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Background: Population aging is an emerging global trend. Because of decreasing fertility rates and improved healthcare, the lifespan of elderly population increased. Consequently, proportion of elderly population is increasing at an alarming rate. This is accompanied by an increased recognition of the occurrence of multimorbidity and associated mortality risks. So, the purpose of this study was to determine the prevalence and predictors of multimorbidity among elderly population in Maharashtra with its variation among socio-demographic spectrum, functional health and health behaviors., Materials and Methods: Sample of elderly population aged > 60 years were selected to examine multimorbidity and its associated risk factors. Statistical methods such as Chi-square test were used to show the association between multimorbidity and other covariates. Binary logistic regression analysis was used to understand the effects of predictor variables on multimorbidity. Receiver Operating Characteristic (ROC) Curve Analysis was carried out to improve the performance of the classification model by using a modified cut-off probability value. Z scores were calculated to compare model performance in training data and test data., Results: The prevalence of multimorbidity in Maharashtra in training data and test data was found to be 32.8% and 32.9%. Residence, living arrangement, MPCE Quintile, marital status, work status, education, tobacco consumption, physical activity, Instrumental Activities of Daily Living (IADL), Activities of Daily Living (ADL) and self-rated health of elderly population were important determinants that exert a significant adverse effect on multimorbidity., Conclusion: Prediction percentages indicate that appropriate actions should be undertaken to ensure good quality of life for all the elderly in Maharashtra., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

Background: The microenvironment of breast cancer plays a significant role in determining the prognosis of the disease. With the shifting paradigm on the predictive factors post-Neoadjuvant Chemotherapy (NAC), it was sought out that Tumour infiltrating lymphocytes (TILs) are of valuable use for the same. Yet, the delineation of the two types - Intrastromal and Intratumoural has seldom been facilitated. This study, therefore, aimed to evaluate, analyse and compare the two - to gauge the importance of the treatment outcome and clinicopathological features., Materials and Methods: 180 breast cancer patients were included in this study who underwent NAC, and their post-surgically resected tumour specimens were sectioned and stained using routine Haematoxylin and Eosin techniques. The evaluation of TILs in the stroma and tumour was done based on the standardised guidelines., Results: Out of the 180 patients, 55 (i.e. 30.56%) displayed pathological complete resolution (pCR). Furthermore, Intratumoural TILs had a slight association with the pCR (p = 0.0335) whereas Intrastromal TILs had a significantly large association with pCR (p < 0.0001) dependent on the lymphocytic response. Backward regression revealed that - the age at operation, pCR, lymph node involvement and menopause highly contributed to predicting 68.2% of the total cases correctly with a sensitivity of 93.0% and specificity of 24.6% for Intratumoral TILs. Age at operation, pCR, lymph node involvement and tumour emboli highly contributed to predicting 71.5% of the total cases correctly with sensitivity of 71.6% and specificity of 71.4% for Intrastromal TILs., Conclusion: TILs and the prediction of NAC and pCR should be made standardised and reproducible so that they can be universally available to all patients with breast cancer. Through this study, further avenues of research have opened up for their relations with clinicopathological features mainly age at operation and menopausal status., Competing Interests: The authors have declared no conflicts of interest., (© 2022 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Aim: As Breast cancer is most common in developed and developing world. Despite of seriousness & importance of breast cancer the awareness is low. This Study highlights the primary screening of breast cancer with the device Intelligent Breast Examination., Objectives: The objectives of this study are to assess the knowledge regarding awareness on screening of breast cancer with Intelligent Breast Examination (IBE), to develop a self-instructional module (SIM) on awareness on screening regarding breast cancer with IBE, and to assess its effectiveness on awareness about screening breast cancer with IBE., Materials and Methods: Evaluative research approach was used. The study used preexperimental research design. The samples (60 primary schoolteachers) were selected by the use of two sampling techniques, i.e., random sampling (for schools) and purposive sampling (study participants). Data were collected in two phases (pre and post) using structured questionnaire followed by the administration of SIM., Results: The results revealed a significant increase in mean knowledge scores (mean pre 11.16 standard deviation [SD] = 2.631 to mean post 21.2 SD = 1.842) regarding awareness on screening of breast cancer with IBE. The calculated paired t value (23.902) is greater than the table value ( t = 1.67) at 0.05 level of significance., Conclusion: The study concluded that the SIM prepared proved to be effective in increasing the awareness regarding screening with IBE in breast cancer., Competing Interests: None

Background: Prediction of low birth weight (LBW) early during pregnancy may prevent LBW by appropriate interventions., Aims/objective: The aim of the study is to develop an antenatal risk scoring scale for prediction of LBW., Subject and Methods: Routine and in-depth information on diet, occupation, and rest was collected from November 1, 2013, to November 13, 2015. A cohort of 1876 and subset of 380 pregnant women attending Krishna Hospital Karad, Maharashtra, India., Statistical Analysis: Multivariate analysis and relative risks (RRs) were found out by SPSS version 16 and tested on a separate set of 251 mothers., Results: The frequency of meals of <4, hard work <6 h of sleep and illiteracy, antenatal morbidity, <10 kg weight gain, <40 kg maternal weight, and anemia during the first trimester were the risk factors identified from subset and cohort, respectively. Based on their RRs, a new scoring system with a total score of 24 and cutoff "12" was identified by using receiver operating characteristics (ROC) curve analysis with 98.6% sensitivity and 41.1% specificity as tested on 251-independent individuals. The second cutoff of "15" score was identified based on the prevalence of LBW in babies of these 251 mothers., Conclusions: The identification of low-, moderate-, and high-risk of LBW was possible at <12, between 12 and 15, and >15 scores, respectively, with good sensitivity and specificity., Competing Interests: There are no conflicts of interest.

Background: Prediction of preterm births in the early stage during pregnancy may reduce prevalence of preterm births by appropriate interventions., Aims/objective: The aim of the study is to develop an antenatal risk scoring system/scale for prediction of preterm births., Subjects and Methods: From a cohort of 1876 and subset of 380 pregnant women attending Krishna Hospital Karad, Maharashtra, routine antenatal and in-depth information on diet, occupation, and the rest were collected and analyzed using SPSS version 16. A scoring system was developed by multivariate analysis based on the relative risk (RR) and tested on separate set of 251 mothers., Statistical Analysis Used: Bivariate analysis by Chi-square test, backward multivariate regression model, receiver operating characteristic curve (ROC) curve analysis, and calculation of RR for identified risk factors. Sensitivity and specificity of newly developed risk scoring scale., Results: Out of six risk factors from whole cohort ( n = 1876) and three risk factors from subsample ( n = 380) identified by bivariate analysis. Further four and three risk factors were retained after multivariate analysis from whole and part of cohort, respectively, and risk scores of "7" and "9" were assigned based on RR cutoff levels of three and five were identified separately for whole and part data by ROC curve analyses together making it "8" with 75.5% sensitivity and 85.5% specificity when tested on 251 independent patients. Based on the prevalence of preterm births, low-, moderate-, and high-risk grading was done by identifying as second cutoff value., Conclusions: Identification of low-, moderate-, and high-risk of preterm births was possible at <8, 8, and 9 and equal to ≥10 with high sensitivity at lower cutoff and high specificity at upper cutoff., Competing Interests: There are no conflicts of interest.

Background and Objectives: Hepatitis C is global health problem affecting a significant portion of the world's population. Available data in Western Maharashtra on seroprevalence, risk factors and genotype distribution are very limited., Objectives: The present study was carried out to estimate the seroprevalence, factors influencing transmission and distribution of genotype of hepatitis C virus (HCV) in a hospital-based population., Materials and Methods: This was a cross-sectional, hospital-based study. A total of 25193 serum samples were tested for HCV and HBV infection. All samples from HCV antibody-positive patients were subjected for HCV RNA detection and genotype. Chi-square, unpaired t-test, logistic regression analysis was used for statistical analysis., Results: The seroprevalence for anti-HCV-Ab was 0.46%. Backward multivariate logistic regression analysis revealed increasing age; alcoholic, blood transfusion and dialysis were significant risk factors. Of 116 patients with HCV, 8 (6.89%) patients had HCV-HBV co-infection. The most common genotype (61.90%) was 3 followed by Genotype 1 (38.09%)., Conclusions: In the present study, significant risk factors were a history of blood transfusion, habit of alcohol, dialysis. The prevention of HCV infection can be achieved by screening of blood and blood products and creating awareness about risk factors. Since the efficacy of current and new therapies differ by genotype, genotype study is essential.

Background & Objectives: Foot length of the newborn has a good correlation with the birth weight and is recommended to be used as a proxy measure. There can be variations in the measurement of foot length. A study was, therefore, carried out to develop a foot length calliper for accurate foot length measurement and to find cut-off values for birth weight and gestational age groups to be used by primary healthcare workers., Methods: This study was undertaken on 645 apparently healthy newborn infants with known gestational age. Nude birth weight was taken within 24 h of birth on a standard electronic weighing machine. A foot length calliper was developed. Correlation between foot length and birth weight as well as gestational age was calculated. Correctness of cut-off values was tested using another set of 133 observations on the apparently healthy newborns. Action-oriented colour coding was done to make it easy for primary healthcare workers to use it., Results: There was a significant correlation of foot length with birth weight (r=0.75) and gestational age (r=0.63). Cut-off values for birth weight groups were 6.1, 6.8 and 7.3 cm and for gestational age of 6.1, 6.8 and 7.0 cm. Correctness of these cut-off values ranged between 77.1 and 95.7 per cent for birth weight and 60-93.3 per cent for gestational age. Considering 2.5 kg as cut-off between normal birth weight and low birth weight (LBW), cut-off values of 6.1, 6.8 and 7.3 were chosen. Action-oriented colour coding was done by superimposing the colours on the scale of the calliper, green indicating home care, yellow indicating supervised home care, orange indicating care at newborn care units at primary health centres and red indicating Neonatal Intensive Care Unit care for infants., Interpretation & Conclusions: A simple device was developed so that the primary health care workers and trained Accredited Social Health Activist workers can identify the risk of LBW in the absence of accurate weighing facilities and decide on the type of care needed by the newborn and take action accordingly.

Introduction: 'Smokeless tobacco' is the term used for the tobacco that is consumed in un-burnt form and it can be used orally or nasally. Cotinine, a nicotine metabolite, is used to quantify exposure to tobacco, which readily gains access to foetal circulation. Cotinine is invariably found in coelomic, amniotic and foetal serum when maternal serum cotinine levels exceed 25ng/ml., Aim: To estimate cotinine levels among pregnant women using and not using smokeless tobacco (mishri) and to correlate cotinine level with anthropometry of newborns., Materials and Methods: A hospital based cohort study was conducted at Krishna Hospital, Karad, District Satara, Maharashtra, India. Pregnant women who were using smokeless tobacco (mishri) during pregnancy were analyzed for cotinine levels in blood by using ELISA kit tech and correlated with anthropometry of newborn babies and compared with non users of tobacco., Results: About 480 gm reduction in Birth weight and 6.5 cm reduction in birth length of babies born to mishri users compared to non users of tobacco and also cotinine levels among users were found significantly negatively correlating with anthropometric measurement of newborn babies., Conclusion: A pro-active effort is essential to educate the women about adverse effects of tobacco in general and on the intrauterine growth of the baby in particular.

Background: Brucellosis is an important but neglected zoonotic disease in India. Due to frequent animal contact, high prevalence of this disease, though expected in rural population, has not been much studied., Aim: The study was carried out to determine serological, clinical, and epidemiological profile including associated risk factors for human brucellosis in rural India., Materials and Methods: In this cross-sectional study, serum samples from 1,733 individuals residing in rural areas were screened for the presence of anti-brucellar antibodies by Rose Bengal Plate test (RBPT), Serum Agglutination test (SAT), and 2-Mercaptoethanol test (2-ME). Clinical symptoms, epidemiological data including risk factors and knowledge about brucellosis were evaluated by personal interview using a structured questionnaire., Results: Of the 1,733 individuals, 998 had direct contact with animals, whereas 735 had no direct contact. The overall positivity rates by RBPT, SAT, and 2-ME test were 10.50% (182), 7.32% (127), and 5.88% (102), respectively. Clinical symptoms resembling brucellosis were seen in 151 (8.71%) subjects. Animal contact especially during milking, parturition/abortion was the major risk factor, followed by raw milk ingestion. None of the participant knew about brucellosis., Conclusion: Regular surveillance of the disease with awareness programs emphasizing prevention and control are needed.

Background: β-lactamases viz., extended spectrum β-lactamase (ESBL), AmpC, and metallo β-lactamase (MBL) production in Klebsiella pneumoniae has led to a serious concern about septicemic neonates in Neonatal Intensive Care Units due to high resistance against commonly used antimicrobials., Purpose: To study the prevalence of ESBL, AmpC, and MBL production in K. pneumoniae isolates in neonatal septicemia, to check antimicrobial susceptibility to various drugs including tigecycline; and to assess burden of multiple drug resistance (MDR)., Materials and Methods: Total 24 clinical isolates of K. pneumoniae isolated from 318 blood samples of suspected cases of neonatal septicemia were studied. Isolates were screened for ESBL, AmpC, and MBL production by Clinical and Laboratory Standards Institute (CLSI) disk method, AmpC cefoxitin screen, and imipenem, meropenem, ceftazidime disk screen respectively; and confirmation was done by CLSI phenotypic disk confirmatory test, AmpC sterile disk method, and imipenem ethylenediamine tetracetic acid double disk synergy test respectively. Antimicrobial susceptibility was determined by Kirby-Bauer's disk diffusion method. Efficacy of tigecycline was evaluated using United States Food and Drug Administration guidelines., Results: Of the 24 K. pneumoniae isolates, co-production of AmpC + MBL was found in more number of isolates (67%) (P < 0.0001) compared to single enzyme production (ESBL and MBL 8% both, AmpC 12.5%). Rate of resistance for penicillins and cephalosporins was highest. Susceptibility was more for imipenem, co-trimoxazole, and meropenem. Nonsusceptibility to tigecycline was low (21%). A total of 23 (96%) isolates were MDR., Conclusions: Routine detection of ESBL, AmpC, and MBL is required in laboratories. Carbapenems should be kept as a last resort drugs. Trend of tigecycline susceptibility has been noted in the study. Continued monitoring of susceptibility pattern is necessary to detect true burden of resistance for proper management.

Background: "Mishri" is one among the various smokeless tobacco products used in the central and southern part of India. The use of newer tobacco products is increasing not only among men, but also among children, teenagers, and women of the reproductive age-group., Objectives: To study socio-demographic profile of mishri users among pregnant women admitted for delivery into Krishna Hospital, Karad - Satara, Maharashtra., Materials and Methods: All the consecutive pregnant women admitted for delivery in Krishna Hospital, Karad over a period of 6 months were enrolled and a detailed history of use of tobacco was obtained from them. A representative sample of mishri used by them for each application was collected and weighed on an electronic weighing machine. The socio-demographic information was collected among all mishri users and age-, parity-matched controls of non-mishri users during pregnancy., Results: A total of 258, i.e., (12%) of the women delivering in Krishna Hospital were using mishri. The mean duration of mishri use was 2 years with a standard deviation (SD) of 1.09 years, frequency of daily application being 1.4 times with an SD of 0.55, dwell time in mouth being 10 min with an SD of 2.9 min, and the quantity of each application being 236 mg with an SD of 66.2 mg. 29% of the teenagers and 68% of the primiparas were found to be using mishri, and a majority of them were housewives, having minimum education and belonging to the middle and lower socio-economic class. It was also found that the family members played a role in influencing the habit of mishri use., Interpretation and Conclusion: A small but significant number of women who deliver in the hospital used mishri during pregnancy and were in need of de-addiction counseling.