Uncovering The Sociological Interpretation of Visual Impairment-Related Inequities and Their Social Determinants in India

Introduction: Determinants of health are divided into four types, such as “Biological-Psychological-Environmental-Social Determinants”. The social determinants of health include gender disparities, economic status, ethnicity, race, geographic isolation, or having a specific health condition. Moreover, the social deter-minants are interdependent and interrelated with one another. There can also be a primary determinant that affects the other determinants. For example, educational level of the patients is associated with knowledge and awareness of eye care and its conditions. However, education might have a different effect than income in should be access of eye care when needed. Methodology: The study is mainly dependent on secondary data analysis. Results: The primary objective of the study is to illustrate the sociological aspects of visual impairment-related inequities and to identify the social determinants of visual impairments and disparities in India. An-other aim of the paper is to present a deeper understanding of how inequities impact the incidence of visual impairment and blindness based on the social determinants of health. The present study adopts the ecological and Commission on Social Determinants of Health (CSDH) framework 2008. We reaffirm the fact that inequi-ties negatively affect the visual impairment and blindness conditions. The national health policies should take into account the social determinants of visual impairment in their policies relating to comprehensive eye care. Social and economic factors are connected with health and welfare; those socio-economic inequalities con-tribute to health inequalities. For reducing the health inequalities around the world, we need effective policy implementation and proper fund pools. Furthermore, committed action on societal determinants of health, sufficient human resources are also necessary to control the health disabilities, include visual impairment

Comparison Of Artificial Neural Network and Decision Tree Methods for Predicting the Maternal Outcome in A Tertiary Care Hospital in Odisha, India

Background: This study used an artificial neural network (ANN) and a decision tree to predict maternal outcomes and their major determinants. An artificial neural network (ANN) and a decision tree were used in this study to determine maternal outcomes and their significant determinants. Methods: Data was gathered from 955 pregnant women at a tertiary care hospital in Bhubaneswar, Od-isha. A popular machine learning algorithm, artificial neural networks (ANN), was used to predict mater-nal outcomes and their determinants. Results: In the bivariate analysis, we found gestational age is significantly associated with maternal out-come (p=<0.001). The accuracy of the ANN model and decision tree was 0.882 and 0.823, respectively. Based on the variable importance of ANN, the significant determinants of maternal outcome were birth weight, systolic blood pressure, haemoglobin, gestational age, age of mother, diastolic blood pressure etc. Conclusion: This model can be utilized in future for Proper precautions and medical check-ups required during the maternal period to avoid a negative maternal outcome.

Comparison of physical fitness in male and female medical students

Background: Students entering medical college find it difficult to cope with the burden of studies and go into depression. They cannot maintain their study habits as before due to extreme tiredness and fatigue following their regular classes. Aim and Objectives: The present study aims to evaluate the physical fitness status of male and female medical students. Materials and Methods: A total of 70 students, 35 male and 35 female, were selected randomly from the first two phases of this college. Their age, height, weight, and BMI were recorded. Their resting pulse rate was recorded after 15 min of resting. Then, each was made to undergo the Modified Harvard Step Test for 5 min or till exertion. Then, their immediate post-exercise pulse rate was recorded. VO2max was calculated and compared to find the physically fit group. Results: We found from the study that female students were similar to males in age, weight, and resting pulse rate. The height and maximum pulse rate post-exercise are more in males and BMI more in females and VO2max was found more in males. Conclusion: The male students are more physically fit than females and can cope with the different strenuous situations better than females. Females need to do regular exercise to increase their fitness.

Role of novel insecticides in crop protection and their selectivity to natural enemies: A review

In the present context of pest management in major crops, as the nature of pest pressure evolves, the requirement of new research-based tactics for pest control becomes a continuous process. Insecticide chemistry plays a major, if not dominant role in these developments. In this review, the toxicological aspects of new novel insecticides against crop pests and their selectivity to natural enemies have been discussed.The progress achieved in toxicological research has introduced new insecticides in crop protection during last two decades which are quite different over the existing groups in terms of chemistry and mode of action. It is evident from their mode of action that these chemicals target alternate physiological and biochemical effect. However, it is important to maintain the diversity in chemistry of insecticides for maximizing flexibility, precision and stability in pest management. In recent years, several new insecticide groups viz., neonicotinoids, butenolides, tetronic and tetramic acid derivatives, oxadiazines, diamides, ketoenols, phenylpyrazoles, pyridines, flonicamid, mitochondrial electron transport inhibitor (METI) acaricides, diafenthiuron, tetrazines, oxazolines, and insecticides from soil microorganisms such as avermectins, milbemycins, spinosyns, pyrrole insecticides and insect growth regulators (IGRs) have been discovered and commercialized for agricultural pest management. The ability of these new groups of insecticides to be effective at low rates or doses, high level of selectivity, greater specificity to target pests along with low toxicity to non-target organisms and the environment, replaced many conventional compounds. The conservation of beneficial organisms like natural enemies and pollinators is the fundamental principle of integrated pest management (IPM). Majority of new insecticide groups are safer and fit well into IPM. It is perceived that in the process of entry of new chemical insecticides in crop protection there is a gradual shift from traditional chemicals to selective novel groups which have minimal side-effects on natural enemies of the pests. These selective insecticides have less adverse impact on the conservation and multiplication of bio agents which can be used in a compatible manner with other tools of IPM. The new chemistries are emphasizing to account separately for possible non-target effects on predators, parasitoids, and pathogens. These factors are becoming increasingly important as the agricultural sector moves away from highly persistent broad-spectrum insecticides to more selective rapidly decaying products.

Indian public health standards (IPHS) for community health centres.

The health care system in India has expanded considerably over the last few decades but the quality of the services is not up to the mark due to various reasons. Hence standards are being introduced in order to improve the quality of services. A task group under the chairmanship of Director General of Health Services, Government of India was constituted to recommend the standards to be called as Indian Public Health Standards. IPHS are a set of standards envisaged to improve the quality of health care delivery in the country under the National Rural Health Mission.

Outcome of parapneumonic empyema.

OBJECTIVE: Empyema thoracis is known to have variable age group affection, causative agents and controversy regarding primary mode of management. To look into current demography, bacteriology and treatment outcome. METHODS: Prospective study made on admitted cases of parapneumonic empyema from July 2001 to June 2003. All cases were treated with chest tube drainage, parenteral antibiotics or thoracotomy in multiloculated or non-improving cases. RESULTS: 0.8% (C.I. 0.6-1.0) of total pediatric admission had empyema, who were more likely to be females (P< 0.05), under-weight (P< 0.05) compared to children admitted for other reasons. Staphylococcus aureus is still the commonest isolate (13.2%). All cases received antibiotics prior to hospitalisation. Majority of cases (90.5%) could be successfully managed with antibiotics and chest tube drainage alone. 9.4% cases needed thoracotomy. 5.8% cases needed salvage thoracotomy following non-improvement with chest tube drainage. Fever remission time and duration of hospital stay were comparable in both groups. Thoracotomy cases required antibiotics for shorter period (P=0.04). Two cases died due to reasons other than mode of management. Radiological and lung function recovery was excellent in most of the cases. CONCLUSION: Chest tube drainage is a safe, efficacious primary method of empyema management.

Severe falciparum malaria.

Falciparum malaria affect all ages with multiple-systemic complications which varies in different age group. We studied 242 children with complicated Falciparum malaria with a median age of 6.5 years to look for occurrence of different complications in younger and older age groups and overall mortality picture. Unarousable coma (40.5%), severe anemia (26.03%), repeated seizures (46.2%) and hepatopathy (32.2%) were commonest complications. Under five children had higher risk of development of cerebral malaria (P<0.01), severe anemia (P<0.05) and seizures (P<0.001); whereas above five children had higher risk of acute renal failure (P<0.05) and malarial hepatopathy (P<0.02). Over all mortality was 9.9%, cerebral malaria being the commonest cause (6.6%). Multi-system involvement was seen in 58.4% cases of death. Children having pulmonary edema, shock and cerebral malaria had high case fatality rate.

A multicentric study with arteether in patients of uncomplicated falciparum malaria.

Two hundred and sixty seven patients of uncomplicated P. falciparum malaria completed study in a multicentric phase III clinical trial of Arteether. Arteether was given intramuscularly in a dose of 150 mg daily for three consecutive days. Each patient was followed upto 28 days of alpha, beta arteether therapy. The cure rate was 97% with fever clearance time between 1-7 days (24-168 hours) and parasite clearance time between 1-3 days (24-72 hours). Parasite reappearance rate was found to be 3% and reported at only three of the centres. Following the treatment no adverse effect was observed on haematological, biochemical and vital clinical parameters.

AIDS in India: recent trends in opportunistic infections.

The first case of AIDS in India was reported in 1986. Subsequently, a surveillance system was developed in 1987. The data from this surveillance activity suggest that the HIV infection has now spread to the general population and to all parts of the country, except Arunachal Pradesh in North-eastern India. With the changing scenario of the AIDS epidemic, a host of opportunistic infections add to the present endemic state of some already existing infections like tuberculosis. This report analyses the AIDS cases in India, reported to the National AIDS Control Organization over the years between 1986 to 1997. A total of 3,551 AIDS cases had been reported till 31st May 1997. Tuberculosis (pulmonary and extrapulmonary) is the major opportunistic infection affecting 62% of the cases followed by candidiasis seen in 57% of the patients. In 1997, of the 390 AIDS cases analysed, tuberculosis (pulmonary and extrapulmonary) accounted for 56.5% of the total cases whereas candidiasis was seen in 61% of the cases. An increasing trend was observed with tuberculosis from 58% in 1986-1992 to 68.5% in 1995. No trend could be established in the case of candidiasis, though, a high prevalence of 66% was seen in the cases between 1986 and 1992. An increase was also observed in cases of PCP, cerebral toxoplasmosis and Kaposi sarcoma. In the AIDS cases, chronic diarrhea (76%), weight loss (87%) and fever (85%) appeared to be the major presenting symptoms. But, of the 390 AIDS cases reported in 1997, only 47% of them were suffering from chronic diarrhea. With increase in the number of AIDS cases, India is burdened with a dual epidemic of HIV/AIDS and tuberculosis. The National AIDS Control Organization in India, is involved in training clinicians and laboratory personnel in the diagnosis and management of the AIDS cases. With better diagnosis of the opportunistic infections, especially diarrhea, in AIDS patients, a better picture will emerge regarding the opportunistic infections which would help clinicians and health planners to tackle the AIDS epidemic in a more effective manner.

Status of Plasmodium falciparum resistance to chloroquine in Orissa.

Orissa is known for its contribution of 15-20% of malaria cases to the national total. Deaths due to malaria in the state are also not uncommon. Proportion of P. falciparum cases have reached to 85%. In the recent years over 0.3 million confirmed malaria cases have been reported each year. Annual consumption of chloroquine in the state is over 170 lakh tablets. A 17 year study on monitoring of choloroquine resistance in P. falciparum in Orissa revealed that out of a total of 1165 tests conducted in vivo, in 12% of the cases RI level of resistance was detected. And 4.4% cases were of RII and 1.9% RIII level. 51% of the sample tested in vitro showed P. falciparum resistance to chloroquine. P. falciparum resistance to chloroquine appears to have been developed by the parasite over the length and breadth of the state. Strengthening of the monitoring of drug resistance in P. falciparum in the state is indicated.

Influence of serum albumin & total protein on fructosamine measurement.

To assess the effect of serum albumin and total protein on the fructosamine level 57 hypoalbuminaemic patients (serum albumin less than 30 g/1), of whom 44 were nondiabetics and 13 were diabetics, were studied. Fructosamine levels of hypoalbuminaemic diabetics was increased only marginally in comparison to healthy controls (P greater than 0.05) whereas in 122 other normalbuminaemic diabetics, the level was found to be significantly higher (P less than 0.001). In control subjects, the correlation between fructosamine and serum albumin (r = 0.69, P less than 0.001) was better than that of total protein (r = 0.42, P less than 0.01) whereas in hypoalbuminaemic patients the pattern was reversed (r = 0.51 and 0.59 respectively), indicating substantial contribution by the globulins. A working formula suggesting approximate contribution of each gram of albumin and globulin in healthy subjects was calculated. It is inferred that the use of serum fructosamine for assessment of glycaemic status could be misleading in patients with lower albumin values. Calculating serum fructosamine values from serum albumin alone in these patients is likely to be inaccurate, as it ignores the contribution of globulins which can be substantial in certain disease conditions. A gross idea regarding the glycaemic status can be obtained by comparing actual and calculated values of fructosamine from the formula.

Epidemiological study of measles in Singur, West Bengal.

A measles survey in 10 villages of Rural Health Unit and Training Centre, Singur revealed 581 cases of measles from January to June 1986. The overall attack rate was 40/1000. The highest attack rate (43.5 per cent) was observed in the age group of 1-2 years followed by 6-8 months age group. 11.5 per cent of the cases were below the age of 9 months and 10.4 per cent cases were above the age of 15 years. 42.3 per cent of cases developed one or the other complications. Diarrhoea and respiratory infections were the two common complications. Case fatality rate was only 0.17 per cent. Epidemiological aspects of these observations are discussed.