medical negligence is on the rise. With every consumer redress forum being more inclined in protecting the consumers, it is imperative for practising Doctors to be more informed on the Medico-legal aspects of their field of practice. Most orthopaedic cases that lead to medico-legal cases result from trauma. Besides, these cases are seen in the Emergency Room, thereby resulting in critical and uncertain decisions. Unlike in other fields where the patient has an existing relationship before any complications occur, rapport-building has to begin much after the treatment has begun. Technological advances in the orthopaedic field, availability of online information on platforms like Google, lack of communication, cutthroat competition among orthopaedic surgeons, awareness about the consumer protection act, mob psychology, interference by anti-social elements and local politicians etc have brought orthopaedic practice at this stage. Following ethical aspects, keeping good repo with patients and society, keeping our documentation perfect and precise, and doing transparent and honest practice can save orthopaedic surgeons in long run. Having empathy towards patients and society, keeping workload in our control, helping each other in crisis, and no medical jousting are also important measures to do safe medical practice in the present era. Keeping in mind the mantra of coming together, working together, and working in harmony is of utmost importance for an orthopaedic practice in recent times.
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Background: Obesity has become a challenge in medical care worldwide. Medical professionals have a significant role to play in preventing and diagnosing weight problems and in providing initial counseling. Health professionals are poorly prepared in weight management, which has an effect on their knowledge and management skills with regard to overweight and obese patients. Hence the present study was carried out to assess the knowledge about epidemiological determinants of obesity and its management amongst medical professionals of Marathwada region of Maharashtra, India.Methods: A cross-sectional study was carried out during the period of March to April 2019 amongst 110 medical professionals at Department of Community Medicine of IIMSR Medical College, Badnapur, Jalna, Maharashtra, who were actively participated in continued medical education (CME) on obesity and its management where the knowledge of medical professionals were assessed. Data was analysed by using appropriate statistical test whenever necessary.Results: In this study, the pre-test good knowledge score was 14 (12.7%), which increased to 61 (55.5%) post CME. The pre-test mean score of level of knowledge was 7.41±4.12 and after CME, it was 12.90±5.21 and the mean difference was 5.49, which was statistically highly significant.Conclusions: As obesity is a public health problem globally, there was marked improvement in the knowledge amongst medical professionals after CME on epidemiological determinants of obesity and its management.
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Background: The pillar of doctor patient relationship is the bond of mutual trust. This pillar is strengthened by effective communication between doctor and patient/relatives. It has been widely accepted that a doctor needs to have very good communication skills in addition to clinical knowledge and skills required for effective healthcare. Every doctor duly needs to demonstrate humanity, healthy behaviour, as well as sensible communication with patients which can build the sustainable ‘trust’ in the treatment offered by that doctor. However, the current curriculum of medical courses is enormously focused on providing competent medical knowledge but lacking the focus on inculcating communication skills.Methods: A cross sectional study was carried out amongst 377 resident doctors of first to third year, from randomly selected medical colleges of Maharashtra having postgraduate courses in clinical subjects and affiliated to Maharashtra University of Health Sciences, Nashik, Maharashtra, India during the period of February 2017 to January 2019. Data was entered in MS Excel sheet and analyzed using percentages and proportions wherever appropriate.Results: Highest study respondents were from General Medicine with 13% of total and having 17.4% males and 8% females among respective genders followed by General surgery and Pediatrics residents with 12.5% each specialty.Conclusions: The study has shown that there was varied knowledge about the communication skills among the resident doctors. The residents have shown fair attitudes and behaviours towards mindfulness and basic communication skills.
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Background: The mutual trust between doctor and patient, an indispensable part of the healthcare, is weakening day by day. This has resulted in unwanted incidences of violence and attacks on doctors. Communication between doctors and patients is an integral part of the relationship and is one of the major determinants of mutual trust. Apart from the knowledge and skills required to treat a disease, communication skill is an indispensable part of a doctor’s professional life. The resident doctors do not get a chance to learn and implement the communication skills required for the doctor patient relationship. Methods: An interventional study was carried out amongst 377 resident doctors of first to third year, from randomly selected medical colleges of Maharashtra having postgraduate courses in clinical subjects and affiliated to Maharashtra University of Medical Sciences, Nashik, Maharashtra during the period of February 2017 to January 2019. Results: There was significant difference in the pre and post test scores for quantified knowledge in relation to training in communication skills (p<0.0001), and also significant difference in the pre and post test scores for quantified knowledge in relation to basic doctor patient relationship, suggesting that the intervention was effective in improving the communication skills. Conclusions: The study has shown that there was significant difference in the pre and post test scores for quantified knowledge in relation to being doctor, basics of communication skills, doctor patient relationship, communication in special situation, and training in communication skills.
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Background: Diabetes has become a major health problem in India. Inadequate knowledge and training of frontline medical care givers like nursing staff, intern doctors and resident doctors may result in increase in both acute and chronic complications amongst diabetes patients. So, it results to high economic burden on family especially in rural parts of India. So, objective of this study was to assess knowledge about diabetes and its management amongst medical interns and nursing staff in tertiary care teaching hospital in Marathwada region of Maharashtra.Methods: This was a cross-sectional study conducted at IIMSR Medical College, Badnapur, Jalna, Maharashtra amongst 70 nursing staff and 70 medical interns by convenient sampling method during the period of June to August 2018. Knowledge on diabetes was assessed through 30 questions.Results: Knowledge related to diabetes and its management is assessed in 70 nursing staff and 70 medical interns using 50 item questionnaires. Out of 70 nursing staff mean knowledge score was 38.13 and out of 70 medical interns mean knowledge score was 40.17. Those nursing staff that had experience more than 5 years and positive family history of DM had significant greater knowledge than counterpart. There was no significant difference in knowledge level in gender, age, degree or diploma and whether in-service education opted or not amongst nursing staff. Amongst intern knowledge was more in those who had positive family history of DM. There was no significant difference in knowledge level in male and female interns.Conclusions: This study concluded that there was knowledge gap about diabetes and its management amongst frontline care givers like nursing staff as compared to medical interns suggesting requirement of additional training and educations amongst frontline health care providers.
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Curriculum is an essentially signified foundation of an academic arena. The master key of the treasure curriculum is anchored in its development. The basic and progressive aspects are the prominent spectrums of curriculum in navigating the stakeholders. Empowerment of curriculum by augmenting its development has been a topic of ongoing discussion in the enrichment of the educational field. By reviewing selected past and present relevant articles, this review article is aimed to provoke and fortify insights for the due perfection, systematization, and standardization in the futuristic aspects towards curriculum development. This is a sincere effort to present the versatile role of the concept of curriculum development and validate its significant aspects by keeping the various stakeholders in mind. It is hoped that this article would help motivate elder and newer generations of curriculum developers, academicians and researchers for expounding the process, for recognizing the intrinsic and upcoming challenges in the field of curriculum development for recognizing needs to refresh, update technology and upgrade pedagogics, for standardizing curriculum at the global application and for instigating an urge to research various aspects of this topic to bring in the due change, advancement and standardization.
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Implementation of assessment is utmost significant to enhance the prospects and strengths of Community Health Needs. Addressing community health needs has been a challenge for the Governments of various nations in the world due to various reasons like rising number of recipients, insufficient resources, increase in demands of resources and discrimination in their supply. The role of community health assessment is central in enabling practitioners, managers and policy makers to identify, categorize and prioritize demands, update the policies and then, to ensure that these health care resources are supplied to optimize health care and maximize its outreach to community members. It has a great potential to be a vital tool which can empower the management and planning of health care across the countries at the level of nationwide, state-wide and district wide communities, populations and families. The objective of this review article is to present the systematic and updated approaches to implement community health needs assessment at multiple levels i.e. district, state and national, keeping those aligned with the approaches indicated within global policies. It’s measurable outcomes are to identify and list the priority health needs, target resources to address inequalities, involve local people, educate and train the stakeholders and provide evidence based updated data for amending existing policies. The process of undertaking community health needs assessment and the importance of contribution of health care personnel in this process is also included here.
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Background: Rabies is one of the most important zoonotic diseases in India. About 99% of all human deaths from rabies occur in the developing nations. Dogs are the main reservoir of rabies in India. It is invariably fatal if proper treatment is not instituted promptly. One of the important factors associated with successful treatment is the knowledge of the caregiver in the proper management of animal bites and rabies vaccination. Hence the present study was conducted to assess the knowledge about epidemiological determinants of rabies & its prevention amongst medical interns.Methods: A cross-sectional study was carried out amongst 76 interns of a Private Medical College in Marathwada region of Maharashtra during the period of September to October 2018. Pre-designed, pre-structured questionnaire was used for data collection. Data was entered in MS Excel sheet and analyzed accordingly.Results: Out of 76 interns, there were 36 (47.3%) males and 40 (52.7%) females. Majority 61(80.3%) were Muslims followed by 14(18.4%) were Hindus. About 68.4% interns correctly knew that the route of administration of vaccination could be either intra-muscular or intra-dermal (p=0.0220). About 1/4th i.e. 25% interns didn’t know about incubation period of rabies in human (p=0.0079). However, 29(38.2%) interns didn’t know about exact site of administration of rabies immunoglobulin is at wound site.Conclusions: The present study concluded that there were significant gaps in the knowledge about prevention of rabies which needs to be overcome immediately with proper training
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Background: The mission of medical education is to provide the medical students adequate learning experiences so that they become competent doctors. In most of the medical schools of India, it is mainly taught by means of didactic lectures, tutorials and practical classes with often least interdisciplinary interaction. Objective: The objective of the present study was to explore the student’s preferences about teaching methods. Methods: A cross sectional study was conducted during the period of July to November 2014 amongst 2nd year undergraduate medical students attending community medicine subject classes. Out of total 150 students, 138 were participated in the study. A pre-designed self-reported questionnaire was used as a tool for data collection. All opinions were rated using a five-point Likert scale, which ranges from “strongly preferred” to “strongly not prefer.” Data was entered in MS Excel and were analysed in the form of percentage and proportions whenever appropriate. Results: In this study, mean age of the students was 19.38 ± SD 0.69 years. Out of 138 students, 81(58.7%) were females and 57(48.3%) were males. Ninety nine (71.74%) students agreed that the length of MBBS curriculum should be 4.5 years. The most preferred mode for theory and practical teaching by students was focused group discussion and bedside clinic respectively. The most common obstacle faced by students during theory and practical learning was one way, non-interactive teaching. Conclusions: The students are interested in more interactive learning sessions. Students felt that the understanding is better with focused group discussion and bedside clinics.
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Climate change is one of the most critical global challenges of our times and its issue of concern for every global citizen. Many important public health challenges are attributed to climate change and rise of vector-borne diseases is one of them. The most deadly vector-borne disease, malaria, caused an estimated 660000 deaths in 2010. However, the world's fastest growing vector-borne disease is dengue, with a 30-fold increase in disease incidence over the last 50 years. Multiple factors have impact on transmission of vector-borne diseases, and causing their appearance in countries where they were previously unknown.
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Health care delivery in India has been envisaged at three levels namely primary, secondary and tertiary. The secondary level of health care essentially includes Community Health Centres (CHCs), constituting the First Referral Units (FRUs) and the Sub-district and District Hospitals. The CHCs were designed to provide referral health care for cases from the Primary Health Centres level and for cases in need of specialist care approaching the centre directly. CHC is a 30-bedded hospital providing specialist care in Medicine, Obstetrics and Gynaecology, Surgery, Paediatrics, Dental and AYUSH. These centres are however fulfilling the tasks entrusted to them only to a limited extent. The launch of the National Rural Health Mission (NRHM) gives the opportunity to have a fresh look at their functioning. For the first time under National Rural Health Mission, an effort had been made to develop Indian Public Health Standards (IPHS) for a vast network of peripheral public health institutions in the country to provide optimal specialized care to the community and achieve and maintain an acceptable standard of quality of care.
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Background: The pterygium is known to cause refractive errors including astigmatism, which can have negative impact on the vision. The present study was carried out to find out the prevalence and socio-demographic determinants of pterygium patients attending Pravara rural hospital, Loni, Maharashtra, India. Methods: A cross-sectional study was conducted in outpatient department of ophthalmology in Pravara rural hospital, Loni. A total of 1910 patients of various ocular morbidities were registered during the studied period in the department of ophthalmology, among these, 100 patients who had pterygium were reviewed. All 100 patients were examined by torch and slit lamp. Data were analysed statistically using percentage and proportions whenever necessary. Results: Out of the 100 pterygium patients, 48% were in the age group of >60 years, followed by 32% in the age group of 51-60 years. In relation to occupation, maximum 82% patients were farm labours followed by 11% were house workers. Majority (62%) having unilateral, while (38%) was having bilateral pterygium. All cases of pterygium were nasal. Conclusion: People who work outdoors are subjected to increase U.V. exposure. So people must be aware of this and they must take appropriate precautions like wearing protective glasses and caps etc.
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Cancer can have profound social and economic consequences for people in India, often leading to family impoverishment and societal inequity. Roughly one million new cases of cancer are added every year in India, which is one-fourth of that recorded in Europe. Recently published India’s National Health Profile 2013, projected that by 2020 India will see a 21% rise on an average in the incidence of cancer with a 19% increase in cancer among men, and a 23 % increase among women. Data from 25 population-based registries across the country was analysed and extrapolated to reach the projections. The incidence of mouth cancers will rise by 51%, 48% increase in the incidence of prostate cancers, 31% for liver cancers and 22% for lung cancers. Cancers of the brain, hypopharynx and oesophagus will dip very marginally. Gall bladder cancers will increase 45%, and ovarian cancers 28%. All cancers are projected to rise in women, including cervical and breast cancers, which will continue to be the two most common types.
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Background: India a vast country has left behind a number of stigmas and prejudices to move ahead as one nation. Still in a number of states, villages, cities and towns, gender bias is persistent leading to female discrimination. Objective: To study the difference in child rearing practices based on sex of child among married women of reproductive age group in urban slum of Mumbai. Methods: A community based, cross-sectional study was carried out among 900 married women of reproductive age group during a period of Jan. 2007 to Jan. 2008 at Shivajinagar urban health centre, which is field practice area of T. N. medical college, Mumbai. Participants were selected by systematic random sampling in an urban slum of Mumbai, Maharashtra. Results: In present study, a total of 900 married women with their children below five year are 1158 (male: 632 & female: 526) were analyzed. There was statistically significant difference between child rearing practices like breast feeding initiation, complimentary feeding, immunization status, nutritional status, and treatment seeking behavior. Conclusion: The findings in the present study confirm that sex based difference in child rearing practices persist in urban slum area of Mumbai.
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Background: The International Labour Organization (ILO) estimates that more than 125 million workers are victims of occupational accidents and diseases in a single year. The important morbid conditions detected in the workers include the diseases of the respiratory system and eye, accidents, injuries, cuts and wounds, skin infections, animal bites, etc. Health Care Workers (HCWs) are attributed to the group at highest risk of occupationally acquired blood borne diseases as the result of contact with blood and body fluids. The present study was conducted to assess the morbidity pattern and occupational hazards in the sweepers working at the tertiary care teaching hospital in Mumbai. Methods: A cross-sectional epidemiological study was carried out in the various wards of Lokmanya Tilak municipal medical college & general hospital, Mumbai during the period of January 2008 to May 2009. Total 267 sweepers were interviewed. A pre-designed and pre-tested questionnaire was used to get information regarding the morbidity pattern and occupational hazards in the sweepers. Results: Out of 267, history of acute illness was elicited from 64 (23.97%) employees. 52 (19.47%) sweepers had history of chronic illness. Among the sweepers, 160 (59.9%) had some sort of morbidity present. The morbid conditions found in the sweepers were musculoskeletal disorders 55 (20.6%), hypertension 46 (17.2%), gastrointestinal problem 26 (9.7%), eye disorders 23 (8.6%) and respiratory system diseases 21 (7.9%). The present study showed that, 226 (84.6%) sweepers used some form of personal protective devices regularly and 41 (15.4%) didn’t use regularly. 113 (42.3%) sweepers had needle prick or sharp injury. 74 (65.5%) sweepers had single needle prick or sharp injury & 39 (34.5%) sweepers had repeated needle prick or sharp injury. Conclusions: Periodic examination should be done annually & immediate corrective measures should be taken to protect the health of employees at risk. Stress management principles must be implemented in the sweepers to enhance physical and mental health. There is need for safety training programme for all health workers including sweepers in the hospitals.
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Venous thromboembolism (VTE) is a leading cause of maternal mortality and morbidity during pregnancy in developed countries. The incidence of VTE increases about 4-fold during pregnancy and at least 14-fold during the puerperium. Risk factors include a personal history of VTE, presence of inherited or acquired thrombophilia, a family history of VTE and general medical conditions, such as immobilisation, overweight, varicose veins, some haematological diseases and inflammatory disorders. VTE is considered potentially preventable with the prophylactic administration of anticoagulants. Low molecular weight heparin has emerged as choice of anticoagulant in the present day obstetric and infertility practice. It has many advantages over unfractionated heparin and warfarin. Longer duration of action, less frequent dosing schedule, better safety profile are few of the advantages. Higher cost as compared to warfarin and unfractionated heparin is the main limiting factor for its use.
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According to World Health Organisation (WHO), domestic violence (DV) is defined as psychological/emotional, physical, or sexual violence, or threats of physical or sexual violence that are inflicted on a woman by a family member: an intimate male partner, marital/cohabiting partner, parents, siblings, or a person very well known within the family or a significant other (i.e. former partner) when such violence often takes place in the home. Intimate partner violence (IPV) and sexual violence against women are major public health problems and violations of human rights. They result in serious short- and long-term physical, sexual and reproductive, and mental health problems, including increased vulnerability to HIV. Near about 15-71% of women experience physical and/or sexual violence by an intimate partner at some point in their lives. Violence against women (VAW) affects all phases of lifecycle of a women, as rightly pointed out by WHO, starting from sex selective abortion in prebirth period; female infanticide, female genital mutilation, child marriage or prostitution in childhood; physical, sexual, psychological abuse, rape, sexual harassment, dowry murders, forced pregnancy in adolescence and adulthood period; ending in physical and psychological abuse in elderly.
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Sexual violence is not only a violation of human rights, but also a public health problem, with intimate partner violence and sexual violence among the most pervasive forms of violence against women. Worldwide, one in three women experience either physical or sexual partner violence or non-partner sexual violence. The lifetime prevalence of sexual partner violence reported by women, in age group of 15 to 49 years, in the WHO multi-country study ranged from 6% in Japan to 59% in Ethiopia, with rates in the majority of settings falling between 10% and 50%. The observed inter community; country and regional variation in the prevalence of violence imply that sexual violence within marriage can be addressed and preventable. The existing prevention programmes need to be tested and scaled up. The majority of women tend to avoid reporting these experiences due to associated shame, reprisal or gender inequity. Current review is an attempt to address the sexual violence among married women in a silent suffering. Various internets based popular search engines were used to explore data from literature, which includes PubMed, PubMed Central, Google Scholar and Medknow. Search was done using the key-word combinations „sexual violence within marriage‟ and ‘intimate partner violence‟. A total of 51 publications were evaluated for this article.
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An increasing number of children are becoming overweight and obese. Overweight and obesity are arbitrarily defined as excess adipose tissue in the body. Although many risk factors for overweight and obesity have been identified for school-age children, less is known for preschool children. Prevention of overweight and obesity in preschool children is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. This review was performed to study determinants and risk factors for overweight and obesity development in early age, effectiveness of preventive strategies in preschool children and outcome measurements of intervention programme in preschool children.
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Background: The period of infectiousness of a new sputum smear-positive pulmonary tuberculosis case is important in determining the risk of exposure faced by the community. Early detection and effective treatment of TB case reduces the period of transmission and the risk of exposure of the community. It is for this reason that the delay in TB diagnosis and treatment should be minimal to control disease transmission and patient suffering. Aims & Objective: To measure delays in diagnosis and treatment of pulmonary tuberculosis, and to identify and assess the risk factors associated with these delays. Material and Methods: A cross-sectional study was conducted of all new smear-positive pulmonary TB patients diagnosed between January 2012 and June 2013 at RNTCP clinic. The time from the onset of symptoms to first health care consultation (patient delay) and the time from first health care consultation to the date of TB diagnosis (health system delay) were analysed. Bivariate and logistics regression were applied to analyse the risk factors of delays. Results: A total of 122 patients with a mean age of 29.9 years were included in the study. Mean total delay between the onset of symptoms and treatment initiation was 53.42 days (median 50, range 14-128), with a mean patient delay of 29.24 days (median 25, range 5-94) and mean health system delay of 21.7 days (median 17, range 3–93). The mean treatment delay was 2.48 days (median 2, range 1-6). Factors independently associated with total delay were cough symptom (OR 3.36, P = 0.038), completed secondary school (OR 0.41, P = 0.018), good knowledge of TB symptoms (OR 0.39, P = 0.011), first visit to a public health facility (OR 0.45, P = 0.044), sputum testing at first health care consultation (OR 0.46, P = 0.048) and stigma attached to TB disease (OR 2.89, P = 0.021). Those associated with patient delay were male sex (OR 0.42, P = 0.020), large family size (OR 2.30, P = 0.027), completed secondary school (OR 0.43, P = 0.025) and good knowledge of TB symptoms (OR 0.45, P = 0.029); while those associated with health system delay were first visit to a public health facility (OR 0.31, P = 0.006), sputum testing at first health care consultation (OR 0.22, P = 0.001), number of health care consultations (OR 4.41, P < 0.001) and pre-diagnosis health care cost (OR 3.35, P = 0.001). Conclusion: Health system delay was an important problem in the area studied, with patient delay being of most concern.