A Cross-sectional study on Out-of-Pocket expenditure towards Immunization and its consequences faced by families with under-five Children Residing at one of the Cities of Western India

Background: When immunization of under-five children results in Out-of-Pocket Expenditure (OOPE), it affects motivation of parents for vaccination inversely. Objectives: To assess determinants affecting preference for specific/mixed type of health facilities and to estimate out-of-pocket expenditure towards immunization of under-five children. To assess opinion of participants for prevention/decreasing OOPE towards immunization. Methods: A community-based cross-sectional study was conducted at one of zones of Ahmedabad city, selected by simple random sampling. Following technique of “30×7 cluster survey” with necessary house-hold information received from Municipal Corporation, selection of 7 children was pursued from each cluster reaching to sample-size of 210 (30 X 7). Results: Of 211 children included in study, 124(58.77%), 68(32.23%) and 19(9%) had taken immunization services from government, private and mixed variety respectively. Majority of families (110, 88.71%) preferring government healthcare-facility for immunization incurred expenses <5000 INR/child as while in other two groups, all beneficiaries had expensed>5000 INR/child. Conclusions: Determinants like child’s gender, parents’ education, Type of family, Socio-economic status, delivery place of child and occupation of father had statistically significant association with preferred place of vaccination. Fixation of upper ceiling-limit of vaccines which are recommended by pediatricians but not covered in government run program was one of suggestions

An Epidemiological study of health behavioral and protective factors among school going adolescents (aged 13-17 years) of Ahmedabad, Gujarat using the Global School-based Student Health Survey (GSHS) questionnaire

Background: Adolescence is considered as the next unsurpassed stage of life to childhood targeting for preventive and health promotional activities. Encouraging these activities firstly requires identification of high-risk behaviors and protective factors prevalent among such adolescents during current epidemiological transition period. Objective: To estimate the prevalence of various health behavioral and protective factors among school going adolescents of Ahmedabad. Methodology: A cross sectional study was conducted among 403 school going adolescents of rural field practice areas of a medical institute using GSHS self-administered questionnaire -Indian version. Almost all aspects of the questionnaire such as dietary behaviors, hygiene, mental health, physical activity, protective factors, tobacco use, violence & unintentional injury, alcohol use and drug use were included in this study. Results: Out of a total of 403 students, 25.3% and 48.9% of students ate fruits and vegetables three or more times a day in past 30 days, respectively. About 41.2 % of students drank carbonated drinks on two or more times per day. Majority (77.7%) of the students brushed their teeth two times per day in past 30 days. Some 9.2% of students felt lonely in past 12 months and 8.4% of students had no close friends. Around 46.2% of students missed classes or school without permission in past 30 days. 30% of students remained physically active for all 7 days in last week. A few of students smoked cigarettes (2.5%) and used any form of tobacco (7.9%) on one or more days during past 30 days. The significant differences were found in many areas of risk behaviors as well as protective factors between boys and girls. Conclusion: Various unhealthy behaviors and protective factors were identified among school going adolescents from the present study. The difference was significant

Metabolic and anatomic characteristics of benign and malignant adrenal masses on positron emission tomography/computed tomography: a review of literature

PET/CT with (18)F-fluorodeoxyglucose (FDG) or using different radiocompounds has proven accuracy for detection of adrenal metastases in patients undergoing cancer staging. It can assist the diagnostic work-up in oncology patients by identifying distant metastases to the adrenal(s) and defining oligometastatic disease that may benefit from targeted intervention. In patients with incidentally discovered adrenal nodules, so-called adrenal "incidentaloma" FDG PET/CT is emerging as a useful test to distinguish benign from malignant etiology. Current published evidence suggests a role for FDG PET/CT in assessing the malignant potential of an adrenal lesion that has been 'indeterminately' categorized with unenhanced CT, adrenal protocol contrast-enhanced CT, or chemical-shift MRI. FDG PET/CT could be used to stratify patients with higher risk of malignancy for surgical intervention, while recommending surveillance for adrenal masses with low malignant potential. There are caveats for interpretation of the metabolic activity of an adrenal nodule on PET/CT that may lead to false-positive and false-negative interpretation. Adrenal lesions represent a wide spectrum of etiologies, and the typical appearances on PET/CT are still being described, therefore our goal was to summarize the current diagnostic strategies for evaluation of adrenal lesions and present metabolic and anatomic appearances of common and uncommon adrenal lesions. In spite of the emerging role of PET/CT to differentiate benign from malignant adrenal mass, especially in difficult cases, it should be emphasized that PET/CT is not needed for most patients and that many diagnostic problems can be resolved by CT and/or MR imaging