Factors Affecting the Availability and Utilization of Essential Medicines in India: A Systematic Review.

Essential medicines or drugs are recognized as highly cost-effective components within contemporary healthcare, demonstrating significant potential for improving health outcomes. The provision of essential medicines directly impacts the functioning of healthcare facilities, resulting in financial hardship. This review aims to fill knowledge gaps by examining obstacles hindering access and utilization of essential medicines in India. This study conducted a comprehensive evidence synthesis, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to analyse articles on the availability and utilization of essential medicines in India. The search strategy included various databases and keywords. Published, peer-reviewed articles focusing on the National/ State List of Essential Medicines and meeting specific criteria were considered. Data items included essential medicines, drug availability, utilization, and challenges. Data was extracted, synthesized, and analysed using thematic framework analysis. Out of 1,129 articles, 11 were selected for review. Studies consistently highlighted the inadequate availability of essential medicines in different Indian states. Availability of essential medicines varies in the range of 17-51 percent across major states of India. Stock-outs of medicines vary from 4 to 14 weeks. Governance issues including differential procurement mechanisms across states of India, hinder seamless availability of essential medicines. Other challenges included distribution and purchasing system inefficiencies, governance-related issues, and facility/ user-level challenges impacting drug utilization. Disruptions in utilization were observed due to improper prescription practices and non-availability of affordable options. Accessibility and affordability also affected drug utilization. Issues with supply chain management and conflicting guidelines further contributed to the obstacles faced in ensuring availability and utilization of essential medicines in India. Ensuring the availability, accessibility, and affordability of essential medicines is of utmost importance. The public health system needs to strengthen its procurement and distribution management. Strengthening the logistics support for an efficient supply of essential medicines will reduce the time lag in receipt of drugs. Guidelines on essential drugs prepared by the National Health System Resource Centre need to be strictly adhered to and monitored in inventory management system. There is an urgent need to develop a sustainable model for achieving uniformity in the availability and utilization of essential medicines in India.

Effect of Job Rotation Concept for Nursing Staff with Special Reference to Private Based Hospital, Vadodara.

Introduction: Employees are placed in various job rotations between two or more tasks or vocations at regular intervals to ensure that they are exposed to all elements of the company. Job rotation is a methodical approach that permits employees to avoid boredom while also allowing them to develop and grow. Both management and personnel objectives are met with this strategy. It aids in the identification of employee potential and abilities. Through job rotation, employees are exposed to all aspects of the company. Employee abilities and competencies are evaluated ahead of time to ensure that the employee is deployed in the best possible position. However, it does permit the pursuit of personal interests while gaining practical knowledge in a variety of industries or processes. The present study was undertaken with an aim to assess the effect of job rotation on the nursing staff in a private hospital of Vadodara. Methodology: The study was cross-sectional in nature where the perception of the nursing staff was gathered through a structured questionnaire. The questionnaire assessed the perception of the staff on a five point likert scale from strongly agree to strongly disagree. The sample size of the study was 126. Mann Whitney Test and Kruskal Wallis test was used to assess the effect of job rotation with respect to gender and age, years of experience respectively. The statistical analysis was undertaken at 95% confidence level with statistical significance at a p value of less than 0.05. Results: The results depicted that there was no difference in the perception towards effect of job rotation with respect to gender and age group. However, with respect to job rotation not interrupting the employees' work life and no effect on personal life, there was statistical significant difference with respect to the years of experience of the nursing staff as the p value was less than 0.05. Conclusion: Job rotation, in their opinion, causes frequent interruptions in both the job and personal life of those who participate in it. The nurses working in the hospital came up with appropriate job rotation ideas that took into consideration their age and years of experience. It appears that most of the criteria indicate that the nursing staff members were satisfied with their job rotation, which lends support to the findings of the study.

Effectiveness of self-designed dental storybook as behavior modification technique in 5 - 7 year-old children: A randomized controlled study.

Background: Dental anxiety is one of the key factors that prevent children from obtaining dental treatment and raises anxiety levels in children. The first dental visit is usually fearful for the child and contributes to managing the child patient in a dental operatory. A pediatric dentist's role is to perform effective treatment using various nonpharmacological behavior management techniques. Aims: The aim of the study was to evaluate and compare the effect of self-designed dental storybook on behavior and pulse rate before and after dental procedures in 57-year-old children. Settings and Design: The study was a prospective, randomized, controlled trial. Materials and Methods: The study was conducted on 380 aged 57 years. Children were randomly allocated into two groups, namely, Group A - Behavior modification using a self-designed dental storybook and Group B - Behavior modification without storybook. Research was carried out in two dental visits (screening, examination, and preventive and restorative treatment) wherein, before and after intervention, pulse rate, Facial Image Scale (FIS), and Venham Scale (VS) were recorded. Descriptive statistical analyses followed by the paired t-test and Wilcoxon signed-rank test were applied and tabulated using the SPSS software version 23.0. Results: There was a significant difference observed in the interventional group as compared to the control group for pulse rate, FIS, and VS. Conclusion: Self-designed dental storybook as an adjuvant was found to be promising behavior modification technique for 57-year-old children.

Association of Anthropometric Measurements, Hemoglobin Level and Salivary Parameters among Caries-free and S-ECC Children.

Context: The implication of severe dental caries in children may have its effect on general health apart from affecting the orodental tissues. Many children reporting with severe caries have shown weighing less due to malnourishment resulting in anemia and modified somatic growth. Aims: Study aimed to assess and compare anthropometric measurements, hemoglobin level, and salivary parameters among caries-free and severe early childhood caries (E-CCC) children. Settings and design: For caries-free group [Group I] and S-ECC group [Group II] data were obtained from age-matched children with similar socioeconomic status. Materials and methods: Children with severe caries and without caries from the age-group 3- 6 years participated in the study. Children were measured for height, weight, measurement of mid-upper arm circumference, and waist circumference. Hemoglobin level was recorded. The collected unstimulated saliva was assessed for flow rate, salivary pH, and its buffering capacity. Statistical analysis used: Both descriptive and inferential statistical analyses were carried out using Windows software and SPSS (21). Tests of significance namely t-test and Chi-square test were used along with regression analysis. Results: Caries experience showed no statistical difference for age and gender among the sample population. Significant difference was found for all anthropometric measurements. When comparison for hemoglobin was done for both groups I and II, significant difference was observed [p = 0.003]. Conclusion: Children with severe dental caries in the present study had low hemoglobin which, if persisted, can lead to anemia. Though the anthropometric parameters may appear normal in children diagnosed with severe early childhood caries, pediatric dentist should ensure the hemoglobin level test, as iron deficiency can affect growth and development of the child, if left undiagnosed. How to cite this article: Deshpande AN, Sudani U, Wadhwa M, et al. Association of Anthropometric Measurements, Hemoglobin Level and Salivary Parameters among Caries-free and S-ECC Children. Int J Clin Pediatr Dent 2022;15(S-2):S164-S171.

Effect of green tea, ginger plus green tea, and chlorhexidine mouthwash on plaque-induced gingivitis: A randomized clinical trial.

BACKGROUND: Dental plaque, a microbial biofilm, is the primary etiological factor leading to the initiation of gingivitis and dental caries. It is therefore important to prevent it by taking effective plaque control measures. This research aimed at comparing the anti-plaque and anti-gingivitis effects of green tea (GT), GT plus ginger (GT + G), and chlorhexidine mouthwash (CHX) in children. MATERIALS AND METHODS: This was a randomized clinical trial, with a sample size of 60 children between the age group of 10-14 years with plaque and gingivitis. They were randomly allocated in three different groups, depending upon the mouthwash used: Group A (GT mouthwash), Group B (GT plus ginger mouthwash), and Group C (CHX mouthwash). Plaque index and gingival index were recorded at baseline, then at interval of 15 days and 30 days after using mouthwash. RESULTS: The mean gingival score and plaque showed a significant reduction from the baseline among all the three groups when compared with subsequent recall visits (15 days after using mouth-rinse and 30 days after using mouthwash) with P < 0.05. CONCLUSION: It can be concluded that the results of all three groups are comparable and hence herbal mouthwash can be used effectively as an alternative to CHX and as an adjunct to mechanical plaque control.

A qualitative research analysis of gender-based parities and disparities at work place experienced by female dentists of Vadodara, India.

AIM: To assess the gender-based parities and disparities at work place experienced by female dentists of Vadodara, India. MATERIALS AND METHODS: In-depth face-to-face qualitative semi-structured interviews in English were conducted among 12 female dentists of Vadodara. Female dentists working with one/more male colleague or auxiliary were selected through purposive sampling. Interviews were conducted as per Kvale's principles and recorded using a digital voice recorder. Transcribed data was analyzed using Giorgi's phenomenological analysis. RESULTS: The recurring themes identified were: (a) Striking work-family balance (b) Dependence on male authority for instating work discipline (c) Male dentists' hostility to "woman in power" concept (d) Male dentists' superiority in technical skills (e) privileges for women dentists. CONCLUSIONS: There is a need to improve the work environment of women dentists. Social support, sensitivity among male colleagues, and generous institutional policies will enable increased contribution from women to the profession.