Disability in New Leprosy Cases - Magnitude, Pattern and Associated Factors: A Cross Sectional Study in a Subdivision of Darjeeling District, West Bengal

Leprosy is an infectious disease, which may lead to disability before, during or after treatment. Leprosy is associated with social stigma and discrimination because of disability and disfigurement and recognized as a disease of major public health significance. As factors associated with occurrence and management of disabilities may vary from area to area, it is important to generate this information in affected populations. This study has been carried out to determine the extent and pattern of disabilities among newly diagnosed leprosy cases, factors associated with disability, provision and utilization of disability preventive services. This cross-sectional study was conducted in Siliguri subdivision of Darjeeling district, West Bengal. All newly diagnosed and registered leprosy cases in a reference year (April 2013 - March 2014) were included. Detailed medical examination and interviews was carried out to assess the disability and to study the relevant aspects. The entire collected data was analysed using SPSS software and chi-square, binary logistic regression were applied to test association between disability and other epidemiological correlates. It was observed that all the disabilities were in multibacillary (MB) cases only. Child leprosy rates of 5.5% appears to be promising statistics. Among 110 new leprosy cases studied, overall proportion of disability was 15.5%; grade 1 and grade 2 disabilities were 9.1% and 6.4% respectively. Hand was the commonest site of involvement, whereas grade 2 disability was highest in feet (2.7%). Disability status was found to be significantly associated with number of nerve involvement and history of treatment interruption. Utilization of disability preventive services was found very poor. Significantly the proportion of disability was highest among leprosy cases aged 60 years or more (37.5%). As no disability was noted in patients below 15 years, march towards achieving one of the targets of Global Leprosy Strategy 2016-20 appears to be closing to goal. Though the situation may be better comparably to some other parts of country, yet the overall proportion of disabilities as well as grade 1 and grade 2 disabilities among newly diagnosed leprosy cases is unacceptably high in the studied area. Community based studies and appropriate interventions can help in achieving the targets pertaining to leprosy situation in general and access to quality services in particular

Effects of Having Usual Source of Care on Preventive Services and Chronic Disease Control: A Systematic Review / 가정의학회지

BACKGROUND: Having usual source of care has been associated with improved receipt of preventive services and control of chronic diseases (such as hypertension, diabetes, and hypercholesterolemia). The objective of this study was to examine whether having usual source of care is associated with improved receipt of preventive services and control of chronic diseases. METHODS: We searched MEDLINE, EMBASE, Cochrane, CINAHL, KMbase, KoreaMed, RiSS4U, National Assembly Library, and KISS for studies released through May 31st 2011. Two authors independently extracted the data. We manually searched the references and twenty recent related articles on PubMed. To assess the risk of bias RoBANS tool was used. RESULTS: We identified 10 studies. Most having usual source of care were associated with improved receipt of preventive services (cervical cancer screening, clinical breast exam, mammogram, prostate cancer screening, and flu shot) compared with no usual source of care. However, gastric cancer and colon cancer screening were difficult to conclude and blood pressure checkup showed mixed results. Overall there was no association between having usual source of care and smoking behaviors and the effect on chronic disease control was difficult to conclude. CONCLUSION: Having usual source of care was associated with improved receipt of preventive services and overall the results were consistent. So, the results suggested that having usual source of care may help to receive preventive services. Hereafter, cohort studies are needed to evaluate casual relationships and more studies are needed in various countries and systems.

Prevention in the United States Affordable Care Act / 예방의학회지

The Affordable Care Act (ACA) was signed into law on March 23, 2010 and will fundamentally alter health care in the United States for years to come. The US is currently one of the only industrialized countries without universal health insurance. The new law expands existing public insurance for the poor. It also provides financial credits to low income individuals and some small businesses to purchase health insurance. By government estimates, the law will bring insurance to 30 million people. The law also provides for a significant new investment in prevention and wellness. It appropriates an unprecedented $15 billion in a prevention and public health fund, to be disbursed over 10 years, as well as creates a national prevention council to oversee the government's prevention efforts. This paper discusses 3 major prevention provisions in the legislation: 1) the waiving of cost-sharing for clinical preventive services, 2) new funding for community preventive services, and 3) new funding for workplace wellness programs. The paper examines the scientific evidence behind these provisions as well as provides examples of some model programs. Taken together, these provisions represent a significant advancement for prevention in the US health care system, including a shift towards healthier environments. However, in this turbulent economic and political environment, there is a real threat that much of the law, including the prevention provisions, will not receive adequate funding.

Periodic Health Examination and Prevention Guidelines for Koreans / 가정의학회지

Periodic Health Examination and Prevention Guidelines for Koreans were first proposed since 1988. Based on that guideline, clinical preventive services has been applied to clinic population in a few University Hospitals since 1991. In 1995, LHMP development committee in Korean Academy of Family Physician Society first published evidence based clinical practice guidelines and updated the guidelines in 2003. Lifetime Health Maintenance Program (LHMP) commitee represents efforts to take a more updated evidence-based approach to the development of the third updated clinical practice guideline in 2009. We focused on approaches that can reliably assess the extent of updating required, a model of limited literature searches with modest expert involvement to reduce the cost and time.