Journal of Family Medicine and Primary Care最新文献

This article explores gender budgeting in Indian healthcare, emphasizing its role in addressing disparities. Examining trends, recent highlights, and implementation, it showcases impacts on maternal health, reproductive services, gender-based violence, and empowerment. Examples such as Ayushman Bharat and Mahila Samman Savings Certificate illustrate economic implications. Beyond healthcare, gender-responsive budgeting is seen as a versatile tool for broader equality. Challenges prompt a call for sustained efforts and a comprehensive framework.

Background and objectives: Diabetes is a major public health concern in India. The majority of studies done in rural population lack systematic methodology in estimating the prevalence of diabetes mellitus. Objectives of this study were to estimate the burden of prediabetes, type 2 diabetes mellitus and its associated risk factors among adults (18-69) years in rural Bengaluru, Karnataka.

Methods: A cross-sectional study was conducted among adults aged 18-69 years in three villages of Devanahalli taluk of rural Bengaluru between May and October 2019. Behavioural and metabolic risk factors related to diabetes were assessed using WHO-STEPS instrument and IDSP-NCD risk factor tool. Fasting blood glucose and OGTT test were performed, and WHO diagnostic criteria were used to diagnose diabetes mellitus.

Results: Prevalence of prediabetes and type 2 diabetes (T2DM) in rural Bengaluru was found to be 6.3% and 10.9%, respectively. Behavioural risk factors related to diabetes measured in the study population were current tobacco use (32.7%), current alcohol use (9.9%), physical inactivity (46.8%) and unhealthy diet (82.3%). Metabolic risk factors measured were obesity (7.5%), central obesity (46.4%), prediabetes (6.3%) and hypertension (24.3%). More than one-thirds of diabetes and three-fourths of hypertension individuals were newly diagnosed by the population-based screening.

Conclusion: The burden of diabetes and its risk factors are high due to the health transition occurring in rural population of Bengaluru. Undiagnosed diabetes mellitus and hypertension in rural population as demonstrated by this study highlight the need to strengthen the population-based screening and diagnosis of T2DM and hypertension (HTN) under the national health programme.

Background: Existing literature does not account for food choice motives associated with the non-communicable disease risk factor of an unhealthy diet, primarily characterised by inadequate fruit and vegetable consumption, among adults residing in Kochi Municipal Corporation. Our study aims to measure the prevalence of inadequate fruit and vegetable consumption in this urban population and to identify priority food choice motives among individuals at risk.

Methods: A community-based cross-sectional study was conducted among 300 adults (mean age 46 years, men 50%) selected by cluster sampling. Information on socio-demographic variables, diet, and food choice motives was collected through a pre-tested structured interview schedule. Binary logistic regression analysis was done to identify factors associated with inadequate fruit and vegetable consumption.

Results: In our study, 86% (95% CI: 82.07-89.93) of participants reported inadequate fruit and vegetable consumption. The food choice motives of "price" [aOR 2.99, 95% CI: 1.32-6.78], "health" [aOR 2.56, 95% CI: 1.08-6.24], and "sensory appeal" [aOR 2.20, 95% CI: 1.06-4.56] were found to be significantly associated with inadequate fruit and vegetable consumption per day (P < 0.05).

Conclusion: The high prevalence of inadequate fruit and vegetable consumption in this urban community necessitates targeted and comprehensive educational campaigns that highlight the health benefits and sensory appeal of fruits and vegetables, as well as the affordability of seasonal produce, to ensure adequate intake of these foods.

Background: The coronavirus disease 2019 (COVID-19) vaccination program among adults in India is one of the highly successful vaccination drives globally, but the acceptance of the COVID-19 vaccine among parents for their children is largely unknown. As parents are primary decision-makers for their children, we aimed to assess parents' perceptions and acceptance for COVID-19 vaccination for children in India.

Aim: To assess parental perceptions and acceptance for COVID-19 vaccination for their children (aged <18 years).

Materials and methods: A cross-sectional anonymous web-based survey was designed and conducted from November 1 to December 15, 2022. All the healthcare workers of a tertiary care institute in eastern Uttar Pradesh, having a child aged <18 years, constituted the study population and were invited. They were recruited through snowball sampling and were sent the study questionnaire in Google form through email and WhatsApp. Bivariate analysis was performed to determine the predictors of child vaccination acceptance among the parents.

Results: A total of 388 healthcare worker parents (HCWPs) having a child <18 years of age completed the survey. The mean age of the parents was 40.28 ± 11.34 years. The majority (96.9%) of them had already received the recommended two doses of the COVID-19 vaccine. Around 91% of the parents agreed that COVID-19 vaccines are important for children's health, whereas 89% agreed that COVID-19 vaccines are effective. A total of 356 (91.7%) parents were willing to vaccinate their children with a COVID-19 vaccine, of which 91.3% intended to do so as soon as possible. The factors significantly associated with the stated willingness for child vaccination among the participants were younger age (P = 0.008), female gender (P = 0000), currently married status (P = 0.00001), urban residence (P = 0.01), lower monthly income (P = 0.03), absence of any chronic illness (P = 0.0003), history of COVID-19 in the child (P = 0.004), and the child being up-to-date with the routine childhood vaccines (P = 0.01).

Conclusion: The HCWPs from eastern Uttar Pradesh, India, have a positive attitude and low vaccine hesitancy toward COVID-19 vaccination for children, with around 92% currently willing to vaccinate their children with COVID vaccine. Further longitudinal studies are required to assess the trend of parental acceptance of COVID vaccine.

Background: The Human Cytomegalovirus (HCMV) is a type of beta herpesvirus widespread in all human populations. It is estimated that up to 80-100% of adults worldwide and most infections are harmless and can cause severe health complications in infants, like hearing loss and developmental issues. Still, immunocompromised individuals can experience serious complications from the virus. Unfortunately, there is limited information on the prevalence of this virus in our country, and no studies have been reported on the rate of CMV transmission yet.

Objectives: This study aims to evaluate the levels of IgM antibodies against Cytomegalovirus (CMV) in East Singhbhum, West Singhbhum, and Seraikela Kharsawan using an ELISA test.

Methods: An indirect ELISA test was performed to detect anti-CMV IgM and the period of study was from January'2021 to June'2023.

Results: The examination tested 55 people for the TORCH profile of CMV parameters from regions of East Singhbhum, West Singhbhum, and Seraikela Kharsawan. Here, 17 people (30.09%) were IgM positive by ELISA.

Conclusions: The serological data confirms that CMV is not being monitored and recognized in the general population, which limits our study between CMV infection, disease, and clinically diagnosed outcomes. This understanding is crucial for the healthcare and policy sectors. Thus, we recommend implementing a surveillance and mindfulness program for at least one-fourth of the population in Jharkhand and continuing to explore and develop effective vaccines to control CMV infections.

Diabetes insipidus (DI) is a disorder of water hemostasis that is associated with polyuria-polydipsia syndrome. Central DI (CDI) primarily results from autoimmune destruction, traumatic injury, or anatomical damage caused by neoplasms. Craniopharyngioma, germinoma, and distant metastases are the main neoplastic causes, with pituitary adenomas rarely manifesting as CDI. Pituitary gland metastasis is rare, with the vast majority of cases being asymptomatic. We present a rare case of pituitary metastasis originating from small-cell carcinoma of the lung with CDI and skin swellings as the primary manifestation, without any evidence of the primary malignancy upon initial presentation. A 56-year-old chronic smoker with newly diagnosed type-2 diabetes mellitus presented with a history of polydipsia and polyuria along with soft tissue swellings in the axilla and the chest for the last 3 months. A water deprivation test and a desmopressin challenge test were performed, revealing the presence of CDI. In light of the CDI, a contrast-enhanced magnetic resonance imaging brain was performed, which displayed a loss of pituitary bright spot and four T2 isointense lesions with post-contrast enhancement in the left frontal, parietal, occipital, and right temporal lobes, suggestive of metastatic lesions. Fine needle aspiration cytology of the swelling revealed cytomorphological characteristics indicating the presence of malignancy, specifically favoring carcinoma. Contrast-enhanced computed tomography thorax revealed a right hilar lung mass infiltrating the surrounding structures with multiple regional and distant metastases. A lung biopsy confirmed the presence of small-cell lung carcinoma (SCLC). The final diagnosis was advanced SCLC with multiple distant metastases associated with CDI, and the patient is currently receiving palliative care and inhalational desmopressin. In conclusion, metastatic lesions and lung cancer must be considered early when patients present with polydipsia and polyuria symptoms.

Teachers are the backbone of any country, the pillars upon which all aspirations and dreams converge, if we paraphrase 11^th President of India, Dr A P J Abdul Kalam,. A teacher of a Medical college has immense potential to shape the foundation and basic wisdom/ technical skills of a young student and resident. So, teachers' absence makes the learners bereft of these gifts- making them vulnerable to construct poor reasoning and judging clinical scenarios inappropriately: deriving incorrect or false interpretation from a given case presentation. For this reason, when the National Medical Commission (NMC) comes up and pushes for an idea ensuring physical presence of workforce at their respective workplaces, everyone should welcome the move. Nevertheless, like every fixture the virtual solution has its unique challenges, requiring nuances for proper assessment, demands reasoned and detailed dissection of actual ground -level situation; hence, I want the regulatory body to tweak the attendance -system to make it suitable for diverse atmosphere, varying working -conditions and rapidly -changing environment. Such formulation should have two- way communication channels between man (and woman) power as well as their regulators. Only then fine -tuning may be expected to be achieved to derive the maximum benefit while reducing chances of error/ omission/ glitch/ incompleteness and fault.

Background: Prediction of preeclampsia in first trimester can lead to early initiation of preventative measures, as well as timely therapeutic intervention, that will prevent the maternal and perinatal morbidity and mortality. This study, prediction of preeclampsia at 11-13⁺⁶ weeks of gestation, was conducted by using serum placental growth factor (PlGF), serum pregnancy associated plasma protein - A (PAPP-A), uterine artery Doppler indices, and mean arterial pressure (MAP), in low-risk pregnant women.

Methods: It is an observational longitudinal prospective study. Pregnant women with singleton pregnancies of gestational age 11-13⁺⁶ weeks were recruited. MAP, bilateral uterine artery Doppler indices, serum PAPP-A, and PlGF were measured. The follow-up of the patients was regularly done till termination of pregnancy and incidence of preeclampsia were noted. Qualitative variables were compared using Chi-square/Fisher exact test, and sensitivity and specificity of each test were analyzed.

Result: Among 139 women, 27 (19%) developed preeclampsia, out of which 10 had early preeclampsia and 17 developed late preeclampsia. By combining all the parameters, the sensitivity in detecting early preeclampsia was found to be 70% and for late preeclampsia cases, 64.7%. The sensitivity of all the parameters in predicting cases of preeclampsia in general is 66.7%, specificity is 74.1%, PPV is 38.3%, and NPV is 72%.

Conclusion: The maternal biomarkers serum PAPP-A, serum PlGF, uterine artery PI, MAP have sensitivity of 70% in detecting early preeclampsia cases and for late preeclampsia cases, 64.71%, in first trimester and it will help in early initiation of preventative measures as well as timely therapeutic intervention.

Background: Cardiometabolic disorders, notably primary hypertension and type 2 diabetes, present substantial global health challenges. The intricate interplay between metabolic and cardiovascular pathways has prompted extensive research into molecular mechanisms linking these conditions. The adipokine Retinol Binding Protein 4 (RBP4), initially recognized for retinol transport, has emerged as a potential biomarker in the network of metabolic and cardiovascular dysfunction. Recent studies implicate RBP4 in insulin resistance and its complications, including hypertension. This study explores RBP4 dynamics in patients with primary hypertension and type 2 diabetes, aiming to contribute valuable insights into diagnostic and therapeutic advancements in managing these interconnected disorders.

Methods: This cross-sectional study, conducted over 2 years in a tertiary healthcare centre of North India, aimed to investigate the serum concentration of Retinol Binding Protein 4 (RBP4) in 119 participants diagnosed with primary hypertension and type 2 diabetes. Ethical guidelines were strictly followed, and comprehensive clinical assessments, including blood pressure measurements, were performed. RBP4 levels were quantified using an ELISA kit, alongside markers of insulin resistance. Statistical analyses, involving t-tests and correlation assessments, sought to unravel potential associations between RBP4, insulin resistance, and blood pressure parameters using SPSS 20.0.

Results: The study comprised 61 healthy control (HC) participants and 58 individuals diagnosed with both essential hypertension and type 2 diabetes (EH+T2D). EH+T2D participants were on average older (45.71 ± 9.29 years vs. 40.34 ± 9.47 years, P = 0.002). Dyslipidemia prevalence was markedly higher in EH+T2D (72.4% vs. 11.4%, P < 0.0001), accompanied by disrupted lipid profiles. Serum RBP4 concentration was significantly elevated in EH+T2D (49.17 ± 19.37 mg/L, P < 0.0001), suggesting its potential role in the shared pathophysiology of primary hypertension and type 2 diabetes. Pearson's correlation analysis revealed associations between RBP4 levels, metabolic, and cardiovascular parameters, underscoring its potential as a link between these conditions.

Conclusion: Elevated serum RBP4 levels suggest its potential as a novel biomarker in the shared pathophysiology of primary hypertension and type 2 diabetes. The correlation analysis highlights the intricate interplay between metabolic, lipid, and cardiovascular parameters, emphasizing the need for holistic interventions.

Background: Physiotherapists are health professionals who enhance mobility and quality of life (QoL) through clinical reasoning and the application of evaluation and treatment strategies. Their role is crucial in promoting health, preventing injury, and maintaining function.

Aim: This paper aims to (1) share early experiences and learnings from integrating physiotherapy in rural primary health care, (2) discuss the scope and role of physiotherapists in the primary care team, (3) list the competencies of physiotherapists in rural primary care settings, and (4) advocate for a re-imagined role of physiotherapists as multi-skilled "primary care physiotherapists."

Setting and method: Using a selection of case stories from rural primary health care settings, the paper provides insights into the integration and impact of physiotherapy within these communities.

Results: The integration of physiotherapy in rural primary health care has demonstrated significant benefits in promoting comprehensive primary health care. The case stories highlight the expanded scope and essential competencies of physiotherapists as vital members of the primary care team.

Conclusion: This paper emphasizes the critical role physiotherapy plays in primary health care and calls for broader recognition and support for physiotherapists. It underscores the need for a re-imagined perspective of physiotherapists in rural settings, advocating for their role as multi-skilled primary care professionals.