Indian Journal of Community Medicine最新文献_第7页

General Practitioners’ Experience of Remote Consultations by Telephone in the General Practice Setting during the COVID-19 Pandemic 全科医生在 COVID-19 大流行期间通过电话进行远程会诊的经验

IF 0.9 Q3 Medicine

Indian Journal of Community Medicine

Pub Date : 2024-05-01 DOI: 10.4103/ijcm.ijcm_841_22

Sajid Mahmood, Kashif Ahmed, Majid Khan, Tahira Perveen, Zafar Ali

The coronavirus disease 2019 (COVID 19) pandemic brought substantial changes in the way doctors used to interact with patients. In the general practice, consultation over the phone has become a norm now. However, it is not well known how this new mode of consultation affected clinicians’ practices. Objective of this study was to find out if doctors working in the general practices were trained enough for telephonic consultation and how this new mode of consultation affected their clinical practice in general. It was an online survey. Information was gathered by using an online questionnaire which was sent electronically to general practitioners (GPs) and general practitioner speciality trainees (GPSTs) working in the general practices based in Leicestershire. Data were analyzed by using software SPSS. Descriptive characteristics of participants were reported in terms of numbers and percentages, whereas Chi square test was run to assess if there is a difference between GPs and GPSTs in terms of their experience of remote consultations by telephone. The questionnaire response rate was 69.3% (n = 133/192). Of the total, 54.1% (n = 72/133) of participants were women. About 36% (n = 48/133) of the participants were GPSTs, whereas 64% (n = 85/133) were qualified GPs. Not having enough training for phone consultation, technical issues during consultation, inadequate supervision framework, difficulties in building therapeutic alliance with patients, making diagnosis and risk assessment, and increased duration of consultation were identified as issues. Similarly, concerns around patients’ confidentiality and medico legal issues were highlighted. GPs and GPSTs reported similar difficulties. In conclusion, lack of training for the telephonic consultation has been identified as a unanimous issue along with other challenges to phone consultations. There is an urgent need to take measures to make telephone consultation more successful, enjoyable, and safe for patient care by addressing identified issues. Larger studies with representative samples are needed to increase generalizability of our findings.

2019 年冠状病毒病（COVID 19）大流行给医生与病人的互动方式带来了巨大变化。在全科诊疗中，电话咨询已成为一种常态。然而，这种新的问诊模式对临床医生的诊疗有何影响却鲜为人知。本研究旨在了解在全科诊所工作的医生是否接受过足够的电话咨询培训，以及这种新的咨询模式对他们的临床实践有何影响。这是一项在线调查。研究人员通过向莱斯特郡全科诊所的全科医生（GPs）和全科医生专业培训生（GPSTs）发送在线调查问卷的方式收集信息。数据使用 SPSS 软件进行分析。以数字和百分比的形式报告了参与者的描述性特征，并进行了卡方检验，以评估全科医生和全科专业实习医生在电话远程会诊经验方面是否存在差异。问卷回复率为 69.3%（n = 133/192）。其中，54.1%（n = 72/133）的参与者为女性。约 36%（n = 48/133）的参与者为全科医生，而 64%（n = 85/133）的参与者为合格的全科医生。电话咨询培训不足、咨询过程中的技术问题、监督框架不足、在与患者建立治疗联盟、进行诊断和风险评估方面遇到困难，以及咨询时间延长等都被认为是问题所在。同样，还强调了对病人保密和医疗法律问题的关注。全科医生和全科护士也反映了类似的困难。总之，缺乏电话会诊方面的培训以及电话会诊面临的其他挑战被一致认为是一个问题。当务之急是采取措施，通过解决已发现的问题，使电话会诊更成功、更愉快、更安全地为患者提供护理。我们需要对具有代表性的样本进行更大规模的研究，以提高研究结果的普遍性。

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引用次数: 0

Perception and Practices Regarding Stubble Burning in Rural Community of Haryana 哈里亚纳邦农村社区对焚烧秸秆的看法和做法

IF 0.9 Q3 Medicine

Indian Journal of Community Medicine

Pub Date : 2024-05-01 DOI: 10.4103/ijcm.ijcm_820_22

Puneet Misra, H. Salve, R. A. Daniel, Vignesh Dwarkanathan, T. Deori, Rakesh Kumar, K. Yadav

Agricultural emissions pose significant health risks, especially in countries like India with abundant agricultural waste. This study focuses on understanding stubble burning perceptions and practices in rural National Capital Region to inform targeted interventions for sustainable farming practices and improved public health. This community-based cross-sectional study was conducted among the randomly selected households of rural Ballabgarh, Haryana. A pre-tested, semi-structured questionnaire was used to obtain information on perception and practices on stubble burning. Data were collected in Epicollect 5 and analyzed in STATA 14. Of the 2000 households approached, 1813 responded with a response rate of 90.7%. Around 53% of the study participants believed that vehicular pollution is the main reason for air pollution, and 90% of them were unaware of the Government schemes related to stop stubble burning and with respect to the practices of stubble disposal. Around 70% of the participants mentioned that respiratory illness is the most severe effect of air pollution. The public was mostly unaware of the government’s efforts to reduce stubble burning. Health promotion initiatives must be carried out to raise community knowledge about the programs available to combat stubble burning, therefore decreasing air pollution and its health implications.

农业排放物对健康构成重大风险，尤其是在印度等农业废弃物丰富的国家。本研究的重点是了解国家首都地区农村对秸秆焚烧的看法和做法，从而为采取有针对性的干预措施，促进可持续农业实践和改善公众健康提供依据。这项以社区为基础的横断面研究是在哈里亚纳邦 Ballabgarh 农村随机抽取的家庭中进行的。研究采用了一份经过预先测试的半结构式问卷，以获取有关焚烧秸秆的看法和做法的信息。数据在 Epicollect 5 中收集，并在 STATA 14 中进行分析。在接触的 2000 户家庭中，有 1813 户做出了答复，答复率为 90.7%。约 53% 的参与者认为车辆污染是空气污染的主要原因，90% 的参与者不了解政府有关制止焚烧秸秆的计划和秸秆处理方法。约 70% 的参与者提到呼吸道疾病是空气污染最严重的影响。公众大多不了解政府为减少焚烧秸秆所做的努力。必须开展健康宣传活动，提高社区对现有秸秆禁烧计划的认识，从而减少空气污染及其对健康的影响。

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引用次数: 0

Unique Program of Indian Undergraduate Medical Education – Family Adoption Through Village Outreach 印度本科医学教育的独特计划--通过乡村外联活动进行家庭收养

IF 0.9 Q3 Medicine

Indian Journal of Community Medicine

Pub Date : 2024-05-01 DOI: 10.4103/ijcm.ijcm_273_24

Aruna Vanikar, Vijayendra Kumar

引用次数: 0

Is it Possible to Decrease Violence against Healthcare Workers in a Simple, Cost-effective Way?: A New Concept 是否有可能以简单、具有成本效益的方式减少针对医护人员的暴力行为？一个新概念

IF 0.9 Q3 Medicine

Indian Journal of Community Medicine

Pub Date : 2024-05-01 DOI: 10.4103/ijcm.ijcm_994_22

P. Garg, Aalam Sohal, Gurleen Kaur, Vipul D Yagnik, S. Dawka

引用次数: 0

Maternal Experiences during Pregnancy, Delivery, and Breastfeeding Practices: A Community-based Analytical Cross-sectional Study 孕产妇怀孕、分娩和母乳喂养的经历：一项基于社区的横断面分析研究

IF 0.9 Q3 Medicine

Indian Journal of Community Medicine

Pub Date : 2024-05-01 DOI: 10.4103/ijcm.ijcm_636_22

Jeevithan Shanmugam, Mohan Kumar, Naveen P. Jayaraj, Palanivel Rajan

Evidence on variation in the information provided to mothers during antenatal and postnatal periods, its influence on breastfeeding awareness, and practice in urban and rural settings of India is scarce. The aim of the study was to assess the variation in mothers experience during pregnancy, delivery, and maternity period across settings and its influence on breastfeeding practices in the first six months of infants’ life. A community-based analytical cross-sectional study was carried out in urban and rural settings of Coimbatore, Tamil Nadu, among 800 mothers who had delivered between one year and six months before the date of the survey using simple random sampling. The proportion of mothers with less than four antenatal visits were significantly higher in urban areas (urban vs rural, 11.4% vs 6.2%). The mean scores for positive experiences during pregnancy (MD −0.99, 95% CI −1.31 to −0.69), experiences during birth and maternity period (MD −0.59, 95% CI −0.83 to −0.35) were significantly lower in the urban areas compared to rural areas. The prevalence of exclusive breastfeeding was 75.8% and 85.0% in urban and rural areas, respectively. Mothers not satisfied with experiences during delivery and maternity period (OR 1.69, 95% CI 1.18 to 2.42) and from urban areas (OR 1.81, 95% CI 1.27 to 2.59) were at significantly increased risk of nonexclusive breastfeeding. The present study showed that mothers from urban areas were not provided with appropriate, adequate, and timely information by the healthcare providers. It is the need of the hour to train and motivate healthcare providers regarding maternal awareness of antenatal, intranatal, and postnatal care practices including breastfeeding and infant care.

在印度的城市和农村地区，产前和产后为母亲提供的信息差异及其对母乳喂养意识和实践的影响方面的证据很少。本研究旨在评估不同环境下母亲在怀孕、分娩和产期经历的差异及其对婴儿出生后头六个月母乳喂养做法的影响。在泰米尔纳德邦哥印拜陀的城市和农村地区，采用简单随机抽样的方法，对调查日期前一年至六个月期间分娩的 800 名母亲进行了一项基于社区的横断面分析研究。产前检查少于四次的母亲比例在城市地区明显较高（城市对农村，11.4% 对 6.2%）。与农村地区相比，城市地区在孕期积极体验（MD -0.99，95% CI -1.31 至 -0.69）、分娩和产期体验（MD -0.59，95% CI -0.83至 -0.35）方面的平均得分明显较低。城市和农村地区纯母乳喂养率分别为 75.8%和 85.0%。对分娩和产期经历不满意（OR 1.69，95% CI 1.18 至 2.42）和来自城市地区（OR 1.81，95% CI 1.27 至 2.59）的母亲非纯母乳喂养的风险明显增加。本研究表明，医疗保健提供者没有为来自城市地区的母亲提供适当、充分和及时的信息。当务之急是对医疗保健提供者进行培训，提高他们对产前、产中和产后护理措施（包括母乳喂养和婴儿护理）的认识。

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引用次数: 0

Awareness among Pediatricians Regarding National Telemedicine Guidelines during the COVID-19 Pandemic: A Survey 儿科医生对 COVID-19 大流行期间国家远程医疗指南的认识：一项调查

IF 0.9 Q3 Medicine

Indian Journal of Community Medicine

Pub Date : 2024-05-01 DOI: 10.4103/ijcm.ijcm_644_22

Areesha Alam, Harpreet Kaur, Shrish Bhatnagar

The success of telemedicine depends on awareness among doctors on how to implement it. We aimed to assess knowledge about national telemedicine guidelines in pediatricians during the coronavirus disease 2019 (COVID-19) pandemic. A cross-sectional study of pediatricians across India was conducted through a structured online questionnaire containing 16 marks. The mean knowledge score (KS) was calculated. Participants were divided into two groups: poor KS (KS <8) and good KS (KS ≥8). The association between factors and KS was assessed using univariate analysis. A total of 503 pediatricians participated (private sector: 80.7% and public sector: 19.3%). Most (61%) belonged to the age group of 31–50 years and were males (75%). The minimum educational qualification was a Doctor of Medicine (MD) in 57% of cases. Despite work experience of more than 5 years in most (70%) of the cases, very few had provided teleconsultation before the pandemic (13.9%). The mean KS was 10.60 ± 2.8, that is, 66.25%. The minimum KS was 1 (6.25%), and the maximum was 16 (100%). Assam, Chandigarh, Himachal Pradesh, Jharkhand, Odisha, Sikkim, and Tamil Nadu showed higher knowledge than other states, although no significant difference was found. The majority (89.1%) had good KS, which is significantly higher among private practitioners as compared to public practitioners. There was no association between KS and age, gender, qualification, and work experience. Pediatricians have good information regarding telemedicine guidelines in India; however, training programs will further empower doctors working in the public sector.

远程医疗的成功取决于医生对如何实施远程医疗的认识。我们旨在评估 2019 年冠状病毒病（COVID-19）大流行期间儿科医生对国家远程医疗指南的了解程度。我们通过一份包含 16 项指标的结构化在线问卷对印度各地的儿科医生进行了横断面研究。计算了平均知识得分（KS）。参与者被分为两组：KS 差（KS <8）和 KS 好（KS ≥8）。采用单变量分析评估了各种因素与 KS 之间的关联。共有 503 名儿科医生参与了这项研究（私立医疗机构占 80.7%，公立医疗机构占 19.3%）。大多数（61%）属于 31-50 岁年龄组，男性（75%）。最低学历为医学博士（MD）的占 57%。尽管大多数病例（70%）的工作经验超过 5 年，但在大流行之前提供过远程会诊的病例很少（13.9%）。平均 KS 为 10.60 ± 2.8，即 66.25%。最低 KS 为 1（6.25%），最高为 16（100%）。阿萨姆邦、昌迪加尔、喜马偕尔邦、恰尔康得、奥迪沙、锡金和泰米尔纳德邦的知识水平高于其他各邦，但未发现显著差异。大多数人（89.1%）具有良好的 KS，私人开业医生的 KS 明显高于公共开业医生。知识水平与年龄、性别、学历和工作经验之间没有关联。儿科医生对印度远程医疗指南有很好的了解；但是，培训计划将进一步增强在公共部门工作的医生的能力。

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引用次数: 0

Effect of Structured Exercise-Based Intervention on Upper Quadrant Dysfunction among Fish Processing Workers with Work-Related Musculoskeletal Disorders 基于结构化锻炼的干预对患有工作相关肌肉骨骼疾病的鱼类加工工人上象限功能障碍的影响

IF 0.9 Q3 Medicine

Indian Journal of Community Medicine

Pub Date : 2024-05-01 DOI: 10.4103/ijcm.ijcm_59_23

Gundmi V Rajesh N., Somu Gangahanumaiah, ArunG Maiya, V. Guddattu

Musculoskeletal disorders (MSDs) are one of the major causes of morbidity, which affect particularly the upper quadrant in industrial settings and so upset the quality of life (QoL). The influence of the protocol of exercise-based programs at the workplace on the well-being of the worker is contradictory. The objective of the study was to find the effect of the structured exercise-based intervention on upper quadrant dysfunction among fish processing workers with work-related MSDs. The intervention group (n = 91) participated in an individually tailored structured exercise-based intervention (SEBI) program for three months, which consisted of stretching, strengthening, and active exercises. The control group (n = 93) was instructed to continue routine daily activities. The outcome measures of the cluster-randomized controlled trial were Neck Disability Index (NDI), Disabilities of Arm, Shoulder, and Hand (DASH), Visual Analog Scale (VAS), and Short Form-36, used to evaluate at baseline, eighth, and twelfth week. The data were analyzed by repeated analysis of variance and Student’s t-tests. The results for the overall perception of upper quadrant dysfunction showed statistically significant differences (P < 0.0001) for NDI, DASH, and VAS. Further, we obtained a significant difference in QoL between the intervention and control groups for physical and psychological health sub-domains. SEBI effectively enhanced the general health of fish processing workers by showing improvements in the measures of NDI, DASH, VAS, and QoL. Hence, SEBI can be recommended in the fish processing industries to achieve potential impact on upper quadrant dysfunction and improve the QoL.

肌肉骨骼疾病（MSDs）是发病率的主要原因之一，在工业环境中对上半身的影响尤为严重，从而影响生活质量（QoL）。在工作场所开展以运动为基础的项目对工人健康的影响是相互矛盾的。本研究的目的是了解结构化运动干预对患有工作相关性 MSD 的鱼类加工工人上象限功能障碍的影响。干预组（n = 91）参加了为期三个月的单独定制的结构化运动干预（SEBI）计划，该计划包括伸展、强化和主动运动。对照组（n = 93）接受指导，继续日常活动。分组随机对照试验的结果测量指标包括颈部残疾指数（NDI）、手臂、肩部和手部残疾（DASH）、视觉模拟量表（VAS）和简表-36，分别用于基线、第八周和第十二周的评估。数据通过重复方差分析和学生 t 检验进行分析。对上象限功能障碍的总体感知结果显示，NDI、DASH 和 VAS 的差异具有统计学意义（P < 0.0001）。此外，我们还发现干预组和对照组在身体和心理健康子域的 QoL 方面存在显著差异。通过对 NDI、DASH、VAS 和 QoL 的测量，SEBI 有效地提高了鱼类加工工人的总体健康水平。因此，可建议在鱼类加工行业采用 SEBI，以实现对上象限功能障碍的潜在影响并改善 QoL。

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引用次数: 0

Enhancing India’s Rabies Eradication Efforts: A Holistic Approach 加强印度根除狂犬病的努力：整体方法

IF 0.9 Q3 Medicine

Indian Journal of Community Medicine

Pub Date : 2024-05-01 DOI: 10.4103/ijcm.ijcm_642_23

S. Saleem, S. Jan

引用次数: 0

Post-Marketing Surveillance of the World's First Novel Cocktail of Rabies Monoclonal Antibodies: TwinRab™ in Real -World Setting. 全球首款新型狂犬病单克隆抗体鸡尾酒上市后的监测：TwinRab™ 在真实世界环境中的应用。

IF 0.9 Q3 Medicine

Indian Journal of Community Medicine

Pub Date : 2024-03-01 Epub Date: 2024-03-07 DOI: 10.4103/ijcm.ijcm_562_23

Muralidhar P Tambe, Malangori A Parande, Mangesh B Nanaware, Nandkumar M Salunke, Trayambak Dutta, Manish Mahajan

Rabies presents with a high fatality rate, which imposes a significant global public health challenge, and therefore the use of post-exposure prophylaxis (PEP) is crucial for prevention. Monoclonal antibodies (mAbs) have emerged as a promising substitute for rabies immunoglobulins (RIGs) due to their high efficacy and standardized manufacturing process. A prospective, open-label, post-marketing surveillance study (PMS) was conducted at Byramjee Jeejeebhoy Medical College (BJMC), Pune. The study included patients aged more than 2 years who had recently sustained Category III-suspected rabid animal bite exposures. These patients were administered TwinRabTM at a dosage of 40 IU/kg in and around the wound as intralesional transfer, along with the anti-rabies vaccine (ARV). Adverse events (AEs) grading was performed with reference to the Food and Drug Administration (FDA) toxicity grading. In this study, 215 subjects received the TwinRabTM mAb with a 100% completion rate. Out of 215 patients, three (1.3%) patients in the range of 18 to 65 years of age showed solicited local AEs, which were resolved after the appropriate treatment intervention, but causality assessment was non-assessable. The overall tolerability assessment showed positive ratings from doctors (91.63%) and patients (67.91%) for the mAb cocktail. The PMS demonstrated the safety of TwinRabTM in patients who experienced Category III-suspected rabid animal bites, thereby supporting its potential as an alternative option for post-exposure prophylaxis in the management of animal bites for the prevention of rabies.

狂犬病致死率很高，给全球公共卫生带来了重大挑战，因此，使用暴露后预防疗法（PEP）对预防狂犬病至关重要。单克隆抗体（mAbs）因其高效性和标准化的生产工艺，已成为狂犬病免疫球蛋白（RIGs）的理想替代品。普纳 Byramjee Jeejeebhoy 医学院（BJMC）开展了一项前瞻性、开放标签、上市后监测研究（PMS）。研究对象包括年龄超过 2 岁、最近遭受过 III 类疑似狂犬病动物咬伤的患者。这些患者在接种抗狂犬病疫苗 (ARV) 的同时，还在伤口内和伤口周围注射了剂量为 40 IU/kg 的 TwinRabTM。不良事件（AEs）分级参照美国食品药品管理局（FDA）的毒性分级进行。在这项研究中，215 名受试者接受了 TwinRabTM mAb 治疗，完成率为 100%。在 215 名患者中，有 3 名（1.3%）年龄在 18 岁至 65 岁之间的患者出现了诱发性局部 AE，这些 AE 在适当的治疗干预后得到缓解，但因果关系无法评估。总体耐受性评估显示，医生（91.63%）和患者（67.91%）对 mAb 鸡尾酒给予了积极评价。PMS证明了TwinRabTM在经历过III类疑似狂犬病动物咬伤的患者中的安全性，从而支持了其作为动物咬伤治疗中暴露后预防的替代选择以预防狂犬病的潜力。

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引用次数: 0

Nursing Intervention Strategies and Their Effectiveness on Restless Leg Syndrome and Psycho-Social Problems in Chronic Kidney Disease Patients. 护理干预策略及其对慢性肾病患者不安腿综合征和社会心理问题的效果。

IF 0.9 Q3 Medicine

Indian Journal of Community Medicine

Pub Date : 2024-03-01 Epub Date: 2024-03-07 DOI: 10.4103/ijcm.ijcm_914_22

Prabhjot Kaur, Surinder Jaspal, Tejinder Kaur

Background: Chronic kidney disease is a global health problem affecting 843.6 million people with 1 million deaths and the 12^th leading non-communicable cause of death worldwide. Insomnia is a disturbing problem found in chronic kidney disease patients, leading to physiological problems like fatigue, edema, and restless leg syndrome most of the time. The objective of this study was to assess the effectiveness of nursing intervention strategies on physiological and psycho-social problems.

Materials and methods: A quantitative research approach with quasi-experimental pre-test and post-test design was used to assess the effectiveness of nursing intervention strategies on physiological and psycho-social problems among 30 chronic kidney disease patients, 15 in control and experimental each, admitted in a selected hospital of Punjab. Convenience sampling was used to assign the samples, and data were collected through an interview schedule by using standardized scales. IEC number: 2017/08/5051.

Results: The result of the study showed that the baseline restless leg syndrome mean score was 9.67, whereas the psycho-social problem baseline mean score was 79.80, and after post-test, the mean score was reduced to 7.67 in physiological and 66.87 in psycho-social problems in the experimental group. Intervention was found to be effective in reduction of physiological and psycho-social symptoms of chronic kidney disease patients significantly (P ≤ 0.05).

Conclusions: The study showed that nursing intervention strategies were effective in reduction of physiological and psycho-social symptoms.

背景：慢性肾脏病是一个全球性的健康问题，影响着 8.436 亿人，造成 100 万人死亡，是全球第 12 大非传染性死因。失眠是慢性肾脏病患者的一个令人不安的问题，大多数时候会导致疲劳、水肿和不安腿综合征等生理问题。本研究旨在评估护理干预策略对生理和社会心理问题的效果：本研究采用准实验性前测和后测设计的定量研究方法，评估护理干预策略对旁遮普省一家选定医院收治的 30 名慢性肾病患者的生理和社会心理问题的影响，其中对照组和实验组各 15 人。采用便利抽样法分配样本，并通过标准化量表的访谈表收集数据。IEC编号：2017/08/5051.结果：研究结果显示，实验组不宁腿综合征基线平均分为 9.67 分，而社会心理问题基线平均分为 79.80 分，经过后测，实验组生理问题平均分降至 7.67 分，社会心理问题平均分降至 66.87 分。研究发现，干预对减轻慢性肾脏病患者的生理和社会心理症状效果显著（P≤0.05）：研究表明，护理干预策略能有效减轻慢性肾病患者的生理和社会心理症状。

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引用次数: 0