Urban Health Unit Research Articles

Vancomycin area under the curve/minimum inhibitory concentration and trough level concordance-evaluation on an urban health unit.

A vancomycin AUC/MIC (area under the curve/minimum inhibitory concentration) of 400-600 mg•h/L is associated with improved clinical outcomes for the treatment of methicillin resistant Staphylococcus aureus (MRSA) infections. Currently, there are still limited studies evaluating the relationship between vancomycin trough and AUC. To evaluate the correlation between vancomycin trough and AUC/MIC and determine if trough-guided monitoring is an adequate predictor of AUC/MIC in the Urban Health population at St Paul's Hospital. This was a retrospective chart review of 29 patients from November 2019 to February 2021. Patient demographics and laboratory data were collected from electronic medical records. The two-level equation-based approach was used to calculate AUC/MIC. The proportion of AUC/MIC values within target (400-600 mg•h/L) despite subtherapeutic troughs, and the proportion of AUC/MIC values supratherapeutic when trough is within target (15-20 mg/L) were the primary endpoints. Fifty-seven sets of levels were collected and 75% of vancomycin troughs and AUC24 were found to be discordant. When trough was 10-14.9 mg/L, AUC24 was > 400 mg•h/L in 94% of cases and when trough was 15-20 mg/L, AUC24 was > 600 mg•h/L in 69% of cases. There was a moderate correlation between vancomycin trough and AUC24h (R 2 = 0.57; p < 0.001). A vancomycin trough between 15 and 20 mg/L may result in an AUC/MIC greater than necessary for clinical efficacy. Considering these findings and the practical concerns of AUC-guided monitoring, a modest reduction in target troughs to prevent vancomycin toxicity warrants clinical consideration and further evaluation.

COVID-appropriate facemask use: A study among patients attending outpatient Departments of a Public Health Institute in West Bengal.

BACKGROUND:In the ongoing COVID-19 pandemic, facemask use has been the most feasible public health measure in preventing transmission of SARS-CoV2 with the dual benefit of controlling the source of infection and decreasing the risk of acquiring infection from infected people. Therefore, COVID-appropriate behavior regarding facemask use is imperative for controlling the pandemic. This study aimed to assess COVID-appropriate mask behavior and factors associated with it among the patients attending outpatient departments of a public health institute in West Bengal.MATERIALS AND METHODS:This cross-sectional study was done among 298 patients attending outpatient departments of Rural and Urban Health Units of a public health institute of Kolkata, during October 2020–February 2021. A pretested questionnaire and an observational checklist based on the World Health Organization guidelines were used to collect data. COVID-appropriate mask behavior was assessed by a five-point domain-wise scale, where good practice regarding facemask usage was considered when the score was three or more. Statistical analyses were done in SPSS 16.0.RESULTS:Good practices regarding COVID-19 appropriate mask-related activities were recorded among 30.2% of the study participants. No difficulties faced during or on wearing a mask (adjusted odds ratio [AOR] = 1.86, 95% confidence interval CI: 1.1–3.33) and higher socioeconomic status (AOR = 2.25, 95% CI: 1.22–4.15) were significantly associated with good practice regarding COVID-19 appropriate facemask usage.CONCLUSION:The magnitude of poor practice regarding COVID-appropriate mask-related behaviors is quite high among the study participants. Awareness regarding correct mask handling, storage, hygiene, disposal, and place of wearing from a reliable source would go a long way to curb the myths and misinformation surrounding mask usage and encourage COVID-appropriate mask behaviors among the general population.

Diabetic Peripheral Neuropathy and its Association with Diabetes Self-care: A Clinic-based Study in an Urban Health Centre, Kolkata

Introduction: Diabetes mellitus is considered as silent epidemic worldwide including India. Peripheral neuropathy is one of the most common complications of diabetes mellitus. Diabetes Self-Management (DSM) is crucial in mitigating the afflictions of diabetes and it’s after effects. There was dearth of studies in view of Diabetic Peripheral Neuropathy (DPN) and diabetes self-management in Kolkata, West Bengal. Aim: To assess the associations between diabetes self-management and DPN in Type 2 Diabetes Mellitus (T2DM) patients attending an urban health clinic in Kolkata. Materials and Methods: This study was conducted from December 2018 to March 2019 among known case of T2DM patients aged 30 years and above attending the Non-Communicable Disease (NCD) clinic at Chetla, under the purview of field practice areas of Urban Health Unit and Training centre (UHU and TC) of All India Institute of Hygiene and Public Health (AIIH and PH) Kolkata, West Bengal. A pre-designed and pre-tested schedule was used to collect data which were analysed using International Business Machines Statistical Product and Service Solutions (IBM SPSS) version 16.0 and represented using various tables. Results: The mean (SD) age of the participants was 54.89 (8.98) years. About 32.4% of the patients had DPN which was significantly associated with increased duration of T2DM {AOR (95% CI)}={1.52 (1.22-1.91)}, lower glucose management sub-scale score {AOR (95% CI)}={2.84 (1.42-5.67)} and lower healthcare use sub-scale score {AOR (95% CI)}={1.86 (1.05-3.31)}. Conclusion: Early screening and education regarding diabetes self-care would be helpful in glycaemic control and in prevention of DPN.

HÁBITOS DE COMPRA E CONSUMO DE ALIMENTOS EM FAMÍLIAS COM MENORES DE CINCO ANOS EM UM MUNICÍPIO DO NORDESTE BRASILEIRO

Introdução: O ambiente alimentar pode influenciar nas decisões sobre os hábitos e modificar a aquisição e consumo de alimentos ao considerar que as escolhas alimentares são determinadas pelo acesso, disponibilidade, propaganda, conveniência e preço. Isso pode ocasionar consideráveis transformações no comportamento alimentar desde a infância. Objetivo: Avaliar os hábitos de compra e de consumo de alimentos em famílias com crianças menores de cinco anos em um município do Nordeste Brasileiro. Metodologia: Trata-se de uma pesquisa transversal, de abordagem quantitativa, realizada com 138 indivíduos nas seis unidades básicas de saúde urbanas do município. Foi realizada entrevista estruturada com aplicação de questionários sobre informações socioeconômicas, hábitos de compra e consumo de alimentos, segurança alimentar, peso e altura auto referidos. Os dados foram analisados no software Statistical Package for the Social Science Statistics (SPSS) versão 23.0. Foi realizado teste de associação entre os hábitos de compra e consumo de alimentos com dados socioeconômicos, estado nutricional antropométrico e segurança alimentar. Resultados: Dentre os hábitos de consumo avaliado, foi verificado que o consumo de salada crua (83,8%), frutas (95,9%) e suco de fruta ou de polpa (93,8%) em pelo menos um dia na semana, foram associados a uma maior escolaridade. Enquanto que a maior frequência de compra e consumo em restaurantes e lanchonetes foi associada a uma maior renda, possuir emprego e não participar de programas sociais. Conclusão: Hábitos de compra e de consumo de alimentos mais saudáveis foram associados com maior escolaridade e condições de trabalho e renda. Assim como acesso à restaurantes e lanchonetes em indivíduos com melhor poder aquisitivo. &#x0D; Palavras-Chave: Consumo de alimentos; promoção da saúde; hábitos alimentares.

A study on unhealthy cervix and its risk factors among currently married women of reproductive age group attending an urban health centre of Kolkata

Background: Cancer of cervix is the third most common cancer in women in India accounting for 21.7% of cancer deaths among women. Unhealthy cervix, characterized by presence of any abnormal growth, ulcer, or vasculature, is a clinically detectable early stage in the life history of cervical cancer. Very few studies have been conducted to determine risk factors of unhealthy cervix.Methods: A clinic-based cross-sectional study was conducted among currently married women of reproductive age group attending Urban Health Unit and Training Centre, Chetla, Kolkata. A total of 189 women attending the clinic was selected using systematic random sampling method was who were interviewed and examined using pre-designed pre-tested schedule. Analysis was done using (SPSS version 16).Results: Among 189 women, 45.5% were diagnosed with unhealthy cervix. Hierarchical logistic regression showed that educational status, PCI, frequency of cleaning external genitalia and extramarital relationship of the spouse were significantly associated with unhealthy cervical condition.Conclusions: Most of the risk factors of unhealthy cervix are behavioral and modifiable. Health education and behaviour change communication of women of reproductive age group would help in reducing their morbidity as well as mortality from cervix related conditions that includes cervical cancer.

Self-care practices among diabetes patients attending a health center in a slum of Kolkata: A qualitative study

Introduction: Type-2 diabetes is a growing health problem worldwide. India has become the diabetes capital of the world. Diabetes requires continuous medical care and education for patient self-management to prevent complications. As self-care activities demand enormous efforts from the patient, there is a necessity to learn their experiences about the hardships they face while self-managing diabetes. Objectives: The main objective is to evaluate the self-care activities along with perceived barriers among patients attending a health centre in a slum of Kolkata. Materials and Methods: This study was conducted in Urban Health Unit and Training Center, Chetla, Kolkata, among 10 male patients of type 2 diabetes for >2 years attending noncommunicable diseases clinics using focus group discussion. Results: Patients with diabetes aged 38–57 years. All of them lived in the slum area. Their duration of diabetes ranged from 2 to 17 years. Most of the participants stated that they suffer from diabetes because of excess “chinta,” that is, worry or stress. They opined that diabetes affected every single part of the body irreversibly. According to the participants, walking, appropriate diet, timely medicines, regular blood glucose monitoring, and stress are to be reduced to control diabetes. Conclusion: Participants were aware of diabetes self-care activities though they lacked knowledge in few domains. Their practice was satisfactory. The patients were distressed due to diet restrictions and felt stress as a main factor in their lives.

Comparing the Professional Role and Tasks Approved in Curriculum with the Ongoing Role and Tasks of Midwives Employed in Tabriz Health Care Units

Background: Midwives play an important role in the implementation of health programs in health care units. The objective of this study was to compare the professional role and task in curriculum with the ongoing role and task of midwives working in the health care units of Tabriz (East Azarbaijan, Iran, 2015). Methods: This cross-sectional study was done via census on all midwives working in rural and urban health units in Tabriz in 2015 (225 persons). The data was collected using a researcher-designed questionnaire based on the national midwifery curriculum approved in 2012. The questionnaire includes questions related to the use of specific teaching courses and their relevancy to the professional roles contained in the curriculum;a self-assessment of the midwives’ current performance was completed by midwives themselves. The validity and reliability of questionnaire were confirmed. Data were presented using mean (SD) and n (%) for numerical and categorical variables. Results: Professional roles and tasks contained in the curriculum were not fully relevant to current roles and tasks of midwives. The highest relevancy was related to the role of education and the lowest relevancy was seen in ongoing tasks related to disease diagnosis, care and intervention. Of the specialized courses, internships in pregnancy and childbirth and its pathology had the highest and lowest applications, respectively. Conclusion: This study showed that, midwifery specialized training courses content and professional role and tasks curriculum- based are not consistent with ongoing expected real world tasks. Therefore, it is essential that reforms are made to enhance the curriculum and efficiently align it with practical responsibilities and expectations.

Making Health Promotion Evidenced-Informed

This large urban health unit identified a need for explicit, strategic, long-term organizational priority toward practical application of evidence in health promotion practice. Becoming a Best Practice Spotlight Organization (BPSO®) candidate provided an opportunity to systematically implement this commitment. The primary goals were to support incorporation of evidence-informed practice throughout the organization, increase interprofessional collaboration, and provide opportunities for knowledge exchange for staff. A mixed-methods evaluation consisting of three phases, including an analysis of previous evaluations, a survey of Champions, and an online focus group with the Steering Committee, demonstrated very positive outcomes. Staff reported increased incorporation of evidence in practice and program delivery. Collaboration and consultation amongst interdisciplinary staff across program areas also increased and staff responded very positively to increased opportunities for knowledge exchange. BPSO® candidacy opportunities should be used by health organizations to increase evidence-informed practice and inspire excellence in health promotion practice.

Inputs to quality: supervision, management, and community involvement in health facilities in Egypt in 2004

BackgroundAs low- and middle-income countries experience economic development, ensuring quality of health care delivery is a central component of health reform. Nevertheless, health reforms in low- and middle-income countries have focused more on access to services rather than the quality of these services, and reporting on quality has been limited. In the present study, we sought to examine the prevalence and regional variation in key management practices in Egyptian health facilities within three domains: supervision of the facility from the Ministry of Health and Population (MOHP), managerial processes, and patient and community involvement in care.MethodsWe conducted a cross-sectional analysis of data from 559 facilities surveyed with the Egyptian Service Provision Assessment (ESPA) survey in 2004, the most recent such survey in Egypt. We registered on the Measure Demographic and Health Survey (DHS) website http://legacy.measuredhs.com/login.cfm to gain access to the survey data. From the ESPA sampled 559 MOHP facilities, we excluded a total of 79 facilities because they did not offer facility-based 24-hour care or have at least one physician working in the facility, resulting in a final sample of 480 facilities. The final sample included 76 general service hospitals, 307 rural health units, and 97 maternal and child health and urban health units (MCH/urban units). We used standard frequency analyses to describe facility characteristics and tested the statistical significance of regional differences using chi-square statistics.ResultsNearly all facilities reported having external supervision within the 6 months preceding the interview. In contrast, key facility-level managerial processes, such as having routine and documented management meetings and applying quality assurance approaches, were uncommon. Involvement of communities and patients was also reported in a minority of facilities. Hospitals and health units located in Urban Egypt compared with more rural parts of Egypt were significantly more likely to have management committees that met at least monthly, to keep official records of the meetings, and to have an approach for reviewing quality assurance activities.ConclusionsAlthough the data precede the recent reform efforts of the MOHP, they provide a baseline against which future progress can be measured. Targeted efforts to improve facility-level management are critical to supporting quality improvement initiatives directed at improving the quality of health care throughout the country.

Health care data recording system for developing countries.

Developed countries have an established pattern for recording clinical data. The unit medical record allows statistics to be extrapolated, as well as disease patterns, births, and causes of deaths. In technologically advanced countries, medical records serve the health needs of clinic and hospital patients. However, it is now becoming clear that the emphasis on hospitalization in patient care is no longer appropriate; the emphasis must be switched from curative services to preventive and basic curative services at the primary health care level. A similar alteration will be necessary in the recordkeeping system. As progress towards literacy occurs, the aim will be to expand and improve the recording of basic data. In the next highest level, the district health center, records can be very simple. Increasing sophistication can be instituted at the higher levels of district hospital and central referral hospital. Obviously there must be adequate medical records to directly support clinical care. This paper goes on to outline the structure of such a system geared to the needs of a developing country. It is basically a model for a pilot project. The various problems which might arise before the system is implemented and can be viable include: 1) precise identification of medical records, 2) the need for standardization and definition of diagnoses, and 3) lack of coordination and/or inappropriate utilization of medical records, procedures, or personnel. Concerning procedures, there could be problems with incorrect data production, erroneous channelling of information, or improper feedback. At the lowest level of the chain would be the rural or urban health unit or the mobile health visitor with the primary health worker (PHW). Forms to be used include an attendance card, an infant weight chart, temperature chart, and referral form. The PHW must be appropriately trained in the recognition of signs and symptoms of diseases most likely to be encountered, basic drug therapy, how to record weight and temperature, and when and to whom to refer a patient. The district center is at the next level in the chain and similar schedules and training have been prepared for this and other health workers at higher levels in the health care chain.