Journal of Family Medicine and Primary Care最新文献

Background: Cognitive and autonomic dysfunction is increasingly being recognized as an important clinical dimension in major depressive disorder.

Aim: The aim of this study is to evaluate the effect of a combined approach of yoga and diet intervention on cognitive and autonomic functions in individuals with major depressive disorders.

Methods: This experimental observational study was conducted at RUHS College of Medical Sciences and Associated Hospitals, Jaipur, on the major depressive disorder population of either sex cognitive function (mini-mental score, Montreal cognitive protocol A and B, P300 latency and amplitude) and autonomic function parameters (frequency and time domain) were recorded at baseline and after three months of a combined approach of yoga and diet intervention.

Results: This study compared cognitive and autonomic function parameters at baseline and after three months of yoga and diet intervention in a major depressive disorder population. Analysis revealed a significant decrease in body mass index (<0.05), systolic blood pressure (<0.001), Hamilton rating scale for depression (<0.001), P300 latency (<0.001), standard deviation of NN interval (SDNN) (<0.001), and mean heart rate (<0.001), whereas there was a significant increase in mini-mental score (<0.001), Montreal cognitive protocol A and B (<0.001), high frequency (HF) (<0.001), root mean square standard deviation (RMSSD) (<0.001), and PNN50 (<0.001) after a combined approach of yoga and diet in the study group as compared to control group participants.

Conclusions: Yoga and diet combined may be an effective adjunct therapy for improving brain health and mental performance, lowering the risk of depression by affecting the neurotransmitter system and raising vagal tone which contributes to learning and memory.

Background: The past decade has witnessed a revolution in smartphones owing to their growing importance and various applications. However, excessive usage can lead to addiction and joint pain in the wrist/thumb area. Despite these negative effects, smartphones offer medical students access to the resources they need.

Objective: To determine the association between smartphone addiction and thumb/wrist pain among undergraduate students of Jazan University.

Methods: A cross-sectional self-administrated, online survey and online convenience sample technique was used. The collected data were analyzed using SPSS Software.

Results: This survey included 337 participants, of which two-thirds were female (66.8%) and the rest male (33.2%); 32.6% of the respondents were studying in the College of Medicine. Of the 337 participants, 32% reported experiencing pain in their wrists or at the back of their neck while using a smartphone. The study found an average Smartphone Addition Scale-Short Version (SAS-SV) score of 32.5 ± 8.0 out of 50 and a total Patient-Rated Wrist Evaluation score of 48.8 ± 14.7, with a pain score of 13.3 ± 11.0 and a function score of 35.5 ± 11.7. The study also revealed a significant association between smartphone addiction and thumb/wrist pain (P value = 0.029), with females and students of the College of Applied Medical Science associated with higher SAS-SV scores, thereby indicating higher smartphone addiction.

Conclusion: Significant correlation exists between smartphone addiction and thumb/wirst pain among medical students of Jazan University.

The LGBTQ community faces specific stressors rooted in societal discrimination, bias, and marginalization, impacting mental health significantly. Persistent discrimination, exclusion, and heteronormative expectations are identified as social determinants that contribute to heightened stress levels, resulting in increased rates of anxiety, depression, and suicidality. Moreover, the COVID-19 pandemic has also severely affected the physical and mental health of a large percentage of the population, particularly impacting the health of marginalized individuals such as LGBT individuals. Studies consistently reveal alarming mental health disparities between LGBTQ individuals and their heterosexual counterparts, with elevated rates of mood disorders, substance abuse, and self-harm. Transgender individuals, in particular, face unique challenges, including high rates of gender dysphoria and discrimination-induced mental distress. The concept of intersectionality within the LGBTQ community emphasizes the compounded burden faced by individuals with multiple marginalized identities, necessitating tailored mental health strategies. The societal context, including legal and policy frameworks, plays a pivotal role in shaping the mental health and scope for LGBTQ individuals. Supportive frameworks, such as anti-discrimination laws, marriage equality, and healthcare policies, contribute to societal acceptance and individual well-being. Additionally, efforts to destigmatize LGBTQ identities, comprehensive sex education, and public awareness campaigns challenging stereotypes are crucial for fostering a more inclusive societal mindset. Establishing robust support networks within the LGBTQ community, including initiatives providing mental health resources, counseling, community spaces, and allyship programs, is vital for community resilience. These efforts not only contribute to the well-being of individuals within the LGBTQ community but also work toward creating a more inclusive society. In conclusion, addressing mental health challenges within the LGBTQ community requires a multifaceted approach involving societal understanding, legal support, destigmatization efforts, and robust community resources. By acknowledging and comprehending the unique struggles faced by the LGBTQ community, society can collectively work toward building a more compassionate, supportive, and inclusive environment for all individuals, irrespective of their sexual orientation or gender identity.

Background: The inter-pregnancy interval (IPI) refers to the time between one pregnancy and the next. Studies have shown that IPIs shorter than 18 months are linked to negative outcomes, such as preterm delivery, infant mortality, and small-for-gestational-age birth. The aim of this study was to measure the prevalence and risk factors of short inter-pregnancy intervals among women receiving care at primary health centers in Jeddah, Saudi Arabia.

Methods and material: This is a cross-sectional study conducted at primary health care centers among mothers with a history of giving birth to at least one child and having two successive pregnancies. The data was collected through face-to-face interviews using a structured questionnaire. Statistical analysis was carried out using RStudio (R version 4.3.0).

Results: A total of 300 responses were analyzed. The prevalence of short IPI was 36.0%, 31.0% had prolonged IPI, and 33.0% had optimal IPI. Lower educational level, unemployment as a student, low or middle income, a rise in the number of children, typically more than six, and an increase in the number of male offspring, mostly four or more, lack of breastfeeding, and breastfeeding duration have all been identified as statistically significant risk factors for short IPIs.

Conclusions: Short inter-pregnancy interval is prevalent in Jeddah city, which can negatively impact the perinatal outcomes. Addressing the risk factors and providing proper education in antenatal and postnatal clinics to reduce the number of unintended pregnancies can help in decreasing the number of short inter-pregnancy intervals and improving maternal and fetal outcomes.

Primary Health Centers have been a critical component of India's healthcare landscape, designed to provide accessible and affordable medical services. However, the term "Primary Health Center" may not adequately convey the comprehensive and family-centered approach that modern healthcare necessitates. Changing the terminology of "Primary Health Center" to "Family Health Center" represents a strategic move toward strengthening public health services in India. This change embodies a commitment to holistic family-centered care, integrated health services, and community engagement. By emphasizing the importance of families in health care, this initiative can help address the diverse health needs of the population and improve health outcomes across communities.

Background: The metabolic syndrome (MetS), according to the Adult Treatment Panel III of the National Cholesterol Education Programme, is a collection of metabolic abnormalities that includes one, two, or all three of the following traits: obesity in the abdomen, dyslipidemia, hypertension, fasting blood sugar, or insulin resistance. This study's aim was to assess the relationship between fasting serum leptin and MetS in elderly adults with T2DM in the Northern Indian population.

Material and methods: The following information was collected from all the participants: (1) anthropometric data, (2) biochemical data, and (3) a lifestyle questionnaire on sociodemographic data, dietary practices, smoking, and alcohol intake to identify their risk factors for diabetes mellitus, CVD, and hypertension.

Results: A total of 36 older participants (56.30%) had a history of hypertension, while 29 elderly participants (44.61%) had diabetes mellitus. A total of 32 elderly participants (49.2%) had MetS, and this group had higher serum leptin (P 0.003), body weight (P = 0.019), BMI (P 0.001), waist circumference (P 0.001), CRP (P = 0.021), insulin (P = 0.001), and HOMA-IR (P = 0.003) values as well as higher percentages of females (P = 0.001), and those with type 2 diabetes mellitus (P = 0.002) and hypertension (P = 0.039) than those in the non-MetS group.

Conclusion: In older persons with T2DM, our study discovered a favorable correlation between serum leptin and MetS. It can act as a standalone indicator of MetS, offering a way to spot populations at risk for associated consequences and enabling early intervention.

Context: The prevalence of gestational diabetes mellitus (GDM) in the Indian subcontinent has increased exponentially, especially after new diagnostic criteria. Identifying women who need close monitoring is a challenge. Ultrasound has been used to guide therapy but its use in the management of GDM has been used indiscriminately due to paucity of information. The use of ultrasound to guide the number of antenatal visits for adequate glycemic control has not been researched adequately. There is also a need to contrive antenatal care strategies that can obtain optimal neonatal outcomes without burdening the health system in low-middle income countries (LMIC).

Aims: Our study was to compare pragmatic standard management of GDM with an ultrasound-guided regime (USGR) to prevent neonatal complications to ensure optimal care.

Settings and designs: A randomized controlled trial was done in a tertiary hospital between May 2019 and September 2021 in South India.

Methods and materials: Five hundred and eighty-eight women were randomized to a standard regime or USGR.

Statistical analysis: χ² and t-test were used to compare outcomes.

Results: Maternal and neonatal outcomes between standard and ultrasound USGR showed no significant difference in outcomes. Fetuses in USGR with AC ≥ 70^th centile had macrosomia (3.59% vs 26.67%, P < 0.001), increased severity of diabetes (2.97% vs 16.67%, P < 0.001), 3^rd- and 4^th-degree perineal tear (2.95% vs 27.27%, P < 0.001). The increased number of visits did not decrease adverse outcomes.

Conclusion: This small well-designed study did not show any advantage with USGR as compared to the pragmatic simple standard regime, in the treatment of women with GDM.

Context: Medical educators face different challenges in this digital era with the pressure for clinical practice as well as teaching. In blended learning Internet technologies are used along with face-to-face teaching to deliver learning methodologies.

Objective: To assess the efficacy of the blended learning dermatology course on Family Medicine residents at a teaching hospital. Methodology: It was interventional (pre and post) study with purposive sampling. All the Family Medicine residents enrolled at The Aga Khan University Hospital participated in the study after giving consents. The course covered most common skin conditions. Multiple slide sessions, online lectures, clinical presentations, case-based scenarios, and quizzes were included in the course. Knowledge was assessed through pre- test by multiple choice questions. Post tests were taken after completion of the modules to assess the improvement in the knowledge of residents about basic dermatological conditions by multiple choice questions. After completion of sessions a survey questionnaire was administered to evaluate the perception of participants about blended learning strategy.

Results: The tests scores were significantly higher in the post test. The majority of the residents were satisfied with the course delivery. A statistically significant difference was found between pre and post test results with a P value 0.000.

Conclusions and recommendation: Blended learning is an effective and innovative teaching strategy that helped family medicine residents to enhance their learning more effectively. We recommend that this method of teaching strategy should be used in other clinical disciplines in different contexts.didifferent contexts.

Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes; so, a nerve conduction study (NCS) is conducted to detect the type of neuropathy that is present. To discuss the NCS findings in diabetic patients. An observational study was conducted in the Physiology Department of AIIMS, Bhopal, in collaboration with the Medicine Department of the Institute. Seventy-two diagnosed type 2 diabetes mellitus (T2DM) patients were examined using NCS (Nihon Kohden Neuropack XI Machine). Microsoft Excel was utilized for data compilation and result analysis. Based on NCS, 94% of patients were abnormal, and 6% were normal. Of abnormal patients, 89% had asymmetrical involvement, and 5% had symmetrical involvement. About 74% had mixed neuropathy, 11% had motor neuropathy, and 10% had sensory neuropathy. Mixed involvement was seen in 60% of patients and axonal involvement in 35% of patients, and 5% were normal. Lower limb involvement was seen predominately. The most common bilaterally involved motor nerve was the peroneal nerve, seen in 49% of cases, whereas the most common bilaterally involved sensory nerve was the sural nerve involved in 59% of cases. The left tibial nerve was the most common unilaterally involved motor nerve seen in 32% of cases, and the left sural nerve was the most common sensory nerve involved in 54% of cases. Asymmetric sensorimotor involvement with mixed involvement (axonal + demyelinating) was seen in diabetic patients. Peroneal and sural nerves were the most common bilaterally involved motor and sensory nerves, respectively. Similarly, the left tibial and left sural nerves were the most common unilaterally affected motor and sensory nerves, respectively.

Background: Family planning (FP) services are pivotal in assessing a country's healthcare efficacy. Despite India's strides in FP promotion, disparities persist in its utilization rates. This study analyzes Karnataka's FP trends by using National Family Health Survey (NFHS) rounds 4 and 5, comparing its indicators with national averages.

Methods: A retrospective record review-based descriptive study design was employed. Data from NFHS-4 (2015-16) and NFHS-5 (2019-21) were analyzed using MS Excel 365. Key variables included age at marriage, total fertility rate (TFR), and various contraceptive methods.

Results: Karnataka exhibited a stable rate of early marriages for women and a decline among men aged 25-29 years. TFR in Karnataka slightly decreased, with increased contraceptive usage and significant growth in modern contraceptive methods. However, male sterilization rates remained low. There was an improvement in health workers' engagement with female non-users and in providing information on contraceptive side effects.

Conclusion: While Karnataka has progressed in FP, challenges such as early marriages persist. Enhancing integration, leveraging technology, and empowering women are essential for comprehensive FP services in India.