Farmers’ suicides in the Vidarbha region of Maharashtra, India: a qualitative exploration of their causes

Background: To explore the various perceived reasons for farmers’ suicides in the Vidarbha region of Maharashtra, their common factors, and to suggest solutions. METHODS: The present formative research was undertaken in the 23 villages surrounding the Anji Primary Health Centre, located in the Vidarbha region of Maharashtra, India. A triangulation of free list and pile sort exercises was used. The data was analyzed by Anthropac 4.98.1/X software. This was followed by a semi-structured focus group discussion. To increase the validity of the results, these findings were presented to the participants and later they were circulated to the 26 farmers’ clubs in the villages for comment and discussion during their monthly, village-based meetings. RESULTS: Farmers perceived debt, addiction, environmental problems, poor prices for farm produce, stress and family responsibilities, government apathy, poor irrigation, increased cost of cultivation, private money lenders, use of chemical fertilizers and crop failure as the reasons for farmers’ suicides. Participants suggested solutions such as self-reliance and capacity building among farmers, a monitoring and support system for vulnerable farmers, support and counseling services, a village-level, transparent system for the disbursement of relief packages. CONCLUSIONS: Farmers’ suicides in Vidarbha are caused by the complex interplay of social, political and environmental constraints. Hence, a comprehensive intervention to ensure self-reliance and capacity building among farmers in modern farming techniques , monitoring and support system for vulnerable farmers, a village-level, transparent system for disbursement of relief packages is required to prevent farmer suicides in the near future. Apart from this, there is a need to strengthen the National Mental Health Program at primary health care level to offer support and counseling to vulnerable farmers in rural area

Comparative study of oxytetracycline and doxycycline on calcium chelation: in-vitro assay

Background: Tetracycline class of antibiotics differ in their pharmacokinetic profile and chelating property. Objective of present study is to assess the effect of oxytetracycline and doxycycline on calcium chelationMethods: For estimation of calcium chelation of Oxytetracycline and Doxycycline, EDTA method (P. Trinder) and calcium binding assay was followed. Different doses of Oxytetracycline (25 mg, 50 mg and 100 mg) and Doxycycline (25 mg, 50 mg and 100 mg) were used in EDTA method and different concentrations of calcium were used in calcium binding assay. The procedure was done according to the standard methodology.Results: The intensity of colour appear to be increased with increase in dose of the Oxytetracycline (25 mg, 50 mg, 100 mg) as the concentration of calcium binding increases. But in Doxycycline intensity of colour is more with 100 mg as compared with 25 mg and 50 mg The UV absorption spectrum of solution of Oxytetracycline (1mM) was changed after the addition of CaCl2 to provide different concentration of Ca2+ (0.1, 0.5 and 1.0 mM).  With minor shift in the absorption coefficient and no shift in wavelength were observed for Doxycycline.Conclusions: The study concludes that oxytetracycline has more calcium chelating property than doxycycline

Assessment of medication adherence among hypertensive patients: a cross-sectional study

Background: Hypertension affects around one billion individuals worldwide and is expected to increase by 29% to reach 1.56 billion by 2025. It is usually asymptomatic, chronic disorder needing lifelong treatment. The objective of this study was to study the medication adherence among hypertensive patients using hill-bone compliance to high blood pressure therapy scale (HILL-BONE CHBPTS) and to compare medication adherence in hypertensive patients with controlled and uncontrolled blood pressure.Methods: A cross-sectional, observational study was conducted for a period of one year in the Outpatient department of Medicine in a tertiary care hospital, Navi Mumbai. A total of 129 hypertensive patients who were on at least six months on antihypertensive medications were enrolled. Blood pressure was measured and details of drug therapy were noted. Medication adherence was assessed using HILL-BONE CHBPTS and respective scores were calculated.Results: HILL-BONE CHBPTS scores were on the higher side signifying poor medication adherence among hypertensive patients. HILL-BONE CHBPTS score correlated significantly in a positive direction with diastolic blood pressure, duration of treatment and the number of medications, As per JNC 8 recommendations, 58.9% (76) hypertensive patients were having blood pressure under control, whereas 41.1% (53) were having uncontrolled blood pressure. HILL-BONE CHBPTS scores were significantly higher (reflecting lower adherence) in hypertensive patients with uncontrolled blood pressure than those having optimally controlled blood pressure.Conclusions: Overall the medication adherence was poor in hypertensive patients. Adherence to therapeutic regimens is an important factor in blood pressure control among hypertensive patients and needs priority. Health education related to medication adherence needs be improved in hypertensive patients

Effectiveness of crossword puzzle as an adjunct tool for active learning and critical thinking in Pharmacology

Background: Modern pedagogic methodologies are being introduced in Medical education and there is a growing evidence of crossword puzzle as an educational tool for active learning, problem solving and critical thinking. The aim of the study was to study the effectiveness of crossword puzzle as an adjunct to the conventional lecture for active learning and critical thinking in Pharmacology. This was a parallel group; pre and post assessment, educational intervention study conducted among second year undergraduate medical students.Methods: Second year medical students were randomly selected and assigned to two groups A (Cross word puzzle) and B (control), after an hour conventional lecture on “Drugs for Hypertension” In both the groups, pre- and post-intervention knowledge was assessed using the MCQ test. A self-designed crossword puzzle on the lecture topic was used as an intervention and students were allowed to read textbooks with a crossword puzzle in intervention group A, whereas control group B were allowed to read textbook only. After 45 minutes, the post-intervention assessment was done in both groups with the same set of MCQ and students’ feedback on crossword usefulness was obtained.Results: The average MCQ test score in Group A improved significantly from 6.65±3.4 pre-intervention to 11.26±2.5 post-intervention (p <0.05) with absolute learning gain 30.73 % and relative learning gain 69.32 %. The average test score in Group B also improved significantly from 5.7±2.9 pre-intervention to 9.59±2.5 post-intervention (p <0.05) with absolute learning gain 25.93 % and relative learning gain 68.23%. There was a significant improvement in the MCQ scores in both the groups after intervention. But the post-intervention MCQ scores in group A (crossword puzzle) was higher and statistically significant (P <0.05) in comparison to group B.Conclusions: Cross-word puzzle promotes active self-learning and develops critical thinking among medical students. It could be used as supplementary educational tool in pharmacology to enhance problem-solving skills along with the information provided through traditional teaching lectures or could be used as a micro task

Drug utilization pattern in dermatology outpatient department at a tertiary care hospital in Navi Mumbai

Background: Skin diseases are common and cause a huge disease burden globally. Different class of drugs and combinational products are available in dermatology for treatment. Periodic prescription analysis in the form of drug utilization study can improve the quality of prescription and curb the menace of irrational prescribing. Aim and objective of the study were to study the prescribing pattern and drug utilization trends in Dermatology outpatient department at a tertiary care hospital in Navi Mumbai.Methods: A cross-sectional, observational study was conducted over a period of three months in dermatology department of a tertiary care teaching hospital, Navi-Mumbai. A total of 102 adult patients visiting dermatology OPD were included and their prescriptions were analyzed with WHO prescribing indicators and additional indices.Results: Analysis showed that the average number of drugs per prescription was 3.27. Percentage of drugs prescribed by generic name was 31.1%. Percentage of drugs prescribed from National Essential drug list (NEDL) was 44.2%. The commonest prescribed drugs were antihistaminics followed by antifungals. Oral tablets were the commonest prescribed dosage form.Conclusions: Antihistaminics and antifungals dominated the prescribing pattern in this study with restraint on polypharmacy, but showed ample scope for improvement to prescribe generic and selection of essential drugs

Socioeconomic status: A theoretical framework for the development and use of assessment tools

Decades of research have established the relationship between socioeconomic status (SES) and health. The tools for the assessment of SES have evolved ever since, growing in complexity over time. The purpose of measuring SES in health research is twofold – to causally link the exposure to poor SES with health state and to find out the causal mechanisms to devise programmatic interventions. In health research, SES should be viewed as a determinant of unequal distribution of health resources that further leads to health disparities. We refer to socioeconomic position as an umbrella term for social stratification that defines individuals/households based on the present circumstances. Socioeconomic position can be measured in three distinctly varied ways – socioeconomic disadvantage, social class, and SES (or position). Tools for the measurement of SES can be classified as indices based on income and expenditure, indices bases on occupation and education, wealth index combining education, and asset-based wealth index. Each tool has its own theoretical assumptions – Weberian, Marxist, or Functionalist perspectives. The choice of tool should depend on theoretical assumptions. The tool should be comprehensive, including all three dimensions – education, occupation, and income. Life-course perspective, linking the timing of exposure to poor SES over the life course is useful in the development of interventions. Study tools incorporating a life course perspective in the measurement of SES are the need of the hour

Socio-demographic determinants of out-of-pocket health expenditure in a rural area of Wardha district of Maharashtra, India

Background & objectives: In India, health expenditure accounts for less than 5 per cent of the Gross Domestic Product and the level of out-of-pocket (OOP) spending is 69.5 per cent of total health expenditures. OOP expenditure exacerbates poverty and has a negative impact on equity and can increase the risk of vulnerable groups slipping into poverty. This study was conducted to estimate the OOP expenditure on health and catastrophic health expenditure and their socio-demographic determinants in a rural area of Maharashtra, India. Methods: This was a prospective observational study involving monthly follow up visits, done in 180 households of three villages under a primary health centre in Wardha district, India. Results: Of the 180 families, 18.9 per cent had catastrophic health expenditure over a period of one year. The median total out-of-pocket health expenditure was '1105.00 with median medical expenditure being '863.85 and median non-medical health expenditure being '100.00. A total of 151 (83.9%) had enough money, 27 (15%) borrowed money and two (1.1%) of them sold assets. The significant correlates for the ratio of out-of-pocket health expenditure to total annual income of the family were the occupation of head of family, caste category and type of village. The significant correlate for catastrophic health expenditure was type of village. Interpretation & conclusions: Around one-fifth of the households had catastrophic health expenditure. People with no healthcare facility located in their village had higher odds of having catastrophic health expenditure. Private providers were preferred for the treatment of acute illnesses and medical college hospitals for hospitalization