Ten Years Risk Prediction of a Major Cardiovascular Event in a Rural Block in Tamil Nadu

Background: India has a high burden of cardiovascular diseases (CVDs). High-risk interventions can be initiated only when individuals at high-risk have been identified. Objectives: The objective was to estimate the prevalence and the sociodemographic pattern of cardiovascular risk factors and to predict the 10 years risk of fatal and nonfatal major cardiovascular events in a rural population in Tamil Nadu. Materials and Methods: A cross-sectional study was conducted among 30 villages of a rural block in Tamil Nadu from March 2012 to February 2013 in the age group of 40-79 years attending our fixed mobile clinics using structured interview schedule and subsequently, the World Health Organization/International Society of Hypertension (WHO/ISH) risk charts were used to predict the 10 years absolute risk of fatal or nonfatal cardiovascular event. Results: A total of 482 individuals were studied of which 68.3% were women and 31.7% were men. Prevalence of overweight, diabetes, and systolic hypertension was found to be 60%, 22.8%, and 34.6%, respectively. A majority (79.9%) of the study population had 10 years cardiovascular risk of <10% while only 2.5% had a risk of more than 40%. As the age advances, the proportion of participants with high-risk also increased and this trend was statistically significant (P = 0.001). Conclusion: Less than 10% of the population had a high-risk of CVD based on WHO/ISH risk score. These charts help identify the high-risk groups in the population in resource-scarce setting and thus an appropriate action can be taken

Large Scale Mobile Medical Service Programme: Data Insights for strengthening local surveillance

ObjectiveWe report the findings of Andhra Pradesh state’s mobile medical service programme and how It is currently used to strengthen the disease surveillance mechanisms at the village level.IntroductionIndia has an Integrated Disease Surveillance project that reports key communicable and infectious diseases at the district and sub-district level. However, recent reviews suggest structural and functional deficiencies resulting in poor data quality (1). Hence evidence-based actions are often delayed. Piramal Swasthya in collaboration with Government of Andhra Pradesh launched a mobile medical unit (MMU) programme in 2016. This Mobile medical service delivers primary care services to rural population besides reporting and alerting unusual health events to district and state health authorities for timely and appropriate action.The MMU service in the Indian state of Andhra Pradesh is one of the oldest and largest public-private initiatives in India. Two hundred and ninety-two MMUs provide fixed-day services to nearly 20,000 patients a day across 14,000 villages in rural Andhra Pradesh. Every day an MMU equipped with medical ( a doctor) and non-medical (1 nurse, 1 registration officer, 1 driver, 1 pharmacist, 1 lab technician, 1 driver) staff visit 2 service points (villages) as per prefixed route map. Each MMU also has its own mobile tablet operated by registration officer for capturing patient details. The core services delivered through MMUs are the diagnosis, treatment, counseling, and free drug distribution to the beneficiaries suffering from common ailments ranging from seasonal diseases to acute communicable and common chronic non-communicable diseases. The routinely collected patient data is daily synchronized on a centrally managed data servers.MethodsFor this analysis, we used aggregated and pooled data that were routinely collected from August 2016-March 2018. Patient details such as socio-demographic variables (age, sex etc.) medical history and key vitals (random blood sugar, blood pressure, pulse rate etc.) and disease diagnosis variables were analyzed. Besides, communication and action taken reports shared with Government of Andhra Pradesh were also analyzed. We report the findings of the programme with reference to strengthing the village level communicable disease surveillance. Unusual health events were defined as more than 3 patients reporting the epidemiologically linked and similar conditions clustered in the same village.ResultsWe observed 4,352,859 unique beneficiaries registrations and 9,122,349 patient visits. Of all unique beneficiaries, 79.3% had complete diagnosis details (53% non-communicable disease, 39% communicable and 8% others conditions). A total of 7 unusual health events related to specific and suspected conditions (3 vector-borne diseases related, 4 diarrhea-related) were reported to district health authorities, of which 3 were confirmed outbreaks (1 dengue, 1 malaria, and 1 typhoid) as investigated by local health authorities.ConclusionsMobile medical services are useful to detect unusual health events in areas with limited resources. It increases accountability and response from the Government authorities if the timely information is shared with competent health authorities. Careful evaluation of the mobile health interventions is needed before scaling-up such services in other remote rural areas.References1. Kumar A, Goel MK, Jain RB, Khanna P. Tracking the Implementation to identify gaps in Integrated Disease Surveillance Program in a Block of District Jhajjar (Haryana). Journal of Family Medicine and Primary Care. 2014;3(3):213-215.2. Raut D, Bhola A. Integrated disease surveillance in India: Way forward. Global Journal of Medicine and Public Health.2014;3(4):1-1

Mobile Medical Units: An alternate Pathway to address the burden of Non Communicable disease in Urban Slums of India

Background: In India despite the increase in health coverage, a small but significant proportion of people in several parts of the country still do not get access to health care services. Mobile Medical Units (MMUs) are a key service strategy to reach such vulnerable population. The present study intends to know the socio-demographic profile of population attending the MMU and the prevalence of Non-Communicable disease (NCD) among them. Materials and Methods: The MMU are located at five different locations in two states. The MMU is equipped to provide primary health care services, essential lab investigations, medications and counselling. The secondary data of beneficiaries attending the MMU during March 2018 to March 2019 was analysed. Results: A total of 84,239 beneficiaries attended the MMU, which comprised of 39 % males and 61% females. There were 55,934 beneficiaries aged 30 years and above. Out of these majority (62.6%) were females and 44.4% beneficiaries were aged between 30 to 45 years. The prevalence of Diabetes and Hypertension among the beneficiaries above 30 years of age was 38.8% and 46.2%respectively. Conclusion: MMU can help in delivering quality health services to the vulnerable population and help early diagnosis of NCD

Lifestyle-associated risk for cardiovascular diseases among doctors and nurses working in a medical college hospital in Tamil Nadu, India

Context: Globally, about 17 million people die of cardiovascular diseases (CVDs) every year and a substantial number of these deaths are attributed to four major risk factors namely unhealthy diet, physical inactivity, tobacco consumption, and alcohol consumption. Doctors and nurses often have a sedentary lifestyle. Aims: This study aimed at assessing the lifestyle-associated risk for CVDs among doctors and nurses in a medical college hospital. Setting and Design: Cross-sectional study among 250 doctors and nurses, selected using a stratified random sampling, working at a medical college hospital in Tamil Nadu. Subjects and Methods: After consenting, each participant answered a questionnaire comprising questions pertaining to the sociodemographic characteristics as well as lifestyle-related risk factors. Risk was categorized into low, moderate, and high based on general risk factors, physical activity risk factors, and dietary risk factors separately. Statistical Analysis: Descriptive statistics and Chi-square analysis were used to analyze the data. Results: It was found that 31.2% of all study subjects and 49.2% of doctors were at high general risk for CVDs; 30.4% of all study subjects and 42.1% of doctors were at high physical activity-related risk for CVDs; 14.4% of all study subjects and 19.8% of all doctors were at high dietary pattern-related risk for CVDs. Advancing age is a statistically significant risk factor across all risk groups. Conclusions: Doctors are at a higher risk for CVDs as compared to nurses as well as the general population

Comprehensive management of complicated crown fracture in a 10-year-old child

Trauma to the maxillary anterior teeth is a common incidence in young patients. Pediatric dentists have to deal with such dental traumatic injuries on a regular basis in their daily routine practice. Some clinical studies have reported reattachment of fractured tooth segment using adhesive resin cement and dentine bonding agent with or without postplacement. This case report presents a comprehensive management of complicated crown fracture in the maxillary anterior teeth with reattachment of the fractured tooth segment with dual-cure adhesive resin and a prefabricated glass-reinforced composite fiber post followed by a permanent restoration

Comparison of anti-hypertensive medication compliance between the tea tribe community and the non-tea tribe community seeking treatment from mobile medical units of Assam

Background: Hypertension is the priority non-communicable disease, whose prevalence ranges from 10% to 55% and an estimated pooled prevalence of 16.1% within the tribal communities of India. Poor compliance to medication is a barrier to control hypertension levels and is an emerging public health challenge. Available evidence suggests varying prevalence of medication non-compliance in different parts of the country. To address the access challenge, National Health Mission supported Mobile Medical Units (MMUs) as one of its key strategies to deliver health services to the remote population. But the role of MMUs in medication compliance is underexplored. Paucity of medication compliance evidence is noted from the North-East states of India. Objectives: To assess medication compliance to oral medications among hypertensive Tea-tribe (TT) and Non-Tea-tribe (NTT) patients of the MMUs; Understand the ecological factors that may influence medication compliance. Methods: A comparative cross-sectional mixed-method study was conducted among the TT and NTT of Assam. A sample size of 196 was derived for the quantitative data and a random number of 6 per district was selected for qualitative data. Multi-stage Simple Random Sampling and Purposive sampling were used to recruit participants. Results: Around 2(2%) of TT and 6(6.1%) of NTT reported moderate level of medication compliance. Medication compliance reported unequal distribution in the categories of education with minimum effect size. The qualitative findings reported patient and provider factors influencing medication compliance significantly. Conclusion: Ensuring uninterrupted access to medication, patient and provider factors which affect medication compliance should be identified and addressed

Predictive Accuracy of a Cardiovascular Disease Risk Prediction Model in Rural South India – A Community Based Retrospective Cohort Study

Background: Identification of individuals at risk of developing cardiovascular diseases by risk stratification is the first step in primary prevention. Aims & Objectives: To assess the five year risk of developing a cardiovascular event from retrospective data and to assess the predictive accuracy of the non laboratory based National Health and Nutrition Examination Survey (NHANES) risk prediction model among individuals in a rural South Indian population. Materials & Methods: A community based retrospective cohort study was conducted in three villages where risk stratification was done for all eligible adults aged between 35-74 years at the time of initial assessment using the NHANES risk prediction charts. Household visits were made after a period of five years by trained doctors to determine cardiovascular outcomes. Results: 521 people fulfilled the eligibility criteria of whom 486 (93.3%) could be traced after five years. 56.8% were in low risk, 36.6% were in moderate risk and 6.6% were in high risk categories. 29 persons (5.97%) had had cardiovascular events over the last five years of which 24 events (82.7%) were nonfatal and five (17.25%) were fatal. The mean age of the people who developed cardiovascular events was 57.24 ± 9.09 years. The odds ratios for the three levels of risk showed a linear trend with the odds ratios for the moderate risk and high risk category being 1.35 and 1.94 respectively with the low risk category as baseline. Conclusion: The non laboratory based NHANES charts did not accurately predict the occurrence of cardiovascular events in any of the risk categories

Prevalence and predictors of gestational diabetes mellitus in rural Assam: a cross-sectional study using mobile medical units

Objective To determine the prevalence and predictors of gestational diabetes mellitus (GDM) in rural Assam, India using a network of Mobile Medical Units.Study design A field-based cross-sectional study.Settings Rural areas of Assam state, India.Participants A total of 1410 pregnant women in gestational age of 24–28 weeksIntervention Identification of pregnant women in 24–28 weeks of pregnancy from villages and administering them Government of India recommended oral glucose tolerance test for GDM confirmation.Primary and secondary outcome measures Presence of gestational diabetes among pregnant women, risk factors and predictors of GDM.Results A total of 1212 pregnant women underwent the oral glucose tolerance test. One hundred and ninety-eight women were ineligible due to existing chronic diseases or very high blood glucose level before the test. The overall GDM prevalence in Assam was 16.67% (95% CI 14.61% to 18.89%). Women aged 26–30 years (adjusted odds ratio, aOR 1.70; CI 1.14 to 2.52), who passed 10th class (aOR 1.58; CI 1.05 to 2.37), belonging to Muslim religion (aOR 1.52; 95% CI 1.05 to 2.21) and above poverty line (aOR 1.38; 95% CI 1.00 to 1.91) had significantly increased likelihood of developing GDM compared with respective baseline groups (p&lt;0.05). Body mass index, gravida and being non-anaemic were non-significant risk factors for GDM. Family history of diabetes (aOR 1.82; 95% CI 1.08 to 3.06) and smoking (aOR 1.61; 95% CI 1.10 to 2.35) were significant and independent predictors of GDM.Conclusion The prevalence of GDM in rural Assam is high. The mobile medical units may play a significant role in the implementation of GDM screening, diagnosis, treatment to ensure better maternal and foetal health outcomes in rural Assam

Highway Emergency Response and Accident Mitigation Service (HERAM) – A Field Report

This paper describes a cross-sectional analysis of data pertaining to accidents that occurred on the National Highway between Hyderabad and Vijaywada, over a period of one year. A fully equipped trauma ambulance was despatched to the site as soon as a call comes on 1033. The victim was attended to by well-trained paramedics in the ambulance and transported to the nearest health care facility. This service attended to 60% of the accidents in the service area. Incidence of fatalities was 5.63%. This service can be established at the national level to provide emergency ambulance care service to accident victims on National Highways