A Randomized controlled trial to assess the effectiveness of group-based Diabetes Self-Management Education (DSME) program on glycemic control and self-care activities among type-2 diabetics in South-East Delhi

Introduction: India has the second-largest population of diabetes globally. The long-term complications due to poor glycemic control are concerning. Diabetes Self-Management Education (DSME) is a fundamental component in managing diabetes better. Objectives: This study was conducted to compare the effectiveness of group-based DSME in achieving glycemic control and improving self-care practices among people with type-2 diabetes as against the usual care. Methods: A non-blinded parallel-arm RCT among adults (? 30 years) diagnosed with Type-2 DM. Written informed consent was taken from each patient before enrollment. The sample size is estimated to be 85 in each arm according to the formula for equivalence design for an RCT. Randomization was done using a computer-generated random number table. The control arm received usual care, while the intervention group received group-based DSME in addition to usual care. At the end of 6 months, the change in glycemic control and self-care activity scores were compared between the two arms. Results: A total of 139 individuals (intervention =69; control =70) were analyzed. The proportion of females (62.1%) was higher than males (37.9%). There was no statistically significant difference at baseline. At end line, HbA1c showed a reduction from 9.3% to 6.9% in the intervention arm (P<0.001), which was greater than that in the control arm (p=0.017). All the self-care components showed a statistically significant improvement, except the medication score. Conclusions: Group-based DSME effectively increases self-care practices among people with diabetes, resulting in better glycemic control

Behavioural and Emotional Problems in Adolescents

BackgroundAdolescents are highly vulnerable age to psychiatric disorders. This study aimed to explore the prevalence and patterns of behavioural and emotional problems in adolescents. It was also aimed to explore associations between socio-environmental stressors and adverse outcomes.Method  A school based cross-sectional study was conducted between January and July 2008. A stratified random sampling was done. 1150 adolescents in 12 to 18 year age group in grades 7 to 12 in 10 co-educational schools (government run and private) were the subjects of the study. Behavioural and emotional problems were assessed using Youth Self-Report (2001) questionnaire. Family stressors were assessed using a pre-tested 23 item questionnaire. Statistical analysis used:  Univariate and multivariate analysis was done. Multiple logistic regression analysis was also done. ResultsPrevalence of behavioural and emotional problems in adolescents was found to be 30%, with girls exceeding boys in all age groups. Internalizing syndrome was the most common (28.6%) psychiatric problem. On stepwise regression analysis, a perceived lack of emotional proximity to mother had the highest odds (3.489) followed by addiction in father (2.642) and marital discord in parents (1.402). Type of school, type of family, socioeconomic status, relationship with father, mother's employment and educational status were not found to be significantly associated.ConclusionAn alarming number of our adolescents suffer from emotional and behavioural problems which have their roots in the family environment. These data suggest urgency in establishing a school based mental health service

Patterns of glycemic control using glycosylated hemoglobin in diabetics

Aim : Till now estimation of blood glucose is the highly effective method for diagnosing diabetes mellitus but it provides a short-term picture of control. More evidence is required to prove that plasma glucose and glycosylated hemoglobin levels together gives a better estimate of glycemic control and compliance with treatment. Indian diabetes risk score (IDRS) is a simplified screening tool for identifying undiagnosed diabetic subjects, requires minimum time, and effort and can help to considerably reduce the costs of screening. Objective : To study patterns of glycemic control using glycosylated hemoglobin in diabetic patients. To find out correlation between levels of plasma glucose and glycosylated hemoglobin in diabetics and to calculate IDRS of the study population. Materials and Methods : A cross sectional study was conducted among 300 known diabetic patients attending outpatient department of a rural medical college in Haryana, India. Following standard procedures and protocols FPG and glycosylated hemoglobin were measured to find out a pattern of glycemic control in them after taking their written and informed consent. A correlation between the levels of glycosylated hemoglobin and fasting blood glucose was also calculated. These patients were made to fill a performa and their demographic and clinical risk factors were noted and based on this, their IDRS was calculated. This was done to validate the IDRS in Indian rural population. Results : Fifty-two percent of the population had fasting plasma glucose level between 125-150 mg/dl, 21% had this level between 151-175 mg/dl. Thirteen percent of the study subjects had HbA1C between 6.5-7.5, more than half (57.3%) had this value between 7.5-8.5, 12% and 18% had values between 8.5-9.5 and 9.5-10.5, respectively. Twelve percent of the participants had HbA1C level higher than 10.5. Correlation of fasting plasma glucose level and HbA1C was also studied and found that correlation coefficient came out to be .311. This correlation was found to be statistically significant ( P = .007). Sixty-five percent of the case had IDRS higher than 60. Conclusions : Glycaemic control in diabetics can be better assessed with glycosylated hemoglobin and FPG together. A positive correlation between FPG and HbA1c allows for the use of HbA1c along with FPG in diagnosing type 2 DM but the two should not be used interchangeably. IDRS can be used as a screening tool for diabetes

Telemedicine: A new tool for transforming fututre healthcare

Telemedicine is the solution to the problem of delivery of health services in far fledge areas. It is the use of computers and automated data to deliver technologies and promote healthcare when the patients are located far away from the professionals.  Its future looks bright with more widespread acceptance by more medical professionals and patients in different forms. There has to be a smart balance between technology and the human intelligence. However, telemedicine cannot be the panacea and surely cannot replace old fashioned medicine everywhere especially emergency medicine. More measures are required to make this change more successful and acceptable

The intergenerational transmission of tobacco habit: Role of parents and the family

Introduction: Tobacco pandemic has become one of the greatest public health challenges of all time. The socio-environmental factors prevailing at home have been identified as one of the most important causes of adopting smoking and other types of smokeless tobacco. Objectives: The present study was conducted to find out the prevalence and pattern of tobacco use in the patients registered in the clinic and to study the role of parental and family influence on tobacco use. Materials and Methodology: This cross-sectional study was performed in a Tertiary Care Hospital in Delhi. The study included all 307 patients who were registered in a cardiac clinic between January and December 2014. The history of tobacco use in siblings, offspring, and parents was taken from these patients. Pedigree profiles provided detailed information about tobacco use in the family. The association between the use of tobacco among parents and tobacco habits was assessed by odds ratio and Chi-square test. Results: Among the patients, 48% were tobacco users and family history of tobacco use was present in 81% of users. Odds ratio of tobacco use in parents, offspring, siblings, and three generations was 3.477, 1.987, 2.626, and 7.626 than that of nontobacco users. Conclusion: Previous anti-smoking campaigns have concentrated much of their effort on discouraging individuals from smoking with the aim of creating a nonsmoking generation. This approach does not take sufficient account of the fact, reconfirmed by our findings that children are influenced by the behavior and attitudes of adults, especially their parents

AN EPIDEMIOLOGICAL STUDY OF ROAD TRAFFIC ACCIDENT CASES AT A TERTIARY CARE HOSPITAL IN RURAL HARYANA

Background- Accidents occur not only due to ignorance but also due to carelessness, thoughtlessness and over confidence. Human, vehicular and environmental factors play role before, during and after a Road Traffic Accidents (RTA). Road traffic injuries are partially predictable and hence preventable. Objectives- To study the pattern of road traffic accidents, socio demographic profile of road traffic injury victims seeking care at Maharishi Markandeshwar Institute of Medical Sciences And Research, Mullana and to study the antecedent factors influencing the road traffic accidents. Material and Methods-The present cross-sectional study was carried out at Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Mullana (Ambala). All the victims who reported to MMIMSR emergency and various OPD clinics of the institute between September 2009 to February 2011 were included in the study. Various parameters like age and sex distribution, time of occurrence, protective gears worn, injuries sustained, receipt of First -Aid, alcohol consumption, category of road user, vehicles involved in RTA, types of RTA, road conditions, environmental conditions etc were studied and valid conclusions were drawn. Results- There was a marked male preponderance (88.77 %) with maximum involvement of younger age groups. Most of the accidents had taken place in the evening hours (6 pm -12 midnight). The vulnerable road users like motorized two wheeler, LMV and pedestrians constituted 41.52%, 19.39% and 13.41% respectively. Only 158 of 545 two-wheeler users wore a helmet at the time of injury. 16.24% of drivers did not have a valid driving license. Not using indicator lights and not following speed limits were two most common factors responsible for these RTA

Misuse of social media marketing by alcohol companies

Background and Aims: Epidemiological transition in the form of noncommunicable diseases (NCDs) now becoming the main cause of mortality and morbidity is very much evident even in developing countries like India. Alcohol is an important risk factor for NCD. The use of alcohol is increasing especially in young people and women. This increased use can be attributed to aggressive and innovative marketing by alcohol, in spite of and due to restrictions on its marketing. Social media, in recent times, has been misused by alcohol companies for marketing their products legally, due to legal loophole. The present study examined the reach of alcohol companies on social media and the marketing strategies used by them. Design, Settings, Participants: Facebook, Twitter and YouTube were explored for accounts and content by alcohol companies for marketing their product. Policies of social media sites pertaining to alcohol marketing were also studied. Measurements: Alcohol marketing was measured in terms of content posted by alcohol companies, use of direct or surrogate advertisement and engagement with users. Findings: Alcohol companies have been conveniently using social media to target young urban population with direct and surrogate advertisements of their products. Current social media policies and laws are ineffective in controlling it. Conclusions: Amendment of laws pertaining to alcohol marketing to include social media also in its ambit is necessary. Social media sites should revise their policies to prevent alcohol marketing and promotion especially to underaged users

Letter to the Editor

Occupational exposure to pathogenic microbes as a result of needles stick injury is associated with significant risk to health care professional’s career, health, families and also the patients.  OBJECTIVES:  To establish the incidence of needle stick injury (NSI) among health care workers (HCW) of a tertiary care centre. To study risk factors for getting NSI and to determine barriers in seeking care after NSI in above mentioned setting. To assess awareness, acceptability and availability of post exposure prophylaxis (PEP) in the tertiary care centre. MATERIAL AND METHODS: A cross- sectional study was conducted among HCWs of MM Institute of Medical sciences and Research, Mullana. A total of 300 health care workers were selected for the study by simple random sampling method.  A self designed, semi- structured interview schedule was used to collect data from the participants by interview method. RESULTS:  80.5% of HCWs reported having had one or more NSI in their career, maximum among the nursing staff (94.2%). The average number of NSIs was found to be 1.85 per HCW per year (±2.29 SD). 17.8% of HCWs had a NSI involving a high-risk patient. (61%) of the NSI were from a hollow-bore type of needle. Most of NSIs were while recapping a needle after use (27%)  or bending the needle for  breaking it before disposal (20%). Majority of the NSI were not reported to the hospital administration. 72% of the respondents had heard about PEP and less than 10 % of them knew about the availability of PEP services in the hospital. CONCLUSION: Training of HCWs regarding safety practices needed to avoid NSI should be  an indispensable ongoing activity at the hospital . Besides health promotion, there should be setting up of an adequate surveillance mechanism in every large hospital and also of facilities for prompt response and treatment of NSI