Family Medicine and Primary Care

A primary care–based patient centric palliative care model Sunil Kumar Raina, Raman Kumar, Rajiv Kumar Gupta Journal of Family Medicine and Primary Care 2019 8(5):1519-1522 The World Health Organization defined palliative care as “an approach that improves the quality of life of patients and their families facing the problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual. The patient centric primary care model (PCCM) promises to provide a solution to control these health-care challenges. The model is largely based on the chronic care model (CCM) and the model developed by the Organized Medicine Academic Guild (OMAG) for delivering health care in India.

Medical problem in Asia pacific and ways to solve it: The roles of primary care/family physician (Indonesia Xperience) Retno Asti Werdhani Journal of Family Medicine and Primary Care 2019 8(5):1523-1527 WHO reported that Environment contributed significantly as the causal of the disease in Asia Pacific. Indonesia is facing major health challenges, namely triple burden health problems, due to communicable diseases, non-communicable diseases and re-emerging disease. Primary care in Indonesia is conducted by Public Health Centers/Puskesmas and Primary Care Clinic covering around 86% of total health care facilities in Indonesia. Primary Care Physician plays important role as a gatekeeper and care coordinator. Primary care in Indonesia responsible for primary prevention and screening, should also be prepared to deal with various reasons for encounters of patient/community health problems, and conduct comprehensive management including referral management. It is therefore necessary to have teamwork with various health workers and patients/families at all levels of prevention.

Need for a universal thalassemia screening programme in India? A public health perspective Arulmani Thiyagarajan, Sudip Bhattacharya, Neha Sharma, Abhay Srivastava, Dipak Kumar Dhar Journal of Family Medicine and Primary Care 2019 8(5):1528-1532 Thalassemia is one of the significant public health concerns as the carrier rate and disease numbers are increasing worldwide. The increase in number is because of consanguineous marriage which has a deep-rooted norm among many people globally. Besides various clinical and psychological problems associated with thalassemia, a lifelong treatment aspect makes it much more difficult for a person or family to sustain with thalassemia or thalassemia-affected children. Though the government has come up with a screening programme for thalassemia, given the fact that it is optional, people tend to ignore it. Examples from Pakistan and Iran remind us to have a mandatory prenatal screening programme which is very much cost-effective. With a highly recommended notion, we suggest that it should be universal to have an antenatal screening programme to avert thalassemia-related deaths.

Cytochemical tests to investigate sperm DNA damage: Assessment and review Soheila Pourmasumi, Alireza Nazari, Niloofar Fagheirelahee, Parvin Sabeti Journal of Family Medicine and Primary Care 2019 8(5):1533-1539 Male factor infertility has been diagnosed as the cause of infertility in about 20% of infertile couples. Sperm analysis is the most common method for diagnosing infertility in a laboratory. However, approximately 15% of infertile men have a normal sperm analysis. Therefore, the result of a routine sperm analysis often cannot be a definitive diagnosis for male factor infertility. Also, approximately 8% of infertile men with normal sperm parameters have high levels of abnormal sperm DNA. This indicates the role of the integrity of sperm DNA in male infertility. Here, we review the current tests available to evaluate the sperm DNA integrity along with their benefits and limitations.

Cosmetovigilance: A review of the current literature Hale Z Toklu, Abigail Antigua, Vanessa Lewis, Mar'Tina Reynolds, Jennifer Jones Journal of Family Medicine and Primary Care 2019 8(5):1540-1545 The term “pharmacovigilance” defines the activities related to the collection, detection, assessment, monitoring, and prevention of adverse reactions occurring with medications. Recently, the spectrum of “-vigilance” has broadened to include safety of herbal products and cosmetic products as well. “Cosmetovigilance” was introduced as a new term used for defining surveillance carried out by industry to address the safety of cosmetic products. It was first used in literature by Vigan (1997) to refer to the monitoring of cosmetic product safety. Today, it is recognized globally as a concept of public health. For this systematic review, a PubMed search was conducted in July 2018 for the term “cosmetovigilance.”

Get lean and go green: Role for "Eat-ology" behavior modification Samra Abouchacra, Satish Chandrasekhar Nair, Oudi Abouchacra, Omar Yaman Journal of Family Medicine and Primary Care 2019 8(5):1546-1549 Obesity rates are rising exponentially reaching global epidemic proportions and are associated with substantially increased morbidity and mortality. Less appreciated are the serious risks this poses on our environment from increased greenhouse gas emissions related to obesogenic behavior. In spite of a plethora of diets, the results are short term and nonsustainable, thereby leaving individuals battling with more weight than they lost. This is likely attributable to inherent flaws in the nature of weight loss diets or perhaps the approach of implementing them. These grim realities will be exposed to lead the way to uncover a novel “behavior modification for weight loss” strategy called Eat-ology. It exposes eating errors and imparts techniques to transform them into eating essentials, thereby enabling weight loss and its long-term maintenance. It is through such approaches that we can hope to win the fight against obesity and achieve not only a leaner global society but also a greener environment.

Nursing efficiency in patient care: A comparative study in perception of staff nurse and hospital management in a trust hospital Homa Mosaffay Khomami, Nasreen Rustomfram Journal of Family Medicine and Primary Care 2019 8(5):1550-1557 Background and Objective: While efficient use of resources and cost control is the responsibility of hospital managers, it is the duty of the nurses to carry out patient care and provide high-quality services. The aim of present research was to study the perception of staff nurses and nurse managers about nursing efficiency in patient care in a trust hospital. Materials and Methods: This quantitative and explanatory research has been done on staff nurses as well as nurse managers in a 550-bedded trust hospital in rural Gujarat of India. Data collection tool was a researcher made questionnaire and the data collection method was interview schedules for staff nurse and nurse managers. The total number of staff nurse in this hospital was 450 including 50 nurse managers. Results: Staff nurses had shown dissatisfaction regarding managers' practice and stated some aspects of managers practice which needed to improve such as keeping competitive salary for staff nurse, providing counseling system to supporting nursing practice, better recognition and acknowledgement system, better job security, providing supportive managerial style, better unit size and Applying vacation system. Conclusions: There was a difference between staff nurses' perception and nurse managers' perception regarding professional characteristics for nursing profession and factors, which affect nursing efficiency in patient care (with 95% confidence interval and P < 0.05).

Evaluation of hypercalciuria in patients receiving intravenous Cefotaxime Zahra Kalantari, Parsa Yousefichaijan, Manijeh Kahbazi, Ali Arjmand Shabestari Journal of Family Medicine and Primary Care 2019 8(5):1558-1561 Introduction: Cefotaxime is one of the third generation cephalosporins, which is used against many infections. This drug has a urinary excretion and potentially may have nephrotoxic effects. Hypercalciuria can cause important complications, including the formation of kidney stones. In the recent study, we decided to evaluate hypercalciuria in children receiving cefotaxime. Materials and Methods: This case-control study was conducted in Amirkabir hospital (Arak, Iran), where 30 children received intravenous cefotaxime were placed in the case group and 30 children without intravenous administration of cefotaxime were included in the control group. The ratio of calcium to creatinine was measured in both groups. Data were analyzed by SPSS software version 23. Results: This study showed that the ratios of male and female children in both the groups were 19 (63.3%) and 11 (36.7%) respectively, the mean age of children in the case group was 2.36 years with a standard deviation of 0.71 and the mean age of the children in the control group was 5.18 years with a standard deviation of 3.31. The ratios of urine calcium to creatinine in the case and control groups were 0.90 with a standard deviation of 1.79 and 0.37 with a standard deviation of 0.44 (P value = 0.003). Conclusion: According to the above results, it is concluded that receiving intravenous cefotaxime may increase calcium to creatinine ratio in children.

Prevalence of smoking among dental students and gauging their knowledge about tobacco cessation methods: An original study Jubin Thomas, R B Vinod Kumar, S Akhil, Ajish M Saji, Amal K Iype, Diana Antony Journal of Family Medicine and Primary Care 2019 8(5):1562-1566 Aims: The aims of this study are to determine the prevalence and type of tobacco use among dental students and to identify the factors that influence them to initiate tobacco use. Subjects and Methods: Dental students at two dental colleges affiliated to State Health University of Kerala answered a 20-item questionnaire during Jan–Feb 2015 that investigated their smoking habits and knowledge about the risk factors of smoking habits. The questions were based on the modified Global Health Professional Students Survey (GHPSS) by WHO. Some additional questions were also added from Global Youth Tobacco Survey (GYTS) by WHO to meet the objective of this study. Result: Current smoking was reported by 17% of the participants. None of the participants smoked more than half a packet of cigarette. More students from families with at least one tobacco user were using tobacco than those from families with no members using tobacco (51.2 versus 37.0%, respectively). The majority of dental students (92%) considered education on tobacco use cessation to be the responsibility of dentists/doctors. Conclusion: One of the main aims of this study was to shed light on the knowledge and attitudes of dental students on tobacco use cessation. Fairly high number of participants reported receiving inadequate information on tobacco cessation during their studies. Dental students should be taught and encouraged early on to routinely discuss with smokers the impacts of smoking on health.

Toll like receptors (TLRs) in response to human gut microbiota of Indian obese and lean individuals Tej Bahadur, Rama Chaudhry, Vishwa Deepak Bamola, Sonu K Agrawal, Pawan Malhotra, Alka M Chutani, Bijay R Mirdha, Bimal K Das, Rahul K Sharma, Chandan K Thakur Journal of Family Medicine and Primary Care 2019 8(5):1567-1570 Background: The rising incidence of obesity is one of the most serious public health issues in the developed as well as in developing countries like India. Obesity and overweight are most important risk factors for many chronic diseases, including cardiovascular diseases, diabetes and cancer. In this study the body mass index (BMI) cut off was taken as 18.5-22.9 kg/m2 for normal, 23.0-24.9 kg/m2 for Overweight and >25 kg/m2 for obese as per WHO recommendation for Asian Indians, which is different for developed and developing countries. Role of gut microbiota mediated immune response in the development of obesity has been studied but the literature on Indian population are lacking. Therefore, a study was conducted to determine Toll like receptors (TLRs) in response to human gut microbiota of Indian obese and lean individuals using viable colonocytes in a Non invasive technique and Flowcytometry. Methods: A total of 20 healthy volunteer (10 obese and 10 lean) were enrolled in the study as per inclusion and exclusion criteria. Viable colonocytes were isolated from fecal samples using a Non invasive technique (SCSR Method). Toll like receptors (TLRs) and immunoglobulin (IgA &IgG) receptor concentration were measured by standard Flowcytometry methods using specific fluorochrome conjugated antibodies. Results: Average TLR2 receptor concentration was significantly higher in obese (6.35 %) as compared to lean (2.9 %) (P = 0.01). TLR4 receptor concentration was 1.4 % in obese and 1.65 % in lean although the difference was not statistically significant (P = 0.59). IgA & IgG receptor concentration was 49.6 % & 11.2 % in the obese and 67.15 % & 8.05 % in the lean respectively but the differences among both the group were not statistically significant. Conclusion: The results of the present study will be helpful for physicians and researchers to find some biomarkers which can determine predisposition of the obesity in Indian population and helps to use alternative therapeutics such as probiotics to maintain gut homeostasis and immune modulation to prevent obesity.

Alexandros Sfakianakis
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