Journal of Family Medicine and Primary Care最新文献

Background: Primary healthcare workforce (PHCW) should be suffered from less burnout after the termination of the COVID-19 response. The current study compared the changes in the three dimensions of burnout in PHCW during and after the response.

Methods: Two convenience-sampling, online, cross-sectional questionnaire studies were conducted in local PHCW. Studies were administered in April 2022 and 8 months after the termination. Burnout was measured by the Chinese version of 15-item Maslach Burnout Inventory-General Survey, which assesses three dimensions: emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (reduced PA). The primary outcome was the prevalence of its three dimensions. Data on demographics, work environment, health conditions, and outlets for stress reduction were collected. We compared burnout and associated factors between the study periods by using Student's t-test, Chi test, or Mann‒Whitney test. The association between factors and burnout was identified by a logistic regression model.

Results: In total, 162 and 200 participants completed the questionnaires during and after the response. No significant differences in demographics, including age, gender, education attainment, work experience, or seniority level were observed. The prevalence of burnout-free status was similar (9.9% vs 12.5%, P = 0.434) between the two periods. Severe burnout decreased from 45.7% to 0%, and moderate burnout nearly doubled after the response. The prevalence of EE decreased the most, by 55.0%, followed by that of DP, which decreased by 38.4% (all P < 0.001); however, there was no difference in the prevalence of reduced PA (77.2% vs 74.5%, P = 0.557). Logistic regression showed that promotion and alcohol consumption decreased the risk of EE. Considering leaving the job increases the risk of DP, a lower self-evaluated health score and more distress were associated with EE and DP. Exercise decreased the risk of reduced PA.

Conclusions: Inconsistent with the hypothesis, we found that severe burnout decreased, but moderate burnout increased in PHCWs after the response. EE and DP decreased more, but reduced PA had no change. Incentives, improved self-evaluated health conditions, alcohol consumption, and exercise ameliorate burnout. Healthcare policy makers must consider multiple effective ways to mitigate burnout in the post-epidemic era.

Background: This qualitative study aimed to explore the early experiences of individuals with patellofemoral arthritis in the Indian context.

Method: The study was conducted in Gujarat, India, with 14 participants, recruited from regional orthopedic outpatient departments. They were interviewed either in person or online using the Zoom platform, with an expert clinician using a semistructured interview guide in the vernacular language.

Results: A scoping review was conducted to find the reported symptoms of the condition, which were identified as anterior knee pain, crepitus, pain while sitting down, walking uphill, and kneeling. Thematic analysis was used to analyze the qualitative data, where four domains of initial symptoms of patellofemoral arthritis were identified: pain, crepitus, stiffness, and difficulty in functional activity. The findings suggest that pain was the primary concern for participants in the Indian context, and initial symptoms are highly affected by individual preferences.

Conclusion: Acknowledging initial symptoms and measuring their severity must be taken into consideration to improve the prognosis of the condition.

Introduction: Like general health, oral health also depends upon their occupational environment and occupational health policies. Workplace exposure to environmental tobacco smoke and its harmful effect is well known. The consumption of tobacco, arecanut, and alcohol is the leading preventable cause for development of oral potentially malignant disorders.

Aim: To determine prevalence of habit-induced oral lesions in different occupations in different geographical places of West Bengal and compare among them.

Method: A total of 841 people aged 15 years and above were selected from different parts of West Bengal. Face-to-face interview was conducted using a structured questionnaire, and oral cavity examination was done in daylight. Data were summarized, and statistical analysis was done.

Statistical analysis used: Chi-square test and univariate logistic regression done.

Results: The people in armed forces had cancer-causing habits most, and managers had cancer-causing habits least. People in armed forces had cancer-causing habits most, and people with Group-1 occupation/managers had cancer-causing habits least.

Introduction: Over the past decade, monitoring of body vitals has gained significant popularity, specifically during and post the recent COVID pandemic. Advancements in smartphones and wearables have been pivotal, providing accessible and cost-effective solutions for at-home health monitoring. Their development often requires a large corpus of labeled datasets, but such large and diverse datasets for developing smartphone-based vital estimation systems, particularly adapted to Indian context, are scarce.

Aims and objectives: This observational study focuses on development of such a dataset in a diverse Indian context and evaluation of smartphone-based pulse rate estimation based on this dataset.

Methods: Data collection considered Indian patients with various medical conditions, body mass index profiles, blood pressure levels, ages, and smoking habits, reflecting a broad demographic spectrum. As part of this study, an algorithm was implemented to estimate the photoplethysmogram (PPG) signal from video recordings of fingers placed on the smartphone camera and subsequently to estimate pulse rate using the acquired PPG data. Smartphone-based pulse rate estimates were compared with readings from pulse oximeters to assess accuracy and feasibility.

Results: The smartphone-based PPG algorithm provides reasonably accurate estimations of pulse rate when compared to traditional pulse oximeters under varied healthcare settings (mean absolute error < 5, intraclass correlation coefficient > 0.90).

Conclusion: Results indicate that the smartphone-based PPG signal captures sufficient information of the cardiac cycle to reliably estimate the pulse rate. Furthermore, system accuracy is consistent across varied subjects and settings, highlighting the importance of tailored data collection for development and evaluation of vital estimation algorithms.

Background: T2DM is a chronic metabolic disorder to manage the same lifestyle modification is cornerstone. In 2022, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) published a consensus report targeting the management of Type 2 Diabetes Mellitus (T2DM), which emphasised the importance of regular aerobic and resistance exercise. Both forms of physical activity (PA) can improve blood glucose, HbA1C levels, flexibility and balance. The ADA and EASD has categorised PA behaviours into 5 S. The 5 S stands for:- Sitting, Stepping, Sleep Sweating, Strengthening. The current study aims at auditing these 5S behaviours in suburban Mumbai population with its impact on HbA1C and body mass index (BMI).

Methodology: A Retrospective, questionnaire-based study was conducted in the Endocrinology outpatient department of tertiary care institute in Mumbai suburban district. The demographic details, anthropometric measurements, HbA1C levels, sleep cycle and daily PA schedule including the 5S behaviours were recorded. The data generated was then statistically analysed using the IBM SPSS software v. 23.

Results: The study included a total of 356 T2DM participants. Prolong sitting had a statistically significant correlation with BMI (P value = 0.003) and HbA1c levels (P value = 0.001), similarly strength training had a positive correlation with HbA1c (P value = 0.048) as well as with total sleep hours (P value < 0.0001). Behaviour like drowsiness was positively correlated with changing shift duty. Additionally, in the present study, it was also observed that more than half of the study population (55.8%) did not track their daily steps.

Conclusion: The findings of the present study emphasize the importance of reducing sedentary time, promoting strength training and enhancing sleep quality in T2DM management. Targeted interventions in these areas can help improve health outcomes and quality of life for T2DM patients.

A lung abscess is a microbial infection of the lungs. An empyema is an accumulation of pus in the pleural space that increases after infection of either lung or pleura generally. The sign of empyema is similar to that of lung abscess in that the patient has complaints of high-grade fever, chest pain, and productive cough. Here, we present the report of a patient who was admitted with high-grade fever, which could not be treated despite aggressive medical treatment due to underlying lung pathology. A 30-year-old woman started having right-sided chest pain; subsequently, she developed fever, which was continuous and high grade in character, for which she visited a local doctor. Right-sided intercostal drainage was done in that hospital, but neither too much drain came out nor she experienced relief in symptoms. Then, she was referred to a tertiary care center in Delhi for further treatment. She got re-evaluated there. During hospitalization, despite treatment with intravenous (IV) paracetamol and third-generation IV antibiotics, the fever did not come down, and hence she was planned for emergency posterior lateral thoracotomy to deal with the underlying pathology causing persistent high-grade fever. High-risk consent was taken for right side thoracotomy and patient was operated in a febrile condition. She was discharged on the third postoperative day with the chest tube in situ. The fever could not be treated for last 3 months despite aggressive medical treatment. Evacuation of pus from the pleural cavity was mandatory here because it was the primary focus to reduce the high-grade fever of patient.

Background and objective: The COVID-19 disease caused by SARS-CoV-2 was declared as pandemic by WHO soon after its emergence in 2019. This virus was known to cause serious clinical symptoms and severe illness. By using RT-PCR, which reports the cycle threshold value, the disease is diagnosed, whereas for the severity of the disease, biomarker levels, like IL-6, CRP, D-dimer, serum ferritin and serum procalcitonin, can be measured. We, thus, aimed to explore any potential correlation of the cycle threshold value and biomarker level with the outcome of COVID-19-positive hospitalized patients.

Method: Patients with the cycle threshold (Ct) value <35 were included in the study and their initial Ct values were noted. Different biochemical parameters, such as C-reactive protein (CRP), serum ferritin, D-dimer, Interleukin-6 and serum procalcitonin, were assessed for severity. They were classified according to Ct value into three groups: Group 1 >30.0, Group 2 20.0-30.0 and Group 3 <20.0.

Results: The study included 370 hospitalized COVID-19 patients with a mean age (mean ± SD) of 51.08 (16.58%) years and 250 (67.5%) males and 120 (32.4%) females. Comparison of data with outcome shows that IL-6, CRP amongst the biomarker and Ct value (deduced by RT-PCR test) were significantly correlated with the mortality (P value < 0.05). The ROC curve was also plotted for these parameters, which shows that IL-6, CRP, PCT and Ct value were better prognostic marker. Poor prognosis was found in Group 2 (Ct value 20.0-30.0) patients compared to Group 1 and Group 3. There was significant correlation (P value < 0.05) between Ct value and outcome of the patient.

Interpretation and conclusion: This study depicts that low Ct value and elevated levels of IL-6 and CRP can be used as a screening tool to detect the mortality in COVID-19 patients as they are significantly correlated with the mortality.

Development of a modern healthcare system largely utilising the limited relations model of the west needs an urgent revision . The strength of the Indian and other eastern civilizations has been the central place that family has always occupied in obtaining healthcare. In the emerging era of health polycrisis, nothing offers a more resilient counter to uncertainty than "family".

Aim: The present study aimed to correlate the association between serum iron, serum ferritin, serum albumin, and Vitamin D with early childhood caries (ECC).

Materials and methods: This study was a single-blinded randomized control trial. A total of 200 children aged between 3-6 years were screened for ECC, according to the AAPD guidelines. Out of 200 children, a total of 177 children fulfilled the inclusion criteria. They were divided into two groups: Group 1 consisted of 99 children with ECC and Group 2 (control group) with 78 children. The decayed, extracted because of caries, and filled primary teeth (deft) index were recorded from these children. Blood samples (approximately 2 ml) were collected by an expert nurse in the morning to determine serum levels of iron, ferritin, albumin, and Vitamin D. The data was statistically analyzed using the Mann-Whitney U test, and P value 0.05 was considered significant.

Results: The mean deft score was 4.83 (±3.54). The mean value of serum iron was 64.66 (±8.35) μg/dl, serum albumin 3.88 (±0.57) gm/dl, and serum ferritin 29.19 (±42.11) ng/ml in ECC children, whereas mean serum iron was 67.78 (±6.17), serum albumin 3.82 (±0.62) gm/dl, and serum ferritin 26.38 (±23.04) ng/ml in caries-free children. Statistically, no significant relationship was observed between serum iron (P = 0.066), serum albumin (P = 0.448), and serum ferritin (P = 0.192) with ECC. The mean value of Vitamin D was 17.44 (±7.59) ng/ml in ECC children and 35.9 (±9.56) in caries-free children who were significantly low in comparison with the non-ECC subjects (P < 0.0001).

Conclusion: The present study suggests no relationship between serum iron, serum albumin, and serum ferritin with ECC, whereas Vitamin D had an inverse relationship with ECC.

Clinical significance: This study sets a benchmark for the dental fraternity and other health specialists to analyze serum iron, serum ferritin, serum albumin, and Vitamin D levels, while generally treating pediatric patients with or without dental caries. Oral health education campaigns should be conducted for public awareness about the importance of iron, ferritin, albumin, and Vitamin D.

Hanging is a common method of suicide/homicide in India. We report a series of three cases of suicidal hangings and one accidental strangulation case seen over 4 months in the Department of Trauma and Emergency Medicine. All our patients presented in very critical condition and were treated with early aggressive management resulting in excellent outcomes.