Determinants of substance use among young people attending primary health centers in India

Background

Substance use is a complex condition with multidimensional determinants. The present study aims to find the prevalence and determinants of substance use among young people attending primary healthcare centers in India.

Methods

A multicentric cross-sectional study was conducted across 15 states in India on 1,630 young people (10-24 years) attending primary health centers. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to capture data on substance use. The degree of substance involvement was assessed and multivariate regression analysis was conducted to determine the risk factors of substance use.

Results

The prevalence of substance use was 32.8%, with a median substance initiation age of 18 years. Among the substance users, 75.5% began before completing adolescence. Tobacco (26.4%), alcohol (26.1%) and cannabis (9.5%) were commonly consumed. Sociodemographic determinants included higher age, male gender, urban residence, positive family history, northeastern state residence and lower socioeconomic class. Over 80% of users had moderate or high involvement.

Conclusions

High substance use prevalence among young people in Indian healthcare centers underscores the urgency of targeted intervention. Insights on determinants guide effective prevention strategies for this complex public health issue.

Health-related physical fitness, physical activity and its correlates among school going adolescents in hilly state in north India: a cross sectional survey

INTRODUCTION

Health-related physical fitness, which includes body composition, cardiorespiratory fitness, muscular endurance, flexibility, power, and strength are associated with risks of chronic diseases and promote good health and wellness. There have been reports of increasing levels of physical inactivity among children and adolescents, leading to increasing rates of obesity and decreased physical fitness. The present study was conducted among school going adolescents to estimate the levels and correlates of PF for timely intervention.

METHODOLOGY

School based cross-sectional study was done among students of class 8-11th in Government schools of Garhwal division of Uttarakhand. Multistage stratified random sampling was applied for recruitment of study participants. We recruited a final sample size of 634 students. Validated questionnaires and standard methods for assessment of physical fitness, physical activity levels and other variables such as waist circumference, hip circumference, BMI and hemoglobin estimation were done.

RESULTS

Average and above average cardiorespiratory fitness score as per Harvard step test among boys (54.3%) was significantly higher as compared to girls (21.3%) (χ2 = 88.93, p < 0.001). There was a significant association between gender and dominant handgrip strength (χ2 = 8.02, p = 0.01) as well as between gender and Shoulder stretch test (SST) of dominant (χ2 = 17.5, p < 0.05) as well as nondominant arm (χ2 = 13.5, p < 0.05). Sit and reach test results also showed a significant association with gender (χ2 = 27.17, p < 0.001). Gender, hemoglobin level, BMI and PAL scores significantly predicted cardiorespiratory fitness scores (R2 = 0.188, F value of the model = 37.69, p =< 0.001)).

CONCLUSION

Physical fitness of school going adolescents in Garhwal division of Uttarakhand was better than other parts of India, with significant gender differences. Physical activity levels (PAL) were poor and are also a significant predictor of physical fitness. More emphasis needs to be paid on the health and fitness of girl students. School based policies to increase PAL among students through innovation and rewards may go a long way in improving the long-term health of the students.

Musculoskeletal Comorbidities among known Diabetes Patients, their Quality of Life, and Healthcare Costs: A Comparative Study From a Tertiary Care Hospital in Uttarakhand

Introduction

Diabetes is a chronic disorder with long-term sequelae and multisystem manifestation. Burden of diabetes in on the rise. Presence of other morbidities can not only have a detrimental effect on the disease treatment and recovery course, but also on the financial burden and quality of life. Present study aims to investigate how musculoskeletal conditions affect individuals with diabetes compared to those without the condition.

Material and Methods

A comparative study was conducted among patients attending the outpatient department of a tertiary care hospital in North India to assess the burden of musculoskeletal disorders in people with and without diabetes. A total of 195 diabetes patients and an equal number of individuals without diabetes were sequentially enrolled from the outpatient department (OPD).

Results

Burden of musculoskeletal comorbidities was significantly higher (46.2%) among people with diabetes than the comparison group (25.1%). The overall odds ratio (OR) for comorbidities of musculoskeletal system was 2.5 times higher in diabetes cases as compared to individuals without diabetes. The OR for rheumatoid arthritis, chronic backache, and osteoarthritis was found to be 3.6, 2.9, and 1.7 respectively. Poor quality of life and higher direct cost of treatment were found among diabetes cases with musculoskeletal comorbidities as against those without these comorbidities.

Conclusion

Presence of musculoskeletal comorbidity is high among diabetes patients, and it has an impact on the quality of life and treatment cost. Screening for musculoskeletal comorbidities should be included as part of the diabetes complication assessment to allow for early detection and treatment.

Awareness Regarding Antimicrobial Resistance and Antibiotic Prescribing Behavior among Physicians: Results from a Nationwide Cross-Sectional Survey in India

(1) Background: Understanding the physicians' knowledge, attitudes, and antimicrobial prescribing behavior is a crucial step towards designing strategies for the optimal use of these agents. (2) Methods: A cross-sectional online survey was conducted among clinicians across India between May and July 2022 using a self-administered questionnaire in English comprising 35 questions pertaining to demographic characteristics, knowledge, attitude, and practices domains. (3) Results: A total of 544 responses were received from 710 physicians contacted. Sixty percent of participants were males, with mean age of 34.7 years. Mean ± Standard Deviation scores for knowledge, attitude, and practices domains were 8 ± 1.6, 20.2 ± 3.5, and 15.3 ± 2.1, respectively. Higher scores were associated with basic [odds ratio (95% Confidence Interval), p value: 2.95 (1.21, 7.2), 0.02], medical and allied sciences [2.71 (1.09, 6.67), 0.03], and central zone [3.75 (1.39, 10.12), 0.009]. A substantial proportion of dissatisfactory responses were found regarding hospital antibiograms, antibiotics effective against anaerobes, WHO AWaRe (access, watch, and reserve) classification of antibiotics, and the role of infection prevention and control (IPC) measures in the containment of antimicrobial resistance (AMR). (4) Conclusions: There is a need to sensitize and educate clinicians on various issues related to antimicrobial use, such as antibiograms, double anaerobic cover, IPC practices, and guideline-based recommendations, to curb the AMR pandemic.

Cervical Vertebral Maturation Assessment using various Machine Learning techniques on Lateral cephalogram: A systematic literature review

Importance

For the assessment of optimum treatment timing in dentofacial orthopedics, understanding the growth process is of paramount importance. The evaluation of skeletal maturity based on study of the morphology of the cervical vertebrae has been devised to minimize radiation exposure of a patient due to hand wrist radiography. Cervical vertebral maturation assessment (CVMA) predictions have been examined in the state-of-the-art machine learning techniques in the recent past which require more attention and validation by clinicians and practitioners.

Objectives

This paper aimed to answer the question "How are machine learning techniques being employed in studies concerning cervical vertebral maturation assessment using lateral cephalograms?"

Method

A systematic search through the available literature was performed for this work based upon the Population, Intervention, Comparison and Outcome (PICO) framework.

Data sources study selection data extraction and synthesis

The searches were performed in Ovid Medline, Embase, PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Database of Systematic Reviews (CDSR). A search of the grey literature was also performed in Google Scholar and OpenGrey. We also did a hand-searching in the Angle Orthodontist, Journal of Orthodontics and Craniofacial Research, Progress in Orthodontics, and the American Journal of Orthodontics and Dentofacial Orthopedics. References from the included articles were also searched.

Main outcomes and measures results

A total of 25 papers which were assessed for full text, and 13 papers were included for the systematic review. The machine learning methods used were scrutinized according to their performance and comparison to human observers/experts. The accuracy of the models ranged between 60 and 90% or above, and satisfactory agreement and correlation with the human observers.

Conclusions and relevance

Machine learning models can be used for detection and classification of the cervical vertebrae maturation. In this systematic review (SR), the studies were summarized in terms of ML techniques applied, sample data, age range of sample and conventional method for CVMA, which showed that further studies with a uniform distribution of samples equally in stages of maturation and according to the gender is required for better training of the models in order to generalize the outputs for prolific use to target population.

Exploring the influence of food labels and advertisements on eating habits of children: a cross-sectional study from Punjab, India

BACKGROUND

Maintaining healthy eating habits among children is challenging due to industrial tactics. There is little research on the effect of nutritional labels and tv ads on the eating habits of children. So the primary aim of the study was to explore the noticeability of the food packaging labels by the children, the information retrieved from the food nutrition labels, and their role in increased frequency of eating out in addition to the perceptions of their parents about the television ads.

METHODS

A cross-sectional study was conducted at schools in Punjab, India. Using multi-stage stratified random sampling, we included 722 school-going children aged 14-18 and their parents. A structured predefined questionnaire collected data using a four-point Likert scale. Descriptive statistics and binary logistic regression were used to draw our inferences.

RESULTS

About 46% of children were eating out > 3 times a week. Nearly 49% said they never looked at the expiry dates on the food packet, and 40% have yet to notice the quality certification. Nearly half do not understand the components of the food label, and 59% said they never changed their buying behavior because of the label. Only 37% of parents expressed their concerns about the timing of the ads when children watch television, while only 25.5% were concerned about the accuracy of the information. Concerns of the parents regarding the timing of the ads, and celebrity endorsements, were potential predictors for the increased frequency of eating out by the children.

CONCLUSIONS

Low awareness regarding the utility of nutrition labels and minimal concerns of the parents increase the frequency of eating out. Unification of our existing policies regarding food labels and tv advertisements to develop family-centric interventions will bring us one step closer to improving the enabling environment to curb the growing menace of childhood obesity.

Effects of sanitation and hygiene perceptions on international travelers' health, travel plans and trip experiences in India

Background

International travelers often experience travelers' diarrhea. However, there is paucity of data on whether self-reported gastrointestinal symptoms influence travelers' perceptions of adequacy of sanitation and hygiene services encountered during travel, and to what degree their travel plans, and overall trip experience are impacted.

Methods

A cross-sectional face-to-face survey was conducted amongst international travelers in India. Data collected included socio-demographics, travel characteristics, self-reported occurrence and frequency/severity of gastrointestinal symptoms, perceptions of sanitation and hygiene encountered, and adverse effects of symptoms on travel plans and trip experiences. Chi-square tests and logistic regression were performed to describe differences and associations between categorical variables.

Results

Of the 300 international travelers surveyed, 46.3% experienced diarrhea. At least two thirds of travelers perceived the quality of sanitation (67.0%) and hygiene (70.0%) encountered to be inadequate. Perceptions of inadequate sanitation (adjusted OR = 3.0; 95% CI 1.7-5.5) and poor hygiene (adjusted OR = 7.7; 95% CI 4.1-15.5) were higher among travelers who experienced diarrhea. Additionally, both higher likelihood of travel plans being affected (adjusted OR = 10.7; 95% CI 5.1-23.6) and adverse impacts on overall trip experience (adjusted OR = 2.8; 95% CI 1.4-5.8) were reported among those who experienced diarrhea.

Conclusions

More than two thirds of travelers surveyed in India experienced inadequate sanitation and hygiene services, with perceptions influenced by occurrence and frequency of diarrhea. Self-reported diarrhea was also associated with adverse effects on travel plans and overall trip experience. While these results may seem intuitive, they have important implications and suggest that improving sanitation and hygiene standards in India could potentially enhance tourism.

Depression and quality of life among elderly: Comparative cross-sectional study between elderly in community and old age homes in Eastern India

BACKGROUND

Depression among elderly is an emerging public health concern. Along with other comorbidities, depression affects the quality of life and functional ability of the geriatric population. This study aimed to assess the depression and quality of life among elderly and compare these parameters among the inhabitants of old age home and in the community.

MATERIALS AND METHODS

A cross-sectional study was conducted among the elderly of the community and old-age homes in the urban areas of Raipur, Chhattisgarh between March and July 2016. Hundred elderly (50 in each group) participated in the study. Geriatric Depression Scale 15 (GDS-15) and Older People Quality of Life (OPQoL)-35 scale were used to assess the geriatric depression and quality of life, respectively. Association between depression and demographic variables were analyzed by Chi-square/Fisher's exact test. Pearson's correlation coefficient was calculated between GDS-15 and OPQoL-35 scale.

RESULTS

The prevalence of geriatric depression was 59%. Quality of life was better among the old-age home elderly participants than that of community elderly when compared for score of life over all (11.78 vs. 13.56), health (12.8 vs. 14.0), social relationship (10.48 vs. 13.9), control over life (11.92 vs. 14.08), home and neighborhoods (9.38 vs. 12.36), psychological and emotional wellbeing (10.96 vs. 13.7), financial circumstances (14.5 vs. 16.7), and leisure and activities (13.86 vs. 15.28). Moderate positive correlation was observed between depression and quality of life.

CONCLUSION

The higher prevalence in our study emphasizes the need to delineate the actual burden in the elderly population and provide necessary supportive measures. It needs to be addressed adequately through a coordinated primary care approach and community and social support. Timely and adequate management of depression can improve the quality-of-life outcomes.

Relevance of health education to e-learning-associated problems among the school-going adolescents in Bareilly city: An interventional study

Background

E-learning has assumed a significant part during the coronavirus disease 2019 (COVID-19) pandemic. Imposition of health education has productive outcomes on e-learners.

Objectives

To evaluate the outcome of health education in preventing and controlling the e-learning-associated health problems among the school-going adolescents in Bareilly city by imparting health education and comparing the pre- and post-intervention findings.

Materials and Methods

An interventional study was led in Bareilly city, Uttar Pradesh, India, among the school-going adolescents aged 10-19 years. All participants were explained about the objectives of the study, and an informed written consent was obtained from the parents or guardians of the study subjects. Data were collected, and their clearing, coding, and recoding were performed appropriately in Microsoft Excel spreadsheets. After this, statistical analysis was performed using SPSS (version 23.0) for windows. The pre- and post-effects of health education on the health problems of students involved in e-learning were assessed by comparing the data and applying the paired sample Wilcoxon rank test.

Results

The pre- and post-effects of health education upon the health problems of students involved in e-learning were evaluated. The various health parameters selected for the comparison were as follows: concentration, mood, behaviour, fitness, headache, body-ache, vision problems, academic performances, body mass index (BMI), sleep cycle, and anxiety. The pre- and post-comparison of all health parameters showed a statistically significant difference.

Conclusions

The outcome of the study stated a statistically significant difference in values of pre- and post-health parameters (concentration, mood, behaviour, fitness, headache, body-ache, vision problems, academic performances, BMI, sleep cycle, and anxiety) associated with e-learning. Hence, this research is highly relevant to the practice of primary care physicians.

Cardiovascular Morbidity, Quality of Life, and Cost of Care among Diabetic Patients: A Comparative Study from a Tertiary Care Hospital of Uttarakhand, India

Objectives:

Diabetes is commonly observed to be associated with several comorbidities, out of which cardiovascular comorbidities are most frequently observed. The present study has been done to estimate the proportion of cardiovascular comorbidities among patients of diabetes and to compare it with that of matched nondiabetics. It also aimed to compare the quality of life (QOL) scores and the cost of treatment between diabetics and nondiabetics with cardiovascular comorbidities.

Methodology:

A hospital-based comparative analytical study was conducted in a tertiary care hospital of Uttarakhand, India. One hundred and ninety-five diabetic were compared with an equal number of age- and gender-matched nondiabetics. We compared the two groups for the presence of comorbidities by Chi-square test and for QOL and cost of care by independent t-test. Regression was done to study factors associated with direct cost incurred for treatment among diabetics with cardiovascular comorbidity.

Results:

The present study reported about four-time higher risk (odds ratio: 3.9; confidence interval: 2.5–6.1) of comorbidities of cardiovascular system (CVS) among diabetics as compared to nondiabetics. QOL scores were reported to be significantly lower among diabetics with comorbidities of CVS in comparison to nondiabetics. Significant predictors of direct cost among diabetics were religion, marital status, income, and use of alcohol.

Conclusion:

Cardiovascular comorbidities have been reported to be four times higher among diabetics in comparison to nondiabetics, leading to an adverse effect on QOL and increased expenditure on treatment.

Tobacco consumption trends and correlates of successful cessation in Indian females: Findings of Global Adult Tobacco Surveys

BACKGROUND

Female gender is being affected disproportionately by tobacco use. The correlates of tobacco use among women are different from men, which has not been studied in India. To develop gender-sensitive interventions and policies in tobacco control, it's essential to ascertain the factors that affect tobacco consumption and successful cessation among Indian women.

METHODS

This secondary data analysis was done for females respondents aged >15 years using the data generated from the GATS-1 (2009-2010) and GATS-II (2016-2017). The primary dependent variables included interest in quitting smoking/SLT, attempt to quit smoking/SLT, successful quitting. The independent variables were broadly categorized as a community, household, and individual level. Simple descriptive analysis using % age relative change was used to calculate the change in tobacco consumption between two rounds of GATS, whereas; bivariate and multivariable logistic regression were used to calculate the unadjusted and adjusted odds ratio for cessation related variables (GATS-2).

RESULTS

There was a 29.5% relative reduction in the prevalence of tobacco use in round-2 among females. A maximum reduction in the prevalence was observed in the 15-29 years (-51.3%), those not exposed the media advertisements (-19.9%). While unadjusted OR depicted that unmarried women, young age, asked by health workers about tobacco use, and advice given by them increased the interest in quitting smoking, none of them emerged to be significant on a multivariable logistic regression except the advice given by the health care provider. Successful cessation (>6 months) of SLT products is possible in urban areas, with decreased exposure to media advertisements.

CONCLUSION

There is an urgent need for gender-sensitive policies in tobacco control and the integration of these policies with relevant national health programs. This shall help to synergize efforts and obtain better outcomes that would support the overarching goal of tobacco-free India.

A Community Based Study to Estimate Prevalence and Determine Correlates of Premature Graying of Hair among Young Adults in Srinagar, Uttarakhand, India

Background

There are several ways by which aging is identified, of which graying of hair is perhaps the most common way. Nowadays, graying of hairs, which was expected to occur after 40s, can be easily observed among younger age group, even before 20s. The present study aims to estimate the prevalence of graying of hairs and its correlates among young adults in Srinagar, Uttarakhand, India.

Methodology

A community-based cross-sectional study was conducted among 384 young adults between 15 and 30-year age group in the urban area of Srinagar tehsil of Pauri district. Graying of hair was assessed on the basis of the number of white hairs on examination of scalp.

Results

The prevalence of premature graying of hairs (PMGHs) was found to be 27.3%. Binary logistic regression analysis showed that a paternal history of PMGH, history of smoking, maternal history of PMGH, sunlight exposure, and body mass index were significant predictors of PMGH.

Limitations

The factors found associated could be better determined through a follow-up study which could not be done in the current study. The present study was carried in a tehsil of one district of Uttarakhand therefore has limited external validity.

Conclusion

The present study highlights the importance of maintaining a healthy lifestyle as well as adequate exposure to sunlight in preventing PMGH.

Diabetic Foot Care Knowledge and Practices in Rural North India: Insights for Preventive Podiatry

BACKGROUND

Diabetic foot ulcer (DFU) is one of the most dreaded complications of Type 2 Diabetes Mellitus (T2DM). Preventive podiatry is most efficient way of minimising DFU. The main aim of the study was to assess the knowledge and foot care practices among patients living with T2DM concerning the DFU.

MATERIALS AND METHODS

We conducted a cross-sectional study in a rural-area of Haryana, India between January to March 2019 amongst 416 people living with T2DM after using multistage random sampling. A pre-tested, structured survey instrument prepared from the recommendation of the American College of Foot and Ankle Surgeons and the Diabetes UK was used after Hindi translation as per standard protocol. The knowledge and practices were classified as good, satisfactory and poor if the total score was between 8-11, 6-7 and <6.

RESULTS

14.2% had a previous history of DFU. The prevalence of good, satisfactory and poor knowledge was 63.5%, 12.5% and 24.0%. Further, 46.7%, 32.7% and 20.6% respondents depicted good, satisfactory and poor practices regarding foot care. On multivariate binary logistic regression analysis, younger age group, higher education, Per capita family income in INR, Blood glucose levels, HbA1c Levels, physical activity and previous history of DFU emerged as significant predictors of good foot-care knowledge and practices.

CONCLUSION

There is an evident gap between foot-care knowledge and practices that should be addressed through comprehensive behaviour change strategies. Comprehensive risk-assessments for diabetes associated complications needs to be piloted at community level to assess the feasibility.

Effect of comorbidities on direct cost among type 2 diabetes mellitus (T2DM) patients in tertiary care government hospital in Uttarakhand, India: A primary data analysis of out of pocket expenditure

BACKGROUND AND AIMS

The objective of present study was to estimate and compare the direct cost between diabetics and age and gender matched non-diabetics. It also aimed to estimate and compare the effect of various comorbidities on direct cost between cases and controls, while simultaneously trying to determine the predictors of direct cost among T2DM patients.

METHODS

A hospital-based pair matched case-control study was conducted in a tertiary care hospital in Garhwal division of Uttarakhand, India to accomplish the objectives of study. Regression analysis was applied to determine the predictors of direct cost among diabetics.

RESULTS

Mean annual direct cost among diabetics was estimated to be US$ 104.6 (Indian Rupees (INR) 7338.9)) in comparison to US$ 27.8 (INR 1905.8) among non-diabetics. The total cost among cases was significantly higher than controls, if they had comorbidities from CVS, nervous, ophthalmic, respiratory and musculoskeletal system. Gender, education, duration of diabetes and number of comorbidities were significant predictors in estimating the direct cost among cases. For each one-year increase in duration of diabetes, direct cost increased by 13.1 unit.

CONCLUSIONS

The study provides us conclusive evidence of significantly higher expenditure among diabetics in comparison to non-diabetics. An effect on direct cost among diabetics was observed with types and increasing number of comorbidities.

Dental problems among diabetics: A case control study from an Indian state

Background

Diabetes is a metabolic disorder, which affects almost all parts of body. Dental problems remain neglected among diabetics which could have negative impact on health and if untreated could lead to financial loss in treatment of diseases.

Aims

To compare the risk, quality of life (QOL), and direct cost of dental problems between cases and controls.

Methods

A hospital-based case control study in a tertiary care hospital of Uttarakhand, India.

Results

The risk of comorbidities of dental problem was 1.8 times higher as compared with controls. Twenty-six percent of cases were found to be suffering from one or the other type of dental problems as compared with 16.4% among controls. The direct cost expenditure among cases was significantly higher as compared with controls.

Limitations

The QOL scores and the cost of treatment obtained could be an overestimate as some of the participants with dental problems also had comorbidities related to other systems of the body.

Conclusion

The risk of dental problems and the direct cost was reported to be significantly higher among cases as compared with controls.

Evaluation of nomophobia among medical students using smartphone in north India

Background

Smartphone's popularity has risen to such an extent in recent years that it is unimaginable for the people to stay away from it for a minute. The excessive usage has given rise to a condition termed as nomophobia or a feeling of discomfort or anxiety experienced whenever unable to use the smartphone. The aim of this study was to evaluate nomophobia among medical students who are using smartphones.

Methods

A cross-sectional study was conducted among the undergraduate medical students. A 20-item nomophobia questionnaire was used to assess the prevalence of nomophobia among the students, and also the purpose and in which context smartphone was used was also asked. Data collected were coded and entered into a Microsoft Excel spreadsheet. It was analysed using the Statistical Package for the Social Sciences, version 16, software (SPSS Inc., Chicago, IL, USA). A chi-square test was used to test the association, and p < 0.05 was considered significant.

Results

The mean age of the 451 students was 20.7 ± 1.72 years, and the majority were females. Mild nomophobia was seen in 15.5% of the students; 67.2% were having moderate nomophobia, while 17.3% were suffering from severe nomophobia. The overall highest mean score was for 'not able to communicate' dimension of nomophobia and lowest for 'giving up convenience.'

Conclusion

Nomophobia is an emerging behavioural problem which needs attention. It is of serious concern that all medical students were suffering from nomophobia, with varying grade of severity. Increasing awareness regarding the harmful effects of smartphone addiction is needed.

The Impact of Aquifer Flushing on Groundwater Arsenic Across a 35-km Transect Perpendicular to the Upper Brahmaputra River in Assam, India

Well testing in the floodplain of the Brahmaputra River in Golaghat and Jorhat districts of Assam, India, shows that groundwater arsenic (As) concentrations increase with distance from the river. To establish the origin of this pattern, an additional 900 wells <60 m deep were tested for As and 9 sites were drilled along a 35-km transect perpendicular to the river. The field data show no relation between groundwater As concentrations ranging from <1 to 660 μg/L along the transect and (a) As concentrations of <1-5 mg/kg in cuttings of aquifer sand recovered while drilling or (b) the degree of reduction of iron oxides in these cuttings. The drilling indicates, however, a marked increase in the thickness of a clay layer capping the aquifer starting from <1-5 m near the river to over 60 m at the most distant site towards the base of the Naga foothills. Organic radiocarbon ages of 18-46 kyr obtained from all but one of 13 clay samples indicate pre-Holocene deposition of the underlying sands across the entire transect. Radiocarbon ages of dissolved inorganic carbon of 0.2, 4.7, and 17.8 kyr were measured in groundwater from 3 monitoring wells installed to 30-60 m depth at distances of 10, 20, and 40 km from the river, respectively. A conceptual groundwater flow model consistent with monitored heads and groundwater ages suggests that thick clay layers capping the aquifer further from the river inhibited flushing of the aquifer and, as a result, preserved higher As levels in groundwater.

Perception of Medical Students regarding “Swachh Bharat Abhiyan” a cleanliness campaign: a qualitative study

Background: Swachh Bharat Abhiyan -A Cleanliness Campaign was launched all over India in 2014 to sensitize people to work in the direction of making India a clean country. Since youth constitute the future of the nation, their perception is very much important for the nation’s progress. Therefore, the present study was conducted among Indian medical undergraduate (IMUG) students regarding their perception about the current cleanliness drive going on in the country. Aims & Objective: To assess the perception of IMUG students about the cleanliness and innovative cleanliness practices. Study Setting & Design: A cross-sectional qualitative study was carried among IMUG students in a medical college of North India. Material & Methods: Study was conducted during the period of the Swachhata Pakhwara Abhiyan, celebrated all over the country to reinforce the cleanliness drive. IMUG students were invited to describe their perception on the topic “How can I keep My India clean”. Statistical Analysis: -Transcript was prepared and deductive coding was done and perceptions of students were categorized into four broad themes: -1. Behaviour change communication 2. Practicing cleanliness.3Interventions required for cleanliness 4. Legislation required in favour of cleanliness. Results: Majority of IMUG Students expressed that it is the behaviour change Communication and habit of practicing cleanliness everywhere, which will bring the change in cleanliness drive in the country with emphasis on innovative intervention and the role of legislation. Conclusion: -Proper direction and consistent motivation along with sound perception of cleanliness among citizens can contribute in reaching the desired goals of cleanliness.

Availability of Village Health and Nutrition Day services in Uttarakhand, India

Background:

Village Health and Nutrition Day (VHND) was identified to provide primary care services (health, nutrition and sanitation) at village level under National Rural Health Mission.

Aim:

The study aimed to assess availability of health, nutrition and sanitation services, required instruments/equipment and medicines at VHND with client satisfaction from the VHND services.

Materials and Methods:

A cross-sectional study was conducted in three districts of Uttarakhand at Nainital, Tehri-Garhwal and Chamoli involving 24 villages in six blocks using multistage stratified sampling using predesigned pretested observation checklists (quantitative data). All the concerned functionaries of health, Integrated Child Development Services and Panchayati Raj Institution were interviewed (qualitative data) to understand the gap in services and remediation.

Results:

Of the 24 VHNDs observed, blood pressure measurement was done at 11 (45.83%) and weight at 13 (54.17%) sites in ante-natal care services; non-availability of blood pressure instrument and adult weighing machine were 45.83% and 41.66% sites, respectively. Immunization for children was provided at 22 sites; however, availability of other services were poor-vitamin A (three), growth monitoring of children (seven); supplementary nutrition (five); identification of households for construction of toilet (eight). Yet, one-third of clients provided three and four for satisfaction from VHND services on the scale score of 1–5.

Conclusion:

It was noted that none of the VHND site was providing all the stipulated services, though immunization was provided mostly. Anganwadi centers were lacking availability of various essential instruments and equipment. So regular orientation of village functionaries for ensuring all the VHND services with the availability of required logistic is recommended.

Cut-off of body mass index and waist circumference to predict hypertension in Indian adults

AIM: To determine the cut-off values of body mass index (BMI) and waist circumference to predict hypertension in adults in north India.

METHODS: A community based cross-sectional study was conducted in 801 subjects in Kanpur, aged 20 years and above, using multistage stratified random sampling technique. A pre-tested structured questionnaire was used to elicit the required information from the study participants and the diagnostic criteria for hypertension were taken according to the Seventh Joint National Committee Report on Hypertension (JNC-7). Receiver operating characteristic (ROC) analysis was used to estimate the cut-off values of BMI and waist circumference to predict hypertension.

RESULTS: The ROC analysis revealed that BMI is a good predictor of hypertension for both men (area under the ROC curve 0.714) and women (area under the ROC curve 0.821). The cut-off values of BMI for predicting hypertension were identified as ≥ 24.5 kg/m² in men and ≥ 24.9 kg/m² in women. Similarly, the ROC analysis for waist circumference showed that it is a good predictor of hypertension both for men (area under the ROC curve 0.784) and women (area under the ROC curve 0.815). The cut-offs for waist circumference for predicting hypertension were estimated as ≥ 83 cm for men and ≥ 78 cm for women. Adults with high BMI or high waist circumference had a higher prevalence of hypertension, respectively.

CONCLUSION: Simple anthropometric measurements such as BMI and waist circumference can be used for screening people at increased risk of hypertension in order to refer them for more careful and early diagnostic evaluation. Policies and programs are required for primary and secondary prevention of hypertension.

Morbidity profile and seasonal variation of diseases in a primary health center in kanpur district: a tool for the health planners

Objective:

The objective of this study was to determine the morbidity profile of patients being treated at the Primary Health Center, their distribution according to gender, and the seasonal trend of diseases.

Materials and Methods:

The study was done retrospectively using secondary data, over a period of 1 year from June 2007 to July 2008, at the OPD of the Primary Health Center at Patara in Kanpur District, India. The study was aimed to study the pattern of diseases according to the classification provided by the Government of India. The data were collected from the OPD registers of the consultant medical officer, and the diagnosis was classified into communicable diseases, nutritional and metabolic disorders, infectious diseases, obstetric complications, and other diseases including injuries.

Results:

A total of 6838 patients had been treated at the OPD, which included 2707 males and 4131 females. It was observed that, while communicable diseases constituted about half of the total burden of the diseases with skin infections being the commonest; the non-communicable diseases constituted about one-fifth of the total disease burden. Significant gender differences were evident in the prevalence of certain diseases such as worm infestation, acute respiratory tract infection, urinary tract infection, reproductive tract infection, chronic obstructive pulmonary disease, gastritis, arthritis/gout, falls/injuries/fractures, anemia, pyrexia of unknown origin, and snake bite. Most of the diseases were observed to have a seasonal variation, with the communicable and infectious diseases peaking in the monsoon months. Surprisingly, the non-communicable diseases such as gastritis and falls and injuries also showed a seasonal variation.

Conclusion:

Many diseases have a seasonal variation and the burden of these diseases could be reduced if we devise measures to detect the changes in their trend through the implementation of surveillance programs in this part of the world, as has been carried out in other countries. The knowledge of the burden of the diseases would also assist the health administrators in judicious allocation of the resources.

Prevalence of hypertension in India: A meta-analysis

AIM: To determine the prevalence of hypertension in the urban and rural population of India.

METHODS: Relevant studies were identified through computer based and manual searches using MEDLINE/ PubMed, Google scholar, EMBASE, Cochrane Library and reference lists of prevalence studies from January 2000 to June 2012. A total of 12 studies were included in the meta-analysis of hypertension in urban India and 10 studies in the analysis of hypertension in rural India after applying the inclusion and exclusion criteria. Estimates of prevalence were calculated using the random effect model for meta-analysis.

RESULTS: The electronic search using appropriate keywords identified 177 titles for prevalence of hypertension in urban India, of which 165 were excluded, and 133 titles for prevalence in rural India, of which 123 were excluded after applying the inclusion criteria. Twelve studies including 125333 subjects were analyzed to assess the prevalence of hypertension in the urban Indian population, whereas ten studies including 24800 subjects were analyzed to determine the prevalence of hypertension in the rural Indian population. The prevalence of hypertension in the urban population was estimated to be 40.8% (95%CI: 40.5%-41.0%) and that of hypertension in the rural population was 17.9% (95%CI: 17.5%-18.3%). It is evident that the prevalence of hypertension is significantly higher in the urban population of India compared to the rural.

CONCLUSION: Current evidence suggests that policies and interventions should be prioritized for reduction of hypertension in the adult Indian population, especially the urban population.

Study on epidemiology of cutaneous amyloidosis in northern India and effectiveness of dimethylsulphoxide in cutaneous amyloidosis

Context:

Amyloidosis, which is characterized by the extracellular deposition of a proteinaceous substance, is usually associated with considerable tissue dysfunction. However, the etiology of the disease remains uncertain and the treatment disappointing.

Aim:

1. To know the epidemiology of cutaneous amyloidosis 2. To evaluate the effect of dimethylsulphoxide on cutaneous amyloidosis.

Settings and Design:

Data was collected from patients attending the Outpatient Department (OPD) over a period of one year.

Material and Methods:

Patients were screened on the basis of signs and symptoms and then confirmed histologically. A total of 62 patients who were suspected to be suffering from amyloidosis on the basis of clinical signs and symptoms and 38 patients who were further confirmed histopathologically underwent the treatment.

Statistical Analysis Used:

Chi-square test was used for testing the significance of proportions.

Results:

63.15 percent of the patients had macular amyloidosis and the interscapular area was the most common area involved (52.63%). Pruritus, pigmentation, and papules responded excellently to dimethylsulphoxide after one month of treatment.

Conclusions:

Cutaneous amyloidosis is a disease found in middle-aged persons, with a female preponderance, and dimethylsulphoxide seems to be an effective therapy.

Childhood obesity in India: a meta-analysis

Developing countries are now facing the double burden of childhood underweight and obesity. Childhood obesity is a recent epidemic with a high magnitude in India. Therefore, the authors decided to assess the prevalence of overweight and obesity among Indian children. Studies were identified through computer-based and manual searches. Estimates of prevalence were studied using random effects meta-analysis. Nine studies including 92,862 subjects were identified and analysed. The prevalence of overweight was estimated to be 12.64% (95% CI 8.48-16.80%) and that of obesity to be 3.39% (95% CI 2.58-4.21%). Current evidence suggests that policies and interventions for children should prioritize reduction of obesity and overweight.

Prevalence of isolated diastolic hypertension and associated risk factors among adults in Kanpur, India

BACKGROUND

Isolated diastolic hypertension (IDH) is a largely unrecognized subtype of hypertension, more commonly seen in the younger age group.

AIMS

(1) To determine the prevalence of IDH in the adult population of Kanpur district. (2) To study the associated risk factors of IDH.

METHODS

A community-based cross-sectional study was conducted in 801 subjects, aged 20 years and above, using multistage stratified random sampling technique.

RESULTS

The prevalence of IDH was 4.5%, which was 6.2% in men and 3.1% in women. A significant proportion of IDH was seen in the 40-49 years age group. Multivariate logistic regression analysis of the associated risk factors showed that gender, physical activity and BMI were significantly associated with IDH.

CONCLUSION

Isolated diastolic hypertension is an emerging problem in developing countries. IDH is more common among men, sedentary individuals and those with a higher BMI.

Sedimentological control on Mn, and other trace elements, in groundwater of the Bengal delta

To reveal what controls the concentration and distribution of possibly hazardous (Mn, U, Se, Cd, Bi, Pb) and nonhazardous (Fe, V, Mo, PO(4)) trace elements in groundwater of the Bengal delta, we mapped their concentrations in shallow groundwater (<60 mbgl) across 102 km(2) of West Bengal. Only Mn is a potential threat to health, with 55% of well water exceeding 0.3 mg/L, the current Indian limit for drinking water in the absence of an alternate source, and 75% exceeding the desirable limit of 0.1 mg/L. Concentrations of V are <3 μg/L. Concentrations of U, Se, Pb, Ni, Bi, and Cd, are below WHO guideline values. The distributions of Fe, Mn, As, V, Mo, U, PO(4), and δ(18)O in groundwater reflect subsurface sedimentology and sources of water. Areas of less negative δ(18)O reveal recharge by sources of evaporated water. Concentrations of Fe, As, Mo, and PO(4) are high in palaeo-channel groundwaters and low in palaeo-interfluvial groundwaters. Concentrations of U, V, and Mn, are low in palaeo-channel groundwaters and high in palaeo-interfluvial groundwaters. Concentrations of Fe and Mn are highest (18 and 6 mg/L respectively) at dual reduction-fronts that form strip interfaces at depth around the edges of palaeo-interfluvial aquifers. The fronts form as focused recharge carries dissolved organic carbon into the aquifer margins, which comprise brown, iron-oxide bearing, sand. At the Mn-reduction front, concentrations of V and Mo reach peak concentrations of 3 μg/L. At the Fe-reduction front, concentrations of PO(4) and As reach concentrations 3 mg/L and 150 μg/L respectively. Many groundwaters contain >10 mg/L of Cl, showing that they are contaminated by Cl of anthropogenic origin and that organic matter from in situ sanitation may contribute to driving reduction.

Clinical predictors of influenza A(H1N1) in Kanpur, India

Influenza A (H1N1) commonly known as swine flu, has covered a large part of the globe rapidly since the outbreak started in Mexico on 18th March, 2009. Given the rapid worldwide spread of the virus, it is important to identify the symptoms that require screening for influenza A(H1N1). Therefore, this study was planned to determine the clinical predictors of influenza A(H1N1) in the population of Kanpur city. Study sample comprised all cases with flu-like symptoms suspected of having influenza A(H1N1) whose nasopharyngeal samples had been sent for laboratory examination. Of the 119 samples sent to the laboratory, 34 were found to be positive for influenza A(H1N1). Best predictors found were fever with shortness of breath (positive predictive value=87.5%) followed by fever with cough without other cold like features (positive predictive value=68.6%). None of the clinical signs had all the attributes of a good predictor of influenza A(H1N1). Fever with cough was the most sensitive (70.6%) and fever with shortness of breath was the most specific indicator (98.8%). Therefore, it was concluded that symptoms like fever with cough without other cold like features and fever with shortness of breath should not be ignored and require expert medical attention for screening of influenza A(H1N1).

Prevalence and determinants of obesity in the adult population of Kanpur district -- a population-based study

Worldwide, obesity is the most prevalent form of malnutrition. It is one of the most significant contributors to ill health and an indirect cause of morbidity and mortality resulting from hyperlipidaemia and glucose intolerance. Very few studies on the prevalence of obesity have been reported from developing countries like India. The present study was therefore undertaken to determine the prevalence of obesity and its predictors in the Indian community. The objectives are: (1) To determine the prevalence of obesity, (2) to study the relationship of obesity with age, (3) to identify the predictors of obesity. This community-based cross-sectional study was conducted on 801 subjects, aged 20 years and above in Kanpur District, using multistage stratified random sampling technique. Data was analysed using the software statistical package for social sciences 10.0.1 for windows. Prevalence of obesity was found to be 4.7%. An increase in body mass index was seen with increasing age. A higher prevalence of obesity was seen in the urban population and in women. Age, gender and daily intake of saturated fatty acids were found to be the main predictors of the obesity. An increase in the level of physical activity resulted in a decrease in the prevalence of obesity (odd's ratio = 0.36). Obesity is an emerging public health problem in the Indian population which indicates that intervention at the primary healthcare level, especially in diet and activity, are important for its prevention.

Study on the use of tobacco among male medical students in lucknow, India*

Objectives:

Is use of tobacco a major health problem among medical students? To find out the factors associated with the use of tobacco.

Materials and Methods:

A cross-sectional study was done on 250 undergraduate male medical students using a pre-designed, pre-tested questionnaire to study about the problem and various correlates of the tobacco use. Data was collected and analysed using Excel and SPSS software.

Results:

Among the tobacco users (28.8%), smoking was found in 87.5% and tobacco chewing in the form of gutka, khaini, gulmanjan (locally available forms of tobacco) in 37.5% as the predominant means of the use of tobacco. The mean age of our sample was 23.5 years. The residential background, i.e., rural or urban, and religion were not significantly associated with the use of tobacco in the present study. Hostellers were found to be more frequent tobacco users as compared to day-scholars. There was a familial aggregation of the use of tobacco. The factor initiating the use of tobacco was usually peer pressure.

Conclusion:

Tobacco use is a significant problem among the male medical students and we need to take steps to stop its use by them so as to prevent them from being exposed to its hazardous effects. This will also make their role in the advocacy of the smoking cessation activities more trustworthy.

Association of angiotensin-converting enzyme, methylene tetrahydrofolate reductase and paraoxonase gene polymorphism and coronary artery disease in an Indian population

BACKGROUND

Coronary artery disease (CAD) and cancer remain the leading causes of death in most developed countries. Elucidating the genetic components that contribute to their pathogenesis is challenging. In this case-control association study, we examine the association of single nucleotide polymorphisms (SNPs) in paraoxonase 573 A/G genes, methylene tetrahydrofolate reductase (MTHFR) 677 C/T and angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism with CAD independently, as well as synergistically, in a north Indian population.

METHODS AND RESULTS

Patients with at least 50% stenosis of at least one major coronary artery were classified as cases. The controls had no myocardial infarction. Polymerase chain reactions (PCR) followed by restriction fragment length polymorphism (RFLP) analyses were carried out to determine the SNPs. No significant association of the polymorphisms of the ACE or MTHFR genes with the risk of CAD was observed. However, the allele frequencies of the 573 A/G polymorphism of the paraoxonase gene differed significantly among cases and controls before and after controlling for confounding factors. The frequencies of AG vs AA genotypes and GG+AG vs AA genotypes also differed significantly in the two groups (p = 0.0002). The interaction of paraoxanase with both MTHFR and ACE independently showed significant positive associations.

CONCLUSIONS

The identification of 'at risk' individuals by genetic mapping of susceptible genes for effective control of other host factors will be a very effective and practical approach for prevention, as well as the development of improved therapy for patients.

Client satisfaction with immunization services in urban slums of Lucknow district

OBJECTIVE

To assess the satisfaction of parents with the immunization services and its association with their sociodemographic characteristics.

METHODS

The study was a part of the coverage evaluation survey conducted using the WHO 30 cluster sampling methodology in the Urban slums of Lucknow district, north India. Analysis for a total of 388 respondents of completely or partially immunized children, was done to assess the level of satisfaction and its determinants.

RESULTS

The overall satisfaction was more than 90% in the respondents of both the categories of the children, however the difference between the satisfaction rates was found to be significant. Also the satisfaction with accessibility (p<0.04) and information given by the health worker (p<0.00) differed significantly between completely and partially immunized. Most of the sociodemographic factors were not found to have a significant association with the satisfaction related to different parameters of the immunization services.

CONCLUSION

The dissatisfaction regarding the various aspects of immunization services emphasizes the imperative need to take urgent intervention, for the achievement of goal of universal immunization.

A study on determinants of immunization coverage among 12-23 months old children in urban slums of Lucknow district, India

CONTEXT

To find out the suitable factors for raising the coverage of immunization.

AIMS

To determine the coverage and to identify the various factors of primary immunization.

SETTINGS AND DESIGN

Urban slums of Lucknow district.

METHODS AND MATERIAL

WHO 30-cluster sampling technique was used for the selection of the subjects. Mother, father or relative of a total of 510 children with 17 children per cluster were interviewed in the study.

STATISTICAL ANALYSIS

Chi-square test, binary logistic regression and multinomial logistic regression analysis were done to test the statistical significance of the association.

RESULTS

About 44% of the children studied were fully immunized. Multinomial logistic regression analysis revealed that an illiterate mother (OR=4.0), Muslim religion (OR=2.5), scheduled caste or tribes (OR=2.3) and higher birth order (OR approximately 2) were significant independent predictors of the partial immunized status of the child; while those associated with the unimmunized status of the child were low socioeconomic status (OR=10.8), Muslim religion (OR=4.3), higher birth order (OR=4.3), home delivery (OR=3.6) and belonging to a joint family (OR=2.1).

CONCLUSIONS

The status of complete immunization is about half of what was proposed to be achieved under the Universal Immunization Program. This emphasizes the imperative need for urgent intervention to address the issues of both dropout and lack of access, which are mainly responsible for partial immunization and nonimmunization respectively.

IL-4 increases Simian immunodeficiency virus replication despite enhanced SIV immune responses in infected rhesus macaques

It is widely believed that a Th1 type CD4 response is critical for enhancement of CD8 immunity and for controlling HIV-1 infection. Th2 type responses, such as what might be seen in a chronic parasitic infection, would sacrifice cellular immunity and thus benefit the virus at the expense of the host. However, there has been little direct examination of the hypothesis in a primate model system. Accordingly, the simian immunodeficiency virus (SIV) infected rhesus macaque model was used to investigate the impact of immunisation with SIV expressing DNA constructs and co-injection with IL-4 on the SIV specific immunological responses, lymphocyte cell counts, as well as the impact on viral load. IL-4 is a Th2 type cytokine, which enhances antibody production and inhibits a CD4 Th1 phenotype. Rhesus macaques were infected with 10 AID50 of SIVmac239 and treated with 9-[2-(phosphonomethoxy)propyl]adenine (PMPA) 9 weeks post-infection. During PMPA treatment, animals were immunised with plasmids that expressed the SIV proteins, env, rev, gag and pol. In addition, they were immunised with a construct that encoded the gene for IL-4. IL-4 co-immunisation increased the neutralizing antibody titres in this group. Importantly, the viral loads in animals vaccinated with IL-4 expressing plasmid increased during the immunisation regimens despite the higher neutralizing antibody titres. In addition, neutralizing antibodies did not correlate with viral set point prior to PMPA treatment, however, there was a correlation between viral loads and antibody titres following the treatment with PMPA. Antibody titres decreased following the suppression of viral load. Importantly, vaccination in the absence of IL-4 protected CD4 levels without increasing viral load. The data support the hypothesis that inappropriate immune bias toward a Th2 pathway would ultimately enhance disease progression.

Therapeutic immunization of HIV-infected chimpanzees using HIV-1 plasmid antigens and interleukin-12 expressing plasmids

OBJECTIVE

To assess HIV-1 DNA vaccination and co-immunization with interleukin (IL)-12 and IL-10 as immunotherapy in the HIV-1 infected chimpanzee model system.

METHODS

Four chimpanzees that were infected with HIV-1-IIIB for longer than 4 years and remained symptom free were immunized with HIV-1 plasmid vaccines. Two chimpanzees were immunized with DNA plasmids that encoded env/rev, gag/pol along with a plasmid that encoded both chains of human IL-12. A third animal was immunized with HIV-1 DNA vaccine constructs and co-immunized with an IL-10 expressing plasmid. Finally a control animal received the HIV-1 DNA vaccine constructs alone.

RESULTS

There was no evidence of systemic toxicity associated with the administration of the DNA vaccines or the cytokine-expressing plasmids. We observed that the IL-12/HIV-1 DNA vaccinated animals had enhanced proliferative responses to multiple HIV-1 antigens at multiple time points. The animal that was co-immunized with HIV-1 and IL-10 did not have any changes in the proliferative responses. Finally, the control chimpanzee demonstrated moderate increases in the proliferative responses to HIV-1 antigens. The animal that received HIV-1 vaccines alone and the animals co-immunized with IL-12 all had declines in viral load over the course of the study, however, the decrease in viral loads were transient in all animals.

CONCLUSION

Immunization of HIV-1 infected chimpanzees with DNA based vaccines containing the env, gag and pol genes can transiently boost the env specific proliferative responses. Co-administration of IL-12 expressing plasmids further leads to transient boosting of the proliferative response to the core protein, p24 as well. However, at these doses the impact on viral load is minimal.

Vaccination of seronegative volunteers with a human immunodeficiency virus type 1 env/rev DNA vaccine induces antigen-specific proliferation and lymphocyte production of beta-chemokines

There is a pressing need to test novel vaccine concepts in an effort to develop an effective vaccine for human immunodeficiency virus (HIV) type 1. A phase I clinical study was done to test the immunogenicity of an HIV env/rev DNA vaccine, which was administered intramuscularly to HIV-1-seronegative persons. Subjects received 3 doses of vaccine at a single concentration (100 or 300 microgram) at 0, 4, 8, and 24 weeks. In at least 1 of multiple assays, the 6 subjects who received the 300-microgram dose had DNA vaccine-induced antigen-specific lymphocyte proliferative responses and antigen-specific production of both interferon-gamma and beta-chemokine. Furthermore, 4 of 5 subjects in the 300 microgram-dose group responded to both the rev and env components of the vaccine. The responses did not persist within inoculated individuals and scored in different individuals at different times in the trial. This study supports that HIV-1 DNA vaccine antigens can stimulate multiple immune responses in vaccine-naive individuals, and it warrants additional studies designed to enhance DNA vaccine immunogenicity.

Micronucleus induction and phagocytosis in mammalian cells treated with diesel emission particles

Micronucleus induction and phagocytosis in V79 and CHO cells treated with diesel emission particles (DEP) were studied. After separation of the sample into supernatant and sediment fractions, the genotoxic activity of DEP was shown to reside in the supernatant fraction for the DMSO-extracted sample, and in the sedimented fraction for the dipalmitoyl lecithin (DPL), a primary component of pulmonary surfactant, dispersed sample. More particles from DMSO sediment samples were phagocytized than DPL sediment by both types of cells. This had no effect, however, on micronucleus induction. CHO cells phagocytized fewer particles, but gave a higher number of micronuclei than V79 cells. CHO cells seem to be more sensitive to DEP. Evidently, micronucleus induction is not the result of phagocytosis per se, but is due to the different response of the indicator cells to the DEP sample tested. These results further indicate that most, if not all, genotoxic compounds associated with DEP can be extracted by DMSO and that genotoxic activity associated with DEP inhaled into the lung may also be expressed by dispersion of particles in pulmonary surfactant.