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Subramanian T.,National Institute of Epidemiology
Indian journal of medical ethics | Year: 2013

The growing public concern about the ethical conduct of healthcare professionals highlights the need to incorporate clinical ethics in medical education. This study examined the knowledge and practice of clinical ethics among healthcare providers in a government hospital in Chennai. A sample of 51 treating physicians and 58 other non-physician service providers from the hospital answered a self-administered, semi-structured questionnaire on their knowledge of and adherence to ethical principles, and the problems they faced related to healthcare ethics. More than 30% did not give a definition of healthcare ethics, and 40% did not name a single ethical principle. 51% stated that they witnessed ethical problems in their settings and named patient dissatisfaction, gender bias by provider, and not maintaining confidentiality. The responses of healthcare providers to various ethical scenarios are reported. Source


Vajo Z.,Debrecen University | Tamas F.,National Institute of Epidemiology | Jankovicsc I.,State Primary Care Center
Clinical and Vaccine Immunology | Year: 2012

With the recent pandemic of influenza A (H1N1) and vaccine shortages, there has been considerable interest in developing influenza vaccines with reduced doses, allowing for increased production capacity. Here we report a prospective, randomized, double-blind, single-center clinical trial of a reduced-dose whole-virion inactivated, adjuvanted influenza vaccine in adult and elderly volunteers. A total of 234 subjects, including 120 adults (18 to 60 years of age) and 114 elderly subjects (>60 years of age) were enrolled to receive either 6 μg or the conventional 15-μg dose of seasonal trivalent influenza vaccines. The subjects were followed for safety analysis, and serum samples were obtained to assess immunogenicity by hemagglutination inhibition testing. The subjects developed antibody responses against the seasonal influenza A virus H1N1 and H3N2 strains, as well as the seasonal influenza B virus included in the vaccines. Single doses of 6 μg fulfilled licensing criteria for seasonal influenza vaccines. No significant differences in rates of seroconversion or seroprotection or in geometric mean titers were found between the two dosage levels. All adverse events were rare, mild, and transient. We found that the present reduced-dose vaccine is safe and immunogenic in healthy adult and elderly subjects and triggers immune responses that comply with licensing criteria. Copyright © 2012, American Society for Microbiology. All Rights Reserved. Source


Mane A.,National Dairy Research Institute | Nirmalkar A.,National Dairy Research Institute | Risbud A.R.,National Dairy Research Institute | Vermund S.H.,Vanderbilt University | And 2 more authors.
PLoS ONE | Year: 2012

Background: The distribution of HPV genotypes, their association with rigorously confirmed cervical precancer endpoints, and factors associated with HPV infection have not been previously documented among HIV-infected women in India. We conducted an observational study to expand this evidence base in this population at high risk of cervical cancer. Methods: HIV-infected women (N = 278) in Pune, India underwent HPV genotyping by Linear Array assay. Cervical intraepithelial neoplasia (CIN) disease ascertainment was maximized by detailed assessment using cytology, colposcopy, and histopathology and a composite endpoint. Results: CIN2+ was detected in 11.2% while CIN3 was present in 4.7% participants. HPV genotypes were present in 52.5% (146/278) and 'carcinogenic' HPV genotypes were present in 35.3% (98/278) HIV-infected women. 'Possibly carcinogenic' and 'non/unknown carcinogenic' HPV genotypes were present in 14.7% and 29.5% participants respectively. Multiple (≥2) HPV genotypes were present in half (50.7%) of women with HPV, while multiple 'carcinogenic' HPV genotypes were present in just over a quarter (27.8%) of women with 'carcinogenic' HPV. HPV16 was the commonest genotype, present in 12% overall, as well as in 47% and 50% in CIN2+ and CIN3 lesions with a single carcinogenic HPV infection, respectively. The carcinogenic HPV genotypes in declining order of prevalence overall included HPV 16, 56, 18, 39, 35, 51, 31, 59, 33, 58, 68, 45 and 52. Factors independently associated with 'carcinogenic' HPV type detection were reporting ≥2 lifetime sexual partners and having lower CD4+ count. HPV16 detection was associated with lower CD4+ cell counts and currently receiving combination antiretroviral therapy. Conclusion: HPV16 was the most common HPV genotype, although a wide diversity and high multiplicity of HPV genotypes was observed. Type-specific attribution of carcinogenic HPV genotypes in CIN3 lesions in HIV-infected women, and etiologic significance of concurrently present non/unknown carcinogenic HPV genotypes await larger studies. © 2012 Mane et al. Source


To predict dwellings for the presence of Aedes larvae rapidly based on Premises Condition Index (PCI) factors, we studied the possible presence of Aedes species mosquitoes larvae among houses in the Chidambaram urban of Cuddalore District in Tamil Nadu, India based on the scores of variables in PCI, namely House, Yard and degree of shadow. Data of these variables were collected in September and October 2006 from 1813 houses in the Chidambaram urban area during the intensive vector control activities employed for the prevention and control of Chikungunya. Methods: The association between presence of larvae and the variables of PCI was tested by Chi-square and Correlation. The predictability of the presence of Aedes larvae based on PCI factors was computed by logistic regression. Results: The study shows 301 containers in 132 houses were found positive with Aedes species out of 1813 houses surveyed. It was further observed that the probability of presence of positive premises was four times higher in the premises with 75% shadow compared with premises with a 25% shadow. These findings showed a significant association (p < 0.001) with positive premises. Conclusions: It is concluded that this study helps in conducting rapid survey to identify the presence of Aedes larvae with a minimum number of staff for both inspection and treatment of Aedes larvae during the epidemic situation. © 2012. Source


Thakur R.,Government of Himachal Pradesh | Murhekar M.,National Institute of Epidemiology
Indian Journal of Tuberculosis | Year: 2013

Background: Delay in TB diagnosis and treatment is associated with increased transmission, morbidity and mortality. Patient and provider factors are responsible for such delays. We conducted a study to estimate these delays and identify associated factors among new sputum positive (NSP) TB patients in Mandi district, Himachal Pradesh. Methods: We interviewed 234 NSP patients to collect information on their health seeking behaviour. We conducted univariate and multivariate analysis to identify factors associated with longer delays. Results: Median patient, health system and total delay were 15, 13 and 36 days respectively. Significant factors associated with total delay included patients' knowledge about TB, seeking care from non-specialized individuals as the first action, consulting >2 health facilities before diagnosis and consulting private health facilities. Patients with low family income and those who had high expenditure on consultations before initial diagnosis were associated with patient and health system delay respectively. Conclusion: It is necessary to increase community awareness about TB symptoms and availability of free treatment at public health facilities. Educating private physicians about the need for maintaining a high index of suspicion of tuberculosis and sensitizing drug-store owners to refer the chest symptomatics to government health facilities would also help in reducing these delays. © The Tuberculosis Association of india, Inc. All rights reserved. Source

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