Untrained Practitioners Research Articles

Clinico-etiological and histopathological correlation in erythroderma: In a tertiary care hospital of Eastern Odisha

Background: Erythroderma, or “exfoliative dermatitis,” is a generalized inflammatory disorder of the skin manifesting with erythema and scaling affecting more than 90% of the skin surface. Primary erythroderma develops in normal skin, and etiological factors include drug reaction, lymphomas, and hematological malignancies, which may be idiopathic. Aims and Objectives: The present study is to evaluate the clinico-etiological and histopathological correlations in erythroderma. Materials and Methods: This prospective observational study was done in the Department of Dermatology, S.C.B. Medical College, Cuttack, from 2021 to 2022. Erythema and scaling involving more than 90% of the body surface area were calculated by Wallace’s rule of nine. A detailed demographic profile and history were recorded with a thorough clinical examination for each patient, involving type of scales, sizes of scales, color of scales, associated lichenification or fissuring, pedal edema, examination of the scalp for scales, hair loss, examination of the nails and mucosa, and associated arthritis. Results: The most common disease was psoriasis (16), Idiopathic (7), followed by atopic and drug-induced dermatitis 6 patients each. Seborrheic dermatitis showed 3 cases, followed by contact dermatitis, Reiter’s disease, Pemphigus foliaceus, Ichthyosis (congenital), Dermatomyositis, and malignancy-induced 2 cases each, whereas contact dermatitis and Dermatophyte infection were found to be one patient each. Conclusion: Though some of the etiology remains unknown, repeated investigations and continued follow-up are necessary to determine long-term complications. The role of alternative medicines and the injudicious use of steroids by quacks or untrained practitioners should be discouraged, and proper awareness should be given to patients with erythroderma.

A novel measurement system for assessing the nose in patients with cleft lip and palate (CLP)

ObjectiveThe presented study shows a new and innovative method to determine nasal asymmetries in a simple way in patients with cleft lip and palate (CLP) in order to plan corrective surgery. Design86 non-syndromic patients with cleft lip and palate were divided into 2 groups: a) patients with unilateral cleft lip and palate b) patients with bilateral cleft lip and palate. Patientsfollow-up of hospital records of 86 patients aged 2–18 years. Main outcomeBased on standardised photos of the nose from 3 different directions, the nose symmetry was assessed. A new digital measurement system was used, which is integrated into proven clinical programmes. These were compared with a control group. In addition, a mirror fog test and a standardised questionnaire were used. ResultThe overall results showed a good symmetry of the nose postoperatively, as well as a high satisfaction of the patients and their parents. Profile and angle measurements showed a better result. ConclusioThe presented measurement system and especially the Cleft Lip Component Symmetry Index (CLCSI) allows an individual and very effective assessment of the symmetry of the nose as well as a control of the growth in patients with CLP. The method is easy to apply in daily practice, even for untrained practitioners.

Village doctors: a national telephone survey of Bangladesh’s lay medical practitioners

BackgroundBangladesh outperforms its Least Developed Country (LDC) status on a range of health measures including life expectancy. Its frontline medical practitioners, however, are not formally trained medical professionals, but instead lightly-trained ‘village doctors’ able to prescribe modern pharmaceuticals. This current study represents the most complete national survey of these practitioners and their informal ‘clinics’.MethodsThe study is based on a national Computer Assisted Telephone Interviewing (CATI) of 1,000 informal practitioners. Participants were sampled from all eight divisions and all 64 districts of Bangladesh, including 682 participants chosen from the purposively recruited Refresher Training program conducted by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), supplemented with 318 additional participants recruited through snowball sampling.Primary and secondary outcome measuresIn addition to demographics, village doctors were asked about the characteristics of their ‘clinics’ including their equipment, their training, income and referral practices.ResultsThree quarters of the wholly male sample had not completed an undergraduate program, and none of the sample had received any bachelor-level university training in medicine. Medical training was confined to a range of short-course offerings. Village doctor ‘clinics’ are highly dependent on the sale of pharmaceuticals, with few charging a consultation fee. Income was not related to degree of short-course uptake but was related positively to degree of formal education. Finally, practitioners showed a strong tendency to refer patients to the professional medical care system.ConclusionsBangladesh’s village doctor sector provides an important pathway to professional, trained medical care, and provides some level of care to those who cannot afford or otherwise access the nation’s established healthcare system. However, the degree to which relatively untrained paramedical practitioners are prescribing conventional medicines has concerning health implications.

Challenges to Addressing Mental Health Repercussions of Large-Scale Immigration Worksite Raids in the Rural United States.

Immigration worksite raids-in which dozens to hundreds of individuals are detained-often target food processing plants or other warehouse-based operations, primary sources of employment for immigrants in rural communities. Drawing on interviews with 77 adults who provided support following six worksite raids, we describe three challenges to identifying resultant mental health impacts: 1) amid poverty and family disappearance, mental health is not the priority; 2) untrained practitioners misidentify signs of declining mental health; and 3) mental health care is linguistically limited, expensive, and inaccessible to working families. We end by discussing how practitioners and advocates can address these challenges.

The Social Media, Human Dignity and Linguistic Violence in Cameroon: A Socio-Pragmatic Perception

Conflicts, violence, human rights abuses, and the influence of the social media are the most serious challenges the modern world and emerging democracies face today, and Cameroon, in which verbal and nonverbal violence, has become a daily social fact, is no exception. The language that we speak or write influences our cultural identities, and perception of our social realities. The aim of the present study is to collect and examine specimens of speech acts specific to acts of violence used by the social media practitioners as sociolinguistic facts in Cameroon, in order to analyse the different expressions that typify instances of use depicting verbal or linguistic violence in their discourse. The types of words, phrases and linguistic forms identified and analysed characteristically describe these texts as authentic lexicon specific to discourse of conflict and violence within Cameroon in the context of social tension and the Anglophone crisis. The objective being to create more public awareness on the devastating consequences of violence to unity, human dignity, insecurity, peace and living together in Cameroon. To handle complex sociolinguistic data of this sort, the mixed quantitative and qualitative methodology was used to collect online reports from content creators, trained and untrained media practitioners and to analyse these from a sociopragmatic perspective in order to describe its impact on the readers and Cameroonians in situ. The qualitative discourse analysis used was based on a combination of different theoretical frameworks including the Critical Discourse Analysis, Speech Act Theory, Semantic theories, communicative acts, and sociopragmatics relevant to pragmatically explain some of the vocabulary, frequently occurring in the corpus and characteristic of the lexemes of violence, referred to as linguistic violence. Note that words carry and transmit powerful vibrations and emotional energy discharges capable of igniting feelings of hatred, anger, insecurity, intolerance, bitterness, and consequently gruesomely unacceptable acts of human rights abuses. Equally, after the analysis, findings reveal that the different discourse types employ different performative speech acts and stylistic devices including connotation, imagery, symbolism, synonymy, polysemy, and neologism in the forms of verbal abuses, insults, minimisation, and stigmatisation that characterise the contemporary Cameroon society, which suffers from verbal abuses and indecent language use that communicates specific hate-filled and hurtful messages characteristic of linguistic violence in Cameroon, with an urgent need to be addressed. After the analysis, several findings reveal an unprecedented increase in violence and atrocities committed by both separatists and government military on the Anglophone population in particular and on Cameroonians as a result of the Anglophone crisis in violation of human rights and dignity. While suggesting the need to seek for a genuine and an inclusive dialogue, tolerance, the use of polite and decent speech acts, for peace to return is imperative, findings equally reveal that conflict and acts of violence has greatly enriched the Cameroon English language vocabulary, compounding old words to take on new meanings and introducing new words with connotative meanings from other languages like French, local and Pidgin English languages.

COMMENT: Alternative medicine under the Mental Health Care Act, 2017: Future implications and concerns.

In recent years, the Indian government has been promoting healthcare with an insufficient evidence base, or which is non-evidence-based, alongside delivery of evidence-based care by untrained practitioners, through supportive legislation and guidelines. The Mental Health Care Act, 2017, is a unique example of a law endorsing such practices. In this paper, we aim to highlight the positive and negative implications of such practices for the delivery of good quality mental healthcare in India.

Alternative medicine under the Mental Health Care Act, 2017: Future implications and concerns

In recent years, the Indian government has been promoting healthcare with an insufficient evidence base, or which is non-evidence-based, alongside delivery of evidence-based care by untrained practitioners, through supportive legislation and guidelines. The Mental Health Care Act, 2017, is a unique example of a law endorsing such practices. In this paper, we aim to highlight the positive and negative implications of such practices for the delivery of good quality mental healthcare in India.

O ultrassom guiado por telemedicina realizado por clínicos gerais não treinados pode ser viável em uma situação de risco de vida: o caso de um hospital de campanha durante a pandemia de COVID-19

ObjectiveTo evaluate the feasibility of telemedicine using a standardized multiorgan ultrasound assessment protocol to guide untrained on-site general practitioners at a field hospital during a life-threatening crisis.Materials and MethodsWe evaluated 11 inpatients with shock, with or without acute dyspnea, for whom general practitioners spontaneously requested remote evaluation by a specialist.ResultsAll of the general practitioners accepted the protocol and were able to position the transducer correctly, thus obtaining key images of the internal jugular vein, lungs, and inferior vena cava when guided remotely by a telemedicine physician, who interpreted all of the findings. However, only four (36%) of the on-site general practitioners obtained the appropriate key image of the heart in the left parasternal long-axis view, and only three (27%) received an immediate interpretation of an image from the remote physician. The mean evaluation time was 22.7 ± 12 min (range, 7-42 min).ConclusionEven in life-threatening situations, untrained general practitioners may be correctly guided by telemedicine specialists to perform multiorgan point-of-care ultrasound in order to improve bedside diagnostic evaluation.

Tooth Wear Evaluation System (TWES) 2.0-Reliability of diagnosis with and without computer-assisted evaluation.

Tooth wear is a multifactorial process, leading to the loss of dental hard tissues. Therefore, it is important to detect the level of tooth wear at an early stage, so monitoring can be initiated. The Tooth Wear Evaluation System (TWES) enables such a multistage diagnosis of tooth wear. The further developed TWES 2.0 contains a complete taxonomy of tooth wear, but its reliability has not yet been validated. The aim of the study was to examine in a randomised controlled trial (RCT) whether diagnoses made based on the TWES 2.0 are reproducible and whether this reproducibility is also achieved with computer-assisted diagnostics. 44 dental students received extensive training in TWES 2.0 assessment and taxonomy. The students each evaluated at least 10 (of the present 14) anonymised patient cases using gypsum models and high-resolution intra-oral photographs according to TWES 2.0. One half initially evaluated on paper; the other half used dedicated software (CMDfact / CMDbrux). After half of the patient cases (5), the evaluation methods were switched (AB/BA crossover design). The diagnoses were then evaluated for agreement with the predefined sample solution. Evaluation of agreement with the sample solution according to Cohen's kappa indicated a value of 0.46 for manual (traditional) evaluation; and 0.44 for computer-assisted evaluation. Evaluation of agreement between examiners was 0.38 for manual and 0.48 for computer-assisted evaluation (Fleiss' kappa). The results of this study proved that the taxonomy of the TWES 2.0has acceptable reliability and can thus be used by dentists. Accordingly, the system can be learned quickly even by untrained practitioners. Comparable results are achieved with computer-assisted evaluation.

Desirable Bodies and Eugen Sandow’s Curative Institute in Edwardian England

Summary In 1907, Eugen Sandow, a famous strength performer, opened an ambitious business adventure centred on the eradication of disease without ‘harmful’ medicines. Sandow’s ‘Curative Institute’ was located in London, employed registered physicians to act as advisers and claimed to enjoy the patronage of thousands. Purporting to heal a variety of diseases through exercise and diet alone, Sandow’s Curative Institute, and his relationship with the medical community in England, has not previously enjoyed sustained study. Surveying Sandow’s Institute, the article highlights the manner in which Sandow co-opted, and was in turn co-opted by, the Medical community. For Sandow, associating with trained physicians gave a respectability and kudos to his endeavours. Among physicians, Sandow marked a point of knowledge, celebrity and, in the case of his Institute’s physicians, a living. Initially harmonious, for the most part, Sandow’s relationship with the medical community deteriorated in 1910 following the publication of a series of grandiose advertisements. Such advertisements were used by the General Medical Council (GMC) as a means of disbarring Sandow’s physicians and delineating public and private knowledge. Done at a time when the medical marketplace in England was teeming with competition, Sandow’s Institute, and his actions, represented a unique, and commercialised, medical enterprise. Studying Sandow’s Institute, and his conflict with the GMC in 1912, this article examines the limits of commercial medicine during this time, as well as the nexus between trained and untrained practitioners.

Post Injection Sciatic Neuritis: A Case Report

For administration of certain drugs, intramuscular injections are used in children. The dorsogluteal area between the iliac crest and the greater trochanter is the most suitable site for intramuscular injection. Due to the poor co-operation of children/wrong technique/lack of trained personnel, there may be a risk of damage to sciatic nerve. A four-year-old boy presented with four day history of left foot drop. He had history of fever for which he consulted a local untrained medical practitioner and received an intramuscular injection at left gluteal region. Magnetic Resonance Imaging (MRI) of pelvis and proximal thigh was performed and showed thickened and increased T2W signal of left sciatic nerve with perineural T2W hyperintensities suggestive of Sciatic Neuritis. Sciatic nerve injury can be potentially devastating, resulting in foot drop due to loss of dorsiflexion of the foot. The most common presentation is a paralytic foot drop that is caused due to involvement of the peroneal division of the sciatic nerve. Imaging of the sciatic nerve by MRI helps in early diagnosis and can assess the extent of involvement.

Post Injection Sciatic Neuritis: A Case Report

For administration of certain drugs, intramuscular injections are used in children. The dorsogluteal area between the iliac crest and the greater trochanter is the most suitable site for intramuscular injection. Due to the poor co-operation of children/wrong technique/lack of trained personnel, there may be a risk of damage to sciatic nerve. A four-year-old boy presented with four day history of left foot drop. He had history of fever for which he consulted a local untrained medical practitioner and received an intramuscular injection at left gluteal region. Magnetic Resonance Imaging (MRI) of pelvis and proximal thigh was performed and showed thickened and increased T2W signal of left sciatic nerve with perineural T2W hyperintensities suggestive of Sciatic Neuritis. Sciatic nerve injury can be potentially devastating, resulting in foot drop due to loss of dorsiflexion of the foot. The most common presentation is a paralytic foot drop that is caused due to involvement of the peroneal division of the sciatic nerve. Imaging of the sciatic nerve by MRI helps in early diagnosis and can assess the extent of involvement.

Health systems challenges and opportunities in tackling non-communicable diseases in rural areas of India.

The increasing burden of non-communicable diseases in rural areas poses new challenges to an already overburdened health systems. We detail these challenges and identify opportunities to address them. The major challenges in service delivery in rural areas include poor accessibility, shortage of adequate manpower especially specialists in rural areas, irregular supply of medicines and lack of adequate diagnostic facilities. This has led to an increased dependency on the private sector resulting in high out-of-pocket and catastrophic health expenditure. The challenges are amplified by lower health literacy, large pool of informal or untrained healthcare practitioners, and lack of proper referral and follow up. The health system opportunities identified include task-shifting by training of mid-level healthcare providers and practitioners from Indian systems of medicine, widening use of e-health and m-health, community engagement and public-private partnerships. Participatory health governance through community engagement has been shown to improve accountability and quality in health systems. Civil society organizations (CSO) can also improve awareness and health-seeking behaviour. New and evidence-based strategies need to be implemented to address health system challenges for tackling non-communicable diseases in rural areas.

How accurate is the diagnosis of rheumatic fever in Egypt? Data from the national rheumatic heart disease prevention and control program (2006-2018).

Rheumatic heart disease (RHD) as a chronic sequela of repeated episodes of acute rheumatic fever (ARF), remains a cause of cardiac morbidity in Egypt although it is given full attention through a national RHD prevention and control program. The present report reviews our experience with subjects presenting with ARF or its sequelae in a single RHD centre and describes the disease pattern over the last decade. A cross-sectional study was conducted in El-Mahalla RHD centre between 2006 and 2018. A total of 17014 individual were enrolled and evaluated. Diagnosis ARF was based on the 2015 revised Jones criteria and RHD was ruled in by echocardiography. The majority of the screened subjects were female (63.2%), in the age group 5–15 years (64.6%), rural residents (61.2%), had primary education (43.0%), and of low socioeconomic standard (50.2%). The total percentage of cases presenting with ARF sequelae was 29.3% [carditis/RHD (10.8%), rheumatic arthritis (Rh.A) (14.9%), and Sydenham’s chorea (0.05%)]. Noticeably, 72% were free of any cardiac insult, of which 37.7% were victims of misdiagnoses made elsewhere by untrained practitioners who prescribed for them long term injectable long-acting penicillin [Benzathine Penicillin G (BPG)] without need. About 54% of the study cohort reported the occurrence of recurrent attacks of tonsillitis of which 65.2% underwent tonsillectomy. Among those who experienced tonsillectomy and/or received BPG in the past, 14.5% and 22.3% respectively had eventually developed RHD. Screening of family members of some RHD cases who needed cardiac surgery revealed 20.7% with undiagnosed ARF sequalae [RHD (56.0%) and Rh.A (52.2%)]. Upon the follow-up of RHD cases, 1.2% had improved, 98.4% were stable and 0.4% had their heart condition deteriorated. Misdiagnosis of ARF or its sequelae and poor compliance with BPG use may affect efforts being exerted to curtail the disease. Updating national guidelines, capacity building, and reliance on appropriate investigations should be emphasized. Since the genetic basis of RHD is literally confirmed, a family history of RHD warrants screening of all family members for early detection of the disease.

Hepatitis B virus infection and associated factors among pregnant women attending antenatal clinics in West Hararghe public hospitals, Oromia region, Ethiopia.

IntroductionGlobally, approximately 350-400 million persons are chronically infected with hepatitis B virus (HBV), over 65 million of whom are in Africa. One in four people with chronic hepatitis B develop serious health problems. Mother-to-child transmission (MTCT) is responsible for more than half of chronic infections. If infected at birth, a child has a 90% chance of becoming a chronic carrier. We evaluated hepatitis B virus prevalence and risk factors for infection among pregnant women attending antenatal clinics in West Hararghe public hospitals, Oromia region, Ethiopia.MethodsWe conducted a cross-sectional study among 363 pregnant women at routine antenatal clinic visits in West Hararghe public hospitals from April-May, 2017. We used systematic random sampling method to enroll participants. We used a structured questionnaire to collect information on risk factors, and collected blood samples to test for hepatitis B Virus surface antigen (HBsAg) by enzyme-linked immunosorbent assay (ELISA). Data were entered using EpiData Version.3.1 and exported to SPSS Version 23.0 for descriptive analyses and binary logistic regressionResultsThe overall seroprevalence of HBsAg among participants was 6.1% (95% CI 3.9-8.5). History of abortion (aOR=4.3, 95% CI 1.3-15.0), traditional tonsillectomy (tonsillectomy conducted by an untrained practitioner) (aOR=4.4, 95% CI 1.1-17.8), admission to a health facility (aOR=4.4, 95% CI 1.2-16.9), multiple sexual partners (aOR=6.3, 95% CI 1.7-23.4) and familial liver disease (aOR=8.2, 95% CI 2.1-32.8) were associated with hepatitis B virus infection among pregnant women.ConclusionThe prevalence of hepatitis B virus in study area indicates a high-intermediate level epidemic. Multiple types of healthcare, as well classic risk factors such as multiple sex partners and a family history of liver disease increased the odds of infection. Hygiene promotion and infection prevention methods in healthcare settings are recommended to avoid nosocomial infections. To reduce MTCT, we recommended screening all pregnant women for hepatitis B virus as part of routine antenatal care and supportive treatment and making available methods of preventing infection at birth, including prophylaxis and birth dose vaccine.

Practitioners’ Views on Learning Using Children’s Peer Interactions Amongst Under Three Year Old Children in Selangor, Malaysia

Research on children’s peer interactions shows many benefits for children’s development especially in developing children’s social competence. Drawing on a case study data from a study that investigated peer interactions among under-three-year-old children in three Malaysian childcare centres, this paper provides a picture of how the children’s peer interactions were understood by largely untrained practitioners at the start of the project, and how the complexity of children’s lived experiences remained hidden to the practitioners until they took part in the video-stimulated recall (VSR) interviews based on children’s peer interactions, and focus group discussions. The latter provided practitioners with an opportunity to deepen their thinking about children’s peer interactions and to begin to see them as linked with learning. In particular, the practitioners perceived that (i) play; (ii) familiarity; and (iii) having friends constituted important learning for children during peer interactions at their early childcare centres. This has implications for understanding the roles of early childhood education practitioners to children’s peer interactions as well as how practitioners can help support children’s learning to make a social difference.
 
 KEYWORDS: Children’s Peer Interactions, Practitioners, Early Childhood Education Centre, Video-Stimulated Recall Interviews, Focus group Discussions

Health and Disease Control in Marwa Village of Jharkhand – A Sociological Study

Health which is a state of complete physical, mental and social well-being and not merely absence of disease and infirmity' is broad one which implies a perfect harmony of man's internal environment with his external environment consisting of physical, chemical and biological surroundings, is a concept unknown to the rural population. The ignorance of this vast majority of the population proves to be a serious social problem. Though health is recognized as a birth right of all citizens, there has been a wide gap between people's need and the achievement in the area of health. Health has now ceased to be regarded as an end in itself. Moreover, there is not only a glaring lack of awareness of and an even more threatening lack of medical facilities in a majority of rural areas in India. Without awareness of health issues, most tribal populations tend to fall ill more frequently and wait too long before seeking medical help, or are referred too late by untrained village practitioners.

The effect of language-focused professional development on the knowledge and behaviour of preschool practitioners

The purpose of this project was to investigate the effectiveness of a language-focused professional development programme on the knowledge and behaviour of preschool practitioners (sometimes called early years practitioners) in the UK. In Study 1 we determined whether the training received by practitioners is effective in improving their knowledge of how to support children’s language and communicative development. In Study 2 we tested whether trained practitioners, and practitioners from centres with embedded Language Champions, were able to implement the techniques they had been taught. For this, we video-recorded practitioners interacting, one to one, with 2- and 3–4-year-old children in their centres. We conclude that (1) practitioners retain the knowledge they have been taught, both about how children learn and about how to promote this learning, and that (2), in some respects, this knowledge translates well into practice; practitioners in centres with embedded Language Champions and trained practitioners used language-enriching behaviours when interacting with children more often than did untrained practitioners. We discuss how the translation of some techniques into overt behaviour could be made more effective.

Trans Formations of Male Falsetto

Abstract With reference to the biographical documentary Doh! Oh Dear, A Female Tear (by professional falsettist Stephen Chen) and the author's personal testimony (as an untrained falsetto practitioner), this essay approaches the subject of male falsetto from three perspectives: the historical, the individual, and the geopolitical. It suggests that the male falsetto in question can be understood as a multilayered “trans” figuration that comes into being in and through historical discourses, individual embodiments, and geopolitical articulations. Given the limited scholarship on falsetto, this piece means to draw attention to and solicit further research on the much-neglected phenomenon of falsetto in queer and transgender studies.

Fast spreading infection of hepatitis C in Northern Area of Pakistan

Background: Worldwide 2.2% of the population hepatitis C virus (HCV) infection, The developing countries are at high risk, including Pakistan that has 4.5% to 8% of the total population which is quit alarming. Blood donors, health professionals, drug abusers and chronic liver disease patients are mainly targeted by researchers and have indicate that the prevalence is as high as 40%. However, Pakistan has a very limited data in general population because of the limited access and facilities for such studies. Methods & Materials: This study was aimed to respond on a local area complaint about the extraordinary increase in HCV infection and a high rise in death ratio in district Swat, northern area of Pakistan. A survey camp was organized and was kept open for all population. People from different age group, gender and cast participated and blood samples were collected in aseptic conditions. Total 768 samples were collected and immediately transferred to laboratory for RNA isolation through kit to proceed for molecular diagnosis through RT-PCR. Results: Data was distributed in age wise, cast wise, gender wise categories. Out of 768 samples 86 samples were shown a positive PCR result, which were observed as 34% in 25-45 years age group and male had a high percentage (63%) as compared to female (37%). Gujjar cast (mountainous resident) was at high risk (72%) as compared to plane area population (28%). Conclusion: This study indicated that males are at high risk because of barbers using contaminated blades and other tools without any proper sterilization. Another majorly observed reason was local uncertified and untrained medical practitioners by mismanagement of medical tools and reuse of syringes. Upon observation we found the disposal of contaminated medical waste in a running water canal passing through the houses, used in many domestic purposes. It is recommended that a serious attention of the government health department is required to educate people against this serious health issue.