The paradigm of preventing human papilloma virus (HPV) infection through currently approved vaccines, namely, Gardasil, manufactured by Merck and Co., Inc. (Whitehouse Station, NJ) and Cervarix, manufactured by GlaxoSmithKline (GSK, Philadelphia) holds tremendous promise for the developing countries in decreasing the burden of HPV infection and its sequelae, such as cervical cancer, genital warts and anogenital cancers. Effective screening programs that have reduced the burden of this killer disease in the developed countries are still lacking in India, despite the high incidence of cervical cancer and the implementation of the National Cancer Control Programme since 1975. The recent breakthrough in the global war against cervical cancer will provide new insight for meeting the future challenge of the prevention of cervical cancer in India.

Background: Fluorosis is one of the common but major emerging areas of research in the tropics. It is considered endemic in 17 states of India. However, the Cuddalore district of Tamil Nadu is categorised as a fluorosis non-endemic area. But clinical cases of dental fluorosis were reported in the field practice area of Department of Community Medicine, Rajah Muthiah Medical College, Annamalai University, Chidambaram. Since dental fluorosis has been described as a biomarker of exposure to fluoride, we assessed the prevalence and severity of dental fluorosis among primary school children in the service area. Materials and Methods: Children studying in six primary schools of six villages in the field practice area of Rural Health Centre of Faculty of Medicine, Annamalai University, Chidambaram, were surveyed. Every child was clinically examined at the school by calibrated examiners with Dean's fluorosis index recommended by WHO (1997). Chi-square test, Chi-square trend test and Spearman's rank correlation coefficient test were used for statistical analysis. Results: Five hundred and twenty-five 5- to 12-year-old school children (255 boys and 270 girls) were surveyed. The overall dental fluorosis prevalence was found to be 31.4% in our study sample. Dental fluorosis increased with age P < 0.001, whereas gender difference was not statistically significant. Aesthetically objectionable dental fluorosis was found in 2.1% of the sample. Villages Senjicherry, Keezhaperambai and Kanagarapattu revealed a community fluorosis index (CFI) score of 0.43, 0.54 and 0.54 with 5.6%, 4.8% and 1.4% of objectionable dental fluorosis, respectively. Correlation between water fluoride content and CFI values in four villages was noted to be positively significant. Conclusion: Three out of six villages studied were in 'borderline' public health significance (CFI score 0.4-0.6). A well-designed epidemiological investigation can be undertaken to evaluate the risk factors associated with the condition in the study region.

Research Question: Is LQAS technique better than cluster sampling technique in terms of resources to evaluate the immunization coverage in an urban area? Objective: To assess and compare the lot quality assurance sampling against cluster sampling in the evaluation of primary immunization coverage. Study Design: Population-based cross-sectional study. Study Setting: Areas under Mathikere Urban Health Center. Study Subjects: Children aged 12 months to 23 months. Sample Size: 220 in cluster sampling, 76 in lot quality assurance sampling. Statistical Analysis: Percentages and Proportions, Chi square Test. Results: (1) Using cluster sampling, the percentage of completely immunized, partially immunized and unimmunized children were 84.09%, 14.09% and 1.82%, respectively. With lot quality assurance sampling, it was 92.11%, 6.58% and 1.31%, respectively. (2) Immunization coverage levels as evaluated by cluster sampling technique were not statistically different from the coverage value as obtained by lot quality assurance sampling techniques. Considering the time and resources required, it was found that lot quality assurance sampling is a better technique in evaluating the primary immunization coverage in urban area.

Background: The growing menace created by the HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) has alarmed not only the public health officials but also the general community. The Voluntary Counseling and Testing Centre (VCTC) services have begun as a cost-effective intervention in reversing this epidemic. Objectives: 1. To study the sociodemographic characteristics of HIV-positive clients and their risk behaviors. 2. To elucidate the reasons for their visit to the VCTC and know the problems anticipated by the clients after revealing their HIV-positive status. Study Design: A cross-sectional record-based study. Materials and Methods: The study was conducted in August 2007 among clients who tested positive for HIV in the VCTC of a district hospital in Karnataka from January to July 2007. Results: Study included 249 individuals, of whom 64.7% were males, 88.7% (age, 15-49 years), married (72.7% males and 84.0% females) and literate (females 71.5% and males 85.7%). A high percentage of nonresponse regarding the pattern of risk behavior was noted among the subjects (males: 42.8% and females: 90.9%). Of the individuals who responded, 91 males (98.9%) and 6 females (75.0%) had multiple heterosexual sex partners, while 1 male had homosexual partner. The figures in females show that two (25%) of them had a history of blood transfusion. The reason for visiting the VCTC were cited as some form of illness (33.3%), confirmation of test results (32.9%), family members diagnosed as HIV positive (12.9%) and 11.6% were referred from Directly Observed Treatment Scheme (DOTS) center. More than three quarter of the sample population anticipated discrimination at the time of medical treatment. Conclusion: People have begun using VCTC services, which reflects a change in their attitude toward HIV. The study provides us a clue to formulate an effective approach to educate people as well as the health personnel who are thought of as one of the important sources of discrimination.

Objective: To assess and compare the efficacy of cold cabbage leaves and hot and cold compresses in the treatment of breast engorgement. Material and Methods: This was a quasi-experimental study conducted in the postnatal ward of the All India Institute of Medical Sciences (AIIMS), New Delhi. The study comprised a total of 60 mothers; 30 in the experimental group and 30 in the control group. The control group received alternate hot and cold compresses and the experimental group received cold cabbage leaf treatment for relieving breast engorgement. The pre- and posttreatment scores of breast engorgement and pain were recorded. The data were analyzed using descriptive and inferential statistical methods using the statistical software STRATA. Results: Both the treatments, i.e., hot and cold compress and cabbage leaves were effective in decreasing breast engorgement and pain in postnatal mothers ( P ≤ 0.001). Cold cabbage leaves and hot and cold compress were both equally effective in decreasing breast engorgement ( P = 0.07), whereas hot and cold compresses were found to be more effective than cold cabbage leaves in relieving pain due to breast engorgement ( P ≤ 0.001) in postnatal mothers. Conclusion: Cold cabbage leaves as well as alternate hot and cold compresses both can be used in the treatment of breast engorgement. Hot and cold compresses are more effective in decreasing pain than cold cabbage leaves in relieving pan due to breast engorgement.

Background: There are significant gaps in the scientific literature concerning female sexual behavior and attitudes surrounding sexuality, which have definitive implications on public health and clinical work. Aim: To study the sexual behavior of young married Indian women. Materials and Methods: The study group comprised 100 consecutive women attending the Department of Pediatrics for the care of noncritical children in a multispecialty, tertiary care teaching hospital setting in North India. Current levels of sexual functioning and satisfaction were assessed by using the Brief Index of Sexual Functioning for Women (BISF-W). All participants were also administered a translated and culturally adapted instrument called Sex Knowledge and Attitude Questionnaire-II (SKAQ-II). Results: Peno-vaginal sex continues to be considered the most desired and actually performed sexual activity for arousal and orgasm, followed by kissing and foreplay. Difficulties while performing sexual activity, in the form of physical problems, were faced by 17% of the participants. The participants displayed adequate sexual knowledge and favorable attitude towards sexuality as measured by SKAQ-II. Conclusion: The present study is a preliminary effort to understand the contemporary female sexual behavior, knowledge and attitude by employing standard instruments. Still further studies are required in this area.

Objective: To identify the sociodemographic characteristics, degree and cause of visual disability among certified visually disabled individuals in a rural district of West Bengal, India and to identify possible lacunae, if any, in the existing certification system. Materials and Methods: A cross-sectional study by secondary data analysis of medical records of 155 visually disabled individuals and their 310 eyes. Demographical features, diagnosis, percentage of visual disability and work activity status of each individual were analyzed. Results: One hundred and thirty one (84.52%) individuals had 100% disability. The number of males was significantly higher than that of females. Fifty eight (37.42%) individuals were below 21 years of age. Phthisis bulbi was the most common cause followed by microphthalmos. Further, 81.29% patients had the same lesion bilaterally. Conclusion: Patients with higher grades of disability have attended certification boards. A large number of disabled individuals comprised children and young adults. Male gender bias demands concern.

Objectives: To assess the magnitude of obesity and overweight among male primary school children, and to find the possible association between obesity/overweight and dietary habits and sociodemographic differentials among them. Study design and Methods: A cross-sectional descriptive study, including 1139 Saudi male children enrolled in the 5 ^th and 6 ^th grades in public primary schools in Al Hassa, Kingdom of Saudi Arabia (KSA), was conducted. The test included a multistage random sampling technique, based on interview using Youth and Adolescent Food Frequency Questionnaire, gathering data regarding dietary intake, dietary habits, followed by anthropometric measurements with the calculation of body mass index (BMI), the interpretation of which was based on Cole's tables for the standard definition of overweight and obesity. Sociodemographic data were collected through a parental questionnaire from. Data analysis was performed using the SPSS 12 software (SPSS Inc. Chicago, IL, USA); both univariate and multivariate analyses were performed. Results: The age of the school children ranged from 10-14 years. The prevalence of overweight among the subjects was 14.2%, while that of obesity was 9.7%; the prevalence was more in the urban, older age students. The mothers of obese and overweight children were less educated and more working. Missing and or infrequent intake of breakfast at home, frequent consumption of fast foods, low servings per day of fruits, vegetables, milk and dairy products, with frequent consumption of sweets/candy and carbonated drinks were all predictors of obesity and overweight among the schoolchildren studied. Conclusion: The prevalence of childhood obesity is escalating and approaching figures that have been reported till now from the developed countries. Less healthy dietary habits and poor selection of food may be responsible for this high prevalence.

Research question: What is the current status of Iodine Deficiency Disorders (IDD) in the state of Jharkhand? Objectives: (1) To determine the status of iodine deficiency in the state. (2) To determine the availability and cost of adequately iodized salt at the retail shops. (3) To study the perceptions of the community regarding iodine deficiency, salt and iodized salt. Design: A cross-sectional community-based survey. Study setting: Thirty clusters selected through the probability proportion to size (PPS) sampling in the state of Jharkhand. Study participants: Children aged 6-12 years, households, retail shopkeepers and opinion leaders. Study tool: Quantitative and qualitative methodology using a pretested questionnaire and focus group discussion used to carry out the community-based survey. Results: Total goiter rate (TGR) was 0.9%. Median urinary iodine level was 173.2 µg/L. The proportion of individuals with urinary iodine levels less than 100 and 50 µg/L were 26.4% and 10%, respectively. Slightly less than two-thirds (64.2%) of the households were found to be consuming adequately iodized salt as measured by titration (greater than 15 ppm). Iodized salt was available across the state and the cost varied between Re. 1 and Rs. 8 per kilogram. A common belief among the community was that iodized salt is equivalent to refined packet salt that is further equivalent to expensive salt. Conclusion: The results of the present survey show that the iodine nutrition in the state of Jharkhand is optimal. Considering that the consumption of adequately iodized salt should increase from 64.2% to the goal of more than 90%, sustained efforts are required in this place to consolidate the current coverage of adequately iodized salt and increase it to greater than 90%.