Department of Community Medicine Cohort · ordinated by Dr Chethan TK & Dr Srividya B. 2. Quiz...

Sri Adichunchanagiri Shikshana Trust [R]

Adichunchanagiri Institute of Medical Sciences

Department of Community Medicine

Chief Patron:

Paramapoojya Sri Sri Sri

Nirmalanandanatha

Mahaswamiji

Chief Advisor

Dr Shivaramu M.G

Principal A.I.M.S

Editor in Chief

Dr Basavaraj Ingalgeri

Professor and Head

Dept. of Community Medicine

Editor

Dr Shashikiran M

Dr Radha R

Associate Professor(s)

Dept. of Community Medicine

Assistant Editors

Dr Shashikanth S K

Dr Sheethal M P

Dr Shashank K J

Dr Gagan S

Dr Chethan T K

Dr Raghavendra S K

Dr Ranjini N

Mrs Veena N H

Dr Chandrasekar C J

Dr Srividya J

Mr. Prakash S N

Mr. Yateesh B R

Cohort Biannual Departmental Newsletter

Contents:

1. Editorial ()

2. World AIDS day 2016 - Report

(Page 3)

3. World Health Day History

(Page 5)

4. RNTCP 2016 Update (Page 10) 5. Exercise and Physical activity

(Page 27)

AIMS/Dept.of CM/Newsletter/2016/Jul-Dec

1

EDITORIAL

A feel honoured and privileged in addressing you. With immense

pleasure I am handing over volume 6 issued to of the Dept of Community

Medicine to you all.

With a wholehearted cooperation and support, it is my humble

endeavour to strengthen community medicine at all levels. In my opinion, we

should work as an academic body to update the faculty members’ knowledge

and being community medicine people, to full fill social responsibilities.

We would like to thank the management, the Principal colleagues and

our Post Graduate and Under Graduate students for their constant support and

feedback in the activities. And endeavours planned and executed by the

department. We are the pleased to inform that UG and PG students who took

up the final exam by the University in the month of June 2016 have passed with

flying colors.

Dr. Shashank Asst. Professor joined the Govt. Medical College,

Chamarajanagara in the month of November 2016. Dr. Ranjini N Asst.

Professor and Dr. Pruthvi tutor joined the department in the month of

December 2016.

Department has organized on the occasion of World AIDS Day – 2016.

Essay competition, Quiz, Poster presentation in the college for Under

Graduates. The department also organized Jatha by UG, PG and Inters at Bellur

town on the occasion of World AIDS Day – 2016.

This issue of the “Cohort”, our biannual newsletter starts of with a brief

report on world AIDS day celebration and goes on to indroduce you, the reader

trough the timeline of world Health Day and the challenges identified for

addressing since inception. The RNTCP update of 2016 is expected to bring you


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up to date on the recent activities of RNTCP and culminating with the

presentations done from our department between Jul-Dec 2016 and a note on

Exercise and Physical activity.

The previous edition was well received and appreciated. We welcome

feedback, both positive and also negative, if any to improve the quality of our

future newsletters. We hope you enjoy reading this newsletter as much we

enjoyed preparing it

Dr Basavaraj M Ingalgeri

Professor and Head



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WORLD AIDS DAY 2016 -

REPORT

As a part of World AIDS day 2016, the following events were organized

at the Department of Community Medicine, AIMS for a period of 5 days

between 3rd & 7th Dec 2106.

1. Essay competition – on 3rd December, for I year MBBS students., a total

of 95 students appeared for the event, the topic was Stigma & HIV/AIDS &

Hands up for AIDS control (WHO theme for the year). The event was co-

ordinated by Dr Chethan TK & Dr Srividya B.

2. Quiz competition – for II year MBBS students. The event was held in two

stages, a preliminary written round attended by 130 students individually (on

5th Dec) & a final round of 5 teams of three students each on 7th December.

The event was co-ordinated by Dr Gagan S, Dr Shashikanth SK, Dr

Raghavendra SK & Dr Chandrasekar CJ. Dr Shashikanth SK was the quiz

master.

3. Poster competition – for III year MBBS students, in all 24 posters were

prepared & presented by students of IV term & VI term, the posters were

judged by a panel of 4 faculty members including Professors from

Microbiology and Obstetrics & Gynecology. The event was co-ordinated by Dr

Shashikanth SK & Mr.Yateesh BR.

Winners were announced and will be distributed on talents day for all the

events.

A rally was also organized on 19th Dec by Bellur Community Health

Centre at Bellur town in which our students, Interns & staff (around 100 in

number) participated with placards about HIV/AIDS prevention.


4

Dr Shashikantha S K,

Assistant Professor



5

World Health Day

The World Health Day is a global health awareness day celebrated every

year on 7 April, under the sponsorship of the World Health Organization

(WHO).

In 1948, the WHO held the First World Health Assembly. The Assembly

decided to celebrate 7 April of each year, with effect from 1950, as the World

Health Day. The World Health Day is held to mark WHO's founding, and is

seen as an opportunity by the organization to draw worldwide attention to a

subject of major importance to global health each year.

The WHO organizes international, regional and local events on the Day

related to a particular theme. World Health Day is acknowledged by various

governments and non-governmental organizations with interests in public

health issues, who also organize activities and highlight their support in media

reports, such as the Global Health Council.

World Health Day is one of eight official global health campaigns

marked by WHO, along with World Tuberculosis Day, World Immunization

Week, World Malaria Day, World No Tobacco Day, World AIDS Day, World

Blood Donor Day, and World Hepatitis Day.

A particular theme is chosen to run the celebration and take care of the

health for whole year. Global Polio Eradication was also one of the special

themes of the year 1995 of world health day. From then, most of the countries

have become free of this fatal disease whereas in other parts of the world its

awareness level has increased.

World Health Day targets all the health issues on global basis for which

the WHO organizes several programs yearly and other related health

organizations at various places like schools, colleges and other crowd places. It


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is celebrated to remember the establishment of the World health Organization

as well as draw the attention of people towards the major health issues in the

world.

WHO is a vast health organization working under UN for addressing

the health issues on a global basis. Since its establishment, it has addressed

serious health issues including chickenpox, polio, smallpox, TB, leprosy and etc

from various developing countries. It has played a significant role aiming to

make the world a healthy world. It has all the statistics about global health

reports.

How World Health Day is Celebrated

World Health Day is celebrated worldwide by the government, non-

government, NGOs including various health organizations at many places by

organizing programmes relating to the public health issues and awareness.

Participated organizations highlight their activities and supports through the

media reports by means of press releases, news and etc.

Health authorities from different country take part in the celebration

with their pledges in order to support on the health issues worldwide.

Varieties of activities are done in the conference of health workers to encourage

people to maintain their health in the presence of media coverage. Debates on

the related topics, art exhibitions, essay writing, competitions and award

ceremony are organized to fulfill the aim of world health day.

Why World Health Day is Celebrated

World Health Day celebration focuses on increasing the life expectancy

by adding good health to the lives of people and promoting healthier living

habits. Youths of the new era are also targeted by this event to prevent and

make them healthy to make the world healthy and free from AIDS and HIV.


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Disease spreading vectors like mosquitoes (malaria, dengue fever, filaria,

chikungunya, yellow fever and etc), ticks, bugs, sand flies, snails and etc are

also spotlighted by the WHO to make the world free from a wide range of

diseases caused by parasites and pathogens. It provides better prevention and

cure from the vector-borne diseases spread by vectors and travelers from one

country to other. WHO supports various health authorities on global basis to

make their own efforts for the public health problems to enhance better life

without any diseases.

World Health Day Themes

1950. “Know your Health Services”.

1951. “Health for your Child and World’s Children”.

1952. “Healthy surroundings make Healthy people”.

1953. “Health is Wealth”.

1954. “The Nurse: Pioneer of Health”.

1955. “Clean water means better Health”.

1956. “Destroy disease carrying Insects”.

1957. “Food for All”.

1958. “Ten years of Health progress”.

1959. “Mental illness and Mental Health in the World of today”.

1960. “Malaria eradication – A world challenge”.

1961. “Accidents and their prevention”.

1962. “Preserve sight- prevent Blindness”.

1963. “Hunger= Disease of millions”.

1964. “No Truce for Tuberculosis”.

1965. “Smallpox – constant alert”.

1966. “Man and his Cities”.

1967. “Partners in Health”.

1968. “Health in the World of Tomorrow”.


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1969. “Health, Labor and Productivity”.

1970. “Early detection of Cancer saves Life”.

1971. “A full life despite Diabetes”.

1972. “Your Heart is your Health”.

1973. “Health begins at Home”.

1974. “Better food for a healthier World”.

1975. “Smallpox: Point of no return”.

1976. “Foresight Prevents Blindness”.

1977. “Immunize and protects your Child”.

1978. “Down with High Blood pressure”.

1979. “A healthy Child: A sure future”.

1980. “Smoking or Health: Choice is yours”.

1981. “Health for all by year 2000 AD”.

1982. “Add life to years”.

1983. “Health for all by year 2000 AD: Countdown has begun”.

1984. “Children’s Health: Tomorrow’s Wealth”.

1985. “Healthy Youth- Our best Resource”.

1986. “Healthy living: Everyone a winner”.

1987. “Immunization: A chance for every Child”.

1988. “Health for All: All for Health”.

1989. “Let’s talk Health”.

1990. “Our Planet our Earth: Think Globally Act Locally”.

1991. “Should Disaster Strike, be prepared”.

1992. “Heart beat: A rhythm of Health”.

1993. “Handle life with care: Prevent violence and Negligence”.

1994. “Oral Health for a Healthy Life”.

1995. “Global Polio Eradication”.

1996. “Healthy Cities for better life”.


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1997. “Emerging infectious diseases”.

1998. “Safe motherhood”.

1999. “Active aging makes the difference”.

2000. “Safe Blood starts with me”.

2001. “Mental Health: stop exclusion, dare to care”.

2002. “Move for health”.

2003. “Shape the future of life: healthy environments for children”.

2004. “Road safety”.

2005. “Make every mother and child count”.

2006. “Working together for health”.

2007. “International health security”.

2008. “Protecting health from the adverse effects of climate change”.

2009. “Save lives, make hospitals safe in emergencies”.

2010. “Urbanization and health: make cities healthier”.

2011. “Anti-microbial resistance: no action today, no cure tomorrow”.

2012. “Good health adds life to years”.

2013. “Healthy heart beat, Healthy blood pressure”.

2014. “Vector-borne diseases”.

2015. “Food safety”

2016. “Beat diabetes”

2017. “Depression: Let's Talk”

Dr Chethan T K,

Dr Gagan S,

Assistant Professor,



10

RNTCP 2016 Update

Case Finding and Diagnosis Strategy

• Early case detection is vital to interrupt the transmission of TB disease

as highlighted in the 12th five-year plan for TB control in India.

• Early identification of people with a high probability of having active TB

(Presumptive TB) is the most important activity of the case finding

strategy.

• Passive case finding alone can lead to missed cases or delayed diagnosis.

Definitions of Presumptive TB

• Presumptive Pulmonary TB: Refers to a person with any of the

symptoms and signs suggestive of TB including cough >2 weeks, fever

> 2 weeks, significant weight loss, haemoptysis, any abnormality in chest

radiograph.

• Contacts of microbiologically confirmed TB Patients, PLHIV, diabetics,

malnourished, cancer patients, patients on immune-suppressants or

steroid should be regularly screened for sign and symptoms of TB.

• Presumptive Extra Pulmonary TB: To the presence of organ specific

symptoms and signs like swelling of lymph node, pain and swelling in

joints, neck stiffness, disorientation, etc and/or constitutional symptoms

like significant weight loss, persistent fever for >2 weeks, night sweats.

• Presumptive DR TB: Refers to those TB patients who have failed

treatment with first line drugs, paediatric TB non responders, TB

patients who are contacts of DR-TB , TB patients who are found positive

on any follow-up sputum smear examination during treatment with


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first line drugs, previously treated TB cases, TB patients with HIV co-

infection.

Tools for Microbiological Confirmation of TB

• Sputum Smear Microscopy (for AFB): Zeihl-Neelson Staining and

Fluorescence staining.

• Culture: Solid (Lowenstein Jensen) media, Automated Liquid culture

systems.

• Drug Sensitivity Testing: Modified DST for MGIT 960 system (for both

first and second line drugs).

• Rapid molecular diagnostic testing: Line Probe Assay for MTB complex and

detection of RIF& INH resistance

• Nucleic Acid Amplification Test (NAAT) Xpert MTB/Rif testing using the

GeneXpert system.

• Radiology, TST, IGRA are other tools for diagnosis of tuberculosis.

Two samples are collected within a day or two consecutive days. One

sample is collected on the spot under supervision and other is collected

early in the morning.

Sputum should be at least 2 ml in quantity.

Results of sputum tests should be reported within a day.


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Diagnosis of Extra-pulmonary TB

• All efforts should be made to establish microbiological confirmation in

case of presumptive EPTB. Appropriate specimens from the presumed

sites of involvement must be obtained from all presumptive EPTB

patients for CBNAAT, Smear Microscopy Culture & DST for M.

tuberculosis, histo-pathological examination, based on type of specimen

and availability of facilities.


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Diagnosis of Drug Resistant TB

• Drug resistant TB is a laboratory based diagnosis.

• Both genotypic and phenotypic testing are available, genotypic testing

being the rapid way of diagnosing.

• Wherever the facilities are available, efforts should be made to obtain

DST results of all the drugs intended to be used in regimen.

• The programme has introduced Bedaquiline through conditional access

programme.

• If Rifampicin Resistance is confirmed by CBNAAT or LPA, start

Standardized Regimen for MDR TB and perform Liquid Culture DST at

base line to Levofloxacin, Moxifloxacin, Kanamycin, Capreomycin,

Ethambutol, Ethionamide, Linezolid and Pyrazinamide along with LPA

for lsoniazid on sample /culture isolate.

• If lsoniazid resistance is detected by LPA, report of result must also

mention Kat G or INH-A mutation.

• If resistance is detected to second line injectable and/or

fluoroquinolones, perform DST for remaining second line drugs. Initiate

or modify treatment as per Drug susceptibility test results.

Treatment of Tuberculosis (Goals)

• To decrease case fatality and morbidity by ensuring relapse free cure.

• To minimize and prevent development of drug resistance.

• To render patient non-infectious, break the chain of transmission and to

decrease the pool of infection.


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Case definitions

• Microbiologically confirmed TB case refers to a presumptive TB

patient with biological specimen positive for acid fast bacilli, or positive

for Mycobacterium tuberculosis on culture, or positive for tuberculosis

through Quality Assured Rapid Diagnostic molecular test.

• Clinically diagnosed TB case refers to a presumptive TB patient

who is not microbiologically confirmed, but has been diagnosed with

active TB by a clinician on the basis of X-ray abnormalities,

histopathology or clinical signs with a decision to treat the patient with

a full course of Anti-TB treatment.

• Microbiologically or clinically diagnosed TB can be divided according

to:

a) Anatomical site of disease: Pulmonary /Extra pulmonary (Miliary

TB considered as pulmonary TB as lungs are also involved)

b) History of previous treatment:

• New case -A TB patient who has never had treatment for TB or has

taken anti-TB drugs for less than one month is considered as a new

case.

• Previously treated patients who have received 1 month or more of

anti-TB drugs in the past.

• Recurrent TB case- A TB Patient previously declared as

successfully treated and is subsequently found to be

microbiologically confirmed TB case is a recurrent TB case.

• Treatment After failure patients, are those who have previously

been treated for TB and whose treatment failed at the end of their

most recent course of treatment.


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• Treatment after loss to follow-up: A TB patient previously

treated for TB for 1 month or more and was declared lost to

follow-up in their most recent course of treatment and

subsequently found microbiologically confirmed TB case.

c) Drug resistance: Mono, Poly, Multi drug and Extensive Drug

Resistant TB.

Drug Regimen for Drug Sensitive TB:

• The programme is now introducing daily regimen for treatment of drug

sensitive Tuberculosis among PLHIV and Pediatric TB patients in the

entire country and for all TB patients in 104 districts initially.

• For new TB cases, the treatment in intensive phase (IP) will consist of

eight weeks of lsoniazid, Rifampicin, Pyrazinamide and Ethambutol in

daily dosages.

• There will be no need for extension of IP.

• Only Pyrazinamide will be stopped in the Continuation Phase (CP), while the

other three drugs will be continued for another 16 weeks as daily

dosages.

• For previously treated cases of TB, the IP will be of 12 weeks, where

injection Streptomycin will be stopped after 8-weeks.

• INH, Rifampicin, Pyrazinamide and Ethambutol in daily dosages as per

weight will be continued for another 4-weeks.


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• At the start of CP, Pyrazinamide will be stopped while the rest of the

drugs - Rifampicin, INH and Ethambutol will be continued for another

20 weeks as daily dosages in the CP.

• The CP in both new and previously treated cases may be extended by

12-24 weeks in certain forms of TB like CNS TB, Skeletal TB,

Disseminated TB etc.

Drug Regimen for MD R/RR-TB cases (without additional resistance):

• These patients are to be treated with standard treatment regimen for

MDR-TB that contains 6 to 9 months of IP with Kanamycin,

Levofloxacin, Ethambutol, Pyrazinamide, Ethionamide and Cycloserine

and 18 months of CP with Levofloxacin, Ethambutol, Ethionamide and

Cycloserine.

• All MDR-TB isolates would be subjected to LC DST at baseline for

Kanamycin and Levofloxacin, the results of which would be received

after 6-8 weeks. Appropriate modifications of the treatment regimens

can be done in the presence of additional resistance.

Drug Regimen for XDR-TB

• XDR TB cases are treated with Injection Capreomycin, Moxifloxacin,

Linezolid, PAS, Clofazimine High Dose INH & Amoxyclav.

• The duration of IP will be for 6-12 months. Only the injectables will be

stopped in CP and the remaining medicines will continue for another 18

months in CP.

• All DR-TB treatment regimen are to be given on daily basis under

supervision


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Drug Regimen for Mono /Poly Drug resistant TB

• Repeat rifampicin DST is to be done in case, result of mono or poly drug

resistant TB is available after 6-8 weeks.

• Mono Drug Resistant TB -The treatment regimen is consisting of

Injectable SLD + FQ + Rifampicin + two out of the first line drugs (from

H, E & Z) to which the patient is sensitive to make a total of 5 effective

drugs regimen given daily.

• In case of reported baseline additional resistance to other FLDs, the

regimen is lnj SLD + FQ + Rifampicin + any FLD to which patient is

sensitive+ one of the remaining Group 4 drugs (Ethionamide,

cycloserine ,PAS).

• In addition, High Dose INH is added to the regimen if LPA shows inhA

mutation or culture reports show low level INH resistance.

• The total duration of treatment will be 9 to 12 months. The Intensive

Phase (IP) is for 3 months with scope for extension to a maximum of 6

months. The Continuation phase (CP) is for a fixed duration of 6 months.

Drug Regimen for MDR/RR-TB cases (with additional resistance)

• In case of resistance to Ethambutol, it is to be omitted.

• In case of resistance to Pyrazinamide, it is to be omitted.

• In case of resistance to both Ethambutol and PZA, PAS to be added in IP

and CP.

• In case of resistance to Levofloxacin or Moxifloxacin, the sensitive one is

to be used along with PAS and clofazimine.


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• In case of resistance to all second line injectable, replace them with

Clofazimine, Linezolid and PAS in IP and CP. The duration of IP will

be from 6 to 12 months.

MDR-TB with Mixed Patterns of Resistance

For lsoniazid resistance, decision on use of lsoniazid in the regimen depends

on following

• If High level resistance detected by Liquid culture - omit INH.

• If low level resistance detected by Liquid culture - add high dose INH.

• If LPA reports INH resistance by Kat G mutation- Omit INH.

• If LPA reports INH resistance by INH A mutation- Use High dose INH.

• Ethionamide in the treatment regimen will be replaced with PAS.

• If RR by CBNAAT, add INH in the standard doses to the treatment

regimen till results of LPA or Liquid culture DST are known.

• For new patients diagnosed as TB and RR by CBNAAT, put up both a

repeat CBNAAT & send sample for liquid culture. If second CBNAAT

also shows RR - start standard MDR-TB treatment regimen with INH

till the results from culture DST are known.


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• For mixed resistance pattern, consider oral drugs in following sequence

of preference Pyrazinamide (If Sensitive), Ethambutol, Ethionamide,

Cycloserine, PAS, Clofazimine,Linezolid, Co-Amoxyclav, High Dose

INH& Clarithromycin.

• Surgery in M/XDR-TB patients:

All patients of M/XDR-TB should be evaluated for surgery at the initiation

of treatment and/or during follow up.

Bedaquiline Conditional Access Programme: Introduction of new anti TB

drug under RNTCP

• The drug has a high volume of distribution, with extensive tissue

distribution, highly bound to plasma proteins and hepatically

metabolized.

• The drug has an extended half-life, which means that it is still present in

the plasma up to 5.5 months’ post stopping BDQ.

• BDQ demonstrates no cross-resistance with existing first- and second-

line anti-TB drugs and has shown significant benefits in improving the

time to culture conversion in MDR-TB patients.

Criteria for Patients to Receive Bedaquiline

• Adults aged > 18 years having pulmonary MDR-TB.

• Females should not be pregnant, or should be using effective non-

hormone-based birth control methods.

• Patients with controlled stable arrhythmia can be considered after

obtaining cardiac consultation.


20

• Once the results of baseline SLDST are available, the patients eligible

and consented to be treated with BDQ containing regimen will be

identified and an appropriate regimen will be designed.

All patients would be counseled and managed indoor for a mandatory period

of 2 weeks to complete the initial 2 weeks of BDQ doses.

Bedaquiline used in

• MDR TB with SLI and FQ resistance

• XDR TB.

• Treatment failures of MDR/XDR TB.

• Dosage of 400 mg daily during week ( 0-2) followed by 200mg 3 times a

week during week 3-24, after IP of 6 months BDQ is omitted.

Major Side effects are:

• Hepatotoxicity.

• Causes QT prolongation.

• Myalgia.


21

• All close contacts of DR-TB cases should be identified through contact

tracing and evaluated for active TB disease as per RNTCP guidelines. If

the contact is found to be suffering from pulmonary TB disease

irrespective of the smear results, he/she will be identified as an

"Presumptive MDR-TB".

• The patient will be initiated on regimen for new or previously treated

case based on their history of previous anti-TB treatment.

Isoniazid Preventive Therapy

• Children < 6 years of age, who are close contacts of a TB patient, should

be evaluated for active TB.

• He/She should be given INH preventive therapy irrespective of their

BCG or nutritional status.

• The dose of INH for preventive therapy is 10 mg/kg body weight

administered daily for a minimum period of six months.

• INH preventive therapy should be considered in following situation: -

• For all HIV infected children who either had a known exposure to an

infectious TB case or are Tuberculin skin test (TST) positive (>=5mm

induration) but have no active TB disease.

• All TST positive children who are receiving immunosuppressive

therapy

• A child born to mother who was diagnosed to have TB in pregnancy

should receive prophylaxis for 6 months, provided congenital TB has


22

been ruled out. BCG vaccination can be given at birth even if INH

preventive therapy is planned.

Treatment outcomes for drug-susceptible TB patients

• Cured: Microbiologically confirmed TB patients at the beginning of

treatment who was smear or culture negative at the end of the complete

treatment.

• Treatment completed: A TB patient who completed treatment without

evidence of failure or clinical deterioration BUT with no record to show

that the smear or culture results of biological specimen in the last month

of treatment was negative, either because test was not done or because

result is unavailable.

• Failure: A TB patient whose biological specimen is positive by smear or

culture at end of treatment.

• Lost to follow up: A TB patient whose treatment was interrupted for 1

consecutive month or more.

• Not Evaluated: A TB Patient for whom no treatment outcome is

assigned.

Outcomes for RR-/MDR-TB and/ or XDR-TB patients

• Cure: Treatment completed as recommended by the national policy

without evidence of failure AND three or more consecutive cultures

taken at least 30 days apart are negative after the intensive phase.

• Treatment completed: Treatment completed as recommended by the

national policy without evidence of failure BUT no record that three or

more consecutive cultures taken at least 30 days apart are negative after

the intensive phase.


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• Treatment success: The sum of cured and treatment completed.

• Treatment failed: Treatment terminated or need for permanent regimen

change of at least two or more anti-TB drugs in CP because of

i. Lack of microbiological conversion by the end of the intensive phase.

ii. Microbiological reversion in the continuation phase after conversion

to negative, or

iii. Evidence of additional acquired resistance to fluoroquinolones or

second line injectable drugs or Adverse drug reactions.

• Conversion and reversion: Conversion (to negative): culture is

considered to have converted to negative when two consecutive

cultures, taken at least 30 days apart, are found to be negative.

• Reversion (to positive): culture is considered to have reverted to

positive when, after an initial conversion, two consecutive cultures,

taken at least 30 days apart, are found to be positive.

Dr Raghavendra S K,

Assistant Professor,



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PUBLICATIONS BY STAFF &

PG STUDENTS

1. Shashikantha SK, Sheethal MP. Prevalence of low birth weight and its

associated factors: a community based cross sectional study in a rural area of

Rohtak, Haryana, India. Int J Community Med Public Health 2016;3:1544-6.

2. Vishma BK, Shashikantha SK, Sheethal MP, Muniyal AS. Awareness

of oral cancer and its risk factors in a rural community in Mandya, Karnataka,

India. Int J Community Med Public Health 2016;3:347-52.

3. Shashikantha SK, Sheethal MP, Vishma BK. Dietary diversity among

women in the reproductive age group in a rural field practice area of a medical

college in Mandya district, Karnataka, India. Int J Community Med Public

Health 2016;3:746-9.

4. Shashikantha S K, Sheethal M P. Prevalence of depression among post

graduate residents in a tertiary health care institute, Haryana. Int J Med Sci

Public Health 2016;5:2139-2142.

5. Sheethal MP, Shashikantha SK. A cross-sectional study on the

coverage and utilization of sanitary latrine in rural field practice area of a

tertiary care hospital in Southern Karnataka. Int J Community Med Public

Health 2016;3:1540-3.

6. Ratnaprabha GK, Gagan S. Commentary on “Ebola Haemorrhagic

fever in Sudan, 1976”. Annals of Community Health. 2016 Jul 1;4(2):14-6.

7. Gagan S, Ramadurg UY, Anjum W. Blood donors profile and

seroprevalence among them-A record based case series study in Bagalkot blood

bank. Annals of Community Health. 2016 Jul 1;4(2):22-5.

8. Gagan S, Anjum W, Mendagudali R, Ramadurg UY. A Community

Based Study to find the selfawareness of Type II Diabetes Mellitus status and


25

compliance in its treatment in Shirur, A Rural Field Practice Area of S. N.

Medical College, Bagalkot. Annals of Community Health. 2016 Oct 1;4(3):25-8.

9. Gagan S, Ghattargi C H, Anjum W, Mendagudali R. Co-Relation Of

Body Mass Index and Waist Hip Ratio with the Prevalence of Diabetes in a

Rural population of Bagalkot. Annals of Community Health. 2016 Oct 1;4(3):37-

9.

10. Sudarshan BP, Chethan TK. A study to assess the prevalence of anemia

and activities of daily living among elderly population residing in a South

Indian rural community. Int J Community Med Public Health 2016;3:437-41.

11. Sudarshan BP, Chethan TK.Morbidity pattern among the elderly

population in the rural area of Pondicherry: a cross sectional study. Int J

Community Med Public Health 2016;3:414-8.

12. Avin Alva BR, Chethan TK. A Study to Assess the Average Age of

Menopause and Menopause Associated Symptoms among Rural Women in

Mangalore, Karnataka. Ntl J Community Med 2016; 7(5):404-408.

13. Chethan TK, Venugopal K. Trends of lipid abnormalities among newly

detected type-2 diabetes mellitus in a tertiary care hospital in Karnataka, India.

Int J Community Med Public Health 2016; 3:750-3.

14. Chethan TK, Shashank KJ. Diabetes Mellitus: Current Challenges and

Barriers in the Delivery and Utilization of Health Care in a Coastal District of

Karnataka. Ntl J Community Med 2015; 7(1):54-59.

15. Chethan T K, Shashank K J. Assessment of Nutritional Status of Under

Five Children Residing in Rural Area of Kerala State - A Cross sectional study.

National Journal of Research in Community Medicine. Vol.5. Issue 1. Jan.-Mar.

2016(056-059).

16. Shashank KJ, Chethan TK. A Study on Breastfeeding Practices among

Mothers in Rural Area of Mangalore District: A Cross-sectional Study. Ntl J

Community Med 2016; 7(2):134-137.


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17. Shashank K J, Chethan T K. HIV/AIDS stigma and knowledge among

high school students in a rural area of Karnataka. National Journal of Research

in Community Medicine. Vol.5. Issue 1. Jan.-Mar. 2016(069-075).

18. Shashank KJ, Chethan TK. Nutritional Status of School Going Children

between the Age Group of 6-12 Yrs in Rural Area of Bijpaur District. Ntl J

Community Med 2016; 7(5):409-412.

19. Navinkumar Angadi, Shubha Davalgi, Raghavendra S K.

“Determinants of Utilization of Maternity Benefit Schemes Among Mothers in

Urban Slums Of Davangere City.” Int J Community Med Public Health. 2016;

3:651-7.


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Exercise and

Physical activity

Adults over the age of 20 years should undertake a minimum of 30-45

minutes of physical activity of moderate intensity (such as brisk walking 5-6

kms/hr) 5-6 days of the week. Greater health benefits can be obtained by

engaging in physical activity of longer duration or more vigorous intensity

such as jogging, running, cycling and swimming.

Sedentary people embarking on a physical activity programme should

undertake a moderate intensity activity of short duration to start and gradually

increasethe duration or intensity. Other day to day activities like walking,

housework, gardening , will be beneficial not only in weight reduction but also

for lowering blood pressure, serum triglycerides. It also elevates HDL

cholesterol in blood. Simple modification in lifestyle like deliberately climbing

up the stairs instead of using the lift and walking for short distance instead of

using a vehicle could also immensely help in increasing our physical activity.

Exercise program should include “warm up” and “cool down” periods

each lasting for 5 minutes. During exercise, the intensity of exercise should

ensure 60-70% increase in heart rate.

Energy expenditure on various physical activities (kcal/min):

Activities Energy (Kcal/min)

Sleeping, Resting, Relaxing 1.0

Sitting, eating, reading, writing, listening, talking 1.5

Standing, washing face, shaving, combing, watering

plants

2.3

Walking, driving, dusting, bathing, dressing 2.8

Sweeping, cleaning utensils, washing clothes, other

house chores

3.3

Warm up & recreational activities, walking up/down

stairs, cycling

4.8


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Carpentry, plumbing, loding/unloading 5.6

Gymnastics, Swimming, digging 6.0

Dr Srividya J,

Post Graduate,


Department of Community Medicine Cohort · ordinated by Dr Chethan TK & Dr Srividya B. 2. Quiz...

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