Background: Of all work settings, hospitals carry the greatest risk of verbal abuse and threats, with 73% of staff on medical premises suffering abuse. The scenario in Indian subcontinent is also not so bright. Doctors are frequently assaulted in India as well where doctors are shot, even stabbed. Thus this study was undertaken to know the exact prevalence of such incidences in Paithan taluka of Aurangabad district. Methods: A community based cross-sectional study was done in the Paithan taluka of Aurangabad district in Maharashtra from October 2015 to December 2015. All the doctors in the urban as well as rural areas of Paithan were interviewed to know their experiences about episodes of workplace violence (WPV) during last 12 months as well as their lifetime experiences. Some of the factors associated with the WPV were also asked along with the perceived reasons for such type of incidences. Results: The prevalence of workplace violence in the last 12 months was found to be 63.41%, whereas the lifetime prevalence was found to be 78.05%. It was observed that 21.95% of the doctors were demanded for extortion money and 11.27% experienced intentional destruction of their hospital property. Workplace violence was seen to be significantly more associated with younger doctors, highly educated doctors, doctors in government service and doctors with comparatively lesser practice experience. Lack of communication was perceived by the doctors as the most common reason for these incidences.Conclusions: Workplace violence is emerging as a bane to the medical profession and has to be dealt with urgently. Poor communication with patients along with other factors should be dealt with to mitigate this problem.

No abstract

Background: Pregnancy, although being considered a physiological state, carries risk of serious maternal morbidity and at times death. This is due to various complications that may occur during pregnancy, labor, or thereafter. The major causes of maternal mortality are mostly preventable through regular antenatal checkup, proper diagnosis, and management of labor complications. Therefore, the factors at different levels affecting the use of these services need to be clearly understood. Objective: To assess the maternal mortality ratio (MMR) and the causes of maternal mortality over a period of 3 years in a tertiary care hospital in Maharashtra. Materials and Methods: A hospital record-based study of maternal deaths over a period of 3 years from January 2012 to December 2014. The information regarding demographic profile and reproductive parameters were collected and results were analyzed using percentage and proportion with the help of Microsoft Excel 2007. Result: Average of MMR over 3 years study period (January 2012 to December 2014) was observed to be 410/1,00,000 live births. Most of the maternal deaths occurred in age group of 19-24 years (43.4%). Majority of maternal deaths was observed in multipara (52.2%) and women coming from rural area (52.9%). 44.9% of maternal deaths occurred within 24 h of admission. Hemorrhage was the leading direct cause of maternal deaths (33.8%) followed by eclampsia (10.3%) and sepsis (8.1%). Among indirect causes of maternal deaths anemia (14.7%) was the leading cause. Conclusion: MMR in our study was very high as compared to national average of 167/1,00,000 live births, being a tertiary care hospital as most of the patients were referred from peripheral centers. Most maternal deaths are preventable by intensive health education, basic obstetric care for all, strengthening referral and communication system and emphasizing on overall safe motherhood.

Objectives: To assess treatment compliance of self-reported dog bite cases and to assess associated demographic and exposure factors. Materials and Methods: The present prospective study was conducted during January 2013 to July 2013 among 260 dog bite cases by purposive sampling at the outpatient department of a tertiary hospital. After obtaining verbal informed consent, a predesigned questionnaire was used. The assessment of treatment compliance of postexposure prophylaxis (PEP) regimen was considered on the basis of intramuscular anti-rabies vaccine (ARV) regimen by classifying completed PEP and defaulted PEP. At the end of PEP regimen of every participant, we obtained information about received ARV doses using telephone survey method. Data were analyzed using statistical software Epi info Version 7. Results: Of 260 dog bite cases, 76.5% cases were completed PEP. The majority, 22.3% cases from age group ≤10 years, 56.2% males, 48.1% from urban area, 25% had primary school education, 32.7% students, 53.8% had bite mark on lower limb, 58.5% were category III exposure, and 70.8% who had received previously immunization against rabies, were completed PEP. The bite due to 54.6% pet dog, 58.1% observable dog, 40% provoked bite, 71.9% cases who had not known about the rabid status of the dog, were completed PEP. The unconditional logistic regression analysis found that demographic and exposure factors were not independently associated with treatment compliance (P > 0.05) except literacy status (P < 0.05). The present study showed maximum completed PEP cases, however, it showed the demographic and exposure factors of dog bite cases were not independently associated with treatment compliance except literacy status.

Background:To assess the maternal risk factors associated with low birth weight (LBW) neonates at a tertiary hospital, Nanded, Maharashtra.Materials and Methods:This study was carried out in a tertiary care hospital in Nanded city of Maharashtra between January 2014 and July 2014 among 160 cases (LBW-birth weight ≤2499 g) and 160 controls (normal birth weight-birth weight >2499. Data collection was done by using predesigned questionnaire and also related health documents were checked and collected the expected information during the interview after obtaining informed consent from mothers. The data were analyzed by Epi Info 7 Version.Results:The present study found the significant association among gestational age, sex of baby, type of delivery, maternal age, religion, education of mother and husband, occupation of mother and husband, type of family, maternal height, weight gain, hemoglobin level, planned/unplanned delivery, bad obstetric history, interval between pregnancies, previous history of LBW, underlying disease, tobacco chewing, timing of first antenatal care (ANC) visit, total number of ANC visit, and iron and folic acid (IFA) tablets consumption with LBW. No significant association was found among maternal age, residence, caste, consanguinity of marriage, socioeconomic status, gravida, birth order, multiple pregnancy, and smoking with LBW in our study.Conclusion:It was concluded that hemoglobin level, weight gain during pregnancy, gestational age, planned/unplanned delivery, bad obstetric history, and IFA tablets consumption during pregnancy were independent risk factors for LBW.

INTRODUCTIONItem analysis is the process of collecting, summarizing and using information from students' response to assess the quality of test items.1,2 However it is said that MCQs emphasize recall of factual information rather than conceptual understanding and interpretation of concepts. 3There is more to writing good MCQs than writing good questions. Properly constructed MCQs can assess higher cognitive processing of Bloom's taxonomy such as interpretation, synthesis and application of knowledge, instead of just testing recall of isolated facts. 4,5 A multiple-choice question (MCQ) consists of a stem with a question line at its end or underneath it, followed by a number of options. One of the options is the correct or best response known as the key, while the others are described as distracters. 6 An essential characteristic of distracters is that all options shall present plausible answers and if possible none shall be incorrect.7 Function of a distracter is to attract students who do not know the correct answer while students who know the correct answer ignore them. Multiple choice questions (MCQ'S) are used as an objective and reliable tool to evaluate learning performance of students. It is also a preferred tool for selection of students for a given course. MCQ needs to be tested for the standard or quality.8 However the items to be used must be of good quality to serve the purpose for it is meant to be. Objectives To assess the item and test quality of multiple choice questions. ABSTRACTBackground: Item analysis is the process of collecting, summarizing and using information from students' response to assess the quality of test items. However it is said that MCQs emphasize recall of factual information rather than conceptual understanding and interpretation of concepts. There is more to writing good MCQs than writing good questions. The objectives of the study was to assess the item and test quality of multiple choice questions and to deal with the learning difficulties of students, identify the low achievers in the test. Methods:The hundred MBBS students from Government medical college were examined. A test comprising of thirty MCQs was administered. All items were analysed for Difficulty Index, Discrimination Index and Distractor Efficiency. Data entered in MS Excel 2007 and SPSS 21 analysed with statistical test of significance. Results: Majority 80% items difficulty index is within acceptable range. 63% items showed excellent discrimination Index. Distractor efficiency was overall satisfactory. Conclusions: Multiple choice questions with average difficulty and also having high discriminating power with good distracter efficiency should be incorporated into student's examination.

Background: Adolescence is the transition period between childhood and adulthood where rapid physical, mental, emotional and social development takes place. Adolescent girls are at greatest risk for nutrient deficiency and it badly affects their overall development. With this background this study was conducted to study some aspects of the socio-demographic profile and to assess the nutritional status of adolescent girls by anthropometry in a rural area of a district. Methods: It was a community based cross sectional study conducted during January 2015 to June 2015 in 10 villages of a district. 583 adolescent girls were interviewed using pre designed, pretested questionnaire and anthropometric examination was done. Results were analyzed with the help of Microsoft Excel 2007 and SPSS version 16.0 statistical software. Results: Mean age of the study population was 13.95±2.48 years. Majority (63.12%) were Hindu and belonged to nuclear family (54.72%). 45.63% were educated up to high school level. Most of the girls belonged to socio economic class IV (45.46%). The prevalence of underweight and stunting in this study was 36.54% and 48.37% respectively. Statistically significant association was found between underweight and marital status of adolescent girls (p=0.029). The association of age group, religion and educational status with stunting was statistically significant (p<0.05). Mean BMI of the total 583 study subjects was 17.66±2.42 kg/m2. The prevalence of thinness was 18.87% in this study, significantly associated with religion, type of family and socioeconomic status (<0.05). Conclusions: Since the prevalence of under nutrition was high among adolescent girls in our study, appropriate health education and nutrition intervention should be directed towards them to improve their nutritional status.

Hepatitis B and Haemophilus influenzae type b (Hib) infections are major public health problems in developing countries, including India. Hence, combination vaccines containing DTwP, recombinant hepatitis B and Hib conjugate vaccines have been developed. Here, we report a Phase IV study which assessed safety and reactogenicity of a new DTwP-HepBCHib vaccine. Three doses of DTwP-HepBCHib vaccine (Pentavac, Serum Institute of India Ltd) or TritanrixHBCHib (GlaxoSmithKline Beecham) were administered to infants at 6, 10 and 14 weeks of age in 2:1 ratio. The subjects were followed till one month after the third dose for safety assessment. Adverse events were captured in structured diaries and physical examinations were performed on each visit. The study was conducted in 1510 infants. Both vaccines caused injection site local and systemic reactions and the incidence was similar in both the groups. The incidence of local solicited reactions was: tenderness 35.9 %-33.6 %; redness 18.1 %-17.2 %; swelling 23.7 %-22.4 %; induration 12.8 % -13.7 %. The percentage of systemic solicited reactions were: diarrhea 2.2 %-2.2 %; drowsiness 3.3 %-3.4 %; fever 14.0 %-11.2 %; irritability 28.1 %-25.4 %; loss of appetite 6.6 %-5.6 %; persistent crying 17.7 %-15.7 %; vomiting 3.5 %-3.0 %. No serious adverse event was caused by the vaccines. The new DTwP-HepBCHib combination vaccine showed similar safety profile to that of an imported vaccine in Indian infants.