Trends in Smoking Among African–Americans: A Description of Nashville’s REACH 2010 Initiative

African Americans bear a disproportionate burden of tobacco related morbidity and mortality despite smoking less than their Caucasian counterparts. Nashville’s REACH 2010 initiative developed community partnerships to promote awareness, education and participatory programs to prevent and decrease smoking among residents of the northern geographic area of Nashville, TN, a majority African American community. A social–ecological model provided the framework for interventions used during a 5 year period that included: (a) community level strategies to increase awareness and knowledge about the effects of smoking; (b) individual level strategies to enlist and train community members to become advocates, lead smoking cessation classes and encourage current smokers in quit attempts; and (c) strategies directed to changing policy through education and partnership building. Smoking prevalence among residents was examined from 2001 through 2005 based on data from the Nashville CDC REACH 2010 Risk Factor Survey and the Tennessee CDC Behavioral Risk Factor Survey. Tests for linear trends indicated a significant decreasing trend (P < .02) of daily smoking and smoking uptake (P < .03) in North Nashville. In contrast to our community an increasing trend was observed in quitting smoking (P < .01). No trends were significant for African Americans in Tennessee. This study suggests that consistent, multiple and multi-level strategies targeted to an African American community may impact smokers who are not ready to quit but willing to reduce their level of smoking. This study underscores the importance of developing and implementing community wide campaigns to address the needs of African Americans.     

Polymyositis-like syndrome with rhabdomyolysis in association with brucellosis

Diffuse myositis with progression to rhabdomyolysis has been reported in association with wide range of viral infections. We report a case of polymyositis-like syndrome complicated by rhabdomyolysis secondary to brucellosis. This case report thus contributes yet another atypical presentation to a disease already infamous for its protean manifestations.     

Executive Summary - The Association of Colon &amp; Rectal Surgeons of India (ACRSI) Practice Guidelines for the Management of Haemorrhoids—2016

This paper outlines the recommendations from the Association of Colon & Rectal Surgeons of India (ACRSI) practice guidelines for the management of haemorrhoids—2016. It includes diagnosis and management of haemorrhoids including dietary, non-surgical, and surgical techniques. These guidelines are intended for the use of general practitioners, general surgeons, colorectal surgeons, and gastrointestinal surgeons in India.     

Disparities in perceptions of healthcare access in a community sample

Disparities in health status persist for many sociodemographic groups in the United States. An understanding of barriers to healthcare access and utilization can assist community-based initiatives in developing strategies to improve the health of minority and low-income populations. Using self-reported information from 3014 community residents, a factor analysis was conducted that defined barriers to healthcare by 4 dimensions: (1) time and competing priorities, (2) convenience and availability, (3) healthcare utilization, and (4) healthcare affordability. Differential effects of demographics were observed on all factors. Racial disparities were found where African Americans experienced more problems based on the convenience and availability of services (P < .02) than did whites, after controlling for income, education, age, and marital status. In addition, gender differences showed that women experienced greater difficulty with time and competing priorities than men (P < .001); however, women experienced fewer problems related to utilization (P < .001). Of the covariates, income was significant (P < .01) on 3 of the 4 indicators. This study points to the need to develop interventions that address the unique challenges faced by different population groups to ensure timely healthcare. In addition, the reduction of economic disparities should be considered as an important strategy to improve public health.     

Onychomycosis in central India: a clinicoetiologic correlation

BACKGROUND: Onychomycosis is mainly caused by dermatophytes, but yeasts and nondermatophyte molds have also been implicated, giving rise to diverse clinical presentations. The etiological agents of the disease may show geographic variation. The aim of the present study was to isolate the causative pathogens and to determine the various clinical patterns of onychomycosis in central India. METHODS: The study population comprised 90 patients with onychomycosis. Nail samples were collected for direct microscopic examination and culture. Clinical patterns were noted and correlated with causative pathogens. RESULTS: The male : female ratio was 3:1 and the mean age was 29.40 +/- 13.61 years. Fingernails were involved in 60%, toenails in 26.67% and both fingernails and toenails in 13.34% of the 90 patients. The clinical types noted were distolateral subungual onychomycosis (64.44%), total dystrophic onychomycosis (17.78%), proximal subungual onychomycosis with paronychia (12.2%), proximal subungual onychomycosis without paronychia (4.44%) and superficial white onychomycosis (1.11%). Dermatophytes were the most common pathogens isolated, being found in 24 patients (26.36%) [Tricophyton rubrum (23.07%), Tricophyton verrucosum (2.22%) and Epidermophyton floccosum (1.11%)], followed by Candida albicans, which was found in 22 patients (24.27%). Thirty-six (39.58%) nondermatophyte molds were isolated from 29 patients. Of these 29 cases, six were associated with Tricophyton rubrum, which was considered the primary pathogen. CONCLUSIONS: Distolateral subungual onychomycosis was the most common clinical presentation; however, total dystrophic onychomycosis and proximal subungual onychomycosis were not uncommon in this part of India. Tricophyton rubrum and Candida albicans were the major pathogens. The clinicoetiologic correlation revealed that a single pathogen could give rise to more than one clinical type.