ABSTRACT
BACKGROUND Dietary salt intake is an important modifiable risk factor for cardiovascular diseases. Estimation of 24-hour salt intake using morning urine samples needs to be validated in the Indian context. We examined the performance of INTERSALT, Tanaka and Kawasaki equations for the estimation of 24-hour urinary sodium from morning fasting urine (MFU) samples. METHODS We enrolled 486 adults aged 18–69 years from four regions of India with equal rural/urban and sex representation to provide 24-hour urine samples. The next day, a MFU sample was obtained. Based on the volume and sodium content of the 24-hour urine sample, 24-hour sodium excretion (reference method) was calculated. Sodium levels in the MFU samples were measured along with other parameters required, and the above equations were used to estimate 24-hour urinary sodium levels. Intraclass correlation coefficient (ICC) was used to assess the degree of agreement between the estimates from the reference method and the three equations. Bland–Altman (BA) plots were used to identify systematic bias and limits of agreement. A difference of 1 g of salt (0.39 g of sodium) between the mean salt intake by 24-hour urine and as estimated by equations was considered acceptable. RESULTS A total of 346 participants provided both the samples. The mean (SD) daily salt intake estimated by the 24-hour urine sample method was 9.9 (5.8) g. ICC was low for all the three equations: highest for Kawasaki (0.16; 95% CI 0.05–0.26) and least for Tanaka (0.12; 0.02–0.22). Only Tanaka equation provided estimates within 1 g of measured 24-hour salt intake (–0.36 g). BA plots showed that as the mean values increased, all the three equations provided lower estimates of salt intake. CONCLUSION Tanaka equation provided acceptable values of 24-hour salt intake at the population level. However, poor performance of all the equations highlights the need to understand the reasons and develop better methods for the measurement of sodium intake at the population level.
ABSTRACT
Background: Most patients with noncommunicable diseases (NCDs) can be managed appropriately at the primary care level, using a simplified standard protocol supported by low-cost drugs. The primary care response to common NCDs is often unstructured and inadequate in low- and middle-income countries. This study assessed the feasibility of integration of NCD prevention and control within the primary health-care system of India. Methods: This study was done among 12 subcentres, 2 primary health centres (PHCs) and one subdistrict hospital in a block in north India. All 28 multipurpose health workers of these subcentres underwent 3-day training for delivering the package of NCD interventions as a part of their routine functioning. A time–motion study was conducted before and after this, to assess the workload on a sample of the workers with and without the NCD work. Screening for risk assessment was done at domiciliary level as well as at health-facility level (opportunistic screening), and the cost was estimated based on standard costing procedures. Individuals who screened positive were investigated with electrocardiography and fasting blood sugar. PHCs were strengthened with provision of essential medicines and technologies. Results: After training, 6% of the time of workers (n = 7) was spent in the NCDrelated activities, and introduction of NCD activities did not impact the coverage of other major national health programmes. Loss during referral of “at-risk” subjects (37.5% from home to subcentre and 33% from subcentre to PHC) resulted in screening efficiency being lowest at domiciliary level (1.3 cases of NCDs identified per 1000 screened). In comparison to domiciliary screening (`21 830.6; US$ 363.8 per case identified), opportunistic screening at subdistrict level (`794.6; US$ 13.2) was 27.5 times and opportunistic screening at PHC (`1457.5; US$ 24.3) was 15.0 times lower. There was significant utilization of NCD services provided at PHCs, including counselling. Conclusion: Opportunistic screening appears to be feasible and a cost-effective strategy for risk screening. It is possible to integrate NCD prevention and control into primary health care in India.
ABSTRACT
Hercule Poirot, the legendary detective, now retired, spent his time growing vegetable marrows. It was a typical day and Poirot was sipping his tisane, reading the day’s paper. He glanced at the Obituaries column (as was his practice now with ripening age).
ABSTRACT
Background: Contaminated hands play a major role in fecal-oral transmission of diseases. In 1847, Dr Semmelweis Ignac pointed to the link between infection and unclean hands, and demonstrated that washing hands could reduce transmission of puerperal fever (child birth fever), a dreaded disease with high mortality in those days. Materials and Methods: A cross-sectional study was conducted to find out the extent of germs present in hand, and also the students' perception on hand washing. This was assessed by questionnaire as well as by collection of swab from hand and performing bacteriological culture in the laboratory. Results: In regard to students' perception about the dirty areas of the hands, it was observed that majority (78%) felt palm was likely to be more dirty while less than 70% felt that web spaces could harbor dirt. Almost 86% reported that they washed hands before eating lunch, but only 21.3% said they always used soap while 47.3% never used it. Availability of soap all the time in the school was reported by only 18.4% students. The swabs of 61% children showed potential pathogens. The commonest of these was Staphylococcus aureus which was seen in 44% samples. Conclusion: The students' hands were contaminated before taking food. Although they washed hands before meals, they hardly used soap due to non-availability of soap. The school authority should be asked to keep soaps in the toilets for hand washing.