Browsing by Author "Raman Kutty, V"

Now showing 1 - 3 of 3
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    The interactions of ethical notions and moral values of immediate stakeholders of immunisation services in two Indian states: a qualitative study
    (BMJ Open, 2013-02) Varghese, J; Raman Kutty, V; Ramanathan, M
    Objectives :- This study examines the existing norms regarding immunisation within the communities and the ethical notions that govern the actions of different health professionals and their collective synergistic or conflicting effects on the governance of the programme. Design :- We used descriptive and analytical qualitative methods as it suited the research question. Setting :- The data were collected from areas under 16 primary health centres in Kerala and Tamil Nadu identified through a three-step sampling process. Participants :- This involved in-depth interviews with stakeholders including providers, beneficiaries and other stakeholders, focus group discussions with mothers of under-five children and participant and non-participant observations of vaccination-related activities. Results :-Unlike most other ethical analyses that look at the ethics of vaccination policies, the interactions of normative principles and notions are analysed in this article. Moral obligation of parents towards their children, beneficence of healthcare providers and the utilitarian aspirations of the state are the key normative principles involved. Our analysis points to the interplay of both synergy and conflict in ethical notions and moral values in the context of immunisation services. Paternalistic interventions like special immunisation campaigns against polio and Japanese encephalitis are a case in point: they generate conflict at the normative level and create mistrust. Conclusions :- Analysis of vaccination policies and programmes needs to go beyond factors that assess monetary benefits or herd immunity. Understanding the interactions of normative notions that shape the social organisation of the providers and the users of vaccination is important in creating a sustainable environment for the programme.
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    Kerala: a unique model of development
    (Health for the Millions, 1991) Kannan, KP; Thankappan, KR; Raman Kutty, V; Aravindan, KP.
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    Serum 25-hydroxyvitamin D-3 levels are elevated in South Indian patients with ischemic heart disease
    (EUROPEAN JOURNAL OF EPIDEMIOLOGY, 2001)
    Several lines of evidence point to a possible relationship between vitamin D and cardiovascular disease. Animal experiments and observational studies in humans suggest vitamin D to be arteriotoxic and an association of high intake of vitamin D with increased incidence of ischemic heart disease (IHD). The major source of vitamin D in adults is vitamin D synthesized in the skin through exposure to the sun. In tropical environment there is a possibility of high level of solar exposure and enhanced serum levels of vitamin D in the population. We explored the relation between serum level of 25-hydroxyvitamin D-3 and IHD in a case-control study involving 143 patients with either angiographic evidence of coronary artery disease or patients with acute myocardial infarction and 70 controls, all men in the age group of 45-65 years. Fasting blood samples were collected, serum separated and serum levels of 25-hydroxyvitamin D-3 was measured by protein binding radioligand assay. Serum levels of cholesterol, triglyceride, calcium, magnesium and inorganic phosphate were also determined. Prevalences of diabetes, hypertension and smoking history were noted. Statistical comparisons of variables between cases and controls were done using chi(2)-tests. Multivariate logistic regression analysis was done to examine the association of IHD with serum levels of 25-hydroxyvitamin D-3 controlling for selected variables. Serum levels of 25-hydroxyvitamin D-3, calcium, inorganic phosphate, total cholesterol, low density lipoprotein and triglycerides were elevated in a higher proportion of patients, compared to controls. Serum levels of 25-OH-D-3 above 222.5 nmol/l (89 ng/ml) was observed in 59.4% of cases compared to 22.1% in controls (p < 0.001; unadjusted odds ratio (OR): 5.17; 95% confidence interval (CI): 2.62-10.21). When controlled for age and selected variables using the multivariate logistic regression, the adjusted OR relating elevated serum 25-hydroxyvitamin D-3 levels ( greater than or equal to222.5 nmol/l, greater than or equal to89 ng/ml) and IHD is 3.18 (95% CI: 1.31-7.73). Given the evidences for the arteriotoxicity of vitamin D, further investigations are warranted to probe whether the elevated serum levels of 25-hydroxyvitamin D-3 observed in patients with IHD in a tropical environment has any pathogenic significance.