The impact of health education intervention on perceptions of menstrual cup among college going female students in peri-urban Bangalore.

OBJECTIVES: To assess the impact of health educational intervention on perceptions of menstrual cup usage among female students enrolled in a degree college in Bangalore district. METHODS: An interventional study was conducted among female students studying in a degree college in peri-urban Bangalore. Universal sampling was followed and a prior face validated questionnaire was administered to the students after to assess their perceptions, followed by a health education intervention. The subjects were followed up after a period of one month, to assess the impact of health education in changing their perception towards menstrual cups. RESULTS: Among 83 study participants with mean age 19.5±0.95 years, post intervention we found a 42 % increase in the total awareness score and a 35 % increase in total attitude score towards menstrual cup use. There was an increase by 36.1 % (p<0.001) among participants who considered menstrual cup better than sanitary napkins. A reduction by 27.7 % (p=0.024) of reported fear of pain and discomfort while using menstrual cup was noted. CONCLUSIONS: There was a significant improvement in the overall awareness about how to use a menstrual cup, advantages, and attitude towards the usage of menstrual cups following the health educational intervention. Health education was found to have a positive impact on perceptions of menstrual cup.

No Child's Play: Under-five Child Feces Management in a Rural Area of Bengaluru Urban District, India.

Background: Inappropriate feces disposal leads to environmental contamination, and increases the risk of exposure to children. We aimed to estimate the proportion of rural households with knowledge and practice of safe management of feces (SMoF) among under-five children and to identify associated factors. Materials and Methods: A cross-sectional study was conducted in eight villages in Bengaluru Urban district over 2 months, using a face-validated semi-structured interview schedule. SMoF was defined based on five criteria - defecation site, transport tool, feces disposal, cleaning of transport tool, and hand washing. Results: Out of 320 under-five children surveyed, 15.7% were pre-ambulatory and 84.3% were ambulatory. The majority of the caregivers (92.5%) felt that children should defecate in the latrine and only 23.7% were aware that child feces were more infectious than adult feces. SMoF was only practiced by caregivers of ambulatory children (52.6%). Households with older caregivers (P = 0.01) and those living in a pucca house (P = 0.02) with a latrine inside (P = 0.04) were found to practice SMoF. Children of households that practiced unsafe disposal of child feces experienced more diarrheal episodes (P = 0.04). Caregivers >20 years were found to have better odds of SMoF [20-25 years (adjusted odds ratio, aOR: 9.02), 26-30 years (aOR: 12.17), >30 years (aOR: 8.93)] compared to those <20 years. Conclusion: The proportion of households with knowledge and practice of SMoF was low. Awareness of SMoF is essential to reduce the incidence of diarrheal diseases and improve sanitation. Our findings also call for awareness building at schools and colleges.

Effect of collaborative care intervention on productivity losses among people with comorbid common mental disorders and cardiovascular disease in rural Karnataka.

Introduction: Common mental disorders (CMD) and cardiovascular diseases (CVD), common health problems among patients seeking primary healthcare, contribute to high economic productivity losses. Collaborative care programs for CMDs and CVDs have shown improvement in clinical outcomes for both conditions; however, data on productivity outcomes are scarce. Objective: Effect of integrated collaborative care on productivity among people with comorbid CMD and CVD in rural Karnataka primary health clinics. Methods: Participants were recruited within a randomized trial in rural South India, where patients received either collaborative or enhanced standard care. In this substudy, 303 participants were followed for 3 months and assessed with the iMTA Productivity Cost Questionnaire (iPCQ). Results: We found a reduction in the proportion of individuals reporting productivity loss at 3 months (66%) compared to baseline (76%; P = 0.002). Productivity losses decreased from INR 30.3 per person per day at baseline to 17.7 at 3 months. Reductions were similar in the two treatment conditions. Conclusion: Medical intervention may foster reduced productivity losses among patients with CMD and CVD. Collaborative care did not translate into higher reductions in productivity losses than "enhanced standard care."

Sleep Quality of Undergraduate Medical Students during and Post-Lockdown: A Cross-Sectional Research.

Background: The COVID-19 and associated lockdowns have significantly impacted the lives of undergraduate medical students, including their sleep quality. This study attempts to investigate how sleep patterns, sleep quality, and associated factors altered during and post-lockdown. Material and Methods: In this cross-sectional study, 171 medical students from colleges registered under the National Medical Council participated. The study used a validated PSQI questionnaire. The data collected through Google forms were analyzed using SPSS v2021. Result: Among 171 study participants, 9.4% had bad sleep quality during lockdown which reduced to 4.7% post-lockdown significantly. Sleep latency and sleep duration were also significantly affected by the lockdown. There was a weak correlation between PSQI score during and post-lockdown, suggesting that individuals with poor sleep quality during lockdown also had poor sleep post-lockdown. According to the study, poor sleep quality decreased after lockdown as opposed to lockdown, with improvements in sleep latency and decreased use of sleep duration. Conclusion: However, there was a weak correlation between PSQI score during and post-lockdown. Increased screen time during lockdown negatively affected sleep quality, emphasizing the importance of practicing sleep hygiene and promoting outdoor activities to reduce stress levels and improve mental health.

Determinants of Childhood Asthma: A Case Control Study from a Tertiary Care Hospital in Bengaluru, South India.

BACKGROUND: Childhood asthma is a common, and often serious, chronic disease with episodic exacerbations in infants and children. There is an increasing trend in the prevalence of childhood asthma in developing countries. Objectives: To identify the determinants of childhood asthma. METHODS: A case control study with 30 cases of childhood asthma and 30 gender- and aged-matched controls selected from the paediatric outpatient department and paediatric ward of a tertiary hospital. The primary caregiver was interviewed to capture sociodemographic details, prenatal and birth history, and history of exposure to environmental risk factors. Odds ratios with 95% confidence intervals were calculated to determine the strength of association between childhood asthma and independent co-variates, followed by subgroup multiple logistic regression analysis. RESULTS: We found that children with a parental history of allergy/atopy [OR=2.88 (1.94-4.27), P<0.001], residence in houses located in industrial areas [AOR=2.72 (2.6-323.1), P<0.001], exposure to incense at home [AOR=2.03 (1.14-29.42), P<0.001], or a history of allergic rhinitis [AOR=3.09 (2.22-243.25), P<0.001] had significantly higher odds of developing childhood asthma. CONCLUSION: Our study found that having homes located in industrial areas, burning incense at home, parental history of allergy, and history of allergic rhinitis in the child are determinants of childhood asthma. The findings from our study can be used to generate awareness regarding risk factors that are linked to childhood asthma.

Impact of a Residential Rural Community-Based Training Program for Medical Students on Cognitive and Affective Domains of Learning in Community Medicine: A Mixed Methods Study.

INTRODUCTION: As part of undergraduate training in community medicine, students of 1st-year MBBS at our medical college in South India undergo rural residential community-based training called Rural Orientation Program (ROP). OBJECTIVE: The objective was to study the impact of ROP at a medical college in South India. METHODOLOGY: Short-term impact was studied immediately before and after ROP using a 30-item questionnaire administered to 142 students. Medium-term impact was studied among 23 students in 2nd-year MBBS. Quantitative component consisted of objective structured practical examination scores and qualitative component documented reflections on learnings. Long-term impact was studied by surveying 287 alumni (batches of 1979 onward) to explore the impact of ROP on their career. RESULTS: We found a significant (P < 0.001) improvement in the median posttest score (21, interquartile range [IQR]: 20-23) when compared to pretest (12, IQR: 10-16). The mean OSPE score was 19.34 ± 3.19 (maximum score = 25) with 54.55% obtaining a score ≥20. Thematic analysis of reflections depicted that students gained insights on factors influencing health and social organizations in rural areas. ROP helped develop empathy toward patients and a holistic approach toward health, in understanding rural dynamics and improved communication skills. CONCLUSION: ROP increases subject knowledge and plays a role in molding attitudes of students toward the care of people in rural areas and improves communication skills. This time-tested model can be replicated in other medical colleges across the country.

Secondhand Smoke Exposure during Pregnancy and its Effect on Birth Outcomes: Evidence from a Retrospective Cohort Study in a Tertiary Care Hospital in Bengaluru.

CONTEXT: The effect of maternal smoking on birth outcomes is well-established, but the effect of maternal secondhand smoke (SHS) exposure is less clear, especially among Indian women. AIM: To evaluate the effect of SHS exposure during pregnancy on birth outcomes such as gestational age at birth, neonatal anthropometry, and Apgar score. SETTING AND DESIGN: Retrospective cohort study at a tertiary hospital in Bengaluru. METHODS: 208 postnatal mothers: 104 each in "exposed" and "nonexposed" group, based on the history of SHS exposure during pregnancy. Sociodemographic and obstetric details were obtained by interview schedule and birth outcomes were obtained from patient charts. STATISTICAL ANALYSIS: Association of SHS exposure with birth outcomes was analyzed using inferential statistics such as Chi-square, t-test, and Mann-Whitney U-test, whereas the strength of association was expressed as relative risk with 95% confidence intervals. P < 0.05 was considered statistically significant. RESULTS: SHS exposed and nonexposed groups were comparable with regard to potentially confounding socioeconomic and obstetric covariates. Babies born to SHS-exposed mothers had significantly lower mean birth weight, mean birth length, and mean birth head circumference by 172.5 g (P = 0.027), 1.6 cm (P = 0.001), and 1.1 cm (P = 0.001), respectively. CONCLUSION: Mothers exposed to SHS during pregnancy were twice likely to deliver low birth weight babies (relative risk [RR] = 1.9 [1.0-3.6], P = 0.02) and babies of low birth length (RR = 2.64 [1.4-4.6], P = 0.001) than unexposed mothers. With a significant risk of adverse birth outcomes found among mothers exposed to SHS during pregnancy, it is important that a "no tobacco smoke" environment at home should be recommended for pregnant women and their families.

Social Impact of End-Stage Renal Disease Requiring Hemodialysis among Patients with Type-2 Diabetes and Their Caregivers in Bengaluru, Karnataka.

INTRODUCTION: Diabetic nephropathy is the leading cause of end-stage renal disease (ESRD) requiring hemodialysis. The social impact of a chronic disease like this is far reaching and often difficult to quantify. OBJECTIVES: To assess the social impact of ESRD among type 2 diabetics requiring hemodialysis and their caregivers. METHODS: A cross-sectional study was carried out between February 2017 and 18 among patients with type 2 diabetes requiring hemodialysis and their caregivers, attending the dialysis unit at St. John's Medical College Hospital, Bengaluru, India. Social impact was assessed under the domains of stress (physiologic and psychologic), quality of life (QOL), cost of care, self-perceived burden, and caregiver burden. Study tools used were semi-structured interview schedule for sociodemographic data, details regarding diabetes, hemodialysis and cost of care, EuroQol-5D-3L, hemodialysis stressor scale, Cousineau Self-Perceived Burden Scale, and Caregiver Burden Scale. RESULTS: A total of 160 participants were included. Majority were males (78%) between 46 and 60 years of age. Most participants experienced moderate stress due to hemodialysis (65%) and moderate self-perceived burden (47.5%). Five (10.6%) participants reported full health, while one (0.6%) reported poor health. Anxiety/depression (80.6%) was the top reported problem among all domains of QOL. Caregiver burden was moderate (53.9%). Annual median cost of direct medical expenditure was ₹258,600 (interquartile range [IQR]: 197,400-433,500) and ₹16,500 (IQR: 9,600-32,100) for nonmedical. CONCLUSION: We conclude that the social impact of ESRD among type 2 diabetics requiring hemodialysis and their caregivers was moderate. Routine counseling of patients receiving haemodialysis and support groups for patients as well as caregivers will help reduce the impact.

Challenges and coping strategies faced by female scientists-A multicentric cross sectional study.

Women can play a pivotal role in the progress and sustainability of the world if they are empowered through education and employment opportunities in Science, technology, innovation and through changing the social stereotypes that restrain them in certain workplaces. In the literature, few recently published studies exist that document the challenges faced by female scientists in their workplaces. The purpose of this study was to understand the challenges and coping strategies faced by female scientists around the world today, in order to contribute to their improved performance. A multi-centre electronic cross-sectional survey across 55 countries was conducted to profile female scientists and to identify the challenges that they experience throughout their career as well as the coping mechanisms that they use to overcome the barriers. A total of 263 female scientists from different countries across the world participated in our study and most participants were from the South East Asian Region. Most female scientists in our study belong to the middle and junior level career category and earning around 1250 USD per month. Most of the scientists reported availability of maternity leave at their workplace but less than a third reported presence of a creche at work. Workplace sexual harassment was reported by 24% of the study population. Work related stress (71.5%) and work life imbalance (46%) are also major challenges faced by female scientists. Self-confidence, dedication and hard work are the most commonly adopted coping strategy. Flexible work timings, woman-friendly management policies, fair appraisal and mentorship appear to reduce the work-related stress and improve work-life balance among female scientists. In conclusion, female scientists face numerous challenges, which can greatly affect both their individual and career growth. Intrinsic (personal) and extrinsic (institutional) factors are important for improving female scientists' wellbeing and productivity.

Barriers to Healthy Lifestyle among College-Going Students in a Selected College in Bengaluru Urban District.

CONTEXT: Cardiovascular diseases (CVDs) are influenced by factors acting at all stages of life. Healthy lifestyle practices among adolescents and youth are crucial in preventing CVDs in the later years. Many barriers prevent young people from practicing healthy lifestyles. AIMS: The aim of this study is to identify barriers to healthy lifestyle among college-going students in Bengaluru Urban District. SETTINGS AND DESIGN: A cross-sectional study was conducted among 722 students aged 15-25 years, in a degree college in Bengaluru Urban district. SUBJECTS AND METHODS: A structured interview schedule with good internal consistency (Cronbach's alpha = 0.887), consisting of 50 questions scored on a 5-point Likert scale with five domains (diet, physical activity, tobacco use, alcohol consumption, and stress) was administered. The total score was classified into high-, moderate-, and low-barrier categories using percentiles. The barrier score for each domain and for each individual question was computed by multiplying the weight of the responses by their frequencies. STATISTICAL ANALYSIS USED: Barriers to healthy lifestyle and its association with sociodemographic variables were analyzed using inferential statistics such as t-test and ANOVA. Significant factors were entered into a multiple linear regression model. RESULTS: The domain of stress emerged as the topmost barrier followed by diet. The main factors responsible for stress among college students were examinations (74.9%), long hours of the study (71.1%), and lack of time (69.6%). CONCLUSIONS: Barriers to healthy lifestyle are common among adolescents and youth. The topmost barriers identified were stress- and diet-related barriers.

Cardiovascular risk factor reduction by community health workers in rural India: A cluster randomized trial.

BACKGROUND: There is a need to identify and test low-cost approaches for cardiovascular disease (CVD) risk reduction that can enable health systems to achieve such a strategy. OBJECTIVE: Community health workers (CHWs) are an integral part of health-care delivery system in lower income countries. Our aim was to assess impact of CHW based interventions in reducing CVD risk factors in rural households in India. METHODS: We performed an open-label cluster-randomized trial in 28 villages in 3 states of India with the household as a unit of randomization. Households with individuals at intermediate to high CVD risk were randomized to intervention and control groups. In the intervention group, trained CHWs delivered risk-reduction advice and monitored risk factors during 6 household visits over 12 months. Households in the non-intervention group received usual care. Primary outcomes were a reduction in systolic BP (SBP) and adherence to prescribed BP lowering drugs. RESULTS: We randomized 2312 households (3261 participants at intermediate or high risk) to intervention (1172 households) and control (1140 households). At baseline prevalence of tobacco use (48.5%) and hypertension (34.7%) were high. At 12 months, there was significant decline in SBP (mmHg) from baseline in both groups- controls 130.3 ±â€¯21 to 128.3 ±â€¯15; intervention 130.3 ±â€¯21 to 127.6 ±â€¯15 (P < .01 for before and after comparison) but there was no difference between the 2 groups at 12 months (P = .18). Adherence to antihypertensive drugs was greater in intervention vs control households (74.9% vs 61.4%, P = .001). CONCLUSION: A 12-month CHW-led intervention at household level improved adherence to prescribed drugs, but did not impact SBP. To be more impactful, a more comprehensive solution that addresses escalation and access to useful therapies is needed.

"DIABETIC TAX" - Cost of Care among Persons with Type 2 Diabetes Mellitus in an Urban Underprivileged Area of Bengaluru.

BACKGROUND: Diabetes mellitus drains a significant percent of the health budget by cost toward direct diabetes care and diabetes-related disabilities. OBJECTIVES: The aim of the study is to assess the annual costs incurred by patients with type 2 diabetes mellitus. METHODOLOGY: This cross-sectional study was undertaken among 153 diabetic people in an urban underprivileged area of Bengaluru from January 2013 to January 2014. This was a cost of illness study done from the patient's perspective using a structured interview schedule. RESULTS: A diabetic person in an urban underprivileged community in Bengaluru spends 11,489.38 ± 28,341.77 annually for diabetic care. Direct and indirect costs accounted for 95% and 5% of costs. Majority were spent on admission (45.1%), followed by drugs (21.8%), investigations (5.6%), and consultations (4.5%). Nonmedical costs such as food and transport accounted for 18% of the costs. About 50% of them had delayed treatment due to financial constraints. Nearly 25% of patient's income and 10.7% of the family income were spent for diabetic care. Higher education, income, duration of disease, hospital admission, type of treatment, and place of treatment were found to be associated with costs. CONCLUSION: Estimates of cost will help conceptualize strategies to deal with the situation at local, regional, and national level.

Nutritional Status, Hygiene Level, Morbidity Profile, and Their Effect on Scholastic Performance among School Children in Two Subcenter Areas of a PHC in Anekal Taluk, Karnataka, India.

BACKGROUND: Various factors such as age, sex, nutrition, hygiene, and morbidity impact the scholastic performance of schoolchildren. OBJECTIVES: (1) The objective of the study is to assess the hygiene level, nutritional status, morbidity profile, and scholastic performance of children attending government schools in two select subcenter areas of Karnataka and (2) to study the association of hygiene level, nutritional status, and morbidity profile with scholastic performance. METHODOLOGY: A cross-sectional study was done from July to August 2017 among children studying in the government schools of Mugalur and Kuthganahalli subcenters under Sarjapur PHC, Anekal Taluk, Bengaluru urban district. After obtaining permissions, general checkup of the students was done for morbidity pattern, and their anthropometric measurements were documented. Hygiene levels of the students were observed with a checklist to obtain scores that were grouped into good and poor. Attendance and grades were obtained from the class teacher to assess the scholastic performance. RESULTS: Of a total 403 students studied, the mean age was 10.2 years (standard deviation: 2.87) with 51.1% girls. Nutrition status was good in 236 (58.6%) students and 262 (65%) had good hygiene. At the time of examination, 211 (53%) had at least one morbidity, with most common being dental caries (16.3%). Logistic regression showed that odds of girls having better grades is 2.4 times more when compared to boys and 2.1 times more likely in students with good hygiene. Students with good hygiene are 2.1 times more likely to have good attendance. CONCLUSION: Hygiene status impacts the attendance and grades of the students. Girl students had significantly better grades than the boys.

Effectiveness of Color Coded Diabetic Control Monitoring Charts among Elderly Diabetics Attending Outreach Primary Care Geriatric Clinics in Rural Karnataka: An Open Label Randomized Control Trial.

INTRODUCTION: Type 2 diabetes mellitus problem is progressively rising every day. The adherence to the treatment approaches and health-seeking make major difference in case of diabetics particularly elderly. Visual tools improve the involvement of patients in their care, especially among populations with low health literacy. OBJECTIVE: To evaluate the effectiveness of color-coded diabetic control monitoring charts on glycemic control among elderly diabetics. METHODOLOGY: 144 elderly diabetic patients attending rural primary care geriatric clinics were randomized into two groups. Those randomized to the intervention group received the color-coded diabetic monitoring chart and a health education package in addition to the usual consultation services. Baseline and 1-year follow-up glycated hemoglobin (HbA1C) values were used to assess the effectiveness of the intervention. RESULTS: The results of multivariate linear regression analysis showed that there was an average reduction of 0.265% in HbA1C value in the intervention group when compared to the nonintervention group when adjusted for baseline HbA1C and number of visits during the intervention period (ß coefficient = 0.265, P < 0.05). CONCLUSION: Color-coded diabetes charts are effective in achieving glycemic control among elderly diabetics, and steps should be made to inculcate visually appealing management approaches in case of elderly diabetic patients.

Productivity losses among individuals with common mental illness and comorbid cardiovascular disease in rural Karnataka, India.

CONTEXT: Common mental disorders (CMD) and cardiovascular diseases (CVDs) frequently co-occur. Productivity losses due to these diseases are substantial in high-income countries. Similar data from the developing world are lacking. AIMS: This study aims to quantify productivity losses among individuals with comorbid CMD and CVD in rural Karnataka, India. SETTINGS AND DESIGN: A cross-sectional study was done among patients with a dual diagnosis of a comorbid CMD and CVD in a district in Karnataka, India. SUBJECTS AND METHODS: Three hundred and three patients were administered the iMTA Productivity Cost Questionnaire to measure losses of productivity at paid work (absenteeism and presenteeism) and unpaid work. STATISTICAL ANALYSIS USED: Valuation of productivity losses was done by multiplying the number of days of lost productivity by the standard value of productivity based on the minimum wage for agricultural work. RESULTS: Among individuals with dual CMD and CVD, 76% had productivity losses. These losses were higher at unpaid (62%) than at paid work (32%). At paid work, losses due to presenteeism were greater than those due to absenteeism. The total days of productivity loss were 1204, amounting to 14.2% of the available person-days. The total productivity loss among 303 individuals with mental illness and comorbid CVD over a 4-week period amounted to 30.3 INR (0.47 USD) per person per day, representing 9.9% of total potential productivity. CONCLUSIONS: Productivity losses due to common mental illnesses and CVDs are high. There is a need to conduct more studies in this field.

Effort-Reward Imbalance and its Association with Health among Pluckers in a Tea Plantation in South India.

CONTEXT: Work-related stress is associated with cardiovascular diseases, musculoskeletal disorders, psychological ailments, and work-related injuries. Imbalance between high effort and low reward at work can lead to work stress among plantation workers. AIMS: To assess the effort-reward imbalance (ERI) among pluckers in tea plantations in South India and its association on chronic health problems, substance abuses, and workplace injuries. SETTINGS AND DESIGN: A cross-sectional study was conducted among 346 tea pluckers from May to June 2015 in six selected tea plantations in Anamalai, South India. PATIENTS AND METHODS: A short version of ERI questionnaire was used to assess the work-related stress among them. Along with ERI questionnaire, sociodemographic details, chronic diseases, substance abuses, and workplace injuries were ascertained. STATISTICAL ANALYSIS USED: Sociodemographic variables were described as frequency and measures of central tendency. Tests of association, such as Chi-square test, were applied. RESULTS: Among the study population, 322 (93.1%) reported more effort, 23 (6.6%) reported more reward, and one (0.3%) had no imbalance between effort and reward. Those in older age group (≥51 years) experienced more effort compared to those in younger age group (≤50 years) (Fisher's exact = 21.905, P = 0.001). Educational status (Fisher's exact = 15.639, P = 0.027) and work experience (Fisher's exact = 23.122, P = 0.003) increased the effort rather than increasing the reward associated with work. No significant association was found between ERI and any chronic diseases, substance abuses, or injuries. CONCLUSIONS: Majority of pluckers in tea plantation experienced more effort compared to reward.

Estimation of work capacity and work ability among plantation workers in South India.

BACKGROUND: Work capacity is the ability to perform real physical work, and work ability is a result of interaction of worker to his or her work that is how good a worker is at present, in near future, and how able is he or she to do his or her work with respect to work demands and health and mental resources. OBJECTIVE: To assess the work capacity and work ability and to study the factors associated with work capacity and work ability of workers at a tea plantation in South India. MATERIALS AND METHODS: A cross-sectional study was conducted at a tea plantation in Annamalai, South India, from March to May 2015. Data were collected using a structured interview schedule comprising of three parts as follows: sociodemographic data, work ability questionnaire, and work capacity assessment. RESULTS: Of the 199 subjects participated in the study, majority [90 (45.3%)] were in the age group of 46-55 years, and 128 (64.3%) were females. Of the 199 workers, 12.6% had poor aerobic capacity (by Harvard Step test), 88.4% had an endurance of more than 1 h, 70.9% had better work productivity and energetic efficiency, and the voluntary activity workers spent most time on household chores. Of the 199 workers assessed, only 9.6% had good work ability. There is negative correlation between work ability and body mass index (BMI). CONCLUSION: Our study found 12.6% workers with poor aerobic capacity and 9.6% of workers with good work ability. Periodic health examinations and other screening procedures should be made as routine in workplace to improve work ability and capacity.

Effectiveness of yoga program in the management of diabetes using community health workers in the urban slums of Bangalore city: A non-randomized controlled trial.

TRIAL DESIGN: Nonrandomized controlled trial. METHODS: Nonrandomized controlled trial. This was an interventional study that was conducted in 4 slums of Bengaluru. Of the 256 diabetes participants, only 109 people agreed to participate in the program. Of 109 people, 52 people agreed to participate in the intervention (agreed to learn and practice Yoga) while the remaining 57 people were assigned to nonintervention group. Randomization and blinding could not be done. OBJECTIVE AND OUTCOME: The study was conducted with objective of assessing the effectiveness of Yoga, Pranayama, and Sudarshan Kriya in the community-based management of diabetes mellitus. The primary outcome variable was Hb1Ac and secondary outcome variables were systolic blood pressure (SBP), diastolic blood pressure (DBP), adherence to medication, and changes in lifestyle. RESULTS: The study was conducted for 40 days. Community health workers made a total of 6 visits during the study. All the 109 participants were available for weekly follow-up. There were no drop outs among the study population. Statistically significant change was seen in the consumption of vegetable (χ2 = 15.326, P < 0.005), fruits (χ2 = 16.207, P < 0.005), salty food (χ2 = 14.823, P < 0.005), bakery food (χ2 = 10.429, P < 0.005) and fried food (χ2 = 15.470, P < 0.005), adherence to metformin (χ2 = 41.780, P < 0.005) and other medication(χ2 = 21.871, P < 0.005) and proportion of patients with DBP under control (χ2 = 9.396, P < 0.005) and proportion of people with glucose random blood sugar under control (χ2 = 29.693, P < 0.005) between the two groups following the intervention. Statistically significant change was also seen in the proportion of people with SBP/DBP ≤140/90 (χ2 = 10.635, P < 0.005) between the two groups. CONCLUSION: The Yoga program was successful in improving dietary practices and medication adherence and in increasing the proportion of diabetics and hypertensive patients under control.

Adherence to prescribed medications for chronic illnesses among older adults in a rural community, Karnataka, India.

AIM: To assess adherence to prescribed medications for chronic illnesses and to identify factors associated with it among rural older adults. METHODS: A cross-sectional study was carried out from September to November 2011 in three subcenters in Lakkur PHC, Kolar District, India. All older adults were listed, and those suffering from chronic non-communicable diseases were included in the study. A structured interview schedule comprising of 48 items was used to measure adherence, and to identify factors associated with adherence in the domains of socioeconomic status, therapy, health systems, patient behavior and physical factors. RESULTS: Of the 184 older adults included in the study, 63.6% were fully adherent to their medication. Non-adherence to medication showed a statistically significant relationship with the absence of a medical store within their village, non-availability of drugs at the nearest medical store, inability to understand the doctor's language, failure to explain the consequences of not taking medicines by the healthcare provider, self-alteration of medicine dosage, fear that medicines will lead to the development of dependence to medicines and difficulty in swallowing. Those who led busy lives, those who had been prescribed three or more types of medicines prescribed per day, those who required special skills to take medicines (injections, inhalers), those who had made adjustments to their usual lifestyle to take medicines and those who had knowledge that medicines need to be taken lifelong were more likely to be adherent to their medications. Four factors, namely, the doctor explaining the consequences of not taking medicines, altering the dosage of the medicines by the patients themselves, the number of medicines prescribed per day and having the knowledge that medicines need to be taken lifelong, were critical determinants of adherence to medications. Geriatr Gerontol Int 2016; 16: 1339-1345.

Prevalence of diabetes and pre-diabetes and assessments of their risk factors in urban slums of Bangalore.

BACKGROUND: To determine the prevalence of diabetes and pre-diabetes and to assess the risk factors associated with diabetes and pre-diabetes in the urban slums of Bangalore. MATERIALS AND METHODS: A cross-sectional study was conducted in four slums of Bangalore in the age group of 35 years and above comprising of total 2013 subjects. Risk factors like age, sex, family history, behavior, physical activity, BMI, waist hip ration, diet habits were assessed to find their association with diabetes. RESULTS: Prevalence of diabetes was 12.33% and of pre-diabetes was 11.57%. Prevalence was more among the females compared to males. Increasing age, over weight and obesity, sedentary life style, tobacco consumption, diet habits showed statistically significant association with prevalence of diabetes and pre-diabetes. CONCLUSION: Physical activity like regular exercises both at the office and at home, fibers-rich diet, blood sugar estimation after 35 years are some of the recommendations which can control diabetes.