Prevalence of diabetes and prediabetes among rural South Indian population

Background: Objective of this study was to assess the prevalence of self-reported and undiagnosed diabetes and prediabetes cases in rural south Indian population.Methods: The study was carried as secondary analysis of the data collected in our Health management information system (HMIS) as a part of our health systems initiative in Alakkudi gram panchayat, Thanjavur district, Tamil Nadu, India. We analysed the fasting glucose and post prandial glucose values of 1307 individuals form our database to assess the prevalence of undiagnosed diabetes and prediabetes as per the cut off recommended by Indian Council of Medical Research 2018 diabetes diagnostic criteria. We also presented the descriptive analysis of demographic features, risk behaviour, anthropometric data along with personal and family history of all the individuals analysed in this study. The secondary data retrieved from the HMIS system was free of any personal identifiers.Results: The self-reported prevalence of diabetes among adults in the village was 6.88% (90 out of 1307). The prevalence of undiagnosed diabetes among adults of Alakkudi village was 12.85% (168 out of 1307) and the prevalence of undiagnosed prediabetes among adults of Alakkudi village was 8.03% (105 out of 1307). Proportion of undiagnosed cases of diabetes in the village was 53%.Conclusions: The proportion of undiagnosed cases of diabetes is quite high in rural India and the proportion of prediabetes is also higher. It is the need of the hour to create awareness regarding diabetes and prediabetes amongst the rural India population and increasing health systems efforts for regular community-based screening among the rural Indians.

A Farmer Becoming a Quasi-doctor: The Daegok Diary and Rural Healthcare from the 1960s to the 1980s / 의사학

This article attempts to review the reality of rural health care in Korea from the 1960s to the 1980s by analyzing the Daegok Diary. There has been two myths about rural healthcare. One is that the absence of institutional medicine was replaced by folk medicine, which could be identified with folk remedies or shamanic healing distinguished from Western medicine. This is a frame that understands institutional and Western medicine as a pair and folk medicine and traditional medicine as another. Another popular belief is that rural healthcare had remained almost nonexistent, and only dramatically improved after the Regional Health Insurance was implemented. Of course, some claim that the Regional Health Insurance was disadvantageous to farmers, but it is generally understood that there was an absence of government policy regarding medical care. The Daegok Diary, telling many aspects of rural life, is a good source to reflect on these common notions. Unlike other farmers' diaries, the diary of Shin Kwonsik contains a wealth of medical culture records because he chose unique ways to cure his and neighbors' illnesses by himself. It can be summarized as the life of “quasi-doctor”. Shin was distinguished from quacks in that he practiced as an intellectual in the village rather than as a profession, and that he learned official medical knowledge and recognized the difference between a licensed physician and himself. Also, he was different from doctors because of the lack of a medical license and the limited range of diseases that he could treat. The life of quasi-doctor shows the social structure of rural areas in Korea from the 1960s to the 1980s. The reality of rural healthcare can be summarized in two ways. First, the medical vacuum was filled by civilian efforts. There was virtually no institutional healthcare in rural areas, but the government did little to improve the situation . The policy of sending doctors to the countryside proved to be ineffective, and the community doctor system did not work properly. Health Insurance was also a system for city workers rather than farmers. In the late 1970s, the situation only slightly improved due to reasons unrelated to the government policy regarding rural healthcare. These were improvements in traffic conditions and the increasing popularity of private insurance, which improved the physical and economic accessibility to medical institutions. Second, Western medicine had become a part of folk medicine. Those who could not go to a hospital utilized Western medicine, which had penetrated the folk medical culture. When people were sick, they bought Western drugs from pharmacies, drug dealers, and sometimes quacks. The knowledge of Western medicine also spread widely, with family medical books such as Million People's Medicine as the medium. These two characteristics show that the existing myths that regard the absence of government policy as that of medical care and interpret the medical vacuum as the prevalence of folk remedies and shamanic healing are far from the truth. From the 1960s to the 1980s, gaps in institutional medicine was filled by Western medicine which had become part of the folk medicine already, and the accessibility of institutional medicine was improved through civilian efforts. Of course, the Daegok Diary shows more than the social structure of rural areas. It also reveals a lot about the man who wrote it, Shin Kwonsik. Unlike the others, Shin chose to become a quasi-doctor because of his separation from the tradition and his desire to learn. He grew up alone without parental care and later moved to Seoul by himself. This meant a break with the tradition. He joined the army in the wake of the Korean War and learned how to give injections there. After he was discharged, he devoured many books and newspapers including Million People's Medicine. In short, the existence of a quasi-doctor like Shin was the result of the combination of the absence of institutional medicine, the predominance of Western medicine, and the characteristic of Shin as a ‘learning modern.’

Investigation and factor analysis of hunting intention for rural grassroots of medical students in Gansu Province / 中国卫生政策研究

The aim of the present research was to investigate and analyze the hunting intentions of medical students for rural grassroots in Gansu and to provide a reference for decision-making on rural health human resource . A questionnaire is the research tool which was used to investigate the views of the senior students from six medical schools , and we studied their employment willingness to rural healthcare institutions .Chi-square test and non-condi-tional logistic regression analyses were used for data analysis .A sample of 600 medical graduates was involved in this investigation.The results of this study show that more than a half (55.6%) of the students would like to work in ru-ral, but only 13.8%of which were “very willing” to work at the rural healthcare institutions .According to the out-comes of this investigation , the number of junior college students who would like to work at the grassroots was 2.3 times the number of the undergraduate students .Medical students whose monthly salary expectations were not high ,with the household registration in rural areas , and having a better understanding of the policy of rural grass-roots em-ployment were more likely to work at the rural healthcare institutions .Based on the findings of this investigation , it can be concluded that the grassroots medical career intention of medical students is not only influenced by its own fac -tors, such as education and household registration , but also the policy of the government , school employment guid-ance and social atmosphere play an important role .The above-mentioned factors should be considered by decision-making and management departments of public healthcare .The departments should introduce a reasonable recruit-ment policy and strengthen the construction of grass-roots medical technology , equipment , and infrastructure , im-prove the grass-roots of employment environment and career development opportunities and strengthen the medical students'employment guidance work to make medical students more willing to work at rural healthcare institutions .

Analysis of disease spectrum of village clinics patients in rural areas of Jiangsu Province / 中华医学科研管理杂志

We investigated the common diseases in patients from village clinics and compared them to those of the general population in rural areas of Jiangsu Province.We found that the treatment rates of chronic diseases such as hypertension and diabetes mellitus were quite low.Village clinics should play a more active role in health record management,healthcare education,and management of chronic diseases for the farmers.

Personnel turnover in county-level healthcare institutions in poor rural areas from 2002 to 2006 / 中华医院管理杂志

ObjectiveTo probe into the HR development of healthcare professionals in poor rural areas. Methods51 county-level healthcare institutions from 13 counties in six provinces were sampled to study the turnover from 2002 to 2006. ResultsThe number of healthcare professionals per 1 000 population in the poor counties investigated was in average lower than that of counties in the same province; the inflow of personnel was higher than that of outflow. Of the inflow, 43. 50％ were fresh university graduates, and 40. 58％ were transferred from other organizations, 95.83％ have degrees of technical secondary schools and above, and 87. 17％ were healthcare professionals. 70. 44％ of the outflow were retirees, and 22. 33％ were transferred outside; 28. 00％ have only senior high school degrees or below, 69. 74％ were healthcare professionals. Conclusions The quality of healthcare personnel has been improved to some extent; but the risk of brain drain remains a challenge. An appropriate mechanism of personnel turnover should be built, and graduates from medical schools should be directed to reinforce healthcare teams in poor areas.

To Steer the Rudder of Fairness:On Government Functions in the Property Rights System Reform in Rural Healthcare Centers / 中国医学伦理学

Community participation in the rural healthcare service is still necessary under existing Chinese social conditions to achieve the goal of providing general rural public with safe,effective,convenient and inexpensive medical and healthcare services,as is declared in the 17th national people's committee report.The property rights system reform in rural healthcare centers is a reflection of community participation,and related problems in its participation process should be handled by steering the rudder of fairness when the Government applies its functions.The ultimate goal of rural healthcare property rights reform is to achieve the healthcare fairness for every rural individual,and thus right of each participator and fairness in the reform should be ensured.