Wednesday, July 3, 2013

Collaborative Program of Indian Association for Adolescent Health: Health checkup for non-communicable diseases and Stress Management training of Nursing students at SKIMS, Soura, Srinagar

 Team of Doctors headed by Dr. Anjum conducted health check up: A program of Department of Community Medicine and Indian Association for Adolescent Health
 Participating in Stress Management Training of Nursing students

 Dr. Majid and Dr Rouf attending the stress management training
Dr. Anjum with her PG discussing with Dr. Jugal Kishore
Dr. Jugal Kishore delivering the session on stress management

Sunday, June 2, 2013

Indian Perspective of Salutogenesis

Concept of salutogenesis was given by Antonovsky wherein health was seen as a movement
in a continuum on an axis between total ill health and perfect health. Person has ability to
comprehend the whole situation and the capacity to use the resources available and this is
called as Sense of Coherence (SOC) which can be measured by objective tool. This concept
of health is not new in Indian culture, rather well developed, and started in more than two
thousand five hundred years back when Gautam Buddha and Mahavira explained their
experiments to achieve perfect health. Their focus was on training of mind with moral and
ethical value system. The followers of those principles were ensured that they get the best
level of their health. There is a need to explore those principles in present context and
objective criteria should be developed to measure such phenomena and their effects on
human health.  
Keywords: Sense of coherence, Eightfolds path, Buddha,
Reference: Jugal Kishore, Tanu Anand. Indian Perspective of Salutogenesis. RR: Journal of Medicine. 2013; 3 (1): 25-28

Health Status of Sewage Workers in Delhi

Sewage contains numerous toxic substances which include poisonous gases and infective
agents. As a consequence of this, sewer workers often suffer from a constellation of
symptoms known as the sewer worker’s syndrome. Very limited data on the occupational
health and safety status of sewage workers is available in India. A cross-sectional study
was conducted in Delhi involving 200 sewage workers and their health profile was
studied using standard procedures. It was found that majority of workers have had cuts
or injuries, experienced irritation of eyes and suffered from skin rashes. One-fifth of
workers reported syncope, and some temporary loss of consciousness. The other major
chronic symptoms included headache (48.5%), skin rashes (45.5%), skin irritation
(41.5%) and body ache (41.5%). 8.5% had raised white blood cell count, 11.7% showed
raised ESR than normal and 30.2% had mild restrictive respiratory changes while 20.7%
showed changes ranging from moderate to severe restriction or obstruction. The study
concluded that sewage workers are suffering from high morbidity and need urgent
attention for the health and safety programs and training focusing more on preventive
measures and change in their life style.
Keywords: Sewer workers syndrome, Sewer, Occupational problem, Eosinophilia
Reference: Ashish Mittal, Pranjal J. Goswami, J. Kishore, J. John. Health Status of Sewage workers in Delhi. RR: Journal of Medicine. 2013; 3 (1): 17-24.  

Friday, May 17, 2013

Noncommunicable disease risk profile of factory workers in Delhi

Background: Non communicable diseases are becoming more prevalent in India. The data for presence of non communicable diseases and its risk factors among factory workers is deficient in India. Materials and methods: A cross sectional comparative study was carried out among 37 factory workers and equal number of comparable subjects from general population. Screening for presence of diabetes along with its risk factors was made in both the groups using pretested predesigned WHO STEPS questionnaire in rural area of Delhi.  Data was analyzed using SPSS version 16 software. The estimation of risk in two groups was done with calculation of Odd’s ratio. P value less than 0.05 was considered significant. Results: A total of 74 participants were included in the present study. Hypertension and diabetes was present in 13.5% and 5.4% of factory workers and 4 (10.8%) and 3 (8.8%) in non-factory subjects. 7 (18.9%) factory and 8 (21.6%) non-factory subjects fell in category of current smoker or smokeless tobacco users. HDL levels were found abnormal among 1(2.7%) case and 9 (24.3%) controls (p value 0.01). Behavioral risk factors -alcohol consumption and fruits and vegetable intake were significantly different among two groups. Conclusion: Factory workers were having better profile than non-factory subjects except for risk factors such as alcohol intake and inadequate fruits and vegetable intake. However healthy worker effect phenomenon cannot be ruled out.
Key words: Non communicable diseases, factory, healthy worker effect phenomenon
Original article published in Indian Journal of Occupational & Environmental Medicine

Lead Poisoning

Rise in lead poisoning cases sparks alarm in Capital

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The increasing number of lead poisoning cases in city hospitals have raised an alarm, with doctors saying what was once a rare occurrence seems to be more common.
"We are attending to over a dozen cases of mild and moderate lead poisoning in a month. Severe cases of lead poisoning occur as an occupational hazard among people working in the metal industry. 
"People suffering from mild and moderate lead poisoning may have repeated anaemia, a low IQ level, headache, impaired fertility and hypertension," said Dr Jugal Kishore, professor, community medicine, Maulana Azad Medical College and Lok Nayak hospital. 
Doctors have called for surveillance of the lead content in humans because there are scores of factories running in violation of the law
Doctors have called for surveillance of the lead content in humans because there are scores of factories running in violation of the law

Officials from SRL Diagnostics claimed that they receive around 600 samples every month for Atomic Absorption Spectroscopy, which detects metal content in human body fluids. 
The officials claimed that at least 350 samples contain lead followed by copper (125), zinc (50) and other metals such as arsenic, mercury, aluminium and chromium. 
Recently, doctors at RML hospital attended to an 18-year-old non-smoker who came to the emergency department suffering from colicky abdominal pain for one week. 
The case was also published in The New England Journal of Medicine because of it being a rare manifestation of lead poisoning. Recently, five-year-old Diya died of lead poisoning at Kalawati Saran hospital after suffering kidney failure.
Her father worked for a battery factory in Uttam Nagar. Doctors call for surveillance of the lead content in human bodies because there are scores of recycled batteries and plastic factories running in rank violation of the law. 
Lead is dangerous because once it gets into the system, it is distributed throughout the body just like helpful minerals such as iron, calcium, and zinc.

Thursday, May 2, 2013

Tuesday, February 5, 2013

Social Attitude on Gang Rape and Public Health Issues

Presented at the Meeting on “rape and violence against women” organized by PUCL and Radical Humanists India on 10th Jan 2013 at Gandhi Peace Foundation, New Delhi
Dr. Jugal Kishore
Professor Public Health Maulana Azad Medical College
Director (Hon) Center for Inquiry-India, 

The Delhi High Court on February 08, 2010 sentenced the prime convict in the 2002 Maulana Azad Medical College student rape case to life imprisonment. The Delhi police had in 2003 filed a charge sheet against four persons - Rahul, Amit, Mohan Lal and Ashok –except raul other were acquitted, two initially and Amit was released in 2010. It took eight years to settle the case.

Ms. Jyoti Singh 23 year old girl who was gang raped on December 16 on moving bus in Munirka Vasant Kunj road and had 13-day of agonizing struggle for life that ended in her death in Singapore. Her companion who was also beaten up by six culprits said that "My friend was grievously injured and bleeding profusely," he said. "Cars, autos and bikes slowed down and sped away. I kept waving for help. The ones who stopped stared at us, discussing what could have happened. Nobody did anything." This indicate our social and legal attitude to the cases of rape not to mention the attitude of police who always justified their inactions because of lack of staff, political pressure, religious and social pressure.

Statistics of violence against women
Every 3rd minute a case of violence against woman is registered in India. Every day 50 cases of dowry related violence are reported. Every 29th minute a woman is raped in 2011 and it was 54 minutes in 2002. The worst is this shameful list is Madhya Pradesh which has had Three thousand four hundred and six cases of rape reported in 2011 (3406) then West Bengal (2363) then Uttar Pradesh (2042) and so on. Fewer cases are reported from Sikkim and Nagaland, Manipur and Goa. The total number of RAPE case reported last year has been 23582.
Violence against women takes many forms – physical, sexual, psychological and economic. These forms of violence are interrelated and affect women from before birth to old age.
Up to 70 per cent of women experience violence in their lifetime.

Violence by an intimate partner
A World Health Organization (WHO) study in 11 countries found that the percentage of women who had been subjected to sexual violence by an intimate partner ranged from 6 per cent in Japan to 59 per cent in Ethiopia.

Women aged 15-44 are more at risk from rape and domestic violence than from cancer, car accidents, war and malaria, according to World Bank data. It is estimated that, worldwide, one in five women will become a victim of rape or attempted rape in her lifetime. The practice of early marriage – a form of sexual violence – is common worldwide, especially in Africa and South Asia. Over 60 million girls worldwide are child brides, married before the age of 18, primarily in South Asia (31.1 million and Sub-Saharan Africa (14.1 million).

Sexual violence in conflict or custody
It is frequently a conscious strategy employed on a large scale by armed groups to humiliate opponents, terrify individuals and destroy societies. Women and girls may also be subjected to sexual exploitation by those mandated to protect them. Violence against women in police custody is common and includes sexual violence, inappropriate surveillance, strip searches conducted by men and demands for sexual acts in exchange for privileges or basic necessities.

Violence and HIV/AIDS
Young women are particularly vulnerable to coerced sex and are increasingly being infected with HIV/AIDS. Over half of new HIV infections worldwide are occurring among young people between the ages of 15 and 24, and more than 60 per cent of HIV-positive youth in this age bracket are female. There is feminizing of AIDS.

Dowry murder
Dowry murder is a brutal practice where a woman is killed by her husband or in-laws because her family cannot meet their demands for dowry — a payment made to a woman’s in-laws upon her marriage as a gift to her new family. In India, 22 women were killed each day in dowry-related murders in 2007.

Honor killing
In many societies, rape victims, women suspected of engaging in premarital sex, and women accused of adultery have been murdered by their relatives because the violation of a woman’s chastity is viewed as an affront to the family’s honor

Trafficking in persons
Between 0.5 to 2 million people are trafficked annually into situations including prostitution, forced labor, slavery or servitude, according to estimates. Women and girls account for about 80 per cent of the detected victims

A 2004 study in the United Kingdom estimated the total direct and indirect costs of domestic violence, including pain and suffering, to be £23 billion per year or £440 per person (Rs.30800 per capita).

What makes the women vulnerable?
  1. Customs
  2. Attitude of society towards girl child
  3. Polygamy and polyandry
  4. Child Marriage
  5. Sati pratha
  6. Casteism
  7. Honor Killing
  8. Female Genital Mutilation
  9. Gender based violence
  10. Poor health conditions such as HIV, STDs, TB, Leprosy
  11. Sexual harassment
  12. Prostitution
  13. Poor educational status
  14. Poor Law and order
  15. Women’s occupations
  16. Women’s insecurity
  17. Misuse of advancement of Technology such as ultrasound machine, emergency pills,
  18. Infanticide and feticides

Prevention and control
These all conditions of women enumerated above are the symptoms of disease which lying in physico-psycho-social environment and has multi-dimensional causation. Causes of women sufferings are more related to her social, cultural, religious, legal, political and mental status. According to my understanding sacred scriptures are responsible for her poor status. As science and humanism are improving the conditions of human being on the other hand the orthodox and rotten scriptures continue to pollute the society’s mind to behavior barbarically. So prevention and control should focus on core of the problem. It has to be multidimensional and integrated in nature. One must understand that woman suffering is not her own problem rather whole family and society gets affected.  Following corrective measures need to be   
  1. Corrections of sacred books
  2. Promoting science based humanism
  3. Annihilation of harmful practices against any gender  
  4. Women’s empowerment and equalizing gender power
  5. Protecting the rights of girl child and reproductive rights
  6. Protecting and promoting health of the women
  7. Educating children and adolescents for life skills
  8. Protecting environment and decreasing consumerism
  9. Strict implementation of laws and making appropriate laws
Most of the preventive and measures are self explanatory, however, here last two need little more elaboration. Life skill education trained the person to learn skills required for day to day life and dealing with stress and strain in life without damaging health.
-Critical thinking
-Coping skills

Life skill education is advocated at school level but very few places it is started. School authorities in both public and private should take this responsibility to inculcate in them these skills. We are not telling our children to develop life skills rather exposing them to consumerism and violence. Society plays a paradoxical role confusing the developing mind. On one side violence is accepted through movies, literature, sacred scriptures, role model based mythological tales and on other side it preaches Ahimsa, peace and love. Both concepts can’t stay together. Young people should be exposed to truth so that they can use their critical thinking for exploring further truth. We have to provide opportunities to learn communication and negotiating skills with your other colleague, friends, family, neighbor and opponents.

What coping mechanism we have if some young girl is rapped. How society react to this is important. For her it is the end of life. Or it is end for rapist also. One does not have other choice. How a young person will cope to this situation need to be told. There should be scope of improvement, tolerance, let go feeling and forgiveness. Society moves on and develops strong flexibility.

1.      Jugal Kishore. Female Feticide: An Instigation of female status. Saarbr├╝cken: LAP LAMBERT Academic Publishing GmbH & Co. Germany 2012.

Saturday, February 2, 2013

Effect of Community-Based Behavior Change Communication on Delivery and Newborn health care practices in a resettlement colony of Delhi

Background: Neonatal morbidity and mortaliy in India continues to be high. Among other reasons, newborn care practices are major contributors for such high rates.
Objective: To assess the effect of behavior change communication (BCC) package among pregnant women regarding neonatal care. 
Material and methods: Semi-structured and pre-tested schedule was used to interview 200 multigravidas on various aspects of neonatal care. Based on the preliminary data BCC package was designed and implemented in intervention block in the community. Follow up was done to find out change in their behaviour.
Statistical Analysis: Data was analyzed using Epi – info and Fischer exact test and chi-square test were applied in the baseline data. A p value of less than 0.05 was considered significant.  Effect of the BCC package is given in terms of relative risk.
Results: BCC package increased 1.76 times higher number of deliveries conducted by trained dais in intervention group. There was significant improvement in using sterile cord tie (p=0.01), applied nothing to the cord and giving bath to their baby within 6 hour of birth (p=0.02) in intervention group as compared to non-intervention group. Significant difference was found between the two groups with regard to breast-feeding practices of baby. Harmful practices were reduced in intervention group. Significant improvement was found in intervention group as compared to non-intervention group with regards to knowledge of danger signals, physiological variants, management of breastfeeding related problems, and awareness of skin-to-skin technique for the management of hypothermic baby. 
Conclusion: Inadequate knowledge and adverse practices regarding neonatal care among mothers in study areas were found. BCC package had favorable impact on behavior of mothers for neonatal care in intervention group. 

Keyword: Neonatal Health Care, Behavior Change Communication, Community Intervention, Breastfeeding, Hypothermia. 

Thursday, January 24, 2013

How to make India healthy: Giving up greed

I had discussion with a cook in a government hospital who is working for last 25 years. He hesitantly elaborated that everyday almost all workers of the kitchen take away eatables to their home such as milk, oil, sugar, butter, eggs, vegetables, etc. I was shocked to learn on the first minute and then realize that this is rampant throughout the country starting from Politicians to sweepers. This is based on the greed. Government resources are diverted to those places where they are already plenty and resource poor places remain poor just because of greed. Office stationary, cars, petrol, powers etc are used for home works. Funding agencies are promoting corruptions by asking 10% to 30% of cut. Not everybody is corrupt and many Robin Hoods are present in the society. But why there is need of such system where we do something which we do not justify and rationalize. Kitchen is vital component of a hospital. If this function well then suffering poor can get good and nutritious food. This can help them to understand the importance of healthy and balanced food.             

Climatic Change challenges the sustainable health and development

Climatic change occurring today tends to be responsible for global warming, thus affecting the human health. Such situations are affecting the health epidemiology. New diseases are emerging and known diseases are re-emerging in areas where it was not so common, earlier. This demands huge resources to sustain the health indicators. The challenge is unpredictability of disease occurrence and emergence of new risk factors to public health.Focus should be on reduction of consuming resources. More environment friendly technologies need to be developed by all sectors of development and public health specialists should be ready with their wisdom, dedication and tools to control any epidemic and prevent suffering and deaths caused by climatic change.

Authors: Jugal Kishore, Nishu Chaudhry. Journal of Energy, Environment & Carbon Credits.

Impact of Climate Change on Habitat and Health 2012; Special Issue: 7-10.

Saturday, January 12, 2013

1st International Conference on Occupational and Environmental Health

1st International Conference on Occupational and Environmental Health with apt theme of “International Collaboration and Capacity Building” scheduled on 1- 2 March, 2013 in New Delhi, the National Capital of India. The theme of the ICOEH 2013 is based on the deliberation that there is a need for enhanced International participation to know and mitigate the gaps in the academia (e.g. research and training), profession (e.g. medical, safety, industrial hygiene, engineering), regulators and service providers and to build the contemporary capacity of all the stakeholder. The aim of this conference is to provide the stepping stone in reducing the disparities among the developed nations who have taken care of many of the Occupational and Environmental Health issues and the developing countries like India, where much is yet required to be done.

This conference will be the appropriate platform to deal with the following topics sketched for the two days of the conference:
• Epidemiology of Occupational and Environmental Conditions and Diseases
• Technology and Infrastructure for Assessment and Diagnosis of Diseases
• Technology and Infrastructure for Health Hazards / Risk Assessment and Management
• Preventive and Promotive Methodologies in Occupational Health
• Polices, Legal Framework and Standard Operating Procedures
• Occupational Health in Informal sector

Panel Discussion:
Prioritizing opportunities for International collaboration & Capacity Building

Pre-conference workshops:
The conference is hinged by two pre-conference workshops, which will be rewarding to the participants for the topics covered, and the contents delivered by the International faculties.

1. STOFFENMANAGER: Management of Chemical Exposures, Simple and Cost Effective Solutions (By NIOH, South African Faculty)

2. On-site, Off-site Disaster Preparedness (By First Response, Australian Faculty and National Institute of Disaster Management, India)

Dr. Jugal Kishore
Chairman, Scientific Committee
Conference Secretariat, 
Room No. 337, Pathology Block, Dept of Community Medicine, 
Maulana Azad Medical College, Delhi Gate, New Delhi
Mobile: +91-9582792331
Dr. Ashish Mittal,
Organizing Secretary, ICOEH 2013
Mobile: +91-9313054881, +91-9910045636

Determinants of Current Smoking Behaviour among Third Year Nursing Students in India: Results from Global Health Professional Student Survey (India)

Health professionals serve as role models to their patients and public at large. Smoking among health
professional would have negative impact on community members. Global Health Professional Student
Survey (GHPSS) indicates health professional students including nursing students do smoke. But the
factors affecting smoking behaviour are yet to be explored. This study examined GHPSS (2007) to identify
factors encouraging smoking among nursing students. Results suggest that male gender, higher age, non
teaching about smoking hazards were major determinants of smoking. The study suggested that the
teaching about smoking hazards should be made mandatory in nursing schools.

Keywords: GHPSS, Nursing student, India, Smoking
Authors: Jugal Kishore, Pratap Kumar Jena, Sagarika Das, Chandan Bandyopadhyay, Indrani Banerjee