Determinants of substance use among young people attending primary health centers in India.

Background: Substance use is a complex condition with multidimensional determinants. The present study aims to find the prevalence and determinants of substance use among young people attending primary healthcare centers in India. Methods: A multicentric cross-sectional study was conducted across 15 states in India on 1,630 young people (10-24 years) attending primary health centers. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to capture data on substance use. The degree of substance involvement was assessed and multivariate regression analysis was conducted to determine the risk factors of substance use. Results: The prevalence of substance use was 32.8%, with a median substance initiation age of 18 years. Among the substance users, 75.5% began before completing adolescence. Tobacco (26.4%), alcohol (26.1%) and cannabis (9.5%) were commonly consumed. Sociodemographic determinants included higher age, male gender, urban residence, positive family history, northeastern state residence and lower socioeconomic class. Over 80% of users had moderate or high involvement. Conclusions: High substance use prevalence among young people in Indian healthcare centers underscores the urgency of targeted intervention. Insights on determinants guide effective prevention strategies for this complex public health issue.

Association of serum cathelicidin and Vitamin D levels with infectiousness in patients with pulmonary tuberculosis: A prospective cohort study.

Background: The immunomodulatory effects of Vitamin D expand to induce the synthesis of an antimicrobial peptide, cathelicidin. There is evidence showing altered levels of cathelicidin in tuberculosis (TB). It has been suggested that Vitamin D-mediated antimicrobial activity depends on its ability to induce cathelicidin. The present study was designed to assess the alterations in serum anti-microbial peptide cathelicidin and 25-hydroxy Vitamin D levels in patients with newly diagnosed pulmonary TB at different treatment times and to study the association between serum Vitamin D levels and cathelicidin. Methods: Serum 25-hydroxyvitamin D and cathelicidin levels were estimated in 147 patients with newly diagnosed pulmonary TB at different times: at the start of anti-tubercular treatment, end of the intensive phase of treatment, and at the end of treatment. Results: There was a statistically significant difference between the levels of serum 25-hydroxyvitamin D and serum cathelicidin at different treatment periods. However, no significant correlation was found between serum Vitamin D and cathelicidin levels or between serum Vitamin D and cathelicidin levels with infectiousness in patients with pulmonary TB. Conclusion: Serum Vitamin D levels and serum cathelicidin levels were significantly reduced at diagnosis, and there was an incremental increase following treatment. However, there was no correlation between the levels of serum cathelicidin and serum Vitamin D or with the infectiousness of the illness.

Association of Common Mental Disorders with Diabetes Mellitus - Evidence from Community-based Matched Case-Control Study in North India.

BACKGROUND: Diabetes mellitus (DM) and depression are major public health problems globally. Evidence of linkage of common mental disorders (CMDs) including depression and anxiety disorders with DM is sparsely reported from community-based settings. OBJECTIVE: The present study aimed to study the association between CMDs and DM among adult population (>30 years) residing in a rural area of North India. MATERIALS AND METHODS: A community-based case-control study was conducted in 28 villages of Ballabgarh block of Faridabad district of Haryana. Cases (diabetes) were recruited from the community with at least 1 year of diabetes. Age- and sex-matched two neighborhood controls were selected from the same community. Diabetic status was confirmed using glycated hemoglobin. CMDs such as depression and anxiety disorders were screened using PRIME-MD Hindi version. Conditional logistic regression was used to study the relationship between diabetes and CMDs. RESULTS: Total 211 cases (diabetic) and 273 controls (nondiabetic) were approached for the study, of which 173 cases and 175 controls were analyzed. Cases and controls were comparable with respect to age, sex, and socioeconomic status. CMDs were found more among cases as compared to controls (67.5% vs. 37.5%) (P < 0.001). On conditional logistic regression analysis, CMDs were significantly higher among diabetes cases (adjusted odds ratio - 3.2, 95% confidence interval: 1.9-5.2). CONCLUSION: Strong evidence of coexistence of CMDs and DM from this population-based study necessitates the need of incorporation of management of CMDs into diabetes control program in India.

Review of Primary Care Treatment Protocols for Hypertension in Various States of India.

SUMMARY: Over the past few decades, hypertension (HTN) has affected both young and old people. The public health problem has an enormous economic impact on societies as well. The present review aimed to understand and compare the differences from the available literature on HTN treatment at the primary care level in various states and at the national level in India. We reviewed the latest international, national, and state guidelines/protocols available for the treatment of HTN. In addition, we also searched the PubMed database with relevant Medical Subject Headings terms and included the articles published in the last 5 years. A total of 204 articles were screened and finally, eligible 5 articles were included in the review. International guidelines preferred thiazide diuretics as a drug of choice. While the state protocols and national guidelines preferred calcium channel blockers, followed by angiotensin receptor blockers as the drug of choice. All these guidelines focused on low-dose monotherapy. These guidelines also summarized additional drugs required in case of comorbid conditions. However, the new Essential Medicine List published by the World Health Organization prefers low-dose fixed-drug combination (two-drug regimen) at the primary care level for treatment of HTN. There was not much cost difference between monotherapy and fixed-drug regimens based on the published studies. With due rise in HTN cases, the standardized protocol is ubiquitously needed for better application, comparison, and streamline of the program. Fixed-drug combination therapy can be considered for better control rates among hypertensives by improving adherence and efficacy.

Cut-off of Anthropometric Measurements and Nutritional Status among Elderly Outpatients in a Tertiary Health Care Center in Telangana.

Introduction:Geriatric population is most vulnerable to various emerging communicable and noncommunicable diseases due to various socio-economic, physiological, psychological and nutritional risk factors. Adequate nutritional status is utmost important in older age as it helps in maintaining the immune response and preventing the morbidities and mortalities in this age. Thus, the opportunistic screening of malnutrition among geriatric population gives an extra edge for achievement of healthy ageing in the elderly. The objective of the present study was to assess the nutritional status among the elderly population and provide cut-off values of various anthropometric measurements for detecting the risk of malnutrition among old age people. Materials and methods:The present cross-sectional study was carried out among people aged . 60 years who visited the geriatric clinic of a tertiary health care center between May and December 2021. The nutritional status of the 468 selected elderly was assessed using the Mini Nutritional Assessment (MNA) tool and various anthropometric measurements. Receiver operating characteristic (ROC) curve and Youden index were used to determine the cut-off values of anthropometric measurements. Correlation between various anthropometric parameters was studied. Data was analyzed using SPSS vs. 20 software. Results:Out of the 468 subjects, around one third had a risk of malnutrition and 7% malnutrition as per the MNA scale. Cut-off values of triceps skinfold thickness, neck circumference and arm muscle circumference were 12.5 cm, 32.5 cm, 18.3 cm and 11.5 cm, 35.5 cm, 21.2 cm for detecting malnutrition and risk of malnutrition, respectively. Neck circumference was found to be the most suitable measurement, with a cut-off value of 32.5 cm and 35.5 cm for detecting malnutrition and risk of malnutrition, respectively, as it possessed the highest Youden index and AUC. Conclusion:The prevalence of malnutrition was found to be low in the present study setting. Our findings firmly established that the neck circumference could be used as a simple, rapid, non-invasive and valid screening tool, with high sensitivity and specificity for detecting the risk of malnutrition in geriatric clinics or primary health care settings.

Profile and treatment outcomes among young patients with tuberculosis aged 15-24 years in Faridabad district of Haryana, India.

OBJECTIVE: This study examined profile and treatment outcomes of young patients with tuberculosis (TB) registered at a district TB centre under the National TB Elimination Programme in Faridabad district of Haryana state in India. METHODS: In this secondary data analysis, we studied the records of young TB patients aged 15-24 years registered under a TB programme during October 2013-December 2017 in Faridabad district of Haryana state. RESULTS: We analysed records of 5257 young patients with TB. Majority (58.7%) were patients with pulmonary TB and most of them (83.6%) were registered as new patients. Majority of the young patients with TB (93.2%) had a successful treatment outcome, and patients having sputum result 2+ or less and patients who did not have a previous history of TB were found to be significantly associated with a successful treatment outcome on multivariable analysis. CONCLUSION: There was a high treatment success rate noted in young patients with TB. More focus is needed to patients having a history of TB and sputum result >2+. Targeted interventions can be designed for these groups in future programmatic strategies to reduce disease burden in this section of young population.

Nutritional Status among Patients with Chronic Hepatitis C in the North-Eastern Part of India: A Cross-Sectional Study from the Tribal Belt of India.

Malnutrition is very common in liver disease patients. The nutrition status of chronic hepatitis C infected patients was assessed in those with both compensated and decompensated liver disease. A prospective non-interventional observational study was conducted in a tertiary care hospital among patients attending the liver clinic under medicine Outpatient Department (OPD), with follow-up till six months since recruitment. A total number of 100 recruited eligible patients was divided into two groups of 50 patients each, one comprised of subjects with decompensated liver disease and the other one with compensated liver disease. Out of the 100 participants, 85% were males, with the majority of them being aged between 41 and 50 years, and underweight. At every visit, low mean values in triceps thickness and mid-arm circumference were observed among patients with decompensated liver disease compared to those with compensated liver disease, which had a significant difference statistically. The clinical symptoms and severe malnutrition were found to be higher and significantly statistically associated with the decompensated liver disease patients.

Mapping of epidemiological determinants of confirmed COVID-19 cases among health-care workers of municipal corporation of Delhi: A roadmap to risk reduction.

BACKGROUND: Coronavirus disease (COVID-19) is a respiratory illness caused by a novel coronavirus which can spread from person to person. Health-care workers of any medical college and hospital are at more risk to the coronavirus disease (COVID-19) than the general population. The aim of this study was to assess the epidemiological profile of confirmed COVID-19 cases among health-care workers of Municipal Corporation of Delhi. METHODOLOGY: A cross-sectional study was planned among 422 health-care workers of Municipal Corporation of Delhi. The questionnaire consisted of questions about sociodemographic data, personal history, and clinical profile such as signs and symptoms and their duration. Data were analyzed by SPSS software version 21.0, and, Chi-square test and logistic regression were used. RESULTS: Mean age of study subjects was 41.1 ± 9.8 years, and males (57.6%) were more as compared to (42.4%) females. Out of total participants, about one-third (36.4%) of study participants were asymptomatic. Study participants with higher education status adjusted odds ratio (AOR) 2.43 (1.25-4.70), living in overcrowding AOR 3.74 (1.86-7.54), and having some comorbidity AOR 2.78 (1.57-4.92) were at higher risk of being symptomatic. CONCLUSION: This study concludes that about one-third of study participants were asymptomatic. Factors such as higher education status, living in overcrowding, presence of some comorbidity, and smokeless tobacco consumption were significantly associated with symptomatic COVID-19 cases. Hence, there is a need to identify these risk factors at an early stage in order to design prevention strategies for better control of such pandemics in future.

Epidemiological Pattern and Trend Analysis of Animal Bite Cases of Anti-Rabies Clinic of Tertiary Care Hospital of Delhi.

Background: Animal bites to humans are a public health problem. Rabies is caused by rhabdovirus which is present in the saliva of rabid animals like dogs, cats, monkeys, and wild animals like fox and jackals. Objective: To find the epidemiological pattern and trend analysis of animal bite cases registered in Anti-rabies clinic of tertiary care hospital of Delhi. Materials and Methods: A retrospective cross-sectional study was planned in Anti-rabies clinic of Hindu Rao Hospital, Delhi, and data from January 2010 to December 2018 was taken. Data were analyzed by SPSS software version 21.0. Results: After interpretation of data from 2010 to 2018, it was found that maximum number of animal bite cases belonged to category 3 (91.0%) and majority (93.6%) were due to dog bite. On analysis of year and season wise trend, it was found that the frequency of cases showed a rising trend from the year 2010, with highest number of cases in the year 2014, while animal bite cases were maximum with arrival of spring season (month of April). Conclusion: This study concludes that animal bite cases are rising over the years and dog bites are most common animal bite cases in Delhi. Most of the animal bite cases occurred during spring season followed by autumn season of the year. So, there is dire need of strengthening the preventive measures for controlling animal bites in the study area.

A Systematic Review to Evaluate Knowledge, Attitude, and Practice Regarding Biomedical Waste Management among Dental Teaching Institutions and Private Practitioners in Asian Countries.

OBJECTIVE: The objective of this study was to assess knowledge, attitude, and practices among dental teaching institutions and private practitioners in Asian countries. MATERIALS AND METHODS: Systematic review of observational studies on BMW management was conducted. We searched the following electronic bibliographic databases: PubMed/MEDLINE and Google Scholar. Manual search was carried out for similar topics in the National Medical Library, New Delhi. In addition, the bibliographies were manually searched. There was no disagreement between the two reviewers. This review was reported and conducted in step with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only studies written in English and published until November 2019 were included. This review was registered in International Prospective Register of Systematic Reviews (PROSPERO registration number is CRD42019124900). RESULTS: In this review, of 678 articles, 24 articles met inclusion criteria. Available scientific studies showed that knowledge regarding BMW management guidelines varied from 33% to 100% among dentists. Most of the studies reported that knowledge and practice regarding segregation of BMW was limited. Most of the study subjects were aware of hazardous effects of amalgam and had amalgam separator. Studies done in Chennai and Karnataka, approximately one-third dentists were not following BMW guidelines for sharp management and most of them were disposing of sharps in general waste bins. CONCLUSION: On the basis of the current evidence and data extracted from the various databases, it can be concluded that knowledge regarding BMW management guidelines among dentists is inadequate and practice regarding the same is poor. Regular training sessions and Continuing Dental Education (CDE) on BMW management guidelines and updates need to be organized for improvement of knowledge and practice regarding BMW among dentists.

Infant and young child feeding practices among mothers of children aged 6 months -2 years in a rural area of Haryana: A qualitative study.

BACKGROUND: India, a low-middle income and a developing country is combating with a triple burden of malnutrition with a very cost-effective measure, infant and young child feeding (IYCF) practices. But there are a lot of challenges in its implementation which need to be catered. The objective of the present qualitative study was to assess IYCF practices among mothers of children aged 6 months to 2 years in a rural area of Haryana. METHOD: Qualitative study was carried out among mothers of children 6 months-2 years in villages of Ballabgarh block of Haryana using focussed group discussion (FGD) and in-depth interview methods. All recordings of FGDs and IDIs were transcribed into verbatim and codes were generated. Thematic analysis of the transcript of in-depth interview and FGD was performed with the help of Doc Tools in MS Word 2016. RESULTS: The mothers had good knowledge about breastfeeding, importance of colostrum, and weaning practices of infants and children of less than 2 years. Though there is evidence of some cultural misbeliefs, most of the taboos are obsolete now. There was a knowledge gap regarding initiation and composition of complementary feeding practices. The awareness about food diversity, effects of junk food, and recommended complementary feeding practices was less. CONCLUSION: There is need of creating awareness among mothers regarding importance of IYCF practices to reduce infant and under 5 mortality in rural area.

Social stigma among tuberculosis patients attending DOTS centers in Delhi.

BACKGROUND: Every year >9 million people suffer from tuberculosis (TB) and India accounts for >25% of global TB burden. Tuberculosis patients experience both psychological and social suffering. Amongst the problems met by tuberculosis patients, social stigma has been increasingly recognized. This study was done to assess social stigma and associated factors among the tuberculosis patients attending Directly Observed Treatment Short-course (DOTS) centers in South East Delhi. MATERIAL AND METHODS: It was a cross-sectional study carried out among tuberculosis patients availing treatment from DOTS centers of South East Delhi. Out of 48 DOTS centers in South East Delhi, 6 centers were selected on the basis of population proportion to size. A total of 270 TB patients were interviewed using a semi-structured, pretested questionnaire consisting of stigma-based questions. Fisher exact and Chi-square test applied. RESULTS: The mean age of patients was 31.5 years (SD ± 11.5) with age ranging from 18 to 77 years. Males were higher (57.4%) compared to females (42.6%). 123 (45.5%) perceived stigma with family/friends and 92/158 (58.2%) perceived stigma at workplace. Young patients (<30 years), males faced more stigma at workplace and lower socioeconomic class faced higher stigma with family and friends (P < 0.05). CONCLUSION: There is still higher stigmatization faced by patients with TB at family/friends and at workplace. Motivation by friends/family and support at workplace has been crucial in achieving successful treatment outcomes.