Background. Careful adherence to standard precautions can protect both health care workers (HCWs) and patients from infections. The present study identified the perceptions and compliance with the use of standard precautions and assessed the determinants of noncompliance among the HCWs in an emergency and trauma triage centre. Methods. A cross-sectional study using a semistructured questionnaire was carried out to collect the relevant information from the study participants. Results. A total of 162 HCWs were recruited into the study, who reported varying degrees of compliance with standard precautions. While most of them declared the use of hand rub (95%) and gloves (77%), reported use of protective eye gear and outer protective clothing was very low (22 and 28%, resp.). Despite a perceived risk of exposure to blood-borne infections, 8% of the HCWs had not completed the hepatitis B vaccination schedule. About 17% reported at least one needle stick injury in the past year but only 5.6% received medical attention. Conclusion. Inadequate adherence to standard precautions among health care providers warrants new training and monitoring strategies. Establishment of an effective occupational health cell incorporating these elements including periodic surveillance could be the way forward.

A case-control study of oesophageal cancer was carried out in Trivandrum, Kerala, involving 267 cases and 895 controls. Risk factors studied in males were pan (betel)-tobacco chewing, bidi and cigarette smoking, drinking alcohol and taking snuff. Only pan-tobacco chewing was investigated in females as very few indulged in the other habits. Among males significant associations with higher risk were observed for bidi smoking (p less than 0.001), bidi plus cigarette smoking (p greater than 0.05) and drinking alcohol (p less than 0.001). While a significant effect of duration of pan-tobacco chewing (p less than 0.005) was observed in males, there was no significant trend, the risk first falling then rising as duration of use increased. This was partly due to confounding with smoking. No effect of pan-tobacco use was observed in females. A step-wise model was fitted, retaining only those risk factors which were significant when adjusted for other factors; the risk factors included were duration of pan-tobacco chewing, duration of bidi smoking, daily frequency of bidi and cigarette smoking and alcohol use (yes or no). An adjusted relative risk of 2.03 was observed for a pan-tobacco habit of more than 40 years' duration, of 4.70 for more than 20 years of bidi smoking, of 4.80 for more than 20 bidis/cigarettes per day, and of 2.33 for regular alcohol use (in each category relative to a baseline of those never indulging in the relevant habit).

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Background Tuberculosis is a major contributor to the global burden of disease, causing more than a million deaths annually. Given an emphasis on equity in access to diagnosis and treatment of tuberculosis in global health targets, evaluations of differences in tuberculosis burden by sex are crucial. We aimed to assess the levels and trends of the global burden of tuberculosis, with an emphasis on investigating differences in sex by HIV status for 204 countries and territories from 1990 to 2019. MethodsWe used a Bayesian hierarchical Cause of Death Ensemble model (CODEm) platform to analyse 21 505 siteyears of vital registration data, 705 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, and 680 site-years of mortality surveillance data to estimate mortality due to tuberculosis among HIV-negative individuals. We used a population attributable fraction approach to estimate mortality related to HIV and tuberculosis coinfection. A compartmental meta-regression tool (DisMod-MR 2.1) was then used to synthesise all available data sources, including prevalence surveys, annual case notifications, population-based tuberculin surveys, and tuberculosis cause-specific mortality, to produce estimates of incidence, prevalence, and mortality that were internally consistent. We further estimated the fraction of tuberculosis mortality that is attributable to independent effects of risk factors, including smoking, alcohol use, and diabetes, for HIV-negative individuals. For individuals with HIV and tuberculosis coinfection, we assessed mortality attributable to HIV risk factors including unsafe sex, intimate partner violence (only estimated among females), and injection drug use. We present 95% uncertainty intervals for all estimates.Findings Globally, in 2019, among HIV-negative individuals, there were 1•18 million (95% uncertainty interval 1•08-1•29) deaths due to tuberculosis and 8•50 million (7•45-9•73) incident cases of tuberculosis. Among HIV-positive individuals, there were 217 000 (153 000-279 000) deaths due to tuberculosis and 1•15 million (1•01-1•32) incident cases in 2019. More deaths and incident cases occurred in males than in females among HIV-negative individuals globally in 2019, with 342 000 (234 000-425 000) more deaths and 1•01 million (0•82-1•23) more incident cases in males than in females. Among HIV-positive individuals, 6250 (1820-11 400) more deaths and 81 100 (63 300-100 000) more incident cases occurred among females than among males in 2019. Age-standardised mortality rates among HIV-negative males were more than two times greater in 105 countries and age-standardised incidence rates were more than 1•5 times greater in 74 countries than among HIV-negative females in 2019. The fraction of global tuberculosis deaths among HIV-negative individuals attributable to alcohol use, smoking, and diabetes was 4•27 (3•69-5•02), 6•17 (5•48-7•02), and 1•17 (1•07-1•28) times higher, respectively, among males than among females in 2019. Among individuals with HIV and tuberculosi...

BackgroundPhysical activity trends for a lower-middle income country like India suggest a gradual decline in work related physical activity and no concomitant increase in leisure time physical activity. Perceived health benefits of physical activity and intention to increase physical activity have been established as independent correlates of physical activity status. In India, not much is known about peoples’ perceptions of health benefits of physical activity and their intention to increase physical activity levels. This study was performed to understand peoples’ perceptions and awareness about health benefits of physical activity in a rural South Indian region.MethodsThis cross-sectional study was conducted using a multistage cluster sampling design. A content validated, field tested questionnaire was administered in person by a trained interviewer in the participants’ native language. The questionnaire assessed the participants’ perceptions about their lifestyle (active or sedentary), health benefits of physical activity and need for increasing their physical activity. In addition, the participant’s physical activity was assessed using version 2 of global physical activity questionnaire. Frequencies and percentages were used to summarise perceived health benefits of physical activity and other categorical variables. Age and body mass index were summarised using mean ± SD, whereas physical activity (MET.min.wk −1) was summarised using median and interquartile range.ResultsFour hundred fifty members from 125 randomly selected households were included in the study, of which 409 members participated. 89% (364) of participants felt they lead an active lifestyle and 83.1% (340) of participants did not feel a need to increase their physical activity level. 86.1%, (352) of the participants were physically active. Though 92.4% (378) of participants felt there were health benefits of physical activity, majority of them (75.1%) did not report any benefit related to chronic diseases. None mentioned health benefits related to heart disease or stroke.ConclusionThere is low awareness of chronic disease related benefits of physical activity and participants do not see a need to increase their physical activity level. Public health awareness programs on importance and health benefits of physical activity would be useful to counter the anticipated decline in physical activity.

Background: Empathy has been shown to improve the physician’s diagnostic skills as well as enhance the quality of communication with the patient. Empathy being an integral component of patient care, this study was designed to measure empathy levels among undergraduate medical students and to identify the factors associated with it in this population. Methods: This cross sectional study was carried out among 437 medical students including interns on the rolls of a medical school in coastal Karnataka. The students were administered a psychometrically validated Jefferson Scale of Empathy–Student Version (JSE-S) questionnaire, to measure various components of empathy. Responses were indicated on a seven point Likert scale and total scores ranged from 20–140, with higher values indicating higher levels of empathy. Results: Mean empathy score among the participants was 100.5±14.8, with significantly higher score being reported by females than males [101.9 vs. 97.3, p=0.002] and by first year students compared to third year students [105.2 vs. 95.3, p<0.01]. Empathy scores showed a declining trend as the students progressed through the medical school (p=0.002). Conclusions: Although the study showed higher empathy level among female medical students, there appeared a declining score among both genders as the years of study progressed with a marginal increase during the internship phase. This necessitates the need for incorporating caregiving as an integral part of the medical school curriculum by stressing on doctor- patient communication skills, which in turn could aid medical students become compassionate physicians.

BackgroundThe World Health Organization (WHO) recommends that people with uncomplicated Plasmodium falciparum malaria are treated using Artemisinin-based Combination Therapy (ACT). ACT combines three-days of a short-acting artemisinin derivative with a longer-acting antimalarial which has a different mode of action. Pyronaridine has been reported as an effective antimalarial over two decades of use in parts of Asia, and is currently being evaluated as a partner drug for artesunate.ObjectivesTo evaluate the efficacy and safety of artesunate-pyronaridine compared to alternative ACTs for treating people with uncomplicated P. falciparum malaria.Search methodsWe searched the Cochrane Infectious Diseases Group Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL), published in The Cochrane Library; MEDLINE; EMBASE; LILACS; ClinicalTrials.gov; the metaRegister of Controlled Trials (mRCT); and the WHO International Clinical Trials Search Portal up to 16 January 2014. We searched reference lists and conference abstracts, and contacted experts for information about ongoing and unpublished trials.Selection criteriaRandomized controlled trials of artesunate-pyronaridine versus other ACTs in adults and children with uncomplicated P. falciparum malaria.For the safety analysis, we also included adverse events data from trials comparing any treatment regimen containing pyronaridine with regimens not containing pyronaridine.Data collection and analysisTwo authors independently assessed trial eligibility and risk of bias, and extracted data. We combined dichotomous data using risk ratios (RR) and continuous data using mean differences (MD), and presented all results with a 95% confidence interval (CI). We used the GRADE approach to assess the quality of evidence.Main resultsWe included six randomized controlled trials enrolling 3718 children and adults.Artesunate-pyronaridine versus artemether-lumefantrineIn two multicentre trials, enrolling mainly older children and adults from west and south-central Africa, both artesunate-pyronaridine and artemether-lumefantrine had fewer than 5% PCR adjusted treatment failures during 42 days of follow-up, with no differences between groups (two trials, 1472 participants, low quality evidence). There were fewer new infections during the first 28 days in those given artesunate-pyronaridine (PCR-unadjusted treatment failure: RR 0.60, 95% CI 0.40 to 0.90, two trials, 1720 participants, moderate quality evidence), but no difference was detected over the whole 42 day follow-up (two trials, 1691 participants, moderate quality evidence).Artesunate-pyronaridine versus artesunate plus mefloquineIn one multicentre trial, enrolling mainly older children and adults from South East Asia, both artesunate-pyronaridine and artesunate plus mefloquine had fewer than 5% PCR adjusted treatment failures during 28 days follow-up (one trial, 1187 participants, moderate quality evidence). PCR-adjusted treatment failures were 6% by day 42 for these treated with artesunate-pyronaridine, and 4% f...

Requiring help in performing ADL, advancing age, and Alzheimer's disease were the likely factors for socially isolation among elderly patients in this surveyed population.