Assessment of prescribing pattern of drugs and completeness of prescriptions as per the World Health Organization prescribing indicators in various Indian tertiary care centers: A multicentric study by Rational Use of Medicines Centers-Indian Council of Medical Research network under National Virtual Centre Clinical Pharmacology activity.

OBJECTIVE: The rational use of medicines as per the World Health Organization (WHO) should be practiced globally. However, data regarding the completeness of the prescriptions and their rational use is lacking from developing countries like India. Thus, the aim of this study was to assess the prescribing patterns of drugs and completeness of prescriptions as per WHO core drug use and complementary indicators to provide real-life examples for the Indian Council of Medical Research (ICMR) online prescribing skill course for medical graduates. METHODS: Prescriptions of the patients, fulfilling inclusion criteria, attending Outpatient Departments of various specialties of tertiary care hospitals, were collected by thirteen ICMR Rational use of medicines centers located in tertiary care hospitals, throughout India. Prescriptions were evaluated for rational use of medicines according to the WHO guidelines and for appropriateness as per standard treatment guidelines using a common protocol approved by local Ethics committees. RESULTS: Among 4838 prescriptions, an average of about three drugs (3.34) was prescribed to the patients per prescription. Polypharmacy was noted in 83.05% of prescriptions. Generic drugs were prescribed in 47.58% of the prescriptions. Further, antimicrobials were prescribed in 17.63% of the prescriptions and only 4.98% of prescriptions were with injectables. During the prescription evaluation, 38.65% of the prescriptions were incomplete due to multiple omissions such as dose, duration, and formulation. CONCLUSION: Most of the parameters in the present study were out of the range of WHO-recommended prescribing indicators. Therefore, effective intervention program, like training, for the promotion of rational drug use practice was recommended to improve the prescribing pattern of drugs and the quality of prescriptions all over the country.

Cost-effectiveness of mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage: an economic evaluation based on the MifeMiso trial.

OBJECTIVE: To assess the cost-effectiveness of mifepristone and misoprostol (MifeMiso) compared with misoprostol only for the medical management of a missed miscarriage. DESIGN: Within-trial economic evaluation and model-based analysis to set the findings in the context of the wider economic evidence for a range of comparators. Incremental costs and outcomes were calculated using nonparametric bootstrapping and reported using cost-effectiveness acceptability curves. Analyses were performed from the perspective of the UK's National Health Service (NHS). SETTING: Twenty-eight UK NHS early pregnancy units. SAMPLE: A cohort of 711 women aged 16-39 years with ultrasound evidence of a missed miscarriage. METHODS: Treatment with mifepristone and misoprostol or with matched placebo and misoprostol tablets. MAIN OUTCOME MEASURES: Cost per additional successfully managed miscarriage and quality-adjusted life years (QALYs). RESULTS: For the within-trial analysis, MifeMiso intervention resulted in an absolute effect difference of 6.6% (95% CI 0.7-12.5%) per successfully managed miscarriage and a QALYs difference of 0.04% (95% CI -0.01 to 0.1%). The average cost per successfully managed miscarriage was lower in the MifeMiso arm than in the placebo and misoprostol arm, with a cost saving of £182 (95% CI £26-£338). Hence, the MifeMiso intervention dominated the use of misoprostol alone. The model-based analysis showed that the MifeMiso intervention is preferable, compared with expectant management, and this is the current medical management strategy. However, the model-based evidence suggests that the intervention is a less effective but less costly strategy than surgical management. CONCLUSIONS: The within-trial analysis found that based on cost-effectiveness grounds, the MifeMiso intervention is likely to be recommended by decision makers for the medical management of women presenting with a missed miscarriage. TWEETABLE ABSTRACT: The combination of mifepristone and misoprostol is more effective and less costly than misoprostol alone for the management of missed miscarriages.

Scaling up a tobacco control intervention in low resource settings: a case example for school teachers in India.

Research on processes of bringing effective tobacco control interventions to scale to increase quit rates among tobacco users is uncommon. This study examines processes to bring to scale one such intervention for school teachers, i.e. Tobacco Free Teacher-Tobacco Free Society (TFT-TFS). This intervention provides a foundation for an effective and low cost approach to promote cessation through schools. The present study was conducted in the states of Bihar and Maharashtra in 2014 using quantitative and qualitative methods. Focus group discussions (FGDs) were analysed using immersion crystallization method. The data presented are from a survey of 291 principals and seven FGDs. This study examined characteristics of principals and teachers, organizational environment, external environmental factors and program characteristics to determine facilitators and barriers for successful dissemination and implementation of the TFT-TFS program. Some facilitators were, incorporation of the program in existing channels like staff meetings and trainings, certification and recognition by the department of education; while some barriers were routine time bound duties (mainly teaching) of teachers and prevalence of tobacco use among teachers and administrators. Principals and teachers expressed a need and high level of interest in the adoption and implementation of the TFT-TFS program in their schools.

Impact of California Fires on Local and Regional Air Quality: The Role of a Low-Cost Sensor Network and Satellite Observations.

PM2.5, or fine particulate matter, is a category of air pollutant consisting of particles with effective aerodynamic diameter equal to or less than 2.5 µm. These particles have been linked to human health impacts as well as regional haze, visibility, and climate change issues. Due to cost and space restrictions, the U.S. Environmental Protection Agency monitoring network remains spatially sparse. To increase the spatial resolution of monitoring, previous studies have used satellite data to estimate ground-level PM concentrations, despite these estimates being associated with moderate to large uncertainties when relating a column measure of aerosol (aerosol optical depth) with surface measurements. To this end, we discuss a low-cost air quality monitor (LCAQM) network deployed in California. In this study, we present an application of LCAQM and satellite data for quantifying the impact of wildfires in California during October 2017. The impacts of fires on PM2.5 concentration at varying temporal (hourly, daily, and weekly) and spatial (local to regional) scales have been evaluated. Comparison between low-cost air quality sensors and reference-grade air quality instruments shows expected performance with moderate to high uncertainties. The LCAQM measurements, in the absence of federal equivalent method data, were also found to be very useful in developing statistical models to convert aerosol optical depth into PM2.5 with performance of satellite-derived PM2.5, similar to that obtained using the federal equivalent method data. This paper also highlights challenges associated with both LCAQM and satellite-based PM2.5 measurements, which require further investigation and research.

Noninvasive assessment of cutaneous alterations in mice exposed to whole body gamma irradiation using optical imaging techniques.

We report the results of a study carried out to investigate the potential of optical techniques such as optical coherence tomography, Mueller matrix spectroscopy, and cross-polarization imaging for noninvasive monitoring of the ionizing radiation exposure-induced alterations in cutaneous tissue of mice. Radiation dose-dependent changes were observed in tissue microvasculature and tissue optical parameters like retardance and depolarization as early as 1 h post radiation exposure. Results suggest that these optical techniques may allow early detection of radiation dose-dependent alterations which could help in screening of population exposed to radiation.

In silico cytotoxicity assessment on cultured rat intestinal cells deduced from cellular impedance measurements.

Early and reliable identification of chemical toxicity is of utmost importance. At the same time, reduction of animal testing is paramount. Therefore, methods that improve the interpretability and usability of in vitro assays are essential. xCELLigence's real-time cell analyzer (RTCA) provides a novel, fast and cost effective in vitro method to probe compound toxicity. We developed a simple mathematical framework for the qualitative and quantitative assessment of toxicity for RTCA measurements. Compound toxicity, in terms of its 50% inhibitory concentration IC50 on cell growth, and parameters related to cell turnover were estimated on cultured IEC-6 cells exposed to 10 chemicals at varying concentrations. Our method estimated IC50 values of 113.05, 7.16, 28.69 and 725.15 µM for the apparently toxic compounds 2-acetylamino-fluorene, aflatoxin B1, benzo-[a]-pyrene and chloramphenicol in the tested cell line, in agreement with literature knowledge. IC50 values of all apparent in vivo non-toxic compounds were estimated to be non-toxic by our method. Corresponding estimates from RTCA's in-built model gave false positive (toxicity) predictions in 5/10 cases. Taken together, our proposed method reduces false positive predictions and reliably identifies chemical toxicity based on impedance measurements. The source code for the developed method including instructions is available at https://git.zib.de/bzfgupta/toxfit/tree/master.

Influence of tobacco industry advertisements and promotions on tobacco use in India: findings from the Global Adult Tobacco Survey 2009-2010.

INTRODUCTION: The developing world, including countries like India, has become a major target for the tobacco industry to market its products. This study examines the influence of the marketing (advertising and promotion) of tobacco products on the use of tobacco by adults (ages 15 and over) in India. METHOD: Data from Global Adult Tobacco Survey 2009-2010 was analyzed using methods for complex (clustered) sample designs. Multivariate logistic regression was employed to predict the use of different tobacco products by level of exposure to tobacco marketing using adults who have never used tobacco as the reference category. Odds ratios (ORs) were adjusted for education, gender, age, state of residence, wealth index, and place of residence (urban/rural). RESULTS: Adults in India were almost twice as likely to be current smokers (versus never users) when they were exposed to a moderate level of bidi or cigarette marketing. For bidis, among adults with high exposure, the OR for current use was 4.57 (95% confidence interval [CI]: 1.6, 13.0). Adults were more likely to be current users of smokeless tobacco (SLT) with even a low level of exposure to SLT marketing (OR = 1.24 [95% CI: 1.1, 1.4]). For SLT, the ORs showed an increasing trend (P for trend < 0.001) with greater level of exposure (moderate, OR = 1.55 [95% CI: 1.1, 2.2]; high, OR = 2.05 [95% CI: 0.8, 5.1]). The risk of any current tobacco use rose with increasing level of exposure to any marketing (minimum, OR = 1.25 [1.1-1.4]; moderate, OR = 1.38 [1.1-1.8]; and high, OR = 2.73 [1.8-4.2]), with the trend highly significant (P < 0.001). CONCLUSION: Exposure to the marketing of tobacco products, which may take the form of advertising at the point of sale, sales or a discounted price, free coupons, free samples, surrogate advertisements, or any of several other modalities, increased prevalence of tobacco use among adults. An increasing level of exposure to direct and indirect advertisement and promotion is associated with an increased likelihood of tobacco use.

The relation between price and daily consumption of cigarettes and bidis: findings from the Tobacco Control Policy Evaluation Wave 1 Survey.

CONTEXT: In India, 14% of the population use smoked tobacco products. Increasing prices of these products is one of the measures to curb their consumption. AIMS: This study analyzes "unit price" and "daily consumption" of cigarettes and bidis and investigates their relation with each other. SETTINGS AND DESIGN: A cross-sectional survey was conducted in four states of India (Bihar, West Bengal, Madhya Pradesh and Maharashtra) as a part of the International Tobacco Control Policy (TCP) Evaluation Project (the TCP India Project) during 2010-2011. METHODS: Information was collected from adult (aged ≥ 15) daily exclusive smokers of cigarette/bidi regarding (a) last purchase (purchase in pack/loose, brand and price) and (b) daily consumption. Average unit price and daily consumption was calculated for different brands and states. Regression model was used to assess the impact of price on daily consumption. RESULTS: Bidis were much less expensive ([symbol in text]0.39) than cigarettes ([symbol in text]3.1). The daily consumption was higher (14) among bidi smokers than cigarette smokers (8). The prices and daily consumption of bidis ([symbol in text]0.33-0.43; 12-15) and cigarettes ([symbol in text]2.9-3.6; 5-9) varied across the four states. The unit prices of bidis and cigarettes did not influence their daily consumption. Smokers purchasing bidis in packs paid substantially less per unit and purchase of bidis and cigarettes in packs influenced their consumption positively. CONCLUSIONS: Cigarettes although more expensive than bidis, seem very cheap if compared internationally. Hence, prices of both cigarettes and bidis do not influence their consumption.

IMS study of climate, altitude, temperature and vasomotor symptoms in the United Arab Emirates.

OBJECTIVE: To examine the relationships between temperature, season (summer versus winter), lifestyle, health, mood, beliefs, and experience of hot flushes and night sweats (HFNS), amongst mid-aged women living in the United Arab Emirates (UAE). METHODS: The UAE climate is hyper-arid, being a hot desert climate, with warm winters and hot summers. A total of 372 peri- and postmenopausal women, aged from 45 to 55 years, from urban UAE regions were included. Data were collected during both summer and winter months. Participants completed questionnaires eliciting information about sociodemographics, HFNS (prevalence, frequency and problem-rating), health and lifestyle (body mass index (BMI), diet, exercise), mood (Women's Health Questionnaire) and menopause attributions and beliefs (Menopause Representations Questionnaire). RESULTS: HFNS were currently being experienced by 46.5% of women, with an average weekly frequency of five and problem-rating of 5.7/10. Seasonal variation in temperature was not associated with prevalence, frequency or problem-rating. Hot flush prevalence was associated with poor health, life satisfaction, mood, employment, lower BMI and diet. Higher frequency was associated with higher BMI and more years since the last period. HFNS were more problematic mainly for women who reported lower life satisfaction and held more negative beliefs about the menopause. CONCLUSIONS: In this UAE study, temperature and seasonal temperature variation did not appear to influence HFNS-reporting, but health, life satisfaction, BMI, beliefs and lifestyle factors partially explained women's experiences of menopausal symptoms. A qualitative study might provide further information about the meanings of HFNS and menopause amongst UAE women.

An International Menopause Society study of climate, altitude, temperature (IMS-CAT) and vasomotor symptoms in urban Indian regions.

OBJECTIVE: To examine the relationships between climate (season, temperature, humidity), lifestyle, health, mood and beliefs and experience of hot flushes and night sweats amongst mid-aged women living in eight urban Indian centers. METHODS: A total of 717 peri- and postmenopausal women, aged 45-55 years, from urban centers in different regions of India were included. Data were collected during both summer and winter months. Participants completed questionnaires eliciting information about sociodemographics, hot flushes (prevalence, frequency and problem-rating), health and lifestyle (body mass index, diet, exercise, alcohol use), mood (Women's Health Questionnaire) and attributions and beliefs (Menopause Representations Questionnaire). RESULTS: The prevalence of vasomotor symptoms was low, with 34% of the sample reporting hot flushes and/or night sweats. Seasonal variation in temperature was not associated with hot flush prevalence, frequency or problem rating. Hot flush prevalence was mainly associated with higher anxiety and intake of spicy foods, frequency with (older) age and (more) frequent exercise, while hot flushes were more problematic for women who reported poorer general health and more negative beliefs about menopause. CONCLUSIONS: In this study of Indian women, seasonal temperature variation did not appear to influence hot flush reporting. Health, mood, beliefs and lifestyle factors appear to explain some, but not all, of the variance in experience of menopausal symptoms.

Development of a simple and rapid method for the specific identification of organism causing anthrax by slide latex agglutination.

UNLABELLED: A specific latex agglutination test (LAT) based on anti-PA (protective antigen) antibodies having detection limit of 5 × 10(4) formalin treated Bacillus anthracis cells or 110 ng of PA was optimized in this study. The optimized LAT could detect anthrax toxin in whole blood as well as in serum from the animal models of anthrax infection. The protocol is a simple and promising method for the specific detection of bacteria causing anthrax under routine laboratory, as well as in field, conditions without any special equipments or expertise. SIGNIFICANCE AND IMPACT OF THE STUDY: The article presents the first report of a latex agglutination test for the specific identification of the cultures of bacteria causing anthrax. As the test is targeting one of anthrax toxic protein (PA), this can also be used to determine virulence of suspected organisms. At the same time, the same LAT can be used directly on whole blood or sera samples under field conditions for the specific diagnosis of anthrax.

Intention to quit among Indian tobacco users: findings from International Tobacco Control Policy evaluation India pilot survey.

INTRODUCTION: Tobacco users face barriers not just in quitting, but also in thinking about quitting. The aim of this study was to understand factors encouraging intention to quit from the 2006 International Tobacco Control Policy (TCP) Evaluation India Pilot Study Survey. MATERIALS AND METHODS: A total of 764 adult respondents from urban and rural areas of Maharashtra and Bihar were surveyed through face-to-face individual interviews, with a house-to-house approach. Dependent variable was "intention to quit tobacco." Independent variables were demographic variables, peer influence, damage perception, receiving advice to quit, and referral to cessation services by healthcare professionals and exposure to anti-tobacco messages. Logistic regression model was used with odds ratio adjusted for location, age, gender, and marital status for statistical analysis. RESULTS: Of 493 tobacco users, 32.5% intended to quit. More numbers of users who were unaware about their friends' tobacco use intended to quit compared to those who were aware (adjusted OR = 8.06, 95% CI = 4.58-14.19). Higher numbers of users who felt tobacco has damaged their health intended to quit compared to those who did not feel that way (adjusted OR = 5.62, 95% CI = 3.53-8.96). More numbers of users exposed to anti-tobacco messages in newspapers/magazines (adjusted OR = 1.76, 95% CI = 1.02-3.03), restaurants (adjusted OR = 2.47, 95% CI = 1.37-4.46), radio (adjusted OR=4.84, 95% CI = 3.01-7.78), cinema halls (adjusted OR = 9.22, 95% CI = 5.31-15.75), and public transportation (adjusted OR = 10.58, 95% = 5.90-18.98) intended to quit compared to unexposed users. CONCLUSION: Anti-tobacco messages have positive influence on user's intentions to quit.

Profile of dual tobacco users in India: an analysis from Global Adult Tobacco Survey, 2009-10.

INTRODUCTION: Individuals who use both smoked and smokeless tobacco products (dual tobacco users) form a special group about which little is known. This group is especially relevant to India, where smokeless tobacco use is very common. The aim of this study was to characterise the profile of dual users, study their pattern of initiation to the second product, their attitudes toward quittingas well as their cessation profile. METHODS AND MATERIALS: The GATS dataset for India was analyzed using SPSS; . RESULTS: In India, dual tobacco users (42.3 million; 5.3% of all adults; 15.4% of all tobacco users) have a profile similar to that of smokers. Some 52.6% of dual users started both practices within 2 years. The most prevalent product combination was bidi-khaini (1.79%) followed by bidi-gutka (1.50%), cigarette-khaini (1.28%), and cigarette-gutka (1.22%). Among daily users, the correlation between the daily frequencies of the use of each product was very high for most product combinations. While 36.7% of dual users were interested in quitting, only 5.0% of dual users could do so. The prevalence of ex-dual users was 0.4%. CONCLUSION: Dual users constitute a large, high-risk group that requires special attention.

Global oral health inequalities in incidence and outcomes for oral cancer: causes and solutions.

The mouth and oropharynx are among the ten most common sites affected by cancer worldwide, but global incidence varies widely. Five-year survival rates exceed 50% in only the best treatment centers. Causes are predominantly lifestyle-related: Tobacco, areca nut, alcohol, poor diet, viral infections, and pollution are all important etiological factors. Oral cancer is a disease of the poor and dispossessed, and reducing social inequalities requires national policies co-ordinated with wider health and social initiatives - the common risk factor approach: control of the environment; safe water; adequate food; public and professional education about early signs and symptoms; early diagnosis and intervention; evidence-based treatments appropriate to available resources; and thoughtful rehabilitation and palliative care. Reductions in inequalities, both within and between countries, are more likely to accrue from the application of existing knowledge in a whole-of-society approach. Basic research aimed at determining individual predisposition and acquired genetic determinants of carcinogenesis and tumor progression, thus allowing for targeted therapies, should be pursued opportunistically.

Non-invasive assessment of healing of bacteria infected and uninfected wounds using optical coherence tomography.

BACKGROUND/PURPOSE: Bacterial infection is one of the main predisposing factors for the delay in wound healing. To facilitate a timely decision for correct therapy, it is important to accurately monitor the morphological changes in the infected wounds using noninvasive tools. In the present study, we have explored the use of optical coherence tomography (OCT) for monitoring the healing of superficial wounds infected with Staphylococcus aureus in mice under in vitro and in vivo conditions and studied the changes in collagen birefringence in the infected wounds. METHODS: The tape stripping method was used for generating superficial skin wounds in mice and wounds were infected with S. aureus. For in vitro studies, infected and uninfected wound tissues were resected, back scattered intensity and birefringence changes in collagen during wound healing were studied on the 2, 4 and 10th day of postinfection using polarization-sensitive (PS) OCT and images were compared with histology. Real-time OCT was used for studying the kinetics of healing of infected wounds under in vivo conditions. RESULTS: From the PS-OCT images, different phases of wound healing such as inflammation, reepithelialization and collagen remodeling could be identified. The edematic regions appeared prominent in infected wounds. Compared with uninfected wounds, reepithelization and collagen remodeling phases of wound healing were delayed significantly in the infected wounds. These changes were comparable with the different stages of wound healing observed under in vivo conditions. CONCLUSION: OCT imaging can provide a rapid assessment of the morphological changes associated with bacteria-infected and uninfected wounds and thereby aid in timely treatment planning.

Tobacco industry interference for pictorial warnings.

AIM: A study was carried out to understand the process of interference by the tobacco industry, to measure the compliance of the industry for displaying pictorial warnings on a tobacco product as per the packaging and labeling rules post 31st May, 2009, and to understand the public opinion on the messages conveyed through such warnings. MATERIALS AND METHODS: A total of 60 samples of tobacco products were purchased after 31 May, 2009, from the retail vendors of tobacco sellers across the country. RESULTS: The government of India has from time to time, taken measures, including legislations, to control tobacco consumption. The actual implementation of these rules has been postponed repeatedly, apparently because of constant pressure exerted by the tobacco industry. The skull and bone sign hurting religious sentiments as stated by the group of ministers proved to be misleading. Later the Group of Ministers (GOM) proposed three very weak and poorly communicative pictorial health warnings to replace those recommended by the Union Health Ministry based on the inputs of the Department of Audio Visual Publicity (DAVP). The industry tried to use strategic means by displaying a dull, diluted, and watered down pictorial warning. The focus group study conducted showed that a scorpion gets associated with the product in a non-scientific manner. X-ray of the lung was hardly understood by anybody. CONCLUSION: Overall the tobacco industry has constantly flouted with the law right from the policy level to its implementation by displaying dull, diluted, and poorly informed pictorial warnings.

Tobacco, education & health.

The incontrovertible scientific evidence about tobacco use causing serious health consequences is now accepted even by the tobacco industry. Research continues to enlarge the spectrum of diseases caused by tobacco use among users as well as among nonusers exposed to secondhand tobacco smoke. This review attempts to illustrate the greater risk to adverse health outcomes among the less educated due to a greater prevalence of tobacco use among them. Numerous surveys worldwide and in India show a greater prevalence of tobacco use among the less educated and illiterate. In a large population based study in Mumbai, the odds ratios for any kind of tobacco use among the illiterate as compared to the college educated were 7.4 for males and 20.3 for females after adjusting for age and occupation. School-dropouts are more likely to take up tobacco use in childhood and adolescence. Student youth taught about the dangers of tobacco use in school are less likely to initiate tobacco use. High tobacco use among the less educated and under privileged affects them in multiple ways: (i) Tobacco users in such households, because of their nicotine addiction, prefer spending a disproportionate amount of their meager income on tobacco products, often curtailing essential expenditures for food, healthcare and education for the family. (ii) Because of high tobacco use and other factors of disadvantage connected with low educational status, they suffer more from the diseases and other health impacts caused by tobacco. This higher morbidity results in high health care expenditures, which impoverish the family further. (iii) Premature death caused by tobacco use in this under- privileged section often takes away the major wage earner in the family, plunging it into even more hardship. Tobacco use is a terrible scourge particularly of the less educated, globally and in India. Tobacco use, education and health in a human population are inter-related in ways that make sufferings and deaths caused by tobacco use even more tragic than normally realized. Tobacco use works against social and economic development and should be appropriately addressed through health education and tobacco cessation services particularly in the underprivileged, illiterate population.

Mid-age health in women from the Indian subcontinent (MAHWIS): general health and the experience of menopause in women.

OBJECTIVES: First, to examine the experience of menopause and quality of life in a migrated Asian population from the Indian subcontinent living in Birmingham, UK, and, second, to compare their experience with a matched sample of Caucasian women living in the same geographical area and also with a sample of Asian women with similar socioeconomic background living in Delhi, India. METHODS: In this cross-sectional study of 153 peri- and postmenopausal women aged 45-55 years, 52 Asian women originating from the Indian subcontinent living in Birmingham (UKA, mean age 51.4 years), 51 Caucasian women (UKC, mean age 52.3 years) and 50 Asian women living in Delhi, India (DEL, mean age 49.72 years) were interviewed to collect information about their lifestyle, general health, menopause experience and help-seeking behavior. The Women's Health Questionnaire and the Menopause Representation Questionnaire (both translated and linguistically validated in Hindi) were used to examine the prevalence of physical and emotional symptoms and the extent to which these were attributed to the menopause. RESULTS: The two Asian groups (UKA, DEL) reported poorer health and generally more physical and emotional symptoms than the UKC group. However, for menopausal symptoms (hot flushes and night sweats) there was a different pattern; the DEL group reported significantly fewer symptoms compared to the UKA and UKC groups (hot flushes: UKC 60.8%, UKA 75%, DEL 32% (p < 0.001); night sweats: UKC 50%, UKA 56.9%, DEL 24% (p = 0.002)). The prevalence of vaginal dryness was highest in the UKA group and lowest in the DEL group (UKC 21.6%, UKA 38.2%, DEL 7.3% (p = 0.005)). The number of symptoms attributed to menopause was significantly lower in the DEL group (9.3 +/- 7.8) compared to the two UK groups (UKC 18.9 +/- 7.4, UKA 19.8 +/- 10.7), but the UKA women tended to attribute some physical symptoms to the menopause such as breathlessness, weight gain and stiff joints that might have other causes. CONCLUSIONS: The UK Asian women's experience of the menopause is more similar to the Caucasian women in the UK than that of the women in Delhi. However, Asian women living in the UK and the Indian subcontinent shared the experience of poor health and reports of more physical and emotional symptoms in general. The possible reasons for these differences are discussed.

Experimental investigation of perturbation Monte-Carlo based derivative estimation for imaging low-scattering tissue.

Experimental results for imaging the low-scattering tissue phantoms based on the derivative estimation through perturbation Monte-Carlo (pMC) method are presented. It is proven that pMC-based methods give superior reconstructions compared to diffusion-based reconstruction methods. An easy way to estimate the Jacobian using analytical expression obtained from perturbation Monte-Carlo method is employed. Simulation studies on the same objects, considered in the experiment, are performed and corresponding results are found to be in reasonable agreement with the experimental studies. It is shown that inter-parameter cross talk in diffusion based methods lead to false results for the low-scattering tissue, where as the pMC-based method gives accurate results.