In spite of the countless benefits of breastfeeding, prevalence of exclusive breastfeeding (EBF) has been far from optimal in the developing world. Breastfeeding problems at or after 4 weeks has been reported as one among the constraints to EBF. The study aimed to determine the breastfeeding problems in the 1 ^st postnatal week, their predictors and impact on EBF rate at 6 months. Under a prospective cohort design, 400 mother-newborn dyads were assessed for breastfeeding problems before discharge and at 60 ± 12 h of discharge. Nearly 89% of the mother-newborn dyads had one or more BF problems before discharge. Major concern was difficulty in positioning and attaching the infant to the breast (88.5%), followed by breast and nipple problems (30.3%). BF problems continued to persist even after discharge in a significant proportion of the mothers (72.5%). The only independent predictor of BF problems in the 1 ^st week was the caesarean section (odds ratio: 1.9, 95% confidence interval: 1.3-3.2, P < 0.05). There was a marked improvement in the EBF status (69.5%) at 6 months, and BF problems did not predict EBF failure at 6 months.

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A retrospective study was performed to assess the pattern of pediatric ocular trauma in a tertiary eye center in eastern India. Records of 672 patients aged 16 years or less with ocular trauma who attended the outpatient department or emergency or treated as inpatients at a tertiary referral center between April 2009 and March 2010 were reviewed. Boys accounted for 70% cases. Most children were of the 5-10 years age group. Closed globe injury was the commonest (418 patients, 62.19%), followed by open globe injuries (127 patients, 19%), orbital injuries (52 patients, 7.67%), superficial foreign bodies (7.14%) and burn (4.01%). Home was found to be the commonest place of injury (44%), and only 51.9% attended the health facility within 24 h. Conservative management was done in 497 (74%) cases, whereas 175 (26%) cases were treated surgically. Final visual outcome of 443 (66%) patients were between 20/20 and 20/50. Sixty-eight patients had worst visual outcome with monocular blindness of the injured eye. Strategies to reduce the incidence of ocular trauma at home should be directed towards raising the parental education and public awareness.

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Background: Following the implementation of family physician program in 2004 in Iranian healthcare system, the understanding in changes in physicians' practice has become important. Objective: The objective of this study was to determine the level of family physicians' job satisfaction and its relationship with their performance level. Materials and Methods: A cross-sectional study was conducted among all 367 family physicians of East Azerbaijan province in during December 2009 to May 2011 using a self-administered, anonymous questionnaire for job satisfaction. The performance scores of primary care physicians were obtained from health deputy of Tabriz Medical University. Results: In this study, overall response rate was 64.5%. The average score of job satisfaction was 42.10 (±18.46), and performance score was 87.52 (±5.74) out of 100. There was significant relationships between working history and job satisfaction (P = 0.014), marital status (P = 0.014), and sex (P = 0.018) with performance among different personal and organizational variables. However, there was no significant relationship between job satisfaction and performance, but satisfied people had about three times better performance than their counterparts (all P < 0.05). Conclusions: The low scores of family physicians in performance and job satisfaction are obvious indications for more extensive research in identifying causes and finding mechanisms to improve the situation, especially in payment methods and work condition, in existing health system.

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Background: The lack of national oral health policy and organized school dental health programs in the country call for affordable, accessible, and sustainable strategies. Objectives: The objective was to compare the oral hygiene, plaque, gingival, and dental caries status among rural children receiving dental health education by qualified dentists and school teachers with and without supply of oral hygiene aids. Materials and Methods: This interventional study was conducted among 15-year-old children selected randomly from four schools in Nalgonda district between September 2009 and February 2010. Schools were divided into four different intervention groups. The intervention groups varied in the form of intervention provider and frequency of intervention one of which being the control group. The oral hygiene, plaque, gingival, and dental caries status was assessed at baseline and 6 months following the intervention. SPSS 16 was used for analysis. Results: The preintervention and postintervention comparison within each group revealed a substantial reduction in mean oral hygiene index-simplified (OHI-S), plaque index (PI), and gingival index (GI) at postintervention compared to baseline in group 4 (1.26, 0.87, and 0.74, respectively) followed by group 3 (0.14, 0.37, and 0.12, respectively). The OHI-S, PI, and GI scores increased in group 1 (0.66, 0.37, and 0.34, respectively) and group 2 (0.25, 0.19, and 0.14, respectively). Mean decayed, missing filled surfaces score between the groups was not statistically significant at baseline and postintervention. Conclusion: The dramatic reductions in the OHI-S, PI, and GI scores in the group supplied with oral hygiene aids call for supplying low cost fluoridated toothpastes along with toothbrushes through the school systems in rural areas.

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Background: Headache disorders are common and burdensome throughout the world, placing high demand on health care services. Good information on their prevalence and distribution through sectors of the population are a prerequisite for planning interventions and organizing services, but unavailable for India. Objectives: To find out the prevalence of headache disorders in Karnataka State and establish important sociodemographic associations. Materials and Methods: Using a door to door survey technique, amongst 2997 households, 2329 individuals were interviewed with a validated structured questionnaire by randomly sampling one adult member (aged 18-65 years) from eligible households in urban (n = 1226) and rural (n = 1103) areas of Bangalore, during the period April 2009 and January 2010. Statistical Analysis Used: Chi-square, odds ratio (OR), and logistic regression. Results: The 1-year prevalence of headache was 63.9% (62.0% when adjusted for age, gender and habitation) and 1-day prevalence (headache on the day prior to the survey) was 5.9%. Prevalence was higher in the age groups of 18-45 years, among females (OR = 2.3; 95% confidence interval: 1.9-2.7) and those in rural areas. Prevalence was higher in rural (71.2 [68.4-73.8]) than in urban areas (57.3 [54.5-60.1]) even after adjusting for gender. The proportion of days lost to headache from paid work was 1.1%, while overall productivity loss (from both paid and household work) was 2.8%. Conclusions: Headache disorders are a major health problem in India with significant burden. It requires systematic efforts to organize effective services to be able to reach a large number of people in urban and rural India. Education of physicians and other health-care workers, and the public should be a pillar of such efforts.

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Scrub typhus is a tropical febrile zoonotic disease caused by Orientia tsutsugamushi of the rickettsial family. These are obligate; intracellular Gram-negative coccobacilli transmitted by the bite of infected mites. It is usually under-diagnosed in India due to its varied and nonspecific clinical presentation, limited awareness, and low index of suspicion among clinicians and lack of diagnostic facilities. This study was planned to monitor the level of scrub typhus-specific antibodies among febrile patients in a tertiary care hospital over a period of 1 year for which a rapid qualitative immunochromatographic assay (Standard Diagnostics, Korea) was introduced for the detection of IgM, IgG and IgA antibodies to O. tsutsugamushi from the serum of suspected febrile patients. A total of 98 out of 772 fever patients (12.69%) tested positive for the presence of antibodies against O. tsutsugamushi. Persistent high-grade fever was the defining characteristic in all the cases with the presence of an eschar in only 10.2% (10/98) of cases. Three patients died during the study period while the rest responded to treatment with doxycycline.

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There is a paucity of scientific information about safe sex practices of Indians immigrants living in popular multicultural nations such as Australia. An online survey of adult Indian men living in Australia was conducted to measure the frequency of use of safe sex practices using the Safe Sex Behavior Questionnaire (SSBQ). Among the respondents of the SSBQ (n = 184), 16.8% (n = 31) reported that never insist on condom use, when having sexual intercourse. One in two men surveyed, agreed that it is difficult for them to discuss safe sex issues with their sexual partners. One in two men said that they used alcoholic beverages prior to or during sexual intercourse. There were no significant differences in SSBQ data among Indian men based on their relationship status. The current study has assessed a range of safe sex practices by involving a community sample of Indian men, and provides baseline data for further evaluation and comparison.

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Background: Job satisfaction is a hypothetical construct that is measured on both cognitive and affective parameters. Job satisfaction has been defined as an affective reaction to one's job and an attitude toward it. Objective: To develop the job satisfaction scale for health care providers. Materials and Methods: After exploring existing job satisfaction scales, extensive review of the literature and detailed discussion with different health providers, the statements were prepared for developing the job satisfaction scale. The data were collected on a sample of 333 and analysis was done using SPSS to calculate the Cronbach's alpha value for reliability and validity of the scale. Principal Component analysis and factor analysis of job satisfaction scale were also done. Results: Reliable and valid scale with Cronbach's alpha value of 0.909 was developed. Scale was tested on a mixed group of health care providers in government health facilities in 2013. In the factor analysis, seven components were identified out of 49 items related to job satisfaction. The seven factors emerged from the analysis. These are: Factor (1) privileges attached with job, (2) interpersonal relation and cooperation, (3) working environment, (4) patient relationship, (5) organization facilities, (6) career development, (7) human resource issues. Conclusion: The job satisfaction scale having high reliability and validity is a good tool; it could be used in the health sector for understanding the satisfaction level of health care providers. Study provides a good starting point for standardization of scale in both urban and rural health care setting.

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Public health laboratories play a critical role in disease surveillance and response. With changes in disease dynamics and transmission, their role has evolved over time, and they serve a range of important public health functions. For their effective functioning, it is important to have specialized manpower in these laboratories, which can contribute to their maximum utilization. The present manuscript is an attempt to explore the human resource capacity building initiatives for public health laboratories in India. Using three parallel methods we have attempted to gather information regarding various human resource capacity building initiatives for public health laboratories in India. Our study results show that there is a paucity of programs providing specialized training for human resources in public health laboratories in India. It highlights the urgent need to address this scarcity and introduce capacity building measures to generate human resources for public health laboratories to strengthen their role in public health action.

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Background: Perceived organizational support (POS) measures the employee perception of support from the organization and helps to understand the employer-employee relationship better. The aim of the study is to understand the healthcare professionals' perception of support from public health department and to examine thehealthcare professionals' difference in perception of support across various demographics variables. Methods: A survey is conducted among healthcare professionals including medical officers and staff nurses working in primary health centres (PHC) in the state of Tamilnadu. In the study, public health department refers to the Directorate of Public Health and Preventive Medicine. Mann Whitney U test and Kruskal Wallis H test are used to assess the difference in POS across demographic variables. Results: The results of the study indicated that the healthcare professionals perceive a moderate levelof support from public health department. The healthcare professionals' POS is found to differ across their age, role and total work experience but not across gender and work experience in the current PHC. Further, the POS of healthcare professionals is found to differ with respect to PHC location and does not differ with respect to PHC type. Conclusion: The results emphasize the need to enhance POS of healthcare professionals. The health policy makers and mangers have to consider the difference in POS of healthcare professionals and make amendments in the human resource policies related to selection and training.

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Three distinct groups of people, the sick, at risk and a healthy population constitute the beneficiaries of any health services. Available health care packages are based on the paradigm of the "natural history of the disease and the five levels of the prevention." Patient-centric "personal care services" and community centric "public health care" are the two packages universally provided to a community. A health care system can only be effective and efficient if there is balanced mix of the personal and public health care delivered as a comprehensive package in a regionalized graded manner by a well-trained manpower. The current health care delivery system is mostly personal care centered and public health component is in the fringes and being delivered as vertical programs through the multipurpose health worker. The alternative model speaks about bi-furcating the two types of services and delivering both as a comprehensive package to the community. As per the constitution of India health services including major public health services are state subject but the nature of emerging public health problems relates to mass movement of people and goods, environmental changes due industry and other developmental activities etc. resulting in the spread of the same beyond the manmade geographical boundary, some public health activity may be included in the union/concurrent list. To deliver the packages a public health cadre may be created at the state and center and be equipped with public health knowledge and skill to deliver well-defined evidence-based service package to control the existing problem and keep strict vigilance to prevent entry/emergence of new health problems.

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