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Background: Population ageing is a recognized international reality, both in developed and developing countries. The number of elderly in the developing world is increasing due to demographic transition, whereas their condition is deteriorating as a result of fast eroding traditional family system coupled with rapid modernization and urbanization. Current statistics for the elderly gives a prelude to a new set of medical, social and economic problems that could arise if a timely initiative in this direction is not taken. Aims & Objective: To determine the pattern of physical morbidity in rural elderly population and to study health related quality of life and utilization of health services among them. Material and Methods: A community based cross-sectional design was adopted for studying the health problems of elderly and their health related quality of life, using WHO Quality of Life-BREF (WHOQOL-BREF) questionnaire. Simple random sampling technique was used for sample collection. A total of 660 individual ≥ 60 years of age were taken up for the study purpose. Results: An overwhelming majority (68.2%) of elderly enjoyed a good quality of life, while those having a fair/poor quality of life were ≤ 15%. Quality of life was better in males in physical, psychological, social and environmental domains. It was more in subjects who had graduated and currently married, belonged to non-scheduled cast and living in extended families (p<0.001). Majority of the subjects were anaemic (64.5%), suffering from dental problems (62.2%) and joint pains (51.4%). Maximum numbers of subjects (92.7%) were utilizing non-government health care facility due to long distance from their houses (33.3%). Conclusion: There is a need to highlight the medical and psychosocial problems that are being faced by the elderly people in India and strategies for bringing about an improvement in their quality of life.

Study objective -To determine the prevalence of rheumatic heart disease (RHD) and study the relationship of this disease to factors such as age, sex, housing, and socioeconomic status in Shimla town and the adjoining rural area. Design -A cross sectional survey, carried out by a specially trained examiner in cardiology. Setting -The study involved high risk school children (5-16 years of age) from Shimla town and the adjoining rural area of Kasumpti-Suni Block in the period 1992-93.Subjects -A total of 15 080 children on the school register (8120 boys and 6960 girls) were examined generally and specifically for evidence of RHD. Main results -Of the 15 080 children screened, the prevalence of rheumatic fever (RF)/RHD was 2-98 per thousand with no significant difference between the age groups of 5-10 and 11-16 years or in either sex (p>0'05). The prevalence was significantly greater in rural schools (4-8/ 1000) than in urban schools (1 98/1000) (p<0.05). There was overcrowding and poor housing in most cases. There were fewer cases of RHD with severe valvular lesions in the younger age group than in the older children. The mitral valve was the valve most commonly affected by RFI RHD.Conclusions -RHD continues to be a serious health problem. Regular surveys are needed to identify cases early and to ensure secondary prophylaxis with penicillin is given thereby preventing recurrence of RF and progression ofthe severity of the valvular lesion. Echocardiography is necessary to identify cases ofRF/RHD. Strategies for preventing RHD should involve primary prevention to avert the first attack of carditis and strengthening of secondary prophylaxis through improved education and motivation of patients, parents, and physicians.

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Hepatitis B vaccine: Coverage and factors relating to its acceptance among health care workers of a tertiary care center in North IndiaBackground: Hepatitis B infection is the major cause of acute and chronic liver disease, cirrhosis, and hepatocellular carcinoma worldwide and has long been recognized as an occupational hazard among health care workers. Thus, this study was planned to evaluate the coverage of hepatitis B vaccine and to study occupational, epidemiologic, and attitudinal factors in its acceptance among health care workers in a tertiary care hospital. Materials and Methods: A cross-sectional study was conducted among HCWs of MM Institute of Medical sciences and Research, Mullana. A total of 600 health care workers were selected for the study by simple random sampling method. A self designed, semi-structured interview schedule was used to collect data from the participants by interview method. Data on demographic, behavioral, and occupational exposure aspects were also collected. Results: The overall prevalence of hepatitis B vaccination acceptance was 60%. Only 40% of the health workers had received the full three dose vaccination schedule while 20% had received one or two doses, and 40% were unvaccinated. Protection against hepatitis B was cited the most common (54%) reason for taking this vaccine. The most important reasons for not taking the vaccine were negligence (41.6%), whereas the commonest (45%) ground cited for not taking the recommended number of dosage was the lack of knowledge about the total number of doses to be taken for full protection. On multiple logistic regression, vaccine safety (AOR = 6.57, 95% CI = 2.64-16.04) followed by history of exposure to blood (AOR = 5.21, 95% CI = 1.81-16.16) and acceptable knowledge about the disease (AOR = 4.76, 95% CI = 1.13-11.45) were identifi ed as reasons for acceptance of the vaccine. Conclusions: Coverage of complete immunization was low among health care workers. Level of knowledge regarding the disease was also not satisfactory. Education programs should focus on increasing healthcare workers' perceived severity to occupational exposure to hepatitis B virus and emphasize the safety and effectiveness of the hepatitis B vaccine. Vaccines should be made available free and mandatory in health organizations. Key words: Acceptance, health care workers, hepatitis B vaccinationOriginal Article INTRODUCTIONHepatitis B virus (HBV) infection is a serious global health problem. Globally, at least two billion people are estimated to have the infection, resulting in over 350 million cases of chronic infection and more than two million deaths annually.[1] It is the tenth leading cause of death worldwide. [1] In India, prevalence of HBsAg among the general population varies from 2% to 8%, which places India in an intermediate HBV endemicity zone. India with 50 million cases is also the second largest global pool of chronic HBV infection. [2] Since contact with body fl uid of an infected person, especially infected blood, is one of the principal modes of t...