Prolonged Stay in Intensive Care Unit and Its Predictors in a Tertiary Care Centre of West Bengal, India

Background : Intensive Care Unit (ICU) is considered as one of the most expensive and complex medical resources of any hospital. Research on ICUs may provide valuable inputs in developing an improved model of patient-care and hospital management and a better utilisation of the scarce resources especially in this ongoing pandemic crisis. ICU Length of Stay has long been used as a surrogate marker for resource utilisation. The following study was conducted in a Tertiary Care Hospital of West Bengal to find out the prevalence of prolonged ICU stay and their related factors. Methodology : This was an Observational, descriptive type study conducted in an intensive care unit of a teaching hospital of West Bengal during April-September 2021. Potential predictors were analysed along with various clinicodemographic profiles of the study subjects for possible association with prolonged ICU-Length of Stay (LOS >14days). Results and Discussion : Out of total 287 patients almost 19% patients had a Length of Stay (LOS) of more than 14 days. The patients admitted in the ICU due to surgical trauma, respiratory or neurological cases were more likely to have a prolonged LOS. Patient who had Coagulopathy, Infection, Oliguria or needed Mechanical ventilation or Vasopressor therapy in the first 24-hour following admission had higher ICU stay. The patients having LOS of >14 days had a higher mean APACHE II score. Conclusion : The predictors identified in this study can be used in targeting this particular group to improve resource utilization and efficiency of ICU

MATERNAL HEALTH SITUATION IN UTTAR PRADESH, INDIA

Health of children and their mothers is a vital aspect of a society's long- term development. Unfortunately, around half of all mothers and over 10 million children die due to preventable causes. Data from a current National Family Health survey (NFHS) was utilized and compared with the previous data of the surveys conducted at national level. The maternal mortality ratio in India has decreased to 113 per 100,000 live births, according to a report released by the WHO. 51.6% womenOnly reported three or more ANC visits where anaemia is still found among 35.4% women. Although 88% of women delivered in a health facility whereas only 5 7.5 % mothers received postnatal care within two months. The Maternal Mortality Ratio (MMR) in Uttar Pradesh is remains high due to a lack of utilisation of available maternal and child health services, putting the health of mother and children at risk. Hence, to improve the health status, evidence-based policies with grass root level programme planning are required.

Issues in Utilisation of MCH Services: Qualitative Insights from Tribal Women of Himachal Pradesh, India

Mothers and children in any country comprise a large vulnerable population subgroup. In order to address the myriad health needs of women and children, maternal and child health (MCH) services have been bolstered in India. Tribal women are facing many hurdles in the utilisation of MCH services which is ultimately affecting their health outcomes.This study aimed to explore the issues and challenges faced by tribal women during the utilisation of MCH services. Beneficiaries were facing issues like hospital environment and sub-centre issues, travelling/ transportation problems, lack of family support, awareness issues, and personal, social, and political issues while utilising maternal and child health services of tribal areas.It was concluded that there is a need to reduce the problems faced by tribal women regarding the utilisation of MCH services to enhance their level of satisfaction in order to promote maternal and child health which will ultimately help in achievement of SDGs.

Abstaining from annual health check-ups is a predictor of advanced cancer diagnosis: a retrospective cohort study

BACKGROUND@#Cancer prevention is a crucial challenge in preventive medicine. Several studies have suggested that voluntary health check-ups and recommendations from health professionals are associated with increased participation in cancer screening. In Japan, it is recommended that individuals aged 40-74 years should undergo annual health check-ups; however, the compliance to this recommendation is approximately <50%. According to the national survey, individuals who do not undergo annual health check-ups are at a higher risk for cancer. However, to the best of our knowledge, no previous study has investigated the association between the use of health check-ups and the incidence rate of cancer. We hypothesised that not undergoing periodic health check-ups and/or less use of outpatient medical services are predictors for advanced cancer.@*METHODS@#To explore the relationship between health check-up or outpatient service utilisation and cancer incidence, this retrospective cohort study used data at two time points-baseline in 2014 and endpoint in 2017-from the National Health Insurance (NHI) claims and cancer registry. A multivariable logistic regression analysis was performed to investigate whether cancer diagnosis was associated with health check-up or outpatient service utilisation.@*RESULTS@#A total of 72,171 participants were included in the analysis. The results of the multivariable logistic regression showed that individuals who skipped health check-ups had a higher risk of cancer diagnosis (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.04-1.40). Moreover, not undergoing health check-ups increased the risk of advanced-stage cancer (OR, 1.78; 95% CI, 1.29-2.44). Furthermore, increased rate of outpatient service utilisation was negatively associated with advanced cancer diagnosis.@*CONCLUSIONS@#This is the first study reporting that not undergoing health check-ups is a predictor of cancer diagnosis and advanced cancer stage. Primary prevention strategies for NHI members who do not undergo health check-ups must be reassessed. Moreover, future research should examine secondary prevention strategies, such as health education and recommendations from health professionals to facilitate adequate utilisation of preventive health services.

The Frequency and Cost of Redundant Biochemistry Test in Tertiary Teaching Hospital

@#Introduction: Laboratory tests account for 66% of clinical decision making and reducing inappropriate test utilisation is a step towards optimising patients’ care and hospital cost savings. This study aims to identify the rate and cost of redundant test requests in our centre. Methods: A cross-sectional study comprising laboratory results of 14 analytes in renal function test (RFT) and liver function test (LFT) were made. Data involved blood results from adult patients admitted to Hospital Universiti Sains Malaysia from January to December 2018. The redundant test is defined as test results consecutively normal twice and requested within 26 hours for analytes in RFT and 50 hours for analytes in LFT. Cost contributions were estimated by multiplying cost-per-test with total redundant requests. The test redundancy in different wards and disease groups were also evaluated. Results: Equal distribution of RFT and LFT requests were observed in both genders (50% respectively), with the most requests seen in the 60 – 79 years age group. More than 20% redundancy rate was observed for seven analytes (ALT, total bilirubin, sodium, urea, potassium, AST, Chloride), and overall redundancy was 19.7%, equals to Malaysian Ringgit (MYR) 669,105.00. Oncology wards and genitourinary diseases contribute to the highest redundancy rate. Conclusion: This study estimated MYR 600 thousands of saving if test redundancy were to be eliminated. The finding is hoped to serve as a platform for future intervention and policymaking. Future planning to optimise the current laboratory request system and collaboration among physicians and laboratory professionals can minimise test inappropriateness.

Evaluation of drug utilisation pattern and cost associated with diabetes mellitusType 2 management in Saudi Arabia

Abstract Diabetic mellitus is an emerging disease in Saudi Arabia. In this regard, a cross-sectional retrospective study was conducted to evaluate drug utilization pattern and the cost associated with non-insulin-dependent diabetes mellitus disease management in Saudi Arabia. Data retrieved from the electronic pharmacy records during the last one year were employed in this study. World Health Organization (WHO) Defined Daily Dose (DDD) method was employed to compute the daily price of each oral hypoglycaemic agent. The American Diabetes Association (ADA) guidelines and protocols were used to evaluate the level of adherence. A total of 17057 patients were enrolled in the study. Out of the 17057 patients enrolled in the study, 60.06 % (10246) were males and the rest females. In monotherapy, biguanides (metformin) were the most recommended and utilised drugs among 5673 patients (33.25%). The most commonly used drug combination was found to be sitagliptin+metformin (1754 units). The cost per unit dose was highest for liraglutide (A10BJ02) 258.32SR (68.79USD), and lowest for metformin (A10BA02) 0.49SR (0.13 USD). Metformin was the choice drug for the diabetes patients; biguanides (metformin) and DPP-4 (sitagliptins) were the most familiar established dose combination employed. Generic drugs should be used in order to reduce overall cost.

Psychoactive drugs in the Brazilian public health system: Use profile and associated factors

Abstract The purpose of this study is to estimate the prevalence of and characterize the use of psychoactive drugs among drug users in a Brazilian municipality, relating the findings to factors associated with the consumption of these substances. Through a cross-sectional design, 1,355 drug users from the public health systems community pharmacies were interviewed. Sociodemographic and health-related data were collected, as well as any other prescribed drugs. The prevalence of psychoactive drug use within the last month was 31.0%, with antidepressants and benzodiazepines being the most prescribed (53.5% and 24.6% respectively). Most psychoactive drug users were female (81.9%), lived with a partner (52.6%), had private health insurance (69.2%) and a monthly per-capita income up to one minimum wage (54.0%). The adjusted Odds Ratio (OR) confirmed the following factors to be positively associated with the use of psychoactive drugs: female gender (OR=2.06; 95% CI 1.44; 2.95), age ≥60 years old (OR=1.77; 95% CI 1.26; 2.48), follow-up with a psychologist (OR=4.12; 95% CI 1.84; 5.25), absence of regular physical activity (OR=1.59; 95% CI 1.13; 2.23), and smokers (OR=1.94; 95% CI 1.26; 2.97). Approximately one out of three individuals used at least one psychoactive drug. Health managers should focus the planning and actions aimed at their rational use for these groups, leading to increased overall treatment success

Utilisation of HIV services by female sex workers in Zimbabwe during the COVID-19 pandemic: a descriptive phenomenological study

This study focuses on female sex workers as a key population group that suffers a degree of vulnerability according to the World Health Organisation (WHO). Key populations refer to people at heightened risk of contracting the human immunodeficiency virus (HIV) due to specific behaviours and social and legal environments which increase their vulnerability to the virus. Key populations are disproportionately affected by HIV, yet they have less access to HIV services compared to the general population. The coronavirus (COVID-19) lockdown and its restrictive measures have further widened the inequalities and gaps in accessing HIV services for this group. A descriptive phenomenological study was undertaken to explore female sex workers' experiences of utilisation of HIV services during COVID-19. The study setting was the Bulawayo Metropolitan Province, Zimbabwe. Data were collected through in-depth individual interviews with 10 female sex workers. Purposive sampling coupled with snowballing was utilised for recruiting participants. Data were analysed guided by the seven-step Colaizzi technique. Rigour was ensured through adhering to Lincoln and Guba's trustworthiness criteria. The study found that the COVID-19 pandemic adversely affected the livelihoods of sex workers and their utilisation of HIV services. There was limited access to HIV services due to an initial lack of travel authorisation letters and financial challenges experienced by study participants. In addition, the quality of care in health care facilities was further compromised by poor screening processes and reduced provider-client interactions. Maintaining access to HIV services for female sex workers during pandemics is critical for the country to attain HIV epidemic control.

A sessão de análise como composição idiomática / The psychoanalytic hour as an idiomatic composition / La sesión de análisis como composición idiomática / La séance d'analyse comme composition idiomatique

Partindo de quatro breves situações clínicas, o trabalho propõe uma discussão sobre a criação de padrões comunicativos entre analista e analisando. Esses padrões dizem respeito ao dialeto próprio que se desenvolve em cada dupla no decorrer de um processo psicanalítico. A maneira como a sessão de análise é organizada pelo analisando traz ao campo analítico formas estéticas e representacionais singulares, segundo uma lógica inconsciente particular. A exploração do fenômeno em questão é feita em diálogo, entre outros, com os conceitos de idioma (Bollas) e uso do objeto (Winnicott), levando por fim a uma aproximação preliminar entre a escuta psicanalítica e a escuta musical. Tal aproximação é assumida como modelo na captação de determinados aspectos formais do encontro clínico.

Presenting four brief clinical situations, this paper proposes a discussion on the creation of communicative patterns between analyst and analysand. These patterns are related to the specific dialect that is built in each analytic pair during a psychoanalytic process. The way in which the psychoanalytic hour is organized by the analysand, brings unique aesthetic and representational forms to the analytic field, according to a particular unconscious logic. The exploration of this phenomenon is done in dialogue, among others, with the concepts of idiom (Bollas) and use of an object (Winnicott), leading to a preliminary approach between psychoanalytic listening and musical listening. This approach is assumed as a model in seizing certain formal aspects of the clinical encounter.

A partir de cuatro breves situaciones clínicas, el trabajo propone una discusión sobre la creación de patrones comunicativos entre analista y analizando. Estos patrones están relacionados con el dialecto específico que se desarrolla en cada par durante un proceso psicoanalítico. La forma en que la sesión de análisis es organizada por el analizando aporta formas estéticas y representacionales únicas al campo analítico, de acuerdo con una lógica inconsciente particular. La exploración del fenómeno en cuestión se lleva a cabo en diálogo, entre otros, con los conceptos de idioma (Bollas) y uso del objeto (Winnicott), conduciendo finalmente a un acercamiento preliminar entre la escucha psicoanalítica y la escucha musical. Este enfoque se asume como un modelo para capturar ciertos aspectos formales del encuentro clínico.

Fondée sur quatre brèves situations cliniques, l'article propose une discussion concernant la création de modèles de communication entre l'analyste et l'analysant. Ces modèles sont liés au dialecte spécifique qui se développe entre les individus de chaque paire au cours d'un processus psychanalytique. La manière dont la séance d'analyse est organisée par l'analysant apporte au champ analytique des formes esthétiques et des représentations singulières selon une logique inconsciente particulière. L'exploration du phénomène en question se fait en dialogue, entre autres, avec les concepts d'idiome (Bollas) et de l'utilisation d'un objet (Winnicott), aboutissant finalement à une approche préliminaire entre l'écoute psychanalytique et l'écoute musicale. Telle approche est considérée comme un modèle pour capturer certains aspects formels de la rencontre clinique.

Prescription pattern in cases of ischemic stroke in general medicine department in Government General Hospital, Kakinada, Andhra Pradesh

Background: Stroke, as a one of the leading causes of mortality and disability, is also very preventable and curable disease. Pharmacotherapy plays an important role in prevention of first-ever stroke as well as secondary cerebrovascular accident. We aimed to evaluate the prescription pattern in cases of ischemic stroke and to check whether rationale prescription of drugs in ischemic stroke patients is being followed in our hospital.Methods: A prospective observational study was conducted in inpatient department of general medicine in government general hospital, Kakinada for a period of six months from April to September 2018. A total of 306 prescriptions of ischemic stroke were selected randomly and prescriptions patterns were assessed and analyzed.Results: Out of the 306 cases, 183 were males (59.80%) and 123 were female (40.19%). Aspirin was given in 88.23% of the patients, Atorvastatin in 97.05%, Clopidogrel in 24.50%, antihypertensives in 67.64%, B complex in 88.23%, Pantoprazole in 85.29% of the patients. Physiotherapy was advised in 47.05% of the patients. Among anti hypertensives, Amlodipine was given in 73.91% patients.Conclusions: Anti hypertensives, lipid lowering agents like Atorvastatin along with anti-platelet drugs like Aspirin and Clopidogrel were commonly prescribed for ischemic stroke cases for treatment and secondary prevention. Antacids and Multivitamin tablets were given as concomitant drugs. Present study showed a rationale utilization of drugs in ischemic stroke patients.

Cântico negro: o uso clínico do conceito de pulsão de morte / Black canticle: the clinical use of the death instinct concept / Canto negro: el uso clínico del concepto de pulsión de muerte / Cantique noir: l'utilisation clinique du concept de la pulsion de mort

Discute-se o conceito de pulsão de morte e seu emprego no caso clínico de um usuário de drogas. Faz-se um apanhado da sua anunciação e das dificuldades em aceitá-lo e utilizá-lo, indicando seu papel central nas patologias não neuróticas. Conjectura-se sobre a elaboração da constituição do aparelho psíquico, e especula-se sobre a mudança de paradigma na psicanálise a partir da introdução da nova dualidade pulsional.

The concept of death instinct and its use in a clinical case of a drug user is discussed. An overview of its announcement and the difficulties in accepting and using it, is made, indicating its central role in non-neurotic pathologies. It is conjectured about the elaboration of the constitution of the psychic apparatus and speculated about the paradigm shift in psychoanalysis from the introduction of the new instinctual dualism.

Se discute el concepto de pulsión de muerte y su uso en un caso clínico de un consumidor de drogas. Se hace una descripción general de su anuncio y las dificultades para aceptarlo y usarlo, lo que indica su papel central en las patologías no neuróticas. Se conjetura sobre la elaboración de la constitución del aparato psíquico y se especula sobre el cambio de paradigma en el psicoanálisis a partir de la introducción de la nueva dualidad pulsional.

Le concept de pulsion de mort et son utilisation dans le cas clinique d'un toxicomane sont discutés ici. On fait un aperçu de son annonce et des difficultés à l'accepter et à l'utiliser, en indiquant son rôle central dans les pathologies non névrotiques. On fait des conjectures sur l'élaboration de la constitution de l'appareil psychique et on spécule sur le changement de paradigme en psychanalyse depuis l'introduction de la nouvelle dualité pulsionnelle.

Drug Utilisation Evaluation Study on Patients with Diabetes Mellitus Among Rohingya Refugees in IMARET Mobile Clinic

@# Since 1978, Rohingya refugees have fled from their native nation, Myanmar to escape ethnic prosecution. They comprise of the Muslim minority ethnic group originating from the Rakhine state in Myanmar. In many host countries, they may have difficulty to access health care services. The Islamic Association of Malaysia (IMAM) Response and Relief Team (IMARET) have taken many initiatives to provide healthcare services to the refugees through their volunteer-led mobile clinics. Therefore, this study aims to evaluate the utilisation of drugs among type 2 diabetes mellitus (T2DM) patients visiting this clinic. Methods: This was a cross-sectional study among Rohingya refugees with T2DM that visited the IMARET mobile clinics from August until November 2017. Convenient sampling method was used. Data were collected through patient’s interview, review of the patient’s prescriptions and their HbA1c readings. Results: A total of 29 T2DM patients were included in this study. The majority were female (75.9%) and aged below 65 years old (75.9%). The most commonly prescribed anti-diabetic agent was metformin (72.2%), followed by glibenclamide (22.2%) and gliclazide (5.6%). Metformin as a monotherapy (31%) was the most frequent treatment prescribed. More patients had controlled T2DM (62.1%) compared to those with uncontrolled DM. We found 90.9% of patients who were treated according to the recommended DM guidelines achieved a good blood glucose control (p=0.02). Conclusion: In Rohingya refugees having T2DM who were treated in the IMARET mobile clinic, the percentage having good control DM status is higher in those whose treatment regimen adheres to the clinical practice guidelines. Drug utilisation evaluation; Diabetic patients; Diabetes mellitus; Rohingya refugees; Mobile clinic

A study on hospital bed utilisation based on disease wise ICD-10 coding in surgery ward of a rural tertiary care hospital of Darjeeling district of West Bengal

Background: Hospital costs are the largest component of health expenditure and they have therefore been a key focus in the drive for increased efficiency in the health sector.1With the simultaneous menace of ever increasing price rise and population explosion there is dearth of the existing meagre resources and thereby it becomes necessary to allocate and utilise the available resources to the fullest with provisions for minimum wastage. The objective of this study is to find out the pattern of diseases with their ICD-10 codes and the hospital performance indicators in patients admitted at the surgery ward of North Bengal Medical College during the study period.Methods: A descriptive epidemiological study with cross-sectional design was done by complete enumeration of all patients admitted in surgery ward of North Bengal Medical College and Hospital in Darjeeling district of West Bengal from July 2016 to September 2016.Results: A total of 2227 patients were admitted during the study period with intra-cerebral haemorrhage (I61) being the most common cause of admission followed by abdominal injury (S36) and burn (T29). The bed occupancy rate was 144.21%, bed turn-over rate 14.26 and average length 9.1. Scatter plot indicates hospital utilisation at Region IV as per Pabon Lasso Model of Hospital Utilisation.Conclusions: A high bed occupancy rate and low bed turn-over rate indicates scarcity of hospital beds, preponderance of severe and chronic cases and unnecessary stay in hospital.

Utilisation of antimicrobial agents in intensive care unit at a tertiary care teaching hospital in eastern India

Background: Antimicrobial agents (AMAs) are the most frequently used drugs in the intensive care units (ICU) and regular auditing can prevent the development of resistance to AMAs, reduce the cost and incidence of adverse drug reactions. The present study was conducted to assess the drug utilisation pattern by measuring the defined daily dose (DDD) per 100 bed days for the AMAs used and their correlation with the APACHE score II.Methods: This was a prospective observational study, conducted in the Central ICU of SCB Medical College and Hospital, Cuttack, Odisha for 4 months. Data regarding demographic profile, diagnosis, APACHE II score, microbiologic investigation, length of stay, outcome and utilisation pattern of AMAs assessing anatomic therapeutic chemical (ATC) classification and measuring the antimicrobial consumption index (ACI) equal to DDD per 100 bed days were collected and subjected to descriptive analysis. Multinomial logistic regression model was used to predict probabilities of different possible outcomes of categorically distributed variables and independent variables.Results: Mean age of study population was 44.70±14.814 with male and female ratio of 1.63:1. Septicaemia was the most common cause of admission. AMAs were prescribed to 92.66% of patients during their stay which constitutes 37.32% of the total drugs used. The DDD per 100 bed days for the AMAs were 118.59 and ceftriaxone was found to be most frequently used. Patients having higher APACHE II score received more no of AMAs (4.20±1.30). Patients having low APACHE II Scores received less number of antibiotics as compared to patients having higher score.Conclusions: AMAs were prescribed to 92.66% patients in the central ICU and there is significant relation between the APACHE II score and number of AMAs prescribed.

Awareness about Social Security Schemes among elderly: A comparative study among rural and urban population of Khordha District, Odisha

Background: Demographic transition has led to a rise in elderly population, their social security being a priority. Awareness and utilisation of these being less researched, we undertook this study. Aim & Objective: To find the awareness regarding existing social security schemes, the pattern of their utilisation and enlist the challenges faced in utilising them. Material and Methods: A cross-sectional study was conducted from January to March 2018, among randomly selected consenting elderly in the urban and rural field-practice areas of a medical college. Data was analysed using EpiInfo software. Results: A total of 540(270 each in urban and rural) participants were included.55.93% in urban and 51.48% in rural were aware and 33.38% in urban and 15.56% in rural utilised atleast one of the schemes. 27.78% in urban and 25.19% in rural expressed their dissatisfaction with the pension received. The differences in the awareness about property protection and old age pension had a statistically significant difference between the urban and rural population with better awareness among the urban elderly. Conclusions: The awareness levels were nearly the same in the urban and rural population, but utilisation rates had a marked difference. Lesser utilisation in rural areas needs to be researched, causes identified and addressed.

Drug utilization study and adverse drug reactions of oral anti diabetics among type 2 diabetes mellitus patients in tertiary care hospital

Background: The aim was to evaluate the drug utilization pattern of oral antidiabetic drugs in type 2 diabetes mellitus outpatients and monitor adverse drug reactions (ADRs) associated with oral antidiabetic drugs.Methods: A retrospective observational study was carried out by collecting the data of type 2 diabetes mellitus patients visiting outpatient department of noncommunicable disease clinic of a tertiary care hospital for a period of one year. The data of demographic, drug utilization pattern and adverse drug reactions of patients on oral antidiabetic drugs was collected and entered in a proforma.Results: Total number of patients in this study were 39 out of which 21 (53.85%) patients were females and 18 (46.15%) patients were males. Majority of patients were in the age group 51-70 years (66.6%). Metformin was the most commonly prescribed drug 76.9% followed by Glibenclamide 17.9%. About 7.7% of patients who were taking oral antidiabetic drugs later switched over to insulin as their blood glucose levels were not controlled. Out of 18 (46.15%) patients, hypertension (38.5%) was the most common comorbid condition and a concomitant drug was prescribed was amlodipine 25.6%. Among all the adverse drug reactions observed, diarrhoea was the most common adverse drug reaction reported 76.9%.Conclusions: Metformin was the most commonly used oral antidiabetic drug. Diarrhoea was the common adverse drug reaction reported.

Study of knowledge attitude practices and utilisation of existing health services by families with regard to newborn health at block level in rural India: a community based, cross sectional, observational study

Background: The present study was undertaken to identify KAP gaps and the objective of the study were to assessment of utilization of existing health service infrastructure at grass route level in rural community with regard to mother and neonatal care.Methods: A community based cross-sectional observational study. About 50 mother neonate pair residing in villages under study belonging to Dewas district, Madhya Pradesh.Results: Age old customs and practices of large family (80%), adolescent marriages (30%), high fertility (50%), poor housing and sanitation (48% or more) are still widely prevalent in rural India. Positive impact of NRHM with launch of JSSY and NSSK was seen in utilization of ANC services among beneficiaries with 100% ANC registrations, 98% institutional deliveries and 100% deliveries conducted by trained health professionals, prompt referral to SNCU. Birth weight was not known in 36% neonates and 18% had not received BCG vaccination. 22% were low birth weight and 22% neonate's required SNCU care. Government emergency transport facility in form of ambulance was either absent (36%) or not utilized (26%) by majority.Conclusions: Lacunae were seen to be persisting regarding awareness and utilisation of few components of maternal and neonatal health care especially in government sector in spite of launch of third phase of NRHM. This was evidenced by, lack of awareness of Obstetric USG facility at civil hospital, non-utilisation of ambulance service for transport, not knowing neonates birth weight and no neonatal follow up care and failure to vaccinate the neonate even till 3rd or 4th week of life.

Utilization pattern of antiepileptic drugs and their adverse effects in tertiary healthcare and teaching hospital

Background: Epilepsy is the most common neurological condition with 65 million cases of active epilepsy found worldwide. The incidence is approximately 0.3 - 0.5% in different world populations with a prevalence rate of five to ten per thousand people. The aim of the present study was to evaluate the prescriptions according to WHO/INRUD drug use indicators and to study the adverse effects to antiepileptic drugs (AEDs).Methods: A cross sectional survey based observational study of 1year duration was conducted at tertiary healthcare hospital. Prescription data of patients (n=361) with Epilepsy from Neurology department was analysed using WHO indicators. The demographic data, type of seizures, AEDs prescribed and adverse drug reactions (ADRs) reported by the patients were recorded. Statistical analysis was done using Microsoft excel 2013.Results: A total of 593 AEDs were prescribed to 361 patients. Average number of AEDs prescribed per prescription was 1.65±0.78 (S.D) with only 02% of newer AEDs. Generalized Tonic Clonic (GTC) was the most common seizure with 55.68%. Phenytoin (32%) was commonly prescribed followed by valproate for GTCS. Carbamazepine was commonly prescribed for partial seizures. Out of 15 ADR cases that has been recorded, phenytoin (73%) was associated with most ADRs followed by valproate (20%). 53% patients were on Monotherapy, 31% on dual drug therapy.Conclusions: Older AEDs are still commonly prescribed drugs. Prescription of newer AEDs to be encouraged, as study revealed majority of adverse effects to drugs like phenytoin and valproate. Study concludes the need of creating awareness of reporting of adverse event to AEDs, in treating physician.

Adição à internet ou uso problemático da internet? Qual dos termos usar? / Dépendance à Internet ou utilisation problématique d'Internet? Quel terme utiliser? / Adición a Internet o uso problemático de Internet: ¿Qué término usar? / Internet addiction or problematic internet use? Which term should be used?

Resumo O uso da internet tem aumentado exponencialmente a nível mundial. Ainda que ele não seja por si só negativo, já que integra benefícios vários, alguns indivíduos parecem exibir problemas relacionados com o seu uso excessivo, descontrolado e disfuncional. Consequentemente, tem sido crescente, particularmente nas últimas duas décadas, o interesse dos investigadores em explorar este uso, quando excessivo e pouco saudável. Porém, e sendo um tema/constructo tratado por diferentes autores com quadros teóricos também diferentes, são vários os termos usados na literatura para descrever este fenómeno. Neste sentido, este artigo propõe-se a apresentar o trabalho uma revisão de literatura de dois dos conceitos mais usados e espartilhados na literatura científica, ou seja, adição à internet e uso problemático da internet.

Résumé L'utilisation d' Internet a augmenté de manière exponentielle dans le monde. Bien que l'utilisation d' Internet ne soit pas négative en soi, étant donné qu'elle intègre plusieurs avantages, certaines personnes semblent présenter des problèmes liés à son utilisation excessive, incontrôlée et dysfonctionnelle. En conséquence, l'intérêt des chercheurs pour exploiter cet usage, qu'il soit excessif ou malsain, a augmenté, particulièrement au cours des deux dernières décennies. Cependant, étant un thème/construit traité par différents auteurs avec différents cadres théoriques, plusieurs termes sont utilisés dans la littérature pour décrire ce phénomène. En ce sens, nous proposons de présenter dans cet ouvrage une analyse de deux des concepts les plus utilisés et les plus partagés dans la littérature scientifique, à savoir l'addition à internet et son utilisation problématique.

Resumen El uso de Internet ha aumentado exponencialmente a nivel mundial. Aunque esto no es por sí solo negativo ya que integra diversos beneficios, algunos individuos parecen presentar problemas relacionados con su uso excesivo, descontrolado y disfuncional. En consecuencia, en las últimas dos décadas ha aumentado cada vez más el interés de los investigadores en estudiar este uso, cuando es excesivo o poco saludable. Sin embargo, y siendo un tema/constructo tratado por diferentes autores con cuadros teóricos también diferentes, son varios los términos usados en la literatura para describir este fenómeno. En este sentido, nos proponemos presentar en este trabajo una revisión de dos de los conceptos más usados y más divididos en la literatura científica, es decir, adición a Internet y uso problemático de Internet.

Abstract Internet use has increased exponentially worldwide. Although the use itself is not negative, since it integrates several benefits, some individuals seem to show problems related to its excessive, uncontrolled, and dysfunctional use. Therefore, the interest of researchers in exploring this use, when it is excessive and unhealthy, has been growing, especially in the last two decades. However, being a subject/construct treated by different authors with different theoretical frameworks, several terms are used in the literature to describe this phenomenon. Regarding this, this article proposes to present a literature review of two of the most used and shared concepts in the scientific literature, that is, internet addiction and problematic internet use.

Socioeconomic Status Affecting Inequity of Healthcare Utilisation in Malaysia

@#Background: Equity is one of the important aspects of universal health coverage. Variation in socioeconomic status (SES) has been proved to contribute discrepancies in the use of healthcare services. This study aimed to assess equity for inpatient, outpatient and dental care utilisation by household SES over time. Methods: This study used five series of National Health and Morbidity Survey data from 1986 to 2015. Healthcare utilisation for inpatient, outpatient and dental care were analysed. SES was grouped based on household expenditure variables accounting for total number of adults and children in the household using consumption per adult equivalents approach. The determination of healthcare utilisation across the SES segments was measured using concentration index. Results: The overall distribution of inpatient utilisation tended towards the pro-poor, although only data from 1996 (P-value = 0.017) and 2006 (P-value = 0.021) were statistically significant (P < 0.05). Out-patient care showed changing trends from initially being pro-rich in 1986 (P < 0.05), then gradually switching to pro-poor in 2015 (P < 0.05). Dental care utilisation was significantly pro-rich throughout the survey period (P < 0.05). Public providers mostly showed significantly pro-poor trends for both in- and out-patient care (P < 0.05). Private providers, meanwhile, constantly showed a significantly pro-rich (P < 0.05) trend of utilisation. Conclusion: Total health utilisation was close to being equal across SES throughout the years. However, this overall effect exhibited inequities as the effect of pro-rich utilisation in the private sector negated the pro-poor utilisation in the public sector. Strategies to improve equity should be consistent by increasing accessibility to the private sectors, which has been primarily dominated by the richest population.