Identification of a threshold for biomass exposure index for chronic bronchitis in rural women of Mysore district, Karnataka, India.

Background & objectives: Exposure to air pollution due to combustion of biomass fuels remains one of the significant risk factors for chronic respiratory diseases such as chronic bronchitis. There is a need to identify the minimum threshold level of biomass index that is significantly associated with chronic bronchitis. This study was undertaken to identify a threshold for biomass exposure index in a rural women population in Mysore district, south India. Methods: A cross-sectional survey was conducted in a representative population of Mysore and Nanjangud taluks. Eight villages each from Mysore and Nanjangud were randomly selected based on the list of villages from census 2001. A house-to-house survey was carried out by trained field workers using the Burden of Obstructive Diseases questionnaire, which evaluated the biomass smoke exposure and chronic bronchitis. All the women aged above 30 yr were included in the study. Results: A total of 2011 women from Mysore and 1942 women from Nanjangud participated in the study. All women were non-smoking and used biomass fuels as the primary fuel for cooking. A threshold of biomass fuel exposure of 60 was identified on multivariate analysis in Mysore district after adjusting for age, passive smoking and working in a occupational exposure to dust, as the minimum required for a significant association with chronic bronchitis. One in every 20 women in Mysore district exposed to biomass fuel exposure index of 110 or more developed chronic bronchitis. Interpretation & conclusions: The minimum threshold of biomass exposure index of 60 is necessary to have a significant risk of developing chronic bronchitis in women. The number needed to harm to develop chronic bronchitis reduces with increasing biomass exposure index and women residing in rural Nanjangud have a higher risk for developing chronic bronchitis as compared to women in Mysore.

Factors affecting 30-month survival in lung cancer patients.

Background & objectives: Age adjusted incidence rate of lung cancer in India ranges from 7.4 to 13.1 per 100,000 among males and 3.9 to 5.8 per 100,000 among females. The factors affecting survival in lung cancer patients in India are not fully understood. The current study was undertaken to evaluate the factors affecting survival in patients diagnosed with lung cancer attending a tertiary care cancer institute in Bangalore, Karnataka, India. Methods: Consecutive patients with primary lung cancer attending Bangalore Institute of Oncology, a tertiary care centre at Bangalore, between 2006 and 2009 were included. Demographic, clinical, radiological data were collected retrospectively from the medical records. Results: A total of 170 consecutive subjects (128 males, 42 females) diagnosed to have lung cancer; 151 non-small cell lung cancer (NSCLC) and 19 small cell lung cancer (SCLC) were included. A higher proportion of never-smokers (54.1%) were observed, mostly presenting below the age of 60 yr. Most subjects were in stage IV and III at the time of diagnosis. More than 50 per cent of patients presented with late stage lung cancer even though the duration of symptoms is less than 2 months. The 30-month overall survival rates for smokers and never-smokers were 32 and 49 per cent, respectively. No significant differences were observed in 30 month survival based on age at presentation, gender and type of lung cancer. Cox proportional hazards model identified never-smokers and duration of symptoms less than 1 month as factors adversely affecting survival. Interpretation & conclusions: Our results showed that lung cancer in Indians involved younger subjects and associated with poorer survival as compared to other ethnic population. Studies on large sample need to be done to evaluate risk factors in lung cancer patients.

Prevalence of chronic cough, chronic phlegm & associated factors in Mysore, Karnataka, India.

Background & objectives: Chronic cough and chronic phlegm are important indicators of respiratory morbidity, accelerated lung function decline, increased hospitalization and mortality. This study was planned to estimate the prevalence of chronic cough and phlegm in the absence of dyspneoa and wheezing and to study its associated factors in a representative population of Mysore district. Methods: A cross-sectional survey was planned in a representative population of Mysore taluk. Eight villages were randomly selected based on the list of villages from census 2001. Trained field workers using the Burden of Obstructive Diseases questionnaire carried out a house-to-house survey. Results: A total of 4333 adult subjects were enrolled in the study with 2333 males and 2000 females. The prevalence of chronic cough in the community was 2.5 per cent and that of chronic phlegm was 1.2 per cent. A significant association was observed between chronic cough and age, gender, occupation and smoking and chronic phlegm with age, gender, occupation, indoor animals and smoking. A multivariate analysis confirmed independent association of age, occupation and smoking for chronic cough and age and smoking for chronic phlegm. On sub-group analysis of males, heavy smokers had higher prevalence of chronic cough and chronic phlegm as compared to light smokers and non smokers. Interpretation & conclusions: The prevalence of chronic cough was 2.5 per cent and chronic phlegm was 1.2 per cent in the general population in Mysore which is lower than that observed in other studies. Heavy smoking was an important preventable risk factor identified in this study and efforts towards smoking cessation are crucial to achieve good respiratory health in the community.

Prevalence of Prediabetes in School-Going Children.

school children in Mysore city. Design: Cross sectional study. Settings: Children aged 5-10 years from three schools in Mysore city were included. Study was done over a period of 1 year during 2006-2007. Participants: 726 children (59.8% males). Main Outcome: Prevalence of prediabetes. Prediabetes was defined as fasting blood sugar level between 100-125 mg/dL. Results: The prevalence of prediabetes was 3.7%. No statistically significant association was observed with major risk factors of diabetes. Conclusions: Efforts must be made to recognize type 2 diabetes in the asymptomatic prediabetes state.

Factors associated with non-adherence to specific allergen immunotherapy in management of respiratory allergy.

Background. Non-adherence to specific allergen immunotherapy is a major hurdle faced by the allergist, contributing to poor clinical outcomes. Objectives. To assess the independent association of various factors with non-adherence to specific allergen immunotherapy. Methods. Fifty consecutive (non-adherent) and control (adherent) subjects receiving specific allergen immunotherapy were included in the study and various factors related to non-adherence including socio-demographic, clinical and immunotherapy related variables were compared between the two groups by univariate and multivariate analysis. Results. On univariate analysis, gender, allergic conjunctivitis, family history, progression of disease, perception of immunotherapy, medicine requirement, and the pattern of missed doses greater than two in the last 10, 20 and 30 doses were found to be significantly associated with non-adherence. On multivariate analysis, independent association was observed with allergic conjunctivitis, family history, perception of immunotherapy, missed doses greater than two in the last 10 doses of immunotherapy and medicine requirement. Conclusions. The independent factors associated with non-adherence may vary between different settings and countries. There is a need for developing individual case holding programmes to improve clinical outcomes in patients receiving specific allergen immunotherapy.

Chronic morbidity profile among elderly.

The most common health problems of the elderly are related to chronic disease as a result of increase in life expectancy. In India, sporadic data have been collected on different health problems of the elderly. While epidemiologic studies specifically targeted at the elderly population are sparce, the Indian Council of Medical Research (ICMR) has carried out several studies on specific chronic disorders such as hearing impairment, blindness, cardiovascular diseases, cancer etc. The data from these studies covering the aged population have been utilised to provide a chronic morbidity profile of the elderly. Based upon the population estimates, the disease load in the Indian elderly population has been estimated. Hearing impairment is the most common morbidity, followed by visual impairment. The common risk factors associated with these chronic disease, are reported upon, and measures for intervention are suggested, wherever feasible. The paper does not cover common morbidities, such as locomotor, urinary and sleep disturbances, which have been reported in other surveys. The availability of population based data from India, and derives the disease burden due to chronic diseases in the elderly is emphasised. Such data can be used to generate the pattern of health problems in the elderly, for initiating appropriate intervention strategies and for fixing priorities for planning health care services amongst the elderly.

Age at marriage and cervical cancer incidence.

Cancer of the uterine cervix is the commonest cancer among Indian women accounting for 1/5 of the total cancer incidence. It is the estimated that by the turn of century 139,000 women in India would be developing cervical cancer. Age at marriage has been recognised as a major risk factor associated with cervical cancer. Over the past 8 decades there has been a rise in age at marriage varying from 14 years in 1901 to 18 years in 1981. Consequently the proportion of women married in the age group 15-19 years has fallen from 88% in 1941 to 45% in 1981. The present paper has attempted to study the effect of change in proportion married below 17 years on cervical cancer incidence for the year 1985 in India. The proportion of married women in the age group 15-19 years was constant around 88% from 1901-41 and from 1951 onwards the reduction in the proportion married has been observed. During the last 35 years, after the start of reduction in the proportion married in the age group (15-19) years, a reduction of 2097 cervical cancer cases or 6.3 percent reduction in the incidence of invasive cervical cancer is observed. It may be postulated that it will take a long time to expect a significant reduction in the incidence of cervical cancer if the primary prevention of rising the age at marriage above 18 years is adopted as a strategy for control of cervical cancer.

Cervical cancer in India--strategy for control.

The available information on the incidence of cancers by site in India have indicated that of incidence of cancer of uterine cervix among women is by far the highest compared to other sites in women. The epidemiology of cervical cancer has been studied extensively in India and in other countries. The majority of factors related to cervical cancer are associated with sexual behaviour. The available evidence for control of cervical cancer is through secondary prevention, namely--early detection through Pap smear. In the present communication the alternative strategies with secondary prevention for control of cervical cancer is worked out. Taking into consideration the number of cervical cancer cases saved, number of woman years saved and the cost aspects the strategy at present for India should be to provide one life time screening for women at the age of 45 years.

Cancer projection by the turn of century-Indian science.

This is an attempt to understand the magnitude of cancer problem in India. The incidence data generated by the three population based cancer registries at Bangalore, Bombay and Madras and the population projections of country have been utilised for estimating the present and future load of new cancer cases. It is estimated that the total number of incident cases in males increased from 0.29 million to 0.43 million by the turn of the century as a result of change in size and composition of population and when adjusted for tobacco habits the estimates increased to 0.49 million. In females the incident cases of cancer for three registries increased from 0.32 to 0.42 million by 2001, with cancer of uterine cervix and breast being the major problems. The above results show an urgent need for strengthening and augmenting the existing diagnostic/treatment facilities which are vow fully inadequate to tackle even the present load.

Un método simple para determinar la edad gestacional de los recién nacidos / a simple method to determine the gestational age in newborn infants

Se presenta un método sencillo para determinar la edad gestacional de los recién nacidos, basado solamente en cuatro características: la cápsula vascular anterior del cristalino, los surcos de la planta de los pies, el nódulo mamario y la firmeza del papellón auricular. La valoración crítica realizada mediante adecuados análisis estadísticos, demostró que se trata de un método útil de gran valor práctico, presentando unos límites de confianza del 95% correspondiente a 11 días. Dicho método es aplicable a todos los recién nacidos, incluso patológicos, en cualquier momento de los primeros 2 días de vida