Costs incurred and determinants of out-of-pocket payments for child delivery care in India: Evidence from a nationally representative household survey

In India, out-of-pocket (OOP) expenditure on health care services has been showing an increasing trend. The cost and willingness to pay determines the use of facility-based maternal health services. Hence, the current study was done to find the costs and determinants of OOP payments on childbirth care in India. We analyzed the most recent National Family Health Survey-4 data (NFHS-4) gathered from the Demographic Health Survey (DHS) program. Stratification and clustering in the sample design were accounted for by using the “svyset” command. Out of 43 507 women, 26 916 (61.9%) had incurred OOP expenditure during their most recent institutional delivery. The average OOP expenditure for delivery care was INR 5985 ($93.3) with median cost being INR 1000 ($15.6). About 80% of women who had OOP expenditure reported that they handled the financial situation by utilizing the money in their bank/savings account. Determinants of OOP expenses were the age of mother, education, religion, state of residence, number of antenatal visits place of delivery, and mode of delivery (P < .05). Out-of-pocket expenditure for accessing care is one of the key determinants of service utilization which, if not addressed by the health system, can deter women from having institutional deliveries in the future.     

Role of pomegranate and citrus fruit juices in colon cancer prevention

Colorectal cancer is the second leading cause of cancer-related deaths in the United States.Recent studies prove that though chemotherapeutic agents are being used for the treatment of colon cancer,they become non-effective when the cancer progresses to an invasive stage.Since consumption of certain dietary agents has been linked with various cancers,fruit juices have been investigated for their consistently protective effect against colon cancer.The unique biochemical composition of fruit juices is responsible for their anticancer properties.In this review,the chemo-preventive effect of fruit juices such as pomegranate and citrus juices against colon cancer are discussed.For this purpose,the bioavailability,in vitro and in vivo effects of these fruit juices on colorectal cancer are highlighted.Moreover,there is a scarcity of studies involving human trials to estimate the preventive nature of these juices against colon cancer.This review will support the need for more preclinical tests with these crude juices and their constituents in different colorectal cancer cell lines and also some epidemiological studies in order to have a better understanding and promote pomegranate and citrus juices as crusaders against colon cancer.     

Efficacy of the Q-switched Neodymium: Yttrium Aluminum Garnet Laser in the Treatment of Blue-black Amateur and Professional Tattoos

Background:

Q-switched neodymium: yttrium aluminum garnet (Nd: YAG) laser at a wavelength of 1064 nm primarily targets dermal melanin and black tattoo ink. Recent studies have shown that this laser is effective in treating black tattoos. There are few studies conducted in India for the same.

Aim:

The aim was to assess the effectiveness of Q-switched Nd: YAG laser (QSNYL) in the treatment of blue-black tattoos following 3 treatment sessions.

Materials and Methods:

This study, a prospective interventional study included a total of 12 blue-black tattoos. Following informed consent for the procedure, as well as for photographs, a questionnaire was administered, and improvement perceived by the patient was recorded. In addition, global assessment score (GAS) by a blinded physician was also recorded. Photographs were taken at baseline and at every follow-up. Each patient underwent three treatment sessions with 1064 nm QSNYL at 4–6 weekly intervals. Fluences ranged from 1.8 to 9 J/cm². The follow-up was done monthly for 4 months from the first treatment session. The response was assessed by patient assessment (PA) and GAS by comparing photographs.

Results:

After three treatment sessions, although no patient achieved clearance, most patients showed good response with few adverse effects. An average of 64.1% (GAS) and 54.2% (PA) improvement was observed in 12 tattoos. Tattoos more than 10-year-old showed quicker clearing than those less than 10-year-old. Amateur tattoos also showed a better response in comparison to professional tattoos.

Conclusion:

Totally, 1064 nm QSNYL is safe and effective for lightening blue-black tattoos in pigmented Indian skin. All patients achieved near complete clearance following the continuation of treatment (an average of six sessions) although this was spaced at longer intervals.     

Attitudes of postgraduate orthodontic students in India towards patient-centered care

The aim of our study was to assess the attitudes of postgraduate orthodontic students in India towards patient-centered care. Two hundred and two students from eighteen dental schools across India completed the modified Patient-Practitioner Orientation Scale (PPOS), a self-administered eighteen-item questionnaire that evaluates the practice orientation of the students in terms of doctor versus patient-centeredness. The results revealed that the attitudes of the orthodontic postgraduate students in India were generally more doctor-centered (mean PPOS score of 3.38). As compared to their male counterparts, the female students were more considerate of the role of psychosocial factors in health and the importance of warm doctor-patient relationships (mean caring subscale score of 3.8 vs. 3.54, p<0.05). The third-year students were relatively more patient-centered than their first-year colleagues (mean PPOS score of 3.56 vs. 3.27, p<0.05) and were more willing to share power and information with their patients (mean sharing score of 3.24 vs. 2.92, p<0.01). In general, the students became more patient-centered as they progressed through their postgraduate course. The results of the study clearly imply the need for more active measures in order to develop a more patient-centered orthodontic health care system in India.     

Association between family history of cancers and risk of prostate cancer

IntroductionFamily history of prostate cancer is an established risk factor for prostate cancer. However, the relationship between family history of cancers other than prostate cancer and prostate cancer risk is inconclusive. This study sought to examine the association between family history of cancers and prostate cancer.MethodsA case–control study was conducted in which cases and controls were randomly selected from a large urology clinic in Central Virginia. Cases were 600 histologically confirmed prostate cancer patients who were diagnosed between January 2000 and December 2005, and controls were 686 patients who visited the clinic during the same period and were diagnosed with urological illnesses other than cancers and prostate-related problems. Data on family history of cancers, lifestyle and demographic factors were collected through mail survey utilizing the method suggested by Dillman. Unconditional logistic regression analysis was used to estimate the odds ratios (OR) and the corresponding 95% confidence intervals (CI) after adjustment for potential confounding factors including body mass index (BMI), alcohol intake, physical activity, smoking, diet, history of vasectomy and sexually transmitted disease (STD), age, race, marital history, education, and income. Multiple comparisons adjustments were made using the Bonferroni adjustment.ResultsMen with a family history of any cancer in first-degree relatives including parents (OR = 2.42, 95% CI = 1.53–3.84) and parents only (OR = 1.90, 95% CI = 1.23– 2.94) were at increased risk of developing prostate cancer. Significant increased risk was also observed with family history of prostate cancer in first-degree relatives (OR = 2.68, 95% CI = 1.53–4.69) and parents only (OR = 3.26, 95% CI = 1.71–6.24). Even after adjustments for multiple comparisons, the significance persisted both in first-degree relatives (OR = 2.68, 95% CI = 1.16–6.21) and parents alone (OR = 3.26, 95% CI = 1.24– 8.63).ConclusionThis study demonstrated an increased prostate cancer risk for men with a family history of any cancer or prostate cancer in first-degree relatives and parents alone. Health care providers need to be aware of the potential risk of family history of cancers on prostate cancer.