Journal of Family Medicine and Primary Care最新文献

Background: Menstruation is a natural physiological process, yet it continues to be surrounded by cultural silence and misconceptions in many communities. Poor menstrual hygiene and lack of awareness contribute to a range of health complications, including reproductive tract infections and psychosocial challenges. While studies on adolescent girls are common, research focusing on college-going young women aged 19-25 is relatively scarce.

Objective: To assess menstrual perceptions, practices, and awareness of premenstrual syndrome (PMS) among college students in Chandigarh, and to identify gaps in menstrual health knowledge and hygiene behavior.

Methods: A cross-sectional descriptive study was conducted among 100 female college students aged 19-25 years in Chandigarh using a pretested structured questionnaire. Data were analyzed using SPSS, with Chi-square tests applied to assess associations.

Results: Although 72% had premenarche knowledge and 98% used sanitary pads, only 33% changed them ≥ 4 times/day, and just 25% used soap and water for perineal hygiene. PMS awareness was low (52%), despite a high prevalence of related symptoms. Cultural restrictions were commonly reported, including food taboos and limited communication with male family members. A significant association was found between premenarche knowledge and menstrual hygiene practices (P = 0.022), and between perception and practice (P = 0.013). Overall, 78% had poor perception scores, and 82% practiced suboptimal hygiene.

Background: The health system financing of almost all low- and middle-income countries, including India, relies heavily on out-of-pocket (OOP) payments. Out-of-pocket expenditure (OOPE) for patient care has been known to cause maximum impoverishment. It can have debilitating consequences for the urban population or households. It is necessary to study patient care costs and the related factors among the households of an urban area to determine their vulnerability to catastrophic expenditure and to protect them from it.

Objective: The objective of the study is to estimate the out-of-pocket and catastrophic health expenditure in the urban population of Rohtak city, Haryana (India).

Methodology: This was a cross-sectional study conducted over a period of one year among urban households of District Rohtak, Haryana (India), who have been residing in the study area for at least one year. A sample size of 390 households was selected using simple random sampling. The study proforma as per the National Sample Survey Office (NSSO) was used to elicit and record relevant information.

Results: The majority, i.e., 81.8% of households, incurred OOPE while seeking treatment from health facilities. On multiple logistic regression analysis to identify significant determinants like medical insurance, age, chronic disease, duration of stay in hospital, and level of healthcare facility availed of net out-of-pocket (OOP) expenditure incurred on IPD treatment revealed no significant odds for incurring net out-of-pocket (OOP) expenditure (P > 0.05).

Conclusion: The majority of households in the study area incurred high OOP health expenditure and only 11.8% were having medical insurance, which highlights the need for active financial protection to bring down the OOP expenditure.

Ayushman Arogya Mandir (AAM) represents a watershed moment in the history of public health, marking a transformative step toward achieving Universal Health Coverage (UHC) in India. This manuscript provides a narrative review and secondary analysis of its impact, implementation challenges, and future potential. A narrative review was conducted in line with the Scale for the Assessment of Narrative Review Articles guidelines to enhance methodological transparency. A structured search was performed across PubMed, Scopus, and Google Scholar, complemented with official Government of India reports and policy documents. The search covered literature from January 2014 to November 2024 to capture developments before and after the launch of AAM in 2018. Search terms included combinations of "Ayushman Arogya Mandir," "Health and Wellness Centres," "Comprehensive Primary Health Care," "Universal Health Coverage India," "Ayushman Bharat," and "National Health Mission." A two-step screening process was followed: (i) titles and abstracts were screened to remove clearly irrelevant items, and (ii) full texts of potentially relevant articles and reports were assessed for inclusion. Peer-reviewed articles, government reports, and publicly available datasets relevant to India's UHC reforms were included, while commentaries without evidence, opinion pieces, were excluded. The analysis explores the initiative's alignment with global UHC principles and its role in enhancing equitable health access across diverse population segments, particularly marginalized communities. Significant paradigm shifts implemented after operationalization of AAM coupled with related health reforms have contributed to progress toward UHC by progressing its UHC Service Coverage Index from 57 in 2015 to 63 in 2021 (World Health Organization) and reduce the out of pocket expenditure from 60.6% in 2014-15 to 39.4% in 2021-22 (National Health Accounts estimates for India 2021-22). Though significant progress has been achieved, there persist challenges such as workforce shortages, infrastructural issues, and supply chain issues which require focused policy interventions. Despite the persisting challenges, AAM demonstrates significant promise as a scalable model for strengthening affordable, accessible, and quality primary healthcare, thereby contributing to India's progress toward UHC and offering lessons for other low- and middle-income countries.

Background: Birth weight is the critical determinant of neonatal survival, with deviations from the norm increasing the risks of perinatal morbidity and mortality. Accurate estimation of fetal weight is essential for effective management during labor, particularly in high-risk pregnancies. Clinical and sonographic methods are the primary techniques for estimating fetal weight, with each method showing distinct advantages and limitations.

Objective: This study aims to compare the accuracy of clinical (Insler's formula) and sonographic (Hadlock's formula) methods in estimating fetal weight, by correlating these estimates with actual birth weight.

Materials and methods: A prospective observational study was conducted, including 100 antenatal cases with term singleton pregnancies. Clinical assessments were performed using Insler's formula, while ultrasound-based fetal weight estimation was done using Hadlock's formula. Birth weight was recorded post-delivery, and statistical analysis was performed to assess correlations and agreement.

Results: The mean fetal weight estimated by Insler's formula was 3.23 ± 0.42 kg, and by Hadlock's formula was 3.16 ± 0.44 kg. The actual birth weight averaged 3.06 ± 0.42 kg. Both methods showed fair agreement with actual birth weight, with Cohen's kappa values of 0.274 (Insler's) and 0.167 (Hadlock's), indicating statistically significant agreement in the Insler's formula group (P < 0.001) but not in the Hadlock's formula group (P = 0.089).

Conclusion: Both clinical and sonographic methods demonstrate fair agreement with actual birth weight, but clinical method (Insler's formula) is more accessible, cost-effective, and accurate for fetal weight estimation in low-resource settings. This study suggests that clinical methods can be reliably used in managing labor and delivery in resource-limited environments.

Purpose/background: Malnutrition and incomplete immunization remain major public health challenges in India. This study has been conducted to determine whether a child's immunization status has an influence on their nutritional status.

Aims: (1) To assess the nutritional status and primary immunization coverage in children aged 12-23 months. (2) To determine the association between sociodemographic factors, nutritional status, and immunization status.

Methods: A comparative community-based cross-sectional study was conducted over four months (from March to June 2023) involving children aged 12-23 months in both urban and rural practice areas associated with the Osmania Medical College. The study included a sample of 400 children, 200 from urban settings and 200 from rural locations, selected using a multistage sampling approach. Chi-square test and binary logistic regression were used for statistical analysis.

Results: The coverage of full immunization, partial immunization, and nonimmunization in urban area is 65%, 34%, and 1%, while in rural area is 48.5%, 49%, and 2.5%, respectively. Underweight, stunted, wasted, and severe acute malnutrition (SAM) children in the urban area are 26%, 23.5%, 11%, and 3.5%, while in rural area, underweight, stunted, wasted, and SAM children are 26%, 32%, 16%, and 5.5%. Statistical analysis shows significant associations between malnutrition and immunization status and various types of malnutrition and independent variables, factors like immunization status, residence, family type, socioeconomic status, and mother's age showed a significant association.

Conclusions: Though progress has been made, achieving universal coverage for nutrition and immunization requires collaboration, planning and monitoring, and systemic changes across all levels of healthcare.

Introduction: As e-cigarettes become more popular, especially among young adults, worries about their effects on physical and mental health are increasing. This study examines the prevalence, social influences, and health perceptions related to e-cigarette use in Jeddah.

Methods: We surveyed 402 adults attending outpatient clinics at King Abdulaziz University Hospital in Jeddah. Participants provided insights on their smoking habits, beliefs about e-cigarettes, and mental health status through validated questionnaires.

Results: Among participants, 7.7% were e-cigarette users, with 56.2%. Social influence is identified as a main reason for usage. Despite the appeal, a large majority (74.4%) recognized the harmful effects of e-cigarettes, associating them with respiratory, cardiac, and cancer risks. Interestingly, while no direct link was found between e-cigarette use and specific health issues, a potential connection to heightened anxiety was observed. The influence of peers played a major role in initiating use.

Conclusion: E-cigarette use is on the rise, driven largely by social factors, with many users acknowledging the health risks. This study highlights the necessity for focused public health campaigns to raise awareness, particularly among young adults. Further research is essential to fully understand the mental health implications of e-cigarette use and its long-term effects on well-being.

Objective: To construct an eXtreme Gradient Boosting (XGBoost) model for predicting short-term recurrence after first-episode acute pancreatitis (AP) and employ SHapley Additive exPlanations (SHAP) analysis for feature interpretation.

Methods: A total of 442 patients with first-episode AP admitted to Cangzhou Central Hospital from October 2018 to June 2023 were retrospectively analyzed. The short-term recurrence was defined as a second attack after first-episode AP within 1 year. The cohort was split randomly, with 70% of the patients (n = 321) used for model training and 30% (n = 121) reserved for validation. Cox regression analysis was employed to identify independent predictors affecting recurrence, and an XGBoost model was constructed based on predictors. The XGBoost model was assessed by using area under the curve (AUC), calibration curve, decision curve analysis (DCA), and SHAP analysis.

Results: Three features were determined as predictors of recurrence. They included elevated triglycerides, alcohol drinking, and pancreatic necrosis. The XGBoost model demonstrated favorable performance, achieving an AUC of 0.933 (95% CI: 0.895-0.970) in the training cohort and of 0.874 (95% CI: 0.777-0.970) in the validation cohort. The calibration curve exhibited strong consistency between the anticipated and observed values, and DCA confirmed that the XGBoost model provided great clinical benefit. SHAP analysis also proved that elevated triglycerides, alcohol drinking, and pancreatic necrosis were decisive for the effect of the XGBoost model.

Conclusion: The XGBoost model can accurately predict short-term recurrence. The SHAP approach can enhance the interpretability of the machine-learning model and support clinical decision-making.

Oral dapsone is effective in treating several dermatologic conditions, including acne vulgaris. However, the rate of adverse effects of oral dapsone is a concern when prescribing it. Topical dapsone may mitigate these adverse effects and enhance the safety and tolerability of dapsone. Here, we review the published reports and studies to examine the efficacy and safety of topical dapsone in treating acne. A literature review was conducted using the PubMed database. The review considered patient and disease factors, such as the type of acne, acne location, patient gender, age, skin type, and race. Other factors, such as the duration and dosage of treatment, monotherapy versus combination therapy, adverse events, and safety profiles, were also compared. Topical dapsone was well tolerated and effective across a variety of acne presentations and patient subgroups. It showed a favorable safety profile, even in patients with comorbidities, such as G6PD deficiency. We conclude that topical dapsone is safe, effective, and well tolerated in the treatment of acne, contrary to its oral form.

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple organs and may lead to serious complications if not detected and treated early. Raising public awareness about SLE is crucial for early diagnosis and management. This study aimed to assess the level of knowledge, awareness, and attitudes regarding SLE among the general population in the Riyadh region of Saudi Arabia.

Methods: A descriptive, cross-sectional study was conducted among residents of the Riyadh region aged 18 years and older. Data were collected using an online validated questionnaire distributed via social media platforms. The questionnaire measured sociodemographic data, general knowledge about SLE, understanding of its causes, symptoms, complications, and treatment, as well as public attitudes. Descriptive analysis and Chi-square tests were used to determine associations between demographic variables and knowledge levels, using SPSS version 25.

Results: A total of 646 participants completed the survey. Only 14.8% of respondents knew that SLE is an autoimmune disease, and 38.7% recognized that it can affect multiple organs. Furthermore, only 33.9% were aware of its potentially life-threatening complications. Significant associations were found between awareness levels and age group (P = 0.000), gender (P = 0.002), and educational level (P = 0.000). The majority (71.3%) expressed a desire to learn more about SLE, and 77.2% agreed that public health campaigns are needed to improve awareness.

Conclusions: This study revealed a significant lack of knowledge and awareness of SLE in the Riyadh region. The findings emphasize the need for targeted educational campaigns and public health efforts to improve early recognition and management of SLE, thereby reducing disease-related complications.