Healing the heart of healthcare: Leaving no one behind: Impact of 15th World Rural Health Conference New Delhi Raman Kumar, Pratyush Kumar Journal of Family Medicine and Primary Care 2019 8(10):3077-3082 More than a 1,000 delegates from 40 countries participated in the 15th WONCA World Rural Health Conference held at India Habitat Centre, New Delhi, from 26-29th April, 2018. The theme of this conference was “Healing the Heart of Healthcare - Leaving no one behind”. The conference was organized by the Academy of Family Physicians of India in association with WoRSA - WONCA Rural South Asia. WONCA is the World Organization of Family Doctors. The conference aspired to bring rural healthcare on global agenda. SDG 3 though focuses on healthcare; however rural healthcare hasn't been emphasized enough. The conference was formally endorsed by the National Health Mission (NHM) under Ministry of Health and Family Welfare (MOHFW) and the Niti Ayog – the National Policy Commission under Government of India. An extensive scientific program with 13 keynote speakers, 250 oral presentations, 85 e-posters, 60 workshops, 26 Ideathon presentations, 20 panel discussions and 10 symposiums spread over 8 parallel meeting rooms, ran over 4 days, kept the delegates engaged throughout. A national consultation on strengthening rural health care witnessed rural health experts from across the world deliberating on rural health challenges and solutions. Niti Ayog – the policy commission the highest policy making body in India cohosted a national consultation on strengthening rural healthcare in India, during this conference. The conference brought together stakeholders of rural health and primary health care, to address current and future challenges in rural health. The conference culminated with the unanimous adoption of the Delhi Declaration, calling for people living in rural and isolated parts of the country to be given special priority if nations are to achieve universal health coverage. The Declaration identifies six areas as priorities to achieve “Health For All Rural People”: equity and access to care, rural proofing of policy, health system development, developing and educating a workforce fit for purpose, realigning the research and people and communities. Delhi declaration was also featured acknowledged by the World Health Organization at its website as an positive outcome.

Camel milk for reduction of diabetes risk: Are we heading toward the right direction? Komal Shah, Sandul Yasobant, Deepak Saxena Journal of Family Medicine and Primary Care 2019 8(10):3083-3085 Diabetes is emerging as an important public health problem in India imparting huge burden on healthcare economics. Recently a milk packaging company has introduced camel milk product with its potential use in reducing risk of diabetes. In this study, we had evaluated the available evidences and found that though camel milk may have some benefits for the patients with type 1 diabetes, its efficacy for improving glycemic profile of type 2 diabetes is highly controversial and further evidences in the form of randomized controlled trials are needed to substantiate the effect.

Role of social marketing in promoting primary care to succeed in current era Arti Gupta, Navya Krishna Naidu, Rakesh Kakkar Journal of Family Medicine and Primary Care 2019 8(10):3086-3089 Social marketing has expanded its purview in the modern era aiming at a behavioral change of target audience on a large scale. Public health practitioners now admit the value of community-based approaches to social change. Three main patterns of health education materials are social marketing communication material, information and education communication (IEC) material, and behavior change communication (BCC) material. Social marketing is a strategy based on marketing principles of selling products. The communication material suggests that the healthcare option for a particular disease is the best solution, and therefore choice or critical thinking is not necessary. IEC strategy attempts at informing people and increasing their knowledge about a disease, having them use it as a basis for action. BCC strategy promotes individual change leading to healthy community behavior. Social marketing communication material for communities should be creative, innovative, original, with clear messages in English and other local languages, reproducible, acceptable, and reflective. Primary care requires customizing health education material using translatable strategies based on social marketing to change health-care patient behavior for wellbeing. The concept of social marketing should be emphasized in early medical education. In the present times, doctors and medical students should be informed about different communication strategies to transform communication material into program tools to achieve health.

Disaster and its impact on mental health: A narrative review Nikunj Makwana Journal of Family Medicine and Primary Care 2019 8(10):3090-3095 The purpose of this study is to understand the linkages between disaster and its impact on mental health. To fulfil this objective, an attempt has been made to examine the existing qualitative literature on disaster and mental health. In this paper, disaster and mental health as a concept has been used in a holistic sense. Based on the review of literature, the following broad themes have been identified: natural disaster and its impact on mental health, man-made disaster and its effect on mental health, effects of industrial disaster on mental health. It examines the post-disaster behavioural and psychological symptoms associated with an impairment in functioning. By this review, various protective factors, including resilience and other coping strategies which amplified the individual's capacity while encountering negative situations, have been identified. The effectiveness of post-disaster intervention techniques is also highlighted. Better preparedness and community empowerment can improve the condition of the vulnerable population affected by the disaster. Thus, efforts should be given for holistic rehabilitation of the affected population.

Capacity and confidence building for general practitioners on optimum insulin use Sanjay Kalra, Prasun Deb, Kalyan K Gangopadhyay, Sunil Gupta, Abhay Ahluwalia Journal of Family Medicine and Primary Care 2019 8(10):3096-3107 Type 2 diabetes is characterised by a progressive decline in insulin secretion, and sooner or later patients require insulin therapy. However, physicians are reluctant to initiate insulin therapy because of perceived inadequacy in managing insulin therapy, cost and lack of benefits. Experts from across the country met at a workshop during 12th National Insulin Summit which was held in September at Hyderabad and came up with key recommendations to build capacity and confidence in general practitioners for insulin usage. Barriers can be overcome through self-education and training; effective patient education; imparting coping skill training to patients; and bridging gaps to improve adherence. Moreover, optimum insulinization requires knowledge about the available options for initiation and intensification of insulin therapy; various insulin regimens; dosing and titration; and choosing effective and simple insulin therapy as per patient characteristics. Hence, the objective of this review article is to help build capacity and confidence among general practitioners on optimising insulin therapy.

Interventions in management of dental fluorosis, an endemic disease: A systematic review Nor Syakirah Binti Shahroom, Geo Mani, Mahesh Ramakrishnan Journal of Family Medicine and Primary Care 2019 8(10):3108-3113 Objective: Mottling and pitting of enamel due to excess fluoride consumption may affect one's self-esteem due to unaesthetic appearance and also in turn can affect the quality of life. This present study was conducted to assess various treatment approaches available for patients with dental fluorosis. Materials and Methods: Literatures were searched from August 1998 to August 2019 for articles in the management of dental fluorosis. The databases used were National Center for Biotechnology Information (NCBI) and Google Scholar. In NCBI, the filters were modified to randomized controlled trial, clinical trial, human trial, and free full-text articles. The following queries were used in order to search for the article: treatment for dental fluorosis, intervention of dental fluorosis, and management of dental fluorosis. Results: All the five studies selected after screening were randomized controlled trials. Total number of patients included in this study were 304 with the mean age of 17.7 years old. They were treated with microabrasion, bleaching, resin infiltration or combination of microabrasion with bleaching, and resin infiltration with bleaching. Microabrasion resulted in less esthetic improvement compared with bleaching. Meanwhile, resin infiltration showed a greater improvement in esthetics in comparison to bleaching. Resin infiltration with additional infiltration time and combination of resin infiltration with bleaching are the best treatment options. Conclusion: Based on this systematic review, resin infiltration with increased infiltration time is the best treatment approach in treating dental fluorosis.

Health-promoting school in India: Approaches and challenges Yogesh K Jain, Nitin K Joshi, Pankaj Bhardwaj, Praveen Suthar Journal of Family Medicine and Primary Care 2019 8(10):3114-3119 Interventions early in life are the need of the hour when it comes to controlling the rising incidence of communicable and non-communicable diseases (NCDs) globally. WHO has issued guidelines towards health promotional initiatives at schools as a part of Global School Health Initiative, and the Government of India has directed many policies and programs to integrate health deep within the school activities. School Health Promotion is an international need with programmes implementing across continents due to numerous documented benefits, to not just the individuals but to the community and country as a whole. Simple teachings like hand hygiene have shown to reduce the incidence diarrhea by more than 50% amongst children (a major cause of mortality in India), thus raising an urgent need of developing a model for health promotion at schools that is replicable, sustainable, and can be modified to the local needs as well. Though the existent programmes have a few documented challenges, a multisectorial involvement of government agencies, educational boards, and health sector along with the school is the way forward to address those challenges and covert the theory of health promoting schools (HPS) into a well-established fact. It presents a scope for the various established and newly emerging Schools of Public Health in the country to come forward and collaborate with these multiple sectors. These collaborations can be the only way to ensure sustainability and incorporation of health promotion into the core academic structure of schools in a diverse and highly populous country like India.

Association of leukemia and mitochondrial diseases—A review Ashwani Sachdeva, Jagadish Prasad Rajguru, Kanwardeep Sohi, Swati Saggar Sachdeva, Kirandeep Kaur, Rani Devi, Vivek Rana Journal of Family Medicine and Primary Care 2019 8(10):3120-3124 Mitochondria play an important role in various metabolic pathways like oxidative phosphorylation free radical generation and apoptosis. Defects in mitochondrial function are responsible for a number of heterogenous clinical presentations along with development and progression of cancer. Decrease in cellular energy (ATP) production because of impaired oxidative phosphorylation is the most important cause for these underlying disorders. The present review article aims to provide current understanding of mitochondrial genetics and biology and relates the mt-DNA alterations in leukemia patients.

A notorious vector-borne disease: Dengue fever, its evolution as public health threat Vineet K Pathak, M Mohan Journal of Family Medicine and Primary Care 2019 8(10):3125-3129 Dengue fever, the most notorious of vector borne diseases is under global resurgence. Incidence has increased 30 fold with global expansion. It is thus imperative to review the origin, history and current epidemiology of dengue, its transmission, factors responsible for resurgence, surveillance and the treatment options available. India being hyperendemic, national level comprehensive studies to estimate the true burden of dengue along with its geographical mapping is the need of the hour. Through integrated and combined efforts from various sectors and policy makers, prevention of dengue must be identified and intensified to control further disease transmission as there is no specific antiviral treatment or vaccine against dengue is available in India.

Role of epidemiological risk factors in improving the clinical diagnosis of streptococcal sore throat in pediatric clinical practice Kapil Bhalla, Parveen Bhardwaj, Ashish Gupta, Shuchi Mehra, Deepak Nehra, Sanjiv Nanda Journal of Family Medicine and Primary Care 2019 8(10):3130-3135 Background and Aims: Antibiotics are frequently prescribed for sore throat in developing countries, that in turn leads to huge healthcare expenditure and their irrational use may lead to antimicrobial resistance in the community. The aim of this study is to investigate the effect of environmental factors on the frequency of occurrence of group A beta hemolytic streptococcus (GABHS) sore throat and to work out enhancing effect on the sensitivity and specificity and positive predictive value of the signs and symptoms of GABHS sore throat for facilitation of rational antibiotic use. Settings and Design: This was a prospective, cross sectional study conducted over period of one year in Pediatric Outpatient Department (OPD) of a Tertiary care teaching hospital. Methods: All the children between the age of 5 years and 15 years of age presenting in OPD with the signs and symptoms of sore throat were included in the study. Statistical Analysis Used: Statistical analysis was carried out by using Statistical Package for Social Sciences software and statistical tests of Pearson's Coefficient, Chi-square Test, Fischer's Test, Likelihood Ratio, Odds Ratio, and ROC Curve were applied. Results: Out of 225 children of the study group, 153 (68%) of the children were in the 5-10 years' age group. Positive throat swab culture was found to be positively associated with high grade fever, pain in throat while swallowing, severely enlarged tonsils, tender lymphadenopathy, poor housing condition, fuel used for cooking, and presence of smoker in house. Conclusions: The study stresses on the need of carefully evaluating children presenting with the symptoms of sore throat as majority of the cases may be viral and thus, self-limiting. Poor housing conditions and indoor pollution contribute to the increased prevalence of sore throat.