Barriers to healthcare and health seeking behaviors among elderly people living in rural regions of India: a study based on 9 villages in Eastern Uttar Pradesh

Background: The elderly population in India is experiencing exponential growth and facing various health and well-being challenges. This demographic shift is especially pronounced in rural areas, affecting social, financial, family, and transportation aspects, subsequently impacting health and well-being. This study aims to comprehensively understand these needs and priorities by exploring the multifaceted challenges faced by the elderly in India. Methods: An exploratory qualitative research study with a quantitative component was conducted in 9 villages in Uttar Pradesh’s Siddhartha Nagar District. Participants included individuals aged 60 years and above (n=29, M:F ratio of 13:16). Data were collected using Focus Group Discussions and Personal Interviews to assess the challenges faced by the geriatric population. The methodology involved multi-directional interactive sessions focusing on health, illness, and coping. Results: Participants averaged over 5.8 medical conditions. Those with better Socio-Economic Status (SES) reported multiple conditions but fewer troubles, while the majority, being very poor, did not consider health a primary concern. There were no complaints about the lack of public health facilities or transportation. The study highlights the complex interactions between healthcare, family, and financial difficulties that older people in rural India experience, underscoring the need for specialised treatments. The low level of knowledge about government programmes emphasises the need for improved outreach techniques to close existing accessibility gaps. Conclusions: The study recommends focused interventions and improved policies to meet the unique needs of India's rural elderly population. Policymakers and healthcare providers can enhance the well-being of this vulnerable demographic by understanding the complex nature of their issues.

Barriers to access healthcare among the elderly population in rural regions of India

Aging care is critical. Hence, the best-known newly developed technologies must be provided to the older population. This paper explains the need for mapping of strategies that must address preventive and promotional care and sickness management, empowering geriatric services, and guaranteeing optimal rehabilitation for the elderly population of India. Databases considered to carry out the literature review was Scopus, PubMed and Web of Science. Scientific articles published in English were only considered. Apart from scientific articles, government report, and newspaper articles, were also reviewed. Data was managed in Mendeley software. Articles based on elderly residing in urban populations and other age groups were excluded from the study. There are multiple barriers between the elderly beneficiaries and the healthcare services which stop the utilization of healthcare services. It can be demographic, aging, geographic, economic, accessibility, psychological, housing, transportation, medical, and social. Financial security is the top reason for not availing of healthcare services, followed by the perception that the ailment is not serious enough. The second reason was the unavailability of accessible healthcare facilities. Therefore, elderly people residing in rural regions, are more prone to varying diseases and are vulnerable to health inequity among other age groups in India. Considering the projected demography, it will only get worse until there is an intervention and feasible infrastructure, healthcare facilities, and services are provided in collaboration with local stakeholders and program monitors.

Prevalence and predictors of vitamin D deficiency among hospital staff in tertiary care center: a cross sectional study

Background: Vitamin D deficiency (VDD) is prevalent across all age groups in general population not sparing the health care workers. This study aimed to assess the prevalence and risk factors of VDD among the hospital workers of tertiary care center in Kashmir valley. Methods: In this cross-sectional study, a total of 216 apparently healthy subjects were screened for VDD from three groups, group A- minimal sunlight exposure (office employees), group B- moderate sunlight exposure (nursing students) and group C- abundant sunlight exposure (gardeners). Serum calcium, phosphorus, alkaline phosphatase, 25-hydroxy vitamin D [25(OH)D], PTH levels and urine calcium/creatinine was assessed in all subjects. Dietary assessment of vitamin D (VD) and calcium intake was done using three days dietary recall. The percent body surface area (BSA) exposed to sunshine was estimated by applying the Wallace rule of nine. Results: Serum 25(OH)D level was found to be lower in group A (17.29±10.87) as compare to group B (21.78±16.37) and group C (26.40±15.59). Prevalence of VDD was 71.6%, 70.6% and 50% in group A, group B and group C respectively. VDD was more prevalent in females and risk increased with age and BMI, decreased with duration of daily sunlight exposure, percentage BSA and dietary VD intake. Conclusions: Burden of VDD is high among hospital workers despite their direct contact with healthcare. Strategies should be made to screen them regularly and supplementation of VD should be provided to effectively counteract VDD.

Primary epithelial splenic cyst: A rare encounter

Splenic cysts are rare with an overall incidence of 0.07% in a large autopsy series and 0.5% among all the splenectomies done. The parasitic splenic cysts, usually caused by Echinococcus granulosus, account for 60% of all primary splenic cysts. The primary epithelial cysts account for 10% of all splenic cysts. We report a case of 30-year-old female presenting with left upper abdominal pain and heaviness. Computed tomography revealed a multiloculated cyst in spleen. Hydatid serology was negative. Total splenectomy was done. Histopathological evaluation was done and a diagnosis of primary epithelial splenic cyst was given.

To remove the buckle or watch?

Scleral buckling is one of the most effective modality for treatment of rhegmatogenous retinal detachment and in selected cases of retinopathy of prematurity. Although quite safe, it has its own set of associated morbidities. This report presents an interesting case, where the scleral buckle migrated posteriorly reaching up to the optic nerve.

Surgical outcomes of microincision vitrectomy surgery in eyes with retinal detachment secondary to retinopathy of prematurity in Indian population

Purpose: To analyze and report outcomes of microincision vitrectomy surgery (MIVS) for Stage 4 and 5 retinopathy of prematurity (ROP). Methods: Medical records of 202 eyes of 129 premature children undergoing MIVS for Stage 4/Stage 5 ROP between January 2012 and April 2015 were evaluated. The primary outcome measure was the proportion of eyes with anatomical success (defined as attached retina at the posterior pole at last follow-up). Complications associated with MIVS were noted and analysis of risk factors associated with poor anatomical outcome was also done using logistic regression. Results: Mean age of presentation of babies with Stage 4 ROP (2.9 ± 1.75 months) was lower than those with stage 5 disease (5.62 ± 2.55 months) (P < 0.005). One hundred seventeen eyes (56% or 58%) had Stage 5, 38 (19%) had Stage 4a, and 47 (23%) Stage 4b. Ninety-four eyes (47%) had received prior treatment (laser and/or anti-vascular endothelial growth factors [VEGF]). Lens-sparing vitrectomy (LSV) was performed in 58 (29%) eyes while lensectomy with vitrectomy (LV) was performed in 144 (71%) eyes. At a mean follow-up of 32.5 weeks, 102 (50.5%) eyes achieved anatomical success, including 74% eyes in Stage 4a and 4b and 33% in Stage 5. Complications included intraoperative break formation (19%), postoperative vitreous hemorrhage (28%), raised intraocular pressure (12.7%), and cataract progression (2.4%). Factors significantly associated with favorable anatomical outcome were Stage 4 disease (vs. Stage 5) (odds ratio [OR] 5.8; confidence interval [CI] =2.6–13.8, P < 0.005), prior treatment (laser ± anti-VEGF) (OR 2.5; CI 1.4–4.7, P < 0.005) surgery with 25G MIVS (vs. 23G) (OR: 1.7; CI = 0.98–3.00, P = 0.05) and LSV (vs. LV) (OR 7; CI = 3.4–14.6, P < 0.005). Retinal break was significantly associated with poor anatomical outcome (OR 0.21; CI = 0.09–0.5, P < 0.005). Conclusion: MIVS along with wide angle viewing systems allow surgeons to effectively manage ROP surgeries while at the same time reducing complication rate in these eyes which have complex pathoanatomy and otherwise grim prognosis.

The prevalence and risk factors for cataract in rural and urban India

Purpose: To report the prevalence and risk factors of cataract and its subtypes in older age group. Methods: A total of 6617 subjects were recruited from both rural and urban areas. A detailed history including data on demographic, socioeconomic and ocular history was obtained. Lens opacity was graded according to the Lens Opacity Classification System III (LOCS III). Results: Cataract was present in 1094 of the rural and 649 subjects in the urban population. Monotype subtype cataracts were found in 32% and 25% in rural and urban population and 12.68% and 18.6% were mixed cataracts in the rural and urban groups. In baseline characteristics history of diabetes, alcohol intake and presence of age-related macular degeneration were the risk factors in urban group. On multivariate analysis, the only significant risk factors for any cataract in subjects ?60 years were increasing age in both rural [odds ratio (OR), 1.07] and urban (OR, 1.08) population, and HbA1c (OR, 1.14) in rural population. Overweight (OR, 0.6) was found to be a protective factor, and lower social economic status (OR, 1.52) a risk factor for cataract in urban population. A significant urban–rural difference was found in the prevalence of cataract and its subtypes (P ? 0.05). Conclusion: We found the risk factors for any cataract in older age group to be increasing age and HbA1c in rural group. Age and lower social economic status were found to be the risk factors in urban arm. A statistically significant difference was found on comparison of the prevalence of cataract and its subtypes between the rural and urban population.

Anti-HBs Antibodies over time in healthcare workers

Background: In developing countries including India only 18 % HCWs are vaccinated against HBV. Inspite of all the recommendations, compliance to vaccination remain poor in majority of health care settings. Aims & Objectives: To estimate serum levels of anti-HBs antibodies in healthcare workers and to correlate the values of Anti-HBs level over time in health care workers. Materials and Methods: This cross-sectional study was conducted on Health care workers of tertiary care hospital. Their demographic details and hepatitis B vaccination history was recorded as per performa. Serum samples of all the subjects were tested for Anti-HBs levels by VIDAS-PC equipment. Results: Out of the 294 HCWs enrolled, 84% (247) were fully vaccinated whereas 16%(47) were partially vaccinated. The vaccination rate was highest among nursing staff (74.9%) followed by doctors (13.8%). 3% of doctors and 12.4% of nurses are still at risk of acquiring HBV infection. On anti -HBs titer estimation, 9.7% of the HCWs had anti-HBs titer < 10 mIU/ml while 90.3% had titre > 10 mIU/ml. Conclusion: This study demonstrated that Hepatitis B immunization must be made compulsory for hospital staff in every health care setting as well as to check their anti HBs titres.

Outcome of vitreoretinal surgery for rhegmatogenous retinal detachment in X-linked juvenile retinoschisis

Purpose: Rhegmatogenous retinal detachment (RRD) is a vision-threatening complication of X-linked juvenile retinoschisis (XLRS). The aim of this study is to report the anatomical and functional outcomes of vitreoretinal surgery for the treatment of RRD in X-linked juvenile retinoschisis (XLRS). Methods: This is a retrospective, interventional, consecutive case series in which case records of 34 eyes of 28 XLRS patients, who underwent surgery for RRD, were reviewed. Statistical analysis used is as follows: visual outcomes were categorized into three groups: improved, remained stable or deteriorated. Wilcoxon signed-rank test was used to determine the difference in visual acuity at baseline and at final visit. Univariate binary logistic regression analysis was used to determine the risk factors for retinal detachment. Any P value < 0.05 was considered as statistical significant. Results: Mean age of the boys at presentation was 9.2 ± 3.5 years. Indication for surgery was RRD in all eyes. Concurrent vitreous haemorrhage was present in four eyes (11.8%). The primary surgical intervention was scleral buckle in 12 eyes and pars plana vitrectomy in 22 eyes. Persistence of subretinal fluid/redetachment was seen in 15 eyes of which 11 eyes underwent additional surgeries. At final follow up, 27 eyes (79.4%) were noted to have an attached retina. Of the total eyes, in 20, 6 and 8 eyes the visual acuity improved, stabilized and deteriorated, respectively. Conclusion: Favourable outcomes are seen in a majority of eyes after vitreoretinal surgery for RRD in XLRS; however, multiple surgical interventions may be necessary.

Association of obesity and age-related macular degeneration in Indian population

Purpose: The aim of this study was to establish the prevalence and association of age-related macular degeneration (AMD) and obesity which was not studied extensively in Indian population over 60 years of age. Methods: This was a cross-sectional, population-based study. A total of 4791 patients with gradable fundus photography were included. All patients underwent detailed ophthalmic examination and AMD was graded with retinal photographs. Grading of AMD was done according to the International ARM Epidemiological Study Group and staged based on grading in worse eye. The association of AMD severity and obesity (based on body mass index, waist–hip ratio, waist circumference, isolated abdominal obesity, isolated generalized obesity, and combined obesity) was assessed. The main outcome variable was an association between the presence and severity of AMD with different grades of obesity. Results: No direct significant association was noted between the presence and severity of AMD and any obesity indices. Subgroup analyses based on lifestyle patterns and common systemic pathologies in AMD population were done. Late AMD was significantly associated with tobacco consumption in population with combined obesity (P = 0.033 and odds ratio = 2.998). Conclusion: No direct association was noted between the presence or severity of AMD and obesity in South Indian population. However, indirect associations between the severity of AMD and combined obesity were found.

Clinical features and treatment outcomes of vasoproliferative tumors in Indian participants

Purpose: The aim of the study was to describe the clinical features and treatment outcomes of vasoproliferative tumors (VPT) in Indian participants. Methods: This study design was a retrospective case series in a tertiary eye care center. Case records of patients diagnosed with VPT from 2011 to 2015 were reviewed, and their demographic details, clinical presentation, and treatment outcomes were documented. Baseline and follow-up visual acuity and tumor dimensions were statistically compared by applying paired t-test. Statistical analysis used SPSS version 14. Results: Twenty-two tumors from 19 eyes of 17 patients were included. Mean age at presentation was 43.5 years (range: 15� years). Mean presenting best-corrected visual acuity (BCVA) was + 1.10 logMAR. Sixty-eight percent eyes had secondary tumors. Most common association of secondary VPT was Coats disease followed by retinal vasculitis, polypoidal choroidal vasculopathy, familial exudative vitreoretinopathy, and traumatic chorioretinopathy. Ten tumors (45%) involved the inferior quadrant. Tumor-associated features were intra/subretinal exudates, vitritis, subretinal fluid, vitreous hemorrhage, preretinal fibrosis, epiretinal membrane, and subretinal blood. Treatment included cryotherapy, intravitreal or oral steroids, laser photocoagulation, cryotherapy with encirclage, cryotherapy with anti-vascular endothelial growth factor, and observation. Complications included tumor recurrence, retinal detachment, raised intraocular pressure, neovascularization of iris, and cataract. Ninety-five percent VPT regressed at mean 21 months (Median: 17 months; Range: 3� months). Mean final BCVA was + 1.21 logMAR. Conclusion: VPTs are commonly unilateral, unifocal, and located anterior to equator in inferior fundus. Secondary tumors are more common than primary tumors. Treatment achieves tumor regression in majority of cases.

Clinical Presentation Of Breast Cancer Patients Attending At Regional Institute Of Medical Sciences, Manipur

Background:Increasing incidence of breast cancer has been a major health problem for women in Manipur. Knowledge of clinical presentation of patients with breast cancer may help in planning prevention, screening and treatment of breast cancer in this region. Methods: This is a retrospective case series study on 150 cases of breast cancer patients who were registered at Regional Institute of Medical Sciences, Manipur during the period from January, 2014 to December, 2016. The data were analyzed using SPSS-21 and results were presented in percentage and simple frequency. Result: Majority (60.0%) of the patients were in the age group of 31-50 years. The commonest presenting symptoms were painless breast lump (90.6%) and the commonest histopathology observed was IDC-NOS (95.3%). Majority of the patients were in stage II(42.6%), illiterate(56.0%), belonged to Class III socio-economic status(50.0%) and age of menarche in majority of the patients(56%) was in the age group of 10-12 years. 91 patients (63.0%) were post menopausal patients. Maximum numbers of patients (86.6%) were multiparous and had history of breast feeding (82.6%) not less than 4 months. 77 patients (51.3%) had normal body mass index(BMI). Only 4 patients (2.6%) had family history of breast cancer. Among 140 operable patients, majority of them(50.0%) were both ER and PR negative, expressed 3+ HER-2/neu (48.0%) and had histological grade III tumor (89.2%). Conclusion: Delay in treatment of breast cancer and further increased incidence rate could be minimized in this region by improving the awareness regarding the risk factors, socio-demographic factors and clinical presentation of this leading cancer.

Morphological variations of nutrient foramina in lower limb long bones.

Background: The major blood supply to long bone is from the nutrient arteries, which enter through nutrient foramina. Nutrient foramen is an opening into the bone shaft which give passage to the blood vessels of the medullary cavity of a bone The direction of the nutrient foramen of all bones is away from growing end and has a particular position for each bone. Objective: The aim of the present study was to study the topographic anatomy and morphology of the nutrient foramina in human adult lower limb long bones. Material and Method: The study was performed on 150 lower limb long bones which included 50 femora, 50 tibiae and 50 fibulae. The bones were obtained from department of anatomy, Punjab Institute of Medical Sciences, Jalandhar. Results: The variations were found in number and location of nutrient foramen in different lower limb long bones. In femur double and triple foramina were observed. Absence of nutrient foramen was observed in femur and fibula. Conclusion: The topographical knowledge of these foramina is useful in certain operative procedures, in orthopedics as well as in plastic and reconstructive surgery, to avoid damage to the nutrient vessels.

Transmuscular course of the medial sural cutaneous nerve and its clinical implications.

Variations of nerve are not only of anatomic and embryological interest but also of clinical importance. Their adequate knowledge will help in increasing surgical precision and decreasing morbidity. Anatomical variations in the formation of the sural nerve are common, although the topographical localization of this nerve is constant. In this report, we describe a case of an anomalous course of the medial sural cutaneous nerve which descended through the gastrocnemius via a tunnel formed within the muscle. Such anatomical variation of the sural nerve is clinically important when evaluating sensory axonal loss in distal axonal neuropathies since sural nerve mononeuropathy is less likely to occur.

Bilateral variation in the Origin of Sternocleidomastoid muscle.

Morphological variations of sternocleidomastoid are not uncommon. During our routine dissection, in the department of anatomy PIMS Jalandhar, we encountered a rare case of presence of third head of sternocleidomastoid, bilaterally. This anomalous head is arising from clavicle lateral to the clavicular head of sternocleidomastoid muscle. This report not only adds to the knowledge of anatomists but will hold good to surgeons, anaesthetists and radiologists as well.

Morphological Variations of Nutrient Foramina in upper limb long bones.

The nutrient artery is the principal source of blood supply to a long bone and is particularly important during its active growth period in the embryo and foetus as well as during the early phase of ossification. The aim of the present study was to study the topographic anatomy and morphology of the nutrient foramina in human adult upper limb long bones. The study was performed on 40 upper limb long bones which include 40 humerii, 40 radii, 40 ulnae. The bones were obtained from department of anatomy Punjab institute of medical sciences, Jalandhar. The variations were found in number and location of nutrient foramen in different upper limb bones. In humerus double and triple foramina were found. In radius and ulna double foramina were observed at the maximum. Absence of nutrient foramen was observed in radius. The knowledge about these foramina is useful in surgical procedures.

Factors affecting induction and development of in vitro rooting in apple rootstocks.

Shoots of apple rootstocks raised in vitro were transferred to various rooting media to study the effect of different factors on root initiation and development. Various concentrations of indole-3-butyric acid (IBA) initiated rooting but maximum rooting percentage was found with 2.0 and 2.5 mg l(-1) of IBA in M7 and with 1.0 mg l(-1) of IBA in MM106. The drawback was that the roots were thick, short and with profuse callus. The presence of activated charcoal (AC) in the rooting medium improved the rooting quality but reduced the rooting percentage in both the rootstocks. In high auxin dip of 70, 80 and 90 mg l(-1) IBA for 2, 2 and 1 hr showed 75-85 per cent rooting in M7, but lacked reproducibility of the results. Whereas in MM106, 66 - 70 % rooting was achieved with 70 mg l(-1) of IBA dip for 3 h. Root induction in shoots in IBA containing liquid medium (LM) in dark for few days and root elongation in IBA--free medium in light proved most effective. On the other hand, continuous light treatment showed reduced rooting. Reduction of MS salts and sucrose in root elongation medium showed decreased rooting. Plantlets from two--stage rooting procedure showed more rapid growth and satisfactory survival during hardening of plants and on transfer to field.

Iodine status and goiter prevalence after 40 years of salt iodisation in the Kangra District, India.

Thirty primary schools were selected in district Kangra utilizing the population proportionate to size cluster sampling methodology in the year 2004. A total of 6939 children were included in the study. The clinical examination of the thyroid of each child was conducted. On the spot casual urine sample and salt samples were collected from a 'sub set of' children included in the study. The Total goiter rate (TGR) was found to be 19.8%. The median Urinary iodine excretion level was 200 microg/l and only 64% of the salt samples had the stipulated level of iodine. The findings of the present study revealed that current iodine status of population is adequate, however, TGR showed mild iodine deficiency (chronic) and there is a need of continued monitoring the quality of iodised salt provided to the beneficiaries under the Universal salt iodisation programme in order to achieve the goal of elimination of Iodine deficiency disorders from district Kangra.

A customised portable LogMAR chart with adjustable chart illumination for use as a mass screening device in the rural population.

AIM: To develop a customised, portable, cost-effective (logarithmic minimal angle resolution) LogMAR chart with adjustable illumination for use as a mass vision-screening device in the rural population. MATERIALS AND METHODS: Visual acuity of 100 individuals was evaluated with a customised chart and compared with the standard Early Treatment Diabetic Retinopathy Study (ETDRS) chart and Snellen's Chart. Bland and Altman analytical techniques were used for analysis. RESULTS: Test-retest variability of the customised chart was just a one-line difference (95% CI for agreement), and so were the results with the standard ETDRS charts; a variability of 3-line was noted with Snellen's chart. Two-line differences were observed when comparison was made with Standard ETDRS chart and 2 to 3-line differences with Snellen's chart. CONCLUSION: The customised portable LogMAR chart with adjustable illumination shows less test-retest variability and better agreement with standard ETDRS chart; therefore, it can be used as a mass vision-screening device in rural settings.

Differential organization of a LINE-1 family in Indian pygmy field mice.

Southern blot hybridization analysis of genomic DNAs digested with restriction endonuclease EcoR I and Ava II from Mus musculus domesticus, Mus booduga and Mus terricolor with a cloned repetitive DNA fragment of Mus booduga as a probe showed difference in restriction pattern of this DNA in these three species. Further Southern analysis of the BamH I digested genomic DNAs from these species hybridized with cloned DNA fragment as a probe and sequencing of the cloned DNA revealed that this 252 bp cloned DNA fragment is a part of BamHI repeat element of genus Mus and is 87% homologous to the contiguous portion of the Mus musculus domesticus LINE-1 element. The species specific fragment pattern generated by different restriction endonucleases using this DNA as a probe revealed difference in the organization of LINE-1 repetitive element in the three species of genus Mus.