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   Table of Contents - Current issue
Coverpage
October-December 2018
Volume 3 | Issue 4
Page Nos. 111-144

Online since Friday, December 28, 2018

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EDITORIAL  

Noncommunicable diseases surveillance in India: Moving toward a more comprehensive approach p. 111
Jai Prakash Narain, KR Thankappan
DOI:10.4103/jncd.jncd_44_18  
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ORIGINAL ARTICLES Top

Diabetic care delivery with package of essential noncommunicable diseases interventions protocol in rural Nepal: A district hospital-based study p. 115
Pawan Agrawal, Priyanka Gupta, Bikash Gauchan, Biplav Shrestha
DOI:10.4103/jncd.jncd_42_18  
Background: Diabetes ranks fourth among the noncommunicable diseases (NCDs) in terms of proportional mortality in Nepal and is increasingly diagnosed in rural population. We aimed to evaluate the care delivery in diabetes patients in a rural primary care hospital that had implemented the World Health Organization's Package of essential NCDs interventions (PEN) protocol. Subjects and Methods: This was a descriptive study in a rural district hospital. The study was conducted over 5 months and was undertaken as a part of the quality improvement project in the hospital. Data were extracted from the electronic medical record of the hospital after approval from hospital administration. Results: The total diabetic patient visits during the study period were 682 of 30,758 total outpatient visits (2%). There were 240 unique diabetic patients. The age ranged from 25 to 82 years with the median age of 52. Glycated hemoglobin was done in 15 of 59 new cases and in 33 of 181 follow-up cases. Urine protein was assessed in 65 of 240 patients. Comorbidities and complications were documented in 96 of 240 patients (40%), hypertension being the most common. Fifty-six patients (23%) had obtained control as per the target levels with different modalities of treatment, 69 (29%) had partial control, 85 (35%) struggled to reach targets, and 30 (13%) failed to appear in follow-up visits. Conclusion: The study described our adherence to the PEN protocol and identified several areas of improvement in our diabetes care delivery such as continuous medical education activities and monitoring of care delivery with similar study in future after implementation of proposed interventions.
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Health professionals' perspectives on factors needed to implement nutrition strategy: A questionnaire validation study p. 120
Reem Saleh Al Gurg, Mohammed Alameddine, Amar Hassan Khamis
DOI:10.4103/jncd.jncd_36_18  
Background: Noncommunicable diseases (NCDs) increasingly recognized as a serious, worldwide public health concern. According to the WHO, NCDs are currently responsible for two-thirds of global deaths annually. Nutritional food and unhealthy diet are contributing to an immense portion of NCDs. Exploring the role of nutrition in healthcare delivery with a particular focus on the United Arab Emirates (UAE) context is also aligned with the UAE Government's Vision 2021. Aim: To develop a reliable and valid questionnaire that helps to assess the agreement about factors needed to implement a nutrition strategy in the UAE. Materials and Methods: One hundred and sixty-one health professionals were invited to respond to a questionnaire assessing agreement with factors needed to implement a nutrition strategy. The questionnaire consisted of 11 factors, each containing four items that made a total of 44 items assessed on a 7-point Likert scale (1 strongly disagree to 7 strongly agree). The questionnaire was evaluated using factor analysis, and Cronbach's alpha was used to test the internal consistency of the responses of participants. Ethical approval was given by the Chair of Humanities and Health Sciences Research Ethics Panel (UAE). Results: The questionnaire was validated by an expert panel. A factor analysis was carried out through responses of the health professional and revealed that the 11 factors are included in the questionnaire; only one item from the factor of resources and enablement was excluded: the exclusion of the item “hospital uses the lifespan approach in nutrition interventions” due to singularity and insufficient load of the variance extracted. Conclusion: The study concluded that the questionnaire was valid and reliable on its form of 43 items divided into 11 factors to assess the agreement toward factors needed to implement a nutrition strategy in the UAE.
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Effectiveness of “percutaneous coronary intervention care program” on selected variables among patients undergoing percutaneous coronary intervention p. 126
Poonam Sharma, Sandhya Ghai, Manoj Kumar Rohit, Monika Dutta
DOI:10.4103/jncd.jncd_33_18  
Objective: The study was conducted to assess the effectiveness of “percutaneous coronary intervention (PCI) care program” among patients undergoing PCI. Subjects and Methods: A quasi-experimental design was adopted, and purposive sampling technique was used to enroll the patients in the experimental and control groups. Different tools were used to collect the data, which include numerical pain and comfort rating scale, Barthel Index for activities of daily living, assessment for the presence of vascular complications, modified CADEQ-SV questionnaire, State-Trait Anxiety Inventory scale, self-structured satisfaction scale, and PCI manual. Results: There was a significant decrease observed in state anxiety (P < 0.001), pain level at 12 h (P = 0.03), discomfort within 12 h (P < 0.001) and 24 h (P = 0.002), improving knowledge regarding coronary artery disease (CAD) (P < 0.001), and activities of daily living as well as significant increase in satisfaction level (P < 0.001) among patients undergoing PCI in the experimental group than the control group. Conclusion: The study concluded that this program was effective in reducing anxiety, pain, and discomfort and increased satisfaction level, knowledge regarding CAD, and independence in self-care activities for PCI patients.
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Segmentation of jet area to quantity the severity of mitral regurgitation by color Doppler echocardiography p. 134
N Chidambaram, GN Balaji, TS Subashini
DOI:10.4103/jncd.jncd_50_18  
Mitral regurgitation (MR) is a disorder of mitral valve and it is one of the most common causes of cardiovascular morbidity and mortality. Mitral valve allows blood to flow from left atrium, to the left ventricle and Mitral Valve regurgitation results in poor apposition of the valvular leaflets, so that the heart's mitral valve doesn't close tightly, allowing blood to flow backward into the left atrium. Transthoracic Echocardiography (TTE) with Doppler is the widely used non-invasive technology for the detection and evaluation of severity of valvular regurgitation. Proximal isovelocity surface area (PISA) method has been widely accepted by clinicians as a means for grading MR severity. In this paper an alternate method to PISA to automatically quantify mitral valve regurgitation severity is proposed. This work attempts to automatically segment the jet region in color Doppler images using K-Means clustering. Further to quantify mitral regurgitation, jet area parameters and shape features are extracted from the segmented jet region which are then modeled using classifiers such as Support Vector machine (SVM) and Back Propagation Neural Network (BPNN). Quantifying MR with PISA calls for considerable expertise as a number of components must be taken into account to fully assess the severity of mitral regurgitation, however the results of the proposed method indicate that it could be used as an alternate method to automatically assess the severity of mitral regurgitation.
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PERSPECTIVE Top

Decoding increasing prevalence of noncommunicable diseases p. 139
Alok K S Thakur
DOI:10.4103/jncd.jncd_46_18  
Background: In recent times, noncommunicable diseases (NCDs) have attained epidemic status in India and several other countries. Globally, each year, NCDs cause premature deaths of nearly 40 million people younger than 60 years accounting for 70% of all deaths; 80% of these premature deaths are reportedly in the low- and middle-income countries. Many studies have reported increasing prevalence of NCDs such as type 2 diabetes, coronary and pulmonary diseases, and cancer. Incidentally, all these studies besides discussing environmental pollution have grossly ignored dietary profiling of affected populace despite the fact that several studies have established a direct correlation between food quality and good health. Objective: Besides pollutants, an attempt is made to analyze mathematically effects of dietary changes over the last four decades on constantly increasing prevalence of NCDs at cellular level. A relationship seems to exist between increasing prevalence of NCD and large-scale consumption of synthetic salt. Conclusions: Elimination of essential trace elements and micro- and macro-minerals in regular diet through synthetic salt fortified with iodine alone appears to cause more harm than benefits associated with iodization of salt than pollutants. Regular intake of essential trace elements is necessary for normal functioning of many fundamental functions of the body such as Na-K pump, electron–proton transport, biochemistry, and thermodynamics. An attempt has been made to study effects of salt constituents used in food at the most fundamental cellular level by means of disturbances in body electrolyte through heat and ion transport mechanism that is fundamental to various underlying processes in human body. Interestingly, almost all the families who switched over to unprocessed rock salt from synthetic iodized salt reported improvement in general health and reported reduction in medical visits.
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