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Introduction: In the management of hypertension and diabetes mellitus, a systematic response like modifications in lifestyles is needed along with the medication. The study was conducted to determine the impact of comprehensive lifestyle modifications on hypertension and diabetes and to compare it with that of physical activity alone as a health education intervention. Materials and Method: A risk factor-based community intervention trial was conducted for one year in 3 villages in coastal Karnataka. The sample of 305 was calculated depending on the expected change in blood pressure and an equal sample size was drawn from each of the villages using a systematic random sampling method. Baseline data on blood pressure level, random blood sugar, and HbA1c levels were recorded. After 1 year of intervention, all the parameters were further recorded along with the adherence to medication for these non-communicable diseases. Results: The mean difference between the groups suggested that participants with physical activity intervention reported a statistically significant reduction in systolic blood pressure. In the comprehensive lifestyle modification group, there was a significant reduction in both diastolic blood pressure and glycated hemoglobin levels (21 mmHg and 2.1%; p < 0.001). Conclusion: The study indicates that in the management of hypertension and diabetes mellitus, the impact of comprehensive lifestyle modifications was more significant compared to physical activity alone. [ABSTRACT FROM AUTHOR]

Background: Dietary habits and physical inactivity are related to the risks of non-communicable diseases (NCDs), such as cardiovascular diseases, Diabetes and Hypertension, of which burdens are increasing all over the world.. It is essential that lifestyle modification and nondrug treatment measures such as health education, reduction in weight through regular exercise, changing in eating patterns is essential to control of Diabetes and Hypertension. Hence the present study is taken up with objectives. Objectives: 1. to assess and compare the impact of health education on life style modification (diet modification) on control of hypertension and diabetes of intervention group. 2. To assess and compare the practice of changed pattern of life style modification (diet modification) of known hypertensives and diabetics with continuous health education module and follow up. Methodology: This community-level education intervention trial to reduce the burden of Non communicable diseases (hypertension and diabetes) was conducted in coastal Karnataka. The study was taken up in a rural area of coastal Karnataka. A specific module for physical activity, diet modification separately for hypertension and diabetics was prepared by experts and this specific module trained social worker introduced diet modification, exercise pattern and habits to the village enrolled participants with involvement of family member who actually cooks at home for 2 months. Results: In the study subjects, it was observed that, the subjects who had higher systolic and diastolic pressure before intervention, changed to the lower levels after intervention. Though the change in blood pressure is not statistically significant. The intervention of overall lifestyle intervention, there was increased subjects with Hb1Ac in the range of 7-9% and reduced subjects with Hb1Ac of >9.1%. Though it was not statistically significant. There was significant improvement in the mean duration of physical activity in order to control the hypertension and Diabetes mellitus. We also noticed that there was reduction in the sedentary hours, though the difference was not statistically significant. Conclusion: Life style intervention with continuous monitoring is essential to bring down the blood pressure and diabetic sugars. We donot need doctors alone to bring the life style modifications and the health workers can initiate it in the villages. The intervention of life style modifications have brought in better care and quality of life in the villages compared to control village. [ABSTRACT FROM AUTHOR]

Objectives: The primary aim of this study was to assess the impact of systematically induced health education on physical activity over control of hypertension, diabetes. The secondary aim of this study was to assess the changed pattern of physical activity among hypertensives and diabetics with continuous follow-up. Methods: This is part of a larger study A community trial in coastal Karnataka with three villages where one village was introduced with physical activity alone. A total of 105 participants who are known hypertensives with SBP more than 130 mm Hg or DBP more than 90 mm Hg and diabetics with Hb1Ac more than 7% were included. A specific module for physical activity was prepared, introduced to participants with involvement of family members, followed up for 1 year, and survey was done. The outcomes of median SBP, DBP, and RBS with Physical activity introduction as compared to baseline were done. Statistical analysis––Median, Interquartile range, and Wilcoxon sign rank test––was used. Results: There was 9–15 mm Hg change before and after intervention reduction in SBP and DBP. The median RBS reduced from 264 mg/dL to 205 mg/dL. Moderate activities time markedly increased & sitting hours decreased to half. Conclusion: There is an impact of systematically induced health education on physical activity over control of hypertension and diabetes & change in the pattern of physical activity with continuous health education module and follow-up. [ABSTRACT FROM AUTHOR]

Background: Diabetes and hypertension contribute to more than half of morbidity, mortality and years lived with disability in developing countries like India. It impacts the quality of life (QoL) of patients and their family. Management of these diseases is in infancy and emphasis is laid on pharmacological interventions. Though nonpharmacological measures are crucial for management, their implementation is questionable. Hence, this study was conducted to measure the effectiveness of lifestyle modifications on QoL among uncontrolled hypertensives and diabetics in rural India. Methods: An interventional study was done in 3 villages with 100 participants each, where village one received lifestyle modification as intervention and village two physical activity and village three control receiving standard care. The baseline data included socio-demographic characteristics such as awareness of hypertension, diabetes, lifestyle pattern and physical activity, and WHO QoL. The participants were trained, followed up, and assessed after 12 months following intervention. QoL scores between groups and pre- and post-intervention in the group were compared using Mann–Whitney U and Wilcoxon signed-rank test, respectively. Results: In this study, there was a significant improvement in overall QoL and in all the four domains, namely physical, psychological, social relationship, and environmental domains in both the intervention villages. QoL was significantly better in both the intervention groups following intervention than compared to the control group. Conclusions: QoL improves with intervention on uncontrolled diabetics and hypertensives. It is time to emphasize on the collaboration among physicians and on the holistic integrative health services delivery for non-communicable diseases. [ABSTRACT FROM AUTHOR]

Background: Diabetes Mellitus shows a rising trend in India, driven by a combination of factors like sedentary lifestyle, unhealthy diet and tobacco use. The cornerstone for interventions to reduce this is lifestyle modification. Aim & Objective: This study aims to determine lifestyle behaviours among uncontrolled diabetics in rural South India. Settings and Design: This is a pilot study conducted as part of a community trial which enrolled uncontrolled diabetics (Glycosylated haemoglobin, HbA1C of 7% or more) selected from baseline survey of 2 RBS readings. Methods and Material: The sociodemographic details, lifestyle habits and treatment adherence of eligible participants were recorded with a validated questionnaire. Statistical analysis used: Data was compared among 2 groups of poor glycaemic control using Chi square test. Results: There was no significant association of age or gender with HbA1C levels. Majority were non-smokers, non-alcoholics and did not exercise. Higher proportions of those with hospital admissions, longer duration of disease and less frequent check-ups had poor control; but these were not statistically significant. Dietary control was inadequate. However, there were no significant association of dietary habits with poor control. Conclusions: Although overall adherence to medication and follow up was satisfactory, lifestyle modification is not being sufficiently followed. [ABSTRACT FROM AUTHOR]

Background: Although most public services provide tests and TB drugs free of charge worldwide, opportunity costs pose barriers to accessing TB services and treatment. 'Kumar Raajratna Bhimrao Ambedkar Vaidakiya Sahay Yojana (KRBAVSY)' popularly known as Free Medical Aid Scheme is in operation in Gujarat since early 70s for SC and since 1991 for SEBC to provide monetary incentive. Primary objective: Evaluation of utilization and effectiveness of Financial incentives given under Free Medical Aids scheme on RNTCP in Gujarat. Methodology: A retrospective cohort study was undertaken in which all TB patients registered under RNTCP in Gandhinagar district were evaluated for their eligibility for KRBAVSY scheme, and whether eligible patients got benefit or not. Also, treatment outcome of patients were compared. Results: Out of total 1430 patients inquired, 896 (62.7%) patients were found eligible for the scheme, while only 87 (9.7%) patients confirmed that they had got the benefit of scheme. Eligible patients who got benefit under scheme had almost five times higher odds of successful outcome of TB treatment. Conclusion: The TB patients who got benefit of KRBAVSY scheme had significantly better successful treatment outcome in comparison to the TB patients who did not get benefit. [ABSTRACT FROM AUTHOR]

Background: Although most public services provide tests and TB drugs free of charge worldwide, opportunity costs pose barriers to accessing TB services and treatment. 'Kumar Raajratna Bhimrao Ambedkar Vaidakiya Sahay Yojana (KRBAVSY)' popularly known as Free Medical Aid Scheme is in operation in Gujarat since early 70s for SC and since 1991 for SEBC to provide monetary incentive. Primary objective: Evaluation of utilization and effectiveness of Financial incentives given under Free Medical Aids scheme on RNTCP in Gujarat. Methodology: A retrospective cohort study was undertaken in which all TB patients registered under RNTCP in Gandhinagar district were evaluated for their eligibility for KRBAVSY scheme, and whether eligible patients got benefit or not. Also, treatment outcome of patients were compared. Results: Out of total 1430 patients inquired, 896 (62.7%) patients were found eligible for the scheme, while only 87 (9.7%) patients confirmed that they had got the benefit of scheme. Eligible patients who got benefit under scheme had almost five times higher odds of successful outcome of TB treatment. Conclusion: The TB patients who got benefit of KRBAVSY scheme had significantly better successful treatment outcome in comparison to the TB patients who did not get benefit. [ABSTRACT FROM AUTHOR]

Aim: To compare air nicotine levels in public places in Ahmedabad, India, before (June 2008) and after (January, 2010) the implementation of a comprehensive smoking ban which was introduced in October 2008. Materials and Methods: Air nicotine concentrations were measured by sampling of vapor-phase nicotine using passive monitors. In 2008 (baseline), monitors were placed for 5-7 working days in 5 hospitals, 10 restaurants, 5 schools, 5 government buildings, and 10 entertainment venues, of which 6 were hookah bars. In 2010 (follow-up), monitors were placed in 35 similar venues for the same duration. Results: Comparison of the overall median nicotine concentration at baseline (2008) (0.06 μg/m3 Interquartile range (IQR): 0.02-0.22) to that of follow-up (2010) (0.03 μg/m3 IQR: 0.00-0.13), reflects a significant decline (% decline = 39.7, P = 0.012) in exposure to second-hand smoke (SHS). The percent change in exposure varied by venue-type. The most significant decrease occurred in hospitals, from 0.04 μg/m3 at baseline to concentrations under the limit of detection at follow-up (%decline = 100, P < 0.001). In entertainment venues, government offices, and restaurants, decreases in SHS exposure also appeared evident. However, in hookah bars, air nicotine levels appeared to increase (P = 0.160). Conclusion: Overall, SHS exposure was significantly reduced in public places after the smoke-free legislation came into force. However, nicotine concentrations were still detected in most of the venues indicating imperfect compliance with the comprehensive ban. [ABSTRACT FROM AUTHOR]

Transformation of research into clinical practice is the most challenging step in evidence based dental practice. Designing the most reliable research with applicable endpoint evaluation is very important as it can lead to successful research outcomes that can be accepted in clinical practice. In the periodontal research few accepted endpoints are used frequently as they are believed to be the gold standard in measuring the periodontal disease and the treatment outcomes. However, a wide range of endpoints used are surrogate endpoints and these endpoints have no direct correlation with the patient centered outcomes. Hence, a direct relationship of surrogate endpoints with true endpoints needs to be established. This review highlights the importance of true endpoints and challenges in implementing these in clinical research. Importance of patient's centered outcomes are also reviewed and duly discussed here. Need for conducting research which includes the true endpoints or the surrogate endpoints with clinical applicability and tangible outcomes, was also suggested in this review. [ABSTRACT FROM AUTHOR]

Background: Awareness towards tobacco hazards has increased with time but its role alone towards cessation is questionable. With widespread menace of tobacco in developing countries like India, not much tobacco chewing prevalence and their quitting patterns data are available in urban Saurashtra region. Objectives: 1. To find out prevalence of various forms of chewing tobacco and quitting attitudes in urban Jamnagar. 2. To study quitting patterns in relation with age of habit initiation, family background and habit duration. Materials and Methods: It was a cross-sectional study involving 2513 individuals as study population by 30-cluster sampling method. The study was carried out between June 2007 and March 2008. Pre-set, pre-tested questionnaire was used for interview purpose and the statistical analysis was done on proportion basis. Results: About 37.2% of study population was ever-tobacco-chewers; 32.9% of them were current-chewers and 4.3% were quitters. Approximately 28.4% of current-consumers were willing to quit. Mawa-masala (63.7%) and Gutka (57.6%) were preferred forms of chewing tobacco and 57.5% of the current-chewers chewed tobacco six to eight times a day. Tobacco initiation age between 20 and 30 years was commoner among quitters (84.2%), while a little younger in current-consumers (76.5%). About 58.3% quitters and 74.0% chewers showing willingness to quit had not consumed tobacco for more than five years, 63.8% of current-chewers had a family member consuming tobacco. With initiation of health problems, 72.2% subjects quit and 55.5% of them already knew about health hazards. Conclusions: Every 4 out of 10 residents was found to be exposed to chewing tobacco. With Mawa-masala and Gutka being the predominant forms, habit onset in late adolescence, years of consumption and family exposure seem to be hampering quitting. Awareness about tobacco hazards alone does not appear to be resulting in successful quitting. [ABSTRACT FROM AUTHOR]

The 2021 tuberculosis (TB) preventive treatment guidelines in India included silicosis as a screening group, yet latent TB infection (LTBI) testing for silica-dust-exposed individuals is underemphasized. Focusing on an estimated 52 million silica-dust-exposed workers, particularly agate-stone workers in Khambhat, Gujarat, our study aims to estimate LTBI prevalence, identify predictors, and gather insights from TB and silicosis experts. Employing a sequential explanatory mixed-methods approach, a cross-sectional study involved 463 agate-stone workers aged ≥ 20 years in Khambhat, using IGRA kits for LTBI testing. In-depth interviews with experts complemented quantitative findings. Among agate-stone workers, 58% tested positive for LTBI, with predictors including longer exposure, type of work, and BCG vaccination. Our findings reveal a nearly double burden of LTBI compared to the general population, particularly in occupations with higher silica dust exposure. Experts advocate for including silica-dust-exposed individuals in high-risk groups for LTBI testing, exploring cost-effective alternatives like improved skin sensitivity tests, and shorter TB preventive treatment regimens to enhance compliance. Future research should explore upfront TB preventive treatment for silica-dust-exposed individuals with high LTBI prevalence and optimal exposure duration. This study underscores the urgent need for policy changes and innovative approaches to TB prevention among silica-dust-exposed populations, impacting global occupational health strategies. [ABSTRACT FROM AUTHOR]

Background: There is a surge in epidemiological modeling research due to sudden onset of COVID-19 pandemic across the globe. In the absence of any pharmaceutical interventions to control the epidemic, nonpharmaceutical interventions like containment, mitigation and suppression are tried and tested partners in epidemiological theories. But policy and planning needs estimates of disease burden in various scenarios in absence of real data and epidemiological models helps to fill this gap. Aims and Objectives: To review the models of COVID-19 prediction in Indian scenario, critically evaluate the range, concepts, strength and limitations of these prediction models and its potential policy implications. Results: Though we conducted data search for last three months, it was found that the predictive models reporting from Indian context have started publishing very recently. Majority of the Indian models predicted COVID-19 spread, projected best-, worst case scenario and forecasted effect of various preventive measurements such as lockdown and social distancing. Though the models provided some of the critical information regarding spread of the disease and fatality rate associated with COVID-19, it should be used with caution due to severe data gaps, distinct socio-demographic profiling of the population and diverse statistics of co-morbid condition. Conclusion: Although the models were designed to predict COVID spread, and claimed to be accurate, significant data gaps and need for adjust confounding variables such as effect of lockdown, risk factors and adherence to social distancing should be considered before generalizing the findings. Results of epidemiological models should be considered as guiding beacon instead of final destination. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most commonly diagnosed cancer among women, along with its diagnosis it brings disarray and economic burden on family. Its treatment is costliest compared to any other cancers. Health policies and health insurances are introduced to bridge the gap between patients and quality cancer care. We aim to understand the level to which health insurance help the breast cancer patients in reducing economic burden due to cancer Methodology: Cross sectional study done in Justice K.S Hegde Hospital in month June, 2018 to August, 2018 with participants being patients with breast cancer. Patients were contacted over the phone and a questionnaire was introduced to those willing to talk on their economic expenditure. Results: 73% of people had insurance to treat breast cancer of which 52% had advantage of Vajpayee Arogya Shree. 24% of people had insurance paid fully for treatment and 34% received partially, it reduced their burden by 51-75%. 46% of people had the cost >1 lakh for treatment which could be burden for 27% who didn't have insurance, and this was among patients from neighboring state for treatment. Conclusions: Insurance reducing the burden is ensured; but choice of hospital for treatment is not with the patient, which is a burden. [ABSTRACT FROM AUTHOR]

Different human races across the globe responded in a different way to the SARS-CoV-2 infection leading to different disease severity. Therefore, it is anticipated that host genetic factors have a straight association with the COVID-19. We identified a total 6, 7, and 6 genomic loci for deceased-recovered, asymptomatic-recovered, and deceased-asymptomatic group comparison, respectively. Unfavourable alleles of the markers nearby the genes which are associated with lung and heart diseases such as Tumor necrosis factor superfamily (TNFSF4&18), showed noteworthy association with the disease severity and outcome for the COVID-19 patients in the western Indian population. The markers found with significant association with disease prognosis or recovery are of value in determining the individual's response to SARS-CoV-2 infection and can be used for the risk prediction in COVID-19. Besides, GWAS study in other populations from India may help to strengthen the outcome of this study. • Genome Wide Association Study for the western Indian population was performed. • Genomics loci for COVID-19 severity and outcome has been identified. • TNFSF4 & 18 , GOT2P2 , and DHX15 are significantly associated with COVID-19 severity. • RFX3 and UBXN10 found to be protective in COVID-19 patients in the study population. • The identified unfavourable alleles can be used for risk prediction for COVID-19. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization recommends direct observation of treatment (DOT) to support patients with tuberculosis (TB) and to ensure treatment completion. As per national programme guidelines in India, a DOT provider can be anyone who is acceptable and accessible to the patient and accountable to the health system, except a family member. This poses challenges among children with TB who may be more comfortable receiving medicines from their parents or family members than from unfamiliar DOT providers. We conducted a non-inferiority trial to assess the effect of family DOT on treatment success rates among children with newly diagnosed TB registered for treatment during June–September 2012. Methods: We randomly assigned all districts (n = 30) in Gujarat to the intervention (n = 15) or usual-practice group (n = 15). Adult family members in the intervention districts were given the choice to become their child’s DOT provider. DOT was provided by a non-family member in the usual-practice districts. Using routinely collected clinic-based TB treatment cards, we compared treatment success rates (cured and treatment completed) between the two groups and the non-inferiority limit was kept at 5%. Results: Of 624 children with newly diagnosed TB, 359 (58%) were from intervention districts and 265 (42%) were from usual-practice districts. The two groups were similar with respect to baseline characteristics including age, sex, type of TB, and initial body weight. The treatment success rates were 344 (95.8%) and 247 (93.2%) (p = 0.11) among the intervention and usual-practice groups respectively. Conclusion: DOT provided by a family member is not inferior to DOT provided by a non-family member among new TB cases in children and can attain international targets for treatment success. Trial Registration: Clinical Trials Registry–India, National Institute of Medical Statistics (Indian Council of Medical Research) [ABSTRACT FROM AUTHOR]

Background: The 5As approach is a clinic-based approach and has been developed for primary health care providers who are uniquely positioned to interact with tobacco users. The 5As stands for: Ask about tobacco use at every visit, advise tobacco users to quit, assess readiness to quit, assist quit attempts through counseling and pharmacotherapy and arrange follow-up to prevent relapse. The present study explores whether auxiliary nurse midwives (ANMs) adhere to the 3As from the recommended 5As model for tobacco cessation. Materials and Methods: The study was a cross-sectional study conducted among 501 ANMs in the state of Gujarat and Andhra Pradesh. Descriptive analysis and chi-square test were employed to test the differences in knowledge levels and practices of ANMs. Bivariate logistic regression was used to examine the association between each predictor variable separately and the outcome variables after adjusting for age and location. Data was analyzed using SPSS version 17 software. Results: Majority of ANMs reported that they were aware of respiratory illnesses, tuberculosis, lung and oral cancer as conditions caused due to tobacco consumption. Awareness of adverse reproductive and child health effects associated with tobacco use was very low. Only about one third of respondents informed all patients about harmful effects. Only 16% of ANMs reported having ever received any on-job training related to tobacco control. ANMs who reported receiving training in tobacco control were about two times more likely to provide information on health effects of tobacco as compared to those who reported not being trained in tobacco control in the state of Gujarat. Conclusions: A majority of ANMs ask patients about tobacco use but provide advice only to patients suffering from specific diseases. A context-specific capacity building package needs to be designed to equip ANMs in recommended 5As approach in tobacco cessation. [ABSTRACT FROM AUTHOR]

Background: Revised National TB Control Programme (RNTCP) in India recommends that all previously-treated TB (PT) patients are offered drug susceptibility testing (DST) at diagnosis, using rapid diagnostics and screened out for rifampicin resistance before being treated with standardized, eight-month, retreatment regimen. This is intended to improve the early diagnosis of rifampicin resistance and its appropriate management and improve the treatment outcomes among the rest of the patients. In this state-wide study from Gujarat, India, we assess proportion of PT patients underwent rapid DST at diagnosis and the impact of this intervention on their treatment outcomes. Methods: This is a retrospective cohort study involving review of electronic patient-records maintained routinely under RNTCP. All PT patients registered for treatment in Gujarat during January-June 2013 were included. Information on DST and treatment outcomes were extracted from 'presumptive DR-TB patient register' and TB treatment register respectively. We performed a multivariate analysis to assess if getting tested is independently associated with unfavourable outcomes (death, loss-to-follow-up, failure, transfer out). Results: Of 5,829 PT patients, 5306(91%) were tested for drug susceptibility with rapid diagnostics. Overall, 71% (4,113) TB patients were successfully treated - 72% among tested versus 60% among non-tested. Patients who did not get tested at diagnosis had a 34% higher risk of unsuccessful outcomes as compared to those who got tested (aRR - 1.34; 95% CI 1.20-1.50) after adjusting for age, sex, HIV status and type of TB. Unfavourable outcomes (particularly failure and switched to category IV) were higher among INH-resistant patients (39%) as compared to INH-sensitive (29%). Conclusion: Offering DST at diagnosis improved the treatment outcomes among PT patients. However, even among tested, treatment outcomes remained suboptimal and were related to INH resistance and high loss-to-follow-up. These need to be addressed urgently for further progress. [ABSTRACT FROM AUTHOR]

For the first time, a biomass electronic junction functioning as a conventional electronic diode inside green leaves of Vinka-rosa and Phumeria rubra mass structure has been experimentally predicted and studied. The experimental diode demonstrated appropriate conventional electronic diode characteristics. The predicted diode junctions were operated for forward and reverse de voltage biases in the range of ±1 to 10 and 1 to 30V respectively. The studies revealed a strong functional dependence on the water content of the green leaf. These studies are sequential to the very recently reported research work of Kosta et al. on bioelectronics and soilelectronics. The study speculatively forecasts the beginning of a new revolutionary era of green biomass electronic circuitry. [ABSTRACT FROM AUTHOR]