Sarit Sharma

Twinning and its correlates: community-based study in a rural area of India.

Abstract A retrospective study was carried out to investigate the twinning rate and its correlates from January 1991 to December 2005 in 10 villages of the Rural Health Centre, Pohir, a field practice area of the Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India. During this study period, 5,070 deliveries took place. A total of 5,017 singleton births and 53 sets of twins were recorded, giving a twinning rate of 10.45 per 1,000 total deliveries. Monozygotic and dizygotic twinning rates were estimated as 2.96 and 7.49 per 1,000 deliveries, respectively. The twinning rate was strongly associated with maternal age; the twinning rate for mothers between 30 and 34 years of age was about 10 times higher than the rate for mothers younger than 20 years. This variation was due to variation in dizygotic twinning; the rate of monozygotic twinning was almost constant for all ages. The twinning rate was highest at gestational order 4 or higher. The perinatal mortality rate among the twins was 173.1 per 1,000 total twin births and was significantly higher among the group in which diagnosis of twins was not done during the prenatal period. We should expect 1 twin birth per 100 births, and because perinatal mortality is alarmingly high in undiagnosed twin pregnancies, early recognition of twin pregnancy during prenatal visits and delivering in a health facility with adequately trained personnel should be encouraged.

Awareness and perceptions of school children about female feticide in urban Ludhiana

Background: Although the Indian girl child’s position is precarious throughout the country, she remains the most vulnerable in Punjab. Objectives: To assess the awareness and perceptions of school children regarding female feticide. Study Design: Crosssectional study. Materials and Methods: The study involved collection of information regarding knowledge and perception of school students about female feticide using multiple choice questionnaire. A total of 527 students between the age group of 11-18 years of various schools of district Ludhiana, Punjab were the study subjects. They had come to participate in the poster competition on organ donation (SAARC Transplant games), organized by Department of Community Medicine, D.M.C and H, Ludhiana. Results: Out of total 527 students, 97.9% were aware of female feticide. Main source of information was TV (56%), followed by newspaper (33%). Majority of the students (65.2 %) felt that discrimination between boys and girls is prevalent in the society. Regarding perception of school students for curbing this social evil, 37.8% school students were of the view that awareness among the masses is the solution to stop this practice, while 25% of the students responded that equal status to girls will stop this practice of female feticide. Conclusions: The school students had optimum level of awareness about female feticide and almost all of them strongly felt that this harmful practice should be stopped altogether.

Depression and anxiety among middle-aged women: A community-based study

Background: Anxiety and depressive disorders constitute a substantial proportion of the global burden of disease and are projected to form the second most common cause of disability by 2020. Objective: To assess the level of depression and anxiety among middle age women and the possible factors behind it. Materials and Methods: A total of 180 women aged 40–60 years were selected by proportionate sampling technique. Age, education, marital status, socioeconomic status, age at marriage, age at menopause, weight and height were noted. Zung-self-rating scales were used for calculating levels of depression and anxiety in these women. The data were analyzed by using statistical software SPSS. Results: The level of syndromal depression and anxiety was found to be 86.7% and 88.9%, respectively. Most of the subjects had the moderate type of depression (49.5%) followed by mild (29.4%) and severe depression (7.8%). While in case of anxiety, most of the subjects (69.4%) had a mild form of anxiety and 17.8% had moderate anxiety level. A significant difference was observed in the level of depression with respect to marital status (P = 0.009) and in the level of anxiety with respect to age (P = 0.021) in the study subjects. On applying logistic regression, none of the factors studied were found to be significant variables for anxiety or depression in the study population. Conclusion: Depression and anxiety are prevalent among the middle-aged women in rural Punjab. Provision of mental health services in this group is essential.

Impact of Health Education on The Knowledge, Attitude and Practices of Teachers Regarding Reproductive Health of Adolescents of Amritsar, Punjab.

CONTEXT Teachers play an important role in guiding the adolescents. Adolescents are ill equipped to deal with the impending changes in their body which makes them vulnerable to STDs, HIV/AIDS and premarital sex. This study attempts to study the impact of reproductive health education on the knowledge, attitude and practices of teachers, about which only a few studies are available. AIMS To study the impact of health education on the knowledge, attitude and practices of teachers regarding reproductive health of adolescents. SETTINGS Senior Secondary schools of Amritsar and Department of Community Medicine, Government Medical College, Amritsar, Punjab, India. STUDY PARTICIPANTS Male teachers of senior secondary schools of Amritsar teaching class 9th-12th. STUDY DESIGN Educational intervention study. SAMPLING METHOD Purposive sampling. MATERIALS AND METHODS The study was started with 155 teachers (teaching class 9th -12th) who willingly participated from 50 senior secondary schools of Amritsar district. It was carried out in three phases. In first phase, after taking informed consent, the teachers filled a pretested questionnaire which was followed by an interactive session on reproductive health in second phase. In third phase, to study the impact of the interactive session and the sustainability of knowledge gained, they were again administered the same questionnaire after a period of 3 months. STATISTICAL ANALYSIS Microsoft Excel, SPSS, Chi-square test. RESULTS Maximum 74 (47.7%) teachers were aware of the psychosocial problems of adolescents. Majority 110 (71%) of the teachers had only partial knowledge about pubertal changes. 117 (75.5%) teachers were unaware about genital hygiene. Only 33 (21.3%) teachers had adequate knowledge about different STDs. 91 (58.7%) and 54 (34.8%) of teachers had adequate knowledge about routes of transmission and prevention of AIDS respectively. Only 37 (23.9%) teachers were imparting sex education to students. After intervention significant favorable changes were seen in their knowledge, attitude and practices regarding most of above mentioned topics. CONCLUSION Although the baseline knowledge of teachers in most aspects of reproductive health of adolescents was found to be low, significant favourable changes were observed after health education.

Factors Related to Non-Referral of Patients with Presumptive Pulmonary TB to Designated Microscopy Centers (DMCs) by Registered Private Practitioners in Urban Areas of Punjab, India.

BACKGROUND Early diagnosis and proper treatment under RNTCP guidelines, forms the mainstay of management of a TB patient. A large proportion of patients with presumptive tuberculosis (TB) visit a Private Practitioner (PP) in the first place. Studies have shown that PPs rely more on X-rays and other diagnostic tools rather than referring the patient to the nearest Designated Microscopy Centre (DMC) for sputum microscopy. AIM The present study was planned to look in to factors responsible for non-referral of patients with presumptive pulmonary TB to the DMCs for diagnosis by PPs. MATERIALS AND METHODS Present study was a case-control study conducted over a period of one year among registered PPs in urban areas of Punjab. The study was carried out in five major cities which have approximately half of the urban population of Punjab. Forty three Private Practitioners per city for referral group and 43 matched PPs for non-referral group were selected. RESULTS Knowledge regarding RNTCP was low in both the referral (38.1%) as well as non-referral (25.6%) group of PPs. Allopathic doctors had significantly higher knowledge regarding TB as compared to ayurvedic and homeopathy doctors, and Registered Medical Practitioners (RMP). Both the knowledge of PPs regarding nearest DMC as well as perception about accessibility of the nearest DMC for the patients were found to be significantly higher in the referral group. Only 15.3% of practitioners in the non-referral group said that they had been contacted by RNTCP staff. CONCLUSION The main factors responsible for non-referral of pulmonary TB suspects to DMCs for diagnosis in the present study included low knowledge regarding RNTCP, lack of awareness regarding place and accessibility of nearest DMC, and inadequate sensitization of PPs by the RNTCP staff.

Duplicate publications: time to ring alarm bells.

Sir, A redundant or duplicate publication is a publication of a scientific paper that overlaps substantially with one already published.(1) As per “Guidelines on Good Publication Practice,”(2) the Committee on Publication Ethics (COPE) defined that a redundant publication occurs when two or more papers, without full cross references, share the same hypothesis, data, discussion points or conclusions. According to Reeves et al., the defining characteristics of a duplicate publication is that in addition to the above, it shares at least some of the same authors.(3) As an example, the article titled “Fertility profile and its correlates in a rural population of Dehradun district” was published as letter to editor in Indian Journal of Community Medicine (IJCM 2007; 32(2):152-3) and as original research article in Indian Journal of Preventive and Social Medicine (Ind J PSM 2007;38(3):142-49). An act of Professional Misconduct-why? The reader after reading the same article in two different journals may falsely substantiate the same observation and place greater reliance on evidence that appears to have been confirmed in more than one study. Moreover, it leads to wastage of valuable space in the journal as well as precious time of the editor. As a consequence, a deserving article might get rejected. Also, the results of meta-analysis might get biased because of the same observation being repeated in two different journals. Tramer et al. concluded in their study that inclusion of duplicated data in meta-analysis led to a 23% overestimation of Ondansetrons antiemetic efficacy.(4) However, some persons are of the view that as journals have different readership, this leads to wider accessibility of the scientific materials to the readers,(5) but in this era of electronic/internet revolution this point seems to be invalid. Possible reason: The most important reason may be deliberate or intentional duplication of the research article in order to increase the number of publications that is unfortunately a basic requirement for career progression in medical profession. Similar apprehensions are also expressed by Dr. AJ Singh in his article titled Plagiarising Plagiarism.(6) Recommended actions: In the light of above discussion, it is evident that the problem of duplicate publications is an issue that needs immediate attention on the part of both editors and readers. The actions to be taken in such cases range from retracting the article to issuing a ban on further publications of such authors. According to COPE Guidelines, the editor has to investigate and label the misconduct as serious or less serious followed by decision on what action to be taken when such misconduct is noticed or reported. The Guidelines provide a list of Sanctions that may be applied separately or combined ranging from a letter of warning to as serious as reporting the case to the General Medical Council or other such authority for appropriate action. Safeguards Increasing awareness among authors and readers regarding this issue. Before submitting an article for publication, the authors should consult the ‘Uniform Requirements for Manuscripts submitted to Biomedical journals.(7) Prompt reporting of such misconduct is the moral responsibility of the readers as well. Most importantly, the editors have a pivotal role to play in prevention of duplicate publications.