Prevalence of Selected Cardiovascular Risk Factors and Their Associated Factors among People Living with HIV/AIDS in India.

Background: Low- and middle-income countries face the dual problem of infectious and non-infectious diseases. Persons living with HIV/AIDS (PLHIV) are also at risk of cardiovascular diseases. Hence, we did this study to determine the prevalence of cardiovascular risk factors (CVRF) among PLHIV and to find the factors associated with it. Methods: We carried out a cross-sectional analytical study among all adults aged ≥18 years registered at a facility-integrated anti-retroviral therapy center in Puducherry, India, from September 2016 to February 2018. After obtaining informed consent, we interviewed the participants to assess physical activity, alcohol, and tobacco use. We measured weight, height, abdominal circumference, and blood pressure, with biochemical investigations such as blood glucose and lipid profile. Results: Of the total 316 adults PLHIV studied, the most common cardiovascular risk factor found was dyslipidemia (82.7%), followed by inadequate physical activity (74.4%). Other behavioral risk factors studied, such as current tobacco use and current alcohol use, showed a prevalence of 12.8% and 5.4%, respectively, among male participants. The prevalence of hypertension among adult PLHIV studied was 15.8%, and diabetes was 12.3%. In the multivariate analysis, diabetes, and hypertension were significantly associated with age and literacy. Obesity was found to be associated with diabetes and abdominal obesity with dyslipidemia. Conclusion: Dyslipidemia was the most common cardiovascular risk factor, followed by inadequate physical inactivity among PLHIV. Regular screening with blood glucose, blood pressure, and lipid profile, and timely cross-referrals can help in the early detection of CVRF among PLHIV and hence improve their quality of life through appropriate treatment.

The Need for Nicotine De-addiction Services among Newly Diagnosed Tobacco-Related Head and Neck Cancer Patients, South India.

OBJECTIVES: This study aimed to determine the proportion of tobacco-related head and neck cancer patients in need of nicotine de-addiction services at the time of diagnosis and factors associated with it. METHODS: Facility-based cross-sectional study was conducted in a tertiary care center. Tobacco-related head and neck cancer patients with a past and present history of tobacco usage registered in cancer clinic from March 2016 to February 2017 were recruited. Participants were interviewed using a pretested and semi-structured questionnaire to gather information on the socio-demographic, clinical characteristics, and tobacco usage. Data were entered in EpiData v3.1 and analyzed using STATA v14. RESULTS: Among 220 participants recruited in the study, 83% were males, 47% were >60 years of age, and 40% had no formal education. Around 49% were smoking tobacco during the treatment period, 41% used smokeless tobacco, and 10% used both smoking and smokeless. The majority (56%) of them had stage T4 tumors. Around 71% of participants required de-addiction services. Those of age more than 70 years (aRR (95%CI) 1.43 (1.1-1.9)), currently employed (aRR (95%CI) 1.5 (1.2-1.9)), living alone (aRR (95%CI) 1.6 (1.0-2.5)) or in a nuclear family (aRR (95%CI) 1.5 (1.2-2)), who initiated tobacco use at a younger age (aRR (95%CI) 1.5 (1.0-2.2) were in higher need of de-addiction services. CONCLUSION: The majority of tobacco-related head and neck cancer patients required nicotine de-addiction treatment. Hence de-addiction services should be established as an integral unit of cancer clinics.

Prevalence and determinants of breast and cervical cancer screening among women aged between 30 and 49 years in India: Secondary data analysis of National Family Health Survey - 4.

Background: ">Breast and cervical cancers are the two leading causes of cancer-related morbidity and mortality in India. Early diagnosis of these cancers through screening offers the best chance to achieve successful treatment outcomes. Hence, the current study was done to determine the prevalence and predictors of breast and cervical cancer screening among women aged 30-49 years in India. Methods: We have analyzed the most recent National Family Health Survey-4 data (NFHS-4) gathered from Demographic Health Survey program. Stratification and clustering in the sample design were accounted using svyset command. Adjusted prevalence ratio (aPR) with 95% confidence interval (CI) was reported. Results: In total, 336,777 women aged 30-49 years were included. Proportion of women aged 30-49 years with history of breast cancer examination in their lifetime was 12.9% (95% CI: 12.6-13.2%), while it was 29.8% (95% CI: 29.3-30.3%) for cervical cancer. It was found that women aged 45-49 years (aPR=1.09), married (aPR=2.18), higher educational level (aPR=1.28), richest quantile (aPR=1.96), no history of pill use (aPR=1.24), obese (aPR=1.06), and healthy dietary habits (aPR=1.47) were more likely to be screened for breast cancer. Predictors for cervical cancer screening were higher age group (aPR=1.06), married (aPR=2.94), secondary educational level (aPR=1.05), richest quantile (aPR=2.24), nonpill user (aPR=1.24), nontobacco user (aPR=1.07), and lower parity (aPR=1.09). Conclusion: A total of 1 out of 10 women in reproductive age group were screened for breast cancer while less than one in three for cervical cancer. Hence, it is important to spread awareness and increase access to screening services to achieve early diagnosis and better treatment outcomes.

Perceived Stress and Its Determinants among Postmenopausal Women in Urban Puducherry.

BACKGROUND: Menopause characterized by a gradual decline in ovarian hormones takes its toll on the women both physically and mentally. These health problems can negatively impact the mental status. Hence, the current study was done to determine the level of stress and its associated factors among postmenopausal women in urban Puducherry, India. MATERIALS AND METHODS: A facility-based cross-sectional study was done among 219 postmenopausal women attending the outpatient department in urban primary health center during May 2017-June 2017. Information regarding sociodemographic profile was collected using pretested semi-structured questionnaire and Cohen's Perceived Stress Scale was used to assess the stress level. We calculated adjusted prevalence ratios (aPRs) to identify the determinants of stress. RESULTS: Among 219 participants, 46.6% were in the age group of 60-74 years; 32.9% had primary to secondary level of education; 56.2% were unemployed; 42.5% belonged to lower socioeconomic class; and 32.9% had both diabetes mellitus and hypertension. The prevalence of stress among the postmenopausal women was 26.0% (95% confidence interval: 20.7-32.2). Postmenopausal woman with higher education (aPR - 2.18), belonging to nuclear family (aPR - 1.93), lesser parity (aPR - 1.18), and current alcohol/tobacco users (aPR-2.32) were found to have a significant association with stress among the study participants. CONCLUSION: The current study showed that more than one-fourth of the postmenopausal women had high to very high level of stress. Education, religion, parity, and substance abuse were the significant determinants of stress. However, further longitudinal research needs to be done to determine whether the factors informed in the current study are truly associated with stress and develop interventions accordingly.

Burden of diabetic kidney disease among persons with type 2 diabetes mellitus registered in a tertiary care center, Puducherry.

BACKGROUND & AIMS: To determine burden of diabetic kidney disease (DKD) and estimate yield and number needed to screen (NNS) in a tertiary diabetes care center. METHODS: DKD was diagnosed if estimated Glomerular Filtration Rate (eGFR) < 60 ml/min/1.73 m2 or Urinary Albumin Creatinine Ratio (UACR) ≥30 mg/g in two urine samples. RESULTS: Of 511 participants, 206 (40%) had DKD. Using both UACR and eGFR, yield and NNS were 39% and three, respectively. CONCLUSION: Using eGFR alone, yield and NNS to find a case of DKD among consecutive adult (≥18 years age) patients with type 2 diabetes mellitus were 26.4% and 4, respectively.

Prevalence and factors related to second hand smoking exposure, knowledge and response among adolescents in rural Puducherry.

OBJECTIVES: To determine the prevalence of Second Hand Smoking (SHS) and assess the factors related to exposure, knowledge and response to SHS among adolescents in rural Puducherry, South India. METHODS: A community based cross-sectional study was conducted among adolescents during March and April 2018. Two out of four villages were selected randomly and all the adolescents were contacted through household visit and questionnaire was administered. Semi structured questionnaire contained three sections: sociodemographic details, environmental assessment and third section contained knowledge about SHS, COTPA and response towards being exposed to SHS, as well as exposure history. Continuous variables like age were summarized as mean (SD). Categorical variables such as awareness, attitude and practise towards SHS were summarized as proportions with 95% confidence interval. RESULTS: Total number of adolescents interviewed was 789. The mean age of the study participants were 14.1 (2.4) years and majority, 440 (55.8%) were boys and 684 (86.7%) belonged to nuclear family. More than one fourth, 210 (26.6%) belonged to middle class of socio-economic status. Environmental assessment of household showed more than half, 456 (57.8%) were staying in pucca house and majority 642 (81.4%) had adequate cross ventilation. It was found that about 70.1% had adequate knowledge about SHS and its harmful effects. Prevalence of exposure to SHS was 49%. Majority (40.5%) told that they will scold or advice the family member to stop smoking if they are exposed to SHS in the living place. However, almost 80% of adolescents mentioned that they will no't react if they see someone smoking in a public place. CONCLUSIONS: Current study found that almost half of the adolescents were exposed to SHS. Even though, almost three fourth had adequate knowledge, attitude towards preventing SHS in public place was found to be poor. Hence, adolescents need to be motivated enough to address the problem in the public place through motivational counselling in adolescent clinics by health care workers.

Screening for red flag symptoms of cancer: A community-based cross-sectional study from urban Puducherry, India.

BACKGROUND: Patients with cancer often delay seeking medical advice in developing countries. In India, only 20%-30% of cancers are being diagnosed in Stages I and II. Screening for red flag symptoms of cancer can be used to identify high-risk individuals in the community. METHODOLOGY: A community-based cross-sectional study was conducted in February 2017 among 302 participants in one of the service areas of Jawaharlal Institute of Postgraduate Medical Education and Research urban health center selected by universal sampling. Data on the presence of red flag symptoms of cancer (persistent cough, persistent change in bowel/bladder habits, nonhealing ulcer, persistent difficulty in swallowing, unexplained weight loss, unexplained lump, persistent unexplained pain, unexplained bleeding, and change in the appearance of mole) and presence of risk factors were collected through interviews. The collected data were entered using EpiData version 3.0. RESULTS: The mean (standard deviation) age of the study participants was 44 (11) years and 50.6% of them were male. At least one red flag symptom of cancer was present in 22 (7.3%) individuals; 9 (2.8%) had unexplained pain, 4 (1.3%) had change in bowel habits, 4 (1.3%) had change in bladder habits, 3 (1%) had cough, 3 (1%) had nonhealing ulcer, 2 (0.6%) had unexplained bleeding, 1 (0.3%) had difficulty in swallowing, 1 (0.3%) had weight loss, 1 (0.3%) had lump, and 1 (0.3%) had change in the appearance of mole. CONCLUSION: Screening for red flag symptoms of cancer is an easy tool that can be used in the community to identify high-risk individuals, which will facilitate early diagnosis of cancer.

Assessment of Quality of Life Based on Psychological, Somatovegetative, and Urogenital Health Problems among Postmenopausal Women in Urban Puducherry, South India: A Cross-Sectional Observational Study.

BACKGROUND: An average Indian woman spends almost one-third of her lifespan in the postmenopausal phase enduring the consequences of hormonal decline. This can have a significant impact on quality of life (QOL). Hence, this study was conducted to assess the QOL and health problems among postmenopausal women in urban Puducherry, South India. METHODS: A cross-sectional study was carried out among postmenopausal women attending urban primary health center between April and May 2017. Information about social, economic, and demographic characteristics was collected using a semi-structured questionnaire, and menopause rating scale was used to assess the QOL. RESULTS: Among 204 participants, 55.4% belonged to elderly age group (≥60 years); 61.3% did not have any formal education; 55.9% of the participants were unemployed; 68.7% were widowed, separated, or divorced; 89.7% belonged to Hindu religion; and 42.2% belonged to lower socioeconomic class. Majority (78%) suffered from psychological problems followed by somatovegetative (62%) and urogenital problems (33%). The prevalence of poor QOL was 37.2% (95% confidence interval: 30.8%-44.0%). Participants belonging to Hindu religion (annual percentage rate [aPR]-4.14), in nuclear family (aPR-2.31), and with chronic comorbidity (aPR-5.52) and alcohol/tobacco users (aPR-6.03) had significantly higher risk of poor QOL. CONCLUSION: The current study found that more than one-third of the postmenopausal women in urban Puducherry have poor QOL with majority suffering from psychological problems. Hence, more focus needs to be given to this target population to achieve physical, social, and mental well-being among females.