Conformance of the Food Vendor Carts Design to the Prescribed Standards as per Food Safety and Standards Regulations: Assessment from an Urban Area of North India

Background: Food Safety and Standards Authority of India, established under the Food Safety and Standards Act, 2006, is mandated with disseminating evidence-based standards, regulating the manufacture, storage, distribution, sale, and import of street food, for ensuring the availability of safe and wholesome food for human consumption and matters connected in addition to that or incidental to that. Hence, this study was conducted to ascertain the conformance of the design of street food vendor’s carts to the prescribed standards. Methods: We conducted a cross?sectional study in Chandigarh between July 2017 and March 2018 among 400 street food vendors. The primary dependent variable of the study was conformance. The carts were evaluated for their conformance to the standard recommended design based upon a checklist designed using the guidelines of Food Safety and Standards Regulations, 2011. Results: Almost half of the respondents had an experience of 6–15 years (48.5%) and were earning between Rs. 500 and 1000/day (56.3%). The majority of them (95%) were migrants from other states. Only 26.3% were using mobile vending sites. On regression analysis, better cart score was predicted by age, education, increasing experience, higher income, when food was prepared at home only, and with assistance in the form of helpers. Conclusions: This study indicates that although the policy was formulated 8 years back, the standards of street food carts were still below par in Chandigarh. The government should give technical specifications and ensure uniformity at the national level.

A Prospective Randomised Controlled Study For Assessment Of Use Of Pneumatic Tourniquet In Above Knee Amputation Of Ischemic Limb In Peripheral Vascular Disease

This is a prospective randomised controlled study for assessment of use of pneumatic tourniquet in above knee amputation of ischemic limb in peripheral vascular disease. The use of tourniquet is said to be a contraindication during surgeries involving amputations in peripheral vascular disease as they might injure the already compromised arteries above the planned level of amputation. Taking into consideration the promising results from some previously done studies, we assumed that the use of a pneumatic tourniquet has potential to improve the outcome following trans–femoral amputation without jeopardizing the healing of surgical stump wound. We selected forty patients for our study. All of them with non salvageable limb due to peripheral vascular disease. They were further randomized to either tourniquet or no tourniquet (control) group. Various parameters noted were intra–operative loss of blood (P<0.0001), post–operative need of transfusions (P<0.037), post–operative fall in haemoglobin(P<0.0001), wound healing, wound dehiscence/ eakdown and revision of amputation. Results of the trial showed that the use of a tourniquet during above knee amputation in peripheral vascular disease significantly reduces intra operative blood loss consequently reducing fall in post operative Haemoglobin and need for blood transfusion

A Prospective Study on Prevalence of Anemia in Children Under Five Years of Age in a Tertiary Care Teaching Hospital in Mathura

Background: Anemia is characterized by reduction in number of red blood cells or their oxygen carrying capacity to meet physiologic needs. It varies by age, sex, altitude, smoking, and pregnancy status. India has the uppermost prevalence (39.86%) of anemia among the 16MM i.e. 16 major pharmaceutical markets such as United States of America, France, Germany, Italy, Spain, United Kingdom, Japan, Australia, Brazil, Canada, China, India, Mexico, Russia, South Africa, and South Korea.4 In India, a survey (2016) reported that the prevalence of anemia among women of reproductive age was 51.40%; pre-school children was 57.30%, and among non-pregnant women was 51.50%. Methods: The duration of study was over a period of one year. Study Area:-This study was conducted in Department of pediatrics in K M Medical College & Hospital, Mathura.100 total numbers of cases were included in this study. Results: The prevalence of anemia was moderate which were in 48 % cases followed by 24% mild,19% not anemic & 9% severe. Conclusions: This study concludes that the main reason behind this high percentage of children with anemia in this age group is prolonged breast feeding, inadequate weaning practices. They are lacking iron and other micronutrient rich diet. It should be provided to the children.

Has Vector-Rodent Relationship Changed in Plague? Experiences of Plague Affected Hilly Terrains of Himachal Pradesh, India.

Background: The present study was conducted with objectives to elucidate the existence of sylvatic cycle of plague and to document the changing pattern of relationship between rodents and fleas. Methods: Collection of samples was done from 15 sites (25 locations) from plague affected areas of Shimla district of Himachal Pradesh, India during 5 visits between June 2011 to July 2012, which were thereafter entomologically investigated in a BSL-3 laboratory Results: 57 fleas (3 species) from 243 rodents (3 species) were collected in domestic (n=16), peridomestic (n=3) and wild (n=6) locations. Rattus rattus (n=197) and Nosopsyllus fascitus (n=43) was most frequently trapped rodent and flea species respectively. Rattus rattus (domestic rodent species) was also trapped from wild areas and Nosopsyllus fascitus (domestic flea species) was also isolated from Rattus norvegicus (wild rodent species). One rare rodent species Cornilurus albipes was also found. Most common rodent-flea association was Rattus norvegicus-Nosopsyllus fascitus. The recovery of rodents and flea was higher in months of June and December respectively. Conclusions: The study concluded that sylvatic cycle persisted in study area and rodent and flea mixing was widely prevalent between domestic and wild area. This demands regular and intensive surveillance in plague prone hilly areas of Himachal Pradesh.

Workload and Performance of Auxiliary Nurse and Midwives at Selected Health Care Settings in North India

Auxiliary Nurse Midwives (ANMs) are the back bone of primary health care services in India. The horizontal integration of various national health programmes has increased their responsibility and workload. So a need was felt to conduct a study to assess the workload and performance of ANMs. The objective of the study was to explore the workload and performance of ANMs in selected health care settings in North India. An exploratory cross-sectional study was conducted in two selected health care settings of North India. The study was conducted on all the 7 ANMs working in the selected health care settings. Data was collected by observing the activities of ANMs using time activity record sheet. The nursing care procedures performed were observed and scored by using performance check list. T-test was used to compare actual time against standard time for performing procedures. ANMs spent 2/3rd of their time in indirect care activities. Direct care and personal activities accounted for 19 % of their time. Their performance was rated as good. Majority of the time spent by ANMs was utilized in performing indirect care activities. This study recommends that more time is needed to be devoted to direct care by ANMs.​

Linking Lifestyle of Marginalized Gujjar Population in Himachal.

It was a qualitative enquiry conducted amongst Gujjar population of Shimla district, Himachal Pradesh (HP). The study was carried out to link various lifestyle factors of the Gujjar population with the 2002 outbreak of plague in HP. Focus Group discussions guide was prepared beforehand which had information about education, livelihood, dietary pattern, relationships, personal hygiene and habits and health care utilization. It was emerged out of the study that the population has poor literacy levels, poor personal hygiene, overcrowding in hutments, closely-knit social structure, lack of awareness about common diseases, and frequent visits to forests and living in caves during their visits. Further, government health care facilities are not routinely utilized by the Gujjar community. These factors might lead to increased proximity and exposure to wild rats among Gujjar population, thus increasing their susceptibility to plague. They are, therefore a potential link between any source of infection in forests and in native population of HP and other states. The government agencies should take various measures to increase health care access of such vulnerable population through outreach health care programs.

A randomised controlled trial of exercise and hot water bottle in the management of dysmenorrhoea in school girls of Chandigarh, India.

Objectives : To estimate the prevalence of primary dysmenorrhoea among school girls and to compare the impact of exercise and hot water bottle on the occurrence and severity of primary dysmenorrhoea among the study population. Material and methods : A cross sectional study was done to estimate the prevalence of dysmenorrhoea in two schools of Chandigarh, India. For the Randomised Controlled Trial, group randomisation of the two schools was done into 2 intervention groups (exercise & hot water bottle groups). 53 girls in school 1 and 75 girls in school 2 participated in the intervention. Comparison of baseline Menstrual Distress Questionnaire (MDQ) scores & Visual Analogue Scale for Pain (VASP) scores were done with 1st, 2nd & 3rd month post intervention scores using mean, standard deviation, t-test. Results : Prevalence of dysmenorrhoea was 60.7%. Median age of the school girls was 14 years. The mean VASP score decreased from 5.75 to 2.96 (P<0.0001) and from 5.16 to 2.06 (P<0.0001) at 3 months, in the exercise and hot water bottle group respectively. The mean MDQ score decreased from 14.53 to 7.85 (P<0.0001) and from 14.92 to 8.16 (P<0.0001) at 3 months, in the exercise and hot water bottle group respectively. Conclusion : Both exercise & hot water bottle can be used in dysmenorrhoeic girls in home setting to provide relief from pain and menstrual distress.

Coverage and Quality of Immunization Services in Rural Chandigarh.

The present study assessed the coverage and quality of immunization services for children aged 12-23 months and mothers who delivered a baby in last one year in rural areas of Chandigarh. Two hundred ten children and 210 mothers were enrolled. 69% of children were fully immunized, 15% were partially immunized and 16% were unimmunized. Among mothers, 79% were fully immunized, 11% partially immunized and 10% were unimmunized. Weaknesses in quality were lack of planning any specific strategy, and inadequate verbal reminder for the appointment.

Community based estimation of extent and determinants of cost of injuries in a north Indian city.

Background and Objectives: Very few community based studies on the economic impact of injuries are available from India. Being based on secondary data sources these underestimate the true burden. Current study aimed to ascertain the incidence and economic impact of injuries in an Indian city. Materials and Methods: Details of injury events during the reference period were elicited in the study population through a community based survey in 2008. The severity of injury was categorized on the basis of need and duration of hospitalization. Direct and productivity costs were assessed for each event of injury. Results: Out of 230 households contacted 212 participated in the study. Overall, 985 people were interviewed. The overall incidence of injury was 48.73/1000 population, Road traffic injuries (RTIs) were the leading cause (35%) of injury, followed by the falls (17%), contact with hot substances (13%), inanimate mechanical force (13%), animate mechanical force (8%), assault (8%) and others (6%). The ratio of fatal: severe non-fatal: mild injuries were 1:14:33. The total direct cost (DC) incurred was Rs. 310,951.67, contributed by medical (44%), surgical (21%), legal (15%), cost of informal care (10%). The total productivity cost of injuries was Rs. 416,700, contributed by mortality cost of Rs. 336, 000 (81%) and morbidity cost of Rs. 807,00 (19%). Conclusions: For every case of fatal injury, there were 14 cases of severe hospitalized injuries and 33 cases of mild injuries. RTIs were the commonest. Injuries had sizeable direct and indirect cost on the society.

Epidemiologic lessons: Chickenpox outbreak investigation in a rural community around Chandigarh, North India.

Purpose: Primary infection with Varicella Zoster virus (VZV) leads to Varicella or chickenpox. The epidemiology of Varicella has changed dramatically since the introduction of the Varicella vaccine in 1995. The routine childhood immunization in a few countries in the western world like Germany and the United States has reduced the incidence of the disease, associated complications, hospital admissions and deaths related to its complications. However, chickenpox outbreaks are common in naive unvaccinated communities in India. Materials and Methods: We report an outbreak of chickenpox that occurred in a village situated on the outskirts of Chandigarh city in North India in the winter of 2007. The outbreak was confirmed by the detection of VZV IgM by enzyme-linked immunosorbent assay (ELISA) on serum samples from the patients. In patients showing active lesions, Giemsa and indirect immunofluorescence was carried out on scrapings from vesicular lesions. Results: A total of 162 cases occurred in the present outbreak. The serum samples were collected from 20 patients, and all of them showed positive serology for VZV IgM antibodies while 19 showed a positive VZV IgG result by ELISA. The scrapings were collected from two patients showing active lesions, and both were positive by the Tzanck smear examination, and VZV antigen could be demonstrated by immunofluorescence. Conclusions: There is an urgent need to identify naive communities and unvaccinated individuals at risk. Also, there is a need for regular training programmes of health workers posted in peripheral centers so that highly contagious communicable diseases can be picked up in time and such outbreaks can be prevented.

Awareness of andropause in males: A North Indian study.

Background: According to the Indian census 2011, India has the largest population of the elderly. Very few studies have been carried out in North India to assess the awareness about andropause in men, which is why this study was conceived. Objectives: To assess the awareness about andropause and its treatment modalities among the men of Chandigarh. Materials and Methods: The present study was conducted at an Urban Health Training Center (UHTC-44 B) of Government Medical College and Hospital Sector 32, Chandigarh (GMCH) in male patients attending the outpatient department. This non-interventional individual cross-sectional study was carried out from August 2010 to August 2011 in men aged 40 years and above. Systematic, random sampling was carried out and the study sample comprised 757 men. The subjects were given pre-structured and pre-tested questionnaires that had questions pertaining to socio-demographic profile, ADAM scale, views about andropause, its treatment modalities, etc., Results: Out of the sample size of 757 men, subjects from the urban area (323; 43.1) were more in contrast to that of the peri-urban (41; 31.9) and slum areas (393; 259). Maximum number of patients belonged to the age group of 40-49 years (342; 26.3), followed by those in age group 60-69 years (141; 18.6). It was found that awareness about the term andropause was found only among 17 (2.2%) subjects, whereas the knowledge of a syndrome synonymous to that of menopause in females was even less 7 (0.9%) patients positive for andropause were found to increase with increase of age (40-49; 35.7, 50-59; 81.2, 60-69; 96.5). Only 123 (11.4%) had an idea about the treatment of andropause. The keenness to resort to treatment or seek medical advice was shown by 355 (47.3%). Subjects in the age group of less than 60 years resorted to injections (15; 4.7) and transdermal patches (6; 1.09) as testosterone-replacement therapy. Herbal medicines were especially taken by those subjects in the age group 60-70 years, (74.3%; 101). Conclusion: Awareness about andropause and its treatment modalities is less in men.

Study of sense of coherence health promoting behavior in north Indian students.

Background & objectives: With advances in knowledge about health promotion, public health professionals are in search for the determinants of personal health behaviours. This study was carried out to explore the level of engagement of north Indian students in health promoting behaviours; to determine their sense of coherence scores; and to ascertain the determinants of health promoting behaviours of these students. Methods: A cross-sectional study was done in four randomly selected colleges of Chandigarh during 2007-2008 in 200 students (100 male, 100 female). Their health promoting lifestyle profile (HPLP) and sense of coherence (SOC) scores were estimated using interviews. The data were analyzed using Pearson's product moment correlation, and also stepwise linear regression analysis. Results: Mean HPLP and SOC scores of the students were 138.69 and 130.87, respectively. Females cared more about their health than males. Male students were more involved in physical activities. There was a linear correlation between the total SOC and HPLP scores (r=0.3). Female students (63%) consulted doctors more than males (50%) and washed their hands more regularly (P<0.05). Only 13 per cent students practiced yoga regularly. Female students had more meaningful relationships with friends and had more faith in God. Regression equation revealed that the two independent variables (SOC and age) accounted for 10.8 per cent of the variance in HPLP. Interpretation & conclusion: Students with higher SOC scores had higher HPLP scores. Female students were more health conscious than male students. In general, college students in Chandigarh had a good health promoting lifestyle and good sense of coherence.

Maternal deaths in Rajasthan: where does the buck stop.

For centuries, the handling of childbirth and childcare was considered the domain of midwives and mothers. The second half of the 20th century witnessed a change in thinking. The role of the state in improving the health of people came to the forefront. In the opening years of the 21st century, the millennium development goals placed maternal and child health at the core of the struggle against poverty and inequality, as a human rights issue. With a booming economy and an improved standard of living, no mother should die in the course of the normal process of giving birth. However, more than 500,000 mothers are still dying each year, mostly of avoidable causes

Detrimental effect of expression of Bt endotoxin Cry1Ac on in vitro regeneration, in vivo growth and development of tobacco and cotton transgenics.

High levels of expression of the cry1Ac gene from Bacillus thuringiensis cannot be routinely achieved in transgenic plants despite modifications made in the gene to improve its expression. This has been attributed to the instability of the transcript in a few reports. In the present study, based on the genetic transformation of cotton and tobacco, we show that the expression of the Cry1Ac endotoxin has detrimental effects on both the in vitro and in vivo growth and development of transgenic plants. A number of experiments on developing transgenics in cotton with different versions of cry1Ac gene showed that the majority of the plants did not express any Cry1Ac protein. Based on Southern blot analysis, it was also observed that a substantial number of lines did not contain the cry1Ac gene cassette although they contained the marker gene nptII. More significantly, all the lines that showed appreciable levels of expression were found to be phenotypically abnormal. Experiments on transformation of tobacco with different constructs expressing the cry1Ac gene showed that in vitro regeneration was inhibited by the encoded protein. Further, out of a total of 145 independent events generated with the different cry1Ac gene constructs in tobacco, only 21 showed expression of the Cry1Ac protein, confirming observations made in cotton that regenerants that express high levels of the Cry1Ac protein are selected against during regeneration of transformed events. This problem was circumvented by targeting the Cry1Ac protein to the chloroplast, which also significantly improved the expression of the protein.

Comparison of the health-promoting orientation of three tertiary care hospitals of India.

Background. Hospitals have been considered as places for the provision of curative services. Nowadays, services related to health promotion are also sought to be provided through hospitals. We compared the health-promoting hospital (HPH) orientation of the Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh with two other tertiary care hospitals in India, which have been declared HPH by WHO. Methods. The score obtained by PGIMER as an HPH as per the WHO standards tool was compared with that of two other tertiary care hospitals in India. A short survey was also conducted of patients visiting PGIMER for their treatment through a selfadministered, pretested questionnaire. A statistical test for difference in proportions was applied. A SWOT analysis was done to assess how PGIMER performed as an HPH. Results. The HPH score of PGIMER was significantly lower (35/80) than that of the other two hospitals. There was no formal HPH policy in PGIMER. One-third of the patients interviewed were not satisfied with the overall preventive and health-promoting services of PGIMER. Apart from the parameters of the HPH standards, PGIMER seemed to satisfy the expectations from it being an apex medical institute. Conclusion. In view of its low score as an HPH, PGIMER should frame an appropriate HPH policy and devise strategies to provide leadership to other hospitals in India.