Response, Remission & Recovery: Need to Review Outcome Measures for Schizophrenia

Schizophrenia is a complex neurobehavioral disorder known to be associated with poor outcome. It causes significant disability in patients and burden of care amongst relatives. Outcome in developing countries has been reported to be far better than western world, which has come into scientific scanner recently. Wide gap exists between expectations of outcome amongst patients, relatives, caregivers and professionals, which is possibly because of limitations in measurements tools. Significant number of patients remain marginalized without improvement in social & occupational functioning preventing their integration into mainstream of society despite \u27clinically reported good outcome\u27 and significant advancement in treatments. The contemporary outcome measure does not capture real-life situations. The concept of response, remission and recovery is being revisited scientifically. There is a strong need to develop culture specific, comprehensive and reliable outcome measures for schizophrenia, which reflects clinical and social outcome in multidimensional measures

Serum magnesium level in eclampsia at tertiary care center, Gujarat, India

Background: Magnesium may be physiologically important in blood pressure regulation whereas changes in magnesium levels could contribute to the patho-etiology of hypertension. The objective of the present study was to study the level and effect of magnesium in eclamptic pregnant women.Methods: This cross-sectional study was conducted among 50 clinically diagnosed women with eclampsia in their third trimester of pregnancy. Inclusion criteria for the study was; females with singleton pregnancy, all in the third trimester which were diagnosed to have PIH based on the development of hypertension for the first time, proteinuria with or without edema, with no history of previous urinary tract troubles and no evidence of UTI. The concentration of total serum magnesium was measured by atomic absorption spectroscopy.Results: Mean age, mean gestational age, mean total hospital stays, mean BMI, mean systolic BP and diastolic BP was 24.3 years with 5.1 SD, 36.4 week with 3.3 SD, 7.8 days with 2.4 SD, 28.9 wt/ht2 with 4.8 SD, 146.5 mmHg with 14.7 SD and 95.9 mmHg with 11.2 SD respectively. Mean magnesium level was 1.9 mmol/L with 2.2 SD.Conclusions: Hypomagnesemia is present in eclamptic pregnant women. In developing countries like India, sufficient dietary supplementation should be given above the recommended dietary allowances in pregnancy at least in susceptible pregnant women

Can perineal tear be predicted by severity of striae gravidarum score?

Background: The objective of this study was to wether perineal tear predicted by scoring of severity of striae gravidarum. The objective of this study was to predict perineal tear by simple non-invasive method and help to prevent maternal morbidity.Methods: Three hundred ninety four patients delivered normally were included in this study. Striae gravidarum score was assessed using the Atwal numerical scoring system. The association was examined between striae and perineal tear as the outcome measure, defined by tears or laceration, and the total striae scores (TSS) was obtained.Results: In present study population mean age was 25.16 years ranging from 16-40 , mean gravidity was 2.16 ranging from 1 -8 ,average baby birth weight was 2.713 kg ranging from  1.62-4.58 The only predictors of perineal tears that were found to be statistically significant in our study were severity of striae gravidarum and episiotomy given or not. In patients with moderate to severe striae there was tear in 90 patients as compared to 29 patients with no or mild striae. 224 patients belonging to no or mild striae group delivered without any perineal tear whereas 51 patients in moderate to severe striae group delivered without tear. Out of these 51 patients 5 were given episiotomy. 2 patients who were given episiotomy had perineal tear as compared to 117 patients who were not given episiotomy. This shows that patients who had an episiotomy were less likely to have perineal tear in most cases.Conclusions: This study demonstrates a significant relation between severity of striae gravidarum and perineal tear. The findings suggest that striae gravidarum assessment may be used in the clinical setting even by paramedical staff as a simple and noninvasive tool to better define women at risk for perineal tear

Impact of educational intervention regarding hazards of obesity and its preventive measures among students of commerce colleges of Ahmedabad city, Gujarat, India

Background: The prevalence of obesity has increased worldwide in almost every country in all the age groups. A college is a key location for educating students about health, hygiene and nutrition, and for putting in place interventions to promote the health of them. Objective of the study was to know the prevalence of obesity and overweight among students of commerce colleges of Ahmedabad city and to assess knowledge of these students regarding hazards of obesity and its preventive measures before and after educational interventional training.Methods: The present interventional study was undertaken during September 2011 to December 2011 in randomly selected 3 commerce colleges of Ahmedabad city, Gujarat. Total 627 students between the age group of 18 to 23 years were examined after taking written informed consent of their parents using pre-designed, pre-tested, semi-structured proforma. Anthropometric measurements were taken and BMI were calculated. The prevalence of overweight and obesity were determined based on the IOTF (International Obesity Task Force) criteria. Single educational training for 45 minutes was given to the students and their post-intervention knowledge for same was assessed after the training. Thus collected data was analyzed using SPSS 17 (Trial version).Results: Overall, the total number of obese adults identified in whole study population was 64 (10.2%) and numbers of overweight adults were 65 (10.3%). Baseline knowledge of the students regarding hazards of obesity like hypertension, cancer, heart attack and diabetes mellitus was 19.7%, 16.1%, 16.5% and 24.5% respectively which was significantly increased to 93.6%, 94.5%, 96.0% and 94.1% respectively after the intervention. Baseline knowledge of the students regarding preventive measure of obesity like avoiding junk food/ healthy diet, exercise and meditation was 23.6%, 24.4% and 25.9% respectively which was significantly increased to 95.3%, 96.9 and 97.4% respectively after the intervention.Conclusions: There was significant improvement in the knowledge regarding hazards of obesity and its preventive measures among college students after our single educational session

Prevalence of nutritional deficiencies other than anaemia among students of government commerce college of Gandhinagar, Gujarat: a cross sectional study

Background: Adolescence and young adulthood are periods of critical development and transition. Adolescent constitutes over 23% of the population in India. Nutrition and health needs of the adolescent are more because of more requirements for growth spurt and increase in physical activity. The aim was to study prevalence of nutritional deficiencies other than anaemia among students of Government Commerce College.Methods: The study was carried by Medicine Department, GMERS Medical College, Gandhinagar, India during period from July 2016 to August 2016 in purposively selected government college of Gandhinagar city. After taking the permission of principal of college and consent of the students, 421 students were examined for signs of various nutritional deficiencies other than anaemia. The data was collected by predesigned, pretested proforma and analyzed using SPSS 17.0 (Trial Version).Results: Out of total 421 students 205 (48.6%) were female. Mean age of the study students was 19.8±1.66 years. Maximum numbers of the students were in the age group of 18-21 years (60.5%). Mean age of female and male students was 19.7±1.79 years and 19.9±2.01 years respectively. The study revealed that vitamin A deficiency was present in 28 (7.0%) students. Vitamin B complex deficiency signs were seen in 96 (23.1%) students. Vitamin C deficiency signs were seen in 44 (10.5%) students. PEM was observed in 55 (13.2%) students. Essential fatty acid deficiency was observed in 60 (14.4%) students.Conclusions: High prevalence of nutritional deficiencies among these students needs great attention and health education

The Latent Group-Based Trajectory Model: Development of Discrimination Measures and Joint Modeling with Subdistributions

In clinical research, patient care decisions are often easier to make if patients are classified into a manageable number of groups based on homogeneous risk patterns. Investigators can use latent group-based trajectory models to estimate the posterior probabilities that an individual will be classified into a particular group of risk patterns. Although this method is increasingly used in clinical research, there is currently no measure that can be used to determine whether an individual's group assignment has a high level of discrimination. We propose a discrimination index and provide confidence intervals of the probability of the assigned group for each individual. We also propose a modified form of entropy to measure discrimination. Additionally, when analyzing research involving disease processes, many researchers are interested in estimating the effect of longitudinally measured biomarkers on the event time outcomes in the presence of competing risks. We propose a method to estimate this effect under the joint modeling framework. The proposed joint model involves three submodels: the first one models the latent risk trajectory groups; the second one models the longitudinal pattern of biomarkers conditional on a specific risk group; and the third one models the subdistribution function conditional on a specific risk group. These methods are significant to public health research since they enable researchers to more confidently assign individual patients to risk groups based on their clinical measurements. The joint model also enables researchers to discover these distinct risk patterns more accurately by using patients' longitudinal data together with event time outcomes, while also adjusting for competing events