Background: The state of Tamil Nadu in India is one of the states with better health indicators in the country. With an ambition to provide still better health care to the residents of the state, the possibilities of the journey towards UHC are analyzed. Objectives: To explore the possibilities of using the existing Chief Minister's Comprehensive Health Insurance Scheme (CMCHISTN) as base to reach Universal Health Coverage (UHC) in Tamil Nadu. Methods: The various dimensions of UHC namely people, benefit, and financial protection are analyzed considering the present status in the state particularly the Chief Minister's Comprehensive Health Insurance Scheme and matched with future needs to reach UHC in Tamil Nadu. This provides the vital indications in success towards UHC. Results and conclusion: The gap between the existing modalities under CMCHSITN and requirements for UHC are within the reachable level. With additional resources and effort, it is possible to reach UHC in Tamil Nadu in the near future. CMCHISTN is one of the best available options for reaching UHC in Tamil Nadu.

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Decades of research have established the relationship between socioeconomic status (SES) and health. The tools for the assessment of SES have evolved ever since, growing in complexity over time. The purpose of measuring SES in health research is twofold – to causally link the exposure to poor SES with health state and to find out the causal mechanisms to devise programmatic interventions. In health research, SES should be viewed as a determinant of unequal distribution of health resources that further leads to health disparities. We refer to socioeconomic position as an umbrella term for social stratification that defines individuals/households based on the present circumstances. Socioeconomic position can be measured in three distinctly varied ways – socioeconomic disadvantage, social class, and SES (or position). Tools for the measurement of SES can be classified as indices based on income and expenditure, indices bases on occupation and education, wealth index combining education, and asset-based wealth index. Each tool has its own theoretical assumptions – Weberian, Marxist, or Functionalist perspectives. The choice of tool should depend on theoretical assumptions. The tool should be comprehensive, including all three dimensions – education, occupation, and income. Life-course perspective, linking the timing of exposure to poor SES over the life course is useful in the development of interventions. Study tools incorporating a life course perspective in the measurement of SES are the need of the hour.

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Oral cancer is very common in India. Most of the oral cancers develop on a potentially malignant (precancerous) lesion. Leukoplakia is the most common precancerous lesion in the oral cavity. The malignant transformation rate of oral leukoplakia is very high. There is no marker to distinguish those lesions that may transform to frank cancer from those that may not. Thus, early identification of oral leukoplakia and its proper treatment is important for best prognosis. This article highlights on the diagnosis and treatment protocol for oral leukoplakia.

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Background: Global Nutrition Targets 2025 specified a set of six global nutrition targets, and one aim is to achieve a 40% reduction in the number of children under 5 years of age who are stunted. National data on underweight provided under National Family Health Survey-4 (NFHS-4) (2015–2016) revealed an underweight prevalence rate around 35.7% as compared to NFHS-3 where it was 42.5%, which reflects only 6.8% reduction in underweight over a decade. Methods: This cross-sectional study was conducted in the rural area of Rohtak district during October 2014 to September 2015 among children who were 1–5 years of age. The anthropometric measurement and nutritional status categorization among children were done using the WHO guidelines. Results: A total of 600 children participated in the study. Around 41.3% of the study participants had stunting as their nutritional status, while taking composite index of anthropometric failure (CIAF) for nutritional status into consideration, nearly 54.4% of the participants were undernourished. Stunting and underweight were more prevalent among girls. Conclusions: Composite anthropometric index provides the actual prevalence or proportion of undernourished children in a community, so the policies should be based on the basis of CIAF so to reduce the prevalence of undernutrition in the community more effectively.

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Introduction: Vaccination is an effective public health intervention; however, coverage of vaccination is declining in states like Tamil Nadu which have good health indicators. Objective: To evaluate the presence of vaccine hesitancy among parents of children between 1 and 5 years of age attending the paediatric out patient department of a tertiary care hospital in Chennai and to assess its relationship with attitudes towards vaccines. Material & Methods: A cross sectional questionnaire-based survey was conducted among 100 consecutively sampled parents of children between 1 and 5 years of age attending a tertiary care paediatric out-patient department. The Parental Attitude towards Childhood Vaccines scale of vaccine hesitancy and the Beliefs and Attitudes towards Childhood Vaccines scale were used to measure vaccine hesitancy and beliefs and attitudes towards vaccination respectively. The data were analysed descriptively and statistical correlation between vaccination attitudes and vaccination hesitancy were studied. Results: In the predominantly urban, educated, working class population, the prevalence of vaccine hesitancy was 21%. But all the children had received complete vaccination appropriate for age. The major drivers for vaccine hesitancy were suspicions about newer vaccines, concerns about adverse effects of vaccines and the perception that there is no need for vaccines against uncommon diseases. The vaccine hesitancy scores were negatively correlated with the vaccine attitude scores (R = -0.266; p = 0.007). Conclusion: Vaccine hesitancy is present among the sampled mothers and is influenced mainly by concerns regarding safety of newer vaccines. Vaccine hesitancy needs to be clearly addressed for strengthening the Universal Immunization Program.

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Introduction: Ovarian cancer is the leading cause of mortality of female gynaecological cancers and ranks seventh as the most common cancer worldwide. The increasing life expectancy has led to increase in its burden exponentially now even in developing countries but limited knowledge is there about the pattern of ovarian tumours. Objective: To determine the burden and describe the pattern of ovarian tumours in patients visiting GMCH. Material and methods: This epidemiological study is retrospective, descriptive hospital based study over five years. The data so collected was analysed using SPSS software. Results: Maximum number i.e 74(24.4%) of cases were in the age group of 50 to 59 years followed by 40 to 49 years. It is also seen that maximum number of cases i.e total of 65 registries were in the year 2013. Maximum number of cases were from the state of Haryana contributing to nearly 41% of total cases. Most of the cases could not be classified into four stages i.e they were categorized as unknown. Chemotherapy is the most commonly used treatment modality. Epithelial adenocarcinoma was the commonest histology subtype. Conclusion: Research should be aimed to find tools for screening and early diagnosis so that better therapeutic approaches can be designed to decrease the burden.

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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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Introduction: The word “poly” is Greek and means many or much. However, the term polypharmacy has been given definitions connected both to the use of more than a certain number of drugs concomitantly and to the clinical appropriateness of drug use. Polypharmacy is the use of multiple medications by a patient, generally older adults (those aged 60 or over 65 years). More specifically, it is often defined as the use of 5 or more regular medications. It sometimes alternatively refers to purportedly excessive or unnecessary prescriptions. The term polypharmacy lacks a universally consistent definition with an increasing share of population in this age group, it is natural to expect an increase in the problems associated with them as well. Health problems are supposed to be the major concern of this section of the society, and it is reported that use of medications has increased significantly among the elderly in the last decade. Objective: The objective of this study is to assess the prevalence of polypharmacy among elderly patients in different Indian states, to make a comparison, and also to study the patterns of polypharmacy and its associated aspects. Materials and Methods: Literature review comprising of original articles, reviews, and case studies was studied to identify articles which correspond to research done on polypharmacy in various different ways published between the years 2010 and 2018. As the review focuses on the geriatric population, so considerable data were searched and collected for the use of medication in geriatrics to assess what makes them prone to polypharmacy, what pattern of polypharmacy they follow, and how they are affected by the consequences. Results: Uttaranchal, Karnataka, and Telangana reported a higher level of polypharmacy with 93.14%, 84.6%, and 82.8%, respectively, whereas Andaman and Nicobar Islands (2%) and West Bengal (5.82%) showed the lowest polypharmacy. Conclusion: Overall comparisons made show that there are more studies needed to assess the level of polypharmacy and ways and measures should be incorporated by the government in states showing high polypharmacy.

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Sickle cell anemia is the most common disease entity of all the monogenic disorders. This is an autosomal recessive disorder. HbS polymerization, vaso-occlusion, and hemolytic anemia are central to the pathophysiology of sickle cell disease, they precipitate a cascade of pathologic events, which in turn lead to a wide range of complications. The disease is particularly more prevalent in certain regions of the country like Odisha, Madhya Pradesh, Tamilnadu and has a significant impact on morbidity. Community based approach by providing availability of screening tests, & pre-marital and pre-pregnancy counselling should be initiated to reduce the disease burden in the society.

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Febrile seizure is the most common seizures seen in infancy and pre-school era. They are mostly benign in nature. There are two categories of febrile seizures, simple and complex. Both the International League against Epilepsy and the American academy of paediatrics have published definitions on the classification of febrile seizures. Simple febrile seizures are mostly benign, but a prolonged (complex) febrile seizure can have long term consequences. Most children who have a febrile seizure have normal health and development after the event, but recent evidence suggests a small subset of children presenting with seizures and fever may have recurrent seizure or develop epilepsy. Diagnosis is solely clinical. But other causes of fever and seizure must be ruled out. Electroencephalogram, lumbar puncture and neuroimaging, all are to be used for specific indications but not routinely. Treatment consists of acute management and prophylaxis for further attack. This review will give an overview of the definition of febrile seizures, epidemiology, evaluation, treatment, outcomes and recent research.

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Recent National Mental Health Survey (2015-16) reported a prevalence of 13.7% for any mental disorders excluding tobacco use disorders in India. Translating it into real numbers, nearly 150 million people need active mental health interventions, disproportionately more in rural areas. Major challenges in delivering comprehensive mental health services in rural India are: a) lack of a well-defined strategy; and b) lack of trained mental health manpower. To fill this gap, the global mental health community has increasingly realized the importance of Community Health Workers (CHWs) and role of stepped care approach in mental health service delivery. We propose a model of stepped care approach to fulfil the need of rural India, utilizing the existing health system components for improving mental health knowledge, reducing social stigma for mental disorders, screening for priority mental disorders at community level, ensuring compliance to treatment, timely follow-up, and community-based rehabilitation by mobilising community support for diagnosed cases. This stepped care approach will integrate mental health into Ayushman Bharat’s Health and Wellness Centres (HWCs) for the provision of comprehensive primary health care. Integration of new age technologies such as telepsychiatry, e-health, and mHealth into the proposed model will make it feasible and cost-efficient for inaccessible parts of the country.

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Acute osteomyelitis requires careful clinical evaluation, a high index of suspicion as it is an uncommon but devastating disease that affects largely previously healthy children. Management of osteomyelitis is a formidable challenge as success of antibiotics in soft tissues has not been replicated in bony tissue due to peculiar anatomy and physiology of the bone. Illness, malnutrition and decreased immunity predispose children to develop acute osteomyelitis. Absence of phagocytic cells in the metaphysis may explain predilection in children. Recently the trend in treatment strategy includes a rapid transition from intravenous to oral antimicrobial therapy and a shortened overall course of therapy. Many new therapeutic options are on the horizon that will likely impact the management of this and other childhood bacterial infections. This review will focus on recent advances in the management of acute hematogenous osteomyelitis in children.

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Background: Driving is a complex task, requiring coordination between multiple mental and physical faculties. Distractions lead to delayed recognition of information needed to drive safely. It is essential to understand distracted driving practices to regulate them and reduce crash risk. This study aims to identify common distractors among professional vehicle drivers in South India. Methodology: A questionnaire-based cross-sectional study was conducted on professional drivers of three-and four-wheeled vehicles. Epicollect 5, a mobile-based data collection tool, was used for data collection and entry. Results: Among 82 male professional drivers (57.3% car, 35.4% bus/lorry), with a mean (standard deviation) age of 38.4 (10.6) years, all reported being distracted by at least one of the listed distractors. Mobile phone usage and cognitive distractions were reported by 75.6% and 79.3%, respectively. Younger drivers (P = 0.005) and those with less than a decade of driving experience (P = 0.038) were more likely to use mobiles while driving. Drivers reporting cognitive distractions were more likely to have met with an accident than those who did not (44.6% vs. 23.5%). Conclusions: Distracted driving is common among professional drivers. Cognitive distractions are as common as distractions due to mobile phones. Sensitization of drivers and strict enforcement of legislation are recommended.

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Anaemia is a condition in which red blood cells have fewer haemoglobin molecules than normal, or fewer red blood cells overall, and thus less ability to carry oxygen to tissues in the body. Nutritional anaemia is a major public health problem in India and is primarily due to iron deficiency. Symptoms of iron deficiency anaemia are primarily non specific and become apparent when there is severe anaemia. The National Iron Plus Initiative (NIPI) is the most ambitious and comprehensive anaemia control programme in the world. The process documentation team conducted 170 interviews in March, April and May 2016 among officials and frontline workers at state, district, block, sector/cluster and field levels and among NIPI beneficiaries in Odisha. To achieve variation in responses and to get full set of information on how NIPI was being implemented, process documentation and survey data were collected in four districts of Odisha– Keonjhar, Jagatsinghpur, Bhadrak and Kalahandi. This review will give an overview about the operational issues encountered during the National Iron Plus Initiative documentation in Odisha.

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Background: India confronts a high burden of anemia among pregnant women, that contributes to significant morbidity and mortality for mother and child. Anemia Mukt Bharat strategy launched by Government of India envisages provision of variety of facility-based interventions for management of anemia in pregnancy. Secondary care hospitals prescribe injectable iron treatment for moderate anemia and blood transfusion services for severe anemia. Objective: To estimate the magnitude and severity of anemia among pregnant women when they presented themselves for the first time at the antenatal care clinic of a secondary care hospital so as to forecast adequate supplies of medicines for managing anemia. Materials and Methods: This was a descriptive study using routinely maintained hospital clinical records during the years 2013–2015. It was conducted in a subdistrict hospital, Ballabhgarh in Faridabad district of Haryana state. Hemoglobin (Hb) level was routinely measured at first visit for all pregnant women using BC-3000 plus autohematology analyzer. Anemia in pregnancy was considered when Hb concentration was <11.0 g/dL. Results: The Hb level at first visit was available for 13,467 women during the study period. The mean Hb level (standard deviation) was 9.3 g/dL (1.3). The proportion of anemic pregnant women was 91.3% (95% confidence interval [CI]: 90.8, 91.7). The most common category of anemia was moderate anemia 62.5% (95% CI: 61.6, 63.2). Conclusion: We found a very high prevalence of anemia in pregnant women presenting to a secondary care setting of a North Indian hospital during their first visit to the facility during the antenatal period.

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Introduction: Cancer is a leading public health problem worldwide. Contributing factors include lack of awareness regarding cancer and improper help seeking behavior. Objective: To assess the awareness regarding early warning signs of cancer, its risk factors and anticipated barriers in seeking help. Methodology: A community-based cross-sectional study was conducted among 470 study participants. Trained workers administered a standardized tool to respondents after obtaining their informed consent. Epi Info software for windows version 7.2 was used for the analysis. Results: Overall, merely 7.7% (36/470) of the study respondents were aware of all the nine warning signs of cancer. The most commonly known early warning sign of cancer was “unexplained swelling” (58.3%). Further, although majority knew that cigarette smoking is a risk factor for cancer (90.4%), very few were aware about the role of inadequate physical activity (9.3%) and diet devoid of adequate amounts of fruits and vegetables (11.9%). There were few anticipated barriers in seeking help such as embarrassment (13.2%) and difficult to interact with a doctor (7.9%). Conclusion: There was inadequate awareness about cancer but a favorable help-seeking behavior. It is, therefore, recommended that health-care professionals should scale up efforts for disseminating information regarding cancer among the people.

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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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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 3^rd-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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The entirety of food and drink that an individual continually expends is called a diet. Proper nutrition – a sufficient, all-around offset diet with regular physical activity, frames the establishment for good health. The majority of the currently prevalent dietary recommendations are based on the health benefits of different individual food products. With the rising concern regarding climate change and evidence highlighting the influence of our nutritional practices on the environment, the time has come to redefine the dietary guidelines and recommendations considering the environmental impact of diet along with the health benefits. Studies have been reliably consistent with demonstrating that an equicaloric diet rich in plant-based products and lower in animal products is beneficial to health and put a lesser burden on the earth. There are five Sustainable Developmental Goals that can be linked with our dietary practices (no poverty, no hunger, good health and well-being, responsible consumption and production, and climate change). A plant-based diet is a suitable solution to the current crisis of noncommunicable diseases and climate change. Moving on to such a dietary practice would require immense changes in the currently prevalent food system with an emphasis on better production and waste management strategies along with improvement in food delivery and consumption practices worldwide. This article brings insight regarding the benefits of a plant-based diet and the need to address the ecological impact of animal-based foods.

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