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Background: The Tobacco Industry (henceforth TI) yearns to portray itself as being "socially responsible" and fights for the decision-making positions; that are it used to deter, delay or dilute tobacco control measures. There is little documented evidence of Tobacco Industry Interference (henceforth TII) from India, the scope of their interference and challenges faced by the experts for effective tobacco control. This research study seeks to cover this significant gap in the literature on the TI of India.Methods: A cross-sectional qualitative research design, based upon in-depth interviews (N = 26), was used to explore the key stakeholders' opinions regarding TII in India. The interviews used a set of questions to collect information about the participant's roles and responsibilities in tobacco control, the nature of TII faced by the participants, means of influence by TI, barriers and challenges to tobacco control efforts.Results: Most of the respondents were engaged in tobacco control, training, advocacy and awareness generation activities for 5-10 years or more. The respondents defined the TI and its scope as per their experience with the help of the power ranking methodology. Most of them perceived TI as 'manufacturers' while others consider them as 'advertisers', 'public relation companies', 'wholesalers', 'vendors', and 'Government firms with TI stocks. The research team identified six significant domains: influencing the policy and administrative decisions, Interference in the implementation of tobacco control laws and activities, false propaganda and hiding the truth, manipulating front action groups (FAG), rampant tobacco advertising and promotion activities and others under which TII activities were classified. Most respondents believed that TI players were interfering in the policy decisions, implementing the tobacco control laws and activities and manipulating the FAG. A detailed taxonomic classification of the TII strategies that emerged from our analysis was linked to article 5.3 of FCTC.Conclusions: The study documented a significant level of TII in different domains, with stakeholders acting at various hierarchical levels. Thus providing insight into the tactics of the TI in order to enable stakeholders to anticipate and pre-empt the kinds of alliances the TI may attempt to build; stimulating academicians and researchers to undertake in-depth analysis into various strategies and therefore underscoring the need to ensuring transparency in official interaction with the TI and its representatives. [ABSTRACT FROM AUTHOR]

We conducted 3 population-based cross-sectional surveys, at 1-month intervals, to estimate the prevalence and time-trend of severe acute respiratory syndrome coronavirus 2 infection in Puducherry, India. Seropositivity rate increased from 4.9% to 34.5% over 2 months and was 20-fold higher than the number of diagnosed cases of infection. [ABSTRACT FROM AUTHOR]

Background: Settings based approach for health promotion at workplaces is surveillance of employees for CVD risk factors, which will help to estimate the prevalence of CVD risk factors and monitor CVD risks among the employees. It was planned to calculate the prevalence of CVD risk factors among group C employees of tertiary care hospital in south India. Materials and Methods: A hospital based cross-sectional survey was conducted among 324 group C employees aged ≥18 years as per the WHO "STEP wise approach to surveillance of non-communicable diseases" (STEPS) methodology. Standardized international protocols were used to measure behavioural risk characteristics (smoking, alcohol consumption, fruit and vegetable consumption, physical activity) and physical characteristics (weight, waist circumference, height and blood pressure). Multivariate analysis was done to know the factors, which carry independent risk of hypertension. Risk factor profiling of the employees was done using WHO/ISH risk prediction chart to estimate the 10 year risk of a fatal or nonfatal major cardiovascular events (myocardial infarction or stroke), according to age, gender, blood pressure, smoking status and presence or absence of self-reported status of diabetes mellitus. Data entry was done using Epi-data version 4.4.2.1. Data cleaning and analysis was done using Statistical Package of Social Sciences (SPSS) version 20. Results: Mean age in years was 34.3 (±8.26) and men contributed 79.3% of study participants. Prevalence of major cardiovascular risk factors was as follows: Current smokers 25.3% men, regular alcohol intake 29.01% between men, overweight (≥23 kg/m2) 26.4%, central obesity 16%, hypertension 13.7% and a past history of diabetes mellitus 15.6%. Almost 3/4th of the participants were following unhealthy diet and living sedentary life style. The relationship between sociodemographic factors and selected risk factors of CVD (tobacco use, alcohol use, unhealthy diet and physical activity) was found significant associated with gender, age, educational status and years of work experience. Around four percent participants had a >10% risk of developing CVD in next 10 years. Conclusion: The prevalence of CVD risk factors is high in the sample population. Employee health and wellness program must be regulated and implemented in the institute, to overcome the burden of cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Background: To compare the morbidity and treatment-seeking pattern of low birth weight (LBW) and normal birth weight (NBW) infants during the first six months. Material and Methods: A prospective cohort study was conducted in the service areas of eight urban primary health centers of Puducherry from October 2019 to July 2021. Details of LBW and sex-matched NBW infants were obtained from the birth registers of selected PHCs. Data were collected using a structured interview schedule on completion of the first, third, and sixth months at their homes. For comparison, Mid-p exact test was used for incidence rates, t-test/Mann-Whitney for continuous variables and the Chi-square/Fisher's exact test for the categorical variables. Results: Ninety-four pairs of LBWS and NBW infants were recruited. The incidence of morbidity during the first six months among LBW and NBW infants was 37.5 and 33.3 episodes per 100 child months, respectively (P value 0.118). Though the incidence of all-cause morbidity was similar, skin infections were significantly higher among LBW (3.10 vs 1.21 per 100 child months, P = 0.04). The incidence of all-cause morbidity was high in LBW infants with poor weight gain. Conclusion: Birth weight was associated with all-cause morbidity during the first three months. However, this association varied in age points and infants' weight gain. [ABSTRACT FROM AUTHOR]

Background: The ever increasing cost of care for Non Communicable Diseases has led to a profound economic impact on healthcare systems especially in Low and Middle Income (LMIC) countries like India. The documentation of total risk approach as a cost effective tool and as a treatment optimization strategy is less. Objective: To establish the optimization of treatment using WHO/ISH risk prediction charts among the newly diagnosed hypertensives during the 'Great Indian BP Survey', Puducherry. Methods: 'The Great Indian BP Survey' was conducted during September, 2015 on a single day among the adults (≥18 years) including employees, students, patients and public who visited the campus area of a tertiary care institute in Puducherry, India. A standard protocol was used to measure the blood pressure (BP) by 33 different teams. Cardiovascular disease risk assessment was done for those newly diagnosed hypertensive individuals using WHO/ISH chart without cholesterol version for South East Asian region D (SEAR-D). Results: Of the total 9906 adults screened, mean (SD) age was 35.5 (13.5) years and 5080 (51.3%) were males. Of them, 2714 (27.4%) were found to have raised BP and out of these 1539 (56.7%) became aware about their raised BP status for the first time. Of the newly diagnosed, only 6% (93/1539) had WHO/ISH risk score of >20%. Conclusion: The study shows that optimization of treatment using WHO/ISH risk prediction can be a cost-effective approach in LMIC like India. [ABSTRACT FROM AUTHOR]

Background: Diabetes registries monitor the population prevalence and incidence of diabetes, monitor diabetes control program, provide information of quality of care to health service providers, and provide a sampling frame for interventional studies. This study documents the process of establishing a prospective diabetes registry in a primary health-care setting in Puducherry. Methods: This is a facility-based prospective registry conducted in six randomly selected urban health centers in Puducherry, with enrollment of all known patients with diabetes attending chronic disease clinics. Administrative approvals were obtained from Government Health Services. Manuals for training of medical officers, health-care workers, and case report forms were developed. Diabetes registry was prepared using Epi Info software. Results: In the first phase, demographic characteristics, risk factors, complications, coexisting chronic conditions, lifestyle and medical management, and clinical outcomes were recorded. Around 2177 patients with diabetes have been registered in six Primary Health Centres out of a total of 2948 participants seeking care from chronic disease clinic. Registration coverage ranges from 61% to 105% in these centers. Conclusion: This study has documented methodological details, and learning experiences gained while developing a diabetes registry at the primary health care level and the scope for upscaling to a Management Information System for Diabetes and a State-wide Registry. Improvement in patient care through needs assessment and quality assurance in service delivery is an important theme envisioned by this registry. [ABSTRACT FROM AUTHOR]

Background: Non-communicable diseases constitute about 68% of global death annually. Among NCD deaths, cardiovascular diseases (CVD) ranks first with a share of 46.2% amounting to 17.5 million deaths. First degree relatives of patients with coronary heart disease have a higher risk of getting cardiovascular events due to interplay between genetic as well as environmental factors. The aim of this research WAS to assess the prevalence of Cardiovascular Disease (CVD) risk factors and to estimate the cardiovascular risk among first degree relatives of CAD patients. Methodology: A cross-sectional study was performed in first degree relatives of coronary artery disease patients in cardiology ward of JIPMER a tertiary care hospital in Puducherry. Overall 218 first degree relatives aged ≥18 were involved in study. The desired information was obtained using a pre-tested questionnaire and participants were also subjected to anthropometric measurements and laboratory investigations. WHO/ISH risk prediction charts for the South-East Asian region was used to assess the cardiovascular risk among the study participants according to age, gender, blood pressure, smoking status, and presence or absence of diabetes mellitus. Results: The study covered 218 adults aged above 18 years. The mean age of the subjects was 41 (± 9) years and 56% subjects were men. Around 10% of the participants had more than 10% risk for the occurrence of cardiovascular events by using WHO/ISH risk prediction charts. In addition, CVD risk factors like physical inactivity, smoking, alcohol abuse, obesity, hypertension, diabetes abnormal lipid profile were found in 22.5%, 19.2%, 16.1%, 12.4%, 33%, 29% and 13.8% study participants, respectively. Conclusion: This cross-sectional study indicates that there is a high burden of CVD risk in the first degree relatives of coronary artery disease patients as assessed by WHO/ISH risk prediction charts. Opportunistic screening programs and appropriate risk stratification based management needs to be initiated for the first degree relatives of CVD patients. [ABSTRACT FROM AUTHOR]

Background Addressing all modifiable risk factors in a composite manner, instead of treating individual risk factors is the current approach in the management of cardiovascular diseases. In patients, attending chronic disease clinic in Urban Health Centre (UHC) functioning under a tertiary care teaching hospital, this study aims to assess 10-year cardiovascular risk using ‘WHO/ISH Cardiovascular Risk Prediction Charts’ and ‘Framingham General Cardiovascular Risk Profile using lipid levels’ and compare the level of agreement between the results obtained. Methodology A retrospective record review was carried out in urban chronic disease clinic during the months of May and June 2013. Records of 280 patients attending the Urban Health Centre were screened using a structured proforma and 180 of them were included subject to selection criteria. The analysis was carried out using IBM SPSS v 21. 10-year cardiovascular risk was calculated using the joint WHO/ISH charts and the General Framingham Cardiovascular Risk Profile charts. Level of agreement between the risk scores was compared using kappa statistics. Institution ethics committee approval was obtained before starting the project. Results 81.7% of the patients were women with a median age of 58 years. Less than half of the patients (45%) had hypertension and another 37.2% had both diabetes and hypertension. 71.6% of the patients had a <10% risk for any cardiovascular event in the next 10 years by using WHO ISH Risk Prediction Charts whereas the same was found in only 30.6% by using Frahmingham Risk Profile. Conclusion Framingham Risk Profile was found to identify more patients as belonging to the higher risk category as compared to WHO/ISH charts. [ABSTRACT FROM AUTHOR]

Neighbourhood environment plays a pivotal role in determining the individual's nutrition through availability and accessibility of healthy food options. This community-based cross-sectional descriptive study examined neighbourhood spatial attributes using Geographical Information System (GIS) and describe perceived nutrition environment among adult residents in urban Puducherry, India. The density of grocery shops, fruits and vegetable shops, food outlets and restaurants were 64.4, 74.8 and 88.7 per km2, respectively. Out of 200 participants, 191 (95.5%) and 190 (95%) reported easy accessibility to fruits and vegetables shops and restaurants, respectively, while 192 (96%) agreed on availability of unhealthy food options in shops. Current study provides framework for assessment of objective and perceived neighbourhood nutrition environment in lower-middle-income countries with a user-friendly and easily administrable tool. [ABSTRACT FROM AUTHOR]

Background: Haemoglobin disorders are unique and important health challenges for tribal populations. Hence, this study was undertaken with the aim to screen for haematological disorders, particularly anaemia and haemoglobinopathies, and to assess the sociodemographic profile in indigenous communities residing in and around Puducherry. Methods: This was a community-based cross-sectional study conducted in both urban and rural areas of Puducherry district. We included 556 participants through convenient sampling. Trained research associates visited community to enrol eligible participants and sought information on sociodemographic parameters, health status, and disease profile, using a structured questionnaire; 2-3 ml of blood was collected in ethylene diamine tetra acid anticoagulant for analysis of haematology parameters. Results: Median age of participants was 28 (17-42) years. Majority (58.8%) of the participants were female, married (52.8%). On thalassemia screening, none of the study participants had any haemoglobinopathy. The burden of anaemia among the study population was 38.7% (95% CI: 34.6-42.8%) and was higher among the female participants in both adolescent (54.5%) and adult (57.8%) age groups. The next common haematological abnormality observed was eosinophilia 21.4% (95% CI: 18-25%), more prevalent among males in the age group of 30-60 years. Conclusion: More than half of the women were anaemic. Multidimensional planning and implementation are needed to improve the socio-economic profile and overall health of this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: Information on out of pocket (OOP) health care expenditure is essential for health planning and devising strategies for Universal Health Coverage (UHC). Aims and objectives: To describe morbidity profile, treatment preferences and OOP expenditure toward health care of under five children in an urban primary health center of Puducherry. Materials and Methods: A cross-sectional study was conducted in four Anganwadi centers selected randomly from a total of 13 centers in the urban service area of JIPMER, Puducherry. All mothers of under five children from selected centers were interviewed regarding sociodemographic details, treatment preferences, and expenditure incurred on illness of under five children by the family for a period of 15 days and 3 months (exclusive of past 15 days) preceding the day of interview. Results: Among the 164 children studied, 23.8% and 30% reported illnesses in the past 15 days and 3 months, respectively. Most frequent illness reported was respiratory infections. Private facilities (60%) were the preferred sources for seeking health care. Median OOP expenditure in last 15 days was Rs. 375 and Rs. 450 for the past 3 months, amounting to 8% and 6.8% of the total family income, respectively. The majority of the health care expenditure was toward drugs (71%). No money was spent toward healthcare in government facilities. Conclusion: Almost all OOP health care expenditure was incurred when the illnesses were managed by private providers. Hence, strategies can be planned to include private providers under UHC. [ABSTRACT FROM AUTHOR]

Background: The workplace is increasingly being used as a setting for health promotion and preventive health activities; not only to prevent occupational injury, but to assess and improve people's overall health. Objective: This study aims at developing and implementing a healthy workplace model in a software industry of Puducherry. Methods: Operations research was carried out in a purposively selected industry in Puducherry. The study was planned in four phases-baseline assessment and risk profiling, intervention, final evaluation and dissemination of results. Baseline evaluation of employees (n = 907) was done by a self-administered questionnaire to collect sociodemographic variables and risk factor profile using noncommunicable diseases (NCDs) LITE Proforma. Results: Healthy workplace committee comprising of several stakeholders was formed, and a formal launch of the health awareness campaign was organized. Broad themes for health education sessions and support activities were identified. Risk profiling of employees showed high levels of risk factors and morbidity-more than 15% were found to be hypertensive and around 55% were obese. Stress and back ache were reported by almost half of the respondents. Modifications in the workplace targeting physical and psychosocial work environment were suggested to the committee, as part of the initiative. This study has demonstrated the feasibility of developing and implementing a healthy workplace model in South India. This model can be replicated or adapted in other industries for health promotion and prevention of NCDs. Conclusion: Dedicated and concerted efforts of the management consistent with the requirements of safety, health and environment at work place with appropriate support from the health system can improve the quality of work and working life. [ABSTRACT FROM AUTHOR]

Childhood obesity is a burden in developed and developing countries. Overweight and obesity are caused by numerous social and environmental factors that infl fence people's food habit and physical activity. Role of primary or secondary prevention is the mainstay plan for controlling this epidemic. Various adaptable best practice models are available in the developed nations. However, further research needs to be done to examine the most effective strategies of intervention, prevention, and treatment of obesity in our setting. Through this paper, we would like to highlight best practices and potential interventions to reduce the burden of obesity in India. [ABSTRACT FROM AUTHOR]

Background: Inadequate attention to management and institutional reforms is an important barrier to achieving universal health coverage. Skilled and motivated public health managers in adequate numbers are an important requirement to overcome this hurdle. However, what are the career choices of medical students? Are they interested in Community Medicine and Public Health? To document the career choices of MBBS students and their perceptions toward Community Medicine as a career option. Methods: A cross sectional survey was carried out among 226 MBBS students (III, V and VII semesters) studying in a tertiary care teaching hospital of South India during July-October 2011. A pre-tested semi-structured questionnaire was used, and information was collected on socio-demographic variables, choice of specialty and reasons for preference. Qualitative content analysis of student feedback was done by categorization and interpretation of data in terms of common themes. Results: Of the 226 available students, 204 (90.3%) students returned the completely filled questionnaires. Of them, 101 (49.5%) were girls. The mean (standard deviation) age of the participants was 20.13 (±1.3) years. Almost all (92.1%) wanted to pursue post-graduation in India and Internal medicine was the most preferred career choice (30.9%). The qualitative responses for opinion about Community Medicine as a career choice were interpreted under two themes; those that were favorable and those not so favorable. Conclusions: There is limited preference for Community Medicine as a career choice. curriculum modification and explanation of career path after post-graduation in Community Medicine will help to generate interest in the subject. [ABSTRACT FROM AUTHOR]

Background: As a measure to reduce the out of pocket health spending in our country, the high level expert group on Universal Health Coverage recommends a National Health Package free of cost to all. Whether availability of services free of cost, will reduce out of pocket expenditure? Aim: To assess this, we studied the out of pocket health spending among the households of a Ramanathpuram, a village in Puducherry, where surplus health services are available free of cost. Settings and Design: An exploratory study was conducted in by 200 purposively selected households of Ramanathpuram, during the months of March-April 2012. Materials and Methods: Information was sought on socio-demographic details (age, gender, and income), expenditure incurred during OPD visits, follow up for chronic diseases, and hospitalization using a pretested questionnaire. Recall periods of 1 and 3 months were considered for OPD visits and hospitalizations, respectively. Results: Of the total 935 individuals from the 200 households included, 51.3% (480) were men and 455 (48.7%) were women. A total of 231 visits to health care facilities were recorded from 143 (71.5%) households, of which 153 (66.2%) were for acute illness and 68 (29.4%) for follow up of chronic diseases and 10 (4.3%) for hospitalization. The mean per visit expenditure for acute illness, chronic diseases, and hospitalization were INR72.7 ± 143.6, 135.7 ± 196.2, and 1340 ± 1192.9, respectively. Government facilities were availed for 175 (75.7%) visits. Majority of those who incurred health expenditure for acute illness (80.4%) and utilized the private sector for acute illness (78.4%) were from higher socioeconomic class (P = 0.001). Conclusion: Majority (58.1%) of the households did not incur health care expenditure. Public health care facilities were preferred (75.5%) for seeking care. Availability of services free of cost reduces out of pocket expenditure among non-hospitalized cases. [ABSTRACT FROM AUTHOR]

The article discusses the notion of essential medicines and their rational use in public health. Essential medicines satisfy the primary health care needs of a population and these are selected based on relevance to public health, efficacy and safety, and cost-effectiveness. The importance of the essential medicine list and the incorporation of which in medical care in India are tackled. The strategies to promote rational use of medicines (RUM) are detailed.

Purpose of study Alignment of curricular objectives, teaching learning activities, and assessment tasks is essential for quality learning. The present study was done to assess the coverage of different topics in theory examinations of Community Medicine for medical undergraduates, in relation to the curriculum and allotted teaching hours. Methodology Question papers of final MBBS part I examinations in Community Medicine ( n = 10), between December 2008 and May 2012, of Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, were analyzed for coverage and weightage to content areas, and compared with number of hours of theory classes ( n = 127). Results The highest coverage was for topics like general epidemiology and epidemiology of specific diseases (20% each), followed by 11% from Reproductive and Child Health (RCH) and 10% from health planning and management. Coverage in exams and the hours of teaching did not correspond for a few topics (epidemiology, RCH). Certain topics were not covered in some question papers (Occupational health, sociology, concepts in health, school health). This could be due to unequal distribution of topics in two papers (with fixed marks) leading to overrepresentation of a few areas and vice versa. As the marking pattern was changed in the last two examinations with lesser number of segments carrying more marks, certain important topics were not covered. It was also observed that only 2.8% (10 out of 351 segments) assessed the ‘reasoning’ domain of learning, while the remaining 97.2% tested recall abilities of the students. Conclusions There is a mismatch between the topics covered in the syllabus and assessment process, mainly targeting at recall level of cognitive domain. [ABSTRACT FROM AUTHOR]

Both diabetes mellitus (DM) and hypertension (HTN) have been on the rise in recent decades all over the world more remarkably in developing countries like India. We intend to measure the prevalence of DM and HTN in the Indian population and to compare the trends and various correlates of these diseases in NFHS (National Family Health Survey)-4 and 5. Data of NFHS-4 and 5 were accessed from dhs program website. All statistical analyses were done in SAS (version 9.4). Mixed effects survey logistic regression models were used for estimating odds ratio (OR).p-values <0.05 were considered significant.1,637,762 individual case entries were evaluated. Both the diseases showed an increasing trend as per the advancing age in both sexes. The highest prevalence of DM is seen in the age group of 45–49 years (7.8%) in females and > 50 years (11.9%) in males as per NFHS-5. Similarly, the highest prevalence of HTN was seen in the age group of45–49 years (31.2%) in females and > 50 years (41.4%) in males as per NFHS-5. The OR (95% CI) of prevalence of DM, HTN and both the diseases in age group >50 years was 14.46 (13.14–15.7), 16.65 (15.78–17.6), 79.5 (64.76–97.73) respectively when compared to reference age group15-19 years. Highest odds for having both DM, HTN concurrently was in age >50 years with aOR(95% CI) 65.32 (52.26–72.63) in NFHS 4 and 35.57 (97.47–45.53) in NFHS 5.Rise in prevalence of DM, HTN and concurrent presence is noted with an apparent increase in cases. [ABSTRACT FROM AUTHOR]

Background: In India, around 10% of mothers with gestational diabetes mellitus (GDM) develop diabetes within months after delivery. But only 29% of them undergo blood glucose testing in the postnatal period. Our study aimed to compare the proportion of mothers with GDM who got postnatal blood glucose checked at 8 weeks among mothers who received health education booklets and mobile reminders. Methods: We conducted a randomised controlled trial among 165 mothers with GDM receiving care from a tertiary health centre between January 2020 and June 2021. Mothers with GDM in the intervention 1 arm received a health education booklet in the third trimester, those in intervention 2 arm received mobile call reminders at the fourth and fifth weeks postpartum, control arm received standard care advised in the hospital; they were followed up at 8 weeks postnatally. We used Chi-square test to compare the effectiveness of intervention and standard care. Relative risk with a 95% confidence interval was calculated to measure the strength of association. A P value <0.05 was considered statistically significant. Results: A total of 161 participants (97.58%) completed the study; Out of 55 mothers with GDM in each arm, 30 (56.60%) in the booklet arm, 23 (42.59%) in the mobile reminder arm, and 13 (24.07%) in the standard care arm had undergone postnatal blood glucose monitoring at 8 weeks. There was a statistically significant difference in the postnatal blood glucose monitoring in the booklet arm (RR: 2.21 [1.35-3.64], P value <0.002) compared to the control arm, but the difference was not significant in the mobile reminder arm (1.65 [0.96-2.86], P value 0.072). Conclusion: Health education booklet and mobile call reminders effectively improved postnatal visit compliance compared to standard care. We can diagnose mothers with GDM progressing to diabetes in the postnatal period by implementing these interventions. [ABSTRACT FROM AUTHOR]

Background: Tobacco use in any form has increased throughout the world. Total tobacco related deaths are projected to rise from 5.4 million in 2004 to 8.3 million in 2030 globally. In India, eight to 10 lakh people die due to tobacco related disease every year. The Global adult tobacco survey (GATS) in India in 2009-2010 revealed that 163.7 million use the smokeless form, 68.9 million smoke, 42.3 million use both smoking and smokeless form of tobacco. Aim and Objective: To find the prevalence, reasons for initiation, willingness to quit tobacco among adults (⩾ 20 years) in Ramanathpuram village of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) rural health centre service area. Materials and Methods: A cross sectional survey was carried out among adults >20 years (n = 315) in one of the four villages of rural field practice area of the JIPMER, Pondicherry. Considering prevalence of tobacco use as 25%, with 20% relative precision, sample size was calculated to be 300. Interns trained in interview techniques collected information using a structured questionnaire after taking informed consent. Data were collected on demographic parameters, current tobacco use, age at initiation, reasons for initiation, harmful effects of tobacco, sources of information and the willingness to quit. Result: Among the 315 people studied, 51.42% were males. Seventy-nine of them (20.6-30.1) used tobacco in any form. The proportion of females exceeded males in the use of smokeless tobacco. The age of initiation of smoking was found to be 22.6 ± 5.7 years, earlier than that for the smokeless form 27.5 ± 12.2 years (P = 0.032). The majority (50.6%) initiated tobacco use due to peer pressure, followed by influence of their family members (30.3%) and stress (17.7%). Although awareness about the harmful effects of tobacco was found in 64% (58.3-68.9) of the subjects, only 21.9% (13.06-32.2) of the tobacco users were willing to quit. Conclusion: About one-fourth of the study population used tobacco but only about one fifth of the users were willing to quit. Hence, targeted awareness activities will be needed for those unwilling to quit tobacco use. [ABSTRACT FROM AUTHOR]

Background: In an individual, the development and severity of Non-Communicable Diseases (NCDs) are determined by the presence or absence of clustering of NCD risk factors in them. We aimed to determine the prevalence and the factors associated with clustering of risk factors of NCDs in the district of Puducherry in India. Methodology: We conducted a community-based cross-sectional survey among the adult population (18–69 years) of Puducherry district (N = 1114) between February 2019 and February 2020. Ten risk factors of NCDs (behavioral, physical measurements and biochemical) were assessed. Individuals having ≥ 3 risk factors were regarded as having clustering of risk factors. Categorical variables are summarized using proportions (95% CI). Adjusted prevalence ratio was estimated using weighted forward stepwise generalized linear modelling. Results: Clustering of NCD risk factors was present in majority (95.2%, 95% CI: 93.8–96.3) of the population. The presence of clustering was significantly higher among women (97.1%, 95% CI: 95.9–98.3) and the urban population (97.2%, 95% CI: 96.1–98.3). The risk factors that primarily drove the high prevalence of clustering were raised salt intake and inadequate intake for fruits and vegetables in nine out of 10 people in the district. Nearly 1 in 10 (13.3%, 95% CI: 11.3–15.3), 1 in 5 (21.5%, 95% CI: 19.1–23.8) and 1 in 4 (26.8%, 95% CI: 24.1–29.4) participants had three, four and five risk factors, respectively. Conclusion: We highlight the urgent need for population-based health promotion interventions in the district of Puducherry targeting the highly prevalent NCD risk factors, especially among the women and urban populations. [ABSTRACT FROM AUTHOR]

Background Microalbuminuria is an early indicator for renal and cardiovascular diseases, especially among patients with diabetes mellitus (DM) and hypertension (HTN). We determined the prevalence and the factors associated with microalbuminuria among patients with type 2 DM and/or HTN in the urban areas of the Puducherry district in India. Methods We included 225 patients aged 40–69 years with DM and/or HTN from a non-communicable diseases (NCDs) survey conducted during 2019–2020 in the urban areas of Puducherry district. The prevalence of microalbuminuria and various biological risk factors of NCDs were assessed as per the WHO STEPS methodology. The prevalence of microalbuminuria was presented as proportions (95% CI), and the adjusted prevalence ratio (aPR) was estimated using weighted forward stepwise generalized linear modelling. P -value ≤0.05 was considered statistically significant. Results The mean (SD) age of the patients was 54 (11) years. Over one-third (38.2%) (95% CI: 31.6–44.4) of patients with DM and/or HTN had microalbuminuria. The prevalence was highest among those having both DM and HTN 48% (95% CI: 37–59), followed by those having only DM 40.6% (95% CI: 29–52.2) and only HTN 27.7% (95% CI: 18.1–38.6). The prevalence of microalbuminuria was twice (aPR = 2.1, 95% CI: 1.1–3.9) higher among women and 2.4 times (95% CI: 1.12–5.1) higher among those having both DM and HTN as compared to those with only HTN. Conclusion The prevalence of microalbuminuria among patients with DM and/or HTN is concerningly high. Population-based screening for microalbuminuria, especially among women and those having both DM and HTN, needs to be undertaken in the urban areas of Puducherry district. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of maternal near‐miss on late maternal death and the prevalence of hypertension or chronic kidney disease (CKD) and mental health problems at 12 months of follow up. Methods: This prospective cohort study was conducted in a tertiary hospital in the southeastern region of India from May 2018 to August 2019, enrolling those with maternal near‐miss and with follow up for 12 months. The primary outcomes were incidence of late maternal deaths and prevalence of hypertension and CKD during follow up. Results: Incidence of maternal near miss was 6.7 per 1000 live births. Among those who had a near miss, late maternal deaths occurred in 7.2% (95% confidence interval [CI] 3.1%–11.3%); prevalence of CKD was 23.0% (95% CI 16.2%–29.8%), and of hypertension was 56.2% (95% CI 50.5%–66.5%) and only two women had depression on follow up. After adjusting for age, parity, socioeconomic status, gestational age at delivery, hemoglobin levels, and perinatal loss, only serum creatinine was independently associated with late maternal death and CKD on follow up. Conclusions: Women who survive a life‐threatening complication during pregnancy and childbirth are at increased risk of mortality and one or more long‐term sequelae contributing to the non‐communicable disease burden. A policy shift to increase postpartum follow‐up duration, following a high‐risk targeted approach after a near‐miss event, is needed. Synopsis: Women who survive life‐threatening complications during pregnancy and childbirth remain at increased risk of mortality and developing long‐term sequelae, contributing to their non‐communicable disease burden. [ABSTRACT FROM AUTHOR]

In the present cross-sectional study, the researchers aimed to assess the contraceptive knowledge, practice, and associated factors among 2228 women in Puducherry, India. National Family Health Survey questionnaire was adopted for data collection and about 1924 women participated. Current use of any contraceptive was 78.6% and female sterilization was 62%. The majority (99.8%) knew female sterilization, but below average for other contraceptive methods. About 10.4% were aware of more than three contraceptive methods. Age group, homemaker, with children or one son, aware of less than three methods, residing nearby to health facility were associated with the higher practice of contraceptive methods. [ABSTRACT FROM AUTHOR]

Cost effectiveness analysis of interim positron emission tomography (PET-2, done after 2 cycles of chemotherapy) based response adaptive therapy (RAT) approaches in advanced Hodgkin lymphoma (aHL) are not available from an Indian perspective. We used a five-year decision analytics model to assess the cost-effectiveness of the two RAT approaches [(escalation (RAT-1) or de-escalation (RAT-2)] compared with standard care (SOC) in aHL (mean age:35 years). Modelling data was derived from secondary sources and sensitivity analyses were performed to assess the robustness of the model. Net monetary benefit (NMB) gained from RAT2 in Indian rupees (INR) (INR 2,26,896) was higher than the RAT1 (INR 1,83,138) when compared with SOC. Proportion achieving the complete response after initial treatment (CR1) was the key determining factor for the RAT1/2 dominance over SOC. Despite higher initial input costs, response-adapted therapy of aHL was cost-effective by minimizing the cost incurred and disutility experienced during relapse and salvage. Despite higher initial costs, response-adapted therapy based on the interim PET scan after 2 cycles of chemotherapy was more cost-effective when compared to standard therapy with 6 cycles of ABVD in patients with advanced Hodgkin's lymphoma. Among the RAT approaches, de-escalation (RAT-2) had better cost-effectiveness than the escalation approach (RAT-1). [ABSTRACT FROM AUTHOR]

Repeated serological testing tells about the change in the overall infection in a community. This study aimed to evaluate changes in antibody prevalence and kinetics in a closed cohort over six months in different sub-populations in India. The study included 10,000 participants from rural and urban areas in five states and measured SARS-CoV-2 antibodies in serum in three follow-up rounds. The overall seroprevalence increased from 73.9% in round one to 90.7% in round two and 92.9% in round three. Among seropositive rural participants in round one, 98.2% remained positive in round two, and this percentage remained stable in urban and tribal areas in round three. The results showed high antibody prevalence that increased over time and was not different based on area, age group, or sex. Vaccinated individuals had higher antibody prevalence, and nearly all participants had antibody positivity for up to six months. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the use of same-day sputum microscopy for the diagnosis of tuberculosis (TB).

Context: Diabetes self-management education plays a critical role in improving patients' clinical outcome and quality of life. Aims: This study aims to study the effectiveness of a structured diabetes educational program on improvement of self-care behavior among type 2 diabetics in urban Primary Health Centres (PHCs) of Puducherry. Settings and Design: A community-based open-label parallel-arm randomized controlled trial was conducted in two randomly selected urban PHCs of Puducherry during December 2015-February 2017. Subjects and Methods: Using systematic random sampling, 157 eligible participants were recruited in intervention and control PHCs each. Sociodemographic, disease characteristics, and anthropometric measures were captured using a pretested questionnaire at baseline. Self-care behavior was recorded with Summary of Diabetes Self-Care Activities scale. Intervention consisted of structured diabetes education sessions with distribution of information leaflets and self-care kits to the intervention-arm participants, while control arm received standard care. At the end of 6 months, endline assessment was done for both groups. Data were analyzed by intention-to-treat, per-protocol, and difference-in-difference analysis using STATA. Results: Footcare increased significantly by 1.95 days/week compared to control arm, while a moderate change of 0.49 days/week in diet compliance and a minimal change of 0.10 days/ week in physical activity were observed. Medication adherence, regular blood sugar testing, and smoking behavior also showed improvement in intervention arm. Conclusions: A structured education program that is culturally tailored showed an overall improvement in self-care behavior. This research supports the need for structured education program for diabetics to empower them and improve self-care practices. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which describes the issues and challenges of sustainable behavior change related to the environmental sanitation in India.

The article reports on the results of a study regarding the prevalence of cardiovascular diseases in an urban area of Chandigarh City in India. According to it, the prevalence rate of physician-diagnosed self-reported hypertension in the study population was 32.3% while that for self-reported heart disease was 10.8%.

Introduction: The World Health Organization (WHO) has released the updated cardiovascular disease (CVD) risk prediction charts in 2019 for each of the 21 Global Burden of Disease regions. The WHO advocates countries to implement population-based CVD risk assessment and management using these updated charts for preventing and controlling CVDs. Objective: To assess the cost-effectiveness of implementing risk-based CVD management using updated WHO CVD risk prediction charts in India Methods: We developed a decision tree combined with Markov Model to simulate implementing two community-based CVD risk screening strategies (interventions) compared with the current no-screening scenario. In the first strategy, the whole population is initially screened using the WHO non-lab-based CVD risk assessment method, and those with ≥10% CVD risk are subjected to WHO lab-based CVD risk assessment (two-stage screening). In the second strategy, the whole population is subjected only to the lab-based CVD risk assessment (single-stage screening). A mathematical cohort of those aged ≥40 years with no history of CVD events was simulated over a lifetime horizon with three months of cycle length. Data for the model were derived from a primary study and secondary sources. Incremental cost-effectiveness ratios (ICERs) were determined for the screening strategies and sensitivity analyses. Results: The discounted Incremental cost-effectiveness ratio per QALY gained for both the two-stage (US$ 105; ₹ 8,656) and single-stage (US$ 1073; ₹ 88,588) screening strategies were cost-effective at an implementation effect of 40% when compared with no screening scenario. Implementing CVD screening strategies are estimated to cause substantial reduction in the number of CVD events in the population compared to the no screening scenario. Conclusion: In India, both CVD screening strategies would be cost-effective, and implementing the two-staged screening would be more cost-effective. Our findings support implementing population-based CVD screening in India. Future studies shall assess the budget impact of these strategies at different implementation coverage levels. [ABSTRACT FROM AUTHOR]

Background Abdominal obesities are better markers for predicting cardiovascular abnormalities than risk stratification based only on body mass index (BMI). We aimed to estimate the prevalence of abdominal adiposities using predictive equations for Asian Indian adults and to determine the prevalence of metabolically healthy subjects among those overweight/obese and with normal BMI. Methods A community-based survey was conducted among those aged 18–69 years in the district of Puducherry between February 2019 and February 2020. We surveyed 2,560 individuals selected through multi-stage cluster random sampling from urban and rural areas (50 wards and 50 villages, respectively) of the district. Anthropometric measurements, such as height, weight, waist circumference, and blood pressure were recorded from each participant. Fasting blood sample was collected from each alternate participant to estimate metabolic risk factors. Results Over four-fifths (85.6%; 95% CI: 84.2–86.9) and two-thirds (69.7%; 95% CI: 67.9–71.6) of the population in the district had high levels of intra-abdominal adipose tissue (IAAT) and total abdominal fat (TAF), respectively. Both the risk factors were significantly higher among women and urban population. About 43% (95% CI: 41–44.9) of the population had high abdominal subcutaneous adipose tissue (SCAT) with a significantly higher prevalence among the urban population. Among those overweight/obese (n  = 773), almost all 99.4% (95% CI: 98.7–99.9) were metabolically unhealthy. Among subjects with normal BMI (n  = 314), only about 2.9% (95% CI: 1.3–4.8) were metabolically healthy. Conclusion We highlight the substantially high prevalence of IAAT, TAF, and SCAT in the district of Puducherry. Almost all the study population was metabolically unhealthy irrespective of their BMI levels. [ABSTRACT FROM AUTHOR]

Objectives: The study was aimed to capture the effect of using injection pads as a tool in educating the diabetic patients who were on insulin. The attitude and practice of the patients in storage of insulin vials and disposal of insulin syringes were also assessed. Materials and Methods: A facility based Quasi-experimental study was carried out among the diabetic patients on insulin, attending diabetic clinic in endocrinology OPD in a tertiary care hospital, Puducherry. One to one intervention was given to the study participants or their attendants (who were involved in injecting insulin), by a trained investigator regarding all the steps of insulin administration. The insulin administration practices before and immediately after the intervention was assessed using a checklist. Results: In total 91 patients were included for the study with mean (SD) age of 53.9 (10.6) years and of them 76% were females. The attitude and practices of the study participants, such as hand washing before handling insulin, checking the expiry date, storage of insulin, inspection of injection site, rolling and cleaning the vial, withdrawal of the syringe up to the required dose, pushing the plunger after inserting the syringe into the vial, checking and removal of air bubbles, cleaning the injection site and allow to dry and injection technique improved significantly after the intervention (P < 0.05). Conclusion: This study findings shows that using injection pads for educating patients helps them to practise better insulin administration. The findings from the study can be applied in routine care and has to be explored further in diabetic patient management. [ABSTRACT FROM AUTHOR]

Introduction: Janani Suraksha Yojana (JSY) direct benefit transfer scheme was launched in the year 2013 in India and there is a paucity of information affecting it. The study aimed to assess the proportion of eligible beneficiaries utilizing JSY direct cash benefit transfer in Puducherry and to identify its barriers and facilitating factors. Methods: This cross sectional study was conducted from January to March 2015 among 152 eligible JSY beneficiaries residing in rural and urban field practice areas of a tertiary care institution in Puducherry, India. Data were collected using a pretested semi structured questionnaire and presented as proportion or percentages. Results: About 144 beneficiaries participated in the study with a response rate of 94.7%. About 46% (66) of them availed cash transfer benefit. The mean time of receiving the benefit is 95.8 days (interquartile range 60-120 days). Among those who have not received (78), about 49 (62.8%) had not applied and 29 (37.18%) filled applications were rejected due to various reasons. About 77.1% (111) of beneficiaries were informed about JSY scheme through health workers. About 52.1% (75/144) still preferred direct bank transfer through the bank. The reasons for not availing benefits includes not having a bank account (24.3%), followed by not having Aadhaar number (9.7%), 11.8% had no ration card, and 13.8% stayed in their mother house. Conclusion: Majority of the beneficiaries did not receive direct cash transfer benefits in urban area than rural area and there is a need to simplify the procedures to improve the uptake of services to this group. [ABSTRACT FROM AUTHOR]

Background & objectives: The World Health Organization (WHO) document released on the World No Tobacco Day, 2020, mentions that tobacco kills over 22,000 people worldwide every day either from its use or second-hand smoke exposure, which is one person every 4 sec. In 2003, the Cigarettes and Other Tobacco Products Act (COTPA) was enacted by the Indian government to control/regulate use of tobacco and tobacco products. Despite various amendments to this law, there has not been any appreciable decrease in tobacco use. The objective of this study was to assess the compliance level with sections 4-10 of COTPA in urban Puducherry in South India. Methods: Random sample survey of 13 wards was carried out in selected parts of the city of Puducherry. The estimated sample size was minimum 160 public places and point of sales (PoS) each. A pre-tested checklist was used to obtain information on compliance with COTPA. Statistical and spatial analysis was performed using STATA v12.0 and QGIS v2.14.21, respectively. Results: Eight per cent of public places, 0 per cent of PoS, 1.7 per cent of educational institutions and 48 per cent of tobacco packages were found compliant with COTPA specifications. The compliance in public places varied from 0 (bus stops) to 55 per cent (religious places). Interpretation & conclusions: The overall compliance with COTPA was found to be very low in urban Puducherry. In order to ensure proper implementation of the laws, effective enforcement with periodic monitoring of various sections of COTPA are needed. [ABSTRACT FROM AUTHOR]

Background: In the ongoing COVID-19 pandemic, an increased incidence of ROCM was noted in India among those infected with COVID. We determined risk factors for rhino-orbito-cerebral mucormycosis (ROCM) post Coronavirus disease 2019 (COVID-19) among those never and ever hospitalized for COVID-19 separately through a multicentric, hospital-based, unmatched case-control study across India. Methods: We defined cases and controls as those with and without post-COVID ROCM, respectively. We compared their socio-demographics, co-morbidities, steroid use, glycaemic status, and practices. We calculated crude and adjusted odds ratio (AOR) with 95% confidence intervals (CI) through logistic regression. The covariates with a p-value for crude OR of less than 0·20 were considered for the regression model. Results: Among hospitalised, we recruited 267 cases and 256 controls and 116 cases and 231 controls among never hospitalised. Risk factors (AOR; 95% CI) for post-COVID ROCM among the hospitalised were age 45–59 years (2·1; 1·4 to 3·1), having diabetes mellitus (4·9; 3·4 to 7·1), elevated plasma glucose (6·4; 2·4 to 17·2), steroid use (3·2; 2 to 5·2) and frequent nasal washing (4·8; 1·4 to 17). Among those never hospitalised, age ≥ 60 years (6·6; 3·3 to 13·3), having diabetes mellitus (6·7; 3·8 to 11·6), elevated plasma glucose (13·7; 2·2 to 84), steroid use (9·8; 5·8 to 16·6), and cloth facemask use (2·6; 1·5 to 4·5) were associated with increased risk of post-COVID ROCM. Conclusions: Hyperglycemia, irrespective of having diabetes mellitus and steroid use, was associated with an increased risk of ROCM independent of COVID-19 hospitalisation. Rational steroid usage and glucose monitoring may reduce the risk of post-COVID. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to develop the Indian 5-level version EQ-5D (EQ-5D-5L) value set, which is a key input in health technology assessment for resource allocation in healthcare.Methods: A cross-sectional survey using the EuroQol Group's Valuation Technology was undertaken in a representative sample of 3548 adult respondents, selected from 5 different states of India using a multistage stratified random sampling technique. The participants were interviewed using a computer-assisted personal interviewing technique. This study adopted a novel extended EuroQol Group's Valuation Technology design that included 18 blocks of 10 composite time trade-off (c-TTO) tasks, comprising 150 unique health states, and 36 blocks of 7 discrete choice experiment (DCE) tasks, comprising 252 DCE pairs. Different models were explored for their predictive performance. Hybrid modeling approach using both c-TTO and DCE data was used to estimate the value set.Results: A total of 2409 interviews were included in the analysis. The hybrid heteroscedastic model with censoring at -1 combining c-TTO and DCE data yielded the most consistent results and was used for the generation of the value set. The predicted values for all 3125 health states ranged from -0.923 to 1. The preference values were most affected by the pain/discomfort dimension.Conclusions: This is the largest EQ-5D-5L valuation study conducted so far in the world. The Indian EQ-5D-5L value set will promote the effective conduct of health technology assessment studies in India, thereby generating credible evidence for efficient resource use in healthcare. [ABSTRACT FROM AUTHOR]

This study aimed at assessing the vaccine effectiveness (VE) of Covishield, which is identical to AstraZeneca vaccine, in preventing laboratory-confirmed Covid-19. Using test-negative case-control design, information on vaccination status of cases with Covid-19 among healthcare workers in our institution in Puducherry, India, and an equal number of controls matched for age and date of testing, was obtained. The groups were compared using multivariable conditional logistic regression to calculate odds ratios (OR). VE was calculated as 100*(1–adjusted odds ratio)%. Using data from 360 case-control pairs, VE of one dose and of two doses, in providing protection against Covid-19 was 49% (95% CI: 17%-68%) and 54% (27%-71%), respectively. Among cases with moderately severe disease that required oxygen therapy, VE following any number of vaccine doses was 95% (44%-100%). Covishield vaccine protected significantly against Covid-19, with a higher protection rate against severe forms of disease. [ABSTRACT FROM AUTHOR]

Aim: To Study the Factors affecting compliance to diabetes management and study risk factors and complications of type II diabetes. Settings and Design: Primary health center, Descriptive study. Materials and Methods: A descriptive study of previously diagnosed diabetics (n = 135) attending the chronic disease clinic of Urban Health Center, Jawaharlal Institute of Postgraduate Medical Education and Research (JIUHC) was carried out during October 2011 to December 2011. Data were collected by personal interview on demographic parameters, duration of diabetes, number of doses missed in the last 15 days, co-morbidities, knowledge and practice of dietary modification, physical activity, self-care, family support, awareness about risk factors and complications of diabetes. Statistical Analysis Used: The findings were expressed in terms of proportions. Chi-square test was used to study the association between socio-demographic factors and compliance. Results: Majority of patients were in the age group of 50-59, of which 80% were females. Compliance (defined as not missing more than two doses in the last 15 days) to oral hypoglycemic agents was found in 103 (76%; 68.5-82.9). Dietary modifications was practiced by 110 (81.4%; 74.2-87.3) and 37% (29.2-45.4) practice physical activity. Annual eye check-up was carried out by 43.7%, renal function test by 46.6% and foot care by 54%. Knowledge regarding risk factors (66%; 42.7-59.4) and complications (79%; 71.8-85.4) was comparatively better than knowledge about self-care. Conclusions: Three-fourth of patients were compliant to medications and diet, but less than half follows modifications in physical activity and other self-care practices. Hence, it is essential to educate and motivate people in primary health-care level about self-care and life-style modifications. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association of maternal serum biomarkers of myocardial damage, oxidative stress and angiogenic imbalance with maternal adverse outcomes in women with severe pre-eclampsia.Methods: This was a prospective cohort study, where maternal serum biomarkers were evaluated in women admitted with severe pre-eclampsia to a tertiary care centre between March 2019 and February 2020. Serum markers included brain naturetic peptide (BNP), cardiac troponin-T (cTnT), cystatin-C (cys-C), soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), Total Anti-Oxidant status (TAO) and malondialdehyde (MAO). Main outcome measures were adverse maternal outcomes defined as eclampsia, pulmonary oedema, acute kidney injury, placental abruption and HELLP syndrome.Results: Adverse maternal outcomes occurred in 93(37.2%, 95% CI: 31.2%-43.6%) of the 250 women with severe pre-eclampsia included in the study, including 21 with pulmonary oedema, 25 with acute kidney injury and 36 with eclampsia. BNP levels were higher among women who developed pulmonary oedema (55.4 pg/mL vs 42.0 pg/mL, p = 0.008). TAO levels were higher in women who developed eclampsia (4.6 mM, IQR 3.1-5.7, p < 0.001) and acute kidney injury (4.1 mM, IQR 3.2-6.3, p = 0.002) compared to those who did not develop any complications (2.93 mM, IQR 2.3-4.1).Conclusions: Even though the endothelial dysfunction and oxidative stress biomarkers were associated with development of preeclampsia, it may have limited utility in identifying women who might develop adverse outcomes. [ABSTRACT FROM AUTHOR]

Background: Keeping in view of rapid industrialization and growing Indian economy, there has been a substantial increase in the workforce in India. Currently there is no organized workplace model for promoting health of industrial workers in India. Objective: To develop and implement a healthy workplace model in three industrial settings of North India. Materials and Methods: An operations research was conducted for 12 months in purposively selected three industries of Chandigarh. In phase I, a multi-stakeholder workshop was conducted to finalize the components and tools for the healthy workplace model. NCD risk factors were assessed in 947 employees in these three industries. In phase II, the healthy workplace model was implemented on pilot basis for a period of 12 months in these three industries to finalize the model. Findings: Healthy workplace committee with involvement of representatives of management, labor union and research organization was formed in three industries. Various tools like comprehensive and rapid healthy workplace assessment forms, NCD work-lite format for risk factors surveillance and monitoring and evaluation format were developed. The prevalence of tobacco use, ever alcoholics was found to be 17.8% and 47%, respectively. Around one-third (28%) of employees complained of back pain in the past 12 months. Healthy workplace model with focus on three key components (physical environment, psychosocial work environment, and promoting healthy habits) was developed, implemented on pilot basis, and finalized based on experience in participating industries. A stepwise approach for model with a core, expanded, and optional components were also suggested. An accreditation system is also required for promoting healthy workplace program. Conclusion: Integrated healthy workplace model is feasible, could be implemented in industrial setting in northern India and needs to be pilot tested in other parts of the country. [ABSTRACT FROM AUTHOR]

Objective: To assess the incidence of postpartum depression (PPD) and its risk factors in women with potentially life‐threatening complications. Methods: Eight hundred and ninety women admitted to a tertiary center in South India with potentially life‐threatening complications were recruited for the study. Within seven days of delivery, women underwent mental health assessments using the EPDS and PHQ‐9 scale. Counseling was provided and follow‐up assessment carried out at 3 months postpartum. Bivariate and multivariate analysis was done to assess the association of risk factors to depression. Results: PPD was observed in 21% of the study cohort. Women with no formal education (OR −2.66, 95% CI: 1.10– 6.40) and those who had a stillbirth (OR 2.48, 95%CI: 1.57–3.93) were found to be associated with PPD after adjusting for other factors. Occurrence of an obstetric near‐miss event did not increase the risk of depression. Most women recovered with postnatal counseling, with only three requiring medication at the end of 3 months. Conclusion: One in five women who develop potentially life‐threatening complications developed PPD. A strategy of screening focused on this high‐risk group, especially in low resource settings, can lead to early recognition and treatment. This in turn can lead to a reduction in the long‐term morbidity associated with PPD. Synopsis: Screening for postpartum depression among women who develop potentially life‐threatening complications during pregnancy and postpartum can be an effective strategy, especially in low resource settings. [ABSTRACT FROM AUTHOR]

Background: Information is paucity about the extent of contraception practise among the unmet need eligible couples after counselling.Objective: To assess the prevalence and associated factors of unmet need for family planning (FP), the extent to which they practise desired contraception methods after baseline counselling and the reasons for not practicing it.Methods: A community-based cross-sectional analytical study was conducted between 2016 and 2019 among 2228 currently married couples with periodic follow ups of unmet need group. Baseline data on unmet need were collected based on the National Family Health Survey questionnaire. Individual and couple counselling were performed through informing choice and the support for decision making was based on the unmet need reasons with follow-ups. The data were analysed using Stata software version 12.0 (StataCorp, College Station, TX).Results: The total study population was 1924. The prevalence of unmet need for FP was 7.1% (137) with 2.9% (55) of unmet need for spacing and 4.3% (82) of limiting births. Age groups between 18 and 24 [adjusted odds ratio (AOR) = 4.463], 25-29 (AOR = 2.339), not having a child (AOR = 0.250), having one child (AOR = 2.369) and having lower socioeconomic status (AOR = 0.155) were significantly associated with unmet need. During the follow-ups, 37.2% (29/78) received who desired limiting births, while 43.6% (34/78) changed to spacing methods. In fact, the main reason for not adopting limiting births is the fear of post-operative surgery-related health problems.Conclusions: This study emphasizes the need for follow-up counselling for guiding contraceptive use and recorded that majority of the unmet need couples started practicing contraception methods during the follow-ups. Besides, change in desired contraception methods was observed. [ABSTRACT FROM AUTHOR]

Background: The problem of type 2 diabetes mellitus and its complications are threateningly increasing in the existing health scenario. The awareness and perception about risk of developing complications and role of self-care practices for glycemic control are very important. This study aimed to develop and validate an educational tool for improving perception about risk of getting complications among patients with diabetes mellitus. Methodology: This mixed method study was conducted in a tertiary hospital. Known risk factors of diabetic complications were identified from literature and drafted based on their strength of association. A panel of eight experts from different departments was constituted to evaluate the risk factors, and the tool was finalised after three rounds using Delphi technique. Content and construct validity of the developed tool were also assessed by the panel. A pilot study among 50 patients with diabetes mellitus was done to assess the effectiveness of the tool. Results: The DiREcT tool developed had 11 risk factors of diabetic complications, each categorised into low, moderate and high risk. On baseline risk assessment, 60% of the participants were in high-risk category for glycemic control. Patient's perception about risk of developing complications increased from 26 to 60% by using the tool. More than 80% of the participants reported that the tool is simple and easy to understand. Conclusion: The DiREcT tool was effective in changing perception of developing complications among patients with diabetes mellitus. It can be used by the healthcare provider at the primary healthcare level for both educating and monitoring of patients with high risk. [ABSTRACT FROM AUTHOR]

Objectives To assess acceptability of teleconsultation among the socioeconomically marginalized sections of patients with rheumatic and musculoskeletal diseases (RMDs), to identify the socioeconomic barriers in continuing rheumatology care during the COVID-19 crisis and to identify patients who could benefit by shifting to tele-rheumatology consultations. Methods This was a cross sectional analytical study done at a tertiary care teaching hospital in India including patients with RMDs who were not on biological diseases modifying agents. Assessment of disease status, socioeconomic status and economic impact of COVID-19 was done via tele-consultation. Results Out of the 680 patients satisfying inclusion criteria, 373 completed the study. The format was found easy by 334 (89.6%) of them and 284 (76.1%) considered tele-rheumatology better than in-person consultation. During the pre-COVID months, the median monthly per capita income of the families of our patients and cost of illness was Indian rupees (INR) 2000 (US$ 26) and INR 1685 (US$ 21.91), respectively. Families whose financial needs were met (OR = 0.38, 95% CI: 0.239, 0.598) or those with schooling upto at least secondary school (OR = 0.442, 95% CI: 0.260, 0.752) (P  =0.002) were less likely to stop prescription drugs. In a hypothetical model, 289 (77.4%) could be successfully switched to tele-rheumatology follow-up. Conclusion The acceptability of tele-rheumatology among socioeconomically marginalized patients with RMDs is good. During times of crisis, patients from poorer strata of society and lower educational background are likely to abruptly stop medications. Switching to a telemedicine-based hybrid model is likely to improve drug adherence with substantial savings on loss of pay and out of pocket expenditure. [ABSTRACT FROM AUTHOR]

Introduction: Rapid urbanization and industrialization drives the rising burden of Non-Communicable Diseases (NCDs) worldwide that are characterized by uptake of unhealthy lifestyle such as tobacco and alcohol use, physical inactivity and unhealthy diet. In India, the prevalence of various NCDs and its risk factors shows wide variations across geographic regions necessitating region-specific evidence for population-based prevention and control of NCDs. Objective: To estimate the prevalence of behavioral and biological risk factors of NCDs among adult population (18–69 years) in the Puducherry district located in Southern part of India. Methodology: We surveyed adults using the World Health Organization (WHO) prescribed STEPwise approach to NCD surveillance (STEPS) during February 2019 to February 2020. A total of 2560 individuals were selected from urban and rural areas (50 clusters in each) through multi-stage cluster random sampling method. STEPS instrument was used to assess behavioral and physical measurements. Fasting blood sample was collected to estimate biochemical risk factors (Diabetes, Hypercholesterolemia) of NCDs. Results: Among men, alcohol use 40.4% (95% CI: 37.4–43.4) was almost twice higher compared to tobacco use 24.4% (95% CI: 21.7–26.9). Nearly half of the population was physically inactive 45.8% (95% CI: 43.8–47.8) and obese 46.1% (95% CI: 44–48.1). Hypertension and diabetes mellitus were present among one-third 33.6% (95% CI: 31.6–35.5) and one-fourth 26.7% (95% CI: 24.1–29.1) of the population which were significantly higher among men (37.1% vs 30.8% and 31.6% vs 23.2% respectively). Physical inactivity and overweight/obesity increased with increasing education levels. Tobacco and alcohol use was more common among men, whereas physical inactivity with obesity and hypercholesterolemia was higher among women. Conclusion: We found high prevalence of various NCDs and its risk factors among the adult population of Puducherry district. [ABSTRACT FROM AUTHOR]