Strengthening breast cancer screening program through health education of women and capacity building of primary healthcare providers.

Background: Globally and in India, breast cancer is a prevalent malignancy. India saw 178,361 new cases and 90,000 deaths in 2020. Timely detection is vital, highlighting the importance of Breast Self-Examination (BSE), especially in low-income settings. Strengthening BSE in awareness and screening efforts is urgent. Despite awareness, practical application lags due to women's reluctance. Effective execution demands partnerships, a multi-sectoral strategy, and training grassroots workers. Objective: To address these challenges, the present study aims to strengthen the breast cancer screening program using BSE strategy and adopting a referral mechanism for the diagnosis and treatment of suspect cases. Methods: A community-based study occurred in specific districts of Rajasthan (2017-2022), enhancing breast cancer screening for women aged 30-65. It involved healthcare providers and local women, utilizing tools like the MT-DM-GP6620 Breast Inspection Model, educational booklets, and semi-structured schedules. The strategy encompassed knowledge assessment, capacity building for healthcare providers, BSE training, increasing women's breast cancer awareness, suspect case referrals, and phone-based follow-up. Results: Our study encompassed 157,225 women aged 30-65 in Jodhpur, Jalore, and Pali districts. Initial breast self-examination (BSE) awareness was below 1%. BSE training reached 218,978 women using booklets and demonstrations, with 72% aged 30-65 and the rest 15-30. Follow-ups reinforced BSE, leading to 745 identified suspect breast cancer cases, mostly due to painless lumps (332 cases). Capacity-building workshops involving 824 medical and paramedical staff strengthened early breast cancer detection in Jodhpur and Jalore, in collaboration with the district health department. Conclusion: The study model's success suggests its applicability in other Rajasthan districts, Indian states, and global breast cancer prevention programs. While positive outcomes were evident, challenges related to culture, cost, and benefits warrant consideration. The approach prioritized early detection through community engagement, reducing patient and government burdens. Community involvement and healthcare engagement were pivotal, with breast self-examination proving effective for enhancing awareness and early detection. Promoting BSE education can significantly enhance breast cancer awareness and early detection.

Overt and Covert Delinquency: Socio-Demographic Correlates in Justice-Involved Adolescent Males.

Delinquent offenses among adolescents is an important public health concern worldwide and has been increasing at an alarming rate in India. The study aimed to assess the prevalence and pattern of delinquency among justice-involved adolescent (JIA) males and determine the associated socio-demographic factors. This cross-sectional study was carried out during the year 2016 to 2019 among 178 male inmates (aged 10-18 years) of an observation home situated at Berhampur city in the state of Odisha, India. More than half (52.8%) of the JIA males committed overt delinquent acts and 47.2% committed covert delinquent acts. Drug trafficking (34.5%) tops the list among different covert delinquent acts followed by stealing things (33.3%) whereas rape (62.8%) was the most frequently committed overt delinquent act followed by murder (25%). Results of the multivariate analysis revealed that older age {adjusted odds ratio (aOR): 4.05; 95% CI [1.73, 9.51]}, lower education status of mother (aOR: 2.81; 95% CI [1.09, 7.22]), single parenthood (aOR: 4.58; 95% CI [1.27, 16.58]), and non-supportive parenting (aOR: 3.13, 95% CI [1.44, 6.80]) were significantly associated with overt delinquency in JIA males. The prevalence of overt delinquency among JIA males was high. Interventional measures incorporating these determinants should be designed to address overt delinquency in this population.

Mental Health Status, Coping Strategies During Covid-19 Pandemic Among Undergraduate Students of Healthcare Profession.

The present study aimed to assess the prevalence of psychological distress, associated lifestyle behaviors, and associated coping strategies among the students of healthcare profession. A total of 588 medical, dental, and nursing students studying in institutes of health sciences, KIIT University, Bhubaneswar, India participated in this cross-sectional online survey during September-October, 2020. A semi-structured questionnaire, DASS-21questionnaire, and Brief COPE were used to collect relevant information. The proportion of students experiencing symptoms of depression, anxiety, and stress was 26.2%, 27.7%, and 9.7%, respectively. Body mass index, presence of comorbidity, and soft drink consumption were significantly associated with psychological distress. Students experiencing psychological distress were applying emotion-focused coping behaviors (venting, acceptance, self-blame, substance use, religion) and avoidant coping behaviors (self-distraction, behavioral disengagement, denial). The prevalence of psychological distress among the students of health profession studying in KIIT University of Bhubaneswar during the period of Covid-19 pandemic is low and it can be further lowered by designing appropriate interventions incorporating healthy lifestyle behaviors and suitable coping strategies thereby ensuring sound mental health of these students.

Protocol of systematic reviews on implementation research on cardiovascular diseases, diabetes mellitus and mental ailments in India.

Introduction: The burden of non-communicable diseases (NCDs) is a major public health concern across the world. Various initiatives have tried to address these with varying degrees of success. Objective: The objective is to assess and collate existing evidence in implementation research done in India on three broad domains of NCDs namely, cardiovascular diseases (CVD), diabetes mellitus (DM), and mental health (MH) in India. Materials and methods: Three systematic review protocols have been drafted to explore and collate extant evidence of implementation research on cardiovascular diseases, diabetes mellitus, and mental health in India, in accordance with the PRISMA-P statement. Academic databases including PubMed, Embase and Science Direct will be searched. Search strategies will be formulated in iterative processes and in accordance with the formats that are specific to the databases that will be searched. In addition, grey literature and non-academic databases will also be explored. Data extracted from the selected studies will be analysed and a narrative summary of the selected articles, using the SWiM (Synthesis without meta-analysis) guidelines will be produced. Intended Outcomes: The outputs of these systematic reviews could help in a better understanding of implementation research gaps and also how to address them. Apart from giving insights into how healthcare initiatives for CVDs, diabetes and mental health could be implemented in a better way, the study could also advocate the need to build and consolidate capacity for implementation research in the country.

Maladaptive Behavior and Associated Factors among Young Children with Autism.

The present study assessed the prevalence of clinically significant maladaptive behaviors and associated factors among young male children diagnosed with autism. A cross-sectional study including mothers of 88 male children with autism aged 2 to 5 y old was conducted in the year 2019. Using the Child Behavior Checklist (CBCL), mothers rated their child's maladaptive behaviors. CBCL overall scores in the clinically relevant range were found in 76 (86.4%) children with autism (87.5% and 42% children had clinically significant internalizing and externalizing problems, respectively). Withdrawn (94.3%), attention problems (60.2%), and sleep problems (53.4%) were the predominant CBCL syndrome scales. Sociodemographic factors like autism severity and caffeine consumption were found to be significantly associated with maladaptive behaviors. There is an urgent need for designing effective behavioral management strategies incorporating various risk factors to enhance the quality of life among these vulnerable children.

Sleep quality and associated factors among undergraduate medical students during Covid-19 confinement.

Problem considered: Medical students are vulnerable to poor sleep quality which may lead to attention difficulties and poor academic performance. Good quality sleep is needed for optimal neurocognitive and psychomotor functions as well as physical and mental health. This study aimed to assess the prevalence of poor sleep quality among undergraduate medical students during home confinement at the time of Covid-19 pandemic and analyze the relationship between sleep quality and relevant socio-demographic and psychological variables. Methods: A cross-sectional study was conducted among 284 undergraduate medical students of a teaching hospital of Bhubaneswar from October-November 2020. Using a semi-structured questionnaire, relevant information was collected. Sleep quality of the students was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire and mental health status of the students using Depression, Anxiety, and Stress Scale - 21 (DASS-21). Results: The prevalence of poor sleep quality among undergraduate medical students was 45%. Multivariate logistic regression revealed that students doing exercise for <3 days/week (AOR: 1.81, 95% CI: 1.01-3.23), spending ≥8 h screen time/day (AOR: 2.02, 95%: 1.12-3.66), having anxiety symptoms (AOR: 3.61, 95% CI: 1.72-7.57), and those who were not satisfied with own self (AOR: 2.69, 95% CI: 1.35-5.38) were more likely to report poor sleep quality. Conclusion: Poor sleep quality was prevalent among undergraduate medical students during their home confinement at the time of Covid-19 pandemic. Sleep educational programs, anxiety management, and lifestyle modifications can be recommended to improve sleep quality among medical students.

Impact of environmental temperature and relative humidity on spread of COVID-19 infection in India: a cross-sectional time-series analysis.

Purpose: Coronavirus disease 2019 (COVID-19) has become a serious public health problem worldwide. This study sought to examine the associations of daily average temperature (AT) and relative humidity (ARH) with the percent increase in COVID-19 cases. Methods: Daily confirmed cases and meteorological factors in 38 districts of India were collected between 1st April 2020 to 30th April 2020. Taking a 5-day time lag of average values of the variables and multiple days-samples, we ran multiple models and performed appropriate hypothesis tests to decide the single preferred model for each sample data. Suitable fixed effects (FE) and random effects (RE) models with cluster-robust standard errors were applied to quantify the district-specific associations of meteorological and other variables with COVID-19 cases. Results: All FE models revealed that every one-degree rise in AT led to a decrease in 3.909 points (on average) in percent increase in COVID-19 cases. All RE models showed that with one unit increase in the malaria annual parasite index, there was a significant increase in 10.835 points (on average) in percent increase in COVID-19 cases. In both FE and RE models, ARH was found to be negatively associated with a percent increase in COVID-19 cases, although in half of these models the association was statistically insignificant. Conclusion: Our results indicate that mean temperature, mean relative humidity, and malaria endemicity might have an essential role in the stability and transmissibility of the 2019 novel coronavirus.

Prevalence of uropathogens and their antimicrobial resistance pattern among adult diabetic patients.

BACKGROUND: The high prevalence of diabetes, urinary tract infection (UTI) in persons with diabetes, and antibiotic resistance throughout the world including India is a cause of concern for health-care providers. OBJECTIVES: The study aimed to assess the prevalence of uropathogens, their resistance pattern, and associated factors of UTI among adults with diabetes. METHODS: A cross-sectional study was conducted during the year 2018-2019 among 504 adult diabetic patients attending a tertiary care hospital of Bhubaneswar, Eastern India. Using recommended culture methods, clean-catch midstream urine samples were examined for the presence of pathogenic bacteria and their antimicrobial susceptibility pattern. RESULTS: The prevalence of UTI was 75.4% and the predominant isolates were Escherichia coli (25.6%), Enterococcus spp. (18.7%), and Klebsiella spp. (8.1%). Most of the bacteria isolates were sensitive to nitrofurantoin (80.8%), gentamicin (76.8%), and amikacin (72.1%) whereas resistant to cefpodoxime (77.6%), cefixime (70.8%), and cefadroxil (65.0%). The overall multidrug resistance (MDR) to two or more antimicrobial agents was observed in 87.4% bacterial isolates. The odds of developing UTIs were significantly higher in females with diabetes (adjusted odds ratio [AOR]: 2.04; 95% confidence interval CI: 1.33-3.13), those with Stage I/II hypertension (AOR: 1.77; 95% CI: 1.04-3.008), and those having glycated hemoglobin level >9% (75 mmol) (AOR: 2.15; 95% CI: 1.13-4.10) compared with their counterparts. CONCLUSION: The prevalence of UTI and MDR to commonly used antibiotics among diabetic patients is alarming, and thus, isolation of uropathogenic bacteria and antimicrobial susceptibility testing is crucial for the treatment of UTI in persons with diabetes.

Glomerular C4d deposition in proliferative glomerular diseases.

INTRODUCTION: The aim of this study was to evaluate the immunohistochemical expression of C4d in native renal biopsies of proliferative glomerular diseases, complement pathways in these diseases, and assess the relationship of C4d with histological and clinicopathological parameters, other complement proteins, and immunoglobulin markers. METHODS: This cross-sectional study was conducted during the year 2018-19 involving 107 native renal biopsies with histologically diagnosed cases of proliferative glomerular diseases. C4d immunohistochemical evaluation of renal tissue sections was performed using polyclonal antihuman C4d as the primary antibody. Patients were classified as positive and negative groups based on their glomerular C4d deposition. RESULTS: The overall prevalence of C4d positivity was 80.4% in proliferative glomerular diseases ranging between 60.0% in C3 glomerulonephritis to 92.9% in membranoproliferative glomerulonephritis. Mixed capillary and mesangial deposition were noted in all cases of proliferative glomerulonephritis. Classical pathway was dominantly involved in all glomerular diseases except C3 glomerulonephritis and IgA nephropathy. Multivariate logistic regression analysis revealed that glomerular IgG staining (aOR: 5.86, 95% CI: 1.26-27.14) and IgM staining (aOR: 3.90, 95%CI: 1.07-14.18) were significantly associated with C4d positivity. CONCLUSION: C4d staining along with immunoglobulin markers such as IgG and IgM and complement proteins can be useful in delineating different complement activation pathways in glomerular diseases and understanding the disease pathogenesis.

Second-hand smoke exposure and its determinants among nonsmoking adolescents residing in slum areas of Bhubaneswar, India.

BACKGROUND: Second-hand exposure (SHS) is a significant public health problem and accounts for over 600,000 deaths among non smokers worldwide every year. The study aimed to estimate the prevalence and determinants of SHS exposure among nonsmoking adolescents residing in slum areas of Bhubaneswar, India. METHODS: Multistage cluster random sampling was used to select 259 nonsmoking adolescents from eleven slum areas. We used descriptive statistics to determine the prevalence of SHS exposure and inferential statistics using multivariable logistic regression model to identify factors associated with SHS exposure. RESULTS: Of the 259 adolescent participants, 67 (25.9%) were exposed to SHS inside home and 97 (37.5%) were exposed outside home. About 47.5% adolescents were exposed to anti-smoking media messages and 22.8% were unaware of the harmful effects of exposure to SHS. SHS exposure inside home was associated with smokeless tobacco use (adjusted odds ratio [aOR]: 10.64; 95% confidence interval (CI): 2.57-43.48), illiteracy of father (aOR: 5.40; 95% CI: 1.51-19.32), non-exposure to antismoking media messages (aOR: 3.53; 95% CI: 1.06-11.72), and absence of knowledge regarding harmful effects of SHS (aOR: 3.72; 95% CI: 1.15-12.05). Also, variables like male gender (aOR: 10.31; 95% CI: 4.50-23.81), smokeless tobacco use (aOR: 2.43; 95% CI: 1.05-5.65), illiteracy of father (aOR: 4.58; 95% CI: 1.23-17.14), and non-exposure to antismoking media messages (aOR: 4.04; 95% CI: 1.49-10.89) had increased SHS exposure outside home. CONCLUSION: The findings underscore the urgent need to implement comprehensive smoke-free policies to reduce SHS exposure among slum adolescents.

Sleep disturbances and associated factors among 2-6-year-old male children with autism in Bhubaneswar, India.

BACKGROUND: Sleep disturbances are considered one of the significant comorbidities of autism; they negatively impact the quality of life of children with autism as well as their parents or caregivers. This study aimed to determine the prevalence of sleep disturbances in Indian male children diagnosed with autism and examine the association of lifestyle behaviors and socio-demographic characteristics with sleep problems. METHODS: The present cross-sectional study was conducted in Bhubaneswar city in the year 2018, involving mothers of 100 male children with autism aged 2-6 years. We used a children's sleep habits questionnaire (CSHQ) to evaluate the sleep problems in children with autism and a semi-structured schedule for gathering information regarding lifestyle behaviors and socio-demographic characteristics. RESULTS: The overall prevalence of parent-reported sleep problems was 93%; the most prevalent CSHQ subscales were: bedtime resistance (95%), sleep anxiety (85%), and sleep duration (81%). The mean ISAA score of the study sample was 133.89 ± 19.59, where 12%, 71%, and 17% of the children had mild, moderate, and severe autism, respectively. Multiple linear regression analysis revealed that variables such as autism severity, screen time, caffeine intake, physical activity, maternal age, child's age, and birth weight were significantly associated with the CSHQ subscales. CONCLUSION: The prevalence of parent-reported sleep problems is very high among the male children with autism in Bhubaneswar, India, and there is an urgent need for interventional measures for appropriate management of this problem among these children.

Impaired Quality of Life and Its Determinants among Postmenopausal Women of Slum Communities in Bhubaneswar, India.

BACKGROUND: The severity of menopausal symptoms negatively impacts a woman's quality of life (QoL). OBJECTIVE: The aim of the study was to assess the prevalence of menopause-related impaired QoL and determine its associated factors among postmenopausal women living in slum areas of Bhubaneswar, India. MATERIALS AND METHODS: This cross-sectional study was conducted among 198 postmenopausal women aged 45-65 years during the year 2016-2017. The Menopause Rating Scale (MRS) was used to assess the prevalence and severity of menopausal symptoms. RESULTS: Joint and muscular discomfort was the most prevalent moderate-to-severe symptom (90.4%), followed by hot flushes (72.8%), irritability (67.2%), and physical and mental exhaustion (64.2%). More than two-third (133, 67.2%) of women had impaired QoL (severe total MRS score ≥17). Multivariate logistic regression analysis revealed that impaired QoL was associated younger age (adjusted odds ratio [AOR]: 4.6, 95% confidence interval [CI]: 2.12-9.98), tobacco consumption (AOR: 2.0, 95% CI: 1.05-3.82), not being satisfied in relation with husband (AOR: 3.33, 95% CI: 1.84-6.06), not having autonomy in health-care decision-making in the family (AOR: 2.30, 95% CI: 1.12-4.73), history of reproductive tract infection (AOR: 4.57, 95% CI: 1.71-12.19), and earlier onset of menopause (AOR: 3.26, 95% CI: 1.18-8.96). CONCLUSION: The point prevalence of menopause-related impaired QOL in postmenopausal women living in slums of Bhubaneswar was high. Incorporating these determinants in the existing strategies can be useful to improve the QoL of these women.

Prevalence of Pain and Its Characteristics in Hospitalized Patients in an Indian Teaching Hospital.

BACKGROUND: Pain has a great impact on the physical and mental condition of hospitalized patients, reduces quality of life, and increases economic burden. AIMS: The study aimed to determine pain prevalence, its characteristics, analgesic treatment, and associated factors for severity and chronicity of pain in hospitalized patients. METHODS: A cross-sectional study was carried out including 847 eligible adult in-patients, aged ≥18 years, admitted to the All India Institute of Medical Sciences, Bhubaneswar, India, from June to August 2018. Pain severity was evaluated by visual analog scale (VAS) at the time of interview and after 1 week/completion of pain treatment. RESULTS: The prevalence of pain during the 24 hours preceding the interview was 70.6%. The duration of pain was ≥4 weeks in 162 (27.1%) patients and severe (VAS ≥ 7) in 144 (24.1%) patients. The mean VAS score was 6.27 ± 1.97 at the time of interview and 3.31 ± 1.89 after 1 week/completion of pain treatment (p < .001). Use of opioid analgesics (adjusted odds ratio [aOR]: 3.18; confidence interval [CI]: 2.23-4.55) was significantly related to pain severity, whereas patients ≥60 years (aOR: 1.64; CI: 0.99-2.70), patients in a nonsurgical ward (aOR: 1.78; CI: 1.21-2.60), and patients using opioid analgesics (aOR: 2.63; CI: 1.73-3.98) had prolonged pain, defined as ≥4 weeks. CONCLUSION: Pain prevalence and intensity in this Indian hospital were high and pain treatment was adequate in many cases. Timely assessment and appropriate management of pain in hospitalized patients is needed to prevent further pain and its complications in these patients.

Morbidity After cardiac surgery under cardiopulmonary bypass and associated factors: A retrospective observational study.

BACKGROUND: The present study aimed to assess the morbidity after cardiac surgery and identify the preoperative and intraoperative factors associated with postoperative morbidity. METHODS: A retrospective observational study was conducted including 362 adult patients aged 18-75 years who underwent open-heart surgery under cardiopulmonary bypass at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India, during the period from June 2016 to May 2017. Using a structured schedule, preoperative and intraoperative data were collected from the hospital's cardiac surgery database, whereas the postoperative data were collected from the intensive care unit (ICU) database and the hospital's clinical information system database. RESULTS: Of 362 patients, 254 (70.2%) had at least one major complication, and the most frequently occurring complication was low cardiac output state (29.8%). The ICU length of stay (LOS) was for > 2 days in 23.2% of patients, and the hospital LOS was for > 7 days in almost 60% of the patients. Multivariate logistic regression analyses revealed that gender, type of surgery, body weight, blood lactate level at ICU admission, and 12-h blood lactate level were significant predictors of complications; gender and 24-h blood lactate level were significantly associated with the prolonged ICU LOS, whereas type of surgery and 24-h blood lactate level were significantly associated with prolonged hospital LOS. CONCLUSION: The appropriate patient management strategy can be tailored based on the personal attributes, surgery type, and blood lactate level for individual patients undergoing cardiac surgery to reduce the likelihood of postoperative complications, ICU LOS, and hospital LOS.

Retailers' tobacco sales, profit margins, and promotional activities in slum areas of Bhubaneswar, India.

We conducted a cross-sectional study during January-June 2017 involving 70 tobacco retailers from 11 slums to learn about the tobacco retailers' practices of tobacco sales, their profit margins from these sales, and their promotional activities in slum areas of Bhubaneswar, India. Slum retailers were gaining a profit margin of ≥ 10% in selling 68% of cigarette brands and in all brands of bidi (smoked tobacco) and smokeless tobacco. Almost 50% of retailers were directly or indirectly advertising tobacco, and in 90% of retail shops, tobacco products were displayed in such a way that they could be seen from outside the shop. Nearly 25% of retailers were providing discounts; 33% were giving a gift or prize or free sample or coupon to customers on purchase of a tobacco product. Understanding retailers' concerns about tobacco sales, promotion, and strict enforcement of Indian "Cigarettes and Other Tobacco Products Act" regulations is critical for tobacco control in slums.

Compliance with packaging and labelling rules for tobacco products marketed in slum areas of Bhubaneswar, India.

BACKGROUND: The Government of India has been issuing notifications regarding packaging and labelling rules for tobacco products since 2003 under the 'Cigarettes and Other Tobacco Products Act' (COTPA) guidelines. METHODS: The present cross-sectional study was carried out during November 2016 to March 2017 to assess the extent of compliance with the COTPA prescribed packaging and labelling rules for packages of tobacco products marketed in 11 slum areas of Bhubaneswar, India. From 81 retail outlets, 42 different brands of tobacco products were purchased which consisted of 23 in smoking form (17 brands of cigarette, 6 brands of bidi) and 19 in smokeless form (9 brands of gutkha, 4 brands of khaini and 6 brands of betel quid with tobacco). RESULTS: In most of the product packages, particularly in smokeless tobacco, the health warnings were not in compliance with the COTPA specifications. In a majority of the tobacco brands (69.0%), specified health warnings occupied less than the prescribed size of 85% of the principal display area of the package. Misleading descriptors and promotional messages were also present. CONCLUSION: The tobacco products marketed in Bhubaneswar slums were not in compliance with the packaging and labelling rules specified by COTPA. This underscores the need for strict implementation of COTPA guidelines and enforcement measures to assure full compliance.

Diabetes, Hypertension and Kidney Disease Combination "DHKD Syndrome" is common in India.

Objectives: The study was designed to find out frequency of (i) Diabetes mellitus (DM) as a cause Chronic Kidney Disease (CKD), (ii) Association between diabetic-CKD (diabetic patients who subsequently developed CKD as complication), hypertension (HT) and obesity. Further assessment was made to (iii) Identify percentage of diabetics attending medical and nephrology OPD had prior testing for proteinuria and or creatinine. Methods: After ethical consideration this prospective observational study was conducted on consecutive 6175 patients who gave consent to participate in two major referral hospitals one in Delhi and other in Bhubaneswar (BBSR). Primary hypertension was defined as blood pressure of ≥140/90 mmHg detected before onset of DM or detected together in the absence of CKD (elevated serum creatinine S Cr ≥1.7 mg/dL and or proteinuria > 0.3g/24H). Upper limit of serum creatinine was kept at 1.7 mg for this study. Mean value of three estimations on different days was recorded. Detail clinical history of DM and HT was taken. Body Mass Index (BMI), ocular fundi examination, urine analysis, serum creatinine, lipid profile, blood glucose, HbA1C tests were conducted in all patients. They were regularly followed up in renal clinic at about 2 month interval for repeat investigations. Blood pressure in nondiabetic-CKD patients was recorded for comparison. Further, consecutive diabetic patients attending general medicine OPD for first time were examined, their previous investigations were carefully scrutinized and recorded. Urine for albuminuria and serum creatinine were tested every month over a period of one year. Results: In Delhi diabetic-CKD was observed in 68.4% and the same was 56.2% in BBSR giving a combined figure of 62.3 percent. On close analysis of past record primary hypertension was observed in 75.4% who subsequently developed diabetes and CKD. Frequency of association between diabetic-CKD and HT were 88.2% and 69.3% in two cities respectively, combined frequency being 78.7 percent. Association of diabetic-CKD and obesity was 55.1 % and 55.9% in two cities respectively with combined frequency of 55.5 percent. In contrast obesity in non-diabetic-CKD patients in Delhi and BBSR was found in 43.1% and 18.5% respectively, combined frequency being 30.8%. Fifty four percent of diabetic patients who attended medical OPD for the first time were found to have proteinuria and elevated serum creatinine. However, they were not earlier tested for those parameters. Hence, they were unaware of CKD. Conclusion: Diabetes was found to be a bigger cause (62.3%) of CKD than what has been reported thus far in India. At presentation association of diabetic-CKD with HT was recorded higher (78.7%) in India. Hence use of the syndrome "DHKD", (complex of diabetes, hypertension and kidney disease) is justifiable. Our study shows 54.4% of diabetic patients attending medicine OPD were uninvestigated by either physician or GP for CKD because urine albumin and serum creatinine tests were lacking. Thus, progression to CKD in many patients went unnoticed. Syndromic diagnosis of "DHKD" therefore in our view is important to create general awareness for early detection and effective treatment of diabetic nephropathy.

Adaptive functioning and its associated factors among girl children residing in slum areas of Bhubaneswar, India.

AIM: Adaptive functioning develops throughout early childhood, and its limitation is a reflection that the child has developmental or emotional problems or even mental retardation. Little is known about the adaptive functioning or developmental status of slum children. The present cross-sectional study was undertaken during the year 2014 to assess the status of adaptive functioning among girl children aged between 3 and 9 years residing in slum areas of Bhubaneswar and to explore the factors associated with poor adaptive functioning. METHODS: Stratified multi-stage cluster random sampling technique was used to select the study population; 256 mother-child pairs from 256 households in selected slum areas were studied. Demographic information was collected, and adaptive functioning was assessed using the modified Vineland Social Maturity Scale. Univariate and multivariate analyses was carried out using Statistical Package for Social Sciences (SPSS) version 21. RESULTS: One-fifth (54, 21%) of the girls sampled had poor adaptive functioning, and 44 (17%) had poor cognitive functioning. Multivariate analysis revealed that the age of the child, parents' education, presence of stunting in children and attending school/early childhood centre were strong predictors of adaptive functioning in slum children. CONCLUSION: One-fifth of girls from slums are developmentally vulnerable; parental education, stunting and early childhood education or exposure to schooling are modifiable factors influencing children's adaptive functioning. Health, education and welfare sectors need to be aware of this so that a multi-pronged approach can be planned to properly address this issue in one of the most disadvantaged sections of the society.

Common mental disorder and its socio-demographic correlates among married women residing in slum areas of Bhubaneswar, India.

The mental health of women residing in slum areas is a neglected and important public health concern. The present cross-sectional study was undertaken during 2012-2013 to assess frequently occurring mental disorders and associated factors among married women 15-45 years of age, residing in slum areas of Bhubaneswar, India. A multistage, cluster, random sampling design was applied to select the study areas. The presence of a mental disorder was determined using a validated, self-reported questionnaire, developed by the World Health Organization. Using a predesigned, pretested schedule, relevant data were collected from 362 eligible, willing women respondents. Eighty women (22.1%) had a mental disorder, 56 (70.0%) of whom never consulted a health-care provider. Results of multiple logistic regression indicated that presence of a mental disorder was positively associated with not being satisfied with managing household financial affairs, not having time to attend social obligations, attending religious services less than four times per month, addiction of a family member to alcohol or drugs, and misunderstandings or quarrels in the family. Policy makers should be encouraged to incorporate such determinants in schemes or programs intended to promote the mental health of married slum women.