Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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Prof. Somashekhar Nimbalkar
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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Saraswati Dental College
Lucknow
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On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : December | Volume : 16 | Issue : 12 | Page : LC01 - LC04 Full Version

Reasons and Barriers of Breast Self-examination among Affluent Women: A Cross-sectional Study


Published: December 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/59697.17245
Sheldon Thompson, N Pragathi Kumar, Tagaram Ramchandra, S Priyanka

1. Assistant Professor, Department of Community Medicine, Ayaan Institute of Medical Sciences, Hyderabad, Telangana, India. 2. Assistant Professor, Department of Community Medicine, Ayaan Institute of Medical Sciences, Hyderabad, Telangana, India. 3. Assistant Professor, Department of Community Medicine, Government Medical College, Nalgonda, Hyderabad, Telangana, India. 4. Assistant Professor, Department of Community Medicine, Government Medical College, Nalgonda, Hyderabad, Telangana, India.

Correspondence Address :
S Priyanka,
Assistant Professor, Department of Community Medicine, Government Medical College, Nalgonda, Hyderabad, Telangana, India.
E-mail: aqua02323@gmail.com

Abstract

Introduction: Breast Self-examination (BSE) is the simplest and easiest way to look for abnormalities. It’s an inexpensive and easy procedure that needs to be implemented from a young age. BSE will help in early diagnosis and treatment of benign and malignant tumours. Inadequate knowledge about BSE was seen usually in non affluent women. Though, affluent individuals have access to good and better healthcare, still there seems to be a lack.

Aim: To understand the reasons and barriers among affluent women concerning BSE.

Materials and Methods: This descriptive cross-sectional study was conducted in the field area of Ayaan Institute of Medical Sciences, Hyderabad, Telangana, India, from March 2021 to February 2022. A total of 250 women were included in the study between the ages of 21-49 years. Data was collected using a predesigned pretested questionnaire to evaluate socio-demographic, reasons and barriers to BSE. Data were presented in numbers and percentages.

Results: The mean age of the study population was 34.60±8.31 years. All 250 women were educated and with the majority being graduates 176 (70.4%), only 140 (56%) had a working occupation and 205 (82%) were married. The feeling of mass in either of the breast 123 (49.2%), followed by family history of breast cancer 99 (39.6%) and breast pain 92 (36.8%) were the common reasons for performing SBE. The barriers to self-examination were majorly due to lack of knowledge 164 (65.6%), lack of breast complaints 164 (65.6%), absence of lump 130 (52%), followed by 115 (46%) who did not like to touch their breast. Forgetfulness was seen in 93 (37.2%) subjects.

Conclusion: Poor awareness of the BSE practice exists even among affluent women. There is an urgent need for awareness about screening techniques, including BSE, in media and health facilities.

Keywords

Breast cancer, Breast lump, Knowledge, Screening

The chief intention of Breast Self-examination (BSE) is for early detection, intervention, and reduction in mortality. Over the years, women were educated about BSE methods, which need to be done once a month (1). Breast self-examination is no cost and a simple method that can be done in private and primarily be implemented as a screening program. The International agency for research on cancer suggested BSE women have increased survival time (2). Breast cancer is the most frequently occurring cancer and the leading cancer death, which amounts to 23% of all cancers in women globally (3). In lesser developed and developing countries, breast cancer is a leading cause of death among cancers (4). In the age group between 15-49 years in developing countries, breast cancer diagnosis is twice as high as in developed countries (5). Breast self-examination is recommended as the woman is familiar with their breast (feel and look) so as to seek help when needed. Usually, the best time for BSE is between the 7th and 10th day of their menstrual cycle once in every month to detect early and reduce the spread (6).

Early detection/diagnosis of breast cancer has a pragmatic effect on prognosis and complication development and increases the quality of life and survival (7). Many researchers noted that a lack of knowledge of BSE is usually seen in non affluent women from less developed countries. Still, women belonging to affluent families were less explored. The present study aimed to understand the reasons and barriers among affluent women with regard to breast self-examination.

Material and Methods

This descriptive cross-sectional study was conducted in the field area of Ayaan Institute of Medical Sciences, Hyderabad, Telangana, India, from March 2021 to February 2022. Institutional Ethical Committee approval (IEC NO.012/AIMS/Research/2021) was obtained prior to the study. Informed consent was obtained from all study participants in the regional language and English (whichever was applicable) from all study populations.

Sample size calculation: Considering the prevalence of breast cancer in India as 28.6% (8). The sample size was calculated for the study using the formula:

N=4pq/L2.

The sample size calculated was 239, rounded-off to 250 subjects. The sampling method used was simple stratified sampling method.

Inclusion criteria: According to B.G Prasad’s socio-economic classification (9), women belonging to the upper class, aged between 21-49 years, and willing to participate in the study were included in the study.

Exclusion criteria: Women who did not belong to the upper class according to BG Prasad’s socio-economic classification, below 21 and above 49 years of age, women with breast cancer, women not willing to participate in the study were excluded from the study.

Questionnaire

A total of 250 study participants met the inclusion criteria and 33 were excluded. A modified predesigned pretested questionnaire (10),(11),(12),(13),(14) was self-administered (Annexure 1) and explained to the study participants whenever necessary. The questionnaire was used to gather the data, and interviews were conducted to fill it out. The questionnaire was divided into three sections:

Section 1- Demographic factors: Such as age, education, occupation and marital status.

Section 2- Reasons for performing BSE: This include- fear of breast cancer, media, doctors advise, breast pain, advised by a health worker, nipple discharge, the feeling of mass, breast cancer in the family, encouraged by family/friend and other reasons;

Section 3-Barriers of BSE: Include- lack of knowledge, dislike to touch, fear/worry if found a lump, lack of time to self-examine, forgetfulness, no breast complaints, culture and belief, unavailability of specialised centre, absence of lump on previous examination and underestimation of the problem.

Section 2 and 3 allowed multiple answers for each question. This tool was created after literature research (10),(11),(12),(13),(14), and evaluating existing papers. It had 20 items as well as response choices (i.e., yes and no). Experts assessed the content validity, and the reliability was backed by a 1-week test-retest evaluation with a pilot sample (n=22) taken from the study population {reliability coefficient (alpha) 0.75 for all items}. Pilot study results were not included in present study. Eleven tutors (MBBS graduates) were considered as interviewers. The interviewers were trained how to fill out the questionnaire. A supervisor was chosen to arrange the interviews, oversee the data collection process, and evaluate and deliver questionnaires to the principal investigator in order to coordinate and manage the data gathering process.

Statistical Analysis

Data was entered into Microsoft Office Excel 2007 and analysed by Statistical Package for Social Sciences (SPSS) trial version 22.0. The results were depicted in the form of numbers and percentages. No statistical test was applied as the study was descriptive.

Results

As shown in (Table/Fig 1), the majority of patients were between 21 and 30 years 101 (40.4%), with a mean age of 34.60±8.31 years. All of them were educated and with the majority being graduates 176 (70.4%), only 140 (56%) had a working occupation, and 205 (82%) were married.

(Table/Fig 2) showed the various reasons for performing breast self-examination. Out of 250 subjects, feeling of mass in either of the breast 123 (49.2%), followed by family history of breast cancer 99 (39.6%) and breast pain 92 (36.8%) were the common reasons for performing SBE. On the advice of doctors and healthcare workers, 78 (31.2%) and 56 (22.4%) subjects self-examined, respectively. With the family/friends encouragement, 28 (11.2%) subjects underwent self-examination. The media influence was quite low, and only 21 (8.4%) examined themselves. The disheartening part was that 11 (4.4%) of subjects did not self-examine themselves because of fear.

As shown in (Table/Fig 3), the barriers to self-examination were majorly due to lack of knowledge 164 (65.6%), lack of breast complaints 164 (65.6%), absence of lump (130, 52%), followed by 115 (46%) who did not like to touch their breast. Forgetfulness was seen in 93 (37.2%) subjects and fear among 72 (28.8%) subjects. Due to the unavailability of specialised centres, 79 (31.6%) refrained from self-examining, and 59 (23.6%) of subjects said they did not have time to examine themselves. The other barriers were culture and belief (17, 6.8%), and 6 (2.4%) women underestimated the problem.

Discussion

The BSE is a practical, cost-free method that may help in breast cancer prevention (15). In developing and low-resourced countries, women getting access to advanced diagnostic procedures is a barrier (16). In these conditions, self-examination can be a reliable method for early detection of breast mass/tumours (17).

The mean age of the study was 34.60±8.31 years. All the subjects were educated, above half of the subjects were working, and most were married. A study by Dadzi R and Adam A, showed the mean age as 24.54±7.19 years, 67% (N=258) were educated (4.8% studied up to high school and 182% studied up to degree and above), 43.4% were employed, and 39.5% were married (18). In the present study, 8.4% of subjects self-examined with media being a source, 53.6% did so, on doctors (31.2%) and healthcare worker’s advice (22.4%), and 10.8% via other sources. Media (48.6%, n=105) was the major source of information about breast cancer and BSE, followed by healthcare professional’s advice 44.4 (96%) and sources like journals and books 84 (38.9%) in a study done by Karayurt O et al., (12).

A study by Ahmed A et al., suggested that 16.2% (n=105) looked for information from books, and 25.4% (n=165) discussed it among friends and self-performed. In contrast, the present study showed that 10.8% (n=27) looked for information from books and magazines, and only 11.2% (n=28) of subjects were encouraged by friends. It was also pointed out that among 301 subjects, 251 (83.4%) examined themselves reasoning nipple discharge, whereas the present study reported only 7.2% (n=18) for the same (19). In the present study, lack of SBE knowledge was reported in 65.6% (n=164) of subjects, forgetfulness in 37.2% (n=93), lack of time in 23.6% (n=59), and fear in 28.8% (n=72) whereas a study by Taleghani F et al., suggested 25.65% (n=387), 35.98% (n=543), 25.58% (n=386) and 18.75% (n=283), respectively (10). Many barriers have been identified in the present study, like lack of knowledge, discernment of disease threat, dislike to touch, fear of detection, and lack of time. However, some of the subjects practiced with the purpose of early detection. Studies done by Al-Dubai SAR et al., (n=222) and Al-Naggar RA et al., (n=251) observed almost similar barriers among Malaysian women (13),(20). In the present study, social culture and belief were the barriers which were also reported by Naghibi SA et al., (21).

Breast screening education strategies have been proven to be effective by many studies (22),(23). Therefore, there is an urgent need to develop and implement an awareness program to improve knowledge of SBE with a final target output of early detection, thereby curbing the increasing trend of disability and mortality due to breast carcinoma.

Limitation(s)

Since, the study sample included only a few people from the field practicing area of the Institution and only among affluent families, the results cannot be generalised to the larger population. Further studies with affluent and non affluent women from other areas can be conducted in future.

Conclusion

Breast self-examination should be widely practiced right from a younger age, with training starting from the school level to reduce the lack of knowledge and fear, even in women of affluent families.

References

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Forouzanfar MH, Foreman KJ, Delossantos AM, Lozano R, Lopez AD, Murray CJL, et al. Breast and cervical cancer in 187 countries between 1980 and 2010: A systematic analysis. Lancet. 2011;378(9801):1461-84. Available from: http:// dx.doi.org/10.1016/S0140-6736(11)61351-2. [crossref] [PubMed]
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Kayode FO, Akande TM, Osagbemi GK. Knowledge, attitude and practice of breast self-examination among female secondary school teachers in Ilorin, Nigeria. Eurepan Journal of Scientific Research. 2015;10(3):42-47.
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Manoharan N, Nair O, Shukla NK, Rath GK. Descriptive epidemiology of female breast cancer in Delhi, India. Asian Pac J Cancer Prev. 2017;18(4):1015-18. Available from: http://dx.doi.org/10.22034/APJCP.2017.18.4.1015.
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DOI and Others

DOI: 10.7860/JCDR/2022/59697.17245

Date of Submission: Aug 17, 2022
Date of Peer Review: Sep 02, 2022
Date of Acceptance: Nov 18, 2022
Date of Publishing: Dec 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 20, 2022
• Manual Googling: Nov 03, 2022
• iThenticate Software: Nov 15, 2022 (5%)

ETYMOLOGY: Author Origin

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