Growth Assessment of Under-Five Children of Employed and Unemployed Mothers of Etawah District, Uttar Pradesh: A Cross-Sectional Study.

Introduction The under-five age group is crucial because the health profile of this age group will have a huge effect on the future development of the nation. Early infancy is marked by several distinct developmental characteristics. Progress in each domain of childhood development is used to track a child's development. Objectives The objectives of the present study were to assess and compare the growth of under-five children of employed and unemployed mothers in the Etawah District of Uttar Pradesh, India. Material and methods A community-based cross-sectional survey was carried out in Etawah district's urban and rural areas between January 2021 and June 2022. A total of 200 mothers with children under the age of five were recruited using the purposive sampling method. To gather pertinent information, a semi-structured, pre-tested, interviewer-administered questionnaire was used. Results In the present study on the comparison of the growth of children among employed and unemployed mothers, it shows that 48 children (50.5%) with a weight between 10.5 and 15 kg were of employed mothers, while 52 children weighing less than 10.5kg were of unemployed mothers (p<0.001). Forty-four children (57.1%) with a chest circumference of more than 48 cm were of employed mothers, while 26 children (78.8%) with a chest circumference of less than 45 cm were of unemployed mothers (p = 0.001). Conclusion The present study indicates that statistically significant differences were found in age-appropriate gain in weight and chest circumference, which was higher among the children of employed mothers in comparison to children of unemployed mothers. There was no statistically significant difference in age-appropriate gain in height, head circumference, or mid-upper arm circumference among the children of employed mothers and unemployed mothers.

Influence of maternal body mass index on interobserver variability of fetal ultrasound biometry and amniotic-fluid assessment in late pregnancy.

OBJECTIVE: To determine the interobserver reproducibility of fetal ultrasound biometric and amniotic-fluid measurements in the third trimester of pregnancy, according to maternal body mass index (BMI) category. METHODS: This was a prospective cohort study of women with a singleton gestation beyond 34 weeks, recruited into four groups according to BMI category: normal (18.0-24.9 kg/m2 ), overweight (25.0-29.9 kg/m2) , obese (30.0-39.9 kg/m2 ) and morbidly obese (≥ 40 kg/m2 ). Multiple pregnancies, women with diabetes and pregnancies with a fetal growth, structural or genetic abnormality were excluded. In each woman, fetal biometric (biparietal diameter (BPD), head circumference, abdominal circumference (AC), femur length (FL) and estimated fetal weight) and amniotic-fluid (amniotic-fluid index (AFI) and maximum vertical pocket (MVP)) measurements were obtained by two experienced sonographers or physicians, blinded to gestational age and each other's measurements. Differences in measurements between observers were expressed as gestational age-specific Z-scores. The interobserver intraclass correlation coefficient (ICC) and Cronbach's reliability coefficient (CRC) were calculated. Bland-Altman analysis was used to assess the degree of reproducibility. RESULTS: In total, 110 women were enrolled prospectively (including 1320 measurements obtained by 17 sonographers or physicians). Twenty (18.2%) women had normal BMI, 30 (27.3%) women were overweight, 30 (27.3%) women were obese and 30 (27.3%) women were morbidly obese. Except for AFI (ICC, 0.65; CRC, 0.78) and MVP (ICC, 0.49; CRC, 0.66), all parameters had a very high level of interobserver reproducibility (ICC, 0.72-0.87; CRC, 0.84-0.93). When assessing reproducibility according to BMI category, BPD measurements had a very high level of reproducibility (ICC ≥ 0.85; CRC > 0.90) in all groups. The reproducibility of AC and FL measurements increased with increasing BMI, while the reproducibility of MVP measurements decreased. Among the biometric parameters, the difference between the BMI categories in measurement-difference Z-score was significant only for FL. Interobserver differences for biometric measurements fell within the 95% limits of agreement. CONCLUSION: Obesity does not seem to impact negatively on the reproducibility of ultrasound measurements of fetal biometric parameters when undertaken by experienced sonographers or physicians who commonly assess overweight, obese and morbidly obese women. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Quality assessment of cancer patient education materials: the current state of systemic therapy patient education in fourteen cancer centres across Ontario, Canada.

PURPOSE: Most patients diagnosed with cancer are administered systemic therapy and these patients are counselled and given printed education (PE) materials. High rates of low health literacy highlight the need to evaluate the quality of these PE materials. METHODS: A current state assessment of the quality of PE materials was conducted in Ontario, Canada. Patient education leaders from 14 cancer centres submitted print materials on the topic of systemic cancer therapy to the assessment team. To report adherence to PE quality and health literacy best practices, the following validated measures were used: readability (FRY, SMOG and Flesch Reading Ease), understandability and actionability (Patient Education Materials Assessment Tool (PEMAT)). Materials at grade level 6 or lower and with PEMAT scores greater than 80% were considered to meet health literacy best practices. RESULTS: A total of 1146 materials were submitted; 366 met inclusion criteria and 83 were selected for assessment. Most materials scored below the 80% target for understandability (x̄ = 73%, 31-100%) and actionability (x̄ = 68%, 20-100%), and above the recommended grade 6 readability level (x̄ = grade 9) meaning that the majority did not meet quality standards or best practices. CONCLUSION: Results suggest that there is significant opportunity to improve the quality of PE materials distributed by cancer centres. The quality of PE materials is a critical safety and equity consideration when these materials convey important safety and self-care directives.

A Prospective, Non-interventional Study of Assessment and Treatment Adequacy of Pain in the Emergency Department of a Tertiary Care Cancer Hospital.

INTRODUCTION: Pain is the most common reason for emergency department (ED) visits by the cancer patients. Treatment inconsistency and inadequacy are reported worldwide in the management of ED pain. We conducted a non-interventional observational study of 100 patients visiting ED with moderate to severe pain in a tertiary care cancer center. AIMS: The goal of this study was to describe the characteristics of pain and its treatment by oncologists in ED. MATERIALS AND METHODS: Management of 100 adult patients with complaints of moderate to severe pain was observed by the investigator in ED. Treatment was provided by the doctors of respective oncological services. Later, patients were interviewed by the investigator to collect data about the details of their pain and treatment adequacy. RESULTS: On arrival to ED, about 65% patients reported severe pain, however no formal pain assessment was performed and no patient received strong opioids. Poor compliance for prescribed analgesic medications was noted in a large number of patients (31%), primarily due to suboptimal pain relief and lack of awareness. Protocol based analgesic treatment was non-existent in ED. Majority of patients remained in significant pain after 30 min of analgesic administration and 24% patients could never achieve more than 50% pain relief at the time of discharge. CONCLUSION: Due to lack of formal pain assessment and laid down protocols, suboptimal pain management is commonly prevalent in ED. Use of strong opioids continues to be scarce in management of severe pain. There is a need to formulate pain management protocols for ED pain.

Stability-indicating HPTLC determination of ambroxol hydrochloride in bulk drug and pharmaceutical dosage form.

A simple, selective, precise, and stability-indicating high-performance thin-layer chromatographic (HPTLC) method for the analysis of ambroxol hydrochloride both as a bulk drug and in formulations was developed and validated. The method employed HPTLC aluminium plates precoated with silica gel 60F-254 as the stationary phase. The solvent system consisted of methanol-triethylamine (4:6 v/v). The system was found to give a compact spot for ambroxol hydrochloride (R(f) value of 0.53 +/- 0.02). Densitometric analysis of ambroxol hydrochloride was carried out in the absorbance mode at 254 nm. The linear regression analysis data for the calibration plots showed good linear relationship with r(2) = 0.9966 +/- 0.0013 with respect to peak area in the concentration range 100-1000 ng/spot. The mean value +/- standard deviation of slope and intercept were 164.85 +/- 0.72 and 1168.3 +/- 8.26 with respect to peak area. The method was validated for precision, recovery, and robustness. The limits of detection and quantitation were 10 and 30 ng/spot, respectively. Ambroxol hydrochloride was subjected to oxidation and thermal degradation. The drug undergoes degradation under oxidation and heat conditions. This indicates that the drug is susceptible to oxidation and heat. Statistical analysis proves that the method is repeatable, selective, and accurate for the estimation of said drug. Stability indicating of new chemical entities is an important part for the drug development of ambroxol hydrochloride and for its estimation in plasma and other biological fluids; the novel Statistical analysis proves that the method is repeatable and selective for the analysis of ambroxol hydrochloride as bulk drug and in pharmaceutical formulations. The proposed developed HPTLC method can be applied for identification and quantitative determination of ambroxol hydrochloride in bulk drug and dosage forms. This work is to determine the purity of the drug available from the various sources by detecting the related impurities.

Prevalence, etiology, and management of neuropathic pain in an Indian cancer hospital.

Neuropathic pain is still an under-diagnosed and undertreated problem in third world countries. This retrospective study was undertaken to detect the prevalence, etiology and treatment profile of neuropathic pain in cancer. During January-December 2007, 716 new cancer pain patients were examined in Tata Memorial Hospital Pain Clinic. A total of 180 patients with a mean age of 47.14 yrs were found to have neuropathic pain characteristics on the basis of clinical impression, site of pain and the underlying cause i.e. due to tumor itself or cancer therapy. Head and neck cancer (32.2%) was found to be the most common cause of neuropathic pain, followed by breast (20.6%), thoracic (14.4%), genitourinary or gynecology (10.0% each), GI (9.4%), and medical oncology (2.8%). About 56% patients were post surgery, 44.4% post chemotherapy and 51.1% patients were post radiotherapy. The most common site of pain was thoracic (36.7%) due to primary or secondary metastatic disease. Pricking type of pain was the most characteristic feature (47.8%) followed by shooting pain (38.3%). The mean pain score was 5.96 +/- 1.5 (SD) and mean duration (months) of pain was 2.8 +/- 2.5. Neuropathic pain was found commonly associated with somatic pain (59.4%). The most common pharmacological agents prescribed were: tricyclic antidepressants (93.9%), anticonvulsants (66%), Opioids (85%), and nonsteroidal anti-inflammatory drugs (NSAIDs) (97.2%). Only 35% patients followed up more than once at the pain clinic. The most common and challenging patients were of orofacial pain. Nerve blocks techniques have a limited role in neuropathic pain.

Assessment of utilization of untied fund provided under the national rural health mission in Uttar Pradesh.

OBJECTIVES: To seek opinion regarding the procurement and spending of untied fund provided to health centers and Village Health and Sanitation Committees (VHSCs) in selected districts in the state of Uttar Pradesh. METHODS: It was a cross sectional descriptive study conducted during September-December 2008. The multi-stage random sampling technique was adopted to select the districts, health facilities and VHSCs. The data was collected using semi structured interview schedule, Focus Group Discussions (FGDs) with ANMs for qualitative information, review of the records of health centers and VHSCs. RESULTS: The concept of untied fund was perceived to be a very good one at all levels. Guideline for utilization of untied fund was either not available or if available, was not clear to concerned personnel. The decision of expenditure of untied funds of CHCs and PHCs was taken in the meeting of Rogi Kalyan Samiti (RKS), but members from other sectors such as PRI, education, revenue department etc. usually did not attend the meeting. Most of Medical Officer in charges (MOICs) were not aware regarding availability of untied fund. About 50% of ANMs were not able to expend the money due to non co-operation of Pradhan. In majority of the cases the decision regarding the utilization of untied fund was taken by ANM herself instead of VHSC meeting. CONCLUSION: Regular update and orientation to the service providers about the untied fund and its efficient utilization, strict monitoring of utilization of untied fund at each and every level is needed.

Geo-spatial analysis of land-water resource degradation in two economically contrasting agricultural regions adjoining national capital territory (Delhi).

The present study was aimed at characterizing the soil-water resource degradation in the rural areas of Gurgaon and Mewat districts, the two economically contrasting areas in policy zones-II and III of the National Capital Region (NCR), and assessing the impact of the study area's local conditions on the type and extent of resource degradation. This involved generation of detailed spatial information on the land use, cropping pattern, farming practices, soils and surface/ground waters of Gurgaon and Mewat districts through actual resource surveys, standard laboratory methods and GIS/remote sensing techniques. The study showed that in contrast to just 2.54% (in rabi season) to 4.87% (in kharif season) of agricultural lands in Gurgaon district, about 11.77% (in rabi season) to 24.23% (in kharif season) of agricultural lands in Mewat district were irrigated with saline to marginally saline canal water. Further, about 10.69% of agricultural lands in the Gurgaon district and 42.15% of agricultural lands in the Mewat district were drain water irrigated. A large part of this surface water irrigated area, particularly in Nuh (48.7%), Nagina (33.5%), and Punhana (24.1%) blocks of Mewat district, was either waterlogged (7.4% area with 0.05 ppm). In fact, sub-surface drinking waters of some areas around battery and automobile manufacturing units in Gurgaon and Pataudi blocks were associated with exceptionally high (>0.1 ppm) Ni concentrations. In general, the ground waters of waterlogged or potentially waterlogged areas in the rural areas of Mewat were more contaminated than the ground waters in the rural areas of Gurgaon district with deeper (>5 m) water depths.Though Cr concentrations in the surface and sub-surface irrigation waters of both Gurgaon and Mewat districts were far above the maximum permissible limit of 1 ppm, their bio-available soil-Cr concentrations were well within permissible limit. Even bio-available Ni concentrations in agricultural lands of Gurgaon district associated with Ni contaminated sub-surface irrigations were well within desirable limit of 0.20 ppm. This was primarily attributed to the calcareous nature of the soils of the study area. About 35% of Gurgaon district and 59% of Mewat district irrigated with poor quality waters were salt-affected. These waterlogged/potentially waterlogged calcareous-salt affected soils of Mewat district were having acute zinc (Zn) deficiency (<0.6 ppm). Some areas with extremely high iron (Fe: 20-25 ppm) and Mn (10-25 ppm) concentrations were also noticed in the Gurgaon, Nuh and Punhana blocks. Generation of reduced conditions owing to paddy cultivation in areas with 3-3.5 m water depths appeared to be the main cause of such point contaminations. Extensive cadmium (Cd) contamination was also noticed in the waterlogged sodic agricultural lands of Nagina village in Mewat district associated with a large scale scrap automobile and battery business. The study could document the processes and provide spatially accurate information to the managers (e.g., National Capital Region Planning Board) and the concerned citizen groups. It could, in fact, clearly point out that dumping of industrial and domestic wastewaters especially from NCT-Delhi into river Yamuna and, to some extent, from NCT-Delhi re-located hazardous industrial units into Najafgarh drain tributaries at Delhi-Gurgaon boundary, and poor "off-farm" water management practices were the main reasons for extensive (point/non-point source) land-water degradation in Gurgaon and Mewat districts of NCR.

A prospective study of ambulatory laparoscopic cholecystectomy: training economic, and patient benefits.

BACKGROUND: Even though ambulatory laparoscopic cholecystectomy (ALC) is safe and cost effective, this approach has yet to gain acceptance in the United Kingdom. We report our 5-year experience of ALC with emphasis on its appropriateness for higher surgical training. METHODS: Between July 1997 and July 2002, patients with symptomatic cholelithiasis who met with appropriate criteria underwent ALC. Surgery was performed either by a consultant surgeon or a higher surgical trainee (HST) under direct supervision in our dedicated day surgery unit. Data were recorded prospectively and patients were interviewed postoperatively by an independent researcher. RESULTS: There were 269 patients (231 female and 38 male) with a median age of 46 years (range 17-76). Conversion to open cholecystectomy was necessary in three cases (1%). Of the patients, 79% (213) were discharged within 8 hours of surgery; 95% (256) were discharged on the same day. Thirteen patients (5%) required overnight admission as inpatients. An HST performed 166 (62%) of the procedures. There was a statistically significant difference in operating time between consultants (41 min) and trainees (47 min, P = 0.001) but no significant difference in clinical outcome or patient satisfaction. The mean procedural cost to the hospital was 768 pound sterling for ALC compared with 1430 pound sterling for an inpatient operation. Of patients, 87% expressed satisfaction with the day case operation. CONCLUSION: Our results for ALC compare favorably with published series. In addition, we have demonstrated that the operation can be performed safely by HST under direct supervision without compromising operating lists or safety.

Spiral CT for lung cancer screening: is it ready for prime time?

Low-dose spiral computed tomography (CT) shows promise as a screening test for lung cancer, as it detects many more malignant pulmonary nodules than does standard plain radiography of the chest. Yet until more data are available we need to temper our enthusiasm. No studies have yet determined if using low-dose spiral CT as a screening test will lead to lower mortality rates. This paper reviews the issue of lung cancer screening and low-dose spiral CT.

Cardiac involvement in limited systemic sclerosis: non-invasive assessment in asymptomatic patients.

Nineteen patients with limited systemic sclerosis (SSc) and without any cardiac symptoms were evaluated non-invasively for silent cardiac involvement using electrocardiography; M-mode, two-dimensional and Doppler echocardiography, and resting and post exercise radionuclide ventriculography. Left anterior hemiblock and mild pericardial effusion were seen in two patients. The interventricular septal thickness and left ventricular posterior wall thickness were greater in patients compared with controls. Patients with limited SSc also exhibited low early diastolic filling velocities and a low early diastolic atrial filling ratio. However, these values did not correlate with the age of the patient or disease duration. Eight patients (42.1%) were found to have cardiac dysfunction, of which four had combined systolic and diastolic dysfunction. Isolated systolic and diastolic dysfunction was seen in three patients and one patient, respectively. The age and disease duration in patients with cardiac dysfunction did not differ from patients without cardiac dysfunction. Functional cardiac involvement occurs in a large proportion (42.1%) of patients with limited SSc, and can be easily picked up by non-invasive methods such as echocardiography and radionuclide ventriculography. The prognostic significance of these findings requires further long term studies.

Dentin desensitizing agents: SEM and X-ray microanalysis assessment.

PURPOSE: To evaluate the effect of four proprietary dentin desensitizing agents on dentin tubular occlusion, chemical composition changes on the dentin surface, and the effect of saliva and toothbrushing on these agents. MATERIALS AND METHODS: Fifty dentin discs, obtained from 50 freshly extracted human premolar and molar teeth were used in this study. These were divided into five groups of 10 discs each. Five discs from each group were treated with the desensitizing agents, viewed under the SEM and subjected to energy dispersive X-ray analysis. The other five discs were treated with the desensitizing agents, immersed in artificial saliva, subjected to simulated toothbrushing equivalent to 3 weeks of normal brushing and viewed under the SEM. The agents studied were Sensodyne Dentin Desensitizer, Therma-Trol Desensitizer Gel, Gluma Desensitizer and All-Bond DS. RESULTS: The Kruskal-Wallis test followed by the Wilcoxon signed-rank test showed that Sensodyne Dentin Desensitizer exhibited the greatest amount of tubular occlusion among the unbrushed samples, followed by Therma-Trol Desensitizer Gel, Gluma Desensitizer and All-Bond DS (P < 0.05) in that order. Toothbrushing increased tubular occlusion in all cases except the Sensodyne Dentin Desensitizer treated samples.

Myopotential inhibition of unipolar demand pacemakers: utility of provocative manoeuvres in assessment and management.

Fifty patients with permanent unipolar pacemakers (48 multiprogrammable, 2 non programmable) with protective insulating sheath placed against the muscular side of the pacemaker pocket were studied to determine the occurrence of inhibition of pacing by sensing of the myopotentials. All the patients were subjected to a combination of different provocative manoeuvres at their nominal R wave sensitivity settings. Myopotential inhibition was exhibited in 35 (70%) patients. Only 3 patients however had reported symptoms suggesting loss of pacing. The most useful provocative manoeuvre was shoulder flexion with adduction against resistance (94.3% positivity). Appropriate sensitivity adjustments resulted in amelioration of the problem in 86% of the patients while still retaining R wave sensing. Myopotential interference continues to be a frequently observed problem even in the present generation of unipolar pacemakers. Provocative tests and appropriate reprogramming should be done in all such patients as a routine.

An arteriographic assessment of renal vasculature in young patients with essential hypertension.

Twenty-five patients below the age of 40 years with Uncomplicated hypertension underwent selective renal arteriography to assess the involvement of interlobar and arcuate arteries. Renal vasculature was abnormal in all 25 patients. Patients with severe hypertension had markedly abnormal renal vasculature. None of the patients with mild hypertension had severe vascular involvement. Functional significance of these arteriographic abnormalities is discussed.

Utilization of audio-visual aids by family welfare workers.

PIP: Communication efforts have been an important component of the Indian Family Planning Welfare Program since its inception. However, its chief interests in its early years were clinical, until the adoption of the extension approach in 1963. Educational materials were developed, especially in the period 1965-8, to fit mass, group meeting and home visit approaches. Audiovisual aids were developed for use by extension workers, who had previously relied entirely on verbal approaches. This paper examines their use. A questionnaire was designed for workers in motivational programs at 3 levels: Village Level (Family Planning Health Assistant, Auxilliary Nurse-Midwife, Dias), Block Level (Public Health Nurse, Lady Health Visitor, Block Extension Educator), and District (District Extension Educator, District Mass Education and Information Officer). 3 Districts were selected from each State on the basis of overall family planning performance during 1970-2 (good, average, or poor). Units of other agencies were also included on the same basis. Findings: 1) Workers in all 3 categories preferred individual contacts over group meetings or mass approach. 2) 56-64% said they used audiovisual aids "sometimes" (when available). 25% said they used them "many times" and only 15.9% said "rarely." 3) More than 1/2 of workers in each category said they were not properly oriented toward the use of audiovisual aids. Nonavailability of the aids in the market was also cited. About 1/3 of village level and 1/2 of other workers said that the materials were heavy and liable to be damaged. Complexity, inaccuracy and confusion in use were not widely cited (less than 30%).^ieng

Socio-demographic evaluation of mass vasectomy camps in Bihar.

PIP: A mass vasectomy campaign was held at Monghyr and Muzaffarpur districts in Bihar state. 458 vasectomy acceptors were interviewed to determine sociodemographic characteristics. The camp facilities were mostly used by the poorer segment of society. 92.4% were Hindus and 7.6% Muslims. The average age was 39.2 years for males and 33.9 years for their wives. Moreover, the acceptors usually had 4 children, including both sons and daughters. Hydrocele and old age were the 2 main reasons for rejection of men who registered.^ieng

A Micro study of motivators in Bihar vasectomy camps.

PIP: In order to assess various aspects of their role in the Indian mass vasectomy camp at Bihar, 18 motivators were surveyed about their involvement in the program, targets fixed for them, methods of motivation, amount of incentive money, ideal time for holding camps, transportation facilities, and suggestions for improvement of the camp. The motivators were young, literate, and came from differing occupations and religions. 8 were themselves sterilized; others used contraceptives such as 'Nirodh' and 'Contab', while the rest said they might be sterilized later. 8 of the motivators began recruiting sterilization cases specifically for the money incentive, while others became involved in other ways. The 2 official motivators who were given the target of bringing in 25-40 cases could not achieve this target, but felt optimistic about future success. Motivators were evenly divided about the sufficiency of the amount of money offered them for sterilization cases. Varying methods of motivating sterilization acceptors for the camp were reported, but neither any theory nor philosophy of motivation was seen to be working. Points of dissatisfaction mentioned by the motivators included inadequate transportation, a waiting time that was too long, inadequate diet given the acceptors, and no proper accomodation given for stay if the patient is not operated on on that day. It is concluded that in a community of illiterate and poor people, the factor of motivation for the small family norm as such is not as strong an incentive as the need for money. An increased incentive to the vasectomy acceptors may bring in more cases for sterilization to the camp.^ieng