Health-Seeking Behavior and its Determinants for Different Noncommunicable Diseases in Elderly.

Steady improvement in quality of life has led to increased survival time of elderly, especially of those with noncommunicable diseases. A study about their health-seeking behavior (HSB) and its determinants is essential for provision of comprehensive care and facilitate policy development. A cross-sectional study was conducted among 350 elderly participants over 60 years of age in an urbanized village of Delhi. Data was collected using a semi-structured questionnaire, and detailed general and systemic examination was done. Tests of significance were applied to assess the HSB with various demographic, clinico-social, and economic variables. A total of 87.4% of the study population was suffering from at least one noncommunicable disease (NCD). Majority of the study subjects' NCDs (72.66%) were diagnosed while getting treatment for a symptom of the disease. Also, 52.94% of the participants had inappropriate HSB. HSB was significantly associated with gender, age, duration of illness, and importantly with modifiable variables like the level of literacy, distance of preferred health facility, and presence of multimorbidity. HSB was found to be inappropriate in over half of the participants. Policymaking should focus on modifiable variables like education, distance of health facility, and multimorbidity, especially for commonly ignored diseases like osteoarthritis and diabetes.

How to Perform Discriminant Analysis in Medical Research? Explained with Illustrations.

Discriminant function analysis is the statistical analysis used to analyze data when the dependent variable or outcome is categorical and independent variable or predictor variable is parametric. It is a parametric technique to determine which weightings of quantitative variables or predictors best discriminates between two or more than two categories of dependent variables and does so better than chance. Discriminant analysis is used to find out the accuracy of a given classification system in predicting the sample into a particular group. Discriminant analysis includes the development of discriminant functions for each sample and deriving a cutoff score that is used for classifying the samples into different groups. Discriminant function analysis is a statistical analysis used to find out the accuracy of a given classification system or predictor variables. This article explains the basic assumptions, uses, and necessary requirements of discriminant analysis with a real-life clinical example. Whenever a new classification system is introduced, discriminant function analysis can be used to find out the accuracy with which the classification is able to differentiate a particular sample into different groups. Thus, it is a very useful tool in medical research where classification is required.

COVID-19 vaccine confidence project for perinatal women (CCPP)-Development of a stepped-care model to address COVID-19 vaccine hesitancy in low and middle-income countries.

Background: COVID-19 vaccine hesitancy (CVH) is common among perinatal women in low and middle-income countries (LMICs), but it is often unaddressed. This could be due to a lack of feasible, scalable, and acceptable interventions and models for CVH in LMICs. Our study aimed to develop a CVH intervention model that can be implemented in LMICs using existing human healthcare resources. Methods: A literature review was conducted on aspects of vaccine hesitancy, pre-existing interventions, and models for addressing vaccine hesitancy (COVID-19 and non-COVID-19). The lead authors (RR and PKuk) formed a team consisting of vaccinators, experts, and stakeholders. Members shared their perspectives and proposals for various models and interventions that could be implemented in LMICs. A CVH intervention model was developed using a logic model, a WHO implementation toolkit, experts' feedback, and consensus. Results: A consensus was reached to develop a COVID-19 Vaccine Confidence Project for Perinatal Women (CCPP), which is a primary health care worker (HCWs)-based stepped-care model. The CCPP model includes HCW training, integration into ongoing COVID-19 vaccination programs, CVH screening, CVH intervention, and referral services suitable for implementation in LMICs. Conclusion: The CCPP project/model provides a practical approach that can help in the early detection and management of CVH. The model can be tailored to different healthcare settings to improve COVID-19 vaccine uptake among perinatal women in LMICs.

Determinants of Expenditure on Diabetes Care: A Community Based Longitudinal Study in aResettlement Colony of Delhi.

INTRODUCTION: Diabetes is one of the expensive diseases due to its chronic nature and gradual involvement of multiple organs, Moreover loss of economic productivity further enhances the cost of care. Several factors were reported to have impact on overall economic burden in diabetic patients. So, the present study aims to determine influence of various socio-demographic and clinical factors on expenditure of diabetes care among patients residing in resettlement colony of East Delhi. METHODOLOGY: A community based one year longitudinal study was conducted in Kalyanpuri area of East Delhi. All the diabetes patients aged 25 years and who were the permanent residents of Kalyanpuri, attending the Diabetic Clinic of a government hospital in November-December 2014 were selected for the study. A pre-tested semi-structured interview schedule was used as study tool. Each subject was followed up 3 monthly from January to December 2015. RESULTS: Data of 150 study subjects was analyzed. Out of 150 subjects 45(30 %) were male and 105 (70%) female. Overall mean age of study subjects was 53 ± 10 years Among socio-demographic factors, Expenditure on diabetes care showed significant association with male gender and among clinical factors, longer duration since diagnosis, use of Insulin with Oral Hypoglycemic drugs, hospitalization and utilization of private care has shown positive association with expenditure on diabetes care. CONCLUSION: The present study concludes that there is need of better provisioning of services for diabetes care in government health facilities to cater needs of growing diabetic population..

Gallstone disease and quantitative analysis of independent biochemical parameters: Study in a tertiary care hospital of India.

INTRODUCTION: Gallstone disease (GSD) represents a significant burden for health-care systems worldwide and is one of the most common disorders among patients presenting to emergency rooms with abdominal discomfort. This study was aimed to know the association of biochemical parameters and development of GSD. MATERIALS AND METHODS: We conducted a case-control study from January 2013 to December 2013 among patients attending outpatient department of general surgery at a tertiary care hospital of Delhi, North India; we recruited 120 cases and the same number of controls in the study. Data collection for both cases and controls was done on a self-designed pretested interview schedule and all the patients were investigated for relevant biochemical parameters. Logistic regression was used for univariate and multivariate analyses to find out different correlates and analyze the independent effects of these correlates on GSD. RESULTS: We have included 120 cases and the same number of age- and sex-matched controls in the study and final analysis. Almost 70% of the cases were females and 30% were males. In multivariate logistic regression, we have found maximum significant association with serum total cholesterol (odds ratio [OR]: 1.013, confidence interval [CI]: 1.003-1.024, P = 0.041) followed by low-density lipoprotein (LDL) cholesterol (OR: 1.017, CI: 1.001-1.034, P = 0.04) and triglycerides (OR: 1.009, CI: 1.001-1.018, P = 0.049). Fasting blood sugar (P = 0.18), high-density lipoprotein cholesterol (P = 0.07), aspartate transaminase (P = 0.21), alanine transaminase (P = 0.29), and total bilirubin (P = 0.13) were not found to be independently associated with GSD. CONCLUSION: Biochemical parameters such as plasma total cholesterol, triglycerides, and LDL cholesterol level were independently associated with GSD.

Tracking the implementation to identify gaps in integrated disease surveillance program in a block of district jhajjar (haryana).

CONTEXT: To strengthen the surveillance system in India, Integrated Disease Surveillance Program (IDSP) was launched in 2004. The frequent occurrence of epidemics even after the launching of the IDSP was an indication toward inadequacy of the system. The responsibility for effective implementation of IDSP at the sub-center level lies with the health workers. AIMS: The aim of the following study was to assess the knowledge and practice of health workers regarding IDSP and to assess the quality of IDSP reports at the sub-center level. SETTINGS AND DESIGN: It was cross-sectional study carried out in the area under Community Health Center Dighal which is the rural field practice area attached to Post Graduate Institute of Medical Sciences, Rohtak in the State of Haryana, India. SUBJECTS AND METHODS: All the 24 sub-centers in the area were visited and 46 health workers (22 male; 24 female) who met the inclusion criteria i.e. who had completed 1 year of their service or had been trained for IDSP, were included in the study. Data were collected on a self-designed, semi-structured and pre-tested schedule by interviewing the study subjects and observation of the records/reports. STATISTICAL ANALYSIS USED: Percentages and proportions. RESULTS: Only 14/46 (~30%) of the workers could expand the abbreviation "IDSP" correctly. Only 4/46 (~9%) workers could narrate any of the trigger events and none could tell all the trigger events. Only at 12 such sub-centers, diagnoses were being written in their out-patient registers according to the defined syndromes. 43/46 (~93%) workers were not aware of the zero reporting. CONCLUSIONS: The surveillance system is much less alert and intense than the desired level and needs to be strengthened.

Designing new growth charts for low-birth weight babies: need of the hour in India.

Literature reveals theories explaining low birth weight (LBW) babies' unplanned catch-up growth is related to several non-communicable diseases (NCDs) in adult-life. Is the current growth chart as per World Health Organization child growth standards of healthy breast feed infants and young child is applicable for even LBW or small for gestational age babies? There are high chances that these LBW babies who are growing "in their centiles" will be diagnosed as mild or moderate protein energy malnutrition (PEM) in clinical settings as the current diagnostic criteria for PEM do not include birth weight as an indicator. Besides they are encouraged for home based extra caloric food to gain weight and thereby encouraging them to "crossing the percentile" in the growth curve. Do these managements really benefit the baby or are we inadvertently exposing them to increased future risk of adult diseases must be considered seriously. Thus, we may require revision to make a separate standardized growth chart for LBW babies indicating how they should grow.

Extent of delay in diagnosis in new smear positive patients of pulmonary tuberculosis attending tertiary care hospital.

BACKGROUND: India is the highest tuberculosis (TB) burden country accounting for one-fifth of the global incidence. It is estimated that, annually, 1.9 million cases are from India and about 0.8 million are infectious, new smear, positive pulmonary TB cases. The present study was a cross-sectional study conducted in a tertiary care hospital to determine the extent of delay in diagnosis and initiating the treatment after diagnosis in new smear, positive pulmonary TB patients attending a tertiary care hospital of Haryana during a 1-year period. METHODS: A total of 204 patients were interviewed after being diagnosed as new sputum, positive TB (NSP-TB) by the treating doctor at the tertiary care hospital and re-interviewed at their home after initiation of anti-TB treatment. Chi-square test and analysis of variance (ANOVA) were used for statistical analysis. RESULTS: More than half of the study patients delayed their first consultation with a health care system. The mean and median patient delay was 32.97 and 16 days, respectively. Lack of awareness of the disease was the leading cause for the patient delay. The mean duration of delay at peripheral health care provider was 60.46 days. The mean and median delay at tertiary care hospital was 8.35 and 4 days, respectively. Most of the patients delayed for diagnosis as per revised national TB control program (RNTCP) guidelines. The mean total delay in diagnosis was 75.71 days. CONCLUSIONS: There is an urgent need to scale up the information education communication activities to decrease the patient delay. Doctor at all level of health care need to be actively involved for subjecting the suspects to sputum examination at the earliest possible, as per RNTCP guidelines.

Congenital malaria--a neglected problem.

Congenital malaria is the least known manifestation of malaria and a much neglected area of research. Most of the existing information is limited to case reports in children born to non-immune women. Congenital malaria can be acquired by transmission of parasitised maternal erythrocytes across the placenta due to microdamage. Congenital malaria has been documented for many years but it was previously thought to be uncommon especially in indigenous populations. Many gaps in knowledge remain. There is a need of considering congenital malaria as differential diagnosis even in low endemic areas, especially in countries where there is social practice of moving the pregnant woman to her native place for childbirth, which may be endemic for malaria. Physicians should judge each case individually, considering such factors as reliability of follow-up and access to medical care and advice accordingly.

Local skin reaction following an accidental injection from a BCG vaccine in a healthcare worker.

Exposure to blood-borne pathogens from sharp injuries continue to pose a significant risk to healthcare workers (HCW). The number of sharps injuries sustained by HCW is still unclear, primarily due to under-reporting of events. Healthcare professionals are at risk of sustaining such injuries from hollow-bore needles. Sharps injuries are associated with risk of infection with blood-borne pathogens such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) hepatitis C virus (HCV) and other live organisms. Here we are reporting a case of an adverse reaction in a HCW due to an accidental sharps injury by a needle used to administer the Bacillus Calmittee Gurien (BCG) vaccine.

Psycho-Social Behaviour of Urban Indian Adolescent Girls during menstruation.

BACKGROUND: Adolescence in females signifies the transition from girlhood to womanhood and is marked with the onset of menarche. Indian society is interwoven into a set of traditions, myths and misconceptions, especially regarding menstruation and related issues. The present study was conducted to assess knowledge and psycho-social behavior related to menstruation among adolescent girls in urban Haryana (state), India. METHOD: A total of 478 adolescent girls in the age group of 15 -19 years from three educational institutes of Rohtak city were selected randomly. It was a community-based, descriptive, cross-sectional questionnaire based study, and a pre-tested, pre-coded, closed ended questionnaire was used. RESULTS: Feeling of sickness was the most common (in more than two-third of subjects) followed by irritability and emotional disturbances. More than 3/4(th) of the subjects did not worship during menstruation, 45% were not allowed in kitchen and nearly one-fourth followed dietary restrictions. More than 16% subjects thought menstruation to be a sign of onset of a disease and little more than 7 % thought it to be a curse. Girls preferred to discuss their menstruation related problems either with their mothers or with their friends. CONCLUSION: Girls have inaccurate and partial information regarding menstruation. There is a need of early intervention in the area of adolescent psycho-social behavior during menstruation.

Pattern and burden of animal bite cases in a tertiary care hospital in Haryana.

Rabies is an endemic disease in both developed and developing world and is responsible for a large number of morbidities and mortalities in humans. Limited supply of vaccine hampers the accessibility of life saving treatment. In our study carried out in a tertiary care hospital in Haryana showed that there were 3617 animal bite cases reported in a year with an average of 9.91 new cases per day. The average economic burden related to management of these bite cases is 3.5 lacs per month. This cost along with vaccine demand can be substantially reduced if intradermal schedule is introduced.

Understanding survival analysis: Kaplan-Meier estimate.

Kaplan-Meier estimate is one of the best options to be used to measure the fraction of subjects living for a certain amount of time after treatment. In clinical trials or community trials, the effect of an intervention is assessed by measuring the number of subjects survived or saved after that intervention over a period of time. The time starting from a defined point to the occurrence of a given event, for example death is called as survival time and the analysis of group data as survival analysis. This can be affected by subjects under study that are uncooperative and refused to be remained in the study or when some of the subjects may not experience the event or death before the end of the study, although they would have experienced or died if observation continued, or we lose touch with them midway in the study. We label these situations as censored observations. The Kaplan-Meier estimate is the simplest way of computing the survival over time in spite of all these difficulties associated with subjects or situations. The survival curve can be created assuming various situations. It involves computing of probabilities of occurrence of event at a certain point of time and multiplying these successive probabilities by any earlier computed probabilities to get the final estimate. This can be calculated for two groups of subjects and also their statistical difference in the survivals. This can be used in Ayurveda research when they are comparing two drugs and looking for survival of subjects.