Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 19 de 19
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Diabetes Metab Syndr ; 14(4): 627-636, 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32422447

RESUMO

BACKGROUND AND AIMS: Worldwide, lifestyle is a significant risk factor for diabetes. Lifestyle changes can lead to differences in the extent of risk of diabetes among women and men. Kerala, a state with one of the best health indicators in India, has a high prevalence of diabetes. This study aimed at comparing the variations in the risk factors for HBG and VHBG among adult women and men in Kerala. METHODS: Data from the fourth round of the National Family Health Survey (2015-16) used to examine the differences in the risk factors for HBG and VHBG in men and women aged 15-49 years. We used bivariate, multivariate and Population Attributable Risk (PAR) techniques for analysing the data. RESULTS: Bivariate results have shown the pattern of HBG and VHBG prevalence in women and men was same among all the age groups; however, men show a higher HBG and VHBG than women in all the age groups. Prevalence of HBG and VHBG was higher in women with a primary education, who were poor and not working as compared to their male counterparts. PARs results show that the prevalence of VHBG was higher among obese men and women as compared to normal men and underweight women. Prevalence of HBG was higher among men as compared to women due to alcohol use and weekly consumption of non-vegetarian food. CONCLUSIONS: The study suggests that there is an urgent need for targeted intervention programs to address the problem of HBG and VHBG in both men and women in Kerala to control blood glucose levels.

2.
Eur Spine J ; 29(3): 586-595, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31845031

RESUMO

PURPOSE: This retrospective study aimed to determine the efficacy of an integrated active, rehabilitation protocol in patients ≥ 65 years of age with chronic mechanical low back pain and compare the results in similar patients in 50-64 years age group. METHODS: Pre- and post-treatment mean numerical pain rating scale (NPRS) score, mean Oswestry disability index (ODI) score, treatment outcome category and minimal clinically important difference (MCID) thresholds achieved for NPRS and ODI scores post-treatment were compared among 697 patients in the 50-64 years and 495 patients in the ≥ 65 years age groups. RESULTS: At a mean treatment duration of 57 days (range, 30-90 days), both mean NPRS score (p < 0.0001) and mean ODI score (p < 0.0001) were significantly higher in the ≥ 65 years age group when compared to the 50-64 years age group. However, post-treatment outcome categories (p = 0.17) and percentage of patients who achieved MCID thresholds for NPRS score (p = 0.13) and ODI score (p = 0.18) were not significantly different between the two groups. There was a significant correlation between post-treatment NPRS score and patient age and pre-treatment NPRS score and between post-treatment ODI score and incidence of osteoporosis and pre-treatment ODI score. CONCLUSION: Although mean NPRS and ODI scores achieved were significantly better in patients of 50-64 years of age, our integrated active, rehabilitation protocol helped achieve significant improvement in NPRS score, MCID thresholds for NPRS and ODI scores and treatment outcomes in patients ≥ 65 years of age, similar to patients in the 50-64 years of age group, at the end of 3 months of treatment. These slides can be retrieved under Electronic Supplementary Material.

3.
J Arthroplasty ; 34(3): 586-593, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30611520

RESUMO

BACKGROUND: Computer-assisted navigation system (CAS) in total knee arthroplasty (TKA) has been shown to improve mechanical alignment and prosthesis positioning as compared to conventional TKA. However, the evidence with regard to whether CAS-TKA has better patient function over conventional TKA is not clear. This systematic review and meta-analysis compares functional outcomes of CAS vs conventional TKA at longer follow-up periods. METHODS: This study was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, Embase, gray literature, and clinicaltrials.gov were searched up to April 30, 2018. All prospective original studies (only level 1 and 2) that compared functional outcomes of CAS-TKA vs conventional TKA, with minimum 2-year follow-up, were included. The research question and eligibility criteria were established a priori. Pertinent data were extracted and random-effects model was used. RESULTS: A total of 18 studies with 3060 knees were included; of which 1538 underwent TKA with CAS and 1522 underwent conventional TKA. Studies were grouped based on the follow-up reported into: (1) ≥2 years to <5 years; (2) ≥5 years to <8 years; (3) >8 years. Pooled mean Western Ontario and McMaster Universities Osteoarthritis Index scores (P < .001) and Knee Society Score-function score (P = .03) were better in the CAS-TKA group in the 5- to 8-year follow-up. For the remaining follow-ups, there was no difference between the 2 groups. CONCLUSION: The meta-analysis concluded that there is limited evidence that CAS-TKA improves functional outcomes at 5- to 8-year follow-up as measured by Western Ontario and McMaster Universities Osteoarthritis Index and Knee Society Score-function scores. More prospective studies with larger sample size and longer-term follow-up are required to support the trend toward better functional outcomes with CAS.


Assuntos
Artroplastia do Joelho , Cirurgia Assistida por Computador , Humanos , Articulação do Joelho/cirurgia , Estudos Prospectivos , Resultado do Tratamento
5.
J Glob Health ; 9(1): 010408, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30546869

RESUMO

Background: Lack of menstrual knowledge, poor access to sanitary products and a non-facilitating school environment can make it difficult for girls to attend school. In India, interventions have been developed to reduce the burden of menstruation for school girls by government and non-governmental organizations (NGOs). We sought to identify challenges related to menstruation, and facilitators of menstrual management in schools in three states in India. Methods: Surveys were conducted among menstruating school girls in class 8-10 (above 12 years of age) of 43 government schools selected through stratified random sampling in three Indian states (Maharashtra, Chhattisgarh, Tamil Nadu) in 2015. For comparison, ten model schools supported by NGOs or UNICEF with a focussed menstrual hygiene education program were selected purposely in the same states to represent the better-case scenario. We examined awareness about menarche, items used for menstruation, and facilitators on girls' experience of menstruation in regular schools and compared with model schools. Factors associated with school absence during menstruation were explored using multivariate analysis. Findings: More girls (mean age 14.1 years) were informed about menstruation before menarche in model schools (56%, n = 492) than in regular schools (36%, n = 2072, P < 0.001). Girls reported menstruation affected school attendance (6% vs 11% in model vs regular schools respectively, P = 0.003) and concentration (40% vs 45%, P = 0.1) and was associated with pain (31% vs 38%, P = 0.004) and fear of stain or smell (11% vs 16%, P = 0.002). About 45% of girls reported using disposable pads in both model and regular schools, but only 55% and 29% of pad-users reported good disposal facilities, respectively (P < 0.001). In multivariate analysis, reported absenteeism during menstruation was significantly lower in Tamil Nadu (adjusted prevalence ratio (APR) 95% confidence interval (CI) = 0.24, 0.14-0.40) and Maharashtra (APR 0.56, CI = 0.40-0.77) compared to Chhattisgarh, and halved in model compared to regular schools (APR 0.50, CI = 0.34-0.73). Pain medication in school (APR 0.71, CI = 0.51-0.97) and use of disposable pads (APR 0.57, CI = 0.42-0.77) were associated with lower absenteeism and inadequate sanitary facilities with higher absenteeism during menstruation. Conclusions: Menstrual hygiene education, accessible sanitary products, pain relief, and adequate sanitary facilities at school would improve the schooling-experience of adolescent girls in India.


Assuntos
Higiene , Menstruação , Instituições Acadêmicas/organização & administração , Absenteísmo , Adolescente , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Índia , Produtos de Higiene Menstrual/provisão & distribução , Setor Público , Inquéritos e Questionários
6.
Int Q Community Health Educ ; 39(1): 31-38, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30376407

RESUMO

Personal hygiene plays an important role in preventing communicable diseases especially in children. In developing countries like India, the burden of communicable diseases is high which makes an awareness program imperative in school children. The objective was to study the outcome of school-based intervention program in promoting personal hygiene among the primary school children of Mumbai and Thane. This is a comparative study carried out from July 2015 to March 2016 between intervention and nonintervention groups before and after intervention. Using random sampling, 119 schools in Mumbai and 24 schools in Thane were selected. Our results suggest that knowledge, attitude, and practices were significantly different in end-line than baseline in the intervention group and had better effects as reflected in scores compared with comparison group. The findings reveal that a health education program clubbed with entertainment and interaction can bring positive attitudinal shift which is otherwise difficult to change.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/organização & administração , Higiene , Serviços de Saúde Escolar/organização & administração , Criança , Feminino , Desinfecção das Mãos/métodos , Humanos , Índia , Masculino , Avaliação de Programas e Projetos de Saúde , Fatores Socioeconômicos
7.
Front Public Health ; 6: 375, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30687689

RESUMO

This article provides a perspective on the evolution of health management education in India, its current state and the way forward. Health management originated in India in response to the administrative needs of the healthcare system, which is now moving toward institutional care, away from its earlier form of home healthcare. As this field evolved over time, new roles emerged for health management professionals. Several articles have been published in the past describing the state and growth in the field of health management education. This article emphasizes the need to rationalize the sector and shape its future to suit the needs of over a billion people, who use the services of multiple organizations, directly or indirectly in a highly dynamic healthcare environment. We have identified the various challenges that affect the sector today; filling vacant positions, matching jobs with training, and changes in curricula required to achieve good matches. Solutions to address these challenges have also been considered, which in our view could be a way forward in this sector.

8.
Reprod Health ; 14(1): 174, 2017 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-29216895

RESUMO

BACKGROUND: In low-middle income countries and other areas of poverty, menstrual hygiene management (MHM) can be problematic for women and girls. Issues include lack of knowledge about menstruation and MHM, and stigma around menstruation, also access to affordable and absorbent materials; privacy to change; adequate washing, cleaning and drying facilities; as well as appropriate and accessible disposal facilities. In order to effect change and tackle these issues, particularly in patriarchal societies, males may need to become advocates for MHM alongside women. However, little is known about their knowledge and attitudes towards menstruation, which may need addressing before they can assist in acting as advocates for change. The present study was undertaken to explore knowledge and attitudes about menstruation among adolescent boys across India, in order to gauge their potential to support their 'sisters'. METHODS: The study was undertaken across three states in India, chosen a priori to represent the cultural and socio-economic diversity. Qualitative data using focus group discussions with 85 boys aged 13-17 years, from 8 schools, was gathered. Data were analysed using thematic analysis. RESULTS: The results were organised into three main themes, reflecting the key research questions: boys' knowledge of menstruation, source of knowledge, and attitudes towards menstruation and menstruating girls. Knowledge comprised three aspects; biological function which were generally poorly understood; cultural rites which were recognized by all; and girls' behaviour and demeanour, which were noted to be withdrawn. Some boys learnt about puberty and menstruation as part of the curriculum but had concerns this was not in-depth, or was missed out altogether. Most gathered knowledge from informal sources, from overhearing conversations or observing cultural rituals. Few boys openly displayed a negative attitude, although a minority voiced the idea that menstruation is a 'disease'. Boys were mostly sympathetic to their menstruating sisters and wanted to support them. CONCLUSIONS: These findings provide some optimism that males can become advocates in moving forward the MHM agenda. The reasons for this are twofold: boys were keen for knowledge about menstruation, searching information out despite societal norms being for them to remain ignorant, they were also largely sympathetic to their menstruating sisters and fellow classmates and understanding of the issues surrounding the need for good MHM.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Homens/psicologia , Menstruação/psicologia , Adolescente , Educação em Saúde , Humanos , Índia , Masculino , Percepção , Pesquisa Qualitativa
9.
BMC Health Serv Res ; 16(Suppl 6): 550, 2016 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-28185581

RESUMO

BACKGROUND: Health systems in low and middle income countries are struggling to improve efficiency in the functioning of health units of which workforce is one of the most critical building blocks. In India, Rogi Kalyan Samiti (RKS) was established at every health unit as institutions of local decision making in order to improve productive efficiency and quality. Measuring efficiency of health units is a complex task. This study aimed at assessing the perception (opinion and satisfaction) of health workers about influence of RKS on improving efficiency of peripheral decision making health units (DMHU); examining differences between priority and non-priority set-ups; identifying predictors of satisfaction at work; and discussing suggestions to improve performance. METHODS: Following a cross-sectional, comparative study design, 130 health workers from 30 institutions were selected through a multi-stage stratified random sampling. A semi-structured questionnaire was administered to assess perception and opinion of health workers about influence of RKS on efficiency of decision making at local level, motivation and performance of staff, and availability of funds; improvement of quality of services, and coordination among co-workers; and participation of community in local decision making. Three districts with highest infant mortality rate (IMR), one each, from 3 zones of Odisha and 3 with lowest IMR were selected on the basis of IMR estimates of 2011. The former constituted priority districts (PD) and the latter, non-priority districts (NPD). Composite scores were developed and compared between PD and NPD. Adjusted linear regression was conducted to identify predictors of satisfaction at work. RESULTS: A majority of respondents felt that RKS was efficient in decision making that resulted in improvement of all critical parameters of health service delivery, including quality; this was significantly higher in PD. Further, higher proportion of respondents from PD was highly satisfied with the current set of provisions and manners of functioning of the sample health units. Active community engagement, participation of elected representatives, selection of a pro-active Chairman, and training to RKS members were suggested as the immediate priority action points for the state government. Mean scores differed significantly between PD and NPD with regard to: influence of RKS on individual-centric, organizational-centric and patient-centric performance, and the responsibilities to be entrusted with RKS. Absenteeism was strongly associated with satisfaction and local self-governance. Work-related factors, systemic factors, local accountability and patients' involvement were found to be the key predictors of satisfaction of health workforce. CONCLUSION: The understanding on quality improvement strategies was found to be very poor among the health workers. Tailor-made capacity building measures at district and sub-district levels could be critical to equip the peripheral health units to achieve the universal health coverage goals. Work environment, systemic factors and accountability need to be addressed on priority for retention of health workforce. The hypothesized link between efficient local decision making, perception of health workers about efficiency of health units and the health status of population needs further investigation.


Assuntos
Eficiência Organizacional , Administração de Instituições de Saúde/métodos , Pessoal de Saúde/psicologia , Política , Adulto , Estudos Transversais , Assistência à Saúde , Feminino , Programas Governamentais , Humanos , Índia , Governo Local , Masculino , Assistência Médica , Pessoa de Meia-Idade , Inquéritos e Questionários
10.
BMC Health Serv Res ; 16(Suppl 6): 554, 2016 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-28185587

RESUMO

BACKGROUND: Local decision making is linked to several service quality improvement parameters. Rogi Kalyan Samitis (RKS) at peripheral decision making health units (DMHU) are composite bodies that are mandated to ensure accountability and transparency in governance, improve quality of services, and facilitate local responsiveness. There is scant literature on the nature of functioning of these institutions in Odisha. This study aimed to assess the perception of RKS members about their roles, involvement and practices with respect to local decision making and management of DMHUs; it further examined perceptual and functional differences between priority and non-priority district set-ups; and identified predictors of involvement of RKS members in local governance of health units. METHODS: As members of RKS, health service providers, officials in administrative/managerial role, elected representatives, and officials from other departments (including independent members) constituted our study sample. A total of 112 respondents were interviewed across 6 districts, through a multi-stage stratified random sampling; we used a semi-structured interview schedule that comprised mainly of close-ended and some open-ended questions. Descriptive and inferential statistics were used to compare 3 priority (PD) and 3 non-priority districts (NPD), categorized on the basis of Infant Mortality Rate (IMR) estimates of 2011 as proxy of population health. Governance, human resource management, financial management and quality improvement functions were studied in detail. Opinion about various individual and organizational factors in local self-governance and predictors of involvement were identified. RESULTS: The socio-demographic profile and composition of respondents were comparable between PD and NPD. Majority of respondents were 'satisfied' with their current roles in the governance of local health institutions. About one-fourth opined that the amount of funds allocated to RKS under National Health Mission (NHM) was 'grossly insufficient'. Fifty percent of respondents said they requested for additional funds, last year, and 38.8 % informed that they requested additional funds for purchase of drugs. About 87 % respondents were satisfied with their role in the local governance of the health units (PD = 94.3 % vs. NPD = 80.7 %). Almost all (PD = 98 % vs. NPD = 80.7 %) opined that local decision making helped in improving the performance of health units. For most of the open-ended questions the responses were non-specific. Staggering differences were found between PD and NPD with respect to their involvement in district plan preparation (NPD = 78.9 % vs. PD = 58.5 %), training in plan preparation (NPD = 47.4 % vs. PD = 27.5 %), participation of officials from other departments (PD = 96.9 % vs. NPD = 45.5 %), and inclusion of activities of other sectors (PD = 70.8 % vs. NPD = 41.8 %). Whereas, no significant PD-NPD difference was found about their perceived 'involvement' in undertaking the 12 designated responsibilities. Composite scores on various individual and organizational factors were compared and found to be varying significantly. Through regression, we inferred work experience, qualification and non-monetary incentives as strong determinants of current level of involvement of RKS members in governance and management of health units. CONCLUSION: Poor knowledge/expectation of RKS members was diluting the decision making process at DMHUs. There is an urgent need to improve their knowledge, understanding and expertise in areas of governance and management practices. A locally-monitored and time-bound capacity building plan could achieve this. Yearly resource allocation for drug procurement needs revision. Specific eligibility criteria based on work experience and qualification may be fixed for RKS membership. Further research may focus on identifying the underlying individual and systemic factors behind such large PD-NPD differences.


Assuntos
Tomada de Decisões , Assistência à Saúde/organização & administração , Governo Local , Adulto , Fortalecimento Institucional , Feminino , Humanos , Índia , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
11.
BMC Health Serv Res ; 16(Suppl 6): 561, 2016 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-28185593

RESUMO

INTRODUCTION: One of the principal goals of any health care system is to improve health through the provision of clinical and public health services. Decentralization as a reform measure aims to improve inputs, management processes and health outcomes, and has political, administrative and financial connotations. It is argued that the robustness of a health system in achieving desirable outcomes is contingent upon the width and depth of 'decision space' at the local level. Studies have used different approaches to examine one or more facets of decentralization and its effect on health system functioning; however, lack of consensus on an acceptable framework is a critical gap in determining its quantum and quality. Theorists have resorted to concepts of 'trust', 'convenience' and 'mutual benefits' to explain, define and measure components of governance in health. In the emerging 'continuum of health services' model, the challenge lies in identifying variables of performance (fiscal allocation, autonomy at local level, perception of key stakeholders, service delivery outputs, etc.) through the prism of decentralization in the first place, and in establishing directed relationships among them. METHODS: This focused review paper conducted extensive web-based literature search, using PubMed and Google Scholar search engines. After screening of key words and study objectives, we retrieved 180 articles for next round of screening. One hundred and four full articles (three working papers and 101 published papers) were reviewed in totality. We attempted to summarize existing literature on decentralization and health systems performance, explain key concepts and essential variables, and develop a framework for further scientific scrutiny. Themes are presented in three separate segments of dimensions, difficulties and derivatives. RESULTS: Evaluation of local decision making and its effect on health system performance has been studied in a compartmentalized manner. There is sparse evidence about innovations attributable to decentralization. We observed that in India, there is very scant evaluative study on the subject. We didn't come across a single study examining the perception and experiences of local decision makers about the opportunities and challenges they faced. The existing body of evidences may be inadequate to feed into sound policy making. The principles of management hinge on measurement of inputs, processes and outputs. In the conceptual framework we propose three levels of functions (health systems functions, management functions and measurement functions) being intricately related to inputs, processes and outputs. Each level of function encompasses essential elements derived from the synthesis of information gathered through literature review and non-participant observation. We observed that it is difficult to quantify characteristics of governance at institutional, system and individual levels except through proxy means. CONCLUSION: There is an urgent need to sensitize governments and academia about how best more objective evaluation of 'shared governance' can be undertaken to benefit policy making. The future direction of enquiry should focus on context-specific evidence of its effect on the entire spectrum of health system, with special emphasis on efficiency, community participation, human resource management and quality of services.


Assuntos
Participação da Comunidade , Assistência à Saúde/organização & administração , Eficiência Organizacional , Política , Tomada de Decisões , Programas Governamentais , Humanos , Índia , Formulação de Políticas , Qualidade da Assistência à Saúde
12.
Front Public Health ; 3: 282, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26779475

RESUMO

INTRODUCTION: Government of India launched a social health protection program called Rashtriya Swasthya Bima Yojana (RSBY) in the year 2008 to provide financial protection from catastrophic health expenses to below poverty line households (HHs). The objectives of the current paper are to assess the current status of RSBY in Maharashtra at each step of awareness, enrollment, and utilization. In addition, urban and rural areas were compared, and social, political, economic, and cultural (SPEC) factors responsible for the better or poor proportions, especially for the awareness of the scheme, were identified. METHODS: The study followed mixed methods approach. For quantitative data, a systematic multistage sampling design was adopted in both rural and urban areas covering 6000 HHs across 22 districts. For qualitative data, five districts were selected to conduct Stakeholder Analysis, Focused Group Discussions, and In-Depth Interviews with key informants to supplement the findings. The data were analyzed using innovative SPEC-by-steps tool developed by Health Inc. RESULTS: It is seen that that the RSBY had a very limited success in Maharashtra. Out of 6000 HHs, only 29.7% were aware about the scheme and 21.6% were enrolled during the period of 2010-2012. Only 11.3% HHs reported that they were currently enrolled for RSBY. Although 1886 (33.1%) HHs reported at least one case of hospitalization in the last 1 year, only 16 (0.3%) HHs could actually utilize the benefits during hospitalization. It is seen that at each step, there is an increase in the exclusion of eligible HHs from the scheme. The participants felt that such schemes did not reach their intended beneficiaries due to various SPEC factors. DISCUSSION AND CONCLUSION: The results of this study were quite similar to other studies done in the recent past. RSBY might still be continued in Maharashtra with modified focus along with good and improved strategy. Various other similar schemes in India can definitely learn few important lessons such as the need to improve awareness, issuing prompt enrollment cards with proper details, achieving universal enrollment, ongoing and prompt renewal, and ensuring proper utilization by proactively educating the vulnerable sections.

13.
Front Public Health ; 2: 72, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25072044

RESUMO

The main objective was to assess knowledge, practices, and restrictions faced by young women regarding their menstrual hygiene. The views of adult women having young daughters were also included and both views were compared. In addition, the factors influencing the menstrual hygiene practices were also studied. The study was carried out during 2008 in Mumbai, India. The mixed methods approach was followed for the data collection. Both qualitative and quantitative methods were used to collect the data. For quantitative survey, totally 192 respondents (96 adult and 96 younger women) were selected. While young women were asked about questions related to their menstruation, adult women were asked questions to find out how much they know about menstrual history of their daughters. The qualitative data helped to supplement the findings from the quantitative survey and to study the factors affecting menstrual practices in young women. The mean age at menarche reported was 13.4 years and 30-40% of young girls did not receive any information about menstruation before menarche. It is thus seen that very few young girls between the age group 15 and 24 years did receive any information before the onset of menstruation. Among those who received some information, it was not adequate enough. The source of information was also not authentic. Both young and adult women agreed on this. Due to the inadequate knowledge, there were certain unhygienic practices followed by the young girls resulting in poor menstrual hygiene. It also leads to many unnecessary restrictions on young girls and they faced many health problems and complaints, which were either ignored or managed inappropriately. The role of health sector was almost negligible from giving information to the management of health problems of these young girls. This paper reemphasizes the important, urgent, and neglected need of providing correct knowledge to the community including adolescent girls.

14.
Indian J Public Health ; 57(1): 36-9, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23649142

RESUMO

Childhood tuberculosis (TB) reflects on-going transmission. Data on childhood TB from TB registers under Revised National Tuberculosis Control Program of 2008 and 2009 in Varanasi district was analyzed. Proportion of childhood TB was 8.3% of total registered cases 12,242. It was lower than estimated 10-20% in endemic areas. In rural Tuberculosis Units childhood case detection was poor. Case detection in ≤5 years was very less. The childhood cases were detected mainly in adolescent age group. Thus, childhood TB is remaining a under diagnosed/under reported disease in India. It needs attention to increase the detection of childhood TB cases to control TB in general population.


Assuntos
Tuberculose/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Masculino , Programas Nacionais de Saúde , Sistema de Registros , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose/prevenção & controle
15.
Eur J Orthop Surg Traumatol ; 23(7): 831-3, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23412201

RESUMO

Ankle sprains are by far the commonest ankle injuries. The traditional clinical approach, to any ankle injury, is a clinical examination followed by radiological examination. We have developed a simple clinical test to rule out fractures in ankle injuries and thereby eliminating the necessity for radiological examination. Our test is simple, reproducible, economic, time saving and avoids potential radiation exposure risks.


Assuntos
Fraturas do Tornozelo , Traumatismos do Tornozelo/diagnóstico , Exame Físico/métodos , Diagnóstico Diferencial , Humanos
16.
Int Orthop ; 35(9): 1281-7, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20686893

RESUMO

Although there is general consensus about the efficacy of total hip replacement (THR) in young patients, the most appropriate bearings in young patients remain highly debated. The three most popular bearings in use include metal-on-polyethylene (MOP), metal-on-metal (MOM) and ceramic-on-ceramic (COC). We conducted a systematic review and meta-analysis of literature to summarise the best available evidence on relative success of the three most popular bearings used in THR in young active patients. Our findings support the use of MOM bearings in the management of the young arthritic hip. These findings, largely based upon observational studies, should be taken in the context of the limitations of such non-randomised study designs.


Assuntos
Artroplastia de Quadril/métodos , Materiais Revestidos Biocompatíveis , Prótese de Quadril , Desenho de Prótese , Adulto , Análise de Falha de Equipamento , Humanos , Pessoa de Meia-Idade , Falha de Prótese , Estresse Mecânico
17.
Int J Qual Health Care ; 20(4): 297-303, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18403570

RESUMO

QUALITY PROBLEM OR ISSUE: One of the prime goals of any health system is to deliver good and competent quality of healthcare. Through World Bank-assisted Maharashtra Health Systems Development Project, Government of Maharashtra in India developed and implemented clinical indicators to improve quality. INITIAL ASSESSMENT: During this, clinical areas eligible for monitoring quality of care and roles of health staff working at various levels were identified. CHOICE OF SOLUTION: Brainstorming discussion sessions were conducted to refine list of potential clinical indicators and to identify implementation problems. IMPLEMENTATION: It was implemented in four stages. (a) Self-explanatory tool of record, standard operating procedures and training manual were prepared during tools preparation stage. (b) Pilot implementation was done to monitor the usefulness of indicators, document the experiences and standardize the system accordingly. (c) The final selection of indicators was done taking into consideration points like data reliability, indicator usefulness etc. For final implementation, 15 indicators for district and 6 indicators for rural hospitals were selected. (d) Transfer of skills was done through training of various hospital functionaries. EVALUATION AND LESSONS LEARNED: Selection and prioritization of clinical indicators is the most crucial part. Active participation of local employees is essential for sustainability of the scheme. It is also important to ensure that data recorded/reported is both reliable and valid, to conduct monthly review of the scheme at various levels and to link it with the quality improvement programme.


Assuntos
Garantia da Qualidade dos Cuidados de Saúde/métodos , Indicadores de Qualidade em Assistência à Saúde , Pesquisa sobre Serviços de Saúde/métodos , Humanos , Índia , Inovação Organizacional , Desenvolvimento de Programas/métodos , Avaliação de Programas e Projetos de Saúde
19.
BMC Complement Altern Med ; 7: 34, 2007 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-17974032

RESUMO

BACKGROUND: The efficacy and safety of a dietary supplement derived from South American botanicals was compared to glucosamine sulfate in osteoarthritis subjects in a Mumbai-based multi-center, randomized, double-blind study. METHODS: Subjects (n = 95) were screened and randomized to receive glucosamine sulfate (n = 47, 1500 mg/day) or reparagen (n = 48, 1800 mg/day), a polyherbal consisting of 300 mg of vincaria (Uncaria guianensis) and 1500 mg of RNI 249 (Lepidium meyenii) administered orally, twice daily. Primary efficacy variable was response rate based on a 20% improvement in WOMAC pain scores. Additional outcomes were WOMAC scores for pain, stiffness and function, visual analog score (VAS) for pain, with assessments at 1, 2, 4, 6 and 8 weeks. Tolerability, investigator and subject global assessments and rescue medication consumption (paracetamol) were measured together with safety assessments including vital signs and laboratory based assays. RESULTS: Subject randomization was effective: age, gender and disease status distribution was similar in both groups. The response rates (20% reduction in WOMAC pain) were substantial for both glucosamine (89%) and reparagen (94%) and supported by investigator and subject assessments. Using related criteria response rates to reparagen were favorable when compared to glucosamine. Compared to baseline both treatments showed significant benefits in WOMAC and VAS outcomes within one week (P < 0.05), with a similar, progressive improvement over the course of the 8 week treatment protocol (45-62% reduction in WOMAC or VAS scores). Tolerability was excellent, no serious adverse events were noted and safety parameters were unchanged. Rescue medication use was significantly lower in the reparagen group (p < 0.01) at each assessment period. Serum IGF-1 levels were unaltered by treatments. CONCLUSION: Both reparagen and glucosamine sulfate produced substantial improvements in pain, stiffness and function in subjects with osteoarthritis. Response rates were high and the safety profile was excellent, with significantly less rescue medication use with reparagen. Reparagen represents a new natural productive alternative in the management of joint health. TRIAL REGISTRATION: Current Controlled Trials ISRCTN25438351.


Assuntos
Glucosamina/uso terapêutico , Osteoartrite do Joelho/tratamento farmacológico , Extratos Vegetais/uso terapêutico , Acetaminofen/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Fator de Crescimento Insulin-Like I/metabolismo , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/sangue , Osteoartrite do Joelho/complicações , Dor/etiologia , Dor/prevenção & controle , Medição da Dor , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA