National Journal of Community Medicine

Recognizing The Significance of Scrub Typhus as An Emerging Threat

Gopinath Ramalingam, Arundadhi M, Sucila Thangam G — Mon, 01 Jul 2024 00:00:00 +0000

Nurse-Led Telehealth Oncology Clinic on ‘Home Management During Chemotherapy’ for Gastrointestinal Cancer Patients: Study Protocol of A Mixed Method Study

Sarita Ahwal, Kanika Rai, Ankur Jindal, Puja Sahai — Mon, 01 Jul 2024 00:00:00 +0000

Introduction: Telehealth is increasingly being used for symptom management among cancer patients on chemotherapy. Objective of the study is to develop Nurse-led Tele-health Oncology Clinic for GI cancer patients regarding ‘Home Management during Chemotherapy’.

Methods: The study will follow sequential explanatory mixed method design where during quantitative phase, using RCT (CTRI/2024/01/062028), GI cancer patients of age 18-65 years and undergoing 2^nd or 3^rd chemotherapy cycle will be randomised after obtaining consent to experimental (EG) & control (CG) groups. Ethical Clearance is already obtained. EG will be followed through Nurse-led Clinic which includes multiple virtual educational & counselling sessions, e-booklet on side effects management, PMRT, Support groups & telephonic follow ups. Effectiveness will be measured in terms of Quality of life, severity of side effects and Anxiety using FACT-G, CTCAE and DASS respectively. In qualitative phase, using extreme case sampling, in-depth interviews from consented participants will be conducted to explore experiences towards intervention.

Analysis: Analysis of quantitative data will use descriptive and inferential statistics. This follows thematic analysis and integration of data.

Conclusion: The study protocol will provide guidance to optimize utility of tele-medicine technology to improve healthcare outcomes especially for the GI cancer patients.

Understanding Contraceptive Utilisation Patterns in Kerala: Insights from NFHS-5

Adwaith Gopan, Binu Kumar B J — Mon, 01 Jul 2024 00:00:00 +0000

Background: In the past decade, Kerala has witnessed an increase in the number of sexually transmitted diseases and unmet family planning needs. This study examines the knowledge of modern contraceptives, their use, and the current use of modern Keralite contraceptives against selected indicators.

Methodology: The dataset from the fifth round of the National Family Health Survey was used for this study (N=10969). To analyse the factors associated with and affecting knowledge and use of contraceptives (current use of modern and ever use of any), chi-square test and binary logistic regression were used.

Results: Wealth, age, and education level were positively associated with knowledge of modern contraceptives, whereas tribals were less aware than other castes. Wealthier, older, and less educated individuals had higher odds of using any/modern contraceptives than poor, younger, and higher educated individuals (odds<1). Muslims are likely to use contraceptives but are less likely to use modern methods than other religions (odds ratio: 1.67 and 0.78). Tribals had higher odds of using contraceptives (odds: 2.13). Urban respondents had lower odds of using modern contraceptives than rural respondents (odds: 0.751).

Conclusions: The higher odds of older, less-educated respondents using sterilisation over reversible contraceptives are likely due to social insecurities and misconceptions. Awareness and promotion of contraceptive use at the government level would help boost its use.

Impact of Vitamin D Supplementation on Glycaemic Control in Type 2 Diabetes Patients: A Double Blind Randomized Controlled Trial

Raja Danasekaran, Gowthamkarthic Ravichandhiran, Soumya Agadi, Hari Krishnan R — Mon, 01 Jul 2024 00:00:00 +0000

Introduction: Vitamin D deficiency is a global health concern affecting diverse populations and it has been linked to various ailments. This study aimed to investigate vitamin D levels among T2DM patients and evaluate the impact of supplementation on those deficient, alongside its effect on quality of life and comorbidities.

Methodology: A double-blinded randomized controlled trial was conducted among T2DM patients aged 18-75 years with HbA1c ≥ 7% and vitamin D deficiency (<12 ng/mL). Participants were divided into intervention (vitamin D supplementation) and control (placebo) groups. Data on demographics, diabetic status, and comorbidities were collected. Blood samples were analyzed for HbA1c and Vitamin D levels.

Results: Of the 66 participants initially recruited, 60 completed the study. No adverse effects were observed. There was no significant difference in glycemic control between the intervention and control groups at 3 and 6 months. Quality of life showed no significant improvement with supplementation.

Conclusion: This study did not find evidence supporting the efficacy of vitamin D supplementation in improving glycemic control or quality of life among T2DM patients with vitamin D deficiency. Further research is warranted to explore alternative interventions or factors influencing glycemic control and quality of life in T2DM patients.

Prevalence and Factors Associated with Depression among High School Students in Ho Chi Minh City, Vietnam

Mon, 01 Jul 2024 00:00:00 +0000

Background: Depression in high school students is a common mental health problem and requires evaluation for early intervention. The study was carried out to determine the prevalence of depression symptoms and associated characteristics among high school students in Ho Chi Minh City, Vietnam.

Methods: This cross-sectional study enrolled participants between February 2022 and June 2022. The instrument utilized was a questionnaire of socioeconomic-demographic variables, educational characteristics, and the self-reported depression scale obtained from the Centre for Epidemiological Studies-Depression (CES-D).

Results: 384 high school students (165 males and 219 females) were questioned. The CES-D had a mean score of 17.3, with 57.6% of participants reporting depressed symptoms. The frequency was 63.3% among male students (OR = 1.84, 95% CI = 1.19-2.83, p = .005). Multiple logistic regression revealed that adolescents with poor health, weak friendships, limited participation in school activities, family problems, financial worries, and negative educational environments were significantly more likely to experience depressive symptoms (odds ratios ranging from 1.60 to 9.97, confidence intervals spanning 1.03 to 78.05, and p-values from <.001 to .044).

Conclusion: The study emphasized the necessity of health promotion programs that target mental health awareness, improve social support networks, and introduce stress reduction techniques in schools to reduce the prevalence of depression among teenagers in Ho Chi Minh City, Vietnam.

Quality of Life and its Associated Factors Among the Elderly Community Dwellers in Rural Bihar – A Community-Based Cross-Sectional Study from Eastern India

Rajath Rao, Basavaraj Yankannavar, Bijaya Naik — Mon, 01 Jul 2024 00:00:00 +0000

Background: Aging, longevity, advanced health care, and demographic transition have altered the quality of life (QOL) among the elderly. This study was planned to assess the QOL among the elderly and the associated factors in rural Bihar.

Methods: This community-based cross-sectional study among 395 elderlies residing in rural Bihar adopted a multistage sampling technique and a standard WHO-QOL BREF tool to assess the QOL. A multivariable linear regression analysis was performed and an adjusted beta-coefficient was reported to determine the factors determining the QOL.

Results: A total of 33 [8.4% (95% CI: 6-11.5%)] out of 395 elderlies had poor QOL. Age [adjusted B= -0.19 (-0.3 to -0.07)], Females [adjusted B= -1.89 (-3.5 to -0.25)], No. of drugs consumed [adjusted B=1.7 (0.4 to 2.99)], presence of any of the comorbidity [adjusted B=-5.9 (-10.8 to -1.1)], presence of Polymorbidity [adjusted B=-3.5 (-6.6 to -0.4)] were found to be independent correlates of QOL scores among elderly.

Conclusion: Almost one in ten elderlies had poor QOL. The physical domain of QOL was affected the most among all the domains. Increasing age, female gender, presence of any co-morbidity, presence of poly-morbidity, and more drug consumption were associated with decreasing QOL scores among the elderly.

Effectiveness of Nutritional Intervention on Bone Mineral Density among Women Aged 30-50 Years in South India

Silpa Chintham — Mon, 01 Jul 2024 00:00:00 +0000

Introduction: By 2050, low bone mineral density in women is expected to increase by 40% globally, considerably increasing the burden of osteoporosis in future generations, which necessitates greater focus on preventive measures. Hence, it was planned to study the effectiveness of calcium rich nutritional intervention on bone mineral density among women aged 30-50 years in South India.

Methods: A quasi-experimental pre-test and post-test control group design was conducted among randomly selected 20 urban and rural women aged 30-50 years. Calcium rich nutritional mix was given for 16 weeks to the interventional arm and for control arm, education on importance of calcium rich diet was given. Bone mineral density was measured by DEXA scan pre and post intervention. Descriptive and inferential statistics were used to analyse the data.

Results: Before intervention, all the women (100%) had mildly reduced bone mineral density; post intervention, majority of the women (80%) had normal bone mineral density, only 20% had mildly reduced bone mineral density. In the control group, 100% had mildly reduced bone mineral density before receiving health education and after 16 weeks of education, 90% had mildly reduced bone mineral density and only 10% had normal bone mineral density.

Conclusion: Calcium rich nutritional intervention given to the experimental group women resulted in a significant improvement in their bone mineral density. However, risk can be lowered by leading a healthy lifestyle that includes enough quantities of dietary calcium, vitamin D, and protein, frequent weight-bearing activity.

A Cohort Study to Evaluate the Effect of Nutritional Intervention on Severe Acute Malnutrition Children Admitted to A Nutritional Rehabilitation Centre in A Tertiary Care Hospital in Central Gujarat, India

Foram Panchal, Rahul Parmar, Kalpita Shringarpure, Jivraj Damor — Mon, 01 Jul 2024 00:00:00 +0000

Background: Undernutrition is one of the most concerning health and development issues in India as well as in the world. Nutritional rehabilitation centres (NRC) were started by Government of India to control severe acute malnutrition. The aim is to assess the effect of nutrition interventional measures for severe acute malnutrition (SAM) children admitted at NRC through selected anthropometric indicators.

Methodology: A hospital-based prospective cohort study was conducted at NRC of SSG Hospital, Vadodara, Gujarat from April to September 2022, all children of 6-60 months of age admitted during this period were observed during their stay with three follow-ups after discharge at 15 days interval. The data was entered in Microsoft Excel and was analysed using Medcalc Software.

Results: A total of 76 children were analysed for anthropometric indicators. A statistically significant difference was obtained between the weight of children at admission, discharge and 3 follow-ups (ANOVA=141, p<0.001); difference of mid upper arm circumference (MUAC) (ANOVA=84.2, p<0.001) and difference of height (ANOVA=43.3. p<0.001) at admission, discharge and follow-up were also statistically significant.

Conclusions: NRCs have had a positive impact on the selected anthropometric indicators of severe malnourished children but lag behind proper follow-up visits.

Estimating HIV Disclosure and Its Impact on Social Relations: A Cross-Sectional Study in Gujarat, India

Khushali D Parikh, Mihir Rupani — Mon, 01 Jul 2024 00:00:00 +0000

Background: The disclosure of HIV-positive status can significantly impact social relationships. This study aimed to evaluate the prevalence of self-disclosure of HIV status and its effects on social relations among individuals living with HIV (PLHIV) in Gujarat, India.

Methods: Conducted from April to June 2021, this cross-sectional study involved 383 PLHIV attending a tertiary-care medical college hospital in Gujarat, India. The sample size was determined using Epi Info software version 7. Data collection utilized a structured questionnaire covering socio-demographic information, HIV disclosure status, and its impact on social relationships. Multiple logistic regression analysis identified predictors of non-disclosure of HIV status to spouses.

Results: Among the 383 participants, 83% disclosed their HIV status to their spouse, while disclosure rates to other social contacts varied. Post-disclosure, 7% reported strained or broken relationships with their spouses. Factors associated with non-disclosure to spouses included older age (adjusted odds ratio [aOR] 1.13, 95% confidence interval [CI] 1.07-1.20), female gender (aOR 6.00, 95% CI 1.81-19.88), lack of post-test counselling (aOR 3.29, 95% CI 1.01-10.70), and spouse being HIV-negative (aOR 3.60, 95% CI 1.27-10.25).

Conclusion: In conclusion, while a significant proportion of PLHIV disclosed their HIV status to spouses, a notable proportion experienced strained relationships post-disclosure. Addressing barriers to disclosure, especially among older individuals and females, and ensuring adequate post-test counselling, may facilitate open communication and support among PLHIV and their social networks.

Risk Factor Analysis of Stunting in Children Aged 6-23 Months in Tanralili District, Maros Regency, Indonesia

Agussalim, Andi Zulkifli, Nur Nasry Noor, Ansariadi, Stang, Shanti Riskiyani — Mon, 01 Jul 2024 00:00:00 +0000

Background: The high rate of stunting is still a nutritional problem in children in Indonesia which has an impact on the quality of future generations. The study aims to determine the risk factors for stunting in children aged 6-23 months in Tanralili District, Maros Regency.

Methodology: This study used a case control study design. The sampling technique uses the side exhaustive method with a ratio of 1: 1, as many as 260 samples consisting of 130 cases and 130 controls. Stata program version 17 is used for data analysis.

Results: Risk factors associated with stunting were maternal age <20 or 35 years (OR=1.953), lower-middle family income (OR=1.947), antenatal care <4 visits (OR=1,820), anemia (OR=2.252), chronic energy deficiency (OR=2.261), low birth weight (OR=2,595), exclusive breastfeeding (OR=2.448), poor home sanitation (OR=2.226;). Working mothers are a protective factor against stunting (OR=0.819). Multivariate analysis shows that exclusive breastfeeding is the dominant risk factor for stunting.

Conclusion: Risk factors for stunting come from mother, child, as well as environmental and family economic factors. The need for integrated and multisectoral programs to increase family income, access to proper home sanitation, maternal education on pregnancy and nutrition and exclusive breastfeeding to reduce the incidence of stunting.

Assessing Quality of In-Patient Care and Patients's Expectations Using A SERVQUAL Approach in A Tertiary Care Hospital in India

Diwakar R, Jegan Joseph, Logaraj M, Kaveri Palanisamy, Manoj Punniyamurthy — Mon, 01 Jul 2024 00:00:00 +0000

Background: Patient satisfaction is a key indicator of healthcare service quality and has implications for the growth and success of healthcare organizations. However, there is often a gap between patients’ expectations and perceptions of service quality, which can vary depending on various sociodemographic factors. This study aimed to assess the expectations, perceptions and service quality gap in a tertiary care hospital using SERVQUAL model.

Materials and Methods: A cross-sectional study was conducted among 120 adult inpatients using a semi-structured questionnaire based on the five dimensions of the SERVQUAL model. The quality gap was calculated as the difference between perception and expectation scores.

Results: The study found a significant negative quality gap across all five dimensions, with the largest gaps observed in reliability and responsiveness. The study also revealed that gender, age, and education influenced patients’ perception of service quality, while type of specialty, residence, monthly income, and occupation did not have a significant effect.

Conclusion: The study highlighted the need for improving the service quality in the tertiary care hospital, especially in terms of reliability and responsiveness. The study also suggested that healthcare managers and providers should consider the diverse expectations and needs of patients based on their sociodemographic characteristics.

Health-Related Quality of Life in Patients with Cancer in India: A Systematic Review

Thufail Korankulangara, Ajitha Katta, Mousami Kirtania, Dahy Sulaiman — Mon, 01 Jul 2024 00:00:00 +0000

Introduction: Cancer poses numerous health-related threats to patients, significantly impacting their Quality of Life (QoL) and that of their caregivers. This systematic review aims to assess the prevalence and severity of QoL-related health issues among cancer survivors in India using the World Health Organization Quality of Life (WHOQOL) framework. The review will explore the patients’ lived experiences that will ultimately manifest the importance of health-related QoL for cancer patients.

Method: The PRISMA guidelines were followed to conduct the review. PubMed, Embase, and Scopus were searched for eligible studies, resulting in the inclusion of 34 quantitative descriptive studies focusing on adult cancer patients in India.

Results: Most of the included studies reported low or below-average overall QoL of the patients. Factors such as pain, fatigue, emotional distress, social relationships, and financial burden significantly influenced overall QoL and its subdomains. Demographic factors (age, marital status, religion), cancer-related variables (stage, site, treatment type), and social determinants of health (education, information access) also played roles in affecting QoL. Due to study inconsistencies, conclusive comparisons were challenging.

Conclusion: The findings underscore the necessity for a comprehensive, culturally adapted approach to enhancing QoL, along with the development of standardized assessment tools and longitudinal study designs.

Mindfulness-Based Interventions for Metabolic Syndrome in The Elderly: A Review of Evidence on Psychological and Physiological Outcomes

Pradhiba SPM, Thephilah Cathrine R, Jayanthi P — Mon, 01 Jul 2024 00:00:00 +0000

Background: Metabolic syndrome poses a significant health challenge in the elderly, affecting both psychological and physiological aspects. The application of mindfulness in treating the lifestyle variables linked to the risk of cardiovascular disease shows promise in improving self-awareness, mood regulation, and attention control. In addition to lowering stress, anxiety, and depression in elderly, mindfulness therapies have the potential to improve glycemic management. This study aims to investigate the potential efficacy of mindfulness-based interventions in addressing this complex issue.

Methods: The Cochrane Library, Embase, and PubMed/MEDLINE electronic databases were searched by the author to find pertinent systematic reviews and meta-analyses.

Results: A summary of the available research review explores the impact of mindfulness-based interventions on elderly individuals with metabolic syndrome from years 2011-2023. Examining both psychological and physiological outcomes, the study focuses on depression, quality of life, and key health indicators such as BMI, cholesterol levels, and blood sugar.

Conclusion: Findings shed light on the potential benefits of mindfulness practices in improving mental well-being and positively influencing metabolic parameters in the elderly population. To fully understand the biological impacts of mindfulness on human physiological processes, more investigation is required.

Exploring Awareness and Perception of Do Not Resuscitate Orders in A Saudi Arabian General Population

Omar Sami Basubrain — Mon, 01 Jul 2024 00:00:00 +0000

Background: Do Not Resuscitate (DNR) orders are crucial, yet often misunderstood, medical directives. This study investigated public understanding and attitudes towards DNRs in Saudi Arabia. This study investigated public understanding and attitudes towards Do Not Resuscitate (DNR) orders in Saudi Arabia.

Methods: A cross-sectional web survey was conducted among 416 Saudi residents aged 18 and above. The survey assessed knowledge, attitudes, and emotional responses related to DNR orders.

Results: Over half (65.7%) lacked sufficient understanding of DNRs, highlighting a knowledge gap. While 56.8% grasped the meaning, less than half saw DNRs as beneficial for reducing pain or easing burdens on loved ones, indicating mixed attitudes. Decision-making preferences varied, with 49.1% advocating for medical professionals' involvement and 31% favouring family decisions. Personal experiences influenced understanding, with those having a family member's DNR order exhibiting higher comprehension.

Conclusion: Significant knowledge gaps and mixed attitudes towards DNRs exist. Public education programs, improved patient communication, and culturally sensitive approaches are recommended to bridge this gap and empower individuals to make informed decisions.

Trends in Inpatient Dermatology and The Impact of the COVID-19 Pandemic at A Tertiary Care Facility in Western India

Mon, 01 Jul 2024 00:00:00 +0000

Background: Little is known regarding the effect of the coronavirus pandemic on the characteristics of dermatology admissions, particularly in the Indian context. Objectives: To conduct a retrospective analysis of the discharge records of all patients admitted to a tertiary care centre in Western India from 1 January 2019 to 31 December 2022.

Methods: Patient records were reviewed and compiled. Diagnoses were grouped to achieve consistency with international studies. Finally, the effect of COVID on admissions was determined. Data samples were assessed using descriptive statistics. Continuous variables were expressed as median or mean. The student’s t-test and chi-square test were utilised to investigate wherever appropriate.

Results: Inpatient care was required for 1,817 patients. Males (1000, 55.04%) were significantly more likely to be admitted than females (817, 44.96%). The leading causes of hospitalisation were bacterial infections (26.42%), vesiculobullous disorders (17.45%), and psoriasiform disorders (11.34%). The greatest number of admissions occurred in 2019, followed by a substantial decline in 2020. Admission rates for vesiculobullous disorders, psoriasiform disorders, and malignancies were significantly higher during the pandemic period.

Conclusions: Our study offers an analysis of the impact of the coronavirus pandemic on the patient profiles of patients admitted to a dermatology ward.