Risk factors of female breast carcinoma: a case control study at Puducherry.

OBJECTIVE: To identify and quantify various demographic, reproductive, socio-economic and dietary risk factors among women with breast cancer. STUDY DESIGN: Case control study. STUDY PERIOD: February 2004 to May 2005. STUDY SETTING: Departments of Surgery, Medicine and Radiotherapy of Jawaharlal Institute of Postgraduate Medical Sciences and Research (JIPMER), Pondicherry. MATERIALS AND METHODS: Cases were women with pathologically confirmed breast cancer. Controls were age-matched women from medicine and surgery wards without any current breast problem or previous breast cancer. A total of 152 cases and 152 controls were enrolled. They were interviewed for parity, breast feeding, past history of benign breast lesion, family history and dietary history with a pre-tested interview schedule after obtaining informed written consent. RESULTS: The significant risk factors were (odds ratios with 95% CI) previous history of biopsy for benign breast lesion 10.4 (1.3-86.3), nulliparity 2.4 (1.14-5.08), consumption of fats more than 30 g/day 2.4 (1.14-5.45) and consumption of oils containing more of saturated fat 2.0 (1.03-4.52). CONCLUSIONS: Nulliparity, past history of benign breast lesion, high fat diet and consumption of oils with more saturated fats were the risk factors.

Computer use among medical students in an institution in southern India.

BACKGROUND: This cross-sectional, descriptive study was conducted in Pondicherry from May to October 2002 to assess computer and internet use among medical students. METHODS: The participants were four batches of undergraduate students, one batch of interns and two batches of postgraduate students. A pre-tested questionnaire was used to collect data from 394 subjects. Written informed consent was obtained from all the participants. RESULTS: Computer knowledge was found to be higher among postgraduates (93.3%) compared to undergraduates (84.5%). Students learnt computers by self-learning, attending classes and using manuals. Writing letters was the most common use of the computer (postgraduates [100%] and undergraduates [87.5%]). Seventy-one per cent of the postgraduates and 43% of the undergraduates used English language dictionaries. About 61% of the undergraduates used computers for playing games. Students also used computer for watching movies. MS Office was the most commonly used software (postgraduates [100%] and undergraduates [72.2%]). The use of software for visual designing and drawing was low. Undergraduates used audio players more often than postgraduates. Most students used the internet for e-mail (postgraduates [100%] and undergraduates [97.3%]). Undergraduate students used the internet for chatting and entertainment. Online banking was also used to some extent. Most of the students were willing to undergo training. All the groups unanimously felt that the institute should provide free training in medical informatics. CONCLUSION: This study revealed high computer use among medical students in an institution with good computer facilities. The majority expressed their willingness to undergo further training.

Byssinosis among male textile workers in Pondicherry: a case-control study.

BACKGROUND: In India, 20 million workers are involved in the manufacturing of textiles. However, there are few epidemiological studies from India that have assessed the magnitude or the risk factors associated with byssinosis. In Pondicherry, textile mills have been in existence for over a century. This case-control study aimed to find the factors associated with the development of byssinosis in textile workers. METHODS: The sample consisted of 761 men above the age of 30 years who had worked for at least 10 years in a textile factory. All the respondents were interviewed by a pretested questionnaire to gather information regarding the symptoms of byssinosis, certain personal characteristics and occupational history. Byssinosis was identified using the classification proposed by the World Health Organization. Two age-matched controls were selected for each case. RESULTS: Univariate analysis of the factors for symptomatic byssinosis showed that dusty worksites, heavy smoking and duration of service > or = 30 years were significant. Logistic regression analysis showed that working in the spinning (odds ratio 6.1) and weaving sections (odds ratio 1.9), heavy smoking (odds ratio 3.9) and > or = 30 years of service (odds ratio 2.0) were independent significant risk factors. CONCLUSION: Efforts to reduce dust levels in the working environment and to discourage smoking among textile workers need to be strengthened to minimize the risk of developing byssinosis.

Poliomyelitis trends in Pondicherry, south India, 1989-91.

STUDY OBJECTIVES: To assess the poliomyelitis trend, including study of the epidemiological features, and to correlate this with the immunisation coverage of infants. DESIGN: Three annual lameness surveys in children aged 0-60 months employing cluster sampling methods and a series of five cross sectional surveys of immunisation coverage in children aged 12-23 months of age were undertaken. SETTING: Pondicherry, India, 1988-92. SUBJECTS: More than 10,000 children in the age group of 0-60 months took part in the three annual lameness surveys and samples of 210 children aged 12-23 months were covered each year in immunisation coverage surveys. MEASUREMENTS AND MAIN RESULTS: Altogether 50 of 11,461, 24 of 10,093, and 17 of 11,218 children surveyed during 1989, 1990, and 1991 respectively had become lame as a result of poliomyelitis, giving prevalences of 4.4, 2.4, and 1.5 per 1000 children for the three surveys. The corrected prevalences of poliomyelitis were 5.9, 3.2, and 2.0 per 1000 children during 1989, 1990, and 1991 respectively. The proportion of cases aged up to 36 months fell from 48% in 1989 to 12.5% in 1990 and 6% in 1991. The age at onset was less than 1 year in most. The median age at onset was 10.7 months. About 54% of the affected children had received three doses of oral poliomyelitis vaccine (OPV) before the onset of paralysis. In 1988 immunisation coverage for the third dose of OPV was 91% and in 1992 it was 97.6%. The drop out rate for the first versus the third dose of OPV fell from 6.3 in 1988 to 1.9% in 1992. CONCLUSION: Three successive annual lameness surveys showed that poliomyelitis was declining between 1989 and 1991. Five immunisation coverage surveys conducted from 1988 to 1992 showed high initial coverage followed by an improvement in the form of almost universal coverage for OPV.

Effect of indoor air pollution on the respiratory system of women using different fuels for cooking in an urban slum of Pondicherry.

BACKGROUND: Some of the highest exposures to air pollutants in developing countries occur inside homes where biofuels are used for daily cooking. Inhalation of these pollutants may cause deleterious effects on health. We studied the effects of exposure to indoor air pollution from the use of cooking fuels on lung functions and respiratory symptoms in women aged 15-60 years. METHODS: The study was conducted in Kuruchikuppam, an urban slum in Pondicherry. The study participants were 105 women using biofuels, 105 using kerosene and 105 using liquid petroleum gas (LPG), selected from among 1117 women aged 15-60 years, by a stratified random sampling technique. These women were interviewed at home to collect information about exposure to fuel smoke and presence of respiratory symptoms. Lung functions were assessed by measuring forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and peak expiratory flow rate (PEFR). Occurrence of respiratory symptoms over six months was noted by making monthly follow up visits. RESULTS: Women using biofuels experienced more respiratory symptoms (23%) than those using kerosene (13%;p > 0.05) or LPG (8%; p < 0.05). Lung functions-FVC, FEV1, FEV1% and PEFR-were significantly lower in biofuel users compared with both kerosene (p < 0.01) and LPG users (p < 0.001). Lung functions in kerosene users also were significantly poorer when compared with LPG users (p < 0.01). Predicted pulmonary functions using multiple regression equations, derived from the data set of the present study, indicated that women using biofuels were more liable to have reduced pulmonary functions than women using kerosene or LPG. CONCLUSION: Women exposed to biofuel smoke suffer more from respiratory illnesses and have decreased pulmonary functions compared with women exposed to kerosene or LPG smoke. To reduce pollutant exposures we recommend the use of smokeless chullas or cleaner fuels such as charcoal, biogas and kerosene.

An exploratory study of the motivation in suicide attempters.

The motivation of one hundred cases of suicide attempters was assessed clinically depending purely on their subjective reports. They were grouped into two, viz., those who primarily wished for a change (here in after called WC) and those who unambiguously wished to die (hereinafter called WD). They were compared with regard to the details of the attempt, methods of attempt, psychiatric and sociodemographic profile. The WC group was observed to have taken less precaution against discovery of their attempt, had low lethality with regard to the method used and had more adjustment problems than psychiatric diseases. They clearly belonged to the low risk group. The WD group had all these findings in the contrary, which put them in the high risk category. This simple way of assessing suicide risk may be having a face validity in the sociocultural context of the present.

Research as a tool for the teaching of epidemiology.

At a medical school in India, undergraduates have been given the opportunity to volunteer to conduct research as a means of improving their knowledge and understanding of epidemiology. First-year clinical students have conducted case-control studies with emphasis on methodological detail. Second-year students have been involved in community-based epidemiological studies. At the intern level, projects related to social factors in health and disease and to health administration have been encouraged. This initiative has been largely welcomed by the students and has yielded highly encouraging results.

PIP: Starting in 1985, at the Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India, modifications concerning teaching community medicine and epidemiology were introduced. Students were encouraged to conduct epidemiological investigations for better understanding of the subject. First-year students were free to participate in a hospital-based case control study involving 3-7 students over a period of 6-8 months. 5 projects were completed between 1990 and 1992 pertaining to risk factor analysis in oral cancers, protein-energy malnutrition, myocardial infarction, birth asphyxia, and cervical carcinoma. Methodology included objectives, review of the literature, definitions, questionnaires, and statistical methods. Faculty members monitored progress. Each student made a presentation to a gathering of 1st- and 2nd-year students and answered their questions. 2nd-year students undertook projects in community medicine lasting 2 months during vacation. Each student had a separate project of value for planning urban and rural field practice areas. Between 1987 and 1992, field studies were carried out on immunization coverage and mothers' knowledge about child immunization; the prevalence of caries among preschool children; cultural and economic factors affecting pregnancy; the epidemiology of cataract; blood pressure and hypertension; the nutritional status of preschool and school-age children; and drug compliance by leprosy patients. Case school studies were also undertaken on risk-factor analysis of low birth weight; factors affecting the acceptance of tubectomy; and treatment-seeking behavior among patients with cervical carcinoma. Similar public presentations were made. Interns were invited to assist in difficult subjects. A hospital study was completed by 2 students on injections given unnecessarily to children aged under 5 years. 111 out of 149 1st- year students questioned stated that they had gained knowledge and skills. Benefits reported included improved thinking, communication, statistical knowledge, understanding of human behavior, and a social view on health and disease.

Paralytic poliomyelitis in children under 6 years in Pondicherry: a community survey.

STUDY OBJECTIVES: To assess the amount of poliomyelitis and its epidemiological features including risk factors. DESIGN: This was a retrospective study of cases of paralytic poliomyelitis among children 0-6 years of age. SETTING: Pondicherry, India, 1983-89. SUBJECTS: A total of 47,960 children aged less than 6 years. MEASUREMENTS AND MAIN RESULTS: In 1989, 469 field workers undertook a door to door survey of children 0-6 years old to identify those with limb paralysis. This was followed by clinical examination to establish the cause, supplemented by case notes held by the Child Development Services. Altogether 203 cases of limb paralysis were identified, 188 of which were judged a result of paralytic poliomyelitis. The prevalence of poliomyelitis in 1989 was 3.9/1000 among children below 6 years of age. There was a male preponderance with a male:female ratio of 1.4:1. The prevalence was least in infants (1/1000) and highest in children aged 2 to 3 years (6.4/1000). The age at onset was less than 12 months in 42% of cases and less than 3 years in 98%. The median age at onset was 13.4 months. Time series analysis showed a high occurrence of cases from May to September between 1983 and 1989. The legs were affected in 97%. About 41% of children had received three doses of oral polio vaccine. There was a history of intramuscular injection, possibly provoking a paralytic attack, in 54% of cases. CONCLUSION: This retrospective community study involving the staff of the Integrated Child Development Services provided valid data about poliomyelitis with little additional cost and minimum training. Because the study covered a whole population of children under 6 years, rather than a sample, the data will help in monitoring and surveillance of poliomyelitis and also in planning strategies for effective control.

Community experience for medical students.

This article outlines the features of community postings for medical students in their second clinical year at the Jawaharlal Institute of Postgraduate Medical Education and Research, in Pondicherry, India. Their exposure to the realities of preventive and social medicine in the field clearly helps them to cope with what would otherwise be only theoretical knowledge.