Giridhara R Babu

ABSTRACT The number of diabetic people in India is increasing. A vast gap of health service need and provision exists. However, the proposed agenda of promotion and recognition of diabetes educators may translate into diabetes effective management at individual level to the maximum possibility. Managing diabetes is a unique and ongoing process. As such, self-management of the disease is crucial. Diabetes patients should receive support to help them to manage diabetic condition as effectively as possible. This study proposes conceptual approach to diabetes self-management education. This framework further articulates the short term and long term outcomes. DSME promotion through educational intervention in a sustained manner has long-term benefits. DSME in an Indian context as optimally trained, effective, efficient, viable health human resource allocation across different levels is not a feasible solution in a low resource setting. This study proposes that a need exists for further research in an Indian context about the scientific credibility of DSME, financial feasibility, cultural acceptability and operation stability of the policy initiative.

The available estimates of incidence and prevalence of syphilis among men who have sex with men (MSM) in the Mainland China are high. We used respondent driven sampling to recruit MSM in the study population. The participants were followed up to monitor the incidence and change of risk behaviors. A face-to-face interview was used to collect information about high-risk behaviors, demographics and recreational drug use. To test the difference between prevalent and incident cases, two nested matched case control studies were carried out. The cases were the HIV or syphilis positives found at baseline and during follow-up. We used density sampling to sample six controls for each case. Our results indicate that compared to incident cases, prevalent cases had higher proportion of reported unprotected anal intercourse for both HIV and syphilis. Regression analysis indicated that unprotected anal intercourse was the main risk factor among HIV-prevalent cases but not in HIV-incident cases. Th...

Antiretroviral drugs are being tried as candidates for the pre-exposure prophylaxis (PrEP) against HIV for a considerable period, due to their potential for immediate inhibition of viral replication. Discrepancies in the findings called for a critical review of the relevant efforts and their outcomes. A systematic literature search identified 143 eligible articles of which only 5 reported complete findings while another 11 were still on-going. Observed moderate efficacy and good safety profile seemed to identify PrEP as a promising step for minimizing the spread of HIV to relatively unaffected population and controlling the epidemic among high risk population groups. But the duration of this efficacy was found to depend heavily on the availability, adherence and other related issues like cost, political commitment, ethical consideration etc. To prevent potential cultural and behavioral modifications, proper pre-administration counseling also seemed critical for the success of PrEP a...

BackgroundChina experiencing an increasing HIV epidemic among men who have sex with men (MSM), and unprotected anal intercourse (UAI) has played a key role in this process. The aims of this study were to examine the trend of UAI and to explore the factors correlated with UAI among MSM in Guangzhou, China.MethodsData from 2008 to 2013 were retrieved from the annual serological and behavioral surveys system. We collected information on demographic, HIV related sexual behavior with men and women, access to HIV prevention services, and symptoms of sexually transmitted infections. Chi-square test was used to examine the similarity of the participants during the study period. Univariate and multivariate logistic regression were conducted to test the factors associated with UAI. Trend test was used to check the change of UAI in different characteristic stratums during the study period.ResultsIn total, 58.4% (range from 54.5% to 62.0%) of the participants reported that they engaged in UAI i...

We conducted descriptive analysis of available information regarding the epidemiology of cholera outbreaks in South and Southeast Asia during 2003-2012. Information from 58 articles, 8 reports, and World Health Organization databases were analyzed. Overall, 113 cholera outbreaks were studied in South and Southeast Asia during the past 10 years. The majority of the outbreaks (69%) occurred in Southeast Asia, including India (52%). The highest number of outbreaks was observed in 2004 (25.7%). The most commonly identified source was contaminated water: however, in some countries, the spread of cholera was facilitated via contaminated seafood (e.g., Myanmar, Thailand, and Singapore). Several genotypes and phenotypes of Vibrio cholerae, the causative agent of cholera, were identified in the outbreaks, including V. cholerae O1 El Tor (Ogawa and Inaba) and V. cholerae O139. The emergence of multidrug-resistant V. cholerae strains was a major concern. Cholera-related mortality was found to ...

There is a paucity of information on the availability of services for diagnosis and management of diabetic retinopathy (DR) in India. The study was undertaken to document existing healthcare infrastructure and practice patterns for managing DR. This cross-sectional study was conducted in 11 cities and included public and private eye care providers. Both multispecialty and stand-alone eye care facilities were included. Information was collected on the processes used in all steps of the program, from how diabetics were identified for screening through to policies about follow-up after treatment by administering a semistructured questionnaire and by using observational checklists. A total of 86 eye units were included (31.4% multispecialty hospitals; 68.6% stand-alone clinics). The availability of a dedicated retina unit was reported by 68.6% (59) facilities. The mean number of outpatient consultations per year was 45,909 per responding facility, with nearly half being new registrations. A mean of 631 persons with sight-threatening-DR (ST-DR) were registered per year per facility. The commonest treatment for ST-DR was laser photocoagulation. Only 58% of the facilities reported having a full-time retina specialist on their rolls. More than half the eye care facilities (47; 54.6%) reported that their ophthalmologists would like further training in retina. Half (51.6%) of the facilities stated that they needed laser or surgical equipment. About 46.5% of the hospitals had a system to track patients needing treatment or for follow-up. The study highlighted existing gaps in service provision at eye care facilities in India.

Background: India has the second largest population of persons with diabetes and a significant proportion has poor glycemic control and inadequate awareness of management of diabetes.

Objectives: Determine the level of awareness regarding management of diabetes and its complications and diabetic care practices in India.

Methods: The cross‑sectional, hospital‑based survey was conducted in 11 cities where public and private providers of diabetic care were identified. At each diabetic care facility, 4–6 persons with diabetes were administered a
structured questionnaire in the local language.

Results: Two hundred and eighty‑five persons with diabetes were interviewed. The mean duration since diagnosis of diabetes was 8.1 years (standard deviation ± 7.3). Half of the participants reported a family history of diabetes and 41.7% were hypertensive. Almost 62.1% stated that they received information on diabetes and its management through interpersonal channels. Family history (36.1%), increasing age (25.3%), and stress (22.8%) were the commonest causes of diabetes reported. Only 29.1% stated that they monitored their blood sugar levels at home using a glucometer. The commonest challenges reported in managing diabetes were dietary modifications (67.4%), compliance with medicines (20.5%), and cost of medicines (17.9%). Around 76.5% were aware of
complications of diabetes. Kidney failure (79.8%), blindness/vision loss (79.3%), and heart attack (56.4%) were the commonest complications mentioned. Almost 67.7% of the respondents stated that they had had an eye examination earlier.

Conclusions: The findings have significant
implications for the organization of diabetes services in India for early detection and management of complications, including eye complications.

Screening and timely treatment of gestational hyperglycaemia (GH) is proved to be beneficial and improves maternal and foetal health outcomes. To understand screening practices, we explored the knowledge and perceptions of doctors working in public health facilities in Bangalore, India. We also studied participation factors by examining whether undergoing glucose estimation tests affects morning sickness in pregnant women. We aimed to understand the screening practices and knowledge of doctors. A semi-structured questionnaire was self-administered by the 50 participant doctors, selected from the sampling frame comprising of all the doctors working in public health facilities. We included 105 pregnant women for baseline assessment, in whom a well-structured questionnaire was used. We reported that gestational diabetes mellitus (GDM) screening was done in nearly all the health centres (96%). However, only 12% of the doctors could provide all components of GDM diagnosis and management correctly and 46% would diagnose by using a random blood glucose test. A majority (92%) of the doctors had poor knowledge (68%) about the cut-off values of glucose tests. More than 80% of pregnant women experienced some discomfort mostly due to rapid ingestion glucose in short span of time. Our study established that screening for GH is done in most public health facilities. Nonetheless, knowledge of doctors on the glucose tests and their interpretation needs improvement. Re-orientation trainings of the doctors can improve their knowledge and thereby can efficiently screen for GH. Further, adequate planning prior to the tests can aid successful completion of them. Significance for public healthRising burden of hyperglycaemia in pregnancy is a cause for concern and is associated with short and long term deleterious consequences for mother and offspring. Hence, there is an urgent need to explore the screening practices for gestational hyperglycaemia (GH). The current study considers patient and doctors' perspectives regarding GH screening. The results from our study indicate several issues during screening of gestational hyperglycaemia in public health facilities in Bangalore, India. These included low awareness levels among doctors, lack of standard operating procedures and lack of adequate care and attention provided to pregnant women. Re-orientation trainings of the doctors within public health facilities can improve their knowledge and thereby can efficiently screen for GH. Further, adequate planning and preparation of the patient prior to the tests can help ensure successful completion of the tests. The findings of the study are comparable with the practices of public health hospitals in India.

Background.
Screening and timely treatment of gestational hyperglycaemia
(GH) is proved to be beneficial and improves maternal and
foetal health outcomes. To understand screening practices, we
explored the knowledge and perceptions of doctors working in public health facilities in Bangalore, India. We also studied participation factors by examining whether undergoing glucose estimation tests affects morning sickness in pregnant women.

Design and Methods.
We aimed to understand the screening practices and knowledge of doctors. A semi-structured questionnaire was self-administered by the 50 participant doctors, selected from the sampling
frame comprising of all the doctors working in public health facilities. We included 105 pregnant women for baseline assessment, in whom a well-structured questionnaire was used.

Results.
We reported that gestational diabetes mellitus (GDM)
screening was done in nearly all the health centres (96%). However, only 12% of the doctors could provide all components of GDM diagnosis and management correctly and 46% would diagnose by using a random blood glucose test. A majority (92%) of the doctors had poor knowledge (68%) about the cut-off values of glucose tests. More than 80% of pregnant women experienced some discomfort mostly due to rapid ingestion glucose in short span of time.

Conclusions.
Our study established that screening for GH is done in
most public health facilities. Nonetheless, knowledge of doctors on the glucose tests and their interpretation needs improvement. Re-orientation trainings of the doctors can improve their knowledge and thereby can efficiently screen for GH. Further, adequate planning prior to the tests can aid successful completion of them.

Background

In China, the HIV/AIDS epidemic is expanding among men who have sex with men (MSM).
As independent risk factors of HIV infection, the epidemics of Chlamydia (CT) and Gonorrhea
(NG) in MSM were not well studied, particular for the risk factors of these infectious.
The objectives of current reported study were to understand the dynamics of HIV and other
sexual transmitted infections (STIs) among MSM in Jiangsu, China, and to measure factors
that correlated with STIs.

Methods

In order to gain more participants, a multisite cross-sectional study design was used in our
study, by using convenience-sampling to recruit MSM in two Changzhou and Yangzhou,
Jiangsu, China, between the July and October of 2009.

Results

In this comprehensive survey involving MSM in two cities of Jiangsu province of China, the
prevalence of STIs of CT (6.54%), NG (3.63%), syphilis (20.34%) and HIV (11.62%) were
measured. Overall, the STIs prevalence (CT, NG or syphilis) for the participants in our study
was 26.39%, meanwhile, 3.4% (14 out of the 413) participants had at least two kinds of
STIs. Meeting casual partners at parks, public restrooms or other public areas, having had
anal sex with men in the past six months, having had STI symptoms in the past year were
positively correlated with STIs positive, with adjusted ORs of 4.61(95%CI 1.03–20.75), 1.91
(95%CI 1.14–3.21) and 2.36(95%CI 1.07,5.24).

Conclusion
Our study findings reiterate the fact that Chinese MSM are highly susceptible to acquiring
syphilis, CT, NG and HIV, and there is an urgent need for intervention targeted towards this
population. Behavioral measures should constitute an important part of the targeted intervention.
Furthermore, the already implemented preventive and diagnostic services for HIV
should be expanded to include syphilis CT and NG, too.

There is limited research on occupational stress and its relation to health from
developing countries such as India. This study was done to evaluate work
conditions of professionals in two highly productive sectors: the information
technology (IT) sector, also known as software development, and Information
Technology Enabled Services (ITES), also known as call centers. The study
employed thirty-two in-depth interviews. The results indicate the presence of
nine stress domains: job control, autonomy, time pressure, length of
experience in industry, night shifts, income, appreciation of work, physical
environment, work-environment and affective or emotional factors. Global
drivers of demand, and local supply of a skilled workforce and the work force
regulatory environment in India determine the work culture in Indian IT
companies. Apart from affecting health of the professionals, these
determinants influence workforce policies, priorities, goals and management
practices. Keywords: Work Culture, Job Stress, Information Technology (IT),
Information Technology Enabled Services (ITES), Qualitative Research