IMMUNIZATION IN ELDERLY

Immunization is one of the key components of preventive health care strategies worldwide. However, which vaccine should be administered by the state in socialized medicine and which vaccine should be advocated to the individuals who can afford the expenditure should be discussed among health practitioners. This article addresses issues pertaining to vaccination among elderly from public health point of view, a largely neglected area in developing countries like India. From the review of literature it is concluded that vaccination against pneumococcal infection, influenza, tetanus and herpes zoster can be considered in older persons. 

Source: Ravneet Kaur, Jugal Kishore. Immunization in Geriatric Population of India: A Critical review. Research and review: A Journal of Immunology 2012; 2 (1).

Concern, Expectation and Satisfaction of Medical tourists in New Delhi, India

Delhi the capital of India, has largest number of hospitals providing medical services to the neighboring states and abroad. On one hand it generates revenue to government and on the the other hand big profit to private hospitals. This demands constant improvement of quality of care to remain competitive with other medical tourism destinations. Assessment of concerns, expectation and satisfaction level of medical tourists about their medical treatment is an important issue, although subjective, but one of the important methods to improve the quality of medical services. There is evidence which suggests that care, which is less than satisfactory to the patients, is also less effective and may reflect a failure to answer patients’ needs, their expectations, or acceptable standard of service. From this study it is concluded that medical tourists were found to be satisfied with services provided in tertiary care hospitals of Delhi. Yet to address their overall concerns and issues, health sector needs to take some steps such as developing/strengthening facilities for follow up, in each country from where medical tourists were coming.

Indu Grewal, JK Das, Jugal Kishore. Concern, Expectation and Satisfaction of medical tourists attending tertiary care hospitals in New Delhi, India. JIMSA July-Sept 2012; 25 (3): 151-154.

How to make India Healthy: Narrowing of streets and expending illegal colonies

Highways and express roads are becoming wider and wider but streets and gallis in each village and colonies are becoming smaller and smaller. Therefore people are interested to move out and their cars to feel the wideness of road and open space. Public space outside one's house is considered one's property and he feel proud to block it or extend the pavement of his/her house to narrow it down. Neighbors will not object or complaint because this help them to capture the space in front of their houses. This greedy nature of humans is promoted by corrupt municipal and police officers. When someone come forward to object such public land capturing then this further help the officers to get more money from the grabber and nothing concrete action against the culprit. Streets are so much narrow in villages that no fire extinguisher can reach to interior of village if any fire broke. Similarly no ambulance can reach to the house if any emergency happened. People are dying due to their own greed and system is helping them to suffer. Who is going to stop this illegal activities. Illegal Colonies are approved for votes without improving basic civic structure of the colony. First municipal, police and other authorities will ignore them deliberately when poor people are settling at public place and then they keep threatening and stopping people for any construction or letting them to improve their housing conditions. For money and votes everything is allowed in the end. System is meant for politicians and officers to exploit the poor.         

What is Public Health?

MEDICINE

·         Primary concerns is an individual

·         Doctor-Patient relationship and ethics reolved around individual 

·         Emphasis on disease diagnosis, treatment, and care for the individual patient

·         Medical paradigm places predominant emphasis on medical care

·         Uniform system for certifying specialists beyond professional medical degree

·         Lines of specialization organized, for example, by: 

-organ system (ophthalmology, neurology, cardiology, etc)

-patient group (obstetrics, pediatrics, Internists)

-etiology and pathophysiology (infectious disease, oncology)

-technical skill (radiology, surgery)

·         Biological sciences central, stimulated by needs of patients; research moves between laboratory and bedside

·         Numerical sciences increasing in prominence, though still a relatively minor part of training

·         Social sciences tend to be an elective part of medical education and teaches to integrate recovered person to his/her family or community

PUBLIC HEALTH

·         Main focus is on populations and groups
·         Comprehensive, broad and holistic in nature and much more cost effective approach to deliver healthcare to people

·         Public and health department relationship, social and public responsibility

·         Emphasis on disease prevention and health promotion for the whole community

·         Public health paradigm employs a spectrum of interventions aimed at the environment, human behavior and lifestyle, and medical care; designing, implementation and evaluation of health programs 

·         Variable certification of specialists beyond professional public health degree

·         Lines of specialization organized, for example, by: 

- analytical method (epidemiology, biostatistics, toxicology)

- setting and population (occupational health, school health, global health)

-substantive health problem (environmental health, nutrition)

-management (Planning, monitoring and evaluation)

-enforcement and advocacy (Public health legislations and politics)

-communication (Behavior change communication, health informations)

·         Life sciences central, with a prime focus on major threats to the health of populations; research moves between laboratory and field

·         Population sciences and quantitative disciplines essential features of analysis and training

·         Social and public policy disciplines an integral part of public health education and health promotion
·         Focus is more on dealing with Social and psychological Determinants of health 

·         Integral component of human development and human rights
·         It is a science and art of preventing disease, prolonging life, and promote health through organizing committee efforts handling all possible determinants of health of the people.

SUICIDAL IDEATION AMONG MEDICAL STUDENTS OF DELHI

Background

Suicide is becoming a public health problem and this act starts with suicidal ideation that is increasing amongst the younger age group, particularly students. However, little is known about this problem amongst medical students in India

Method 

A cross sectional study was carried out on 265 undergraduate students of a medical college in Delhi using pre-tested and self-administered questionnaire consist of socio-demographic profile, risk factors for suicide, and a validated scale to assess suicidal ideation and thought. Analysis was done using Microsoft Excel and WHO EPI-INFO 2005.

Results

The prevalence of suicidal ideation amongst medical students was 53.6%. Although everybody was aware of the meaning of suicide and the damage that it could cause to the individual and family, still 4.9% students seriously contemplated suicide and 2.6% have attempted suicide at least once in their life. Suicidal ideation was highest in first professional year medical students (64.4%) and lowest among the third professional year students (40.4%). Suicidal ideation was significantly associated with “impulsive or reckless behaviour in difficult situations” with 70.9% of the students showing reckless behaviour also having suicidal ideation compared to 30.7% not having such behaviour. Also, a significant association between the feeling of “it’s all too much to manage” and suicidal ideation was observed, with 78% of the students having this feeling also found to be having suicidal ideation as compared to 4.5% of those without this feeling.  A significant association was found between gender suicidal ideation. Also a significant association was found between the feeling of being “better off dead” and “non-working mothers”.  However, no association of suicidal ideation or attempted suicides was found with age, father’s education, and father’s occupation.

Conclusion

High prevalence of suicidal ideation amongst medical students suggests that there is an urgent need for a mental health program for medical students that provides counseling services and creates more opportunities for recreational activities.

Authors: Abhinav Goyal, Jugal Kishore, Tanu Anand, Akanksha Rathi

Journal of Mental health and human behavior 2012; 17 (1): 60-69; ipsnz.org/journal%20march_2012/8_org_article3.pdf

Sign the Petition for Sanal Edamaruku

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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.

Recommendations of Conference on Environment Health

The International Development Centre (IDC) Foundation in collaboration with department of Community Medicine MAMC, and CPCB, has organized the National Conference on Management of Water, Air, Noise, Solid Waste and Plastic Waste during Commonwealth Games at New Delhi, 6 -7 November 2009.
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.

How to make healthy India: Series of thoughts and discussion

Health a state of physical, mental and social well bring and not merely absence of disease or infirmity and ability to lead a socially and economically productive life. This shows that health is not just related to body and mind but also social and economic sector. When it is social and economic productive life then other domains play a significant roles such as occupational, vocational, etc. To achieve them all suitable environments are required whether it is biological, physical, chemical, water, electricity, transport, etc. In true sense nothing is possible without health and health is not possible without support of so many determinants. This need to be understood by any human system, particularly who are responsible for safety and protection of humanity. But majority of times neither the health professionals nor governments understand comprehensively. Doctors are support to lead the health team but they themselves isolated in some domain and never learn skills in all aspects of health to better realize the meaning of health profession.      

Awareness about Environmental Health among Nursing Personnel in Delhi

The environment is one of the primary determinants of individual and community health. Nursing personnel are considered as one of the vital messengers of knowledge to bring change in total health. The study has been conducted with the aim of comparing the knowledge level of nursing personnel regarding environment and health and the related legal issues. It is a hospital based cross-sectional comparative study conducted on sample of 82 and 120 nurses in the year 2000 and 2011. The results show a marked difference in the awareness level of the subjects in the two years. However the knowledge regarding the legal issues and correctness of knowledge is still lacking. Effect of environmental pollution on health is yet to be understood in its totality. There is a need to impart environment education. A suitable modification for inclusion of environmental health in nursing curriculum may be needed.

Jugal Kishore, Rajbala Rojha, Dipanweeta, Sumeena. Journal of Nursing Science and Practice 2012; 2 (1): 1-8. Availabe from 

http://www.stmjournals.com/index.php?journal=JoNSP&page=issue&op=view&path%5B%5D=130

Feasibility and Complications between Phacoemulsification and Manual Small Incision Surgery in Subluxated Cataract

Purpose. To compare the feasibility of cataract surgery with implantation of endocapsular supporting devices and intraocular lens (IOL) in subluxated cataract in phacoemulsification and manual small incision cataract surgery (MSICS). Design. Prospective randomized intervention case series consisting of 60 eyes with visually significant subluxated cataract. Method. The patients were randomly distributed between the two groups equally. The main outcome measure was implantation of in-the-bag IOL, requirement of additional procedure and complications, if any. Results. Capsular bag retention in subluxated lenses is possible in 90% cases in phacoemulsification versus 76.67% cases in MSICS (P = 0.16). Both groups, achieved similar best corrected visual acuity (P = 0.73), although additional procedures, intraoperative, and postoperative complications weremore common inMSICS. Conclusions. Achieving intact capsulorhexis and nuclear rotation in MSICS may be difficult in cases with large nucleus size and severe subluxation, but subluxated cataracts can be effectively managed by both phacoemuslification and MSICS.

Authors: Ruchi Goel, Saurabh Kamal, Sushil Kumar, Jugal Kishore, K. P. S.Malik, Sonam Angmo Bodh, Smriti Bansal, and Madhu Singh

http://www.hindawi.com/journals/jop/2012/205139/

Insecticide-treated bednets as an environment friendly method for malaria control

Malaria is a mosquito borne public health problem in some ninety countries worldwide affecting at least 300 million people. It imposes economic burden on families, businesses, health systems, government budgets and is associated with poverty, poor health and malnutrition among children. Among various methods of mosquito control, mosquito nets specially when they are treated with insecticides provide safest, cheapest, effective, free of side effects, environmental friendly and easy to use method which provide both individual and community benefits. Other methods of personal protection like mosquito coils, mats, repellents, liquid vaporisers and insecticides like DDT are associated with hazards to human health or environment. Therefore strategies like social marketing are required to promote the large scale use of insecticide treated bednets.

Key words: Malaria, insecticide treated bednets (ITN), hazards, mosquito repellents

Insecticide-treated Bednets Use as an Environment Friendly Method for
Malaria Control. Authiors: Charu Kohli, Jugal Kishore

http://www.stmjournals.com/index.php?journal=JoEECC&page=issue&op=view&path%5B%5D=109

Question bank in Community Medicine

The book provides all previous ten years question papers of various universities of India which are arranged chapter-wise and logically and focusing on must know and nice to know areas. Each question has been labeled with year and university in which it has appeared. The book contains more than 3700 questions and also frame of answers for few questions.

http://centurypublications.blogspot.in/search?updated-min=2012-01-01T00:00:00-08:00&updated-max=2013-01-01T00:00:00-08:00&max-results=4

Practical and Viva in Community Medicine

This book consists of socio-clinical history taking in the family and community setting, clinical case presentation, statistical and epidemiological exercise, spots, and short question answers and viva questions. This is very useful book for practical examination in community medicine/preventive and social medicine/public health/community nursing/family medicine both for undergraduate and post graduate students.

A textbook of health worker & Auxiliary Nurse Midwife

This book is meant for auxiliary nurse midwife, health workers, sanitary inspector, TB health visitors, NGO workers. It covers-Introduction of human body, home nursing, first aid, concept of health, fundamentals of epidemiology, immunity, hygiene, oral health, environmental health, biomedical waste management, airborne diseases, contact diseases, blood borne diseases, water borne diseases, zoonoses, vector borne diseases, emerging and re-emerging diseases, tuberculosis, non-communicable diseases, home visiting, population health, RCH, nutrition, mental health, school health, communication and health education, social welfare.

PREVALENCE OF TOBACCO USE IN GROUP C AND D EMPLOYEES IN A MEDICAL COLLEGE OF DELHI

One in three adults worldwide smokes tobacco and smoking is characterized by chemical dependence which falls into a model of chronic disease. Consumption of tobacco is a public health problem, which involves all age groups and all strata of people. This study aims to find out the prevalence of tobacco use and smoking and nicotine dependence among Group C and D employees of a medical college. We carried out a cross sectional study among 115 Group C and D employees of a Medical College, New Delhi, using predesigned and pretested questionnaire to describe the tobacco consumption and the Fagerstrom test to screen the patients with nicotine dependence. The data were collected and analyzed using EPI- INFO 3.5.1 version. Results showed that the prevalence of tobacco use in Groups C & D was 38% with significant male preponderance and out of these daily user group accounts for 28.7%. Prevalence of tobacco use was significantly higher in Group D being 51% as compared to 24% in Group C. Very high nicotine dependency was seen in age group 31–40 years, which was 57.1%. Around 58% of employees with middle school education were tobacco users and as education level increased, the proportion of tobacco users declined. With rising income level, the tobacco use decreased. To conclude, tobacco use among Group C and D workers in a medical college is high and the major concern is nicotine dependence. This also highlights the need of an educational package to decrease the use of tobacco and motivation for accepting treatment for nicotine dependence.

Authors: Aayushi Jain, Jugal Kishore, Jyotiranjan Sahoo. Research & Review: A Journal of Health Professionals 2011; 2-3 (1): 24-30

Knowledge, Attitude and Practice for tobacco control among dental professionals in the city of Delhi

To assess the knowledge, attitude, and practices of dental practitioners in Delhi concerning use of tobacco in their patients, a self-administered questionnaire was administered to conveniently selected 100 subjects consisted of students, interns, institutional, and private dental practitioners. Although knowledge about harmful effects of tobacco was high but only some advocate tobacco cessation practices actively, maintain records on tobacco use and follow-up on advice to patients to quit. However, all felt that there is a need to include tobacco cessation in their daily practice. Lack of formal training in tobacco prevention and cessation, lack of time, lack of resources and skills, not optimistic about the effectiveness of their counseling, and thought that it was not their role are most often cited to explain the reluctance of dentists and hygienists to provide tobacco cessation interventions. This is considered a lost opportunity for them which can be better utilized if they are trained for this important task.

Authors: Neha Gupta, P Jain, Jugal Kishore. Research & Review: A Journal of Health Professionals 2011; 2-3(1): 16-23.

http://www.stmjournals.com/index.php?journal=RRJoHP&page=article&op=viewFile&path%5B%5D=1440&path%5B%5D=277

Myths, beliefs and perceptions about mental disorders and health-seeking behavior in Delhi, India

Objectives: To assess the perceptions, myths and beliefs about mental disorders and health seeking behavior in the India. Methods: A cross sectional study was carried out with a sample of 436 subjects (360 subjects from urban and rural communities of Delhi; 76 medical professionals working in different organizations in Delhi). Pre-tested interview schedule consisting items on perceptions, myths and beliefs about causes, treatment and health seeking behavior for mental disorders was used. The collected data was statistically analyzed using computer software package Epi-info. Appropriate tests of significance were applied to detect any significant association. Results: The mental disorders could be because of loss of semen or vaginal secretion (Rural=33.9%; Urban=8.6%, professional 1.3%), less sexual desire (Rural =23.7%; Urban = 18%), excessive masturbation (Rural=15.3%; Urban=9.8%), gods punishment for their past sins (Rural=39.6%; Urban=20.7%; professional 5.2%), and polluted air (Rural=51.5%; Urban=11.5%; professional 5.2%). More people (37.7%) living in joint families than nuclear families (26.5%) believed that sadness and unhappiness cause mental disorders. 34.8% of rural and 18% of the urban subjects believed that children do not get mental disorders that means they have conception of adult oriented mental disorders. 40.2% in rural, 33.3% in urban areas and 7.9% professional believed that mental illnesses are untreatable. Many believed that psychiatrists whom they think are eccentric (Rural=46.1%; urban 18.4%; professional 37.9%), tend to know nothing and do nothing (Rural=21.5%; Urban 13.7%; professional 3.9) while 74.4% of rural, 37.1% of urban and 17.6% professional subjects do not know that the psychiatry is a branch of medicine. More people in rural areas than urban area think that keeping fasting or a faith healer can cure them from mental illnesses where as 11.8% of medical professional believed it. Most of the people like to go to someone close who can listens to their problems when they are said and anxious. Only 25.3 in rural and 34.7% in rural population would like to go to psychiatrist when they or their family members are suffering from mental illness. Conclusion: This study concluded that the myths and misconceptions are prevalent significantly more in rural areas than urban and medical professionals and need to be communicated to change their behavior for positive attitude to mental disorders so that health seeking behavior can improve.

Available from: http://www.indianjpsychiatry.org/text.asp?2011/53/4/324/91906