Self medication among elderly poses challenges in urban settings

Background: Self-medication can be defined as obtaining and consuming one (or more) drug(s) without the advice of a physician. Using over the counter medicine is a common practice in developing countries including India. Studies have shown relatively high rates of self-medication among elderly and suggested awareness programmes among this group. Objectives of current study are to determine the prevalence of self-medication among geriatric population and to educate them about self-medication by an interactive session.Methods This was a cross sectional, questionnaire based study to evaluate the prevalence of self-medication in geriatric population in senior citizen club of Adajan and Ghoddod area of Surat city. Questionnaires were designed and modified from previous studies. Written informed consent was taken from those willing to participate in the study. After filling of pre-questionnaire, an interactive session was arranged and post-questionnaire were given to all participants. Data obtained were subjected to statistical analysis.Results: Number of participants in present study was 100. Self-medication was most common in age group of 65 to 75 years (48%) followed by less than 65 years (33%). 85% participants reported having taken non-prescription drugs. Drugs commonly used for self-medication were analgesics (85) and antacids (80). Side effects due to self-medication were reported by 22 participants. Main reasons for self-medication cited were to save expenses (65) and to save time (62). Post study awareness increased to 98%.Conclusions: Prevalence of self-medication is high in elderly. Interactive session can increase awareness regarding self-medication

Aerobic Fitness, Micronutrient Status, and Academic Achievement in Indian School-Aged Children

Aerobic fitness has been shown to have several beneficial effects on child health. However, research on its relationship with academic performance has been limited, particularly in developing countries and among undernourished populations. This study examined the association between aerobic fitness and academic achievement in clinically healthy but nutritionally compromised Indian school-aged children and assessed whether micronutrient status affects this association. 273 participants, aged 7 to 10.5 years, were enrolled from three primary schools in Bangalore, India. Data on participants’ aerobic fitness (20-m shuttle test), demographics, anthropometry, diet, physical activity, and micronutrient status were abstracted. School-wide exam scores in mathematics and Kannada language served as indicators of academic performance and were standardized by grade level. The strength of the fitness/achievement association was analyzed using Spearman’s rank correlation, multiple variable logistic regression, and multi-level models. Significant positive correlations between aerobic capacity (VO2 peak) and academic scores in math and Kannada were observed (P < 0.05). After standardizing scores across grade levels and adjusting for school, gender, socioeconomic status, and weight status (BMI Z-score), children with greater aerobic capacities (mL * kg-1 * min-1) had greater odds of scoring above average on math and Kannada exams (OR=1.08, 95% CI: 1.02 to 1.15 and OR=1.11, 95% CI: 1.04 to 1.18, respectively). This association remained significant after adjusting for micronutrient deficiencies. These findings provide preliminary evidence of a fitness/achievement association in Indian children. While the mechanisms by which aerobic fitness may be linked to academic achievement require further investigation, the results suggest that educators and policymakers should consider the adequacy of opportunities for physical activity and fitness in schools for both their physical and potential academic benefits

Community-Based ART Programs: Sustaining Adherence and Follow-up

The advent of antiretroviral therapy (ART) in 1996 brought with it an urgent need to develop models of health care delivery that could enable its effective and equitable delivery, especially to patients living in poverty. Community-based care, which stretches from patient homes and communities—where chronic infectious diseases are often best managed—to modern health centers and hospitals, offers such a model, providing access to proximate HIV care and minimizing structural barriers to retention. We first review the recent literature on community-based ART programs in low- and low-to-middle-income country settings and document two key principles that guide effective programs: decentralization of ART services and long-term retention of patients in care. We then discuss the evolution of the community-based programs of Partners In Health (PIH), a nongovernmental organization committed to providing a preferential option for the poor in health care, in Haiti and several countries in sub-Saharan Africa, Latin America, Russia and Kazakhstan. As one of the first organizations to treat patients with HIV in low-income settings and a pioneer of the community-based approach to ART delivery, PIH has achieved both decentralization and excellent retention through the application of an accompaniment model that engages community health workers in the delivery of medicines, the provision of social support and education, and the linkage between communities and clinics. We conclude by showing how PIH has leveraged its HIV care delivery platforms to simultaneously strengthen health systems and address the broader burden of disease in the places in which it works

Final logistic regression models predicting odds of academic success in math and Kannada from aerobic fitness (n = 273).

<p>Odds ratios are presented as point estimates (95% confidence interval) and are adjusted for school, gender, SES, and BMIZ. Academic success in math and Kannada is defined as a Z-score > 0.</p><p>*<i>P</i> < 0.05;</p><p>**<i>P</i> < 0.01;</p><p>***<i>P</i> < 0.001</p><p>Final logistic regression models predicting odds of academic success in math and Kannada from aerobic fitness (n = 273).</p

Percentage of participants with above average academic performances by maximum speed reached on 20-m shuttle test.

<p>Scoring above average in math (solid triangle) and Kannada (solid square) was defined by an academic Z-score > 0. The initial speed of the 20-m shuttle was set at 4 km * h^-1 (1.11 m * s^-1) and increased by 0.5 km * h^-1 (0.14 m * s^-1) every minute. Academic Z-scores were adjusted for school, gender, and SES. The percentage of participants with above-average performances in math and Kannada increased as the maximum speed reached increased. The number of participants reaching the above maximum speeds is as follows: 7.0 or 7.5 km * hr^-1, 22 students; 8.0 or 8.5 km * hr^-1, 89 students; 9.0 or 9.5 km * hr^-1, 109 students; 10.0 km * hr^-1 or greater, 53. Participants reaching maximum speeds of 10.0 km * hr^-1 or greater were grouped due to the relatively small number of participants who reached speeds above 10.0 km * hr^-1. Values presented are adjusted mean±SE.</p

Prevalence of micronutrient deficiencies (n = 268–273).

<p>Values are percentages (% deficient).</p><p>^a Analysis only for participants with CRP < 47.62 nmol * L^-1</p><p>Prevalence of micronutrient deficiencies (n = 268–273).</p

Characteristics of participants (n = 273 unless stated otherwise).

<p>Values are percentages (number) for categorical data, median (Q1, Q3) for non-normally distributed data, and mean ± SD for normally distributed data.</p><p>^a n = 243</p><p>Characteristics of participants (n = 273 unless stated otherwise).</p

Maternal mortality and the metempsychosis of user fees in Liberia: A mixed-methods analysis

ABSTRACT: Liberia, a country recently afflicted by civil conflict and an epidemic of Ebola virus disease, has one of the highest rates of maternal mortality in the world. A biosocial analysis of this problem can help identify and address barriers impeding access to, and equitable delivery of, quality maternal health care. We analyzed 258 maternal death reviews reported to the National Public Health Institute of Liberia in 2017 and compared data with existing demographic and health statistics. Quantitative information on maternal death was contextualized with 44 in-depth interviews conducted among four groups of study participants. Forty percent of reported maternal deaths in 2017 occurred among women 25–34 years old; 36% were due to hemorrhage; 74% occurred at a health facility; and 29% occurred within 24 h after delivery. The number of deaths reported to the government of Liberia through maternal death reviews (n = 258) was substantially lower than the number expected based on the size of the population, crude birth rate, and the maternal mortality ratio. Qualitative findings highlighted inaccessible and unreliable transportation to health facilities; staff-related challenges, including staff attrition and burnout, inadequate training and clinical proficiency, staff absences, and neglect of patients; a lack of drugs and medical supplies; and the emergence of an inefficient and financially burdensome system of referrals by trained traditional midwives. Most notable was the finding that user fees for maternal health care in Liberia—eliminated in public facilities after the war—have resurfaced in the form of informal, out-of-pocket expenditures made by patients and their families. Keywords: Maternal mortality, User fees, Liberia, Structural determinants, Health equit