Pestilent relationship between smoking and hypertension or pulse pressure among males over 15 years in India: NFHS-5 Survey.

OBJECTIVE: The Global Adult Tobacco Survey conducted in India has divulged that 28.6% of the populace aged 15 years and above partakes in tobacco consumption in various modalities. Despite the availability of numerous studies on the correlation between smoking and hypertension, the nexus between tobacco smoking and hypertension remains enigmatic. Smoking has predominantly been linked to blood pressure, with scant investigations exploring the plausible association that may subsist between smoking and pulse pressure. METHODOLOGY: This study is based on secondary data analysis from the fifth National Family Health Survey (NFHS-5). 17 Field Agencies gathered information from 636,699 households, 724,115 women, and 101,839 men. The data related to only men was included and analysed in this present study. RESULTS: Male participants had a mean age of 32.2+1.2 years, an average waist circumference of 80.4+12.2 cm, and mean systolic and diastolic blood pressure of 123.4+13.8 mmHg and 80.5+10.2 mmHg. Daily smokers had a slightly higher likelihood of hypertension compared to non-smokers (OR = 1.2, p <0.001). Male quitters had significantly lower odds of hypertension (OR = 0.9, p <0.001). Quitters had reduced odds of narrow pulse pressure but increased odds of wide pulse pressure (OR = 0.81 and 1.14, respectively). CONCLUSION: The study found that regular smoking was associated with hypertension, while factors such as age, obesity, urban dwelling, wealth, and tribal residence were linked to increased blood pressure. Male quitters had a lower likelihood of hypertension, and middle-aged men and those with central obesity showed distinct associations with deranged pulse pressure.

Assessment of acceptability of black wheat flour products and factors affecting it among Anganwadi beneficiaries and workers: A mixed-method prospective observational study.

Introduction: Malnutrition is very common in India and black wheat might be an acceptable solution to this problem. The aim of the study was to assess acceptability of black wheat flour products and factors affecting it among Anganwadi beneficiaries and workers. Materials and Methods: This was a mixed-method prospective observational study. All the family members enrolled for supplementary nutrition and Anganwadi workers/helpers of three randomly selected Anganwadi centers were taken in the study. For qualitative data, in-depth interview was done, and for quantitative data, 9-point hedonic scale was administered. Braun and Clarke's six-phase data analysis framework was used for qualitative data. Results: A total of 16 pregnant females, 14 lactating females, 16 children, 2 Anganwadi workers, and 3 Anganwadi helpers participated in the study. Thematic analysis of the data revealed five significant themes. It included characteristics of black wheat flour, the process of making the product (experience of making the product), family acceptability, availability, and hygiene. Participants expressed that the black color appearance is one of the negative influencers in the acceptability of black wheat flour. Most of the participants liked the taste as well as the texture. However, kneading, rolling, and puffing were more challenging than traditional wheat flour. On the hedonic scale, the mean rank of acceptability is lowest for color (3.03), followed by puffing (3.49) and highest for texture (4.87) and taste (4.60). Conclusion: Our study results revealed that black wheat is acceptable to the Anganwadi beneficiaries and workers.

Analysis of clinical profile and role of various prognostic factors in early bone marrow response in children with acute lymphoblastic leukemia treated by Modified Multicenter Protocol (MCP) 841 protocol: Experience from a tertiary care center in North India.

BACKGROUND: It is important to study the clinical profile of pediatric patients with acute lymphoblastic leukemia (ALL) and assess various prognostic factors implicated in response to induction chemotherapy for optimal treatment outcomes in India. The present study was done to evaluate the clinical profile and to find the correlation of day 7 and day 28 marrow blast response with already established prognostic factors in children with ALL in the region of North India using MCP 841 protocol for all patients. METHODS: A total of 60 children up to ages 14 years with ALL were given treatment in the form of induction remission (MCP-841 protocol) I1 cycle (induction 1) therapy for 29 days. Complete hemogram for blast cells and bone marrow examination (bone marrow aspiration and, if required, bone marrow biopsy) was done on days 7 and 28 (completion of I1 cycle) to see early bone marrow response. Early response to induction therapy was compared in patients with and without high-risk factors, and results were analyzed statistically. RESULTS: Out of 60 enrolled children, 56 (93.4%) patients were in complete remission at the end of induction 1 cycle. Various risk factors were found to be of prognostic significance in first remission and early response to induction therapy were initial total leukocyte count (TLC) at presentation, immunophenotype of ALL; while other factors including age and sex was not found to be significant. CONCLUSION: Prevalence and significance of various prognostic factors implicated in pediatric ALL tend to be different in various populations. A better understanding of such factors in these populations will help in the tailoring of risk-adapted treatment protocols to local needs.

Community health workers willingness to participate in COVID-19 vaccine trials and intention to vaccinate: A cross-sectional survey in India.

Background: Vaccine hesitancy is of considerable concern as it threatens the great potential of a vaccine against COVID-19. This study aims to determine factors associated with community health workers' willingness to participate in clinical trials of COVID-19 vaccine, and their vaccination intention, in India. Methods: A cross-sectional study was conducted among 377 community health workers using self-administered anonymous questionnaire during the lockdown periods in India. Participant's socio-demographics, willingness-to-participate in COVID-19 vaccine trials, intention to accept COVID-19 vaccine were recorded in a Likert scale. Data were analysed descriptively, and a multivariate logistic regression model was used to investigate factors associated with willingness to participate and accept the vaccine. Results: Among 377 CHWs, 70 (19%) intended to participate in COVID-19 vaccine trial, 151 (40%) responded positively regarding their intention to get vaccinated. Those with knowledge on development of COVID-19 vaccine [aOR 3.05 (95% CI: 1.18-7.88), p = 0.021], and men [aOR 3.69 (95% CI: 1.51-8.97), p = 0.004] were more willing to participate in clinical-trial, while an undergraduate degree, and trust in domestic vaccines were identified as deterrents for the same. Perceiving COVID-19 as risk [aOR 2.31 (95% CI: 1.24-4.31), p = 0.009], and male gender [aOR 2.39 (95% CI: 1.17-4.88), p = 0.017] were factors associated with intention to get vaccinated. Respondents who had knowledge about COVID-19 virus were less likely to uptake the hypothetical vaccine [aOR 0.32 (95% CI: 0.12-0.88), p = 0.027]. Conclusions: Increasing knowledge regarding COVID-19 is not enough to improve vaccine acceptance rates. Targeted interventions addressing socio-demographic determinants related to COVID-19 vaccination should help improve acceptance.

Suicide deaths among medical students, residents and physicians in India spanning a decade (2010-2019): An exploratory study using on line news portals and Google database.

BACKGROUND: Despite having one of the world's largest medical education consortium, India lacks a comprehensive and nationally representative data on suicide deaths among medical students and physicians unlike the one found in most of the developed nations of the world. AIM: We aimed to explore the different characteristics of suicide deaths among medical students, residents and physicians in India over a decade (2010-2019). METHODS: Content analysis of all suicide death reports among medical students, residents and physicians available from online news portals and other publicly available sites was done. Search was done retrospectively using pertinent search words individually or in combination with language restricted to Hindi and English and timed from January 2010 to December 2019. Reports on completed suicide by allopathic medical students, residents and physicians from India were included. Socio-demographic and suicidological variables were analysed using R software. RESULTS: A total of 358 suicide deaths among medical students (125), residents (105) and physicians (128) were reported between 2010 and 2019. Around 7 out of 10 suicides happened before the age of 30 and had mean age 29.9 (±12.2) years. Female residents and physicians were younger than their male counterparts at the time of suicide. Overall maximum suicide deaths were concentrated in South India except the state of Kerala. The specialty of anesthesiology (22.4%) followed by obstetrics-gynaecology (16.0%) had the highest suicide deaths. Violent suicide methods were more commonly used by all, with hanging being the most common mean of suicide. Academic stress among medical students (45.2%) and residents (23.1%), and marital discord among physicians (26.7%) were the most noticeable reasons for suicide. Mental health problems were the next most common reason in medical students (24%) and physicians (20%) while harassment (20.5%) was in residents. Twenty six percent had exhibited suicide warning signs and only 13% had ever sought psychiatric help before ending their lives. A total of nine reports of suicide pact were found with the average deaths per pact being 2.4 and predominantly driven by financial reasons. CONCLUSION: Academic stress among medical students and residents, and marital discord in physicians emerged as the key reasons for suicide. However, this preventable domain should be further explored through focused research. This is the first of its kind study from India which attempted to explore this vital yet neglected public health issue using the most feasible and practical method of online news content-based analysis.

Impact of a Brief Structured Psychoeducation Session on Antiepileptic Drug Adherence and Treatment Outcome in Persons with Epilepsy: A Prospective Cohort Study.

BACKGROUND: Poor adherence to antiepileptic drugs is one of the most important causes of treatment failure in persons with epilepsy (PWE). This study was aimed at assessing the impact of psychoeducation on drug adherence and treatment outcome in PWE. METHODS: It was a prospective cohort study with a pre and posttest intervention design. A cohort of 100 epilepsy patients aged 18-65 years and on antiepileptic drugs for at least 6 months attending the outpatient department was enrolled in the study. Drug adherence was measured by Medication Adherence Rating Scale. A structured eight-domain epilepsy psychoeducation session with pictorial description was given to the study subjects in two parts (group and individually) lasting for a total of 30 min on the day of baseline assessment. Adherence and treatment outcome variables were assessed by an independent observer 4 months after the psychoeducation session. Chi-square test and paired t-test were used to analyze the data using SPSS version 20 with P value less than 0.05 considered as significant. RESULTS: There was a statistically significant (P < 0.001) increase in the number of patients who were adherent to medications after psychoeducation session. There was a significant reduction in mean seizure frequency (0.68 ± 0.65) and seizure severity in terms of injuries sustained during seizure episodes post intervention. Regularities in the follow-up visits were also witnessed. A significant decrease in the number of hospital admissions (0.09 ± 0.32), mean inpatient treatment days (0.44 ± 2.19), and emergency room visits (0.19 ± 0.15) was noted 4 months after the psychoeducation session indicative of better treatment outcome. CONCLUSION: The present study proves the efficacy of a structured educational program in improving drug adherence and treatment outcome in a cohort of people with epilepsy.

Factors Associated with Poor Antiepileptic Drugs Adherence in Below Poverty Line Persons with Epilepsy: A Cross-Sectional Study.

Background Adherence to antiepileptic drugs (AED) is essential for adequate seizure control in epilepsy. People with low socioeconomic status are more vulnerable to poor adherence to AED. The present study aimed to explore factors associated with poor adherence to antiepileptic drugs in below poverty line (BPL) persons with epilepsy (PWE). Methods The research had a cross-sectional design with inclusion of persons aged 18 to 65 years and an established diagnosis of epilepsy. Holding a BPL card (Yellow card) was taken as a measure for BPL criteria. Adherence to antiepileptic drugs was assessed using medication adherence rating scale (MARS). Univariate analysis with Chi-square test was used to determine the association between various variables and AED adherence, while the predictors of adherence were identified using multivariate logistic regression analysis. Results There was a total of 88 BPL PWE. The mean age of male and female patients was 35.0 ± 15.0 & 32.0 ± 10.1 years, respectively. Adherence for drugs were found to be 30.7% and nonadherence to be 44.3%. Low (illiterate or primary) education (OR 0.041 [0.01-0.21]), polytherapy (OR 0.088 [0.02-0.40]), and substance abuse (OR 0.05 [0.01-0.58]) were found to have significant association with nonadherence to AEDs. Age, gender, marital status, family composition, occupation, rural urban background, distance from health care facility, duration of epilepsy, and side effects of AED were not found to have significant association with adherence. Conclusion There is a need for psychoeducational programs for the people having low education status and polytherapy to form positive beliefs in AEDs. Substance abuse should also be addressed while treating them.

Seven versus Ten Days Antibiotics Course for Acute Pyogenic Meningitis in Children: A Randomized Controlled Trial.

OBJECTIVES: To compare the efficacy and safety of 7 d vs. 10 d empirical antibiotic therapy in cases of acute pyogenic meningitis in children aged 3 mo to 14 y with rapid initial recovery. METHODS: A total of 96 children aged 3 mo to 14 y with acute pyogenic meningitis were randomized to either 7 d or 10 d therapy on Day 5 of the therapy, if they were in clinical remission and had improving cerebrospinal fluid (CSF) abnormalities. The primary outcome was treatment failure in each group within 10 d of enrolment or relapse of meningitis defined as recurrence of signs and symptoms of meningitis within 2 wk of discharge. Secondary outcome was the presence of sequelae in patient at 30 d and 90 d follow-up post discharge. RESULTS: Out of 111 screened children, 96 patients completed the trial, 48 in each group. There were 7 treatment failures and relapses each in the group receiving 7 d antibiotics while 6 failures and relapses each were seen in 10 d antibiotics group. There was no statistically significant difference in treatment failure in both the groups [2.1 (-0.12-0.16); p = 0.76]. No deaths or significant adverse effects of the drugs occurred during this study. Four cases of nosocomial sepsis were reported with 2 cases in each group. On subsequent 30 d and 90 d follow-up, no statistically significant difference was found between the two groups regarding frequency of hearing impairment, frequency of hydrocephalus [-2.1 (-0.09-0.13); p = 0.65] and various neurological sequelae [6.2 (-0.06-0.19); p > 0.05]. CONCLUSIONS: Short course antibiotic therapy may be adequately effective for treatment of acute pyogenic meningitis beyond neonatal age in children with initial rapid recovery.

Prevalence and risk factors for nonalcoholic fatty liver disease in obese children in rural Punjab, India.

BACKGROUND: Pediatric nonalcoholic fatty liver disease (NAFLD) is associated with insulin resistance, hypertension, metabolic syndrome, cardiovascular problems, and increased risk of chronic liver disease and Type II diabetes mellitus. The aim of the study was to assess the metabolic profiles and associated risk factors of NAFLD in obese children. MATERIALS AND METHODS: Children with a body mass index (BMI) of >27 kg/m2 an adult equivalent cutoff (Indian Academy of Paediatrics, 2015 guidelines) aged 5-18 years presenting to the pediatric outpatient unit of PGIMER Satellite Centre, Sangrur, India, were retrospectively recruited over a 1-year period. Anthropometry, lipid profile, thyroid levels, liver function test, fasting blood sugar, and blood pressure were measured. Ultrasonography was used to diagnose NAFLD. Logistic regression was used to assess the risk factors. RESULTS: A total of 100 children participated in the study. The mean age was 10.6 ± 2.6 years and the mean BMI-Z score was 2.6 ± 0.5. The prevalence of NAFLD was 62%. Alanine transaminase (ALT) was significantly elevated in all the children with NAFLD. Lipid levels and BMI Z-score were similar in both groups. Unadjusted odds ratio shows statistically significant association of ALT (2.058 [1.11-1.01]) and waist circumference (1.089 [1.19-0.99]) with NAFLD. With adjusted odds ratio only, ALT (1.12 [1.24-1.01]) was found to be significantly associated with NAFLD. CONCLUSION: There is quite a high prevalence of nonalcoholic fatty liver in obese Indian children. All children with raised liver enzymes should undergo sonography to rule out NAFLD.

A comparative study of sleep quality in different phases of the medical course: A study from Haryana (North India).

BACKGROUND: Inadequate sleep quality is a crucial problem in today's hectic lifestyle. Sleep is known to facilitate cognitive skills, aid memory, and is important for physical, emotional and intellectual health. OBJECTIVES: To determine the sleep quality of the medical undergraduate students and to explore differences in various phases of medical curriculum. MATERIAL AND METHODS: Sleep quality was assessed in 400 medical students in various phases of the medical course using the Pittsburgh Sleep Quality Index (PSQI). Chi square test was used for comparisons of the all seven components of PSQI and sleep quality for different study year, whereas ANOVA was used for comparison of the components and global score. RESULTS: Of the total, 25.3% of the participants classified their sleep quality as either very or fairly bad, and 31.1% reported taking more than 30 min to fall asleep. The average hours slept per night was 7.1 ± 1.21. Of the total, 8.4% of the participants reported using sleep medication at least once a week. Subjective sleep quality and sleep duration were found to be significantly different among the four groups. CONCLUSION: Poor subjective sleep quality was high for students in all class years of the undergraduate medical course. The comparison across the various phases of the course showed that first years reported worse sleep quality than did those in other class years.

A comparative study of serum zinc levels in small for gestational age babies and appropriate for gestational age babies in a Tertiary Hospital, Punjab.

INTRODUCTION: Zinc deficiency is very much prevalent among pregnant women in developing countries. Zinc is required to maintain normal structure and function of multiple enzymes including those that are involved in foetal growth. Zinc deficiency increases risk of baby being born preterm, low birth weight, small for gestational age (SGA). AIMS AND OBJECTIVES: To compare serum zinc levels in small for gestational age babies with respect to appropriate for gestational age (AGA). MATERIAL AND METHODS: Out of total 200 newborn, hundred SGA newborn comprised the study group and hundred AGA newborn comprised the control group. Cord blood sample was collected immediately after birth and zinc levels were determined by atomic absorption spectrophotometry method. RESULTS: The mean (±SD) serum zinc levels of study and control groups were 56.8 ± 40.6 µg/dl and 107.4 ± 72 µg/dl respectively and difference between two groups were found to be statistically significant. The mean serum zinc levels of preterm SGA group and term SGA group were 46.26 ± 22.54 µg/dl and 63.35 ± 47.47µg/dl respectively. Statistically significant difference was found in mean serum zinc levels between the two groups. CONCLUSION: SGA neonates have significant zinc deficiency as compared to AGA neonates. This zinc deficiency is even more pronounced in SGA newborns that are born preterm. This warrants the future investigation and necessary intervention on zinc supplementation during pregnancy and to preterm and SGA babies for better maternal and child health outcomes.

A Cross-sectional Study of Gender-Based Violence against Men in the Rural Area of Haryana, India.

BACKGROUND: Research across the globe highlights rights violations and abuses experienced by women and seldom are channeled toward any atrocities being experienced by men. Objectives: To find the prevalence, characteristics, and sociodemographic correlates of gender-based violence against men. MATERIALS AND METHODS: It was a community-based, cross-sectional study using multistage random sampling in which a total of 1000 married men in the age group of 21-49 years were interviewed using modified conflict tactics scale. RESULTS: In the present study, 52.4% of men experienced gender-based violence. Out of 1000, males 51.5% experienced violence at the hands of their wives/intimate partner at least once in their lifetime and 10.5% in the last 12 months. The most common spousal violence was emotional (51.6%) followed by physical violence (6%). Only in one-tenth cases, physical assaults were severe. In almost half of the cases, husband initiated physical and emotional violence. Gender symmetry does not exist in India for physical violence. Less family income, education up to middle class, nuclear family setup, and perpetrator under the influence of alcohol were identified as risk factors. Earning spouse with education up to graduation is the risk factor for bidirectional physical violence. CONCLUSION: Besides women, men are also the victims of gender-based violence. This demands the future investigation and necessary intervention on gender-based violence against men in India.

Reciprocate and nonreciprocate spousal violence: A cross-sectional study in Haryana, India.

BACKGROUND: Prevention of intimate partner violence is an important public health goal owing to its negative psychological and physical health consequence. OBJECTIVES: Estimate the prevalence of reciprocate and nonreciprocate violence, severity of injuries, and related risk factors. MATERIALS AND METHODS: The present study was a community-based cross-sectional study using multistage random sampling in which a total of 880 currently married women in the age group 15-49 years were interviewed using modified conflict tactics scale. Logistic regression was used to identify factors associated with both the types of domestic violence. RESULTS: Total prevalence for spousal violence was 33.2% (283), out of which 14.84% (42) were reciprocally violent. Alcoholic husband [Adjusted Odds Ratio (AOR): 3.262, P = 0.001], late year of marriage (>2 years) [AOR: 0.359, P = 0.001], low education of the participants [AOR: 1.443, P = 0.033], and low socioeconomic class [AOR: 0.562, P = 0.004] are the risk factors for nonreciprocate domestic violence. Alcoholic husband [AOR: 4.372, P = 0.001] and nuclear family [AOR: 3.115, P = 0.001] were found as significant risk factors for reciprocate domestic violence. Women indulging in reciprocate violence were associated with more severe injuries than nonreciprocate violence. CONCLUSION: This study depicts that every third female has experienced spousal violence and also highlights the existence of reciprocate violence in India. Alcoholism, low education of husbands, and living in nuclear family are the important determinants for reciprocate violence. Also, reciprocate violence is associated with severe injuries.

Study of Domestic Violence among Currently Married Females of Haryana, India.

BACKGROUND: No nation is untouched by domestic violence, and it is well-known that domestic violence has serious impact on women's health and well-being. The present study aimed to assess the prevalence and characteristics of domestic violence and injuries owing to domestic violence among currently married women. MATERIALS AND METHODS: This was a community-based, cross-sectional study conducted in the rural and urban areas of Haryana. In total, 880 currently married females of the reproductive age group were interviewed using the Women's Questionnaire (used in National Family Health Survey-3) which is according to the Modified Conflict Tactics Scale. RESULTS: Totally, 37% of the females had ever experienced domestic violence and 28.9% currently experienced domestic violence. All types of violence (except sexual violence) were significantly more common in the rural area than the urban area. Injuries owing to domestic violence were reported by more than half (55.4%) of the women. Among spousal violence, emotional violence was the most common type of violence followed by physical violence. Only 0.1% and 4.5% of females had ever initiated physical and emotional violence respectively, against their husbands, and in rest of the cases, it was the husband who initiated violence. CONCLUSION: Awareness regarding domestic violence needs to be made, and law enforcement regarding it needs to be made stringent. Rehabilitation of victims of domestic/spousal violence should also be considered on priority.