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Care seeking behavior of the victims of unintentional injuries: A community-based study in a community development block of Purba Bardhaman District, West Bengal 意外伤害受害者的求医行为:对西孟加拉邦普尔巴-巴达汉地区一个社区发展区的社区研究
Pub Date : 2024-04-01 DOI: 10.4103/jfmpc.jfmpc_1738_23
Sankar Nath Jha, Soumyaneel Das, Archi Chandra, Anwesha Dey, Ramaprasad Roy
ABSTRACT Care-seeking after injury episodes is generally associated with major uncertainties concerning its incidence, care, and cure/disappearance, and the price of care. Though the utilization pattern of the population is shaped by social, economic, cultural and political factors, it varies widely for the rich and the poor. With this background, a community-based epidemiological study was conducted to determine the care-seeking behavior of victims of unintentional injuries. A cross-sectional study was conducted from May 2023–September 2023 in the Bhatar block of Purba Bardhaman district, West Bengal. Cluster random sampling was applied to select a required sample of 555 individuals from 24 villages. Study tools used were predesigned and pretested schedules developed by the researchers with the help of guidelines for conducting community surveys on injuries provided by the World Health Organization (WHO). The study had approval from the Institutional Ethics Committee. Descriptive statistics were performed using SPSS V16. Out of 49 injury episodes, 51.0% had received first aid. Out of 39 injury episodes seeking medical attention, a traditional practitioner, healer or bone setter was the type of first medical contact in the case of the majority of injury episodes (38.5%), followed by a hospital (35.9%). Low utilization of government healthcare facilities is a cause for concern. Reliance on unqualified informal healthcare providers is also a cause for concern. Our findings will help design community interventions to increase the provision of appropriate first aid in unintentional injuries.
摘要 受伤后寻求护理通常与受伤的发生率、护理、治愈/消失以及护理价格等重大不确定因素有关。虽然人口的使用模式受社会、经济、文化和政治因素的影响,但富人和穷人的使用模式差异很大。在此背景下,我们开展了一项基于社区的流行病学研究,以确定意外伤害受害者的就医行为。 这项横断面研究于 2023 年 5 月至 2023 年 9 月在西孟加拉邦 Purba Bardhaman 区的 Bhatar 街区进行。研究采用集群随机抽样法,从 24 个村庄中选取了 555 个所需样本。所使用的研究工具是研究人员在世界卫生组织(WHO)提供的社区伤害调查指南的帮助下预先设计和测试的调查表。研究获得了机构伦理委员会的批准。研究人员使用 SPSS V16 进行了描述性统计。 在 49 次受伤事件中,51.0% 接受过急救。在 39 起寻求医疗救助的受伤事件中,大多数受伤事件(38.5%)的首次医疗接触是传统医师、医士或郎中,其次是医院(35.9%)。 政府医疗设施的利用率低是一个令人担忧的问题。对不合格的非正规医疗服务提供者的依赖也令人担忧。我们的研究结果将有助于设计社区干预措施,以增加对意外伤害提供适当的急救。
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引用次数: 0
DRESS syndrome due to anti-TB drugs: A complex case with successful re-desensitization of group A drugs 抗结核药物导致的 DRESS 综合征:一个复杂病例,成功实现了对 A 组药物的再脱敏
Pub Date : 2024-04-01 DOI: 10.4103/jfmpc.jfmpc_1516_23
C. Morán-Mariños, F. Llanos-Tejada, J. Salas-López, A. Chavez-Huamani, Renato Casanova-Mendoza, Renzo Villanueva-Villegas
ABSTRACT Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare, life-threatening adverse reaction caused by certain medications. Clinical findings usually include rash, fever, lymphadenopathy, and eosinophilia, and in some cases, they may affect major organs. This reaction caused by antituberculosis (TB) medication poses a public health risk due to treatment discontinuation, adherence, or success in cure. We present a 23-year-old female patient who developed DRESS syndrome as a result of group A anti-TB drugs (ATDs), an exceedingly rare occurrence. The patient’s medication was successfully retrieved using a re-desensitization protocol.
摘要 伴有嗜酸性粒细胞增多和全身症状的药物反应(DRESS)综合征是由某些药物引起的一种罕见的、危及生命的不良反应。临床表现通常包括皮疹、发热、淋巴结肿大和嗜酸性粒细胞增多,在某些病例中还可能累及主要器官。这种由抗结核(TB)药物引起的不良反应会导致治疗中断、依从性下降或治愈失败,从而对公共健康造成威胁。我们为您介绍一位 23 岁的女性患者,她因服用 A 组抗结核药物(ATDs)而出现 DRESS 综合征,这种情况极为罕见。通过重新脱敏方案,患者成功地恢复了用药。
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引用次数: 0
Do tribal community children show varied antiepileptic response? 部落社区的儿童是否表现出不同的抗癫痫反应?
Pub Date : 2024-04-01 DOI: 10.4103/jfmpc.jfmpc_1671_23
Hemasri Velmurugan, Krishnapriya Neelambaran, P. Thangaraju
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引用次数: 0
Determinants of public institutional births in India: An analysis using the National Family Health Survey (NFHS-5) factsheet data 印度公立医院分娩的决定因素:利用全国家庭健康调查(NFHS-5)概况介绍数据进行分析
Pub Date : 2024-04-01 DOI: 10.4103/jfmpc.jfmpc_982_23
Rohan Kar, A. Wasnik
ABSTRACT Institutional births ensure deliveries happen under the supervision of skilled healthcare personnel in an enabling environment. For countries like India, with high neonatal and maternal mortalities, achieving 100% coverage of institutional births is a top policy priority. In this respect, public health institutions have a key role, given that they remain the preferred choice by most of the population, owing to the existing barriers to healthcare access. While research in this domain has focused on private health institutions, there are limited studies, especially in the Indian context, that look at the enablers of institutional births in public health facilities. In this study, we look to identify the significant predictors of institutional birth in public health facilities in India. We rely on the National Family Health Survey (NFHS-5) factsheet data for analysis. Our dependent variable (DV) in this study is the % of institutional births in public health facilities. We first use Welch’s t-test to determine if there is any significant difference between urban and rural areas in terms of the DV. We then use multiple linear regression and partial F-test to identify the best-fit model that predicts the variation in the DV. We generate two models in this study and use Akaike’s Information Criterion (AIC) and adjusted R2 values to identify the best-fit model. We find no significant difference between urban and rural areas (P = 0.02, α =0.05) regarding the mean % of institutional births in public health facilities. The best-fit model is an interaction model with a moderate effect size (Adjusted R2 = 0.35) and an AIC of 179.93, lower than the competitive model (AIC = 183.56). We find household health insurance (β = -0.29) and homebirth conducted under the supervision of skilled healthcare personnel (β = -0.56) to be significant predictors of institutional births in public facilities in India. Additionally, we observe low body mass index (BMI) and obesity to have a synergistic impact on the DV. Our findings show that the interaction between low BMI and obesity has a strong negative influence (β = -0.61) on institutional births in public health facilities in India. Providing households with health insurance coverage may not improve the utilisation of public health facilities for deliveries in India, where other barriers to public healthcare access exist. Therefore, it is important to look at interventions that minimise the existing barriers to access. While the ultimate objective from a policy perspective should be achieving 100% coverage of institutional births in the long run, a short-term strategy makes sense in the Indian context, especially to manage the complications arising during births outside an institutional setting.
摘要 住院分娩可确保产妇在熟练医护人员的监督下,在有利的环境中分娩。对于印度这样新生儿和孕产妇死亡率较高的国家来说,实现 100%的住院分娩覆盖率是政策的重中之重。在这方面,公共卫生机构发挥着关键作用,因为由于现有的医疗服务障碍,它们仍然是大多数人的首选。虽然这一领域的研究主要集中在私立医疗机构,但对公共医疗机构中住院分娩的促进因素的研究却很有限,尤其是在印度。在本研究中,我们希望找出印度公共医疗机构住院分娩的重要预测因素。 我们依靠全国家庭健康调查(NFHS-5)的数据进行分析。本研究中的因变量(DV)是公共医疗机构的住院分娩率。我们首先使用韦尔奇 t 检验来确定城市和农村地区在 DV 方面是否存在显著差异。然后,我们使用多元线性回归和部分 F 检验来确定预测 DV 变化的最佳拟合模型。在本研究中,我们生成了两个模型,并使用阿凯克信息准则(AIC)和调整后的 R2 值来确定最佳拟合模型。 我们发现城市和农村地区在公立医疗机构住院分娩的平均比例方面没有明显差异(P = 0.02,α = 0.05)。最佳拟合模型是一个交互模型,其效应大小适中(调整后 R2 = 0.35),AIC 为 179.93,低于竞争模型(AIC = 183.56)。我们发现,家庭医疗保险(β = -0.29)和在熟练医护人员监督下进行的家庭分娩(β = -0.56)是印度公立医疗机构住院分娩的重要预测因素。此外,我们还发现低体重指数(BMI)和肥胖对 DV 有协同影响。我们的研究结果表明,低体重指数和肥胖之间的交互作用对印度公共医疗机构的住院分娩率具有很强的负面影响(β = -0.61)。 在印度,为家庭提供医疗保险可能不会提高公共医疗设施的分娩利用率,因为在印度,公共医疗服务还存在其他障碍。因此,重要的是要考虑采取干预措施,尽量减少现有的就医障碍。虽然从政策角度来看,最终目标应该是在长期内实现 100%的住院分娩覆盖率,但就印度的情况而言,短期战略是有意义的,尤其是在住院分娩以外的分娩过程中出现的并发症。
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引用次数: 0
Relationship of obesity indices with clinical severity and nerve conduction studies in females presenting with median nerve compression neuropathy at the wrist 女性腕部正中神经压迫性神经病患者肥胖指数与临床严重程度和神经传导研究的关系
Pub Date : 2024-04-01 DOI: 10.4103/jfmpc.jfmpc_1253_23
Fawaz Salamh, Syed S Habib, Fawzia AlRouq, Anas Albarrak, T. Al-khlaiwi, Adeena Khan
ABSTRACT Carpal tunnel syndrome (CTS) is considered to be one of the most common peripheral nerve disorders with female preponderance which significantly reduces work efficacy and needs further research on its preventable factors, especially obesity. We studied the effects of obesity indices on Phalen’s test duration and median nerve conduction study (NCS) parameters in patients presenting with CTS. We examined 229 female patients presenting with clinical features of CTS. Clinical examinations including Phalen’s test, median NCSs, and body composition were evaluated. Obesity indices and electrophysiological parameters were compared. There were significant associations of both body mass index (BMI) degrees and body fat percent (BF%) with clinical and NCS parameters with a linear relationship. BF% and BMI were strongly negatively correlated with Phalen’s test duration (BF%; r = -0.334, BMI; r = -0.270 P = 0.001). On the other hand, BF% and BMI were positively correlated with median distal latency (BF%; r = 0.338, BMI; r = 0.372, P value = 0.001), M-latency (BF%; r = 0.264, BMI; r = 0.285, P = 0.001), median motor conduction velocity (MMCV) (BF%; r = 0.119, P = 0.072, BMI; r = 0.173, P = 0.009), median sensory conduction velocity (MSCV) (BF%; r = -0.195, P = 0.003, BMI; r = 0.327, P = 0.001), and sensory nerve action potential (SNAP amplitude) (BF%; r = -.239, BMI; r = -0.350, P = 0.001). Nerve conduction parameters are significantly affected by obesity degree defined by BMI and BF%. Therefore, combining BMI and BF% assessments gives more clinical information regarding CTS severity and management. The true predictive value of these indices needs to be elucidated further.
摘要 腕管综合征(CTS)被认为是最常见的周围神经疾病之一,女性患者居多,大大降低了工作效率,因此需要进一步研究其可预防因素,尤其是肥胖。我们研究了肥胖指数对 CTS 患者法伦氏试验持续时间和正中神经传导研究(NCS)参数的影响。 我们对 229 名具有 CTS 临床特征的女性患者进行了检查。临床检查包括法伦氏试验、正中神经传导检查和身体成分。比较了肥胖指数和电生理参数。 体重指数(BMI)和体脂率(BF%)与临床和 NCS 参数有明显的线性关系。体脂率和体重指数与法伦氏试验持续时间呈强烈负相关(体脂率;r = -0.334;体重指数;r = -0.270 P = 0.001)。另一方面,BF% 和 BMI 与中位远端潜伏期(BF%;r = 0.338,BMI;r = 0.372,P = 0.001)、M-潜伏期(BF%;r = 0.264,BMI;r = 0.285,P = 0.001)、中位运动传导速度(MMCV)(BF%;r = 0.119,P = 0.072,BMI;r = 0.173,P = 0.009)、中位感觉传导速度(MSCV)(BF%;r = -0.195,P = 0.003,BMI;r = 0.327,P = 0.001)和感觉神经动作电位(SNAP 振幅)(BF%;r = -.239,BMI;r = -0.350,P = 0.001)。 神经传导参数会受到以体重指数(BMI)和体重指数(BF%)定义的肥胖程度的显著影响。因此,结合 BMI 和 BF% 评估可为 CTS 的严重程度和管理提供更多临床信息。这些指数的真正预测价值有待进一步阐明。
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引用次数: 0
Response to “The h-Index: Understanding its predictors, significance, and criticism” 对 "h 指数:了解其预测因素、意义和批评"
Pub Date : 2024-04-01 DOI: 10.4103/jfmpc.jfmpc_1871_23
Sudip Bhattacharya
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引用次数: 0
An uncommon presentation of segmental Becker’s nevus involving the T4 dermatome 涉及 T4 皮节的节段性贝克痣的罕见表现
Pub Date : 2024-04-01 DOI: 10.4103/jfmpc.jfmpc_1646_23
M. N. Arvind, Avinash H. Rajanna, Mahesh S. Kanth, Aditya Chandrashekar
ABSTRACT This case report explores a rare manifestation of Becker’s nevus, where the patient exhibited an unusual dermatomal distribution featuring a hyperpigmented, irregular patch with associated hypertrichosis on the T4 segment. While Becker’s nevus is a well-known dermatological condition typically observed in the upper back region, instances of dermatomal distribution are exceptionally uncommon. This case presents a unique occurrence of segmental Becker’s nevus, highlighting the atypical presentation of this condition.
ABSTRACT 本病例报告探讨了贝克尔痣的一种罕见表现,患者表现出不寻常的皮肤分布,其特点是色素沉着、不规则斑块,并伴有 T4 节段肥厚。虽然贝克痣是一种众所周知的皮肤病,通常发生在上背部,但皮损分布异常罕见。本病例展示了一种独特的节段性贝克痣,突出了这种疾病的非典型表现。
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引用次数: 0
Investigation of the frequency and relationship between trichomonas infection in the preterm delivery (a case-control study in Amir Al-Momenin Hospital, Semnan) 早产中滴虫感染的频率及其关系调查(塞姆南省阿米尔-穆明宁医院病例对照研究)
Pub Date : 2024-04-01 DOI: 10.4103/jfmpc.jfmpc_1411_23
Elham Saffarieh, Shabnam Tarahomi, Shaghayegh Pazoki, Ali Khaleghian
ABSTRACT Preterm delivery is a common complication during pregnancy periods and imposes a high cost on the healthcare system due to the care needs of premature babies. Sexually transmitted infections are one of the effective factors in the occurrence of preterm delivery and the diagnosis and treatment of these infections are effective in reducing complications and preventing preterm delivery. In this study, the role of Trichomonas vaginalis (T. vaginalis [TV]) infection in preterm delivery has been evaluated. In a prospective case–control study, women with preterm birth were assigned to the case group, and women with full-term delivery on the same day were also assigned randomly to the control group. After receiving the history and physical examination, a sample was taken from the cervix for TV culture. The data were included in the SPSS version 23 software. A significance level of less than 0.05 was considered. The overall prevalence of this infection was 10%. The prevalence of chlamydial infection was 2% among mothers with full-term delivery and 16.4% among mothers with premature birth, and there was a significant difference between the two groups (P = 0.021). The logistic regression analysis to determine the effect of Trichomonas infection on premature birth showed that there was the probability of the occurrence of premature delivery increases in mothers with trichomoniasis infection with lower age, higher body mass index, the presence of underlying disease, lower educational level, housewives, lower parity and gravity and having a history of fetus abortion more than 13 times with its occurrence probability occurs in mothers without Trichomonas infection (P = 0.046, Exp (β) =13.266). According to the present results, TV screening for pregnant women, especially in high-risk groups, is emphasized to reduce the incidence of preterm delivery and related complications, especially neonatal complications.
摘要 早产是孕期常见的并发症,由于早产儿需要护理,给医疗系统带来了高昂的成本。性传播感染是早产发生的有效因素之一,诊断和治疗这些感染可有效减少并发症和预防早产。本研究评估了阴道毛滴虫(T. vaginalis [TV])感染在早产中的作用。 在一项前瞻性病例对照研究中,早产产妇被分配到病例组,同一天足月分娩的产妇也被随机分配到对照组。在接受病史和体格检查后,从宫颈取样进行 TV 培养。数据均纳入 SPSS 23 版软件。显著性水平小于 0.05。 这种感染的总体发病率为 10%。足月分娩母亲的衣原体感染率为 2%,早产母亲的感染率为 16.4%,两组之间存在显著差异(P = 0.021)。为确定滴虫感染对早产的影响而进行的逻辑回归分析表明,感染滴虫的母亲中,年龄较小、体重指数较高、存在基础疾病、受教育程度较低、家庭主妇、奇数和重力较低、胎儿流产史超过 13 次的母亲发生早产的概率增加,而未感染滴虫的母亲发生早产的概率为 13.266(P=0.046,Exp(β)=13.266)。 根据本研究结果,应强调对孕妇,尤其是高危人群进行电视筛查,以降低早产及相关并发症,尤其是新生儿并发症的发生率。
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引用次数: 0
Nutritional experiences of postpartum mothers - A qualitative study 产后母亲的营养经验 - 一项定性研究
Pub Date : 2024-04-01 DOI: 10.4103/jfmpc.jfmpc_904_23
Shainy Sravanthi Bathula, Kanta Helena, Krishnaveni Avvaru
ABSTRACT The postpartum period is crucial for both mother and infant as additional maternal nutrition needs to support the needs of self and that of an infant in the form of adequate breastfeeding. The dietary choices of women during the postpartum period were heavily influenced by traditional cultural beliefs surrounding these periods. To explore the experiences regarding postpartum nutrition and various nutritional practices during this period. The study was a community-based cross-sectional qualitative study performed in the urban field practicing area of Government Medical College during the months of October and November 2022 on postnatal mothers who have crossed not more than one month of completion of their postpartum period (first six weeks of delivery). Two focus group discussions (FGDs) and 15 in-depth interviews (IDIs) were conducted with the postnatal mothers and their caregivers using a pre-prepared semi-structured discussion guide comprising open-ended questions. Each interview/discussion was recorded electronically after taking verbal consent. The recorded responses were transcribed verbatim and translated into English. The data were analyzed thematically and were grouped into a few broad themes. Most mothers followed strict dietary restrictions for the first 15 days of delivery. Fruits were avoided by many of the mothers. The mothers took iron-rich foods like jaggery and green leafy vegetables in excess. Protein-rich foods like meat, egg, fish, and dal were avoided by most of the mothers. The beliefs of the mothers and caregivers about various food items were that they may cause ill health to mother and baby, considered as hot and cold foods and also out of ignorance. Most of the practices were beneficial to the mother and a few of them were harmful like avoiding protein-rich foods, few vegetables, most fruits, and night meals. The harmful nutritional practices can be addressed by educating the mother and also the caregiver who prepares the puerperal diet.
摘要 产后时期对母亲和婴儿都至关重要,因为母亲需要额外的营养来满足自身和婴儿的需要,并通过适当的母乳喂养来满足婴儿的需要。妇女在产后期间的饮食选择在很大程度上受到围绕这些时期的传统文化信仰的影响。 本研究旨在探讨产后营养方面的经验以及产后期间的各种营养做法。 该研究是一项以社区为基础的横断面定性研究,于 2022 年 10 月和 11 月期间在政府医学院的城市实习区进行,对象是产后未满一个月(分娩后前六周)的产后母亲。 利用事先准备好的半结构化讨论指南(包括开放式问题),对产后母亲及其护理人员进行了两次焦点小组讨论(FGD)和 15 次深入访谈(IDI)。在征得口头同意后,每次访谈/讨论都进行了电子录音。 记录的回答被逐字转录并翻译成英文。我们对数据进行了专题分析,并将其归纳为几个大的主题。 大多数母亲在产后 15 天内严格遵守饮食限制。许多母亲都避免吃水果。母亲们过量摄入富含铁的食物,如琼脂和绿叶蔬菜。大多数母亲避免食用富含蛋白质的食物,如肉、蛋、鱼和豆类。母亲和看护人对各种食物的看法是,它们可能会对母亲和婴儿的健康造成不良影响,被认为是冷热食物,也是出于无知。 大多数做法对母亲有益,少数有害,如避免食用富含蛋白质的食物、少量蔬菜、大多数水果和夜餐。有害的营养做法可以通过教育产妇和准备产褥期饮食的护理人员来解决。
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引用次数: 0
Developmental delay in a community setting: Role of a primary care physician 社区环境中的发育迟缓:初级保健医生的作用
Pub Date : 2024-04-01 DOI: 10.4103/jfmpc.jfmpc_1708_23
Manish Taywade, Payel Roy, Pankaj K. Mohanty
ABSTRACT The early part of childhood especially the first 1000 days plays an essential role in the growth and development of the child. Various internal and external factors affect the child’s development, including genetic factors, socioeconomic status, sociocultural environment, maternal mental health, and the parenting environment. There is a high prevalence of developmental delay 17.6% globally, whereas in India, it is around 6.6%. Numerous screening tools are available to detect developmental delay in the child early. Early identification and intervention are crucial because we can have a better outcome for the child if intervention is performed on time. The children can be identified during the postnatal follow-up period. Literature has shown that few parents take their children for regular developmental assessment after delivery. Identifying the developmental impairment early from a primary care physician’s point of view is essential. In India under the Rashtriya Bal Swasthya Kariyakram (RBSK), the children are screened at home, Anganwadi centers, and schools to detect at-risk children under 4D’s, so that early intervention can be planned by linking them to District Early Intervention Center.
摘要 童年早期,尤其是最初的 1000 天,对儿童的成长和发展起着至关重要的作用。影响儿童发育的内部和外部因素多种多样,包括遗传因素、社会经济地位、社会文化环境、母亲心理健康和养育环境。全球发育迟缓的发病率高达 17.6%,而印度的发病率约为 6.6%。有许多筛查工具可以及早发现儿童的发育迟缓。早期识别和干预至关重要,因为如果能及时进行干预,就能为儿童带来更好的结果。可以在产后随访期间对儿童进行识别。文献显示,很少有家长在产后定期带孩子进行发育评估。从初级保健医生的角度来看,及早发现发育障碍至关重要。在印度,根据 Rashtriya Bal Swasthya Kariyakram(RBSK)计划,在家庭、Anganwadi 中心和学校对儿童进行筛查,以发现 4D 以下的高危儿童,从而将他们与地区早期干预中心联系起来,计划进行早期干预。
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引用次数: 0
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Journal of Family Medicine and Primary Care
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