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   Table of Contents - Current issue
Coverpage
July-December 2019
Volume 5 | Issue 2
Page Nos. 83-163

Online since Thursday, December 19, 2019

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EDITORIAL  

Community physicians: Words, actions and outcomes: TRP5 p. 83
Vikas Bhatia, Susmita Dora
DOI:10.4103/IJCFM.IJCFM_85_19  
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REVIEW ARTICLE Top

Changing world, changing trusts and health providers' sufferings p. 86
Shakunatala Chhabra
DOI:10.4103/IJCFM.IJCFM_26_19  
Workplace violence (WPV) is a serious problem anywhere, but is one of the most complex issues in health settings. Many factors contribute to WPV is health setting, health workers functioning in stressful environment, 24-h access to many, presence of drugs, and human sufferings with limitations in care. Violence may take a variety of forms, verbal aggression to physical assault, use of deadly weapons against physicians, others, and even patients. It is, therefore, associated with a variety of risks to workers safety, as well as organizational liability. The objective was to know happenings and challenges in the prevention of violence against health providers. This simple review of available studies and opinions was done by using Uptodate, ERMED CONSORTIUM, Cochrane Library, Delnet, and MedIND, and self-experiences were added. Physical violence (PV) against doctors and other health personnel is increasingly being reported. It is believed that more than 75% of doctors face violence during their practice. Almost half of the violent incidents occur in critical care units. WPV has been categorized into physical and mental, but all types of violence are destructive, in one or other way. There is evidence that female health workers are exposed to PV more often than others. It is essential to identify risk factors in order to prevent and manage WPV against health providers. Reasons for violent outbursts include inadequate workforce, infrastructure to treat patient load, and long waiting times. Many health personnel never report exposure of violence to anyone because of various reasons including perception that reporting was useless. Though it is difficult to completely eliminate violence in health-care settings, and although there is no “one-size-fits-all” approach for prevention, there are many ways to reduce the potential for violent occurrences and to minimize the impact if violence does occur.
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PERSPECTIVES Top

Theme of World Health Day continued for the 2nd year in row (2018–2019) – What it means to India p. 92
Pushpa , Dewesh Kumar, Vidya Sagar, Vivek Kashyap, Anju Prabha Kumari
DOI:10.4103/IJCFM.IJCFM_71_19  
Every year, the World Health Organization (WHO) celebrates World Health Day with a particular theme to aware the masses about the subject and focus on its relevance. For the past 2 years (2018–2019), the WHO has kept the theme same considering its prime importance in the contemporary world. The theme “Universal Health Coverage: Everyone Everywhere” is very pertinent for developing countries like India where universal access to adequate health care is a distant dream. Increasing health-care needs with high out-of-pocket expenditure is not allowing the public to move out of poverty. In contrast to continuous rise in the demand for health care, the supply side in India is not prepared to meet the challenges of complex determinants of health. In the past, there have been several interventions in the form of health insurance schemes with its own challenges of fragmentation of risk pools and no linkages with primary health care. Considering these challenges, the Government of India (GOI) has adopted a two-pronged strategy under the ambit of Ayushman Bharat Program. The first approach is upgrading primary health centers and subcenters to health and wellness centers and the second is the launch of Pradhan Mantri Jan Arogya Yojana. Through this program, GOI aims to achieve universal health coverage by 2022 which is achievable, but the challenges in reality are immense.
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Indicators of scientific impact: The need for a tectonic shift p. 97
Sujiv Akkilagunta, Pradeep Deshmukh, Vikas Bhatia
DOI:10.4103/IJCFM.IJCFM_12_19  
The proliferation of research witnessed in the past couple of decades has increased the need for distinguishing the impact of publications. As it could take a long time for a scientific finding to be translated into action, surrogate measures are sought after. Citation of a published work is often considered the ideal surrogate measure. The growth of social media and the use of published work in policy documents and news media have called for other alternate measures. The measures of scientific impact are formulated into impact indicators. Journal impact factor is a widely known indicator of scientific impact. Initially intended for the purpose of rating journals, it is often used for rating the article and the author. Impact factor is an average and is influenced by the outliers. The field of research, citation index, and the problem of deliberate self-citation influence it. The h-index, an author-level metric, should be interpreted with other complementary indices such as the e-index and q-index. Altmetric Attention Score, a novel indicator which uses alternative measures of impact such as used in social media, discussions, and policy documents, is a promising indicator.
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Swachh Bharat Abhiyan – A long journey to achieve a big dream p. 100
P. Karpaga Priya, Ashwini Katole, Gouri Kumari Padhy
DOI:10.4103/IJCFM.IJCFM_49_19  
Even after 70 years of independence, poor state of sanitation glares as one of the challenges of India. The government has tried to establish a well functioning sanitation program in the country since 1954. This program has undergone lot of changes since then and in 2014 it was renamed as Swachh Bharat Abhiyan. In order to promote safe water practices, several pipelines were installed and rivers were cleaned. Imposing Swachhta Abhiyan for carrying out activities, conducting several training programs and workshops, opening of Pink toilets, Namami Ganga, Swachh Vidyala are few of the worth mentioning initiatives under the program. Though the services are being provided at door-steps and the citizens are supported financially for toilet construction, the actual proportion of people using these toilets is under debate. Swachhata Pakhwada is being celebrated twice a year. Post celebration observance of safe disposal of waste and minimal usage of plastic is questionable. Achieving an open defecation free nation with assured safe sanitation is an initiation from the government and acceptance by the population. Implementation of these programs can only lead India becoming one of the cleanest countries in the world.
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MEDICAL EDUCATION Top

Role of smartphone technology in medical education in India p. 103
Ankit Chandra, Baridalyne Nongkynrih, Sanjeev Kumar Gupta
DOI:10.4103/IJCFM.IJCFM_42_19  
Introduction: In this era of technology, a smartphone has become a powerful tool. It is often used in communication and entertainment. It has a significant role in medical education, too. Objective: The objective of this study was to discuss the use of smartphone in medical education, its advantages and disadvantages, and challenges to its widespread use in this field. Material and Methods: A review of the literature was done in PubMed and Google Scholar for the articles related to our objective. Results: A smartphone can help a student in acquiring the study material (books, videos and updates), making better notes/record and for searching answers. It has the advantage of easily fitting into the pocket, improving the accessibility to the internet, and can be used as a mini-computer to edit documents. In the field of medical research, a smartphone can ease the review of literature and data collection. It is beneficial in resource constraint settings; help in integration of specialities and uniformity in teaching. However, it has certain disadvantages like being a costly device with a limited lifespan, prone to theft or damage, can cause dependency, information overload, distraction during class, increase in screen time, and can cause straining of eyes or sleep disturbances. Several studies have shown medical students using it for studies and they have a positive attitude toward it. Conclusion: Smartphone technology can be revolutionary for medical education if used aptly. There are certain challenges in the implementation of a smartphone in medical education in India which can be addressed through certain measures.
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ORIGINAL ARTICLES Top

Effect of teaching communication skills to medical undergraduate students: An exploratory study p. 108
Rakesh K Nayak, Deepti M Kadeangadi
DOI:10.4103/IJCFM.IJCFM_66_19  
Introduction: Good communication skills are an essential component of physician training. Effective communication between the doctor and the patient leads to better compliance, better health outcomes, decreased litigation, and higher satisfaction both for doctors and patients. Traditional medical teaching imparts students with theoretical and practical knowledge of diseases process, diagnostic and treatment modalities but does not address communication skills, which are most essential in dealing with patients. Material and Methods: The present randomized control study was conducted in a Medical College of North Karnataka. A total of 60 students participated who were randomly assigned into two groups. Attitude toward learning communication skill was assessed using the Communication Skills Attitude Scale (CSAS). Pre- and post-assessment of communication skill was done using the Kalamazoo Essential Elements Communication Checklist. Results: All the study participants (n = 60) were 3rd-year MBBS students with the mean age of 21 ± 1.8 years. The CSAS median score for positive attitude was 57.5 and for negative attitude was 25 (minimum score = 13 and maximum score = 65). Significant difference was noted in the study group after training in communication skills (P < 0.01) compared to the control. Conclusion: Adequate training in communication does improve the skills of medical students and help in better relationship with patients.
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Education to increase early detection and myths about cancer among population in sub-district Medan Selayang Indonesia p. 114
Sry Suryani Wdjaja, Rusdiana , Maya Savira
DOI:10.4103/IJCFM.IJCFM_32_19  
Introduction: Cancer is estimated to affect about 14 million new cases globally each year. In Indonesia, the incidence is estimated at about 347,000 new cases each year. Most cancer patients seek medical advice only at advanced stage due to ignorance and lack of knowledge. Aims: This is a community service study with the aim to conduct the training of tutor (TOT) of social health-care workers about awareness, early detection, and myths of cancer in subdistrict Medan Selayang, Indonesia. Settings and Design: This is a community service study. Material and Methods: Two hundred and five social health-care workers were trained on “Early Detection and myths about cancer” covering six sessions in six rural areas. A competition was held after 1 month of training. Statistical Analysis Used: t-test was used to perform the statistical analysis. Results: There was a statistically significant increase (P = 0.03) in Inspeksi visual asam asetat (IVA) participants (n = 95) in 2018 compared to 2017 (n = 26). Most of the 2017 participants were around 30 years and 45 years old (65%) and were not well educated (63%). The myths of cancer among the participants was assessed as good (20%), average (30%), and below expectation (50%). Conclusion: TOT of social health-care workers shows a good response on educating people about early detection and myths of cancer. Social health-care providers play an important role in improving community health care.
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Quality of life after myocardial infarction in women from rural India p. 117
Yashvi Gupta, Anjalee Anil Chiwhane
DOI:10.4103/IJCFM.IJCFM_33_19  
Introduction: Health expenditures in survivors of myocardial infarction (MI) causes increased financial burden. Secondary prevention strategy can be planned with knowledge of health-related quality of life (HRQoL) in survivors of MI. Aim: To study HRQOL using Mac New Heart questionnaire. Objective: Female survivors of MI will undergo the questionnaire and the scores across physical, social and emotional domains will be noted. Material and Methods: Observational study. Female survivors of MI attending follow up in cardiac outpatient department between January 2017 and January 2018 were subjected to MacNew Heart Disease HRQoL questionnaire. Statistical Analysis Used: Pearson's correlation coefficient; software used was SPSS 22.0 version. Results: Mean age 60 years; mean duration since MI – 7.88 months; 74% were married and 88% on vegetarian diet. Those women with mean age of 40 years, vegetarian and married had better mean scores. The emotional score improved over a period of time whereas the physical and social score remained the same. Conclusion: Female survivors above 40 years showed poor scores across all three domains and therefore need early cardiac rehabilitation as also long-term follow up.
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Evaluation of knowledge and awareness regarding usage of mcp card amongst health functionaries and beneficiaries p. 123
Veena Melwani, Manju Toppo, Amreen Khan
DOI:10.4103/IJCFM.IJCFM_13_19  
Introduction: Mother and child protection (MCP) card has been developed as a tool to help families to know about various types of services which they need to access for the health and well-being of women and children. The auxiliary nurse-midwife (ANM)/anganwadi worker (AWW) record the desired information in place provided in the card and the beneficiaries are pregnant women and mother/families of children up to 3 years of age. The present study was therefore undertaken with the objectives to assess the knowledge of health functionaries on appropriate usage of MCP card; to study the knowledge of beneficiaries about the MCP card and its importance in maternal and childcare. Material and Methods: This was a cross-sectional study, conducted from February 1, 2018 to April 30, 2018 on health functionaries at anganwadi center and beneficiaries of MCP card. One hundred and five anganwadis and 3 beneficiaries per anganwadi were selected using convenience sample consisting of one pregnant female, one mother/family member of child <6 months and one mother/family member of child between 6 months and 3 years. Data regarding sociodemographic details of health functionaries and beneficiaries along with data regarding usage of MCP card were assessed. Results: Overall knowledge regarding immunization was maximum (87.6%) among health functionaries, whereas knowledge regarding five cleans was minimum (10.5%). Only 56.3% and 76.5% AWW and ANM received orientation training regarding MCP card. Out of 315 beneficiaries, only 50.8% beneficiaries knew about correct validity of MCP card, i.e., 0–3 years and 190 (60.3%) beneficiaries found MCP card helpful during referral. Majority of beneficiaries wanted custody of MCP card to be with the mother or beneficiary themselves. Only 8.6% and 4.4% beneficiaries wanted custody of card to be with AWW and ANM, respectively. Conclusion: The MCP cards are being used adequately for keeping the background information, antenatal care provided to the mother, and immunization among both health functionaries and beneficiaries.
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Activity limitation and participation restriction in veterans of Indian Armed Forces: A cross-sectional study p. 129
V. K. Sashindran, Puja Dudeja, Vivek Aggarwal
DOI:10.4103/IJCFM.IJCFM_51_19  
Introduction: The armed forces provide lifelong medical benefits to all their veterans. As most of them are older, their health needs are quite different from those of serving personnel. Having led a relatively active and disciplined life in the services, their general health might also be better than that of their civilian counterparts. Unfortunately, there are no data available on the health of Indian military veterans. This study was planned to ascertain the level of activity limitation (AL) and participation restriction (PR) and determine factors affecting AL and PR. Material and Methods: This community-based, cross-sectional study was conducted among 406 veterans and their spouses aged 60 years and above residing in an urban housing society. House-to-house surveys were conducted. The study was done over 6 months (July–December 2016). Ethical clearance and informed consent were taken. The questionnaire used in the study was designed by incorporating elements from the International Classification of Functioning, Disability, and Health questionnaire and the WHO Disability Assessment Schedule. Results: Of the 406 veterans and their spouses surveyed, 188 (46.3%) were male and 218 (53.7%) were female. The majority of them were in the age groups of 61–70 years (175, 43.1%) and 71–80 years (173, 42.6%). Most of them were living with other family members with only 59 (14.5%) living alone. AL score was good or average in most of them (263 and 124, respectively), and it was bad or very bad in only a small number (11 and 8, respectively) Similarly, the PR score was good or average in 316 and 78 participants, respectively. Only 12 (2.8%) had a bad PR score. PR score increased significantly beyond the age of 80 years (P = 0.00). AL was more in males as compared to females. PR was more in those who were not married/divorced/single (P < 0.05). AL and PR were independent of the type of caregivers (P > 0.05). The most common ailments reported by males were body aches and pains, hearing defects, and problems related to micturition. Complaints of feeling low or depressed were significantly higher in females (P < 0.05). The top five causes of morbidity in the study population were hypertension (209, 51.5%), diabetes (125, 30.8%), defective vision (116, 28.6%), cataract (105, 25.9%), and dental problems (102, 25.1%). Conclusion: This study provides an insight into the magnitude of disease, impairment, and disability among veterans. Hypertension was the most common morbidity. Assessment of the AL and PR is useful planning geriatric care and educating caregivers and families to improve the quality of life of the elders.
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Nutritional status of pulmonary tuberculosis patients: A hospital-based cross-sectional study p. 134
Akanksha Shukla, Shivam Pandey, S. P. Singh, Jyoti Sharma
DOI:10.4103/IJCFM.IJCFM_39_19  
Introduction: Undernutrition among tuberculosis (TB) patients is associated with adverse treatment outcomes and increases risk of mortality. The nutritional status of pulmonary TB patients attending Outpatient Department of Combined Hospital, Thakurganj, Lucknow, Uttar Pradesh, India. Material and Methods: Two hundred recently diagnosed patients and those who were on intensive phase therapy were selected prospectively. A structured questionnaire was used to collect sociodemographic, lifestyle, health, and dietary information of the selected TB patients. Clinical information was collected from medical records. Nutritional status was measured as body mass index (BMI) (weight and height) using standard techniques. Results: Nutritional status measured as BMI was categorized as underweight (<18.5) and normal (BMI >18.5) was the primary outcome of the study. Ninety-eight (49%) TB patients were very severely undernourished (BMI <16) and 159 (79.5%) patients had BMI <18.5. Only 44.5% patients reported receiving diet counselling during hospital visit. The adjusted analysis showed higher odds of underweight among patients who had breathing difficulty (adjusted odds ratio [AOR] = 2.85; confidence interval [CI] = 1.19–6.85; P= 0.01). Patients with diabetes had significantly lower odds of underweight (AOR = 0.12; CI = 0.02–0.95; P= 0.04). Higher odds of low BMI were also found among patients consumed tobacco (AOR = 2.4; CI = 0.95–6.28; P= 0.05), using open defecation (AOR = 3.77; CI = 0.91–15.64; P= 0.06), but findings were not statistically significant. Conclusion: This study has demonstrated high proportion of severe undernutrition among pulmonary TB patients. There is an urgent need for the provision of proper nutrition management and counseling of TB hospitals at the hospitals as per the national nutrition guidelines for TB patients.
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Assessment of menstrual hygiene among adolescent girls of East Delhi: A community-based cross-sectional research from an urban resettlement colony p. 141
Anita Shankar Acharya, Nidhi Tiwari, Sanjeev Kumar Rasania, Jyoti Khandekar, Damodar Bachani
DOI:10.4103/IJCFM.IJCFM_53_19  
Introduction: Even though menstruation is a normal physiological process, menstrual hygiene is a most neglected issue with many myths and social stigmas being associated with it. Due to unhygienic menstrual practices, young girls are vulnerable to reproductive tract infections and pelvic inflammatory diseases and other complications. Therefore, the objective of this study was to assess the knowledge, attitude, and practices of menstrual hygiene among adolescent girls. Material and Methods: This is a descriptive cross-sectional study conducted in an urban resettlement colony of Kalyanpuri, East Delhi. One hundred and five adolescent girls participated in the study. The mean age of the participants was 14.18 ± 2.13 years. Predesigned and pretested semi-structured questionnaire was used. Institutional Ethical clearance was obtained. Results: In this study, out of 105 girls, only 35.2% girls had knowledge about menstruation before they experienced menarche. Only 56.2% girls were aware that menstruation is a normal physiological process. Overall knowledge level about menstrual hygiene was unsatisfactory. Only 31.4% of girls were using sanitary pads during menstruation, 59.25% of the respondents had good practices. About 12.4% girls had positive attitude toward menstrual hygiene. Conclusion: Although practices on menstrual hygiene management among adolescents were fairly satisfactory, knowledge and attitude still need to improve. Findings indicate the need of behavior change communication campaigns along with frequent reinforcement of school health education programs.
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Depression and associated factors in type 2 diabetic patients: A community-based cross-sectional study from East Delhi p. 147
Kanika Singh, Anita Shankar Acharya, Sanjeev Kumar Rasania
DOI:10.4103/IJCFM.IJCFM_56_19  
Introduction: Diabetes is a chronic disease which has no cure and requires life-long management, frequent hospital visits, as well as monitoring of blood sugar levels, which can cause distress to the patient. Various risk factors have been identified that may influence the course of diabetes and its complication, of which depression has emerged as a significant factor. Diabetes mellitus doubles the likelihood of depression as compared to normal individuals. We conducted this study to find the prevalence of depression and its associated factors in diabetes mellitus patients in East Delhi. Material and Methods: A community-based cross-sectional study was conducted among 250 diabetics aged above 30 years in East Delhi in 2017. They were screened for depression using Physical Health Questionnaire 9. Sociodemographic details, diabetic profile, and behavioral factors were assessed. Data were collected and entered in SPSS software version 23. Multivariate analysis was done for associated factors. Results: Out of total 250 study patients who fulfilled the inclusion and exclusion criteria, 79 (31.6%) were males and 171 (68.4%) were females. Age, gender, marital status, type of family, diabetic profile, comorbidity, complications, blood pressure status, body mass index, physical activity, stress, and sleeping hours were the factors assessed for the association with depression. Conclusion: Diabetes is a chronic illness requiring a variety of self-management behaviors. To improve patients' diabetes self-management behaviors, health-care providers should cultivate patient-centered relationships. Screening of all diabetics for depression is of paramount importance.
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CASE REPORT Top

May–Thurner Syndrome p. 154
S. Neethu, Fathimath Sahla, John Alexander, Thara Pratap, Muhammed Jasim Abdul Jalal
DOI:10.4103/IJCFM.IJCFM_43_19  
May–Thurner syndrome (MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. We would like to substantiate that MTS is often underdiagnosed, and it should always be suspected in left iliofemoral vein thrombosis in young individuals.
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SHORT COMMUNICATION Top

The Maintenance and Welfare of Parents and Senior Citizens Act, 2007- Helping the conditions of the elderly in India p. 157
Utsav Raj, Abhiruchi Galhotra
DOI:10.4103/IJCFM.IJCFM_40_19  
Aging in India is exponentially increasing due to the impressive gains that society has made in terms of increased life expectancy. About 8.6% of the total population in India is in this age group, with 8.2% males and 9% females. With increasing age, an aged person becomes dependent and faces a lot of problems. There is a feeling of neglect and sadness and that the people have an indifferent attitude toward them. Furthermore, the prevalence of mistreatment with the elderly is on the rise. Such a situation has resulted because of degenerating traditional values and weakened family system. The Maintenance and Welfare of Parents and Senior Citizens Act came into existence in the year 2007 to provide maintenance support to elderly parents and senior citizens. Parents according to the Act mean biological, adoptive, and stepparents, and the age of parents is irrelevant to claim maintenance. Adult children and adult grandchildren are legally obligated to pay maintenance; the amount is determined by the needs of the claimant so that the elderly person can lead a normal life. If children intentionally abandon the senior citizen completely, he/she is liable to pay a fine of Rs. 5000 or face imprisonment for 3 months or both. The legislative approach has its limitation, but it has the potential to arouse the social and ethical debates in the country to alleviate the dependent status of older persons.
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LETTER TO EDITOR Top

Updating the Kuppuswamy's socioeconomic status scale for the year 2019 p. 162
M. A. Bashar
DOI:10.4103/IJCFM.IJCFM_50_19  
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