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Biomedical subjects

K R John

Publications and source records attributed to K R John.

18 recordsLinked to original sources
PubMed2006

PCR amplification of the IS6110 insertion element of Mycobacterium tuberculosis in fecal samples from patients with intestinal tuberculosis.

PCR amplification of insertion element IS6110 of Mycobacterium tuberculosis in fecal samples was evaluated in the diagnosis of intestinal tuberculosis (ITB). The numbers of samples that tested positive by PCR with SalI digestion were 16/18 untreated-ITB samples, 0/8 treated-ITB samples, 12/14 smear-positive pulmonary tuberculosis samples, and 0/30 control samples. The sensitivity, specificity, positive predictive value, and negative predictive value of fecal PCR were 88.8%, 100%, 100%, and 93.7%, respectively.

Base Sequence↗
PubMed2005

Genetic heterogeneity among Vibrio alginolyticus isolated from shrimp farms by PCR fingerprinting.

AIMS: To study the strain variability among Vibrio alginolyticus isolates from different sources by insertion sequence-targeted PCR fingerprinting and whole cell protein profile analysis. METHODS AND RESULTS: Eleven strains of V. alginolyticus were isolated from seven different sources including healthy, infected, farm-reared and wild shrimps. Following biochemical characterization, the isolates were analysed by PCR fingerprinting and whole cell protein analysis by SDS-PAGE. The strains were genetically different irrespective of the sources of isolation. CONCLUSIONS: Strain variation exists in V. alginolyticus isolates obtained even from the same source, and PCR fingerprinting is a simple and efficient method in identifying strain-specific variations among the different isolates. SIGNIFICANCE AND IMPACT OF THE STUDY: Vibrio alginolyticus is implicated in severe vibriosis of marine aquaculture systems although many strains are avirulent and could be used as probiotic strains. As a wide variation exists among this species, differentiating the harmful and beneficial strains would help in finding ways of controlling the infections by eliminating harmful shrimp pathogenic vibrios.

Animals↗
PubMed2004

A comparison of economic aspects of hospitalization versus ambulatory care in the management of neuritis occurring in lepra reaction.

Neuritis is one of the important causes of deformities and disabilities in leprosy. Neuritis has been managed both in the field and in hospital. This study was done to compare the economic aspects of cost of ambulatory vs in-patient management of neuritis in leprosy. The quality of life of the affected patients and the clinical improvement in the 2 groups were also studied. Twenty six patients fulfilling the study criteria were randomized into the ambulatory and in-patient group (13 in each group). The primary outcome examined was cost, in various categories; the secondary outcomes included pre- and post-treatment comparison of Quality of Life (QOL) scores and tests of sensory and motor function. The direct and indirect medical costs incurred by patients in the hospitalized group were higher than those patients in the ambulatory group. The difference in the direct medical costs between the two groups was Rs. 9110.5, and the extra direct non medical costs incurred by patients in the hospitalized group was Rs. 888.50 because of more frequent visits of family members. A greater percentage of ambulatory than in-patients returned to work in </= 15 days (53.8% vs 15.3%), and the mean duration before returning to work was 19.5 days ambulatory patients compared to 66.8 days for in-patients group. The QOL scores and motor and sensory function tests showed no significant difference between groups. Although the sample size was small, these preliminary results suggest that substantial cost minimization by ambulatory care is possible without significantly affecting the quality of life or peripheral nerve function.

Adolescent↗
PubMed2002

Quality of hysterectomy care in rural Gujarat: the role of community-based health insurance.

Community-based health insurance (CBHI) may be a mechanism for improving the quality of health care available to people outside the formal sector in developing countries. The purpose of this paper is to identify problems associated with the quality of hysterectomy care accessed by members of SEWA (Self-Employed Women's Association), an Indian CBHI scheme, and discuss mechanisms that would optimize quality of care. Data on hysterectomy care were collected through a review of 63 insurance claims and semi-structured interviews with 12 providers. Quality of hysterectomy care accessed by SEWA's members varied from potentially dangerous to excellent. Dangerous conditions included operating theatres without separate hand-washing facilities or proper lighting, the absence of qualified nursing staff, performing hysterectomy on demand, removing both ovaries without consulting or notifying the patient, and failing to send the excised organs for histopathology, even when signs were suggestive of disease. Women paid substantial amounts of money, even for poor and potentially dangerous care. In order to improve the quality of care for its members, a CBHI scheme can: (1) gather data on the costs and complications for each provider, and investigate where these are excessive; (2) use incentives to encourage providers to make efficient and equitable resource allocations; (3) contract with providers giving a high standard of care or who agree to certain conditions; and (4) inform and advise doctors and the insured about the costs and benefits of different interventions. In the case of SEWA, it is most feasible to identify a limited number of hospitals providing better quality care and contract directly with them.

Adult↗
PubMed2002

Attitudes toward tuberculosis of final year medical students from Canada, India, and Uganda.

BACKGROUND: Tuberculosis, although both preventable and treatable, continues to be the world's leading cause of death from an infectious agent. PURPOSE: To extend the results of our previous study of knowledge and practices of final year medical students regarding tuberculosis at three medical schools from endemic and nonendemic areas and to describe their attitudes. METHODS: Eight statements assessing attitudes, as part of a larger survey, were administered to final year medical students at McMaster University in Canada, Christian Medical College in India, and Makerere University in Uganda. RESULTS: One hundred sixty surveys were returned with 155 completed attitude responses. The response rate was 68.4% (65 of 95) for McMaster University, 39.7% (23 of 58) for the Christian Medical College, and 78.3% (72 of 92) for Makerere University. Analysis showed that six of eight attitude items were slightly statistically different among the schools with minimal effect of curriculum time and patient exposure. CONCLUSIONS: Despite quite varied exposure to tuberculosis, students from endemic and nonendemic areas responded similarly on statements addressing attitudes toward tuberculosis.

Awareness↗
PubMed2001

Characteristics of a new reovirus isolated from epizootic ulcerative syndrome infected snakehead fish.

Epizootic ulcerative syndrome (EUS) has been infecting a wide range of fishes in the South and Southeast Asia for the last 2 decades. One reovirus-like agent (snakehead reovirus, SKRV), isolated from an EUS-infected snakehead fish and investigated in the present study, is the only reovirus so far isolated from an EUS-infected fish. SKRV was characterised by the presence of a double-stranded RNA genome with icosahedral symmetry and double capsid. The virus had an average size of 71 nm, a buoyant density of 1.36 g ml(-1) in CsCl and lacked a lipid-containing envelope. Apart from the above, the presence of a segmented genome and structural proteins falling into 3 specific size classes confirmed that the virus belongs to the family Reoviridae. SKRV differed from aquareoviruses by the lack of a cytopathic effect (CPE) with syncitium formation and in the segmentation pattern of RNA genome. The resistance to pH (3.0 to 9.0) and heat treatment and inability to multiply in mammalian cell lines and haemagglutinate human 'O' red blood cells (RBCs) differentiated SKRV from the rest of the similar genera in the family Reoviridae. Serological comparison indicated the antigenic distinctness of the isolate from selected American and European aquareoviruses. SKRV grew well in SSN-1 and SSN-3 cells at 25 to 30 degrees C but not in the most common Aquareovirus susceptible coldwater fish cell line--CHSE-214.

Animals↗
PubMed2001

Knowledge and practices regarding tuberculosis: a survey of final-year medical students from Canada, India and Uganda.

CONTEXT: Tuberculosis is one of the most common infectious diseases worldwide and is responsible for the largest number of deaths from a single infectious cause. OBJECTIVE: The objective of this study was to compare the knowledge of and practices regarding tuberculosis in final-year medical students at schools from endemic and non-endemic areas. SUBJECTS: Final-year medical students at McMaster University in Canada, the Christian Medical College in India, and Makerere University in Uganda. METHODS: A questionnaire consisting of 20 multiple-choice questions assessing knowledge, practices, and exposure. A total knowledge score (maximum=13) and a total practice score (maximum=5) were created for each study site. RESULTS: 160 questionnaires were returned; the response rate was 68.4% (65/95) for McMaster University, 39.7% (23/58) for the Christian Medical College and 78.3% (72/92) for Makerere University. Students from Makerere University had the highest knowledge scores but differences were non-significant after adjustment for patient exposure and curriculum time (F(2,153)= 1.80, P=0.16). Differences in practice scores, however, remained significant after adjusting for curriculum time and patient exposure (F(2,153)=5.14, P=0.006). Knowledge score (F(1,156)=5.05, P=0.02), patient exposure (F(1,153)=9.11, P=0.003), and curriculum time and patient exposure (F(2,153)=5.14, P=0.006) were statistically significant positive predictors of the total practice score. CONCLUSIONS: This study demonstrated significant differences in undergraduate exposure to tuberculosis, total knowledge, and practice competency at three medical schools in Canada, India, and Uganda. In general, the knowledge base and practice competency of all three graduating classes was adequate.

Analysis of Variance↗
PubMed2001

Quality of hysterectomy care in rural Gujarat: the role of community-based health insurance.

Community-based health insurance (CBHI) may be a mechanism for improving the quality of health care available to people outside the formal sector in developing countries. The purpose of this paper is: (1) to identify problems associated with the quality of hysterectomy care accessed by members of SEWA, an Indian CBHI scheme; and (2) to discuss mechanisms that might be put in place by SEWA, and CBHI schemes more generally, to optimize quality of health care. Data on the structure and process of hysterectomy care were collected primarily through review of 63 insurance claims and semi-structured interviews with 12 providers. Quality of hysterectomy care accessed by SEWA's members varies tremendously, from potentially dangerous to excellent. Seemingly dangerous aspects of structure include: operating theatres without separate hand-washing facilities or proper lighting; and the absence of qualified nursing staff. Dangerous aspects of process include: performing hysterectomy on demand; removing both ovaries without consulting or notifying the patient; and failing to send the excised organs for histopathology, even when symptoms and signs are suggestive of disease. Women pay substantial amounts of money even for care of poor, and potentially dangerous, quality. In order to improve the quality of hospital care accessed by its members, a CBHI scheme can: (1) gather data on the costs and complications for each provider, and investigate cases where these are excessive; (2) use incentives to encourage providers to make efficient and equitable resource allocation decisions; (3) select, and contract with, providers who provide a high standard of care or who agree to certain conditions; and (4) inform and advise doctors and the insured about the costs and benefits of different interventions. In the case of SEWA, it is most feasible to identify a limited number of hospitals providing better-quality care and contract directly with them.

Adult↗
PubMed2000

The impact of lymphatic filariasis on labour inputs in southern India: results of a multi-site study.

A multi-site study was undertaken, in the rural areas of three districts in Tamil Nadu state, in southern India, to examine the impact of acute and chronic forms of lymphatic filariasis, caused by infection with Wuchereria bancrofti, on labour inputs. More than half of the acute episodes of adenolymphangitis (ADL) observed in the study communities caused total disability. The mean (S.D.) time that each ADL case was able to allocate to economic activity each day during these acute episodes was much less than seen in the controls matched for sex, age and occupation [0.97 (2.36) v. 4.48 (3.82) h; P < 0.01]. The acute disease also severely affected domestic activities, with female ADL cases spending only 1.54 (2.12) h/day on domestic activity, compared with 4.18 (2.61) h by controls. The subjects with chronic filariasis also spent significantly less time in economic activity than their matched controls [4.40 (3.79) v. 5.13 (3.83) h/day; P < 0.01). Although the acute episodes have a dramatic effect on the productivity of the affected individual, the labour loss caused by chronic disease is more serious, as the manifestations of chronic disease mostly affect the most productive age-groups, persist for life and are mostly irreversible. The adverse impact of acute and chronic filariasis was observed in males and females, farmers and non-farmers and during the rainy, winter and summer seasons. It is estimated that about 3.8% of the potential labour inputs of the men and 0.77% of those of the women were lost because of lymphatic filariasis. In addition to this loss, the total economic burden of the disease must include the costs of treatment and other health care and of the resources spent on control programmes. Estimates of the disease burden are likely to be useful in determining the costs and benefits of the recently launched campaign to eliminate lymphatic filariasis.

Acute Disease↗
PubMed1999

Variation in in-patient stroke management in ten centres in different countries: the INCLEN multicentre stroke collaboration.

BACKGROUND AND PURPOSE: Large within-country variations have been described in stroke management and there have been a few studies of between-country variation (in the USA and the UK). We designed a study to examine stroke management across a wide range of countries representing different stages of economic development. Large variations would suggest the need to explore methods of increasing the uptake of evidence-based stroke practice. METHODS: Members of the International Clinical Epidemiology Network (INCLEN) from 14 centres in ten countries agreed to review the records of the last 50 patients admitted to hospital with a clinical diagnosis of stroke. Information on demographic variables, the clinical diagnosis of stroke type, investigations performed and treatments given and the discharge destination of the patient were recorded and sent to the coordinating centre in Australia for analysis. RESULTS: There were statistically significant between-centre differences in the proportions of patients cared for by a neurologist, staying in hospital for at least ten days and having CT or MRI scans. Significant between-centre differences were also seen for treatment, for example, the use of aspirin in non-haemorrhagic stroke varied from 11 to 79%. The variation (for all interventions studied) was no longer statistically significant when examined within strata according to availability of facilities. CONCLUSIONS: The large variation between centres in the management of stroke is largely 'explained' by the availability of resources, even for interventions that do not depend on resource availability. It will be important to develop management guidelines that reflect evidence-based practice of relevance across a range of economic settings.

Age Factors↗
PubMed1998

Measles vaccination before nine months.

OBJECTIVE: To measure the protective effect of measles vaccine administered before 9 months of age and compare overall mortality of children vaccinated at 6-8 months and at 9-11 months. METHOD: Non-concurrent cohort study involving all 13 134 children born between 16 January 1986 and 31st December 1991 in Kaniyambadi block near Vellore who had not left the area by six months of age. Main outcome measures were risk of disease and death among the under-five-year-olds according to age at measles immunization. RESULTS: Unimmunized children had a higher risk of developing measles compared to the immunized (P < 0.05). There was no significant difference in risk of measles among those vaccinated prior to and after nine months of age. Unvaccinated children were at significantly higher risk of death than vaccinated children (P < 0.001). There was no difference in risk of death between infants vaccinated between 6 and 8 months and those vaccinated between 9 and 11 months. There was no difference in the risk of death between boys and girls vaccinated between 6 and 8 months with standard-titre Edmonston-Zagreb vaccine. CONCLUSION: Administration of standard-titre Edmonston-Zagreb measles vaccine at 6-8 months is an effective and safe preventive measure for measles, especially where the age-specific attack rate for children < 9 months is high.

Age Distribution↗
PubMed1992

The teaching of behavioural sciences.

Medical science over the last few decades has undergone vast changes. Technologically it has advanced at a rapid pace. There has been a realization as well that the behaviour of individuals and communities also influences the occurrence of disease. Medical schools around the globe have realized the need for incorporating behavioural sciences as an integral part of the basic sciences taught to medical students. This paper presents the experience of Christian Medical College, Vellore in teaching behavioural sciences. Students are taught sociology, psychology and medical anthropology through a community-based, problem-oriented teaching programme. The students have first-hand experience of living in a community and learn by observation and interaction. Pre- and post-assessment has shown a significant improvement of their knowledge and attitude. Feedback from students also indicates that they find this programme relevant and interesting.

Behavioral Sciences↗
PubMed1990

Teaching nutrition to medical students: a community-based problem-solving approach.

This paper presents a community-based problem-solving educational programme which aims at teaching medical and other health science students the importance of nutrition and its application. Through community surveys students assess the nutritional status of children under five using different anthropometric methods. They understand the cultural beliefs and customs related to food fads and the reasons for them. They also acquire the skill to educate the community using the information gathered. They use epidemiological methods such as case control study to find associations between malnutrition and other causative factors. Feedback from students has been positive and evaluation of students' knowledge before and after the programme has shown significant improvement.

Community Medicine↗
PubMed1990

The role of intrahousehold contact in the transmission of leprosy.

This study examines the role of intrahousehold contact in the transmission of leprosy using the case control methodology. The study was done in the leprosy control area of the Community Health and Development (CHAD) Programme of the Christian Medical College. Three age, sex and village matched controls were selected for each case. This study shows that persons with intrahousehold contact with leprosy have a higher risk of acquiring leprosy compared with those who did not (RR 2.509; 95% confidence limits 1.23-5.109).

Adolescent↗
PubMedDate not supplied

Prescription patterns and cost analysis of drugs in a base hospital in south India.

BACKGROUND: In the rural areas of developing countries the cost of drugs is a major concern to both physician and patient; yet there are few data on prescribing patterns and expenditure. We examined the cost of commonly prescribed drugs in a community health care programme in a base hospital of the Christian Medical College, Vellore. METHODS: The study was carried out over a period of 3 months during which 2756 prescriptions were analysed. The number and type of drugs prescribed and the frequency and total cost of the prescriptions were noted. RESULTS: The number of drugs prescribed for each patient ranged from 1 to 7 with a mean (SD) of 2.4 (1.1). The most commonly prescribed groups of drugs were vitamins, analgesics, antibiotics, sulphonamides and anti-inflammatory agents. The mean (SD) cost per prescription was Rs 8.8 (8.6). The expenditure on the most commonly used drugs was approximately 50% of the total cost. The cost per prescription was less than Rs 10 in 70% of the cases. All the drugs were from the World Health Organization's essential drugs list. CONCLUSIONS: Most prescriptions for drugs given at our hospital could be afforded by villagers.

Costs and Cost Analysis↗
PubMedDate not supplied

Morbidity pattern, health care utilization and per capita health expenditure in a rural population of Tamil Nadu.

BACKGROUND: Information on the existing morbidity pattern, pattern of health care utilization and the per capita health expenditure is essential to provide need-based health care delivery to a rural population. To obtain this information we performed a study in the K.V. Kuppam Block, North Arcot Ambedkar District, Tamil Nadu. METHODS: We did a cross-sectional study, interviewing respondents from 300 households, from 3 panchayats using a multistage sampling technique. Information relating to 1440 persons was collected. The morbidity data was obtained initially for the week prior to the day of interview, followed by one week to one month and then for two months to one year. RESULTS: During 1990-91, 825 of the 1440 persons (57.3%) did not have any illness. Sex had no bearing on the number of illnesses. Of the 60 children less than 2 years of age, 42 (70%) had one or two illnesses. The period prevalence of infective and parasitic diseases was found to be 21.9% with an average of 3 episodes. Services rendered by private practitioners (registered, non-registered and indigenous) were utilized by 59% of the households and 79% of the households had used allopathic treatment at some time. The average per capita per annum health expenditure was Rs 89.9 (Rs 449 per household). This increased significantly with increase in the household size (p < 0.001) and per capita income (p < 0.01). CONCLUSION: The health-seeking behaviour of this population can be changed if efficient services are rendered through government primary health centres and subcentres. This would allow the existing voluntary agency to withdraw without much change in the per capita health expenditure.

Adolescent↗