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Background: Tuberculosis is a communicable disease requiring prolonged treatment. The therapeutic regimens as recommended by WHO have been shown to be highly effective for both preventing and treating tuberculosis but poor adherence to medication is a major barrier to its global control. Aim: The aim was to elicit reasons of treatment default from a cohort of tuberculosis patients treated under Directly Observed Treatment Short course chemotherapy. Settings and design: This cross-sectional study was conducted in Agra city using the multistage simple random sampling. Materials and Methods: A total of 900 patients attending DOTS centres of the selected designated microscopy centers (DMCs) were included in the study from January 2007 onward. The information was obtained from treatment cards of patients and those who defaulted were further interviewed in community. Statistical analysis: Chi-square test was applied to observe the significance of association using the Epi Info software (version 6). Results: More default was observed among the age group of >45 years (22.8%), male (18.7%), business men (30.6%), and retired and unemployed patients. Other factors associated with higher default were pulmonary disease (18.2%), retreatment cases (30.6%) and category II patients (26.4%). Important reasons of default were side effects following medication (43.2%), improvement in symptoms (14.4%), and lack of time (13.5%). No relief in symptoms and lack of awareness were other important reasons. Conclusions: Noncompliance was found to be mainly due to side effects of medicines, lack of time, and unawareness. So educating the patient about various aspects of tuberculosis and some measures to decrease side effects are of utmost importance.

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Background: Life style related behavioural risk factors are mainly implicated for increased burden of cardio- vascular diseases. Research related to these risk behaviours especially among medical students is essential, considering their role as future physicians and role models in public health intervention programmes. Objective: To evaluate the burden of cardiovascular risk behaviours among students of a medical college of Delhi, India. Materials and Methods: A cross sectional study was carried out among undergraduate medical students of a medical college in Delhi. Self administered questionnaire was used to collect information on identification data and risk behaviours in relation to cardiovascular diseases. Binary logistic regression analysis was done to calculate adjusted odds ratio to assess association between risk behaviours and covariates. Results: The minimum recommendation of taking at least five servings per day of fruits and vegetables was complied only by 12% of students. Consumption of carbonated soft drinks either once or more on daily basis was present in 23.7% students and 32.0% reported frequent consumption of fast foods in past week. Consumption of alcohol was present in 28.8% students but only small proportion of students (7%) was current tobacco users. Large proportions of students (42.6%) were either not carrying out or were involved in only occasional physical activity in past week. Conclusions: Unhealthy behavioural practises are present and may progress as student advance through medical college. Developing strategies targeting at these risk behaviours and determining factors is necessary to promote healthy life style among medical students.

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Objective: To study the prevalence of obesity and overweight among school children in Puducherry. To identify any variation as per age, gender, place of residence and type of school. Setting and design: Secondary data analysis of a school-based cross sectional study in all the four regions of Puducherry. Materials and Methods: Children between 6 and 12 yrs were sampled using multistage random sampling with population proportionate to size from 30 clusters. Anthropometric data (BMI) was analyzed using CDC growth charts. Data was analyzed using SPSS, BMI (CDC) calculator, CI calculator and OR calculator. Results: The prevalence of overweight (΃85 ^th percentile) among children was 4.41% and prevalence of obesity (>95 ^th percentile) was 2.12%. Mahe region had the highest prevalence of overweight (8.66%) and obesity (4.69%). Female children from private schools and urban areas were at greater risk of being overweight and obese. Conclusions: Childhood obesity is a problem in Puducherry and requires timely intervention for its control.

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Background: The National Rural Health Mission of India advocates public private partnerships (PPPs) to meet its "service guarantee" of Emergency obstetric care (EmOC) provision. The Janani Suraksha Yojana (JSY) has a provision of Rs. 1500 for contracting in obstetric specialists. Objectives: The study aimed to understand the issues in the design and implementation of the PPPs for EmOC under the JSY in Maharashtra and how they affect the availability of EmOC services to women. Materials and Methods: A cross-sectional study using the rapid assessment approach was conducted in Ahmednagar district of Maharashtra spanning 1-year duration ending in June 2009. Primary data were obtained through interviews with women, providers, and administrators at various levels. Data were analyzed thematically. Results: The PPP scheme for EmOC is restricted to deliveries by Caesarean section. The administrators prefer subsidization of costs for services in private facilities to contracting in. There are no PPPs executed in the study district. This study identifies barriers to women in accessing the benefit and the difficulties faced by administrators in implementing the scheme. Conclusion: The PPPs for EmOC under the JSY have minimally influenced the out-of-pocket payments for EmOC. Infrastructural inadequacies and passive support of the implementers are major barriers to the implementation of contracting-in model of PPPs. Capacities in the public health system are inadequate to design and manage PPPs.

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Background: Healthcare providers being over-worked and under staffed are prone to poor mental health. Unhealthy work place compounds it further. Aims: This study was aimed at to assess the mental health status of a medical university employee with special reference to work place stressors. Settings and design: A cross-sectional study was designed and carried out at a Rural Health University. Materials and Methods: Both the General Health Questionnaire (GHQ)-12 and Holmes-Rahe Scale were used to evaluate 406 participants. Statistical analysis: Multivariate analysis, correlation, and ANOVA by SPSS 11.0. Results: The minimum age of the participant was 19 years and the maximum 64 years, with an average age at 35.09 years. On the GHQ scale 239(58.9%) recorded psychiatric morbidity out of which 201(49.5%) had moderate and 38(9.3%) severe morbidity. Doctors were the highest stressed group (P ≤ 0.04). Prominent work environmental stressors were poor departmental reorganization, lack of cohesiveness in department, difficult superiors and juniors (P ≤ 0.001, Pearson correlation). Stressors associated with work organization and work nature were: noninvolvement in departmental decision making and lack of proper feedback; along with; work load, lack of clarity in job, and a erratic work schedule (P ≤ 0.001 on Pearson correlation). Harassment, favoritism, discrimination, and lack of self-expression (P ≤ 0.003) were other factors responsible for work dissatisfaction. Conclusions: A high stress level was detected in the study population. The principal stressors were work environment related. Poor work culture was found to lead to job dissatisfaction among majority.

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Background: Globally, Telephone help-lines have proved their utility in several crisis situations. They were introduced in India for helping persons in need of counseling or emergency care such as victims of suicide, cardiac arrests, etc. The utility of such help-lines in HIV/AIDS has not been established .Hence this study done in ASHA Foundation, Bangalore. Objectives: To determine the characteristics of persons who access the HIV/AIDS helpline. To determine the reasons for calling the helpline. To identify the gaps in the provision of this service. Materials and Methods: Details on all calls received on ASHA Foundation's HIV/AIDS help line during the period January 2007 to December 2008, were entered on MS excel worksheet and analyzed using the SPSS software. Results: Majority of callers are male, are in the age group of 20-39 years and educated. The most common reasons for calling the helpline were for HIV testing, information about HIV/AIDS, care and support services and referrals to other services not linked to HIV/AIDS. Reasons for calling were linked to risk ( HIV testing, condom use etc) in younger persons, and to avail of care and support services in the older age-group. Conclusions: The main users of the HIV/AIDS helpline are urban ,young, educated males.

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Background: Bar girls are unorganized, difficult to reach high-risk group, and an urban phenomenon. Objectives: To study the demographic profile and sexual behavior of bar girls. Materials and Methods: Study setting is an urban slum area situated in the northwest part of Mumbai. Study design is a community-based cross-sectional study. Study duration was from January 2003 to January 2005. Phase I: Identification of key informants was done. Phase II: Mapping of bar girls in the study area was done with the help of key informants. Sampling: Out of the estimated 800-1200 bar girls, 120 bar girls who were willing to participate in the study were included in the study after obtaining informed consent. Confidentiality of names and locations was assured to both key informants and study subjects. Information was gathered about demographic profile, educational status, and their sexual behavior by conducting one to one interview with the use of predesigned, pre-tested semi-structured questionnaire. Results: Most of the bar girls were in the age group of 21-25 years 52 (43.3%). None of them were educated above secondary level. Most of the subjects belong to West Bengal state 58 (48.4%). Majority of the subjects 88 (73.3%) reported that they have ever practiced commercial sex, and money was the criteria of selection of customers 53 (60.22%). Condom usage was reported less with regular customer as compared with that of nonregular customers (χ² = 6.02, P < 0.02). Conclusions: Need to emphasize condom use with each and every sexual act irrespective of type of customers.

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Background: Mathematical models could provide critical insights for informing preparedness and planning to deal with future epidemics of infectious disease. Objective: The study modeled the H1N1 epidemic in the city of Jaipur, Rajasthan using mathematical model for prediction of progression of epidemic and its duration. Materials and Methods: We iterated the model for various values of R ₀ to determine the effect of variations in R ₀ on the potential size and time-course of the epidemic, while keeping value of 1/g constant. Further simulation using varying values of 1/g were done, keeping value of R ₀ constant. We attempted to fit the actual reported data and compared with prediction models. Results: As R ₀ increases, incidence of H1N1 rises and reaches peak early. The duration of epidemic may be prolonged if R ₀ is reduced. Using the parameters R ₀ as 1.4 and 1/g as 3, it estimated that there would have been 656 actually infected individuals for each reported case. Conclusion: The mathematical modeling can be used for predicting epidemic progression and impact of control measures. Decreasing the value of R ₀ would decrease the proportion of total population infected by H1N1; however, the duration of the outbreak may be prolonged.

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