Excess Screen Time and its Associated Factors among Young Men in a Rural Community of North India

Screen-based media usage among young people is blooming rapidly due to technological and digital revolution. We conducted community-based cross-sectional study to determine the prevalence of excess screen time and its association with sociodemographic and behavioral patterns in a rural block of Haryana, India. A semi-structured interview schedule was administered by trained physicians to ascertain screen time in a typical day and various socioeconomic and behavioral factors among a random sample of 860 young men aged 18-24 years. The prevalence of excess screen time was 61.8% (95% confidence interval [CI] 58.4-65.1). It was significantly associated with education (adjusted odds ratio [AOR] 1.7, 95% CI 1.1-2.6) and occupation (AOR 2.2, 95% CI 1.2-3.9) of the father and their sleep duration of ≤8 h (AOR 1.6, 95% CI 1.2-2.3). Limiting the screen time as per international standards and behavioral interventions are needed for this young population.

Folate supplementation as a strategy to reduce Neural Tube Defects

Folic acid is a vitamin known to prevent neural tube defects, megaloblastic anaemia, cardiovascular morbidity and mortality, etc. The main natural sources of folate are plant and vegetables e.g. green leafy vegetables, broccoli, asparagus, citrus fruits (orange, strawberry), beans, nuts, cauliflowers, beets, corn etc. and meat products like liver. The primary function of folate is its contribution in the synthesis and repair of the DNA. The bioavailability of food folate is approximately 50%. The bioavailability of folic acid taken with meal compared to with water on empty stomach is 85% and 100% respectively.(1) Hence, it is easier to achieve the recommended daily allowances with fortified food as compared to natural food due to higher stability and bioavailability of synthetic folate when compared to natural food.(2)

Molecular interaction studies on the binding ability of hydrated zinc sulphate with aqueous solution of ascorbic acid at different temperatures

The ternary systems containing Water, Ascorbic acid (AA) and ZnSO4·7H2O were investigated using three approaches namely volumetric studies, viscosity studies and conductance studies. The solvent systems used were 2, 4 and 6% (by weight) of AA in water. The studies were conducted at four temperatures (303.15–318.15 K with an interval of 5 K) and pressure 0.1 MPa with concentration of ZnSO4·7H2O in the solution ranging from 0.01 to 0.12 m. Various parameters like partial molar volume (ϕ v), apparent molar volume ( ϕ v o ) $({\phi }_{\text{v}}^{\text{o}})$ , Hepler’s constant ( ( d 2 ϕ v o / d T 2 ) p ) $({({d}^{2}{\phi }_{\text{v}}^{\text{o}}/d{T}^{2})}_{p})$ , partial molar expansibility ( ϕ E o ) $({\phi }_{\text{E}}^{\text{o}})$ and transfer volume ( Δ t r ϕ v o ) $({{\Delta}}_{tr}{\phi }_{\text{v}}^{\text{o}})$ have been evaluated from volumetric studies. The viscosity studies have yielded Jones-Dole parameters (A and B) and free energy of activation per mole for solvent ( Δ μ 1 0 ‡ ) $({\Delta}{\mu }_{1}^{0{\ddagger}})$ and solute ( Δ μ 2 0 ‡ ) $({\Delta}{\mu }_{2}^{0{\ddagger}})$ . The conductance data has been used to calculate molar conductance (Λm), limiting molar conductance ( Λ m o ) $({{\Lambda}}_{\text{m}}^{\text{o}})$ and Walden product ( Λ m o η o ) $({{\Lambda}}_{\text{m}}^{\text{o}}{\eta }_{\text{o}})$ . The results of these studies agree with each other and have concluded the structure breaker behavior of ZnSO4·7H2O in the solvent system containing AA and water.

Protocol for process evaluation of SMART Mental Health cluster randomised control trial: an intervention for management of common mental disorders in India

INTRODUCTION

In India about 95% of individuals who need treatment for common mental disorders like depression, stress and anxiety and substance use are unable to access care. Stigma associated with help seeking and lack of trained mental health professionals are important barriers in accessing mental healthcare. Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health integrates a community-level stigma reduction campaign and task sharing with the help of a mobile-enabled electronic decision support system (EDSS)-to reduce psychiatric morbidity due to stress, depression and self-harm in high-risk individuals. This paper presents and discusses the protocol for process evaluation of SMART Mental Health.

METHODS AND ANALYSIS

The process evaluation will use mixed quantitative and qualitative methods to evaluate implementation fidelity and identify facilitators of and barriers to implementation of the intervention. Case studies of six intervention and two control clusters will be used. Quantitative data sources will include usage analytics extracted from the mHealth platform for the trial. Qualitative data sources will include focus group discussions and interviews with recruited participants, primary health centre doctors, community health workers (Accredited Social Health Activits) who participated in the project and local community leaders. The design and analysis will be guided by Medical Research Council framework for process evaluations, the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework, and the normalisation process theory.

ETHICS AND DISSEMINATION

The study has been approved by the ethics committee of the George Institute for Global Health, India and the Institutional Ethics Committee, All India Institute of Medical Sciences (AIIMS), New Delhi. Findings of the study will be disseminated through peer-reviewed publications, stakeholder meetings, digital and social media platforms.

TRIAL REGISTRATION NUMBER

CTRI/2018/08/015355.

Test concordance of three serological assays for detection of anti-SARS-CoV-2 antibody: Result from a population-based sero-epidemiological study in Delhi.. [DOI: 10.21203/rs.3.rs-1720417/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background Several methodological tests are available to detect SARS-CoV-2 antibody. Tests are mostly used in the aid of diagnosis or for serological assessment. No tests are fully confirmatory and have variable level of diagnostic ability. We aimed at assessing agreement with three serological tests: quantitative anti receptor binding domain ELISA (Q-RBD), qualitative ELISA (WANTAI SARS-CoV-2 Ab) and qualitative chemiluminiscence assays (CLIA). Methods This study was a part of a large population based sero-epidemiological cohort study. Participants aged 1 year or older were included from 25 randomly selected clusters each in Delhi urban (urban resettlement colony of South Delhi district) and Delhi rural (villages in Faridabad district, Haryana). Three type of tests were applied to all the baseline blood samples. Result of the three tests were evaluated by estimating the total agreement and kappa value. Results Total 3491 blood samples collected from March to September, 2021, out of which 1700 (48.7%) from urban and 1791 (51.3%) from rural. Overall 44.1% of participants were male. The proportion of sero-positivity were 78.1%, 74.1% and 31.8% by Wantai, QRBD and CLIA tests respectively. The total agreement between Wantai and QRBD was 94.2%, 53.1% between Wantai and CLIA, and 56.6% between QRBD and CLIA. The kappa value between these three tests were 0.84 (95% CI: 0.80–0.87), 0.22 (95% CI: 0.19–0.24) and 0.26 (95% CI: 0.23–0.28). Conclusions There was strong concordance between Wantai and QRBD test. Agreement between CLIA with other two tests was low. Wantai and QRBD may be used interchangeably.

Gestational Diabetes Mellitus Among Pregnant Women Attending Ante-natal Clinic at a Secondary Care Health Facility in Haryana, India

Introduction: Gestational diabetes has serious health effects during pregnancy and childbirth. We estimated the occurrence of gestational diabetes mellitus (GDM) among pregnant women in a secondary care hospital in Haryana.

Methods: It was a hospital-based cross-sectional study, done in an ante-natal clinic (ANC) at a sub-district hospital (SDH), Faridabad district of Haryana, India. Eligible pregnant women attending the ANC clinic were recruited. An oral glucose tolerance test (OGTT) with 75 g of glucose was done with a collection of blood for fasting blood sugar (FBS) and two-hour post-OGTT blood glucose. A pre-tested semi-structured interview schedule was administered. Both the modified International Association of the Diabetes and Pregnancy Study Groups criteria (IADPSGC) and the Diabetes in Pregnancy Study Group of India (DIPSI) criteria were used. Data were presented as percentages, means, standard deviation, and 95% confidence interval (CI). Bi-variable and multi-variable logistic regressions were done. The level of significance was set at 0.05.

Results: Of the 623 eligible participants, 66.1% were within the 20-25 age group. The GDM was found in 14.1% (95%CI: 11.5-17.1) participants as per modified IADPSG criteria and 6.7% (95%CI: 4.9-9.0) participants as per DIPSI criteria, respectively. Increasing age [adjusted odds ratio (AOR): 1.24 (95% CI: 1.05-1.47), p=0.008] and increasing years of schooling [AOR: 1.19 (1.01-1.41), p=0.032] were significantly associated with GDM by DIPSI criteria. Family history of DM was also found to have an increased odds with GDM using modified IADPSG criteria [AOR 2.87 (95% CI: 1.09-7.54), p=0.032]. 

Conclusion: Considerable proportion of pregnant women were found to have GDM in a Sub-district hospital at Ballabgarh in north India. The study highlighted the need and generated evidence about the feasibility of GDM screening utilizing routine staff in a secondary care facility.

Antibody response to SARS-CoV2 among COVID-19 confirmed cases, and correlates with neutralizing assay in a subgroup of patients in Delhi National Capital Region, India.. [DOI: 10.1101/2022.05.17.22275193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background

Plaque reduction neutralization test (PRNT) is the gold standard to detect neutralizing capacity of the serum antibodies. Neutralizing antibody confers protection against further infection. The present study was done with the objective to measure the antibody level against SARS-CoV2 among laboratory confirmed COVID-19 cases and to evaluate whether the presence of anti-SARS-CoV2 antibodies indicate virus neutralizing capacity.

Methods

One hundred COVID-19 confirmed cases were recruited. Sociodemographic details and history of COVID-19 vaccination, contact with positive COVID-19 cases, and symptoms were ascertained using a self-developed semi-structured interview schedule. Serum samples of the participants were collected within three months from date of the positive report of COVID-19. The presence of anti-SARS-CoV-2 antibodies (IgA, IgG and IgM antibodies), receptor binding domain antibodies (anti-RBD), and neutralizing antibodies were measured.

Findings

Almost all participants had Anti-SARS-CoV2 antibodies (IgA, IgG and IgM) (99%) and Anti-RBD IgG antibodies (97%). However, only 69% had neutralizing antibodies against SARS-CoV2. Anti-RBD antibody levels were significantly higher among participants having neutralizing antibodies compared to those who didn’t.

Interpretation

The present study highlights that presence of antibodies against SARS-CoV2, or presence of anti-RBD antibody doesn’t necessarily imply presence of neutralizing antibodies.

Funding

World Health Organisation

“Better to Die Than Take These Medicines”: A Community-Based Qualitative Study on the Determinants of Treatment Loss-to-Follow-Up in Tuberculosis Patients in District Faridabad, Haryana, India

Introduction

India is the biggest contributor to the global incidence of tuberculosis (TB). A major reason behind the persistently high incidence of TB in India is treatment loss-to-follow-up (LTFU). The consequences of LTFU include continuous transmission to uninfected individuals, drug resistance, and a higher rate of death in incompletely treated patients. It is a significant hurdle to making India ‘TB-Free’ by 2025. Hence, we conducted a community-based qualitative study to understand the determinants of treatment of LTFU in TB patients in the Faridabad district of Haryana, India. 

Methodology

We enrolled TB patients who had completed treatment as well as those who had been LTFU. We also enrolled National Tuberculosis Elimination Programme (NTEP) functionaries, healthcare providers, family members, and community members. In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted to understand stakeholders’ perceptions of reasons for LTFU. The grounded theory approach was used with inductive analysis. Data were triangulated from stakeholders’ interviews. Themes and sub-themes were identified. A Health Belief Model for TB treatment completion was developed.

Results

Fifty-eight IDIs and four FGDs were conducted between May-June 2018. The major themes influencing the treatment of LTFU which emerged from the analyses were - the role of external motivators, regular use of alcohol, lack of/or inappropriate knowledge related to treatment, lack of family support, and side effects of anti-tubercular drugs, and a poor experience with the health system. Stigma was not found to be a major determinant - in the few cases that it affected treatment, it spurred treatment completion rather than LTFU.

“I completed the course with great difficulty. Then they started it again! […] I said-Sorry, sir, I can’t go through this again. It’s better to die once than to die a thousand deaths.” - Fifty-one-year-old male patient who was lost-to-follow-up on re-treatment.

Discussion

This study was a comprehensive multi-stakeholder qualitative undertaking to identify the determinants of LTFU. Our qualitative approach explained the associations between LTFU and certain factors (e.g.: alcohol use, side effects, etc.) found in previous quantitative studies. The strength of this study was that we ensured participation by patients as well as all district-level stakeholders from the national health programme, which no previous qualitative study on the treatment LTFU in India had achieved. The entire qualitative analysis was done manually and in Hindi (the language in which interviews were conducted). Hence, no data were lost in translation. The limitation was that its findings were specific to the study area and study population, as is the case with all qualitative studies.

Conclusion

All healthcare providers should be sensitised to the determinants of treatment LTFU, so that they can pay special attention to at-risk patients and take appropriate steps to prevent LTFU. For instance, patients with a pattern of regular alcohol use should be counselled and may be referred to deaddiction centres, with the continuum of care maintained. The journey from tuberculosis diagnosis to treatment completion is often extremely traumatic for the patient. The onus to successfully complete treatment lies not with the patient alone, but with the health system as well.

Virulence gene mutations as a differentiator of clinical phenotypes: insights from community-acquired uropathogenic Escherichia coli

Uropathogenic Escherichia coli (UPEC) remains an important cause of urinary tract infection during pregnancy. Multiple molecular virulence determinants and antibiotic resistant genes facilitate its pathogenesis and virulence phenotype. Hence it is hypothesized that there will be considerable variation in genes among the isolates from symptomatic as well as asymptomatic bacteriuria (ABU) during pregnancy. The aim of this study was to decipher the genetic variation among the two phenotypes. Six different UPEC isolates collected from urine specimens of consecutive pregnant females (five, symptomatic bacteriuria and one, ABU) were tested for their growth kinetics, and biofilm formation. A total of 87 virulence determinants and 56 antibiotic resistance genes were investigated using whole-genome sequencing, to identify putative drives of virulence phenotype. In this analysis, we identified eight different types of fully functional toxin antitoxin (TA) systems [HipAB, YefM-YoeB, YeeU-YeeV (CbtA), YhaV-PrlF, ChpBS, HigAB, YgiUT and HicAB] in the isolates from symptomatic bacteriuria; whereas partially functional TA system with mutations were observed in the asymptomatic one. Isolates of both the groups showed equivalent growth characteristics and biofilm-formation ability. Genes for an iron transport system (Efe UOB system, Fhu system except FhuA) were observed functional among all symptomatic and asymptomatic isolates, however functional mutations were observed in the latter group. Gene YidE was observed predominantly associated with the biofilm formation along with few other genes (BssR, BssS, YjgK, etc.). This study outlines putative critical relevance of specific variations in the genes for the TA system, biofilm formation, cell adhesion and colonization among UPEC isolates from symptomatic and asymptomatic bacteriuria among pregnant women. Further functional genomic study in the same cohort is warranted to establish the pathogenic role of these genes.

Prevalence of depression and health related quality of life among patients with diabetes mellitus and hypertension attending a secondary care hospital in district Faridabad, Haryana

Background:  Diabetes mellitus (DM) and hypertension (HT) have significant effect on the mental health of the patient. and. We aimed to estimate the prevalence of depression, and the quality of life among patients with diabetes mellitus and hypertension who attended a secondary care hospital. Methods: A cross-sectional study was carried out among 618 patients who had DM and/or HT.  PHQ-9 and WHO-BREF QOL questionnaire were administered to assess depression and health related quality of life respectively. Results: More than 2/3rd of patients had depression. Among those who had depression, nearly half (46%) had moderate depression and 2.1% had severe depression. The proportion of severely depressed patients was higher in diabetes mellitus group compared to the hypertension group.   Patients that were depressed had poorer quality of life compared to non-depressed, and the difference was statistically significant. Conclusion: Patients with diabetes mellitus and hypertension may be screened for depression and managed accordingly.

Effectiveness of Intravenous Iron Sucrose Therapy in Routine Antenatal Care for the Treatment of Moderate to Severe Anemia Among Pregnant Women Attending a Secondary Care Hospital in North India: A Retrospective Analysis

Introduction: Anemia during pregnancy is an important public health problem and is associated with a number of maternal and fetal complications. Intravenous iron sucrose (IVIS) has been reported to be safe and efficacious in raising the hemoglobin (Hb) level among pregnant women. However, most of the studies were conducted in controlled research settings, and there is a paucity of data on the effectiveness when IVIS is given as routine therapy in public health facilities. The objective of this study was to estimate the change in mean Hb level four weeks after the last dose of IVIS infusion in pregnant women with moderate to severe anemia in a public healthcare setting.

Methods: Records of pregnant women having moderate anemia (Hb level: 7.0-9.9 gm/dL), who received IVIS in calculated dose during routine antenatal care between 1 January 2018 and 31 July 2018, were reviewed. Data were analyzed using STATA version 13 software (StataCorp LLC, College Station, TX). Hb levels before the start of the therapy (baseline) and four weeks after the last infusion (endline) were compared. A value of p < 0.05 was considered statistically significant.

Results: The mean (±SD) Hb level increased from 8.5 (±0.88) gm/dL at baseline to 10.3 (±1.24) gm/dL four weeks after the last dose of IVIS infusion. The mean (±SD) increase in Hb level was 1.7 (±1.29) gm/dL (95% CI: 1.57, 1.87). The change from moderate and severe anemia to normal Hb levels was observed in 28.4% and 28.6% of women, respectively.

Conclusion: IVIS therapy is effective in improving Hb levels when given as routine therapy in a secondary level public healthcare facility.

V. S, K. C. S, Chaudhuri S, Pundir S, Kocher D, Gautam H, Sood S, Das BK, Kapil A, Hari P, Kumar A, Kumari R, Kalaivani M, R. A, Salve HR, Malhotra S, Kant S. Prevalence and resistance pattern of uropathogens from community settings of different regions: an experience from India

Introduction

Urinary tract infection (UTI) is one of the most common infections in clinical practice worldwide in both healthcare and community settings causing significant morbidity and mortality. It is one of the major conditions at the community level treated empirically and regarded as a potential cause of emergence of antimicrobial resistance (AMR). Limited information is available regarding community-acquired UTI (CA-UTI) from India.

Methodology

This is a first of its kind, multicentric-cross-sectional study at the community level targeting patients attending the out-patient department (OPD) of the community health centre (CHC) from four geographical regions (North, South, West and East) of India. The study had been designed to determine the epidemiology, antibiogram profile and identification of extended-spectrum beta-lactamase (ESBL) producer and carbapenem resistant (CR) uropathogens. Samples were collected prospectively from UTI suspected patients coming at CHC and processed at the tertiary healthcare centres using a common standard operating procedure. Clinical history of all the patients exhibiting significant bacteriuria was collected and data was analysed.

Result

Overall, 250 out of a total of 2459 (10.1 %) urine samples were positive for bacteria with significant bacteriuria (adult: paediatrics, 6.7 : 1). Females were predominantly affected (male: female, 1 : 2.9). History of recent episode of UTI was observed as the commonest risk factor followed by diabetes mellitus. Altogether, 86 % of total cases were caused by Escherichia coli (68 %) and Klebsiella pneumoniae (17.6 %) together. Among the commonly used oral antibiotics for the Gram-negative bacilli (GNB), the highest resistance was observed against beta-lactams, first- and second-generation cephalosporins, fluoroquinolones and co-trimoxazole. Overall, the prevalence of ESBL producer and CR isolates were 44.8, and 4.3 %, respectively. However, the ESBL production, CR and nitrofurantoin resistance among the uropathogenic E. coli (UPEC) isolates was 52.8, 5.1 and 14 %, respectively. No resistance was found against fosfomycin among the UPEC isolates.

Conclusion

The current study highlights the increasing incidence of AMR among uropathogens at the community-settings of India. A significant percentage of ESBL producers among the isolated UPEC and K. pneumoniae were observed. The currently available evidence supports the clinical recommendation of fosfomycin and nitrofurantoin for empiric therapy in CA-UTI in India.

Analyzing occupational heat stress using sensor-based monitoring: a wearable approach with environmental ergonomics perspective

Occupational heat stress could impose a greater risk of heat-related morbidities among the exposed users, declining their work productivity and contributing to a financial burden. This necessitate the implementation of adequate preventive measures and control policies to improve the users' well-being and productive capacity. The emergence of modernistic sensors gives rise to workplace heat stress monitoring at a substantially lower cost than expensive conventional equipment. Present work unveils the productive role of sensor-based safety helmet, which could monitor the environmental variables, heat stress indices, and users' physiological variables as an indicator of heat strain. The proposed safety helmet was tested under three different work environments with users' engaged in specific work activities. Notable variations were perceived among the measured data under respective work conditions and physical activity performed. Higher heat risk exposures were attributable to the outdoor condition compared to indoor work conditions. For wet bulb globe temperature index, strong association (p-value < 0.01) was observed with fighter index of thermal stress (R ²-value = 0.959) followed by discomfort index (R ²-value = 0.899) and heat index (R ²-value = 0.867). Results revealed a rise in measured physiological parameters under the heavy workload activity (shoveling task; outdoor location) followed by hacksaw cutting task (indoor location), while least values were associated with light workload activity (drilling task; indoor location). The proposed design intervention could be considered an effective site-specific solution for monitoring heat stress exposures and keeping exposed users well aware of the prevalent thermal work conditions at the individual level.

Prevalence of Anemia Among Adolescent Girls Residing in Rural Haryana: A Community-Based Cross-Sectional Study

Background

Anemia continues to be a major public health problem in India despite multiple initiatives to address it among various vulnerable groups including adolescents.

Aim

This study was conducted to assess the prevalence of anemia among rural adolescent girls who had attained menarche.

Methods

The community-based cross-sectional study was conducted in 28 villages of Ballabgarh Block of district Faridabad, Haryana. From the computerized Health Management Information System data (HMIS), a random list of 363 adolescent girls was generated. Adolescent girls who had attained menarche were included in the study. Hemoglobin level was measured for all the consented or assented participants using a digital hemoglobinometer (HemoCue201+ photometer, HemoCue AB, Angelholm, Sweden).

Results

A total of 272 participants were enrolled in the study. Mean (SD) age at menarche was 13.2 (1.2) years. Prevalence of anemia among adolescent girls who had attained menarche was observed to be 71.7% (95% CI: 66.3 - 77.1) as per the WHO classification. Among the 195 anemic adolescent girls, severe, moderate, and mild anemia was observed in 4.8%, 41.2%, and 25.7%, respectively. In multivariable analysis, after adjusting for the age, the mother’s education was significantly associated with anemia (Adjusted Odds Ratio = 0.46, 95% CI: 0.22 - 0.96, p-value = 0.04).

Conclusion

The prevalence of anemia among rural adolescent girls who had attained menarche was high. Mother’s education status had a protective effect on anemia among adolescent girls.

Prevalence of serum cobalamin and folate deficiency among children aged 6–59 months: A hospital-based cross-sectional study from Northern India

Context:

Cobalamin and folate are essential for the synthesis of nucleic acids and in the maintenance of myelin. They are required during the period of the rapid growth of infancy and childhood. Their deficiency may result in nutritional anemia and neurological manifestations. There is paucity of literature regarding the prevalence of cobalamin and folate deficiency among North Indian children aged 6–59 months.

Aim:

The aim of this study was to estimate the prevalence of serum cobalamin and folate deficiency among children aged 6–59 months, attending a secondary care hospital.

Settings and Design:

Children were recruited from pediatrics OPD of the sub-district hospital (SDH), Ballabgarh, Haryana, through systematic random sampling. Hemoglobin was measured by an automated analyzer. Serum cobalamin and serum folate were estimated using enhanced chemiluminescence based immunoassay.

Results:

A total of 420 children were recruited, of which 392 provided a blood specimen. Prevalence of cobalamin, folate deficiency, and anemia were 22.3% (95% CI: 18.3–26.7), 10.9% (95% CI: 8.2–14.6), and 81.9% (95% CI 77.7–85.4), respectively. The proportion of children with cobalamin deficiency who had anemia was 97.7% compared to 95.7% among those with no cobalamin deficiency (P = 0.396). Similarly, the proportion of children with folate deficiency who had anemia was 95.2% compared to 96.2% among those with no folate deficiency (P = 0.765).

Conclusion:

We found that almost one in five children aged 6–59 were deficient in cobalamin, and one in ten were deficient in folate.

Underweight, Overweight and Anaemia among Persons Aged 60 years or Older Residing in an Urban Resettlement Colony of Delhi: A Cross-sectional Study

Introduction: Nutritional deficiencies are common among elderly person aged 60 years or older. Elderly persons suffer the dual burden of overnutrition and undernutrition. These nutritional disorders can be corrected if diagnosed and managed at the earliest. Aim: To estimate the prevalence and factors associated with underweight, overweight, obesity and anaemia among elderly persons in an urban resettlement colony of Delhi, India. Materials and Methods: The present study was a crosssectional survey in which elderly persons who were residents of Dr Ambedkar Nagar, an urban resettlement colony in Dakshinpuri Extension of Delhi were recruited. The study period was from December 2019 to March 2020. A pretested semi-structured interview schedule was used to collect sociodemographic details. The anthropometric measurements, namely, height and weight were carried out as per standard practice. Capillary blood haemoglobin level was measured by a digital haemoglobinometer. Chi-square test for distribution and multivariable logistic regression for association were performed. Results: Data was collected from 959 participants, with a response rate of 91.2%. The prevalence (95%CI) of underweight, overweight and obesity were 15.5% (13.3, 18.0), 21.9% (19.3, 24.6) and 9.6% (7.7, 11.6), respectively. Persons aged 70 years or older and illiterate persons had increased chance of being underweight. Women had increased chance of being overweight or obese. The prevalence of anaemia among participants was 72.1% (95% CI 69.2% - 74.9%), using the cut-off of anaemia as haemoglobin levels <13 gm/dL in men, and <12 gm/dL in women. Conclusion: The prevalence of underweight, overweight/ obesity and anaemia among elderly persons in the study population was high. Community-based measures need to be taken to address them.

Effect of iron-fortified rice on the hemoglobin level of the individuals aged more than six months: A meta-analysis of controlled trials

Fortification of staple food items with iron is a potential strategy to address anemia for a larger population. We reviewed studies to assess the impact of iron-fortified rice (IFR) on hemoglobin levels of individuals more than six months of age. We included studies assessing the effectiveness of IFR (with or without other micronutrients) conducted in any part of the world available in PubMed, Embase, Web of Science, Cochrane Library, Google Scholar, clinicaltrials.gov, International database of prospectively registered systematic reviews in health and social care (PROSPERO), unicef.org, and who.int databases and published from January 1, 1990 to April 1, 2019 (PROSPERO registration number: RD42020139895). We extracted the changes in hemoglobin, serum ferritin, and serum transferrin levels among the participants. Finally, data from 15 trials and their 21 subsets were analyzed. Mean difference in hemoglobin was 0.53 g/dl (95% CI: 0.26, 0.80, P < 0.001, I2 = 84%) in the IFR group compared to the control group. In the subgroup analysis after removing studies with small sample size and high risk for bias, a mean difference of 0.44 g/dl (95% CI: 0.20, 0.69, P < 0.001, I2 = 82%) was observed. No significant effect on serum ferritin or transferrin levels was observed. From this review it can be concluded that fortification of rice with iron can be adopted as an intervention to improve hemoglobin levels, especially in countries where rice is the major part food of staple diet. Research is needed on an optimal iron compound for fortification and the acceptance of IFR.

Oral HIV self-testing among men who have sex with men in New Delhi, India: Perceptions & apprehensions: A qualitative study

Background & objectives

The overall adult prevalence of HIV in India was estimated to be 0.22 per cent in 2019. The HIV prevalence among men who have sex with men (MSM), a high-risk group for HIV, was estimated to be 4.3 per cent, which is 16 times higher than the national average. In Delhi, the estimated prevalence among MSM was 1.8 per cent. Despite free HIV testing services being made available by the National AIDS Control Programme for more than two decades, many MSM were not aware about their HIV status. Therefore, newer testing strategies are needed. Oral HIV self-testing (HIVST) has proved to be one such promising innovation. At present, there are no programme guidelines on HIVST and oral HIVST kit is not available in India. The aim of this study was to understand the perceived advantages and disadvantages of introduction of oral HIVST strategy among MSM.

Methods

MSM who were registered with the selected non-governmental organizations working as targeted intervention sites in Delhi, India, were recruited for focus group discussions (FGDs) between January and May 2021. For the purpose of this study, MSM were defined as males who had anal/oral sex with male/hijra partner in the past one month. A total of six FGDs were conducted using a prepared FGD guide. The FGD guide included questions on problems faced during conventional HIV testing, participants' awareness, acceptability and perceptions of oral HIVST. The data were manually coded and entered in NVivo release 1.5 and themes were identified.

Results

A total of 67 respondents participated in the FGDs. A total of 28.4 per cent MSM were beggars at traffic lights, 12 per cent were sex workers and 11.9 per cent were bar/event dancers. Nearly half (50.7%) of the participants had undergone HIV testing less than twice in the preceding one year. None of the MSM were aware about oral HIVST. Perceived advantages of oral HIVST were ease of use, confidentiality and the non-invasive pain-free procedure. Perceived concerns included lack of post-test counselling, linkage to care, poor mental health outcomes and forced testing.

Interpretation & conclusions

Most MSM had positive perceptions about oral HIVST. Therefore, it is likely that the introduction of oral HIVST may result in higher uptake of HIV testing among MSM.

Patient Satisfaction Among the OPD Attendees at a Secondary Care Hospital in Northern India

Patient satisfaction reflects the quality and effectiveness of healthcare. Healthcare services have become more patient-centric in today’s era as patients are viewed as active consumers of healthcare services rather than passive recipients. Measuring patient satisfaction level has become an objective criterion for defining the effectiveness of these services. Feedback from patients makes healthcare services more responsive to the expectations of patients. We conducted a cross-sectional study among 200 OPD attendees of a secondary-care hospital to assess the level of satisfaction. A 5-point Likert scale was used to record the responses. For overall satisfaction with the OPD services, most common responses were “good” or “very-good”, with mean (SD) score of 3.8 (0.77). Majority of the patients were satisfied with facilities such as drinking water and toilets, and with consultation time provided by the doctors. The patients were not satisfied with the time taken at the registration window and behavior of other hospital employees. This highlights the importance of reorientation training on communication and interpersonal skills for all categories of healthcare staff.

Mitogen-activated protein kinase kinase 7 in inflammatory, cancer, and neurological diseases

Stress-activated mitogen-activated protein kinase kinase 7 (MKK7) is a member of the dual-specificity mitogen-activated protein kinase family. In the human body, MKK7 controls essential physiological processes, including but not limited to proliferation and differentiation in multiple tissues and organs. MKK7, along with the MKK4 pathway, has been implicated in stress-activated activities and biological events that are mediated by c-Jun N-terminal kinase (JNK) signaling. Although numerous studies have been performed to identify the role of JNK in multiple biological processes, there are limited publications that focus on dissecting the independent role of MKK7. Recent research findings have spurred testing via in vivo genetically deficient models, uncovering previously undocumented JNK-independent functions of MKK7. Here we discuss both JNK-dependent and-independent functions of MKK7 in vivo. This review summarizes the role of MKK7 in inflammation, cytokine production, cancer, and neurological diseases.

Serological prevalence of SARS-CoV-2 antibody among children and young age group (between 2 and 17 years) in India: An interim result from a large multicentric population-based seroepidemiological study

Background:

Estimating seroepidemiolgical prevalence of SARS-CoV-2 antibody is an essential public health strategy. There is insufficient evidence of prevalence among those belonging to young age population in India.

Objective:

To compare the SARS-CoV-2 seropositivity rate between children and adults in selected sites from India.

Materials and Methods:

This was a multicentric population-based seroepidemiological study conducted in selected urban and rural areas of five sites selected from four states (Delhi, Odisha, Uttar Pradesh, Tripura) of India. Participants aged ≥1 year were included from different clusters of each area. Total serum antibody against SARS-CoV-2 virus was assessed qualitatively by using a standard enzyme-linked immunosorbent assay (ELISA) kit.

Results:

Data collection period was from 15 March 2021 to 10 June 2021. Total available data was of 4509 participants, of whom 700 were <18 years of age and 3809 were ≥18 years of age. The site-wise number of available data among those aged 2–17 years was 92, 189, 165, 146 and 108 for the sites of Delhi urban, Delhi rural, Bhubaneswar rural, Gorakhpur rural and Agartala rural area, respectively. The seroprevalence was 55.7% in the <18 years age group and 63.5% in the ≥18 years age group. The prevalence among female children was 58% and among male children was 53%.

Conclusion:

SARS-CoV-2 seropositivity rate among children was high and comparable to that of the adult population. Hence, it is unlikely that any future third wave by prevailing SARS-CoV-2 variant would disproportionately infect children 2 years or older.

Community practices in COVID-19 outbreak in rural Ballabgarh, Haryana – A mixed methods study

Background:

More than 43 million cases and 5.2 lakhs death have occurred due to COVID-19 in India. Approximately 1 lakh people (cumulative) have been infected by COVID-19 in Faridabad district alone as of 4 April 2022. To understand the effects of COVID-19 on community practices this study was conducted.

Methods:

A community-based cross-sectional study was conducted in Intensive Field Practice Area of Comprehensive Rural health Services Project (CRHSP), Ballabgarh, Haryana. Five hundred participants (≥18 years) were selected by using simple random sampling from Health Management Information System (HMIS) maintained at Centre for Community Medicine, AIIMS, New Delhi. Participants were informed regarding study and consent was taken. A semi-structured interview schedule was administered.

Results:

Study participants included 500 adults (52.2% Male). Mean age (S.D.) of participants were 39.1 (14.9) years. Almost all participants started practicing hand sanitisation (496, 99.2%), avoiding crowd (488, 97.6%), and covering face with cloth/handkerchief (459, 91.8%). More than 80% (428, 85.6%) started using mask, and following cough etiquettes (405, 81.0%). More than three-fourth (389, 77.8%) participants were very unsatisfied with lockdown. Majority faced financial difficulties (322, 64.4%), followed by difficulty in their entertainment/recreational activity (158, 31.6%), difficulty in acquiring ration/food items (87, 17.4%) and mental stress (46, 9.2%) during lockdown.

Conclusions:

Rural community of Ballabgarh showed positive practices with respect to prevention of COVID-19. Financial distress and job loss due to lockdown were widely reported from the rural community. Majority of the community was displeased with lockdown as intervention for COVID-19.

Hilaire C, Schulz E, Kröller-Schön S, Keaney JF. PGC1α Regulates the Endothelial Response to Fluid Shear Stress via Telomerase Reverse Transcriptase Control of Heme Oxygenase-1

OBJECTIVE

Fluid shear stress (FSS) is known to mediate multiple phenotypic changes in the endothelium. Laminar FSS (undisturbed flow) is known to promote endothelial alignment to flow, which is key to stabilizing the endothelium and rendering it resistant to atherosclerosis and thrombosis. The molecular pathways responsible for endothelial responses to FSS are only partially understood. In this study, we determine the role of PGC1α (peroxisome proliferator gamma coactivator-1α)-TERT (telomerase reverse transcriptase)-HMOX1 (heme oxygenase-1) during shear stress in vitro and in vivo. Approach and Results: Here, we have identified PGC1α as a flow-responsive gene required for endothelial flow alignment in vitro and in vivo. Compared with oscillatory FSS (disturbed flow) or static conditions, laminar FSS (undisturbed flow) showed increased PGC1α expression and its transcriptional coactivation. PGC1α was required for laminar FSS-induced expression of TERT in vitro and in vivo via its association with ERRα(estrogen-related receptor alpha) and KLF (Kruppel-like factor)-4 on the TERT promoter. We found that TERT inhibition attenuated endothelial flow alignment, elongation, and nuclear polarization in response to laminar FSS in vitro and in vivo. Among the flow-responsive genes sensitive to TERT status, HMOX1 was required for endothelial alignment to laminar FSS.

CONCLUSIONS

These data suggest an important role for a PGC1α-TERT-HMOX1 axis in the endothelial stabilization response to laminar FSS.