A comparative study of maternal & neonatal outcome and patient satisfaction with intravaginal misoprostol versus intravenous oxytocin in patients with premature rupture of membranes beyond 36 weeks gestation

Background: Premature rupture of membranes (PROM) occurs in about 10% of patients beyond 36 weeks of gestation. In this situation, labor induction with prostaglandins, has been proved to be beneficial and results in decreased chorioamnionitis, neonatal antibiotic therapy, neonatal intensive care (NICU) admission, and increased maternal satisfaction. Many techniques for induction of labor are available. This prospective randomized comparative study was thus taken up to compare the outcomes of misoprostol versus oxytocin with respect to the maternal and neonatal outcomes and patient satisfaction.Methods: A prospective randomized study was carried out where 200 women admitted to department of obstetrics & gynecology, Pravara Rural Hospital, PMT, Loni with PROM beyond 36 weeks of gestation were included where 100 each were included in two groups- vaginal misoprostol group & oxytocin infusion group.Results: Nearly 58% of the cases of PROM were in the age group 21-25 yrs. Vaginal deliveries were 42% in misoprostol group, where as 44% in oxytocin group; whereas LSCS were 7% in misoprostol group and 5% in oxytocin group. Maximum number of cases had APGAR score between 7-10 in both the groups. Patients with misoprostol induction were more satisfied as compared to patients with oxytocin induction.Conclusions: Labor induction with oxytocin infusion for PROM beyond 36 weeks in an unfavorable cervix is associated with longer duration of the second stage and a higher risk of cesarean delivery for failure to progress in comparison to those with transvaginal misoprostol. Patients with misoprostol induction were more satisfied as compared to patients with oxytocin induction

Population genomics and ancestral origins for health disparities research

Ameliorating health disparities – avoidable differences in health outcomes between population groups – is both a social imperative and a pressing scientific challenge. The relative importance of genetic versus environmental effects for health disparities, i.e. the enduring question of nature versus nurture, particularly for complex common diseases that have multifactorial etiologies, has long been debated. The importance of social and environmental determinants of health disparities is well established, whereas the role of genetics is more controversial. Nevertheless, these two classes of effects are not mutually exclusive; genes are expressed and function in the context of specific environmental conditions. Thus, it is reasonable to consider the influence of genetic and environmental factors on health disparities together. Indeed, the importance of interactions between genetic and environmental factors for shaping health outcomes has recently been recognized as a promising avenue for health disparities research. The major aim of this thesis was to investigate both genetic and environmental contributions to health disparities by leveraging population biobanks and large genomic datasets. Biobank datasets, which include collections of genetic data together with rich clinical, phenotypic, and environmental data for thousands of individuals, are ideally suited for this purpose. The thesis consists of two main parts: (1) population pharmacogenomics, and (2) complex common health disparities. The first part of the thesis investigates the partitioning of pharmacogenomic variation between populations in different geographic and socioeconomic locales (in Colombia and the US) to study differences in predicted therapeutic response among populations, and the second part of the thesis illustrates the use of a large population biobank to understand health disparities and their complex relationship to genetic, environmental, and social factors. Results from the first part of the thesis highlight how population genomics can be a powerful tool for clinical decision-making especially in settings where resources are limited (e.g. Colombia) or where resources are unequally distributed between population groups (e.g. US). These findings support the precision public health paradigm, which shifts the focus of genomic characterization efforts from individuals to populations to identify interventions that work best at the population level. This allows for uniform priors for treatment to be adjusted based on population membership. Results from the second part of the thesis demonstrate the massive potential of employing biobanks to investigate health disparities and to decompose their effects into genetic and environmental components. Interactions discovered between genetic and environmental risk factors underscore how environmental effects on disease can differ among ancestry groups, suggesting the need for group-specific interventions. Beyond these specific research advances, this thesis also takes a step towards addressing the lack of diversity in genomics research. Genomics research is currently biased towards European ancestry cohorts, and results from these studies may not transfer to more diverse ancestry groups. This genomics research gap has the potential to exacerbate existing health disparities. The focus on ancestrally diverse populations, both in developing countries and for underrepresented minority groups in the US and the UK, has the potential to support health equity through ancestrally-guided insights and interventions.Ph.D

Impact of social factors on health practices of the elderly: an analytical study in rural Surendranagar

Introduction: Increased attention to health promotion and disease prevention are important for the appropriate care of the elderly. With the increasing life expectancy, a focus on preventive measures to decrease morbidity and improve quality of life in old age has also developed. To that end, health behavior and lifestyle have become important areas of concern over the last 20 years. Social factors lay a significant impact on the health practices. This study was therefore taken up to study the above factor and draw conclusions.Aims and objectives: 1. To study the various health practices of the elderly. 2. To find out association between the socio demographic features and the prevailing health practices.Methods: A Cross sectional analytical study was carried out. All the subjects were interviewed personally to know the details and were treated with due respect after a consent. Out of all the talukas in rural Surendranagar, Sayla was selected randomly after which Sayla village was selected in a similar manner from all the villages in the talukas.Results: The mean age of the subjects was 68±7.5. Majority of the subjects were unemployed and illiterate (58%). Social factors like Social class, staying with children and staying in joint family were significantly associated with good health practices.Conclusions: The Health practices of the elderly can be improved upon by large scale health education programmes which can be targeted on the age group. Patient compliance improvement can be achieved by explaining them about the disease and treatment protocol in detail at the time of their health visit.

Study on breastfeeding practices among rural women in the field practice areas of a tertiary care teaching hospital

Background: Breastfeeding is one of the most important determinants of child survival, birth spacing, and prevention of childhood infections. The beneficial effects of breastfeeding depend on breastfeeding initiation, its duration, and the age at which the breast-fed child is weaned. Data from NFHS-4 suggest that in India, in Gujarat where only 56% of infants are exclusively breastfed and 50% of infants are initiated with breastfeeding within one hour of birth. This study was planned to identify the gaps in breastfeeding practices so that necessary interventions can be designed and thereby implemented. The objective is to study the breastfeeding practices of mothers having children below 2 years of age in the field practice areas of the medical college and to associate the findings of these practices with the socio-demographic characteristics of the population.Methods: The study conducted was a community based cross-sectional one in the six villages of RHTC of PIMSR. The study was conducted by surveying a total of 204 mothers to study their breastfeeding practices which were categorized into ‘good’ and “not so good’ practices. From this the total score was calculated and associated with socio-demographic variables.Results: Majority of the mothers were in the age group 18-22 and educated up to ‘primary’ and most of them were from social class IV and V. Only 23% of the mothers had adequate knowledge of exclusive breastfeeding. About 70% practiced both early initiation of breastfeeding and feeding colostrum whereas nearly 80% practiced exclusive breastfeeding.Conclusions: It is concluded from the study that even though the practice of breastfeeding was found quite good, the gaps in the knowledge and practice must be addressed through health education and support through peer and health groups. Documenting the success stories will go a long way for community education and behavioral change in communication at the community level for adequate breastfeeding practices

Does the social status of the elderly impact morbidities among them? – A cross sectional Study in a district of Gujarat

Background: The aging population is both medical & sociological problem for the country and they suffer with high rates of morbidity and mortality. So Social factors lay a significant impact on the health practices and this study will help us to understand and evaluate their health problems of elderly. Aims and Objective: 1. To assess the social status of elderly population. 2. To associate the findings with morbidities of elderly Methods: A cross sectional study was carried out in urban and rural area of Surendranagar district among 611 elderly, using a predesigned and pre tested questionnaire by directly questioning the subjects with oral and written consent. For selection of the area, in both areas, the sampling units were enumerated and samples were collected by using simple random sampling, data was entered and analyzed using MS excel 2007. Result: Nearly 60 % of the subjects were currently unemployed and the predominant family system was 3 generation family. Majority of the families in the urban areas were from social class 4, whereas in the rural areas were from social class 5. Having poor social score had a statistically significant association with presence of morbidity in elderly both areas. Conclusions: Majority of elderly in both urban and rural areas had a poor social status. Role of the family and social structure on the health of the elderly can be clearly established. However, support structure must be developed in our social system in a way that the destitute and dependent elderly are taken care of by either government system or social organizations like NGOs and old age home

Impact of Curriculum Implementation Support Programme in changing the Knowledge, Attitude and Perceptions of Medical faculties towards Competency Based Medical Education in a Private Medical College

Background: CBME is a skill-based curriculum focusing on the desired competencies stated to be achieved by merits. To sensitize and train the faculty about CBME, the Curriculum Implementation Support Program (CISP) workshops have been held at various colleges across India. Aim& Objective: To find out the changes in the knowledge, perceptions and attitudes among medical teachers regarding CBME following CISP training. Methods and Material: The study carried out was cross-sectional and the data was collected before and after conduction of the CISP training programme. All the medical teachers who were enrolled in the CISP training were included in the study. The outcome result for knowledge-based questions was recorded as multiple choice options and that for attitudes and perceptions was recorded with a 5-point Likert scale ranging from strongly agree to strongly disagree. Statistical analysis used: Descriptive statistics were calculated using numbers and simple proportions. Results: There was a significant improvement in the knowledge and perceptions of medical teachers following CISP training showing its impact. The perceived challenges as felt by the faculties also reduced substantially. Conclusions: Capacity building programmes must be conducted at regular intervals for faculties for successful implementation of all the components of CBME

Evaluation of immunization coverage among children aged 12-23 months in Surendranagar city

Background: Infectious diseases are a major cause of morbidity & mortality in children. One of the most cost effective & easy methods for child survival is immunization. In May 1974, the World Health Organization (WHO) officially launched a global immunization programme known as Expanded Programme of immunization (EPI) to protect all the children of the world against 6 Vaccine Preventable Diseases by the year 2000. It was later redesignated as Universal Immunization Programme (UIP) since 1985. The objectives of this study were to assess the dropout rate and primary immunization coverage of children aged 12-23 months in Surendranagar city and to know the various reasons for partially or not immunizing the child.Methods: A community-based cross-sectional study. Thirty clusters were selected out of a total of 282 blocks of Surendranagar using the cluster sampling method. Cluster sampling method was used for sample selection and the proforma designed by UNICEF was used as a study tool. Sample size was 210 children (7 Children from each cluster) of aged 12-23 months. The obtained data were analyzed using appropriate statistical tests like Z test and X2 test. Results: Out Of the 210 surveyed children, 121(57.62%) were males and 89(42.38%) were females. Immunization card was available for 69.52% of children and fully immunized were 70.47%. Coverage was highest for BCG (95.71%) followed by OPV3 (82.85%), DPT3 (79.52%) and lowest for measles (75.23%). As far as the dropout rate is concerned, it was 21.39%, 10.21%, and 9.37% for BCG to measles, DPT1 to DPT3, and OPV1 to OPV3, respectively. Amongst the various reasons main reasons for dropout or unimmunization of children were ignorance in about 64% and lack of information regarding time, place and schedule (21%).Conclusions: Improvement should focus on reducing the dropout rate from DPT2/OPV2 to DPT3/OPV3 and improving coverage of measles and also Vitamin A

Population Pharmacogenomics for Precision Public Health in Colombia

While genomic approaches to precision medicine hold great promise, they remain prohibitively expensive for developing countries. The precision public health paradigm, whereby healthcare decisions are made at the level of populations as opposed to individuals, provides one way for the genomics revolution to directly impact health outcomes in the developing world. Genomic approaches to precision public health require a deep understanding of local population genomics, which is still missing for many developing countries. We are investigating the population genomics of genetic variants that mediate drug response in an effort to inform healthcare decisions in Colombia. Our work focuses on two neighboring populations with distinct ancestry profiles: Antioquia and Chocó. Antioquia has primarily European genetic ancestry followed by Native American and African components, whereas Chocó shows mainly African ancestry with lower levels of Native American and European admixture. We performed a survey of the global distribution of pharmacogenomic variants followed by a more focused study of pharmacogenomic allele frequency differences between the two Colombian populations. Worldwide, we found pharmacogenomic variants to have both unusually high minor allele frequencies and high levels of population differentiation. A number of these pharmacogenomic variants also show anomalous effect allele frequencies within and between the two Colombian populations, and these differences were found to be associated with their distinct genetic ancestry profiles. For example, the C allele of the single nucleotide polymorphism (SNP) rs4149056 [Solute Carrier Organic Anion Transporter Family Member 1B1 (SLCO1B1)∗5], which is associated with an increased risk of toxicity to a commonly prescribed statin, is found at relatively high frequency in Antioquia and is associated with European ancestry. In addition to pharmacogenomic alleles related to increased toxicity risk, we also have evidence that alleles related to dosage and metabolism have large frequency differences between the two populations, which are associated with their specific ancestries. Using these findings, we have developed and validated an inexpensive allele-specific PCR assay to test for the presence of such population-enriched pharmacogenomic SNPs in Colombia. These results serve as an example of how population-centered approaches to pharmacogenomics can help to realize the promise of precision medicine in resource-limited settings

Awareness Regarding Key Aspects of the Sickle Cell Disease and Trait among the Affected In a Tertiary Care Hospital in South Gujarat

Introduction: Sickle cell disorder is an autosomal recessive condition, in which inheritance of an affected gene from both parents results in a disorder. SCD is more prevalent among the socio- economically disadvantaged and medically underserved communities mainly in Tapi District of Gujarat. Objectives: 1.To study Awareness Regarding Sickle Cell Disease or Trait among the affected 2.To find out the association between the awareness level and the socio-demographic profile of the subjects. Methodology: Descriptive Cross-sectional study was carried out in Janak Smarak hospital in Vyara Town, Tapi District, for a period of one year and minimum of 75 persons with SCD and 150 persons with SCT were taken for the study. Results: The overall Knowledge regarding disease was averaging only at 15 %. The categorization of subject having “Good” or “Not so good” among the subject were predominantly poor with a majority of them showing Not so Good condition (84%) whereas only 16% showed good Knowledge. Conclusion: The overall Knowledge regarding disease was averaging only at 15 % which showed that the awareness seems to be grossly deficit even among the affected. It hence shows that the counseling of the disease among the affected was not adequate. So Counselling & IEC can play a very important role to eliminate the disease from the community

Prevailing IYCF Practices Among Under Five Years Children and Its Association with Acute Respiratory Tract Infections in Surendranagar District

Background: The optimal infant and young child feeding practices during the early years of life is of paramount importance as this period is the “critical window” for the promotion of health, good growth, behavioural and cognitive development.ARI is considered as one of the major public health problems and recognized as the leading cause of mortality and morbidity in many developing countries. Objectives: The study was conducted to find out the prevalence of ARI among children. To explicate the association of ARI with IYCF practices. Material and methods: This was a community based cross sec- tional study conducted in Surendranagar district, Gujarat. Data of 400 Under Five years children was obtained and analyzed using appropriate test. Results: Out of 400 children studied, majority of children having malnutrition were in the rural area (Grade I= 70.27%, Grade II= 74.55, Grade III= 81.25%). Longer the duration of continue breast feeding lesser are the chances for ARI. The association was statisti- cally highly significant. (p<0.01).When the prevalence of ARI was assessed were seen that majority of 34% % of the children in rural area. Conclusion: It suggests importance of proper IYCF practices in prevention of ARI in early life