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1.
Indian J Med Ethics ; -(-): 1-2, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32546454

RESUMO

During a pandemic, narrowing ethics into silos such as clinical and public health does not help the cause of ethics, which often gets neglected in desperate times. Our response to a recently published article in this journal, tries to take this discussion forward. Keeping medical ethics at the centre of our response to the Covid-19 pandemic would benefit healthcare systems at all levels. This would also help us be prepared for future pandemics. Strengthening healthcare systems would also provide an opportunity to improve non-Covid care.

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2.
Indian J Med Ethics ; V(1): 49-53, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32103800

RESUMO

Diabetes care in low-resource rural areas is often compromised by access and finance barriers, leading to ethical dilemmas for physicians in diagnosis and treatment. Rural health workers should be educated on how poverty, disproportionate rural health infrastructure, and illiteracy impact diabetes care to facilitate a paradigm shift from blaming patients for poor adherence to improving health systems in order to address underlying structural care seeking barriers of cost, distance and social stigma. With these barriers urban, high resource protocols cannot be implemented and there is need for separate evidence-based protocols for rural, low resource populations. Having such set protocols coupled with continuous training and use of mobile/telemedicine technology could help shifting tasks to nurses and peripheral health workers. The National Programme For Prevention And Control Of Cancer, Diabetes, Cardiovascular Diseases & Stroke may benefit from this communitising care model by setting up PHC-level NCD clinics run by trained nurses and health workers with physician backup using technology as needed. This way of utilizing non-physician health workers to treat uncomplicated diabetes patients may not only allow physicians quality time and more resources to treat complicated diabetes patients but also provide good quality, accessible care within everyone's reach.

3.
Trop Doct ; 50(2): 111-115, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31779530

RESUMO

Scrub typhus and leptospirosis are bacterial zoonotic diseases reported from different parts of India, whose prevalence in Chhattisgarh is unknown. Our study was carried out to delineate the prevalence of these illnesses there and to assess the clinical profiles of rural and urban patients. A total of 169 patients with acute febrile illnesses (AFI) was enrolled in our study from May to December 2018, of whom 35 (20.7%) tested positive for scrub typhus and only one tested positive for leptospirosis by respective IgM ELISA. Scrub typhus seropositivity was higher in rural patients (25.0%) than in urban (18.1%). Patients in the age group 16-30 years were the most commonly affected. The commonest presenting symptoms were fever with headache (68.57%), extreme weakness (57.14%), myalgia/arthralgia (54.29%) and abdominal pain (51.43%). The preliminary evidence for the presence of scrub typhus in Chhattisgarh necessitates its inclusion in the panel of tests for AFI.

4.
J Family Med Prim Care ; 8(10): 3114-3119, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31742128

RESUMO

Interventions early in life are the need of the hour when it comes to controlling the rising incidence of communicable and non-communicable diseases (NCDs) globally. WHO has issued guidelines towards health promotional initiatives at schools as a part of Global School Health Initiative, and the Government of India has directed many policies and programs to integrate health deep within the school activities. School Health Promotion is an international need with programmes implementing across continents due to numerous documented benefits, to not just the individuals but to the community and country as a whole. Simple teachings like hand hygiene have shown to reduce the incidence diarrhea by more than 50% amongst children (a major cause of mortality in India), thus raising an urgent need of developing a model for health promotion at schools that is replicable, sustainable, and can be modified to the local needs as well. Though the existent programmes have a few documented challenges, a multisectorial involvement of government agencies, educational boards, and health sector along with the school is the way forward to address those challenges and covert the theory of health promoting schools (HPS) into a well-established fact. It presents a scope for the various established and newly emerging Schools of Public Health in the country to come forward and collaborate with these multiple sectors. These collaborations can be the only way to ensure sustainability and incorporation of health promotion into the core academic structure of schools in a diverse and highly populous country like India.

6.
Indian J Med Ethics ; 4(2): 145-147, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31271359

RESUMO

Rabies is a fatal disease once contracted, and a serious public health problem. Immunisation was unaffordable and inaccessible for most affected people in India. Omesh Bharti's operational research allows us to reduce the unit dose needed for life saving rabies immunoglobulin (RIG) for class 3 rabid animal bites thereby raising hopes that access to this drug will improve. This study also suggests how public health research should question established guidelines that are rooted in impractical biomedicine without considering sociopolitical realities. The randomised controlled trial as a standard of research methodology is not only impractical but unnecessary. We discuss some of the challenges such as stockout of life saving medicines like RIG and suggest possible solutions. There is still a need to determine the correct RIG dose and the best technique for administering, storage and timing of this important drug.


Assuntos
Mordeduras e Picadas , Raiva , Animais , Humanos , Imunoglobulinas , Índia , Saúde Pública
7.
Indian J Med Ethics ; 4(2): 120-122, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31271362

RESUMO

The Government of India has passed a notification making the non-reporting of tuberculosis (TB) by a clinical establishment a punishable offence. This article examines this move from an ethical standpoint. One of the main ethical concerns relates to the violation of patient confidentiality that may result from this. Also as regards improvement in patient care, there appears to be a poor cost-benefit ratio in terms of the actionable data obtained by this There may be possible adverse consequences by a limiting of access to care due to penalising of non-reporting. In terms of the bigger picture, the notification may lead to an increased tension between the private sector and Government. Moreover, it is the position of the authors that such a step distracts attention from the more important issues that plague TB care in India today.


Assuntos
Confidencialidade/ética , Revelação/ética , Notificação de Doenças/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Notificação de Abuso/ética , Tuberculose/epidemiologia , Humanos , Índia/epidemiologia , Setor Privado/legislação & jurisprudência , Saúde Pública/legislação & jurisprudência
8.
Int J Biol Macromol ; 133: 817-830, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31002908

RESUMO

Chitosan, a natural biopolymer with osteoconductive properties is widely investigated to generate scaffolds for bone tissue engineering applications. However, chitosan based scaffolds lacks in mechanical strength and structural stability in hydrated condition and thereby limits its application for bone tissue regeneration. Thus in the present study, to overcome the limitations associated with chitosan based scaffolds, we fabricated polyelectrolyte complexation mediated composite scaffold of chitosan and chondroitin sulfate incorporated with nano-sized bioglass. Developed scaffolds were successfully characterized for various morphological, physico-chemical, mechanical and apatite forming properties using XRD, FT-IR, FE-SEM and TEM. It was observed that polyelectrolyte complexation followed by incorporation of bioglass significantly enhances mechanical strength, reduces excessive swelling behavior and enhances structural stability of the scaffold in hydrated condition. Also, in-vitro cell adhesion, spreading, viability and cytotoxity were investigated to evaluate the cell supportive properties of the developed scaffolds. Furthermore, alkaline phosphatase activity, biomineralization and collagen type I expression were observed to be significantly higher over the composite scaffold indicating its superior osteogenic potential. More importantly, in-vivo iliac crest bone defect study revealed that implanted composite scaffold facilitate tissue regeneration and integration with native bone tissue. Thus, developed composite scaffold might be a suitable biomaterial for bone tissue engineering applications.


Assuntos
Osso e Ossos/citologia , Cerâmica/química , Quitosana/química , Sulfatos de Condroitina/química , Nanocompostos/química , Engenharia Tecidual , Tecidos Suporte/química , Fosfatase Alcalina/metabolismo , Animais , Materiais Biocompatíveis/química , Materiais Biocompatíveis/farmacologia , Regeneração Óssea/efeitos dos fármacos , Osso e Ossos/efeitos dos fármacos , Adesão Celular/efeitos dos fármacos , Diferenciação Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Desenho de Fármacos , Humanos , Teste de Materiais , Osteogênese/efeitos dos fármacos , Porosidade , Coelhos
10.
Indian J Med Ethics ; 4(1): 39-45, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29976548

RESUMO

The Pre-Conception and Pre-Natal Diagnostic Techniques Act was written to prevent societally unacceptable harms including intentional sex selection. The pragmatism required to enforce this law has profound effects on the ability of rural Indians to access diagnostic ultrasonography. In so doing, it may have inadvertently placed a heavier burden on the poorest and worsened health inequity in India, creating serious ethical and justice concerns. It is time to re-examine and update the law such that diagnostic ultrasonography is widely available in even the most peripheral primary health and community health centres. Shorter, more accessible ultrasonography training courses should be offered; collaboration between radiologists and rural practitioners and facilities should be encouraged. Finally, modern ultrasound machines can carefully record all images via a "silent observer" modality. With some modifications to previously used silent observer modalities, this technology allows both greater access and better policing of potential misuse of ultrasound technology.


Assuntos
Revelação , Intenção , Diagnóstico Pré-Natal/ética , Serviços de Saúde Rural/ética , População Rural , Tecnologia/métodos , Ultrassonografia , Comportamento Cooperativo , Ética Médica , Feminino , Equidade em Saúde , Instalações de Saúde/ética , Instalações de Saúde/legislação & jurisprudência , Pessoal de Saúde/educação , Pessoal de Saúde/ética , Nível de Saúde , Humanos , Índia , Acesso dos Pacientes aos Registros/ética , Pobreza , Gravidez , Cuidado Pré-Natal/ética , Cuidado Pré-Natal/legislação & jurisprudência , Cuidado Pré-Natal/métodos , Diagnóstico Pré-Natal/métodos , Pré-Seleção do Sexo/ética , Justiça Social
11.
Natl Med J India ; 31(1): 59, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30348932
12.
Indian J Med Ethics ; 3(4): 334-336, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30156558

RESUMO

The Bawaskars in their Comment "Emergency care in rural settings: Can doctors be ethical and survive?" raise a context-specific question about the sustainability of emergency care in rural, low resource areas. This could be broadened to "What efforts are needed to sustain emergency care systems run by the private sector in rural, low resource areas without catastrophically affecting patients or healthcare providers?" There are enough constitutional, legal and ethical imperatives to state that all emergency care should be available to everyone irrespective of paying capacity. The State should be responsible for providing emergency care via the public sector or for strategically purchasing it from private providers. Even if that arrangement is not viable, private sector providers cannot expect the community to underwrite the sustainability of such services and the return on investment in their training. Finally, we suggest that the principles of ethics cannot be invoked for justifying the financial viability and sustainability of the private sector in an unequal world.


Assuntos
Serviços Médicos de Emergência , Tratamento de Emergência , Humanos , Índia , Setor Privado , Setor Público
15.
16.
Seizure ; 55: 4-8, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29291457

RESUMO

PURPOSE: The World Health Organisation (WHO) strategy for non-physician health workers (NPHWs) to diagnose and manage people with untreated epilepsy depends on them having access to suitable tools. We have devised and validated an app on a tablet computer to diagnose epileptic episodes and now examine how its use by NPHWs compares with diagnosis by local physicians and a neurologist. METHODS: Fifteen NPHWs at Jan Swasthya Sahyog (JSS) a hospital with community outreach in Chhattisgarh, India were trained in the use of an epilepsy diagnosis app on a tablet computer. They were asked to determine the app scores on patients in their communities with possible epilepsy and then refer them first to their local JSS doctors and then to a visiting neurologist. With the neurologist's opinion as the "gold standard", the misdiagnosis rate from the NPHWs was compared with that of the local physicians. RESULTS: There were 96 patients evaluated completely. The NPHWs misdiagnosed eight and the physicians seven. There were more uncertain diagnoses by the NPHWs. In the 22 patients who presented for the first time during the study, the NPHWs misdiagnosed three and the physicians five. CONCLUSIONS: NPHWs using an app achieved similar misdiagnosis rates to local physicians. Both these rates were well within the range of misdiagnosis in the published literature. These results suggest that task-shifting epilepsy diagnosis and management from physicians to NPHWs, who are enabled with appropriate technology, can be an effective and safe way of reducing the epilepsy treatment gap.


Assuntos
Agentes Comunitários de Saúde , Epilepsia/diagnóstico , Aplicativos Móveis , Neurologistas , Médicos , Adolescente , Adulto , Criança , Erros de Diagnóstico/estatística & dados numéricos , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Software , Adulto Jovem
18.
Indian J Med Ethics ; 3(1): 55-60, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29251606

RESUMO

Even though 1% of people require palliative and end-of-life care in low-resource situations, it remains an uncharted arena. Yet it is as important as curative care to alleviate suffering. Palliative care is not only a need in cancer and HIV disease; but is needed in a diverse group of illnesses ranging from tuberculosis, renal failures, paraplegia to chronic lung diseases. In a lower resource setting, the gaps in palliation may be the need for more technology and interventions or more healthcare professionals. Thus, palliative care will initially mean ensuring that life-prolonging treatment that most patients do not get is ensured to them. It is morally unacceptable to focus on comfort care as an alternative to advocating for patients' rights for appropriate life-prolonging treatments. If organised well and standard protocols are developed to support health workers, appropriate care can be provided for all people. Ethical principles of autonomy, nonmaleficence and benevolence will have to guide this development. We will have to prioritise for high value care which means choosing cheaper alternatives that are just as effective as more expensive diagnostic or therapeutic modalities. There is a need to settle the priorities between palliative and disease-modifying or curative treatments. Major roadblocks that limit access of the rural poor to palliative care relate mainly to the misconceptions among policy-makers and physicians, large gaps in health worker training and cultural mindsets of care-providers. A specific example of misplaced policies and regulations is the poor availability of opiates, which can make end-of-life care so much more dignified in illnesses that have chronic pain or breathlessness. A three-tiered structure is proposed with a central palliative care unit which will oversee several physicians and specially trained nurses for noncommunicable diseases, who will oversee primary healthcare centre-based nurses, who in turn, will oversee village health workers.


Assuntos
Pessoal de Saúde , Recursos em Saúde , Acesso aos Serviços de Saúde/ética , Cuidados Paliativos , Pobreza , População Rural , Assistência Terminal , Temas Bioéticos , Humanos , Índia , Cuidados para Prolongar a Vida , Manejo da Dor , Ética Baseada em Princípios
20.
J Family Med Prim Care ; 7(5): 982-992, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30598944

RESUMO

Background: The cartridge-based nucleic acid amplification test (CBNAAT) Xpert MTB/RIF is more sensitive than smear microscopy for the diagnosis of tuberculosis (TB). It is also more expensive, costing 1450 INR as compared to 10 INR per smear. Objectives: We conducted a prospective study to evaluate the impact of CBNAAT results on patient management in our low-resource, high-burden Indian rural setting. Materials and Method: Between February and July 2017, clinicians were asked to complete one questionnaire at the time of CBNAAT request and another when reviewing the result. The first questionnaire, "Form 1," concerned pretest treatment status and asked clinicians to rate their confidence in the diagnosis. "Form 2" concerned postresult treatment and investigation plan. Results: Over the study period, 206 CBNAATs were requested. Form 1 was not completed for 85 patients and 21 were excluded leaving 100 in the main analysis. MTB was detected (MTB-D) in 60 of 100 (60%) of samples tested. At the time of CBNAAT request, 56 of 100 (56%) of patients were already on treatment, this being empirical in 34 of 100 (34%). Despite this, 17 of 60 (28.3%) of MTB-D results occurred in patients not yet started on treatment. Postresult treatment status was available for 94 of 100 CBNAATs (55 MTB-D and 39 MTB-ND). Following an MTB-D result, all 17 patients not on treatment started and all 38 on so already continued. Following an MTB Not Detected (MTB-ND) result, 26 of 27 (96.3%) of patients not yet on treatment remained so, but only 2 of 12 (16.7%) already on treatment stopped. Even where the clinician's pretest confidence in TB was low, 9of 30 (30%) of CBNAAT results were MTB-D. Conclusion: In a low-resource high-burden setting, CBNAAT may have greatest impact where the clinician's pretest confidence in TB is low and empirical treatment has not been started. This is because MTB-D results will lead to appropriate initiation of treatment and MTB-ND results may enable clinicians to hold-off treatment.

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