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Background and Objective(s): Diabetes is a major public health concern in India. The majority of studies done in rural population lack systematic methodology in estimating the prevalence of diabetes mellitus. Objectives of this study were to estimate the burden of prediabetes, type 2 diabetes mellitus and its associated risk factors among adults (18–69) years in rural Bengaluru, Karnataka. Methods: A cross-sectional study was conducted among adults aged 18–69 years in three villages of Devanahalli taluk of rural Bengaluru between May and October 2019. Behavioural and metabolic risk factors related to diabetes were assessed using WHO-STEPS instrument and IDSP-NCD risk factor tool. Fasting blood glucose and OGTT test were performed, and WHO diagnostic criteria were used to diagnose diabetes mellitus. Results: Prevalence of prediabetes and type 2 diabetes (T2DM) in rural Bengaluru was found to be 6.3% and 10.9%, respectively. Behavioural risk factors related to diabetes measured in the study population were current tobacco use (32.7%), current alcohol use (9.9%), physical inactivity (46.8%) and unhealthy diet (82.3%). Metabolic risk factors measured were obesity (7.5%), central obesity (46.4%), prediabetes (6.3%) and hypertension (24.3%). More than one-thirds of diabetes and three-fourths of hypertension individuals were newly diagnosed by the population-based screening. Conclusion: The burden of diabetes and its risk factors are high due to the health transition occurring in rural population of Bengaluru. Undiagnosed diabetes mellitus and hypertension in rural population as demonstrated by this study highlight the need to strengthen the population-based screening and diagnosis of T2DM and hypertension (HTN) under the national health programme.

Background: Fluorosis is caused because of excessive fluoride intake. Karnataka is one among the states that have reported high fluoride content in the groundwater. This study aimed to determine the prevalence of and clinical manifestations suggestive of fluorosis, along with the causes for fluorosis among the population of Kaiwara village. Methodology: The present cross-sectional survey was performed among 3003 permanent residents of Kaiwara village. Demographic details such as age, occupation, education, economic status, and anthropometric details were recorded. Parameters such as predominant diet, genu valgum, and grades of goiter were studied and recorded to determine their association with fluorosis. Dean's index was used to detect dental fluorosis. The levels of fluoride in urine were estimated using the ELICO-LI-126 Fluoride ion analyzer. Results: The most observed age group among study subjects was 10–49 years (males: 813 and females: 1304). Age, diet, genu valgum, and grade of goiter were significantly (P < 0.001) associated with Dean's index. Of the study subjects, about 11.8% were unable to touch their toes indicating fluorosis. 2.075 mg/dl was the mean baseline fluoride level found in all the four samples from the main water tanks supplying water to the village. Out of 100 urine samples randomly taken, all had fluoride levels above the acceptable levels (>0.1 ppm). Conclusion: Hydric fluorosis is endemic among the general population of Kaiwara village in Karnataka. The main leading cause for fluorosis occurrence in this region might be due to high fluoride levels reported in the groundwater. [ABSTRACT FROM AUTHOR]

Background and objective: Reverse osmosis technique is an adequate method for treating ground water for reducing the burden of abnormal levels of fluorides. The method protects the general population from diseases associated with high fluoride levels in the body. The objective of the present study was to assess the suitability and sustainability of reverse osmosis technology for community de-fluoridation of water used for cooking and drinking purposes in Kaiwara village, Karnataka. Methodology: This interventional study was conducted between July 2012 and June 2014 at Kaiwara village, Karnataka using reverse osmosis technique for de-fluoridation of water used for drinking and cooking. Complete chemical analysis of water was done before intervention, and processed water supplying the village was tested every six months after intervention for about two years. The variation in chemical concentrations of various components were analysed. Results: The mean baseline level of fluoride in untreated water was 2.075 mg/dl (above the safety limit), which dropped to 0.08 mg/dl at the end of first six months following the intervention, 0.042 mg/dl in 12 months, 0.1 mg/dl at 18 months and 0.01 mg/dl at 24 months after intervention, which were all below the safety limits for India in the treated water. The mean total dissolved solids in the water was 542.25 mg/dl in the untreated water, which dropped to zero after the first six months, remained at zero in the next six months, rose to 120 mg/dl at 18 months and then dropped to 70 mg/dl at 24 months in the treated water. The observed values were reduced significantly. Discussion: The study concluded that it is possible to set up a community de-fluoridation plant using reverse osmosis technique at Kaiwara village, Karnataka which is economically sustainable and acceptable by local population. [ABSTRACT FROM AUTHOR]

Background: Dental health professionals (DHPs) are in ideal position to provide tobacco intervention services to tobacco users and assist them in the quitting process. However, lack of training in effective tobacco interventions is an important barrier to incorporating tobacco cessation services into routine dental practice. This study was undertaken to assess the knowledge, attitude, and practice regarding tobacco cessation among DHPs in Bengaluru city, India. Materials and Methods: A cross-sectional questionnaire study was conducted among 266 DHPs from various dental colleges across Bengaluru city, India. The questionnaire comprised of 32 items and used a four-point Likert scale (strongly agree/agree/disagree/strongly disagree) was used to assess attitudinal variables and threepoint Likert scale (always/nearly, always, sometimes, rarely/never) was used to measure levels of reported activity. The survey data was analyzed using the SPSS 16 version software package. Descriptive statistics (frequency) was generated for the each question to assess their attitude and practice. Results: The response rate for the questionnaire was 100%. The mean age of the clinicians was around 32 ± 5 years, and about 55% of the participants were females. About 71.9% of the DHPs never used tobacco in any form, 28% used tobacco; of them 23.5% were regular users (all smokers), and 4.5% were occasional smokers. All of them were aware that tobacco use was linked to various cancers including oral cancers and lung diseases. All DHPs routinely asked their patients about tobacco use; 27% provided brief advice on tobacco cessation, and 9% followed up on their patients quit attempts. A lack of training was considered the most important barrier by almost all the participants, and 82% strongly agreed that training is essential to provide tobacco cessation services to patients. Conclusion: In the present study, although dentists possessed knowledge about tobacco cessation, it was not adequate. Dental professionals play an important role in educating patients regarding the oral health risks of tobacco use and motivating them to quit. Widespread implementation of effective tobacco cessation training programs for health professionals is needed. [ABSTRACT FROM AUTHOR]

Background: Body Mass Index (BMI) has been shown to be an important predictor of risk of non- communicable diseases (NCDs) and associated with risk factors for NCDs This study was conducted to determine the association of BMI with sociodemographic, biochemical (fasting glucose, lipid profile), blood pressure and anthropometric (waist hip measurements) risk factors for NCDs in a rural area. Methods: This cross sectional study was conducted in a village in Karnataka, through a house-to-house survey of persons ≥ 18 years of age, employing a questionnaire and laboratory investigations. Anthropometric measurements, blood pressure, fasting blood glucose and lipid profile was measured. Findings: Of the 585 subjects, 45%, 25.3%, 29.7% were in normal, underweight and pre-obese/obese BMI categories respectively. Prevalence of hypertriglyceridemia, abnormal HDL, systolic hypertension (≥ 140mmHg), diastolic hypertension (≥ 90mmHg) was 17.7%, 72.6%, 7.5% and 10.3% respectively In the pre-obese/obese category, 72.5% had abnormal waist circumference and WHR (41%) respectively. Association of BMI with gender, age, waist-hip ratio, systolic and diastolic blood pressure, fasting triglycerides (all P = 0.001) and HDL (P = 0.038) was observed. Conclusion: BMI was associated with increased waist circumference, dyslipidemia, increased fasting blood glucose and hypertension and are serious health problems in rural India also.

Background: National Family Health Survey report (NFHS)-3 reports revealed that immunization coverage in India among children between 12-23 months was low at 43.5%. In lieu of strengthening Routine Immunization (RI), Government of Karnataka undertook state-wide training of Medical officers and Health workers on RI with concurrent efforts of strengthening cold chain system in health centers. With this background, this study was undertaken to assess the cold chain practices in urban health centers of Bangalore city. Methodology: This Cross-sectional study was conducted during October-December 2008 in three-zones of Bruhat Bangalore Mahanagara Palike (BBMP) covering 35 units. Physical verification of the available cold chain equipments was done using predesigned pretested checklist and face to face interview of cold chain handlers was employed. Results: Of 35 centers, 33(94%) and 32(91%) of them had atleast one functional Ice-lined refrigerator(ILR) and one deep freezer(DF) respectively. Good storage code practice was practiced in 12 out of 33 ILRs. Functional thermometer was available in 31(91%) ILRs of which 23(74%) had temperature in the recommend range. With respect to knowledge of cold chain handlers on RI, 86% were trained on RI and their overall knowledge regarding cold chain practices was satisfactory except for knowledge on temperature in DF and on conditioning of ice-packs. Conclusion: Availability of cold chain equipments has improved and Cold storage practice was good/fair in most of the centers. Knowledge of cold chain handlers was low with respect to select cold chain practices.

Background: Children with disabilities are expected to have poor nutritional status in comparison to children without disabilities. However, limited data on nutritional status of children with and without disabilities in rural settings in India., Objective: To assess and compare the nutritional status of children with and without disability., Methods: A cross-sectional study among children aged 5-15 years was conducted in the rural practise area of a medical college in Karnataka. 290 children (145 with and 145 children without disability) of similar age and sex were studied. Age and sex-specific World Health Organization (WHO) BMI centiles, 24 h dietary calorie and protein intakes were assessed and compared. Median and interquartile ranges were calculated for quantitative variables. Mann-Whitney U test was used to assess the differences in quantitative variables among the two groups., Results: As per WHO BMI centiles, 33.1% with and 37.20% without disabilities were undernourished. The median calorie consumed by children with disabilities was 1169.0 (946.5-1586.0) significantly lower compared to that of children without disability, that is, 1362.0 (1167.0-1641.0). The median protein consumed by children with disabilities was 28.0 (22.5-38.0) significantly lower compared to that of children without disability, that is, 32.0 (28.0-40.0)., Conclusions: Children with disabilities had similar rates of undernutrition as that of their non-disabled peers and their lesser dietary intake in terms of calories and proteins., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Family Medicine and Primary Care.)

Background: With increase in life expectancy, adoption of newer lifestyles and screening using prostate specific antigen (PSA), the incidence of prostate cancer is on rise. Globally prostate cancer is the second most frequently diagnosed cancer and sixth leading cause of cancer death in men. The present communication makes an attempt to analyze the time trends in incidence for different age groups of the Indian population reported in different Indian registries using relative difference and regression approaches., Materials and Method: The data published in Cancer Incidence in Five Continents for various Indian registries for different periods and/or publications by the individual registries served as the source materials. Trends were estimated by computing the mean annual percentage change (MAPC) in the incidence rates using the relative difference between two time periods (latest and oldest) and also by estimation of annual percentage change (EAPC) by the Poisson regression model., Results: Age adjusted incidence rates (AAR) of prostate cancer for the period 2005-2008 ranged from 0.8 (Manipur state excluding Imphal west) to 10.9 (Delhi) per 105 person-years. Age specific incidence rates (ASIR) increased in all PBCRs especially after 55 years showing a peak incidence at +65 years clearly indicating that prostate cancer is a cancer of the elderly. MAPC in crude incidence rate(CR) ranged from 0.14 (Ahmedabad) to 8.6 (Chennai) . Chennai also recorded the highest MAPC of 5.66 in ASIR in the age group of 65+. Estimated annual percentage change (EAPC) in the AAR ranged from 0.8 to 5.8 among the three registries. Increase in trend was seen in the 5-64 year age group cohort in many registries and in the 35-44 age group in Metropolitan cities such as Delhi and Mumbai., Conclusions: Several Indian registries have revealed an increasing trend in the incidence of prostate cancer and the mean annual percentage change has ranged from 0.14-8.6.

Objectives: To assess the medical, disability prevention and rehabilitation and psychosocial needs of leprosy patients., Design: Community-based cross sectional study., Results: 259 registered leprosy-affected people were studied. 26% of subjects had presented by voluntary reporting. The mean detection delay was 8.25 months (SD 6.45). 66.8% of the study subjects had received regular treatment. Knowledge about multi-drug therapy (MDT) was satisfactory in 44.4% whereas knowledge of reactions was highly unsatisfactory. 7.7% had leprosy reactions among which only 25 received medical care. Disability proportion was 20.1% out of which 8.5% had Grade 1 and 11.6% had Grade 2 deformity. All these disabled individuals needed skin care, 44.2% of them needed wound care and 36.5% needed joint care. There was wide discrepancy between need for self care, training received and resources available for practising the same. The extent of dehabilitation was more among subjects with visible deformities., Conclusion: Medical needs identified in study subjects include capacity building of patients regarding MDT & reactions, plus awareness generation in general community such that voluntary reporting is enhanced and the detection dela shortened in the district. Strengthening drug inventory and distribution systems fo uninterrupted supply of drugs is essential. There is a need to reorient health care staff regarding leprosy management and DPMR. Rehabilitation needs identified are capacity building with regard to prevention of deformity and supplies (POD tool kit for self care) for the same. It is recommended that the district heath system should conceptualise and implement an evidence-based field level disability care and prevention programme, with community-based rehabilitation approach.

Incidence as a measure of risk for development of cancer is a well accepted epidemiological concept which can be precisely defined. The present communication documents an estimate of the current probability of development of cancer for specific age groups as well as for entire life time risk at the India country level for several cancers and 'all sites together'. The published data on age specific cancer incidence rates from 12 population based registries located at various parts of the country along with the abridged life tables relating to the Indian population formed the basic material for computation. Employing life table methodology for estimates, the current probability of developing cancer of all sites from 35-64 years is 4.67% in males and 6.55% in females while life time risk was found to be 9.05% and 10.2% respectively. The greater risk in females was mainly due to the high risk of development of cancer of the uterine cervix and breast. When the age-period of 35 to 70+ years were considered, the probability percentage was found to be 9.94 % in males whereas it was 11.6% in females. According to these estimates 1 in 10 men and 1 in 8 women in India can expect develop cancer of any form, in their life span after the age of 35 years. The probability of developing tobacco related cancers from 35 to 70+ years was found to be 4.75% and 2.16% in males and females respectively. Estimation in terms of probability will be useful in evaluating the changes in the disease spectrum as a result of change in mortality experience and population structure over a period of time.

The disability adjusted life year (DALY) has been employed to quantify the burden of diseases. This measure allows for combining in a single indicator "years of life lived with disabilities (YLD)" and "years of life lost from premature death (YLL)" . The present communication attempts to estimate the burden of cancers in-terms of YLL, YLD and DALY for "all sites" and leading sites of cancer in India for the years 2001, 2006, 2011 and 2016. The YLL, YLD and DALY were estimated by employing Global Burden of Disease (GBD) methodology using the DISMOD procedure. The published data on age, gender and site specific cancer incidence and mortality for the years 2001-2003 relating to six population-based cancer registries viz. Bangalore, Barshi, Bhopal, Chennai, Delhi and Mumbai, expectation of life by gender for urban areas of the country for 1999-2003 and the projected population during years 2001, 2006, 2011 and 2016 were utilized for the computations. DALYs were found to be lower for males (2,038,553, 2,313,843, 2,656,693 and 3,021,708 for 2001, 2006, 2011 and 2016 respectively) as compared to females (2,560,423, 2,961,218, 3,403,176 and 3,882,649). Amongst males, highest DALYs were contributed by cancer of the lung and esophagus while in females they were for cancers of breast and cervix uteri. It is estimated that total DALYs due to cancer in India combined for both genders would increase from 4,598,976 in 2001 to 6,904,358 by 2016. Premature mortality is a major contributor to disease burden. According to the present estimates, the YLL component of DALY is about 70.0%. The above described computations reveal an urgent need for initiating primary and secondary prevention measures for control of cancers.

Ovarian cancer has emerged as one of the most common malignancies affecting women in India. The present communication reports the trends in the incidence rate of ovarian cancer for Indian women. The data published in Cancer Incidence in Five Continents for various Indian registries for different periods and / or publication by the individual registries served as the source material. Mean annual percentage change (MAPC) in rates was computed using relative differences between two time periods. During the period 2001-06, the age-standardized incidence rates (ASR) for ovarian cancer varied from 0.9 to 8.4 per 100,000 person years amongst various registries. The highest incidence was noted in Pune and Delhi registries. The Age Specific Incidence Rate (ASIR) for ovarian cancer revealed that the disease increases from 35 years of age and reaches a peak between the ages 55-64. The trend analysis by period showed an increasing trend in the incidence rate of ovarian cancer in most of the registries, with a mean annual percentage increase in ASR ranged from 0.7% to 2.4 %. Analysis of data by ASIR revealed that the mean annual percentage increase was higher for women in the middle and older age groups in most of the registries. Estimation of annual percent change (EAPC) in ovarian cancer by Poisson regression model through Maximum Likelihood Estimation (MLE) for the data of 3 population-based cancer registries vs. Mumbai, Chennai and Bangalore for the period 1983-2002 revealed that linear regression was found to be satisfactory fit between period and incidence rate. Statistically significant increase in EAPC was noted with the crude rate (CR,) ASR, and ASIR for several age-groups. Efforts should be made to detect ovarian cancer at an early stage by educating population about the risk factors. Most of the ovarian cancers are environmental in origin and consequently, at least in principle avoidable.