Understanding survival analysis: Kaplan-Meier estimate

Kaplan-Meier estimate is one of the best options to be used to measure the fraction of subjects living for a certain amount of time after treatment. In clinical trials or community trials, the effect of an intervention is assessed by measuring the number of subjects survived or saved after that intervention over a period of time. The time starting from a defined point to the occurrence of a given event, for example death is called as survival time and the analysis of group data as survival analysis. This can be affected by subjects under study that are uncooperative and refused to be remained in the study or when some of the subjects may not experience the event or death before the end of the study, although they would have experienced or died if observation continued, or we lose touch with them midway in the study. We label these situations as censored observations. The Kaplan-Meier estimate is the simplest way of computing the survival over time in spite of all these difficulties associated with subjects or situations. The survival curve can be created assuming various situations. It involves computing of probabilities of occurrence of event at a certain point of time and multiplying these successive probabilities by any earlier computed probabilities to get the final estimate.
This can be calculated for two groups of subjects and also their statistical difference in the survivals. This can be used in Ayurveda research when they are comparing two drugs and looking for survival of subjects.

Manish Kumar Goel, Pardeep Khanna, Jugal Kishore.Understanding survival analysis: Kaplan-Meier estimate. International Journal of Ayurveda Research | October-December 2010 | Vol 1 | Issue 4: 212-216, http://www.ijaronline.com/text.asp?2010/1/4/212/76794

Violation of Drug and Magic Remedies Act India

Country is trapped in false beliefs and religion. Unfortunately not many people with high degrees coming forward to stop this menace. Today news is that Uncle burns two small boys (3 years and 18 months old) in Ghaziabad to rid them of demonic presence. On sunday, the family had organized a hawan at their house after suggestion of a Pundit to rid of demonic effect leading to recurrent illness among family members. The small children were forced to get the cleansing effect of sacred fire of hawan when both burnt. Interesting thing is that instead of rushing to hospitals the family members immediately too the children to Kalkaji Temple in Delhi bypassing almost 4-5 big hospitals believing that only goddess Kali could save them but that didn't work. After that they rushed the kids to a sufi saint's mosque in Deoband near Saharanpur. But before reaching to that destination children died in the way. Although later on three people wee arrested including Pundit. Such incidences are common features of newspaper in India. (Source Mail Today 25th Jan 2011)

We have legislation "The Drugs and magic Remedies Act 1955" which prohibit such practices carried out by Pundits, Ojhas, Maulvis, faith-healers, and hundred thousands of quacks who has magic remedies for almost all illnesses and advertised on prime TV channels and leading newspapers. All are violating this legislation and liable for punishment. Magic remedies includes a talisman, mantra, kavacha, and any other charm of any kind which is alleged to possess miraculous powers for or in the diagnosis, cure, mitigation treatment or prevention of any disease in human beings or animals or for affecting or influencing in any way the structure or any organic function of the human or animal body. Advertisement of such remedies is banned and contravention of any provision of this Act shall be punished with imprisonment, which may extend to 6 months or 1 year in second or subsequent violation, or with fine or with both.

Occupational Stress Amongst Nurses from Two Tertiary Care Hospitals in Delhi

Nirmanmoh Bhatia, Jugal Kishore, Tanu Anand, Ram Chander Jiloha

Background: Nursing is known to be a stressful profession. Nursing staff working at the bottom of the hierarchy and in public hospitals are the ones who are more stressed out. There is a
paucity of data on prevalence of stress amongst nurses in the Indian setting. The individual contribution of various stressors, operational in nurse’s personal and professional life, to the overall stress levels also needs to be studied.
Method: A hospital based cross sectional study was carried out on 87 randomly selected staff nurses working in two tertiary care teaching hospitals of Central Delhi. Data was collected using
pre-tested and self-administered questionnaire. Sociodemographic profile, stressors in daily life, stressors at workstation and total stress level was also assessed. The data was fed and analysed using WHO’s EPI-INFO 2005 software.
Results: 87.4% of nurses from the sample reported occupational stress. The prevalence of occupational stress amongst nurses was 87.4%. ‘Time Pressure’ was found to be the
most stressful whereas ‘Discrimination’ was the least stressful of the given possible sources of stress in everyday life. Other highly stressful sources were: handling various issues of life simultaneously with occupation such as caring for own children/parents, own work situation and personal responsibilities. ‘High level of skill requirement of the job’ was the most important stressor and ‘helpfulness of supervisors/senior sisters’ was the least significant stressor
directly related to nursing profession. Other significant work related stressors were: the fact that their jobs required them to learn new things and that they had to attend to, too many patients at the same time.
Conclusion: High prevalence of stress was found amongst nurses, and suggests the need for stress reduction programmes targeting specific important stressors.
Key Words: Nurses, Stress, Occupational Stress, Tertiary Care Hospitals, India
Australasian Medical Journal AMJ 2010, 3, 11, 731-738 (http://www.amj.net.au/index.php?journal=AMJ&page=search&op=titles&searchPage=10)

Benign Prostatic Hyperplasia: Health Seeking Behaviour of patients at a tertiary care hospital. Aman Deep Dr. Gopal Krishna Ingle Dr. Jugal Kishore

Background: Benign Prostatic Hyperplasia is a widely prevalent condition
affecting elderly men throughout the world. With increasing
life expectancy, there has been a rise in the percentage of
elderly men and so for this disease across the globe. There is
lack of information about health seeking behaviour of patients
with Benign Prostatic Hyperplasia. Therefore the study was
designed with the objectives of assessing health-seeking
behaviour and the effect of literacy on it among adult and
older subjects suffering from Benign Prostatic Hyperplasia
attending a tertiary care hospital.
Method: A series of 81 patients suffering from Benign Prostatic
Hyperplasia above the age of 50 years, attending surgical Out
Patient Department of a tertiary care hospital in Delhi, were
assessed for their health seeking behaviour using a pre-tested
and a modified questionnaire designed for assessing health
seeking behaviour.
Results: Positive health seeking behaviour of patients was observed in
44%, who reported to a doctor within a month of noticing
their problem. A greater proportion of the literates was aware
about the symptoms suggestive of enlarged prostate and
consulted a qualified health care practitioner as their first
action. More literates approached the higher level of health
care facility on being referred and had maximum faith in
allopathic system of medicine. Also, lesser number of literates
had performed pooja (Hindi word for worship) or other
traditional rituals for relief of their problems.
Conclusion: We concluded that majority of subjects suffering from
Benign Prostatic Hypertrophy were not aware of their
disease and their health-seeking behaviour was poor and
could be related to literacy. Our data highlights the need
for public awareness program targeting the younger male
population so that early detection and treatment can be
offered.
Key Words: Benign Prostatic Hyperplasia, Health Seeking Behaviour,
Awareness.
Australasian Medical Journal AMJ 2010, 1, 3, 213-216 (http://www.amj.net.au/index.php?journal=AMJ&page=article&op=view&path%5B%5D=166.)

My Books on Public Health

2012

1.  Sanjay Kumar, Jugal Kishore. Inequity in Indian Healthcare: An analysis of women’s health. Saarbrücken: LAP LAMBERT Academic Publishing GmbH & Co. Germany 2012. ISBN -13: 978-3-659-19185-5; ISBN – 10: 365919185x; EAN: 9783659191855

2.   Jugal Kishore. Female Feticide: An Instigation of female status. Saarbrücken: LAP LAMBERT Academic Publishing GmbH & Co. Germany 2012. ISBN -13: 978-3-659-15473-7; ISBN – 10: 3659154733; EAN: 9783659154737

3.  Nupur Agarwal, Jugal Kishore, GK Ingle. How to prevent and manage your low back pain: A guide for healthy posture and lifestyle. ISBN 978-3-659-15872-8, Paperback, pp80. Saarbrücken: LAP LAMBERT Academic Publishing GmbH & Co. Germany 2012. 

4.   Suman Lata, Jugal Kishore, Gurmeet Singh. Breastfeeding and College Girls: An exploratory study to assess the knowledge and attitude of College girls regarding breastfeeding. SBN 978-3-8484-9882-6, Paperback. Saarbrücken: LAP LAMBERT Academic Publishing GmbH & Co. Germany 2012. 

5.    Medha Goyal Charu Kohli, Jugal Kishore. Effect of Educational Booklet on Depression. ISBN 978-3-659-10276-9. Saarbrücken: LAP LAMBERT Academic Publishing GmbH & Co. Germany 2012

6.   J Kishore. A Textbook for Health Worker and Midwife. 1^st edition, pp. 300; New Delhi: Century Publications 2012. 

7.  J Kishore. National Health Programs of India: National Policies and Legislation related to health, Ed.9^th 2010 (September), pp. 814; New Delhi: Century Publications 2012. 

8.   J Kishore, I Grewal. Practical and Viva in Community Medicine. 2^nd Edition. New Delhi: Century Publications 2012. 

2011

9.    J Kishore. Question Bank Community Medicine. 1^st Ed.  New Delhi: Century Publications 2011. 

10.  J Kishore. National Health Programs of India: National Policies and Legislation related to health, Ed.9^th 2010 (September), pp. 814; New Delhi: Century Publications 2011. 

2010

11.  J kishore. Practical and Viva: Community Medicine. Ed.1^st 2010, pp. 450; New Delhi: Century Publications 2010.

12.  J Kishore. National Health Programs of India: National Policies and Legislation related to health, Ed.8^th 2009 (September), pp. 814; New Delhi: Century Publications 2010 (Revised Reprint).

2009

13.  J Kishore. National Health Programs of India: National Policies and Legislation related to health, Ed.8^th 2009 (September), pp. 814; New Delhi: Century Publications 2009.

14.   J Kishore. Bhrun Hatiya: Apradhi Kaun? (Hindi translated by dr. Panna Lal) Ed 1^st, ISBN978-81-88132-17-1, pp 144; New Delhi: Century Publications 2008.

2007

15.  J Kishore. National Health Programs of India: National Policies and Legislation related to health, Ed. 7^th 2007 (September), ISBN 81-88132-17-9, pp. 700; New Delhi: Century Publications 2007.

16.    J Kishore. A Dictionary of Public Health, Ed 2^nd, ISBN 81-881320-10-0, pp 1050; New Delhi: Century Publications 2007.

2006

17.    J Kishore. National Health Programs of India: National policies and legislation related to health, Ed. 6^th 2006 (July), ISBN 81-88132-15-2, pp. 549; Century Publications, Jamia Nagar, New Delhi 110025;

2005              

18.   J Kishore. National Health Programs of India: National policies and legislation related to health, Ed. 5^rd 2005 (Aug), Century Publications, Jamia Nagar, New Delhi 110025;

19.     J Kishore. “The Vanishing Girl Child” 1^st ed Century Publications, New Delhi 25.

20.    J Kishore. “A Text of Health for Health Workers”, 2^nd Ed Century Publications New Delhi 25

2004

21.    J Kishore, GK Ingle. Biomedical Waste Management in India. ISBN 818813208-X, pp 144, 1^st Edition, 2004, Century Publications New Delhi.

22.    J Kishore. A Textbook of Health for Health Workers. 1^st Edition 2004, Century Publications New Delhi.

2002

23.    J Kishore. “A Dictionary of Public Health”, ISBN 81881320, pp 624 1^st Ed. 2002 Century Publications, Jamia Nagar New Delhi 25.

24.  J Kishore. National Health Programmes of India: National policies and legislation related to health, ISBN 818813204-7, pp. 410,  Ed. 4^rd 2002, Century Publications, Jamia Nagar, New Delhi

2001

25.    J Kishore. National Health Programmes of India: National policies and legislation related to health, Ed. 3^rd 2002, Century Publications, Jamia Nagar, New Delhi

26.    J Kishore & P C Ray. “Pioneering Social Reformers of India” 2001; Wisdom Publications, New Delhi, 2001. In Hindi-Bharat Ke Agrani Samaj Sudharak 2002.

2000

27.    J Kishore. National Health Programmes of India: Ed. 2^rd 2002, Century Publications, Jamia Nagar, New Delhi

28.    Ishwar Ke Bina Jeena. (Living without God-Translated to Hindi by BP Nidaria and Jugal Kishore) Published by Century Publication, New Delhi 2000

1998

29.   J Kishore. “Comprehensive Review of Community Medicine”, based on MCQ and important notes, Ed. 1998, Century Publications, Jamia Nagar, New Delhi

30.  P C Ray & J Kishore. “The Great Warriors of Human Rights Movement From India” Ed. 1998; Wisdom Publication, New Delhi. In Hindi Manav Adhikar Andolan Ke Bharatiya Yoddha 2002.

1994.

31. Jugal Kishore. “Bhavnayen” An Anthology of Hindi Poems, JK Indu Parkashan, New Delhi.1994. 

response to the Article "Its an emergency" of Lalita Panicker

The Hindustan Times
Dear Editor
I read the Lalita Panicker's article titled "Its an emergency" with great interest. It is serious concern for every sensible person in the country and also in the world. It am delighted to find stylish jargon of emotional words used in the article with little content and facts and figures. On one side government is not ready to give free to poor of the country grains instead allowing them to rotten in their stores. On other side whole opposition, media and sensible people of the country are kept quiet for all corruptions, mishandling and mismanaging of public fund, escalating prices of essential commodities. One can blame the health sector for all deaths and diseases happening in the country but to just inform our dear colleague and friends that health of a person is also depended on food, shelter, water, power, transport, etc. Government can not made the food free but can make the health free whereas women and children of this country dying more from malnutrition than other diseases. It is also not true that women and child health was not the top priority of government for such a long time. It is also not true that we are lack of facts and figures but it depends on presenter and listners. It is painful to say that most of the policies and high profile meetings on health are attended by people who have never gone through public health of the country so it is quite possible for them to react in such a manner. Whole print and audiovisual media can also be blamed for this as they are also not more than 2% of space and time spending on health issues similar to the government budget. Issue of commonwealth game is rightly highlighted where health of women and children are neglected by the Contractors and contracting agencies. Government and contracting agencies have violated the Contract Labour (Regulation and Abolition) Central Rules 1971: Construction and Maintenance of Creches. Similarly what government and highest courts of the country have done to those private giant hospitals who didn't fufil social responsibility of serving 15-20% of the poor. So in conclusion I can say that it is easy to blame others without finding faults in selt. It is also interesting to accept useless suggestions of foreigners in five star hotel and not hearing the prophecy and hard work of your own people
response

Recommendations of National Conference on Air, Noise, Water, solid waste and Plastic waste during Commonwealth games in 2010

RECOMMENDATIONS OF THE BRAINSTORMING CONFERENCE
ON MANAGEMENT OF WATER, AIR, NOISE, SOLID WASTES AND PLASTIC WASTE DURING COMMONWEALTH GAMES 2010 TO BE HELD AT DELHI

1. Public information
The Conference is duly informed of the overall planning and certain micro-planning exercises conducted by various organizations belonging to Municipal Corporation of Delhi, the Delhi Development Authority, the Government of National Capital Territory and the Central Government. Much of the information was not known to most of the participants. It is recommended that a vigorous campaign be made by a designated coordinating agency to inform the general public through various media so as to generate confidence in the public that care for environment is part of the efforts being made to hold a successful and green Commonwealth Games at Delhi.
2. Air quality management
The Olympics held in China in 2008 owe part of the success to certain bold decisions, such as closing down polluting industries one month before the event. Likewise, a large number of public offices were closed one week before the Olympics. The strong democracy that we are may not accept such arrangement. However, potential polluters need to be identified and sternly warned to keep pollution under control failing which immediate action to shut them down would be taken. Such units may be in Delhi or near its border in Sahibabad, Ghaziabad and Faridabad. In any case, coal-based thermal power stations of Delhi and near its border will need to be shut down two weeks before the Games are held. The diesel generating sets, which number more than 2 lakh in Delhi, can remain out of operation if uninterrupted power supply is assured. It is recommended that a close scrutiny be made as to which polluting industrial units should be so warned and which thermal power stations should be shut down. It may also be assessed as to which offices can be closed for four weeks without significant interruption in public service. The manpower thus made idle may be utilized for assisting in the organizing the Games. Uninterrupted power supply should be arranged for Delhi for the period of the Games. It is further recommended that as a mitigative measure, greenery should be increased near the sporting arena.
3. Air quality monitoring
Delhi is noted by the World Health Organisation among the major cities that have poor environmental conditions. While poor quality of water can be countered by bottled drinking water, there is no such alternative to poor quality of air. Athletes are particularly sensitive to air quality because heavy breathing during running and other exercise sports can cause serious injury to their pulmonary and cardiovascular systems. It is therefore recommended that air quality is monitored regularly and accurately right from now to get baseline data, obtain actual trend of results of measures implemented to improve air quality and predict with confidence the anticipated air quality during October 2010, when the Commonwealth Games will be held.
4. Prediction of air quality
In the last decade, introduction of CNG-run public transport vehicles, manufacture of fuel-efficient automobile engines and production of lead-free petrol and low-sulphur diesel did cause a remarkable improvement of air quality of Delhi. The advantage is wearing out on account of a phenomenal increase in the number of automobiles on the road in spite of the recently established Delhi Metro system and an improved fleet of buses. Traffic jams are becoming more frequent and more intense with time. Emission of certain pollutants, such as ozone and fine particulate matter, has tended to increase with the aforesaid changes in fuel and engines. In the euphoria of gains noticed earlier, the new threats are overlooked. While data on concentration of ozone is scanty, a lot of data is available on the precursors of ozone, which are the hydrocarbons, oxides of nitrogen and sunlight. It is recommended that careful observations need to be made to assess the concentration of ozone and fine particulate matter and to relate such observations to the doze-effect on health of the affected population. In particular, it is recommended that concentration of ground level ozone is observed and estimated by modelling, and its trend be analysed to provide authentic information for the athletes who can be at threat if it rises above a certain level.
5. River quality
River Yamuna will be viewed by a large number of athletes, visitors, journalists and commentators during the Commonwealth Games. The view is appalling. The adverse publicity of the care given to this major water body, which is included among the holy rivers according to faith of the majority of population of the country, will reflect adversely on the responsiveness and effectiveness of our administration. By now several authorities have conceded that hardly anything is possible to upgrade the river water quality to an acceptable level. This myth can be blown away with the application of bio-remediation, i.e., by dosing selected bacteria into a body of water, which quickly multiply, decompose organic pollutants and mitigate odour. Thus, the drains of Delhi can be made to clean the Yamuna. It is recommended that bioremediation be applied on the tributary drains, the river and poorly performing sewage treatment plants in Delhi.
6. Solid wastes management
Packaging and containers are likely to be discarded in large quantities during the Commonwealth Games. To regard them as wastes is to increase the burden of their handling and disposal. To regard them as resource is an approach to get wealth and energy from waste. Biodegradable packaging is technically possible. Most of the containers have the possibility of reuse by segregating them according to the possibility of their reuse. It is, therefore, recommended that bio-degradable packaging is prescribed for certain items carefully selected for the purpose and arrangements are made to segregate the containers according to the potential of their reuse.
7. Household garbage disposal
The sweepings from the dwellings and kitchen wastes make an excellent combination to be treated by vermiculture process at the household level. Residents that have small garden or large enough terraces can adopt this technique to produce and utilise compost from the wastes generated in their own homes and thereby significantly reduce the quantity of garbage that need to be handled and disposed of by a municipal service. It is recommended that domestic vermiculture units may be vigorously promoted including technical and financial support for the manufacture and use of the bins required in the process.
8. Mock drill
Whatever services and regulatory controls are planned for the duration of the Commonwealth Games should be rehearsed in order that the deficiencies in the plan are noticed and rectified. Such mock drills are also greatly helpful in generating awareness and co-operation of the people and in the assessment of net benefits of the plan. It is recommended that at least two mock drills may be held before the Commonwealth Games to practice and validate planned services and regulatory controls.