Cardiovascular Risk Profiling Using the Globorisk Calculator among Noncommunicable Disease Patients Attending Primary Health Centers of a Tertiary Care Teaching Hospital in South India: A Cross-Sectional Analytical Study

Background

Cardiovascular diseases (CVDs) account for over three-quarters of all deaths taking place in developing nations.

Objective

The present study aims to stratify noncommunicable disease (NCD) patients using the Globorisk chart for predicting their 10-year risk of a major (fatal or nonfatal) CVD event and to estimate the level of agreement between this country-specific chart and the existing World Health Organization (WHO)/International Society of Hypertension (ISH) risk strata.

Methods

A record-based cross-sectional analytical study was conducted in 2018 among adults attending the NCD clinic of one rural and one urban primary health center in Puducherry. Laboratory and office risk calculators of the Globorisk chart were used to calculate the risk.

Results

The median age (interquartile range (IQR)) of the 760 study participants was 58 (50-65) years. When calculated using the Globorisk prediction chart, 22.1% (n = 168) of the participants had a <10% risk for any CVD event in the next 10 years, whereas the same risk was found in 71.1% (n = 540) by using the WHO/ISH risk chart. There was no agreement found between the two risk charts (k = 0.0174; P-value = 0.26).

Conclusion

The Globorisk chart was found to identify more patients as belonging to the higher risk category as compared to WHO/ISH charts.

Adherence to the National Tobacco-Free School Policy in Selected Schools of Puducherry District in India: A Cross-Sectional Exploratory Study

INTRODUCTION

The objective of this study was to estimate the level of compliance and the factors associated with high adherence to the Tobacco-Free Educational Institutions (ToFEI) guidelines of the Government of India among schools in the district of Puducherry, India.

METHODS

This cross-sectional study was conducted among schools (N=50) in the Puducherry district in 2021-2022 using a "Self-Evaluation Scorecard" of the ToFEI guidelines. The assessment was done through in-person interviews with the schools' heads/representatives. The level of compliance to indicators was presented as proportions, and factors associated with high compliance were assessed using the chi-square test.

RESULTS

No school met all the ToFEI indicators. The majority (88%) showed no evidence of the use of tobacco products inside the premises. More than half of the schools (58%) adhered to the criteria of not having tobacco shops within 100 yards and 56% reported the inclusion of the "No Use of Tobacco" norm in their guidelines. Schools located in rural areas (p-value <0.01) and those with teachers who attended any tobacco-related workshop were more likely to comply with the ToFEI indicators (p-value 0.05). After relaxing the criteria for 'High Adherence' to at least four indicators, we found that 20% of schools showed high adherence to the ToFEI indicators.

CONCLUSION

Overall compliance of schools to the ToFEI guidelines is low in Puducherry. Sensitizing the relevant stakeholders in the district for implementing ToFEI guidelines and institutionalizing tobacco control activities in the school are the needs of the hour.

Development and Validation of Scale Assessing the Preparedness of Objective Structured Clinical Examination in Undergraduate Competency based Medical Education

Background

Formative assessments methods such as objective structured clinical examination (OSCE) are reliable and valid assessment tools employed under the competency-based medical education (CBME) curriculum. However, there was no uniform scale to assess the attributes of OSCE for any of the medical subjects. Hence, this study was done to develop and validate a scale to assess the attributes of OSCE and make sure that the intended objectives of the OSCE are achieved.

Methods

The scale was developed using literature review and expert opinion. It consisted of 10 questions and response to these items was based on a 5-point Likert scale ranging from "strongly agree" to "strongly disagree." The final version was administered among 30 students undertaking survey community diagnosis (CD) posting during their third semester. Exploratory and confirmatory factor analysis was performed to validate the scale.

Results

Two-factor structures were obtained with eigenvalues of 4.32 and 1.90. Factor 1 consisted of seven items (positively faced questions) accounting for 42.84% of the variance, whereas Factor 2 had the remaining three items (negatively faced questions) explaining 19.36% of the variance. Thus, together, the two factors explained 62.20% of the variance. Goodness-of-fit indices revealed good Comparative fit index (CFI) s of 0.90, Tucker Lewis index (TLI) of 0.87, and acceptable Standardized Root Mean Square Residua (SRMR) of 0.13. The reliability coefficient (Cronbach's alpha) for the scale was 0.81.

Conclusion

This study develops and validates a scale that can be used universally for assessing the attributes of OSCE across all disciplines and in medical education institutes in India.

Profile of Non-communicable disease risk factors among nurses in a tertiary care hospital in South India

PURPOSE

The work nature of nurses and the associated lifestyle changes put them at high risk of developing non-communicable diseases (NCDs). This study was conducted to estimate the prevalence of NCD risk factors among nurses working in a tertiary care hospital in Puducherry and to determine the associated factors among nurses.

METHODS

We conducted a cross-sectional study among all nurses (N=1217) in the tertiary care hospital aged between 21 and 60 from May 2019 to April 2020. We assessed NCDs behavioral, physical and biochemical risk factors using a self-administered questionnaire. The adjusted prevalence ratio was calculated using a generalized linear regression model to determine factors associated with NCD risk factors.

RESULTS

The response rate was 99% (1217/1229), and 77.5 % of the participants were women. Current tobacco use, and alcohol consumption were 1.5% (95% CI: 0.8-2.2) and 2.9% (95% CI: 2-3.9) respectively with significantly higher prevalence among men. Overweight or Obesity (BMI >23 kg/m2) was 77.7%, with a significantly higher prevalence among those aged ≥30 and married. Prevalence of hypertension was 14.4 % (95% CI: 12.5-16.4), and diabetes mellitus was 11.5 % (95% CI: 9.7-13.6) were significantly higher among those aged ≥50 years. One-third of nurses, 34.3% (95% CI: 31.6-37.1), had hypercholesterolemia, significantly higher among men.

CONCLUSION

We found a high prevalence of various NCD risk factors among the nurses. We highlight the urgent need for initiating health promotion interventions, especially to improve intake of healthy diet and physical activity among nurses aged ≥30 years.

Association between behavioural risk factors and metabolic syndrome among adult population in India: A systematic review and meta-analysis of observational studies

AIMS

The impact of behavioural risk factors on the metabolic syndrome has not been well understood by the researchers. This information is important to the policymakers for developing effective strategies and implement relevant policies or programs. Hence, we undertook this meta-analysis to estimate the effect of behavioural risk factors on the burden of metabolic syndrome.

DATA SYNTHESIS

We conducted a search in the databases, such as PubMed Central, EMBASE, MEDLINE, and Cochrane library, and search engines, such as ScienceDirect and Google Scholar, from inception until March 2021. We used the Newcastle-Ottawa Scale (NOS) to assess the quality of published studies. We carried out a meta-analysis with random-effects model and reported pooled odds ratio (OR) with 95% confidence interval (CI). In total, we analysed 30 studies with 41,090 participants. The majority of the studies had good to satisfactory quality as per NOS. Physical activity had a statistically significant association with the prevalence of metabolic syndrome (pooled OR = 1.57; 95%CI: 1.28 to 1.93, I² = 91%). However, smoking (pooled OR = 0.96; 95%CI: 0.75 to 1.23, I² = 90.5%) and alcohol (pooled OR = 1.00; 95%CI: 0.75 to 1.33, I² = 90.8%) did not reveal a statistically significant association with the burden of metabolic syndrome.

CONCLUSION

Physical inactivity was found to be a significant risk factor for metabolic syndrome. Given the evidence, it is important that the clinicians and policymakers are alike to recommend regular physical activity among the patients and general population.

Effect of COVID-19 driven lockdown on social contact pattern in Puducherry, India: A longitudinal study

Objective

This study was undertaken to assess the change in social contact and transmission dynamics among adults in the Puducherry district during the different phases of country-wide lockdown.

Methods

Adults aged 18-69 years in Puducherry were assessed for frequency and duration of contacts in the following time points: prior to lockdown (March 2020), during lockdown, immediate post-lockdown (April, June 2020), and seven months post-lockdown (February 2021). Adjusted incidence rate ratios (aIRR) were obtained using a generalized estimating equation. We also assessed the exponential trajectory of the time-varying reproduction number (R_t) during and after lockdown.

Results

Compared to pre-lockdown phase, frequency of social contacts during 1^st week, 4^th week of lockdown, and immediate post-lockdown were reduced by 89% (aIRR = 0.11; 95% CI: 0.09-0.13), 40% (aIRR = 0.60; 95% CI: 0.52-0.69) and 91% (aIRR = 0.09; 95% CI: 0.07-0.10) respectively. However, the decline was not statistically significant at seven months post-lockdown. Correspondingly, we observed an initial spike in R_t during the lockdown phase followed by a gradual decline during the immediate post-lockdown phase. However, seven months post-lockdown, R_t has increased again.

Conclusion

The study showed high compliance to the lockdown measures in Puducherry during the lockdown and immediate post-lockdown periods. However, as the lockdown measures were relaxed, the contact rate returned to the pre-lockdown state.

Is the rural population of Puducherry district healthy in terms of the burden of non-communicable diseases? Findings from a cross-sectional analytical survey

Introduction:

Epidemiological transition remains a key contributor to the rising prevalence of non-communicable diseases (NCDs) across developing nations. Population-specific NCD risk factors estimates derived using World Health Organization (WHO) 'STEP-wise approach' are crucial for devising evidence-based public health interventions to combat NCDs.

Objective:

To estimate the prevalence of behavioral and biological risk factors for NCDs among the rural adult population of Puducherry district in India.

Methodology:

STEPS survey was conducted by following all three steps (behavioral, physical measurements and biochemical risk factors) of NCD risk factor assessment. A total of 790 participants were selected from 50 villages through multistage cluster sampling method. STEPS instrument was used to assess behavioral risk factors, physical measurements and biochemical (fasting blood glucose and total cholesterol) risk factors.

Results:

Tobacco use and alcohol consumption were present among 11.3% (95% Confidence Interval (CI): 9-13.6%) and 19.2% (95% CI: 16.5-22.4%) of the population, respectively. Low physical activity, inadequate intake of fruits and vegetables, overweight and obesity were observed among 29.3% (95% CI: 26.2-32.7%), 89.8% (95% CI: 87.6-92%), 15.6% (95% CI: 13.1-18.3%) and 38.9% (95% CI: 35.4-42.2%), respectively. About 28.2% (95% CI: 25.2-31.6%) had hypertension and 24.4% (95% CI: 20-29%) had diabetes mellitus. Abdominal obesity was twice highly prevalent among women. Tobacco and alcohol use were more common among men, whereas low physical activity, obesity and hypercholesterolemia were higher among women.

Conclusion:

Public health interventions to promote healthy lifestyle need to be initiated especially to increase physical activity, intake for fruits and vegetables, and quitting of tobacco and alcohol consumption in the rural population of Puducherry.

Evaluation of LAMP for detection of Shigella from stool samples in children

Background

To assess the diagnostic accuracy of loop-mediated isothermal amplification (LAMP) for the detection of Shigella from stool samples from children.

Methods

Consecutive stool samples from children aged <13 years old who presented with acute watery diarrhoea or dysentery to the Department of Paediatrics were collected and processed in the Department of Microbiology. All the stool samples were subjected to culture, conventional PCR and LAMP. Genomic sequencing was performed for samples that were positive by LAMP but negative by both culture and conventional PCR. The LAMP results were compared to those from culture and to a composite reference standard based on culture and conventional PCR.

Results

Amongst the 374 stool samples tested, 291 samples were positive by LAMP and 213 were positive by the composite reference standard. The sensitivity of LAMP was 100 % (98.3–100 %) and its specificity was 51.6 % (43.6–59.5 %) with a disease prevalence of 57 %. The sensitivity and specificity of LAMP improved to 99.3 % (94.2–100) and 98.2 % (94.5–99.9), respectively, using latent class analysis, while assuming that genomic sequencing has perfect specificity.

Discussion

The authors have standardized the LAMP procedure for direct application to clinical stool samples. LAMP is a sensitive and specific method for the diagnosis of Shigella from stool samples of children as compared to both culture and conventional PCR.

Willingness to quit tobacco and its correlates among Indian tobacco users-Findings from the Global Adult Tobacco Survey India, 2016-17

Background

Willingness to quit in a tobacco user forms the basis for future quit attempts and quitting successfully.

Objective

To determine the prevalence and correlates of willingness to quit among tobacco users in India using the Global Adult Tobacco Survey (GATS), India, 2016-2017.

Methods

GATS, 2016-17 was a multistage geographically clustered sample survey done among 74,037 individuals aged 15 years and above across all the states and two of the Union Territories of India. Data of all those reported using any form of tobacco were studied for past attempts to quit tobacco, advised to quit by a health care provider, and exposure to anti-tobacco messages delivered through various media and the correlation of these with the willingness to quit using multivariate analysis.

Results

Of the 21,085 current tobacco users in the survey, 11,679 (52.2%), were willing to quit all forms of tobacco. Multivariate analysis showed that those in younger age groups (OR: 1.39 [1.23-1.56]), higher education levels (OR 1.15 [1.05-1.18]), time of first tobacco use in the day being more than 60 min after waking up in the morning (OR 1.11 [1.03-1.2]), history of attempts to quit in the past 12 months (OR 1.78 [1.69-1.87]), those advised to quit by health care provider in the past 12 months (OR 1.11 [1.06-1.17]), those using single form of tobacco (OR 1.1 [1.05-1.17]), those exposed to anti-tobacco messages in newspapers/magazines (OR 1.1 [1.05-1.17]), and cinemas (1.14 [1.08-1.20]) were more willing to quit compared to their counterparts.

Conclusion

Enhanced publicizing of anti-tobacco messages through the currently employed media, and ensuring that doctors give a brief advice to quit during any contact with a tobacco user could improve the willingness to quit and the consequent quit rate, especially among those tobacco users who are in younger age groups and who have attempted to quit earlier.

Influence of maternal and perinatal characteristics on risk of postpartum chronic hypertension after pre-eclampsia

OBJECTIVE

To assess the prevalence of new-onset postpartum chronic hypertension (PPCH) after pre-eclampsia and to determine the factors are associated with it.

METHODS

This study was conducted in a tertiary center in south India, between June 2018 and February 2019, consisting of pre-eclamptic women who were recruited as part of an ongoing cohort and had completed at least 3 months of postpartum follow-up. Demographic, medical, and laboratory details were collected. Primary outcome was a diagnosis of new-onset PPCH at 3 months.

RESULTS

PPCH at 3 months was noted in 32 (18.1%) women. During postnatal follow-up, 2 (1.1%) women experienced hemiplegia from stroke and 19 (10.7%) had elevated serum creatinine levels (>1.1 mg/dL). On multivariate analysis, advancing maternal age (adjusted odds ratio [aOR] 1.10, 95% confidence interval [CI] 1.01-1.21), multiparity (aOR 2.79, 95% CI 1.07-7.24), and eclampsia (aOR 3.07, 95% CI 1.03-9.13) increased the risk of PPCH at 3 months postpartum.

CONCLUSION

One in five women present with a diagnosis of new-onset PPCH within 3 months postpartum in a cohort of predominantly preterm and/or severe pre-eclampsia. A significant but weak association of PPCH with peripartum clinical characteristics was noted. The role of biochemical, hemodynamic, and echocardiographic biomarkers should be evaluated for prediction of PPCH after pre-eclampsia in future studies.

Unconditional probability of dying and age-specific mortality rate because of major non-communicable diseases in India: Time trends from 2001 to 2013

Background:

Unconditional probability of dying because of four major non-communicable diseases (NCDs) between 30 and 70 years of age is the selected global indicator to measure the impact of NCD prevention and control programs.

Objective:

To calculate the unconditional probability of dying and age-specific mortality rate because of major NCDs in India from 2001 to 2013.

Methods:

This study used multiple data sources that are available in the public domain—Census 2001 and 2011, Sample Registration System, causes of death reports in 2001–03, 2004–06, and 2010–13. Unconditional probability of dying between ages 30 and 70 years during 2001, 2006, and 2013 was calculated by the formula suggested by the World Health Organization. Line graphs were used to depict time trends in age-specific mortality rates over the years in four major NCDs (cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases).

Results:

The age-specific mortality rate because of four NCDs showed a decrease of 51 deaths per 100,000 population from 2001 to 2013. Of the four NCDs, age-specific mortality rate was highest in cardiovascular diseases (238.2/100,000 population) and least in diabetes mellitus (21.9/100,000 population); it was 76.3 and 58.2/100,000 population for cancer and chronic respiratory diseases, respectively. The probability of dying was very less and was almost the same from 30 to 44 years of life and increased steeply after that till 70 years of life; and it was more in males (24%) compared with females (17.4%).

Conclusion:

Although India has shown a decreasing trend in premature mortality because of NCDs in the past decade, the rate of decrease is not on par to achieve the global “25 × 25” target.

High levels of non-communicable diseases risk factors among transgenders in Puducherry, South India

Context:

Identification and documentation of risk factors for non-communicable diseases (NCDs) among an 'invisible community' like the transgenders (TGs) will throw light on the prevailing health status of one of the most marginalized populations in India, thereby paving way for initiating measures that would cater to their healthcare needs.

Aims:

To estimate prevalence of risk factors for NCDs among TGs registered in a community-based organization in Puducherry.

Settings and Design:

A cross-sectional descriptive study among adult (≥18 years) TGs in a community-based organization in Puducherry.

Methods and Material:

Data on sociodemographic details, selected risk factors of NCDs—alcohol use, tobacco use, physical inactivity, obesity, unhealthy diet, hypertension, and self-reported diabetes mellitus (DM) were collected using a pre-tested structured questionnaire. Dependence levels on tobacco and/or alcohol were obtained using “Fagerstrom Addiction Scale” and “Alcohol Use Disorder Identification Test” scales, respectively.

Statistical Analysis Used:

Data were single entered using EpiData and analyzed using EpiData Analysis.

Results:

Of the 200 TGs included in the study, mean (SD) age was 30 (8.8) years. Around 47% belonged to upper-lower socioeconomic class. About 90% of the participants had unhealthy dietary practice, 84% were physically inactive, 41% had high waist hip ratio, 36% were obese, 16% had high blood pressure, and 8% had self-reported DM. Prevalence of tobacco use was 43.5% with high nicotine dependence noted in 29% (23/79) of smokeless tobacco users and 12% (2/17) of smokers. Alcohol use was reported among 64.5% of which one fifth had possible dependence.

Conclusion:

Prevalence of selected risk factors for NCDs was high among TGs when compared to general population in Puducherry, which warrants targeted health interventions and priority in policy planning.

Effect of metformin on thyroid function tests in patients with subclinical hypothyroidism: an open-label randomised controlled trial

PURPOSE

Though most of the observational studies have shown that metformin can reduce serum thyroid stimulating hormone (TSH) level in patients of hypothyroidism with diabetes or polycystic ovarian disease, randomised controlled trials are sparse. The primary objective of this study was to evaluate the effect of metformin on thyroid function tests (TSH, free T4, and free T3) in patients with subclinical hypothyroidism (SCH).

METHODOLOGY

In this open label, parallel arm, randomised controlled trial, 60 patients of SCH (TSH 5.5-10 mIU/L) were randomised to either metformin group (1500 mg/day) or control group.

RESULT

A total of 46 patients (23 in each group) completed the study and no significant difference in serum TSH, free T4 or free T3 was found in between the 2 groups. Neither there was any significant change in serum TSH, free T4 or free T3 (pre and post 6 months) within the individual groups. However, the rate of normalisation of serum TSH in patients with negative thyroid antibody was significantly higher than patients with positive thyroid antibody (71.4% vs. 18.8%; P = 0.026) in metformin group in post hoc analysis. Fasting plasma glucose, serum high-density lipoprotein and indices of insulin sensitivity significantly improved in metformin group. Four patients (17%) had mild gastrointestinal adverse effects in the metformin group.

CONCLUSION

We did not find any significant change in thyroid function test in patients with SCH with metformin therapy.

Household out-of-pocket expenditure on health care - A cross-sectional study among urban and rural households, Puducherry

CONTEXT

A major proportion of health expenditure is by households as out-of-pocket expenditure (OOPE) in India. Recent estimates at district level are required for planning implementation of Universal Health Coverage.

AIMS

To estimate the proportion of households incurring OOPE and the average amount spent by the household for healthcare.

SETTINGS AND DESIGN

A cross-sectional study was conducted during August 2016 in the field practice areas of a medical college in Puducherry. A random sample of 240 households (120 rural and 120 urban) with 1,029 participants (531 rural and 498 urban) were surveyed.

SUBJECTS AND METHODS

A pretested questionnaire was used to collect information on sociodemographic details, morbidity, healthcare services utilized, and expenses incurred. Recall period of 1 month was fixed for OP/Pharmacy Services and 6 months for IP services.

RESULTS

In total, 120 rural and 120 urban households were surveyed; out of which, majority of the households were below poverty line [rural (83.3%, n = 100), urban (69.2%, n = 83)] and belonged to other backward classes [rural (60.8%, n = 73), urban (83.3%, n = 100)]. The proportion (95% CI) of households which incurred OOPE was 68.3% (59.5%-76%) in rural and 65.8% (57%-73.7%) in urban areas. The median (inter quartile range) proportion of OOPE out of the household budget was 3.31% (0.4%-10.96%) in rural and 5.15% (0.83%-16.3%) in urban areas.

CONCLUSIONS

Even in a resource rich setting as the selected areas of Puducherry, majority of the households (67%) reported OOPE. The study estimates are lesser than the national estimates, but the availability and accessibility of resources are higher in Puducherry compared with the other parts of country.

Effect of cabergoline monotherapy in Cushing's disease: an individual participant data meta-analysis

CONTEXT

The primary treatment of choice for Cushing's disease (CD) is the removal of the pituitary adenoma by transsphenoidal surgery (TSS). The surgical failure is seen in up to 75% of cases depending on the experience of the surgeon in different studies. Medical therapy is one of the options for the treatment of recurrent or persistent CD.

METHODOLOGY

The primary outcome of this meta-analysis was to find the proportion of patients achieving normalisation of 24-h urinary free cortisol (remission of CD) following cabergoline monotherapy. Literature search was conducted in January 2018 in PubMed/MEDLINE database from its date of inception to 31st December 2017. The search strategy used was "[(cushing) OR Cushing's] AND cabergoline". Individual participant data were extracted from the included studies and risk of bias was analysed by review checklist proposed by MOOSE.

RESULTS

The individual participant data of 124 patients from six observational studies were included in this meta-analysis. 92 patients (74.2%) had past pituitary surgery. The proportion of patients achieving remission of Cushing’s disease (CD) with cabergoline monotherapy was 34% (95% confidence interval 0.26–0.43; P = 0.001) [corrected]. The previous surgery [odds ratio (OR) 28.4], duration of cabergoline monotherapy (OR 1.31) and maximum cabergoline dose (OR 0.19) were predictors for remission of CD. Mild and severe side effects were reported in 37.3% and 5.6% of patients, respectively, during cabergoline monotherapy.

CONCLUSIONS

This meta-analysis shows that cabergoline monotherapy is a reasonable alternative for subjects with persistent or recurrent CD after TSS. It can also be used in CD patients either as a bridge therapy while waiting for surgery or in those unwilling for surgery or have contraindication to it.

Are Police Personnel in Puducherry Healthy? Findings from "Partners in Prevention" Programme in Puducherry, India

Background

Prevalence of cardiovascular diseases are reported to be high in police force, which constitute a special occupational group. "Partners in Prevention" was a special surveillance activity carried out among the personnel of the Department of Police, Government of Puducherry by JIPMER, Puducherry. The present study reports the prevalence of metabolic syndrome and other cardiovascular risk factors in this group.

Materials and Methods

The design was cross-sectional analytical study covering 1618 policemen during 2013-15. A pre-tested questionnaire was used for collecting data. Anthropometric and biochemical measurements were carried out using standard techniques. Metabolic syndrome was diagnosed using the International Diabetes Federation (IDF) consensus worldwide definition. Statistical analysis was performed using the IBM- SPSS 21 software.

Results

The mean (SD) age of the participants was 45.7 (10.1) years. Majority (90%) of the participants were males and were in the age group of 30-59 years. Metabolic syndrome was observed in two-fifth (42%) of the study population. We found the prevalence as: hypertension (45.2%), abnormal HDL levels (62.3%), diabetes (34.7.1%), and high body mass index of >=25 kg/m² (60.5%).

Conclusion

Our study identified that police personnel were having high CVDs and risk factors. It calls for an urgent need to initiate screening and secondary prevention programmes.

Epidemiology of mental disability using Indian Disability Evaluation Assessment Scale among general population in an urban area of Puducherry, India

BACKGROUND

There is paucity of information on epidemiology of mental disability in India.

OBJECTIVE

The objective of this study was to assess mental disability, and to study the association between sociodemographic and comorbid chronic conditions with mental disability.

MATERIALS AND METHODS

This community-based cross-sectional study was conducted among ≥5 years age group in an urban area attached to a Tertiary Care Medical Institute in Puducherry, India. Mental disability was assessed using Indian Disability Evaluation and Assessment Scale. Chronic morbid conditions and other associated factors were collected using pretested questionnaire.

STATISTICAL ANALYSIS

Univariate and multiple logistic regression analysis.

RESULTS

About 2537 subjects were covered with a response rate of 94.1%. Overall, the prevalence of mental disability was found to be 7.1% (181/2537). Among them, majority had mild mental disability (151, 83.4%), followed by moderate (21, 11.6%), severe (8, 4.4%), and profound (1, 0.6%) mental disability. Univariate analysis showed that age group status, marital status, education level, occupation, family type, religion, hypertension, joint pain, backache, current smoking, current alcohol use, and conflicts were associated with mental disability (P < 0.05). Multiple logistic regression analysis showed that male gender (adjusted odds ratio [AOR] =2.064), widowed status (AOR = 27.022), separated/divorced status (AOR = 16.674), currently married status (AOR = 18.487), being illiterate (AOR = 4.352), having 1st-10th standard education (AOR = 2.531), being in an unskilled (AOR = 0.287) or semiskilled/skilled occupation (AOR = 0.025), belonging to a nuclear family (AOR = 1.816), and absence of family conflicts (AOR = 0.259) were significantly associated with mental disability compared to their counterparts.

CONCLUSION

Mental disability is more common in this area. Males, lesser education level, skilled or unskilled occupation, nuclear family, and conflicts were associated with mental disability after adjusting other variables. Multicentric cross-sectional analytical studies will explore the mental disability burden and its associated factors at regional or country level.

Is rule of halves still an occurrence in South India: Findings from community-based survey in a selected urban area of Puducherry

Background:

The objective of the present study was to assess the applicability of the rule of halves in an urban population of Puducherry, South India. We also aimed to find the correlates associated with undiagnosed hypertension to facilitate targeted screening.

Methodology:

We derive our observation from a community-based cross-sectional study conducted using the World Health Organization STEPwise approach to surveillance in urban slum of Puducherry during 2014–15. Blood pressure (BP) was measured for all the study subjects (n = 2399), and the subjects were classified as hypertensive using Joint National Committee 8 criteria, systolic BP (SBP) ≥140 mm Hg and/or diastolic BP (DBP) ≥90 mmHg and/or known hypertensives and/or treatment with antihypertensive drugs. Controlled hypertension was defined as SBP <140 mmHg and DBP <90 mmHg.

Results:

Of 2399, 799 (33.3%; 95% confidence interval [CI]: 31.4%–35.2%) adults were found to have raised BP by any means (known and unknown hypertensives). Of the 799, 367 (15.3%; 95%CI: 13.9%–16.8%) of study participants were known hypertensives. Of the known hypertensives, 74.7% (274/367) were put on treatment (drugs and or lifestyle modification), and 80% (218/274) were on regular treatment. Higher proportions of men were found to have undiagnosed hypertension compared to women (26.1 vs. 19.8%, P < 0.001). Similarly, adult from below poverty line (23.8 vs. 20%, P < 0.001), unskilled laborer (26.6 vs. 20%, P < 0.001), and literacy less than middle school (12.3 vs. 23%, P < 0.001) had more undiagnosed hypertension.

Conclusion:

In the selected urban area of Puducherry around one-third of the adult populations are having hypertension, including the 54% of undiagnosed hypertension. Adults from the vulnerable subgroups such as lower level of literacy, below poverty line, and unskilled work are found to have higher proportions of undiagnosed hypertension.

Role of Components in the Formation of Self-microemulsifying Drug Delivery Systems

Pharmaceutical research is focused in designing novel drug delivery systems to improve the bioavailability of poorly water soluble drugs. Self-microemulsifying drug delivery systems, one among the lipid-based dosage forms were proven to be promising in improving the oral bioavailability of such drugs by enhancing solubility, permeability and avoiding first-pass metabolism via enhanced lymphatic transport. Further, they have been successful in avoiding both inter and intra individual variations as well as the dose disproportionality. Aqueous insoluble drugs, in general, show greater solubility in lipid based excipients, and hence they are formulated as lipid based drug delivery systems. The extent of solubility of a hydrophobic drug in lipid excipients i.e. oil, surfactant and co-surfactant (components of self-microemulsifying drug delivery systems) greatly affects the drug loading and in producing stable self-microemulsifying drug delivery systems. The present review highlighted the influence of physicochemical factors and structural features of the hydrophobic drug on its solubility in lipid excipients and an attempt was made to explore the role of each component of self-microemulsifying drug delivery systems in the formation of stable microemulsion upon dilution.

Student-centred learning in Community Medicine: An experience from Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry

BACKGROUND

Student-centred learning (SCL) places the student at the centre of policies, practices and decision-making in the teaching-learning process. SCL methodology also advocates active involvement of students in the curriculum planning, selection of teaching-learning methods and assessment process. We planned an education innovation project to assess the perception of fifth semester undergraduate medical students towards implementation of an SCL methodology.

METHODS

The study was done among 87 fifth semester undergraduate medical students (batch of 2010-11) in the noncommunicable disease epidemiology section of Community Medicine at the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry. The students divided themselves into seven groups and developed the learning objectives, selected teaching-learning methods and assessment process for each session. The facilitators had 3-5 rounds of interaction with each group before the session. Qualitative analysis of feedback collected from students and external faculty after each session was done. The effect of implementing the SCL methodology was assessed by the reaction level of Kirkpatrick's training evaluation model by using a rating scale Results. Of the 87 eligible students, 73 (83.9%) returned the forms for evaluation. All seven groups were able to formulate the learning objectives. Most of the groups had used PowerPoint slides and videos as a teaching-learning tool. Innovative assessment methods such as crosswords and 'chocopati' were used by some groups. In general, the perception of students was favourable towards SCL compared to conventional methods and they felt that this methodology should be adopted more often. Time management and organization of sessions were the main problems encountered by the students. The mean (SD) score for the items 'sessions were useful', 'sessions were enjoyable' and 'sessions improved my knowledge' were 6.2 (1.8), 7.1 (1.8) and 6.3 (1.9), respectively.

CONCLUSION

The majority of students found the sessions on innovative teaching-learning and assessment techniques enjoyable, useful and informative. The sessions showed that students took an active part in curriculum planning, execution and evaluation.

Experiences of junior public health nurses in delivery of maternal healthcare services to tribal women in kerala

Background:

The maternal health care indicators are better in Kerala even in the tribal districts than the national averages. The tribal population scattered in hilly areas or other difficult terrains heavily constraints the MPHW female (Junior Public Health Nurse in Kerala) from providing services. The study was intended to describe the experiences of the Junior Public Health Nurses (JPHN) in delivery of maternal health care services to tribal women in Kerala.

Materials and Methods:

JPHNs posted in Thariode panchayat under the sub centers of CHC Thariode in Wayanad district of Kerala. This is a Qualitative study with in-depth interview of the JPHNs using an interview guide.

Results and Inferences:

The various difficulties experienced by JPHNs in delivering the services in tribal areas were lack of sufficient time for field work, travel difficulties faced due to the hilly terrain and lack of public transport facilities, more time spent on travel than actual time spent for field work, cultural and language barriers and extra inputs put up in service delivery to tribal women.

Conclusion and Recommendations:

The JPHNs serving in tribal areas overcame various constraints in service delivery like hilly terrain, limited public transport facilities, long hours spent in travelling, cultural and language barriers by putting in extra effort, time and personal money to fulfill their responsibilities. It is suggested that the JPHNs be given compensatory off to complete records and extra remuneration to cover their out of pocket expenditure on travelling to difficult areas.

Awareness of occupational injuries and utilization of safety measures among welders in coastal South India

BACKGROUND

Awareness of occupational hazards and its safety precautions among welders is an important health issue, especially in developing countries.

OBJECTIVE

To assess the awareness of occupational hazards and utilization of safety measures among welders in coastal South India.

METHODS

A cross-sectional study was conducted among 209 welders in Puducherry, South India. Baseline characteristics, awareness of health hazards, safety measures and their availability to and utilization by the participants were assessed using a pre-tested structured questionnaire.

RESULTS

The majority of studied welders aged between 20 and 40 years (n=160, 76.6%) and had 1-10 years of education (n=181, 86.6%). They were more aware of hazards (n=174, 83.3%) than safety measures (n=134, 64.1%). The majority of studied welders utilized at least one protective measure in the preceding week (n=200, 95.7%). Many of them had more than 5 years of experience (n=175, 83.7%), however, only 20% of them had institutional training (n=40, 19.1%). Age group, education level, and utilization of safety measures were significantly associated with awareness of hazards in univariate analysis (p<0.05).

CONCLUSION

Awareness of occupational hazards and utilization of safety measures is low among welders in coastal South India, which highlights the importance of strengthening safety regulatory services towards this group of workers.

Outcomes of respiratory diphtheria in a tertiary referral infectious disease hospital

BACKGROUND

Diphtheria is a fatal disease and may cause serious complications if not recognized early and treated properly.

OBJECTIVES

To study the epidemiology, clinical features, complications, and outcomes in respiratory diphtheria.

MATERIALS AND METHODS

Diphtheria cases admitted in the infectious disease hospital, Beliaghata, Kolkata, India between January 2009 to January 2011 were evaluated in respect to demographic profile, immunization status, clinical features, complications, and outcomes.

RESULTS

200 diphtheria cases were studied. 150 (75%) patients had history of an adequate immunization, and 100 (50%) patients were from lower socio-economic groups. Common clinical features observed were throat pain in 148 (74%) cases and fever in 112 (56%) cases. Complications observed were myocarditis in 136 (68%) cases, neuropathy in 30 (15%) cases, and respiratory compromise in 14 (7%) cases. Death occurred in 5 (2.5%) patients.

CONCLUSIONS

diphtheria is still a public health problem in many developing countries. Strict public health measures like an increased immunization coverage, improvement of socio-economic status, easy availability of anti-diphtheritic serum (ADS), early recognition and effective treatment-all may reduce the incidence and mortality.

Risk factors for cardiovascular diseases: is the social gradient reversing in northern India?

BACKGROUND

In the past century, most developed countries witnessed a reversal of social gradient in cardiovascular diseases. To examine whether this phenomenon is also under way in developing countries, we assessed the prevalence of selected risk factors for cardiovascular diseases among different social groups living in urban and rural areas of northern India.

METHODS

Four hundred adults > or =30 years of age, selected by cluster sampling, were surveyed from 8 purposively selected communities of Chandigarh and Haryana during 2004-05. The WHO STEPS tool for surveillance of risk factors was used to enquire about sociodemographic characteristics, tobacco use, alcohol intake, physical activity and to measure weight, height, blood pressure, and waist and hip circumference. Prevalence of risk factors such as tobacco use, physical inactivity, overweight (BMI > or =25 kg/m2), and hypertension (> or = 140/90 mmHg or on anti-hypertension treatment) were estimated according to the area of residence and across educational categories after controlling for the effects of confounding variables.

RESULTS

The prevalence of hypertension in urban (39%; 95% CI 29.5%-49.2%), slum (35%; 95% CI 27.2%-42.9%) and rural (33%; 95% CI 25.4%-40.8%) communities was found to be statistically similar (p > 0.05) after controlling for age, gender and education. The prevalence of physical inactivity (17% v. 12%), central obesity (90% v. 88%), overweight (20% v. 19%) and hypertension (34% v. 36%), were found to be statistically similar among literate and illiterate population after controlling for the effect of age, sex and place of residence (p > 0.05). However, the risk of tobacco use was significantly lower among literates (OR 0.3, 95% CI 0.1-0.8).

CONCLUSION

In selected communities of northern India, most of the cardiovascular disease risk factors did not have a social gradient except tobacco use, which was more common in the lower social group.

Hepatitis E epidemic with bimodal peak in a town of north India

INTRODUCTION

An epidemic of viral hepatitis occurred in Mandi Gobindgarh town of Punjab in northern India during year 2005-06. An attempt was made to study the outbreak clinically, serologically, and etiologically.

METHODS

Line listing and spot mapping of all cases of jaundice presented to civil hospital was done. An active search of cases was made through house-to-house visit with the help of 33 teams and 6 supervisors. Twenty two blood samples collected from acute cases were tested for anti-HAV IgM and anti-HEV IgM by ELISA. HEV specific PCR was also carried out. Sanitary survey was also done and water samples were tested for coliforms.

RESULTS

In house to house survey 3170 cases of jaundice were reported; of them 2171 (68.5%) were males. Mean age was 28.8 years. Overall attack rate was 5.2%. The epidemic continued for more than a year and bimodal peak was observed. Civil hospital campus which has separate water supply had no jaundice case. About 95% blood samples from icteric patients were found to be positive for IgM and IgG antibodies of HEV. Eighteen persons died during the epidemic, mostly in old age group. Case fatality ratio was 0.57%. No deaths occurred among 17 pregnant women who had developed hepatitis.

CONCLUSION

The epidemic was caused by hepatitis E virus, which was transmitted due to faecal contamination of municipal water supply.