The projects of Dharma foundation of India are centered around developing care models based on the WHO guidelines of Active Ageing and Towards Building Age Friendly Communities for older persons The strategy supports full participation and inclusion of older persons in the life of their communities.This project taught Self Management of Arthritis and Hypertension to older women.
A Study on Changing Status of Mithilanchal Villages 1895 2005ijtsrd
The nature of society is changeable. Man is born and grows in a group. He performs his various roles in life and dies. One generation is replaced by another generation. The new generation changes the assumptions and working procedures of the old generation according to its own needs. Procreation results in the growth of a new generation. Diseases, famines, natural calamities and wars also decrease population. Social institutions and organizations change with the changes in human needs. The systems of production and technology changes according to the economic needs of man. As a result, the mental relationship between man and machine also change. Culture, working procedure, values system and organization also change with the changes in population, generation needs and relation between man and machine. The present paper is denoting about the changing status of Mithilanchal villages in the state of Bihar in India. This is a comparative study in between two periods of time, 1895 2005. Dr. Pramod Gandhi | Dr. Baby Kumari "A Study on Changing Status of Mithilanchal Villages (1895-2005)" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-6 , October 2020, URL: https://www.ijtsrd.com/papers/ijtsrd33295.pdf Paper Url: https://www.ijtsrd.com/humanities-and-the-arts/sociology/33295/a-study-on-changing-status-of-mithilanchal-villages-18952005/dr-pramod-gandhi
It is important to get practical insights into the problems faced by community dwelling elderly in rural and urban India.
Information collected can act as a guideline for taking necessary steps to reform awareness and attitude of assistive technology amongst professional care providers of the elderly and the elderly in India.This keynote presentation was done at Akita,Japan ,in October 2009.
I am Gautam, PG dip in Geriatric Care from NISD,Delhi on behalf of Agebengal I publish this matter for awareness of Senior Citizen lifestyle and care in institutional or non - instititutional set up.
A Study on Changing Status of Mithilanchal Villages 1895 2005ijtsrd
The nature of society is changeable. Man is born and grows in a group. He performs his various roles in life and dies. One generation is replaced by another generation. The new generation changes the assumptions and working procedures of the old generation according to its own needs. Procreation results in the growth of a new generation. Diseases, famines, natural calamities and wars also decrease population. Social institutions and organizations change with the changes in human needs. The systems of production and technology changes according to the economic needs of man. As a result, the mental relationship between man and machine also change. Culture, working procedure, values system and organization also change with the changes in population, generation needs and relation between man and machine. The present paper is denoting about the changing status of Mithilanchal villages in the state of Bihar in India. This is a comparative study in between two periods of time, 1895 2005. Dr. Pramod Gandhi | Dr. Baby Kumari "A Study on Changing Status of Mithilanchal Villages (1895-2005)" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-6 , October 2020, URL: https://www.ijtsrd.com/papers/ijtsrd33295.pdf Paper Url: https://www.ijtsrd.com/humanities-and-the-arts/sociology/33295/a-study-on-changing-status-of-mithilanchal-villages-18952005/dr-pramod-gandhi
It is important to get practical insights into the problems faced by community dwelling elderly in rural and urban India.
Information collected can act as a guideline for taking necessary steps to reform awareness and attitude of assistive technology amongst professional care providers of the elderly and the elderly in India.This keynote presentation was done at Akita,Japan ,in October 2009.
I am Gautam, PG dip in Geriatric Care from NISD,Delhi on behalf of Agebengal I publish this matter for awareness of Senior Citizen lifestyle and care in institutional or non - instititutional set up.
Impact of People's Participation in the Decentralized Participatory Planning...inventionjournals
International Journal of Humanities and Social Science Invention (IJHSSI) is an international journal intended for professionals and researchers in all fields of Humanities and Social Science. IJHSSI publishes research articles and reviews within the whole field Humanities and Social Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Building Inclusive Cities: Planning Tools that promote the Right to the CityWellesley Institute
This presentation looks at the ways in which cities can be inclusive and examines interesting projects happening around the globe.
Carolyn Whitzman, Professor of Urban Planning
University of Melbourne
This presentation examines the ways in which local action can achieve health equity.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Invited guest presentation at University of Illinois at Chicago, Health Inequities class on Friday, February 1, 2013. Professors Linda Rae Murray MD, MPH, and Angela Odoms-Young, PhD. Selected quotations, selected results from the Cook County PLACE MATTERS Health Equity Report released July 2012.
The role of Social Work in India in assessing and protecting people in need. ...Bimal Antony
This is an essay which presents the following two points.
1. The role of Social Work in India in assessing and protecting people in need.
2. The extent to which Social Work changed over the last 40 years and factors that contributed to some of these changes.
The Global Development Lecture Series brings together scholars involved in cutting edge research on international development. It aims to facilitate dialogue and discussion, providing a space for leading development thinkers to share their latest research ideas with Manchester's staff and students.
Impact of People's Participation in the Decentralized Participatory Planning...inventionjournals
International Journal of Humanities and Social Science Invention (IJHSSI) is an international journal intended for professionals and researchers in all fields of Humanities and Social Science. IJHSSI publishes research articles and reviews within the whole field Humanities and Social Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Building Inclusive Cities: Planning Tools that promote the Right to the CityWellesley Institute
This presentation looks at the ways in which cities can be inclusive and examines interesting projects happening around the globe.
Carolyn Whitzman, Professor of Urban Planning
University of Melbourne
This presentation examines the ways in which local action can achieve health equity.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Invited guest presentation at University of Illinois at Chicago, Health Inequities class on Friday, February 1, 2013. Professors Linda Rae Murray MD, MPH, and Angela Odoms-Young, PhD. Selected quotations, selected results from the Cook County PLACE MATTERS Health Equity Report released July 2012.
The role of Social Work in India in assessing and protecting people in need. ...Bimal Antony
This is an essay which presents the following two points.
1. The role of Social Work in India in assessing and protecting people in need.
2. The extent to which Social Work changed over the last 40 years and factors that contributed to some of these changes.
The Global Development Lecture Series brings together scholars involved in cutting edge research on international development. It aims to facilitate dialogue and discussion, providing a space for leading development thinkers to share their latest research ideas with Manchester's staff and students.
Graphs and charts analyzing low legislative productivity in Congress as well as trends in partisanship and ideological gaps among Congressional leaders
Seminar on the topic - Policies for care of elderly in India includes provisions, rights, legal protection and services available for elderly people in INDIA.
Factors influncing demanding senior care productÃkash Raƞga
The empirical study attempts to find how the old age people are known to the health care related products of Bangladesh in different economic status. The physical and health condition of older men and women trend to same in many other developed and developing countries. In the context of growing number of older population it has become one of the major challenges for the planners of Bangladesh.
This Policy Framework is intended to inform
discussion and the formulation of action plans
that promote healthy and active ageing.(World Health Organization)
As various smart home technology companies spring up in India, in this report, we explore how smart homes can benefit the elderly by listing the cultural dimensions of the elderly in India and taking a closer look at a model for elderly care in Norway for inspiration.
Care in China - a study of senior citizens' wellbeing lifestylesPiia Tiilikainen
The purpose was to understand Chinese seniors and their lifestyles, as well as potential care needs. The study was commissioned by Active Life Village Ltd. and carried out by Tongji University, School of Inclusive Design in Shanghai using service design methods such as observation and video diaries. Three typical personas were found: 'The Health-conscious Couple', 'The Independent Granny' and 'The Young-Old'. Report highlights their typical day and key findings related to wellbeing and care.
The National Policy for Older Persons (NPOP) 1999 India Sailesh Mishra
The Indian government after many years of debate finally declared the National Policy of the Older Persons in January 1999, the International Year of the Older Persons. The policy highlights the rising elderly population and an urgent need to understand and deal with the medical, psychological and socio-economic problems faced by the elderly. However what the policy did emphasize was on the dominant role the non governmental organizations should play to assist the government in bringing forth a society where the needs and the priorities of the elderly are taken into account. It recognized the Older Persons as a Resource of the Country.
Effectiveness of Gardening Therapy in Intergrating People with Mental illness into the Society
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Simple Square Foot Gardening for Schools - Teacher Guide =
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SocialIissues of Elderly People in IndiaSulimpaDas1
It is all about those people who still have superstitious beliefs about old age homes, who still stigmatize them.
If you looking for an Retirement Home in kolkata then please go and check this website -https://www.aumorto.in/
#retirementhome #retirementhomekolkata #oldagehome
Healthcare delivery systems in India need a thorough look by reformist in India. Ehealth may be a probable option tool to help integrating hospital and community care
IMPLEMENTING ACTIVE AGEING (A WHO FRAMEWORK POLICY) IN COMMUNITY DWELLING E...Alakananda Banerjee
The innovative project empowers elders in community on health and social issues. Local Senior Citizen Organizations in cities are adopted. A Multi Service Health Centre is run by elders, in a space donated by the organization. Collaborative sessions on common diseases are taken by allied health professionals training older persons who volunteer to be local supervisors. These supervisors take care of elders in their neighborhood who are inactive /needing long term care. The nuclei of elders thus formed, are aware of issues pertaining to them, improving their QOL. Elders participate /plan activities according to existing culture and environment for e.g. in our two Agreements for Performance of Work with WHO SEARO at New Delhi (2014) & Kolkata (2015) targeted older women volunteers, where self management of chronic diseases like arthritis, hypertension with simple lifestyle modifications incorporating diet and exercises were taught. The focus group of women planned interventions with inputs from professionals. Our projects are monitored and data published in various national and international journals. www.dharmafoundationofindia.org.Supervisors refer elders to the centre, which help elders avail health services in the neighborhood and ,financially help sustain running of the Centre too. Such simple, cost effective intervention can be future guidelines of Multi Service Health Centres/Community /Recreation Centres/Polyclinics in the urban areas and Primary Care Centres in rural and semi urban areas. Preventive health models which empower populations may be one of the important aspects of future eldercare in India. We hope to develop future guidelines with data from multicentric projects in India.We have our projects of MSHC presently at Kolkata and Ahmednagar(Maharashtra)
Neuroplasticity, also known as brain plasticity, is an umbrella term that describes lasting change to the brain throughout an animal's life course. The term gained prominence in the latter half of the 20th century, when new research showed many aspects of the brain remain changeable (or "plastic") even into adulthood.
Physical therapists are exercise experts, providing services for a wide range of people to
optimise their physical ability. They prescribe exercise as part of a structured, safe, and
effective programme.
An important part of their role is to help people remain active as they age. More than any other
profession, physical therapists (known in many countries as physiotherapists) prevent and treat
chronic disease and disability in aging adults through specifically prescribed activity and
movement.
The World Health Organization encourages regular physical activity for older adults, because it
has been shown to improve the functional status and quality of life in this group of individuals.
An Age Friendly Initiative: Introducing Self Management to Community Dwelling Elders
The Self Management Workshop entails skill development of elders in chronic health issues.Education and awareness helps elders to understand common diseases ,prevention and maintaining a healthy life.
A growing number of elderly with chronic diseases or disabilities require a family caregiver, or several, for physical, emotional, and financial support; for daily activities and medical.
Medical advances, new drugs, improved technology, and possible preventive strategies might be decreasing mortality and extending life. Since the 1970’s, medical care has resulted in a progressive shift from “care in the community to care by the community.”
This oral presentation was given at the International Congress on Gerontology and Geriatric Medicine, AIIMS 2009.
Effect of Active Ageing Program in Improving Geriatric Depression Score in Co...Alakananda Banerjee
Depression is a common mental disorder that presents with depressed mood, loss of interest, pleasure, feeling of guilt or low self worth, disturbed sleep/appetite, low energy and poor concentration.
According to WHO, these problems can become chronic or recurrent and lead to substantial impairment in an individual’s ability to take care of his/her everyday responsibilities.
Community based mental health studies have revealed that the point prevalence of depressive disorders amongst the geriatric population in India varies between 13-25%.
According to WHO remaining active means maintaining one’s physical , social and mental potential throughout the entire lifecycle, allowing the involvement of elderly in social, economic, cultural, spiritual and civic activities.
A Support Group for Breast Cancer may be one of the aspects of care of breast cancer, where education and awareness of problems faced by women after a breast cancer may be discussed and shared.
The involuntary loss of urine, which is objectively demonstrable, with such a degree of severity that it becomes a social or hygienic problem is a common scene in older women. These slides focus on role of physiotherapy in treatment of urinary incontinence in older women
TOWARDS BUILDING AN AGE FRIENDLY COMMUNITYCollaborative initiative of WHO-S...Alakananda Banerjee
Community and Health Services a feature of the WHO Guidelines on Towards Building Age Friendly Community was adopted for community dwelling older women at Chattarpur Extension,New Delhi.Results of the collaboration betwwen WHO-SEARO and dharma Foundation of India is shared in these slides
The Dharma Foundation of India under the leadership of Dr Alakananda Banerjee is working to promote the Active Ageing Initiatives in India. This slides give a brief outline of the work done in New Delhi,India
Age Friendly City, First international age-friendly cities conference,Dublin ...Alakananda Banerjee
It is important for cities to understand that the infrastructure of a city should help in mobility and self sufficiency of elders who live in the community. The WHO has frame worked guidelines based on criteria which may help to make a city Age Friendly. This concept does not only help the elders ,but all populations in general can have a safe and healthy environment.
Universal health coverage was established in the WHO constitution of 1948 declaring health a fundamental human right.The goal of universal health coverage is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them.
Older people are at the heart of the strategy, and their responses and contributions will be vital to developing the plan further
A linked-awareness that everyone has an interest in these developments, because we will be older in time, and hope to live in a community and a society that respects ,includes and cares for us
It presents the vision of the new partnership, its aims and approaches, and an outline of practical and cost effective ways to achieve them through technology social and environment changes.
DFI is determined to set standards and lead the way for other cities in India.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Towards building an age friendly city :Building community and health service at New Barrackpore,North 24 Paraganas,West Bengal.
1. FINAL REPORT
(24TH
AUGUST TO 31st
NOVEMBER 2015)
TOWARDS BUILDING AN AGE FRIENDLY COMMUNITY AT
NEW BARRACKPORE, KOLKATA, WEST BENGAL
SELF MANAGEMENT AND COMMUNITY INITIATIVE FOR JOINT PAINS AND
HYPERTENSION IN OLDER WOMEN
2. FINAL REPORT DHARMA FOUNDATION OF INDIA
2
CONTENTS
1. Project team
2. Background
3. Project Area
4. Project objectives
5. Methodology
6. Results
7. Discussion
8. Conclusion
9. References
10. Acknowledgement
3. FINAL REPORT DHARMA FOUNDATION OF INDIA
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1. PROJECT TEAM:
NAME PHONE NO. EMAIL ID PRESENT ADDRESS
PERMENENT
ADDRESS
DESIGNATED
Alakananda
Banerjee 9811020093 dharma.dfi@gmail.com
66-A,Street No 2,
Krishna Nagar,
Safdarjang Enclave,
New Delhi-110029 New Delhi Project Director
Basab Kumar
Bandyopadhyay 9582322562 bkban17@gmail.com
B 8/126 Kendriya
Vihar, Behind
Haldiram, VIP Road,
Kolkata
Kolkata, West
Bengal
Project Coordinator
Robins Kumar 9910848401 robins.342@gmail.com
66-A,Street No 2,
Krishna Nagar,
Safdarjang Enclave,
New Delhi-110029
New Delhi, India
Project Advisor
4. FINAL REPORT DHARMA FOUNDATION OF INDIA
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2. BACKGROUND:
2.1Population Ageing in India: A major demographic issue for India in the 21st century is
population ageing, with wide implications for economy and society in general. With the
rapid changes in demographic indicators over the last few decades, it is certain that India
will move from being a young country to an old country over the next few decades.
Presently (Census 2011), India has around 90 million elderly almost 8% of the total
population and by 2050, the number is expected to increase to 315 million, constituting 20
per cent of the total population. The Population Composition in the percentage of
population in the age group 60 years and above, in bigger states of India is as mentioned
below (Indian Census 2011). Since our project area is New Barrackpore, Kolkata we have
highlighted that the urban parts of the state of West Bengal show a higher trend, with
9.3 % of population as elderly men and 9.6% as elderly women.(1)
(Table 1)
Table 1: Percentage of population in the age group 60 years and above in main states of India(Source :Indian Census 2011)
5. FINAL REPORT DHARMA FOUNDATION OF INDIA
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According to WHO definition of older or elderly person, age classification varied between
countries and over time, reflecting in many instances the social class differences or
functional ability related to the workforce, but more often than not was a reflection of the
current political and economic situation. Many times the definition is linked to the
retirement age, which in some instances, was lower for women than men. This transition in
livelihood became the basis for the definition of old age which occurred between the ages
of 45 and 55 years for women and between the ages of 55 and 75 years for men.
2.2 Towards building an age friendly community: In developing countries, the share of
elder population in urban communities will multiply 16 times from about 56 million in 1998
to over 908 million in 2050. By that time, elders will comprise one fourth of the total urban
population in less developed countries. (4)
Seeing this huge increase in the number of older
persons it is important that cities provide structures and services to support their
residents’ wellbeing and productivity. Older people in particular require supportive and
enabling living environments to compensate for physical and social changes associated
with ageing. The concept of Age Friendly City was conceived in June 2005 at the opening
session of the XVIII IAGG World Congress of Gerontology and Geriatrics in Rio de Janeiro,
Brazil. Later many other countries participated, wherein a Guide for Global Age Friendly
Cities was published by the WHO, (Ageing and life course, Family and Community Health)
in 2007.The guideline included the checklist of core age-friendly features which provided a
universal standard for an age-friendly city (5)
The eight essential features taken into consideration which make a city age friendly are
i. Outdoor spaces and buildings
ii. Transportation
iii. Housing
iv. Social participation
v. Civic participation and employment
6. FINAL REPORT DHARMA FOUNDATION OF INDIA
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vi. Respect and social inclusion
vii. Communication and information
viii. Community and health service
The concept of Towards Building an Age Friendly City emphasizes an active role of the
older persons as full partners in improving their life and environment placing strong
importance on collaboration, active participation, and community engagement with elders.
The WHO framework on Active Ageing also forms the basis for success of an Age Friendly
City. Active Ageing is the process of optimizing opportunities for health, participation and
security in order to enhance quality of life as people age. In an age-friendly city, policies,
services, settings and structures support and enable people to age actively by recognizing
the wide range of capacities and resources among older people (Active Ageing: A Policy
framework)
2.3 Health of older persons in India: The incidence of health conditions in older persons,
such as falls, cognitive impairment, vision impairment, hearing impairment, delirium,
dizziness and frailty, is increasing. The average Indian doctor does not get exposed to the
required education to manage such conditions. Geriatric medicine is not encouraged as a
practice. As a result of this, except for a few private hospitals, geriatric patients are
attended to in the internal medicine department of most government owned public
hospitals. Internists, without being specially qualified to assess and treat geriatric
conditions attend to such patients. Therefore, the average geriatric medical condition goes
under/untreated and the total burden in the population of such conditions is always
underestimated. With increasing life spans, older persons in India are commonly facing
health problems which were considered rare two generations back.
2.4 Older women in India: Various studies proved that the share of older women
especially in rural areas appears to be larger than their male because of their higher life
expectancy. Income insecurity, illiteracy, age related morbidity, and physical and economic
dependency are factors that tend to make the Indian older persons, and particularly older
7. FINAL REPORT DHARMA FOUNDATION OF INDIA
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women, vulnerable. In addition to problems of illiteracy, unemployment, widowhood and
disabilities, older women in India also face life-long gender based discrimination, resulting
in differential patterns of ageing of men and women.(2)
The Global Report on Ageing in the
21st Century (2012) reinforces the observations made in India that there is multiple
discrimination experienced by older persons, particularly older women, including access to
jobs and health care, subjection to abuse, denial of the right to own and inherit property,
and lack of basic minimum income and social security (UNFPA &Help Age International,
2012).Compared to men, the health status of women in India was found to be poor.
Currently, elder women in India face a multitude of health problems like cough, joint pains,
blood pressure, heart disease, diabetes and cataract/loss of vision.(2)
2.5 About joint pain and hypertension in older women: Joint pains in forms of arthritis,
fibromyalgia, and osteoporosis are common in elderly. Most studies in India show that
more than half of the older persons (more number of women than men) represented
various physical problems from which joint pains is the commonest one, with 59.5% men
and 67.3% women in India suffering from this condition(2)
Hypertension is one of the most
important treatable causes of mortality and morbidity in the older persons(8)
In a meta-
analysis of 34 epidemiological studies from rural and urban populations of India, it was
observed that hypertension is emerging as a major public health problem in India and is
more prevalent among urban people compared to those of rural area.(3)
Patients with
hypertension may experience adverse effects on well-being and health-related quality of
life which can be associated with headache, dizziness, and tiredness. Hypertension is the
key disease which leads to cardiovascular diseases.
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2.6 Self management and community initiatives for older women: Proper nutrition and
lack of exercises plays a major role in an individual’s overall health; psychological and
physical health status. In this collaborative attempt between WHO SEARO and DFI on the
concept “Towards Building an age friendly world”,(4)
we have introduced a self
management and community initiative for 108 older women in the urban community.
Older women with joint pains and hypertension are chosen to participate in this project.
This program is a multi-dimensional intervention that engages subjects with in a series of
classes in which they are helped to develop critical knowledge, skills and motivation to
move forward in their recovery and achieve their personal goals. Such nonmedical
interventions can assist elders in coping with and adapting to their illnesses as proven
through various studies provide better functional outcomes and are more cost effective
than conservative care, surgery or more invasive procedures.
2.7 Programs of Dharma Foundation of India (DFI) towards Building Community and
Health Service: The DFI has worked since 2010 to establish an Age Friendly Community at
New Delhi in collaboration with local senior citizen organisations. The present DFI-WHO
SEARO collaboration shall entail and effort towards this cause at New Barrackpore,Kolkata
in the state of West Bengal.
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9
3. PROJECT AREA:
The project area chosen for this work is New Barrackpore in West Bengal. It lies in the
suburban area of Kolkata. (Figure as below)
3.1 Geography of New Barrackpore: New Barrackpore comes in the jurisdiction of Kolkata
700131. New Barrackpore (also spelt New Barrackpur) is a town and a municipality under
New Barrackpore police station of Barrackpore subdivision, District Kolkata, in the Indian
state of West Bengal.
3.2 Statistics of New Barrackpore: Statistics of New Barrackpore is still not available in
India Census 2011. India Census 2001 shows the following statistics (5)
(Table 2)
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Population
83,192 (Census-2001) (Male-41,813, Female - 41,379)
% of Literacy 95.19% (Male-97.59%, Female-92.72%)
Area 16.89 Sq. K.M.
Ward 19 Nos.
Mouza 4 Nos.
Holding 14,680 Nos.
Density of Population 4925 Nos.
Population under BPL 20,889 Nos.
No. of Hospital
One Maternity & General Hospital run by Municipality, Ambulance-2 Nos.
Two IPP-VII Centres, 11 sub-Centres,
4 CUDP-II Health Sub-Centres
Post Office 3 Nos. (One-Main & Two sub-Post Office)
Cinema hall 1 No.
Police Station 1 No.
Road
115.84 KM. (Pucca –108.80 KM,
Kuccha – 7.04 KM,)
Drain
321.10 KM (Pucca – 43.92 KM, Under Ground Drain - 0.51 KM,
Kuccha – 276.67 KM)
Educational Institution
College – 3, H.S School – 7,
Secondary School – 3 ,Jr. H.S. - 1,
Primary School-36
Water
Hand Tube well –316 Nos.,
Deep Tube well- 15 Nos.
Burial Ground 2 Nos. (Muslim - 2)
Table 2: Statistics of New Barrackpore, Indian Census 2001
3.3 Profile of New Barrackpore:
11. FINAL REPORT DHARMA FOUNDATION OF INDIA
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New Barrackpore's population is primarily based on the descendents of refugees from
Bangladesh (formally East Pakistan), who migrated here prior to 1950s due to turmoil in
Bangladesh. New Barrackpore hosts 'Pushpa Mela' every winter with many fascinating
collections of many enterprising florists. 'Kristi' is a community auditorium where often
cultural events are held. There are universities and good Bengali medium schools in the
vicinity. Some centres and playgrounds cater to various activities for children in the area.
Common transport like auto rickshaw, cycle rickshaw, van, bus take commuters from the
interior part of the New Barrackpore to the main street or road connecting to the other
parts of Kolkata .The condition of roads available are satisfactory, the roads are
appropriately lit with good lights. Some of the roads leading to markets are congested and
water logged during the rainy season. Water is available through pipelines systems or
carried by people from tube wells constructed in some areas.
Buses, taxis frequently ply on these roads connecting the main parts of Kolkata to New
Barrackpore. The Kolkata International airport is approximately 10 kms from the centre of
New Barrackpore. The New Barrackpore railway station is very close by so communication
to the city of Kolkata and other districts are quite easy.
12. FINAL REPORT DHARMA FOUNDATION OF INDIA
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3.4 Facilities for older persons at New Barrackpore: Most elderly are associated with one
of the many organisations in the area. There are many temples and community centres at
New Barrackpore which older persons visit. Festivals like Dassera, Diwali are held in great
spirits and scale where elders play an important role. The main health problems faced by
older women in the area are diabetes, cardiac issues and arthritis. Most of the seniors avail
health benefits under government sponsored schemes like CGHS, ECHS etc. The
neighbouring organisations hold health camps and awareness workshops which are
sponsored from big hospitals like Apollo, Fortis and local nursing homes. These hospitals
are around 10-15 kms from New Barrackpore. During emergencies elders visit these
hospitals. The population of elders also belong to the low socio economic class, who are
labourers or working as helpers in houses/residencies of the area. These elders take health
consults from the charitable health clinics running in the vicinity like Tridhara, Vivekananda
Parishad and Palli Udayan. There are chemists, grocery shop, fish and vegetable markets in
Municipality Markets in each block of New Barrackpore.
4. PROJECT OBJECTIVES:
To teach self management of joint pains and hypertension through exercises and
diet modifications to older women.
To connect older women to community group therapy and peer groups having
similar problems.
To create a future model for community and health services and promote age
13. FINAL REPORT DHARMA FOUNDATION OF INDIA
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friendly cities.
5. METHODOLOGY:
5.1 Training:
Physiotherapists, dieticians and their assistants were trained for doing assessments and
prescribing intervention of exercises and diet protocols for joint pain and hypertension.
5.2 Interventions:
5.2.1 Self-management: Self-management is about using one’s own resources to help
manage their condition. A combination of the following techniques is used.
i. Keeping active, exercising daily.
ii. Following healthy diet pattern.
iii. Keeping notes or a diary regarding one’s own symptoms, treatment and
activities to establish what makes the arthritis or hypertension better or
worse.
5.2.2 Community Initiatives: Every subject attends 2 workshops/group therapies on joint
pains and hypertension. We held peer group discussion meetings in the Community Centre
in small and big groups to learn/share from each other, how to manage the symptoms of
joint pains and hypertension. Two follow visits for every subject was arranged at the
Community Centre. It was encouraged to perform group exercises and share notes on their
participation in self managing their health problems. Awareness of their problems was
shared in brief presentations on the topics by the physiotherapist and dietician.
14. FINAL REPORT DHARMA FOUNDATION OF INDIA
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5.2.3 Physical Therapy Intervention: The following interventions advise to the subjects by
the physical therapists after a detailed assessment of her joint pains and hypertension.
i. Joints protection
ii. Practical changes at home and at work
iii. Managing pain
a) Exercises for subjects with joint pain: The following points were explained to subjects (6) (7)
i. Benefits of exercises
Better range of movement and joint mobility
Increased muscle strength
Less stiffness
Increased strength and energy
Managing weight
Better sleep
Maintain bone strength
Improve sense of well-being
ii. Types of exercise shown
Range of movement
Strengthening
Aerobic exercises
Breathing exercises
iii. Keeping active with arthritis
Walk to work, to the shops etc
Mopping the floor, is a good aerobic exercise
Doing the washing up can help loosen finger joints
Gardening can work out the whole body
15. FINAL REPORT DHARMA FOUNDATION OF INDIA
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b) Exercises for subjects with hypertension and prevention of hypertension: Having high
blood pressure and not getting enough exercise are closely related. The risk of high blood
pressure (hypertension) increases with age, and if the blood pressure is already high,
exercise and physical activities to ones daily routine help.(7)
Physical activity that increases
heart and breathing rates is considered aerobic activities are,
Household chores
Climbing stairs
Walking
Jogging
At least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity
a week or a combination of moderate and vigorous activity is recommended to control
hypertension(8)(9)
.
5.2.4 Diet Intervention:
a) Diet and Osteoarthritis:
A healthy diet to keep weight down was recommended (10)
High in fruit and vegetables
High in starch and fiber
Low in fatty foods and salt
Low in added sugars
The following points were reiterated
Cut Extra Calories
Fruits and Vegetables
Add Omega-3 Fatty Acids
b) Diet and hypertension
Interaction between diet and hypertension: Importance of proper diet play a very major
role in the prevention, management and treatment of hypertension is explained .As
hypertension is a lifestyle disorder which requires various diet modifications will be
16. FINAL REPORT DHARMA FOUNDATION OF INDIA
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explained to subjects. (10)(12)
Counseling people regarding the complications of hypertension
as well as educating how changes in the diet especially in the intake of salt consumption,
fat and sugar intake can lower the blood pressure and hence decrease the complications
holds key importance. Education on maintenance of ideal body weight and reduction in
body weight (if overweight), lowers the blood pressure.
5.3 Inclusion and exclusion criteria:
Women equal or more than 50 years of age.
Able to understand and follow exercise and diet regime.
Able to move in and around the house.
Women who were bedridden and requiring long term care will be excluded.
Women diagnosed with accelerated hypertension will be excluded
Women with severe cardiac and neurological disorders will be excluded
5.4 Sampling Method:
17. FINAL REPORT DHARMA FOUNDATION OF INDIA
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A community initiative to recruit subjects was arranged by a local senior citizen
organization and other organization working for upliftment of senior citizens at New
Barrackpore .A community centre situated in the municipal market of New Barrackpore
was chosen as the place for holding workshops and follow up visits .The physiotherapist
and dietician were available everyday at the centre. Mr. Ashit Bhattacharya an active
member of the local senior citizen organization was the point of contact. Awareness of the
workshop and its benefits to older women having joint pain and hypertension was
advertised by the local cable TV operators with a campaign stating “Awareness and
Assessment of Joint Pains and Hypertension in Older Women” The programs was
scheduled for 30th
August 2015 and 30th
September 2015.A convenient sampling method
was used to recruit women, above and equal to 50 years of age, amongst those who
attended the “Awareness And Assessment Program “at the community centre.
5.5 Duration of project and resource material on intervention:
Duration of project was three months. Each subject was asked to continue exercises and
diet as prescribed for 8 weeks. They were encouraged to keeping notes or a diary regarding
one’s own symptoms, treatment and activities. Resource material of intervention protocols
on exercises and diet explained in easy pictorial format were distributed.
18. FINAL REPORT DHARMA FOUNDATION OF INDIA
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5.6 Caregiver Education: Caregivers of older persons who accompanied them to the
workshops were educated about subject problems and how to help her at home to do
exercise and diet modification. The caregivers of subjects older than 70 years were handed
additional resource material.
5.7 Outcome measures: The following outcome measures were documented as part of
initial assessment.
Age, education, marital status, occupation.
Mini Nutritional Assessment: The MNA is a validated nutrition screening and
assessment tool that can identify subjects who are malnourished or at risk of malnutrition.
The MNA was developed nearly 20 years ago and is the most well validated nutrition
screening tool. Originally comprised of 18 questions, the current MNA now consists of 6
questions and streamlines the screening process.
Blood Pressure (BP)measurement (using a sypgnomanometer)
Brief Pain Inventory: The Brief Pain Inventory (BPI) has become one of the most
widely used measurement tools for assessing clinical pain. The BPI allows patients to rate
the severity of their pain and the degree to which their pain interferes with common
dimensions of feeling and function. Initially developed to assess pain related to cancer, the
BPI has been shown to be an appropriate measure for pain caused by a wide range of
19. FINAL REPORT DHARMA FOUNDATION OF INDIA
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clinical conditions.
Barthel Index (BI): The Barthel scale or Barthel ADL index is an ordinal scale used to
measure performance in activities of daily living (ADL).
5.8 Procedures: All participants who attended the “Awareness and Assessment Program”
were screened and selected based on the inclusion and exclusion criteria. Out of 124
women who participated in the program, 12 subjects were excluded based on screening, 4
subjects declined to participate in the intervention therefore 108 subjects were selected
and assessed individually on the above outcome measures. After detailed assessment of
demographic profile, pain and blood pressure, exercise and diet interventions were
explained to each subject recruited. Resource material was distributed to each selected
subject in the first workshops. Resource material was also given to caregivers of subjects
who needed to be helped at home. Follow up was done to each subject telephonically.
Caregivers were also contacted incase subject could not explain her condition. Every
subject was asked to follow up twice in the community centre for group sessions .The BP,
BPI and BI was documented at the beginning and end of 8 weeks of start of intervention.
6: RESULTS:
6.1 Statistical analyses: Data were entered in Microsoft Excel spreadsheet. Descriptive
statistics like mean, median and proportions were calculated using Statistical Package for
the Social Sciences (SPSS) version 13.0. About 95% confidence intervals were calculated for
proportions.
6.2 Demographic profile: Mean value of age of subjects was 62.3 with range between 50-
85 (SD-7.64).Out of total sample size, it was found that 93% were married and 7% were
widowed. The educational status of the participants were, 26% (n-28) were illiterate, 20%
(n-22) studied till matric (10th
standard), 20% (n-22) studied till intermediate (12th
standard), 32% (n-34) were graduates and 2 %( n-2) were post graduates. Occupational
status of subjects showed 83 %( n-90) were housewives, 11 %( n-12) were doing
government or private job and 6 %( n-6) had retired.
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6.3 Common health problems reported by subjects: As documented in the Brief Pain
Inventory (BPI), 72% subjects (n-78) complained of pain in the knee joint, 35% (n-38) were
suffering from lower backache, 9% (n-10) had neck pain, 10% and 12% had pain their upper
extremity and lower extremity respectively. In addition the following problems were
reported, 9% subjects (n-10) were diagnosed by their physician with vertigo, 49% subjects
(n-53) with diabetes and 59 % subjects (n-64) with hypertension. (Figure of chart as below)
6.4 Nutritional Status: (Mini nutritional assessment, MNA):
The Mini Nutritional assessment showed 96% subjects falling in the category of normal
nutritional status and 4% were at the risk of malnutrition. There were no subjects who fell
in the category of malnourishment. (Table 3)
No of subjects 108
12-14 points: Normal nutritional status
96%
8-11 points: At risk of malnutrition
4%
0-7 points: Malnourished
0%
Table 3: Mini Nutritional Assessment
72%
35%
9%
10%12%
9%
49%
59%
Common health problems
Knee Pain
Back Pain
Neck Pain
Lower Limb Problem
UpperLimb Problem
Vertigo
Diabetes
Hypertension
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Compliance to dietary modifications: Standard diet of subjects was checked during the
initial assessment. Diet modification was explained to all participants by the dietician. The
dietician followed up with each subject telephonically .Two follow ups were done at the
community centre. It was documented at the end of project that 43% subjects complied
with the diet modifications. It was also documented that 53% took regular medications in
the form of calcium and vitamin supplements.
6.5 Joint Pain: Brief Pain Inventory (BPI) was used to measure the intensity, location of
pain and hindrance in activity of daily living due to pain. Almost every subject complained
of pain. 72% of subjects complained of pain in the knees, which was seen as the
commonest joint pain. We found significant difference in all the component of BPI in our
final assessment. Incidence of pain in joints showed improvement in the final assessment.
There was a significant improvement in symptoms of worst pain, least pain and average
pain in the past 24 hours and interference of pain in past 24 hours in general activity,
mood, walking ability, normal work, relationship with other people, sleep and enjoyment
of life. (Table 4)
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Sr.No BPI Pre BPI Post
Std.
Deviation
P-value t-Value Sig. (2-
tailed)
1
Have you had pain other
than everyday kinds of
pain today? 99% 99%
- 0 0
2 Location of Pain?
Knee Pain 72% 70%
- - -
Back Pain 35% 34%
- - -
Neck Pain 9% 9%
- - -
Lower Limb Pain 8% 5%
- - -
Upper Limb Pain 6% 6%
- - -
3
WORST PAIN in the last
24 hours? 4.47 3.27
1.34969 0.656 9.197 0
4
LEAST PAIN in the last
24 hours? 3.36 2.62
1.10084 0.636 6.818 0
5
AVERAGE PAIN in the
last 24 hours?
3.46 2.84 1.01132 0.758 6.375 0
6
Pain you have RIGHT
NOW?
4.27 4.27 - 0 0
7
What TREATMENTS or
MEDICATIONS presently
you are on?
Drugs(for pain relief) 78% 73%
- - -
Exercise 65% 87%
- - -
Yoga 54% 62%
- - -
8
Did you get RELIEF from
the treatments or
medications provided?
48.88 52.77 0.82974 0.841 -5.412 0
9
In the past 24 hours, has
pain has INTERFERED
with your:
General activity
4.22 3.07 1.59915 0.841 7.461 0
Mood
3.67 3.21 1.02129 0.585 4.638 0
Walking ability
4.37 4.09 0.82974 0.792 3.479 0.001
Normal work
4.42 4.1 0.90511 0.909 3.721 0
Relations with other
people
1.74 1.61 0.6279 0.885 2.145 0.034
Sleep
2.02 1.79 0.73123 0.961 3.29 0.001
Enjoyment of life 6.02 5 1.3874 0.935 7.629 0
Table 4: Brief Pain Inventory
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In the initial assessment the BPI also showed, physical activity in terms of exercises was
done by 65% subjects, yoga done by 54%, and medications taken for pain relief by 78%
subjects. The final assessment showed increase of 87% in subjects performing exercises
and 62% subjects did yoga. Medications for pain relief decreased, with 73% subjects taking
them by the end of the project.
6.6 Blood Pressure (pre and post exercise) in subjects:
59% subjects reported to have hypertension as diagnosed by their physician, 53% subjects
took anti hypertensive medications prescribed by their physician. Subjects were not given
any advice on medications and were asked to continue medications as prescribed by their
physician. Initial assessment included information on existing blood pressure
measurements. At the end of three months there was no difference in blood pressure as
initial and post assessment mean score of diastolic and systolic pressure was in normal
value of 120/80 mm of Hg. (Table 5)
Mean
Diastolic(mm of Hg)
Mean
Systolic (mm of Hg)
Pre 79.9 125.9
Post 79.3 124.2
Table 5: Blood Pressure Measurements
6.7 Activity of Daily Living (ADLs) based on Barthel Index:
Mean paired t-test were used to compare the change in activity of daily living functioning
of subjects at the beginning and end of project. There was significance difference (t-test-
7.079) between initial and final assessments documented on BI. Subjects showed
improvement in self care activities like using a toilet. (Table 6)
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Paired Samples Test
Paired Differences
t p
Sig. (2-
tailed)
Mean
difference
Std.
Deviation
Std. Error
Mean
95% Confidence Interval
of the Difference
Lower Upper
Barthel – Pre+Post -4.81481 7.06862 0.68018 -6.16319 -3.46644 -7.079 1.34 0
Table 6: Barthel Index
6.8 Follow up on phone and at the community centre:
The selected subjects are called once a week, to enquire about problems faced by them in
following the interventions explained. Those subjects who did not give their phone
numbers are individually informed by the local organization to visit the physiotherapist and
dietician at the Community Centre. The physiotherapist calls all selected subjects
telephonically took feedback on improvement in pain and any symptoms of hypertension.
Those subjects who are having problems with pain were asked to see the physiotherapist
at the Community Centre.
6.9 Community Initiatives through group meetings:
Group Therapy and discussion meeting amongst older women having similar problems are
discussed. Subjects share notes and discuss how they are managing their pain and
hypertension. Group discussion was interactive and joyful.
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6.10 Feedback from participants:
Feedback of the awareness and assessment program (see feedback format as below) was
taken on phone from 20 subjects randomly 2 weeks after the Awareness and assessment
program. Program evaluations which were answered in YES or NO included the following:
1. You have gained knowledge and applied knowledge learned.
2. You found Awareness and Assessment Program useful and interesting.
3. The resource materials provided to you were helpful.
4. Follow up on phone and visiting physiotherapist and dietician at the community centre
was helpful.
5. Can self-management help deal with chronic health conditions in older persons?
6. Do you feel motivated to follow interventions advised after meeting peers in group
therapy and follow up sessions?
7. Your suggestions. (in few words)
The participants felt that the program helped them to understand the pain problems
better. 89% participants gave positive feedback (YES) on all the above points.11%
participants suggested that awareness and assessment programs should be conducted by
grassroots level senior citizen organizations for continuous monitoring of health problems.
They felt motivation towards self-management of chronic diseases is difficult to sustain
and can be helped with group therapy and meetings with peer groups with similar
problems. They felt pictures of exercises specific to different joints in the resource material
helped them to remember the intervention as explained by the physiotherapist.
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7. DISCUSSION:
Joint pain and hypertension are common chronic problems associated with ageing and a
major worldwide problem for medical, psychosocial, and economic reasons. Joint pains
leads to considerable morbidity in terms of pain, functional disability, lowered quality of
life, and psychological problems. Patient centered programs for self management of
arthritis, tested in the United States on volunteers from the community with
osteoarthritis and rheumatoid arthritis, had beneficial effects on pain, depression,
exercise taken, communication with doctors, and participants' perception of their capacity
to manage the disease. (15)
A previous study on review of self management programs
commissioned by the Department of Health in UK suggested that these programs can
improve knowledge, performance of self management behaviors, self efficacy, and
aspects of health status compared with standard care. (13,14)
This is relevant to the UK
government's promotion of the expert patient program in primary care settings, a generic
self management program for people with a variety of chronic diseases
(www.expertpatients.nhs.uk/). In this project we hypothesized that participation of older
women diagnosed with joint pains and or hypertension in a self management and
community initiative program, would improve their overall general health and function. At
the end of the three month duration of the project we saw enthusiasm in subjects to
involve themselves in such initiatives for self care. Women also participated in informing
friends/neighbors to join the program. They also took responsibility in arrangement in the
workshops, distributed tea and snacks to subjects, documented registration of subjects,
which overall helped in conducting a smooth program. Telephonic follow ups of subjects
and reviews in group sessions showed that the women were well motivated and
understood the exercise intervention clearly. But the subjects did not respond well to diet
interventions as they felt they were taking balanced nutrition and did not feel the need to
follow diet modifications, but they felt they should make the changes for their family
members (son/daughter/husband)!
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Caregivers responded well to concerns of their elder women at home (>60 years of age).
Women in the age group 50-59 years of age complained of caregivers not giving them
much time towards their health problems. They also felt that due to pressure of their
routine work like helping husband and children, they are unable to take care of their own
health. Most subjects in this age group complained of pain in legs and arms. Group
sessions encouraged discussion amongst subjects to speak how they were handling their
exercises as part of their daily chores. Group exercises motivated subjects to do regular
exercises and share problems they faced. Involvement of activities like stair climbing and
walking which help hypertension was well accepted by subjects. There was also joy and
cheer in these sessions as they met their friends and neighbors. It is well proven that group
therapy improves mental stimulation; improves social isolation, gives sense of
accomplishment, slow memory loss and help muscle building. Our project adds
substantially to the literature on self management and community initiatives because
participants were recruited from members of senior citizen organizations, the intervention
had an impact on the wellbeing of subjects as they already were friends or neighbors living
in the same community. The results of the BPI showed primarily an improvement in knee
pain, and most of all an improvement in the interference of pain in their general activity,
mood, walking ability, relation with other people, sleep and enjoyment of life participants
were more confident about managing pain and other arthritis related symptoms as a
result. Other outcomes, in particular the Barthel Index showed an significant improvement
especially in toilet use, which included handling clothes, wipe, flushing the toilet showing a
favorable trend in the subjects. These findings indicate that the intervention improves
participants' ability to manage their symptoms and leads to an improvement in the pain
interfering in their life. There were no changes in outcomes of hypertension even though
subjects reiterated improving their participation in activities like stair climbing and walking.
The results of no changes may be due to the fact that most subjects were on anti
hypertensive medication prescribed by their physician. A study of a longer duration may
show changes in blood measurements or lead to reduction in medications for
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hypertension. It is not clear whether these changes have positive and long term effects on
patient behavior and morbidity. It is clear that group sessions of workshops which include
awareness and understanding of health program, may motivate an older person to be
disciplined to follow simple intervention of exercises and diet and therefore self manage
their health problem .It may be interesting to have further research on whether only self
management may results in same benefit as against a program which combine self
management with community initiatives.
As mentioned in WHO guidelines, an “age-friendly” city is one that promotes active aging;
that is, it optimizes opportunities for health, participation, and security in order to enhance
quality of life as people age. They all address needs related to health (e.g., accessible and
affordable health and health care services and opportunities to stay active), participation
(e.g., accessible public transportation, information services, recreational programs, social
connections, volunteer opportunities, place to worship, and the need to be valued and
respected), and security (e.g., home and community safety, transportation safety, financial
security) (16).
Self management and community initiative programs may be an ideal way to
promote good health in older persons. It may be a cost effective way to prevent and cure
common diseases seen in this population. Such initiatives may not replace hospital based
care but empowers older person to understand their health problems and promote
prevention of further co morbidities.
Strength and Limitations: Telephonic interviews with subjects who did not attend the
follow up sessions in community centers indicated the main reason was timing of the local
group; subjects were busy with local festivities or had difficulties with access to the
community centers. Results of the intention to treat and per intervention analyses suggest
that poor attendance did not affect the final results—results were similar for all subjects
who had been offered the complete intervention and those who attended one or more
sessions. Such programs need to consider how to maximize participation, and the relatively
poor uptake of the intervention is of concern in terms of the accessibility and acceptability
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of self management program in the community. Our project show small positive changes
across all outcome measures, BPI and BI, but these were statistically significant only for
general health outcomes. But it does indicate that the intervention can lead to benefits in
wellbeing for participants with pain; however, although these benefits were statistically
significant, the effects were small and their clinical relevance for the population tested as a
whole is unclear. Further work is needed to establish any predictive factors that might
indicate older persons of different age groups who are most likely to benefit. Larger effects
may be more likely in volunteers with high levels of motivation and morbidity.
Indications for further research: The main impact of this complex intervention was on
general health outcomes, but the process by which this was achieved is unclear.
Psychological benefits needs to be included. We need to understand further how to
incorporate plans to whereby the intervention can effect change. It may be an important
aspect to understand how the various components of the intervention may impact on
different outcomes which could allow appropriate targeting of older persons to the
intervention. This is important given the heterogeneity of this population receiving a
generic self management approach to any chronic disease.
8. Conclusions
Results of this project show that self management and community initiatives provide some
relief for older persons who are prone to suffer from joint pains. Prevention of co
morbidities can be an important benefit of this program. Self management and community
initiatives may be an effective way to build community health services, which is one of the
features of making a city, age friendly. It may be fruitful to formulate research and projects
on understanding this program in various cities of India which can help global policies to
improve community and health services for older persons in India and abroad.
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9. Acknowledgements:
We sincerely express our appreciation to WHO-SEARO for funding and guiding us
throughout the project. We also thank all the subjects who enthusiastically participated .We
wholeheartedly thank the following organizations for furthering the cause of senior citizens
in the community at New Barrackpore.
1. Welfare Association of Senior Citizen(New Barrackpore)
2. RCC Bilkanda (New Barrackpore)
3. Junior Red Cross Unit (Indian Red Cross Unit,North 24 Paraganas)
4. Help for Human and Human Rights, Lenin Garh
10. References:
1. Indian census 2011, chapter 2,population composition
2. Women and Aging: Problems and Prospects;
http://www.wscpedia.org/index.php?option=com_content&view=article&id=789:comminity-
care&catid=17:completed-projects
3. Gupta R. Meta-analysis of prevalence of hypertension in India. Indian Heart Journal 1997; 49: 43-8.
4. Global Age Friendly Cities, A Guide
http://www.who.int/ageing/publications/Global_age_friendly_cities_Guide_English.pdf?ua=1
5. Statistics of New Barrackpore, https://en.wikipedia.org/wiki/New_Barrackpore
6. Physical Activity and Health http://www.cdc.gov/nccdphp/sgr/pdf/sgrfull.pdf
7. Exercise and arthritis. American College of Rheumatology.
http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/exercise.asp. Accessed Dec. 18,
2012.
8. Physical activity and blood pressure. American Heart Association.
http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/PreventionTreatmentofHighBloodPressure/Physical-
Activity-and-Blood-Pressure_UCM_301882_Article.jsp. Accessed July 27, 2015.
9. AskMayoExpert. Hypertension care process model, incorporate lifestyle modifications. Rochester, Minn.: Mayo
Foundation for Medical Education and Research; 2014.
10. Prevalence, awareness, treatment and control of hypertension among the elderly in Bangladesh and India: a
multicentre study, hypertension study group http://www.who.int/bulletin/arch
11. Diet and Arthritis, Dr Áine O’Connor,Nutrition Scientist,British Nutrition Foundation.
12. Diet, nutrition and the prevention of hypertension and cardiovascular diseases K Srinath Reddy1,* and Martijn B
Katan2Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India:
Division of Human Nutrition and Epidemiology, Wageningen University, Wageningen, The Netherlands
13. Barlow J et Al. Self-management approaches for people with chronic conditions: a review. Patient Educ
Counsel 2002;48: 177–87.
14. Warsi A, Wang P,LaValley M, Avorn J, Solomon DH. Self-management education programs in chronic disease: a
systematic review and methodological critique of the literature. Arch Intern Med 2004; 1641–9.
15. Lorig KR, Mazonson PD, Holman HR. Evidence suggesting health education for self-management in patients with
chronic arthritis has sustained health benefits while reducing health care costs. Arthritis Rheum 1993; 36: 439–46.
16. Louise Plouffe and Alexandre Kalache Towards Global Age-Friendly Cities: Determining Urban Features that Promote
Active Aging,Journal of Urban Health: Bulletin of the New York Academy of Medicine, Vol. 87, No. 5
doi:10.1007/s11524-010-9466-0 * 2010 The New York Academy of Medicine