Could mid-upper arm circumference be a valid proxy to the body mass index for elderly persons?

Introduction: In elderly persons, due to physiological, anatomical, and functional changes, body mass index (BMI) may not be suitable for the assessment of nutritional status. Mid-upper arm circumference (MUAC) can be a proxy indicator to identify underweight and overweight/obesity among elderly persons. This study aimed to estimate the correlation between MUAC and BMI, and the cutoffs for MUAC using receiver operating characteristic (ROC) analysis. Material and Methods: This survey was carried out in a resettlement colony of Delhi. The participants were residents of the area who were aged 60 years or older, and selected by a simple random sampling technique. The arm span, weight, and MUAC of the participants were measured. The correlation between MUAC and BMI for gender and age group was calculated. The ROC curve was also constructed. Results: A total of 946 eligible participants were enrolled. The correlation between MUAC and BMI was 0.67 (P < 0.001) and 0.76 (P < 0.001) among men and women, respectively. The MUAC cutoff for underweight was <25 cm with a sensitivity of 68.8% and specificity of 84.9%. The area under the curve (AUC) was 0.84 (0.80–0.88). The MUAC cutoff for overweight/obesity was ?27 cm with a sensitivity of 83.9% and specificity of 64.9%, and AUC was 0.78 (0.75–0.82). Conclusion: The MUAC of the participants increased as the BMI of the participants increased. MUAC cutoff was determined using the ROC curve for underweight and overweight/obesity among elderly persons.

Willingness of medical students to volunteer during the Covid-19 pandemic: Assessment at a tertiary care hospital in India

BACKGROUND The involvement of medical students in strategies to control Covid-19 might be considered to cope with the shortage of healthcare workers. We assessed the knowledge about Covid-19, willingness to volunteer, potential areas of involvement and reasons for hesitation among medical students towards volunteering. METHODS We did this cross-sectional study among undergraduate students at a tertiary care teaching hospital in New Delhi. We used a web-based questionnaire to elicit demographic information, knowledge of Covid-19, willingness to volunteer and reasons deterring them from working during the Covid-19 pandemic, and self-declared knowledge in six domains. RESULTS A total of 292 students participated in the study with a mean (SD) age of 19.9 (3.1) years. The mean (SD) knowledge score of Covid-19 was 6.9 (1.1) (maximum score 10). Knowledge score was significantly different among preclinical (6.5), paraclinical (7.18) and clinical groups (7.03). Almost three-fourth (75.3%) participants were willing to volunteer in the Covid-19 pandemic, though 67.8% had not received any training in emergency medicine or public health crisis management. Willingness to work was maximum in areas of social work and indirect patient care (62.3% each). Lack of personal protective equipment was cited as a highly deterring factor for volunteering (62.7%) followed by fear of transmitting the infection to family members (45.9%), fear of causing harm to the patient (34.2%) and the absence of available treatment (22.2%). CONCLUSIONS A majority of the students were willing to volunteer even though they had not received adequate training. Students may serve as an auxiliary force during the pandemic, especially in non-clinical settings.

Prevalence of Household-level Food Insecurity and Its Determinants in an Urban Resettlement Colony in North India.

An adequate food intake, in terms of quantity and quality, is a key to healthy life. Malnutrition is the most serious consequence of food insecurity and has a multitude of health and economic implications. India has the world’s largest population living in slums, and these have largely been underserved areas. The State of Food Insecurity in the World (2012) estimates that India is home to more than 217 million undernourished people. Various studies have been conducted to assess food insecurity at the global level; however, the literature is limited as far as India is concerned. The present study was conducted with the objective of documenting the prevalence of food insecurity at the household level and the factors determining its existence in an urban slum population of northern India. This cross-sectional study was conducted in an urban resettlement colony of South Delhi, India. A pre-designed, pre-tested, semi-structured questionnaire was used for collecting socioeconomic details and information regarding dietary practices. Food insecurity was assessed using Household Food Insecurity Access Scale (HFIAS). Logistic regression analysis was performed to determine the factors associated with food insecurity. A total of 250 women were interviewed through house-to-house survey. Majority of the households were having a nuclear family (61.6%), with mean familysize being 5.5 (SD±2.5) and the mean monthly household income being INR 9,784 (SD±631). Nearly half (53.3%) of the mean monthly household income was spent on food. The study found that a total of 77.2% households were food-insecure, with 49.2% households being mildly food-insecure, 18.8% of the households being moderately food-insecure, and 9.2% of the households being severely food-insecure. Higher education of the women handling food (OR 0.37, 95% CI 0.15-0.92; p≤0.03) and number of earning members in the household (OR 0.68, 95% CI 0.48-0.98; p≤0.04) were associated with lesser chance/odds of being food-insecure. The study demonstrated a high prevalence of food insecurity in the marginalized section of the urban society. The Government of India needs to adopt urgent measures to combat this problem.

Cost of Ambulatory Care by Mobile Health Clinic Run by a Medical College in India for the Year 2008-09.

Background: The feasibility of using mobile health clinics (MHCs) to deliver health services in urban poor areas has to be explored as the health needs of the residents are not sufficiently addressed by the existing primary health care delivery system in India. Objective: To estimate the cost of providing primary health care services and the out of pocket expenditure (OOPE) incurred, while utilizing these services provided through the MHC based Urban Health Program of a Medical College in North India for the year 2008-2009. Materials and Methods: A cross-sectional study to estimate OOPE was conducted among 330 subjects selected from patients attending the mobile health care facility. For estimation of provider cost, 5 steps process involving identification of cost centres, measurement of inputs, valuing of inputs, assigning of inputs to cost centers, and estimation of unit cost were carried out. Results: Total annual cost of providing services under Urban Health Program in the year 2008-2009 was Rs. 7,691,943 Unit cost of providing outpatient curative care, antenatal care, and immunization were Rs. 107.74/visit, Rs. 388/visit and Rs. 66.14 per immunization, respectively. The mean OOPE incurred was Rs. 29.50/visit, while utilizing outpatient curative services and Rs. 88.70/visit for antenatal services. Conclusion: The MHC can be considered as a viable option to provide services to urban poor.

High burden of dental caries in geriatric population of India: A systematic review.

Oral health is an essential component of health throughout life. Poor oral health and untreated oral diseases can have a significant impact on the quality of life of the elderly. The objective of this study was to estimate the burden of dental caries among the elderly persons in India in the past two decades. A systematic review from available literature was carried out. Six community-based articles were included in this review. The selected studies were screened by using STROBE checklist for observational studies. All studies were found to contain the required essentials of observational studies. Weighted prevalence of dental caries experience was calculated. Trend was generated using Microsoft Excel program. The prevalence of dental caries experience ranged from 31.5 to 100%. Weighted prevalence of dental caries experience was 83.6% and 82.3% for 2000-2004 and 2005-2009, respectively. There is a high burden of dental caries in the elderly population. Treatment and restorative services need to be provided to alleviate this problem.

Prevalence of dental caries among adults and elderly in an urban resettlement colony of New Delhi.

BACKGROUND: Dental caries remains the most important dental health problem in developing countries. In India the prevalence of dental caries is reported to be about 50-60%. Most of the Indian studies have been carried out in school children and very few in adults. This study aimed to estimate the prevalence of dental caries in the adult population (aged 35-44 years) and in the elderly (60 years and above) in an urban resettlement colony in New Delhi. METHODOLOGY: A community-based cross-sectional study was carried out in Dakshinpuri, New Delhi, from January to February 2007. A local adaptation of the WHO questionnaire was used. Oral examination was done and dentition status was recorded by trained investigators and according to the standard procedures. RESULTS: A total of 452 participants were enrolled in the study. The prevalence of dental caries in the 35-44 years age-group was 82.4% and it was 91.9% in those > or =60 years. The DMF index was 5.7 +/- 4.7 in the 35-44 years age-group and 13.8 +/- 9.6 in the > or =60 years age-group. Of the participants, 27.9% were currently using tobacco. A statistically significant association was found between tobacco consumption and dental caries ( P = 0.026). The awareness about good and bad dental practices was found to be low among the study participants. One-fifth of the individuals with dental problems relied on home remedies. CONCLUSION: The prevalence of dental caries among adults is high in this population. There is a need to generate awareness about oral health and the prevention of dental caries and to institute measures for the provision of dental care services at the primary level.