An evaluation of Primary health care system in Kerala

The thesis entitled An Evaluation of Primary Health Care System in Kerala. The present study is intended to examine the working of primary health care system and its impact on the health status of people. The hypothesis tested in the thesis includes, a. The changes in the health profile require reallocation of resources of primary health care system, b. Rate of utilization depends on the quality of services provided by primary health centers, and c. There is a significant decline in the operational efficiency of the primary health care system. The major elements of primary health care stated in the report of AlmaAta International Conference on Primary Health Care (WHO, 1994)” is studied on the basis of the classification of the elements in to three: Preventive, Promotive, and Curative measures. Preventive measures include Maternal and Child Health Care including family Planning. Provision of water and sanitation is reviewed under promotive measures. Curative measures are studied using the disease profile of the study area. Collection of primary data was done through a sample survey, using pre-tested interview schedule of households of the study area. Multi stage random sampling design was used for selecting the sample. The design of the present study is both descriptive and analytical in nature. As far as the analytical tools are concerned, growth index, percentages, ratios, rates, time series analysis, analysis of variance, chi square test, Z test were used for analyzing the data. Present study revealed that no one in these areas was covered under any type of health insurance. Conclusion states that considering the present changes in the health profile, traditional pattern of resource allocation should be altered to meet the urgent health care needs of the people. Preventive and promotive measures like health education for giving awareness among people to change health habits, diet pattern, life style etc. are to be developed. Proper diagnosis and treatment of the disease at the beginning of the stage itself may help to cure majority of disease. For that, Public health policy must ensure the primary health care as enunciated at Alma- Ata international Conference. At the same time Public health is not to be treated as the sole responsibility of the government. Active community participation is an essential means to attain the goals.

Determinants of Consumer Purchase Decisions of Health Insurance in Kerala

This research work was to study the level of awareness of consumers about health insurance concept and market, consumer perceptions about health insurance providers, schemes and various factors that influence buying decision of health insurance. There is need to bring entire age group – high risk and low risk under health insurance cover. Widening the cover of health insurance calls for indepth understanding of consumer thinking and extensive marketing efforts based on that. Hence the study of consumer perceptions and the impact of different contributing factors on consumer purchase decision assume significance to the marketer. Understanding the consumer thinking on health insurance will also be of relevance to governmental/non governmental agencies, as affordable health care to all is a policy objective of the government and new schemes are being launched in this area.

Labour, social and health outcomes of immigrants in Australia : effects of language proficiency using the IV approach

Language has been of interest to numerous economists since the late 20th century, with the majority of the studies focusing on its effects on immigrants’ labour market outcomes; earnings in particular. However, language is an endogenous variable, which along with its susceptibility to measurement error causes biases in ordinary-least-squares estimates. The instrumental variables method overcomes the shortcomings of ordinary least squares in modelling endogenous explanatory variables. In this dissertation, age at arrival combined with country of origin form an instrument creating a difference-in-difference scenario, to address the issue of endogeneity and attenuation error in language proficiency. The first half of the study aims to investigate the extent to which English speaking ability of immigrants improves their labour market outcomes and social assimilation in Australia, with the use of the 2006 Census. The findings have provided evidence that support the earlier studies. As expected, immigrants in Australia with better language proficiency are able to earn higher income, attain higher level of education, have higher probability of completing tertiary studies, and have more hours of work per week. Language proficiency also improves social integration, leading to higher probability of marriage to a native and higher probability of obtaining citizenship. The second half of the study further investigates whether language proficiency has similar effects on a migrant’s physical and mental wellbeing, health care access and lifestyle choices, with the use of three National Health Surveys. However, only limited evidence has been found with respect to the hypothesised causal relationship between language and health for Australian immigrants.

The health effects of temperature : current estimates, future projections, and adaptation strategies

Climate change is expected to be one of the biggest global health threats in the 21st century. In response to changes in climate and associated extreme events, public health adaptation has become imperative. This thesis examined several key issues in this emerging research field. The thesis aimed to identify the climate-health (particularly temperature-health) relationships, then develop quantitative models that can be used to project future health impacts of climate change, and therefore help formulate adaptation strategies for dealing with climate-related health risks and reducing vulnerability. The research questions addressed by this thesis were: (1) What are the barriers to public health adaptation to climate change? What are the research priorities in this emerging field? (2) What models and frameworks can be used to project future temperature-related mortality under different climate change scenarios? (3) What is the actual burden of temperature-related mortality? What are the impacts of climate change on future burden of disease? and (4) Can we develop public health adaptation strategies to manage the health effects of temperature in response to climate change? Using a literature review, I discussed how public health organisations should implement and manage the process of planned adaptation. This review showed that public health adaptation can operate at two levels: building adaptive capacity and implementing adaptation actions. However, there are constraints and barriers to adaptation arising from uncertainty, cost, technologic limits, institutional arrangements, deficits of social capital, and individual perception of risks. The opportunities for planning and implementing public health adaptation are reliant on effective strategies to overcome likely barriers. I proposed that high priorities should be given to multidisciplinary research on the assessment of potential health effects of climate change, projections of future health impacts under different climate and socio-economic scenarios, identification of health cobenefits of climate change policies, and evaluation of cost-effective public health adaptation options. Heat-related mortality is the most direct and highly-significant potential climate change impact on human health. I thus conducted a systematic review of research and methods for projecting future heat-related mortality under different climate change scenarios. The review showed that climate change is likely to result in a substantial increase in heatrelated mortality. Projecting heat-related mortality requires understanding of historical temperature-mortality relationships, and consideration of future changes in climate, population and acclimatisation. Further research is needed to provide a stronger theoretical framework for mortality projections, including a better understanding of socioeconomic development, adaptation strategies, land-use patterns, air pollution and mortality displacement. Most previous studies were designed to examine temperature-related excess deaths or mortality risks. However, if most temperature-related deaths occur in the very elderly who had only a short life expectancy, then the burden of temperature on mortality would have less public health importance. To guide policy decisions and resource allocation, it is desirable to know the actual burden of temperature-related mortality. To achieve this, I used years of life lost to provide a new measure of health effects of temperature. I conducted a time-series analysis to estimate years of life lost associated with changes in season and temperature in Brisbane, Australia. I also projected the future temperaturerelated years of life lost attributable to climate change. This study showed that the association between temperature and years of life lost was U-shaped, with increased years of life lost on cold and hot days. The temperature-related years of life lost will worsen greatly if future climate change goes beyond a 2 °C increase and without any adaptation to higher temperatures. The excess mortality during prolonged extreme temperatures is often greater than the predicted using smoothed temperature-mortality association. This is because sustained period of extreme temperatures produce an extra effect beyond that predicted by daily temperatures. To better estimate the burden of extreme temperatures, I estimated their effects on years of life lost due to cardiovascular disease using data from Brisbane, Australia. The results showed that the association between daily mean temperature and years of life lost due to cardiovascular disease was U-shaped, with the lowest years of life lost at 24 °C (the 75th percentile of daily mean temperature in Brisbane), rising progressively as temperatures become hotter or colder. There were significant added effects of heat waves, but no added effects of cold spells. Finally, public health adaptation to hot weather is necessary and pressing. I discussed how to manage the health effects of temperature, especially with the context of climate change. Strategies to minimise the health effects of high temperatures and climate change can fall into two categories: reducing the heat exposure and managing the health effects of high temperatures. However, policy decisions need information on specific adaptations, together with their expected costs and benefits. Therefore, more research is needed to evaluate cost-effective adaptation options. In summary, this thesis adds to the large body of literature on the impacts of temperature and climate change on human health. It improves our understanding of the temperaturehealth relationship, and how this relationship will change as temperatures increase. Although the research is limited to one city, which restricts the generalisability of the findings, the methods and approaches developed in this thesis will be useful to other researchers studying temperature-health relationships and climate change impacts. The results may be helpful for decision-makers who develop public health adaptation strategies to minimise the health effects of extreme temperatures and climate change.

A study of the information seeking bebavior of science and technology teachers and researchers of Cocbin University of Science and Technology and University of Kerala in the cbanged library environment

Information communication technology (IC T) has invariably brought about fundamental changes in the way in which libraries gather. preserve and disseminate information. The study was carried out with an aim to estimate and compare the information seeking behaviour (ISB) of the academics of two prominent universities of Kerala in the context of advancements achieved through ICT. The study was motivated by the fast changing scenario of libraries with the proliferation of many high tech products and services. The main purpose of the study was to identify the chief source of information of the academics, and also to examine academics preference upon the form and format of information source. The study also tries to estimate the adequacy of the resources and services currently provided by the libraries.The questionnaire was the central instrument for data collection. An almost census method was adopted for data collection engaging various methods and tools for eliciting data.The total population of the study was 957, out of which questionnaire was distributed to 859 academics. 646 academics responded to the survey, of which 564 of them were sound responses. Data was coded and analysed using Statistical Package for Social Sciences (SPSS) software and also with the help of Microsofl Excel package. Various statistical techniques were engaged to analyse data. A paradigm shift is evident by the fact that academies push themselves towards information in internet i.e. they prefer electronic source to traditional source and the very shift is coupled itself with e-seeking of information. The study reveals that ISB of the academics is influenced priman'ly by personal factors and comparative analysis shows that the ISB ofthc academics is similar in both universities. The productivity of the academics was tested to dig up any relation with respect to their ISB, and it is found that productivity of the academics is extensively related with their ISB. Study also reveals that the users ofthe library are satisfied with the services provided but not with the sources and in conjunction, study also recommends ways and means to improve the existing library system.

Studies on seed pathology and seedling diseases of some important indigenous tree species of kerala

In forestry, availability of healthy seeds is an important factor in raising planting stock. Initial seed health and storage conditions are the major factors governing the germinability of seeds. Like seeds of agricultural and horticultural crops, forest tree seeds are also liable to be affected by micro-organisms during storage, which affects the germination, and reduces the viability. Further introduction of seed-borne diseases into newly sown crops/areas on account of using unhealthy seeds is also not ruled out. Availability of healthy stock of seedlings is intrinsic for raising plantations and to meet this requirement elimination of nursery diseases by appropriate chemicals is of prime imortance. As exotic tree species may become susceptible to various native pathogens, it is generally considered better to select indigenous tree species for large scale plantations as they are well adapted to local environment. However, before taking up large scale afforestation progranme involving any indigenous tree species, it is essential to have knowledge about seed disorders and seedling diseases and their management. with a View to select appropriate tree species with fewer seed disorders and seedling disease problems for use in further plantation programme, four indigenous tree species such as Albizia odoratissima (L.f) Benth., Lagerstroemia microcazpa Wt., Pterocazpus marsupiwn Roxb. and Xylia xylocarpa (Roxb.) Taub. were evaluated to meet the above parameters

Seoimentology And Geochemistiiy Of Some Selected Mangrove Ecosystems Of Kerala, Southwest Coast Of India

As a result of the issues of care and conservation and sustainable utilisation, the proper management of mangrove forests have become more pressing than ever. Much recent ecological and toxicological debate has been centered around the question of validity of making predictions about the future of mangrove ecosystemas a result of the newly evolved environmental policy. Though muchinformation exist on the biodiversity, floristic composition and characteristics, geographical distribution and uses of mangroves, systematic documentation of the various sedimentological and geochemical phenomena in relation to the mangrove flora are scarce. Hazardous, persistent, man-made chemicals and waste produces are entering the mangrove ecosystem at from the adjacent watersheds which strengthened alarming rates the indispensible need for further researches on the environmental behaviours, fate and the effect of such products. Studies on the effect of heavy metals, pesticides and the other toxic signals through bioassay and toxicity tests on mangrove species as well as in sediments definitely will furnish ample clues to establish the actual operative mechanisms of these environments. A thorough review of literature made in this angle reveals that some attempts have already been initiated the world over the record the physico-chemical characteristics of major abiotic components such as sediments and water of many mangrove ecosystem, however, adequate information is lacking in the Indian Environmental Science scenario. The present investigation is an attempt to record the sedimentological, mineralogical and geochemical characteristics of sediments as well as the heavy metal enrichment in the various species ofmangrove flora of three important mangrove ecosystems of Kerala, located at Veli (SouthKerala), Kochi (Central Kerala) and Kannur (North Kerala). The results of the above investigation have been analysed statistically, discussed based on the available literature and presented in this thesis under seven chapters

“Assessment of Heavy Metals in the Environmental Compartments of the Central and Northern Coast of Kerala, India”

The nearshore marine ecosystem is a dynamic environment impacted by many activities, especially the coastal waters and sediments contiguous to major urban areas. Although heavy metals are natural constituents of the marine environment, inputs are considered to be conservative pollutants and are potentially toxic, accumulate in the sediment, are bioconcentrated by organisms and may cause health problems to humans via the food chain. A variety of metals in trace amounts are essential for biological processes in all organisms, but excessive levels can be detrimental by acting as enzyme inhibitors. Discharge of industrial wastewater, agriculture runoff and untreated sewage pose a particularly serious threat to the coastal environment of Kerala, but there is a dearth of studies in documenting the contaminant metals. This study aimed principally to assess such contamination by examining the results of heavy metal (Cu, Pb, Cr, Ni, Zn, Cd and Hg) analysis in seawater, sediment and benthic biota from a survey of five transects along the central and northern coast of Kerala in 2008 covering a 10.0 km stretch of near shore environment in each transect. Trophic transfer of metal contaminants from aquatic invertebrates to its predators was also assessed, by employing a suitable benthic food chain model in order to understand which all metals are undergoing biotransference (transfer of metals from a food source to consumer).The study of present contamination levels will be useful for potential environmental remediation and ecosystem restoration at contaminated sites and provides a scientific basis for standards and protective measures for the coastal waters and sediments. The usefulness of biomonitor proposed in this study would allow identification of different bioavailable metals as well as provide an assessment of the magnitude of metal contamination in the coastal marine milieu. The increments in concentration of certain metals between the predator and prey discerned through benthic food chain can be interpreted as evidence of biotransference.

Mosquito larvae borne viruses from the central travancore region of kerala: isolation and characterization

The present study was initiated when several massive outbreaks of Chikungunya, Dengue and Japanese Encephalitis were frequently reported across the State of Kerala. Multiple symptoms persisted among the affected individuals and the public health officials were in search of aetiological agents responsible for the out breaks and, other than clinical samples no resources were available. In this context, a study was undertaken to focus on mosquito larvae to investigate the viruses borne by them which remain silently prevalent in the environment. The study was not a group specific investigation limited to either arbovirus or enterovirus, but had a broad spectrum approach. The study encompassed the viral pathogens that could be isolated, their impact when passaged through cell lines, growth kinetics, titer of the working stocks in specific cell line, the structure by means of transmission electron microscopy(TEM), the one step growth and molecular characterization using molecular tools.

SHGs and Cooperatives in the Fishing Sector: An Inclusive Development Option for the Fisher folk of Kerala

The Kerala model of development mostly bypassed the fishing community, as the fishers form the main miserable groups with respect to many of the socio-economic and quality of life indicators. Modernization drive in the fishing sector paradoxically turns to marginalization drives as far as the traditional fishers in Kerala are concerned. Subsequent management and resource recuperation drives too seemed to be detrimental to the local fishing community. Though SHGs and cooperatives had helped in overcoming many of the maladies in most of the sectors in Kerala in terms of livelihood and employment in the 1980s, the fishing sector by that time had been moving ahead with mechanization and export euphoria and hence it bypassed the fishing sector. Though it has not helped the fishing sector in the initial stages, but because of necessity, it soon has become a vibrant livelihood and employment force in the coastal economy of Kerala. Initial success made it to link this with the governmental cooperative set up and soon SHGs and Cooperatives become reinforcing forces for the inclusive development of the real fishers.The fisheries sector in Kerala has undergone drastic changes with the advent of globalised economy. The traditional fisher folk are one of the most marginalized communities in the state and are left out of the overall development process mainly due to the marginalization of this community both in the sea and in the market due to modernization and mechanization of the sector. Mechanization opened up the sector a great deal as it began to attract people belonging to non-fishing community as moneylenders, boat owners, employers and middle men which often resulted in conflicts between traditional and mechanized fishermen. These factors, together with resource depletion resulted in the backwardness experienced by the traditional fishermen compared to other communities who were reaping the benefits of the overall development scenario.The studies detailing the activities and achievements of fisher folks via Self Help Groups (SHGs) and the cooperative movement in coastal Kerala are scant. The SHGs through cooperatives have been effective in livelihood security, poverty alleviation and inclusive development of the fisher folk (Rajasenan and Rajeev, 2012). The SHGs have a greater role to play as estimated fall in demand for marine products in international markets, which may result in reduction of employment opportunities in fish processing, peeling, etc. Also, technological advancement has made them unskilled to work in this sector making them outliers in the overall development process resulting in poor quality of physical and social infrastructure. Hence, it is all the more important to derive a strategy and best practice methods for the effective functioning of these SHGs so that the

Health monitoring of a new hysteretic damper subjected to earthquakes on a shaking table

This paper presents the experimental results obtained by applying frequency-domain structural health monitoring techniques to assess the damage suffered on a special type of damper called Web Plastifying Damper (WPD). The WPD is a hysteretic type energy dissipator recently developed for the passive control of structures subjected to earthquakes. It consists of several I-section steel segments connected in parallel. The energy is dissipated through plastic deformations of the web of the I-sections, which constitute the dissipative parts of the damper. WPDs were subjected to successive histories of dynamically-imposed cyclic deformations of increasing magnitude with the shaking table of the University of Granada. To assess the damage to the web of the I-section steel segments after each history of loading, a new damage index called Area Index of Damage (AID) was obtained from simple vibration tests. The vibration signals were acquired by means of piezoelectric sensors attached on the I-sections, and non-parametric statistical methods were applied to calculate AID in terms of changes in frequency response functions. The damage index AID was correlated with another energy-based damage index-ID- which past research has proven to accurately characterize the level of mechanical damage. The ID is rooted in the decomposition of the load-displacement curve experienced by the damper into the so-called skeleton and Bauschinger parts. ID predicts the level of damage and the proximity to failure of the damper accurately, but it requires costly instrumentation. The experiments reported in this paper demonstrate a good correlation between AID and ID in a realistic seismic loading scenario consisting of dynamically applied arbitrary cyclic loads. Based on this correlation, it is possible to estimate ID indirectly from the AID, which calls for much simpler and less expensive instrumentation.

Source location of acoustic emission waves for structural health monitoring of bridges

The process of structural health monitoring (SHM) involves monitoring a structure over a period of time using appropriate sensors, extracting damage sensitive features from the measurements made by the sensors and analysing these features to determine the current state of the structure. Various techniques are available for structural health monitoring of structures and acoustic emission (AE) is one technique that is finding an increasing use. Acoustic emission waves are the stress waves generated by the mechanical deformation of materials. AE waves produced inside a structure can be recorded by means of sensors attached on the surface. Analysis of these recorded signals can locate and assess the extent of damage. This paper describes preliminary studies on the application of AE technique for health monitoring of bridge structures. Crack initiation or structural damage will result in wave propagation in solid and this can take place in various forms. Propagation of these waves is likely to be affected by the dimensions, surface properties and shape of the specimen. This, in turn, will affect source localization. Various laboratory test results will be presented on source localization, using pencil lead break tests. The results from the tests can be expected to aid in enhancement of knowledge of acoustic emission process and development of effective bridge structure diagnostics system.