Background: Menstruation and menstrual practices are still clouded by taboos and socio-cultural restrictions resulting in adolescent girls remaining ignorant of the scientific facts and hygienic health practices, which sometimes result into adverse health outcomes. Objectives: (i) To elicit the beliefs, conception and source of information regarding menstruation among the study population and (ii) to find out the status of menstrual hygiene among adolescent girls. Materials and Methods: A descriptive, cross-sectional study was conducted among 160 adolescent girls of a secondary school situated in the field practice area of Rural Health Unit and Training Center, Singur, West Bengal, with the help of a pre-designed and pre-tested questionnaire. Data were analyzed statistically by simple proportions. Results: Out of 160 respondents, 108 (67.5%) girls were aware about menstruation prior to attainment of menarche. Mother was the first informant regarding menstruation in case of 60 (37.5%) girls. One hundred and thirty-eight (86.25%) girls believed it as a physiological process. Seventy-eight (48.75%) girls knew the use of sanitary pad during menstruation. Regarding practices, only 18 (11.25%) girls used sanitary pads during menstruation. For cleaning purpose, 156 (97.5%) girls used both soap and water. Regarding restrictions practiced, 136 (85%) girls practised different restrictions during menstruation. Conclusions: Menstrual hygiene, a very important risk factor for reproductive tract infections, is a vital aspect of health education for adolescent girls. Educational television programmes, trained school nurses/health personnel, motivated school teachers and knowledgeable parents can play a very important role in transmitting the vital message of correct menstrual hygiene to the adolescent girl of today.

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Health promotion is very relevant today. There is a global acceptance that health and social wellbeing are determined by many factors outside the health system which include socioeconomic conditions, patterns of consumption associated with food and communication, demographic patterns, learning environments, family patterns, the cultural and social fabric of societies; sociopolitical and economic changes, including commercialization and trade and global environmental change. In such a situation, health issues can be effectively addressed by adopting a holistic approach by empowering individuals and communities to take action for their health, fostering leadership for public health, promoting intersectoral action to build healthy public policies in all sectors and creating sustainable health systems. Although, not a new concept, health promotion received an impetus following Alma Ata declaration. Recently it has evolved through a series of international conferences, with the first conference in Canada producing the famous Ottawa charter. Efforts at promoting health encompassing actions at individual and community levels, health system strengthening and multi sectoral partnership can be directed at specific health conditions. It should also include settings-based approach to promote health in specific settings such as schools, hospitals, workplaces, residential areas etc. Health promotion needs to be built into all the policies and if utilized efficiently will lead to positive health outcomes.

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Background: The global health impact and disease burden due to chronic arsenic toxicity has not been well studied in West Bengal. Objective: To ascertain these, a scientific epidemiological study was carried out in a district of the state. Materials and Methods: Epidemiological study was carried out by house-to-house survey of arsenic affected villages in the district of Nadia. A stratified multi-stage design has been adopted for this survey for the selection of the participants. A total number of 2297 households of 37 arsenic affected villages in all the 17 blocks were surveyed in the district. Result: Out of 10469 participants examined, prevalence rate of arsenicosis was found to be 15.43%. Out of 0.84 million people suspected to be exposed to arsenic, 0.14 million people are estimated to be suffering from arsenicosis in the district. Highest level of arsenic in drinking water sources was found to be 1362 μg/l, and in 23% cases it was above 100 μg/l. Majority of the population living in the arsenic affected villages were of low socio-economic condition, inadequate education and were farmers or doing physical labour. Chronic lung disease was found in 207 (12.81%) subjects among cases and 69 (0.78%) in controls. Peripheral neuropathy was found in 257 (15.9%) cases and 136 (1.5%) controls. Conclusion: Large number of people in the district of Nadia are showing arsenical skin lesion. However, insufficient education, poverty, lack of awareness and ineffective health care support are major factors causing immense plight to severely arsenic affected people.

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Background: Because of the environment in which they work, many health care workers are at an increased risk of accidental needle stick injuries (NSI). Objective: To study prevalence and response to needle stick injuries among health care workers. Materials and Methods: Study Design: Cross-sectional study. Setting: A tertiary care hospital in Delhi. Participants: 322 resident doctors, interns, nursing staff, nursing students, and technicians. Statistical Analysis: Proportions and Chi-square test. Results: A large percentage (79.5%) of HCWs reported having had one or more NSIs in their career. The average number of NSIs ever was found to be 3.85 per HCW (range 0-20). 72 (22.4%) reported having received a NSI within the last month. More than half (50.4%) ascribed fatigue as a cause in their injury. Most of the injuries (34.0%) occurred during recapping. In response to their most recent NSI, 60.9% washed the site of injury with water and soap while 38 (14.8%) did nothing. Only 20 (7.8%) of the HCWs took post-exposure prophylaxis (PEP) against HIV/AIDS after their injury. Conclusions: The occurrence of NSI was found to be quite common. Avoidable practices like recapping of needles were contributing to the injuries. Prevention of NSI is an integral part of prevention programs in the work place, and training of HCWs regarding safety practices indispensably needs to be an ongoing activity at a hospital.

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Research question: What is the prevalence of dysmenorrhea severity and its associated symptoms among adolescent girls? Objectives: (1) To study the prevalence of dysmenorrhea in high school adolescent girls of Gwalior. (2) To study the evidence of severity of the problem with associated symptoms and general health status. Study design: An explorative survey technique with a correlational approach. Setting and Participants: Nine hundred and seventy adolescent girls of age 15 to 20 years, studying in the higher secondary schools (Pre-University Colleges) of Gwalior. Statistical analysis: Percentages, Chi-square test, and Test-Retest Method. Results: The prevalence of dysmenorrhea in adolescent girls was found to be 79.67%. Most of them, 37.96%, suffered regularly from dysmenorrhea severity. The three most common symptoms present on both days, that is,day before and first day of menstruation were lethargy and tiredness (first), depression (second) and inability to concentrate in work (third), whereas the ranking of these symptoms on the day after the stoppage of menstruation showed depression as the first common symptoms. Negative correlation had found between dysmenorrhea and the General Health Status as measured by the Body surface area.

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Air pollution is responsible for many health problems in the urban areas. Of late, the air pollution status in Delhi has undergone many changes in terms of the levels of pollutants and the control measures taken to reduce them. This paper provides an evidence-based insight into the status of air pollution in Delhi and its effects on health and control measures instituted. The urban air database released by the World Health Organization in September 2011 reported that Delhi has exceeded the maximum PM10 limit by almost 10-times at 198 μg/m3. Vehicular emissions and industrial activities were found to be associated with indoor as well as outdoor air pollution in Delhi. Studies on air pollution and mortality from Delhi found that all-natural-cause mortality and morbidity increased with increased air pollution. Delhi has taken several steps to reduce the level of air pollution in the city during the last 10 years. However, more still needs to be done to further reduce the levels of air pollution.

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Background: The waste produced in the course of healthcare activities carries a higher potential for infection and injury than any other type of waste. Inadequate and inappropriate knowledge of handling of healthcare waste may have serious health consequences and a significant impact on the environment as well. Objective: The objective was to assess knowledge, attitude, and practices of doctors, nurses, laboratory technicians, and sanitary staff regarding biomedical waste management. Materials and Methods: This was a cross-sectional study. Setting: The study was conducted among hospitals (bed capacity >100) of Allahabad city. Participants: Medical personnel included were doctors (75), nurses (60), laboratory technicians (78), and sanitary staff (70). Results: Doctors, nurses, and laboratory technicians have better knowledge than sanitary staff regarding biomedical waste management. Knowledge regarding the color coding and waste segregation at source was found to be better among nurses and laboratory staff as compared to doctors. Regarding practices related to biomedical waste management, sanitary staff were ignorant on all the counts. However, injury reporting was low across all the groups of health professionals. Conclusion: The importance of training regarding biomedical waste management needs emphasis; lack of proper and complete knowledge about biomedical waste management impacts practices of appropriate waste disposal.

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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: India is one of the seven identified countries in the South-East Asia region regularly reporting dengue fever (DF)/dengue hemorrhagic fever (DHF) outbreaks and may soon transform into a major niche for dengue infection in the future with more and more new areas being struck by dengue epidemics. Objective: To study the clinical manifestations, trend and outcome of all confirmed dengue cases admitted in a tertiary care hospital. Study Design: Record-based study conducted in a coastal district of Karnataka. Required data from all the laboratory confirmed cases from 2002 to 2008 were collected from Medical Records Department (MRD) and analyzed using SPSS 13.5 version. Results: Study included 466 patients. Majority were males, 301(64.6%) and in the and in the age group of 15-44 years, 267 (57.5%). Maximum number of cases were seen in 2007, 219 (47%) and in the month of September, 89 (19.1%). The most common presentation was fever 462 (99.1%), followed by myalgia 301 (64.6%), vomiting 222 (47.6%), headache 222 (47.6%) and abdominal pain 175 (37.6%). The most common hemorrhagic manifestation was petechiae 84 (67.2%). 391 (83.9%) cases presented with dengue fever, 41 (8.8%) dengue hemorrhagic fever, and 34 (7.3%) with dengue shock syndrome. Out of 66 (14.1%) patients who developed clinical complications, 22 (33.3%) had ARDS and 20 (30.3%) had pleural effusion. Deaths reported were 11(2.4%). Conclusion: Community awareness, early diagnosis and management and vector control measures need to be strengthened, during peri-monsoon period, in order to curb the increasing number of dengue cases.

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Noncommunicable diseases (NCDs) have become a major public health problem in India accounting for 62% of the total burden of foregone DALYs and 53% of total deaths. In this paper, we review the social and economic impact of NCDs in India. We outline this impact at household, health system and the macroeconomic level. Cardiovascular diseases (CVDs) figure at the top among the leading ten causes of adult (25-69 years) deaths in India. The effects of NCDs are inequitable with evidence of reversal in social gradient of risk factors and greater financial implications for the poorer households in India. Out-of-pocket expenditure associated with the acute and long-term effects of NCDs is high resulting in catastrophic health expenditure for the households. Study in India showed that about 25% of families with a member with CVD and 50% with cancer experience catastrophic expenditure and 10% and 25%, respectively, are driven to poverty. The odds of incurring catastrophic hospitalization expenditure were nearly 160% higher with cancer than the odds of incurring catastrophic spending when hospitalization was due to a communicable disease. These high numbers also pose significant challenge for the health system for providing treatment, care and support. The proportion of hospitalizations and outpatient consultations as a result of NCDs rose from 32% to 40% and 22% to 35%, respectively, within a decade from 1995 to 2004. In macroeconomic term, most of the estimates suggest that the NCDs in India account for an economic burden in the range of 5-10% of GDP, which is significant and slowing down GDP thus hampering development. While India is simultaneously experiencing several disease burdens due to old and new infections, nutritional deficiencies, chronic diseases, and injuries, individual interventions for clinical care are unlikely to be affordable on a large scale. While it is clear that "treating our way out" of the NCDs may not be the efficient way, it has to be strongly supplemented with population-based services aimed at health promotion and action on social determinants of health along with individual services. Since health sector alone cannot deal with the "chronic emergency" of NCDs, a multi-sectoral action addressing the social determinants and strengthening of health systems for universal coverage to population and individual services is required.

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Background: Road Traffic Accident (RTA) is one among the top five causes of morbidity and mortality in South-East Asian countries. ^[1] Its socioeconomic repercussions are a matter of great concern. Efficient addressing of the issue requires quality information on different causative factors. Research Question: What are different epidemiological determinants of RTA in western Nepal? Objective: To examine the factors associated with RTA. Study Design: Prospective observational. Setting: Study was performed in a tertiary healthcare delivery institute in western Nepal. Participants: 360 victims of RTA who reported to Manipal Teaching hospital in one year. Study Variables: Demographic, human, vehicular, environmental and time factors. Statistical analysis: Percentages, linear and logarithmic trend and Chi-square. Results: Most of the victims i.e. 147 (40.83%) were young (15 to 30 years); from low i.e. 114 (31.66%) and mid i.e. 198 (55%) income families and were passengers i.e. 153 (42.50%) and pedestrians i.e. 105 (29.16%). Sever accidents leading to fatal outcome were associated with personal problems (P<0.01, χ² - 8.03), recent or on-day conflicts (P<0.001, χ² - 18.88) and some evidence of alcohol consumptions (P<0.001, χ² - 30.25). Increased prevalence of RTA was also noticed at beginning i.e. 198 (55%) and end i.e. 69 (19.16%) of journey; in rainy and cloudy conditions (269 i.e. 74.72%) and in evening hours (3 to 7 p.m. 159 i.e. 44.16%). Out of 246 vehicles involved; 162 ( 65.85%) were old and ill maintained. The contributions of old vehicle to fatal injuries were 33 (50%). Head injury was found in 156 (43.33 %) cases and its associated case fatality rate was 90.90%. In spite of a good percentage receiving first aid i.e. 213 (59.16%) after RTA; there was a notable delay (174 i.e. 48.33% admitted after 6 h) in shifting the cases to the hospitals. The estimated total days lost due to hospital stay was 4620 with an average of 12.83 days per each case. Conclusion: Most of the factors responsible for RTA and its fatal consequences are preventable. A comprehensive multipronged approach can mitigate most of them.

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Diabetes has emerged as a major public health problem in India. It is estimated that there were 40 million persons with diabetes in India in 2007 and this number is predicted to rise to almost 70 million by 2025. The impact of rapid urbanization, industrialization and lifestyle changes has led to an increasing trend in prevalence of diabetes and its associated complications such as neuropathy, nephropathy, vascular diseases (cardiac, cerebral and peripheral) and retinopathy. Diabetic retinopathy is a important cause of avoidable blindness in India. Treatment interventions at early stages of diabetic retinopathy can reduce burden of blindness due to diabetic retinopathy. With the available cost-effective methods of early screening, appropriate strategies/models need to be developed. Such models need to have a well-developed mode for screening, diagnosis and referral at each hierarchal level beginning from primary health centers to specialized institutes for eye care. The National Program for Control of Blindness of India recommends opportunistic screening for identification of diabetic retinopathy. Every opportunity of contact with high-risk cases for diabetes and/or diabetic retinopathy should be utilized for screening, diagnosis and referral. All the stakeholders including the private sector will need to play a role. Along with this, awareness generation and behavior change amongst the diabetics and care support systems should also be part of the overall model. A major role can be played by community participation and improving the health seeking behavior among diabetics in order to reach a larger population and increasing the compliance for continued care.

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Background: Urinary tract infections (UTIs) are amongst the most common infections described in outpatients setting. Objectives : A study was conducted to evaluate the uropathogenic bacterial flora and its antimicrobial susceptibility profile among patients presenting to the out-patient clinics of a tertiary care hospital at Jaipur, Rajasthan. Materials and Methods : 2012 consecutive urine specimens from symptomatic UTI cases attending to the outpatient clinics were processed in the Microbiology lab. Bacterial isolates obtained were identified using biochemical reactions. Antimicrobial susceptibility testing was performed by the Kirby-Bauer disc diffusion method. Extended spectrum beta lactamase (ESBL) production was determined by the double disk approximation test and the Clinical and Laboratory Standards Institute (formerly NCCLS) confirmatory method. Results: Pathogens were isolated from 346 (17.16%) of the 2012 patients who submitted a urine sample. Escherichia coli was the most frequently isolated community acquired uropathogen accounting for 61.84% of the total isolates. ESBL production was observed in 23.83% of E. coli strains and 8.69% of Klebsiella strains. With the exception of Nitrofurantoin, resistance to agents commonly used as empiric oral treatments for UTI was quite high. Conclusion : The study revealed E. coli as the predominant bacterial pathogen for the community acquired UTIs in Jaipur, Rajasthan. An increasing trend in the production ESBLs among UTI pathogens in the community was noted. Nitrofurantoin should be used as empirical therapy for primary, uncomplicated UTIs.

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Background: The outcome of any disease is influenced by the decisions to seek care, timely arrival at appropriate diagnostic and treatment services and the receipt of adequate care from service providers. Satisfaction in service provision is increasingly being used as a measure of health system performance. Satisfaction manifests itself in the distribution, access and utilization of health services. Objectives: To determine the areas and causes of low satisfaction among the patients and suggest methods for improvement. Materials and Methods: Multistage stratified random sampling was used to select the government allopathic health facilities of Lucknow district and systematic random sampling for the selection of the patients for the interview. Results: The accessibility was difficult in 42% patients and waiting time more than 30 min for 62.5% of those attending the tertiary level health facility. The satisfaction with the duration of the outpatient department (OPD) (64.6%) and the presence of signboards (46.6%) was also found to be low. The overall satisfaction regarding the doctor-patient communication was more than 60% at all the levels of health care facilities but that with the examination and consultation was less than 60% at the primary level as compared to more than 80% elsewhere. The most important motivating factor for the visit to the tertiary (48.2%) and secondary level (71.9%, 67.1%) of health facilities was the faith on doctors or health facility. Conclusions: The level of patient satisfaction is severely deficient in several areas and needs improvement for the achievement of optimal health of the people.

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Background: Change in socio-economic status and various health problems adversely affect an individual's way of life during old age. Objectives: To study the health and social problems of the elderly and their attitude towards life. Materials and Methods : Descriptive study carried out in the Field practice area of the Department of Community Medicine in South India. A total of 213 elderly patients (60 years old and above) who attended the outreach clinics were interviewed using a pre-tested schedule. Findings were described in terms of proportions and percentages to study the socio-economic status of the samples and its correlation to social problems. Results: Around 73% of the patients belonged to the age group of 60-69 years old. Nearly half of the respondents were illiterate. Around 48% felt they were not happy in life. A majority of them had health problems such as hypertension followed by arthritis, diabetes, asthma, cataract, and anemia. About 68% of the patients said that the attitude of people towards the elderly was that of neglect. Conclusions: The results of the study showed that there is a need for geriatric counseling centers that can take care of their physical and psychological needs. The stringent rules for eligibility to social security schemes should be made more flexible to cover a larger population.

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