Modalities of Empowerment and Strengthening of Ex-servicemen.

BACKGROUND: Older people including ex-servicemen (ESM) in India are left to fend for themselves due to nuclear family system. Most children are not staying with them due to reasons such as acquiring of education or employment at distant places. These factors, coupled with deteriorating health with advancing age, change in value system and attitude amongst children who give more importance to materialism, it was felt necessary to find modalities to empower and strengthen ESM by available methods of including progressive weight training, yoga and meditation. METHODS: An interventional "Before and After" study was planned for a period of three months for in-patient ESM of a military hospital for common lifestyle diseases namely stroke, diabetes, senile depression, acute myocardial infarction and hypertension. Data of anthropometry, laboratory investigations and Hamilton rating scale for depression (HRSD) were taken before the study. These cases were then subjected to interventions (progressive weight training and spiritual health enhancement by yoga with meditation for three months) followed by same measurements again. RESULT: Statistically significant differences were observed before and after study with respect to pulse, respiratory rate, blood pressure, blood glucose, total cholesterol, low density lipoproteins (LDL), very low density lipoproteins (VLDL) and Hamilton depression score (p<0.05). The sleep pattern, sense of well being and posture while sitting to standing and walking with degree of support (stick/other person's help) improved considerably after the interventions. CONCLUSION: ESM are recommended to be trained much before retirement on progressive weight training and yoga in regimental centre/station institute. Provision to be made in existing ex-servicemen contributory health scheme (ECHS) polyclinics for employment of part time trainers for weight training and yoga. The physical and spiritual strengthening results in better capability to deal with old age and its problems.

Study of Disorders of Visual Acuity among Adolescent School Children in Pune.

BACKGROUND: Disorders of visual acuity are known to affect the learning abilities of school children. Various authors have reported varying prevalence in India and abroad. METHODS: A rapid, community based survey was conducted to assess the prevalence of disorders of visual acuity among adolescent school children in three schools in Pune Cantonment. A sample of 236 children studying in six sections were examined after random selection by a two stage sampling technique ensuring representation to each of the classes. Visual acuity was assessed for all the children available in the selected section on the date of survey. A questionnaire based study of the knowledge and attitude of the parents of the 50 affected children was also conducted. RESULT: 50 children (25 males and 25 females) were found to have errors of refraction, resulting in prevalence rate of 21.19% with confidence intervals of 15.97% to 26.40%. CONCLUSION: The study highlights significantly high prevalence of uncorrected errors of visual acuity among adolescent school children as well as the need for instituting IEC activities aimed at improving the general lack of appreciation of the seriousness of the problem by the parents and consequent neglect of urgent corrective measures.

Anthropometric Parameters of Armed Forces Personnel.

BACKGROUND: The prevalence of obesity has increased globally in the last few decades. Anthropometry is an accepted method of measuring obesity. Charts of weight for height and age as well as Anthropometric indices like Body Mass Index (BMI) are commonly used to define normal, overweight and obese individuals. Weight for height charts currently in use in the Army belong to pre-independence era. It is widely believed that these have been obtained from life insurance tables made for British / American civilian population. The World Health Organization (WHO) encourages its member countries to develop their own reference anthropometric indices. METHODS: Anthropometric measurements were recorded for 902 healthy Armed Forces personnel in the age range of 28 to 52 years selected by stratified random sampling. These measurements were used to obtain mean values, standard deviations, medians and percentiles for various anthropometric parameters. RESULT: BMI for the study subjects ranged from 14.67 to 27.90 kg/m(2) with a mean of 20.52 Kg/m(2). No individual was categorized as obese using the current international cut-off of BMI >30 kg/m(2). With the exception of height, all other anthropometric parameters like weight, BMI, waist circumference, and waist-hip ratio were found to increase with increasing age. Correlation of BMI with waist circumference and BMI with Waist Hip Ratio in the study subjects was found to be statistically significant. The weight for height and age chart developed by this study shows an increase in weight in all age and height categories as compared to the weight for height chart currently in vogue in the Indian Army. CONCLUSION: The weight for height and age chart calculated in our study, shows considerable variation when compared to weight for height and age chart currently being used in Indian Army. The average weight for majority of height and age categories was found to be higher than in the Indian Army chart. It is recommended that a large multi-centric study should be taken up to gather more evidence to replace the current chart.

Prevalence and Determinants of Hypertension in a Rural Community.

BACKGROUND: There are few epidemiological studies on prevalence of hypertension and its determinants in rural population. This cross sectional study was done to determine the same in a rural community. METHODS: A random sample of 406 people (218 men and 188 women) of 30 years and above was selected from a rural area. The pre tested proforma was used to collect the data by trained doctors. RESULT: Prevalence of smoking and tobacco use was 16%, alcohol intake 9.4 %, daily salt intake (≥ 5 gram) 34.2%, daily saturated fat intake (≥ 10 % of daily energy intake) 47 .0 % and physical inactivity (work and leisure) as 18.5%. Body Mass Index (BMI) was ≥ 25 in 18 % and ≥ 30 in 3.2% men and women. Prevalence of truncal obesity (Waist Hip Ratio: men ≥ 0.9; women ≥ 0.8) was 8.5% with higher incidence in men. Prevalence of abdominal obesity (men ≥ 102 cms; women ≥ 88 cms) was found in 15.7 % with higher incidence in men. Differences in prevalence of risk factors between men and women were statistically significant in case of smoking, alcohol consumption and abdominal obesity. 18.5% men and women were suffering from systolic hypertension (≥ 140 mg Hg) and 15 % from diastolic hypertension (≥ 90 mg Hg). Prevalence of risk factors for hypertension was significantly more among subjects suffering from systolic and diastolic hypertension than normotensive subjects. CONCLUSION: Prevalence of systolic hypertension in rural community was 18.5 % and of diastolic hypertension 15% with higher prevalence in the age group of 60 years and above, in case of men and women. There was a significant linear trend in prevalence of systolic hypertension with respect to age group in men whereas it was not significant in case of women.

Gender Inequality: Is the National Population Policy's Objective of Two Child Norm Heading the Correct Way?

BACKGROUND: Male Preference is well known phenomena world wide from ancient ages. A descriptive study was carried out to assess the attitude of women towards birth of son, use of contraception methods and sex determination methods in rural village Kasurdi in Pune district. METHODS: Univariate analysis was carried out by considering each factor determining sex preference separately as well as using a Logistic Regression Model. Adequacy of fit of the model has also been tested. RESULT AND CONCLUSION: Out of 110 respondents interviewed, 62.7% felt that male child is necessary in the family. Univariate analysis revealed that sex of first child, concern undergone for second pregnancy with regards to sex of the child, number of children in family and type of family were significant factors contributing to the son preference. The analysis under the logistic regression model revealed that sex of the first child and concern undergone in second pregnancy with respect to the sex of the second child are the most dominating and significant factors in the causation of son preference. The difference between family sizes when compared with the sex of first child was statistically significant signifying that if the first child is a male then it hardly matters whether the second child is male or female, but if the sex of first child is female then the families land up with bigger family size. On an average most of the respondents favour two children with an equal share of male and female children.

Determinants of Nutritional Status of School Children.

BACKGROUND: A cross sectional study was carried out to determine the nutritional status of school children in Army School, Pune. METHODS: Anthropometric survey of 760 school children was carried out and compared against the NCHS/WHO reference standards to determine their nutritional status. Associations of nutritional status with socio-economic status, education status of parents, mothers working status and family size were determined. RESULT: The prevalence of stunting was 13.81%, wasting 6.71% and under nutrition 9.87%. Mothers' educational level, wasting, socio economic status and family size were significantly associated with the nutritional status of the child. CONCLUSION: Maternal educational status, socio-economic status and family size are important determinants of nutritional status of school children.

Insecticide treated bednet strategy in rural settings: can we exploit women's decision making power?

Use of insecticide treated bednets in prevention of malaria is a widely propagated global strategy, however, its use has been reported to be influenced and limited by many variables especially gender bias. A cross sectional field epidemiological study was conducted in a rural setting with two outcome variables, 'Bednet use'(primary outcome variable) and 'Women's Decision Making Power' which were studied in reference to various predictor variables. Analysis reveals a significant effect on the primary outcome variable 'Bednet use' of the predictor variables- age, occupation, bednet purchase decision, women's decision making power, husband's education and knowledge about malaria and its prevention. The study recommends IEC on treated bednets to be disseminated through TV targeting the elderly women who have better decision making power and mobilizing younger women who were found to prefer bednets for prevention of mosquito bites for optimizing the use of treated bednets in similar settings.

Breast Feeding Practices among Families of Armed Forces Personnel in a Large Cantonment.

BACKGROUND: There seems to be a gap in the available literature and scientific knowledge about breast-feeding practices among families of armed forces personnel in our country, which needs to be studied. METHODS: A cross sectional epidemiological study design was undertaken on a randomly selected sample of 175 families of armed forces personnel staying in a large cantonment and having at least one child in the age group of 3-24 months. RESULT: The study observed positive association between various breast feeding practices such as feeding colostrum, demand/scheduled feeding, exclusive breast feeding for 4-6 months, partial breast feeding for 6 - 18 months and various sociodemographic variables such as age, religion, socio-economic status of mother (military rank of husband), parity and place of residence of the mother (where childhood was spent). CONCLUSION: Higher proportion of mothers feeding colostrum was observed because of better educational status of mothers and organized health education activities available to the families of armed forces personnel. Majority (89.14%) gave demand feed and only 10.86% gave scheduled feed. On the other hand a relatively smaller percentage (47.43% and 29.32%) followed the correct practice about duration of exclusive and partial breast-feeding respectively.

Inappropriate Use of Hospital Beds in a Tertiary Care Service Hospital.

BACKGROUND: The cost of medical care is continuing to rise and cost containment measures need to focus on inappropriate hospitalization. Armed Forces Medical Services ensure universal access to its consumers but continuous increase in patient load is stretching the capability of service hospitals. The present study was undertaken to determine the rate of inappropriate hospitalization in a large tertiary care service hospital. METHODS: Appropriateness Evaluation Protocol (AEP) was used to assess the appropriateness of hospital days, the study being carried out in the acute medical and acute surgical wards of the hospital on randomly selected days over a period of three months. RESULTS: Inappropriate patient days were found to be 29.48% during the study period, with 34% of acute surgical patient days and 24.4% of acute medical patient days found to be inappropriate. No statistically significant difference was observed in the rate of inappropriate hospital stay between serving personnel and ex-servicemen. 31.25% non local patients as compared to 25.81% of local patients were found to have inappropriate hospital stays, though the difference was not found to be statistically significant. 60.71% of inappropriate stays were found in the initial period of admission (1-5 days), the phenomenon being observed both in the acute surgical and acute medical wards. CONCLUSION: The study shows that the rate of inappropriate patient days is quite high among the study population and regular utilization reviews need to be carried out to conserve health care resources available with the service hospitals.