Palliative care in India: Situation assessment and future scope.

Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life‑threatening illness, through prevention and relief of suffering by means of early identification, assessment and treatment of pain, and other problems – physical, psychosocial, and spiritual. It is estimated that in India the total number of people who need palliative care is likely to be 5.4 million people a year. Though palliative care services have been in existence for many years, India ranks at the bottom of the Quality of Death index in overall score. However there has been steady progress in the past few years through community‑owned palliative care services. One of the key objectives of the National Programme for prevention and control of cancer, diabetes, cardiovascular diseases, and stroke is to establish and develop capacity for palliative and rehabilitative care. Community models for the provision of home‑based palliative care is possible by involving community caregivers and volunteers supervised by nurses trained in palliative care. Training of medical officers and health care professionals, and sensitization of the public through awareness campaigns are vital to improve the scope and coverage of palliative care. Process of translating palliative care plan into action requires strong leadership, competent management, political support and integration across all levels of care.

Student-centred learning in Community Medicine: An experience from Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry.

Background. Student-centred learning (SCL) places the student at the centre of policies, practices and decision-making in the teaching–learning process. SCL methodology also advocates active involvement of students in the curriculum planning, selection of teaching–learning methods and assessment process. We planned an education innovation project to assess the perception of fifth semester undergraduate medical students towards implementation of an SCL methodology. Methods. The study was done among 87 fifth semester undergraduate medical students (batch of 2010–11) in the noncommunicable disease epidemiology section of Community Medicine at the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry. The students divided themselves into seven groups and developed the learning objectives, selected teaching–learning methods and assessment process for each session. The facilitators had 3–5 rounds of interaction with each group before the session. Qualitative analysis of feedback collected from students and external faculty after each session was done. The effect of implementing the SCL methodology was assessed by the reaction level of Kirkpatrick’s training evaluation model by using a rating scale. Results. Of the 87 eligible students, 73 (83.9%) returned the forms for evaluation. All seven groups were able to formulate the learning objectives. Most of the groups had used PowerPoint slides and videos as a teaching–learning tool. Innovative assessment methods such as crosswords and ‘chocopati’ were used by some groups. In general, the perception of students was favourable towards SCL compared to conventional methods and they felt that this methodology should be adopted more often. Time management and organization of sessions were the main problems encountered by the students. The mean (SD) score for the items ‘sessions were useful’, ‘sessions were enjoyable’ and ‘sessions improved my knowledge’ were 6.2 (1.8), 7.1 (1.8) and 6.3 (1.9), respectively. Conclusion. The majority of students found the sessions on innovative teaching–learning and assessment techniques enjoyable, useful and informative. The sessions showed that students took an active part in curriculum planning, execution and evaluation.

Outcomes of respiratory diphtheria in a tertiary referral infectious disease hospital.

Background: Diphtheria is a fatal disease and may cause serious complications if not recognized early and treated properly. Objectives:To study the epidemiology, clinical features, complications, and outcomes in respiratory diphtheria. Materials and Methods:Diphtheria cases admitted in the infectious disease hospital, Beliaghata, Kolkata, India between January 2009 to January 2011 were evaluated in respect to demographic profile, immunization status, clinical features, complications, and outcomes. Results: 200 diphtheria cases were studied. 150 (75%) patients had history of an adequate immunization, and 100 (50%) patients were from lower socio-economic groups. Common clinical features observed were throat pain in 148 (74%) cases and fever in 112 (56%) cases. Complications observed were myocarditis in 136 (68%) cases, neuropathy in 30 (15%) cases, and respiratory compromise in 14 (7%) cases. Death occurred in 5 (2.5%) patients. Conclusions:diphtheria is still a public health problem in many developing countries. Strict public health measures like an increased immunization coverage, improvement of socio-economic status, easy availability of anti-diphtheritic serum (ADS), early recognition and effective treatment-all may reduce the incidence and mortality.

Risk factors for cardiovascular diseases: Is the social gradient reversing in northern India.

Background. In the past century, most developed countries witnessed a reversal of social gradient in cardiovascular diseases. To examine whether this phenomenon is also under way in developing countries, we assessed the prevalence of selected risk factors for cardiovascular diseases among different social groups living in urban and rural areas of northern India. Methods. Four hundred adults >30 years of age, selected by cluster sampling, were surveyed from 8 purposively selected communities of Chandigarh and Haryana during 2004–05. The WHO STEPS tool for surveillance of risk factors was used to enquire about sociodemographic characteristics, tobacco use, alcohol intake, physical activity and to measure weight, height, blood pressure, and waist and hip circumference. Prevalence of risk factors such as tobacco use, physical inactivity, overweight (BMI >25 kg/m2), and hypertension (>140/90 mmHg or on anti-hypertension treatment) were estimated according to the area of residence and across educational categories after controlling for the effects of confounding variables. Results. The prevalence of hypertension in urban (39%; 95% CI 29.5%–49.2%), slum (35%; 95% CI 27.2%– 42.9%) and rural (33%; 95% CI 25.4%–40.8%) communities was found to be statistically similar (p>0.05) after controlling for age, gender and education. The prevalence of physical inactivity (17% v. 12%), central obesity (90% v. 88%), overweight (20% v. 19%) and hypertension (34% v. 36%), were found to be statistically similar among literate and illiterate population after controlling for the effect of age, sex and place of residence (p>0.05). However, the risk of tobacco use was significantly lower among literates (OR 0.3, 95% CI 0.1–0.8). Conclusion. In selected communities of northern India, most of the cardiovascular disease risk factors did not have a social gradient except tobacco use, which was more common in the lower social group.

Hepatitis E epidemic with bimodal peak in a town of north India.

INTRODUCTION: An epidemic of viral hepatitis occurred in Mandi Gobindgarh town of Punjab in northern India during year 2005-06. An attempt was made to study the outbreak clinically, serologically, and etiologically. METHODS: Line listing and spot mapping of all cases of jaundice presented to civil hospital was done. An active search of cases was made through house-to-house visit with the help of 33 teams and 6 supervisors. Twenty two blood samples collected from acute cases were tested for anti-HAV IgM and anti-HEV IgM by ELISA. HEV specific PCR was also carried out. Sanitary survey was also done and water samples were tested for coliforms. RESULTS: In house to house survey 3170 cases of jaundice were reported; of them 2171 (68.5%) were males. Mean age was 28.8 years. Overall attack rate was 5.2%. The epidemic continued for more than a year and bimodal peak was observed. Civil hospital campus which has separate water supply had no jaundice case. About 95% blood samples from icteric patients were found to be positive for IgM and IgG antibodies of HEV. Eighteen persons died during the epidemic, mostly in old age group. Case fatality ratio was 0.57%. No deaths occurred among 17 pregnant women who had developed hepatitis. CONCLUSION: The epidemic was caused by hepatitis E virus, which was transmitted due to faecal contamination of municipal water supply.