Thiruvananthapuram, India
Thiruvananthapuram, India

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Chow C.K.,University of Sydney | Chow C.K.,Population Health Research Institute PHRI | Corsi D.J.,University of Sydney | Corsi D.J.,Ottawa Hospital Research Institute | And 29 more authors.
BMJ Open | Year: 2017

Objectives: This study examines in a cross-sectional study 'the tobacco control environment' including tobacco policy implementation and its association with quit ratio. Setting: 545 communities from 17 high-income, upper-middle, low-middle and low-income countries (HIC, UMIC, LMIC, LIC) involved in the Environmental Profile of a Community's Health (EPOCH) study from 2009 to 2014. Participants: Community audits and surveys of adults (35-70 years, n=12 953). Primary and secondary outcome measures: Summary scores of tobacco policy implementation (cost and availability of cigarettes, tobacco advertising, antismoking signage), social unacceptability and knowledge were associated with quit ratios (former vs ever smokers) using multilevel logistic regression models. Results: Average tobacco control policy score was greater in communities from HIC. Overall 56.1% (306/545) of communities had <2 outlets selling cigarettes and in 28.6% (154/539) there was access to cheap cigarettes (<5cents/cigarette) (3.2% (3/93) in HIC, 0% UMIC, 52.6% (90/171) LMIC and 40.4% (61/151) in LIC). Effective bans (no tobacco advertisements) were in 63.0% (341/541) of communities (81.7% HIC, 52.8% UMIC, 65.1% LMIC and 57.6% LIC). In 70.4% (379/538) of communities, >80% of participants disapproved youth smoking (95.7% HIC, 57.6% UMIC, 76.3% LMIC and 58.9% LIC). The average knowledge score was >80% in 48.4% of communities (94.6% HIC, 53.6% UMIC, 31.8% LMIC and 35.1% LIC). communities in the highest quintile of the combined scores had 5.0 times the quit ratio in men (Odds ratio (OR) 5.0, 95% CI 3.4 to 7.4) and 4.1 times the quit ratio in women (OR 4.1, 95% CI 2.4 to 7.1). Conclusions: This study suggests that more focus is needed on ensuring the tobacco control policy is actually implemented, particularly in LMICs. The gender-related differences in associations of policy, social unacceptability and knowledge suggest that different strategies to promoting quitting may need to be implemented in men compared to women. © 2017 Chow CK, et al. BMJ Open.


Cohen A.,London School of Hygiene and Tropical Medicine | Eaton J.,CBM National Co ordination Office | Radtke B.,Community Mental Health | George C.,Dr Somervell Memorial CSI Medical College | And 3 more authors.
International Journal of Mental Health Systems | Year: 2011

Objective: To compare and contrast three models of community mental health services in low-income settings.Data Sources/Study Setting: Primary and secondary data collected before, during, and after site visits to mental health programs in Nigeria, the Philippines, and India.Study Design: Qualitative case study methodology.Data Collection: Data were collected through interviews and observations during site visits to the programs, as well as from reviews of documentary evidence.Principal Findings: A set of narrative topics and program indicators were used to compare and contrast three community mental health programs in low-income countries. This allowed us to identify a diversity of service delivery models, common challenges, and the strengths and weaknesses of each program. More definitive evaluations will require the establishment of data collection methods and information systems that provide data about the clinical and social outcomes of clients, as well as their use of services.Conclusions: Community mental health programs in low-income countries face a number of challenges. Using a case study methodology developed for this purpose, it is possible to compare programs and begin to assess the effectiveness of diverse service delivery models. © 2011 Cohen et al; licensee BioMed Central Ltd.


Abraham A.,Dr Somervell Memorial Csi Medical College | Varghese S.,Government Medical College | Satheesh M.,Government Medical College | Vijayakumar K.,Government Medical College | And 2 more authors.
Indian Journal of Community Health | Year: 2014

Introduction: Gynecological morbidities constitute an important health problem among women of reproductive age group in India. Many of them did not seek care and bare it silently. Aims and Objectives: The purpose of this study was to measure the prevalence of self-reported gynecological morbidities among women of 15 to 45 years and to find out association with certain selected socio-demographic factors. This study also tried to study the health seeking behavior of women. Methodology: A population based cross sectional survey was conducted across Vakkom Panchayat, it’s area comes under Rural Health Centre of the Department of Community Medicine, Govt. Medical College, Thiruvananthapuram. A total of 540Women of 15 to 45 years was included in the study by two stage sampling technique. Results: Of the total, 199 {(36.85%) 95% CI -31.14, 42.94} women in the study reported at least one type of gynecological morbidity. Major morbidity reported was menstrual problems (25.0%). Prevalence of overall gynecological morbidities was found to be significantly more among women who married early (<18years) Adjusted OR 1.66 (95%CI- 1.05, 2.64).On subgroup analysis the factors like age group of women (below 30yrs), age at menarche below 13 years & presence of thyroid hormone disorders were found to be significantly (p<0.05) related to menstrual diseases in the regression model. Only 110 (55.3%) women sought treatment for any one of the morbidity. Majority took treatment from private hospitals. Conclusion: Prevalence of gynecological morbidities was high in this community. The data collected are valuable & could serve as preliminary data to pilot innovative delivery of gynecologic healthcare services. © 2014, Indian Association of Preventive and Social Medicine. All rights reserved.


Khatib R.,Hamilton Health Sciences | McKee M.,London School of Hygiene and Tropical Medicine | Shannon H.,McMaster University | Chow C.,University of Sydney | And 29 more authors.
The Lancet | Year: 2016

Background WHO has targeted that medicines to prevent recurrent cardiovascular disease be available in 80% of communities and used by 50% of eligible individuals by 2025. We have previously reported that use of these medicines is very low, but now aim to assess how such low use relates to their lack of availability or poor affordability. Methods We analysed information about availability and costs of cardiovascular disease medicines (aspirin, β blockers, angiotensin-converting enzyme inhibitors, and statins) in pharmacies gathered from 596 communities in 18 countries participating in the Prospective Urban Rural Epidemiology (PURE) study. Medicines were considered available if present at the pharmacy when surveyed, and affordable if their combined cost was less than 20% of household capacity-to-pay. We compared results from high-income, upper middle-income, lower middle-income, and low-income countries. Data from India were presented separately given its large, generic pharmaceutical industry. Findings Communities were recruited between Jan 1, 2003, and Dec 31, 2013. All four cardiovascular disease medicines were available in 61 (95%) of 64 urban and 27 (90%) of 30 rural communities in high-income countries, 53 (80%) of 66 urban and 43 (73%) of 59 rural communities in upper middle-income countries, 69 (62%) of 111 urban and 42 (37%) of 114 rural communities in lower middle-income countries, eight (25%) of 32 urban and one (3%) of 30 rural communities in low-income countries (excluding India), and 34 (89%) of 38 urban and 42 (81%) of 52 rural communities in India. The four cardiovascular disease medicines were potentially unaffordable for 0·14% of households in high-income countries (14 of 9934 households), 25% of upper middle-income countries (6299 of 24 776), 33% of lower middle-income countries (13 253 of 40 023), 60% of low-income countries (excluding India; 1976 of 3312), and 59% households in India (9939 of 16 874). In low-income and middle-income countries, patients with previous cardiovascular disease were less likely to use all four medicines if fewer than four were available (odds ratio [OR] 0·16, 95% CI 0·04-0·57). In communities in which all four medicines were available, patients were less likely to use medicines if the household potentially could not afford them (0·16, 0·04-0·55). Interpretation Secondary prevention medicines are unavailable and unaffordable for a large proportion of communities and households in upper middle-income, lower middle-income, and low-income countries, which have very low use of these medicines. Improvements to the availability and affordability of key medicines is likely to enhance their use and help towards achieving WHO's targets of 50% use of key medicines by 2025. Funding Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, GlaxoSmithKline, Novartis, King Pharma, and national or local organisations in participating countries. © 2016 Elsevier Ltd.


Mathew R.,Saveetha University | Jobin S.R.,Dr Somervell Memorial Csi Medical College
Research Journal of Pharmaceutical, Biological and Chemical Sciences | Year: 2014

Early detection and antimicrobial susceptibility surveillance are important for its effective management and prevention of complications in Enteric fever. The present study was conducted to find out the sensitivity pattern of the isolates to the commonly used antibiotics in Enteric fever.A total of 290 blood samples were collected from patients with pyrexia for isolation of the agent by blood and clot culture. Antimicrobial susceptibility was done by disc diffusion method and Minimum inhibitory concentration (MIC) was determined using agar dilution technique for Ciprofloxacin and Ofloxacin. Among the 290 cases, culture was positive in 40 patients (13.79%). Out of 40 Salmonella isolates, 29 isolates were Salmonella enterica serovar typhi and 11 were Salmonella enterica serovar paratyphi A. MIC of ciprofloxacin and ofloxacin were high for one strain of Salmonella enterica serovar typhi. All the isolates were sensitive to ceftriaxone. To conclude, presence of quinolone resistance among Salmonella isolates from blood needs continuous monitoring and further evaluation.


Objective To examine and compare tobacco marketing in 16 countries while the Framework Convention on Tobacco Control requires parties to implement a comprehensive ban on such marketing. Methods Between 2009 and 2012, a kilometre-long walk was completed by trained investigators in 462 communities across 16 countries to collect data on tobacco marketing. We interviewed community members about their exposure to traditional and non-traditional marketing in the previous six months. To examine differences in marketing between urban and rural communities and between high-, middle- and low-income countries, we used multilevel regression models controlling for potential confounders. Findings Compared with high-income countries, the number of tobacco advertisements observed was 81 times higher in low-income countries (incidence rate ratio, IRR: 80.98; 95% confidence interval, CI: 4.15–1578.42) and the number of tobacco outlets was 2.5 times higher in both low- and lower-middle-income countries (IRR: 2.58; 95% CI: 1.17–5.67 and IRR: 2.52; CI: 1.23–5.17, respectively). Of the 11 842 interviewees, 1184 (10%) reported seeing at least five types of tobacco marketing. Self-reported exposure to at least one type of traditional marketing was 10 times higher in low-income countries than in high-income countries (odds ratio, OR: 9.77; 95% CI: 1.24–76.77). For almost all measures, marketing exposure was significantly lower in the rural communities than in the urban communities. Conclusion Despite global legislation to limit tobacco marketing, it appears ubiquitous. The frequency and type of tobacco marketing varies on the national level by income group and by community type, appearing to be greatest in low-income countries and urban communities. © 2015, World Health Organization.


Remesh A.,Dr Somervell Memorial Csi Medical College
Asian Journal of Pharmaceutical and Clinical Research | Year: 2013

The rising prevalence of the pandemic of obesity urges the need for newer and effective drugs in its management. The pharmacotherapy of obesity is burdened by limitations in the number of drugs, inefficacy and side effects of existing drugs and continuous withdrawal of marketed drugs. This article gives an overview of factors involved in the regulation of energy homeostasis and the occurrence of obesity by a presumable shift in the controlling pathways. There are various putative targets which are implicated in the pathogenesis of obesity and these are the potential targets of drugs used in the treatment. A better understanding of Pathophysiology of obesity and the current status of pharmacotherapy can open up new vistas in this promising and needful area of research.


Remesh A.,Dr Somervell Memorial Csi Medical College | Gayathri A.M.,Dr Somervell Memorial Csi Medical College | Singh R.,Dr Somervell Memorial Csi Medical College | Retnavally K.G.,Dr Somervell Memorial Csi Medical College
Journal of Clinical and Diagnostic Research | Year: 2013

Background: Antibiotics are prescribed frequently and there is always an overuse with a risk of resistance and increasing costs. Rational drug prescribing is essential for minimizing the health care costs and for reducing the resistance. The implementation of a strict antibiotic policy by all the health care institutes is being made mandatory nowadays. An improving awareness among the prescribers which can be created through educational interventions, can promote the rational use of antibiotics. Hence, we considered it worthwhile to study the knowledge, attitude and the perception of the practitioners towards a rational antibiotic use. Materials and Methods: All the registered practitioners who were working in the hospital setting and were willing to give written informed consents, were enrolled in the study. All the participants who were enrolled in the study during a one month period, had to fill up a predesigned, structured and validated questionnaire which was used to assess the knowledge, attitude and the perception among physicians towards the rational use of antibiotics. Results: About 65% of the participants who provided complete information in the questionnaire, were included in analysis. Among them, more than 50% agreed on the existence of an essential drug list, on the knowledge about new antibiotics and on prescribing antibiotics rationally and on the interpretation of the culture and the sensitivity results. A majority strongly agreed that they ensured that their patients completed the course, that they provided counselling and that they took special interest in the proper use of antibiotics. There was a consensus on the overuse, issues of resistance, and on the input from fellow colleagues. Conclusion: The participants in our study had knowledge about the rational use of antibiotics, an attitude to prescribe drugs as per the essential drug list and a perception that anti-biotics were being overused and that rational drug prescribing had an important role in the antibiotic resistance.


PubMed | Karabük University, McMaster University, Post Graduate Institute of Medical Education and Research, Fundacion Oftalmologica de Santander and 24 more.
Type: Journal Article | Journal: Lancet (London, England) | Year: 2016

WHO has targeted that medicines to prevent recurrent cardiovascular disease be available in 80% of communities and used by 50% of eligible individuals by 2025. We have previously reported that use of these medicines is very low, but now aim to assess how such low use relates to their lack of availability or poor affordability.We analysed information about availability and costs of cardiovascular disease medicines (aspirin, blockers, angiotensin-converting enzyme inhibitors, and statins) in pharmacies gathered from 596 communities in 18 countries participating in the Prospective Urban Rural Epidemiology (PURE) study. Medicines were considered available if present at the pharmacy when surveyed, and affordable if their combined cost was less than 20% of household capacity-to-pay. We compared results from high-income, upper middle-income, lower middle-income, and low-income countries. Data from India were presented separately given its large, generic pharmaceutical industry.Communities were recruited between Jan 1, 2003, and Dec 31, 2013. All four cardiovascular disease medicines were available in 61 (95%) of 64 urban and 27 (90%) of 30 rural communities in high-income countries, 53 (80%) of 66 urban and 43 (73%) of 59 rural communities in upper middle-income countries, 69 (62%) of 111 urban and 42 (37%) of 114 rural communities in lower middle-income countries, eight (25%) of 32 urban and one (3%) of 30 rural communities in low-income countries (excluding India), and 34 (89%) of 38 urban and 42 (81%) of 52 rural communities in India. The four cardiovascular disease medicines were potentially unaffordable for 014% of households in high-income countries (14 of 9934 households), 25% of upper middle-income countries (6299 of 24,776), 33% of lower middle-income countries (13,253 of 40,023), 60% of low-income countries (excluding India; 1976 of 3312), and 59% households in India (9939 of 16,874). In low-income and middle-income countries, patients with previous cardiovascular disease were less likely to use all four medicines if fewer than four were available (odds ratio [OR] 016, 95% CI 004-057). In communities in which all four medicines were available, patients were less likely to use medicines if the household potentially could not afford them (016, 004-055).Secondary prevention medicines are unavailable and unaffordable for a large proportion of communities and households in upper middle-income, lower middle-income, and low-income countries, which have very low use of these medicines. Improvements to the availability and affordability of key medicines is likely to enhance their use and help towards achieving WHOs targets of 50% use of key medicines by 2025.Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, GlaxoSmithKline, Novartis, King Pharma, and national or local organisations in participating countries.


PubMed | Dr Somervell Memorial Csi Medical College
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2013

Antibiotics are prescribed frequently and there is always an overuse with a risk of resistance and increasing costs. Rational drug prescribing is essential for minimizing the health care costs and for reducing the resistance. The implementation of a strict antibiotic policy by all the health care institutes is being made mandatory nowadays. An improving awareness among the prescribers which can be created through educational interventions, can promote the rational use of antibiotics. Hence, we considered it worthwhile to study the knowledge, attitude and the perception of the practitioners towards a rational antibiotic use.All the registered practitioners who were working in the hospital setting and were willing to give written informed consents, were enrolled in the study. All the participants who were enrolled in the study during a one month period, had to fill up a predesigned, structured and validated questionnaire which was used to assess the knowledge, attitude and the perception among physicians towards the rational use of antibiotics.About 65% of the participants who provided complete information in the questionnaire, were included in analysis. Among them, more than 50 % agreed on the existence of an essential drug list, on the knowledge about new antibiotics and on prescribing antibiotics rationally and on the interpretation of the culture and the sensitivity results. A majority strongly agreed that they ensured that their patients completed the course, that they provided counselling and that they took special interest in the proper use of antibiotics. There was a consensus on the overuse, issues of resistance, and on the input from fellow colleagues.The participants in our study had knowledge about the rational use of antibiotics, an attitude to prescribe drugs as per the essential drug list and a perception that antibiotics were being overused and that rational drug prescribing had an important role in the antibiotic resistance.

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