Τετάρτη, 28 Αυγούστου 2019

Lord Mountbatten's the last supper: How British empire botched up the future of India, Pakistan and Bangladesh
Raman Kumar

Journal of Family Medicine and Primary Care 2019 8(8):2555-2557

The Lancet, leading health science journal, has published a political editorial, raising interest in the impact of British colonization on the current status of development, economy and healthcare of the Indian subcontinent. Over two centuries, the East India Company and the British empire siphoned out at least £ 9.2 trillion; or $44.6 trillion; since the exchange rate was $4.8 per pound sterling during much of the colonial period. It is to be noted that the Indian expectation of life at birth was just 22 years in 1911. Food grain was available, however the purchasing power of ordinary Indians was being squeezed. The per capita annual consumption of food grains went down from 200kg in 1900 to 157kg on the eve of World War II, and further down to 37kg by 1946. The Indian sub-continent has still not come out of the systemic malnutrition inflicted upon the population. Today less than two billion people, a quarter of earth's population, live in India, Pakistan and Bangladesh. The landlocked populations of these countries are known as the black hole of humanity waiting for ultimate catastrophe; natural or man-made humanitarian crisis. What happens to these countries now was determined long before and planned by the British empire when their representatives packed bags and transferred power to the local natives. The partition of India was the most tragic human genocide artificially perpetrated in human history. More than 14 million people were displaced and close to two million people died or went missing. It was the parting gift by the British empire to the people of India. This was more tragic than the holocaust. A permanent scar and hatred that would not heal even after a century was created by the British empire. The 200 years of anti-incumbency and hatred against the British was forgotten and used to build a civil war. Enough hatred was fumed between the native population of India and Pakistan. This hatred was further institutionalized between the two countries having separate militaries. It was a grand exit plan for the empire leaving behind no traces of crime and keeping the pride and benevolence intact. After seventy years, it is important to revisit the political circumstances prevailing during colonial period. It is important for the people India, Pakistan and Bangladesh to think about future and not be victim of the political plan rolled out as an exit plan by the empire. 

Personal or family history of metabolic traits predispose to higher hepatotoxic effects of alcohol
Ajeet Singh Bhadoria, Surabhi Mishra, Kanchan Gawande, Raman Kumar

Journal of Family Medicine and Primary Care 2019 8(8):2558-2560

World Health Organization Global Status 2018 Report on alcohol and health states that global total alcohol per capita consumption has drastically risen from 2005 to 2016. Presence of inherited metabolic traits (MTs) such as diabetes, hypertension, and obesity predisposes to early and more severe liver damage, even with smaller quantity and shorter duration of exposure to alcohol. This editorial highlights the need for screening of individuals with either addiction of alcohol or alcoholic liver disease for personal and family history of diabetes, hypertension, obesity, and other MTs for risk stratification and specific interventions. Health education and awareness regarding deleterious effects of alcohol among those who have a personal or family history of MTs should be ensured. 

#1WordforFamilyMedicine Korea and 2018 WONCA World Conference highlights
Kyle Hoedebecke, SeoYoung Kang, Eonchi Shin

Journal of Family Medicine and Primary Care 2019 8(8):2561-2562

Primary palliative care competency framework for primary care and family physicians in India-Collaborative work by Indian Association of Palliative Care and Academy of Family Physicians of India
Shrikant Atreya, Jenifer Jeba, Nikki Pease, Ann Thyle, Scott Murray, Alan Barnard, Dan Munday, Lulu Mathews, Mhoira Leng, Gayatri Palat, Alka Ganesh, Sulagna Chakraborty, Sahaya Anbarasi, Raman Kumar, Maryann Muckaden, Elizabeth Grant

Journal of Family Medicine and Primary Care 2019 8(8):2563-2567

The discrepancy in the demand for palliative care and distribution of specialist palliative care services will force patients to be eventually cared for by primary care/family physicians in the community. This will necessitate primary care/family physicians to equip themselves with knowledge and skills of primary palliative care. Indian National Health Policy (2017) recommended the creation of continuing education programs as a method to empower primary care/family physicians. With this intention, a taskforce was convened for incorporating primary palliative care into family/primary care practice. The taskforce comprising of National and International faculties from Palliative Care and Family Medicine published a position paper in 2018 and subsequently brainstormed on the competency framework required for empowering primary care/family physicians. The competencies were covered under the following domains: knowledge, skills and attitude, ethical and legal aspects, communication and team work. The competency framework will be presented to the National Board of Examinations recommending to be incorporated in the DNB curriculum for Family Medicine. 

Health problems in healthcare workers: A review
Aroop Mohanty, Ankita Kabi, Ambika P Mohanty

Journal of Family Medicine and Primary Care 2019 8(8):2568-2572

Much has been written about the well-being and quality of patients in recent years but little attention has been focused on well-being of healthcare workers (HCWs) who provide comprehensive healthcare to patients. It has been found that the HCWs are more stressed because of less staffs, increasing work load, longer working hours, high clientele expectation and peculiar problems and hazards of work place. There is increased morbidity in HCWs in comparison to general population. Though they are aware, measures of well being, engaging the HCWs in promotion of their workplace and making changes to enhance its realization needs to be done to improve their health by themselves, at administrative and institutional level. 

Medical students' life and virtual social networks a guide for educational managers and parents
Yousef Mehdipour

Journal of Family Medicine and Primary Care 2019 8(8):2573-2576

Introduction: Social networks have revolutionized the world. Students in Iran after entering the university often enter the college far from family, so the effects of such networks become more evident during the students' period. However, considering the role of the university in the training of specialist human resources, the researcher in this study, the status and application of virtual social networks in the life of students of Zahedan University of Medical Sciences were studied. Materials and Methods: This is a descriptive-analytical study that was conducted cross-sectional in 2018. All students of Zahedan University of Medical Sciences were the statistical population (4,600) that a sample of 900 people was selected as the final sample. The data gathering tool was a researcher-made questionnaire. To determine the content validity of the questionnaire and its confirmation, the opinions of professors and experts were used, and its reliability was measured by a test-retest method and confirmed by Cronbach's alpha (0/75). After data collection, SPSS software version 16 was used to analyze the data. Results: The average daily student use of social networks was 2 h and 40 min, most of them were subscribed to Telegram, and connecting with friends was the main motive for joining social networks. There was no significant relationship between the use of social networks and the average student's lessons and also most of them had a moderate dependence on the Internet and had a high dependence on the social networks. In addition, there was a significant difference between Internet dependence and the gender of students. Conclusion: A large percentage of students have become members of various social networks. There was excessive and unplanned use of the internet and social networks among them. Hence, by creating good opportunities and attractive social activities in universities to provide more participation of students in the real world, this can provide suitable times for them and prevent their dependence on virtual social networks. 

Determination of antifungal minimum inhibitory concentration and its clinical correlation among treatment failure cases of dermatophytosis
Vinod K Maurya, Dileep Kachhwaha, Archana Bora, Prabhat K Khatri, Laxmi Rathore

Journal of Family Medicine and Primary Care 2019 8(8):2577-2581

Introduction: Dermatophytes are most common infectious agents causing superficial mycosis worldwide. A number of topical as well as systemic antifungal drugs are available for treatment of dermatophytosis. Superficial mycosis caused by dermatophytes can be easily treated by topical or oral antifungal drugs, but in the course of time, an increased number of treatment failure cases are appearing. Possible cause for treatment failure could be poor patient compliance, poor drug penetration into affected lesion, and also drug resistance in dermatophytes. The aim of this study is to investigate minimum inhibitory concentration and clinical correlation in treatment failure cases of dermatophytosis. Methods: Skin, hair and nail samples were collected from treatment failure cases of dermatophytosis. A total 75 isolates were tested for MIC against four antifungal drugs in the study. Fluconazole, itraconazole, ketoconazole and terbinafine were the antifungal drugs tested using broth microdilution method. MIC50 and MIC90values were recorded. Results: A total of 75 dermatophytic isolates were tested. Dermatophytic isolates in this study were Trichophyton mentagrophytes (n = 31), T. rubrum (n = 13), T. tonsurans (n = 12), T. verrucosum (n = 9), M. gypseum (n = 5), E. floccosum (n = 4) and T. violaceum (n = 1). MIC90 value for fluconazole and terbinafine was significantly higher. Conclusion: MICof 17.33% isolates for fluconazole and 33.33% isolates for terbinafine were lower than cut-off value, which indicates that not all treatment failure cases are due to drug resistance. 

Factors influencing the use of modern contraceptive methods among rural women of child bearing age in the Democratic Republic of the Congo
Freddy Rukema Kaniki

Journal of Family Medicine and Primary Care 2019 8(8):2582-2586

Context: This study reports the unique findings of factors influencing the use of modern contraceptives (MC) among women of childbearing age in Minembwe, a rural community of the Democratic Republic of the Congo. Aims: The study aimed at assessing the contributing factors to the use of MC in African rural communities. Methods and Materials: This descriptive study used a structured questionnaire to collect primary data distributed to women after obtaining their consent. Statistical Analysis Used: The data collected were analyzed using IBM-SPSS version 21.0. Results: Totally, 370 respondents comprising 53.2% women of over 30 years of age. All the 18 health facilities were stock out for both implants and injectable contraceptives during the study period. There were only 3 Medical doctors, 84 Nurses, and 180 other healthcare workers in a population of 86,153 including 18,092 women in reproductive age. About 22.0% spend between 31 and 45 minutes walking to the nearest healthcare facility. The majority (85.7%) of the women did not use any contraceptive. The major factors influencing the uptake of MC are religion inclination (67.4%) disapproval by husbands (40.9%), fear of health problems/side effects (32.6%), and the urge to have more children (20.5%). Conclusions: There is a need to further enlighten women of rural African communities on the need to use MC methods for birth control and other benefits. There is a need to enlighten the religious and traditional leaders and the community to support the use of family planning in order to minimize maternal and child mortality rate. 

Comparison of salivary epidermal growth factor in patients with recurrent aphthous stomatitis, smokers, and healthy individuals
Fatemeh Rezaei, Erfan Hosseini, Farzad Rezaei

Journal of Family Medicine and Primary Care 2019 8(8):2587-2591

Background: Recurrent aphthous stomatitis (RAS) is one of the most common oral ulcerative diseases with unknown etiology. Epidermal growth factor (EGF) has been suggested to play a similar role in RAS. Therefore, this study investigated the salivary EGF level in patients with RAS, the patients without RAS, and smokers. Materials and Methods: A total of 91 samples were recruited in this case-control study: 30 RAS patients, 30 controls, and 31 smokers. Age and gender were matched in the groups. In the case group, the salivary sample was taken during the infection and remission periods. Salivary EGF concentration was measured by Crystal Dibiotic assay (made in China) using ELISA technique. Finally, the data were analyzed by SPSS software (Version 18.0, Inc., Chicago, IL, USA). Results: The results of paired t-test showed no statistically significant difference in salivary EGF between the infection and remission periods (P = 0.987). ANOVA test showed a statistically significant difference in EGF between the study groups (P < 0.001), as the mean salivary EGF was significantly lower in the smokers than the case and control groups during the infection and remission periods. Conclusion: The present study showed a lower level of salivary EGF in the smokers without a history of RAS. There was no statistically significant difference between the infection and remission periods in salivary EGF in the patients with RAS. Furthermore, salivary EGF showed no statistically significant difference between the patients with RAS and the controls. 

Impact of practice modification on oral health status of students: An interventional study from a tribal area of India
Aritra K Bose, CP Anusha, Dilip Dhaku Kadam, Lekshmi A Neethu

Journal of Family Medicine and Primary Care 2019 8(8):2592-2596

Context: Tooth decay precipitated by poor oral hygiene is one of the most common oral diseases that affect 60–90% of school children. It not only interferes with speech, self-esteem but pain caused by decay also affects nutrition intake, resulting in malnutrition with abnormal cognitive development. Aim: To evaluate the impact of health education and supervised brushing intervention on their oral health status. Settings and Design: Cross-sectional interventional study. Methods and Materials: The study was conducted on students of class 8th, 9th, and10th of an Ashramshala (tribal residential school). All the students present in the school on the day of data collection were included in the study. A semistructured questionnaire was used for data collection. A qualified dentist, who is part of research team, conducted oral examination of the students. They were asked to demonstrate their brushing method and relevant observation was noted. The oral health status of the students was analyzed using DMF (decayed, missed, and filled) index and oral hygiene index- simplified score (OHI-S). Three training and educational sessions of one hour each were conducted separately for each class and a separate session was conducted for the teachers and caretakers of the school. Thereafter, randomly selected students (peers) were asked to demonstrate the technique to their peers to ensure proper understanding. Compliance was ensured through weekly follow ups to the school by the research team. DMF score and OHI-S were recalculated after 3 months and compared with their previous scores. Statistical Analysis: Chi-square test, one-way analysis of variance and paired t-test were used for analysis. Results: The mean DMF and OHI-S score of the students was 2.61+/-2.309 and 2.11+/-0.96, respectively. A significant change (P = 0.021) in OHI scores was observed as a result of intervention. Conclusions: Promoting healthy dental practice with supportive supervision form the cornerstone for good health and hygiene. 

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