Department of Community Medicine

Development of Skill-based Competency Module of Community Medicine subject by using Community Based Medical Education approach for Indian Medical Graduates

Sun, 01 Jun 2025 00:00:00 GMT

Development of Skill-based Competency Module of Community Medicine subject by using Community Based Medical Education approach for Indian Medical Graduates Praveen, Gangnahalli Introduction: The undergraduate medical education programme is designed with a goal to create an “Indian Medical Graduate” (IMG) possessing requisite knowledge, skills, attitudes, values and responsiveness, so that she or he may function appropriately and effectively as a physician of first contact of the community while being globally relevant. Thus, it is an approach in which the focus of teaching–learning and assessment is on real-life medical practice. Objectives: To Develop, Validate & Assess the Impact of skill-based Competency Module of Community Medicine subject by using Community-based medical education approach. Methodology: This study aims to Design, validate & implement skill-based competency module for and to take feedback from medical undergraduate students. Materials & Methods: An observational study was conducted by preparing the draft of the selected skill-based competencies of the community medicine subject named as community diagnosis module and validated with help of experts of subject and health education profession by using content validity Index. This is followed by the implementation of the module to second MBBS students, assessment of the outcome and feedback collection. Results: The Content Validity Index, based on assessments from ten field experts, yielded a score of 0.86, indicating good validity. Feedback analysis from medical student’s post-implementation revealed that transitioning from classroom teaching to community experiences was the most valued aspect of the program. Student feedback indicated a favourable consensus on various aspects of the module, including its objectives, teaching methods, materials, assessments, and active participation in activities. Conclusion: The development of a skill-based Competency Module for Community Medicine, by using community-based medical education approach, holds significant promise for improving the competency and skills of Indian Medical Graduates. This module will equip them with the knowledge and skills necessary to address the complex and evolving public health challenges faced by communities

Effects of Micronutrient levels on the maternal mitochondrial DNA copy number (mtDNA-CN) in apparently healthy term pregnant women (≥37 weeks) and in turn its effect on birth weight of the baby-A Mixed Methods Research Study.

Mon, 01 Jan 2024 00:00:00 GMT

Effects of Micronutrient levels on the maternal mitochondrial DNA copy number (mtDNA-CN) in apparently healthy term pregnant women (≥37 weeks) and in turn its effect on birth weight of the baby-A Mixed Methods Research Study. Manjula, R Background: Nutrient intake is important to the well-being of pregnant women and the fetus. Micronutrients are necessary for normal growth and development of the fetus and deficiencies have been found to be associated with intrauterine growth retardation and small for gestational age infants. The nutritive composition of a diet has important influence on mitochondrial health—nutrients provide the substrates to harvest energy in the form of adenosine triphosphate (ATP) to affect key cellular functions and processes. Micronutrients were known to stabilise the mitochondrial DNA which could be related to Birth weight. Hence this study was taken up with following objectives. Objectives: a. Quantitative study: 1. To estimate the micro nutrient levels such as serum Ferritin, vitamin B12, Vitamin A, Vitamin D, Calcium, Selenium and Zinc in apparently healthy term pregnant women(≥37 weeks) and to study the causes for nutritional anemia in this area. 2. To estimate the maternal mitochondrial DNA copy number in term pregnant women using Q-PCR technique. 3. To study the correlation between the different micronutrient levels with Dietary diversity and maternal mitochondrial DNA copy number among them. 4. To study the effects of different micronutrient levels and maternal mitochondrial DNA copy number on the birth weight of the baby.b. Qualitative study: 1. To explore the cultural beliefs and practices related to diet and nutrition in pregnancy through focus group discussions among term pregnant women, Care givers like mothers and mother-in laws . Methods: After obtaining ethical clearance, present study was conducted in 150 apparently normal term (>37 completed weeks) pregnant women at tertiary care centre. Informed consent was obtained. Data was collected using the pre-designed questionnaire. Collected 5ml of venous blood under aseptic precaution and they were stored in Central Research Lab at -20 Degree. After serum separation, Micronutrients estimations and mitochondrial DNA copy number was done using Q-PCR technique. Complete Blood Count(Using Penta ES 60 cell counter) Serum ferritin, serum Vitamin B12 and Vitamin D (SNIBE Maglumi 1000 autoanalyser, which works on the principle is Chemiluminucence method (CLIA). Zinc and Calcium was estimated using a Fully automated analyser BA-400 of Bio-system company. Selenium by inductive couple plasma mass spectrometry (ICP-MS). Vitamin A By chromatographic methods using HPLC method. Results: In the present study Dietary diversity, Calorie intake, protein intake, Gestational weight gain was associated with Birth weight of the baby, Dietary Diversity and protein intake was found to be statistically significant(p<0.05). There was statistically significant positive correlation between maternal serum zinc, serum calcium and serum folic acid with dietary diversity with correlation co-efficient of 0.183, 0.192 and 0.21 respectively There was a statistically significant negative correlation between Maternal mitochondrial DNA copy number and birth weight of the baby (r=-0.25, p=0.002). There was a statistically significant positivecorrelation between maternal serum micronutrients such as ferritin (r=0.17, p=0.035), Vitamin D3(r=0.21,p=0.008), Calcium (r=0.16, p=0.04), and folic acid (r=0.23, p=0.004). Serum Ferritin, Vitamin D, Selenium, Zn, Calcium, Folate levels were significantly lower in mothers of low birth weight baby when compared with normal weight baby. Antioxidant micronutrients Se, Zn, Vitamin D was negatively correlated with Mt DNA CN. There is a reduced affordability for the protective food items which are rich in micronutrients. There is a high calorie malnutrition and hidden hunger noted in our study group. Dietary diversity is an important factor which determines the adequate micronutrient intake. It should be increased by incorporating the food items rich in micronutrients in pregnancy. There was a less compliance for IFA supplementation. Conclusion: There is an association between micronutrients and Birth weight of the baby. Only improving Dietary diversity is not going to help in improving the micronutrient levels, but proper planning of menu with good representation of protective food could help. Since there is lot of prejudices in the food intake in pregnancy, nutrition education could help. Micronutrient Supplementation could have questionable benefit, since the compliance for tablet intake was very poor. Food fortification could be helpful in improving the micronutrient supplementation and good birth weight of the baby. Mitochondrial DNA copy number gave the objectivity for the present study at the molecular level, could have influenced by the micronutrients and in turn affect the birth weight of the baby

A Prospective Study To Assess The Factors Affecting Nutritional Status Of People Living With Hiv/Aids (Plha) Receiving Anti-Retroviral Therapy (Art)

Thu, 01 Apr 2021 00:00:00 GMT

A Prospective Study To Assess The Factors Affecting Nutritional Status Of People Living With Hiv/Aids (Plha) Receiving Anti-Retroviral Therapy (Art) Hiremath, RN Background: The current HIV/AIDS (Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome) pandemic is a worldwide concern, the impact of which is expected to be felt over the years ahead, with critical public health implications. Focus on improving nutrition in HIV/AIDS patients is vital and the need of the hour. This is because, proper nutrition not only optimizes existing immune system function, but can significantly reduce the incidence of HIV-related complications and improves the patient’s quality of life. Nutritional management among PLHA is hence an essential but often neglected element in the HIV continuum of care and efforts need to be invested in studying as well as understanding the complicated web of associated factors. The main aim of the study was to assess the nutritional status and socio-demographic factors of ART-Naïve PLHA and their association, by prospectively following them for one year. Materials and Methods: A Prospective study was carried out among ART-naive PLHA, registered in five Institutional ART centers in Pune, Maharashtra and followed up for one year from their inclusion date in the study. Accounting for 15% loss-to-follow-up, the sample size was estimated to be 430. Systematic random sampling was employed to achieve the target sample size from all five ART centers. Ethical clearance was obtained from the Institutional Ethical Clearance Committee. All patients were recruited for the study on a voluntary basis, confidentiality was ensured in every step. Data was collected by means of personal interview and anthropometric measurements and relevant blood investigations were carried out as per study protocol. Results: Overall, 430 participants were enrolled in the study, and baseline data were collected from them. However, only 378 remained till the end of the study period (13 months) and were included in the final analysis. With the mean age of the study cohort of 41yrs, and even after one year of treatment, undernutrition in our study was at 34.9%, anaemia at 59.9%, low albumin at 12.9%, low total protein at 13.8%, which were higher in spite of regular treatment and monitoring. 72% were consuming an inadequate diet. The majority, 57.1%, had a poor Quality of life (QoL) index, while 31.5% and 11.5% had good and excellent QoL indices, respectively and the majority, 52.9% showed food insecurity. Chi-square test of independence was used to test the association which showed, No or same Job, decreased or no income, food insecurity, poor quality of life, decreased level of haemoglobin, low before-after perceived health status, after 1 year of ART were significant predictors of low nutrition status. Also, female respondents were significantly at higher risk of low nutrition status while on ART. The study also showed the majority of the PLHA practiced wrong cooking/poor eating habits and consumed unpasteurized milk. Few of the Water, sanitation and hygiene (WaSH) and food consumption patterns showed alarming practices which needed to be changed. These practices are the “Art of preserving life” in this century where in communicable diseases are at high, especially in developing nations. About 31% of the subjects were found to be overweight/obese, with 32% being tobacco users and 8.31% alcohol drinkers, flagging the need to implement preventive measures for Non communicable diseases (NCDs) even among PLHAs. Conclusion: Poor/no income, job insecurity, food insecurity, poor QoL, anaemia at the end of one year of ART, female gender and those living in urban areas were significant predictors of undernutrition among PLHA. Synergistic effects of malnutrition, food insecurity, poor diet and health status influence poor outcomes in the already compromised household conditions due to increased financial constraints with superimposed emotional breakdown. Hence, even a tiny fraction in weight loss would result in significant morbidity and decreased survival rate among PLHA. Study findings also recommended PLHA to follow good WaSH practices and cooking/eating habits, as these factors act synergistically with other factors to affect the holistichealth of PLHA. The study findings also indicate the incorporation of early screening for NCD risk factors among PLHA, to prevent and manage the same at the earliest, before it can aggravate the already compromised immune status among PLHA