Inappropriate Care Research Articles

Candidacy Decisions for Long-term Ventilation.

Decisions to initiate long-term ventilation (LTV) in children with severe neurologic impairment have recently been subject to candidacy determinations by home ventilation teams that exclude patients based on their neurologic status alone. Determinations of whether decisions are inappropriate require careful analysis of specific clinical circumstances and attention to the family's values. In this Ethics Rounds, we present a case of a previously healthy child who sustained an acute severe anoxic brain injury and was assessed by the medical team to have a high likelihood of remaining minimally conscious or unconscious. It was determined that he was not a candidate for LTV based on the severity of neurologic impairment. The family disagreed and declined withdrawal of ventilatory support. Drawing upon our backgrounds in intensive care, pulmonology, and bioethics, we offer commentary on utilizing a candidacy-based approach for LTV decisions in children with severe neurologic impairment from variable perspectives, including clinical determinations of inappropriate care, ablest biases and discrimination, and obligations to maintain a just process.

Dignity in people with dementia: A concept analysis.

Background: Dignity, an abstract and complex concept, is an essential part of humanity and an underlying guiding principle in healthcare. Previous literature indicates dignity is compromised in people with dementia (PwD), but those PwD maintain the capacity to live with dignity with appropriate external support. Alzheimer's disease and related dementias (ADRDs) lead to progressive functional decline and increased vulnerability and dependence, leading to heightened risks of PwD receiving inappropriate or insufficient care that diminishes dignity. Considering the increased disease prevalence and the continuously escalating costs of dementia care, establishing a productive value-based guideline may prevent suffering, maximize dignity, and thus promote quality of life (QoL).Aim: The goal of this project is to identify actionable targets for integrating dignity harmoniously and practically into care planning and management for PwD.Research Design: We conducted a concept analysis using Walker and Avant's eight-step process. A comprehensive literature search was conducted (PubMed and CINAHL) with the keywords "dignity," "dementia," "Alzheimer's disease," and "dementia care."Results: A total of 42 out of 4910 publications were included. The concept of dignity in PwD is operationalized as the promotion of worthiness and the accordance of respect that allows the presence and expression of a person's sense of self, regardless of physical, mental, or cognitive health. The concept has two subdimensions: absolute dignity which encompasses the inherent self and relative dignity characterized by its dynamic reflective nature. Worthiness and respect are the two main attributes, while autonomy is an underlying component of dignity. Specific antecedents of dignity in PwD are empowerment, non-maleficence, and adaptive environmental scaffolding. As a consequence of facilitating dignity in PwD, QoL may be enhanced.Conclusion: As a foundational and necessary humanistic value, incorporating dignity into dementia care can lead to efficient and effective care that optimizes QoL in PwD throughout their disease progression.

Clinical characteristics, treatment, and treatment switch after molecular-genetic classification in individuals with maturity-onset diabetes of the young: Insights from the multicenter real-world DPV registry.

Individuals with maturity-onset diabetes of the young (MODY) are often misdiagnosed as type 1 or type 2 diabetes and receive inappropriate care. We aimed to investigate the characteristics and treatment of all MODY types in a multicenter, real-world setting. Individuals with MODY from the diabetes prospective follow-up (DPV) registry were studied. We compared clinical parameters during the first year of diabetes and the most recent treatment year after MODY diagnosis. A total of 1640 individuals were identified with GCK-MODY (n = 941) and HNF1A-MODY (n = 417) as the most frequent types. Among these, 912 individuals were available with information during the first and the most recent treatment year (median duration of follow-up: 4.2 years [2.6-6.6]). Positive beta cell autoantibodies were present in 20.6% (15.2% IAA). Median age at diagnosis ranged from 9.9 years in GCK-MODY (Q1-Q3: 6.2-13.1 years) and INS-MODY (2.7-13.7 years) to 14.3 years (5.0-17.1) in KCNJ11-MODY. Frequency of oral antidiabetic agents (OAD) use increased and insulin decreased in HNF4A-MODY (OAD: 18% to 39%, insulin: 34% to 23%) and in HNF1A-MODY (OAD: 18% to 31%, insulin: 35% to 25%). ABCC8-MODY was characterized by a decrement in nonpharmacological treatment (26% to 16%) and "insulin only" treatment (53% to 42%), while the proportion of individuals treated with OAD but no insulin increased from 0% to 21%. Our results indicate that some teams caring for individuals with MODY are hesitant with regard to current recommendations. Registries are an essential source of information and provide a basis for discussing treatment guidelines for MODY.

Physician-reported barriers and facilitators to thyroid hormone deprescribing in older adults.

Thyroid hormone is one of the most commonly prescribed medications in the United States. Misuse of and overtreatment with thyroid hormone is common in older adults and can lead to cardiovascular and skeletal adverse events. Even though deprescribing can reduce inappropriate care, no studies have yet explored specific barriers and facilitators to guide thyroid hormone deprescribing in older adults (defined as discontinuation of thyroid hormone when initiated without an appropriate indication or dose reduction in those overtreated). We conducted semi-structured interviews with 19 endocrinologists, geriatricians, and primary care physicians who prescribe thyroid hormone. Interviews were completed between July 2020 and December 2021 via two-way video conferencing. We used both an inductive and deductive content analysis guided by the Theoretical Domains Framework to evaluate transcribed and coded participant responses. Thematic analysis characterized themes related to barriers and facilitators to thyroid hormone deprescribing practices in older adults. The most commonly reported barriers to thyroid hormone deprescribing were related to patient-level factors, followed by physician- and system-level factors. Patient factors included patients' perceived need for thyroid hormone use and patient anxiety/concerns about potential side effects related to thyroid hormone dose reduction, patient lack of knowledge, and misinformation regarding deprescribing. Physician- and system-level barriers included clinic visit time constraints, physician inertia, physician lack of knowledge about deprescribing, perceived lack of sufficient patient follow-up, and electronic health record limitations. The most prominent physician-reported facilitators to thyroid hormone deprescribing were effective physician-to-patient communication, and positive physician-patient relationship, including patients' trust in their treating physician. Barriers and facilitators to thyroid hormone deprescribing in older adults were reported at multiple levels including patient-, physician-, and system-level factors. Interventions to improve thyroid hormone deprescribing in older adults should aim to improve patient education and expectations, increase multidisciplinary physician awareness, and overcome physician inertia.

Sexual and Gender Identity-Associated Disparities in University Students' Experiences with Inappropriate, Disrespectful, and Coercive Health Care.

Purpose: Inappropriate, disrespectful, or coercive health care (IDCH) is associated with patient age and sexual orientation and gender identity (SOGI) and can impact healthcare engagement and outcomes. Emerging adulthood is a critical period for establishing trust in health care, yet little is known about university students' IDCH experiences. This study assessed the IDCH prevalence and identified IDCH-SOGI associations in a university student sample. Methods: Using data from the cross-sectional IDC Survey (2021), we quantified the lifetime prevalence of 18 IDCH items in a sample of 3403 university students. Chi-squared and Kruskal-Wallis tests were used to assess bivariate associations between IDCH items and SOGI. We modeled associations between demographic characteristics and two types of provider-sexual misconduct using logistic regression. Results: Statistically significant associations between SOGI and 17 of the analyzed IDCH items were identified. Self-reported IDCH experiences were more prevalent among minoritized SOGI students than heterosexual cisgender students, including receiving inappropriate/harmful treatment and dismissive or biased provider communication. Gender minority and sexual minority cisgender male and female students had significantly higher odds of ever being touched inappropriately during an exam, compared with heterosexual cisgender males (adjusted odds ratios [95% confidence interval]: 3.07 [1.59-5.93], 2.34 [1.24-4.41], and 1.85 [1.16-2.90], respectively). SOGI was not significantly associated with experiencing a provider's sexual advances. Conclusion: University students with historically minoritized SOGIs may be particularly vulnerable to IDCH experiences; research is needed to understand differential experiences within minoritized sexual and gender subpopulations. Patient and provider education about healthcare norms and trauma-centered care could potentially reduce IDCH and its harms.

Factors Affecting Health Seeking Behavior of Elderly People in a Community of Pokhara, Nepal

Introduction: Individuals have different opinion regarding willingness to seek help from health care services. Thus, a study aimed to find out the health care seeking behaviour, factors affecting health care seeking behaviour and association between health seeking and those factors among elderly people. Methods: Cross-sectional analytical study was conducted among 197 elderly people of 65 years and above in Pokhara Metropolitan City Ward No.28. Non probability purposive sampling technique was used. Data was collected by face to face interview technique using self-developed structured interview schedule. SPSS 16 was used for data analysis. Descriptive statistics frequency, percentage, mean and standard deviation were used for data analysis. Inferential statistics (Chi-square test) was used to reveal the association between the selected factors and health seeking behaviour.. Results: Finding showed 77.66% of respondents sought appropriate health care where as only 22.34 % of respondents sought inappropriate health care. Among those who sought care from appropriate health care, 65.48% of respondents sought care from governmental hospital. Among those who sought inappropriate health care still 22.72 % of respondents had belief in traditional healer. Accompany for the treatment of elderly was found statistically significant and other factors was not found statistically significant Conclusion: Based on the findings more than two third of the respondents reported that they seek appropriate health care. Among those respondents nearly half of respondents’ reason for seeking appropriate health care was good experience of medical treatment in the past. Among those whose health seeking behaviour is inappropriate, still one fourth of respondents had belief on traditional healer. Key words: Health seeking behavior; Elderly people; Nepal

How do experts determine where to intervene on test ordering? An interview study

Abstract Objectives Lab testing is a high-volume activity that is often overused, leading to wasted resources and inappropriate care. Improving test ordering practices in tertiary care involves deciding where to focus scarce intervention resources, but clear guidance on how to optimize these resources is lacking. We aimed to explore context-sensitive factors and processes that inform individual decisions about laboratory stewardship interventions by speaking to key interest holders in this area. Methods We conducted semi-structured interviews with test-ordering intervention development experts and authors of test-ordering guidance documents to explore five broad topics: 1) processes used to prioritize tests for intervention; 2) factors considered when deciding which tests to target; 3) measurement of these factors; 4) interventions selected; 5) suggestions for a framework to support these decisions. Transcripts were double coded using directed-content and thematic analysis. Results We interviewed 14 intervention development experts. Experts noted they frequently consider test volume, test value, and patient care when deciding on a test to target. Experts indicated that quantifying many relevant factors was challenging. Processes to support these decisions often involved examining local data, obtaining buy-in, and relying on an existing guideline. Suggestions for building a framework emphasized the importance of collaboration, consideration of context and resources, and starting with “easy wins” to gain support and experience. Conclusions Our study provides insight into the factors and processes experts consider when deciding which tests to target for intervention and can inform the development of a framework to guide the selection of tests for intervention and guideline development.

Exploring the meaning of care among lived experiences of patients with blindness: an interpretive phenomenological study†

Abstract Objective To explore the meaning of care experienced by people with blindness in hospitals. Methods Interpretive phenomenology along with the 6-step method of van Manen was used to conduct the study. Using purposeful sampling, 15 people with legal blindness were interviewed. Thematic analysis was used to isolate the meaning of care. Results Five themes emerged: (a) nurses in the eyes of patients with blindness; (b) negligence in the caring moments; (c) being cared for in ambiguity; (d) Uncoordinated care; and (e) Psychological discomfort. These sub-themes were condensed into an overarching theme titled as “marginalized patients inside the stereotypical healthcare system.” Conclusions Lived experiences of patients with blindness revealed that hospitals provide stereotypic or inappropriate care for this minority group in society. Health professionals particularly nurses should be skilled to provide person-centered and coordinated care for patients with blindness.

Gender Harmony: A Case for Nursing Informatics.

The design of digital health information systems around a conflated gender/sex binary contributes to health inequities. Lack of specific information that supports affirming communication lead to inappropriate care, disrespectful encounters with healthcare staff, and avoidance of health services by clients who have been harmed by misgendering, deadnaming and being outed. The HL7 International Gender Harmony Model (HL7 GHM) supports the design, implementation and use of DHIS that enable affirming clinical interactions and care. This case study will demonstrate how applying the HL7 GHM can address the harms reported in a recently published account of one patient in Canada.

Psychiatric-Mental Health Nurse Educators' Perceptions of Teaching Dissociative Disorders: A Reflexive Thematic Analysis.

Although the prevalence of dissociative disorders (DDs) is up to 10 percent of the general population, psychiatric-mental health (PMH) registered nurses lack education on how to care for individuals diagnosed with these disorders. Sixty-two PMH nurse educators completed an anonymous online survey about their perceptions of teaching DDs to nursing students. Braun and Clarke's six-phase framework was used to conduct an inductive, reflexive thematic analysis of the data. Three primary themes were identified: lack of resources, differing opinions on the value of teaching DDs, and stigma. Though roughly 75 percent of participants reported that they teach DDs to their nursing students, they endorsed concerning misperceptions about the diagnoses. By failing to properly educate future PMH RNs about DDs, individuals with DDs are at risk of receiving inadequate and inappropriate nursing care and experiencing poor outcomes.

Perceptions of medical doctors and patients about imaging for people with low back pain: A qualitative study.

Low-value care is the use of substitutive/ineffective/harmful strategies based on available evidence, and it is considered one of the main contributors to the burden related to low back pain in health care systems. The use of routine imaging for patients with low back pain is the main example of inappropriate care. Therefore, understanding the perceptions of medical doctors and patients from Brazil about this practice may help propose strategies to reduce imaging rates. To investigate the perceptions of medical doctors and patients about imaging for the diagnosis of nonspecific low back pain. A qualitative study using the framework analysis method. Primary and secondary care. Fifteen patients with low back pain and 15 doctors participated in this study. Sociodemographic data were collected from all participants, and the interviews were performed using a set of questions created based on the literature. Patients and doctors believe that the main reason for ordering imaging tests is to identify the source of pain, and imaging could be useful for tracking disease progression over time or if there is a lack of improvement after treatment. Patients' expectations and pressures play a role in the decision to order imaging tests, but clinicians believe that education is the preferred strategy to reduce imaging rates. Identifying the source of pain, tracking the disease progression, and patients' expectations and pressures were the main drivers of imaging requests for low back pain. Educational strategies were suggested to reduce the use of routine imaging.

Valuation of knowledge, attitude, practices of tuberculosis among the health care workers from Islamabad Pakistan

BackgroundTuberculosis (TB) as a foremost infectious disease adds massive burden to morbidity and mortality rate, despite of well-structured TB control programs around the globe. Inappropriate health care management system and poor implementation on standard in relevance to TB, remain some reasons causative to TB prevalence and its rising antimicrobial resistance. Health Care Workers (HCWs) laboring as a part of TB control system, are the vital warriors in achieving the goals of TB End Strategy by 2035. Their performance is influenced by their knowledge, attitude, and practices (KAP) toward this infectious disease. This study aimed to signify the role of KAP score of health care Workers in the better control and prevention of TB in the Islamabad Capital Territory (ICT), Pakistan. MethodsA cross-sectional study on Knowledge, Attitude and Practice study of Tuberculosis (TB) among health care Workers, was done in ICT, which is the capital of Pakistan. The KAP of TB was collected for the 306 Health Care Workers from all the Islamabad TB referring health facilities which refer the TB patients for testing to the National Reference Laboratory, Islamabad Pakistan. Eligible health care workers were requested to respond on KAP questionnaire after informed consent. KAP questionnaire comprised of knowledge, attitude, and practices section including demographic information. All the data was analyzed using IBM SPSS statistics 21. One Way Analysis of Variance (ANOVA) was applied to calculate KAP mean score against different variables. On the significant data sets of ANOVA output, Tukey's Multiple Comparison Test was applied for pairwise comparison. Pearson correlation coefficient was utilized to explore the association between two qualitative variables. The non-parametric tests were applied to evaluate difference of KAP score in relation to demographic covariates individually. ResultsFrom June to July 2023, we conducted TB KAP study among Health Care Workers of ICT, Pakistan. The average age was 33 years (range 26–30 years). Majority of the recruited subjects were not being trained for dealing with TB infection. The results demonstrated that Health Care Workers working were lacking their knowledge about mode of TB transmission, best diagnostic technique, and contraction of TB infections. The mean knowledge, attitude and practices mean scores were 15.05 (SD = 3.96), 83.68 (SD = 15.74) and 6.31 (SD = 2.21), respectively. Mean knowledge score of Health Care Workers were significantly related to their educational level and occupation while no significant association was declared with working experience as TB staff. Pearson coefficient of attitude score with knowledge of Health Care Workers was of weak level (0.28). Practice mean score was correlated to knowledge mean score at a moderate level (r = 0.40). On the other hand, practice score was r = 0.29 with attitude mean score had shown weak level correlation. A number of demographic factors were strongly linked to each of the mean score of knowledge, attitude, and practices. ConclusionThese findings highlighted the significant involvement of education, profession, and professional trainings in the better knowledge, attitude, and practices of the TB related health care Workers. For a better management system of infectious diseases like TB, a well-trained and professionally competent staff of Health Care Workers is important so as to achieve the goal of TB-End strategy by 2035 from Pakistan, which is the 5th highest burden country for TB.

Exploring Ethical Dimensions in Neuropalliative Care.

Neurologic illnesses can be challenging to diagnose, involve changes in consciousness, and are often complicated by prognostic uncertainty. These disorders can affect how individuals interact with their environment, and as a result, many ethical concerns may arise related to their medical care. Key ethical issues in neuropalliative care include shared decision-making, evolving autonomy and capacity, best interest and harm principles, beneficence and nonmaleficence, futile and inappropriate care, justice and equity, and ableism. The four core principles of medical ethics, beneficence, nonmaleficence, justice, and autonomy, are foundational in considering approaches to these ethical challenges. Shared decision-making is rooted in the principle of autonomy. Evolving autonomy and capacity evoke autonomy, beneficence, and nonmaleficence. The best interest and harm principles are rooted in beneficence and nonmaleficence. Questions of futility and inappropriate care are founded in the principles of nonmaleficence, autonomy, and justice. Ableism invokes questions of nonmaleficence, autonomy, and justice. Practitioners of neurology will encounter ethical challenges in their practice. Framing decisions around the core ethical principles of beneficence, nonmaleficence, autonomy, and justice will help clinicians navigate challenging situations while acknowledging and respecting each patient's individual story.

A cross-sectional quantitative analysis of the readability and quality of online resources regarding thumb carpometacarpal joint replacement surgery

BackgroundThumb carpometacarpal (CMC) joint osteoarthritis is a common degenerative condition that affects up to 15 ​% of the population older than 30 years. Poor readability of online health resources has been associated with misinformation, inappropriate care, incorrect self-treatment, worse health outcomes, and increased healthcare resource waste. This study aims to assess the readability and quality of online information regarding thumb carpometacarpal (CMC) joint replacement surgery. MethodsThe terms “thumb joint replacement surgery”, “thumb carpometacarpal joint replacement surgery”, “thumb cmc joint replacement surgery”, “thumb arthroplasty”, “thumb carpometacarpal arthroplasty”, and “thumb cmc arthroplasty” were searched in Google and Bing. Readability was determined using the Flesch Reading Ease Score (FRES) and the Flesch-Kincaid Reading Grade Level (FKGL). FRES >65 or a grade level score of sixth grade and under was considered acceptable. Quality was assessed using the Patient Education Materials Assessment Tool (PEMAT) and a modified DISCERN tool. PEMAT scores below 70 were considered poorly understandable and poorly actionable. ResultsA total of 34 websites underwent qualitative analysis. The average FRES was 54.60 ​± ​7.91 (range 30.30–67.80). Only 3 (8.82 ​%) websites had a FRES score >65. The average FKGL score was 8.19 ​± ​1.80 (range 5.60–12.90). Only 3 (8.82 ​%) websites were written at or below a sixth-grade level. The average PEMAT percentage score for understandability and actionability was 76.82 ​± ​9.43 (range 61.54–93.75) and 36.18 ​± ​24.12 (range 0.00–60.00) respectively. Although 22 (64.71 ​%) of websites met the acceptable standard of 70 ​% for understandability, none of the websites met the acceptable standard of 70 ​% for actionability. The average total DISCERN score was 32.00 ​± ​4.29 (range 24.00–42.00). ConclusionsMost websites reviewed were written above recommended reading levels. Most showed acceptable understandability but none showed acceptable actionability. To avoid the negative outcomes of poor patient understanding of online resources, providers of these resources should optimise accessibility to the average reader by using simple words, avoiding jargon, and analysing texts with readability software before publishing the materials online. Websites should also utilise visual aids and provide clearer pre-operative and post-operative instructions.

Discharged, but where to? The Current Situation of Long Stay Patients in German Psychiatric Clinics

The study analyses the number, characteristics and reasons for a length of stay of patients in German psychiatric clinics in excess of 6 months. The study was implemented in the form of a nationwide online survey, which was addressed to chief physicians of psychiatric clinics. In the sample, 174 patients in 80 psychiatric clinics were identified who could not be discharged because no suitable follow-up services were available in the region. The majority of patients are male, often have an F2 diagnosis and exhibit aggressive behaviour during their hospital stay. To avoid inappropriate health care and prevent prolonged stays for a subgroup of mentally ill people, individual complex services should be implemented in community psychiatry.

Newborn care knowledge and practices among care givers of newborns and young infants attending a regional referral hospital in Southwestern Uganda.

A child born in developing countries has a 10 times higher mortality risk compared to one born in developed countries. Uganda still struggles with a high neonatal mortality rate at 27/1000 live births. Majority of these death occur in the community when children are under the sole care of their parents and guardian. Lack of knowledge in new born care, inappropriate new born care practices are some of the contributors to neonatal mortality in Uganda. Little is known about parent/caregivers' knowledge, practices and what influences these practices while caring for the newborns. We systematically studied and documented newborn care knowledge, practices and associated factors among parents and care givers. To assess new born care knowledge, practices and associated factors among parents and care givers attending MRRH. We carried out a quantitative cross section methods study among caregivers of children from birth to six weeks of life attending a regional referral hospital in south western Uganda. Using pretested structured questionnaires, data was collected about care givers' new born care knowledge, practices and the associated factors. Data analysis was done using Stata version 17.0. We interviewed 370 caregivers, majority of whom were the biological mothers at 86%. Mean age was 26 years, 14% were unemployed and 74% had monthly earning below the poverty line. Mothers had a high antenatal care attendance of 97.6% and 96.2% of the deliveries were at a health facility Care givers had variant knowledge of essential newborn care with associated incorrect practices. Majority (84.6%) of the respondents reported obliviousness to putting anything in the babies' eyes at birth, however, breastmilk, water and saliva were reportedly put in the babies' eyes at birth by some caregivers. Hand washing was not practiced at all in 16.2% of the caregivers before handling the newborn. About 7.4% of the new borns received a bath within 24 hours of delivery and 19% reported use of herbs. Caregivers practiced adequate thermal care 87%. Cord care practices were inappropriate in 36.5%. Only 21% of the respondents reported initiation of breast feeding within 1 hour of birth, Prelacteal feeds were given by 37.6% of the care givers, water being the commonest prelacteal feed followed by cow's milk at 40.4 and 18.4% respectively. Majority of the respondents had below average knowledge about danger signs in the newborn where 63% and mean score for knowledge about danger signs was 44%. Caretaker's age and relationship with the newborn were found to have a statistically significant associated to knowledge of danger signs in the newborn baby. There are variable incorrect practices in the essential new born care and low knowledge and awareness of danger signs among caregivers of newborn babies. There is high health center deliveries and antenatal care attendance among the respondents could be used as an opportunity to increase caregiver awareness about the inappropriate practices in essential newborn care and the danger signs in a newborn.

Interdisciplinary videoconference model for identifying potential adverse transition of care events following hospital discharge to postacute care

Discharge from hospitals to postacute care settings is a vulnerable time for many older adults, when they may be at increased risk for errors occurring in their care. We developed...

Transitional Medicine of Intractable Primary Dyslipidemias in Japan.

Transitional medicine refers to the seamless continuity of medical care for patients with childhood-onset diseases as they grow into adulthood. The transition of care must be seamless in medical treatment as the patients grow and in other medical aids such as subsidies for medical expenses in the health care system. Inappropriate transitional care, either medical or social, directly causes poorer prognosis for many early-onset diseases, including primary dyslipidemia caused by genetic abnormalities. Many primary dyslipidemias are designated as intractable diseases in the Japanese health care system for specific medical aids, as having no curative treatment and requiring enormous treatment costs for lipid management and prevention of complications. However, there are problems in transitional medicine for primary dyslipidemia in Japan. As for the medical treatment system, the diagnosis rate remains low due to the shortage of specialists, their insufficient link with generalists and other field specialists, and poor linkage between pediatricians and physicians for adults. In the medical care system, there is a mismatch of diagnostic criteria of primary dyslipidemias between children and adults for medical care expense subsidization, as between The Program for the Specific Pediatric Chronic Diseases and the Program for Designated Adult Intractable Diseases. This could lead some patients subsidized in their childhood to no longer be under the coverage of the aids after transition. This review intends to describe these issues in transitional medicine of primary dyslipidemia in Japan as a part of the efforts to resolve the problems by the Committee on Primary Dyslipidemia under the Research Program on Rare and Intractable Disease of the Ministry of Health, Labour and Welfare of Japan.

Role of Oleum Jecoris Aselli 6 CH in the Management of Malnutrition of Children – A Clinical Study

Introduction: Malnutrition is a serious health condition that occurs when your diet doesn't contain the right amount of nutrients, or when your body can't absorb nutrients from food. Malnutrition can include: Stunting, Wasting, Underweight, Micronutrient deficiencies, and Overweight. Need For Study In India about 2/3 portion of the under five children of our country is malnourished among them 5-8% is severely malnourished whole rest fall in the group of mild or moderate malnutrition so it can be said that malnutrition one of the most wide spread conditions affecting child health. A significant proportion of these children live in economic and social environment which impedes the child’s physical and mental development, this condition include poverty, poor environment sanitation, diseases, infections, inadequate access to primary health care, inappropriate child caring and feeding practices. According to Holistic Concept of Homoeopathy malnutrition is not only caused by deficiencies but also due to body’s inability to absorb and assimilate the food. This is the area where Homoeopathic Medicines plays vital role in the treatment of malnutrition. This itself creates its need to study. Materials and Methods: This clinical study was conducted in the sample of population from Dhwani Homoeo Clinic, Ahmedabad, and Gujarat. Fifty cases of malnutrition were analyzed. The study sample included children aged 3 to 8 years and of both sexes. These cases were analyzed after considering their age, sex, low body weight, poor appetite, thin arms and legs, weakness, faintness, fatigue, irritability and recurrent history of infection in body. The investigations were conducted in necessary cases. The cases were analyzed up to one year with regular interval of follow-ups. All the cases were analyzed under following protocols: Conclusion: As a result of study of selected 50 cases it was found that the age groups between [6-8 years] were found to be more prone to such disorders [60%]. Maximum sex incidences of the patients of the study were male children [54.00%]. Out of selected cases 28 children [56%] were belong to nuclear family. It was observed that those children [27 cases] [54%] who were taken care by other family members and not mothers were more prone to develop malnutrition.56% of children [28 cases] were having poor dietary intake as a root cause of malnutrition.54% of children [27 cases] had reduced absorption of macro and micro nutrients.76% [38 cases] had recurrent history of infection, 70% [35 cases] had poor appetite, 64% [32 cases] had irritability of mind, 54% [27 cases] had wasting of muscles. 84% [42 cases] cases were improved by Nutrition as well as Health Education as well as Homoeopathic Medicine.

IJCM_72A: A study on newborn care practices and associated factors influencing their health in urban slums of Kurnool city, Andhra Pradesh.

Background: Neonate is essential time for child to grow. Worldwide, Neonatal mortality are estimated to be about 3 million due to insufficient care. In 2021, 2.3 million neonates have died in first four weeks of life, roughly 6400 neonatal deaths per day. Lack of knowledge in new born care, inappropriate new born care practices are some of the contributors to neonatal mortality. Newborn care practice interventions can prevent neonatal deaths. Understanding the community and traditional newborn care practices is necessary to implement effective programme for promotion of newborns health. Hence present study was done to describe selected newborn care practices in urban slums of Kurnool. Objectives: To assess Newborn-Care Practices and to determine the relationship between Newborn-Care Practices and selected socio-demographic variables. Methodology: A Community-based, Cross-sectional study was done among 220mothers who were residing in urban slums of Kurnool City, Data were collected between October 2023 to November 2023 using Semi-structured questionnaire by Simple Random sampling technique. IEC permission was obtained. Written informed consent was obtained from participants. Data were analyzed using SPSS-Version23. Results: Mothers who were practicing delayed-bathing were observed in the age group 18-24 years 135(61.36%)followed by 25-30 years 60(27.2%),the difference was statistically significant(x2=9.84)(p=0.043),Safe cord care practices were observed more among 18-24 years132(60%),it was found to be statistically significant(x2=23.5)(p=<0.001). Early initiation of breast feeding was more common among age group 18-24 years93(42.2%), it was found to be statistically significant(x2=6.51)(p=0.039). Conclusion: The practice of essential newborn care still needs to improve in Bareilly; There is strong need to implement community-based interventions to improve the newborn care practices & to reduce the high-risk newborn care practices like unsafe cord care, delayed breast feeding, early bathing, Prelacteal feeding & discarding colostrum need through health workers.