Need for Interactive Data Visualization in Public Health Practice: Examples from India.

The world is full of data which is increasing by leaps and bounds. In health care, big data is becoming common with increased electronic health data accumulation and/or accessibility to public data previously held under lock and key. At the same time, health data visualization applications have become popular over recent years. Against this background, a review was done to summarize the application of data visualization in public health & the challenges faced. Peer-reviewed original research articles and review articles searched in Google Scholar and Pubmed databases that were indexed in the last ten years period, using the keywords "Big data" or "data visualization" or "Interactive visualization techniques." Other related information in books, blogs, and published documents were searched in Google search engine using the same keywords. Contents from the downloaded documents were presented and discussed under three headings viz. (a) the visualizations that are still current and how they have evolved further, (b) tools or methods that can be used by end-users to make their own modifications, (c) the platforms to disseminate them. Usage of different plots in public health is explained with suitable examples using the data from public health datasets. From the discussion it can be understood that when big data is visualized well, it can identify implementation gaps and disparities and accelerate implementation strategies to reach the population groups in most need for interventions. As health administrator may come from diverse specialties, robust training and career development for big data in public health is the need of the hour.

Student perceptions regarding the usefulness of explicit discussion of "Structure of the Observed Learning Outcome" taxonomy.

One method of grading responses of the descriptive type is by using Structure of Observed Learning Outcomes (SOLO) taxonomy. The basis of this study was the expectation that if students were oriented to SOLO taxonomy, it would provide them an opportunity to understand some of the factors that teachers consider while grading descriptive responses and possibly develop strategies to improve scores. We first sampled the perceptions of 68 second-year undergraduate medical students doing the Respiratory System course regarding the usefulness of explicit discussion of SOLO taxonomy. Subsequently, in a distinct cohort of 20 second-year medical students doing the Central Nervous System course, we sought to determine whether explicit illustration of SOLO taxonomy combined with some advice on better answering descriptive test questions (to an experimental group) resulted in better student scores in a continuous assessment test compared with providing advice for better answering test questions but without any reference to SOLO taxonomy (the control group). Student ratings of the clarity of the presentation on SOLO taxonomy appeared satisfactory to the authors, as was student understanding of our presentation. The majority of participants indicated that knowledge of SOLO taxonomy would help them study and prepare better answers for questions of the descriptive type. Although scores in the experimental and control group were comparable, this experience nonetheless provided us with the motivation to orient students to SOLO taxonomy early on in the medical program and further research factors that affect students' development of strategies based on knowledge of SOLO taxonomy.

Assessment of Self Perception of Competencies among a Group of Dental interns in Pondicherry, India.

CONTEXT: The general dentist must not only have a broad biomedical and clinical education but also be able to demonstrate professional and ethical behavior as well as effective communication and interpersonal skills. In addition he or she must have the ability to evaluate and utilize emerging technologies, continuing professional development opportunities, and problem-solving and critical thinking skills to effectively address current and future issues in health care. But the extent to which the core competencies are taught and the students' level of proficiency in these competencies in Indian scenario is to be explored at large. AIMS: The present study aims at assessing the self-perceived level of competencies and their importance for future practice and the extent to which the competencies are taught in the curriculum among interns of dental college in Pondicherry, India. SETTINGS AND DESIGN: The cross-sectional observational study was conducted among dental interns of Indira Gandhi Institute of Dental Sciences, Pondicherry. SUBJECTS AND METHODS: A total of 72 interns participated in the study. A short version of the Freiburg Questionnaire to Assess Competencies in Medicine" was used in this study. Questionnaire has three sections with same set of questions, which the student had to rate: (i) To what extent do you have the following competencies at your disposal? (ii) To what extent will your future job require the following competencies? and (iii) To what extent is competencies taught to you? After the results were obtained a focused group discussion with the responders was done. Focused group discussion consisted of open questions to the groups in all the four domains and the responses of the students were scribed. RESULTS: In all four domains, self-perceived level of competency was not satisfactory. However, all students stated that the competencies were highly relevant for their future practice. Despite this, most of the competencies are not taught to necessary extent in the curriculum. The results of the present survey revealed that the participating students perceived deficiencies in all domains of competencies. CONCLUSIONS: These results indicate that the core competencies are still barely integrated into dental curricula and that further research in this field is needed.

Primary hyperparathyroidism in Saudi Arabia: a review of 46 cases.

Records of 46 patients who were treated for primary hyperparathyroidism at King Khalid University Hospital, Riyadh Saudi Arabia from 1st July 2000 to 30th June 2006 were reviewed. Mean age at diagnosis was 44 years (range 13 - 70 years) and average duration of symptoms was 39 months (1 month to 11 years). There were 35 females and 11 males with a ratio of 3.2:1. Bone pains were the major symptoms at presentation in 45.7% followed by no symptom in 23.9%, renal stones in 15.2%, polyuria in 6.5%, while 4.3% each presented with depression, and constipation. Males had significantly more severe disease with higher serum calcium, higher urinary calcium excretion, and higher serum creatinine. Ninety six percent of patients had successful surgery and 4% (two patients) each had recurrence and hungry bone syndrome. It is concluded that PHPT in Saudi Arabia continues to be a symptomatic disorder with skeletal and renal manifestations occurring at a younger age and males having more severe disease. Further prospective studies are needed to verify our findings.

Prevalence of undetected cognitive impairment and depression in residents of an elderly care home.

The elderly population in Malaysia is growing rapidly. Some of the most vulnerable are in residential care. Research is needed into the characteristics of this population to aid clinicians and policy makers in addressing the needs of this group. This observational, cross-sectional study aims to determine prevalence of undetected cognitive impairment and depression in elderly care home residents in Malaysia. One hundred and sixty-seven people over 60 years of age living in a state run residential home were interviewed. Validated assessment tools were used to measure dependency, cognitive impairment and depression. The prevalence of probable dementia is 36.5%, with increasing prevalence with age and level of dependence. Prevalence of depression is 67.0% (major depression 13.2%), with more depression in males and in the Indian population. None of the identified cases had been previously investigated or treated for dementia or depression.

A Goal Unrealized: Patient Empowerment on Hand Hygiene- A Web-Based Survey from India.

INTRODUCTION: Each year, millions of patients around the world are affected by Health Care Associated Infections (HCAIs). Understanding and assessing the global burden of HCAI is one of the key areas of work to improve the hand hygiene. AIM: To assess the patient empowerment and awareness on hand hygiene among online users. MATERIALS AND METHODS: A web-based cross-sectional survey was conducted during September 2013 to December 2013 among adults. A predesigned questionnaire to assess the awareness on hand hygiene was sent to volunteers through emails and social networking sites. The data were transferred to excel sheet and analyzed in Epi info and represented in proportions and percentages. RESULTS: Total 94 (57%) participants responded to the survey among which 51.1% were males and 48.9% were females. Majority of them belongs to the age group of 20 to 35 years. Only 28.7% of them said they will ever ask health care worker to wash their hands before they examine. A 27.7% of the participants reported that their country/community have a program that educates/communicates with patients about the importance of hand hygiene. CONCLUSION: Adherence and compliance to hand hygiene practices is suboptimal among people. There seems to be a lack of knowledge regarding hand hygiene.

The Proposal of a BDS Syllabus Framework to Suit Choice Based Credit System (CBCS).

INTRODUCTION: Higher education takes a new dimension universally in the form of choice based Credit System (CBCS). In India, the University Grants Commission (UGC) has made CBCS mandatory in all fields except for Health Profession. Not much attempts were made in designing a BDS syllabus to suit CBCS. AIM: Aim of the study was to propose a model dental syllabus to fit into choice based credit system. MATERIALS AND METHODS: A model BDS syllabus Prototype for CBCS was designed based on the UGC guidelines for terms as well as calculations for CBCS. Engineering curriculum models from IIT and Anna University were also referred to. RESULTS: Semester based BDS syllabus was designed without changing the norms of Dental Council of India (DCI). All the must know areas of the subjects were considered as "core" areas and the desirable and nice to know areas are left for "electives" by the students. By this method, none of the subject was left out at the same time students are provided with electives to learn deeper on their topics of choice. CONCLUSION: The existing BDS syllabus can be effectively modified by incorporating few changes based on the UGC regulations for Choice based credit system. The proposed framework gives an insight on the nature of modifications that are needed. By adopting this, BDS Course regulations can also follow CBCS without neglecting or reducing the weightage of any subject.

The influence of a high level of corn oil on rat serum lipoproteins.

Although the stated requirement for linoleic acid in humans is less than 2% of the dietary calories, recently there has been considerable emphasis on the necessity to substitute dietary polyunsaturates for saturates in order to reduce serum cholesterol levels. In this study we have sought to determine the nutritional consequences of feeding a very high level of linoleate to rats. Three groups of thirty adult animals each were fed a semipurified diet consisting by weight of casein 17%; mineral mixture 5.5%; vitamin mixture in glucose 2.2%; cellulose fiber 3.0%; and corn oil 0% (group A), 10% (group B) or 40% (group C), which was provided at the expense of glucose. At the end of four weeks on the diets, blood was obtained in the fasting state from 16 rats in each group. The serum was ultracentrifugally fractionated into six classes of lipoproteins and analyzed for lipid composition and protein content. Disc gel electrophoresis using lipid and protein stains established that the various lipoprotein subclasses were reasonably free of adjacent density fractions. Although the total serum cholesterol levels were practically the same in the three groups, the cholesterol moiety of the major low density lipoproteins, LDL2 (d 1.019-1.050), but not of very low density lipoproteins, VLDL (d 1.006) or low density lipoproteins, LDL1 (d 1.006-1.019), was substantially and very significantly increased in rats fed the high level of corn oil as compared to the other groups. The concentration of the very low density lipoproteins was significantly lower in group C than in the groups A and B. The LDL2 concentration but not that of LDL1 was significantly greater in group C as compared to group A. The cholesterol/total lipid ratio was significantly greater in both LDL2 and LDL1 but not in VLDL of group C as compared with group A. The serum high density lipoproteins were relatively less influenced by the ingestion of an excessive level of corn oil at this time period. The serum lipoprotein levels as well as their lipid composition were generally similar in groups A and B and suggested that a moderate level (5%) of dietary linoleate did not cause any untoward changes in rats. On the basis of current information on the metabolism of lipoproteins, it has been proposed that the increase in rat serum LDL2 of group C reflects the status of the liver and that a large portion of the cholesterol moiety of LDL2 is perhaps derived from the liver while the protein and phospholipid portions may represent remnants of VLDL catabolism.(ABSTRACT TRUNCATED AT 400 WORDS)

Poliomyelitis trends in Pondicherry, south India, 1989-91.

STUDY OBJECTIVES: To assess the poliomyelitis trend, including study of the epidemiological features, and to correlate this with the immunisation coverage of infants. DESIGN: Three annual lameness surveys in children aged 0-60 months employing cluster sampling methods and a series of five cross sectional surveys of immunisation coverage in children aged 12-23 months of age were undertaken. SETTING: Pondicherry, India, 1988-92. SUBJECTS: More than 10,000 children in the age group of 0-60 months took part in the three annual lameness surveys and samples of 210 children aged 12-23 months were covered each year in immunisation coverage surveys. MEASUREMENTS AND MAIN RESULTS: Altogether 50 of 11,461, 24 of 10,093, and 17 of 11,218 children surveyed during 1989, 1990, and 1991 respectively had become lame as a result of poliomyelitis, giving prevalences of 4.4, 2.4, and 1.5 per 1000 children for the three surveys. The corrected prevalences of poliomyelitis were 5.9, 3.2, and 2.0 per 1000 children during 1989, 1990, and 1991 respectively. The proportion of cases aged up to 36 months fell from 48% in 1989 to 12.5% in 1990 and 6% in 1991. The age at onset was less than 1 year in most. The median age at onset was 10.7 months. About 54% of the affected children had received three doses of oral poliomyelitis vaccine (OPV) before the onset of paralysis. In 1988 immunisation coverage for the third dose of OPV was 91% and in 1992 it was 97.6%. The drop out rate for the first versus the third dose of OPV fell from 6.3 in 1988 to 1.9% in 1992. CONCLUSION: Three successive annual lameness surveys showed that poliomyelitis was declining between 1989 and 1991. Five immunisation coverage surveys conducted from 1988 to 1992 showed high initial coverage followed by an improvement in the form of almost universal coverage for OPV.

Serological response to tetanus toxoid: a field study in Pondicherry, India.

To study the serological response to various doses of tetanus toxoid given to pregnant women, 320 samples of blood obtained from 173 pregnant women were analysed using the indirect haemagglutination technique. Two doses of toxoid were necessary to achieve protective titres in women who were previously unimmunized. The antibody levels appeared to persist for up to 4 years. During a subsequent pregnancy, a single booster dose of toxoid was sufficient to raise the titres adequately for protection. These findings are in accordance with the immunization programme followed for prophylaxis against tetanus among pregnant women.

Time utilisation pattern of medical officers in Primary Health Centres of Pondicherry.

PIP: The time utilization pattersn of 6 medical officers in primary health centers in the Pondicherry region were recorded over a 6-day period. Time was classified as either productive or nonproductiveand distributed into 6 categories: 1) direct services, including acutal technical work performed; 2) support activities, primarily related to administration; 3) travel; 4) personal; and 5) away from duty. Overall, 53.3% of the time was classified as productive. Direct services accounted for an average of 36% of the medical officers' time, 23% was spent on supportive services, and personal activities and absenteeism comprised a further 37%. Medical care accounted for 70% of the direct service time and maternal and child health services for an additional 13%. Staff interaction absorbed the bulk of the supportive service time (29%), followed by liaison work (26%) and records a reports (20%). It is recommended that medical officers allocate some of their nonproductive time toward the following activities: 1) improving patient care and spending more time with individual patients, 2) upgrading school health and maternal and child health, 3) weekly field visits, 4) monthly staff meetings and on-the-job training programs, and 5) careful scrutiny of reports and records maintained by staff. In-service training on the delivery of primary health care and health administration can be expected to improve patient care.^ieng

The influence of some dietary factors and/or treadmill exercise on rat and chicken tissue lipids and serum lipoproteins.

Four different experiments, one with cockerels and three with rats, are described which relate to the effect of dietary factors and/or exercise on serum and liver lipids as well as on serum lipoproteins. Several classes of lipoproteins were isolated by preparative ultracentrifugation, and their purity assessed by gel electrophoresis. The lipid composition and protein content of serum lipoproteins and tissue were also determined. Dietary cholesterol produced an enormous increase (200 fold) in serum very low density lipoproteins in cockerels. This lipoprotein was apparently of very large particle size because it failed to penetrate the spacer gel during disc electrophoresis. In rats fed a cholesterol-supplemented diet, the increase in very low and low density lipoproteins was relatively insignificant in comparison with the cockerels. However, in both species, the liver was overloaded with cholesterol. Further, the serum high density lipoproteins, HDL2 were greatly diminished in both species as a result of cholesterol ingestion for 7 weeks. As a possible explanation for these related observations, it was proposed that HDL2 was utilized in the formation of cellular membranes by cholesterol-burdened, hyperplastic livers. A very high level of dietary corn oil (40% by weight) caused drastic changes in rat liver lipid levels and in serum lipoprotein profiles. Specifically, liver cholesterol and triglycerides were increased about 200% over normal. In another experiment, tissue lipids and serum lipoprotein levels were determined in treadmill-exercised rats and in sedentary controls. Two levels (4 and 40%) of a fat mixture (1:1, hydrogenated coconut oil: corn oil) were used in this study. The serum cholesterol was unchanged in the 4 groups, while the serum triglycerides were reduced in exercised rats given 4% but not 40% fat as compared to respective controls. Rats fed 40% fat and exercised had near normal levels of liver lipids which was in sharp contrast to their sedentary controls. The low denstiy lipoproteins were surprisingly higher in exercised rats given high fat than in sedentary controls. It was suggested that the direct synthesis of these lipoproteins by the liver may be necessitated under unusual conditions. In conclusion, considering the central role of liver in lipid and lipoprotein metabolism greater attention should be focused on this organ in future experiments on the control of hyperlipoproteinemia.

Symphysis-fundal height measurement--a reliable parameter for assessment of fetal growth.

Intrauterine growth retardation (IUGR) is one of the major causes of perinatal mortality in countries like India. Fundal height traditionally measured in relation to umbilicus and xiphisternum is of little value in predicting the fetal growth. Some workers have found that symphysis fundal height (SFH) measurements could be useful in screening pregnancies for growth retardation. A prospective study was taken up in 109 pregnant women attending the antenatal clinic of our Institution. Serial measurements of SFH, abdominal girth, double abdominal wall thickness (DAWT) and maternal weight gain were recorded. SFH measurements obtained were arranged on the basis of 10th, 50th and 90th percentile and represented graphically. Statistical analysis showed that the coefficient of variation was smallest for SFH as compared to abdominal girth and maternal weight gain. The babies (single born) delivered were between 2600 g and 3700 g irrespective of whether the maternal weight gain was 143 g/week or 424 g/week. The abdominal wall thickness had no influence on the measurement of SFH. An attempt was made to develop a nomogram of SFH for our population. This is a simple, reliable and inexpensive method in the screening of pregnancies for IUGR.

Byssinosis among male textile workers in Pondicherry: a case-control study.

BACKGROUND: In India, 20 million workers are involved in the manufacturing of textiles. However, there are few epidemiological studies from India that have assessed the magnitude or the risk factors associated with byssinosis. In Pondicherry, textile mills have been in existence for over a century. This case-control study aimed to find the factors associated with the development of byssinosis in textile workers. METHODS: The sample consisted of 761 men above the age of 30 years who had worked for at least 10 years in a textile factory. All the respondents were interviewed by a pretested questionnaire to gather information regarding the symptoms of byssinosis, certain personal characteristics and occupational history. Byssinosis was identified using the classification proposed by the World Health Organization. Two age-matched controls were selected for each case. RESULTS: Univariate analysis of the factors for symptomatic byssinosis showed that dusty worksites, heavy smoking and duration of service > or = 30 years were significant. Logistic regression analysis showed that working in the spinning (odds ratio 6.1) and weaving sections (odds ratio 1.9), heavy smoking (odds ratio 3.9) and > or = 30 years of service (odds ratio 2.0) were independent significant risk factors. CONCLUSION: Efforts to reduce dust levels in the working environment and to discourage smoking among textile workers need to be strengthened to minimize the risk of developing byssinosis.

Scorpion envenomation as a risk factor for development of dilated cardiomyopathy.

OBJECTIVES: Though scorpion envenomation is known to lead to acute myocarditis and a reversible decrease in left ventricular function, it has not been implicated as an etiological factor in idiopathic dilated cardiomyopathy. We studied the association of idiopathic dilated cardiomyopathy with a history of scorpion sting as well as with socio-economic status, history of smoking and alcoholism, rural habitation, and history of snake bites. METHODS: Consecutive cases of idiopathic dilated cardiomyopathy were recruited for this study: The association with putative risk factors was studied using a case-control study design with two sets of controls. One set of controls were age and sex matched inpatients selected at random, the other set of controls were spouse, or if not available, a close relative, ordinarily resident with the patient. RESULTS: On analysis, none of the factors except scorpion envenomation had a significant association. A past history of scorpion envenomation had an adjusted odds ratio of 8.01 (3.55-18.06) when compared to one set of controls and an odds ratio of 8.33 (6.55-10.59) when compared to the second group of controls. CONCLUSIONS: Our study indicates that a history of scorpion envenomation acts as a risk factor for the subsequent development of idiopathic dilated cardiomyopathy. Despite an apparently complete recovery from a scorpion sting, many patients probably retain sub-clinical deficits that predispose to the development of cardiomyopathy later in life, when other factors get added on. The known association of cardiomyopathy with catecholamine excess in experimental situations in animal studies, and in other disease states in humans, supports this hypothesis.

Infant mortality in Pondicherry--an analysis of a cohort of 8185 births.

Infant mortality rate is one of the 12 global indicators for monitoring Health for All. Reliable data on infant mortality are not available for the majority of developing countries including India. To plan strategies for bringing down the rate and, later, to evaluate them, 'Cause Specific Rates' would be necessary. Pondicherry has achieved low rates of infant mortality. A study was conducted in the Anganwadis of Pondicherry to determine the causes of infant deaths. The 8185 children born between 1-4-1987 and 31-3-1988 in Pondicherry formed the study group. The Anganwadi workers collected information on the cause of death for the 222 children dying within the first year. The infant mortality rate was 27.1 per 1000 live births. Acute respiratory infections and diarrheal diseases accounted for 45% of the deaths.

Prediction of dengue outbreaks in Kerala state using disease surveillance and meteorological data

Background: Dengue is one of the most serious and fast emerging tropical diseases. Its incidence of is influenced by many meteorological factors such as rain fall in mm, temperature, humidity etc. Information about these factors can be used to forecast the incidence of dengue fever cases in the next coming months.Methods: The current study was an analytical study using retrospective secondary data from Kerala state. The annual integrated disease surveillance reports of dengue fever cases. Rain fall data and mean monthly temperatures for a period of twelve years from 2006 to 2017 were used. Best fitted model was developed and accuracy of the prediction was tested. All analyses were performed in R software using the mgcv package and nlme package.Results: A total of 144 months study period from January 2006 to December 2017 was used for analysis. Five different models developed for prediction of dengue cases among them, best fitted model including optimal combination of meteorological variables and recent and long term transition of dengue was selected. Out of 84 months predictions in the training period, 68 months prediction was correctly negative, 5 months prediction was correctly positive, 2 months prediction was incorrectly negative and 9 months prediction was incorrectly positive.Conclusions: A better predictive generalized additive model can be developed using the optimal combination of meteorological predictors and dengue fever counts. It will enable the health care administrators to forecast future out breaks and to take better precautionary measures.