Integration of primary palliative care into geriatric care from the Indian perspective.

The rising trend in the ageing population alongside social, cultural, and economic changes poses a major threat to the health care system in the country. Elderly population have dynamic and complex health care needs, are debilitated by the progressive chronic life-threatening diseases, and live a compromised quality of life. Palliative care, with its multifaceted approach, can provide respite to the elderly population. A decentralized approach in which palliative care is provided by the local community will ensure seamless continuity of care and care at an affordable cost. General practitioners or family physicians play a vital role in delivering primary palliative care to the elderly population in the community. An integrating primary palliative-geriatric care model will ensure that care is provided in alignment with the patients' and their families' wishes along the trajectory of the life-threatening illness and at the patients' preferred place. However, delivering primary palliative care in the community can be riddled with challenges at various levels, such as identification of patients in need of palliative care, interpersonal communication, addressing patients' and caregivers' needs, clarity in roles and responsibilities between general practitioner and family physicians and specialist palliative care teams, coordination of services with specialists, and lack of standard guidelines for palliative care referral. Various geriatric-palliative care models have been tested over the years, such as delivering palliative and end-of-life care for disease-specific conditions at specified care settings (home or hospice) and provision of care by different specialist palliative care teams and general practitioners or family physicians. Akin to the aforementioned models, the National Health Program in the country envisages to strengthen the integration of geriatric and palliative care. The integrated geriatric-palliative care model will ensure continuity of care, equitable distribution of service, impeccable inter-sectoral collaboration and care at an affordable cost.

Comparative evaluation of transpalatal arch and vertical holding appliance at different heights.

Objectives: An effective method for controlling vertical dysplasia remains a concern for orthodontists. This study aims to compare the stresses on the maxillary first molars while changing the height of the loop/acrylic pad of the transpalatal arch (TPA) and vertical holding appliance (VHA) during swallowing using finite element analysis. Methods: Head and neck computed tomography (CT) of a patient with levelled and aligned maxillary teeth was taken for a three-dimensional reconstruction. Six models comprising the maxilla, molars, and surrounding periodontal ligament (PDL) with different heights of loop/acrylic pads of the appliances were constructed. A force of 112 g/cm2 was applied to the loop/acrylic pads of both appliances to simulate the average tongue pressure. The distribution of von Mises stresses occurring at the PDL due to the tongue pressure was mapped at the cervical area, furcation, distobuccal, mesiobuccal, and palatal root apices. Separately, subjects requiring TPA and VHA at different heights during orthodontic treatment were asked to rate their comfortability with the appliance on the visual analogue scale (VAS). Results: The VHA demonstrated higher values of stresses at all heights from the palatal floor compared to the corresponding heights of the TPA. The 8 mm model of VHA was found to be functionally effective. This height was also perceived to be acceptable for most patients on the VAS. Conclusions: The acrylic pad of VHA when kept at a distance of 8 mm from the palatal floor enhances the functional efficiency of the appliance with an acceptable comfortability for the patient.

Cephalometric evaluation of the cervical spine posture following fixed functional therapy with Forsus™ appliance.

Background: To investigate whether fixed functional therapy for mandibular advancement with the Forsus™ appliance would produce any changes in the cervical spine posture. Materials and Methods: This prospective clinical exploratory study was conducted on 12 patients (six females and six males) with a mean age of 15 ± 1.3 years, having mandibular retrusion, Class II malocclusion, who were treated with the Forsus™ appliance. Lateral cephalogram was taken twice, once at the baseline (T1) before the commencement of the treatment and once following termination of fixed functional treatment (T2). Eleven measurements representing the vertical and the sagittal craniofacial proportions, and the head posture, were taken into account. Data were analyzed using SPSS version 22. The variations between before and after treatment measurements were collated using paired t-test. P < 0.05 was considered statistically significant. Results: No significant differences were noticed in the angle linking the horizontal lines of the head and the superior crest of the spinal column before and after the treatment, with P = 0.73. The cervical curvature angle also failed to show any significant difference with P = 0.14. Conclusion: Fixed functional therapy with the Forsus™ device resulted in dentoalveolar and soft tissue alterations alone but did not alter the cervical spine posture.

Enablers and barriers towards ensuring routine immunization services during the COVID-19 pandemic: findings from a qualitative study across five different states in India.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to disruption in delivering routine healthcare services including routine immunization (RI) worldwide. Understanding the enablers and barriers for RI services during a pandemic is critically important to develop context-appropriate strategies to ensure uninterrupted routine services. METHODS: A community-based, cross-sectional descriptive study was conducted in five different states of India, nested within an ongoing multicentric study on RI. Telephone in-depth interviews among 56 health workers were carried out and the data were analyzed using a content analysis method. RESULTS: During the COVID-19 pandemic, healthcare providers encountered many challenges at the health system, community and individual level when rendering RI services. Challenges like the limited availability of personal protective equipment and vaccines, deployment for COVID-19 duty at system level, the difficulty in mobilizing people in the community, fear among people at community level, mobility restrictions and limited family support, as well as the stress and stigma at individual level, were barriers to providing RI services. By contrast, the issuing of identification cards to health staff, engaging community volunteers, the support given to health workers by their families and training on COVID-19, were factors that enabled health workers to maintain RI services during the pandemic. CONCLUSIONS: When addressing the COVID-19-related public health emergency, we should not lose sight of the importance of services like RI.

Issues and challenges of polypharmacy in the elderly: A review of contemporary Indian literature.

The aging population is of growing concern all across the globe as well as in India. Polypharmacy has been defined as the simultaneous use of multiple medications by an individual and the clinical suitability of such use. Polypharmacy is found more frequently in the geriatric population. Researches in India have also reiterated the fact. Polypharmacy in the geriatric population leads to many negative consequences such as increased adverse drug reactions, falls, frailty, and even increased mortality. Moreover, it leads to increased out-of-pocket expenditure. Polypharmacy also poses risk of poor treatment adherence and missed dose in the geriatric population. Mitigation measures in this regard may include increased awareness among physicians, improved medication management and adherence, efforts to reduce self-medication, and improper crosspathy.

Sociobehavioural matrix and knowledge, attitude and practises regarding HIV/AIDS among female sex workers in an international border area of West Bengal, India.

BACKGROUND: HIV/AIDS is still a big public health challenge of India. Female Sex Workers (FSWs) belong to an important high risk group (HRG) in the transmission of HIV/AIDS. International borders have intermingling of population and also plenty of migrant population. Thus study on FSW s with relation to HIV/AIDS in an international border area is an important area of Research. AIMS: The present study was planned with the objectives of: to determine the sociodemographic profile of the FSW under the study, to assess their knowledge and attitude towards HIV/AIDS and to find out their sexual practices. SETTINGS AND DESIGN: It was a community based descriptive cross sectional study, done at the Indo-Bhutan border town of Jaigaon in Alipurduar District of West Bengal with the help of a Non-governmental organization (NGO) working on Targeted Interventions (TI) for FSW. METHODS AND MATERIAL: Total 90 FSWs were interviewed using predesigned pretested questionnaire. The questionnaires used were prior validated by National AIDS Control Organisation (NACO). STATISTICAL ANALYSIS USED: The data were analysed by SPSS 14.0. RESULTS AND CONCLUSIONS: The analysis revealed that 35 % of the study population were illiterate. It was also found that 81% of respondents had heard about HIV/AIDS; 76.7% had knowledge about its spread through vaginal sex, 67.8% had idea regarding its Mother to Child transmission. 92% felt PLHIV should not be kept away from others, 93% felt they shouldn't be deprived from property. Regarding sexual activity, 76.7% had sexual activity more than 3 times/week and 97.8% used condom persistently in last one year. Coordinated Efforts is required to be taken in this regard to tackle these problems.

Human immunodeficiency virus prevalence and high-risk behavior of home-based and nonhome-based female sex workers in three high-prevalent North-Eastern States of India.

BACKGROUND: Female sex workers (FSWs) have been identified as an important target group for human immunodeficiency virus (HIV)/sexually transmitted infections prevention. OBJECTIVES: This study aimed to describe sociodemographic and sex work characteristics and to identify the risk factors for HIV infection with special focus on the variations between home-based (HB) and non-HB (NHB) FSWs in three high-prevalent North-Eastern states of India: Manipur, Mizoram, and Nagaland. METHODS: Data from the National Integrated Bio-Behavioural Surveillance (IBBS) conducted in India during 2014-2015 were utilized in the study. IBBS is a quantitative survey conducted among identified high risk sub within India. Logistic regression analyses were performed using SAS 9.3.2 to determine the distribution and associations of sociodemographics and risk behaviors with HIV seropositivity of HB and NHB FSWs. RESULTS: HIV prevalence was found higher among NHB FSWs compared to HB FSW (7.3% vs. 4.6%). The proportions of FSW among HB (66.7%) were in sex work for longer duration are significantly higher than for NHB (60.2%) while risk of HIV infection due to injecting drug use was higher in NHB FSW (11.7% vs. 8.7%). Reference to FSW who were currently married, those who were widowed/divorced/separated had 2.73-fold risk of HIV. FSW who did not have any other income source were associated with 1.73 times more risk of HIV infection. Injecting drugs user among FSW respondents had four times higher likelihood to be HIV positive. CONCLUSION: A substantial proportion of NHB FSWs is mobile in nature. Targeted interventions are required urgently to minimize HIV risk among those FSWs especially the widowed/divorced/separated, sex work is only income source and who used injecting drugs for nonmedical purpose.

Study of aqueous cytokines in patients with different patterns of diabetic macular edema based on optical coherence tomography.

PURPOSE: To compare aqueous angiogenic and inflammatory cytokine concentrations in different patterns of diabetic macular edema (DME) based on optical coherence tomography (OCT). METHODS: This prospective study was conducted between July 1, 2015, and March 31, 2016, for 9 months. Aqueous samples were obtained from 52 consecutive DME patients and 16 controls. DME patients were divided according to OCT patterns into diffuse retinal thickening (DRT; n = 17), cystoid macular edema (CME; n = 20) and serous retinal detachment (SRD; n = 15) groups. Interleukin (IL)-6, IL-8, vascular endothelial growth factor (VEGF) and tumor necrosis factor alpha (TNF-α) levels were measured by RayBio(R) Human ELISA Kit. RESULTS: IL-6, IL-8 and VEGF levels differed significantly between three DME groups (p < 0.001 in all cases), but the differences in TNF-α levels were not significant (p = 0.226). VEGF and IL-6 levels correlated with central foveal thickness in DRT and SRD groups, respectively. CONCLUSION: Aqueous cytokine levels vary with different morphological patterns of DME though the role of TNF-α needs to be studied further, and both anti-angiogenic and anti-inflammatory agents are required simultaneously for treatment of DME.

Sexual behavior of transgenders and their vulnerability to HIV/AIDS in an Urban Area of Eastern India.

Transgender (TG) people experience a gender identity that is different from their anatomical sex. For their high-risk sex behavior, they are important group for targeted intervention of HIV/AIDS. The objective of the study was to find the sexual behavior of TG people and to assess few aspects of their vulnerability to HIV/AIDS. This cross-sectional survey was done from June to August 2012, in field practice area of "Kosish," a nongovernmental organization run by TGs in Alipore of Kolkata metropolitan city, India. Information was collected by interviewing 90 TG of 11 selected hotspots using a predesigned questionnaire. Results revealed that 4.5% were illiterate. Drug abuse was reported by 22.2% participants. Inconsistent condom use was found. Venereal disease research laboratory reactivity was found in 11.11%. Nearly 16.7% had experienced sexual violence in the past 3 months. Thus, interventions for overall empowerment of the TGs are recommended.

Effect on contrast sensitivity after clear, yellow and orange intraocular lens implantation.

The objective of this study is to evaluate contrast sensitivity function (CSF) after clear, yellow- and orange-tinted intraocular lens (IOL) implantation. This was a prospective randomized study of 98 patients with senile cataract for a period of 6 months from day 1 of August 2014 to day 31 of January 2015. After phacoemulsification, 33 patients were implanted with clear IOLs (AcrySof UV-filtering IOL, SA60AT), 32 patients were implanted with yellow coloured IOLs (AcrySof Natural blue-light-attenuating and UV-filtering IOL, SN60AT with IMPRUV(®) filter) and 33 patients were implanted with orange-tinted blue-filtering IOLs (PC440Y Optech). After 1 month, monocular CSF was done under photopic (85 cd/m(2)) and mesopic (3 cd/m(2)) illumination condition with CSV-1000 test. The best corrected visual acuity (BCVA) after 1 month was 0.021 ± 0.058 logMAR for clear lens, 0.022 ± 0.059 logMAR for yellow lens and 0.019 ± 0.065 logMAR for orange lens (p = 0.989). Uniocular average photopic contrast sensitivity was 1.36 ± 0.19, 1.43 ± 0.18 and 1.46 ± 0.15 log units for clear lens, yellow lens and orange lens, respectively (statistically not significant; p = 0.076). Average mesopic contrast sensitivity was 1.02 ± 0.21 log units for clear lens, 1.00 ± 0.17 log units for yellow lens and 0.99 ± 0.15 log units for orange lens (statistically not significant; p = 0.771). Yellow or orange coloured blue-filtering IOLs are comparable to clear IOLs in terms of photopic and mesopic contrast sensitivity.

Is the coverage of mass-drug-administration adequate for elimination of Bancroftian filariasis? An experience from West Bengal, India.

BACKGROUND: Bancroftian filariasis is the second most common mosquito-borne disease in India. Government of India adopted mass-drug-administration (MDA) since 2004 for its elimination by 2015 AD. OBJECTIVE: The aim was to assess the coverage, compliance, factors-related to noncompliance to MDA. MATERIALS AND METHODS: A cross-sectional survey of 1 week was conducted within 2 weeks after completion of MDA for 2012 in three villages and two municipal wards of North 24 Parganas district of West Bengal, India selected as clusters by multistage random sampling. Information was collected via interview of inhabitants of the clusters selected by systematic random sampling and drug administrators of the selected clusters along with verifying left over medicines, if any. RESULTS: Both appropriate medicine distribution (83.4%) and 61.28% of people who received drug reported consumption and effective consumption rate (48.01%) fell short of the target. The lowest consumption (38.15%) was noted in one of the rural cluster (villages), followed by municipal wards (43.14%). Consumption was significantly higher among rural residents and Hindu community. Fear of the adverse reaction was the commonest (63.02%) cause of noncompliance. Contrary to the requirement, almost all consumptions were unsupervised by drug administrators. Only 10.71% of the respondents reportedly were paid house to house campaign of forthcoming MDA. About 64% participants had heard about filariasis out of which 71% & 47% mentioned swelling of legs as symptoms and mosquito bite as mode of spread, respectively. About one-third opined mosquito control and MDA each as means of prevention. Approximately, 60% participants had heard about MDA. Information education and communication related to MDA program was conspicuously inadequate in the last round. CONCLUSION: Mass mobilization as in intensive pulse polio immunization with effective monitoring and supervision is the need of the hour for universal coverage of MDA with supervised on the spot consumption of tablets.

Treatment expenditure pattern of epileptic patients: a study from a tertiary care hospital, kolkata, India.

Introduction. Neurological diseases are very important causes of prolonged morbidity and disability leading to profound financial loss. Epilepsy is one of the most important neurological disorders. It being a cost intensive disorder poses a significant economic burden to the country. Aims and Objectives. The study was conducted among the persons with epilepsy (PWE) to assess their expenditure pattern for epilepsy treatment and its rural urban difference. Materials and Methods. 315 PWE selected by systematic random sampling and their caregivers were interviewed with the predesigned, pretested semistructured proforma. Subsequently data were compiled and analyzed using SPSS 18.0 software. Results and Conclusion. Majority of the study population were in the age group of 16-30 years. Majority belonged to classes IV and V of Prasad socioeconomic status scale. Average total expenditure per month for treatment of epilepsy was 219 INR, mainly contributed by drugs, travel, investigations, and so forth. Rural population was having higher treatment expenditure for epilepsy specially for travel and food and lodging in order to get epilepsy treatment. Wage loss in the last three months was present in 42.86% study subjects which was both affected by seizure episodes and travel for visits. Better district care would have helped in this situation.

Epidemiological profile of snake bite in south 24 Parganas district of West Bengal with focus on underreporting of snake bite deaths.

BACKGROUND: Snake bite is a neglected public health problem in India. Very few community based epidemiological studies in India have been published so far on this issue. Most of the studies were carried out on hospital data. Previous community-based survey in the state revealed that only 22% snake bite victims attended hospitals. OBJECTIVES: The objective of the present study is to find out the epidemiological profile of snake bite in eight blocks of the South 24-Paraganas district of West Bengal and to explore the under reporting of snake bite deaths in health facilities in that area during the study period. MATERIALS AND METHODS: A retrospective analysis of snake bite data was carried out from a community-based epidemiological survey on 1.9 million populations. This survey was done door-to-door from January 2009 to October 2010 to get epidemiological profile of snake bite of the previous 2 years. The data of direct survey was compared with the official report of the same area to evaluate the hospital-based data with focus on underreporting of snakebite deaths. RESULTS: A total number of snake bite cases as found in the survey in the study area was 4871. There was a huge gap between the two data (direct survey and official data). Only 7.23% snake bite deaths were officially reported. Only 22.19% of the snake bite victims attended the hospitals. Nearly 65.7% of the snake bite deaths were due to common krait bite, most of them occurring in the months of June to September. CONCLUSIONS: Official reporting system is still having a huge deficiency in India. Snake bite needs to get more attention from the health authority.

Domestic violence among ever married women of reproductive age group in a slum area of Kolkata.

BACKGROUND: Domestic violence has serious impact on women's health and well-being. A nationwide survey conducted in India observed that 37.2% of women experienced violence after marriage. OBJECTIVES: To assess the prevalence of domestic violence among the ever married women in reproductive age group and to find out the types of domestic violence and factors associated with it. MATERIALS AND METHODS: The study was a community based cross-sectional study, conducted in a slum area of Kolkata. RESULTS AND CONCLUSION: Overall prevalence of domestic violence was 54%, of which 41.9% suffered from both current and lifetime physical and psychological violence. Presence of property, higher per capita income and social support were protective factors against domestic violence, whereas alcohol addiction and multiple sex partners were the important contributory factors for it. The study recommended more social support, awareness and income generation for women in the slum areas.

Healthcare-seeking behavior of patients with epileptic seizure disorders attending a tertiary care hospital, kolkata.

INTRODUCTION: Neurological diseases are very important causes of prolonged morbidity and disability, leading to profound financial loss. Epilepsy is one of the most important neurological disorders Healthcare seeking by epilepsy patients is quite diverse and unique. AIMS AND OBJECTIVES: The study was conducted among the epilepsy patients, to assess their healthcare-seeking behavior and its determinants. MATERIALS AND METHODS: Three hundred and fifteen epilepsy patients, selected by systematic random sampling, in the neuromedicine outpatient department of a tertiary care hospital were interviewed with a predesigned, pretested, semi-structured proforma. RESULTS AND CONCLUSION: More than 90% sought healthcare just after the onset of a seizure. The majority opted for allopathic medicine and the causes for not seeking initial care from allopaths were ignorance, faith in another system, constraint of money, and so on. A significant association existed between rural residence and low social status of the patients with initial care seeking from someone other than allopaths. No association was found among sex, type of seizure, educational status of the patients, and care seeking. The mean treatment gap was 2.98 ± 10.49 months and the chief motivators were mostly the family members. Patients for anti epileptic drugs preferred neurologists in urban areas and general practitioners in rural areas. District care model of epilepsy was proposed in the recommendation.

Tobacco abuse among school going adolescents in a rural area of West Bengal, India.

Adolescents are vulnerable targets of tobacco industry with all consequences of usage. Studies reveal that tobacco abuse is rising in this age group in India. A cross sectional survey was carried out in two coeducational high schools of Anandanagar village of Singur block, Hooghly district, West Bengal among 276 students of VIII-IX standard to study the knowledge and abuse of tobacco and to find out influencing socio-demographic factors. Knowledge score was higher in females, students from nuclear families, and those with literate parents. Low prevalence of tobacco intake was obtained among the students, with 9.8% reported having ever used smokeless tobacco and 4.3% ever smoked. Tobacco intake was higher among those with a history of parental tobacco intake. Continued information education and communication (IEC) activities should be conducted by the school authorities, with involvement of nongovernment organizations (NGOs) and parents for primary prevention.

Non-cirrhotic portal fibrosis among children admitted in a tertiary care hospital of Kolkata: a search for possible aetiologies.

Non-cirrhotic portal fibrosis (NCPF) is reported to be a very infrequent cause of portal hypertension (PHT) in paediatric population, but a number of cases of NCPF were found in the paediatric ward of NRS Medical College and Hospital, Kolkata which prompted us to do a study with objectives to find out the proportion of NCPF cases among the study population (the total number of PHT cases admitted in the study period) and their sociodemographic profile with special reference to residence in arsenic affected areas. It was a clinic-based retrospective study. All children below 12 years during the study period (August 2005 to July 2008) with clinical features suggestive of PHT were screened for NCPF. Relevant investigations were done and guardians of all the PHT patients were interviewed with a predesigned pretested questionnaire. Among the total 134 cases of PHT, 29 (21.64%) were due to NCPF and the remaining 105 (78.36%) cases were due to other causes of PHT other than NCPF. Among the sociodemographic variables studied significant association was found with residency in arsenic affected areas. The study highlights the need of extensive studies to validate the association in the paediatric population.