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.

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.

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.

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.

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.