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   Table of Contents - Current issue
Coverpage
July-December 2022
Volume 8 | Issue 2
Page Nos. 81-160

Online since Saturday, December 31, 2022

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INVITED EDITORIALS  

Secondhand smoke: An unintended public health concern Highly accessed article p. 81
Suneela Garg, Akash Deep Sharma
DOI:10.4103/ijcfm.ijcfm_64_22  
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Publication ethics p. 86
Shashi Kant
DOI:10.4103/ijcfm.ijcfm_66_22  
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REVIEW ARTICLE Top

Health-related quality of life: The neglected facet of women's health in India p. 88
Pallika Singh, SK Rasania
DOI:10.4103/ijcfm.ijcfm_86_21  
Quality of life (QoL) is a multidimensional concept and an essential health component that usually includes both positive and negative aspects of life. The measure of health-related QoL (HRQOL) enables health agencies and social partners to address areas of public health importance and formulate policies which eventually demonstrate the impact of health on QoL. Women form an important pillar of society as they are the primary caretaker of children and elders in every country of the world and therefore, the QoL of women determines the health of the next generation and future public health challenges for families, communities, and the health-care system. Providing health services at par with quality is the need of the hour and a very important health goal considering women's health. Poor delivery of clinical care, failure to meet the professional standards of patient care by health-care providers, mistreatment and abuse by health-care professionals, and inequitable delivery of care are some of the key issues in the delivery of quality maternal health-care services in India and therefore primary health-care professionals should be made familiar with the concept of the HRQoL in the community they are serving. Indian health-care systems need to address to the inequalities and taking off the consumer-centric, market approach of privately run corporate health facilities along with setting up of accountability of all the stakeholders to provide quality care, especially in the government-run facilities and creating a promising environment in health care for women focusing on pregnant and postpartum mothers.
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ORIGINAL ARTICLES Top

Knowledge, awareness, and risk prevention among hepatitis patients attending a tertiary care hospital in Delhi p. 93
VK Tiwari, P Balsundaram, T. P. Sherin Raj
DOI:10.4103/ijcfm.ijcfm_9_22  
Introduction: People living with chronic viral hepatitis in India often lack awareness on risk factors and prevention. Moreover, due to fear of stigma and discrimination, they often delay appropriate and timely treatment, resulting in chronic treatment and impoverishment. The objective of this study is to assess knowledge, awareness, and prevention regarding risk factors among viral hepatitis-infected patients attending a super-specialty hospital in Delhi. Material and Methods: Data were collected from 389 patients using systematically random sampling using a pretested, structured interview schedule from patients attending Institute of Liver and Biliary Sciences, New Delhi. Results: Findings revealed that 90.7% of the respondents believed that hepatitis B virus/hepatitis C virus (HBV/HCV) can be transmitted through sexual contact with a person who is infected, 94.3% said that it can be transmitted by transfusion of infected blood, 90% reported that it can be spread from infected mother to child during child birth, 93.8% responded that it can be transmitted if a person uses a razor, pierced ear ring, needle, or syringe used by an infected person, 83% believed that HBV/HCV can cause cancer in 90% of the respondents in long run, and more than 35% believed that HBV/HCV is curable. Results also show that 7.2% of the respondents have been vaccinated for HBV infection in the past, 20.8% of the respondents have screened their families for hepatitis B infections, and 77.9% of the respondents have received antiviral medications. Conclusion: HBV/HCV-infected patients had less knowledge about various facts regarding disease and continue to experience emotional disturbances, stigma, and discrimination.
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Utilization of modern family planning methods among women of reproductive age group in North-Central Nigeria; rural – urban comparison p. 99
Ikrama Hassan, Changkat Lucky, Anazodo Michael, Odonye Eselema Caleb, Kwakipi Hellen, Ezeala Adaku, Lawal Abdulmumuni Ahmed, Tomen Ezekiel, Joshua Anna, Bello Surajudeen Oyeleke
DOI:10.4103/ijcfm.ijcfm_61_21  
Introduction: Contraception is one of the most successful developmental interventions, unique in women empowerment and population control. Family planning (FP) reinforces the right to determining the number and spacing of children. Hence, we determine the utilization of modern FP methods among urban and rural dwellers. Material and Methods: This is a cross-sectional study of reproductive age women in Lafia, Nigeria. Ten primary healthcare centers (PHCs) each were selected from the urban and rural locations over 6 months using multi-staged sampling technique. Questionnaire was administered, and the data were analyzed using SPSS V 23. P < 0.05 was considered significant. Results: Most participants were aged between 20 and 29 years. The prevalence of using modern methods of FP was 17.3%. More than three quarters of urban women are using contraceptives compared with one quarter of rural women. There was a difference between those who ever used measures to delay pregnancy and their locations, P = 0.049. Women in the rural areas use the cycle beads, while those in the urban areas use the injectables. Need for more children was the most common reason for discontinuing FP, others are FP failure, absence of spouse, and fear of side effects. Age of the participants was found to be a good predictor of using modern FP method, P = 0.022. Conclusion: There is low prevalence of modern FP utilization in this study despite knowing where to access the services (PHCs). Three of four urban women are using FP compared with one out of four among rural women. The cycle beads and the injectables were the most common methods. Age is a major determinant of using FP.
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Assessment of sleep quality among postgraduate residents of a tertiary care hospital in Kashmir: Using the Pittsburgh Sleep Quality Index p. 106
Awhad Mueed Yousuf, Tanzeela Bashir Qazi
DOI:10.4103/ijcfm.ijcfm_53_22  
Introduction: The Postgraduate medical training is long and emotionally taxing. These occupations are associated with stress and good workload along with night shifts which effects the sleep quality. Studies have documented that high levels of stress among medical residents have been associated with sleep problems. Our study aims to investigate sleep quality among the postgraduate residents of a tertiary care hospital using Pittsburgh Sleep Quality Index. Material and Methods: It was a cross sectional study that was conducted from 1 November 2021 to 31 December 2021. Study participants included Postgraduate medical residents working at a tertiary care hospital in district Srinagar of Kashmir valley. A total of 400 participants took part in the study. Results: The mean age of the participants was 33.4 years (S.D 4.9). Majority of the participants (54%) were females. The mean global Pittsburgh Sleep Quality Index score (±SD) for sleep quality was 8.46 (±4.5) with a median score of 6 and Inter Quartile Range of 6.5. Conclusion: Poor sleep quality was reported in 75% of the residents. This highlights the need for awareness about this problem. There is a need for early interventions in order to introduce flexible working hours for medical residents and to provide shifts of manageable durations.
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Health insurance coverage and out-of pocket expenditure: A study among rural and urban households of Faridabad, Haryana p. 110
Mitasha Singh, Pooja Goyal, Sangeeta Narang, Abhishek Singh, Mansi Singal
DOI:10.4103/ijcfm.ijcfm_83_21  
Introduction: Catastrophic health spending is one of the major factors pushing people into poverty. Reducing “out-of-pocket expenditure (OOPE)” on health through health insurance coverage is an effective approach. The objectives of this study are (1) to estimate health insurance coverage among rural and urban households (HHs) and (2) to determine the proportion of income spent on health as OOPE among the selected HHs. Material and Methods: A cross-sectional study was conducted in rural and urban parts of district Faridabad, Haryana. A sample of 374 were taken from rural and urban areas. The unit of the study was HHs in both the areas. The proportion of income spent on health care (both direct and indirect expenses included) as OOPE was taken as outcome variable. Results: Health insurance coverage was higher among urban HHs (58.0%) as compared to the rural (38.5%). The rural population was availing of private consultation, laboratory, and pharmacy services to a greater extent than the urban; hence, they were spending a substantial proportion of their income on health-care services. The majority of the HHs in the rural and urban areas spent up to 20% of their income on health care. Conclusion: Universal health coverage without health insurance is unlikely.
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Morbidity profile and dynamics of determinants of health-seeking behaviour in geriatric population of Chandigarh, India p. 115
Sonia Puri, Praizy Bhandari, NK Goel, Munish Kumar Sharma, Sarabmeet Singh Lehl, Monica Gupta
DOI:10.4103/ijcfm.ijcfm_77_21  
Introduction: Aging is a natural process that usually results in physiological, biological, emotional, and financial decline. As a result, a robust health system is required to meet their escalating health needs. Through this study, we got an opportunity to study the morbidity profile of the elderly and to assess their health-seeking behavior and its determinants in urban areas of Chandigarh. Material and Methods: The sample consisted of 360 participants. Multistage and proportionate sampling techniques were used to recruit study subjects. A structured interview was carried out to get information on the different parameters of health-seeking behavior of the elderly population. Results: The most pervasive determinant of health-seeking behavior was perceiving health issues related to age, no family support, and health-care expenditure. Conclusion: The elderly had a positive behavior toward seeking help with regard to health care. Multiple morbidities were evident among the elderly, and modern medication was the greatest choice. Improved perspective toward health, easy accessibility, and awareness regarding the disease may contribute to the willingness of seeking help for the health-care needs.
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Evaluation of prescribing pattern based on World Health Organization indicators in Maharashtra during COVID-19 pandemic p. 121
Sharon Jacob, Rajendra Malviya, Swati Sandhan, Prasanna Deshpande
DOI:10.4103/ijcfm.ijcfm_100_21  
Introduction: Community pharmacy (CP) is one of the health care centers that have a key role to play in the current COVID-19 pandemic period. Prescriptions monitoring studies are essential as this helps in understanding the current prescribing pattern adopted by physicians. Furthermore, only few CP-based research studies were noted. This study was conducted with an aim to study prescribing pattern using World Health Organization (WHO) indicators from few community pharmacies in Maharashtra, India, during COVID-19 Pandemic period. Material and Methods: An observational study was conducted and sample comprised of prescriptions collected from different parts of Maharashtra (Mumbai, Pune. and Nashik). One thousand and fifty-six prescriptions were collected and data was collected for a period of 6 months (August 2020–January 2021). The variables of interest in this study were: Number of medications in each prescription, number of prescriptions with generic names, number of antibiotics and injectables in each prescription, number of prescribed drugs from essential drug list (EDL), and defined daily dose (DDD). Results: Out of 3058 drugs prescribed, it was found that average number of drugs per prescription was 2.89 (standard deviation ± 1.37). Only 23 (0.75%) were prescribed by generic name. Antibiotics and injectables were 399 (37.78%) and 29 (2.74%), respectively. Drugs that were prescribed from EDL were only 920 (30.08%). The total class of antimicrobial agents prescribed (Anatomical Therapeutic Chemical group J01) was 13. After calculating DDD, DDD of Azithromycin was found to the highest (81.6 g). Conclusion: Among five WHO indicators, only the percentage of encounters with an injection was in compliance with the WHO recommended value. Further studies are required for better understanding of this area.
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Prevalence, patterns, clinico-social, and behavioral factors associated with the consumption of sugar-sweetened beverages among undergraduate medical students of central India p. 129
Soumya Kanti Mandal, G Revadi, Darshan Parida, Anindo Majumdar
DOI:10.4103/ijcfm.ijcfm_94_21  
Introduction: Excessive consumption of sugar-sweetened beverages (SSBs) in adolescents has become a global issue. As its link to obesity and noncommunicable diseases is clear, it is imperative to understand SSB consumption behaviors in the future health-care professionals. The objective of this study is to document the prevalence, patterns, and clinico-social and behavioral factors predicting high intake of SSBs among medical students. Material and Methods: This cross-sectional study was conducted using a self-reported, web-based, questionnaire. All the students and interns who were part of a publicly funded premiere teaching hospital between October and November 2019 were included in this study. The semi-structured questionnaire enquired regarding socio-demographic, clinical details, amount, behavioral patterns, and money spent in connection with SSB consumption. Data were analyzed using IBM SPSS version 24. Results: The mean age of participants was 19.3 ± 1.6 years, 71.7% being males. The current prevalence of SSB consumption was 90.5%. Furthermore, 49.9% and 29.1% of participants preferred soft drinks and sweetened fruit juice, respectively. Multivariate analysis showed that male gender (adjusted odds ratio [aOR]: 1.83, (1.03–3.25), current alcohol consumption (aOR: 4.09, 1.25–13.42), and recent (last week) consumption of a SSB predicted high intake of SSBs [aOR: 7.36, (3.41–15.87)] whereas, preference of energy/sports category of drinks predicted low intake of SSBs [aOR 0.10, (0.02–0.47)]. Conclusion: The consumption of SSBs among medical students was high. Targeted health education and behavior change interventions should be provided to males, alcohol users, and frequent consumers.
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Oral health status and oral health related quality of life in Kodhu tribes – A descriptive cross sectional study p. 137
Prathyusha Chatti, Vamsi Krishna Reddy, Vineela Parlapalli, Siva Kumar Pydi, Adithya Teja Prasad Pallekonda, Karishma Janapareddy
DOI:10.4103/ijcfm.ijcfm_91_21  
Introduction: In this modern era, a significant group of people is living in isolated hilly areas far away from civilization with their custom and beliefs. They are known as “tribes.” “Kodhu” tribe is one of the major Indian tribes present in the remote areas of Visakhapatnam. The objective is to assess the oral health status and oral health-related quality of life and education level in Kodhu Tribe in residing in Araku and Paderu regions of Visakhapatnam. Material and Methods: A descriptive cross-sectional study was conducted among the Kodhu tribal population situated in the Araku and Paderu areas Visakhapatnam, Andhra Pradesh. The study comprised of 800 participants selected using a simple random sampling technique. Chi-square test was used to assess the oral health status of the tribal population, while, independent t-test was used for multiple comparison of OHIP-14 and oral health status. A p-value ≤ 0.05 was considered statistically significant. Results: Among 800 participants, 458 were illiterate, and 342 were literate. The prevalence of dental caries was 49% among the illiterates while literates had 50.4% prevalence and the difference was statistically significant (P < 0.03). The periodontal status prevalence was found to be higher in illiterates (56.4%). The domains that are present in OHIP were found to be significantly associated with dental caries, periodontal status, and oral mucosal lesions (P < 0.001). Conclusion: The oral health status of Kodhu tribe was found to have high prevalence of the periodontal disease and dental caries. Regular oral examination by dental professionals, dental health education, and motivation to maintain oral hygiene should be insisted to improve the oral health status of this tribal community.
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Could mid-upper arm circumference be a valid proxy to the body mass index for elderly persons? p. 143
Anil Kumar Goswami, Ramadass Sathiyamoorthy, Kalaivani Mani, Shashi Kant, Sanjeev Kumar Gupta
DOI:10.4103/ijcfm.ijcfm_23_22  
Introduction: In elderly persons, due to physiological, anatomical, and functional changes, body mass index (BMI) may not be suitable for the assessment of nutritional status. Mid-upper arm circumference (MUAC) can be a proxy indicator to identify underweight and overweight/obesity among elderly persons. This study aimed to estimate the correlation between MUAC and BMI, and the cutoffs for MUAC using receiver operating characteristic (ROC) analysis. Material and Methods: This survey was carried out in a resettlement colony of Delhi. The participants were residents of the area who were aged 60 years or older, and selected by a simple random sampling technique. The arm span, weight, and MUAC of the participants were measured. The correlation between MUAC and BMI for gender and age group was calculated. The ROC curve was also constructed. Results: A total of 946 eligible participants were enrolled. The correlation between MUAC and BMI was 0.67 (P < 0.001) and 0.76 (P < 0.001) among men and women, respectively. The MUAC cutoff for underweight was <25 cm with a sensitivity of 68.8% and specificity of 84.9%. The area under the curve (AUC) was 0.84 (0.80–0.88). The MUAC cutoff for overweight/obesity was ≥27 cm with a sensitivity of 83.9% and specificity of 64.9%, and AUC was 0.78 (0.75–0.82). Conclusion: The MUAC of the participants increased as the BMI of the participants increased. MUAC cutoff was determined using the ROC curve for underweight and overweight/obesity among elderly persons.
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A cross-sectional study of musculoskeletal disorder and their environmental determinants among cycle rickshaw pullers of Delhi: A geographical information system-based analysis p. 148
Nitesh Kumar, SK Rasania, Anita Shankar Acharya, Nazish Rasheed
DOI:10.4103/ijcfm.ijcfm_44_22  
Introduction: Rickshaw pulling is among the major activities in the informal sector. Cycle rickshaw pulling involves the task of prolonged sitting, fixed posture, and vibrations which could increase the risk of developing many health problems including one of the major problems of musculoskeletal disorder (MSD). Rickshaw pulling remains important for urban transport system, and such activities contribute in terms of employment and transportation services. The injury and illness resulting from work leads to lower productivity and quality employment which force them to increase their daily hours of working. The work environment and various other environmental determinants for MSD were assessed. The spatial variability of these environmental determinants and MSDs of cycle rickshaw pullers was studied in Delhi. Material and Methods: A cross-sectional study was conducted among cycle rickshaw pullers of Delhi. Five districts were randomly selected, and out of 448 study subjects, a total of 425 were included in the study. Consent was obtained before the study. The Nordic Musculoskeletal Questionnaire instrument for MSDs was used. The spatial distribution of MSD and risk factors was studied using QGIS software. Results: MSD was observed in 51.5% of the cycle rickshaw pullers and the prevalence increased with age from 9.6% to 34.7%. A statistically significant association of MSD with duration of work, sleeping hour, and sleeping place was observed. Poor road condition and posture were also having an association with MSD. Conclusion: Every second cycle rickshaw puller was having MSD. Lifestyle, road conditions, harsh environmental condition, strenuous physical exertion, and ergonomics of the cycle rickshaw were important factors contributing for MSD.
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MEDICAL EDUCATION Top

Challenges of objective structured clinical examination as a tool in medical assessment p. 156
Priyamadhaba Behera, Gokul Gopi, Archana Siddaiah, Pooja R Sridhar, Binod Kumar Patro, Sonu Hangma Subba
DOI:10.4103/ijcfm.ijcfm_12_22  
Medical education is witnessing changes across the globe to produce more competent and responsive medical graduates to meet patients' growing needs. Medical educators are aspiring for more objective and relevant assessment methods for the evaluation of medical graduates. Objective structured clinical examination (OSCE) introduced in the year 1975 for clinical evaluation has gone through many changes over the past 45 years and matured over time. The article describes the challenges of OSCE as a tool in medical assessment from students' and organizers' perspectives. We have also suggested a feasible solution to address the challenges while conducting OSCE to assess medical students.
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