Community Medicine

According to published reports from the WHO, health care is undergoing a transformation that reflects the increasing importance of community care based on social, group, and individual needs. Community health care is provided by multidisciplinary teams, with nurses occupying irreplaceable positions. Nurse competencies constitute significant potential in the area of community based preventive care as well as the more traditional roles in treatment and recovery. Data was obtained from health care professionals and the public through a structured interview. The study population included 1,007 physicians, 1,005 nurses and 2,022 laypersons. Respondents were selected randomly with the aid of quotas. The parameters for the selection of health care workers (nurses and physicians) were constructed based on registration data from the Institute of Health Information and Statistics. Layperson selection was based on data from the Czech Statistical Office. The Statistical Analysis of Social Data ...

Medical schools' curricular content ranges widely from precise basic science material to a heterogeneous mix of clinical presentations to diffuse social and life issues. The context within which this content is delivered is also variable, covering precisely designed laboratory settings, structured clinical ward settings, and uncontrolled community settings. Educators in medical schools, while able to cover curriculum content didactically, may find it challenging to adequately facilitate a wide and varied exposure to relevant learning issues. This challenge becomes greater when moving from the basic science laboratory to the community setting. The response of the student to community-oriented programmes is an important consideration in helping educators to assess possible learning outcomes beyond the stated learning objectives. This adds an important dimension to the restricted learning environment of the lecture room. It is in fact noted that some of the skills doctors require, can only be gained through planned practical learning experiences in a representative range of health problems encountered in their normal setting (World Health Organization, 1985).

Background: The people of low and middle income countries bear about 80% of the global burden of diseases that are attributable to high blood pressure. Hypertensive people contribute half of this burden; the rest is among the people with lesser degrees of high blood pressure. Prehypertension elevates the risk of CVD, and that of end-stage renal disease. Bangladesh is a developing country, with more than 75% of the population live in rural area. This study aims to determine the prevalence and predictors of pre-hypertension and hypertension among the adults in rural Bangladesh. Methods: A cross-sectional study of major non-communicable disease risk factors (tobacco and alcohol use, fruit and vegetable intake, physical activity) was conducted in rural surveillance sites of Bangladesh. In addition to the self-reported information on risk factors, height and weight, and blood pressure were measured during household visits using standard protocols of the WHO STEPwise approach to Surveillance. The study population included 6,094 men and women aged 25 years and above. Adjusted and unadjusted logistic regression analyses were performed to evaluate the association of prehypertension and hypertension with various factors. Results: The prevalence of pre-hypertension and hypertension was 31.9% and 16.0%, respectively. The men had a higher prevalence (33.6%) of pre-hypertension compared to the women (30.3%). Multivariate analysis showed that increasing age [OR 2.30 (1.84-2.87)] and higher BMI [OR 4.67 (3.35-6.51) were positively associated with pre-hypertension. For hypertension, multivariate analysis showed that increasing age [OR 4.48 (3.38-5.94)] and higher BMI (specially the overweight category) was positively associated. Significant linear relationships of prehypertension were found with age [P for trend < 0.0001] and BMI [P for trend < 0.0001]. Linear regression for hypertension shows significant association with age [P for trend < 0.0001] but not with BMI [P for trend 0.3783]. Conclusion: Approximately one third and one-sixth of the adult population of rural Bangladesh are affected with pre-hypertension and hypertension, respectively. This poses a great challenge ahead, as most of the people with pre-hypertension will progress towards hypertension until otherwise undergo in any pharmacological or lifestyle intervention.

This study was conducted to create awareness about Leptospirosis, an important zoonotic disease, in two villages of Navsari district using street play and poster exhibition. The pre-intervention assessment revealed poor knowledge scores on various aspect of leptospirosis which significantly improved after intervention (p<0.05). Street play in local language and pictorial posters are effective health educational tools amongst illiterates and repeated use, before the transmission season, for maximum impact.

Background Accurate childhood cancer burden data are crucial for resource planning and health policy prioritisation. Model-based estimates are necessary because cancer surveillance data are scarce or non-existent in many countries. Although global incidence and mortality estimates are available, there are no previous analyses of the global burden of childhood cancer represented in disability-adjusted life-years (DALYs). Methods Using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 methodology, childhood (ages 0-19 years) cancer mortality was estimated by use of vital registration system data, verbal autopsy data, and population-based cancer registry incidence data, which were transformed to mortality estimates through modelled mortality-to-incidence ratios (MIRs). Childhood cancer incidence was estimated using the mortality estimates and corresponding MIRs. Prevalence estimates were calculated by using MIR to model survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated by multiplying age-specific cancer deaths by the difference between the age of death and a reference life expectancy. DALYs were calculated as the sum of YLLs and YLDs. Final point estimates are reported with 95% uncertainty intervals. Findings Globally, in 2017, there were 11•5 million (95% uncertainty interval 10•6-12•3) DALYs due to childhood cancer, 97•3% (97•3-97•3) of which were attributable to YLLs and 2•7% (2•7-2•7) of which were attributable to YLDs. Childhood cancer was the sixth leading cause of total cancer burden globally and the ninth leading cause of childhood disease burden globally. 82•2% (82•1-82•2) of global childhood cancer DALYs occurred in low, low-middle, or middle Socio-demographic Index locations, whereas 50•3% (50•3-50•3) of adult cancer DALYs occurred in these same locations. Cancers that are uncategorised in the current GBD framework comprised 26•5% (26•5-26•5) of global childhood cancer DALYs. Interpretation The GBD 2017 results call attention to the substantial burden of childhood cancer globally, which disproportionately affects populations in resource-limited settings. The use of DALY-based estimates is crucial in demonstrating that childhood cancer burden represents an important global cancer and child health concern. Funding Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities (ALSAC), and St. Baldrick's Foundation.

Objectives: Determination of intraocular pressure of diabetes and diabetic retinopathy patients and the normal population. Methods: Six hundred sixty four patients (n=1328 eyes) of age 40 years or more were studied in five groups. Eyes of diabetic patients without diabetic retinopathy, mild/moderate nonproliferative diabetic retinopathy, severe nonproliferative diabetic retinopathy, proliferative diabetic retinopathy and control group on exclusion of ocular comorbidities. Data recorded were age, sex, intraocular pressure by noncontact tonometer and grades of diabetic retinopathy in each eye. Results: The mean intraocular pressure was 18.24 ± 3.72 mmHg in the 908 diabetic eyes. Of the 908 eyes the intraocular pressure was 15.00 ± 2.61 mmHg in no apparent diabetic retinopathy (n = 495), 17.6 ± 2.8 mmHg in mild to moderate nonproliferative diabetic retinopathy (n=239), 19.4 ± 2.6 mmHg in severe diabetic retinopathy (n = 144), 20.9 ± 6.3 mmHg in eyes with proliferative diabetic retinopathy (n = 30) and 15.72±3.71 mmHg in the 420 nondiabetic control eyes. The intraocular pressure of each diabetic group was considerably higher than the nondiabetic group (p < 0.001). One way ANOVA test showed the test as highly significant at 5% level and intraocular pressure values of all these five groups differ significantly. Conclusions: The intraocular pressure is higher in diabetic patients than normal. Intraocular pressure increased significantly on increasing severity of diabetic retinopathy showing a positive correlation between intraocular pressure and grades of diabetic retinopathy.

Background: Anterior knee pain (patellofemoral pain syndrome) is a very common problem that poses difficult diagnostic and therapeutic problems. It accounts for up to 74% of knee pain experienced by adolescents participating in sports, with prevalence of 15% in females and 12% in males. Although etiology and pathogenesis of patellofemoral pain syndrome are poorly understood, many predisposing factors suggest an underlying genetic, developmental, or familial abnormality. Various clinical tests have been used to diagnose anterior knee pain but data regarding validity are scarce and inconclusive. Q-angle is the most common test done to identify and treat anterior knee pain. The objective of this study is to evaluate quadriceps angle (Q angle) in patients with anterior knee pain in our setup. Materials and Methods: A descriptive study was undertaken at Tribhuvan University Teaching Hospital (TUTH), Kathmandu. One hundred patients with symptomatic anterior knee pain presenting to Orthopaedics OPD or Sports Clinic of the Department of Orthopaedics, TUTH, who could meet the inclusion criteria were taken up for the study. Results: Total124 symptomatic knees of 100 patients (55 male and 45 females) were evaluated. Mean Q-angle was 15.57 degrees; Mean Q-angle of symptomatic knees was 16.62 degree (male-14.55, female-19.05) and 13.84 degrees of asymptomatic knee (male-12.65, female-15.39). Mean q-angle in female was 17.71 degree and in male was 13.81degree. Conclusions: Q-angle was significantly high in females and symptomatic knee with anterior knee pain. The relationship between Q-angle and knees with anterior knee pain was statistically significant (P-0.001).

Background: India carries the leading cancer load for cervical cancer, however, awareness regarding cervical cancer is poor among women of reproductive age group. The study was conducted with objectives to find out awareness regarding cervical cancer among women of reproductive age group from urban slum; and to assess screening and preventive practices and reasons for non screening .

Objective: To find out association of treatment outcome with age, sex and type of cases in patients attended at DTC of SMS Hospital, Jaipur (Raj.)
Materials and methods: A record based cross-sectional study of tubercular patients - whose outcome of treatment was declared. Study variables were –types of case, age, sex. Outcome was assessed as Cure Rate, Failure Rate, Defaulter Rate, Case Fatality Rate
Result: Overall Cure Rate observed 43.3% and it significantly varied with type of case, age and sex of case. Overall Defaulter Rate observed 30%. More defaulters were in relapse retreated cases and in elderly (>60 yrs.) cases. Overall Failure Rate observed 8.3% and it was highest in Cat. I cases and significantly varied with age and sex. Overall Case Fatality Rate observed 15%. About 3/4th of total deaths were observed in Failure and Relapse retreated cases. CFR showed not significant variation with sex.
Conclusions: Cure Rate significantly varied with type of case, age and sex of case. Defaulters were more in Relapse retreated cases and in elderly (>60 yrs.) cases. Failure Rate was highest in Cat. I cases and significantly varied with age and sex

Background: Globally about 36 million people die due to NCDs (Non-communicable diseases), which account for 63% of total deaths. Cardiovascular diseases account for 48% of the NCDs.
Objective: To estimate the prevalence of risk factors of NCDs among the residents of a block of Murshidabad district of West Bengal
Methods: This observational cross sectional community based study was conducted in a rural area of a district in West Bengal, India with the objective to find out the prevalence of risk factors of NCDs like obesity, diabetes mellitus, hypertension, dyslipidemia and addiction to tobacco and alcohol. A total of 390 subjects were studied using questionnaire and anthropometric measurement and biochemical tests.
Results: Mean age of the sample population was 42±8.4 years. Current use of tobacco smoking was 36 % among males and 6% of men were current alcohol users. Tobacco use was significantly more among males. About 87% of study subjects took more salt and 28% use more oils than recommended. Seventy one percent of study population could not afford >5 servings of fruits and vegetables per day. Most of the females (68%) had Low level of physical activity when compared with men (37%). Overweight was seen in 38% and 46% had dyslipidaemia. Hypertension was more prevalent (25%) than Pre-diabetes (19%) or Diabetes (11%).
Conclusion: The present study highlighted high burden of risk factors of NCDs in the rural community of West Bengal. Community based intervention for screening for these risk factors and health behaviours followed by awareness program can only curb the burden.

Skin diseases have a very high frequency either in developed as well as in undeveloped countries. Guerrero, Chiapas, and Oaxaca are the most impoverished states in Mexico, where 24% of the population lacks basic health care, and only 15% are estimated to have access to specialists. Community Dermatology program was founded in 1991 with the intention of improving the dermatological health of remote, marginalized inhabitants of the state of Guerrero. The program consists of a two-day visit to a pre-selected community;

INTRODUCTION: Breastfeeding promotion is a significant child survival strategy. Interventions to improve early and correct infant feeding practices can result in considerable reduction in neonatal morbidity and mortality. It is important for staff nurses to have adequate knowledge about breastfeeding and skills to counsel mother and family members. The objective of the present study was to assess the knowledge and counseling skills of the staff nurses, positioned at L1-L2 delivery points, with regard to IYCF. MATERIAL AND METHODS: A Labor Room Assessment was conducted by Department of Community Medicine, K.G.M.U, Lucknow for strengthening of labor rooms of different levels in districts of Badaun and Saunbhadra. An IYCF checklist based on WHO and IMNCI guidelines was prepared and 22 staff nurses of level 2 delivery points (5 from 24*7 PHC and 14 from CHC of Badaun, 2 from 24*7 PHC and 1 from CHC of Saunbhadra) were interviewed about their knowledge and counseling skills regarding IYCF. RESULTS: Only two-third (63.6%) had knowledge about initiation of breast feeding within 1hour. High knowledge was seen for benefits of colostrums where all the staff nurses (100%) knew that colostrums are rich in antibodies and vitamins. Regarding counseling skills, all the 22 nurses reminded mothers about the benefits of exclusive breast feeding for 6 months and dangers of artificial feeding and water.

Background: Non-compliance to blood pressure-lowering medication is a major reason for poor control of hypertension worldwide. We assessed the level of compliance to anti-hypertensive therapy and identified factors contributing to poor compliance among hypertensives in Kano. Methodology: Three hundred and sixty outpatients were interviewed using a pre-tested, structured, mostly closed ended questionnaire in Murtala Mohammed Specialist Hospital in Kano, Nigeria.

The literature on community-oriented medical education is reviewed. In response to major changes in the origin, expression and place of management of much illness, many medical schools are turning their attention increasingly to the community from whence to derive their curriculum and wherein to effect their teaching. The traditional hospital base of teaching is eroding, necessitating new, innovative approaches to medical education. Becoming community-oriented, or using community-based learning, offers potential benefits for the schools, the students, and the public. The experience of others demonstrates the necessity of enlisting community representatives as partners in the process of change. Institutional barriers are significant and careful planning is needed to overcome them.

Background and Objectives: Iron deficiency anemia, is common in pregnant women. The global prevalence of anemia in pregnancy (AIP) is estimated as 41.8% and in more than 80% of countries in the world, the prevalence of AIP estimated at 29%. AIP is associated with increased maternal, neonatal and perinatal mortality, low birth weight, premature birth, and delayed child development. This study aimed to assess the effect of applying WHO-UNICEF guidelines for AIP control at Hodeida city, Yemen. Methods: Facility based interventional prospective study had conducted in 17 health centers of Hodeida city which had randomly distributed to 8 experimental and 9 control health centers, selecting 250 pregnant women from experimental health centers and equal number from control ones. Experimental health centers had intervened through training on, and managing pregnant women for anemia according WHO-UNICEF guidelines while pregnant women at control health centers had managed according health centers own approaches. Pregnant women at both types' health centers had followed 3 times till labor for Hb response, pregnancy and labor courses and complications. Data statistically analyzed using SPSS program (Version 22) including descriptive statistics, t test for examining the difference in means of Hb response, pregnancy and labor complications among the experimental and control groups Results: The study revealed statistically significant 20% higher Hb improvement rate in experimental group compared with control group on applying WHO-UNICEF guidelines for AIP control at primary health centers (P = 0.00, t= 4.27). Also, statistically significant decrease of pregnancy complications (P = 0.02, t=-2.445) and labor complications (P = 0.001, t=-3.472) had been reached on applying the protocol. Conclusion: Applying WHO-UNICEF guidelines for AIP control at primary health centers improved Hb response and decreased antenatal and natal complications.

BACKGROUND: Outpatient Department (OPD) congestion and long waiting time in OPD is an important challenge for hospital administration. OBJECTIVE: A time motion study was conducted in OPD of Domjur Rural Hospital on around forty patients by simple observation technique to find out the time spent in various service delivery sections and the overall satisfaction of patients regarding total time spent in OPD. METHODS: Data obtained by simple observation technique and patient interview. RESULTS: Average waiting time in various sections was observed and statistically analyzed. Study revealed maximum time is spent by a patient in waiting outside OPD for consultation but time for consultation is very less. Interview of patients were also conducted regarding their satisfaction and suggestions were provided to hospital management for implementation of newer techniques in order to reduce OPD congestion.

Background: A revolution in health care is occurring as a result of changes in the practice of medicine and in society. Medical education, if it is to keep up with the times, needs to adapt to society's changing attitudes. Presently medical education has been criticised for its orientation and insensitivity to people's need. The MBBS curriculum of medical institutions of Nepal has been focusing on community-based approaches and is still guided by the same notion. The question put forward is whether it has been appropriate to nurture the present health needs and aspiration of people. Objective: The objective of the present study is to review the existing community based medical education in health institutions of Nepal to strengthen the components of community care. Materials and methods: Qualitative study was done by reviewing the curricula and existing community medicine courses/activities in MBBS curriculum Findings and Discussion: The curriculum of all the health institutions have addressed signifi cantly on community medicine practice. As per Institute of Medicine, the community medicine practice is achieved through community based learning experiences like community diagnosis, concurrent fi eld with families of sick members and district health system management practice. In BP Koirala Institute of Health Sciences, community medicine practice is undertaken through exposure to community diagnosis program, health care delivery system, family health exercise, applied epidemiology and educational research methodology, management skills for health services and Community Oriented Compulsory Residential Rotatory Internship Program (COCRRIP). In KUSMS, community medicine module is carried out as-community diagnosis program, community health intervention project, school health project, occupational health project, health delivery system functioning, family health care activities and Compulsory Residential Rotatory Internship Program in outreach clinics. In the practice the practical aspects are largely unstructured that waste too much time in non-educational activities and rely on learning and doing. Meanwhile, expectation of the community is increasing and the challenge of nurturing their demands has come in forefront. Community has perceived that the medical schools are concentrating on fulfi lling the demand of their curriculum rather directing on their health care need. Conclusion: Health institutions need to be accountable to take the responsibility of strengthening the health status of the community of their catchments areas. The practice of community medicine need to be done in an innovative way and these schools should execute continual intervention activities and complement other institutions working in their areas.

Population Council, a nonprofit, nongovernmental research organisation established in 1952, seeks to improve the wellbeing and reproductive health of current and future generations around the world and to help achieve a humane, equitable, and sustainable balance between people and resources.

Background-Drug dependence has been showing a rising trend all over the world perhaps as a result of newer and greater stresses related to rapid changes in life styles. During adolescence students are more vulnerable due to increased academic pressure, peer group influence and increased popularity and availability of substances. Understanding the pattern and circumstances leading to substance abuse will help to go for appropriate interventions to protect the young adults from substance abuse. Aims and Objectives-To find out the sociodemographic profile, prevalence, causes and types of substance abuse among undergraduate medical students of KPC medical college, Kolkata. Materials and methods-A sample of 452 undergraduate medical students of KPC Medical College were included in the study during May 2015 to April 2016; stratified random sampling was done and 452 students were selected taking 113 students from each semester of students of the 4 semesters. Data was collected using a pre-tested questionnaire and analysis of data was done using suitable statistical tests. Results-Prevalence of substance abuse was found to be 60.26% and it was predominately high among male students (75.09%). Alcohol (77.29%) was found to be the most common abuse followed by cigarette (76.56%), gutkha (20.51%) and drugs (13.55%). Academic pressure and curiosity were the major initiating factors. Conclusion-The medical students though aware of the hazards are continuing substance abuse and it reflects lack of health consciousness along with increased academic and peer group pressure. Proper counselling with well planned policies should be implemented to root out the evil of substance abuse among the future doctors.

Background: Suboptimal breastfeeding accounts for death of 1.4 million children every year. Of all proven preventive health and nutrition interventions, IYCF (infant and young child feeding practices) has the single greatest potential impact on child survival. Objectives: 1. To assess the infant and young child feeding (IYCF) practices among mothers 2. To evaluate the various indicators of infant and young child feeding practices among the same group. 3. To impart knowledge about appropriate infant and child feeding practices to the mothers. Materials And Methods: A community based cross-sectional study among mothers of children aged 0-23 months attending the Anganwadis in a selected area of the rural health centre of Travancore Medical College, Kollam. A pre-tested structured interview schedule was used for the purpose. Analysis: Data was entered into Microsoft Excel and analyzed by SPSS version 16 Results: Out of 50 children studied more than half were females and most of them belonged to birth order less than 2.There was early initiation of breast feeding and exclusive breast feeding in 60% of children. Colostrum was given to 78% children. Only 32% were given prelacteal feeds. 83% of children in the 12-23 months age group were still breastfed. Iron rich food was given to only 52.1% children. All the children studied had Minimum Meal Frequency (MMF). Minimum Meal Diversity (MMD) and Minimum Acceptable Diet were observed in 91.3%. Conclusion: It is clearly evident from our study that the IYCF indicators; core and optional indicators showed acceptable values.

Background: Work-family conflict (WFC) and Family-work conflict (FWC) are likely to exert negative influences on an individual's mental health, resulting in lower life satisfaction and greater internal conflict at work-family interface. Existing literature on WFC ignores the teaching profession, despite it being a universal phenomenon. This study expands on WFC & FWC occurring in the lives of female teachers, with special mention of psychological distress and wellbeing of the working women. Methods: The main objectives of the study were to compare WFC with FWC among married teachers of urban Meerut and to assess various factors associated with them. It was a cross-sectional study conducted in schools of urban block of Meerut, Uttar Pradesh on 384 teachers aged 20-50 years, and married for at least 3 years. Data was collected using a questionnaire containing Breyer's work family conflict scale and analysed using SPSS V25, ANOVA, and Pearson's correlation Results: FWC (Mean 5.97; SD=1.962) was found to be greater than WFC (Mean 4.93.01; SD=1.571). More than 60% of the participants were always or often asked to bear the brunt of dual role, even when most of them (~58%) were working solely due to family needs. Variables like reason for working, work experiences and demand for dual roles were found to be important in deciding WFC as well as FWC. Conclusions: This study explores WFC/ FWC and governing factors in these conflicts. Present study found that family roles created more friction towards work roles in teachers rather than work roles creating friction in family roles.

The present study investigated the cultivable mesophilic (37°C) and thermophilic (60°C) cellulose-degrading bacterial diversity in a weathered soil-like sample collected from the deep subsurface (1.5 km depth) of the Homestake gold mine in Lead, South Dakota, USA. Chemical characterization of the sample by X-ray fluorescence spectroscopy revealed a high amount of toxic heavy metals such as Cu, Cr, Pb, Ni, and Zn. Molecular community structures were determined by phylogenetic analysis of 16S rRNA gene sequences retrieved from enrichment cultures growing in presence of microcrystalline cellulose as the sole source of carbon. All phylotypes retrieved from enrichment cultures were affiliated to Firmicutes. Cellulose-degrading mesophilic and thermophilic pure cultures belonging to the genera Brevibacillus, Paenibacillus, Bacillus, and Geobacillus were isolated from enrichment cultures, and selected cultures were studied for enzyme activities. For a mesophilic isolate (DUSELG12), the optimum pH and temperature for carboxymethyl cellulase (CMCase) were 5.5 and 55°C, while for a thermophilic isolate (DUSELR7) they were 5.0 and 75°C, respectively. Furthermore, DUSELG12 retained about 40% CMCase activity after incubation at 60°C for 8 h. Most remarkably, thermophilic isolate, DUSELR7 retained 26% CMCase activity at 60°C up to a period of 300 h. Overall, the present work revealed the presence of different cellulose-degrading bacterial lineages in the unique deep subsurface environment of the mine. The results also have strong implications for biological conversion of cellulosic agricultural and forestry wastes to commodity chemicals including sugars.

Background: Mosquito-borne infections especially dengue has created several outbreaks in the present days.
Agricultural and horticultural college students are at increased risk of getting infected since they are involved in a lot
of field activities. The main aim of our study is to assess the awareness about mosquito-borne infections among
agricultural and horticultural students of all the academic years. Also, to analyse the preventive measures and sanitary
methods followed by the students to prevent the infection.
Methods: This cross-sectional study was conducted in Tamil Nadu Agricultural University (TNAU), Coimbatore
including 250 students who are involved in the field works. The questionnaire consisting of 24 multiple choice
questions were distributed and collected after filling. The data were processed and statistical significance was
calculated using the software SPSS version 20.
Results: Females have comparatively good knowledge (54.8%) than males (46.9%). Students whose age is less than
20 years have good knowledge (64%) when compared to students with age more than or equal to 20 years (40.8%).
Agricultural students have comparatively fair knowledge (54.5%) than Horticultural students (47.1%). There is a
significant association between knowledge and age.
Conclusions: The results of our study revealed that the students have fair level of knowledge about mosquito-borne
infections especially dengue. Not only creating awareness is important, it should also be looked into that people
implement their knowledge into day-to-day practice to prevent the mosquito-borne infections.

Background: Integrated Child Development Service (ICDS) is India’s response to the challenge of meeting the holistic needs of children below six years of age, adolescent girls expectant and nursing mothers through the network of Anganwadis.
Objectives: To assess the knowledge of Anganwadi Workers of Jaipur Zone (Rajasthan) India.
Materials and methods: 8 AWCs were selected from each of the 5 Zones of Jaipur. So, total 40 AWCs were included in the present survey. Performance of each of the AWW from identified AWCs was assessed as per the ‘Form no. (1)’ of ICDS. Performance of various districts and various activities were analyzed and inferred in proportion and percentages.
Results: 100% of AWWs of Jaipur zone was well aware about the care of pregnant women and lactating women except Kangaroo Method Care (KMC) which is known to only 10%. All the surveyed AWWs had knowledge about Infant feeding and family planning except the advantage of breast feeding which were know to 72.5%. Referral services about children, pregnant women and lactating mothers were known to 80% of surveyed AWWs.
Conclusion: Knowledge of AWWs was excellent except Kangaroo Cara Method, advantage of breast feeding and Referral services.

Introduction: Child Malnutrition Treatment Centre (CMTC) provide nutritional therapy to severe malnourished children. The objective of the study is to evaluate Strengths, Weaknesses, Opportunities and Challenges (or Threats) of Community Malnutrition Treatment Centre (CMTC), Mahuva. Methodology: Out of 3 functioning CMTCs in Surat district, CMTC Mahuva was randomly selected & SWOC (Strengths, Weaknesses, Opportunities and Challenges) analysis of the centre was done by interviewing superintendent, nutritionist, other staff of centre and beneficiaries’ mothers. Results: CMTC Mahuva having strengths such as definite guide-lines, motivated and trained human resource and financial resource, good infrastructure, support by Superintendent of CHC Mahuva. Weaknesses like insufficiency of budget, nonavailability of pediatrician in nearby place and lack of fully functioning Nutritional Rehabilitation Centre at district level also co-exist. Centre is having external opportunities like use of Ro...

Background: Badminton being an overhead sport requires scapular stability and coordinated motion at the shoulder complex. It has been proven that muscle imbalance due to the overuse leading to instability is a major factor leading to scapular dyskinesia (SD). Although, SD has been studied in bilateral overhead athletes, badminton being a unilateral overhead sport was not deeply evaluated and no emphasis given on the side of affection and type of SD. Objectives: 1. To find the prevalence of SD in elite badminton players in Pune 2. To observe the pattern of SD with its relation to the dominant side 3. To find the commonest type of SD Methods: 100, injury-free, male and female elite badminton players (18-29 years old) playing for 5 to 10 years with regular training of 1.5-2 hours per session with a minimum of 4 sessions per week were included in the study. The SD was measured by performing the lateral scapular slide test (LSST). Results: The overall prevalence came to 73%. 61% were found to have SD on the dominant (playing) side. Type 1 was more common compared to type 2 SD. There was a statistically significant difference found on the basis of number of years played (p<0.05). Conclusion: This study indicates that SD is prevalent in elite badminton players on the dominant side with type 1 being the commonest. Players who played between 8 to 10 years reported with an increased prevalence.

Background: Despite the fact that the usage of family planning methods has increased over a period of time, there exists a knowledge, attitude and practice gap among the peoples of various groups in our society regarding age, religion, caste, community etc. The objective of the study was to assess the level of knowledge, attitude, and practice of different family planning methods among the women of schedule caste community. Methods: A community based cross sectional study was done among 104 married women of the reproductive age group. Result: Most of the women (50%) were in the age group (25-34) years.77.5% of the study participants were unemployed. Only 13.6% women had completed graduation. Average age at marriage was 19.73±3.813 years. Almost 96.1% women knew about any one method of contraception. The most common source of information was mass media (76.8%). 87.2% had positive attitude towards family planning. 65.7% females were using family planning methods currently. 25.4% were using traditional while 75.6% were using any type of modern methods. OCP is the most popular contraceptive method (47%) followed by condom (21.6%). Majority of females (40%) were using contraceptive methods for spacing of birth. 84% user said that they did not get any side effect. 53.3% women did not use any type of family planning method because they want children. Conclusion: Our study highlights that more strategic approach should be recommended to develop the socioeconomic and demographic status in relation to fertility and family planning aspects for the people of scheduled caste community.

Immunology was born as the study of organism’s defense with the development of vaccination by the English physician Edward Jenner in 1796; it inaugurated a whole new look into medical and biological phenomena. Culminating in the end of XIX century with Pasteur’s Microbiologic Revolution, bringing into scene the idea of specific infectious agents being the cause of certain diseases, and later with Paul Ehrlich’s concept of ‘magic bullets’, specific substances that would be capable of inhibiting those specific agents. This has produced the enormous technological development of immunobiologicals, like vaccines, antibiotics, serotherapy, diagnostics, monoclonal antibodies used as therapeutic molecules in more recent years.

Aim To define food safety and risk perception of foodborne diseases in the private home setting and identify specific behaviours during food purchase, storage and preparation in a large survey study. Subject and methods A large sample of individuals (n=1,000) living in the area of Cassino, Italy, volunteered to participate in the study. All participants were randomly recruited and underwent a questionnaire-based interview at their home regarding food-safety measures. Logistic regres-sion analyses were used to test for correlations between demographic characteristics and knowledge/behaviours of food diseases. Risks of hazardous practices in the home were calculated according to educational, physical, occupational and marital status. All analyses were performed using the EPIINFO 3.5 statistical program. Results Our data showed that there was an insufficient amount of knowledge regarding foodborne diseases and pathogens. In most families, we found that there was a lack of correct adherence to food hygiene, mainly due to errors during both food preparation and storage. There was a higher risk for food safety errors in families with children, older persons and pregnant women. Conclusion Our findings confirm that the home environment represents an important site for the spread of pathogens responsible for foodborne diseases. In order to adopt good hygiene practices in the home setting, consumers need to be informed about safety procedures of domestic food handling, storage and preparation.

Background
Accurate childhood cancer burden data are crucial for resource planning and health policy prioritisation. Model-based estimates are necessary because cancer surveillance data are scarce or non-existent in many countries. Although global incidence and mortality estimates are available, there are no previous analyses of the global burden of childhood cancer represented in disability-adjusted life-years (DALYs).
Methods
Using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 methodology, childhood (ages 0–19 years) cancer mortality was estimated by use of vital registration system data, verbal autopsy data, and population-based cancer registry incidence data, which were transformed to mortality estimates through modelled mortality-to-incidence ratios (MIRs). Childhood cancer incidence was estimated using the mortality estimates and corresponding MIRs. Prevalence estimates were calculated by using MIR to model survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated by multiplying age-specific cancer deaths by the difference between the age of death and a reference life expectancy. DALYs were calculated as the sum of YLLs and YLDs. Final point estimates are reported with 95% uncertainty intervals.
Findings
Globally, in 2017, there were 11·5 million (95% uncertainty interval 10·6–12·3) DALYs due to childhood cancer, 97·3% (97·3–97·3) of which were attributable to YLLs and 2·7% (2·7–2·7) of which were attributable to YLDs. Childhood cancer was the sixth leading cause of total cancer burden globally and the ninth leading cause of childhood disease burden globally. 82·2% (82·1–82·2) of global childhood cancer DALYs occurred in low, low-middle, or middle Socio-demographic Index locations, whereas 50·3% (50·3–50·3) of adult cancer DALYs occurred in these same locations. Cancers that are uncategorised in the current GBD framework comprised 26·5% (26·5–26·5) of global childhood cancer DALYs.
Interpretation
The GBD 2017 results call attention to the substantial burden of childhood cancer globally, which disproportionately affects populations in resource-limited settings. The use of DALY-based estimates is crucial in demonstrating that childhood cancer burden represents an important global cancer and child health concern.

In contrast to modern science, the original idea of ‘herd immunity’ is not a natural process as inoculation or variolation is a must.  Wherein the virulence of virus is considerably condensed with the help of natural substances like herbs and leaf juices. 

The intermixing of virus loaded biochemical synthesis fetches in nose-diving the virus mutation, by this means, the infection turns into mild, unlike the natural attack.  The inherent antigens in animals will quickly respond to face the attack of the mild virus by producing awe-inspiring antibodies in order to develop immunity within the stipulated period.     

Shepherds in rural India are performing the herd immunity for their livestock with the help of herbal produces in order to prevent the virus-causing epidemics. They attenuate the virulence of virus with help of leaf juice extracted from Amma Talli plant before inoculation or variolation.

Introduction: Child Malnutrition Treatment Centre (CMTC) provide nutritional therapy to severe malnourished children. The objective of the study is to evaluate Strengths, Weaknesses, Opportunities and Challenges (or Threats) of Community Malnutrition Treatment Centre (CMTC), Mahuva. Methodology: Out of 3 functioning CMTCs in Surat district, CMTC Mahuva was randomly selected & SWOC (Strengths, Weaknesses, Opportunities and Challenges) analysis of the centre was done by interviewing superintendent, nutritionist, other staff of centre and beneficiaries’ mothers. Results: CMTC Mahuva having strengths such as definite guide-lines, motivated and trained human resource and financial resource, good infrastructure, support by Superintendent of CHC Mahuva. Weaknesses like insufficiency of budget, nonavailability of pediatrician in nearby place and lack of fully functioning Nutritional Rehabilitation Centre at district level also co-exist. Centre is having external opportunities like use of Ro...

Background-In 2005, Government of India launched National rural health mission in hopes to bridge the gap between healthcare delivery system to the needed community. One of the key strategies under the National Rural Health Mission is having a community health worker who is an Accredited Social Health Activist (ASHA) for every village with a population of 1000. Objectives-1. To evaluate the work performance of ASHA workers in their field practice area 2. To gather feedback given by the ASHA workers regarding incentives received by them and the challenges they face during their disposal of duties and responsibilities. Methods and Methodology The present study is conducted in the Chaapi and Hazipur village of Katihar sadar Block, and Kolasi village of Korha Block of Katihar District (Bihar). In this study Purposive Sampling is used for selecting the sample of ASHA. Total 45 villages ASHAs were interviewed using predesigned semi-structured questionnaire from June to October, 2018. Results: Maximum numbers (68.89%) of ASHA were qualified to 8 th Standard and only 2.22% respondents were having qualification of graduate and above. About 71.11 % and 17.78 % of the respondents spent 2-4 hours and 4-6 hours a day respectively for catering to health services in rural areas. Majority of the ASHA belongs to Upper Lower (33.33%), Lower middle (28.89%) and Upper lower (28.89%) socio economic status. 77.78 % of the respondents agreed that the main purpose to join as ASHA was to financially support their family. About 55.56 % joined as ASHA to do social work. Only 64.44 % of the ASHA were able to diagnose dehydration and its reasons. 88.89 % of the respondents were able to test anemia and also ensures treatment for it. About 77.78 % of the respondents were able to screening of pregnant woman for problems and danger signs and referral, and 73.33 % have interpersonal communication skills. Majority of the ASHA workers (88.89%) suggested that the honorarium that they get should be regularised and 77.78 % suggested for improving transportation facilities and 86.67 % opinionated to have periodic retraining and upgrading their knowledge and skill base.

Background: Adolescence represents one of the critical transitions in lifespan characterized by tremendous pace in growth, development and acquisition of secondary characteristics that occurs between the age 10-19years. Adolescents have been found to be at a high risk for most of the negative consequences ascribed to unsafe sexual practice, such as Sexually Transmitted Infections and unwanted pregnancy. Hence, this study was conducted to assess the level of knowledge and practice of safe sex amongst in-school and out-of-school adolescents Methodology: This was a comparative cross sectional study conducted among 138 in-school and out of school adolescent respectively using quantitative method of data collection. SPSS version 20 was used for data analysis, adjusted odds ratio and 95% confidence interval were used as point and interval estimates respectively on the logistic model while a p-value of ≤0.05 was considered statistically significant. Results: The mean age of the out of school adolescents was 16.0±2.3 years as compared to14.2±2.4 years among their in-school counterpart with the level of practice of safe sex adjudged to be good among 8(47.1%) and 40 (47.6%) of the respondents in school and those out of school respectively (χ 2 = 0.002; p = 0.966) Conclusion: The study has brought to light the need to constantly provide adolescents either in or out of school with relevant information on safe sex through appropriate channels in order to improve their level of knowledge and practice of sex.

Background: Childhood obesity is a growing healthcare burden in India and other developing countries. Causes of overweight and obesity are attributed to various socio-economical and environmental factors that influence the food habit and physical activities. Obesity is more prevalent among the rich children of urban area than the rural setting. Aims and Objectives: To find out the prevalence of overweight and obesity among the school going children. Material and Methods: Present single centre cross sectional study was performed on 396 children of age 12 to 14 years at one school in January 2019. To capture the demographic and lifestyle data a pre-designed questionnaire was used. Collected data was statistical analyzed using SPSS ver. 20 software. Level of significance was assessed at 5%. Results: Prevalence of overweight and obesity was 8% and 5% respectively. We observed that the obesity was more prevalent among girls. Fast food was the major cause for obesity and lack of physical activity makes it sever. Conclusions: Observations of this study shows that overall 13% children were overweight and obese. This study suggest that the physical activities, games, health education and awareness programs should be included in the education system for students, teachers to fight and control the obesity and overweight.

The antigens of the ABO blood group system (A, B and H determinants, respectively) are complex Carbohydrate molecules on the extracellular surface of red blood cell membranes. However, along with their expression on red blood cells, ABO antigens are also highly expressed on the surface of a variety of human cells and tissues, including the epithelium, sensory neurons, platelets, and the vascular endothelium. Also there is association between ABO blood group status and von Will brand factor. Deficiency of vWF leads to Hemorrhagic disorders, while elevated levels are a risk factor for thrombosis. Earlier studies state that the O group individuals have prolonged bleeding time and clotting time. The objective of this study was to assess the relationship between Bleeding time and clotting time among various Blood groups. This is a cross sectional study including 433 Undergraduate students. There was a difference in BT & CT found with respect to blood groups but there was no statistical significance in it. Also no statistically significant difference was observed in BT & CT in Rh-ve & Rh+ve blood group. The difference in O blood group and Non O blood group was also not significant. A large multicentric study in which the levels of von Will brand’s factor should be carried out to clear the gray area around this topic.

Background: The current COVID-19 pandemic has posed significant challenges to public health. In mitigating its spread, social distancing by imposing a lockdown is being promulgating; but various societies are reacting differently it. The current study aims to find out the community callousness towards lockdown of COVID-19 and the reasons thereof. Methods: This is a community based cross-sectional study was conducted over a period of seven days from 24 th to 31 st March in the initial part of lockdown. To observe the effectiveness of lockdown, our team consisting of a doctor, a community health worker/guide and a driver visited the concerned areas. Observations were made whether the people were following the lockdown instructions in letter and spirit or not. Once the people were seen flouting these rules, they were interviewed, as to the reasons thereof and were counseled properly. Results: On the first day of the visit, 736 people were seen to violate the norms. The mean age of the violators was 29.86 + 3.24 years. The number of people defying the lockdown regulations decreased substantially in the successive days. There was a significant difference in flouting rules across age groups, genders, level of education, and employment status (P < 0.05).The main reason of people not adhering to lockdown was, "Since they are healthy, COVID-19 won't afflict them" (P < 0.05). Conclusion: A good number of people were seen pretty callous towards the lockdown announced for mitigation of COVID-19 pandemic, but with proper counseling, almost

Introduction: Gastro-intestinal disorder are more common among all hostel residents, it may due to unhygienic mess condition or taking food mostly from outside. it can be modifiable factor, at present time most of student live hostel life in his/her life time period for study, then it became a matter of concern to know the prevalence and etiology of it and try to modify it. Material and Methods: A cross-sectional study was conducted in UG, PG Girls and Boys hostels of S.S.M.C. Rewa M.P. A random sampling method was used to obtain study population. The total sample size was 296, Data were collected in a pre-structured questionnaire and analyzed with the help of Instat Graph pad and appropriate statistical tests were applied. Result: The overall prevalence of GIT Disorder was found to be 63.17% among hostel residents, The prevalence was more common69.10% in Boys Hostels and less common 54.23% in girls hostel and it will increase as the duration of stay in Hostel were increased, and it was more common in Non-Vegetarian (70.53%). Conclusion: High prevalence of GI disorders was related to living condition and dietary pattern so if we can improve the hygiene in hostel and regulate their dietary pattern than the prevention of various GIT problems can be done.

Background: Pityriasis versicolor (PV) is a chronic superficial fungal disease of the stratum corneum etiologically associated with the Malassezia spp. As the routinely used KOH wet mount is time consuming and requires an expert to interpret the results, a new staining method that can replace KOH wet mount has to be found out. Objective: To demonstrate the diagnostic efficacy of cellophane tape Pugh's staining in comparison with routinely used KOH wet mount for the diagnosis of PV. Methods: A total number of 450 specimens from different body sites of 422 PV cases with respect to colour of the lesions were studied. Skin scrapings were subjected to KOH wet mount and cellophane tape stripping and staining method was used in case of Pugh's staining. Statistical analysis was done. Result: Both the KOH wet mount and cellophane tape Pugh's staining gave similar results. Out of 450 lesions sampled, 402 (89.3%) gave positive results. Fungal elements were seen more clearly in purple colour of the stain. The sensitivity and specificity of Pugh's stain when compared with KOH wet mount was 100%. Conclusion: Cellophane tape Pugh's staining used as a novel method in this study has the potential to replace the KOH wet mount, as the routine method for the rapid diagnosis of PV.

Stress is a condition which disrupts or destabilizes homeostasis, e.g., homeostasis of central nervous system (CNS), of blood pressure (BP), of skeletal muscular efficiency and so on. The cause of stress-related diseases is increasing day by day throughout the world. Stress-related disorder will be one of the causes of disability if proper measures are not taken to overcome it. Pranayama, an important part of Yoga is breathing exercise, derived from two Sanskrit words: "Prana" and "yama", which means control over bodily functions and mind. Regular practice of breathing exercise (Pranayama) increases parasympathetic tone, decreases sympathetic activity and simultaneously improves cardiovascular and respiratory functions. It also decreases the effects of stress and strain on the body and improves the physical and mental health. This study was done to find out the effect of simple slow and deep voluntary breathing on body and mind which was evaluated by recording blood pressure (BP) with the help of sphygmomanometer and stethoscope. The volunteers for the study included all medical students of age group 18-25 years, of Nepal Medical College and Teaching Hospital, Attarkhel, Jorpati, Kathmandu, Nepal. Result was found to be decrease in both systolic and diastolic blood pressure after performing 5 minutes of this slow deep voluntary breathing exercise. The decrease of diastolic blood pressure and mean blood pressure were significant.