Doctors Attitude towards Sexual Health Problems - A Practise Survey.

BACKGROUND: Sexual problems are common in the society. But the medical professionals are reluctant to address sexual health issues. In this study we are assessing the attitude of medical practitioners towards various sexual health issues. METHODS: : The study used anonymous self-responsive questionnaire survey of hundred medical practitioners from various parts of Kerala. Medical practitioners were asked to respond to various questions regarding their area of practise, their training in sexual medicine and about their perception and attitude towards patients' sexual health problems. Data collected and basic descriptive statistics were calculated. RESULTS: Out of 125 anonymous self-responsive survey questionnaires send to medical practitioners, we received hundred completed responses. Only 18% reported that they had some training in sexual medicine. Most of the medical practitioners are having the opinion that sexual problems are common in the society and only very few percentage (about 4%) seek help from medical practitioners regarding their sexual health issues. Anxiety and inhibition from the patient side to disclose and lack of privacy in the busy OPD are the major obstacles which prevent patients to seek medical help. Majority of doctors are reluctant to ask about their patients sexual issues. The participants identified that lack of time and privacy in the busy OPD and lack of proper training to address sexual issues are the major factors that prevent doctors from addressing sexual issues in their day to day clinical practice. CONCLUSION: Sexual issues are common in the society. This study identified gaps in sexual health training among medical professionals in Kerala. Lack of proper training to address the sexual health issues is a major obstacle in managing sexual problems which can be addressed by improving training in sexual medicine to both medical students and medical practitioners.

Quality of life and sociodemographic factors associated with poor quality of life in elderly women in Thiruvananthapuram, Kerala.

BACKGROUND: India is going through a phase of demographic transition leading to population aging and feminization of aging resulting in increased proportion of elderly women than men. Problems faced by the elderly women are more critical than men due to family and social conditions prevailing in India. OBJECTIVE: The study made an attempt to assess the quality of life (QOL) using the World Health Organization QOL (WHOQOL-BREF) scale and sociodemographic factors affecting QOL of elderly women residing in a community setting in South Kerala. METHODS: A community-based, cross-sectional study to assess the QOL of elderly women using WHOQOL-BREF questionnaire. Data were collected from 160 elderly women. RESULTS: 2.5% (95% confidence interval [CI]: 0.07-4.84) of the study participants were having "very good" QOL. 38.8% (95% CI: 31.2-46.4) had "good," 43.1% (95% CI: 35.4-50.8) had "poor," and 15.6% (95% CI: 9.98-21.22) had "very poor" QOL, respectively. QOL was least in the psychological domain followed by physical and health-related, social, and environmental domains. Logistic regression revealed age above 70 years (adjusted odds ratio [OR] - 11.3), nonpossession of property (adjusted OR - 8.99), neglecting attitude by family (adjusted OR - 6.9), and absence of visit by friends and relatives (adjusted OR - 9.9) as risk factors, whereas residing in the urban area as a protective factor (adjusted OR - 0.1) for poor QOL. CONCLUSION: It is possible to improve the QOL of elderly women by providing financial security, ensuring care, and by enhancing social relationships of elderly women.

Summary of the National Cancer Institute 2023 Virtual Workshop on Medical Image De-identification-Part 1: Report of the MIDI Task Group - Best Practices and Recommendations, Tools for Conventional Approaches to De-identification, International Approaches to De-identification, and Industry Panel on Image De-identification.

De-identification of medical images intended for research is a core requirement for data-sharing initiatives, particularly as the demand for data for artificial intelligence (AI) applications grows. The Center for Biomedical Informatics and Information Technology (CBIIT) of the US National Cancer Institute (NCI) convened a virtual workshop with the intent of summarizing the state of the art in de-identification technology and processes and exploring interesting aspects of the subject. This paper summarizes the highlights of the first day of the workshop, the recordings, and presentations of which are publicly available for review. The topics covered included the report of the Medical Image De-Identification Initiative (MIDI) Task Group on best practices and recommendations, tools for conventional approaches to de-identification, international approaches to de-identification, and an industry panel.

Pediatric Autoimmune Pancreatitis: A Single-Center Retrospective Case Series.

OBJECTIVES: Autoimmune pancreatitis (AIP) is a rare form of a chronic, immune-mediated, inflammatory pancreatic condition. There is limited data regarding presentation and outcome in the pediatric population. We described a single-center case series of 4 pediatric patients with AIP to better understand the presentation, symptoms, and outcomes of this rare condition. METHODS: Data collected included demographics, serology markers, symptoms at presentation, imaging, additional organ involvement, histology, treatment methods, and outcomes. The diagnosis of AIP was made by a combination of serology, pancreatic imaging, histology, extrapancreatic manifestations, and steroid response. RESULTS: All patients were diagnosed with type 2 AIP. Abdominal pain, emesis, and obstructive jaundice were the most common symptoms at presentation. Autoimmune markers were negative. Cross-sectional abdominal imaging showed diffuse/focal pancreatic gland enlargement and common bile duct stricture universally and main pancreatic duct irregularity in half of the patients. Biopsies showed lymphoplasmacytic infiltration with associated pancreatic fibrosis and atrophy. Treatment with an 8-week tapering course of prednisone showed prompt response with resolution of symptoms and normalization of laboratory test results. CONCLUSIONS: Our case series shows that AIP in children is a rare entity with a distinct clinical presentation, classical radiographic and histological features with good long-term prognosis.

Obesity Burden and Physical Activity Pattern Among Doctors in South India.

Context: A career as a doctor makes him prone to develop health issues like obesity and obesity-related noncommunicable diseases. Aims: This study aims to find the burden and determinants of obesity among Modern Medicine doctors in Kerala. Settings and Design: We conducted a cross-sectional study among 240 doctors working in South Kerala from 2018 to 2019. Methods and Material: The sample size was calculated using a formula and stratified random sampling was done for the selection of study participants. An interviewer-administered structured questionnaire was used for data collection. Physical activity was measured using International Physical Activity Questionnaire. Statistical Analysis: Data were entered in MS Excel and was analyzed using Statistical Package for Social Sciences version 26.0. The significance of association was tested using the χ2 test. Binary logistic regression was done to predict the factors associated with overweight and obesity. Results: Out of 240 study participants, 128 (54%) were females and 112 (46%) were males. Among the 240 doctors, 54% (114) were either overweight or obese. A low level of physical activity was reported among 54.5% of doctors. Male gender odds ratio (OR) = 2.8 (95% confidence interval [CI] = 1.29-6.06), nuclear family OR = 2.7 (95% CI = 1.32-5.42), daily hours of sleep <6 hours OR = 4.92 (95% CI = 2.29-10.5), history of obesity among parents OR = 3.54 (95% CI = 1.04-12.02), reported the presence of private practice OR = 3.34 (95% CI = 1.25-8.96), and holding a graduation degree alone were found to be significantly associated with obesity. Conclusions: The study found that majority of the doctors (55%) were either overweight or obese. Awareness and behavior change communication among doctors on modifiable risk factors like having adequate sleep and reducing the hours spent in private practice is needed to reduce the burden of obesity among doctors.

Impediments to Optimal Health-care Utilization of a Particularly Vulnerable Tribal Group in Wayanad: A Qualitative Study.

INTRODUCTION: The pathways and mechanisms through which constraints that impede optimal utilization of the government health-care service provisions translate into health inequities among Particularly Vulnerable Tribal Groups seem to be an area that warrants research. OBJECTIVE: The objective is to explore and understand the mechanisms/pathways through which various factors result in health care inequity among the Kattunayakan tribe in Wayanad. MATERIALS AND METHODS: Designed as a qualitative case study, using observations and interviews with mothers, community members, and frontline health-care personnel, the study was conducted in a Kattunayakan hamlet in Wayanad. The data, in the form of digital audio recordings and field notes, were transcribed, coded, and analyzed using a thematic approach. RESULTS AND DISCUSSION: Axes of inquiry like access to health-care institutions, acceptability of the services provided, hurdles faced by the tribes, the health-care personnel, and how the system responded to these issues were explored. Disregard for the identity and culture of the tribes, geographical barriers for utilization and providing health services, proactive efforts from government systems, collaborations with private and professional bodies are important factors that possibly influence health inequities among tribes. CONCLUSION: Acknowledgment of the sociocultural identity of the tribes, gaining their trust, proactive efforts from the government machinery, innovative context-specific programs, strategic partnerships and a departure from the "blame the victim" philosophy are key in the effort to provide services that meet the health-care needs of the tribes.

Analysis of psychological characteristics impacting spinal cord stimulation treatment outcomes: a prospective assessment.

BACKGROUND: Psychological factors are recognised as influencing the outcome of spinal cord stimulation (SCS) although there is currently no consensus as to which factors impact upon SCS efficacy. OBJECTIVE: To identify psychological characteristics that may impact the efficacy of SCS. STUDY DESIGN: Prospective evaluation. SETTING: Single secondary care center in Dudley, United Kingdom. PATIENTS: Seventy-five patients were initially recruited and 56 patients (31 women and 25 men) were followed-up for 12-months. INTERVENTION: SCS for the management of chronic non-cancer pain. MAIN OUTCOME MEASURES: Outcome measures assessed at baseline, 6 months, and 12 months following SCS implantation included the visual analogue scale (VAS), Oswestry disability index (ODI), hospital anxiety and depression (HAD) scale, and the pain coping strategies questionnaire (PCSQ). RESULTS: Statistically significant improvements were observed for the VAS (P < 0.001), ODI (P = 0.011), anxiety (P = 0.042), and depression (P = 0.010) in the HAD scale and for the subscales reinterpreting pain sensation (P = 0.018), control over pain (P = 0.001), and ability to decrease pain (P < 0.001) of the PCSQ. We observed that depression and autonomous coping (control over pain, ability to reduce pain, and catastrophizing) may impact sensory aspects such as pain intensity and disability scores affecting the outcome of SCS treatment. Age at time of implant and duration of pain prior to implant were also found to impact SCS efficacy. LIMITATIONS: It has been reported that loss of analgesia may be experienced within 12 to 24 months following SCS implantation and therefore, it would be of interest to follow patients over a longer period. CONCLUSIONS: This study demonstrates that psychological aspects such as depression and autonomous coping may impact SCS treatment. Addressing these issues prior to SCS implantation may improve SCS long-term outcome.

Clinical Profile of Chikungunya Patients during the Epidemic of 2007 in Kerala, India.

BACKGROUND: The association of the present Chikungunya pandemic with a mutation in the Chik virus is already established in many parts of the world, including Kerala. Kerala was one of the worst-affected states of India in the Chikungunya epidemic of 2006-2007. It is important to discuss the clinical features of patients affected by Chikungunya fever in the context of this change in the epidemiology of the disease. AIM: This study tries to analyze the clinical picture of the Chikungunya patients in Kerala during the epidemic of 2007. SETTING AND DESIGN: A cross-sectional survey was carried out in five of the most affected districts in Kerala, India. MATERIALS AND METHODS: A two-stage cluster sampling technique was used to collect the information. Ten clusters each were selected from all the five districts, and the size of the clusters were 18 houses each. A structured interview schedule was used for data collection. Diagnosis based on clinical signs and symptoms was the major case-finding strategy. RESULTS AND CONCLUSION: Of the 3623 residents in the surveyed households, 1913 (52.8%) had Chikungunya clinically. Most of the affected were in the adult age group (73.4%). Swelling of the joints was seen in 69.9% of the patients, followed by headache (64.1%) and itching (50.3%). The knee joint was the most common joint affected (52%). The number of patients with persistence of any of the symptoms even after 1 month of illness was 1388 (72.6%). Taking bed rest till the relief of joint pain was found to be a protective factor for the persistence of the symptoms. Recurrence of symptoms with a period of disease-free interval was complained by 669 (35.0%) people. Older age (>40 years), a presentation of high-grade fever with shivering, involvement of the small joints of the hand, presence of rashes or joint swelling during the first week of fever and fever lasting for more than 1 week were the significant risk factors for recurrence of symptoms predicted by a binary logistic regression model. In conclusion, we found that there is substantial acute and chronic morbidity associated with the Chikungunya epidemic of 2007.

Determinants of childhood tuberculosis--a case control study among children registered under revised National Tuberculosis Control Programme in a district of South India.

AIM: To study the determinants of Tuberculosis (TB) in children between the age group of 0-14 years receiving treatment under Revised National TB Control Programme (RNTCP). METHODS: A case (registered under RNTCP) control study was undertaken with 41 cases and 82 controls. RESULTS: Factors found to have significance according to binary logistic regression were low-birth weight (LBW) [Odd's ratio = 3.56],Malnutrition [Odd's ratio = 3.96], Passive smoking [Odd's ratio=6.28] and exposure to fire-wood smoke [Odd's ratio = 6.91]. CONCLUSION: LBW, malnutrition, passive smoking and fire-wood smoke are the risk factors to be addressed to prevent pediatric TB.