Vol 7, Issue 2, Apr-Jun, 2017

Cardiovascular disease burden is an overwhelming health care issue and accounts for 17.3 million deaths globally according to the Global Burden disease statistics from 2013. This translates into 31.5% of all deaths and 45% of all noncommunicable disease deaths.1,2 Cardiovascular disease accounts for 1 in every 3 deaths in the United States of America, making it the leading cause of death in both men and women.3 Recent work suggests that women with ischemic heart disease (IHD) have worse outcomes, prognosis and morbidity compared with men.4 Important differences exist in presentation, management and outcomes of IHD amongst men and women. The National Registry of Myocardial infarction study evaluating 481,581 women hospitalized with myocardial infarction over a 12 year span found that women were more likely than men to present without chest pain and had a higher mortality than men within the same age group.5 Multiple studies have shown that women with acute coronary syndromes are more likely to have delayed presentation; they are also less likely to receive rapid diagnostic testing and suffer delays in treatment initiation as compared with men.6, 7, 9 Several reasons could account for these disparities including.

The paper examines 1422 global publications on health tourism research, as covered in Scopus database during 2007-16, experiencing an annual average growth rate of 7.26% and qualitative impact averaged to 8.78 citations per paper. The top 10 most productive countries individually contributed global share from 2.91% to 22.41%, with largest global publication share coming from USA (24.12%), followed by U.K. (12.59%), Canada and Australia (7.45% and 7.10%), India and Germany (3.45% and 3.38%) etc. Together, the 10 most productive countries accounted for 70.61% share of global publication output during 2007-16. Six of top 10 countries scored relative citation index above the average (1.46): Italy (2.97), Netherlands (1.99), Germany (1.92), Canada (1.66) and France (1.59) during 2007-16. Medicine, among subjects, contributed the largest publication share (66.67%),%), followed by social sciences (20.32%), business, accounting & management (12.38%), environment science (8.65%), biochemistry, genetics & molecular biology (5.70%), nursing (5.49%), arts & humanities (4.57%) and economics, econometrics & finance (3.66%) during 2007-16. The top 15 most productive organizations and authors together contributed 17.02% and 14.77% respectively as their share of global publication output and 27.66% and 32.41% respectively as their share of global citation output during 2007-16. Among the total journal output of 1317 papers, the top 10 journals contributed 17.16% share to the global journal output during 2007-16. Of the total global health tourism research output, the top 19 highly cited publications registered citations from 82 to 178 and they together received 2224 citations, with 117.05 citations per paper. These 19 highly cited papers involved the participation of 26 authors and 27 organizations. Among leading countries contributing to high cited research, the largest number of papers (7) came from USA, followed by U.K (5 papers), Italy (4 papers), Belgium, Netherlands and Canada (3 papers each), Denmark, Australia and Germany (2 papers each), Switzerland, France, New Zealand, Spain, Iran, Thailand, Laos, Cambodia, Philippines, Indonesia, Vietnam, Israel and Chile (1 paper each). The 19 highly cited papers involved the participation of 95 authors and 78 organizations. These 19 highly cited papers were published in 16 journals; of which of which 2 papers were published in Emerging Infectious Diseases and Human Reproduction and 1 paper each in other journals. Key words: Health tourism, Global publication, Bibliometrics, Scientometric.

Introduction: To evaluate the role of participatory rural appraisal (PRA) in community based rehabilitation (CBR) to detect and manage childhood blindness from rural community. Methods: Fifteen rural project areas with pre-existing CBR project were shortlisted. Main criteria of this selection were pre-existing CBR project with significant number of children with visual impairment. We have adopted PRA methodology to reach the rural community whilst aiming to detect childhood blindness. PRA approaches were also utilized to achieve immunization, spacing between child birth, proper maternal and child health and overall improvement of lifestyle. Information about the villages was collected from villagers by social mapping performed by the villagers themselves. Student’s t test was used to analyze the result. Results: 128 children (CBR program) with visual disability were identified out of which 77.14% were blind and 22.86% had SVI. After adopting PRA approach 84 new cases (p<0.05%) were detected of which 71.43% were blind and 28.57% had SVI. Main causes of blindness were cornea related (31.28%), lens related (21.72%) and buphthalmos (17%). Immunization of child improved from 11% to 81% (p=0.011) over a period of one year. Common practices including food habit, spacing between child births improved. 41% children are mobilized to blind school for rehabilitation. Conclusion: PRA methodology is a new approach in community ophthalmology and is very promising to detect and rehabilitate visually impaired children. PRA is very useful to improve knowledge, to plan rehabilitation as well to treat underlining causes of childhood blindness. Key words: Participatory Rural Appraisal, Childhood blindness, Community, Social mapping, Immunization

Background: Although a large population uses the Indian Railways for long-distance journeys, data about their knowledge, attitude, and perception towards medicinal drugs, healthcare, and hygiene while travelling, is sparse. Methods: We conducted a cross-sectional survey from March 2016 to December 2016 among 114 randomly sampled long-distance train passengers. A self-administered questionnaire, directed towards knowledge, attitude, and perception of passengers towards medicinal drugs, healthcare, and hygiene while travelling, was administered. The completeness of the questionnaire was validated by an interview. The association between the type of coach and the various variables mentioned in the questionnaire was calculated by the chi-square test or the Fisher’s exact test. Results: Of the 114 respondents (77.19 % males, 22.81 % females), 61.4 % carried medicines with them while travelling. The most common class of drug carried by the respondents was non-steroidal anti-inflammatory drugs (NSAIDs). Although 61.4 % of the participants claimed to consult a doctor before consuming any drug, 43.85 % of them had no knowledge of either the indications or the adverse effects of the drugs that they consumed. 32.45 % of the respondents complained of being physically/psychologically stressed during/after the journey. A majority of the travellers (93.85 %) believed that hygiene and cleanliness had a role in preventing illness while travelling. Only 2.69 % of the respondents were aware of the healthcare facilities provided by the Indian Railways. A significant (p < 0.05) association was found between the type of coach and the method of obtaining drug information, feeling stressed, and food preference. However, due to the small sample size these findings cannot be generalized. Conclusion: There is a need to create awareness about common over-the-counter drugs among long-distance train travellers in India. Healthcare facilities provided by the Indian Railways must be publicized. Key words: Attitude, Drugs, Healthcare, Knowledge, Long-Distance Train Travel, Perceptions.

Context: Morbidity management is one of the key aspects in the life of Lymphatic Filariasis (LF) patients. National Vector Borne Disease Control Programme (NVBDCP) is giving more emphasis by conducting morbidity management training camps every year since 2004 to help LF patients to manage and cope-up with the existing morbidity. Aim: To study the morbidity management among LF patients in Udupi district, Karnataka. Study Setting and Design: The study was conducted in Udupi district, Karnataka, India in 2013. The design was stratified random sampling with proportional allocation method. Materials and Methods: Community based cross sectional study, 178 subjects suffering from LF were selected using stratified random sampling with proportional allocation method. An interview based method was used to collect the data. Lympoedema Morbidity Management Questionnaire were designed based on the guidelines provided by National Vector Borne Disease Control Programme (NVBDCP). Results: Among 178 LF patients only about 34% had knowledge about the disease causation. About 98.3% had good hygiene practice towards affected area but only 30% of them regularly practiced one or the other exercise as recommended. Conclusion: The study clearly indicates the outreach focus on LF patients needs to be enhanced by grass root level health workers. The program has to ensure that all the LF patients will undergo morbidity management training and know how to take care of lymphoedema. Key words: Morbidity Management, Lymphatic Filariasis, Mass Drug Administration.

Introduction: Health statistics decide the foundation and course of health policies and programs. Indicators such as the Birth Rate, Death Rate, Life Expectancy at Birth, Morbidity/ Mortality patterns etc. reveal the extent and nature of the health problems in the community and thus assists in establishment of the priorities for policy planning and implementation. The present study is being done to assess the morbidity pattern in indoor patients in a tertiary care hospital. Materials & Methods: A cross sectional study done in a tertiary care hospital with sample size of 4511. Results: the study found out that maximum patient (44.4%) were admitted under Chapter I i.e. certain infectious and parasitic diseases and 72% of hospital admissions were accounted for by 12 common causes of morbidity. Discussion: The most of the results of our study were comparable with other studies. The differences in some variables may be there due to that the study is being limited to IPD patients of medicine ward. Conclusion: Acute infectious diseases are the leading causes of morbidity in all ages and both sexes. Key words: Hospitalization, IPD, Morbidity, Mortality.

Introduction: Unbalanced distribution of medical technologies and devices between rural and urban parts of the country is a major problem for developing countries like Turkey. In Turkey, after the establishment of Public Hospital Unions (PHUs), legislative changes were made to ensure the autonomy of public hospitals. Aims: This study aims to analyze the spatial distribution of medical devices in Turkey using PHUs as a decision-making unit. Methods: Data came from the 2014 PHUs statistics year book. The total number of PHUs is 89. A hierarchical cluster analysis was performed to classify PHUs according to the total number of different kinds of medical devices. A Euclidean distance measure and Wards method were used in the analysis. Results: Study results show that, in Turkey, PHUs consist of 2 different clusters. The first represents PHUs in rural Turkey, and the second represents PHUs in urban Turkey. PHUs which represent big cities of Turkey and have high population density are in the first cluster, and all other PHUs are in the second. Conclusions: It is advisable for health policy makers and health technology assessment authorities in Turkey to focus on the differences between rural and urban parts of the country during the re-evaluation of medical technology resource allocation decisions. Further studies could explore the accessibility, safety, and usability of medical technologies. We anticipate that these efforts will form a basis to improve the surveillance and efficiency of the medical devices market in developing countries. Key words: Medical Devices, Developing Countries, Turkey, Public Hospital Unions (PHUs), Hierarchical Cluster Analysis.

Introduction: The presence of unwed mothers is a major problem that the tribal communities face today in Wayanadu. They are experiencing Multiple Social, Psychological, Economical and Educational disadvantage. The authors have studied socio-demographic profile and assessed the Self-esteemand psychological distress of this vulnerable group. Methods: the study follows cross sectional descriptive design, a sample of 40 respondents were interviewed through a proforma to collect socio-demographic details and administered Rosen Berg Self-esteem scale and self-reporting questionnaire to assess psychological distress. The data was analysed using descriptive statistics and correlation. Results: The socio demographic profile shows that majority of the unwed women are illiterate ad in the productive age group with low income and there is negative co-relation between self-esteem and psychological distress. Conclusion: Poor self-esteem is associated with a broad range of mental disorders like depression, suicide, eating disorders and anxiety. It is argued that an understanding of the development of self-esteem, its active protection and promotion are critical to the both mental and physical health. Hence, it hoped that the present study will be of great use in alleviating the distress associated with the unwed motherhood and promoting their Self-esteem and quality of life by addressing their psycho social concerns. Key words: Self Esteem, Psychological Distress, Tribal Unwed Mother, Poverty, Vulnerability.

Context: To maintain high level of proficiency and better patient outcomes, medical personnel suffer from high degree of stress. The aim of this study was to determine the prevalence of stress and associated coping strategies among medical undergraduate students in a south Indian medical college. Settings and Design: Cross-sectional study was done among 1st year students in a private medical college in Tamil Nadu, India. A self-administered pretested questionnaire was used to collect socio-demographic information and information on perceived mental stress (PSS-10) and coping strategies (Brief COPE). Results: About 80% of the boys and 75% of the girls reported a moderate or higher stress level according to the PSS. Most commonly employed coping mechanism among students under stress was religion (25%). Among boys, the most common mechanism was humor (26%) and that of girls was religious methods (30%). Conclusions: Stress was common among first year medical students. There is a requirement for stress management training among MBBS students. Key words: Undergraduate medical student, Perceived stress, Coping strategies, Cross-sectional study, India.

Background: Private sector (which is the largest health care provider in India), is expensive & often the only one providing the kind of services needed by the elderly. There are no published studies from India reporting the satisfaction of the elderly about the health care services from the private sector. So this study was undertaken with the following objectives 1. To describe morbidity pattern & to assess functional status among the elderly receiving their care from the private hospitals 2. To know their satisfaction about health care services obtained from the private hospitals. Materials & Methods: An interview based cross sectional study was conducted among elderly (60 years and above) receiving health care services from the private hospitals of Mangalore city. Elderly were assessed for 1. Activities of Daily Living [ADL], 2. Instrumental activities of daily living [IADL], 3. Satisfaction about the health care services received by them in private hospitals. The data was analyzed using SPSS software for windows, version 16.0. Chi-square test was applied to know if the observed differences between socio demographic factors, dependency in physical activity and their type of care (subsidized or free) received by those elderly patients were statistically significant. Results: Majority (132 out of 189) of the study participants were between 60 to 74 years of age group. There was a predominance of Non Communicable disease / conditions {like hypertension (89.4%)}. Assessment of ADL & IADL revealed that, dependency (38.6%) was noticed for household work. Dependency was seen in patients (elderly) with advancing (75 years and above) age groups (p < 0.005). Most of the elderly were not satisfied with health care services they were receiving even though it was free / subsidized. Conclusion: 1. there was a predominance of Non Communicable disease (hypertension, visual impairment and diabetes mellitus) among those elderly who were receiving their care in private hospitals of Mangalore city. 2. Most of the elderly receiving their care from the private hospitals of Mangalore were capable of performing their physical activities independently. 3. Most of the elderly were dissatisfied with the health care services they were receiving in the private hospitals of Mangalore city irrespective of the type of services that were provided to them (paid/ free/subsidized). 4. Those elderly who had intact ADL & IADL were also dissatisfied. Key words: Elderly, Morbidity, Satisfaction, Activities, Dependency, Disability, Private Health Care.

Introduction: Institutional births are advocated as a key strategy to reduce maternal mortality This study is aimed to identify whether the practice of place of birth is changing over time and to explore the factors contributing to women’s decision for choice of place of birth. Methods: A community based cross-sectional study was carried out in an urban resettlement colony of Delhi. A semi-structured questionnaire was used to interview the mothers with children less than or equal to 3 years of age. The place of birth was assessed in relation to socio-demographic and obstetric characteristics of the study participants. Reasons for preferring home birth were also analyzed. Results: A total of 1293 mothers were included in the study. Of these majority 1068 (82.6%) had institutional births while 225 (17.4%) were home births. A skilled birth attendant was present in only 39 (17.3%) of home births while 17 (7.5%) mothers gave birth with the help of relatives. Higher socio-economic status and higher income of the family; higher educational status of mother and head of the family was associated with institutional birth and the difference was statistically significant. Main reasons cited for preferring home birth were tradition (29.2%), financial constraints (7.3%), no one to look after (16.3%), pressure from family despite of awareness 6.3%, and other reasons. Conclusions: Institutional births have shown an increasing trend in India, however a significant proportion of women still prefer home as place of birth. Socio-cultural factors and financial constraints have an important role in MCH service utilization and need to be addressed. Key words: Institutional birth, Home birth, Skilled birth attendant, Antenatal care

The association of autoimmune hypothyroidism with Nephrotic syndrome is a rare but significant since it is amenable to Levothyroixine therapy with a good prognosis. It is suspected in patients presenting with overlapping features of both disease conditions with supportive laboratory parameters. We describe the case of a 25 year old individual who presented with nephrotic syndrome associated with underlying autoimmune thyroiditis and was successfully treated with Levothyroixine to attain long lasting remission. Keywords: Nephrotic Syndrome, Hypothyroidism, Levothyroixine Therapy, Autoimmune disorder, Prednisone therapy.

Latent Autoimmune Diabetes of Adult (LADA) is an autoimmune form of diabetes mellitus characterised by onset in adulthood and slow progression of beta cell failure. It is commonly misdiagnosed as type 2 diabetes mellitus and treated with oral hypoglycaemic agents, ultimately resulting in delay of insulin initiation. Acute hyperglycaemic crisis in the form of diabetic ketoacidosis is a rare initial presentation of LADA with very few cases reported so far. We present the case of a 40 year old housewife with no past or family history of diabetes that presented with diabetic ketoacidosis and was subsequently discovered to be affected with LADA. Keywords: Latent Autoimmune Diabetes of Adult (LADA); Diabetic Ketoacidosis, Autoimmune disorder, Type 1 diabetes mellitus, Type 2 diabetes mellitus. Key Message: Latent Autoimmune Diabetes of Adult (LADA) is a variant of adult onset diabetes which is commonly misdiagnosed as type 2 diabetes mellitus (T2DM) and must be ruled out early in the disease course since the treatment strategy differs from that of type 2 diabetes mellitus.