Preventive Health Checkup: Utilization, Motivators, and Barriers Among the General Population in a Rural District in Tamil Nadu, India.

BACKGROUND: The main goals of preventive health care include the early detection of disease by screening, identifying and reducing disease risk factors, and improving the current disease processes. Moreover, early disease discovery in the latent stage facilitates prompt intervention, reducing morbidity and death. OBJECTIVE: To estimate the proportion of people who have availed preventive health check-ups in Perambalur and to determine the motivators and barriers to health check-ups among adults (age group: 18 years and above). MATERIALS AND METHODS: We conducted a cross-sectional study among the general population from September 2021 to November 2021. A total of 436 participants were included in the study. A structured questionnaire was used to collect the socio-demographic characteristics and preventive health check-up details, along with the motivators and barriers. The data were entered in Microsoft Excel (Microsoft, Redmond, WA), and analysis was done using SPSS version 26 (IBM Corp., Armonk, NY). RESULT: The mean ± SD of the age of the general population was 52.27 ± 21.09. Out of 436 participants, only 130 (29.82%) had undergone preventive health check-ups in the past. The subjects with young age (p = 0.006), those who obtained COVID-19 vaccination (p = 0.001), subjects with stable occupation (p = 0.002), and those with higher education (p < 0.001) (chi-square test) had preventive health check-ups. A significant association was found between motivators and barriers for age, gender, education, occupation, marital status, the presence of comorbidities, and vaccination status against COVID-19. CONCLUSION: Preventive health check-up is still not up the ladder of health care for the general population. The health programmes should orient the public towards the concept of individual responsibility in health.

A two-centre experience of tonsil biopsies in the investigation of patients with tonsillar asymmetry.

INTRODUCTION: We aim to evaluate our experience of tonsil biopsies in the investigation of patients presenting with asymmetrical tonsils. METHODS: A two-centre retrospective analysis of all patients who underwent histology sampling of the palatine tonsils between 1 January 2013 and 31 December 2018 was completed. Data collected included patient demographics, method of obtaining tonsil tissue, histological diagnosis and need for repeat tissue sampling. A follow-up period of 36 months was allowed to establish whether any patients re-presented with missed diagnoses. RESULTS: In total, 937 patients were included for analysis: 375 (40.0%) had a biopsy, of which 191 (50.9%) were performed in clinic. The mean duration from initial appointment with the ear, nose and throat clinic to tissue sample collection was 17.6 days (range 0-327 days) for all biopsies, reducing to 0.2 days (range 0-17 days) for biopsies performed in clinic. This was significantly shorter than for tonsillectomies (mean 38.9 days, range 0-444 days; p<0.05). Of the patients who underwent tonsil biopsy, six (1.6%) had malignancy that was not unequivocally diagnosed on initial biopsy. In all six patients, prior clinical suspicion was high, and repeat tissue sampling was undertaken on receipt of negative histology results. CONCLUSIONS: Tonsil biopsy is a viable alternative to tonsillectomy for histology in the assessment of tonsil asymmetry. Tonsil biopsy in the outpatient setting has reduced surgical morbidity, significantly less delay in diagnosis, less inconvenience for patients and lower healthcare costs compared with formal tonsillectomy. Although tonsil biopsies should not be used in isolation, they can be useful in the investigation of patients presenting with tonsillar asymmetry.

What do we want? Training! When do we want it? Now? A training needs analysis for adaptive radiotherapy for therapeutic radiographers.

INTRODUCTION: Therapeutic radiographers (TRs) have adapted to the changing requirements and demands of the oncology service and in response to advanced techniques such as on-line adaptive MRI-guided radiotherapy (MRIgRT). The skills required for MRIgRT would benefit many TRs not just those involved in this technique. This study presents the results of a training needs analysis (TNA) for the required MRIgRT skills in readiness for training TRs for current and future practice. METHODS: A UK-based TNA was used to ask TRs about their knowledge and experience with essential skills required for MRIgRT based on previous investigations into the topic. A five-point Likert scale was used for each of the skills and the difference in values were used to calculate the training need for current and future practice. RESULTS: 261 responses were received (n = 261). The skill rated the most important to current practice was CBCT/CT matching and/or fusion. The current highest priority needs were radiotherapy planning and radiotherapy dosimetry. The skill rated the most important to future practice was CBCT/CT matching and/or fusion. The future highest priority needs were MRI acquisition and MRI Contouring. Over 50% of participants wanted training or additional training in all skills. There was an increase in all values for skills investigated from current to future roles. CONCLUSION: Although the examined skills were viewed as important to current roles, the future training needs, both overall and high priority, were different compared to current roles. As the 'future' of radiotherapy can arrive rapidly, it is essential that training is delivered appropriately and timely. Before this can occur, there must be investigations into the method and delivery of this training. IMPLICATIONS FOR PRACTICE: Role development. Education changes for therapeutic radiographers.

Anxiety and Stress During the COVID-19 Lockdown Among the General Population in Perambalur: A Cross-Sectional Study.

Background The coronavirus disease 2019 (COVID-19) pandemic and lockdown had a significant impact on mental health during the last two years. However, the majority of studies do not concentrate on the risk and protective factors that influence the relationship between COVID-19 and subjective well-being. Therefore, the present study aims to identify such stressful experiences and the influence of COVID-19 and various stressors. Methodology We have conducted this community-based, cross-sectional, analytical study in the Perambalur district of Tamil Nadu for four months. After obtaining approval from the Institutional Ethics Committee, we gathered data for the study. Two field practice areas were involved in data collection. A convenient sampling procedure was used to select 291 households for the study. The lead investigator interviewed one individual from each household, preferably the head of the family. A semi-structured questionnaire was used to collect the pertinent information. The Coronavirus Anxiety Scale (CAS), Perceived Stress Scale (PSS), and Generalized Anxiety Disorder (GAD) scale were used to assess anxiety and stress. All collected data were entered into Microsoft Excel (Microsoft Corporation, Redmond, WA), and SPSS software version 21 (IBM Corp., Armonk, NY) was used to analyze the results. Results Among the participants, 34% had a history of COVID-19 infection, and 58.4% of the families had at least one chronic comorbidity among the family members. The CAS score was significantly associated with the residence (p = 0.049), marital status (p = 0.001), and previous history of COVID-19 (p = 0.016) of the study participants. The study found that gender was the only factor associated with both the PSS score (p = 0.022) and the GAD scale score (p = 0.010) of the study participants. Conclusions Even though doctors can treat many mental health illnesses for a comparatively minimal cost, there is still a wide disparity between those who require care and those who have access to it. Governmental programs and regulations that conduct routine surveys to identify anxiety and stress can lead to successful preventative strategies.

Water, Sanitation, and Hygiene (WASH) Practices Among Households in Perambalur District: A Cross-Sectional Study.

Background Sanitation, cleanliness, and access to clean water are essential for maintaining human health and well-being. Poor water, sanitation, and hygiene (WASH) practices are linked to diseases that lead to poor health outcomes, such as pneumonia and diarrhea, trachoma, infestations of soil-transmitted helminths, respiratory tract infections, and pulmonary tuberculosis. The aim of this study is to evaluate household WASH practices in the rural and urban field practice areas of the Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, India, and identify the factors that influence them. Methodology We conducted a five-month cross-sectional survey with 278 households in the rural and urban field practice areas of a tertiary care center in Perambalur district. We gathered data using the core questions developed by the World Health Organization-United Nations Children's Fund (WHO-UNICEF) Joint Monitoring Programme (JMP), which is affiliated with UN-Water. Data analysts used a Pearson chi-square test to assess the relationship between WASH practices and several independent covariates, and we regarded P < 0.05 to be statistically significant. Results Among the 278 households, 118 respondents were from rural areas and 160 (57.7%) from urban areas. For drinking water, 31.4% of rural households used tube wells or boreholes, while 56.8% of those used public taps. In metropolitan areas, 25.6% of people used bottled water and 54.4% used water from tanker trucks. In terms of sanitation, 25.2% of households lacked a toilet and 72.7% used the flush/pour flush technique. Water, sanitation, and hygiene practices have been found to be associated with a population's socioeconomic status and place of residence. The Pearson chi-square test revealed that the rural population has 99.1% more improved drinking water sources than the urban population, which was statistically significant (P < 0.001). Conclusion In rural areas, nearly 92% of households used improved sources of drinking water compared to only 55% of households in urban areas. On the other hand, just 47.5% of households in the rural area had improved sanitation compared to 95% of households in the urban area. Therefore, the Indian government should take steps to enhance urban drinking water quality and rural sanitation infrastructure.

The Use of Sanitary Latrines and the Practice of Open-Air Defecation in a Rural Setup in Perambalur District: A Cross-Sectional Study.

Background Public health initiatives aim to decrease infectious diseases by enhancing sanitation, which is their primary goal. The practice of sporadically contaminating the environment with human feces has been around for generations and is embedded in the cultural behavior of villagers in India. This study aimed to estimate the proportion of people with access to latrine facilities and the proportion of people who practice open defecation in the villages of Perambalur, Tamil Nadu. Methodology This community-based, cross-sectional, analytical study was conducted in two rural villages in the Perambalur district for six months. After obtaining approval from the institutional ethics committee, we informed participants about the study's purpose. We conducted the study in selected rural areas and included every single residence in the hamlet, irrespective of whether the residents were permanent or temporary. We did not include families that were not reachable at any point during the survey. A convenient sampling procedure was used to select 330 houses for the study. The lead investigator interviewed one individual from each household, preferably the head of the family. A semi-structured questionnaire was used to collect the pertinent information. All collected data were entered into Microsoft Excel (Microsoft Corp., Redmond, WA, USA), and SPSS software version 21 (IBM Corp., Armonk, NY, USA) was used to analyze the results. Results Only around 3.6% of the study participants lived in kutcha households, and about 99.1% of participants identified as Hindu. The proportion of household latrines used was 64.1% among the study participants. Of them, 52.3% engaged in open defecation. Only 4.7% of participants had access to an underground drainage system. Most participants gained knowledge from medical professionals (84.8%). Social media was the second most used source, accounting for about 60.7% of the total. The most frequent reason given for practicing open-air defecation was the perception that constructing restrooms would be expensive (76.3%), while the second most frequent reason was a lack of land (53.4%). An independent t-test found no statistically significant relationship between the availability of household latrines and the number of girls or boys, age, or family income. Compared to those living in semi-pucca and kutcha households, most participants (77.3%) who lived in pucca houses had household latrines. The chi-square test revealed that this proportional difference was statistically significant (p = 0.0001). Conclusions The study participants used household latrines 64.1% of the time. Of the participants, 52.3% engaged in open defecation. The government's initiative to build toilets has only helped a quarter of the population, which needs to be improved. Only 5% of people living in rural areas have access to an underground drainage system. The results of our study provide a justification for the government program's mandate that healthcare practitioners must deliver health education. Therefore, a personalized approach is required to overcome the behavioral barrier among rural people and achieve behavior change.

Effect of Climatic Variables on Abundance and Dispersal of Lecanosticta acicola Spores and Their Impact on Defoliation on Eastern White Pine.

The disease complex white pine needle damage (WPND), first reported in 2006, has now escalated to an epidemic state across the northeastern United States. Although this complex is composed of several fungal species, Lecanosticta acicola is considered to be the primary causal agent. Knowledge regarding the epidemiology, specific climatic factors that affect the spread of L. acicola on eastern white pine (Pinus strobus) in natural forest settings, and potential risks repeated defoliation may have on tree health is limited. Therefore, this study examined how climatic variables affect the abundance and distance of spore dispersal of L. acicola and compared litterfall caused by defoliation versus natural needle abscission. Conidia were observed on spore traps from May through August, with a peak in abundance occurring in June, corresponding to the defoliation of second- and third-year foliage measured in litter traps. During peak spore production, relative humidity and the occurrence of rainfall was found to have the greatest influence on spore abundance. Our results will aid managers in determining how far from infected trees natural regeneration will likely be affected and predicting future disease severity based on climatic conditions.

Middle ear cholesteatoma: Compared diagnostic performances of two incremental MRI protocols including non-echo planar diffusion-weighted imaging acquired on 3T and 1.5T scanners.

BACKGROUND AND PURPOSE: To compare diagnostic performances for cholesteatoma diagnosis of incremental MRI protocols including non-echo planar diffusion-weighted imaging (DWI) performed on 3T and 1.5T scanners. MATERIALS AND METHODS: Thirty-nine patients with suspected cholesteatoma underwent 3T and 1.5T non-echo planar DWI and additional unenhanced T1-, delayed gadolinium-enhanced T1- and high-resolution T2-weighted standard acquisitions. Patients either underwent surgical tympanoplasty (n=21) or close clinicoradiological follow-up (n=18). Four radiologists independently and prospectively interpreted two incremental MRI protocols, differing in the magnetic field strength of the diffusion-weighted acquisition and comprising the three standard sequences. At each step, diagnostic performances were expressed as sensitivity, specificity, positive predictive value, negative predictive value and accuracy. RESULTS: Forty middle ear lesions including 21 cholesteatomas were identified. Univariate and multivariate analysis did not demonstrate significant reader, sequence addition or DWI magnetic field effect on diagnostic performances. Concerning non-echo planar DWI alone, sensitivity, specificity, positive predictive value, negative predictive value and accuracy ranged between 90.5-100%, 68.4-100%, 76.9-100%, 90.0-100% and 82.5-95.0, respectively. CONCLUSION: Non-echo planar DWI for cholesteatoma diagnosis can be performed on 1.5T or 3T scanners indifferently. High sensitivity and negative predictive value and relatively lower specificity and positive predictive value are achieved by a single non-echo planar DWI protocol.

Imaging of illicit drug use.

Illicit drug abuse is a continuing menace of epidemic proportions associated with serious medical and social problems. Drug abuse can have a wide variety of presentations some of which can be life-threatening. The clinical diagnosis can be challenging as the history is usually limited or absent. Radiologists need to be familiar with varied imaging presentations and the related complications of illicit drug abuse to ensure correct diagnosis and appropriate timely treatment. This review will illustrate the imaging spectrum of illicit drug abuse involving several organ systems and also discuss the pathophysiological consequences of drug abuse.

A training simulator for ultrasound-guided percutaneous nephrostomy insertion.

Increasing trainee numbers and changes to working patterns have resulted in a scarcity of training opportunities for training-grade doctors wishing to learn nephrostomy tube insertion techniques. A method of introducing trainees to the skills required to perform percutaneous nephrostomy in a safe, non-threatening environment, without risk to patients, is desirable. Commercial and biological nephrostomy phantoms are available, but they are expensive and not widely available, and a cheap, safe, valid alternative is desirable. We describe a simple technique for producing a gelatin-based phantom, which we suggest has face and content simulator validity. The use of this nephrostomy phantom could optimise existing clinical training opportunities through familiarisation with nephrostomy technique and equipment, and development of the psychomotor skills required for successful nephrostomy insertion prior to undertaking supervised procedures on patients.

Possible observation of phase separation near a quantum phase transition in doubly connected ultrathin superconducting cylinders of aluminum.

The kinetic energy of superconducting electrons in an ultrathin, doubly connected superconducting cylinder, determined by the applied flux, increases as the cylinder diameter decreases, leading to a destructive regime around half-flux quanta and a superconductor to normal metal quantum phase transition (QPT). Regular steplike features in resistance versus temperature curves taken at fixed flux values were observed near the QPT in ultrathin Al cylinders. It is proposed that these features are most likely resulting from a phase separation near the QPT in which normal regions nucleate in a homogeneous superconducting cylinder.

Generating Quitline calls during Australia's National Tobacco Campaign: effects of television advertisement execution and programme placement.

OBJECTIVE: The study sought to measure the relative efficiency of different television advertisements and types of television programmes in which advertisements were placed, in generating calls to Australia's national Quitline. DESIGN: The study entailed an analysis of the number of calls generated to the Quitline relative to the weight of advertising exposure (in target audience rating points (TARPs) for particular television advertisements and for placement of these advertisements in particular types of television programmes. A total of 238 television advertisement placements and 1769 calls to the Quitline were analysed in Sydney and Melbourne. RESULTS: The more graphic "eye" advertisement conveying new information about the association between smoking and macular degeneration leading to blindness was more efficient in generating quitline calls than the "tar" advertisement, which reinforced the message of tar in a smoker's lungs. Combining the health effects advertisements with a quitline modelling advertisement tended to increase the efficiency of generating Quitline calls. Placing advertisements in lower involvement programmes appears to provide greater efficiency in generating Quitline calls than in higher involvement programmes. CONCLUSIONS: Tobacco control campaign planners can increase the number of calls to telephone quitlines by assessing the efficiency of particular advertisements to generate such calls. Pairing of health effect and quitline modelling advertisements can increase efficiency in generating calls. Placement of advertisements in lower involvement programme types may increase efficiency in generating Quitline calls.

A correlation study of objective functionality and WOMAC in total knee arthroplasty.

Function studies after total knee arthroplasty (TKA) generally use either self-reported instruments or objective quantitative measurements of walking activities, but it is unclear how objective factors influence self-reports. This retrospective multicenter study assessed the impact of objective variables on subjective self-reported functional outcome after TKA in 128 patients at a mean of 41 months after TKA. Self-reported disability was measured by the Western Ontario and McMaster University (WOMAC) scale, and the quality of walking and representative daily activities were determined objectively by the DynaPort knee test. Objective assessment was found to be a poor predictor of WOMAC abnormality, with correlations of 0.343, 0.246, and 0.269 with WOMAC function, stiffness, and pain, respectively. The results of WOMAC are thus strongly influenced by factors other than quantitative parameters of the lower extremity. These findings provide support for including an objective assessment of activities of daily living together with a subjective self-report.

Destruction of the global phase coherence in ultrathin, doubly connected superconducting cylinders.

In doubly connected superconductors, such as hollow cylinders, the fluxoid is known to be quantized, allowing the superfluid velocity to be controlled by an applied magnetic flux and the sample size. The sample-size-induced increase in superfluid velocity has been predicted to lead to the destruction of superconductivity around half-integer flux quanta. We report transport measurements in ultrathin Al and Au0.7In0.3 cylinders verifying the presence of this destructive regime characterized by the loss of the global phase coherence and reveal a phase diagram featuring disconnected phase coherent regions, as opposed to the single region seen in larger superconducting cylinders studied previously.

Social work in primary care: a demonstration student unit utilizing practice research.

A neighborhood primary health care program serving a socially and economically oppressed community, and a graduate school of social work have collaborated to create a social work student field work unit in a primary health care setting, to demonstrate emerging and innovative social work roles in an ever-increasing managed care environment. Patients with high levels of psychosocial stress make large demands on the primary care system and consume considerable laboratory and diagnostic treatment resources. Development of social services in primary care settings is a relatively new concept, however it has been clearly demonstrated that primary care physicians need the skills of social workers to handle the psychosocial and environmental aspects of illness. The principal goal was to demonstrate social work practice in a primary care health setting, utilizing practice research approaches. Validation of effectiveness was noted, as depression, anxiety, adjustment reactions (to name a few) were decreased, resulting in fewer physician visits, less somatization and improved compliance with medical and diet/nutrition regimens. The case examples and single subject data presented provide qualitative evidence, in the context of a natural experiment, for the profession to pursue this model further in both program development and research.

A Department of Social Work uses data to prove its case [corrected].

The introductions of managed care with its emphasis on cost containment has led a Department of Social Work Services at a large urban teaching center to better document and justify its roles. A concrete result was the saving of social work positions during budget cutbacks and downsizing. There is also information in these data to help clarify the differential roles of social workers and utilization review nurses in the hospital case management/discharge planning processes. The system came about because of concerns around cost containment, the need for more systematic discharge planning and the advent of the Prospective Payment System and Diagnosis Related Groups (DRG's) as a means of reimbursement to hospitals.

Predictors of hospital length of stay and nursing home placement in an elderly medical population.

OBJECTIVE: To identify predictors of adverse outcomes (nursing home placement and hospital length of stay) in a cohort of older hospitalized patients. DESIGN: Prospective cohort study. SETTING: A suburban medical center in the New York City metropolitan area. PARTICIPANTS: Patients aged 65 years and older admitted from the emergency department to medical services who could be seen within 24 hours. Patients with terminal illness, planned stays < 2 days, and admission to other than medicine were excluded. MEASUREMENTS: Sociodemographic data, mobility, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), mental status, length of stay (LOS), discharge diagnosis, and disposition (nursing home vs. other). RESULTS: Of 681 patients screened, 322 were eligible and assessed at admission,206 were reassessed at discharge. Using multiple regression, greater dependency in IADL, more household help, and impaired mental status at admission predicted hospital LOS significantly (P = 0.0001). Compared with those discharged home, the nursing home (NH) group had lower scores on mean mobility and mean ADLs and IADLs and was more likely to exhibit a decline in at least one ADL. Stepwise discriminant analysis was performed using admission, discharge, and combined variables. In our final model of the predictors of discharge disposition, the use of admission functional variables, age, and sex correctly classified 100% of the NH group and 91% of the other group, with IADL, ADL, and mobility defining the function that discriminated the groups. CONCLUSIONS: Our data indicate the value of cognitive and physical function at admission as predictors of adverse outcomes and support early assessment of the elderly for discharge planning for long-term care.

Diet and physical activity patterns of Lakota Indian adults.

OBJECTIVES: This study assessed specific dietary practices and overall physical activity patterns of Lakota adults residing on Indian reservations in South Dakota. Perceived barriers to changing dietary and physical activity behaviors were also examined. DESIGN: A convenience sample of Lakota adults was surveyed. Data on consumption of higher-fat foods, fruit and vegetable intake, use of sugar-sweetened beverages, physical activity patterns, and barriers to change in diet and physical activity were collected via in-person interviews. SUBJECTS/SETTING: A total of 219 adults from 2 adjacent reservations in South Dakota participated. RESULTS: Higher-fat foods consumed most frequently included margarine and butter (32.0% > or = 5 times per week); eggs (30.1% > or = 5 times per week); whole milk (25.7% > or = 5 times per week); potato chips, corn chips, and popcorn (15.1% > or = 5 times per week); and bacon and sausage (13.3% > or = 5 times per week). Few subjects reported consuming fruit on a daily basis. Vegetables were consumed somewhat more frequently. Most subjects reported engaging in mild or moderate physical activities 3 or more times per week, although women were found to engage in moderate and strenuous physical activities less frequently than men. Major barriers to fruit intake included expense (16.4%), quality (14.2%), and availability (13.2%). Barriers to vegetable intake mentioned most frequently included availability (11.4%), cost (10.4%), and quality (9.1%). Taste was the most frequently mentioned barrier to cutting intake of high-fat foods (27.9%). Lack of child care (15.8%), lack of time (14.7%), and safety concerns (14.6%) were the most salient barriers to regular exercise. APPLICATIONS/CONCLUSIONS: Nutrition interventions are needed that address the major barriers to diet change reported by Lakota adults. Efforts to increase physical activity should focus on Lakota women and should address the identified barriers to regular exercise.

The new confidentiality for the 21st century in a managed care environment.

As society becomes more dependent on technology to store and obtain information quickly and effectively, there has been increasing concern in the social work community about protecting privacy and maintaining confidentiality, especially in a managed care environment. The concept of confidentiality is very different in a technologically advanced environment. This article reviews relevant social work, legal, and other professional literature on confidentiality, technology, and managed care. A three-level topology of client problems and behaviors is delineated and illustrated through practice examples, which demonstrate the different types of information that can be computer stored and retrieved and electronically transmitted. The articles discussed the levels of security, including log-on procedures, firewalls, and encryption, which can be used at each level to protect sensitive information, and presents guidelines to help professionals protect and promote confidentiality within the constraints of technology and managed care.