High prevalence of type 2 diabetes in an urban settlement in Kerala, India

Background. Prevalence of type 2 or non insulin dependent diabetes mellitus is high among Indians living in India as well as abroad. Prevalence among persons of Indian origin in many countries is greater than that of people of other ethnic extraction. The Indian state of Kerala is distinguished by a high level of achievement in the health sector, characterised by both lower mortality rates and greater density of health care institutions that ensure access to most people. These attributes make the prevalence of diabetes and the pattern of its management in Kerala worth studying. Objective. To estimate the prevalence of diabetes among persons 20 years or older in an urban housing settlement in Trivandrum city, the capital of Kerala, as well as study the management of the disease in subjects affected. Design. Cross sectional survey for detecting diabetes and other chronic diseases in all willing residents of an urban housing settlement in Trivandrum, the capital city of Kerala, as part of a preventive campaign against lifestyle diseases. Fasting plasma glucose, serum triglycerides, cholesterol, height, weight and blood pressure were measured, and a detailed questionnaire administered to ascertain previous diabetic status and management. Results. Overall prevalence of type 2 diabetes is 16.3%. In the 30-64 age group, age standardised prevalence is 13.7%. Gender differences in prevalence are negligible. Greater prevalence is associated with advancing age, body mass index above 24.99, sedentary habits, serum total cholesterol > 239, serum triglycerides > 149, hypertension and smoking. Compared to non-diabetics, diabetics have greater mean and range of fasting plasma glucose values (8.87 + /-3.6 mM/l as against 4.34 + /-0.53 mM/l). 32 out of 38 diabetics among the subjects (82.4%) were already diagnosed even before the survey; of them, 89% were on medication. 3% of subjects had impaired fasting glucose, or FPG level between 110-125 mg/dl. Conclusion. Prevalence of type 2 diabetes among a group of urban residents in Trivandrum city in Kerala is very high. This is associated also with a high detection rate and compliance to treatment.     

Bakhtin's Philosophy and Medical Practice — Toward a Semiotic Theory of Doctor — patient Interaction

Doctor-patient interaction has gained increasing attention among sociologists and linguists during the last few decades. The problem with the studies performed so far, however, has been a lack of a theoretical framework which could bring together the various phenomena observed within medical consultations. Mikhail Bakhtin's philosophy of language offers us tools for studying medical practice as socio-cultural semiotic phenomenon. Applying Bakhtin's ideas of polyphonic, context-dependent and open-ended nature of human communication opens the possibilities to develop prevailing theoretical and empirical approaches to the study of medical consultations. This revised version was published online in July 2006 with corrections to the Cover Date.     

Single-handed practices – their contribution to an undergraduate teaching network in the first year of the new curriculum

OBJECTIVES: The new curriculum at King's College School of Medicine and Dentistry, which commenced in September 1996, requires all medical undergraduates to have a general practice placement throughout the 5 years of their medical education. DESIGN: This paper discusses recruitment, training and support of teaching practices for the new curriculum, reviews the distribution of single-handed general practices in the network and, via a selection of monitoring and evaluation procedures, discusses the implications of a policy which is inclusive of single-handed practices. The findings relate to the experience of the first semester of the first year of the new curriculum. It also examines the contributions that single-handed practices have made to the teaching network and the kind of support needed, if single-handed practices are to continue to contribute to the King's teaching network. SETTING: King's College School of Medicine and Dentistry. SUBJECTS: Medical undergraduates. RESULTS: The findings of this paper revealed that over a third of general practice provision is via single-handed practices in South-east London. Within the undergraduate teaching network, 10% of practices are single-handed. Students are welcomed and receive a learning experience comparable to those students in larger practices. Attendance at training events has proved difficult for some of these tutors, but the extra input from the department, in order to address this deficit, has not been onerous. Indeed, single-handed practices have not been unique with regard to difficulties in attendance at training events. CONCLUSIONS: The study concludes that single-handed practices can make satisfactory provision for undergraduates in the new curriculum and there is no evidence from this study to suggest otherwise.     

Interactive technology applications for behavioral counseling: issues and opportunities for health care settings

CONTENT: This article discusses the rationale for, and the potential benefits and limitations of, computer-based interactive health communication (IHC) programs for health behavior counseling. We describe common barriers to health behavior counseling in medical settings and show how IHCs can address these issues. Following an overview of current and likely near-future IHCs, the potential impact of IHCs on the patient-provider relationship is considered. Results from evaluations of IHCs are summarized and important and unique issues in evaluating IHCs are discussed. We conclude with recommendations for clinical applications, including recommendations for consumers considering purchase or adoption of IHCs and recommendations for future research.     

Risk factors for mental disorder hospitalization after the Persian Gulf War: U.S. Armed Forces, June 1, 1991-September 30, 1993

Effects of Persian Gulf War (August 2, 1990–July 31, 1991) and Gulf War occupation on post-War hospitalization risk were evaluated through Cox proportional hazards modeling. Active-duty men (n = 1,775,236) and women (n = 209,760) in the Army, Air Force, Navy, and Marine Corps had 30,539 initial postwar hospitalizations for mental disorders between June 1, 1991 and September 30, 1993. Principal diagnoses in the Defense Manpower Data Center hospitalization database were grouped into 10 categories of ICD-9-CM codes. Gulf War service was associated with significantly greater risk for acute reactions to stress and lower risk for personality disorders and adjustment reactions among men. Personnel who served in ground war support occupations (men and women) were at greater risk for postwar drug-related disorders. Men who served in ground war combat occupations were at higher risk for alcohol-related disorders. Longitudinal studies of health, hospitalization, and exposure beginning at recruitment, are needed to better understand how exposure to combat affects the mental health of military personnel.     

我国农村地区实施大病统筹合作医疗或医疗保险方案的技术缺陷

在我国中等发达及上农村地区,大病统筹合作医疗或医疗保险以其可缓解农村居民的就医经济风险而受到欢迎,但是在方案的拟订过程中尚存在一些明显的技术缺陷,比如,“大病”的技术定义、农村居民就医经济风险分析、风险临界线界定、保险经付比测算和保险费率厘定等,这些技术的缺乏,已严重影响农村合作医疗或医疗保险的推广和实施效果。     

The diluting effect of medical work groups on feedback efficacy in changing physician's practice

Feedback intervention has been advocated as a successful method to modify the way that physicians practice medicine. However, most studies concerned with modifying physician profiles have focused on interns and residents. The results presented here concern regular staff and therefore provide a better basis for generalization. Over a 2.5-year period, we analyzed the use of clinical resoucces by physicians practicing in four medical specialties in two hospitals. Hierarchical multiple regression models were used to control case mix in order to identify the specific effects attributable to feedback. The information failed to modify the physicians' practice profiles. Our results suggest that this failure is related to the organization of inpatient medical practice as a group effort. This mode of practice has a negative effect on feedback efficacy. First, it weakens one of the main feedback mechanisms, that is personal identification with the data. Second, it probably generates mutual adjustment among physicians, thus eliminating practice variations at the source.     

Under fives mortality in the urban slums of Lucknow

The main objective of this study was to elicit proportional cause specific mortality in the underfives in the urban slums of Lucknow in North India. The families with under five mortality in the 28 randomly selected slums in 1993 were located from the records of the slum health workers and verbal autopsy was conducted to assign a cause of death. There were 71 deaths among 2796 children. The annual under five mortality was 25.4 and the under five mortality rate was 126.7. After the neonatal period, “high fever” that could not be classified into any other disease incorporated in the verbal autopsy instrument, was the most common symptom associated with death, seen in 21.1% cases (95% C.I.: 15.5–34.4%) followed by these diseases: pheumonia in 19.7%, diarrhea in 18.3% and measles in 11.4%. “High fever” as the leading symptom associated with death is being reported for the first time from the urban slums of India. There is an urgent need to identify the underlying etiologies of death due to “high fever” and the policy implications are that children with fever must receive immediate and continued medical attention till the symptom persists.     

Metallurgical evaluation of the compatibility of surgical clips with their appliers

Summary Five aneurysm clips and their respective appliers (Heifetz, Vari-Angle, McFadden, Scoville, and Yaargil) were tested for the production of small metal shards that could provoke a foreign body reaction or increase the risk of a stresscorrosion failure. Pivot and Vari-Angle-McFadden clips produced numerous large shards, the Scoville clip produced a few fine shards, and the Yaargil and Heifetz clips produced none. Metal shard production due to cold metal transfer is attributed to the abrasive mechanical interaction between clips and appliers made from metals with different degrees of hardness.     

反复流产患者的中医护理对策

目的 :探讨结合现代护理观为指导的具有中医特色的整体护理模式。方法 :运用中医基础理论知识 ,针对引起反复流产患者的病因 ,将患者主要分为内分泌异常型、免疫异常型、生殖道异常型、感染型、全身性疾病影响型、染色体异常型施以护理。结果 :依据不同证型 ,有的放矢的实施护理 ,使患者明确了引起反复流产的根本原因、治疗措施、注意事项、预防保健方法 ,消除了紧张、恐惧、焦虑等心理障碍 ,树立了再次妊娠的信心 ,提高了妊娠成功率