Vol 7, Issue 4, Oct-Dec, 2017

Public health in India remains an enigma with evernew challenges emerging in control of communicable diseases and burden of non-communicable disease also on the rise. Since independence 70 years ago, India has achieved major milestones in public health, but on many fronts we are still lacking as compared to the progress made in other countries similar to ours in the level of income and population size. China with a population larger than India has better health indicators and has done much better than India in achieving the Millennium Development Goals (MDG).1 As for the achievement of MDG, India ranks the lowest among the BRICS (Brazil, Russia, India, China and South Africa) countries.1 With the new Sustainable Development Goals (SDG) set for 2030, the path ahead for India is not easy. It is time that we introspect our approach towards public health in India and try to improve the health of the millions who have been bereft of the benefits from the growth story of the country and left impoverished because of health related expenditures.2 In an attempt to discuss some major shortfalls in our health planning, this article will deal with the issue of specific disease programmes in improving public health in India.

Introduction: School teachers can play an important role be identifying problems of adolescents and guide them towards healthy adolescence. Hence the current research was planned to study, their involvement in adolescent health. Methods: A cross-sectional study was conducted among the teachers from secondary schools in Sangli district (Maharashtra, India). Informed consent was taken. Data was collected by self-administered questionnaire during August-2015 to March-2016. Two-stage sampling technique was used; for the first stage stratified random sampling and convenience sampling for the second. Descriptive statistics, Mann-Whitney test and binary logistic regression were used for statistical analysis. Results: Seven hundred and five participants were included in final analysis. Mean score of “involvement in adolescent health scale” was 48.4±13. Teachers from the urban area had a higher score but the urban-rural difference was not statistically significant. By using binary logistic regression, adolescent health training was found to be the best predictor for involvement in adolescent health. Mean scores for attitude, awareness and practices subscales were 70.2(±23), 48.7(±17.1) and 26.1(±15) respectively. Conclusion: Involvement of the teachers in adolescent health was low; teachers from urban area fared slightly better than rural counterparts. The attitude of the teachers regarding adolescent health was good, however, awareness and practices were poor. Adolescent health training helped in the better involvement of the teachers. Key words: Adolescent Health, Adolescent Behavior, School Teachers, Awareness, India.

Introduction: We have been using task trainers for teaching various techniques such as injections for carpal tunnel, trigger finger and tenosynovitis and knee lavage. However, at present these skills are being taught in a nonsystematic manner and we do not have an objective method of evaluating them. The aim of this study was to device an objective tool for measurement of these skills. Methods: A total of 80 fourth year MBBS students participated in the study. A MCQ test was used for base line assessment of student’s knowledge of the knee anatomy. The students were divided into three groups for instruction on knee joint injection i.e. didactic (lecture), video and hands on training group. The three groups performed a task of simulated knee joint injection on an anatomical knee model and assessed using a newly prepared assessment tool. A second MCQ test was conducted after the joint injection task. Each participant was asked to rate his or her confidence in performing knee joint injections with use of l0-point Likert scale before and after the instruction. Results: On comparing the means by one-way Anova, the mean score was highest for the hands on training group (26.32) followed by video group (20.46) and lecture group (16.15) respectively. The difference in the scores between three groups was statistically significant (p<0.000). Participants in all three groups showed gain in knowledge and confidence at performing the task. The overall internal consistency (cronbach’s alpha) of the assessment tool developed was 0.63. However high convergent validity (inter-item correlation) was found for 8 out of 9 items of the assessment tool. Conclusion: Availability of an objective assessment tool for orthopaedic skills will systemize the delivery and evaluation of these skills. Further the experience gained through this study will be used to develop objective assessment tools to evaluate the skills in other medical disciplines. Key words: Joint injection, Knee injection, Procedural skills, Skill assessment, Knee arthrocentesis, Injection skills.

Background: The patients with schizophrenia have higher mortality rates and shortened life span. The major causes of this excess mortality are medical disease, unhealthy lifestyle, substance misuse, poor compliance or treatment refusal, and suicide among unnatural causes. The peoples diagnosed with schizophrenia expect to live 9-12 years lesser than those in the general population on average. Objectives: To study the prevalence of medical co-morbidities; association of medical co-morbidities with socio-demographic and clinical variables among schizophrenia patients; and to determine the association of I.C.D. -10 subtypes of schizophrenia with medical co-morbidities. Materials and methods: The cross-sectional study was conducted on 100 patients over a period of 4 months as per defined inclusion and exclusion criteria at tertiary care center. A semi-structured proforma, designed for the study was used to collect the sociodemographic and clinical details. Results: Co-morbid medical illness was reported in 22% of patients. The most common physical illness was endocrinological disorders (31.82%). The patients who had higher age and exposure to psychotropic medications were significantly associated with medical co-morbidities (p<0.05). The co morbid medical illnesses were not significantly associated with type of medication used, subtype of schizophrenia and family history of mental illness (p>0.05) whereas reported significant association with history of substance use (p<0.05). Conclusion: The prevalence of medical co-morbidities was found to be 22%, lower than that in previous literature. Sometimes the physical illnesses remain unrecognized in such patients so integrated approaches require for prevention and treatment modalities. Key words: Medical illness, Co-morbidities, Schizophrenia, Chronic illness.

Objective: The main objective of this study was to assess the status of women’s health in Goa and Sikkim based on the factsheets of NFHS-3 and NFHS-4. In addition, the study also compares and contrasts the achievements of reproductive health indicators in Goa and Sikkim. Methodology: The study adopted a descriptive analysis of NFHS fact sheets of Goa and Sikkim. The fact sheets were obtained from the web portal of NFHS at the International Institute of Population Sciences (IIPS), Mumbai and the indicators of women’s health were then compared between NFHS-3 and 4. These indicators include marriage and fertility, ante-natal care (ANC) services, performance in neonatal tetanus and anaemia control, performance in mother and child protection card, post-natal care (PNC), delivery services, women’s empowerment and gender based violence. Results: Despite remarkable progress observed from NFHS-3 to NFHS-4, many parameters pertaining women’s health such as; access to maternal care, women’s empowerment, and nutritional status still require further improvement. The progress in Sikkim is relatively sluggish compared to Goa however the status of women empowerment is relatively better in Sikkim. Better performance in several indicators in both these states need to be consolidated for achieving targets in the future. To further the improvement in these indicators requires a strong political commitment, continuous monitoring by competent authorities and mobilization of appropriate resources. Conclusion: The performance of Goa is relatively better compared to Sikkim. The indicators analysed in this study including access to resources strongly influence the health status and the empowerment of women which is linked with reproductive health outcomes. In addition both the fact sheets reveal that women in these two states take part in household decision making. Key words: Antenatal Care, Delivery Care, Gender Based Violence, Maternal Health, Women’s Empowerment.

Context: Children are one of the most vulnerable groups of societies and are at risk of many social evils. They should be identified and provided protective environment and loving care for their adequate growth and development. Aims: To study the Health Profile of children placed in Remand Home. Settings and Design: This was a cross-sectional descriptive study carried out in a government run Remand home in Solapur. Methods and Material: Based on the pilot study, 200 children were included in the study. They were examined regarding their physical and psychological health. If necessary help from remand home authorities, parents and friends, social workers and teachers was taken. Physical examination of children and psychological examination with the help of Strengths and Difficulties Questionnaire was done. Statistical analysis used: Chi square test. Results: Out of 200 children, 78 were delinquent and 122 were non-delinquent. 144 were boys and 56 were girls. Most common reason of admission was financial constraints among non-delinquents and theft among delinquents. In conduct problem scale delinquents and non-delinquents significantly differed but not in case of scales. Overall one or more behavioural problems were seen in 50% of children in Remand Home. One or more physical morbidities were seen in 66.5% of children. Conclusion: In 5 different scales of SDQ scores, 6-30% children were found abnormal. Most of the children belonged to normal and borderline range. One or more physical morbidities were seen in 66.5% of children. Key words: Delinquents, Children, Juveniles, Remand home, Psychological problems. Key Messages: Children in remand homes with psychosocial problems should be identified and taken care of to prevent emergence of juvenile delinquency.

Introduction: The International Diabetes Federation (IDF) showed that nearly 7 crore people in India were suffering from diabetes in 2015 and this number is projected to be 12.5 crore by 2040. India’s economic boom has been accompanied by a dramatic upsurge of diabetes. Globalization of unhealthy lifestyles are closing the gap between urban and rural diabetes. So it has become important to estimate the diabetes prevalence and risk factors in rural Agra, India where no community based data was available. Material and Methods: This community based cross-sectional study was carried out in rural Agra from June 2013 to 2014. The sample size was calculated to 1209. Data was collected using a structured and pre-tested questionnaire while fasting blood glucose measured with the help of Glucocard - Vital Glucometer. The data was compiled and statistically analyzed using SPSS-22 software. Results: The prevalence of Diabetes Mellitus in rural Agra was found to be 7% with a diagnostic gap of 37%. Prevalence of Diabetes was observed significantly associated with the age, occupation and socioeconomic status. Prevalence of Diabetes Mellitus was significantly more in people with higher Body mass index (13.3%), centrally obesity (10.3%) and higher Waist Hip Ratio (8.4%) than with normal BMI (4.4%) , non-obese (4.2%) and normal WHR category (1.6%). On multiple logistic regression age, hypertension, BMI and WHR contribute as risk factors for developing Diabetes mellitus. Conclusion: As evident from findings diabetes is becoming common in rural population also, adding to the problem is poor awareness. Health care systems should be strengthened for early detection and effective treatment of disease. Key words: Diabetes, Prevelance, Risk factors, Diagnostic gap, Prevalence, Body mass index.