Background: Cesarean delivery (CD) rates in India (21.5%) and in Jammu and Kashmir (41.7%), in particular, are way above the World Health Organization (WHO) accepted threshold of 10-15%.The study aimed to recognize the sociodemographic components associated with preference for the mode of delivery.These may form the target for future intervention.Methodology: This was a cross-sectional, hospital-based study to examine the sociodemographic factors influencing expecting mother's choice of delivery: Cesarean delivery or vaginal delivery (VD).Gravid women attending antenatal clinics were interviewed using a structured questionnaire, and data were analyzed.Results: Between August 2017 and July 2019, 1000 pregnant women participated in the study.Among them, 561 (56.1%) preferred CD.Univariate analysis revealed that patients with increasing age (30-34: OR: 1.61, p-value = 0.001; 35-39: OR: 1.94, p-value < 0.001) preferred CD over VD.Participants residing in urban areas (OR: 1.93, p-value < 0.001) and multigravid women (OR: 1.71, p-value < 0.001) preferred CD.Participants who had undergone both lower segment caesarean section (LSCS) and VD in the past and those who received information from healthcare professionals (OR: 0.17, 95% confidence interval (Cl): 0.09-0.28,p-value < 0.001) did not choose CD.Multivariate analysis revealed that urban residency adjusted odds ratio (AOR): 1.73, p-value = 0.001), multigravid women AOR: 1.56, p-value = 0.009) preferred CD whereas patients who received information from a healthcare professional (AOR: 0.15, 95% CI: 0.09-0.27,p-value < 0.001) did not choose CD.Conclusion: More than half of the women preferred CD as a mode of delivery, which is a matter of concern for both health authorities and society.The findings of this study help us better understand the variables affecting childbearing women's decisions regarding the technique of delivery.This study also emphasizes the important role that medical personnel plays in educating patients and their partners about the advantages and process of normal vaginal birth.

Background Intrinsic capacity (IC) is conceptualized by World Health Organization (WHO) with a focus on healthy aging. Identifying impairment could help in making a person-centred plan for the care of older adults. Objectives Establish the prevalence of IC among community-dwelling older adults age >60, the prevalence of impairment in each domain, and identify factors associated with an impairment in IC. Methods This cross-sectional observational study in the community setting included 1000 older adults aged 60 years and above in two-year study period. The 6 domains of IC including cognition, locomotor capacity, psychological, vitality, hearing, and vision were derived from the comprehensive geriatric assessment. The IC composite score was calculated based on these domains, and a higher IC score indicated greater IC. Results During the study period, 1000 older adults, with the median age of 66.5 (IQR-63-73) were included, and 629 (62.9%) were women. Only in 157 (15.7%) community-dwelling older adults, all 6 domains were intact. Impairment in one, two, and three domains was seen in 442 (42.2%), 305 (30.5%), and 91 (9.1%), respectively. The most prevalent impaired domain was locomotor (593, 59.3%), followed by vision (441, 44.1%), hearing (193, 19.3%), cognition (106, 10.6%), mood (38, 3.8%), and vitality (37, 3.7%). The factors associated with lower IC included increasing age (β-coefficient −0.01, 95% CI: −0.02 to −0.01, p value = 0.002), impaired activities of daily living (β-coefficient −0.13, 95% CI: −0.49 to −0.18, p value <0.001), and chronic neurologic illness (β-coefficient −0.10, 95% CI: −0.77 to −0.18, p value = 0.001). Conclusions In conclusion, we found that impairment in IC was frequent in community-dwelling older adults, and it is associated with age, presence of chronic neurologic illness, and declining functionality. The adoption of IC should be seen as an opportunity to disseminate geriatric care in our healthcare systems which lack the necessary attention to the needs of older persons.

Background The World Health Organization has conceptualised the health and healthcare of older adults around the concept of healthy ageing. Healthy ageing is defined as “the process of developing and maintaining the functional ability that enables well-being in older age”. This functional ability is the sum of two key factors: intrinsic capacity and interacting environment. This concept of intrinsic capacity encompasses a wide spectrum of health characteristics including the physiological and psychological changes associated with the ageing process. In general, IC declines from a high and stable state to an impaired status as people age. Monitoring individuals for changes in intrinsic capacity in the context of their environment will provide a holistic method of tracking the functioning of older adults at both a population and individual level, providing an opportunity to address any reversible factors of decline. However, this would require a clear and objective conceptualisation of the concept of intrinsic capacity. Methodology One hundred subjects were recruited via invitation by advertisement on the institute campus. Study participants underwent detailed physical examination and measurement of various physical and chemical biomarkers which were likely to represent intrinsic capacity as evidenced by the literature review. Outcomes measured were a decline in ADL, IADL, mortality and hospitalisation over a follow-up period of six months. Exploratory factor analysis (EFA) was done to obtain a clinical construct of the proposed entity of intrinsic capacity. Unpaired t-test and univariate logistic regression were used to check for the association between the composite score (IC) and its domains with the decline in ADL, IADL, mortality and hospitalisation. Results One composite score (composite IC score) and eight subfactors emerged. The composite score and subfactor domains showed good construct validity. Composite intrinsic capacity score and subdomains of strength and cognition were significantly different among subjects with and without ADL and IADL decline. Univariate logistic regression showed that composite intrinsic capacity score was a predictor of decline in ADL and IADL even after adjusting for age, sex, comorbidity status and education level of the subject with an adjusted odds ratio of 0.99 and 0.98, respectively. Subdomains of strength and cognition also predicted a decline in ADL and IADL independently. Conclusion The development of an objective construct of the concept of intrinsic capacity, using commonly measured clinical and biochemical parameters, is feasible and predictive of the subsequent functionality of an individual.

Medical education is witnessing severe disruption worldwide due to the ongoing COVID-19 pandemic. But at the same time, it is important to provide continuity of teaching and timely certification assessment. Overcoming the obstacles to conduct the professional examination due to SARS-CoV-2 spread, we conducted the MD Geriatric medicine final professional examination in a hybrid virtual format. In addition to creating case repository for single system cases, we included geriatric cases with multiple combination of geriatric syndromes. The examinees were assessed by the external examiners virtually through a video conferencing platform. The end results were well appreciated by all key stake holders. The concerns, logistics and experience of conducting the MD Geriatric medicine examination in a virtual format are summarized here.