Family Medicine and Primary Care

Physicians and healthcare professionals in the era of #Metoo Jagdish Khubchandani, Raman Kumar, Sharon L Bowman Journal of Family Medicine and Primary Care 2019 8(3):771-774 Gender Based Violence is and has been a pervasive problem in our societies and communities. In recent times, there has been a renewed emphasis on the problem given the #MeToo movement and social activism. In this editorial, we discuss healthcare professions and gender-based violence in light of the #MeToo movement. Also, three major types of exchanges in the healthcare field have been described in relation to gender-based violence. Implications for practice and prevention of gender-based violence in healthcare systems worldwide have been discussed. Healthcare industry is one of the biggest and most prominent enterprises worldwide with lives at stake. Safety of providers and patients and violence free healthcare workplaces can significantly improve health outcomes. The #MeToo movement reminds us of our responsibilities and professional codes of conduct and demands that we always keep at the forefront—the rights of those we serve or interact with.

Public health crisis of road traffic accidents in India: Risk factor assessment and recommendations on prevention on the behalf of the Academy of Family Physicians of India Ranabir Pal, Amrita Ghosh, Raman Kumar, Sagar Galwankar, Swapan Kumar Paul, Shrayan Pal, Debashis Sinha, AK Jaiswal, Luis Rafael Moscote-Salazar, Amit Agrawal Journal of Family Medicine and Primary Care 2019 8(3):775-783 Roads are considered a sign of development bringing colossal benefits to community as socioeconomic and logistic facilitator. Yet, growth of road network has brought road crashes leading to civic pain from premature deaths of productive age group. In 2017, 16 citizens were killed and 53 injured every hour on Indian roads as per officially reported data, while a fair number go unreported. This is unacceptably high when compared with international standards. Risk correlates of road traffic injuries (RTIs) need to be redefined so as to form a continuum with other confounding factors that impact to take lives on road. Risk factors impacting RTIs vary from human components to the roles and responsibilities of healthcare stakeholders. We should have made roads safer for all citizens because a large percentage of population – children, pedestrians, cyclists, motorcyclists, and the elderly – are most vulnerable. A taskforce was set up by the Academy of Family Physicians of India to scientifically analyze the literature available to assess risks and put forward appropriate recommendations.

Fixing accountabilities and finding solutions to tackle acute (communicable) diseases viewed as collateral damage due to errors of omission and commission in primary care Sudip Bhattacharya, Amarjeet Singh Journal of Family Medicine and Primary Care 2019 8(3):784-787

Out-patient coverage: Private sector insurance in India Ramandeep S Gambhir, Ravneet Malhi, Saru Khosla, Rina Singh, Arvind Bhardwaj, Mandeep Kumar Journal of Family Medicine and Primary Care 2019 8(3):788-792 Background: There has been a growth of 25% in the health insurance business in India during the last few years with the expansion of the private health insurance sector. The share of the private health insurance companies has increased considerably, despite the fact that from the patients' point of view, health insurance is not a good deal. Aim: To provide information and assess the current status of private sector insurance with regard to out-patient coverage in India. Materials and Methods: The present review was conducted after doing extensive literature search of peer review journals in Pubmed and various search engines like Google. Data of Indian private health insurance companies was also utilized. No limitation in terms of publication date and language was considered. The main focus of the present review would be on the private health insurance sector with a spotlight on the out-patient coverage and various obstacles faced by the private health insurance sector. Results: Out-patient (OPD) coverage is one of the important emerging trends in the private sector health insurance. OPD cover assists the insured to claim expenses other than that incurred during hospitalization. However, it is still not a full-fledged offering under health insurance and major insurance companies are providing this cover for an additional premium. Conclusion: Private is strongly being advocated and receiving growing consideration by our country's policy makers that can deal with alarming health care challenges in India. However, it is not the only option.

Pulse therapy: Opening new vistas in treatment of pemphigus Subhasish Mustafi, Rupam Sinha, Samhita Hore, Suman Sen, Subhadeep Maity, Pritha Ghosh Journal of Family Medicine and Primary Care 2019 8(3):793-798 Pemphigus is comprised of a group of life-threatening autoimmune diseases that is characterized by circulating IgG antibodies targeting several types of keratinocyte antigens. After introduction of systemic steroids, survival has improved dramatically. However, mortality and morbidity were still very high due to side effects of steroids. Pulse therapy is defined as discontinuous/intermittent intravenous infusion of very high doses of corticosteroids along with certain immunosuppressive agents over a short period. This therapy was introduced to minimize the side effects of conventional corticosteroid therapy. The target is to achieve a faster response and stronger efficacy and to decrease the need for long-term use of systemic corticosteroids. As a result, this therapy has gained its popularity since three decades. The purpose of this article is to review the various available pulse therapy regimens with dosage, indications and contraindications and side effects.

The relationship between gender, age, anxiety, depression, and academic achievement among teenagers Mahnaz F Khesht-Masjedi, Somayeh Shokrgozar, Elahe Abdollahi, Bahareh Habibi, Tahereh Asghari, Reyhaneh Saber Ofoghi, Sabra Pazhooman Journal of Family Medicine and Primary Care 2019 8(3):799-804 Background: Researchers have shown that the anxiety and depression have an important role in academic achievement. Objectives: This study is designed to identify the impact of anxiety and depression on academic achievement in students living in North of Iran. Patients and Methods: In this study 666 secondary school students (13–19 years old) were involved in North of Iran, were involved in this study. We used two instruments for data collection, The Beck Anxiety Inventory and The Beck Depression Inventory. Results: The results indicate that girls with 21.8% were more anxious than boys with 11.6% (F = 21.448, t = 5.420), while boys with 29.5% are more depressed than girls with 17.8% (F = 25.530, t = 4.847). Additionally, there were a significantly negative correlation between academic achievement with anxiety and depression. There was no statistically significant difference in the mean of anxiety and age between teenagers, but a significant depression level of respondents who are 18 and 19 years old was significantly different from other ages. Conclusions: It is recommended that along with academic performance, mental health be developed in school settings using support strategies such as educational guidance and counseling, teaching life skill programs, and psychotherapy. It was concluded that there is an urgent need to pay more attention to the anxiety and depression of adolescents in Iran. The findings of the study will be useful in assisting educators, counselors, and psychologists to develop strategies to enhance students' psychological well-being.

Parent's knowledge, attitude, and practice about children car seats at Unaizah city, KSA Ghadah A AlSallum, Alshamoos A Alwassel, Abdullah M Alshushan, Abdulrahman K Abaalkhail, Mohammad A Alhasoon, Abdullah S Aldamigh Journal of Family Medicine and Primary Care 2019 8(3):805-811 Background: Motor vehicle collision (MVC) is a major cause of death in children worldwide. Using children car seats will stabilize them during accidents and decrease the morbidity and mortality from MVC dramatically. There is no study in Saudi Arabia about car seat use and relationship between using it and children morbidity and mortality following a car accident. Objectives: To assess knowledge, attitude, and practice of children car seats among parents at Unaizah city, KSA, to assess the level of awareness regarding the children car safety system, to determine the parent level of education, socioeconomic status, and other factors affecting their behavior regarding car seats, to determine the prevalence of car seat use among parents in Unaizah city, and to assess the effectiveness of car seat policies on parents' behavior. Design: Cross-sectional study. Settings: Public and private pediatric clinics at Unaizah city in Qassim region. Materials and Methods: The study was conducted from May to June 2018, among parents with child ≤7 years old. Anyone who could not complete the questionnaire for any reason was excluded from our study. SPSS version 20 has been used to analyze all data. Main Outcome Measures: To assess knowledge, attitude, and practice of children car seats among parents at Unaizah city, KSA. Sample Size: 350. Results: There were 350 participants who were included in this study of which females were dominant 77.1%. The age range of parents was 25–35 years old. Most of them complied with the seatbelt policy (56.7%). Among these numbers, 130 participants use a seatbelt for security reason while others were to protect from irregularities. More parents do not put baby seat in the car (57.3%) while 57 participants use child seat every time the child rides in the car. Conclusion: The overall knowledge, attitude, and practices toward children car safety seat in this study was relatively low. This signifies the need of parents to step up their awareness to safe guard their children while on the road. Limitations: Small sample size and limited to pediatrics clinics visitors.

Knowledge and awareness toward anterior cruciate ligament (ACL) injury among population of Aseer region, Saudi Arabia Alsheri Shaker, Mohammed Sultan M. Alshehri, Fayez Saeed Alshehri, Mazen Mohammed Alshahrani, Meshary Safar Alshahrani, Omar Mohammed Alamri Journal of Family Medicine and Primary Care 2019 8(3):812-817 Purpose: The aim of this article is to determine the knowledge and awareness of population toward anterior cruciate ligament (ACL) injury in Aseer region, and to determine the extent of knowledge about what does a person with ACL injury suffer from, and thus investigate the main sources of information that public obtained their medical information about sport injury from. Materials and Methods: This is a cross-sectional study based on a questionnaire distributed to the participants either in malls, campuses, or campaigns and filled by them in Aseer region. A sample of 576 participants was successfully interviewed. Convenience sampling method was used. Results: Nearly all of the participants considered this injury as a multi-factorial incident resulting from a combination of any of the following risk factors: sports, high body weight, heavy housework, and car accidents. Regarding mechanisms responsible about occurrence of ACL injuries during playing sports, the majority (60.8%) proposed a combination of two or more incorrect technical movements: lack of self-protection awareness, insufficient preparation, and overload of exercise. Regarding the participant's information about methods that could decrease pain of ACL injury, about three quarters of all participants (72.2%) stated that resting could alleviate pain. Moreover, most of individuals with previous ACL injury confirmed this. In addition, those with pervious ACL injury supported the role of ice significantly more than the remainder (53.6% vs. 48.1%). Prescription pain medications were selected by 47.3% of all participants. In all, 53.8% of all participants considered Internet as a main source of information about ACL injury. Conclusion: Findings indicated reasonable awareness of the general population in Aseer region about the seriousness of ACL injury, but there was a lack of information about risk factors other than sports, that is, dangerous actions that increase incidence of ACL injuries and their characteristic symptoms.

Prevalence of splenic vein thrombosis and risk of gastrointestinal bleeding in chronic pancreatitis patients attending a tertiary hospital in western India Vikas Pandey, Mallangoud Patil, Ruchir Patel, Alisha Chaubal, Meghraj Ingle, Akash Shukla Journal of Family Medicine and Primary Care 2019 8(3):818-822 Background: Splenic vein thrombosis (SVT) is most commonly caused by acute and chronic pancreatitis (CP). Variceal gastrointestinal (GI) bleeding is a potentially life-threatening event in such patients. The aim of this study was to determine the prevalence of SVT in CP patients and the risk of variceal GI bleeding. Materials and Methods: A total of 187 consecutive patients with a diagnosis of CP were assessed for the presence of SVT at the gastroenterology department of a tertiary care hospital. Thirty seven patients had evidence of SVT. Patients with portal vein thrombosis or cirrhosis were excluded. Potential factors associated with SVT were assessed. Results: Of the 187 CP patients assessed, 37 patients (19.8%) (male 33; female 4; mean age 41.9 years) had evidence of SVT. Among patients with SVT, most common etiology of CP was alcohol abuse (70.3%). Seven patients (18.9%) with SVT presented with clinically significant upper GI bleeding. The source of GI bleeding was gastric varices in three patients (8.1%) and non-variceal source in four patients (10.8%). All three patients with gastric varices were managed by splenectomy. There were no new variceal bleeding episodes in other 33 patients (89.2%) during mean follow-up of 16.4 months. On comparison of patients with and without SVT, the factors associated with significantly higher incidence of SVT were smoking (P = 0.019, odds ratio 3.021, 95% confidence interval 1.195–7.633) and presence of pseudocyst (P = 0.008, odds ratio 3.743, 95% confidence interval 1.403–9.983). Complete resolution of SVT was seen in three patients (8.1%) after resolution of underlying pseudocyst. Conclusion: SVT is a common complication of CP, particularly in patients with pseudocysts and history of smoking. Most patients remain asymptomatic and the risk of variceal bleeding is low. Splenectomy is the treatment of choice in patients with variceal bleeding. Conservative approach is preferred in other patients. Resolution of pseudocysts may lead to resolution of SVT in some patients.

Beneficial effects of gluten free diet on IgA tissue transglutaminase levels and various growth parameters in celiac disease patients Dayanand Hota, Kapil Bhalla, Sanjiv Nanda, Ashish Gupta, Shuchi Mehra Journal of Family Medicine and Primary Care 2019 8(3):823-827 Context: In the resource poor country like India it is difficult to get HLA screening and EMA testing in patients with celiac disease in small centres. Aims: To study the effect of gluten free diet on IgA tissue transglutaminase levels and various growth parameters in patients with celiac disease. Settings and Design: This was a prospective study conducted in the department of paediatrics of a tertiary referral hospital in north India in 3 stages viz. on presentation, after 3 months and 6 months of initial presentation. Materials and Methods: 392 patients with symptoms suggestive of celiac disease were screened for IgA tTG levels more than 10 folds of upper limit of normal. 50 cases (who followed up for 6 months regularly) were enrolled in the study. Spectrum of various growth and clinical parameters were also studied. Statistical analysis used: Statistical analysis was performed by the SPSS version 20.0. Data were checked for normality before statistical analysis. p value less than 0.05 was considered statistically significant. Results: 50 cases were enrolled in study. After initiation of gluten free diet, improvements were seen in various growth factors like height (12.71%) and weight (3.47 cm) after 6 months. Serum tTG(IgA) levels decreased to 94.88±55.35 U/mL from baseline level of 202±83.96 U/mL after 6 months. Conclusions: Gluten free diet has major role in improvement in growth parameters as well as anemia. So, early detection of celiac disease is an important step in prevention of morbidity associated with this chronic disease.