Application of Health Belief Model to Comprehend Adherence to COVID-19-appropriate Behavior among COVID-19 Vaccinees in Himachal Pradesh.

BACKGROUND: The augmentation of precautionary behaviors through the application of health belief model (HBM) constructs could help in curbing the current pandemic. OBJECTIVES: The objectives are to assess adherence to CAB and to evaluate its predictors using the constructs of HBM among COVID-19 vaccinees in Himachal Pradesh. MATERIALS AND METHODS: A cross-sectional study using a telephone survey, with two-step stratified random sampling, was employed to acquire a sample of 441 respondents from Himachal Pradesh. Formal interviews were conducted using pretested, structured, self-administered questionnaires. RESULTS: The mean age of respondents was 32.16 years (standard deviation = 12.77; range = 18-78 years). Maximum adherence was seen for wearing masks at 83% (95% confidence interval [CI]: 79.3%-86.3%), followed by maintenance of respiratory hygiene at 72.3% (95% CI 68%-78.4%). Nearly 42.2% (95% CI 37.6%-47.8%) conformed to social distancing norms. We observed minimum adherence for handwashing practices of 12.9% (95% CI 10%-16.3.0%). On bivariate analyses, except for perceived severity, all HBM constructs were significantly associated with CAB. However, after adjusting for gender, age, education, area of residence, and reduced income in multivariate analysis, perceived susceptibility, perceived barriers, and exposure to cues to action remained significant predictors of CAB. CONCLUSIONS: The study highlights the empirical evidence of the application of HBM constructs to enhance behavioral adherence to COVID-19 precautionary measures.

Game change in Indian Health Care System through reforms in medical education curriculum focusing on primary care- Recommendations of a joint working group.

Despite the stated aim of Medical Council of India (body regulating medical education in India) to produce an Indian Medical Graduate with requisite knowledge, skills, attitudes, values and responsiveness, so that he or she may function appropriately and effectively as a doctor of first contact of the community while being globally relevant, it appears that we failed. The joint working group extensively consisting of medical teachers have come up with suggestions which may work as the game changer in Indian Health care system. The key is to dedicate medical education towards primary care.

Building Evidence for Coverage of Fully Vaccinated Children of 12-23 Months of Age across Districts of North India, 2015.

CONTEXT: Unprecedented low coverage (63%) of fully vaccinated (FV) children in the recent round of national survey district level household (HH) and facility survey 4 (DLHS-4) propelled health system of Himachal Pradesh for an independent rapid assessment of FV coverage. AIM: The aim of the study was to assess the FV coverage among 12-23-month old children in the state. SETTINGS AND DESIGN: A community-based survey with an interviewer-administered questionnaire was carried out in all 12 districts of Himachal Pradesh from September 2015 to January 2016. SUBJECT AND METHODS: WHO 30 × 7 cluster technique was used. STATISTICAL ANALYSIS USED: Chi-square and unpaired Student's t-test along with 95% confidence intervals. RESULTS: A total of 2492 children across 35,551 HHs (2.4% of state share) were surveyed with FV coverage of 98.1% (95% confidence interval [CI]: 97.5-98.6) and 86% (95% CI: 84.6-87.3) based on history and card, respectively. CONCLUSIONS: The reported FV coverage in the current study was observed too high in the state as reported in earlier round of the national surveys (except DLHS-4).

Prevalence of Autism Spectrum Disorder among Rural, Urban, and Tribal Children (1-10 Years of Age).

INTRODUCTION: Studies on autism spectrum disorders (ASDs) have largely focused on children in specific settings. The current scenario of research in ASDs is limited largely to clinic-based case reports, case series, and retrospective chart reviews. The present study is the first population-based prevalence study conducted across rural, urban, and tribal populations in India. MATERIALS AND METHODS: A cross-sectional two-phase study was conducted covering children in the age group of 1-10 years of age across geographical regions representing rural, urban, and tribal populations. The first phase (screening phase) involved administration of the Hindi version of the Indian Scale for Assessment of Autism. Those identified as suspected of ASD and 10% of all classified as nonsuspects for autism were also evaluated by the clinical team in second phase (evaluation phase). RESULTS: Forty-three children out of a total of 28,070 children in rural, urban, and tribal area in the age group of 1-10 years were diagnosed as cases of ASD yielding a prevalence of 0.15% (95% confidence interval [CI] =0.15-0.25). Logistic regression analysis showed a two times significantly higher risk of diagnosing ASD in rural area as compared to tribal (odds ratio [OR]; 95% CI = 2.17 [1.04-4.52], P = 0.04). Male sex and upper socioeconomic group of head of family/father had a higher risk of getting diagnosed as autism as compared to lower socioeconomic group (OR; 95% CI - 3.23; 0.24-44.28, P = 0.38). CONCLUSIONS: Estimation of true prevalence of ASD in India is going to improve policies on developmental disabilities.

Pattern of health promises for Indian democracy: A qualitative review of political manifestos.

INTRODUCTION: India is a multiparty parliamentary democracy and second most populous country in the world. In spite of pressing needs of the population, healthcare is still not considered a driving electoral mobilizer as compared to the older democracies such as the UK and USA. Only three National Health Policies (1983, 2002 and 2017) have been promulgated by the respective governments during the past 70 years of India's independence. National policies are often preceded by commitment of political parties documented in the manifestos. Type and nature of promises in the manifesto of National Political Parties (NPPs) are reflective of vision and intentions of parties. The present study was done to qualitatively analyze the pattern of expressed intensions in terms of health promises made for 16th Lok Sabha (people house) elections of India in the year 2014 by its NPPs. METHODS: Manifestos of NPP, as notified by election commission of India, were retrieved from their respective website and effort was also made with an online search. Manifesto of five out of total seven NPPs could be accessed and analyzed. Consensus-based criteria of assessment were developed by public health experts and each manifesto was assessed independently by two experts. In a case of difference in scoring, independent opinion was sought from the third expert for adjudication. RESULTS: Two NPPs mentioned majority of statements as goals and rest focused for health strategies. The focus of statements was for public health problems (11.5%), public health financing (9.0%), and improving infrastructure (9.0%). All parties were committed for improving health services as it shared 30.8% space as statements in all five manifestos. All statements were of primary or secondary prevention in nature and focused more on improving processes (47.4%) and increasing inputs (31.6%). Whereas, Communist Party of India focused only on inputs (60.0%) and outputs (40.0%). CONCLUSION: Promises made by all NPPs were quite progressive, inclusive, and comprehensive in nature; however, much of these do not find space in public debates on television and election speeches.

Dementia in a tribal landlocked elderly population at high altitude: What explains the lower prevalence?

INTRODUCTION: Studies across the populations have suggested that dementia is differentially distributed with a lower prevalence in developing regions than the developed ones. A comparison in the prevalence of dementia across populations may provide an insight into its risk factors. Earlier, we reported on the prevalence of dementia in elderly population in migrant, urban, rural, and tribal populations. The present study was conducted with a view to estimating the prevalence of dementia in Tribal Landlocked Elderly Population at high altitude and therefore to draw some conclusions on the differential distribution of dementia across populations. METHODS: A cross-sectional comprehensive two-phase survey of all residents aged 60 years and older was conducted. Phase 1 involved screening of all individuals aged 60 and above with the help of a cognitive screen specifically developed for the tribal population. Phase 2 involved clinical examination of individuals who were suspected of dementia as per the developed cognitive screening test. RESULTS: The results revealed that six individuals out of a total of 481 studied above 60 years of age in the studied population scored between 17 and 23, thus qualifying as suffering from mild cognitive impairment. Importantly, none of the individuals above 60 years of age scored <17. DISCUSSION: The current study is in conformity with our previous study conducted on urban, rural, and migrant areas of the state of Himachal Pradesh again emphasizing on dementia being rare in tribal populations and thereby pointing to the presence of some protective factors among tribal people.

Prevalence of mental retardation in urban and rural populations of the goiter zone in Northwest India.

BACKGROUND: The existence of an endemic goiter belt along the southern slopes of the Himalayas has been known for a long time. Prevalence of neonatal hypothyroidism is high and there has been little work on the prevalence of mental retardation in this part of India. OBJECTIVE: The study was conducted with the aim to know the prevalence of mental retardation in the urban and rural populations of Himachal Pradesh, India and to generate a hypothesis on the differential distribution (geographical) of mental retardation. METHODS: This cross-sectional study was conducted in the rural and urban areas of the district of Kangra, Himachal Pradesh, India among children of 1-10 years of age. In the first phase, the children in the age group of 1-10 years were screened for mental retardation using the Ten Questions Screen, whereas in the second phase the suspects were evaluated clinically. RESULTS: The prevalence of mental retardation was found to be 1.71% in the study population with higher prevalence (3.3%) in the 73-120 months age group. The prevalence was higher among the males in all study populations [rural: 1.9%, urban (nonslum): 1.6%, and urban slum: 7.14%). The prevalence was similar among the urban (nonslum) (1.75%) and rural (1.11%) populations, whereas it was higher (4%) in the urban slum population. A prevalence of 2% was seen in families from the lower middle class and 1.8% among families from the lower class in the rural population, whereas a prevalence of 2% was seen among lower middle class families of urban (nonslum) areas. CONCLUSION: The prevalence of mental retardation was higher in our study than in other parts of the country. The study concludes with the hypothesis that the prevalence of mental retardation is differentially distributed geographically with socioeconomic factors being important predictors.

Post-hoc principal component analysis on a largely illiterate elderly population from North-west India to identify important elements of mini-mental state examination.

BACKGROUND: Mini-mental state examination (MMSE) scale measures cognition using specific elements that can be isolated, defined, and subsequently measured. This study was conducted with the aim to analyze the factorial structure of MMSE in a largely, illiterate, elderly population in India and to reduce the number of variables to a few meaningful and interpretable combinations. METHODOLOGY: Principal component analysis (PCA) was performed post-hoc on the data generated by a research project conducted to estimate the prevalence of dementia in four geographically defined habitations in Himachal Pradesh state of India. RESULTS: Questions on orientation and registration account for high percentage of cumulative variance in comparison to other questions. DISCUSSION: The PCA conducted on the data derived from a largely, illiterate population reveals that the most important components to consider for the estimation of cognitive impairment in illiterate Indian population are temporal orientation, spatial orientation, and immediate memory.

To evaluate the utility of 10 warning signs questionnaire in assessment of cognitive function among elderly people.

INTRODUCTION: Routine screening of high-risk elderly people for early cognitive impairment using mini-mental state examination (MMSE) and its modifications may be constrained by demographic and other variables. Warning signs (as reported by family/caregivers) may be a useful alternative. The present data analysis was carried out with the aim to identify the role of 10 warning signs screen as an alternative tool for screening for cognitive impairment among elderly. MATERIALS AND METHODS: For the purpose of this analysis (correlation), data available with us from a study conducted on the elderly population (60 years and above) from selected geographical areas (Migrant, Urban, Rural, and Tribal) of Himachal Pradesh was used. RESULTS: A high statistically significant was found between scores on 10 warning signs screen and Hindi mental state examination/Bharmouri mental state examination (modifications of MMSE). CONCLUSIONS: Ten warning signs screen can be an important screening total for assessment of cognitive impairment in the elderly Indians.

Prevalence of Hypertension in a Tribal Land Locked Population at High Altitude.

Introduction. Extensive pubmed search reveals paucity of data on prevalence of hypertension in tribal population at high altitude. The data is all the more scarce from our part of India. Studies among tribal populations at high altitudes provide an interesting epidemiological window to study human evolution and adaptation to hypobaric hypoxia. Material and Methods. 401 participants above the age of 20 years were evaluated for blood pressure using a stratified simple random technique among villages located at high altitude. Results. Out of a total of 401 individuals studied 43 (males: 35; females: 8) were identified as hypertensive yielding a crude prevalence of 10.7%. The prevalence was higher in males (35/270; 12.9%) as compared to females (8/131; 6%). Prevalence was the highest in the age group of 30-39 among males (16/35; 45.7%) while it was the highest in the age group of 40-49 among females (7/8; 87%). Conclusions. Prevalence of 10.5% is noteworthy when interpreted in light of prevalence of hypertension in general population especially if hypobaric hypoxia is considered to have a protective effect on blood pressure in high altitude native populations.

Using Multistate Observational Studies to Determine Role of Hypertension and Diabetes as Risk Factors for Dementia.

BACKGROUND: Evidence suggests that modifiable risk factors which can be targeted by prevention are vascular diseases, such as diabetes, midlife hypertension (HTN), midlife obesity, midlife cholesterol, mid- and late-life depression as well as lifestyle factors such as smoking, physical inactivity, and poor diet. METHODS: A comprehensive search of the National Library of Medicine's PubMed database and Google Scholar was conducted. A combinations of medical subject headings and free text words that included search terms related to the exposure (e.g., prevalence, HTN, raised BP, high BP, diabetes, high blood sugar, DM, India, state), were combined with search terms related to the outcomes (e.g., prevalence, disease burden, estimate, dementia, India). The filters included were English for the language category and humans for the study category. RESULTS: The PubMed search initially identified 269 references, and a total of 204 abstracts were screened by inclusion criteria. Full-text assessment of 136 articles on prevalence of dementia resulted in 20 relevant articles from which the different regions of the country were identified. Based on the search conducted according to the regions; 287abstracts of the prevalence of HTN and 577 on the prevalence of diabetes mellitus were screened. There were 43 full-text articles on the prevalence of HTN and diabetes from the regions where the prevalence of dementia was available. Of these potentially relevant articles were 14 in number. CONCLUSION: Despite the uncertainty in the role, the data analysis, therefore, points to a role in the prevention of HTN and diabetes to prevent dementia.

Feasibility of using everyday abilities scale of India as alternative to mental state examination as a screen in two-phase survey estimating the prevalence of dementia in largely illiterate Indian population.

INTRODUCTION: A situation analysis report on elderly in India shows that the literacy rate for persons aged above 60 is 36%. Using HMSE and its modification in the first phase of a two phase study to estimate the prevalence of dementia in such a population must be read with caution as these tests are literacy dependent. We conducted a post hoc analysis to explore the feasibility of using EASI as an alternative to HMSE and its modifications as the first phase screen in two phase surveys to estimate the prevalence of dementia. MATERIALS AND METHODS: A post hoc analysis was conducted on data obtained from a study conducted on elderly population (60 years and above) from selected geographical areas (Migrant, Urban, Rural and Tribal) of Himachal Pradesh state in North-west India. The co-relation coefficient was used to establish the strength of association between EASI and HMSE and its modification and therefore the feasibility of using it as an alternative. RESULTS: As the scores on EASI rise, the scores on HMSE fall both pointing to identification of the same clinical diagnosis i.e., dementia. Further the Pearson Correlation coefficient at -2.52 was found to be statistically significant. CONCLUSION: EASI may be used as alternative to mental state examination.

Socio demography of mental retardation: A community-based study from a goitre zone in rural sub-Himalayan India.

INTRODUCTION: Mental retardation is one of the most common disabilities of childhood which can be prevented by timely identification of the causative agent and an adequate management accordingly. District Kangra lies in the sub-Himalayan belt and forms a part of the 2400 km long goitre belt along the southern slopes of the Himalayas. OBJECTIVE: To study the prevalence of mental retardation among children (1-10) years of age. MATERIALS AND METHODS: A two-phase cross-sectional study was conducted in the rural area of district Kangra. A 30-cluster sampling technique was used to screen a population of children 1-10 years of age from five randomly selected panchayats (village government units) of district Kangra. The screening was based on a modified version of the ten questions screen, adapted to the local population. In the first phase a door to door survey was done to identify suspects of mental retardation. In the second phase, the children found positive in the first phase were called for examination by the pediatrician to confirm mental retardation. RESULTS: A total of 2420 children were screened in the first phase of which 95 tested positive. About 52 of these children were found to be mentally retarded in the second phase giving a prevalence of 2.15%. The 69% of these children belonged to the lower middle class and 28.3% belonged to middle class families using the Uday Parekh scale for assessment of the socio-economic status. CONCLUSION: Prevalence of mental retardation is high in district Kangra of Himachal Pradesh in comparison to other states of India. This could be attributed to the good primary health care in Himachal Pradesh where institutional deliveries are about 70%. This may have led to better survival of children with congenital disorders and those that suffer perinatal trauma.

Hypertension and diabetes as risk factors for dementia: A secondary post-hoc analysis from north-west India.

INTRODUCTION: A relation between midlife risk factors (hypertension and diabetes) and dementia has been studied in past and an association has been documented, in spite of some studies pointing to the contrary. MATERIALS AND METHODS: The study was based on post-hoc analysis of data obtained from a study conducted on an elderly population (60 years and above) from selected geographical areas (migrant, urban, rural and tribal) of the Himachal Pradesh state in North-West India. RESULTS: Analysis of variance revealed an effect of risk factors on cognitive scores; however, post hoc Tukey's honest significant difference (HSD) test revealed that only hypertensives' demonstrated higher chances of scoring lower on cognitive measures. DISCUSSION: The possibility that hypertension and diabetes affect dementia needs further evaluation, more so in Indian context.

Level of literacy and dementia: A secondary post-hoc analysis from North-West India.

INTRODUCTION: A relation between literacy and dementia has been studied in past and an association has been documented. This is in spite of some studies pointing to the contrary. The current study was aimed at investigating the influence of level of literacy on dementia in a sample stratified by geography (Migrant, Urban, Rural and Tribal areas of sub-Himalayan state of Himachal Pradesh, India). MATERIALS AND METHODS: The study was based on post-hoc analysis of data obtained from a study conducted on elderly population (60 years and above) from selected geographical areas (Migrant, Urban, Rural and Tribal) of Himachal Pradesh state in North-west India. RESULTS: Analysis of variance revealed an effect of education on cognitive scores [F = 2.823, P =0.01], however, post-hoc Tukey's HSD test did not reveal any significant pairwise comparisons. DISCUSSION: The possibility that education effects dementia needs further evaluation, more so in Indian context.

Is dementia differentially distributed? A study on the prevalence of dementia in migrant, urban, rural, and tribal elderly population of himalayan region in northern India.

BACKGROUND: Throughout the world, a large number of surveys have been carried out to find the prevalence of dementia with variable results. AIMS: This study was to generate data on the prevalence of dementia and to generate a hypothesis on the differential distribution across populations. MATERIALS AND METHODS: Four settings identified for the purpose of this study included a migrant, urban, rural, and tribal. The study was conducted in two phases: 1) A screening phase and 2) a clinical phase, on 2,000 individuals above 60 years of age. To complete the required sample of 2,000 elderly individuals, 500 individuals were approached from each site. Nobody refused to participate. RESULTS: A total of 32/2,000 (1.6%) elderly individuals were classified as demented. No case of dementia was reported from tribal population. A look at sex differential reveals that majority (21/32; 66%) of individuals identified as demented were females. As age advanced scores on cognitive screen decreased with elders above 80 years of age showing lowest scores. Out of 32, 18 (56%) of patients classified as demented were more than 80 years of age. CONCLUSION: The findings of this study are in agreement with previous studies which point towards differential distribution of dementia across populations.

Factors influencing early health facility contact and low default rate among new sputum smear positive tuberculosis patients, India.

Early case identification and prompt treatment of new sputum smear positive case are important to reduce the spread of tuberculosis (TB). Present study was planned to study the associated factors for duration to contact the health facility since appearance of symptoms and treatment default. Methodology. It was prospective cohort study of TB patients already registered for treatment in randomly selected TB units (TUs) in Himachal Pradesh, India. Relative risk (RR) was calculated as risk estimate to find out the explanatory variables for early contact and default. Results. Total 1607 patients were recruited and 25 (1.5%) defaulted treatment. Patients from nuclear family (aRR: 1.37; 1.09-1.73), ashamed of TB (aRR: 1.32; 1.03-1.70), wishing to disclose disease status (aRR: 1.79; 1.43-2.24), but aware of curable nature (aRR: 1.67; 1.17-2.39) and preventable (aRR: 1.35; 1.07-1.70) nature of disease, contacted health facility early since appearance of symptoms. Conclusion. Better awareness and less misconceptions about disease influences the early contact of health facility and low default rate in North India.

Snakebite profile from a medical college in rural setting in the hills of Himachal Pradesh, India.

OBJECTIVE: The objective of the following study is to assess the clinical profiles and manifestations of snakebite patients in the rural hilly setting of Shivalik and the Lesser Himalayan region of Himachal Pradesh. MATERIALS AND METHODS: A hospital record-based retrospective descriptive study was carried out that included details on demography, clinical profile, treatment and outcome among 200 patients over a period of 2 years. The data was analyzed using Chi-square test for comparison. RESULTS: 142 (71%) patients were young (age group of 16-45 years) and the number of male patients was 118 (59%) and female patients were 82 (41%). All the cases recorded presented in the months of April to November. Not a single case was recorded from December to March. The most frequently bitten sites were the lower limbs particularly the feet. 86 (43%) of the patients presented without any features of envenomation. Neuroparalysis was the commonest presentation in 53 (46%) patients followed by hemotoxicity in 36 (31%) among symptomatic patients. Early morning neuroparalysis syndrome was the presentation in 26.4% patients. Allergic reactions in the form of early anaphylaxis were noted in 7% patients. CONCLUSION: Snake bite is a neglected tropical disease affecting poor villagers in rural areas. Future research focusing on understanding epidemiological determinants of snake bite is desired.

Feasibility of Development of a Cohort in a Rural Area of Sub-Himalayan Region of India to Assess the Emergence of Cardiovascular Diseases Risk Factors.

Introduction. Rural area of India is facing epidemiological transitions due to growth and development, warranting a longitudinal study to assess the development of CVDs risk factors. Objective. Feasibility of setting up a rural cohort for the assessment and development of biochemical risk factors for CVDs. Methodology. In Himachal Pradesh, house-to-house surveys were carried out in six villages for anthropometry and assessment of lipid profile. All the information was stored in specifically designed web-based software, which can be retrieved at any time. Results. A total of 2749 individuals of more than 20 years of age were recruited with a 14.3% refusal rate. According to Asian criteria, measured overweight and obesity (BMI > 27.5 kg/m(2)) were 44.9% and 10.5%, respectively. Obesity was significantly more (P = 0.01) among females (11.7%) as compared to males (8.4%). The prevalence of prehypertension and hypertension was observed to be 16.3% and 37.4%, respectively. Eighty percent of individuals had borderline (46.5%) to high (35.4%) level of triglycerides (TGs). Elevated total cholesterol (TC) and low density lipoprotein (LDL) level were observed among 30.0% and 11.0% individuals only. Conclusion. A high prevalence of biochemical risk factors for CVDs in a rural area urges establishment of an effective surveillance system.