Context : Hypertension is a major chronic lifestyle disease. Several non-pharmacological interventions are effective in bringing down the blood pressure (BP). This study focuses on the effectiveness of such interventions among young adults. Aims : To measure the efficacy of physical exercise, reduction in salt intake, and yoga, in lowering BP among young (20-25) pre-hypertensives and hypertensives, and to compare their relative efficacies. Settings and Design: The study was done in the urban service area of JIPMER . Pre-hypertensives and hypertensives, identified from previous studies, constituted the universe. The participants were randomized into one control and three interventional groups. Materials and Methods: A total of 113 subjects: 30, 28, 28 and 27 in four groups respectively participated for eight weeks: control (I), physical exercise (II) - brisk walking for 50-60 minutes, four days/week, salt intake reduction (III) - to at least half of their previous intake, and practice of yoga (IV) - for 30-45 minutes/day on at least five days/week. Statistical Analysis Used: Efficacy was assessed using paired t test and ANOVA with Games Howell post hoc test. An intention to treat analysis was also performed. Results : A total of 102 participants (29, 27, 25 and 21 in groups I, II, III and IV) completed the study. All three intervention groups showed a significant reduction in BP (SBP/DBP: 5.3/6.0 in group II, 2.6/3.7 in III, and 2.0/2.6 mm Hg in IV respectively). There was no significant change (SBP/DBP: 0.2/0.5 mmHg) of BP in control group (I). Physical exercise was most effective (considered individually); salt intake reduction and yoga were also effective. Conclusions : Physical exercise, salt intake reduction, and yoga are effective non-pharmacological interventions in significantly reducing BP among young hypertensives and pre-hypertensives. These can therefore be positively recommended for hypertensives. There is also a case to deploy these interventions in the general population.

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Background: The prevalence of childhood bronchial asthma and allergic disease has increased in developed countries. Studies have identified asthma among Indian children. Still, there is paucity of information on the overall prevalence of childhood asthma in India. Objective: To assess time trends and the overall prevalence rate of bronchial asthma among Indian children. Materials and Methods: Literature search for data sources was done through an extensive search in indexed literatures and website-based population survey reports. Fifteen epidemiological studies were identified on the development of asthma in Indian children from 300 potentially relevant articles. A broad criterion to define both allergic and non-allergic descriptions of asthma in Indian children was formed. Moreover, in the absence of universally accepted criteria by reporting of prevalence by researchers, weighted average data was considered during calculations of prevalence rates, irrespective of the criteria for diagnosis. Statistical analyses used were mean and median. Results: Wide differences in samples, primary outcome variables, lack of consistency in age category, rural-urban variation, criteria for positive diagnosis, and study instruments confounded the outcome variables. The mean prevalence was 7.24 ± SD 5.42. The median prevalence was 4.75% [with IQR = 2.65 - 12.35%]. Overall weighted mean prevalence was found to be 2.74. Childhood asthma among children 13 - 14 years of age was lower than the younger children (6 - 7 years of age). Urban and male predominance with wide inter-regional variation in prevalence was observed. Conclusions: Our findings indicate that the burden of bronchial asthma in Indian children is higher than was previously understood.

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Objective: To study the prevalence of health disorders among computer professionals and its association with working environment conditions. Study design: Cross sectional. Materials and Methods: A sample size of 200 computer professionals, from Delhi and NCR which included software developers, call centre workers, and data entry workers. Result: The prevalence of visual problems in the study group was 76% (152/200), and musculoskeletal problems were reported by 76.5% (153/200). It was found that there was a gradual increase in visual complaints as the number of hours spent for working on computers daily increased and the same relation was found to be true for musculoskeletal problems as well. Visual problems were less in persons using antiglare screen, and those with adequate lighting in the room. Musculoskeletal problems were found to be significantly lesser among those using cushioned chairs and soft keypad. Conclusion: A significant proportion of the computer professionals were found to be having health problems and this denotes that the occupational health of the people working in the computer field needs to be emphasized as a field of concern in occupational health.

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Background: According to WHO estimates India will be the global capital of diabetes by 2025, accounting for 57.2 million diabetics. Worsening the situation is the fact that diabetes affects the economically productive age-group (45­65 years) in developing countries. Objective : To measure quality of life (QOL) and study the clinical profiles and associated sociodemographic factors affecting diabetic patients aged 20 years and above. Materials and Methods: We conducted a hospital-based cross-sectional study using a generic instrument, Short-Form 36 (SF-36 of the Medical Outcome Study Group) to measure QOL of diabetic subjects aged ≥20 years. Two hundred and sixty diabetics, including 91 males and 169 females, were selected from the clinics of SSK Hospital and Dr RML Hospital of New Delhi. Data was analysed using SPSS for Windows, version 12. Results: The mean age of the respondents was 49.7 years, with 80% of respondents being in the age-group of 40­69 years. The majority (52.1%) of female respondents were illiterate and 91.1% were economically dependent. Of the male respondents, 65.9% were skilled workers. Substance abuse was present among 41.8% male subjects. Type 2 diabetes was the commonest, with 94.6% of the subjects having this form. The mean duration of diabetes was 6.96 ± 6.08 years. Oral hypoglycemic agents were being taken by 70.77% of the respondents. Among the diabetics the most common comorbidity was hypertension (30.8%) and the commonest complication was neuropathy (26.2%). We calculated the body mass index (BMI) of all subjects and found that, 46.2% of the male and 59.8% of the female respondents were either overweight or obese. As predicted by the waist/hip ratio (WHR), 53.8% of the male and 66.9% of the female respondents had high risk for CHD. Regular physical activity was undertaken by less than half of the subjects (46.5%). Out of eight domains of QOL in the SF-36, the two most affected were 'General Health' and 'Vitality.' Overall, males had higher QOL scores; this was found to be statistically significant (P = 0.0001). SF-36 and its eight domain scores had significant association with socioeconomic status, education, and habitual physical activity. Conclusion : Diabetes had an adverse effect on the QOL of these study subjects. Females had a significantly poorer QOL than males. The domains most affected were 'General Health' and 'Vitality.' Poor scores in the QOL domains were significantly associated with lower socioeconomic status, lesser education, and lesser habitual physical activity.

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Background : The number of physician scientists worldwide is decreasing. A review of literature suggests paucity of information examining perceptions and practices towards research among medical undergraduate students in India. Hence, this study was undertaken. Objectives : To understand (a) the awareness, skills, perceptions and practices among undergraduate (UG) medical students towards research, (b) the factors responsible for willingness to take up research as a career among the undergraduates. Material and Methods : This is a questionnaire-based qualitative study. This study was conducted in Kasturba Medical College, Mangalore. A pre-tested questionnaire examining their awareness, perceptions and practices towards research in medical field was used. Consent was obtained from the Dean of the College and student participation was voluntary. Analysis : The information was analyzed using SPSS version 11. Univariate and Multivariate analyses were done to know the willingness to consider research as a career. Results : A total of 471 students responded giving a response rate of 55.41%. Nearly 70% were aware about research though their level of awareness varied. Various skills of conducting research were known to 47% of the students. Most (76%) were part of a research team mainly as a part of the medical curriculum, a few (8.3%) were confident of research as a career option. The multivariate reveals that those with good skill and students who involved in research in addition to curriculum were more likely to take up research as career option/would continue to do research in future. Conclusions : Good training and student support programs exclusively for research would motivate students to opt for research careers.

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Introduction: Behavior pattern influences the risk of unintentional injuries. This study was conducted to identify the pattern of household unsafe behavior in different socioeconomic strata, in Pune city, India. Materials and Method: Population-based, cross-sectional study. Behaviors influencing the risk of burn, poisoning, drowning, and road traffic injuries were questioned from 200 randomly selected households. Results: Nearly 28% of the households did not have a separate kitchen, 37.5% cooked at the ground level, 33.5% used a kerosene pressure stove, 12% used unprotected open fire as a source of warmth in winter, and 34.5% stored inflammable substances at home. Ninety one percent of the households reported storing poisonous chemicals in places that could not be locked. In 68.3% of the households with children below five years, these chemicals were kept in places accessible to children. Nearly 21% of the individuals, who could swim, did so in unsafe places and 25.2% of them were not trained in swimming. In 35.5% of the households, children used streets as playgrounds. Among all two-wheeled vehicle riders, 35.6% reported not having a helmet and 57.7% of those who had a helmet did not use it regularly. Socioeconomic status was strongly associated with the unsafe behaviors related to burns, drowning, and road traffic injuries. Conclusion: The study identifies the sociocultural and behavioral factors leading to unsafe behaviors, placing individuals at risk of unintentional injuries, which can be used as a first step toward prevention.

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Context : Climate change is a significant and emerging threat to public health and to meet the challenge, health systems require qualified staff. Aims : To study the preparedness of medical interns to meet the challenge of protecting health from climate change. Settings and Design: Medical colleges in a coastal town. Cross-sectional study. Materials and Methods: A proportionate number of medical interns from five medical colleges were included in the study. Level of awareness was used as a criterion to judge the preparedness. A self-administered, pretested, open-ended questionnaire was used. Responses were evaluated and graded. Statistical Analysis Used: Proportions, percentage, Chi-test. Results : About 90% of the medical interns were aware of the climate change and human activities that were playing a major role. Ninety-four percent were aware of the direct health impacts due to higher temperature and depletion in ozone concentration, and about 78% of the respondents were aware about the change in frequency / distribution of vector-borne diseases, water borne / related diseases, malnutrition, and health impact of population displacement. Knowledge regarding health protection was limited to mitigation of climate change and training / education. Options like adaptation, establishing / strengthening climate and disease surveillance systems, and health action in emergency were known to only nine (7%), eight (6%), and 17 (13%), respectively. Collegewise difference was statistically insignificant. Extra / co-curricular activities were the major source of knowledge. Conclusions : Majority of medical interns were aware of the causes and health impacts of climate change, but their knowledge regarding health protection measures was limited.

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Aim: To do a prospective clinicohistological study of premalignant and malignant lesions of the oral cavity, and compare it with a 10-year retrospective data, especially in terms of incidence, age distribution, personal habits, and site and type of lesion. Material and Methods: Sections from 776 lesions of the oral cavity, which included 647 lesions of a 10-year (1993 - 2003) retrospective study and 129 lesions of a one-year (2003 - 2004) prospective study, were observed clinically, and a histological correlation was carried out. Results: Premalignant lesions included 78 cases of leukoplakia, 68 cases of oral submucous fibrosis, and 76 cases of squamous papilloma. Their incidence has increased in the last decade from 0.15 to 0.53. These lesions commonly presented in the fourth decade of life, as white patches in leukoplakia and oral submucous fibrosis, and as a growth in squamous cell papilloma. Squamous cell carcinoma was the commonest lesion (57%). Its incidence has increased significantly in the last decade. The mean age of presentation was the sixth decade. A personal history of tobacco chewing was given by most of the patients in the retrospective group, while the use of pan masala was found to be maximum in the prospective group. The overall agreement between the clinical and histological diagnosis was 95.36% (740 / 776) and the kappa coefficient of agreement was 0.9256. Conclusion: Histology along with a detailed clinical workup was found to be a useful, reliable, and accurate diagnostic technique for lesions of the oral cavity. An increase in premalignant lesions in the prospective study, associated with increased pan masala intake is alarming and needs to be taken care of.

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Objective: In this study, the various factors determining the out-of-pocket expenditure on child health care by households are discussed to answer the following questions: How much are households currently spending on child health care? Is there any role of socio-economic status of households on expenditure on child health care? What percentage of their income is spent on child health care and is it catastrophic? Materials and Methods: Four slums with a total a population of 7000 were selected for this study. Households where there is history of illness/ sickness in children under 5 years in last one month were included in the study. Results: There were a total of 218 episodes of child illness in the households. The household's belonging to socio- economic class I and II had higher spending on child's illness per episode as compared to households of socio- economic class III, IV, and V. Socioeconomic status was the key determinant of health care expenditure. Conclusion: In this study, it has been found that almost all the households suffered from catastrophic health expenditure.

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Research Question: What is the sickness prevalence in the slums of a metropolitan city? Objectives: To estimate the morbidity prevalence with reference to a socio-economic and demographic perspective of the slum population of Delhi. Study Design: A cross-sectional study was conducted and data were collected by a two-stage random sampling method. In the first stage, slum locations were selected and in the second stage households were selected. Participants: Data were collected from 1049 households consisting of 5358 individuals' information. Results: The overall morbidity prevalence is 15.4%. It is 14.7 and 16.3% for males and females, respectively but the differences are not statistically significant. The reported higher morbidity prevalence and the illiteracy status are significantly associated. Diseases of the respiratory system appear to be very high among slum dwellers. Conclusion: From this study, it can be concluded that the number of years of staying in the slum area, presence of a separate kitchen, type of house, it being Pucca or Kuccha, types of toilet pits or open defecation are the important environmental factors for the reports of higher morbidity patterns from the slum area.

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Background: Indoor residual spray (IRS), with appropriate insecticide, is an effective weapon for the control of malaria. Two rounds of indoor residual spray, with synthetic pyrethroid, are given in highly malaria endemic areas. It aims to prevent transmission of malaria by adult vector mosquitoes. Aims : To assess the impact of indoor residual spray in the highly malaria-endemic villages of Kalol taluka in Gandhinagar district. Design : High risk population for malaria, based on last three-year malaria situation. Setting: Malaria endemic rural areas in Gandhinagar district where indoor residual spray was undertaken with synthetic pyrethroid in 2006 and 2007. Study Variables: Exploratory - Rural areas; Outcome - coverage, acceptance. Analysis: Percentage and proportions. Results: Prior to the introduction of synthetic pyrethroid, in 2005, the annual parasitic incidence of the sprayed villages was 33.4. It came down to 8.8 in 2006. Continuation of this strategy in the same villages further brought down the annual parasitic incidence to 1.5 in 2007. A similar trend of steady decline was observed in actual numbers of cases and other malariometric indices as well. Conclusion: IRS, it still has a major role in the control of malaria if implemented with proper supervision, better coverage and community participation.

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Research Question : What are the risk factors affecting the survival of emergency victims with chest pain as chief complaint. Objectives : 1. To find out the relative risk of different risk factors. 2. To find out whether the association between survival rate and various sociodemographic variables are statistically significant or not. Study Design : Descriptive study. Setting : This study is based on the Pre-hospital care Records (PCR) of the Emergency Management and Research Institute (EMRI) from May 2007 to December 2007, in Andhra Pradesh. Participants : 2020 emergency victims, with chest pain as the chief complaint, reported to EMRI from May to December 2007. Study Variables : Demographic characteristics of the victims, time and day of the incident, response time in handling the emergency, and so on. Statistical Analysis : Proportions, Chi-Square test, and Odds Ratio. Results : Of all the risk factors studied, gender (Male), age (65 +), and incident location (residence), proved to be the risk factors for the non-survival of the victims of medical emergencies, with chest pain as the chief complaint. It was also observed that there was a statistically significant association (P < 0.05) between age, gender, area (urban and rural), and occupation with the survival rate. The response time was significantly associated with the survival rate, only for critical cases. Survival rate increases to 33% with response time less than 15 minutes from less than 5% with the response time more than 15 minutes.

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Background: Mining is a hazardous occupation in which workers are exposed to adverse conditions. In India, gypsum mining is mainly carried out in the state of Rajasthan, which contributes about 99% of the total production. Objective: The present study was carried out in 12 different gypsum mines in Rajasthan state to determine the health status of the miners. Materials and Methods: One hundred and fifty workers engaged in mining activities were included in the study and their health status was compared with that of 83 office staff of the same mines. The health status of the employees was evaluated using a standardized medical questionnaire and pulmonary function testing. Statistical Analysis: The unpaired 't' test was used to determine whether there was any significant difference between the miners and the controls and the chi-square test to compare the prevalences of various respiratory impairments in workers with that in controls; we also examined the differences between smokers and nonsmokers. Results: Our findings show that the literacy rate is low (42%) among the miners. Pulmonary restrictive impairment was significantly higher amongst smokers as compared to nonsmokers in both miners and controls. Hypertension (22.6%), diabetes (8.8%), and musculoskeletal morbidity (8%) were the common diseases in miners. Conclusion: This study shows that there is high morbidity amongst miners, thus indicating the need for regular health checkups, health education, use of personal protective devices, and engineering measures for control of the workplace environment.

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Background: Regular IEC programs during antenatal and intranatal period, through individual or group approach, brings desirable changes in health practices of people, resulting in a healthy mother and a healthy baby. Materials and Methods: This study was conducted to assess the level of IEC services regarding pregnancy and child care, received by the women at an MCH clinic of an urban health center, where the study subjects comprised 400 antenatal (AN) and postnatal (PN) women and mothers of children under five years. Results: Warning signs of danger was explained to only 10% of the AN and PN women. Advice regarding family planning appeared to be the most frequently covered, though that too was explained to less than half of the subjects. About one third of the women were advised on breast feeding. Only 8% of the mothers had been told about all issues regarding pregnancy and child care. Breast feeding and weaning was properly explained to 85.7 and 81.1% of the total mothers of U5 children. Advice regarding subsequent nutrition was given to 60.9% of mothers. About only a quarter of the total mothers were advised on home management of diarrhea and acute respiratory infections. Very few mothers were counseled about the growth pattern of the children and none were shown the growth chart. Only 12.9% of the mothers were informed about all issues. Conclusion: IEC regarding maternal and child care other than feeding practices is a neglected service in the health facility where the study was conducted.

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