Prevalence and determinants of emotional violence faced by married women in Delhi, India: A cross-sectional study.

Context: Emotional violence is the lesser recognized form of intimate partner violence (IPV) but causes long-lasting harm to a woman's mental and physical wellbeing. Aims: To estimate the prevalence and describe the determinants of emotional violence faced by women residing in a metropolitan city of India. Settings and Design: This cross-sectional study was conducted among 'presently married' women living in an urban residential area of Delhi. Methods and Material: We used the NFHS-3 questionnaire and criteria to record the study participants' responses regarding their experience of 'emotional violence'. Women saying yes to emotional violence further quantified the frequency of each type of abuse into 'often' or 'sometimes' in the past 12 months. Informed consent was obtained from all participants, and the Institutional Ethics Committee approved the study. Statistical Analysis Used: Logistic regression analysis was used to determine emotional violence with various socio-demographic factors and other forms of IPV. Results: A total of 99 (19.8%) women had 'ever' faced psychological abuse by their husbands. 15.2% of women were humiliated by husbands, and 11.6% of women were insulted and made to feel bad about themselves. Women whose husbands consume alcohol (OR = 1.74 (1.07-2.84), exhibit controlling behaviour, (OR = 2.79 (1.74-4.46) exhibit physical (OR = 10.83 (6.4-18.32) or sexual (OR = 5.53 (3-10.2) violence were at significantly higher risk of facing psychological abuse within their marriages. Conclusions: Physical violence and controlling were found to be significantly associated with the experience of emotional violence after adjusting for all other variables. Primary care physicians should be sensitized to this critical health issue.

Coping Strategies and Perception toward Drugs, Electronic Gadgets, and Media in Relation to Stress: A Cross-sectional Study among Residents of a Suburban Area.

BACKGROUND AND OBJECTIVES: Stress is an indispensable part of modern-day living. The study deals with coping strategies by the participants and their perception toward drugs, electronic gadgets, and media as stress creators, busters, or relievers. MATERIALS AND METHODS: A cross-sectional study was conducted among 400 community dwellers in a suburban area of Delhi. A structured questionnaire with Likert scale was used to assess coping strategies to stress and perception of use of electronic gadgets, media, and substance abuse as stress creators, busters, and relievers. RESULTS: For coping strategies, 52.8% (95% confidence interval: 47.73-57.73) of the participants wanted to discuss problems with their families, but others considered mobile phones (51.5%, 46.48, 56.50), television (70.5%, 65.77, 74.93), and social networking sites (33.5%, 28.89, 38.36) to be their stress busters than creators. An age-associated statistically significant difference in perception about stress creator and buster scores between younger versus older was observed (P = 0.000), whereas gender-wise males perceived substance abuse to be a stress reliever in contrast to females (P = 0.000). CONCLUSION: Family plays an important role in the mitigation of stress. However, excess reliance on social media by younger people and substance abuse by males in stressful situations need to be addressed adequately.

Stress: Prevalence and correlates among residents of a suburban area.

BACKGROUND AND OBJECTIVES: Stress is a major concern in the present scenario as it is occurring in a big way involving all age groups. The objectives of this study were estimating the prevalence of stress, assessing the associated stress factors, and symptoms of stress among residents of suburban community. MATERIALS AND METHODS: The community-based cross-sectional study was conducted in a suburban area in Delhi from June to August 2017. Adults and children aged 14 years and above permanently residing (1 year or more) in the area were included in the study. A sample size of 384 was calculated with the alpha error set to 05% and absolute error 05%, and to cater for refusals, a total of 400 participants were approached. A structured questionnaire was used for the study by interview method. To estimate the prevalence of stress, a standardized scale, depression, anxiety, and stress scale 21 was used. RESULTS: The mean age of the participants in the study was 36.31 (±15.10), with 51.2% of males and 48.8% of females. Among the children, the leading factors associated with stress were studies (41.2%), poverty (22.1%), and competitions (16.2%). Among the adults, the leading factors were financial problems (35.2%) and children's studies (23.1%). The most common reported somatic symptom during stress was headache (59.8%) and psychological symptom was "unable to sleep" (47.5%). The prevalence of stress was 26% in a subset of sample in this study. There was a statistically significant association of stress with family size, the level of stress decreased with an increase in family size. CONCLUSION: The study emphasizes the need for effective prevention and management of stress in the community and schools.

Health risks and interventions in prediabetes: A review.

Prediabetes is a condition which appears prior to the development of diabetes in which blood glucose is abnormally high but do not reach the diagnostic threshold of type 2 diabetes mellitus. It is characterized by a cluster of metabolic abnormalities viz. dysglycemia, dyslipidemia, hypertension, physical inactivity, obesity, insulin resistance, procoagulant state, endothelial dysfunction, oxidative stress and inflammation, placing prediabetic subjects to an increased risk for diabetes and its complications. Recent studies demonstrate that complications of diabetes i.e. microvascular and macrovascular complications may manifest in some prediabetic subjects. This article reviews prediabetes-related risk factors and health issues. In addition, this article also highlights the interventions to prevent the development of diabetes in prediabetic subjects.

Cross-sectional correlates of oxidative stress and inflammation with glucose intolerance in prediabetes.

BACKGROUND: Prediabetes is a condition in which blood glucose level is above the normal but below the diagnostic value of diabetes mellitus. Besides progression to diabetes mellitus, prediabetic subjects are at risk for cardiovascular disease (CVD). It is associated with oxidative stress and inflammation and therefore this research was conducted with the aim to evaluate the risk of cardiovascular disease in prediabetic subjects by measuring the markers of oxidative stress and inflammation and their possible correlation with glucose intolerance. MATERIALS AND METHODS: A total of 400 human subjects were recruited for the present cross-sectional study. Of them, 200 were prediabetic subjects and 200 were age and gender-matched control subjects. Blood samples were collected from all participants and analyzed for 8-hydroxy-2'-deoxy-guanosine (8-OHdG), malondialdehyde (MDA), reduced glutathione (GSH) and high sensitivity C-reactive protein (hs-CRP). RESULTS: The markers of oxidative stress i.e. 8-OHdG and MDA were found to be significantly increased in prediabetic subjects as compared to control subjects except GSH, which was significantly reduced in prediabetic subjects. Similarly, hs-CRP (a marker of inflammation) was significantly increased in prediabetic subjects compared to controls. On correlation analysis, 8-OHdG, MDA and hs-CRP were significantly and positively correlated with glucose intolerance in prediabetes whereas GSH showed significant negative correlation with glucose intolerance. CONCLUSION: In conclusion, markers of oxidative stress and inflammation should be taken into consideration while evaluating the risk for CVD in prediabetes since these markers were well correlated with glucose intolerance in prediabetic subjects.

Functional analysis of vocal folds by transcutaneous laryngeal ultrasonography in patients undergoing thyroidectomy.

BACKGROUND: Transcutaneous laryngeal ultrasound (TCLUS) can assess Vocal folds (VF) by subjectively identifying mobility or objectively by calculating vocal fold displacement velocity (VFDV). Optimal diagnostic approach (subjective assessment, VFDV estimation or a combination of both) is unresolved; hence, we conducted this prospective study in patients undergoing thyroidectomy. METHOD: Two anaesthetists performed TCLUS pre- and post-operatively for functional assessment of 200 VFs on 100 patients. Their findings were compared with pre-operative flexible laryngoscope (FL) performed by surgeons and with post-operative C-Mac video laryngoscope (C-Mac VL) by another independent anaesthetist. Correlation between FL and TCLUS findings and inter-rater agreement between TCLUS findings of both anaesthetists was analysed. Decision curve analysis (DCA) was performed to compare clinical benefit of hoarseness, subjective VF movement, VFDV, and combined assessment for detecting disabled VFs. RESULTS: We found good correlation between VF mobility on TCLUS and FL (Spearman's r = 0.93, P < 0.0001) as well as C-Mac VL (Spearman's r = 0.83, P < 0.0001) with excellent inter-rater agreement between both anaesthetists. DCA showed combined assessment to have marginally higher clinical benefit than other diagnostic approaches at intermediate threshold probabilities while its benefit was similar to subjective evaluation at higher threshold probabilities. CONCLUSION: Provided achievement of optimal acoustic window, TCLUS can reliably assess disabled VFs with FL reserved for their confirmation or doubtful cases. Subjective assessment of VF mobility should suffice in most cases with additional VFDV estimation reserved pre-operatively for situations with higher risk of VFs disability, and post-operatively when subjective VF assessment findings are discordant from pre-operative status.

Bone densitometry status and its associated factors in peri and post menopausal females: A cross sectional study from a tertiary care centre in India.

OBJECTIVE: Osteoporosis is a skeletal disorder characterized by diminished bone strength that increases the risk of fracture at instances of trivial trauma. Asians have a lower bone mass than the west. The present study was designed to add data from India on women above the age of 40 years with respect to low bone mineral density (BMD) and its associated high risk factors. MATERIALS AND METHODS: After a written informed consent, a detailed history was taken. Basal metabolic index was recorded, and biochemical and endocrine tests were done, followed by dual X ray absorptiometry scan. RESULTS: Average age of the study population was 46.54 years and BMI 26.58. The prevalence of osteopenia in the study was 36%, and that of osteoporosis, 4%; the overall prevalence of low BMD being 40%. Proportion of women with low BMD increased with advancing age and menopausal status. On endocrine evaluation, 53.44% cases with insufficient vitamin D, 62.5% with hyperparathyroidism, 100% with hypothyroidism, 75% with hyperthyroidism suffered from low BMD. Among chronic diseases, 75% women with diabetes, 33.3% with hypertension, 25% with deranged liver function and 50% with rheumatoid arthritis were found to have low BMD. 46.75% women with sun exposure less than one hour daily had poor bone mineralization. The proportion of women with normal BMD decreased from 84.09% to 43.33% with decrease in daily physical work. On logistic regression analysis, insufficient serum vitamin D concentrations, less physical work and inadequate sun exposure were found to be significantly associated with low BMD. CONCLUSION: Low BMD is not a disorder confined to postmenopausal women alone. It is widely prevalent in women above 40 years of age. Screening women above 40 in the absence of any high risk factors has the potential of nipping this silent killer in the bud.

Designing of a phytosome dosage form with Tecomella undulata as a novel drug delivery for better utilization.

In recent past scientists are moving for the novel herbal medicines for treatment of almost all diseases as they have no or lesser adverse effects as compared with modern allopathic medicines. The potency of any dosage form is depending on effective drug delivery level of any therapeutically active drug molecule. Phytosome is a novel approach to drug delivery system that produce more absorption and utilization than conventional herbal extracts and shows enhanced bioavailability. The present investigation is to prepare and evaluate phytosomes of Tecomella undulata using aqueous extract of its stem bark and lecithin. Solvent evaporation method was used for preparation of phytosomes. Phytosomes were studied for their evaluation parameters such as morphology, release character, drug entrapment efficiency, size of particles and charge on surface. Phytosomes were successfully developed and having unilemellar vesicles, good entrapment efficiency and drug release in nano sizes (up to 90%) and average particle size 153.2 nm with -23.7 mv charge on their surface. The results showed that the phytosomes can improve the bioavailability without resorting any pharmacological adjuvant or structural modification of the ingredients.

Assessing providers' vaccination behaviors during routine immunization in India.

Progress has been made toward improving routine immunization coverage in India, but universal coverage has not been achieved. Little is known about how providers' vaccination behaviors affect coverage rates. The purpose of this study was to identify provider behaviors that served as barriers to vaccination that could lead to missed opportunities to vaccinate. We conducted a study of health-care providers' vaccination behaviors during clinic visits for children <3 years of age. Information on provider behaviors was collected through parent report and direct observation. Compared with illness visits, parents were eight times more likely to report vaccination status was verified (p < 0.001) and three times more likely to report receiving counseling on immunization (p = 0.022) during vaccination visits. Training of all vaccination practitioners should focus on behaviors such as the necessity of verifying vaccination status regardless of visit type, stressing the importance of counseling parents on immunization and emphasizing what is a valid contraindication to vaccination.

Pediatricians' perceptions of vaccine effectiveness and safety are significant predictors of vaccine administration in India.

BACKGROUND: New vaccine introduction is important to decrease morbidity and mortality in India. The goal of this study was to identify perceptions that are associated with administration of four selected vaccines for prevention of Japanese encephalitis (JE), typhoid fever, influenza and human papillomavirus (HPV) infection. METHODS: A random sample of 785 pediatricians from a national list of Indian Academy of Pediatrics members was selected for a survey to assess perceptions of vaccine effectiveness and safety, and vaccine administration practices. Logistic regression was used to assess factors associated with selective or routine use. RESULTS: Pediatricians reported administering typhoid (91.6%), influenza (60.1%), HPV (46.0%) and JE (41.9%) vaccines selectively or routinely. Pediatricians who perceived the vaccine to be safe were significantly more likely to report administration of JE (OR 2.6, 95% CI 1.3 to 5.3), influenza (OR 4.3, 95% CI 2.0 to 9.6) and HPV vaccine (OR 6.2, 95% CI 3.1 to 12.7). Pediatricians who perceived the vaccine to be effective were significantly more likely to report administration of JE (OR 3.3, 95% CI 1.6 to 6.5), influenza (OR 7.7, 95% CI 2.5 to 23.1) and HPV vaccine (OR 3.2, 95% CI 1.6 to 6.4) CONCLUSION: Understanding the role perceptions play provides an opportunity to design strategies to build support for vaccine use.

Attitudes and practices of auxiliary nurse midwives and accredited social health activists in Uttar Pradesh and Bihar regarding polio immunization in India.

Although India was removed from the list of polio endemic countries in January 2012, maintaining the focus on polio vaccination is critically important to prevent reintroduction of the virus. In 2009-2010, we conducted a study to assess the attitudes and practices of frontline health workers in India regarding polio immunization in Uttar Pradesh and Bihar. More than 95% of auxiliary nurse midwives (ANMs) and accredited social health activists (ASHAs) agreed that polio supplementary immunization campaigns helped in increasing acceptance of all vaccines. The majority of ANMs (60-70%) and ASHAs (56-71%) believed that polio immunization activities benefitted or greatly benefitted other activities they were carrying out. Less than 5% of ANMs and ASHAs felt they were very likely to face resistance when promoting or administering polio vaccine. This study provides information that may be useful for programs in other countries for polio eradication and in India for measles elimination.

Predictors of administration and attitudes about pneumococcal, Haemophilus influenzae type b and rotavirus vaccines among pediatricians in India: a national survey.

INTRODUCTION: According to the World Health Organization in 2008, pneumonia accounted for 20% of deaths and diarrheal diseases accounted for 13% of deaths among children under 5 in India. Vaccines are available for Streptococcus pneumoniae (pneumococcal conjugate vaccine (PCV)), Haemophilus influenzae type b (Hib vaccine), and rotavirus. Barriers to including these vaccines in routine immunization schedule in India include potential negative impacts on fragile existing immunization programs and cost. Pediatricians who are members of the Indian Academy of Pediatrics (IAP) are important stakeholders for vaccine delivery and maintaining public confidence in vaccines. METHODS: A random sample of 785 pediatricians belonging to IAP was selected for the survey conducted from June 2009 to June 2010. Descriptive analyses using sampling weights were performed to evaluate the distributions of variables assessing vaccine-related attitudes and behaviors among pediatricians. Logistic regression was used to assess factors associated with routine vaccine use. RESULTS: The majority of pediatricians reported administering PCV (85.6%), Hib (95.9%), and rotavirus (80.2%) vaccine selectively or routinely. Pediatricians who had high perceived disease susceptibility were 2.42 times more likely to report routine administration of Hib vaccine (OR 2.42, 95% CI 1.24, 4.74). Pediatricians who had high perceived Hib vaccine efficacy were 4.74 times more likely to administer Hib vaccine routinely (OR 4.74, 95% CI 2.09, 10.74). Perceptions of disease susceptibility and severity or of vaccine safety and efficacy were not associated with routine administration of PCV or rotavirus vaccine. CONCLUSIONS: Understanding predictors of routine use of a new vaccine could help focus interventions to improve the routine use of other vaccines. The importance of perceived susceptibility to and severity of diseases caused by S. pneumoniae, Hib, and rotavirus and perceived efficacy and safety of the vaccines by pediatricians presents an opportunity to design strategies to build support for new vaccine introduction and may have important implications for national immunization policy in India.

Comparison of attitudes about polio, polio immunization, and barriers to polio eradication between primary health center physicians and private pediatricians in India.

OBJECTIVES: The objectives of this study were to compare attitudes and perceptions of primary health center (PHC) physicians and pediatricians in Uttar Pradesh and Bihar toward polio disease, immunization, and eradication, and to identify barriers to polio eradication. METHODS: PHC physicians from blocks with at least one confirmed polio case during January 2006 to June 2009 were selected for an in-person survey. Pediatricians were members of the Indian Academy of Pediatrics and were selected from a national directory of members for telephone or mail survey. RESULTS: A higher percentage of PHC physicians than pediatricians reported that an unvaccinated child was susceptible to polio (82.1% vs. 63.0%, p<0.0001) and that polio disease was severe in a child aged 1-5 years (77.7% vs. 62.2%, p<0.0001). PHC physicians and pediatricians expressed confidence in the protectiveness and safety of oral polio vaccine and cited parents' lack of awareness of the importance of polio eradication as an important barrier to eradication. Strengthening routine immunization efforts was reported as the leading intervention required to eradicate polio. CONCLUSIONS: PHC physicians and pediatricians support and have confidence in the success of polio eradication efforts. These findings will be useful for policy-makers involved in the planning of eradication strategies. Providers and parents need to maintain confidence in polio vaccination if polio is to be eradicated.

Attitudes of pediatricians and primary health center physicians in India concerning routine immunization, barriers to vaccination, and missed opportunities to vaccinate.

BACKGROUND: India has some of the lowest immunization rates in the world. The objective of this study was to determine the attitudes and practices of pediatricians and physicians working in primary health centers (PHCs) regarding routine immunization and identify correlates of missed opportunities to vaccinate children. We focused on Uttar Pradesh and Bihar, which has faced some of the greatest challenges to achieving high routine immunization coverage. METHODS: A sample of pediatricians from Uttar Pradesh and Bihar was selected from the national membership of the Indian Academy of Pediatrics to participate in either a phone or mail survey. For the sampling frame, the PHCs within selected blocks were enumerated to provide a list from which individuals could be randomly sampled. In all, 614 PHCs in Uttar Pradesh and 159 PHCs were selected for in-person surveys. RESULTS: The response rate for pediatricians was 47% (238/505) and 93% for PHC physicians (719/773). The greatest barrier to vaccinating children with routine immunizations, reported by both pediatricians (95.7%) and PHC physicians (95.1%), was parents' lack of awareness of their importance. Correlates of missing an opportunity to vaccinate for PHC physicians included holding other health care workers responsible for vaccination. PHC physicians were 50% to 70% less likely to vaccinate a child themselves if they thought another type of health care worker was responsible. CONCLUSIONS: Future interventions to increase vaccination coverage should address parental knowledge about the importance of vaccines. Understanding and addressing factors associated with missed opportunities to vaccinate may help improve vaccine coverage in Uttar Pradesh and Bihar.