Prevalence of intimate partner violence among pregnant women attending a public sector hospital in Bengaluru, southern India

Background Intimate partner violence (IPV) is recognized as an important public health problem globally as well as in India. It may result in adverse physical and mental health consequences for the victim or unfavourable pregnancy outcomes if it happens during pregnancy. The possible risk factors for IPV can be explained by four levels of ecological factors: individual, partner, household and community. We estimated the prevalence of IPV and its association with selected ecological risk factors among pregnant women availing of antenatal care at a public sector hospital in Bengaluru, southern India. Methods We included 350 women above the age of 18 years with a confirmed pregnancy of less than 24 weeks and having no obstetric complication. We used the Conflict Tactics Scale to determine the presence of IPV. The risk factors measured were—individual level: respondent’s age, education, occupation, gravidity, planned or unplanned pregnancy, substance abuse, presence of depression and anxiety; partner-related: spouse’s education, occupation and marital discord; household/community-related: socioeconomic status, social support, religion and consanguinity. Results The prevalence of IPV was 3.7%. Factors that were significantly associated on multivariate analysis were higher age (above 20 years) (adjusted odds ratio [AOR] 1.82 [1.12–2.97], p=0.016) and presence of depression (AOR 6.84 [1.76–26.61], p=0.005). Conclusion The prevalence of IPV was less in our study population compared to figures reported from other Indian study settings.

Acute critical care course for interns to develop competence

Background All medical graduates must know how to stabilize and manage critically ill patients. A 2-day intensive course, called the acute critical care course (ACCC), was conducted to train interns in technical and non-technical skills for managing a patient whose condition is deteriorating. This analysis aims to assess the feasibility and effectiveness of ACCC for interns. Methods We developed and conducted the ACCC to train interns. It included lectures and skill stations. Twenty-four interns participated in the course. Immediate, post-course, quantitative and qualitative feedback was taken online. Qualitative information was also collected verbally and later by email. These data were analysed both quantitatively and qualitatively. Thematic analysis was used to identify, analyse and report the patterns of responses and behaviour. Results The average score for the utility of the course was 4.7 and for the skill stations it was 4.6 on a scale of 5. The qualitative analysis of the feedback emphasized the need for the course before the clinical posting and more skill-based modules rather than lectures. The interactive style of teaching and training in communication using role-play was appreciated. Few suggestions to improve the course were provided. Conclusions Implementing the ACCC needed simulation, interactive discussions, role-play, modified Pendleton’s feedback, and reflective exercise that form the basis of a range of educational principles. The blended learning set of objectives of ACCC were the pillars for this successful internship training programme.

Correlation between epicardial fat thickness with intima–media thickness and ankle–brachial index in patients with metabolic syndrome

Background An increase in epicardial fat thickness (EFT) has been associated with increased cardiovascular risk and the development of atherosclerosis. Transthoracic echo-cardiography provides a reliable measurement of EFT. We evaluated the relationship of EFT with carotid intima–media thickness (CIMT) and ankle–brachial index (ABI), in patients with metabolic syndrome. Methods We assessed 80 patients with metabolic syndrome who underwent echocardiography; EFT was measured by two cardiologists. The CIMT (B-mode colour imaging of extracranial carotid arteries using high-resolution ultrasound) was also measured by a certified ultrasonographer, and ABI was measured by the main researcher. Results We did not find any correlation between ABI with EFT (r=0.0103, p=0.93) or with CIMT (r=–0.1625, p=0.15). However, we found a significant correlation between EFT and CIMT (r=0.2718, r2=0.074, p=0.015). When we evaluated the risk for a CIMT >0.9 mm in patients with an EFT >3 mm, we found a statistically significant association (p=0.039). Interestingly, only 1 patient with an EFT <3 mm had a CIMT >0.9 mm. Conclusion We found that the EFT correlates with CIMT in patients with metabolic syndrome, which explains, at least in part, the higher risk of atherosclerosis in them. Measurement of EFT should be part of the cardiovascular risk evaluation in patients with metabolic syndrome.

Prediction of stature from long bones versus hand and foot measurements: A comparative study of the Kolhapur population

Background Estimation of stature is usually done by measurement of the long bones. Although hand and foot dimensions are useful in predicting stature, they are population-specific. Methods We compared the accuracy of predicting stature by hand and foot dimensions, with long bone (tibia and ulna) lengths, and developed a stature predictive regression formula from the parameters used for the sample population in Kolhapur. We recorded hand and foot measurements and long bone measurements of 1000 consenting participants 18–50 years of age using a stadiometer for height and an anthropometric rod compass for other measurements. Correlation between the variables and stature was determined using Pearson’s correlation analysis (p<0.05). A multiple linear regression formula was derived for the prediction of stature. Results A positive correlation was observed between mean stature and foot length (r=0.67, p<0.05), tibia (r=0.66, p<0.05), ulna (r= 0.75, p<0.05) and hand length (r=0.69 left, r=0.72 right, p<0.05). There was no correlation between foot breadth and stature. Multiple linear regression analysis of hand and foot dimensions returned R2=62.96 and standard error of estimate 4.689 with comparable computed and experimental measurements. Conclusion The dimensions of the hand and foot can be used to predict stature. The formula derived from the multiple regression analysis incorporating hand and foot dimensions is a good fit to estimate stature in the study population.

Yoga nidra practice shows improvement in sleep in patients with chronic insomnia: A randomized controlled trial

Background Yoga nidra is practised by sages for sleep. The practice is simple to use and has been clearly laid out, but its role in the treatment of chronic insomnia has not been well studied. Methods In this randomized parallel-design study conducted during 2012–16, we enrolled 41 patients with chronic insomnia to receive conventional intervention of cognitive behavioural therapy for insomnia (n=20) or yoga nidra (n=21). Outcome measures were both subjective using a sleep diary and objective using polysomnography (PSG). Salivary cortisol levels were also measured. PSG was done before the intervention in all patients and repeated only in those who volunteered for the same. Results Both interventions showed an improvement in subjective total sleep time (TST), sleep efficiency, wake after sleep onset, reduction in total wake duration and enhancement in subjective sleep quality. Objectively, both the interventions improved TST and total wake duration and increased N1% of TST. Yoga nidra showed marked improvement in N2% and N3% in TST. Salivary cortisol reduced statistically significantly after yoga nidra (p=0.041). Conclusion Improvement of N3 sleep, total wake duration and subjective sleep quality occurred following yoga nidra practice. Yoga nidra practice can be used for treatment of chronic insomnia after supervised practice sessions.

Respectful maternity care in the achievement of universal health coverage

The attainment of universal health coverage (UHC) is incomplete without achieving respectful maternity care (RMC). While planning for UHC, the need and importance of RMC should be considered. In India, the government has started a health scheme on UHC, namely the Ayushman Bharat Scheme. RMC being an important component of UHC, if not achieved, will result in failure to achieve UHC in the true sense.