Assessment of Vitamin D Levels and Other Bone Related Biochemical Markers in Healthy Adults in Rural Population of Uttarakhand, India.

Despite being close to equator and receiving sufficient sun rays, evidences revealed that Indians have severe deficiency of vitamin D (vit D) ranging from 41 to 100% in different geographical locations. Therefore, in this study levels of 25(OH)D (physiologically measurable form) along with other bone metabolism associated biochemical markers were determined in serum sample of 300 apparently healthy study subjects (rural) from Doiwala block of Dehradun district in the state of Uttarakhand. Demographic data was also obtained based on a structured questionnaire to establish an association between 25(OH)D levels and various dietary and socio-cultural factors. Results demonstrated that of all study subjects, 197 (65%) had 25(OH)D levels below < 12 ng/mL (deficient) and 65 (21%) had 25(OH)D levels between 12 and 20 ng/mL (insufficient) with all other markers falling within respectively established reference ranges. Further, in univariate analysis, gender, occupation (indoor and outdoor), education were independently associated with vitamin D status. Additionally, parathyroid hormone associated significantly with gender and occupation, while calcium associated significantly with gender, occupation and education. Lastly, regression analysis revealed that gender and occupation independently associated with vitamin D status of subjects. In conclusion, apparently healthy subjects showed considerable vitamin D deficiency thereby generating an urgent need for formulating and implementing better government policies for enrichment of vitamin D levels among rural adults of Uttarakhand in future. Supplementary Information: The online version contains supplementary material available at 10.1007/s12291-022-01048-6.

Assessment on Quality of Healthcare Services during Childbirth: A Community-based Mixed-method Study in the Women of Puducherry.

Background: A women's right to a positive childbirth experience should be the heart of any care provided. To assess the quality of childbirth services and mistreatment by healthcare providers among reproductive age group women and to explore factors influencing the same between women and stakeholders. Material and Methods: A community-based, mixed-method study was conducted from April to September 2021 in field practice areas of a medical college in Puducherry district. The sample size for the quantitative study was 348 and the women were chosen using a multi-stage sampling technique. Women were interviewed with a semi-structured questionnaire. In-depth and key informant interviews between women and stakeholders were done for the qualitative data collection. Results: Three-fourths (77.0%) of women preferred government tertiary healthcare facilities for obstetric care. Although 69.0% and 75.6% of the participants did not experience any verbal and physical abuse, respectively, the qualitative study results were quite the opposite. While 92.8% of the women complained that no birth companion was allowed during their delivery. Moreover, 79.9% of the women did not have the freedom to choose their comfortable birthing position. The levels of mistreatment in the rural areas were slightly higher than that of the urban areas. Conclusion: Quality care is a fundamental approach to maternity care. A fair bit of women experiences mistreatment during childbirth in healthcare setups. However, the chief concern here is the perception of such abuse by the mothers as normal due to their lack of knowledge regarding women's rights.

Prevalence of hypertension and associated cardiometabolic risk factors in urban Rishikesh, Uttarakhand.

BACKGROUND: Hypertension is one of the leading causes of premature death worldwide and is a major risk factor for cardiovascular disease and all-of them cause mortality. Out of the estimated 1.13 billion people who have hypertension, less than 1 in 5 people have it under control. AIM AND OBJECTIVES: To study the prevalence of hypertension and associated risk factors in the urban population of Rishikesh and the association of hypertension with other determinants. METHODOLOGY: A community based cross-sectional study was conducted in an urban area of Rishikesh. The World Health Organization (WHO) steps instrument and protocol was used for the assessment of risk factors and measurements. i.e. anthropometry and blood pressure. Sample size was calculated to be 478. Data was entered and analyzed using SPSS Version 20.0. Appropriate statistical tests were done. A P value of < 0.05 was considered significant. RESULTS: The prevalence of hypertension in urban Rishikesh is 32.4%. The prevalence in male and female is 34.5% and 31.3% respectively. Among hypertensives 45.8% had hypertriglyceridemia, 32.2% had low high-density lipoproteins (HDL), 52.25% had fasting blood glucose more than 100, and 55.4% were obese individuals. Multivariate logistic regression analysis identified that age, waist circumference, body mass index, triglycerides level, and physical activity were independently associated with hypertension. CONCLUSIONS: As the prevalence of hypertension and cardiometabolic risk factors were higher, necessary health interventions were required to reduce the morbidity/mortality of the disease.

Association of Obesity and Metabolic Syndrome among Urban Dwellers of Rishikesh, Uttarakhand.

BACKGROUND: Noncommunicable diseases include heart disease, stroke, cancer, diabetes, and chronic lung diseases and are collectively responsible for almost 70% of all deaths worldwide. Metabolic syndrome (MetS) predisposes to coronary artery disease irrespective of age, gender, or family history of diabetes. AIM AND OBJECTIVES: The aims of this study were as follows: (1) to assess the prevalence and its predictors of obesity among the urban population, (2) to analyze the association of obesity with MetS, and (3) to analyze the correlation of obesity with different components of MetS. MATERIALS AND METHODS: A community-based cross-sectional study was conducted in an urban area of Rishikesh. The World Health Organization STEPS instrument and protocol were used for the assessment of risk factors and measurements. The sample size was calculated to be 478. Data were analyzed using SPSS version 20.0. Appropriate statistical tests for bivariate and multivariate analysis were done. P < 0.05 was considered statistically significant. RESULTS: The prevalence of MetS among obese individuals was significantly higher (57%) according to the National Cholesterol Educational Program Adult Treatment Panel 3 definition (P < 0.001). The prevalence of MetS in male and female obesity was 56.8% and 57.1%, respectively. Body mass index was significantly correlated with systolic blood pressure (BP) (r = 0.238, P = 0.001), diastolic BP (r = 0.281, P = 0.001), Fasting blood glucose (FBG) (r = 0.136, P = 0.003), and triglycerideTriglycerides (TG) (r = 0.12, P = 0.009) and negatively correlated with High Density Lipoproteins (HDL) (r = -0.041, P = 0.37). Whereas, waist-hip ratio was significantly correlated with systolic BP (r = 0.277, P = 0.001), diastolic BP (r = 0.251, P = 0.001), FBG (r = 0.232, P = 0.001), and TG (r = 0.273, P = 0.001) and not with HDL (r = 0.033, P = 0.466). CONCLUSIONS: As the prevalence of MetS is higher among obese individuals, health interventions required to reduce the morbidity/mortality and need to be addressed in adult populations.

Prevalence of Vitamin D Deficiency Among Infants in Northern India: A Hospital Based Prospective Study.

BACKGROUND: Vitamin D deficiency is one of the major nutritional deficiencies and an important contributor to nutritional and growth failure in infants, especially in those with low socioeconomic status. AIM: The primary objective of this study was to determine the proportion of vitamin D deficiency in infants, and the secondary objective was to assess the correlation between infant and maternal vitamin D levels. METHODS: This prospective, observational study was carried out at a tertiary care center, All India Institute of Medical Sciences in Rishikesh, Uttarakhand, India, in the Department of Pediatrics from January 2017 to December 2018. Children aged less than one year and their mothers were enrolled in the study. All the infants attending the Department of Pediatrics for well-child visits and sick-child visits were enrolled after obtaining written, informed consent. Infants with major congenital malformations and liver and kidney dysfunction were excluded. Serum vitamin D level of <20 ng/mL was defined as vitamin D deficiency. RESULTS: A total of 200 infants and 200 mothers were enrolled in the study. Among the study infants, 80% were neonates, and 20% were infants beyond the neonatal period. The prevalence of vitamin D deficiency was 74% in infants and 85.5% in mothers. Nearly half of the infants and mothers had severe vitamin D deficiency. Logistic regression analysis showed a positive correlation between maternal and infant vitamin D levels (r=0.074, p<0.001) and also with neonatal age group and low socioeconomic status. Hyperphosphatemia and hypocalcemia were predominant biochemical manifestations. CONCLUSION: The prevalence of vitamin D deficiency among the study infants was 74%. Neonatal age group, lower socioeconomic status, and maternal vitamin D deficiency were major determinants of vitamin D deficiency in infants.

Undiagnosed elevated blood pressure and its life style related risk factors among adults: Cross sectional survey.

BACKGROUND: Globally, high blood pressure (BP) is a main health problem among adult population. High BP is considered as a major risk factor which may lead to many cardiovascular diseases. Globally, it is also the leading cause of death. According to the American Heart Association, a BP of 120/80 mm of Hg is a normal range but when the systolic blood pressure ≥130 and diastolic blood pressure ≥80, it is always labeled as hypertension. OBJECTIVES: In the present study, the researchers wanted to identify the prevalence of undiagnosed elevated blood pressure in the adult population of Uttarakhand, India and also try to explore its lifestyle-related risk factors. METHODS: This study was an exploratory survey with a cross-sectional design. Data were collected from 440 participants by using the cluster sampling technique. RESULTS: The male:female ratio among participants was 1:4 and most of the participants were aged 25-30 years. The study found that the prevalence of high blood pressure was 26%, in which marginal elevated BP prevalence was 16%, hypertension stage I was 7%, and hypertension Stage II was 3% which is significantly higher in number at a young age. Lifestyle-related risk factors showed a significant association of hypertensive status with gender, consumption of balanced diet, and personal habits. This increases the chances of elevated blood pressure in young adults. CONCLUSION: All health professionals must be sensitized for elevated blood pressure problems among the young adult populations. Elevated blood pressure should be considered as a warning alarm at an early age when prescribing any medication and during any invasive procedure. Awareness should be created among public regarding elevated blood pressure issues at a younger age and motivate people to adopt a healthy and stress-free lifestyle.