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1.
Health Econ ; 33(2): 280-309, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37904287

RESUMO

Bans on sex-selective abortions are typically implemented to make sex ratios more equitable, but they may have adverse effects on surviving children. We examine the impacts of a ban on prenatal sex selection in India on postnatal health outcomes. We first show that the ban increased the share of female children born to mothers, especially among firstborn female families. Strikingly, we also find that the ban led to a worsening of mortality outcomes for both girls and boys in firstborn female families. In terms of mechanisms, we find that fertility increases in firstborn female families after the ban, pointing to the following channel: firstborn female families are disproportionately affected by the ban and are more likely to use the son-biased fertility stopping rule to achieve a desired number of sons. Children in firstborn female families likely face greater competition for parental resources, which may worsen their health.


Assuntos
Saúde da Criança , Fertilidade , Gravidez , Masculino , Criança , Humanos , Feminino , Aborto Eugênico , Mães , Pais
2.
BMC Public Health ; 23(1): 2304, 2023 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-37990176

RESUMO

OBJECTIVE: This prospective study aimed to evaluate the effects of a health education intervention on cardiovascular disease (CVD) risk factors among school teachers. METHODS: The study, conducted from August 2016 to May 2017, involved teachers from four schools in Baruipur, West Bengal, India. It was a multicentric, quasi-experimental study with an intervention group receiving tailored health education promoting lifestyle modifications, while the control group received no intervention. Baseline and endline assessments included behavioural and biological characteristics related to cardiovascular health and risk assessment. Data were analysed using JAMOVI. RESULTS: The intervention group showed significant improvements in physical activity levels [Cohen's d (Cd): 0.43, p = 0.006] and the consumption of fruits and vegetables (Cd: 1.00, p = < 0.001). Notably, there was a considerable reduction in the consumption of salt (Cd: -0.93, p = 0.039), oil (Cd: -0.98, p = < 0.001), fast food (Cd: -0.99, p = < 0.001), junk food (Cd: -0.99, p = < 0.001), and red meat (Cd: -1.00, p = < 0.001) among participants. However, there were no significant improvements in biological characteristics within the intervention group. In contrast, the control group exhibited no significant changes in behavioural and biological characteristics compared to baseline. The intervention group showed a minor non-significant reduction (3.0%) in their 10-year cardiovascular risk compared to baseline (Cd: -1.00, p = 0.50), while the control group had a negligible non-significant increase (0.7%) in their cardiovascular risk (Cd: 1.00, p = 1.00). CONCLUSION: Health education intervention positively influenced behavioural characteristics, such as physical activity and dietary habits, among school teachers. However, no significant improvements were observed in biological characteristics or cardiovascular risk factors.


Assuntos
Doenças Cardiovasculares , Humanos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Professores Escolares , Cádmio , Estudos Prospectivos , Fatores de Risco
3.
J Family Med Prim Care ; 12(8): 1576-1581, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37767438

RESUMO

Introduction: Globally, one-third of current health expenditure had been out-of-pocket expenditure (OOPE). The health system financing of almost all low- and middle-income countries including India rely heavily on out-of-pocket (OOP) payments for health care. OOPE on health payments is particularly hard on any community, especially the poor leading to incomplete or even no treatment during their ill health. This study estimated OOPE among residents of a rural community in West Bengal and explored the associated factors with high OOP expenses. Methods: A community-based cross-sectional study was conducted in a rural community in Singur, West Bengal from June 2019 to February 2020. The study was done among 398 villagers selected from 15 clusters or villages. Households were randomly selected in each village. All members of the selected households were interviewed. SPSS was used for data analysis both for descriptive and inferential statistics. Results: Only 14.6% of morbid persons had catastrophic expenditure. The incidence of catastrophic expenditure was higher among those who opted for private practitioners and or ayurveda, yoga and naturopathy, unani, siddha, and homeopathy (AYUSH) facilities. There was zero catastrophic expenditure for the unqualified sector. There was an increasing trend of OOP payments among the lower socioeconomic groups. Again, low-income individuals had a higher share in cumulative expenditure (Gini coefficient of 0.35). Most of the participants (78.4%) had no health insurance coverage. Conclusion: Promotion for higher utilization of public health facilities may reduce the burden of OOP expenses. Government health insurance schemes must be widened with the inclusion of coverage of outpatient services. Integrating AYUSH services in the public sector is another option to reduce OOP expenses.

4.
Biophys J ; 122(18): 3798-3815, 2023 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-37571825

RESUMO

The spatiotemporal organization of cell surface receptors is important for cell signaling. Cortical actin (CA), the subset of the actin cytoskeleton subjacent to the plasma membrane (PM), plays a large role in cell surface receptor organization. However, this has been shown largely through actin perturbation experiments, which raise concerns of nonspecific effects and preclude quantification of actin architecture and dynamics under unperturbed conditions. These limitations make it challenging to predict how changes in CA properties can affect receptor organization. To derive direct relationships between the architecture and dynamics of CA and the spatiotemporal organization of PM proteins, including cell surface receptors, we developed a multiscale imaging and computational analysis framework based on the integration of single-molecule imaging (SMI) of PM proteins and fluorescent speckle microscopy (FSM) of CA (combined: SMI-FSM) in the same live cell. SMI-FSM revealed differential relationships between PM proteins and CA based on the PM proteins' actin binding ability, diffusion type, and local CA density. Combining SMI-FSM with subcellular region analysis revealed differences in CA dynamics that were predictive of differences in PM protein mobility near ruffly cell edges versus closer to the cell center. SMI-FSM also highlighted the complexity of cell-wide actin perturbation, where we found that global changes in actin properties caused by perturbation were not necessarily reflected in the CA properties near PM proteins, and that the changes in PM protein properties upon perturbation varied based on the local CA environment. Given the widespread use of SMI as a method to study the spatiotemporal organization of PM proteins and the versatility of SMI-FSM, we expect it to be widely applicable to enable future investigation of the influence of CA architecture and dynamics on different PM proteins, especially in the context of actin-dependent cellular processes.


Assuntos
Citoesqueleto de Actina , Actinas , Actinas/metabolismo , Citoesqueleto de Actina/metabolismo , Proteínas de Membrana/metabolismo , Membrana Celular/metabolismo
5.
Cureus ; 15(3): e36888, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37139275

RESUMO

Background and objectives In contrast to their peers who are healthy, children with thalassemia disease are likely to have a lower quality of life (QoL). Knowledge of attributes affecting the QoL of thalassemic children may help identify key areas of intervention to improve it. Thus, the current study was envisioned to find out the quality of life (QoL) of children with beta-thalassemia major (ß-TM) and its various correlates. Methods Between May 2016 and April 2017, an institution-based cross-sectional observational study was conducted in the thalassemia unit of Calcutta National Medical College and Hospital (CNMC&H), Kolkata, West Bengal, India. During the study period, 328 ß-TM children and their carers were interviewed using a structured schedule. Results In the final multivariable logistic regression model, thalassemic children who were residing in an urban area (adjusted odds ratio (AOR) (95% confidence interval (CI)): 2.1 (1.1-4.0)), had mothers with a higher educational level (middle and above) (AOR (95%CI): 2.1 (1.1-4.0)), had working parents (AOR (95%CI): 2.7 (1.2-6.3)), had no family history of thalassemia (AOR (95%CI): 3.5 (1.6-8.0)), received less number of blood transfusion in the previous year (<12) (AOR (95%CI): 2.1(1.1-4.2)), had higher pre-transfusional hemoglobin (Hb) level (AOR (95%CI): 1.7(1.1-2.6)), had no transfusion-transmitted infections (TTIs) (AOR (95%CI): 2.8 (1.5-5.2)), had higher body mass index (BMI) Z score (AOR (95%CI): 1.6 (1.1-2.2)), and had higher Carer Quality of Life (CarerQoL) score (>5) (AOR (95%CI): 3.2 (1.6-6.2)) were more likely to have favorable QoL (Pediatric Quality of Life Inventory (PedsQL) score > 54.3). Interpretation and conclusions The QoL of the study participants was significantly correlated with their carers' CarerQoL, mother's educational level, parent's working status, place of residence, family history of the disease, blood transfusion frequency, pre-transfusional Hb level, and nutritional and comorbidity status.

6.
bioRxiv ; 2023 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-36747866

RESUMO

The spatiotemporal organization of cell surface receptors is important for cell signaling. Cortical actin (CA), the subset of the actin cytoskeleton subjacent to the plasma membrane (PM), plays a large role in cell surface receptor organization. This was however shown largely through actin perturbation experiments, which raise concerns of nonspecific effects and preclude quantification of actin architecture and dynamics under unperturbed conditions. These limitations make it challenging to predict how changes in CA properties can affect receptor organization. To derive direct relationships between the architecture and dynamics of CA and the spatiotemporal organization of PM proteins, including cell surface receptors, we developed a multiscale imaging and computational analysis framework based on the integration of single-molecule imaging (SMI) of PM proteins and fluorescent speckle microscopy (FSM) of CA (combined: SMI-FSM) in the same live cell. SMI-FSM revealed differential relationships between PM proteins and CA based on the PM proteins’ actin binding ability, diffusion type and local CA density. It also highlighted the complexity of cell wide actin perturbation, where we found that global changes in actin properties caused by perturbation were not necessarily reflected in the CA properties near PM proteins, and the changes in PM protein properties upon perturbation varied based on the local CA environment. Given the widespread use of SMI as a method to study the spatiotemporal organization of PM proteins and the versatility of SMI-FSM, we expect it to be widely applicable to enable future investigation of the influence of CA architecture and dynamics on different PM proteins, especially in the context of actin-dependent cellular processes, such as cell migration. Significance: Plasma membrane protein organization, an important factor for shaping cellular behaviors, is influenced by cortical actin, the subset of the actin cytoskeleton near the plasma membrane. Yet it is challenging to directly and quantitatively probe this influence. Here, we developed an imaging and analysis approach that combines single-molecule imaging, fluorescent speckle microscopy and computational statistical analysis to characterize and correlate the spatiotemporal organization of plasma membrane proteins and cortical actin. Our approach revealed different relationships between different proteins and cortical actin, and highlighted the complexity of interpreting cell wide actin perturbation experiments. We expect this approach to be widely used to study the influence of cortical actin on different plasma membrane components, especially in actin-dependent processes.

7.
J Family Med Prim Care ; 11(8): 4555-4561, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36352948

RESUMO

Context: Multimorbidity is considered as a priority for global health research. It is defined as the coexistence of two or more chronic health conditions in an individual. It is increasingly being recognized as a major concern for primary care physicians due to its huge impact on individual, family, and societal level. Aim: The aim of this study was to find the quantum of gender-related inequalities and determinants of multimorbidity among the elderly people in a rural part of West Bengal. Materials and Methods: This is a cross-sectional study carried out among 246 elderly people (60 years and above) in a community setting from Oct 2017 to Sep 2018. Logistic regression analysis was done to find out the predictors of multimorbidity. Data were analyzed using the SPSS software (version 16.0. Chicago, SPSS Inc.). Results: Approximately 82% of the study subjects were suffering from multi-morbidity with a significant difference between males (80.9%) and females (88.5%). In binary logistics, people of both the genders aged >70 years, who had less than primary level education, had more than three children, whose source of income was from their children (sons/daughters), were dependent on others for daily routine were at high risk of being multimorbid; whereas depression was a significant predictor of multimorbidity in females and not in males. In multivariable analysis, age remained the only significant predictor for both the gender and for females; depression remained significant after adjusting with significant variables in binary logistics. Conclusion: Morbidity screening at each visit, individual as well as family counseling and lifestyle modifications help to cope with the rising burden of multimorbidity at the primary care level. More insight into the epidemiology of multi-morbidity is necessary to take steps to prevent it, lower its burden and align health-care services as per needs.

8.
Asian J Transfus Sci ; 16(1): 99-105, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36199400

RESUMO

BACKGROUND: Multi-transfused thalassemic children are at higher risk of acquiring transfusion-transmitted infections (TTIs). There are limited data available on TTIs among thalassemic children, especially on its impact on their quality of life (QoL). AIM: The aim of this study is to find out the proportion of multi-transfused ß-thalassemia major (ß-TM) children suffering from TTIs, its risk factors and impact on QoL. METHODS: This was a hospital-based, analytical observational study, cross-sectional in design, conducted among 328 ß-TM children and their caregivers attending thalassemia day care unit of a medical college during May 2015-April 2016, with a structured schedule. Data were analyzed with appropriate statistical methods using the Statistical Package for the Social Sciences. RESULTS: Two-fifth (39.9%) of them were found to have TTIs with hepatitis C being the most common (34.5%), followed by hepatitis B (4.5%) and human immunodeficiency virus (1.8%). In the multivariable model, place of residence (adjusted odds ratio [AOR] - 2.23 [1.19-4.17]), per capita monthly family income (AOR - 1.84 [1.10-3.07]), and blood transfusion frequency (AOR - 1.19 [1.10-1.29]) were significant predictors of TTIs adjusted with their age, age at diagnosis, last pretransfusional hemoglobin level, size of spleen, and caregivers knowledge regarding the disease. The study participants with TTIs had a lower QoL compared to others as there were significant differences in between the total QoL scores ([49.9 ± 15.6 vs. 57.4 ± 15.5], P ≤ 0.001) and its various domains. CONCLUSION: There was high burden of TTIs among multi-transfused ß-TM children and it has significant negative impact on their quality of lives.

9.
J Cell Biol ; 221(7)2022 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-35552363

RESUMO

Colocalization analysis of multicolor microscopy images is a cornerstone approach in cell biology. It provides information on the localization of molecules within subcellular compartments and allows the interrogation of known molecular interactions in their cellular context. However, almost all colocalization analyses are designed for two-color images, limiting the type of information that they reveal. Here, we describe an approach, termed "conditional colocalization analysis," for analyzing the colocalization relationships between three molecular entities in three-color microscopy images. Going beyond the question of whether colocalization is present or not, it addresses the question of whether the colocalization between two entities is influenced, positively or negatively, by their colocalization with a third entity. We benchmark the approach and showcase its application to investigate receptor-downstream adaptor colocalization relationships in the context of functionally relevant plasma membrane locations. The software for conditional colocalization analysis is available at https://github.com/kjaqaman/conditionalColoc.


Assuntos
Software , Membrana Celular , Microscopia Confocal/métodos , Microscopia de Fluorescência/métodos
10.
Drug Discov Today ; 27(8): 2209-2215, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35364270

RESUMO

Machine learning (ML) approaches have been widely adopted within the early stages of the drug discovery process, particularly within the context of small-molecule drug candidates. Despite this, the use of ML is still limited in the pharmacokinetic/pharmacodynamic (PK/PD) application space. Here, we describe recent progress and the role of ML used in preclinical drug discovery. We summarize the advances and current strategies used to predict ADME (absorption, distribution, metabolism and, excretion) properties of small molecules based on their structures, and predict structures based on the desired properties for molecular screening and optimization. Finally, we discuss the use of ML to predict PK to rank the ability of drug candidates to achieve appropriate exposures and hence provide important insights into safety and efficacy.


Assuntos
Descoberta de Drogas , Aprendizado de Máquina
11.
Indian J Community Med ; 47(4): 555-561, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36742971

RESUMO

Background: Use of maternal near-miss (MNM) cases as an adjunct has been advocated to understand the processes of obstetric care because they share similar pathways as maternal deaths. Identifying the predictors and care pathway is crucial to improve the quality of care and end preventable maternal deaths. Materials and Methods: This case-control study was conducted at a tertiary care facility in Kolkata from May 2019 to March 2020. Women admitted with complications during pregnancy, childbirth, or within 42 days of postpartum, who met the World Health Organization (WHO) near-miss criteria, were identified as cases, and equivalent age-group matched controls were recruited. Sample size of 60 cases and 60 controls was estimated, assuming a power of 80%, level of significance 0.05, and case-control ratio of 1. After obtaining approval from the institutional ethics committee and informed written consent from the participants, data was collected through face-to-face interview and review of records. Statistical analysis including care pathway analysis (using three-delay model) was performed using Statistical Package for Social Sciences version 16. Results: Joint family type (adjusted odds ratio [AOR] [CI] = 5.06 [1.48, 7.28]), lack of antenatal checkups (AOR [CI] = 7.85 [1.47, 12.09]), previous history of cesarean section (AOR [CI] = 3.94 [1.09, 14.33]), first delay in seeking care (AOR [CI] = 13.84 [3.62, 32.83]), and preexisting medical disorders (AOR [CI] = 11.03 [4.62, 22.80]) were identified as significant predictors of MNM in the adjusted model. Significant difference in the proportion of first and second delays in the care pathway was observed between cases and controls. Conclusions: Identification of risk factors of MNM and pattern of delays in the care pathway will help improving quality of obstetric care.

12.
Indian J Community Med ; 46(2): 216-220, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34321729

RESUMO

CONTEXT: Tobacco smoking is one of the preventable causes of death. Global Adult Tobacco Survey 2 report showed that 19% Indian males were current smokers. It is important to find out factors which help smokers on smoking cessation, ultimately to prevent of lung and other morbidities. There are few community-based studies on intention and attempt to quit smoking in rural area. AIMS: The present study aimed to determine the factors associated with intention and attempt to quit smoking among current smokers. SETTINGS AND DESIGN: A cross-sectional study was conducted from June to September 2019 among 198 male daily smokers residing in the rural field practice area of AllH and PH, Kolkata. SUBJECTS AND METHODS: After cluster sampling, data were collected by predesigned schedule by the face-to-face interview. RESULTS: 151 (76.3%) study subjects intended to quit smoking. 63 (31.8%) study subjects attempted to quit in last 1 year. Thirty-one (47.5%) showed high-to-medium nicotine dependence. There was a significant association of intention to quit with agriculture as occupation (acquisitive crime [AOR]-2.17, confidence interval [CI]-1.01-4.63), low nicotine dependence (AOR-2.98, CI-1.43-6.21), doctor's advice (AOR = 2.84, CI-1.27-6.33), and family pressure (AOR = 2.16, CI-1.07-4.38). Attempt to quit was significantly associated with low nicotine dependence (AOR = 5.85, CI-2.85-12.00), family pressure (AOR = 2.94, CI-1.47-5.91). CONCLUSION: Along with counseling to reduce nicotine dependence, comprehensive approach both from family members as well as health care providers, is vital to escalate the quitting behaviour in smoking habit.

13.
Indian J Public Health ; 65(2): 130-135, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34135180

RESUMO

BACKGROUND: Village Health and Nutrition Day (VHND) is a community participation program focusing on pregnant women, lactating mothers, children (0-5 years), and adolescent girls. OBJECTIVES: To assess the status of VHND functioning in the rural areas, and to determine the facilitators and barriers of health care service utilization among the beneficiaries. Also, to explore the challenges faced by the front-line workers while conducting the program. METHODS: A cross-sectional descriptive study with a mixed-methods approach was conducted among the beneficiaries and the service providers in twelve selected VHND sessions from March to July 2019 in Singur, Hooghly district, West Bengal. Both quantitative and qualitative methods of research were applied to assess the status of the functioning of 12 VHNDs. RESULTS: Among the beneficiaries who attended the sessions; 28.57% were pregnant women, 16.53% were lactating mothers and 17.44% were under-five children. Nonavailability of line-list of adolescent girls and nonavailability of Vitamin A in oil were major observations. Barriers leading to poor service utilization among beneficiaries were the long-distance of the VHND session site, lack of counseling on proper lifestyle practices, poor and inadequate infrastructure. House visits by the Accredited Social Health Activists regarding the information on VHND sessions found to be an important facilitating factor for beneficiaries. Major challenges identified among the healthcare workers were lack of logistics supply, inadequate workforce, and improper the maintenance of the VHND session site. CONCLUSION: Proper resource mobilization, maintenance and cleanliness of the session sites, appropriate and wholesome counseling can vastly improve the quality of VHND with the concurrent improvement of maternal and child health.


Assuntos
Lactação , Estado Nutricional , Adolescente , Criança , Participação da Comunidade , Estudos Transversais , Feminino , Humanos , Índia , Gravidez
14.
J Family Med Prim Care ; 10(2): 917-921, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34041098

RESUMO

CONTEXT: Garment Industry is considered to be the second-largest employment sector in India. Occupational health problems among workers are often ignored, work-related musculoskeletal disorders (WMSD) accounts for the majority of it. The leverage of a healthy workforce is indispensable in the smooth running of the country's economic machinery. AIMS: To find out the prevalence of WMSD among the workers and to assess the relationship of WMSDs with sociodemographic, behavioral, and occupational factors. SETTINGS AND DESIGN: A cross-sectional study was conducted from June 2017 to August 2019 among 222 workers in three garment factories located in a municipality area of south 24 Parganas District, West Bengal. METHODS AND MATERIAL: Sociodemographic and behavioral characteristics, occupational differentials, and morbidity profiles were assessed using a pre-designed, pre-tested schedule. STATISTICAL ANALYSIS USED: Data were analyzed by SPSS ver. 16.0. Logistic regression was done to determine the associates of WMSDs. RESULTS: Most of the workers were males (70.27%), belonged to the age-group of 36-55 (42.34%) and were illiterate (33.78%). WMSD was prevalent among 70.72% of the workers. Presence of WMSD was significantly associated with educational status{illiterate (OR: 3.59; CI: 1.56-8.22), below secondary (OR-2.89;CI: 1.26-6.62)}, sitting job (OR: 2.02; CI: 1.01-4.03), unsatisfactory working environment (OR: 8.38; CI:1.95-36.06), and level of distress {mild (OR-2.89;CI: 1.26-6.62), moderate-severe (OR: 6.98; CI: 1.46-33.25)}. CONCLUSIONS: Improving health awareness and periodic health check-up is the need of the hour for the sustenance of the massive workforce, which can be achieved through the integration of basic occupational health services (BOHS) with primary health care (PHC) infrastructure.

15.
Indian J Public Health ; 65(1): 22-27, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33753685

RESUMO

BACKGROUND: Barbers are occupationally predisposed to blood borne viral infection (BBVI) such as human immunodeficiency virus, hepatitis B and C. Unhygienic workplaces, improper disinfection and inadequate wound-care can increase the susceptibility of both clients and barbers to BBVI. There is paucity of studies on practices regarding BBVI among barbers, especially in India. OBJECTIVES: To identify the pattern and predictors of practices related to BBVI transmission among male barbers in a rural area of West Bengal. METHODS: A cross-sectional study was conducted from June 2017 to August 2019 in Indas block of Bankura district among 138 male barbers, who were permanent residents and worked for >6 months. Barbers, randomly selected from 10 Gram Panchayats according to probability proportionate to size, were interviewed. Two barbering sessions were observed. Data were analyzed using SPSS version 16 software. Univariate and multiple linear regression was carried out to identify predictors of better practices. P < 0.05 was considered for statistical significance. RESULTS: Dangerous practices such as reuse of blades (8, 5.8%) and face-towel (77, 55.8%), sale/distribution of used blades (77, 55.8%), improper disinfection of sharps (79, 57.2%), reuse of alum without disinfection (129, 93.5%), and improper wound care (71, 51.4%) were observed. Predictors of better practice regarding BBVI were better attitude regarding BBVI (B = 0.172, standard error [SE] = 0.046, P = 0.000) and increased years of schooling (B = 0.054, SE = 0.021, P = 0.012). CONCLUSION: Inimical infection control practices were noticed. They are serving the general people and therefore they should be imbibed with correct BBVI knowledge and must do away with all hazardous practice during their barbering activities.


Assuntos
Barbearia , Hepatite B , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Hepatite B/epidemiologia , Humanos , Índia/epidemiologia , Masculino
16.
Asia Pac J Public Health ; 33(4): 369-377, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33588576

RESUMO

India's scheduled tribe population very often bears the brunt of inequity in accessing health care. The mixed-method research assessed the health care seeking behavior (HSB) of a tribal community residing in the eastern fringes of Kolkata metropolis. An adult, preferably the head, in 209 households was interviewed followed by qualitative interviews with relevant stakeholders. Conceptual framework of Andersen's behavioral model helped in identifying the potential predisposing, enabling, and need factors that influenced HSB. A total of 25.4% respondents reportedly sought informal care during last illness episode. Multivariable hierarchical-regression model (Nagelkerke R2 = 0.381) showed that respondents' education level [adjusted odds ratio (AOR) = 2.52], household size (AOR = 3.14), nonenrollment to health insurance (AOR = 2.47), decision making by household head (AOR = 2.40), distance from the nearest urban primary health center (AOR = 3.18), and poor perception to illness severity (AOR = 2.24) were significantly associated to inappropriate HSB. Predominant health system barriers that emerged from qualitative interviews were irregular logistics, unfavorable outpatient timing, absence of female doctors, and nonretention of doctors at local urban primary health center. Community level barriers were poor awareness, self-medication practices, poor health insurance coverage, and poor public transportation. Recognition of these determinants may help in developing health promotion interventions tailored to their needs.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde , Grupos Populacionais , Adulto , Humanos , Índia , Modelos Psicológicos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Grupos Populacionais/psicologia , Grupos Populacionais/estatística & dados numéricos , Pesquisa Qualitativa
17.
Korean J Fam Med ; 42(1): 66-72, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31955549

RESUMO

BACKGROUND: India is home to a large number of thalassemic children. Despite malnutrition being an essential determinant of their therapeutic goals and quality of life (QoL), it was hardly ever explored. With this background, this study aimed to estimate the proportion of ß-thalassemia major (ß-TM) children experiencing malnutrition, its attributes, and impact on their QoL. METHODS: This cross-sectional, hospital-based, analytical observational study was conducted among 328 ß-TM children attending the thalassemia day care unit of a medical college from May 2016 to April 2017, with a structured schedule. Data were analyzed following appropriate statistical methods using SPSS statistical package ver. 16.0 (SPSS Inc., Chicago, IL, USA). RESULTS: Among the study participants, 48.2% were malnourished with a mean body mass index of 13.9 kg/m2 . In the multivariable logistic regression model, participants' age (adjusted odds ratio [AOR], 1.15; 95% confidence interval [CI], 1.02-1.29), caste (AOR, 2.11; 95% CI, 1.23-3.60), mothers' educational level (AOR, 2.05; 95% CI, 1.22- 3.44), blood transfusion frequency (AOR, 1.25; 95% CI, 1.16-1.31), and palpable spleen size (AOR, 1.22; 95% CI, 1.08-1.37) were significant predictors of malnutrition after adjusting for pre-transfusion hemoglobin level and hemolytic facies status. In multiple linear regression analysis, malnutrition negatively impacted total QoL (unstandardized beta [standard error], -4.4 [1.7]; P=0.009) and various domains of the study participants except the social and school domains adjusted for age, sex, caste, place of residence, parents' educational level, and socioeconomic status. CONCLUSION: Almost half of the study participants had malnutrition. Malnutrition had a negative impact on their QoL.

18.
J Glob Infect Dis ; 12(3): 144-148, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33343166

RESUMO

CONTEXT AND AIMS: Tuberculosis (TB) in India is a leading public health problem plagued by social determinants such as stigma and discrimination, which may affect treatment seeking, adherence, and possibly treatment outcome. This study was conducted to elicit the perceived discrimination, its determinants, as well as to determine whether perceived discrimination is predicting treatment outcome among TB patients registered in an Urban Health District, Kolkata City, India. SETTINGS AND DESIGN: An institutionbased follow-up study was conducted where all the TB patients registered within the 1st 4 months of data collection were followed up for their current course of treatment. SUBJECTS AND METHODS: Perceived discrimination was assessed at treatment initiation, after intensive period and after continuation phase using a predesigned and pretested questionnaire. STATISTICAL ANALYSIS USED: Multivariable logistic regression analyses were performed to identify the determinants of perceived discrimination as well as the treatment outcome. RESULTS: Perceived discrimination by family members, neighbors, and colleagues was reported by 9.4%, 36.5%, and 34.2% participants, respectively, overall discrimination being 37.9%. Multivariable analysis revealed that discrimination was significantly more among patients with older age group, females, and from joint families. Perceived discriminated was found to be significantly predicting unfavorable treatment outcome even after adjustment with background and treatment-related variables. CONCLUSIONS: Sensitization programs should incorporate measures to address stigma and discrimination and more emphasis needs to be placed on women and elderly patients.

19.
J Educ Health Promot ; 9: 277, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33282982

RESUMO

BACKGROUND: Students must be made aware about the essentiality of optimum level of physical activity and the fact that it is the key to good health and an important technique to prevent and control a lot of noncommunicable diseases including depression and other related mental ill-health. MATERIALS AND METHODS: It was an institution-based intervention study among 187 Madrasah students of classes VII and VIII, conducted in five-phase assessment of the training needs of Madrasah students on different aspects of healthy lifestyle, development of a need-based module to be used by teachers to impart training of students through classroom setting, training of teachers to use the module to train students, training of students by the trained teachers in classroom setting, and evaluation of effectiveness of the training module. RESULTS: The mean pretest knowledge score in study Madrasah was 2.64 ± 1.35 (Mean ± SD) and post test score was 4.13 ± 0.88 (Mean ± SD). In paired t-test, t-value was 13.54 and P < 0.05 with effect size of 1.370 (Cohen's d). Practice related to the mean score in pretest was 2.38 ± 1.08 and posttest score was 2.73 ± 1.03. In paired test, t-value was 6.25 and P < 0.05 with effect size of 0.458 (Cohen's d). CONCLUSIONS: The study revealed the effectiveness of training by teachers using the module developed by the researcher to address significant changes in lifestyle-related issues.

20.
J Family Med Prim Care ; 9(9): 4603-4612, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33209770

RESUMO

CONTEXT: With the aging of Indian society, maintaining salubrious cognitive health in late life is a public health priority. Early detection and possible prevention of cognitive impairment (CI), thus, will help in increasing the quality of life of elderly people and decreasing the social, psychological, and economic burden of their families and caregivers. AIMS: The study aimed to assess proportion of CI and its predictors. SETTINGS AND DESIGN: This community-based cross-sectional study was conducted among 135 elderly people selected from 15 villages out of a total 64 villages in rural field practice area Singur of AIIH&PH, Kolkata. METHODS AND MATERIAL: Cluster sampling technique was used and villages were selected according to probability proportional to size method. Data was collected using a predesigned, pretested structured schedule, which included sociodemographic and behavioral variables, Montreal cognitive assessment tool, Geriatric depression scale short form (GDS 15), and mini nutritional assessment tool. STATISTICAL ANALYSIS USED: Predictors of CI were assessed by univariate and multivariable logistic regression using MS-Excel 2016 and SPSS version 16 software. RESULTS: Mean age of the study participants was 67.03 ± 6.7 years with 51.9% of them being females. Proportion of CI was observed to be 48.1% which was significantly associated with increasing age [AOR = 1.1 (1.02-1.13)], decreasing years of schooling [AOR = 1.1 (1.01-1.2)], depression [AOR = 2.7 (1.3-5.8)], and malnourished group [AOR = 4.5 (1.01-20.3)]. CONCLUSION: The burden of CI among the study population was found to be quite high. It is an alarming situation which needs improved screening facility for early detection. Nutritional upliftment and screening for depression should also be done on a regular basis.

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