Optimizing Blood Pressure Management in Type 2 Diabetes: A Comparative Investigation of One-Time Versus Periodic Lifestyle Modification Counseling.

Background Type 2 diabetes mellitus (T2DM) often coexists with hypertension, significantly increasing cardiovascular risks. Lifestyle modification counseling has shown promise in managing T2DM and its comorbidities. However, the optimal frequency and structure of counseling for blood pressure control remain uncertain. Our study examines the best approach for managing blood pressure in T2DM patients by comparing the outcomes of two counseling strategies: a single session and periodic counseling over time. Methodology A total of 110 diabetic patients were enrolled, with 52 patients in each group after loss to follow-up. A randomized controlled trial compared one-time counseling (control) to six months of periodic counseling (intervention) on lifestyle modification. A weighing machine, stadiometer, 24-hour dietary recall, food frequency questionnaire, biochemical blood sugar level analysis, and telephonic follow-up were the essential tools used. The data were analyzed using SPSS version 24.0 (IBM Corp., Armonk, NY, USA), employing descriptive statistics, including frequencies, percentages, graphs, mean, and standard deviation. Statistical significance at the 5% level was tested using probability (p) calculations. The Kolmogorov-Smirnov test confirmed normal distribution (p > 0.05). Parametric tests, specifically independent t-tests, were used for between-group comparisons of continuous variables, while categorical variables were analyzed using the chi-square test or Fisher's exact test. Intragroup comparisons over time employed repeated-measures analysis of variance for continuous variables. Changes within groups after six months were assessed using paired t-tests. All statistical analyses adhered to a significance level of p < 0.05. Results The gender distribution at baseline was similar between the control (55.8% male, 44.2% female) and intervention (46.2% male, 53.8% female) groups, with no significant differences (p = 0.327). The mean weight was 66.67 ± 11.51 kg in the control group and 67.14 ± 11.19 kg in the intervention group (p = 0.835), and the body mass index was 25.61 ± 4.09 kg/m² and 26.29 ± 6.01 kg/m², respectively (p = 0.503). Clinical parameters such as fasting blood sugar, postprandial blood sugar, glycosylated hemoglobin, and blood pressure showed no significant differences between the control and intervention groups at baseline (p > 0.05). After six months, the intervention group exhibited a trend toward lower blood pressure compared to the control group, but the differences were not statistically significant. The mean systolic blood pressure was 132.15 ± 14.867 mmHg in the control group and 129.15 ± 9.123 mmHg in the intervention group (p = 0.218). Changes in blood pressure over the six-month period showed significant decreases within the intervention group, while changes in the control group did not reach statistical significance. The mean difference in systolic blood pressure in the intervention group was 5.54 ± 9.77 mmHg (p = 0.0001), indicating a notable reduction, while the control group had a smaller and statistically insignificant increase of 2.308 ± 9.388 mmHg (p = 0.082). Conclusions This study addresses a significant gap in the literature by comparing the efficacy of one-time vs. periodic counseling in T2DM management. While periodic counseling shows promise in improving diastolic blood pressure, further research is needed to understand its nuanced effects and optimize lifestyle interventions for T2DM patients.

Statistical estimation of noise induced hearing loss among the drivers in one of the most polluted cities of India.

In the present study, an attempt has been made to assess the impact of vehicular noise upon the 3-wheeler tempo drivers and to know whether there is any relationship between hearing loss and cumulative noise exposure. For this purpose, 3-wheeler tempo drivers (Exposed group) and non-commercial light motor vehicle car drivers (Unexposed group) were chosen as study subjects. Three traffic routes were selected to assess the noise level during waiting and running time in the exposed and unexposed groups. Among all three routes, the highest mean noise level (Leq) was observed on the Chowk to Dubagga route for waiting and en-route noise measurement. It was measured as 84.13 dB(A) and 86.36 dB(A) for waiting and en-route periods of 7.68 ± 3.46 and 31.05 ± 6.6 min, respectively. Cumulative noise exposure was found to be significantly different (p < 0.001) in all age groups of exposed and unexposed drivers. Audiometric tests have been performed over both exposed and unexposed groups. The regression analysis has been done keeping hearing loss among tempo drivers as the dependent variable and age (years) and Energy (Pa2 Hrs) as the independent variable using three different criteria of hearing loss definitions, i.e., World Health Organization, National Institute for Occupational Safety and Health (NIOSH), Occupational Safety and Health Administration criteria. Among these three criteria, the NIOSH criterion of hearing loss best explained the independent variables. It could explain the total variation in dependent variable by independent variable quite well, i.e., 68.1%. The finding showed a linear relationship between cumulative noise exposures (Pa2 Hrs) and the exposed group's hearing loss (dB), i.e., hearing loss increases with increasing noise dose. Based on the findings, two model equations were developed to identify the safe and unsafe noise levels with exposure time.

Exploring access to HIV-related services and programmatic gaps for Men having Sex with Men (MSM) in rural India- a qualitative study.

BACKGROUND: Despite the Link Worker Scheme to address the HIV risk and vulnerabilities in rural areas, reaching out to unreached men having sex with men (MSM) remains a challenge in rural India. This study explored issues around health care access and programmatic gaps among MSM in rural settings of India. METHODS: We conducted eight Focused Group Discussions (FGDs), 20 Key Informant Interviews (KIIs), and 20 In-Depth Interviews (IDIs) in four rural sites in Maharashtra, Odisha, Madhya Pradesh, and Uttar Pradesh between November 2018 and September 2019. The data in the local language were audio-recorded, transcribed, and translated. Data were analyzed in NVivo version 11.0 software using the grounded theory approach. RESULTS: Primary barriers to health care access were lack of knowledge, myths and misconceptions, not having faith in the quality of services, program invisibility in a rural setting, and anticipated stigma at government health facilities. Government-targeted intervention services did not seem to be optimally advertised in rural areas as MSM showed a lack of information about it. Those who knew reported not accessing the available government facilities due to lack of ambient services, fear of the stigma transforming into fear of breach of confidentiality. One MSM from Odisha expressed, "…they get fear to go to the hospital because they know that hospital will not maintain confidentiality because they are local people. If society will know about them, then family life will be disturbed" [OR-R-KI-04]. Participants expressed the desire for services similar to those provided by the Accredited Social Health Activists (ASHA), frontline health workers for MSM. CONCLUSION: Programme invisibility emerges as the most critical issue for rural and young MSM. Adolescent and panthis emerged as Hidden MSM and they need focused attention from the programme. The need for village-level workers such as ASHA specifically for the MSM population emerged. MSM-friendly health clinics would help to improve healthcare access in rural MSMs under Sexual and Reproductive Health Care.

Immunity against diphtheria among children aged 5-17 years in India, 2017-18: a cross-sectional, population-based serosurvey.

BACKGROUND: Diphtheria is re-emerging as a public health problem in several Indian states. Most diphtheria cases are among children older than 5 years. In this study, we aimed to estimate age-specific immunity against diphtheria in children aged 5-17 years in India. METHODS: We used residual serum samples from a cross-sectional, population-based serosurvey for dengue infection done between June 19, 2017, and April 12, 2018, to estimate the age-group-specific seroprevalence of antibodies to diphtheria in children aged 5-17 years in India. 8309 serum samples collected from 240 clusters (122 urban and 118 rural) in 60 selected districts of 15 Indian states spread across all five geographical regions (north, northeast, east, west, and south) of India were tested for the presence of IgG antibodies against diphtheria toxoid using an ELISA. We considered children with antibody concentrations of 0·1 IU/mL or greater as immune, those with levels less than 0·01 IU/mL as non-immune (and hence susceptible to diphtheria), and those with levels in the range of 0·01 to less than 0·1 IU/mL as partially immune. We calculated the weighted proportion of children who were immune, partially immune, and non-immune, with 95% CIs, for each geographical region by age group, sex, and area of residence (urban vs rural). FINDINGS: 29·7% (95% CI 26·3-33·4) of 8309 children aged 5-17 years were immune to diphtheria, 10·5% (8·6-12·8) were non-immune, and 59·8% (56·3-63·1) were partially immune. The proportion of children aged 5-17 years who were non-immune to diphtheria ranged from 6·0% (4·2-8·3) in the south to 16·8% (11·2-24·4) in the northeast. Overall, 9·9% (7·7-12·5) of children residing in rural areas and 13·1% (10·2-16·6) residing in urban areas were non-immune to diphtheria. A higher proportion of girls than boys were non-immune to diphtheria in the northern (17·7% [12·6-24·2] vs 7·1% [4·1-11·9]; p=0·0007) and northeastern regions (20·0% [12·9-29·8] vs 12·9% [8·6-19·0]; p=0·0035). INTERPRETATION: The findings of our serosurvey indicate that a substantial proportion of children aged 5-17 years were non-immune or partially immune to diphtheria. Transmission of diphtheria is likely to continue in India until the immunity gap is bridged through adequate coverage of primary and booster doses of diphtheria vaccine. FUNDING: Indian Council of Medical Research.

Health-related quality of life of chronic obstructive pulmonary disease patients: A hospital-based study.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease characterized by the presence of persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities owing to significant exposure to noxious particles or gases. Restricted activities of daily living as a result of reduced pulmonary function or dyspnea, impair quality of life in such patients. METHODS: A cross-sectional study was conducted in a tertiary care hospital of Lucknow with 250 COPD patients to assess their health-related quality of life (HRQOL) using the St. Georges Respiratory Questionnaire (SGRQ). Study participants were selected using a systematic random sampling method. RESULTS: HRQOL of participants was significantly impaired. Employment status and airflow limitation severity of study participants had a statistically significant negative correlation whereas, duration since diagnosis of disease was seen to have a statistically significant positive correlation with SGRQ scores. CONCLUSION: COPD deteriorated the quality of life of patients. The activity score was the most affected. Urban residents had a comparatively poor HRQOL.

Validation of a questionnaire to identify noise-induced hearing loss among drivers.

OBJECTIVE: To assess the validity of a questionnaire (consisting of 10 items/questions) to identify hearing loss (HL) among three-wheeler tempo and noncommercial car drivers. MATERIALS AND METHODS: This was a cross-sectional study conducted in an urban area of Lucknow city. Three-wheeler tempo drivers and noncommercial car drivers were assessed for HL by audiometry. A total of 300 subjects, who fulfilled the study criteria, were selected for the interview and health assessment. The pure tone audiometry was conducted after >12 hours of the last noise exposure to avoid temporary threshold shift. RESULTS: The percentage of respondents aged between 31 and 40 years was 36%. The highest affirmative response item was "Do you have trouble hearing in noisy background?" constituting 68% and the lowest affirmative response item was "Do you have trouble understanding the speech of women and children?" constituting 33.7%. Kappa values showed that there was significantly (<0.05) mild agreement between most of the items and the gold standard for mid and high-frequency HL. The area under the curve for low, mid, and high frequency HL was 0.76% (95% CI = 0.68-0.84), 0.69 (95% CI = 0.73-0.75), and 0.67 (95% CI = 0.62-0.73), respectively. The sensitivity and specificity were reasonable for all the definition of HL at different cutoff scores. CONCLUSION: A self-reported questionnaire-based approach may be used for the assessment of HL especially when audiometry is not feasible.

Prevalence and pattern of mental illnesses in Uttar Pradesh, India: Findings from the National Mental Health Survey 2015-16.

AIM: To estimate the prevalence and distribution of psychiatric morbidity, and study pattern of help-seeking in a community representative sample from the state of Uttar Pradesh in northern India. METHOD: A multi-stage, stratified, random cluster sampling was used. The survey was conducted on 3508 adults during 2015-16 using M.I.N.I 6.0.0, modified Fagerström Nicotine Dependence Scale for all forms of tobacco, questionnaires for epilepsy and intellectual disability. The WHO Pathway Interview Schedule was used to study pattern of help-seeking behaviour. Focused group discussions (FGDs) and key informant interviews (KIIs) were also carried out. RESULT: Current and lifetime prevalence of 'any mental morbidity' (excluding tobacco use disorders) was 6.08% and 7.97%, respectively. The prevalence of substance use disorders, was 16.36%, of which tobacco use disorders alone contributed 16.06%. Neurotic and depressive disorders were the next most common morbidity. Schizophrenia and other psychotic disorders had a current prevalence of 0.09%. High-risk for suicide was reported to be 0.93%. Treatment gap varied between 75 and 100% for different disorders. FGDs and KIIs reflected a higher burden of substance use, including prescription drug abuse, substantial prevalence of cultural mental morbidity, deep rooted stigma, low help-seeking behaviour, and issues surrounding homeless mentally ill persons in the community. CONCLUSION: The survey revealed high mental morbidity and alarming treatment gap. FGDs and KIIs also highlight the burden of morbidity that probably goes un-noticed, due to socio-cultural systems and stigma. Findings from this survey are intended to be the groundwork for the (re)planning of mental healthcare infrastructure in the state.

Screening Depression Among Elderly in a City of Southeast Asia.

INTRODUCTION: Changing family structure (Joint to Nuclear), increased life expectancy above 60 years of age, generation and communication gap, financial dependency on children leads to conflict among family members. This may sometime lead to old age home settlement of elderly people. All these condition leads to isolation and insecurity among elderly people and this condition affect the mental status of elderly people which may sometime lead to depression among Old Age Homes residents and family living elderly people. OBJECTIVE: To study the prevalence of depression and diagnosed systemic morbidities among elderly people. To study the predictors of depression among study subjects. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted among elderly people (age ≥60 years) residing in old age homes (OAHs) and in community/families in Lucknow, India. Multistage sampling technique was used to include required sample of subjects from the community and for OAHs all the elderly people living in OAHs were included. Geriatric depression scale was used to screen depression. RESULTS: Depression was 27.7% among elderly people residing in OAHs while it was 15.6% those residing at their own homes. In community most frequent morbidity was hypertension (17.7%) while 41.1% elderly people had no diagnosed morbidity. In OAHs out of total the musculoskeletal morbidity (33.7%) was most frequent and 18.8% had no diagnosed morbidity. On multivariate analysis financial dependency and education were found to be statistically significant. CONCLUSION: Depression was more common among elderly living in Old Age Homes as compare to those living in community. Hypertension, musculoskeletal morbidities and eye related morbidities were most frequent diagnosed morbidities. Financial Dependency & Education were found to be primary predictors of depression.

Determinants of prelacteal feeding in rural northern India.

BACKGROUND: Prelacteal feeding is an underestimated problem in a developing country like India, where infant mortality rate is quite high. The present study tried to find out the factors determining prelacteal feeding in rural areas of north India. METHODS: A crosssectional study was conducted among recently delivered women of rural Uttar Pradesh, India. Multistage random sampling was used for selecting villages. From them, 352 recently delivered women were selected as the subjects, following systematic random sampling. Chi-square test and logistic regression were used to find out the predictors for prelacteal feeding. RESULTS: Overall, 40.1% of mothers gave prelacteal feeding to their newborn. Factors significantly associated with such practice, after simple logistic regression, were age, caste, socioeconomic status, and place of delivery. At multivariate level, age (odds ratio (OR) = 1.76, 95% confidence interval (CI) = 1.13-2.74), caste and place of delivery (OR = 2.23, 95% CI = 1.21-4.10) were found to determine prelacteal feeding significantly, indicating that young age, high caste, and home deliveries could affect the practice positively. CONCLUSIONS: The problem of prelacteal feeding is still prevalent in rural India. Age, caste, and place of delivery were associated with the problem. For ensuring neonatal health, the problem should be addressed with due gravity, with emphasis on exclusive breast feeding.

Hospital waste management in nonteaching hospitals of lucknow city, India.

OBJECTIVE: To assess hospital waste management in nonteaching hospitals of Lucknow city. MATERIALS AND METHODS: A cross-sectional, descriptive study was conducted on the staffs of nonteaching hospitals of Lucknow from September 2012 to March 2013. A total of eight hospitals were chosen as the study sample size. Simple random sampling technique was used for the selection of the nonteaching hospitals. A pre-structured and pre-tested interview questionnaire was used to collect necessary information regarding the hospitals and biomedical waste (BMW) management of the hospitals. The general information about the selected hospitals/employees of the hospitals was collected. RESULTS: Mean hospital waste generated in the eight nonteaching hospitals of Lucknow was 0.56 kg/bed/day. About 50.5% of the hospitals did not have BMW department and colored dustbins. In 37.5% of the hospitals, there were no BMW records and segregation at source. Incinerator was used only by hospital A for treatment of BMW. Hospital G and hospital H had no facilities for BMW treatment. CONCLUSION: There is a need for appropriate training of staffs, strict implementation of rules, and continuous surveillance of the hospitals of Lucknow to improve the BMW management and handling practices.

Factors associated with the preference for delivery at the government hospitals in rural areas of Lucknow district in Uttar Pradesh.

For assuring safe maternal and newborn health, institutional delivery was given paramount importance. In India, in spite of several efforts, lesser than 40% deliveries are conducted at health facilities, mostly at private sector. The present cross-sectional study aimed to find out the determinants of preference for delivery at government hospitals in rural areas of Lucknow, a district in Uttar Pradesh. Multistage random sampling was used for selecting villages. From them, 352 recently delivered women were selected, following systematic random sampling. Overall, 84.9% of deliveries were conducted at health institutions. Out of them, 79.3% were at government hospitals. Applying multivariate logistic regression, Hindu women (odd's ratio [OR] = 3.205), women belonging to lower socio-economic class (OR = 4.630) and late registered women (OR = 2.320) were found to be more likely to deliver at government hospitals. Attention should be given to religion, social status and timing of registration for ensuring higher fraction of deliveries at government set-up.

Role of prescribers in the level of patient satisfaction: a study in public health care settings.

AIMS: To assess the level of patient satisfaction with the various aspects of interaction of the health provider with the patient such as communication, examination and information regarding prescription in the allopathic public health facilities of Lucknow district. SETTINGS AND DESIGN: Public health facilities of Lucknow district, India. INTRODUCTION: Satisfaction in service provision is increasingly being used as a measure of health system performance. The satisfaction with the service provider i.e., the prescriber is a vital component of the whole process of consultation and largely determines the compliance of the patient to the treatment prescribed. Apart from this, satisfaction also varies according to the sociodemographic characteristics of the beneficiaries. We have therefore tried to study these factors in the present study. MATERIALS AND METHODS: Multistage stratified random sampling was used to select the health facilities while the patients were selected by systematic random sampling for the interview. STATISTICAL ANALYSIS: Number and percentages, mean and χ(2) test. RESULTS: The overall satisfaction regarding the doctor patient communication and certain aspects of examination was highest for the residents (75.4%) followed by the super specialists (71.5%) and specialists (69.1%). CONCLUSIONS: The findings of the study will help us educate the prescribers about the various neglected areas of the consultation which will go a long way to develop a consistent relationship between the providers and the beneficiaries for the attainment of the "Health for All".

Assessment of prescription pattern at the public health facilities of Lucknow district.

OBJECTIVES: To study the prescription pattern at the different levels of public health facilities of Lucknow district and to assess the average cost of drugs prescribed. METHODS: Multi-stage stratified random sampling was done to select 1625 prescriptions of the patients attending the different level of public health facilities in Lucknow district, from August 2005 to September 2006, which was used for the development of study tools, collection of data and analysis. RESULTS: The important components of prescription viz. examination findings, weight of the child, follow up visit and the signatures of the prescribers were absent in the prescriptions at the primary level. Polypharmacy was common (3.1 ± 1.6 drugs per prescription). The prescription of drugs by generic name was low (27.1%). The prescriptions at the secondary level health facilities were incomplete with respect to mentioning the suffix/prefix of the drug, full name, dose, frequency and strength of the drugs, and directions specifying the route and duration of the treatment. The average cost of drugs/prescription/day in US$ (Mean, SD) was found to be the highest at the tertiary level (0.34, 0.43), which decreased significantly at the primary level health facilities. CONCLUSION: The pattern of prescription in terms of completeness and rationality was poor. There is an urgent need to improve the standards of drug prescription.