Journal of Family Medicine and Primary Care最新文献

Background: Cause-of-death (CoD) information is crucial for health policy formulation, planning, and program implementation. Verbal Autopsy (VA) is an approach employed for the collection and analysis of CoD estimates at the population level where medical certification of cause of death is low and, secondly, for integrating it with the existing public health system by utilizing the grassroots level workforce.

Objective: The study aims to understand the field perspectives on implementing the 2022 WHO VA instrument in rural India through the existing public health system.

Methods: This article is derived from a qualitative arm of study that was conducted in one of the blocks of Kanpur district, Uttar Pradesh. Frontline health workers (FHWs), as well as Medical Officers (MOs) serving in the Community Health Centre (CHC) area, were selected as study participants. A 5-day training and orientation workshop was conducted to train the FHWs to conduct computer-assisted personal interview VA using the 2022 WHO VA instrument. MOs have been trained to assign the CoD via Physician-Certified VA (PCVA). In-depth interviews (IDIs) were conducted with FHWs involved in conducting VA and physicians involved in conducting PCVA within the field practice area.

Results: A total of 13 IDIs were conducted, consisting of 10 FHWs and 3 MOs, within the selected CHC area of Ghatampur. Based on the responses received, five major themes were identified. Although VA is being used to collect CoD information from the community in India through a Sample Registration Survey (SRS), the key findings suggest that this activity could be scaled up by utilizing the existing public health system. However, additional manpower may be required for constant monitoring and evaluation of the program. Incentivization of FHWs would aid in the timely completion of VAs and coordination with local and higher health authorities.

Conclusion: The perception of healthcare workers about the feasibility and acceptability of VA in this study highlighted some of the challenges and possible solutions that could aid in developing a comprehensive model to improve CoD information at the population level through the existing public health system.

Background: Breaking bad news is one of the most difficult tasks for practicing doctors, especially for those working in health care specialties where life-threatening diseases are diagnosed and managed routinely. Our aim was to elicit the knowledge and practices of doctors and identify barriers faced by them in disclosure of bad news across the provinces of Pakistan.

Methods: Cross-sectional, multi-centered study supported by an external grant in 15 Government and Private Hospitals across Pakistan. A total of 1185 doctors were surveyed. Responses were compared across provinces.

Results: 80% of doctors across all specialties considered life-threatening diagnoses like cancer and stroke as equivalent to bad news, whereas less than 50% perceived conditions like malaria and typhoid as bad news. Regarding the level of difficulty encountered in giving bad news on a scale of 0 to 6, over 57% doctors rated it 4 and above. The reasons identified were lack of confidentiality, lack of privacy, lack of time, lack of training, fear of patients' and family reactions, not wanting to hurt the patient or causing more distress, concern of having failed the patient, and their own reactions among others.

Conclusions: Technical proficiency, training, good patient-centered communication, and incorporating socio-cultural aspects are essential for effective disclosure of bad news.

Background/purpose: This study aimed to determine the medicine usage behaviors of patients (>65 years) registered to the family health care center (FHCC) in a rural area.

Methods: This cross-sectional and descriptive study was performed on 224 geriatric patients admitted to the FHCC in Terme town of Samsun between January 2018 and March 2018. The questionnaire consisting of 29 questions about sociodemographic characteristics, knowledge of drugs, and usage habits was applied to the participants by using the face-to-face interview technique. SPSS (version 23.0. SPSS Inc. Chicago. IL. USA) program was used in the analysis. P values of less than 0.05 were considered significant.

Results: The mean age was 73.01± 0.3.14 years, 53.19% were male, 87.4% were married, and 52.9% had chronic diseases. Of all participants, 56% stated that they visited physicians when they got ill; 22% used drugs at home without consulting a physician. The presence of chronic disease appears to be associated with keeping drugs at home (P = 0.023). The most common medicines consumed without a prescription were painkillers; 67.6%. 20.9% of the participants stated recommending medication to their surroundings related to their level of education (P = 0.011). Furthermore, 24.9% stated that they had stopped their medications before the recommended time. Moreover, 82.9% of the group read the instructions before use. Those signs were more significant in males and in those >75 years old (P = 0.001 and P = 0.024, respectively).

Conclusion: Rational use of medicine was associated with gender, chronic disease, and educational level in geriatric patients. The importance of rational drug use in society should be explained by individual characteristics.

Introduction: The COVID-19 pandemic has significantly impacted global healthcare systems. Vaccination is an effective strategy to battle the disease. Policies and distribution frameworks have varied widely across countries. The paper aims to highlight the global vaccination trends in these nations, based on their economic classification, which will illuminate key takeaways that will allow for better pandemic management policies.

Methods: A list of the most populated countries across each income slab was drawn up, and information on their vaccination campaigns was collected from national government portals and official health department websites of these countries in a structured manner. Data collected for the attributes was qualitatively described and converted into binary responses for quantitative analysis. ANOVA test, Chi-square test, and regression models were employed.

Results: A consistent decreasing trend was noted in the percentage of the population vaccinated as the spectrum from higher-income countries to lower-income countries was traversed for all dose statuses. Fewer types of vaccines were available in the lower-income countries. Though compliance with the CDC vaccination strategies guide was largely noted, a linear regression univariate analysis of vaccination drive parameters carried out for single-dose vaccination yielded statistically significant results for medical provider vaccine standardization (P-value = 0.002), vaccination requirements (P-values <0.001), and provider recommendation. (P-values <0.001) Vaccine hesitancy was not dependent on economic status.

Conclusion: Concerted global initiatives like vaccine donation would assist efforts in mitigating disease spread. Prompt busting of baseless anti-vaccine narratives and strengthening healthcare infrastructure to meet national requirements should be given due importance.

Context: Transgender people commonly faced stigma which has been linked to violence, abuse, and discrimination, often forcing them to remain hidden.

Objectives: This study plans to estimate the size of the transgender population and to assess the vulnerability and risk of transgender people in the society.

Methods: This cross-sectional study was conducted among 171 transwomen aged 18 years and above residing in two districts in Manipur recruited using the respondent-driven sampling (RDS) method. Interviews were conducted using a semistructured questionnaire, and the multiplier method was applied for the size estimation. Descriptive statistics were generated. Ethical approval for the study was obtained from the institutional ethics committee.

Results: The mean ± SD age of realization of their sexual identity and age of expressing gender identity was 9.06 ± 2.9 and 17.3 ± 2.7 year, respectively. The reported network size was found to be 40.37 ± 38.7, and the estimated size of the transgender population was found to be 2201 (95% CI 1987.6-2403.1). Most of the respondents (157, 91.8%) had 'Ever experienced harassment due to their sexual identity', with the majority (138, 87.9%) reporting 'verbal abuse', while (108, 63.1%) reported 'sexual abuse' and 43.9% of them said they had a 'psychological effect' due to the abuse.

Conclusion: The majority of the respondents had faced some form of harassment or abuse due to their gender identity, leading to the psychological effect on them. There is an urgent need for developing a comprehensive measure focusing on mainstreaming the transgender persons by creating an enabling environment for their holistic development.

A patient with a history of Asian flu, mumps meningo-encephalitis, and skull-base fracture and severe porencephaly who was able to walk without assistance, has not been reported. The patient is a 65 year-old male with a history of Asian flu at 6 months of age, Mumps meningoencephalitis at 6 years of age, structural epilepsy since 15 years of age, traumatic brain injury with skull-base fracture at 51 years of age, arterial hypertension, diabetes, hyperlipidemia, previous alcoholism, and polyneuropathy. He presented with only mild right-sided spastic hemiparesis, dysarthria, decreased tendon reflexes in the lower limbs, spastic-ataxic gait, but he was able to walk unassisted. Cerebral MRI showed massive porencephaly with left lateral and third ventricular hydrocephalus. It was concluded, that patients with severe hemihydrocephalus since childhood may still be able to walk without support.

The National Eligibility cum Entrance Test for Undergraduate (NEET-UG) in India serves as a unified admission examination for undergraduate medical courses, aiming to standardize assessment across diverse educational backgrounds. Despite its goals, NEET-UG has faced criticism over fairness, excessive reliance on coaching, and its impact on students' holistic development. The article reviews the limitations of the current NEET-UG format and proposes reforms, emphasizing the need to align the syllabus more closely with medical requirements by reducing physics and chemistry content and prioritizing biology. It suggests restructuring NEET-UG into a two-step examination to improve differentiation among candidates and reduce malpractice. Introducing a computer-based format, expanding the question pool, and adding interdisciplinary topics relevant to healthcare, such as Psychology, Nutrition, Physical Education, Cell biology, Genetics, public health and sociology, are also recommended. Additionally, the paper compares NEET-UG with global medical entrance exams, noting that broader subject assessments and critical thinking skills could enhance candidate evaluation. The Indian medical education system is the largest in the world. Given its vast capacities, it is crucial to reform the selection process to ensure that human resources in health can effectively address the pressing public health needs of India, the world's most populated country. The proposed reforms aim to create a fairer, more comprehensive selection process that minimizes stress, encourages holistic education, and better meets medical education standards.

Background: India shares 2/3 of global TB burden. MDR and HIV coinfections are the main obstacle in achieving the successful TB control because it decrease the therapy effect.

Objective: To analyze the long-term trends of incidence of tuberculosis cases and identify any differences between actual and projected cases after the COVID-19 pandemic.

Methodology: A retrolective study was conducted in SMS medical college, Jaipur, and data were extracted from state TB cell and annual report published by central TB division. A multiplicative model was used for conducting time series analysis. The projected yearly number of cases were estimated using the line of best fit based on the least square method.

Result: An increasing trend in the incidence of TB was observed, rising from 1,517,363 in 2008 to 2,404,815 in 2019. Similarly, DRTB also showed an increasing trend from 10,267 (0.67% of total new cases) in 2011 to 66,255 (2.75%) in 2019. The new cases of DRTB in 2020 were significantly lower than the projected number. The trend of HIV coinfection in TB cases fluctuated over the past decade.

Conclusion: The findings reveal a concerning upward trajectory in TB incidence and DRTB cases over the decade. The fluctuating trend in HIV coinfection in TB cases emphasizes the complexity of addressing these interconnected health challenges.

Our prospective case series evaluates the clinical feature, histopathological picture, and treatment of benign eyelid lesions in a tertiary referral setting. Participants were first nine patients referred to the author with unilateral eyelid swelling. Main outcome measures were clinical features, histopathological picture, and response to surgical intervention. Benign eyelid lesions in our case series were epidermal inclusion cyst, giant conjunctival inclusion cyst, epidermoid cyst, dermoid cyst, intradermal nevus, dermal nevus, apocrine hidrocystoma, capillary hemangioma, and lobular capillary hemangioma. The histopathological diagnosis of eight lesions were consistent with their respective clinical diagnosis, while one lesion was misdiagnosed. Surgical excision was done in all cases. One case underwent revision surgery for complication. This series highlights the importance of achieving higher diagnostic accuracy with thorough knowledge of clinical features and subsequent confirmation with histopathological analysis.

Introduction: The COVID-19 pandemic has not only affected the health status of the population but has also had a serious impact on family dynamics, especially in the relationship between parents and children. Home confinement along with the closures of schools has had a strong negative impact on the psychosocial wellbeing of children. This study assesses the effects of the pandemic on families, parenting stress, and emotional well-being of children in villages under Mugalur Sub-centre, Sarjapur PHC, Bengaluru.

Materials and methods: A cross-sectional study was undertaken from January 2022 to April 2022 among parents having children in the age group of 4 to 10 years residing in villages under Mugalur Sub-center, Sarjapur PHC, Bengaluru District. The proportional allocation sampling method was followed to collect data from 210 participants using the effects of questionnaire, parent stress scale, and strength and difficulties questionnaire- parent version.

Results: Among 210 study participants, 105 (50%) were found to have moderate to high stress due to the pandemic. Parenting stress was found to be high in 40 (20%) parents and moderate in 63 (30%) parents. Assessment of the emotional well-being of children showed that 24 (11.5%) children have clinically significant problems. Significant associations were found between the effect of, parental stress and high parental stress correlated with low emotional well-being of children.

Conclusion: This study emphasizes the urgent need for targeted mental health support for families, particularly during crises such as the pandemic. Interventions aimed at reducing parental stress and promoting children's emotional well-being are crucial for mitigating adverse effects and ensuring the long-term well-being of families and communities.