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Introduction: Overweight and obesity has become a worldwide epidemic and is a growing public health concern. The increase in prevalence and severity of obesity among children and adolescents has been attributed largely to behavioral factors such as changing eating habits and sedentary lifestyles. Objective: To determine prevalence of obesity and abdominal obesity among adolescents and its association with sociodemographic factors and lifestyle. Methods: Present cross-sectional study was conducted in the urban field practice area under the Community Medicine Department of LLRM Medical College, Meerut, among 872 adolescents. All localities in the field area were covered and house to house survey was done. Questions were asked about eating patterns, physical activity and sedentary lifestyle. Data was collected and analyzed using appropriate statistical tests. Results: The prevalence of overweight and obesity was 17.43, 6.88%, respectively. Obesity was significantly higher among females, those who indulged in unhealthy eating habits were physically inactive, watched television for a longer duration and ate junk while watching television. Conclusion: In the present study, we found that high junk food consumption and a sedentary lifestyle were found to be significantly associated with childhood overweight/obesity. As a result, timely interventions should be taken to improve awareness about healthy lifestyle behavior to prevent obesity and its complications among adolescents.
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Adverse cardiac remodeling refers to progressive structural and functional modifications in the heart because of increased wall stress in the myocardium, loss of viable myocardium, and neurohormonal stimulation. The guideline-directed medical therapy for Heart failure (HF) includes Angiotensin receptor-neprilysin inhibitor (ARNI) (sacubitril/valsartan), ?-blockers, sodium-glucose co-transporter 2 (SGLT2) inhibitors, and mineralocorticoid receptor antagonists (MRA). ARNI is under-prescribed in India despite its attractive safety and efficacy profile. Therefore, the consensus discusses objectives and topics related to ARNI in the management of cardiac remodeling, and experts shared their views on the early timely intervention of effective dosage of ARNI to improve the diagnosis and enhance mortality and morbidity benefits in cardiac reverse remodeling (CRR).
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Iron deficiency (ID) with or without anemia is frequently observed in patients with heart failure (HF). Uncorrected ID is associated with higher hospitalization and mortality in patients with acute HF (AHF) and chronic HF (CHF). Hence, in addition to chronic renal insufficiency, anemia, and diabetes, ID appears as a novel comorbidity and a treatment target of CHF. Intravenous (IV) ferric carboxymaltose (FCM) reduces the hospitalization risk due to HF worsening and improves functional capacity and quality of life (QOL) in HF patients. The current consensus document provides criteria, an expert opinion on the diagnosis of ID in HF, patient profiles for IV FCM, and correct administration and monitoring of such patients.
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Heart failure (HF) is a huge global public health task due to morbidity, mortality, disturbed quality of life, and major economic burden. It is an area of active research and newer treatment strategies are evolving. Recently angiotensin receptor-neprilysin inhibitor (ARNI), a class of drugs (the first agent in this class, Sacubitril–Valsartan), reduces cardiovascular mortality and morbidity in chronic HF patients with reduced left ventricular ejection fraction (LVEF). Positive therapeutic effects have led to a decrease in cardiovascular mortality and HF hospitalizations (HFH), with a favorable safety profile, and have been documented in several clinical studies with an unquestionable survival benefit with ARNI, Sacubitril–Valsartan. This consensus statement of the Indian group of experts in cardiology, nephrology, and diabetes provides a comprehensive review of the power and promise of ARNI in HF management and an evidence-based appraisal of the use of ARNI as an essential treatment strategy for HF patients in clinical practice. Consensus in this review favors an early utility of Sacubitril–Valsartan in patients with HF with reduced EF (HFrEF), regardless of the previous therapy being given. A lower rate of hospitalizations for HF with Sacubitril–Valsartan in HF patients with preserved EF who are phenotypically heterogeneous suggests possible benefits of ARNI in patients having 40–50% of LVEF, frequent subtle systolic dysfunction, and higher hospitalization risk.
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Background: Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana has been launched to provide financial protection expenditure to nearly 500 million vulnerable Indians. For expanding the coverage under the scheme, it is necessary to understand the perspective of health care service providers involved in the scheme. Aim & Objective: To find out the bottlenecks in implementation of PMJAY scheme using empanelled hospitals’ perspective Settings and Design: Cross sectional study Methods and Material: 8 Public and 23 Private hospitals were selected through Simple Random Sampling from the list of PMJAY empanelled hospitals. The PMJAY Medical Officer co-ordinators in the empanelled hospitals were interviewed using a predesigned and pretested questionnaire. Statistical analysis used: Data was analysed using descriptive statistics in Epiinfo software. Results: Among the 31 empanelled hospitals studied, 93.5% were satisfied with the process for empanelment under PMJAY. 64.5% hospitals were not satisfied with the Health Benefit Packages. 77.4% hospitals perceived the PMJAY to be poorer as compared to private health insurance with reasons being poor grievance reprisal, poor claim processing and settlement, denial of reimbursement of health packages, poor rates of health packages and little information about the scheme. Conclusions: Various hurdles are being faced in the implementation of the scheme. There definitely remains a huge scope for further improvements so as to enhance the insurance coverage in the country.
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Background: Infants and pre-school are most susceptible to undernutrition. Integrated Child Development Services is the programme focussing undernourished children by providing them supplementary nutrition. Aim& Objective: To study prevalence of undernutrition in 0-6 year old children and to study factors associated with it. To study impact of supplementary nutrition on undernourished children. Settings and Design: A longitudinal study. Methods and Material: The present longitudinal study was conducted in randomly selected Anganwadis of urban Meerut. Children found to be suffering from under nutrition were followed up at interval of six months to see the impact of supplementary nutrition provided to them at the anganwadi centre. A detailed history of relevant underlying factors responsible for causation of under nutrition were taken from mothers of these children. Statistical analysis used: chi square test was used to find out association between risk factors and undernutrition. Risk factor found statistically significant were further analysed using step wise multiple logistic regression analysis. The impact of supplementary nutrition was assessed using paired t test. Results: Iron folic acid supplementation during pregnancy, exclusive breast feeding in children, immunization and time of initiating complementary feed were found statistically significant on both chi-square and multiple logistic regression analysis. No impact of supplementary nutrition was found on anthropometric measurements of children. Conclusions: The main focus for fighting undernutrition in children (0-6 years) should be on preventing risk factors associated with mothers in antenatal period and during child rearing practices
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Background: Diabetes is an insidious public health problem. India has the second largest number of adults living with diabetes worldwide (77 million). Indian Diabetes Risk Score (IDRS) is a simple, cost-effective and feasible tool for mass screening programme at community level. Aim & Objective: To assess diabetes risk in adults aged 30 years and above and to identify high risk subjects for screening undiagnosed diabetes in an urban population of Meerut. Settings and Design: Community based cross-sectional study. Methods and Material: All adults who were ?30 years of age and non-diabetic were interviewed using pre-designed, pre-tested questionnaire for their socio-demographic profile and lifestyle. Fasting Blood glucose of all study subjects were done to screen undiagnosed diabetics. Statistical analysis used: Centers for Disease Control (CDC), Epi Info TM 7.2.3.1 was used. Pearson’s Chi Square were applied. Results: 33.4% were found to have high diabetes risk. Risk of diabetes increases with age. 7.6% of the study subjects were found to be diabetic and were unaware of their diabetic status. Physical inactivity and increasing waist circumference were found to be significantly associated with risk of diabetes. Diabetes risk was also significantly associated with positive family history. Conclusions: Screening and early identification of high risk individuals would help in early diagnosis and treatment to prevent or to delay the onset of diabetes mellitus and its complications.
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Background: Around 5.9 million children still die every year before reaching their fifth birthday. Child morbidity and mortality due to preventable causes remains high in developing countries. Aim & Objective: To find out the relationship of morbidity with child rearing practices and sociodemographic characteristic. Material and Methods: To cover a sample size of 400 in urban health center area population under 5 children every alternate family was selected by systematic random sampling from the total of 1867 registered families at urban health center. The data was obtained by the interview of mothers and examination of children using predesigned and pretested Questionnaire. The data thus collected, was first coded and then transferred to a master chart on Microsoft Excel sheet, from which distribution as well as co-relation tables were prepared, analyzed and statistically evaluated by SPSS version 20.0.Result: In the present study, the overall fortnightly incidence of morbidity among under 5 children was found to be 65.3% (boys – 64.2%, girls – 66.5%). Exclusive breastfeeding (p < 0.001); time of initiation of breastfeeding (p < 0.001); complementary feeding (p < 0.05) and hand washing practices (p < 0.001) are statistically significant predictors of child morbidity Conclusion: We need comprehensive child health care programme having all three promotive, preventive and curative services.
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Objective Omega-3 fatty acids, especially alpha-linolenic acid (ALA), which are present in nuts may reduce cardiovascular disease (CVD) risk, by changing vascular inflammation and improving endothelial dysfunction. The objective of the study was to evaluate the acute effects of two different diets, one containing walnuts and the other almonds on endothelial function. Methods Twenty-seven overweight volunteers underwent a randomized 2-period, crossover, controlled intervention study. The subjects were given either walnut or almond diets which varied in monounsaturated fatty acid (MUFA) and polyunsaturated fatty acid (PUFA) content. The walnut diet provided 23.1% energy from PUFA and the almond diet provided 7.6% energy from PUFA. Endothelial function was assessed physiologically by flow-mediated dilation (FMD) and biochemically by sVCAM (soluble vascular cell adhesion molecules). Results The walnut diet significantly improved FMD (p = 0.004) and decreased sVCAM (p = 0.009) whereas the almond diet tended to improve FMD (p = 0.06) and significantly decreased sVCAM (p = 0.004). Conclusion Both walnut and almond diets improved FMD and sVCAM and there was no significant difference in physiological and biochemical markers between the two diets.
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Providing quality health services to everyone and everywhere is the dream of many countries and India is one of them. Universal health coverage means that everyone is able to access essential quality health services without facing financial hardship (1). On the other hand it does not mean that every health service will be provided free of cost to everyone everywhere. With the advancement in medical science the cost of treatment is increasing day by day and it is pushing people specially the marginalized one into poverty. It is has been said that poverty breeds diseases and diseases breeds poverty. If one has to provide minimum plethora of essential quality health services to all in India then one has to make efforts to decrease out of pocket expenditure on health. As per WHO tracking universal health coverage global monitoring report 2017 (2), 17. 3 % Indians spend more than 10% of their annual income for treatment and 3.9 % spend more than 25% of their annual income on treatment. In fact when we look at the data provided by National Sample Survey round 71 (3) it is apparent that expenditure on free medicines for In patients has reduced from 31% to 8.99% and for out-patients from 17.98% to 5.34 % in two decades that’s from 1986 to 2004. While the government spending on health as percentage of GDP is almost stationary. It clearly indicates that either the cost of treatment is increasing or the number of patients have increased tremendously due to increase in population. This issue of increasing population needs to be addressed at war footing otherwise despite increasing the government spending on health it will not be able to reduce out of pocket expenditure.
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Background: Adolescent obesity is becoming a major public health problem in urban areas of India and its prevalence is increasing in all socioeconomic groups irrespective of religion, region and caste. Aims & Objectives: To find out prevalence of overweight & obesity among adolescents and to study its association with sociodemographic factors. Material & Methods: This cross-sectional study was carried out in the area covered by Urban Health and Training Centre of Lala Lajpat Rai Memorial Medical College, Meerut. Sample size was estimated by keeping the prevalence as 10% with 95% confidence interval and relative precision of 20%. A total of 872 adolescents were selected randomly using proportional allocation method. Results: The prevalence of overweight was found to be 17.4% and obesity 6.9%. The prevalence was significantly higher among females and in those belonging to nuclear families as well as higher socioeconomic status. Conclusion: The prevalence of overweight and obesity is quite high in the urban area and there is a need to develop an effective programme for the prevention of obesity in these areas.
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Background. Majority of the qualified medical practitioners in the country are in the private sector and more than half of patients with tuberculosis (TB) seek treatment from them. The present study was conducted with the objective of assessing the treatment modalities in pulmonary tuberculosis by the private physicians in Meerut City, Uttar Pradesh, India. Methods. A cross-sectional study was carried out covering all the private physicians (graduates and postgraduates in Medicine and Chest Diseases) registered under the Indian Medical Association, Meerut Branch (n=154). The physicians were interviewed by a pre-designed and pre-tested questionnaire about the treatment modalities practiced by them. Results. Only 43.5% private physicians had attended any Revised National Tuberculosis Control Programme (RNTCP) training in the past five years. Only 33.1% of them were aware of the International Standards of Tuberculosis Care (ISTC). Fifty-three different regimens were used to treat the patients. Majority of physicians (76%) prescribed daily regimens while 24% administered both daily and intermittent treatment. None of the private physicians prescribed exclusive intermittent regimen. Eighty-seven different treatment regimens were used for the treatment of multidrug-resistant TB (MDR-TB) with none of them prescribing standard treatment under RNTCP. Conclusion. As majority of private practitioners do not follow RNTCP guidelines for treating TB, there is an urgent need for their continued education in this area.
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Antitubercular Agents/administration & dosage , Data Collection , Directly Observed Therapy , Humans , India , Practice Patterns, Physicians' , Practice Guidelines as Topic , Private Practice , Tuberculosis, Pulmonary/drug therapyABSTRACT
The prevalence of obesity has increased worldwide in all segments of the population due to increased industrialization, urbanization, mechanization, and associated changes in diet and lifestyles. Change in diet habit of consuming more high energy fast foods and shifting to sedentary lifestyle has affected our children and also increased the risk of chronic diseases among adolescents. Childhood obesity has association with increased risk of coronary heart disease, stroke, and cancer in later life. Therefore, its control and prevention is one of the major concerns for all developing nations. The present school-based cross-sectional study was carried out among 2785 affluent adolescents of six public schools in Meerut during the period October 2003 to March 2004. The objective is to assess the magnitude of overweight and obesity in adolescents and associated risk factors, with the help of the ELIZ health pathway based on body mass index criteria. Prevalence of overweight and obesity was found to be 19.7% and 5.3% in girls and 18.36% and 10.82% in boys. Obesity was found to be significantly associated with high intake of junk foods (P < 0.05), binge eating, high calorie intake (P < 0.05), lower physical activity (P < 0.05), and prolonged TV watching (P < 0.05).
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The prevalence of RTIs in 600 married females (15-44 yrs.) representing 12 subcentre villages of Daurala block of Meerut was 35.3%. The reproductive tract infections were significantly associated with place of last delivery (P< 0.001), person conducted the last delivery (P< 0.001) and in women had history of abortions (P< .005).
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Abortion, Induced/statistics & numerical data , Adolescent , Adult , Female , Genital Diseases, Female/epidemiology , Home Childbirth , Humans , India/epidemiology , Middle Aged , Parity , Postpartum Period , Pregnancy , Prevalence , Rural HealthABSTRACT
The prevalence of anaemia in 504 adolescent girls (10-18 yrs) representing 24 subcentre villages of Daurala block of Meerut was 34.5%. The prevalence of mild, moderate and severe anaemia among adolescent girls was 19.0%, 14.0% and 1.4% respectively. Majority (55.2%) were having mild anaemia and only 4.0% had severe anaemia. Anaemia was found to be significantly associated with educational status (P < 0.05), birth order (P < 0.05), awareness regarding anaemia (P < 0.05) and marital & obstetric status (P < 0.05) with no association with age, anthropometry and menarcheal age (P > 0.05).
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Adolescent , Adolescent Nutritional Physiological Phenomena , Anemia/epidemiology , Awareness , Child , Educational Status , Female , Humans , India/epidemiology , Prevalence , Rural PopulationSubject(s)
Child , Child, Preschool , Family Characteristics , Female , Health Status Indicators , Humans , Immunization/statistics & numerical data , India/epidemiology , Infant , Male , Morbidity , Nutritional Status , Poverty AreasABSTRACT
Iron deficiency anemia is the most wide spread micronutrient deficiency disorder in the world, being most prevalent in women and young children. The present study was conducted to find out the prevalence of anemia in children and its contributory factors with reference to early iron supplementation. It was a cross sectional study done on 137 children of age 1-2 years in urban slums of Meerut. Prevalence of anemia in the study group was 59.9%. The socio-economic status, mother's educational status, birth weight, sibling order, and type of weaning food did not show any significant relationship with the prevalence of anemia in these children, whereas, weaning time, nutritional status and early iron supplementation had a positive impact on it. Exclusive breast feeding upto 4 months followed by weaning, adequate nutritional status and early iron supplementation have a definite role in prevention of anemia in children.
Subject(s)
Age Factors , Anemia, Iron-Deficiency/drug therapy , Dietary Supplements , Female , Humans , Infant , Iron/therapeutic use , Male , PrevalenceABSTRACT
The present study was done among 500 women of reproductive age group. Study revealed overall prevalence rate of RTI of 44.8%. Excessive vaginal discharge was the most common presenting symptom (42.0%). Inspite of such an high prevalence of reproductive tract infections, only 22.8% of the women sought treatment for their problem. The study suggests to improve the awareness about RTI and its treatment facility among women and also recommends to develop a strategy to train and reorient the health personnel.