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De Silva V.A.,University of Colombo | Jayasekera N.E.L.W.,Directorate of Health Services | Hanwella R.,University of Colombo
Annals of General Psychiatry | Year: 2013

Background: Medically unexplained symptoms have been reported among both civilians and military personnel exposed to combat. A large number of military personnel deployed to the Gulf War in 1991 reported non-specific symptoms. These symptoms did not constitute a clearly defined syndrome. Post-traumatic stress disorder (PTSD) and to a lesser degree exposure to combat are associated with physical symptoms.Methods: This is a cross-sectional study of representative samples of Sri Lanka Navy Special Forces and regular forces deployed in combat areas continuously during a 1-year period. Multiple physical symptoms were elicited using a checklist of 53 symptoms. Cases were defined as individuals with ten or more symptoms. Symptoms of common mental disorder were identified using the General Health Questionnaire 12 (GHQ-12). PTSD was diagnosed using the 17-item National Centre for PTSD checklist civilian version.Results: Prevalence of multiple physical symptoms was 10.4% (95% CI 8.11-12.75). Prevalence was significantly less in the Special Forces (5.79%) than in the regular forces (13.35%). The mean number of symptoms reported by those who met the criteria for PTSD was 12.19 (SD 10.58), GHQ caseness 7.87 (SD 7.57) and those without these conditions 2.84 (SD 3.63). After adjusting for socio-demographic and service variables, 'thought I might be killed' , 'coming under small arms fire' , and 'coming under mortar, missile and artillery fire' remained significant. Multiple physical symptoms were associated with functional impairment and poor perceived general health.Conclusions: Prevalence of multiple physical symptoms was significantly lower in the Special Forces despite high exposure to potentially traumatic events. More multiple physical symptoms were reported by personnel with PTSD and common mental disorders. Multiple physical symptoms were associated with functional impairment. © 2013 de Silva et al.; licensee BioMed Central Ltd.

Sarkar J.,Directorate of Health Services | Murhekar M.V.,National Institute of Epidemiology
Indian Journal of Tuberculosis | Year: 2011

New sputum negative (NSN) tuberculosis case detection in Jalpaiguri district has been consistently low. Availability and accessibility of health facilities with chet x-rays is key for the diagnosis of NSN cases. To identify factors associated with utilisation of x-ray facilities in the district, we interviewed 4,875 chest symptomatics who were sputum negative on two occasions with an antibiotics course in between. Chest radiography was available in only three public health facilities in the district. Low income, long distance from the public health facilities with chest radiography and high cost of x-rays at private hospitals were key factors associated with symptomatics not undergoing X-ray. It is necessary to increase facilities for radiological diagnosis and provide mobility support for the symptomatics in Jalpaiguri.

Mahdi S.S.,Directorate of Health Services | Habib O.S.,University of Basrah
Eastern Mediterranean Health Journal | Year: 2010

This was a cross-sectional study in Basra, and involved 353 women who had recently given birth drawn from health care institutions. The main objective was to determine the factors that helped determine the women's choice of place of delivery: Hospital or home. Only 16.1% delivered at home, while 83.9% delivered in hospital. The main reasons for choosing hospital delivery were safety and security (96.6% of the women), better hygiene (66.6%) and because of medical advice (63.2%). The main reasons for the choice of home delivery were social support and privacy (98.2%). The women were consistent in their choice of delivery place across different pregnancies (previous, present and future).

Samuel P.P.,Center for Research in Medical Entomology | Thenmozhi V.,Center for Research in Medical Entomology | Nagaraj J.,Center for Research in Medical Entomology | Kumar T.D.,Directorate of Health Services | Tyagi B.K.,Center for Research in Medical Entomology
Journal of Vector Borne Diseases | Year: 2014

Background & objectives: A longitudinal, entomological and virological study was conducted from 2007 to 2010 in four dengue fever affected areas of Thiruvananthapuram district, Kerala to understand the risk factors involved in the dengue transmission.Methods: Aedes surveys were carried out seasonally in the selected localities both indoors and peridomestic sites. Water holding containers were sampled for the presence of immature. Outdoor and indoor resting/landing mosquitoes were collected. Blood meal identification was performed by gel diffusion test and viral assay using the ELISA test.Results: The species found were Aedes (Stegomyia) aegypti (Linn.), Ae. (Stegomyia) albopictus (Skuse) and Ae. (Stegomyia) vittatus (Bigot). Aedes aegypti and Ae. albopictus immature stages were also found during the study period. Aedes aegypti was the only prevalent species in the water-starved Vizhinjam, a rural coastal area with breteau index (BI) ranging from 40 to 271. Aedes albopictus was recorded in rest of the three surveyed localities— two urban and one rural ghat areas of Thiruvananthapuram district.Interpretation & conclusion: The vector control measures should be focused mainly on source reduction of water storage containers present in both outdoor (Ae. albopictus and Ae. vittatus) and indoor (Ae. aegypti). To achieve effective vector management, a public health response beyond routine larviciding or focal spraying is essential throughout the year. © 2014 Malaria Research Center. All Rights reserved.

Srinivasan R.,Vector Control Research Center | Jambulingam P.,Vector Control Research Center | Kumar N.P.,Vector Control Research Center | Selvakumar M.,Vector Control Research Center | And 2 more authors.
Acta Tropica | Year: 2015

The temporal distribution of sand flies in relation to environmental factors was studied in the Kani tribe settlements located on the southernmost part of the Western Ghats, Kerala, India, between June 2012 and May 2013. This area is known for occurrence of cutaneous leishmaniasis (CL) cases. Employing hand-held aspirator, light trap and sticky-trap collection methods, a total of 7874 sand fly specimens, comprising 19 species was collected. Sergentomyia baghdadis was predominant species, followed by Phlebotomus argentipes. Sand fly abundance was significantly higher indoors (χ2=9241.8; p=0.0001) than outdoors. Mean density of P. argentipes in human dwellings, cattle sheds and outdoors was 7.2±2.9, 27.33±21.1 and 0.64±0.2 females/per man-hour (MHR), respectively. No sand fly species other than P. argentipes was obtained from cattle sheds. Although, sand fly populations were prevalent throughout the year, their abundance fluctuated with seasonal changes. Multiple regression analysis with backward elimination indicated that the increase in precipitation and relative humidity contributed to a significant positive association with the increase in sand fly abundance, while the increase in temperature showed no association. Fully engorged female sand flies tested for blood meal source showed multiple host-blood feeding. Analysis of resting populations of sand flies collected from human shelters indicated that the populations were found maximum on interior walls at 6-8 and >8ft height, including ceiling during summer (F=83.7, df=6, p=0.001) and at the lower half of the wall at 0 and 0-2ft height, during monsoon season (F=41.4, df=6, p=0.001). In cooler months, no preference to any height level (F=1.67, df=6, p=0.2) was observed. Proportion of females sand flies with Sella's classification of abdominal stages, namely full-fed, half-gravid and gravid females did not vary significantly (t=1.98, p=0.13827) indoors, confirming their endophilic behaviour. Risk of CL transmission in these tribal settlements is discussed. © 2015 Elsevier B.V.

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