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3.  Risk Factors for Acute Myocardial Infarction in Central India: A Case-Control Study 
Atherosclerosis is a multi-factorial disease involving the interplay of genetic and environmental factors. Studies highlighting the public health importance of risk factors like chronic infections causing acute myocardial infarction (AMI) in the Indian context are scarce. This study was undertaken to study the association of socio-demographic and life-style factors with acute myocardial infarction in central India.
Materials and Methods:
The cases and controls were group-matched for age, gender, and socio-economic status. A blinded research associate administered the study questionnaire. We performed an unconditional multiple logistic regression analysis.
The case-control study included 265 cases of AMI and 265 controls. The results of final model of logistic regression analysis for risk factors of AMI included 11 risk factors at α = 0.05. They were waist hip ratio, body mass index, stress at home in last 1 year, hypertension, family history of CHD, past history of gingival sepsis, tobacco smoking, raised total serum cholesterol, Chlamydia pneumoniae, Helicobacter pylori and raised C-reactive protein.
The findings confirm the role of conventional risk factors for cardiac disease and highlight need for research into the association between chronic infections with AMI.
PMCID: PMC4317976  PMID: 25657508
Atherosclerosis; acute myocardial infarction; risk factors
4.  Air Nicotine Levels in Public Places in Ahmedabad, India: Before and After Implementation of the Smoking Ban 
To compare air nicotine levels in public places in Ahmedabad, India, before (June 2008) and after (January, 2010) the implementation of a comprehensive smoking ban which was introduced in October 2008.
Materials and Methods:
Air nicotine concentrations were measured by sampling of vapor-phase nicotine using passive monitors. In 2008 (baseline), monitors were placed for 5-7 working days in 5 hospitals, 10 restaurants, 5 schools, 5 government buildings, and 10 entertainment venues, of which 6 were hookah bars. In 2010 (follow-up), monitors were placed in 35 similar venues for the same duration.
Comparison of the overall median nicotine concentration at baseline (2008) (0.06 μg/m3 Interquartile range (IQR): 0.02-0.22) to that of follow-up (2010) (0.03 μg/m3 IQR: 0.00-0.13), reflects a significant decline (% decline = 39.7, P = 0.012) in exposure to second-hand smoke (SHS). The percent change in exposure varied by venue-type. The most significant decrease occurred in hospitals, from 0.04 μg/m3 at baseline to concentrations under the limit of detection at follow-up (%decline = 100, P < 0.001). In entertainment venues, government offices, and restaurants, decreases in SHS exposure also appeared evident. However, in hookah bars, air nicotine levels appeared to increase (P = 0.160).
Overall, SHS exposure was significantly reduced in public places after the smoke-free legislation came into force. However, nicotine concentrations were still detected in most of the venues indicating imperfect compliance with the comprehensive ban.
PMCID: PMC4317977  PMID: 25657509
Air nicotine monitoring; second-hand smoke; smoke-free law; smoking ban
5.  Determinants of Patient's Adherence to Hypertension Medications in a Rural Population of Kancheepuram District in Tamil Nadu, South India 
Non-communicable diseases, no longer a disease of the rich, impose a great threat in the developing nations due to demographic and epidemiological transition. This increasing burden of non-communicable diseases and their risk factors is worrisome. Adherence to hypertension (HT) medication is very important for improving the quality of life and preventing complications of HT.
To study the factors determining adherence to HT medication.
Settings and Design:
A community-based cross-sectional study was conducted in a rural area of Kancheepuram district, Tamil Nadu, with a total population of around 16,005.
Materials and Methods:
This study was carried out over a period of 6 months (February-July) using a pre-structured and validated questionnaire. All eligible participants were selected by house-to-house survey and individuals not available on three consecutive visits were excluded from the study. The questionnaire included information on demographic characteristics, lifestyle habits, adherence to HT medication, blood pressure, and body mass index (BMI). Caste was classified based on Tamil Nadu Public Service commission.
Statistical Analysis:
Data were entered in MS Excel and analyzed in SPSS version 16. P value <0.05 was considered statistically significant. Ethical Consideration: Informed verbal consent was obtained prior to data collection. The patient's adherence to HT medication was assessed using the Morisky 4-Item Self-Report Measure of Medication-taking Behavior [MMAS-4].
We studied 473 hypertensive patients of which 226 were males and 247 were females. The prevalence of adherence was 24.1% (n = 114) in the study population. Respondents with regular physical activity, non-smokers and non-alcoholics were more adherent to HT medication as compared with respondents with sedentary lifestyle, smoking and alcohol intake (P < 0.005). Based on health belief model, the respondents who perceived high susceptibility, severity, benefit had better adherence compared with moderate and low susceptibility, severity, benefit.
PMCID: PMC4317978  PMID: 25657510
Health belief model; hypertension; non-adherence; rural area
6.  Accuracy of Visual Assessment by School Teachers in School Eye Screening Program in Delhi 
Although school eye screening is a major activity of the National Program for Control of Blindness, inadequate evidence exists about accuracy of school teachers in screening.
Compare quality of referral for subnormal vision by school teachers and primary eye care workers (PECW) in school children and to establish appropriate cutoff for identification of subnormal vision in school going children.
Materials and Methods:
This was a cross-sectional study involving school children studying in classes 1 to 9 in different schools of Delhi evaluated for sub-normal vision. Vision was recorded by the teacher and a primary eye care worker especially trained for the study using the optotypes of Early treatment Diabetic Retinopathy Survey (ETDRS) vision chart with standard lighting.
The total number of children enlisted in the 20 selected schools was 10,114. Of these, 9838 (97.3%) children were examined in the study. The mean age of children enrolled in the study was 11.6 ± 2.19 years with 6752 (66.9%) males. The sensitivity and specificity of teachers in comparison to PECW using 6/9.5 vision level as cutoff for referral was 79.2% and 93.3%, respectively compared to 77.0% and 97.1%, respectively on using the 6/12 optotype. The results showed significantly higher sensitivity and lower specificity for private schools against government schools and for older against younger children.
Our results show that the use of teachers and shift to use of the 6/12 sized “E” for the school eye screening (SES) program is appropriate and would substantially reduce the work of eye care providers while improving its overall efficiency.
PMCID: PMC4317979  PMID: 25657511
Accuracy; national program for control of blindness; refractive errors; school eye screening; sensitivity and specificity
7.  Prevalence and Correlates of Metabolic Syndrome in the Adolescents of Rural Wardha 
Background and Objective:
Metabolic syndrome is a major concern as a precursor of cardiometabolic diseases. The present study was designed to study the magnitude and correlates of metabolic syndrome among the adolescents of rural Wardha.
Materials and Methods:
A cross-sectional study was carried out among the adolescents (10-19 years) of Anji PHC. A sample of 405 was selected by random sampling from the sampling frame available with department of Community Medicine. We collected data about their sociodemographic variables and other cardiometabolic risk factors. Fasting blood sample was collected to measure lipid profile and blood glucose. Blood pressure and anthropometric measurements (height, weight, and waist circumference) were also taken.
Prevalence of metabolic syndrome using ATP-III criteria modified for adolescents was found to be 9.9% (95% CI: 7.3-13.1) in the study population and lower level of high-density lipoprotein (HDL) cholesterol was found with a prevalence of 58.3% (95% CI: 53.4-63.0). The prevalence of metabolic syndrome was found to be significantly (P < 0.05) associated with the presence of obesity and hypertension among family members.
There was a moderately high prevalence of metabolic syndrome among rural adolescents.
The early identification of cardiometabolic risk factors such as hypertension and obesity can help prevent metabolic syndrome, diabetes, and cardiovascular disease.
PMCID: PMC4317980  PMID: 25657512
Adolescent; metabolic syndrome; dyslipidemia
8.  Mainstreaming of Emergency Contraception Pill in India: Challenges and Opportunities 
Emergency Contraception Pill (ECP) is an essential intervention to prevent unwanted pregnancies. However, its use has remained low due to various barriers including reservations among medical fraternity.
Materials and Methods:
This paper presents findings on barriers to ECP's easy access for potential users from (i) a cross-sectional survey of providers' attitudes, beliefs, and practices and interviews with key opinion leaders, (ii) three consultations organized by Population Council with policymakers and public health experts, and (iii) evidence from scientific literature.
The major barriers to easy access of ECP include misconceptions and reservations of providers (disapproval of ECP provision by CHWs, opposition to its being an OTC product, and myths, misconceptions, and moral judgments about its users) including influential gynecologists.
For mainstreaming ECP, the paper recommends educational campaign focusing on gynecologists and CHWs, relaxing restrictive policy on advertisement of ECP, involving press media and strengthening supply chain to ensure its regular supply to ASHA (CHW).
PMCID: PMC4317981  PMID: 25657513
Easy access; emergency contraception; family planning; levonorgestrel; provider barriers
10.  Major Sites of Cancer Occurrence Among Men and Women in Gandhinagar District, India 
This study examines major cancer sites among the population of Gandhinagar district, India during the year 2009-2011.
To study leading cancer incidents and mortality and their age distribution in both sexes in Gandhinagar district.
Materials and Methods:
Primary data were collected from various sources and entered in computer and analyzed. Quality checks were done, and duplicate cases were eliminated. For mortality data, death registration units were contacted.
Total 2360 incident cases (1374 males and 986 females) and 736 mortality cases (464 males and 272 females) were recorded during the year 2009-2011 in Gandhinagar district. Among males, the leadings sites were mouth, tongue, lung, esophagus, hypopharynx, and larynx, whereas in females they were breast, cervix, ovary, mouth, tongue and myeloid leukemia. Majority of cases were found in the age group of 35-64 years and the proportion in male and female in this age group was 62.51% and 71.05%, respectively.
The study helps to understand the possible cancer patterns in Gandhinagar district. Foremost causes of cancer in leading sites in males were tobacco related, and the proportion of cancers associated with tobacco was 53% in our study. It highlights the possibility of easy and early detection of cancers, especially by oral cancer screening in the population. Further, the findings highlight the need of cancer cervix and breast screening among the women at regular intervals through camp approach in the community, as these are the most common sites (40% of female cancers).
PMCID: PMC4317983  PMID: 25657514
Population based cancer registry; age; gender; incidence; mortality; Mortality/incidence% (M/I%) ratio
11.  Newborn Hearing Screening: Present Scenario 
In 2009 many countries of the world met to discuss newborn and infant hearing screening current issues and guiding principles for action under World Health Organization (WHO) banner, though most of the countries who had begun this work as universal program or high risk screen do not have exact data and protocol. The developing countries also decided to become part of it and common guideline was proposed. India being part of it included hearing screening as one of the 30 diseases to be screened under Rashtriya Bal Swasthya Karyakram (RBSK). This article discusses all these issues of newborn hearing screening in the world and India.
PMCID: PMC4317984  PMID: 25657515
Hearing screening; neonatal hearing screening; Rastriya bal swasthya karyakram 2013; TEOAE
16.  Medical Research Misconduct Need Regulatory Reforms 
The medical research misconduct has become a global problem. Except from countries like the USA, China, and Germany the exact figures of misconduct are not available. The research misconduct include fabricating the data, falsifying data, and plagiarism. The irresponsible research practices are publishing research data more than once, conflicts of interest is not declared, selective reporting of data and including an author who has not contributed at all and many more. About 2% of scientists have been found to admit the fabricating the data and 33% researchers were involved in irresponsible research practices. There is no formal regulatory programs available to monitor the research projects. Few developed countries like the USA, Germany, and China tried to develop programs which can monitor the medical research misconduct. There is a need to develop a regulatory system at national and institutional level to regulate the research activity to ensure that good ethical and scientific standards are practiced by medical researchers.
PMCID: PMC4215497  PMID: 25364140
Ethics; irresponsible research practices; plagiarism; research misconduct
20.  Pre and Post-stroke Use of Statins Improves Stroke Outcome 
Although there is sufficient evidence that HMG CoA Reductase Inhibitors reduce stroke recurrence in patients with or ischemic heart disease, it remains unclear whether they also improve outcomes given before or after stroke onset and whether such an effect is more robust with pre-stroke or post-stroke use of statins.
Materials and Methods:
We carried out a retrospective analysis of a large University Health Consortium Database. Patients with statin use before or after stroke onset were included in the analysis. Twenty patients discontinued statins after stroke onset. The outcome measures were discharge home or long-term care facility and/or death within 45 days.
Patients with prior statin use were more likely to be discharged home (1.67, CI 1.12-2.49), as were post stroke statin patients who had a more robust effect OR 2.63, CI 1.61-4.53).
Patients started on statins after stroke were more likely to be discharged home versus patients already on statins before stroke onset. However, both groups were also more likely to be discharged home than those patients not on statins.
PMCID: PMC4215501  PMID: 25364144
HMG CoA reductase inhibitors; ischemic stroke; outcome
21.  Oral Health Care Availability in Health Centers of Mangalore Taluk, India 
Community-oriented oral health programs are seldom found in India. When primary health care systems were in the 1980s, dentistry was not adequately included. This has left oral health far behind other health services.
To find the availability of dental professionals, infrastructure, equipment, and treatments provided in health centers of Mangalore taluk.
Materials and Methods:
A cross-sectional study was conducted among medical officers and dentists working in all the health centers of Mangalore taluk, using an interview schedule, the oral health care availability inventory (ORAI).
Among 23 health centers of Mangalore taluk, dental services were available at six health centers (26%) [two community health centers (CHCs) and four primary health centers (PHCs)]. Mouth mirrors, dental explorers, and extraction instruments were available at six health centers [two CHCs (100%) and four PHCs (19%)]. No health centers provided orthodontic tooth corrections, removal of impacted teeth, oral biopsies, and fabrication of removable dentures.
Availability of dental services was limited in the health centers, and a vast majority of the rural population in Mangalore taluk did not have access to dental care.
PMCID: PMC4215502  PMID: 25364145
Dental health services; dentists supply and distribution; health centers; rural health services
22.  Trends in Average Living Children at the Time of Terminal Contraception: A Time Series Analysis Over 27 Years Using ARIMA (p, d, q) Nonseasonal Model 
India's National Family Welfare Programme is dominated by sterilization, particularly tubectomy. Sterilization, being a terminal method of contraception, decides the final number of children for that couple. Many studies have shown the declining trend in the average number of living children at the time of sterilization over a short period of time. So this study was planned to do time series analysis of the average children at the time of terminal contraception, to do forecasting till 2020 for the same and to compare the rates of change in various subgroups of the population.
Materials and Methods:
Data was preprocessed in MS Access 2007 by creating and running SQL queries. After testing stationarity of every series with augmented Dickey-Fuller test, time series analysis and forecasting was done using best-fit Box-Jenkins ARIMA (p, d, q) nonseasonal model. To compare the rates of change of average children in various subgroups, at sterilization, analysis of covariance (ANCOVA) was applied.
Forecasting showed that the replacement level of 2.1 total fertility rate (TFR) will be achieved in 2018 for couples opting for sterilization. The same will be achieved in 2020, 2016, 2018, and 2019 for rural area, urban area, Hindu couples, and Buddhist couples, respectively. It will not be achieved till 2020 in Muslim couples.
Every stratum of population showed the declining trend. The decline for male children and in rural area was significantly faster than the decline for female children and in urban area, respectively. The decline was not significantly different in Hindu, Muslim, and Buddhist couples.
PMCID: PMC4215503  PMID: 25364146
Demography; family size at sterilization; sterilization; time series
23.  Healthcare Seeking Behavior for Back and Joint Pain in Rural Gadchiroli, India: A Population-Based Cross-Sectional Study 
Musculoskeletal back and joint pain is common in rural agrarian communities in India.
To understand the healthcare seeking behavior for back and joint pain among adults in rural Gadchiroli, India.
Materials and Methods:
A cross-sectional survey of 315 randomly selected respondents from 84 villages between 30 and 60 years of age was conducted by community health workers (CHWs) between October 2010 and January 2011.
Among 280 respondents on whom good quality data were available, 215 (76.8%) respondents had back and/or joint pain in 6 months preceding the survey. A majority of the respondents with pain had sought care (170; 79.1%), mainly from private practitioners (116; 68.2%). Severe pain and inability to work were the reasons to seek care. Complete pain relief was considered the major indicator of an effective treatment. Injectable medications (127; 59.1%) and intravenous fluids (92; 42.8%) were considered highly effective; while about 50% were unaware of the role of physiotherapy and surgery for this problem. When asked about the preferred provider who should provide village level treatment of this problem, more than half (135; 62.8%) of the respondents chose a trained village health worker.
A majority of the individuals with back and/or joint pain in rural Gadchiroli seek care, mainly from private practitioners. However, for the village-level treatment of this problem, respondents preferred a trained village level worker. High expectation of complete pain relief, preference for injectable medications, and low awareness about nonpharmacological modalities will be the major challenges while providing community level care for this problem.
PMCID: PMC4215504  PMID: 25364147
Back pain; healthcare seeking; joint pain; musculoskeletal pain; rural India
24.  Level of Motivation Amongst Health Personnel Working in A Tertiary Care Government Hospital of New Delhi, India 
To assess the level and factors of motivation amongst permanent government employees working in a tertiary health care institution.
Material and Methods:
A sample of 200 health personnel (50 in each category) i.e. doctors, nurses, technician, and support staff were contacted through face to face interview. Motivation was measured as the degree to which an individual possessed various identified motivation domains like Drive, Control, Challenge, Relationship and Rewards. Each domain was represented by 4 dimensions- accordingly a closed-ended statement represented each of these dimensions and responses were assessed on a Likert based scale. Data management was done using SPSS, ver. 19.
The average age for different health personnel were: Doctors 48.68 (±8.53), nurses 40.72 (±7.76), technician 38.4 (±10.65) and support staff 43.24 (±9.52) years. The average year of work experience was: Doctor 19.09 (±9.77), nurses 17.2 (±8.420), technician 14.84 (±10.45), support staff 18.24 (±10.28). A comparison of overall motivation index (mean score) revealed that nurse had highest level (3.47), followed by support staff (3.46), doctor (3.45) and technician (3.43). Based on their individual mean scores, the healthcare providers were categorised into three different levels of motivation and it was found that majority of the health personnel i.e.70% of support staff, 62% nurse, 56% doctor and technician, had high to very high level of motivation index. The mean scores for all the five factors as well as their respective ranks were also found out and it was deduced that “relationship” assumed first rank for doctors (mean score: 3.71) and technician (mean score: 3.75), whereas “control” assumed greatest significance for nurses (mean score, 3.62) and support staff (mean scores, 3.61). Based upon the mean scores, “reward” assumed third rank among all the four categories. Kruskal-Wallis test was applied to test if the different categories of health personnel varied with respect to five factors of motivation and it was found that their orientation towards the various motivational components differed significantly only with respect to Drive (P < 0.01).
There is scope for enhancing staff motivation.
PMCID: PMC4215505  PMID: 25364148
Challenge; control; doctor; drive; motivation; relationship; reward
25.  Role of Hospital-Based Cancer Registries: A Decade of Experience of Cancer Cervix from a Tertiary Care Centre, India 
Hospital-based registries are important tools for policy formulations and region-specific data creation, particularly in case of cervical cancer, which is preventable by an effective screening program.
To study the epidemiological characteristics and trends in cervical neoplasia in an urban population over a decade.
Materials and Methods:
Data were collected from the histopathological records of patients from January 2000 to December 2009.
A total of 1315 gynecological malignancies were reported with cancer cervix being the most common (70.4%) with a progressive increase in the number from 56 in 2000 to 157 in 2009. Squamous cell cancer was the predominant variant with majority in advanced stage. The mean age was 50.1 years with doubling of cases in the ≤35-year category. Of 742 colposcopic biopsies performed, cervical intraepithelial neoplasia (CIN) 1 was diagnosed in 34.9%, CIN 2 in 11.8%, CIN 3 in 7.8%, and microinvasive cancer in 0.8% cases.
Though screening programs are in place, their effectiveness can be judged only by such reporting systems that aid in modifying the current cancer control strategies.
PMCID: PMC4215506  PMID: 25364149
Cancer cervix; cancer registry; cervical neoplasia; CIN; squamous cell cancer

Results 1-25 (627)