A randomised controlled trial to evaluate the effectiveness of a culture and disease-specific, patient-centric multi-component tobacco cessation intervention package for the patients attending non-communicable disease clinics in Punjab, India

BACKGROUND

Developing an infrastructure to support tobacco cessation through existing systems and resources is crucial for ensuring the greatest possible access to cessation services. The present study aims to evaluate the effectiveness of a newly developed multi-component cessation among tobacco users in Non- Communicable Disease (NCD) clinics, functioning under the National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases, & Stroke (NPCDCS) of the Government of India.

METHODS

The intervention package consisting of culture- and disease-specific four face-to-face counselling sessions, pamphlets, and short text messages (bilingual) with follow-ups at 3rd, 6th, and 9th months with an endline assessment at 12th months was delivered to the intervention arm of the two-arm- parallel group randomised controlled trial at two selected NCD clinics. Self-reported seven-day abstinence, frequency of use, expenditure in seven days at each follow-up, FTND score, stage of change and plasma cotinine values were assessed at baseline, follow-ups, and endline (using Liquid Chromatography -Mass Spectrometry), as applicable.

RESULTS

The intervention arm reported a significantly more reduction in self-reported frequency of tobacco use at 6 months (mean: 13.6, 95% CI (7.8-19.4)), 9 months (mean: 20.3, 95% CI (12.2-28.4)) and 12 months (mean: 18.7, 95% CI (8.7-28.7)). The plasma cotinine concentration at endline in the intervention arm was statistically significantly lower than the baseline concentration.

CONCLUSION

Strengthening existing health systems is crucial for offering cessation support in the resource-restraint setting of LMICs to assist in quitting sustainably.

Complementary and Alternative Medicine/Therapy for Tobacco Cessation in India: A Secondary Analysis of GATS-1 and 2

Background

India has nearly 267 million adult tobacco users, with a slowly improving quitting rate. Among the many approaches to quitting the habit, such as counseling, nicotine replacement therapy, nicotine patch or gum, and prescribed allopathic medicines. Complementary and alternative medicine/therapy (CAM), a thousand-year-old practice in India, may also prove to be a potential method in tobacco cessation; however, there is scarce literature on the extent of use of CAM among tobacco users who attempt to quit the habit. Therefore, this study attempts to examine the potential of CAM as a strategy for tobacco control in India.

Material and Methods

We undertook a secondary analysis of the data from both rounds of the Global Adult Tobacco Survey (GATS 2009 and 2016). The dependent variable included in the analysis was the use of traditional medicine as a method for quitting tobacco in three types of users-smokers, smokeless tobacco users, and dual users. The prevalence of CAM use was reported, and Chi-square test was applied to find the factors significantly associated with the use of CAM among tobacco users considering a P value of 0.05 to be statistically significant.

Results

The overall prevalence of traditional medicine use for GATS-1 was observed to be more among dual users (4%), while for GATS-2, it was highest among smokers (3%). For both rounds of the GATS survey, the use of traditional medicine was found to be higher among males, rural residents, users with no education or less than primary education, and the eastern region.

Conclusions

CAM has a promising potential for supporting tobacco cessation provided a concerted effort is undertaken to standardize pharmacopeia and establish robust clinical evidence. In addition, there is a need to create awareness, build the capacity of healthcare providers, and foster academic-industrial research in indigenous Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) systems.

Comparison of gum elastic bougie-guided insertion of LMA ProtectorTM versus the conventional method in achieving oesophagal patency - A randomised comparative study

Background and Aims

The passage of a Ryle's tube through the drain port on the laryngeal mask airway (LMA) ProtectorTM has been reported to be arduous despite the larger gastric channel. There are no studies on the evaluation of the guided insertion of LMA ProtectorTM to achieve adequate gastrointestinal drainage function.

Methods

This randomised study included 132 patients who underwent surgery under general anaesthesia. The gum elastic bougie (GEB)-guided insertion of LMA ProtectorTM (group I) was compared with the conventional method (group II), and the alignment of the tip of the drain tube with the oesophagus was assessed. The insertion characteristics of the device, accuracy of LMA ProtectorTM placement, haemodynamic parameters, and post-operative airway morbidity following the insertion of the device were also compared between the two groups.

Results

The first-attempt success rate for the placement of LMA ProtectorTM and the patency of oesophagus was higher in group I patients than in group II (100% vs 84.8%; P < 0.001). However, the time taken for device insertion and associated haemodynamic changes were significantly longer in group I. The patients in group I had better visualisation of laryngeal structures. The GEB-assisted insertion of LMA ProtectorTM resulted in less incidence of blood staining at the cuff of the device.

Conclusion

GEB-guided insertion of LMA ProtectorTM achieved better oesophageal patency than the conventional insertion method. This method also had higher first-attempt success at the placement of the device and was observed to be less traumatic.

Trends and determinants of tobacco use initiation in India: analysis of two rounds of the Global Adult Tobacco Survey

OBJECTIVES

Early initiation of tobacco use can lead to lifelong addiction and increases tobacco-attributable morbidity and mortality. This study assesses trends in tobacco use initiation and factors associated with tobacco use initiation using disaggregated data from two rounds of the Global Adult Tobacco Survey India (GATS; 2009-2010 (GATS 1) and 2016-2017 (GATS 2)).

DESIGN

Secondary analysis of repeated cross-sectional studies.

SETTINGS AND PARTICIPANTS

The study involved data from 69 296 individuals and 76 069 households in GATS 1 and 74 037 individuals and 77 170 households in GATS 2, two rounds of a nationally representative survey in India.

OUTCOME MEASURES

Mean age of initiation (as recalled by the participants) of smoked and smokeless tobacco (SLT) use (dependent variable) was compared and analysed across different sociodemographic variables (independent factors). We assessed change in mean age of initiation of tobacco usage on a daily basis between GATS 1 and GATS 2, and investigated the factors associated with early tobacco use initiation in the GATS 2 dataset (reported using adjusted ORs (aORs) with 95% CIs).

RESULTS

The mean age of initiation of smoked tobacco and SLT in GATS 2 was 20.9±8.5 and 22.3±10.6 years, compared with 18.5±9.7 and 19.7±12.0 years in GATS 1. The mean age of initiation increased with age and among those who were better aware of the adverse effects of tobacco. As per GATS 2, males initiated smoked tobacco and SLT use earlier (20.6±7.4 and 21.7±9.1) than females (23.3±14.2 and 23.2±12.6 years). Younger participants (15-24 years) reported earlier initiation of SLT (15.5±4.2 years) compared with others. Binary logistic regression depicted variables associated with early initiation of tobacco. Awareness about the harms caused by tobacco affected the odds of SLT (aOR 1.4, 95% CI 1.3 to 1.7) and dual usage initiation (1.8, 1.6 to 2.0), but not of initiation of smoked tobacco products (1.1, 0.9 to 1.2).

CONCLUSIONS

More robust health advocacy campaigns that communicate the harmful effects of tobacco on health could be useful to delay tobacco initiation, along with reducing the ease of access and affordability of tobacco products among vulnerable groups.

Estimating the Cost of Delivering Tobacco Cessation Intervention Package at Noncommunicable Disease Clinics in Two Districts of North India

INTRODUCTION

Integrated care is likely to improve outcomes in strained healthcare systems while limiting costs. NCD clinics were introduced under the "National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease, and Stroke" (NPCDCS) in India; however, there is limited literature on the costs of delivering tobacco cessation interventions within NPCDCS. One of the study's objectives was to estimate the cost of delivering a culturally specific patient-centric behavioral intervention package in two district-level NCD clinics in Punjab, India.

METHODS

Costing was undertaken using the health systems perspective. A top-down or financial costing approach and a bottom-up or activity-based approach were employed at each step of development and implementation. The opportunity cost was used to include the cost of human resources, infrastructure, and capital resources used. All infrastructure and capital costs were annualized using a 3% annual discount rate. Four additional scenarios were built up concerning three major components to reduce costs further when rolled out on a large scale.

RESULTS

The cost of intervention package development, human resource training, and unit cost of implementation were estimated to be INR 6,47,827 (USD 8,874); INR 134,002 (USD 1810); and INR 272 (USD 3.67), respectively. Based on our sensitivity analysis results, the service delivery cost varied from INR 184 (USD 2.48) to INR 326 (USD 4.40) per patient.

CONCLUSION

The development costs of the intervention package accounted for the majority proportion of the total cost. Of the total unit cost of implementation, the telephonic follow-up, human resources, and capital resources were the major contributory components.

IMPLICATIONS

The current study aims to fill gaps by estimating the unit-level health systems cost of a culturally sensitive, disease-specific, and patient-centric tobacco cessation intervention package delivered at the outpatient settings of NCD clinics at the secondary level hospital, which represents a major link in the health care system of India. Findings from this study could be used to provide supportive evidence to policymakers and program managers for rolling out such interventions in established NCD clinics through the NPCDCS program of the Indian Government.

Prioritizing tobacco control & its cessation under sustainable development goals with a focus on India

Sustainable development goals (SDGs) were meant to put each and everywhere 'at par'. The tobacco epidemic globally is one major deterrent to their achievement. While it gets addressed under SDG 3 through the Framework Convention on Tobacco Control (FCTC) - the World Health Organization (WHO) global treaty (the target 3.a of SDG 3), the progress made globally and by India is slow. As a result, many countries may fall short of achieving the target of reducing tobacco usage (taking 2016 as base year) by 30 per cent by the year 2030. India with its high burden of tobacco use and abysmally low quitting along with soaring economic costs of tobacco related diseases and deaths can do better with the engagement of multisectoral stakeholders to strengthen tobacco control under SDGs. Moreover, there is a need to emphasize that the goal of O - Offer to Quit of WHO MPOWER can be achieved through increasing 'onus' on policy makers, and strategists, and opportunities for masses, tobacco users, healthcare professionals (HCPs) and enforcers to have tobacco cessation delivered optimally. By doing so, the United Nations can significantly facilitate a reduction in tobacco use and the resultant economic costs. Furthermore, it will assist the WHO to fulfil the targets set for 2030 under SDG 3.a by the FCTC member countries. In addition, it will fulfil the vision and mission defined in the Chandigarh declaration of the 5th National Conference on Tobacco or Health for India to be tobacco free by 2030.

Awareness of electronic cigarettes in India: Findings from the 2016-2017 Global Adult Tobacco Survey (GATS)

INTRODUCTION

Electronic nicotine delivery systems (ENDS) have recently emerged as a public health threat globally. Despite the low proportion of e-cigarette users (1.22%) reported in the Global Adult Tobacco Survey-2, the Government of India enacted the Prohibition of E-cigarettes Act 2019 (PECA), prohibiting all forms of ENDS/ENNDS. The current analysis presents nationally representative findings on the level of awareness of e-cigarettes in India and its correlates and characteristics of those aware of e-cigarettes.

METHODS

The current secondary analysis from GATS-2 among adults aged ≥15 years from all states and Union Territories of India used a standard protocol for data collection and management. A multi-stage cluster sampling design was used. The respondents who were aware of e-cigarettes were included (n=2524). Binomial logistic regression analysis was conducted, and adjusted odds ratios (AORs) with 95% CI, were calculated to measure the associations between independent and dependent variables.

RESULTS

Only 3.4% of the respondents were aware (either heard or seen) of e-cigarettes and their awareness was found significantly higher among males (AOR=2.07; 95% CI: 1.90-2.24), urban population (AOR=2.83; 95% CI: 2.61-3.07), and higher education (AOR=0.41; 95% CI: 0.38-0.45).

CONCLUSIONS

Public awareness campaigns about the harms of e-cigarettes and the law (PECA) need to be rolled out in urban and rural areas. Capacity-building exercises of implementers and enforcers at the grassroots level could also support communicating the harms to hard-to-reach groups. Further, regular compliance monitoring of the legislation and prosecution of violators would facilitate its effective implementation at the national and sub-national levels.

Feasibility of tobacco cessation intervention at non-communicable diseases clinics: A qualitative study from a North Indian State

BACKGROUND

One of the 'best buys' for preventing Non-Communicable Diseases (NCDs) is to reduce tobacco use. The synergy scenario of NCDs with tobacco use necessitates converging interventions under two vertical programs to address co-morbidities and other collateral benefits. The current study was undertaken with an objective to ascertain the feasibility of integrating a tobacco cessation package into NCD clinics, especially from the perspective of healthcare providers, along with potential drivers and barriers impacting its implementation.

METHODS

A disease-specific, patient-centric, and culturally-sensitive tobacco cessation intervention package was developed (published elsewhere) for the Health Care Providers (HCPs) and patients attending the NCD clinics of Punjab, India. The HCPs received training on how to deliver the package. Between January to April 2020, we conducted a total of 45 in-depth interviews [medical officers (n = 12), counselors (n = 13), program officers (n = 10), and nurses (n = 10)] within the trained cohort across various districts of Punjab until no new information emerged. The interview data wereanalyzed deductively based on six focus areas concerning feasibility studies (acceptability, demand, adaptation, practicality, implementation, and integration) using the 7- step Framework method of qualitative analysis and put under preset themes.

RESULTS

The respondent's Mean ± SD age was 39.2± 9.2 years, and years of service in the current position were 5.5 ± 3.7 years. The study participants emphasized the role of HCPs in cessation support (theme: appropriateness and suitability), use of motivational interviewing, 5A's & 5R's protocol learned during the training & tailoring the cessation advice (theme: actual use of intervention activities); preferred face-to-face counseling using regional images, metaphors, language, case vignettes in package (theme: the extent of delivery to intended participants). Besides, they also highlighted various roadblocks and facilitators during implementation at four levels, viz. HCP, facility, patient, and community (theme: barriers and favorable factors); suggested various adaptations to keep the HCPs motivated along with the development of integrated standard operating procedures (SOPs), digitalization of the intervention package, involvement of grassroots level workers (theme: modifications required); the establishment of an inter-programmatic referral system, and a strong politico-administrative commitment (theme: integrational perspectives).

CONCLUSION

The findings suggest that implementing a tobacco cessation intervention package through the existing NCD clinics is feasible, and it forges synergies to obtain mutual benefits. Therefore, an integrated approach at the primary & secondary levels needs to be adopted to strengthen the existing healthcare systems.

Awareness regarding the antitobacco laws and perceptions regarding interventions for effective tobacco control among young adults of Haryana, India

Background

Tobacco is one of the major behavioral risk factors for noncommunicable diseases in India. Tobacco control depends on public awareness regarding prevalent antitobacco measures.

Objectives

The present study documents the understanding of young adults (<25 years) regarding the antitobacco laws and their perception regarding interventions for effective tobacco control.

Methods

A cross-sectional study was conducted in two districts of Haryana. A semistructured questionnaire was used to assess tobacco use, participants' awareness of sections 4, 5, 6 (a), and 8 of the Cigarette and Other Tobacco Products Act (COTPA, 2003), sources of information about antitobacco laws, and their implementation. The perception of participants about the effectiveness of laws and provisions was assessed using a three-point Likert scale.

Results

Of the 1470 participants, 517 (35.2%) smoked or used smokeless products. They reported the media (84.6%) to be the most critical source of information about antitobacco laws, followed by the health department (57.6%) and family/peer group (44.9%). Most participants were aware of the prohibition of smoking in offices or banks, educational institutions, hospitals, and other public places. Both tobacco users and nonusers perceived health education programs to be an effective intervention to reduce tobacco use (P < 0.01).

Conclusion

The awareness regarding COTPA has increased among the general population. The media could be a powerful tool to counteract the pro-tobacco cues in society. The need of the hour is to focus on improving compliance with antitobacco laws at the population level to achieve a tobacco-free India.

Comparison of oropharyngeal leak pressure of LMA Protector and LMA-ProSeal in different head and neck positions in anaesthetized and paralyzed patients; A prospective randomized study

Background and Aims

Oropharyngeal leak pressure (OLP) of LMA Protector is reported to be higher compared to other second generation supraglottic devices (SGDs) indicating better seal with patient's airway and hence enhanced safety. To ascertain its benefit in patients undergoing surgeries where head and neck position other than neutral is required, we conducted a prospective randomized study to compare OLP of LMA Protector with LMA-ProSeal (PLMA) with head and neck in neutral, extension, flexion, and rotation position.

Methods

80 American Society of Anesthesiologists (ASA) I-II patients aged more than 18 years undergoing elective surgery under general anaesthesia were recruited. Patients were randomized in the LMA Protector or PLMA group. After induction of anaesthesia, OLP was measured in both the groups in different head and neck position. The insertion characteristics of both SGDs were also recorded and compared.

Results

The OLP of LMA Protector and PLMA was found to be comparable in neutral head position (p = 0.08). There was no significant difference in OLP of both devices in extension, flexion, or head rotation. In both the study groups, head extension position led to significant decrease in OLP compared to supine position. With the flexion and rotation positioning of head and neck, significant increase in OLP in each group was noted.

Conclusion

The OLP of LMA Protector and PLMA are comparable in different head and neck position. With both the devices, there was significant decrease in OLP with extension whereas significant increase was noted in flexion and rotation of head and neck.

Development of a multi-component tobacco cessation training package utilizing multiple approaches of intervention development for health care providers and patients attending non-communicable disease clinics of Punjab, India

Background

Providing patients with personalized tobacco cessation counseling that is culturally sensitive, and disease-specific from healthcare providers (HCPs) as part of their routine consultations is an approach that could be incorporated, using existing healthcare systems such as the Non-Communicable Disease (NCD) clinics. This paper describes the development of a multi-component culturally tailored, patient-centric, disease-specific tobacco cessation package utilizing multiple approaches of intervention development for healthcare providers and patients attending these clinics in Punjab, India, along with a proposed framework for implementation.

Methods

The proposed intervention package was developed in 6 stages. These included a review of literature for identifying successful cessation interventions for ethnic minority groups, co-production of the package with all stakeholders involved via a series of consultative meetings and workshops, understanding contextual factors of the state and 'factor-in' these in the package, pre-test of the package among HCPs and tobacco users using in-depth interviews, micro detailing and expansion of the package by drawing on existing theories of the Cascade Model and Trans-Theoretical Model and developing an evolving analysis plan through real-world implementation at two pilot districts by undertaking a randomized controlled trial, assessing implementer's experiences using a mixed-method with a primary focus on qualitative and economic evaluation of intervention package.

Results

A multi-component package consisting of a booklet (for HCPs), disease-specific pamphlets and short text messages (for patients; bilingual), and an implementation framework was developed using the 6-step process. A major finding from the in-depth interviews was the need for a specific capacity-building training program on tobacco cessation. Therefore, using this as an opportunity, we trained the in-service human resource and associated program managers at the state and district-level training workshops. Based on the feedback, training objectives were set and supported with copies of intervention package components. In addition, the role and function of each stakeholder were defined in the proposed framework.

Conclusion

Consideration of tobacco users' socio-cultural and patient-centric approach makes a robust strategy while developing and implementing an intervention providing an enlarged scope to improve care services for diversified socio-cultural communities.

Variations in the patterns of tobacco usage among indian females - findings from the global adult tobacco survey India

Background

Males dominate in tobacco usage, as well as in tobacco research, knowing that women face more severe health consequences. There is a specific lack of information on epidemiological statistics, risks, and the level of knowledge among women regarding tobacco. This study examines the Global Adult Tobacco Survey (GATS)-India dataset to estimate female tobacco usage and assess socio-economic variations in tobacco consumption, awareness regarding the adverse effects of tobacco, noticing pack health warnings (PHW), and intention to quit tobacco use well as factors influencing these domains.

Methods

Using a geographically clustered multistage sampling method, the nationally representative GATS II (2016–17) interviewed 40,265 female respondents aged 15 years and above from all Indian states and union territories. Standard operational definitions were used to estimate the primary independent variables (community, individual, and household categories) and dependent variables like awareness regarding the adverse effects of tobacco, noticing pack health warning (PHW), and intention to quit tobacco. Sampling weights were adjusted while performing the analysis. Bivariate and multivariable analysis were used to generate the estimates.

Results

Of the total female respondents, 84.2% were never-users, 13.3% ever consumed Smokeless Tobacco (SLT) products, 1.8% ever smoked tobacco, and 0.8% were dual users once in their lives. Around 16% of the women had exposure to Second Hand Smoke (SHS) either at their homes, workplaces or in public places. Overall, maximum awareness was seen among non-smoker females (64.7%) and dual users (64.7%), followed by women exposed to SHS, SLT users, and smokers. PHW was noticed more by the bidi smokers, followed by SLT users and cigarette smokers. Factors that positively affected intention to quit smoking included younger age, secondary school education, self-employed status, the habit of buying packed cigarettes/bidi, believing that smoking causes serious illness, and attempted quitting in the last 12 months.

Conclusion

A high proportion of women consume tobacco which is significantly influenced by socio-demographic factors. Tobacco regulators should be especially concerned about women as the tobacco marketing experts target them. Mobilizing self-help groups and organizations working for women and children could assist broader campaigns to generate awareness and motivate quitting attempts.

Tobacco use and uncontrolled hypertension among Indian men: Insights from the National Family He alth Survey (NFHS-4), 2015-2016

Background

Tobacco use is a modifiable risk factor for developing cardiovascular diseases, of which hypertension is a major killer. Uncontrolled hypertension (UHT) is a major public health concern that exerts a financial and service burden on the health system.

Aim

The current analysis aimed to determine the association between tobacco use and UHT among Indian males.

Material and Methods

Data from the 4^th National Family Health Survey (NFHS) of 1,04,120 men aged 15-54 years were used. We estimated the adjusted prevalence ratio for having UHT among reported tobacco users and non-users.

Results

The prevalence of UHT was the lowest (41.02%) among those who did not consume tobacco in any form. Among tobacco users, those smoking tobacco had the highest prevalence (53.53%) of UHT followed by those using both smoked and smokeless forms of tobacco (43.84%) and those using only smokeless forms of tobacco (42.26%). Factors significantly associated with UHT were alcohol consumption (aPR: 1.30; 95% CI: 1.19-1.43), belonging to the richer wealth quintile (richest quintile- aPR: 1.27; 95% CI: 1.05-1.38), being overweight (aPR: 3.14, 95% CI: 2.35-4.21), and being obese (aPR: 2.89, 95% CI: 2.12-.94). Higher educational status was significantly protective against UHT (aPR: 0.75; 95% CI: 0.63-0.88).

Conclusions

Tobacco use is significantly associated with hypertension in Indian men. Addressing tobacco control and prevention of UHT remain the cornerstones for achieving the SDG target 3.4 by 2030, which aims to reduce premature mortality from NCDs by a third by 2030 relative to 2015 levels.

Association of Hypertensive Disorders of Pregnancy (HDP) and tobacco use among women of reproductive age group in India: A secondary data analysis from NFHS-4

Introduction

Tobacco use in any form is known to exert several perinatal complications. Through this study, the authors aimed to study the association between tobacco use and Hypertensive Disorders of Pregnancy (HDP) among women (aged 15-49 years) in India.

Methodology

We used data from the National Family Health Survey (NFHS-4, 2015-2016) to study the association between tobacco use and HDP among women of reproductive age (15-49 years) in India. Since the NFHS follows a complex multi-level sampling, sampling weights were used to study the univariate and multivariate associations between the independent and dependent variables. Adjusted odds ratios (AORs) are reported along with 95% Confidence Intervals.

Results

A sample of 1,07730 women was included in the analysis. HDP was more likely to be experienced by smokeless and smoking tobacco users (AOR 1.3, 95% CI (1.0-1.6) and AOR 2.7, 95% CI (2.0-3.7), respectively). Women with secondary (AOR 0.7, 95% CI (0.7-0.8)) and higher education (AOR 0.7, 95% CI (0.6-0.8)) were less likely to suffer from HDP as compared to those with no education. Women with daily (AOR 0.7, 95% CI (0.5-0.8)), weekly (AOR 0.8, 95% CI (0.6-0.9)) or occasional AOR 0.7, 95% CI (0.6-0.9)) consumption of fruits were less likely to experience HDP as compared to women with no fruit intake.

Conclusion

Healthy diet and lifestyle factors can contribute to reduce the risk of HDP across women. The antenatal check-ups in India should also comprehensively focus on screening and counseling of women against tobacco use.

Predictors of hypertension among current smokeless tobacco users in India; analysis from the fourth round of National Family Health Survey (2015-2016)

Background

Hypertension is a major modifiable risk factor for cardiovascular and cerebrovascular diseases. The association between different risk factors including smoking and hypertension is studied extensively; however, there is a paucity of literature with respect to association between smokeless tobacco use and hypertension in India. In the current study, the relationship between smokeless forms of tobacco use and hypertension is being investigated.

Methodology

This study analyzed the data from fourth round of National Family Health Survey conducted during 2015-2016. Socio-demographic variables such as age, sex, education, wealth index, body mass index, smoked forms of tobacco use, and smokeless forms of tobacco like paan, gutkha, Khaini, etc., presence of co-morbidities were the independent variables. Hypertension was the dependent variable.

Results

It was observed from the present analysis that, smokeless tobacco use is a risk factor for hypertension both in the case of females OR-1.1**(1.08-1.13) as well as males OR-1.07**(1.03-1.1). The other predictors observed were overweight, consumption of alcohol, and diabetes.

Conclusion

It was concluded from the present study, that consumption of smokeless tobacco use acts as an independent risk factor for hypertension.

Strategic Initiatives to Improve Tobacco Cessation Delivery in India

BACKGROUND

Globally, India is recognized for providing comprehensive coverage of tobacco cessation through the infrastructure and resources over the last two decades. Nevertheless, its current tobacco burden is worrying due to an increase in ~2 million initiators and 5.87% tobacco related deaths annually.

OBJECTIVE

It was to identify and describe challenges and barriers in tobacco cessation delivery that exist at various levels of health care as well as at the level of tobacco users, their care givers and communities in which they live.

METHOD

Besides authors' first-hand collective experience in the tobacco control for over 80 years and ~35 years in tobacco cessation and reviewed references, the stakeholders communications during various events along with telephonic or in-person with some of them were assimilated to comprehend an overall understanding of the issue.

RESULTS

The challenges and barriers are primarily due to low priority assigned by the relevant functionaries, the inadequacy of resources, poor engagement of health-and insurance-sectors and healthcare workers, a low intent to quit by its users, suboptimal and discontinuous enforcement of the Cigarette and Other Tobacco Products Act of 2003 (COTPA), and indifference of the non-users.

CONCLUSION

The countrywide strategic initiatives required "as a package" should include political and bureaucratic commitment, mass communication on benefits of quitting, licensed current users quitting through a timeline, use of systems approach in tobacco cessation delivery, implementation, and enforcement of vendor licensing and the proposed amendments in COTPA. Their perceived benefits will become a win-win situation for all stakeholders engaged in tobacco cessation delivery.

Theoretical constructs of smoking cessation among current tobacco smokers in India: a secondary analysis of Global Adult Tobacco Survey-2 (2016-2017)

BACKGROUND

Quitting tobacco smoking is a complex process, and the transtheoretical model describes the various stages of behaviour change that smokers experience to stop smoking. Predictors of intention to quit and stage of behavioural change could assist policy-makers in establishing tailor-made strategies to offer support.

OBJECTIVE

In the current study, we analysed the determinants of cessation among 9499 current smokers of India recorded during the second Global Adult Tobacco Survey (2016-2017).

METHODS

Bivariate analysis, multivariate analysis (binary logistic regression was performed for past quit attempts and intention to quit smoking in the future; multinomial logistic regression to understand predictors of various stages of change determining cessation behaviour of current smokers) was undertaken.

RESULTS

The majority of the smokers was men (91.0%), in 25-44 years age group, (42.3%), daily wagers (37.4%) and resided in the rural area (73.3%), with bidi being the most commonly smoked product (72%). Nearly 72% tried to quit without any assistance with 36.6% (precontemplation), 27% (contemplation), 28% (preparation (or action)) and 8.1% in (relapse) stage. Men ((1.049); 95% CI 1.047 to 1.051), the primary (1.192; 95% CI 1.190 to 1.193) as well as higher education, being married (1.231; 95% CI 1.229 to 1.234) and urban residence (1.167; 95% CI 1.1.65 to 1.168) were found to be associated with higher prevalence of previous quit attempts. The regression modelling found out that intent to quit reduced with increasing age and was similarly prevalent with any level of education.

CONCLUSION

Understanding stages of behavioural change could assist the stakeholders in developing individualised interventions along with the development of intensive cessation protocols in clinical and public health settings.

Evaluating the impact of culturally specific patient-centric behavioral intervention package versus usual care for tobacco cessation among patients attending noncommunicable disease clinics in North India: A single-blind trial pilot study protocol

Background

In a low and middle-income country (LMIC) like India, non—communicable diseases (NCDs) contribute a major proportion (61.8%) of all causes of death. Out of this, 48% of cardiovascular diseases , 23% of Chronic Respiratory Diseases , and 10% of Cancer deaths are attributable to tobacco use. Tobacco use is a major risk factor for NCDs and thus, the tobacco cessation approach is a high priority intervention to combat complications and death among NCD patients. While several interventions are available for tobacco cessation, in resource constraint countries like India, the effectiveness of low-cost, culturally specific patient-centric tobacco cessation behavioral intervention holds a potential that needs to be evaluated. A newly developed evidence-based tobacco cessation intervention package will be compared with the existing/usual care provided under the National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) at NCD clinics.

Methods and design

2 arm, parallel-group randomized controlled trial.

Participants

Patients aged ≥30 years suffering from NCD, currently using tobacco, and attending NCD clinics in 2 districts of Punjab, India.

Sample size

A total of 200 participants meeting the selection criteria will be recruited. They will be allocated either to the intervention arm or control (usual care) arm (100 each) using block randomization.

Intervention

For the participants, there will be 4 face-to-face disease-specific cessation counseling sessions, disease-specific pamphlets, short text messages in vernacular language, that is, Punjabi. Follow-ups will be done at the third, sixth, ninth, and 12th months.

Primary outcome

Seven-day abstinence, biochemically verified by plasma cotinine levels.

Secondary outcome

Quit attempts, number of sticks/number of times of smokeless tobacco usage in a day, and stage of behavior change in tobacco users.

Discussion

This multicomponent culturally specific-patient-centric behavioral intervention package for tobacco cessation at NCD clinic settings focusing on the individual, family, and social environment could increase the outreach of cessation services using existing resources, thereby strengthening health systems and enhancing the quality of life of NCD patients.

Trial registration

The protocol for the study has been registered with the Clinical Trials Registry in India under the registration number CTRI/2018/01/011643.

Conformance of the food vendor carts design to the prescribed standards as per food safety and standards regulations: Assessment from an urban area of North India

Background

Food Safety and Standards Authority of India, established under the Food Safety and Standards Act, 2006, is mandated with disseminating evidence-based standards, regulating the manufacture, storage, distribution, sale, and import of street food, for ensuring the availability of safe and wholesome food for human consumption and matters connected in addition to that or incidental to that. Hence, this study was conducted to ascertain the conformance of the design of street food vendor's carts to the prescribed standards.

Methods

We conducted a cross-sectional study in Chandigarh between July 2017 and March 2018 among 400 street food vendors. The primary dependent variable of the study was conformance. The carts were evaluated for their conformance to the standard recommended design based upon a checklist designed using the guidelines of Food Safety and Standards Regulations, 2011.

Results

Almost half of the respondents had an experience of 6-15 years (48.5%) and were earning between Rs. 500 and 1000/day (56.3%). The majority of them (95%) were migrants from other states. Only 26.3% were using mobile vending sites. On regression analysis, better cart score was predicted by age, education, increasing experience, higher income, when food was prepared at home only, and with assistance in the form of helpers.

Conclusions

This study indicates that although the policy was formulated 8 years back, the standards of street food carts were still below par in Chandigarh. The government should give technical specifications and ensure uniformity at the national level.

A cross sectional study to assess tobacco use and its correlates among patients attending non-communicable disease clinics of a Northern Jurisdiction in India

Background:

Non-Communicable Diseases (NCDs) continue to rise unabated globally and the existing evidence has unequivocally established the relationship between tobacco use and NCDs. In 2010 the Government of India (GOI) introduced NCD clinics under the National Program for Prevention and Control of Cancer, Diabetes, Cardio Vascular Diseases and Stroke (NPCDCS) with the purpose of preventing and combating the NCD epidemic. This study was undertaken with an objective to comprehensively determine tobacco use and its correlates among patients attending these NCD clinics.

Methods:

A descriptive cross-sectional study was carried out among 1172 patients attending NCD clinics at district level, in Punjab, India between May to October 2018. Using systematic sampling every fourth patient was interviewed and equal numbers of visits were made to both the clinics.

Results:

Overall, the current tobacco use in any form was reported to be 10.2% among the study respondents. Majority of the tobacco users were males (23.3%), in 40–49 year age group, (18.7%), residing in urban area (15%), educated up to secondary school (18%) and non-government occupation bracket (27.4%) and hypertension disease category (41.6%). More SLT users had thought of quitting in past in comparison to smokers (46.6% vs 40%) and had higher quit attempts in past (42.5% vs 38.3%). In the binary logistic regression analysis, odds of tobacco use increased with increasing age, three times higher among participants who were employed (OR 3.75; CI 1.41-10.02),6 times higher in COPD disease category (OR 6.88; CI 2.1-20.59).

Conclusion:

Higher tobacco use among the NCD clinic attendees with increasing age predisposes them to develop grave complications. This calls for the need to administer intensive behaviour change interventions for tobacco cessation at the existing NCD clinics. This could further strengthen existing health systems and thereby improving health outcomes followed by achieving Sustainable Development Goals.

Tobacco consumption trends and correlates of successful cessation in Indian females: Findings of Global Adult Tobacco Surveys

BACKGROUND

Female gender is being affected disproportionately by tobacco use. The correlates of tobacco use among women are different from men, which has not been studied in India. To develop gender-sensitive interventions and policies in tobacco control, it's essential to ascertain the factors that affect tobacco consumption and successful cessation among Indian women.

METHODS

This secondary data analysis was done for females respondents aged >15 years using the data generated from the GATS-1 (2009-2010) and GATS-II (2016-2017). The primary dependent variables included interest in quitting smoking/SLT, attempt to quit smoking/SLT, successful quitting. The independent variables were broadly categorized as a community, household, and individual level. Simple descriptive analysis using % age relative change was used to calculate the change in tobacco consumption between two rounds of GATS, whereas; bivariate and multivariable logistic regression were used to calculate the unadjusted and adjusted odds ratio for cessation related variables (GATS-2).

RESULTS

There was a 29.5% relative reduction in the prevalence of tobacco use in round-2 among females. A maximum reduction in the prevalence was observed in the 15-29 years (-51.3%), those not exposed the media advertisements (-19.9%). While unadjusted OR depicted that unmarried women, young age, asked by health workers about tobacco use, and advice given by them increased the interest in quitting smoking, none of them emerged to be significant on a multivariable logistic regression except the advice given by the health care provider. Successful cessation (>6 months) of SLT products is possible in urban areas, with decreased exposure to media advertisements.

CONCLUSION

There is an urgent need for gender-sensitive policies in tobacco control and the integration of these policies with relevant national health programs. This shall help to synergize efforts and obtain better outcomes that would support the overarching goal of tobacco-free India.

Outcomes of integrating quitline methodology in tobacco cessation delivered through a model tobacco treatment clinic of a private sector hospital at Rajasthan, India

India despite progress in tobacco cessation delivery in government sector has lagged in private health sector. Adopting a two-fold approach of intensive intervention-based counseling with (or without) pharmacotherapy; and prescheduled proactive follow-ups over the subsequent year, this study reports 337 tobacco patients, each followed for a period of 1 year. It observed a quit rate (QR) of 40.9% for total abstinence at 1 year but with a drop of 15.9% when patients were followed up, up to 6 months (49.6%) versus 6-12 months (34.7%). The pharmacotherapy did not benefit to whom it was prescribed (196 [58.2%] patients; QR: 34.7%) versus the rest to who it was either not prescribed or was declined (141 [41.8%] patients; QR 49.6%). Countrywide tobacco cessation clinics (TCCs) may be established in private sector hospitals, and the component of quitline methodology of making proactive calls may be integrated to improve QR in India.

Chemical plaque control - A brief review

Dental plaque is a complex microbial population of bacterial and salivary polymers present on the tooth surface. It is understood that human diseases must be avoided and a high social concern for the population as a whole. The argument for the implementation of successful prevention measures is strong for life-threatening diseases or those with serious morbidity. However, regardless of seriousness, the case for avoiding any disease may be based on the belief that it is easier to be healthy than dead or sick. Thus plaque prevention is an efficient way to both treat and avoid periodontal diseases, it is an important component of gingival and periodontal diseases' primary management.

Karanjin

Karanjin [IUPAC: 3-methoxy-2-phenylfuro-(2,3-h-chrome-4-ol)], a bioactive furanoflavonoid and a potent biomolecule, was first isolated from Pongamia pinnata (L.). The crude extracts from root, leaf and seed having active constituent karanjin is highly valued in both traditional and modern knowledge systems. This review highlights, critically assesses, and presents the probable biosynthetic pathways of karanjin and its isolation methodologies with a view to actualizing its full potential. Karanjin exhibits multiple health benefits and applications, with evident anti-diabetic, anti-cancer, anti-inflammatory, anti-hyperglycemic, antioxidant, anti-colitis, anti-ulcer, and anti-Alzheimer properties. Consequently, the physiochemical properties and biological effects of karanjin have been detailed and analyzed. The efficacy of karanjin has been attenuated by toxicological studies that have proven karanjin to be non-toxic at physiological conditions as substantiated by in vitro and in vivo studies. In addition, the multiple insect repellent/insecticidal properties of karanjin and its availability as an acaricide/bio-insecticide have been reviewed. This review article underscores and endorses the immense potential for novel drug leads in various medicinal and industrial applications, suggesting a deeper insight into its metabolic fate, bioavailability, and cellular effects that await further investigations.

Harnessing the potential of tobacco cessation programme amidst COVID-19 pandemic in India

The COVID-19 pandemic of the 21st Century continues to spread, and tobacco users are at a higher risk of contracting the disease. As a measure to contain its spread, many nations have called for various measures like maintaining social distancing norms, the prohibition of spitting in the public place, partial or complete lockdown, and many more. This shutdown episode has disrupted the entire supply chain in our country, and it is quite natural that tobacco users are also experiencing a scarcity of tobacco products, like others. This adverse situation is an opportune moment for the Indian health systems to target tobacco users to motivate, facilitate, and support the cessation process. Additionally, social distancing can be achieved by utilizing and optimizing our existing health services. In our country, we have dedicated regional & national quitlines and m-Cessation facilities for tobacco users who are willing to quit. These initiatives could reduce the risk of COVID among tobacco users, facilitate the tobacco cessation movement, and provide credence to the advocacy for increasing taxes on tobacco products in the country.

One size doesn't fit all: contouring and addressing social vitals in reversing tobacco epidemic in Punjab, India

There are many tobacco users who wish to quit. In some cases, ostracism related to religious proscriptions serves as a barrier and prevents them from revealing their addiction status. Religion as an institution has an immense influence on human behaviour. It contributes to the cultural identity of individuals, moderating uniformity in their behaviour and social life. We describe a case from a province in Punjab in North India, where tobacco use is a 'taboo' due to the widely practised faith of Sikhism. The case illustrates how a doctoral thesis student, along with the healthcare providers at a non-communicable disease clinic, overcame the concealment of tobacco use of a patient with hypertension due to fear of social exclusion. The student assisted him in quitting tobacco use through a culturally specific, patient-centric, individualised, behavioural intervention using religion as a backdrop. This case study highlights the importance of recognising and appreciating the dynamics of sociocultural factors to develop a suitable and successful deaddiction strategy. This case elaborates how a simple 'nudge' of religious tenets-based counselling helps the tobacco addict transgress or tide over such barriers.

Fuelling the tuberculosis epidemic: The role of tobacco control in ending the TB emergency

BACKGROUND

Ending the TB epidemic by 2030 is among the key targets for countries to achieve Sustainable Development Goals. In current times we are grappling with dual burden of tuberculosis as well as tobacco use.

METHODS

There is sufficient evidence to establish that tobacco smoking significantly spikes up the risk of acquiring, developing and death among tuberculosis patients. Active or passive exposure to tobacco smoke is significantly associated with tuberculosis infection and tuberculosis disease, independent of a large number of other potential confounders.

RESULTS

Despite having substantial evidence about the impact of tobacco control measures, particularly tobacco cessation, on TB outcomes, the integration of TB and tobacco control still remains far-off.

CONCLUSION

It is high time when TB control programs must begin to address tobacco control as a potential preventive intervention to combat colliding epidemics of tobacco and tuberculosis. This white paper discusses about the role of tobacco control in reaching the ambitious goal of ending TB epidemic by 2030.

Exposure to second hand smoke and its correlates in Northern State of India

Background

Second-hand smoke (SHS) has enormous adverse health impacts with grave health implications for the next generation. Section 4 of Indian legislation, Cigarettes and Other Tobacco Products Act, prohibits smoking at public places, thus protecting people from SHS.

Objective

The objective of present study was to assess the exposure to SHS at home and working areas in Punjab, India.

Methods

The present cross-sectional study was conducted from December 2015 to March 2016. A three-stage sampling technique was used for collecting data from three randomly selected districts representing three major regions of Punjab, India. A sample size of 510 individuals was divided equally into an urban and rural area with proportionate sampling on the basis of subsets of age groups and gender. The questionnaire based on tobacco questions for the survey, a subset of key questions from global adult tobacco survey was used.

Results

At home, the odds of exposure to SHS exposure was higher (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 0.6-7.3) in urban area, females, low educational status, and nongovernment employee as compared to their counterparts. At workplace, (OR = 3.9 and 95% CI = 1.11-14.3) SHS exposure was higher in rural area, among males, primary and middle education and nongovernment or self-employed occupation.

Conclusion

SHS exposure was low in Punjab, India especially in females as compared to other states of the country. The socio-economic disadvantaged groups and people with low education were more likely to experience exposure to SHS at workplace, which should be targeted to reduce tobacco consumption.

Using non-communicable disease clinics for tobacco cessation: A promising perspective

Globally, non-communicable diseases (NCDs) are responsible for 38 million (68%) of the world's 56 million deaths, of which 28 million occur in low- and middle-income countries. Tobacco use is a major preventable and modifiable behavioural risk factor for NCDs. It takes annually a toll of over 7 million people and by 2030, it is anticipated to kill over 8 million people every year. Internationally, WHO has advocated the Framework Convention on Tobacco Control and MPOWER policy to combat the tobacco epidemic. As part of its global commitment towards tobacco control, the Government of India has enacted a comprehensive law, namely Cigarette and Other Tobacco Products Act, in 2003, for governing tobacco control in the country followed by launching of the National Tobacco Control Programme for its effective implementation along with strengthening of tobacco cessation facilities at national and sub-national levels. As per the National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke, there is a provision of screening of risk factors for NCDs (including tobacco) besides providing treatment and behavioural advice for NCDs. However, presently, tobacco cessation services for NCD patients are under-utilized, probably due to lack of a skilled and dedicated workforce. Delivery of effective patient-centric, disease-specific, culturally sensitive tobacco cessation services at an NCD clinic might efficiently reduce complications of NCDs among patients using tobacco and might further reduce morbidity and mortality attributable to NCDs in India.

Identification, functional characterization, and pharmacological profile of a serotonin type-2b receptor in the medically important insect, Rhodnius prolixus

In the Chagas disease vector, Rhodnius prolixus, two diuretic hormones act synergistically to dramatically increase fluid secretion by the Malpighian tubules (MTs) during the rapid diuresis that is initiated upon engorgement of vertebrate blood. One of these diuretic hormones is the biogenic amine, serotonin (5-hydroxytryptamine, 5-HT), which controls a variety of additional activities including cuticle plasticization, salivary gland secretion, anterior midgut absorption, cardioacceleratory activity, and myotropic activities on a number of visceral tissues. To better understand the regulatory mechanisms linked to these various physiological actions of serotonin, we have isolated and characterized a serotonin type 2b receptor in R. prolixus, Rhopr5HTR2b, which shares sequence similarity to the vertebrate serotonin type 2 receptors. Rhopr5HTR2b transcript is enriched in well-recognized physiological targets of serotonin, including the MTs, salivary glands and dorsal vessel (i.e., insect heart). Notably, Rhopr5HTR2b was not enriched in the anterior midgut where serotonin stimulates absorption and elicits myotropic control. Using a heterologous functional receptor assay, we examined Rhopr5HTR2b activation characteristics and its sensitivity to potential agonists, antagonists, and other biogenic amines. Rhopr5HTR2b is dose-dependently activated by serotonin with an EC50 in the nanomolar range. Rhopr5HTR2b is sensitive to alpha-methyl serotonin and is inhibited by a variety of serotonin receptor antagonists, including propranolol, spiperone, ketanserin, mianserin, and cyproheptadine. In contrast, the cardioacceleratory activity of serotonin revealed a unique pharmacological profile, with no significant response induced by alpha-methyl serotonin and insensitivity to ketanserin and mianserin. This distinct agonist/antagonist profile indicates that a separate serotonin receptor type may mediate cardiomodulatory effects controlled by serotonin in R. prolixus.

Study on validity of a rapid diagnostic test kit versus light microscopy for malaria diagnosis in Ahmedabad city, India

Light microscopy of blood smears for diagnosis of malaria in the field has several limitations, notably delays in diagnosis. This study in Ahmedabad in Gujarat State, India, evaluated the diagnostic performance of a rapid diagnostic test for malaria (SD Bioline Malaria Ag P.f/Pan) versus blood smear examination as the gold standard. All fever cases presenting at 13 urban health centres were subjected to rapid diagnostic testing and thick and thin blood smears. A total of 677 cases with fever were examined; 135 (20.0%) tested positive by rapid diagnostic test and 86 (12.7%) by blood smear. The sensitivity of the rapid diagnostic test for malaria was 98.8%, specificity was 91.5%, positive predictive value 63.0% and negative predictive value 99.8%. For detection of Plasmodium falciparum the sensitivity of rapid diagnostic test was 100% and specificity was 97.3%. The results show the acceptability of the rapid test as an alternative to light microscopy in the field setting.

The molecular characterization of the kinin transcript and the physiological effects of kinins in the blood-gorging insect, Rhodnius prolixus

The dramatic feeding-related activities of the Chagas' disease vector, Rhodnius prolixus are under the neurohormonal regulation of serotonin and various neuropeptides. One such family of neuropeptides, the insect kinins, possess diuretic, digestive and myotropic activities in many insects. In this study, we have cloned and examined the spatial expression of the R. prolixus kinin (Rhopr-kinin) transcript. In addition, in situ hybridization has been used to map the distribution of neurons expressing the kinin transcript. Physiological bioassays demonstrate the myostimulatory effects of selected Rhopr-kinin peptides and also illustrate the augmented responses of hindgut contractions to co-application of Rhopr-kinin and a R. prolixus diuretic hormone. Two synthetic kinin analogs have also been examined on the hindgut. These reveal interesting properties including a relatively irreversible effect on hindgut contractions and activity at very low concentrations.

Ralstonia solanacearum iron scavenging by the siderophore staphyloferrin B is controlled by PhcA, the global virulence regulator

PhcA is a transcriptional regulator that activates expression of multiple virulence genes in the plant pathogen Ralstonia solanacearum. Relative to their wild-type parents, phcA mutants overproduced iron-scavenging activity detected with chrome azurol S siderophore detection medium. Transposon mutagenesis of strain AW1-PC (phcA1) generated strain GB6, which was siderophore negative but retained weak iron-scavenging activity. The ssd gene inactivated in GB6 encodes a protein similar to group IV amino acid decarboxylases, and its transcription was repressed by iron(III) and PhcA. ssd is the terminal gene in a putative operon that also appears to encode three siderophore synthetase subunits, a integral membrane exporter, and three genes with no obvious role in siderophore production. A homologous operon was found in the genomes of Ralstonia metallidurans and Staphylococcus aureus, both of which produce the polycarboxylate siderophore staphyloferrin B. Comparison of the siderophores present in culture supernatants of R. solanacearum, R. metallidurans, and Bacillus megaterium using chemical tests, a siderophore utilization bioassay, thin-layer chromatography, and mass spectroscopy indicated that R. solanacearum produces staphyloferrin B rather than schizokinen as was reported previously. Inactivation of ssd in a wild-type AW1 background resulted in a mutant almost incapable of scavenging iron but normally virulent on tomato plants. AW1 did not produce siderophore activity when cultured in tomato xylem sap, suggesting that the main location in tomato for R. solanacearum during pathogenesis is iron replete.

Contents of minerals in green leafy vegetables cultivated in soil fortified with different chemical fertilizers

Content of selected minerals in spinach (Spinacea oleracea) and ambat chuka (Rumex vesicarius) cultivated in soil fortified with different chemical fertilizers was determined in a pot experiment. Addition of NPK (Nitrogen, Phosphorus and Potassium) fertilizer along with micronutrients, iron and zinc, enhanced the concentration of zinc, iron and magnesium in selected green leafy vegetables markedly (p < 0.05), while the concentration of copper was not altered significantly (p > 0.05). Potassium content in the green leafy vegetables was not affected (p > 0.05) by the addition of chemical fertilizers to soil. Spinach and ambat chuka differed remarkably in their mineral contents. Contents of potassium, zinc and copper were significantly high in spinach, while the contents of magnesium and iron were markedly high in ambat chuka (p < 0.05).

Physical map of a conditionally dispensable chromosome in Nectria haematococca mating population VI and location of chromosome breakpoints

Certain isolates of the plant pathogenic fungus Nectria haematococca mating population (MP) VI contain a 1.6-Mb conditionally dispensable (CD) chromosome carrying the phytoalexin detoxification genes MAK1 and PDA6-1. This chromosome is structurally unstable during sexual reproduction. As a first step in our analysis of the mechanisms underlying this chromosomal instability, hybridization between overlapping cosmid clones was used to construct a map of the MAK1 PDA6-1 chromosome. The map consists of 33 probes that are linked by 199 cosmid clones. The polymerase chain reaction and Southern analysis of N. haematococca MP VI DNA digested with infrequently cutting restriction enzymes were used to close gaps and order the hybridization-derived contigs. Hybridization to a probe extended from telomeric repeats was used to anchor the ends of the map to the actual chromosome ends. The resulting map is estimated to cover 95% of the MAK1 PDA6-1 chromosome and is composed of two ordered contigs. Thirty-eight percent of the clones in the minimal map are known to contain repeated DNA sequences. Three dispersed repeats were cloned during map construction; each is present in five to seven copies on the chromosome. The cosmid clones representing the map were probed with deleted forms of the CD chromosome and the results were integrated into the map. This allowed the identification of chromosome breakpoints and deletions.

Nht1, a transposable element cloned from a dispensable chromosome in Nectria haematococca

Certain isolates of the plant-pathogenic fungus Nectria haematococca mating population VI (MPVI) contain dispensable chromosomes that are unstable during sexual reproduction. Several of these chromosomes carry genes for phytoalexin detoxification and thus contribute to the pathogenic potential of this organism. A repeated DNA sequence, Nht1, was cloned from one of these dispensable chromosomes in N. haematococca MPVI. One copy of the repeated element (Nht1A) was completely sequenced. It is 2,198 bp long and it possesses incomplete inverted terminal repeats (ITRs) at each end. Nht1B, a partially sequenced copy of Nht1, has complete ITRs. Nht1A appears to contain 2 introns and encodes a protein of 550 amino acids that is highly similar to the protein encoded by the Fusarium oxysporum transposon, Fot1. Due to the presence of ITRs, its repeated nature, and its similarity to Fot1, we conclude that Nht1 is a transposable element. Within North American N. Haematococca MPVI populations, Nht1 is distributed discontinuously. Its copy number in different field isolates varies from zero to approximately 100 copies per genome. The Nht1A source isolate is estimated to contain nine to 11 copies of Nht1; at least six are on the chromosome from which Nht1A was cloned.