Trends of humoral immune responses to heterologous antigenic exposure due to vaccination & omicron SARS-CoV-2 infection: Implications for boosting.

Background & objectives: Vaccination and natural infection can both augment the immune responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but how omicron infection has affected the vaccine-induced and hybrid immunity is not well studied in Indian population. The present study was aimed to assess the durability and change in responses of humoral immunity with age, prior natural infection, vaccine type and duration with a minimum gap of six months post-two doses with either ChAdOx1 nCov-19 or BBV152 prior- and post-emergence of the omicron variant. Methods: A total of 1300 participants were included in this observational study between November 2021 and May 2022. Participants had completed at least six months after vaccination (2 doses) with either ChAdOx1 nCoV-19 or an inactivated whole virus vaccine BBV152. They were grouped according to their age (≤ or ≥60 yr) and prior exposure of SARS-CoV-2 infection. Five hundred and sixteen of these participants were followed up after emergence of the Omicron variant. The main outcome was durability and augmentation of the humoral immune response as determined by anti-receptor-binding domain (RBD) immunoglobulin G (IgG) concentrations, anti-nucleocapsid antibodies and anti-omicron RBD antibodies. Live virus neutralization assay was conducted for neutralizing antibodies against four variants - ancestral, delta and omicron and omicron sublineage BA.5. Results: Before the omicron surge, serum anti-RBD IgG antibodies were detected in 87 per cent participants after a median gap of eight months from the second vaccine dose, with a median titre of 114 [interquartile range (IQR) 32, 302] BAU/ml. The levels increased to 594 (252, 1230) BAU/ml post-omicron surge (P<0.001) with 97 per cent participants having detectable antibodies, although only 40 had symptomatic infection during the omicron surge irrespective of vaccine type and previous history of infection. Those with prior natural infection and vaccination had higher anti-RBD IgG titre at baseline, which increased further [352 (IQR 131, 869) to 816 (IQR 383, 2001) BAU/ml] (P<0.001). The antibody levels remained elevated after a mean time gap of 10 months, although there was a decline of 41 per cent. The geometric mean titre was 452.54, 172.80, 83.1 and 76.99 against the ancestral, delta, omicron and omicron BA.5 variants in the live virus neutralization assay. Interpretation & conclusions: Anti-RBD IgG antibodies were detected in 85 per cent of participants after a median gap of eight months following the second vaccine dose. Omicron infection probably resulted in a substantial proportion of asymptomatic infection in the first four months in our study population and boosted the vaccine-induced humoral immune response, which declined but still remained durable over 10 months.

Recent public health concerns of the high-altitude tribal population of Lahaul and Spiti, Himachal Pradesh.

Objective: India has a tribal population of 8.6%. Health concerns of the high-altitude tribal population in India play a vital role in overall socio-economic development and health transformation of the country. Therefore, the aim of this study was to determine the current health problems among the tribal population of Lahaul and Spiti district of Himachal Pradesh. Material and Methods: The study area encompasses one regional hospital (RH) in Keylong (the district headquarters), three community health centers (CHCs), and 16 primary health care centers (PHCs). In addition, the district has 37 sub-centers (SCs) and 21 Ayurveda dispensaries to serve the district. The data for this study were gathered over a 4-year period from records of daily out-patient department registration from the various health centers (RH, CHCs, and PHCs) from 2017 to 2020. Results: In terms of communicable diseases, the population in the concerned region was more likely to have acute respiratory infection, enteric fever, tuberculosis, and typhoid. Hypertension, asthma, bronchitis, and diabetes mellitus type II were determined to be the most common non-communicable diseases. Conclusion: Acute respiratory disease, hypertension, diarrhea, accidental injuries, and eye problems were shown to be prevalent in the study area. The population's position in relation to these five diseases indicates the community's sensitivity to a variety of common conditions. There is a need to review the needs and priorities of the concerned population and create goals and targets to meet those needs using validated public health measures.

Non-utilization of oral health services and associated factors among children and adolescents: an integrative review.

OBJECTIVE: To review publications exploring non-utilization of oral health services and to identify factors associated with non-utilization of oral health services among children and adolescents. MATERIALS AND METHODS: An integrative review design was adopted. A search was conducted for research articles published during the period from 2000 to April 2021 in five databases, Medline via Ovid, Scopus, CINAHL, Cochrane Library and Web of Science. Inclusion criteria were original articles examining non-utilization of oral health services among 0-19 years old and studies published in peer-reviewed journals in English. Thematic analysis was undertaken to identify common themes. The Newcastle-Ottawa scale was used to evaluate the quality of the studies. RESULTS: Twenty-one geographically diverse articles were included. Nineteen studies were cross-sectional, one was a prospective cohort and one a case-control study. Non-utilization of dental health services tended to be higher in children than adolescents. There were predisposing (age, gender, ethnicity, parent's level of education), enabling (family income, dental insurance) and need factors (subjective and objective oral health related parameters) that had been shown to be associated with non-utilization of dental services among children and adolescents. CONCLUSIONS: This integrative review found predisposing, enabling and need factors to be associated with dental health service non-utilization.

Predictors of adherence to prescribed antihypertensive medications among Hypertensive (15-49 years) in India: A secondary data analysis of National Family Health Survey 4.

Background: Adherence to medications is one of the key determinants of therapeutic control of high blood pressure and is seen as a bottleneck in our fight against hypertension control. We have little scientific evidence from India that highlights the determinants of treatment adherence. Aim: The purpose of this study was to identify the predictor adherence to the currently prescribed antihypertensive medications. Material and Methods: We did a secondary data analysis of the National Family Health Survey, 2015-2016 datasets. As there were no direct variables to measure adherence, this was derived from the responses to the survey question: "currently taking a prescribed hypertensive medication to lower Blood Pressure" among those already diagnosed as hypertensives by the physician. The other sociodemographic and household-level variables were used as independent variables for analysis. Results: The level of awareness about their hypertensive status among the 15-49-year-olds who were subjected to blood pressure measurement was 9.34% (70,267/80,3081). Of these, 70,267 participants, 65878 with valid hypertensive individual data were included in the final analysis. Among them, 26.78% are currently adhering to antihypertensive medication. Female gender (adj OR; 95% CI: 1.17 [1.09-1.24]) and non-reserved caste ([OR] 1.24; 95% [CI]: 1.18-1.32) depicted better adherence to the current treatment. The hypertensives who preferred taking treatment from shops or at home or some other place in comparison to health facilities had a significant association with adherence (adj OR: 1.64; 95% CI: [1.43-1.88]). Conclusion: The current study reported low adherence to the current antihypertensive medication. Gender, higher age group, obesity, and place of taking the treatment were strongly associated with adherence to treatment.

Effect of smoking on periodontal health and validation of self-reported smoking status with serum cotinine levels.

OBJECTIVE: To investigate whether self-reported smoking and serum cotinine levels associate with periodontal pocket development and to determine the accuracy of self-reported smoking using serum cotinine. MATERIALS AND METHODS: This 4-year prospective cohort study included data from 294 dentate adults, aged ≥30 years, who participated in both the Health 2000 Survey and the Follow-up Study of Finnish Adults' Oral Health. Subjectively reported smoking status (daily smokers n = 62, occasional smokers n = 12, quitters n = 49, and never-smokers n = 171), serum cotinine levels, demographic factors, education level, dental behaviours and medical history were collected at baseline. The outcome measure was the number of teeth with periodontal pocketing ≥4 mm over 4 years. RESULTS: Self-reported daily smokers had 1.82 (95% CI: 1.32-2.50) higher incidence of deepened periodontal pockets than never-smokers. A positive association was observed between serum cotinine (≥42.0 µg/L) and the development of periodontal pockets. The misclassification rate of self-reported smoking was 6%. CONCLUSIONS: Both self-reported daily smoking and higher serum cotinine were associated with periodontal pocket development. Self-reported smoking was fairly accurate in this study. However, higher cotinine levels among a few self-reported never-smokers indicated misreporting or passive smoking. Thus, self-reports alone are not enough to assess the smoking-attributable disease burden.

Are the tribal highlanders protected from hypertension? A meta-analysis on prevalence of hypertension among high altitude tribal population of India.

BACKGROUND: The so-called protected tribal population are also facing burden of noncommunicable diseases. The high altitude tribes are thought to be genetically and environmentally protected from hypertension (HTN) like diseases. OBJECTIVE: The objective is to estimate the prevalence of HTN among tribes residing at high altitudes (>6000 feet above sea level) of India. METHODS: The meta-analysis was undertaken during March to August 2018. National Library of Medicine's PubMed database, and Google scholar were comprehensively searched including search terms such as "blood pressure, hypertension and prevalence" combined with "tribal, tribes, high altitude, India." Articles on the prevalence of HTN were searched first and then were segregated on the basis of high altitude (>6000 ft). RESULTS: Initially, 69 references and a total of 16 abstracts were screened. After applying the inclusion and exclusion criteria on 16, eight studies were included. Meta-analysis of the prevalence of selected studies resulted in a pooled estimate mean prevalence of HTN among tribal population to be 11.43% (95% confidence interval: 6.72%-17.21%). CONCLUSION: The role of epidemiological transition needs to be read in the context of social anthropology to identify factors preventing HTN among high altitude tribes.

Is calorie intake the fundamental driver of noncommunicable diseases in India - A systematic review.

BACKGROUND: Nutrition epidemiology initially focused on few nutrients thought to be responsible for noncommunicable diseases (NCDs). The database of Indian Nutrition Survey is based majorly on calorie intake. OBJECTIVE: The objective was to compare the change in the average calorie intake from 1990 to 2012 with the emerging epidemic of diabetes and hypertension (HTN) in India since 1990. METHODS: A comprehensive search was made in National Library of Medicine's PubMed database and Google Scholar from March to August 2018, on the above-mentioned subjects. Reports of national surveys (National Sample Survey Office and National Nutrition Monitoring Bureau) were included for average calorie intake among different states from year 1990 onward. Region-wise search depicted by national nutrition surveys resulted in 277 and 587 abstracts on the prevalence of HTN and diabetes mellitus, respectively. There were 51 full-text articles and abstracts on the prevalence of HTN and diabetes from the above regions. RESULTS: The average calorie intake per capita per day in the four zones of country in rural areas decreased from 1990 to 2012. An increasing trend in the prevalence of diabetes from rural areas was observed from 1994 to 2012. The per capita average calorie intake per day in urban areas from 1999 through 2011 in all zones except the eastern part of country was on rise. There was no consistent trend in the prevalence of HTN in any of the zones. CONCLUSION: It is not just an increase in calories, but a trade-off between the demand for calories and the demand for healthy lifestyles determines the prevalence of NCDs.

Epidemiological profile and management patterns of acute myocardial infarction in very young patients from a tertiary care center.

BACKGROUND: Cardiovascular disease is the leading cause of death in India. Previously it was thought to be a disease of the elderly but now an epidemiological transition is being seen with increasing incidence in the very young adults as well. Such patterns are not well studied in the South East Asian population. OBJECTIVE: To study the epidemiological profile of very young (≤35 years) adults presenting with an acute myocardial infarction (AMI) in comparison with an older cohort. METHODOLOGY: The present study included all patients presenting with AMI to the emergency or to the out-patient department of the G B Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi between January 2014 and October 2015. A total of 102 subjects ≤35 years with AMI comprised the study subjects (cases) and were compared with 104 subjects >35 years old with AMI (Controls). RESULTS & CONCLUSION: Most of the very young AMI patients presented with an anterior wall ST segment elevation myocardial infarction, a stable hemodynamic profile, single vessel disease and better left ventricular ejection fraction as compared with controls. Most of the patients were from urban and semi-urban areas, middle and lower middle socioeconomic status and were smokers but lacked other traditional risk factors.

Body image satisfaction among female college students.

OBJECTIVE: To determine body image satisfaction among newly entrant women students in a professional institution. MATERIALS AND METHODS: A cross-sectional study using body image satisfaction described in words was undertaken, which also explored relationship with body mass index (BMI) and other selected co-variables such as socio-demographic details, overall satisfaction in life, and particularly in academic/professional life, current health status using 5-item based Likert scale. Height, weight, hip and waist circumference measurement was carried out using standard protocol. Data collection was carried through personal interview using pre-designed, pre-tested semi-structured interview schedule by female investigators during August-September 2010 and analysis carried out by computing percentages and Chi-square test. RESULTS: Out of 96 study samples, 16.66%, 51.04%, and 32.29% girl students perceived their body image as fair, good and excellent, respectively while overall 13.54% were dissatisfied with their body image. The body image satisfaction had significant relationship with image perception (P<0.001), current general health status (P<0.001) and self weight assessment (P<0.001). Mother's education had a statistically significant (P=0.004) but negative relationship with outcome variable. Students with low weight (BMI <18.5 kg/m(2)) had a significantly higher (85.71%) prevalence of body image satisfaction while overweight students (BMI≤23 kg/m(2)) had a significantly higher (54.54%) prevalence of dissatisfaction (P<0.001). DISCUSSION: High body image satisfaction is reported in this study and was found to be significantly related to anthropometric measurements. On an encouraging note, this level needs to be preserved for overall mental and healthy development of students. Proactive preventive measures could be initiated on personality development, acceptance of self and individual differences while maintaining optimum weight and active life style.