Related Complaints Research Articles

Active sitting with backrest support: Is it feasible?

Ergonomics science recommends office chairs that promote active sitting to reduce sitting related complaints. Since current office chairs do not fulfill this recommendation, a new chair was developed by inverting an existing dynamic chair principle. This study compares active sitting on the inverted chair during a simulated computer-based office task to two existing dynamic office chairs (n = 8). Upper body stability was analysed using Friedman ANOVA (p = .01). In addition, participants completed a questionnaire to rate their comfort and activity after half a working day.The inverted chair allowed the participants to perform a substantial range of lateral spine flexion (11.5°) with the most stable upper body posture (≤11 mm, ≤2°, p ≤ .01). The results of this study suggest that the inverted chair supports active sitting with backrest support during computer-based office work. However, according to comfort and activity ratings, results should be verified in a future field study with 24 participants.Practitioner Summary: This experimental laboratory study analyses the feasibility of active sitting with a backrest support during common office work on a new type of dynamic office chair. The results demonstrate that active sitting with a backrest support is feasible on the new but limited on existing chairs.

Gastric Emphysema - A Rare Complication of a Massive Upper Gastrointestinal Bleed

Gastric emphysema (GE) is a rare condition in which gas accumulates in the stomach wall secondary to disruption of the wall by pressure, vomiting, or other mechanical processes. Radiologically, it resembles emphysematous gastritis but is benign in comparison. Emphysematous gastritis is a life threatening infection of the gastric wall by gas producing organisms. Emphysematous gastritis while rare, has a mortality rate as high as 80%. CT imaging is the most sensitive and specific way to differentiate emphysematous gastritis versus gastric emphysema. On CT, air in the hepatic venous system is highly suspicious for emphysematous gastritis. Gastric distension and vomiting frequently precede the formation of the intramural air. Pulmonary disease, instrumentation of the stomach, and obstructing lesions of the antrum and pylorus are also common contributing factors. Here we present a case of a 83 year old male who initially presented to our institution with shortness of breath. The patient was admitted after being diagnosed with COPD exacerbation and was medically managed by the medical, ICU, and cardiology team. On Day 6 of the clinical course, the patient was found to have abdominal distention with related complaints. A CT abdomen/pelvis demonstrated a significantly distended stomach with air-fluid levels and peripheral non-dependent lucencies concerning for intramural gas. Abdominal decompression was initiated via nasogastric tube placement, which yielded a large volume of red, bloody gastric contents. Shortly after decompression, the patient became unresponsive and pulseless. Despite resuscitation attempts, the patient was unable to be stabilized and surgery was unable to attempt to surgical repair the stomach. The true incidence of GE is unclear as most patients are asymptomatic, however around 40 cases have been reported in the literature since the 1890s. This case demonstrates a rare presentation of gastric emphysema related to distention secondary to a massive upper GI hemorrhage. Although most cases of GE are benign and non-life threatening, this case depicts one of the rarer complications of GE. Due to the unique aspects of this case, it is imperative that physicians be abreast and vigilant in assessing patients who have the signs and symptoms of GE. More research is needed to allow for a better understanding and prompt detection of GE in order to decrease the probability of complications in an otherwise normally benign process.

Time, Distance and Economics Influencing Cancer Care: Experience From a Regional Cancer Center in India

Background: There is a geographical, socioeconomical and logistic diversity among the cancer patients who reach a regional cancer center. In a developing economy like that of India's, only a minority of patients have medical insurance. So in our setup a cancer patient is met with time, distance and financial challenges. These intangible factors theoretically are expected to influence the ultimate outcome of cancer treatment. Aim: To evaluate the prevailing demographic and economic variables of cancer patients visiting our RCC and to look for any correlation among each other. Methods: The demographic details of cancer patients registered at our RCC between August 2017- September 2017 were retrieved retrospectively. Distance traveled to get to the RCC and get a diagnosis of cancer, time taken for diagnosis and initiation of treatment, and the source of finances for treatment were collected. A correlation among these factors was attempted to be identified. Statistical correlation was identified using Student t-test. Results: Among 591 patients who were analyzed, the median age of patient was 55 years old. The median time taken for the patient to reach the RCC from permanent residence after the beginning of cancer related complaints was 3.19 months. The median distance traveled for the same was 131 km. The source of income was private employment for 223 patients and government employment for 164 patients and self-employment for 200 patients. Only 164 patients had some kind of structured health scheme to manage their health care expenses. Among these, 96 patients had private insurance/reimbursement and 64 patients had government reimbursement. 384 (64%) of patients presented with advanced and locally advanced stage disease while 114 (19%) patients presented to us with early stage disease. However a correlation between delay in presentation to the RCC, distance traveled to reach the RCC, source of income and advanced stage of disease couldn't not be established. Conclusion: Majority of patients visiting our RCC is from far off places and most of these patients pay for the cancer treatment themselves without any support from government or private insurances. All these factors may be responsible for late or advanced stage presentation of cancer patients.

Hepatitis C Follow-Up After Hospital Discharge

Introduction: A sustained virologic response against hepatitis C virus (HCV) is now viable with development of direct-acting antiviral regimens. Although social factors, co-morbidities and insurance may determine if a patient is treated against HCV, it is imperative to follow-up with gastroenterology (GI) for management strategies. We aimed to determine if patients with chronic hepatitis C established care with GI after hospital discharge. Methods: Retrospective chart review of 62 patients with confirmed or reported history of chronic hepatitis C was performed. Confirmation was established with detection of HCV RNA. Patients admitted for both GI-related conditions as well as non GI-associated complaints were included. Presence of cirrhosis, portosystemic encephalopathy (PSE), esophageal varices (EV) and ascites was evaluated. Follow-up with GI after discharge was the primary outcome. Secondary outcomes included 30-days re-admissions, mortality, and GI evaluation during their inpatient stay. Results: Of the 62 patients, 46 (74.2%) were males. 49 (79.0%) patients were confirmed to have HCV but the rest only reported a prior history of chronic hepatitis C. Median age was 54 years and average length of stay was 8.3 days. 9 (14.5%) patients were readmitted to the hospital within 30 days. 22 (35.5%) reported concurrent alcohol use and 24 (38.7%) admitted illicit drug use. Cirrhosis was present in 22 (35.5%), PSE in 12 (19.3%), EV in 10 (16.1%) and ascites in 12 (19.3%) patients. 41 (66.1%) were admitted for non-GI related complaints. At discharge, 35 (56.4%) were referred to GI but only 16 (25.8%) followed with GI as outpatient. Of those that did see GI after discharge, 13 (81.2%) were within first three months of discharge. 9 (14.5%) patients died either during hospitalization or after discharge. Conclusion: Most patients with reported history of hepatitis C did not have cirrhosis and their inpatient admissions were not related to GI problems. Consequently, most of these patients did not see GI as an outpatient. With the change in insurance approval trends for treatment of chronic hepatitis C, this population in initial stages or without cirrhosis would benefit from earlier evaluation by GI to facilitate management before the onset of cirrhosis and its associated complication. Future avenues include introducing prompts in the electronic health record system at the time of discharge to refer patients to GI as well as contacting patients within 30 days of discharge to remind of outpatient visits.

An Evaluation of Pediatric Out Patient Department (POPD) of a Private Dental College Hospital by Accompanying Parents of Child Patients

Purpose:The Pediatric Out-patient-department (POPD) of a dental hospital deals with children with different tooth related complaints. Dental treatment of a child patient requires three way interactions between the child, the parent and the dental surgeon. Though health of the patient remains the top priority for caregivers, satisfaction with the delivery system is vital for long lasting doctor-patient relationship. Thepurpose of the study was to evaluate the performance of Pediatric OPD by the accompanying parents of children receiving treatment at the OPD of a private dental college hospital.Methods: A cross sectional study was carried out at the POPD of Sapporo Dental College Hospital, Uttara Model Town of Dhaka city during May-July 2017. Sampling was done by simple random sam- pling method .Data were collected from the parents of 122 children aged between 1-12 years by using a self-administrated questionnaire.Results: Majority of the participating parents were residents of Uttara Model Town or areas in the vicinity and were employed, educated and are middle are middle socioeconomic class. More than sixty percent (62.3 %) of the respondents were parents of children between 4-7 years of age. More than 90% of the patients had waiting time at the department between 0-30 minutes. Treatment cost was described as ‘low or ‘reasonable’ by 87% of the parents. Only 8.2% mentioned ‘unsatisfactory’ regarding the cleanliness of Pediatric OPD. More than 95% of the respond- ents expressed ‘Satisfactory’ and ‘good’ level of satisfaction with general performance of OPD and the treatment provided by the dental team.Conclusion: Parents expressed general satisfaction with the performance of Pediatric Department of Sapporo Dental College Hospital.Update Dent. Coll. j: 2018; 8 (1): 05-10

Safety of on-scene medical care by EMS nurses in non-transported patients: a prospective, observational study

BackgroundAfter on-scene examination and /or treatment, emergency medical services (EMS) nurses must decide whether the patient requires further assessment or treatment, most frequently in a hospital. The primary objective of this study was to assess the reliability of the current EMS protocol by determining whether the decision not to transport the patient to a care provider was correct or not.MethodsAdults receiving on-scene medical care by an EMS rapid responder or full team without transport to the hospital were included in this prospective observational study. The primary outcome measure was secondary consultation within 24 h after an on-scene EMS evaluation without transport for the same or a closely related complaint. The secondary outcome measures were patient satisfaction, type of secondarily consulted health care provider, provisional and definitive diagnosis, and correctness of the EMS members’ decision to provide on-scene medical care without transport.ResultsOf the 1095 participating patients, 271 (24.7%) patients requested secondary medical attention for the same complaint. This percentage was significantly larger in incidents attended by an ambulance team than by a rapid responder (N = 248 (26.5%) vs. N = 23 (14.4%); p < 0.05). In eleven (1.0%) cases an urgent medical diagnosis requiring admission was missed. A total of 873 (79.7%) patients were satisfied with the decision not to be transported. In 44 (4.0%) cases the EMS nurse’s decision was rated incorrect since the patient needed help contradictory to the EMS nurse’s recommendation.ConclusionsThe data show that EMS nurses can effectively examine patients, but a low threshold of referral for consultation should be considered because one in four patients requested secondary medical attention for the same complaint(s) again. However, due to a low response rate (11.3%) more research is needed to further determine the safety of the current EMS protocol.Trial registrationNot applicable.

Medical needs and major complaints related to pruritus in Germany: a 4‐year retrospective analysis using Google AdWords Keyword Planner

It is difficult to estimate the prevalence of acute and chronic pruritus in the population at large due to a lack of affected persons seeking medical assistance. To discover the incidence of pruritus in Germany and determine what the most common related complaints are via an analysis of Google's search volume. From June 2013 to April 2017, the Google AdWords Keyword Planner was utilized to select and critically assess relevant keywords for 'pruritus'. Among a total of 13 691 470 German language Google searches on the topic of pruritus, it was found that the most searched for terms included atopic eczema (24.3%) and the layman's term for psoriasis ('Schuppenflechte'; 17.8%), as well as just psoriasis (13.4%). 'Juckreiz', the German word for pruritus, was determined to be only the sixth most searched for term (2.9%). Anal pruritus and pruritus of the entire body comprised the most searched for localizations. The various factors that impact pruritus, particularly skin conditions and disorders, were established to be among the most searched for terms (72.6%). A decreased monthly search volume was associated with the changing seasons; the summertime had the lowest number of searches for pruritus. The Google search engine analysis provided insight for this study into the unexpectedly large number of unmet medical needs of those suffering from pruritus within Germany, especially that of specific localizations on the body.

Which Communities Complain to Policymakers? Evidence from Consumer Sentinel

Consumer complaints provide a signal of the problems that different American communities face. I use a large database of millions of complaints to examine how per capita complaint rates vary across communities, as well as heterogeneity in who complains to different agencies and about different consumer protection issues. I find higher complaint rates in more heavily Black, more educated, higher income, older, and more urban communities and lower complaint rates in more heavily Hispanic and higher household size communities. The demographics of complaints are quite different for the Consumer Financial Protection Bureau, with much higher rates of complaints from Black and college educated areas compared to the Federal Trade Commission or Better Business Bureaus. I also find much higher rates of finance related complaints from Black communities across all reporting agencies.

LO13: Eye care in the emergency department: what proportion of patients presenting to the emergency department with isolated eye related complaints could alternatively be seen by an optometrist?

Introduction: Approximately 2-3 percent of emergency department (ED) visits are due to eye-related complaints, adding to the ED workload. Many of these could be seen instead by an optometrist who specializes in the examination, diagnosis and treatment of eye-related disorders. We sought to determine the proportion of ED patients with isolated eye-related complaints that could be managed by an optometrist. Methods: We performed an administrative database study and descriptive analysis of all patients presenting to Calgary EDs with eye-related complaints during a one-year period. We determined optometry eligibility by reviewing discharge diagnoses and assessing whether that condition was within the Alberta Association of Optometrys (AAO) defined scope of practice. Patients were considered ineligible if their condition was related to bites, stings, thermal burns, assault, MVA or operative complications; if they required hospitalization or referral to a non-eye specialist (e.g. neurology); if they had associated headache, dizziness, syncope, hypertension, neurologic abnormality (e.g. diplopia); if they had facial cellulitis, orbital infections, adverse drug effects, or if they underwent observation in the ED because of concerns about a cardiac or neurological condition. Results: In 2015, 7686 patients were seen in Calgarys 5 EDs with eye related complaints. Of these, 76.2% were optometry-eligible and 75% of optometry-eligible patients arrived during day or evening hours (0800-2100). The most common presenting complaints were visual disturbance (24.8%), redness (22.1%), and pain or photophobia (16.4%). Optometry-eligible patients waited an average of 110 min and had an ED LOS of 149 min. Conclusion: Approximately 3 in every 4 patients seen in the ED for eye related complaints could alternatively be seen by an optometrist. Further research is required to establish the feasibility of diversion to an optometrist from the ED for eye-related complaints.

Integrated Public Grievance Redressal System (iPGRS) A Next-Gen Solution for a Next-Gen Railway

Railways receive millions of service related complaints and grievances from the passengers annually through various channels (web-based, mobile app, social media, phone or paper based etc.). However, these channels are usually disparate, siloed, and heavy with manual processes. For many rail companies, there is no uniform business process or single platform visibility to address these grievances. The result is a high level complexity (multiple channels, differing processes and so on) that increases response times in addressing them. Railway companies in the Asian continent started to semi-automate their complaints processes but the process is not sufficiently robust to survive the large volumes expected in the future. Today, most railways employ a small 'grievance department' with people working in shifts 24x7 and manually handling thousands of complaints daily. Moreover, the penetration of smartphones is leading to a drastic increase in the volume of complaints, resulting in railways having to consider hiring more people. The result of this is two-fold – i) added cost pressures due to increase in staffing and ii) reduction in revenues due to loss of passenger satisfaction. iPGRS is an omni-channel solution that helps railways overcome these challenges. iPGRS integrates grievances from multiple channels onto a single platform, and creates a Service Request (SR)-based workflow that enables monitoring of grievances resolutions. Concerned stakeholders in the grievance department receive these Service Requests as an action item in their workflow and it becomes their responsibility to properly address and close each request. Feedback related to a grievance resolution is integral to ensuring transparency and accountability in a system that handles large volumes of grievances. The iPGRS system also includes many automation techniques, like rule-based engine, text analytics and more, to speed up the whole process. iPGRS offers a 360-degree integrated dashboard for further analysis and service improvements. We developed a prototype and demonstrated this solution to a large passenger rail organization in Asia for their consideration.

Correlation between physical markers and psychiatric health in a Portuguese systemic lupus erythematosus cohort: The role of suffering in chronic autoimmune disease.

BackgroundSystemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects a large number of people throughout the world. Anxiety, depression and fatigue are common symptoms of SLE that substantially contribute to decreased quality of life. This study investigates the interplay between physical and psychiatric manifestations of lupus. To this end, an SLE patient cohort was examined for correlations between clinical presentation, laboratory tests, and psychological indicators.MethodsSeventy-two lupus patients were evaluated for psychological status using a battery of instruments, including assessments for fatigue (CFS & FSS), depression (HADS), anxiety (HADS), overall health (SF-36 & PSQI) and intimate relationship satisfaction (RAS & CSI). Scores from these assessments were correlated with lupus clinical profiles and laboratory test values.ResultsThe prevalence of depression in the SLE patient cohort was 41.7%, as measured by the hospital depression and anxiety scale. The study identified that pain (p = 0.001), body mass index (p = 0.026), Chalder’s fatigue scale (p < 0.001), fatigue severity scale (p < 0.001), and anxiety (p = 0.001) are all positively correlated with depression in SLE patients. Total complement (CH50) (p = 0.032), and SF-36 physical and mental characteristic assessments are negatively correlated with depression. Longitudinal analysis indicated that the disease related complaint alopecia (p = 0.008) and relationship assessment scale scores (p = 0.004) may also be correlated to depression in SLE patients. Multivariant scrutiny of the clinical and psychosocial characteristics identified the fatigue severity scale (p = 0.026), SF-36 physical function (p = 0.040), physical role function (0.030), and mental health (p = 0.002) as the best indicators directly correlated with depression for the SLE cohort.ConclusionThese results reveal the influence of physical manifestations of lupus including fatigue, pain, body mass index and anxiety, as well as decreased physical and mental function, on depression. Fatigue is the strongest factor correlated with depression in SLE patients in the cohort. Both physical and social/psychological aspects likely contribute to the depression and anxiety in lupus.

One year’s activity and outcome data from an ambulatory cardiology unit

In 2015, the Belfast Trust piloted an ambulatory cardiology unit (ACU). The ethos of the ACU was to reduce pressure on the Emergency Department by providing a unit where rapid evaluation, treatment and follow-up could be provided by the cardiology team and, at the same time, reduce inpatient admissions to cardiology beds. The service proved effective in reducing admissions to cardiology beds by 13.5% over a 1-year period, while patient outcomes at 30 days and 6 months demonstrated that the service is safe, with only 1.7% of patients readmitted at 30 days and 6 months with the same or a related complaint. The principles of ACU could be adopted by many other specialities.

Balneotherapy is an alternative treatment for mastalgia; a randomized controlled trial

IntroductionMastalgia is the most common breast related complaint. Balneotherapy is widely used as a non-pharmacological treatment modality in many European countries. The objective of this study was to determine the efficacy of balneotherapy in patients with mastalgia. MethodsA randomized controlled clinical trial was conducted with forty women with mastalgia. Patients were randomly assigned to the control and balneotherapy groups. Conventional therapy was recommended for both groups for 6 weeks. The balneotherapy group was also given a total of ten sessions of balneotherapy during the last two weeks. Breast pain level, serum cytokine levels including interleukin-1β and tumor necrosis factor (TNF)-α and quality of life were evaluated in both groups before and 6-weeks after study. The Breast pain questionnaire was used for the assessment of mastalgia. This questionnaire includes sensorial and affective data, visual analog scale (VAS) and present pain intensity (PPI). Quality of life was measured by using Short Form (SF)-36. ResultsBaseline total breast pain scores (BPS) and cytokine levels were similar between the groups. Total BPS (p = 0.001), VAS (p = 0.039) and PPI (p = 0.004) in the balneotherapy group significantly improved after therapy. TNF-α level in the balneotherapy group also significantly decreased after therapy (p = 0.003). The results of SF-36 showed that five subscales were significantly improved in the balneotherapy group however only social functioning was significantly improved in the control group after treatment. ConclusionThe results of the study revealed that balneotherapy may be an effective method in the treatment of mastalgia and it can be recommended by clinicians.

Profile and outcome of childhood tuberculosis treated with DOTS at a tertiary care hospital in central India: an observational study

Background: Children contribute a significant proportion of the tuberculosis (TB) burden in India and suffer severe TB related morbidity and mortality, particularly in endemic areas. Diagnosis and management of pediatric TB especially Extra pulmonary (EPTB) is challenging. The present study was designed to study clinical, laboratory characteristics and outcome of childhood tuberculosis.Methods: A retrospective analysis of 90 cases of TB in children within 2 year period was conducted at Pediatric Department and DOTS center at a tertiary care hospital from January 2015 to December 2016.Results: In the present study 20% of the total TB patients attending DOTS OPD were Children. Most common symptoms were Fever (53.3 %), Cough (46.6%), abdominal pain (18.8%), lymphadenopathy (13.3%), osteo-articular symptoms (13.3%), weight loss (10%), CNS related complaints like convulsions and unconsciousness (6.6%). History of contact was present in 10 cases (11%). Sputum examination was positive in 9 cases (10%) who were predominantly older children above 12 years. Mantoux test was positive in 9 cases (10%). Only one patient was HIV positive. Extra pulmonary tuberculosis (EPTB) patients were more common than pulmonary. 47 out of the 90 cases (52%) were receiving DOTS for EPTB. Out of the 90 cases 84 (93.3%) were on New Category 1 treatment and 6 (6.6%) were on Cat 2 treatment. Out of the total 90 cases 3 defaulted, 3 died, rest completed treatment with good compliance and no side-effects and were declared cured.Conclusions: In present study, it was found that extra-pulmonary tuberculosis (EPTB) patients are more common than pulmonary tuberculosis in pediatric age group. Sputum positivity yield is very low in pediatric age group. Success of treatment with DOTS is good (94.4%). No adverse effects of ATT were observed.

Reflexology: A randomised controlled trial investigating the effects on beta-endorphin, cortisol and pregnancy related stress

Reflexology is used for various pregnancy related complaints. A three-armed, pilot randomised controlled trial was conducted to test changes in physiological and biochemical stress parameters. Ninety primiparous volunteers experiencing low back and/or pelvic girdle pain (LBPGP) were recruited to receive either six reflexology or footbath treatments or usual care. Primary outcome data included pain intensity and frequency measured on a visual analog scale (VAS), and salivary beta-endorphin and cortisol levels. 61 (68%) women completed the intervention. A clinically important reduction of 1.63 cm occurred for VAS pain frequency following reflexology. Beta-endorphin levels increased by 8.8% and 10.10% in the footbath and usual care groups respectively and decreased by 15.18% for the reflexology group. Cortisol increased by 31.78% for footbath participants, 31.42% in usual care and 18.82% in the reflexology group. Reflexology during pregnancy may help reduce LBPGP, and associated stress. However, antenatal reflexology is under researched and requires further investigation.

A study of clinical patterns in benign breast disorders

Background: This is a prospective study aimed at evaluating patients presenting with breast related complaints at Dr. D.Y. Patil Medical College, Pimpri, Pune. It outlines various clinical patterns in benign breast disorders; this includes age, type of presentation, side and quadrant of breast involved, size of breast lump and the eventual diagnosis.Methods: A prospective study was conducted at Dr. D.Y. Patil Medical College, Pimpri, Pune, between July 2016 and July 2017. Author evaluated 50 patients, male and female, of all ages, presenting with complaints suggestive of a benign breast disorder. Patients that were a proven case of carcinoma of breast and those diagnosed with a malignant condition of the breast during evaluation were excluded from the study.Results: The incidence of benign breast disorders is the highest in the age group of 21 to 30 years (42%). Most common presentation of benign breast disorder in the series was found to be lump in the breast (58%). The Left breast (44%) was noted to be more commonly involved than the Right breast (40%). Most commonly involved quadrant of breast was the upper inner quadrant (30%), followed by the upper outer quadrant (24%).Most of the breast lumps were of size ranging from 3 to 3.9cm (36.58%) followed by those of size ranging from 2 to 2.9cm. (21.95%). Fibroadenoma (42%) was the most common benign breast disorder in present study, followed by fibro-adenosis (18%).Conclusions: Every benign breast disorder presents in a certain age group and follows a certain clinical pattern as outlined in this study. Detailed history taking and clinical examination while keeping in mind these clinical patterns, along with ultrasound and FNAC (triple test), aids in establishing the diagnosis of a benign breast disorder within 72 hours. Hence, the anxiety caused by breast lumps and nodularity can be alleviated by excluding the diagnosis of carcinoma breast. And since majority of benign lesions are not associated with an increased risk for subsequent breast cancer, unnecessary surgical procedures can be avoided.

Finding Out the Possibilities of Improving OPD Services

Introduction: National Hospital for Respiratory Diseases (NHRD) at Welisara is the Premier tertiary care hospital in Sri Lanka for respiratory diseases. No studies have been done in its OPD set up to collect data which could have been invaluable for future planning and implementation. This study was done to gather such vital information in view of improving services rendered by NHRD OPD. Few parameters like socio-demographic details, distance to the hospital, cost for the visit, having a referral letter given by a doctor, number of persons accompanied the patient and reasons to visit NHRD were studied.Methodology: This was a descriptive cross sectional study of patients who attended OPD of NHRD. Interviewer administered questionnaire was given to randomly selected 420 patients who were above 18 years of age and who were on their first visit to the hospital.Results: Majority of patients were less educated and were coming from a low socio-economic background. Both sexes presented equally to the OPD. 68% of patients were coming from within 20 km of distance from the hospital and for 62%, the cost for the visit was found to be 200 rupees or less. Only for 7% of people, NHRD was the nearest hospital. 95% of patients has presented with respiratory related conditions while only 2% had a referral letter with them. Most of the patients (around 80%) were accompanied by 2 or 3 persons. More than 70% visited NHRD due to its reputation as the leading hospital in the country for respiratory diseases.Conclusion: Middle aged less educated people with a low socio-economic status were the people who mostly visited the NHRD OPD. Most had respiratory system related presenting complaints. This is of significance and should be considered in giving health education to these patients. Majority of the patients resided close by to the hospital and their cost for the visit roughly showed similarities to the distances they travel. Though most patients visit NHRD after using nearby health facilities, lack of a proper referral system and accompained too many people can worsen the overcrowding at OPD. Strengthening the usage of nearby healthcare facilities can reduce this as NHRD was found to be the nearest hospital for very few of this population. Most common reason for visiting NHRD OPD was the reputation NHRD has gained as the leading hospital of the country for Respiratory disease, which should be conserved.

Structurofunctional analysis based on postinsertion problems with complete dentures in Moradabad, North India: A cross-sectional study.

Background:Complaints with complete dentures is a common and expected phenomenon. However the type and character of complaint varies between population and is influenced by the socio economic condition, prevalent dental awareness etc. This study attempts to find the most common complaints with complete dentures, their causes and also presents a classification of the same.Method:A cross-sectional analytical study was conducted by performing a survey on a sample of population over an 18 month period utilizing a customized questionnaire. The complaints were divided into four categories viz. discomfort, retention, esthetics and miscellaneous. Consequently each denture was evaluated for structural and functional defects. The findings were classified into error in denture base, physiopsychological, error in occlusion and teeth selection. The data was statistically analyzed.Results:Error in denture base was the predominant cause of complaints. However physiopsychological and error in occlusion and teeth selection were also important second factors in certain groups of complaints. Highest number of complaints (23.07%) belongs to discomfort in mandibular posterior region. While the least number of complaints are concerned with speech as reported by both males and females (both at 2.02%).Conclusion:Discomfort with complete dentures was the largest complaint reported followed by loss of retention with esthetics and miscellaneous complaints. Discomfort in mandibular posterior region was the most frequent complaint reported while speech related complaints were least in number. Most common cause of complaints was error in denture base.

PENGARUH KUALITAS PELAYANAN PAJAK DAN KEPATUHAN MATERIAL WAJIB PAJAK DAN IMPLIKASINYA TERHADAP REALISASI PENERIMAAN PAJAK (SURVEY PADA KPP DI KANWIL DJP JABAR I)

The research was conducted on 7 Tax Offices in West Java Regional Office I. ThePhenomenon is a disappointment related complaints against the service tax, the low ratio of taxcompliance, as well as realization of tax revenues do not reach the target. The purpose of this study is to investigate how the quality of the tax service, influences atasservice quality to compliance materials, influence the quality of the tax service and taxpayercompliance material to the realization of tax revenue in the KPP in West Java Regional Office I. The method used in this research is descriptive and verificative method with quantitativeapproach. The population in this study were 7 KPP in West Java Regional Office I. Respondentsin this study is the Taxpayer at 7 KPP in West Java Regional Office I, a member of the sampleused in this research method is 150 samples. Statistical tests used are Path Analysis, Pearsoncorrelation calculations, the coefficient of determination, test validity, test reliability, and testhypotheses with SPSS 22 for Windows as tool of analysis. The results showed that the variable tax service quality of material tax compliance has a lowrelationship with the direction of a positive relationship. Then the variable of tax service qualityand material tax compliance to realization of tax revenues has a strong relationship with thedirection of a positive relationship.

Social determinants of health and well-being among municipal school children in Mumbai

Background: HBSC seeks to identify and explore the extent of the inequalities related to socioeconomic status (SES), age and gender among the younger age group, and highlight the need for preventive action. Hence, this study was carried out, to find out the social context as a determinant of their health and well-being. The objectives of the study were to study the socio-demographic characteristics of the students; to find the social determinants and its association with their perceived health outcomes.Methods: The study was carried out among 426 Municipal school students in Mumbai. They were enquired about their socio demographic characteristics, their personal habits and behaviour, relationship with their parents, siblings and friends, performance in school, academic pressures, and also about any health related complaints if they had. Results: The study shows less communication of students with their parents, more so with their fathers’. Students were seen to have more friends and would also spend more time with them, especially boys. Academic achievement was better among girls and those from less affluent families and it also showed a dip in the higher age groups. Regular consumption of breakfast, fruits, vegetables was seen less among girls and older students. Boys and those from less affluent families were seen to be more involved in high risk behaviour. Conclusions: All the factors mentioned in the study are shown to have adverse effects on the perceived health outcome of the students. These social factors need to be addressed to improve the health and well-being of the younger generations.