A Comparative Evaluation of Push-Out Bond Strength of Six Different Root Canal Sealers: An In-Vitro Study.

BACKGROUND: Adhesiveness with radicular dentin is absent with gutta-percha, leading to microleakage and hence re-infection. Root canal sealer helps to achieve an adhesive interface between gutta-percha and root dentin thereby resisting the displacement forces during the functioning of teeth which is evaluated by the push-out test. The aim of this study is to compare the push-out bond strength and to assess the relative bond failure between dentin-sealer, sealer-main cone of (1) epoxy resin, (2) silicon, (3) mineral trioxide aggregate (MTA), (4) calcium hydroxide, (5) bioceramic, (6) zinc oxide eugenol containing root canal sealers. METHODOLOGY: Sixty human permanent lower premolars with one root were collected, disinfected, and decoronated at cemento-enamel junction. Instrumentation was done with a K3 40,0.06 Ni-Ti rotary file and obturated using the main cone and sealer. Based on the sealer utilized, six groups were created: Group 1: AH-Plus, Group 2: RoekoSeal, Group 3: MTA Fillapex, Group 4: Apexit, Group 5: Smart Paste Bio, and Group 6: Procosol. One slice each was obtained from the coronal, middle, and apicalsections of all the obturated canals. Push-out bond strength and failure modes were studied. Statistics involved analysis of variance (ANOVA) followed by the post hoc Tukey test. RESULTS: All three sections exhibited the highest strength for Smart Paste Bio sealer and the least was for RoekoSeal. With all the sealers, the apical section had the highest strength followed by the middle and coronal. CONCLUSION: The smart seal system was superior to all other sealers and displayed a good bond to dentin.

Quality assessment of a rural population-based cancer registry (PBCR) at Ratnagiri, Maharashtra, India for the years 2017-18.

Background: Cancer registries are valuable resources for cancer control and research. To justify their purpose, their data should be of satisfactory quality by being comparable internationally, complete in their coverage, valid in their values and timely in reporting. This study aimed to assess the quality of the Ratnagiri Population Based Cancer Registry's data for the years 2017-18 across the four dimensions of data quality. Methods: Regarding comparability, the registry procedure was reviewed vis-à-vis the rules they follow for cancer registry operation. We have used four methods for validity: re-abstraction and re-coding, diagnostic criteria methods- like the percentage of microscopically verified (MV%) and of death certificate only (DCO%) cases, missing information like proportion of cases of primary site unknown (PSU%) and internal validity. Semi-quantitative methods were employed for assessing completeness. Timeliness for all years of registry functioning was assessed qualitatively. Results: The overall accuracy rate of the registry was found to be 91.1% (94.7% for demographic and 88% for tumour details). Mortality to incidence ratios were found to be 0.50 for females and 0.59 for males. MV% was found to be 90.8% for males and 91.5% for females. The average number of sources per case was found to be 1.5. DCO% was found to be 2.7%. PSU% was 7.4%. Conclusion: We have positive results regarding the data's validity and comparability, but there is scope for improvement concerning completeness. Continuous training of the registry personnel and monitoring of the registry is recommended.

Head and neck cancer burden in India: an analysis from published data of 37 population-based cancer registries.

Head and neck cancer (HNC) is a major public health problem in India. This article presents the HNC burden in different regions of India. The published population-based cancer registries (PBCRs) data from the National Cancer Registry Programme, Bengaluru, and the Tata Memorial Centre, Mumbai, India, were utilised. The 37 PBCRs were divided into six regions including central, east, north, northeast, west and south. The age-standardised incidence rate of HNC was 25.9 (95% CI 25.7-26.1) and 8.0 (95% CI 7.9-8.1) per 100,000 population, respectively, in males and females. HNC accounted for about 26% of all cancer cases in males and 8% in females. The risk of developing HNC was 1 in 33 for males and 1 in 107 for females. The northeastern registries reported the highest incidence rate 31.7 per 100,000 population in males followed by northern (28.5), central (28.3), western (24.4), southern (23.9) and eastern (18.3). In females, the incidence was in the range of 6.2-10.1 per 100,000 population. For all PBCRs together, the HNC burden was two to three times higher in the age group 60+ as compared to 20-39 years. The HNC burden in India is higher than in the USA, UK, Australia, Africa and Brazil. The PBCRs from the south-east Asia region such as the Colombo district, Sri Lanka, as well as Siraha, Saptari, Dhanusha and Mohattari - Nepal have also reported a high burden of HNC. All regions reported mouth as a leading cancer site followed by tongue, larynx, hypopharynx and tonsil except the northeastern region registries where hypopharynx was the top leading cancer. The burden of other sites of HNC is low. Raising awareness of the disease and associated risk factors, providing early detection services, as well as easy access to diagnosis and treatment are required. The government should focus on building the infrastructure and capacity building to control this disease.

Prediabetes in rural adolescent girls from DERVAN cohort: data from the KONKAN region of the state of Maharashtra, India (DERVAN-4).

Background: India is witnessing an epidemic of type 2 diabetes. Overweight/obesity, overnutrition, physical inactivity, and family history are well-known risk factors for diabetes. We investigated the role of undernutrition in the development of diabetes among rural adolescent girls. Methods: DERVAN cohort study was set up in the KONKAN region of the western Indian state of Maharashtra. It enrolled 1,520 adolescent girls (16-18 years old at the time of enrollment). We measured glycemic parameters (glucose, insulin, and HbA1C) and body size using anthropometry and body composition using bioimpedance. Prediabetes was diagnosed using the American Diabetic Association (ADA) criteria. We also calculated various HOMA indices for insulin resistance (HOMA-IR), ß-cell function (HOMA-ß), insulin sensitivity (HOMA-S), and compensatory ß-cell response using a homeostasis model. BMI, body fat%, and waist circumferences were treated as exposures and all the glycemic parameters and indices as outcomes. Results: The median age of the subjects was 16.6 years. The median weight, height, and BMI were 40.7 kg, 151.7 cm, and 17.5 kg/m2, respectively. Prevalence of underweight was 28.8%, and stunting was observed in 30.4%. Thinness and obesity using BMI were observed in 58.4% and 4.2%, respectively. The median body fat% was 22.5, and excess body fat (>35%) was observed in 5.7%. The prevalence of prediabetes was 39.4%. Fasting insulin concentrations, HOMA-IR, and HOMA-ß showed a positive trend across body composition quartiles (p < 0.001). HOMA-S and compensatory ß-cell response showed an inverse trend (p < 0.001). Compared with prediabetic girls in the overweight/obese group, girls most undernourished group had lower median insulin concentrations (8.1 µIU/ml vs. 17.1 µIU/ml), lower HOMA-IR (1.1 vs. 2.3), and lower HOMA-ß (75.6 vs. 129.2) but higher sensitivity (87.4 vs. 43.7) (p < 0.001) for all. Conclusion: We have reported a high prevalence of prediabetes among rural adolescent girls with a very low prevalence of obesity. Prediabetes in obesity is driven by hyperinsulinemia and overworking of the pancreas while poor ß-cell function and poor insulin secretion are major drivers in the undernourished group. The high-risk diabetes screening programs are much needed for the undernourished populations. Caution should be exercised for planning the interventions as overfeeding (or overnutrition) is likely to put the populations at risk of development of obesity and insulin resistance.

Unraveling the importance of fabrication parameters of copper oxide-based resistive switching memory devices by machine learning techniques.

In the present study, various statistical and machine learning (ML) techniques were used to understand how device fabrication parameters affect the performance of copper oxide-based resistive switching (RS) devices. In the present case, the data was collected from copper oxide RS devices-based research articles, published between 2008 to 2022. Initially, different patterns present in the data were analyzed by statistical techniques. Then, the classification and regression tree algorithm (CART) and decision tree (DT) ML algorithms were implemented to get the device fabrication guidelines for the continuous and categorical features of copper oxide-based RS devices, respectively. In the next step, the random forest algorithm was found to be suitable for the prediction of continuous-type features as compared to a linear model and artificial neural network (ANN). Moreover, the DT algorithm predicts the performance of categorical-type features very well. The feature importance score was calculated for each continuous and categorical feature by the gradient boosting (GB) algorithm. Finally, the suggested ML guidelines were employed to fabricate the copper oxide-based RS device and demonstrated its non-volatile memory properties. The results of ML algorithms and experimental devices are in good agreement with each other, suggesting the importance of ML techniques for understanding and optimizing memory devices.

Diurnal variation in salivary progesterone in fertile Indian women.

Research question: Is there a diurnal variation in salivary progesterone levels during menstrual cycle among Indian women? Design: A longitudinal study was carried out to measure progesterone in saliva among small cross-sectional sample (n = 31) of fertile Indian women of reproductive age comprising young adults (18-25 years, n = 11), adults (26-38 years, n = 9) and middle aged (39-45 years, n = 11). Saliva samples were collected twice daily (morning and evening) across the entire menstrual cycle of 31 women. Results: Mean ages at enrolment and menarche were 30.6 years and 13.6 years respectively. Fifty-five percent of the women were married. The menstrual cycle range was 20-40 days. After controlling for age and menstrual cycle length, statistically significant diurnal variation in progesterone levels was observed across menstrual cycles with high levels in the morning. Conclusions: This is the first report on salivary progesterone in subjects with Indian ethnicity and could have clinical implications for designing point of care kits for menstrual cycle management, fertility and reproduction.

Clinical features and risk factors for death in acute undifferentiated fever: A prospective observational study in rural community hospitals in six states of India.

BACKGROUND: Acute undifferentiated fever (AUF) ranges from self-limiting illness to life-threatening infections, such as sepsis, malaria, dengue, leptospirosis and rickettsioses. Similar clinical presentation challenges the clinical management. This study describes risk factors for death in patients hospitalized with AUF in India. METHODS: Patients aged ≥5 y admitted with fever for 2-14 d without localizing signs were included in a prospective observational study at seven hospitals in India during 2011-2012. Predictors identified by univariate analysis were analyzed by multivariate logistic regression for survival analysis. RESULTS: Mortality was 2.4% (37/1521) and 46.9% (15/32) died within 2 d. History of heart disease (p=0.013), steroid use (p=0.011), altered consciousness (p<0.0001), bleeding (p<0.0001), oliguria (p=0.020) and breathlessness (p=0.015) were predictors of death, as were reduced Glasgow coma score (p=0.005), low urinary output (p=0.004), abnormal breathing (p=0.006), abdominal tenderness (p=0.023), leucocytosis (p<0.0001) and thrombocytopenia (p=0.001) at admission. Etiology was identified in 48.6% (18/37) of fatal cases. CONCLUSIONS: Bleeding, cerebral dysfunction, respiratory failure and oliguria at admission, suggestive of severe organ failure secondary to systemic infection, were predictors of death. Almost half of the patients who died, died shortly after admission, which, together with organ failure, suggests that delay in hospitalization and, consequently, delayed treatment, contribute to death from AUF.

Determination of Manganese in Serum Using GFAAS: Serum Reference Values for Manganese in the Adolescent Girls of the DERVAN Cohort.

Current proposed method allows for the determination of manganese in serum sample using aqueous standard calibration technique on Graphite Furnace atomic absorption spectrophotometer (GFAAS) using deuterium background correction. This method involves determination of manganese from digested serum samples without the use of matrix modifier. Pyrolysis and atomization temperatures are 1200 °C and 2200 °C respectively. The limit of detection (LoD) and limit of quantitation (LoQ) of the method are 0.0097 ng/ml (0.18 nmol/l) and 0.032 ng/ml (0.58 nmol/l) respectively. Validation of the method was carried out using seronorm trace element level-1 serum standard with excellent agreement between measured value and certified value. Accuracy was demonstrated by the spike and recovery study with analytical recovery between 98.8 and 100.6% in serum. The serum reference value for manganese in adolescent girls of rural Konkan region of India range from 4.7 to 215 nmol/l.

Comparative evaluation of mineral trioxide aggregate and biodentine apical plug thickness on fracture resistance of immature teeth: An In vitro study.

Aim: This study aims to compare the fracture resistance of simulated immature teeth after using different thicknesses of Mineral Trioxide Aggregate (MTA) and Biodentine apical plug. Materials and Methods: Forty human maxillary anterior teeth were selected. Teeth were randomly divided into eight groups of five teeth in each group. Positive control group = 5 teeth; prepared without access cavity preparation. Access cavities of the remaining 35 teeth were prepared, and instrumented with Peeso reamers. Negative control = 5 teeth; filled with calcium hydroxide. Thirty teeth divided into Groups 1 and 2 of MTA (MTA-Angelus, Londrina, Brazil) and Biodentine (Septodant, Saint Maur des Fosses, France) and each group divided into three subgroups: subgroup A - 3 mm apical plug; subgroup B - 6 mm apical plug; and subgroup C: full canal length. The rest of the canals in subgroups A and B were filled with gutta-percha and AH Plus sealer. After the required storage period, all the samples were subjected to fracture testing under universal testing machine and fracture strength was recorded. Data were analyzed using 1-way analysis of variance with the Tukey post hoc test for multiple comparisons. Results: The negative control group showed the lowest fracture resistance compared with the other groups (P < 0.0001). The 6-mm apical plug subgroup of biodentine showed the highest fracture resistance. Conclusion: Within the limitations of this study, MTA and Biodentine can be used as an apical plug instead of root canal filling material to increase the fracture resistance of immature teeth.

Résumé Objectif: Cette étude vise à comparer la résistance à la fracture de dents immatures simulées après utilisation de différentes épaisseurs de trioxyde minéral Agrégat (MTA) et bouchon apical Biodentine. Matériel et Méthodes: Quarante dents antérieures maxillaires humaines ont été sélectionnées. Les dents étaient divisé au hasard en huit groupes de cinq dents dans chaque groupe. Groupe témoin positif = 5 dents; préparé sans préparation de la cavité d'accès. Les cavités d'accès des 35 dents restantes ont été préparées et instrumentées avec des alésoirs Peeso. Contrôle négatif = 5 dents; rempli de calcium hydroxyde. Trente dents réparties en groupes 1 et 2 de MTA (MTA-Angelus, Londrina, Brésil) et Biodentine (Septodant, Saint Maur des Fosses, France) et chaque groupe divisé en trois sous-groupes: sous-groupe A - bouchon apical de 3 mm; sous-groupe B - bouchon apical de 6 mm; et sous-groupe C: longueur totale du canal. Les autres canaux des sous-groupes A et B étaient remplis de gutta-percha et de scellant AH Plus. Après le stockage requis période, tous les échantillons ont été soumis à des essais de fracture sous une machine d'essai universelle et la résistance à la rupture a été enregistrée. Les données étaient analysé à l'aide d'une analyse de variance unidirectionnelle avec le test post hoc de Tukey pour des comparaisons multiples. Résultats: le groupe témoin négatif a montré la résistance à la fracture la plus faible par rapport aux autres groupes (p <0,0001). Le sous-groupe du bouchon apical de 6 mm de la biodentine a montré le plus résistance à la fracture. Conclusion: Dans les limites de cette étude, le MTA et la Biodentine peuvent être utilisés comme bouchon apical au lieu de canal radiculaire matériau de remplissage pour augmenter la résistance à la fracture des dents immatures. Mots-clés: bouchon apical, biodentine, résistance à la fracture, agrégat de trioxyde minéral.

COVID-19 vaccine confidence project for perinatal women (CCPP)-Development of a stepped-care model to address COVID-19 vaccine hesitancy in low and middle-income countries.

Background: COVID-19 vaccine hesitancy (CVH) is common among perinatal women in low and middle-income countries (LMICs), but it is often unaddressed. This could be due to a lack of feasible, scalable, and acceptable interventions and models for CVH in LMICs. Our study aimed to develop a CVH intervention model that can be implemented in LMICs using existing human healthcare resources. Methods: A literature review was conducted on aspects of vaccine hesitancy, pre-existing interventions, and models for addressing vaccine hesitancy (COVID-19 and non-COVID-19). The lead authors (RR and PKuk) formed a team consisting of vaccinators, experts, and stakeholders. Members shared their perspectives and proposals for various models and interventions that could be implemented in LMICs. A CVH intervention model was developed using a logic model, a WHO implementation toolkit, experts' feedback, and consensus. Results: A consensus was reached to develop a COVID-19 Vaccine Confidence Project for Perinatal Women (CCPP), which is a primary health care worker (HCWs)-based stepped-care model. The CCPP model includes HCW training, integration into ongoing COVID-19 vaccination programs, CVH screening, CVH intervention, and referral services suitable for implementation in LMICs. Conclusion: The CCPP project/model provides a practical approach that can help in the early detection and management of CVH. The model can be tailored to different healthcare settings to improve COVID-19 vaccine uptake among perinatal women in LMICs.

A brief psycho-social intervention for COVID-19 vaccine hesitancy among perinatal women in low-and middle-income countries: Need of the hour.

COVID-19 vaccines are one of the most effective strategies for preventing COVID-19 infection, as well as the associated mortality and morbidity. Despite the availability of COVID-19 vaccines, vaccine acceptance among perinatal women is challenging in low and middle-income countries (LMICs). Further, the vaccine hesitancy among perinatal women may have an impact on their children's vaccinations. The purpose of this paper is to briefly discuss the existing research on COVID-19 and non-COVID-19 vaccine hesitancy, psychosocial aspects, measures, and the individual level interventions for vaccine hesitancy among perinatal women. In our opinion, there is a need for further research with a specific focus on developing effective and feasible individual-level interventions to address COVID-19 vaccine hesitancy among perinatal women in LMICs.

Tobacco and cancer awareness program among school children in rural areas of Ratnagiri district of Maharashtra state in India.

Background: Promoting awareness of tobacco and cancer in the community needs multipronged efforts. We performed a study to evaluate whether we could raise awareness about the harmful effects of tobacco, oral and esophageal cancer among school students by providing them health education. Moreover, we also compared the awareness level in students of age group 12 to ≤14 years with the age group >14 to 18 years. Methods: We conducted an awareness program in the schools of Ratnagiri district of Maharashtra state. Students aged 12-18 years participated in this study. We provided health education to school students using a standard presentation; the presentation was rich in illustrations depicting the harmful effects of tobacco as well as oral and esophageal cancer's signs, symptoms, diagnosis, treatment, and preventive measures. After the health talk, a questionnaire was circulated. The questions were focused on tobacco, signs, and symptoms of the diseases along with early detection, prevention, and treatment of cancer. Results: A total of 1354 students participated in the program. Totally, 567 (41.9%) students were from 6th to 8th grade (Group A, age group 12 to ≤14) and 787 (58.1%) students were from 9th to 12th standards (Group B, age group >14 to 18). Overall scores were high, ranging from 69% to 98%. Group A scored in the range of 69% to 95%, and Group B scored in the range 72%-98% The difference between the two groups was found to be statistically significant (P-value ≤0.05). Conclusion: A standardized health education program helped to raise awareness about the harmful effects of tobacco and cancer amongst school children. Further studies are needed to evaluate whether educating school children has an impact on community understanding of the disease.

Analysis and Prediction of Hydrothermally Synthesized ZnO-Based Dye-Sensitized Solar Cell Properties Using Statistical and Machine-Learning Techniques.

Dye-sensitized solar cells (DSSCs) are one of the most versatile and low-cost solar cells. However, DSSCs are prone to low power conversion efficiency (PCE) compared to their counterparts, owing to their different synthesis parameters and process conditions. Therefore, designing efficient DSSCs and identifying the parameters that control the PCE of DSSCs are a critical tasks. We have collected data from hydrothermally synthesized DSSCs in the present work, published from 2005 to 2020. In line with publishing trends in the said period, we evaluate ZnO as a popular photoactive material for DSSC applications. We further analyzed the performance of hydrothermally synthesized ZnO DSSCs using different statistical techniques and provided some significant insights. We further applied the machine-learning technique with a decision tree algorithm to understand and discover the possible set of rules and heuristics that govern the morphology of the hydrothermally grown ZnO. In addition, we also employed supervised and unsupervised machine-learning models using conventional decision trees and classification and regression trees, respectively, to identify the dependence of the PCE of ZnO DSSCs on the different synthesis parameters. The reported work also evidences the PCE predictions of the ZnO DSSCs by using random forest and artificial neural network algorithms. The results substantiate that the random forest and artificial neural network algorithms successfully predict the PCE of the ZnO DSSCs with reasonable accuracy. Thus, we present a novel approach of applying statistical analysis and machine-learning algorithms to understand, discover, and predict the performance of DSSCs. We recommend extending the said know-how to other solar cells to identify rules and heuristics and experimentally realize highly efficient solar cells in shrinking manufacturing windows with a cost-effective approach.

Antimicrobial susceptibility pattern of oral gram negative anaerobes from Indian subjects.

OBJECTIVES: There is paucity of information on the antimicrobial susceptibility pattern of oral anaerobic bacteria. In this study, an attempt has been made to evaluate the antimicrobial susceptibility/resistance trend of oral Gram negative bacteria from Indian subjects. METHODS: Minimum inhibitory concentrations (MIC) of 304 isolates against twelve different antibiotics were determined using gradient diffusion MIC strips. The organisms were isolated and identified based on phenotypic characteristics and included Porphyromonas gingivalis, Prevotella species, Tannerella forsythia, Fusobacterium nucleatum, Aggregatibacter actinomycetemcoitans, Eickenella corrodens and Capnocytophaga species. For each antimicrobial agent, MIC50 and MIC90 were calculated and expressed. RESULTS: Resistance to azithromycin, clindamycin, and amoxicillin was observed in most of the anaerobic bacterial species studied. High degree of susceptibility was observed to amoxillin-clavulanic acid, doxycycline and moxifloxacin. A single strain of P. melaninogenica was resistant to moxifloxacin. The susceptibility pattern varied with cephalosporins among species. Ceftriaxone showed highest and cefazolin least efficacy among cephalosporins. All anaerobic bacteria tested were susceptible to metronidazole. Strains of T. forsythia were more resistant to several antibiotics than other anaerobic bacteria. All three species of capnophilic bacteria displayed high degree of resistance to metronidazole and significant resistance to amoxicillin, azithromycin, clindamycin, cefazolin and cefuroxime. CONCLUSIONS: Amoxicillin-clavulanic acid, doxycycline, moxifloxacin and metronidazole appeared to be the most effective drugs against gram negative anaerobic bacteria. However, the MIC50 and MIC90 values against metronidazole were on the higher side of the normal indicating a potential for developing resistance.

Is small placenta a risk for low birth weight in KOKAN? (Data from a coastal region in the state of Maharashtra, India).

KOKAN region is characterized by undernutrition across all stages of lifecycle. Developmental Origins of Health & Disease hypothesis suggests that environmental influences in the early period of growth and development can contribute to the risks of noncommunicable diseases (NCD) in adulthood. Newborns and placentas of 815 pregnant mothers delivered in a rural hospital were studied. We tested the hypothesis that low placental weight will be associated with low birth weight (LBW). Mothers had a mean age of 26 years and were smaller in size at delivery [mean height of 152.1 cm (±6.1 cm), weight 52 kg (±10.2 kg), body mass index (BMI) 22.5 kg/m2 (±4.1 kg/m2)]. Mean placental weight was 488 g (±120 g). Mean birth weight, length, and head circumference of the newborn were 2.54 kg (±0.5 kg), 46.3 cm (±3.1 cm), and 32.7 cm (±1.7 cm), respectively. Prevalence of LBW, stunting, and small head size was 41.6%, 42.2%, and 18.2%, respectively. Maternal height, weight, and BMI at delivery were all positively associated with placental weight (p < 0.01 for all). Mothers with placentas in the lowest placental weight tertile had an increased likelihood of producing an LBW baby [OR 7.7, 95% CI (5.0, 11.8)], a stunted baby [OR 1.9 (1.4, 2.9)], or a baby with a small head circumference [OR 2.4 (1.4, 4.0)]. Mothers in the lowest height tertile had odds of producing a LBW baby [OR 1.8 95% CI (1.2, 2.7)] or a stunted baby [OR 1.6 (1.1, 2.3)]. There is a need to improve the nutritional status of women in KOKAN region which may reduce the risk of NCD.

Development of a brief psychological intervention for perinatal depression (BIND-P).

BACKGROUND: Lack of recognition in national programs, poor referral system, and non-availability of trained human resources are the important barriers for the delivery of perinatal depression (PND) services in low- and middle-income countries (LAMICs). To address this there is an urgent need to develop an integrative and non-specialist-based stepped care model. As part of its research thrust on target areas of India's National Mental Health Programme (NMHP), the Indian Council of Medical Research funded a research project on the outcome of PND at four sites. In this article, we describe the development of the primary health care worker-based stepped care model and brief psychological intervention for PND. METHODS: A literature review focused on various aspects of PND was conducted to develop a model of care and intervention under NMHP. A panel of national and international experts and stakeholders reviewed the literature, opinions, perspectives, and proposal for different models and interventions, using a consensus method and WHO implementation toolkit. RESULTS: A consensus was reached to develop an ANM (Auxillary nurse midwife)-based stepped-care model consisting of the components of care, training, and referral services for PND. Furthermore, a brief psychological intervention (BIND-P) was developed, which includes the components of the low-intensity intervention (eg, exercise, sleep hygiene). CONCLUSION: The BIND-P model and intervention provide a practical approach that may facilitate effective identification, treatment, and support women with PND. We are currently evaluating this model across four study sites in India, which may help in the early detection and provision of appropriate and integrative care for PND.

What shapes adolescents' diet and physical activity habits in rural Konkan, India? Adolescents' and caregivers' perspectives.

OBJECTIVE: To explore, adolescents' and caregivers' perspectives, about shaping of diet and physical activity habits in rural Konkan, India. DESIGN: Five focus group discussions (FGD) were conducted with adolescents and two with caregivers. Data were analysed using thematic analysis. SETTING: FGD were conducted in secondary schools located in remote rural villages in the Ratnagiri district, Konkan region, Maharashtra, India. PARTICIPANTS: Forty-eight adolescents were recruited including twenty younger (10-12 years) and twenty-eight older (15-17 years) adolescents. Sixteen caregivers (all mothers) were also recruited. RESULTS: Three themes emerged from discussion: (i) adolescents' and caregivers' perceptions of the barriers to healthy diet and physical activity, (ii) acceptance of the status quo and (iii) salience of social and economic transition. Adolescents' basic dietary and physical activity needs were rarely met by the resources available and infrastructure of the villages. There were few opportunities for physical activity, other than performing household chores and walking long distances to school. Adolescents and their caregivers accepted these limitations and their inability to change them. Increased use of digital media and availability of junk foods marked the beginning of a social and economic transition. CONCLUSION: FGD with adolescents and their caregivers provided insights into factors influencing adolescent diet and physical activity in rural India. Scarcity of basic resources limited adolescent diet and opportunities for physical activity. To achieve current nutritional and physical activity recommendations for adolescents requires improved infrastructure in these settings, changes which may accompany the current Indian social and economic transition.

aDolescent and prEconception health peRspectiVe of Adult Non-communicable diseases (DERVAN): protocol for rural prospective adolescent girls cohort study in Ratnagiri district of Konkan region of India (DERVAN-1).

INTRODUCTION: Precise impact of nutritional insufficiencies in adolescence as a risk factor for non-communicable diseases (NCD) in later life as adults remains largely unknown.We are conducting research into the effects of nutrition on adolescent girls of Ratnagiri district by a prospective cohort study (aDolescent and prEconception health peRspectiVe of Adult Non-communicable diseases cohort). Our study focuses on the physical health, nutritional parameters and cognitive profiles of adolescent girls, during the prenatal and postnatal period and we aim to follow this cohort and their offspring for 20 years. METHODS AND ANALYSIS: Cohort recruitment began in June 2019. Our aim is to recruit more than 1500 adolescent girls, age 16-18 years, over a period of 3 years. The recruit's cognition, diet and physical activity will be recorded. The following investigations will be performed: body composition by anthropometry and bioimpedence, and blood pressure, fasting blood sample to measure glucose, insulin, lipids, micronutrients and hormones, abdominal ultrasonography to measure liver, pancreas and kidneys.A biorepository has been created for long-term storage of blood, urine and saliva samples for future analysis. By this longitudinal study, we aim to identify the effects of malnutrition on the behavioural and biological measures in adolescent subjects and evaluate if these are associated with the onset of NCDs in adulthood. ETHICS AND DISSEMINATION: Institutional Ethic Committee (IEC) of BKL Walawalkar Rural Medical College and Hospital has granted the permission to carry out the study. IEC is registered with Government of India. Its registration code is EC/755/INST/MH/2015/RR-18. It is not a clinical trial but as required we have also registered the study on Clinical Trial Registry of India (CTRI). The registration code is CTRI/2019/04/018453.Appropriate written informed consent and assent are obtained from the parents and the adolescent girls, respectively. We plan to publish our results in peer-reviewed journals.

Perinatal depression-knowledge gap among service providers and service utilizers in India.

INTRODUCTION: Lack of access to perinatal mental health (PMH) services is a significant public health problem in India. Barriers to accessing PMH services include the stigma, non-availability of services, poor knowledge, negative perception, attitude among perinatal women (PWs) and service providers. The present study attempted to examine the knowledge gap regarding perinatal depression (PD) among service providers [Nursing providers (NPs), Medical Practitioners (MPs)] and service utilizers (PWs). METHODS: This cross-sectional study was conducted in two tertiary care teaching hospitals of India, one in a major metro and the other in a rural area. PWs, MPs and NPs were assessed for knowledge about PD using a semi-structured proforma and Perinatal Depression Monitor. RESULTS: Among the 270 PWs, 8.51% were knowledgeable (PWA) and 91.49% were ignorant (PWB) about depression. PWB group were low educated (n = 140, 56.68%), and unemployed (n = 207, 83.80%) with lower family income [(≤₹10,356 per month), n = 170, 68.28%)]. There was knowledge discrepancy among NPs, MPs and PWA group in terms of a) PD is a normal part of pregnancy (agree- NPs = 71.52%, MPs = 10.00%, PWA-17.39%), b)biological causes of PD (agree- NPs = 45.23%, MPs = 70.00%, PWA = 26.03%) and c)antidepressant medications for PD (useful- NPs = 23.80%, MPs = 70.00%, PWA = 21.73%). Majority of the respondents agreed that all women should be screened for depression during pregnancy (NPs = 34.78%, MPs = 80.95%, PWA = 95.00%) and postpartum periods (NPs = 34.78%, MPs = 76.19%, PWA = 90.00%). CONCLUSIONS: Low PD literacy among the PWs, misconception about aetiology and management among the NPs could be major barrier for delivery and utilisation of PD services. Thus, there is an urgent need to improve PD literacy among PWs and NPs.

Menarche among rural adolescent girls in Dervan (Data from the KONKAN region of the state of Maharashtra, India).

CONTEXT: Associations between age at menarche and risk of type 2 diabetes and cardiovascular disease are well established in adults. But little is known about these risks in adolescents. AIM: To examine the association between age at menarche and anthropometric indicators, and also examine nutrition among the rural adolescent girls of KONKAN region. SETTING AND DESIGN: We investigated 1,071 school going adolescent girls who underwent holistic education and various clinical investigations as a part of community program. Age at menarche was recorded and anthropometric measurements were performed. Macronutrient intake was estimated by 24 h recall. STATISTICAL ANALYSIS USED: We used trend statistics and logistic regression to examine the association. RESULTS: A total of 813 girls had attained menarche. Mean age at menarche was 13.0 years. When compared with premenarchal girls anthropometric parameters were significantly higher in postmenarchal girls (P < 0.05 for all) and the prevalence of stunting and thinness was lower (P < 0.001 for both). There was a decreasing trend for weight (P < 0.001), BMI (P < 0.001), and waist circumference (P < 0.05) with increasing age of onset of menarche, and increasing trend for stunting and thinness (P < 0.001 for both). More than 65% of the girls were eating below the recommended daily allowance of calories, protein, and fat. Adolescents with late onset of menarche had increased likelihood of stunting (P < 0.01) and thinness (P < 0.001). CONCLUSIONS: Adolescent girls in the KONKAN region with late menarche are thin and stunted. There is an urgent need to improve nutritional status of adolescent girls from KONKAN as malnutrition can affect the onset of menarche.