Anaemia of chronic disease among pulmonary tuberculosis patients is associated with inflammatory marker at the start of intensive phase.

Background: Tuberculosis (TB) disrupts iron balance through systemic inflammation. Pulmonary tuberculosis (PTB) is linked to diverse anaemia types, necessitating intricate haematological and biochemical assessments for diagnosis. This study aims to describe the prevalence of anaemia of chronic disease (ACD), iron deficiency anaemia (IDA) among PTB patients and factors associated with these types of anaemia. Methods: A cross-sectional analysis was conducted from community-based cohort study involving sputum-positive PTB patients from 2018 to 2020 in urban Puducherry. Participants were enrolled from 10 primary health centres within 2 weeks of initiating anti-tubercular treatment (ATT). Blood samples were collected for assessing haematological and biochemical parameters. The sTfR/log ferritin ratio was used to distinguish between ACD and IDA. Data were captured using Epicollect5 and analysed using STATA V14. Result: Of the 176 PTB patients included, 63.07% (111/176) had anaemia, with ACD being the predominant type (84.6%, 94/111). The C-reactive protein (CRP) levels were higher among the anaemic group [40.77 (16.66-58.51) mg/dl vs 24.65 (14.23-47.26) mg/dl] and higher among the ACD as compared to IDA [46.9 (22.3-61.2) vs 20.8 (13.0-39.1) mg/dl]. Undernourished [adjusted prevalence ratio (APR) =3.43; confidence interval (CI): 1.21-9.69] and patients having low risk of dependence on tobacco [APR = 1.52; CI: 1.10-2.11] had higher risk of ACD. Female patients had higher risk of IDA [APR = 4.95, P < 0.01]. Conclusion: The largest proportion of the PTB participants with anaemia had ACD. Acute-phase reactant and inflammatory marker are increased among newly diagnosed new sputum smear-positive (NSP) PTB participants at the start of ATT. Addressing inflammation is needed for combating anaemia in PTB patients.

Effect of Community-Based Health Education on Misconceptions Related to Caregiving for Cancer among Elderly in a Rural Area of Puducherry: A Pre-Post-Intervention Study.

Background and Aim: Families are crucial in providing comprehensive support to cancer patients, including physical, psychological, spiritual, and financial assistance. Unfortunately, cancer-related myths and stigma can have detrimental effects on those affected and their caregivers. This study aims to remove the misconceptions prevailing in a rural population of Puducherry regarding caregiving for cancer among elderly through a health education campaign. Materials and Methods: A pre- and post-intervention study was conducted among 217 adults above 18 years of age in a rural area of Puducherry. The intervention was delivered through pamphlet distribution, health talks, and discussion. Attitude, beliefs, and knowledge regarding the misconceptions about cancer were assessed in a five-point Likert scale and then the difference in the proportion of subjects with misconceptions about cancer before and after the intervention was tested using the McNemar test. Results: Among the respondents, 77% were females, 15% were illiterate, and 9.6% had a history of cancer in the family. About 23% felt cancer lends a bad name to the family and 24% considered palliative care as not necessary since end-stage cancer patients would die. Post-intervention, the perception that herbal items or diets may treat cancer declined from 45% to 18%, and that a cancer patient in the family lends bad name to the family declined from 23% to 3% (P < 0.001). Conclusions: Community-based intervention can effectively reduce misconceptions related to caregiving for cancer among elderly in rural areas. These interventions can also improve the quality of care and support provided to cancer patients.

Myths, beliefs, and attitude toward cancer among the family caregivers of cancer patients: A community-based, mixed-method study in rural Tamil Nadu.

Background and Aim: Family support is one of the most crucial components of cancer care. The familial beliefs and myths associated with cancer can seriously affect the quality of life and treatment outcome of cancer patients. This study intends to explore the prevailing myths, beliefs, and attitude toward cancer among the family caregivers of cancer patients. Materials and Methods: A community-based, exploratory, mixed-method study was conducted among family caregivers of cancer patients in Cuddalore and Villupuram districts of Tamil Nadu. Content analysis method was used for in-depth interviews. Sociodemographic characteristics and attitude of the study participants were described using proportions. Results: A common myth about causation of cancer was that it was contagious or of infective origin. Disbelief in tobacco's causation of cancer was found among the study participants. Family members' support was viewed as an essential component for cancer patients. Majority of the participants in the quantitative survey showed favorable attitude toward cancer patients. The common misconception about cancer treatment was that surgery/biopsy can spread cancer and herbal products can cure cancer. Conclusion: Even though a majority of the participants showed favorable attitude toward their cancer patients, false beliefs and myths regarding causation and treatment of cancer are prevalent in the community.

Malnutrition leads to increased inflammation and expression of tuberculosis risk signatures in recently exposed household contacts of pulmonary tuberculosis.

Background: Most individuals exposed to Mycobacterium tuberculosis (Mtb) develop latent tuberculosis infection (LTBI) and remain at risk for progressing to active tuberculosis disease (TB). Malnutrition is an important risk factor driving progression from LTBI to TB. However, the performance of blood-based TB risk signatures in malnourished individuals with LTBI remains unexplored. The aim of this study was to determine if malnourished and control individuals had differences in gene expression, immune pathways and TB risk signatures. Methods: We utilized data from 50 tuberculin skin test positive household contacts of persons with TB - 18 malnourished participants (body mass index [BMI] < 18.5 kg/m2) and 32 controls (individuals with BMI ≥ 18.5 kg/m2). Whole blood RNA-sequencing was conducted to identify differentially expressed genes (DEGs). Ingenuity Pathway Analysis was applied to the DEGs to identify top canonical pathways and gene regulators. Gene enrichment methods were then employed to score the performance of published gene signatures associated with progression from LTBI to TB. Results: Malnourished individuals had increased activation of inflammatory pathways, including pathways involved in neutrophil activation, T-cell activation and proinflammatory IL-1 and IL-6 cytokine signaling. Consistent with known association of inflammatory pathway activation with progression to TB disease, we found significantly increased expression of the RISK4 (area under the curve [AUC] = 0.734) and PREDICT29 (AUC = 0.736) progression signatures in malnourished individuals. Conclusion: Malnourished individuals display a peripheral immune response profile reflective of increased inflammation and a concomitant increased expression of risk signatures predicting progression to TB. With validation in prospective clinical cohorts, TB risk biomarkers have the potential to identify malnourished LTBI for targeted therapy.

Profile of Non-communicable disease risk factors among nurses in a tertiary care hospital in South India.

PURPOSE: The work nature of nurses and the associated lifestyle changes put them at high risk of developing non-communicable diseases (NCDs). This study was conducted to estimate the prevalence of NCD risk factors among nurses working in a tertiary care hospital in Puducherry and to determine the associated factors among nurses. METHODS: We conducted a cross-sectional study among all nurses (N=1217) in the tertiary care hospital aged between 21 and 60 from May 2019 to April 2020. We assessed NCDs behavioral, physical and biochemical risk factors using a self-administered questionnaire. The adjusted prevalence ratio was calculated using a generalized linear regression model to determine factors associated with NCD risk factors. RESULTS: The response rate was 99% (1217/1229), and 77.5 % of the participants were women. Current tobacco use, and alcohol consumption were 1.5% (95% CI: 0.8-2.2) and 2.9% (95% CI: 2-3.9) respectively with significantly higher prevalence among men. Overweight or Obesity (BMI >23 kg/m2) was 77.7%, with a significantly higher prevalence among those aged ≥30 and married. Prevalence of hypertension was 14.4 % (95% CI: 12.5-16.4), and diabetes mellitus was 11.5 % (95% CI: 9.7-13.6) were significantly higher among those aged ≥50 years. One-third of nurses, 34.3% (95% CI: 31.6-37.1), had hypercholesterolemia, significantly higher among men. CONCLUSION: We found a high prevalence of various NCD risk factors among the nurses. We highlight the urgent need for initiating health promotion interventions, especially to improve intake of healthy diet and physical activity among nurses aged ≥30 years.

Experiences of Volunteers and Patient Satisfaction in Home Based Palliative Care, Puducherry, South India-A Descriptive Qualitative Study.

Background: Increasing burden of non-communicable diseases and ageing population has parallely increased the need for Palliative care. Unavailable, inaccessible, and inadequate palliative care services in our setting increased the need for volunteers. In Puducherry, palliative care programme was implemented through trained volunteers in 2015. Objectives: To explore the experiences of volunteers who provide palliative care and also to get feedback on volunteering from the patients who received care. Settings and Design: A descriptive qualitative study was carried out at two Non-Governmental Organizations (NGO) working for palliative care in and around Puducherry. Methods and Material: Participants were selected purposively to include seven volunteers and eight patients to attain information saturation. The time period of this study was between September and October 2018. Analysis Used: Manual thematic analysis was done to identify codes, which were grouped to form categories and themes. Results: Factors that facilitated participants to take up the role of volunteers were witnessing the death of family members with unmet palliative care when required and experiences in organizations working for elderly and disabled children. Improvement in patients' condition and patient satisfaction motivated them to continue, despite lack of resources and social support. Their perception was of having become bolder and empathetic by working as palliative care volunteers. Patients reported satisfaction with the provision of drugs and other materialistic support like clothes and sweets during festivals; however, their basic and financial needs remained unmet. Conclusion: The palliative care programme or the National programme for elderly should focus on components that would improve the quality of palliative care by reducing patients' dissatisfaction. Support in terms of provision of drugs, financial help and nutrition is necessary to improve both the patients' and volunteers' satisfaction in palliative care services.

Risk factors for death during treatment in pulmonary tuberculosis patients in South India: A cohort study.

OBJECTIVE: Identifying the risk factors for deaths during tuberculosis (TB) treatment is important for achieving the vision of India's National Strategic Plan of 'Zero Deaths' by 2025. We aimed to determine the proportion of deaths during TB treatment and its risk factors among smear positive pulmonary TB patients aged more than 15 years. STUDY DESIGN: We performed a cohort study using data collected for RePORT India Consortium (Regional Prospective Observational Research in Tuberculosis). SETTING: Revised TB Control Program (RNTCP) in three districts of South India. PARTICIPANTS: The cohort consisted of newly diagnosed drug sensitive patients enrolled under the Revised National TB Control Program during 2014-2018 in three districts of southern India. Information on death was collected at homes by trained project staff. PRIMARY OUTCOME MEASURES: We calculated 'all-cause mortality' during TB treatment and expressed this as a proportion with 95% confidence interval (CI). Risk factors for death were assessed by calculating unadjusted and adjusted relative risks with 95% CI. RESULTS: The mean (SD) age was of the 1167 participants was 45 (14.5) years and 79% of them were males. Five participants (0.4%) were HIV infected. Among the males, 560 (61%) were tobacco users and 688 (75%) reported consuming alcohol. There were 47 deaths (4%; 95% CI 3.0-5.3) of which 28 deaths (60%) occurred during first two months of treatment. In a bi-variable analysis, age of more than 60 years (RR 2.27; 95%CI: 1.24-4.15), male gender (RR 3.98; 95% CI: 1.25-12.70), alcohol use in last 12 months (RR 2.03; 95%CI: 1.07-3.87), tobacco use (RR 1.87; 95%CI: 1.05-3.36) and severe anaemia (RR 3.53: 95%CI: 1.34-9.30) were associated with a higher risk of death. In adjusted analysis, participants with severe anaemia (<7gm/dl) had 2.4 times higher risk of death compared to their counterparts. CONCLUSION: Though deaths during TB treatment was not very high, early recognition of risk groups and targeted interventions are required to achieve zero TB deaths.

Extent of contraception methods practised by unmet need couples after counselling: a cross-sectional follow-up study in Puducherry, South India.

BACKGROUND: Information is paucity about the extent of contraception practise among the unmet need eligible couples after counselling. OBJECTIVE: To assess the prevalence and associated factors of unmet need for family planning (FP), the extent to which they practise desired contraception methods after baseline counselling and the reasons for not practicing it. METHODS: A community-based cross-sectional analytical study was conducted between 2016 and 2019 among 2228 currently married couples with periodic follow ups of unmet need group. Baseline data on unmet need were collected based on the National Family Health Survey questionnaire. Individual and couple counselling were performed through informing choice and the support for decision making was based on the unmet need reasons with follow-ups. The data were analysed using Stata software version 12.0 (StataCorp, College Station, TX). RESULTS: The total study population was 1924. The prevalence of unmet need for FP was 7.1% (137) with 2.9% (55) of unmet need for spacing and 4.3% (82) of limiting births. Age groups between 18 and 24 [adjusted odds ratio (AOR) = 4.463], 25-29 (AOR = 2.339), not having a child (AOR = 0.250), having one child (AOR = 2.369) and having lower socioeconomic status (AOR = 0.155) were significantly associated with unmet need. During the follow-ups, 37.2% (29/78) received who desired limiting births, while 43.6% (34/78) changed to spacing methods. In fact, the main reason for not adopting limiting births is the fear of post-operative surgery-related health problems. CONCLUSIONS: This study emphasizes the need for follow-up counselling for guiding contraceptive use and recorded that majority of the unmet need couples started practicing contraception methods during the follow-ups. Besides, change in desired contraception methods was observed.

One-hour Recovery Time in Subjects Undergoing Percutaneous Liver Biopsy: A Quality Improvement and Patient Safety Project.

Introduction Liver biopsy is the gold standard in diagnosing, staging and guiding clinical management in liver disease. There are currently no standard guidelines for liver biopsy recovery time. The aims of this project are to study the safety of a one-hour recovery time after percutaneous liver biopsies and to measure the rate of complications and identify risk factors. Methods A total of 500 consecutive subjects who underwent a percutaneous liver biopsy at a single-center teaching institution (Brooke Army Medical Center) were enrolled between December 2016 and October 2018. Biopsies were performed using a 14-gauge Bard® Monopty® core biopsy needle using bedside ultrasound. Complications were defined as: Pain level > 5 out of 10, hospitalizations, emergency department visits, or other. Major complications were defined as: hospitalizations and emergency department visits. Results The only complication that required hospitalization was identified during the first hour of recovery. Liver biopsies of subjects with body mass index (BMI) ≥35 kg/m2 were not associated with more complications when compared to patients less than 30 kg/m2. Using a spinal needle (3.5'') to anesthetize the liver capsule in subjects with excess subcutaneous tissue did not result in more complications when compared to the standard 1.5'' needle. Only 3% of the patients who received lidocaine alone for the biopsy required post-procedure medications. Conclusion Ultrasound-guided percutaneous liver biopsies, using a 14-gauge needle, were overall found to be safe. A one-hour post recovery period is adequate to identify all immediate major complications.

Effect of malnutrition on radiographic findings and mycobacterial burden in pulmonary tuberculosis.

BACKGROUND: The relationship between malnutrition and tuberculosis (TB) severity is understudied. We investigated the effect of malnutrition on radiographic findings and mycobacterial burden. METHODS: Subjects included newly diagnosed, smear-positive, culture-confirmed, pulmonary TB cases enrolled in the Regional Prospective Observational Research for TB (RePORT) cohort. Multivariate regression models were used to evaluate the relationship at start of treatment between body mass index (BMI) and chest radiograph (CXR) findings of cavitation and percentage of lung affected and mycobacterial growth indicator tube (MGIT) time to positive (TTP). Severe malnutrition was defined as BMI<16 kg/m2, moderate malnutrition as 16-18.4kg/m2, and "normal"/overweight as ≥18.5 kg/m2. RESULTS: Of 173 TB cases with chest x-ray data, 131 (76%) were male. The median age was 45 years (range 16-82); 42 (24%) had severe malnutrition and 58 (34%) moderate malnutrition. Median percentage of lung affected was 32% (range 0-95), and 132 (76%) had cavitation. Individuals with severe malnutrition had, on average, 11.1% [95% CI: 4.0-13.3] more lung affected, compared to those with normal BMI, controlling for diabetes and cavitation. In multivariable analyses, cases with severe malnutrition had a 4.6-fold [95% CI, 1.5-14.1] increased odds of cavitation compared to those with normal BMI, controlling for smoking. Median MGIT TTP was 194.5 hours. Neither severe (aRR 0.99; 95% CI, 0.9-1.2) nor moderate (aRR 0.97; 95% CI, 0.8-1.1) malnutrition was associated with MGIT TTP. CONCLUSION: We found that malnutrition was associated with increased extent of disease and cavitation on CXR. These findings may reflect the immunomodulatory effect of malnutrition on pulmonary pathology.

Tuberculosis screening among pregnant women attending a tertiary care hospital in Puducherry, South India: is it worth the effort?

BACKGROUND: The national tuberculosis (TB) programme in India recommends screening all pregnant women for TB, but this is rarely implemented. We carried out systematic TB screening among women attending the antenatal clinic of a tertiary care hospital in Puducherry, South India, during February to April 2018. OBJECTIVE: To assess the number screened and number (proportion) with presumptive and active TB, and understand potential implementation from the healthcare providers' perspective. METHODS: We conducted a mixed-methods study. The quantitative phase was a cross-sectional study including 4203 pregnant women. Data were captured using a structured proforma. Any of the following symptoms constituted 'presumptive TB': any cough, haemoptysis, fever, weight loss, night sweats, neck swellings, joint pains, neck stiffness and disorientation. Those screening positive were referred for investigations and evaluation by a chest physician. The qualitative phase involved seven one-to-one interviews with healthcare providers. Manual thematic analysis was performed to generate themes. RESULTS: Among 4203 women (two HIV-positive) screened, 77 (1.8%) had presumptive TB. Cough was the predominant symptom (n = 75). Only 12 women could produce a sputum sample, of whom one (0.02%) was diagnosed with active TB by the Xpert MTB/RIF assay. Challenges cited by healthcare providers were lack of awareness among clients and providers, high case load, lack of dedicated staff, perception that TB screening is a low-yield, low-priority activity and losses in the referral process. Suggested solutions were providing dedicated staff and space for screening, educating women to self-report using posters and videos, and creating a one-stop care provision. CONCLUSIONS: The TB yield among pregnant women was very low, calling into question the value of systematic screening in a low-HIV setting. However, the findings may not be generalizable. Evidence is urgently needed from primary and secondary care facilities. The challenges and solutions identified may help in optimizing the screening process.

High Prevalence of Chronic Respiratory Symptoms among Autorickshaw Drivers of Urban Puducherry, South India.

CONTEXT: Auto-rickshaw (three wheelers open cabin type of vehicle) drivers are exposed to traffic air pollution. Studies have demonstrated reduced pulmonary function among drivers. However, limited studies have determined the prevalence of chronic respiratory symptoms or chronic obstructive pulmonary disease (COPD) among drivers. AIMS: Among auto-rickshaw drivers of urban Puducherry to determine prevalence of (i) chronic respiratory symptoms by using Indian Study on Epidemiology of Asthma, Respiratory Symptoms, and Chronic Bronchitis (INSEARCH) questionnaire and (ii) COPD by measuring peak expiratory flow rate (PEFR). SETTING AND DESIGNS: Cross-sectional, descriptive study. SUBJECTS AND METHODS: Cluster random sampling was used to select 297 auto-rickshaw drivers. Subjects were interviewed using the INSEARCH questionnaire. PEFR was measured using Wright's peak flow meter. We also assessed exposure to tobacco smoke. STATISTICAL ANALYSIS USED: Prevalence and 95% confidence interval of chronic respiratory symptoms and COPD were calculated. RESULTS: All the auto-rickshaw drivers were male, and 75% were in the age group of 31-50 years. They spend most of the time on the roadside either driving or waiting at the auto-stand. Prevalence of nonspecific respiratory symptoms among auto-rickshaw drivers was 76% (breathlessness on exertion 68%, cough at night and phlegm in the morning 22%, wheezing 18% assessed for last 12 months). Around 28% of them had PEFR <80%. The prevalence of tobacco smoking was also high (64%), and 100% had exposure to tobacco smoke at the workplace. CONCLUSION: The nonspecific chronic symptoms were high among auto-rickshaw drivers as compared to the general population noted from a multicentric study done in India. We recommend that auto-rickshaw drivers should use personal protective equipment and would require regular screening and treatment for respiratory impairment.

Estimation of Need for Palliative Care among Noncancer Patients Attending a Tertiary Care Hospital.

CONTEXT: Palliative care services, until recently, were mainly restricted to cancer patients with incurable diseases. Hence, evaluative studies of palliative care are sparse in areas other than oncology. AIMS: To estimate what proportion of patients attending the Departments of Neurology, Cardiology, and Nephrology of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, required palliative care and to identify the palliative care needs of those patients. SETTINGS AND DESIGN: This was an exploratory descriptive study conducted in the three departments of JIPMER. MATERIALS AND METHOD: There was no predetermined sample size for the study. The participants were all adult inpatients and outpatients who were in need of palliative care in the departments of Cardiology, Nephrology, and Neurology on the day of study. STATISTICAL ANALYSIS: Percentage distribution was used to analyze the categorical variables such as education, gender, age, patients in need of palliative care, and their needs. RESULTS: The study showed that one in ten non-cancer patients in tertiary care hospitals may require palliative care services. Apart from issues in physical domain, a substantial proportion of participants also had issues in the psychological, emotional, and financial domains. CONCLUSION: This study highlights the need for incorporation and initiation of palliative care services in other non-cancer specialties in tertiary care hospitals to ensure holistic management of such cases. Counseling service has also to be rendered as part of palliative care since a good share of the patients had psychological and emotional issues.

Smoked and smokeless tobacco use among pulmonary tuberculosis patients under RNTCP in urban Puducherry, India.

BACKGROUND: Smoking is associated with unfavourable treatment outcomes like failures and defaults among the TB patients. OBJECTIVES: To study the prevalence and pattern of tobacco use among the pulmonary tuberculosis (PTB) patients in urban Pondicherry and study the association of various socio-demographic variables with current smoked and smokeless tobacco users. METHODS: A cross-sectional study was conducted among 235 PTB patients from 6 randomly selected urban PHCs of Pondicherry from Jan 2013 to March 2014. Fagerstrom Test for Nicotine Dependence was used. Chi-square test and multiple-logistic regression were done. RESULTS: Prevalence of smoking among the PTB patients at the time of TB diagnosis was 35.3%, whereas the same during the continuation phase (CP) was 23.4%. Among 83 smokers at the time of diagnosis, 52 modified and 31 did not modify their smoking after TB diagnosis. Similarly, prevalence of smokeless tobacco use both at the time of TB diagnosis and during CP was 9.8%. Male and lower education level was associated with current smoking. Similarly, female and lower education level was associated with current smokeless tobacco use. CONCLUSIONS: One-third of PTB patients used smoked or smokeless tobacco during their CP. Health programme needs to concentrate on PTB patients who continue to use smoked or smokeless tobacco during their treatment; necessary interventions need to be planned.

Breaking Up Sedentary Behavior: Perceptions From Cancer Survivors.

BACKGROUND: Limited data exist on the benefits of, barriers to, and potential strategies to break up time spent sitting in cancer survivors. Such data will be meaningful given the consequences of prolonged sitting. OBJECTIVES: The aim of this study was to conduct a mixed-method research study consisting of semistructured telephone interviews to identify recurrent themes associated with prolonged sitting in cancer survivors. METHODS: African American breast cancer survivors (N = 31) were recruited from a local tumor registry. Telephone interviews were conducted and group consensus processes were used to identify recurrent themes. The a priori categories were benefits, barriers, and potential strategies to breaking up prolonged periods of sitting. RESULTS: Recurrent themes contributing most to prolonged sitting were leisure time interest (45%: eg, watching television and reading) and health challenges (27%: eg, pain and fatigue). Most (66%) women perceived improved health as benefits to breaking up time spent sitting. Nonetheless, many (41%) survivors reported health (eg, pain and fatigue) as the biggest challenge to interrupt time spent sitting. Engaging in light intensity activities (eg, staying active, keep moving) was the most commonly reported strategy for breaking up prolonged sitting. CONCLUSIONS: African American breast cancer survivors identified the benefits and barriers to breaking up time spent sitting as well as potential strategies to interrupt time-spent sitting. IMPLICATIONS FOR PRACTICE: Clinicians are integral in promoting breaks from prolonged sitting throughout the initial phases of the cancer continuum. Successful studies will begin with early intervention in the clinical setting, with increasing intensity as survivors transition to the recovery phase.

Estimation of the cardiovascular risk using World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts in a rural population of South India.

BACKGROUND: World Health Organization/International Society of Hypertension (WHO/ISH) charts have been employed to predict the risk of cardiovascular outcome in heterogeneous settings. The aim of this research is to assess the prevalence of Cardiovascular Disease (CVD) risk factors and to estimate the cardiovascular risk among adults aged >40 years, utilizing the risk charts alone, and by the addition of other parameters. METHODS: A cross-sectional study was performed in two of the villages availing health services of a medical college. Overall 570 subjects completed the assessment. The desired information was obtained using a pre-tested questionnaire and participants were also subjected to anthropometric measurements and laboratory investigations. The WHO/ISH risk prediction charts for the South-East Asian region was used to assess the cardiovascular risk among the study participants. RESULTS: The study covered 570 adults aged above 40 years. The mean age of the subjects was 54.2 (±11.1) years and 53.3% subjects were women. Seventeen percent of the participants had moderate to high risk for the occurrence of cardiovascular events by using WHO/ISH risk prediction charts. In addition, CVD risk factors like smoking, alcohol, low High-Density Lipoprotein (HDL) cholesterol were found in 32%, 53%, 56.3%, and 61.5% study participants, respectively. CONCLUSION: Categorizing people as low (<10%)/moderate (10%-20%)/high (>20%) risk is one of the crucial steps to mitigate the magnitude of cardiovascular fatal/non-fatal outcome. This cross-sectional study indicates that there is a high burden of CVD risk in the rural Pondicherry as assessed by WHO/ISH risk prediction charts. Use of WHO/ISH charts is easy and inexpensive screening tool in predicting the cardiovascular event.

Experience of non-scalpel vasectomy in a rural area of Tamil Nadu.

BACKGROUND: Only 0.7% of men participate in the sterilization programme in Tamil Nadu. Various strategies were adopted to achieve a target of 10%. We aimed to assess the motivational strategies adopted by the health staff of Sathya Vijayanagaram block of Thiruvannamalai district in Tamil Nadu to improve the acceptance of non-scalpel vasectomy among the beneficiaries and to describe the sociodemographic characteristics of the acceptors of the technique. METHODS: This qualitative study, conducted in November-December 2010, involved in-depth interviews of the health staff of Cheyyar Health Unit district. All those who accepted non-scalpel vasectomy between 2007 and 2010 were interviewed. RESULTS: Early identification of targets and sustained motivation through a team approach, supported by administrative arrangements and intense information-education-communication activities, resulted in non-scalpel vasectomy contributing to 13% of all sterilizations. Acceptors were men from lower socioeconomic strata. CONCLUSION: The strategies adopted by the health system have contributed to the acceptance of non-scalpel vasectomy in the remote villages of a block in Tamil Nadu. This endeavour may be replicated in other districts of Tamil Nadu and others states of India to achieve the goals set for population control.

Socioepidemiologic profile and treatment-seeking behaviour of HIV/AIDS patients in a tertiary-care hospital in south India.

India has the third largest number of people living with HIV/AIDS. Provision of free antiretroviral therapy (ART) for eligible persons living with HIV (PLHA) has been scaled up significantly both in terms of facilities for treatment and number of beneficiaries. This study aimed at describing the profile of HIV/AIDS patients on ART from a tertiary-care hospital and to explore the factors associated with treatment-seeking behaviour, family support, and perceptions regarding HIV and ART. This is a descriptive study conducted at the ART centre in a tertiary-care hospital in Puducherry. Study population consisted of 130 HIV-positive patients aged more than 18 years on free firstline ART for at least 6 months. Data on sociodemographic details, clinical details, treatment-seeking behaviour, family support, and perceptions regarding HIV and ART were collected using a pretested questionnaire. Data are presented as percentages. In total, 130 patients on ART for at least 6 months were included in the study--61% were males (n=79), 39% were females (n=51); half of them belonged to the age-group of 36-50 years. Half of the participants were diagnosed to have HIV/AIDS between 1 and 3 year(s); two-thirds had one or more co-infection(s). The majority were aware of the side-effects of ART. After advice to start ART, there was a delay in starting treatment in one-fifth of the subjects due to depression, fear of stigma, disclosure to family, and side-effects. More than two-thirds of the patients travelled more than 30 km distance. Families of HIV-positive subjects were supportive in accompanying to the ART centre, collecting drugs, reminders to take medication, and motivation to complete the treatment. Alcohol (50%) and tobacco consumption (39%) was common among the subjects. Half of the respondents stated stigma, death, and pain as the main fears, and all of them stated high levels of trust and rapport with their doctors. This study reveals several positive aspects among ART beneficiaries. However, issues, like tobacco and alcohol consumption, travelling long distance for drug collection, fear of stigma and death, and concerns regarding the future, need to be addressed.