Depression, sleep, body image, and lifestyle: Prevalence and associated factors of depression among school-going adolescents in Delhi National Capital Region.

Background: Adolescents are known to be vulnerable to depression, which worsened during the COVID-19 pandemic. They also exhibit poor sleep quality and body image issues (BIIs) which are considered risk factors for depression. There is a paucity of Indian studies regarding adolescent depression and its correlation with lifestyle. Aims: To detect the prevalence of depression in adolescents, and understand its association with sociodemographic variables, sleep quality, BIIs, and lifestyle factors. Materials and Methods: A cross-sectional study was conducted among 392 adolescents attending classes 8th-12th in two schools in Delhi National Capital Region. A pre-tested semi-structured questionnaire was used to collect sociodemographic and lifestyle data. Depression anxiety stress scale-21 was used to detect depression. Pittsburgh Sleep Quality Index and Stunkard Figure Rating Scale were used to evaluate sleep quality and BIIs. Data was analyzed using Statistical Package for Social Sciences Version-25. Results: Depression was present in 40.3% of students. It was more common in girls, older students, students in higher classes, who lacked siblings and whose mothers were engaged in professions as well as those with BIIs. However, after multivariate analysis, the association of depression with poor sleep quality, meal skipping, lack of exercise, family history of mental illness, and inverse association with open discussion of one's thoughts and worries with family remained significant. Conclusions: Depression is common among adolescents and shows associations with poor sleep quality and lifestyle choices. Awareness of these associations may enable better screening and early intervention for vulnerable adolescents.

The Association of Neovascularization With Optical Coherence Tomography Angiography Parameters in Proliferative Diabetic Retinopathy.

AIM: We aim to find an association between neovascularization (NVn) and optical coherence tomography angiography (OCTA) parameters in proliferative diabetic retinopathy (PDR). METHODS: In a prospective study, 41 subjects including 28 (68%) males and 13 (32%) females having PDR were examined for neovascularization disc (NVD) and neovascularization elsewhere (NVE) clinically and with fundus fluorescein angiography (FFA). A total of 79 eyes were found to be involved. We examined OCTA parameters including foveal avascular zone (FAZ) size, perimeter and circularity, and vessel density (VD) in the superficial capillary plexus (SCP), deep capillary plexus (DCP), outer retina (OR), outer retinal chorio-capillaries (ORCC), chorio-capillaries (CC), and choroid (C) in these subjects. RESULTS:  In eyes with NVD, the central foveal thickness (CFT) (p=0.83) and sub-foveal choroidal thickness (SFCT) (p=0.08) were higher, the FAZ area was significantly larger (p=0.005), and the VD was lower in all retino-choroidal layers. However, it was significantly lower in SCP foveal (p=0.005) and ORCC foveal (p=0.05) than in eyes not having NVD. For NVE, the CFT (p=0.03) and SFCT (p=0.01) were more in affected eyes. The eyes without NVE had a better circularity index (p=0.07) and the highest VD in OR slab (p=0.02) than those eyes that had NVE < ½ disc area (DA) and NVE > ½ DA. On comparing eyes without NVE, NVE < ½ DA, and NVE > ½ DA, the latest had the highest VD in SCP (p=0.59) and lowest VD in DCP (p=0.43) and OR (p=0.02). The VD in ORCC, CC, and choroid was highest in the no NVE group, followed by the NVE > ½ DA and NVE < ½ DA groups in that order. The subjects having vitreous hemorrhage (VH) and intra-retinal microvascular abnormalities (IRMA) had higher values for CFT and SFCT than eyes without these. CONCLUSIONS:  An increased CFT and SFCT are associated with the appearance of NVD, NVE, VH, and IRMA. The presence of NVD, VH, and IRMA is associated with a larger FAZ area, while that of IRMA and NVE is associated with reduced FAZ circularity. Eyes with NVD, VH, and IRMA had lesser VD in all the retino-choroidal layers. Eyes with NVE > ½ DA had the highest VD in SCP and lowest in DCP and OR; this pattern of VD foretells severer affection in NVE. IRMA was associated with a larger FAZ area, larger FAZ perimeter, and lesser circularity, indicating the presence of central ischemia.

The Effect of Community-Based Intervention on Dengue Awareness and Prevention Among Poor Urban Communities in Delhi, India.

BACKGROUND: This study aimed to assess the efficacy of a dengue intervention program in economically deprived urban regions of India, with a particular emphasis on housing conditions and community involvement. Given the global significance of dengue fever as a vector-borne disease, successful vector management requires effective community engagement. Study Design: A quasi-experimental study. METHODS: This study was conducted with 314 participants from Delhi's Sanjay Colony, divided into control and intervention groups. The study spanned 14 months (August 2020 to September 2021). The intervention program comprised two educational sessions held one month apart, covering dengue awareness, health self-care, and environmental maintenance. Data were collected at baseline, after each intervention session, and during a final follow-up assessment three months later. RESULTS: The primary outcome, the house index (HI), revealed statistically significant differences (P<0.001) favoring the intervention group. The total score (TS) for mosquito-borne disease, TS of knowledge, TS of attitude, and TS of practices all exhibited significant improvements in the intervention group. Participants showed an enhanced understanding of dengue causes, symptoms, and mosquito behavior related to breeding and biting. The HI in the intervention group decreased significantly from 21.65% to 4.45% (P<0.05). CONCLUSION: This study, grounded in the health belief model (HBM), demonstrated the effectiveness of the intervention program in reducing HI and improving knowledge and preventive practices regarding dengue fever in impoverished urban neighborhoods of Delhi. The intervention program may be beneficial in such a poor urban community.

Effectiveness of Child-To-Child Approach in Preventing Unintentional Childhood Injuries and Their Consequences: A Non-Randomized Cluster-Controlled Trial.

BACKGROUND: Child-to-child approach is an innovative strategy for preventing and reducing the morbidity and mortality burden of unintentional childhood injuries. OBJECTIVES: To test effectiveness of Child-to-child Approach in preventing unintentional childhood injuries and their consequences. STUDY DESIGN: Community-based non-randomized cluster-controlled trial of parallel design. PARTICIPANTS: 397 children and adolescents. INTERVENTION: Eldest literate adolescent of selected families of intervention area were trained on prevention of injuries. They were to implement the knowledge gained to prevent injuries in themselves and their younger siblings and also disseminate this knowledge to other members of their families. OUTCOME: Data was collected from both intervention and control areas during pre- and post-intervention phases on the magnitude of injuries, time for recovery from injuries, place for seeking treatment, cost of treatment, knowledge and practice of participants and their families regarding injuries. RESULTS: During post-intervention phase, the intervention group experienced a significant reduction in incidence of injuries, increased preference for institutional treatment of injuries and increased knowledge and practice regarding injuries, in com-parison to its pre-intervention data and data of the control group in post-intervention phase. Total time for recovery and cost of treatment for injuries also decreased in intervention group in post-intervention phase, though differences were not statistically significant. CONCLUSIONS: Child-to-child approach is effective in reducing childhood injuries, improving choice of place for seeking treatment, increasing knowledge of participants, improving family practices regarding prevention of injuries and reducing expenditure on treatment of childhood injuries.

Unintentional childhood injuries and their association with activity and location at the time of injury - A case-Crossover study in Delhi.

BACKGROUND: Childhood injury has been identified as a grave public health problem globally as well as in India. Most studies have reported injuries to have occurred while the child was at home, though injuries while on road, school, or playground also commonly occurred. OBJECTIVE: The objective of the study is to find the association between unintentional childhood injury and the activity and location of the child at the time of injury. METHODS: The present study is part of a larger study for preventing childhood injuries, conducted from August 2017 to January 2019 in Delhi, and reports the activity and location of the children at the time of injury. A total of 173 injuries that occurred during the total study duration were included in the analysis. Data regarding activity and location of the subjects were collected and analyzed by case-crossover study design, during "case/hazard period" and two "control/reference periods." RESULTS: Majority of the injuries occurred while the subjects were at home and engaged in activities other than normal activity. When various locations and activities were combined, unmatched odds ratios (ORs) were raised for activity other than normal activity (statistically significant) and for location other than at home. Similar results were obtained for matched Mantel-Haenszel OR, with activity other than normal being significantly more risk for injury (P = 0.000). CONCLUSION: Majority of unintentional injuries occurred in children and adolescents, while the subjects were away from home and engaged in any activity other than normal daily activities. This indicates the importance of teaching safety behavior to children so that they can prevent being injured wherever they go and whatever activity they perform.

Economic Benefit in Treatment of Unintentional Childhood Injuries by Implementation of Child-To-Child Approach.

BACKGROUND: Childhood injury has been recognized as a major threat to child survival and health, as well as economic burden, which includes the cost to government and out-of-pocket expenses (OOPE) to families. Child-To-Child Approach is an innovative technique to reduce childhood injuries and expenses on their treatment. OBJECTIVES: To assess economic benefit in the treatment of unintentional childhood injuries, including OOPE by families, by the implementation of the child-To-Child approach. MATERIALS AND METHODS: The present study is part of a quasi-experimental before-and-after intervention study conducted in the rural area of Delhi for the prevention of childhood injuries through intervention by the child-To-Child approach. Cost of injury treatment, including travel and accommodation expenses, and wage loss were noted. The projected gain in the total cost and out-of-pocket expenditure on injury treatment throughout 20 years of childhood and adolescence were calculated. RESULTS: Both incidences of injuries and total expenditure for treatment of injuries had decreased during the postintervention period in the intervention group, against a rise in the control group. The proportion of OOPE for availing private health care facilities for treatment of injuries, which was more than one-fourth of total expenses, also had decreased in the intervention group during the postintervention period. On economic analysis, it is projected that there will be enormous gain in cost by the implementation of child-To-Child approach in the study area in 20 years, along with saving of OOPE of the families. CONCLUSION: Child-To-Child approach is effective in preventing childhood injuries and reducing the cost of treatment of injuries.

A comparison of patient treatment pathways among multidrug-resistant and drug-sensitive TB cases in Delhi, India: A cross-sectional study.

BACKGROUND: The delay in the diagnosis and treatment initiation of patients with MDR-TB worsens individual prognosis and increases the risk of disease transmission in the community. These delays have been attributed to delay in treatment-seeking by the patient and shifting to multiple healthcare facilities before being tested and diagnosed through India's National Tuberculosis Elimination Program (NTEP). OBJECTIVE: to identify treatment pathways in patients with MDR-TB from the time of onset of symptoms and treatment seeking until diagnosis at a PMDT site and subsequent treatment initiation. We also compared these characteristics with those of patients with DS-TB. METHODS: We recruited a total of 168 patients with MDR-TB and DS-TB each, in Delhi. Data were analyzed using IBM SPSS Version 25. RESULTS: The mean (SD) patient delay for initial treatment-seeking was 20.9 (15.9) days in patients with MDR-TB, and 16.1 (17.1) days in patients with DS-TB (p < 0.001). The median time from visit to the first healthcare facility (HCF) until confirmation of MDR-TB diagnosis was 78.5 days, and until treatment initiation was 102.5 days. Among patients with DS-TB, the time interval from a visit to the first HCF until the initiation of ATT-DOTS was 61.5 days.. Patients diagnosed with DS-TB, whose first source of treatment was a private facility (n = 49), reported a significant delay in the initiation of ATT-DOTS (p < 0.001). CONCLUSIONS: Despite the introduction of universal drug sensitivity testing in individuals having presumptive MDR-TB, a significant delay in the diagnosis and initiation of effective MDR-TB treatment persists as a major public health challenge in India.

The effect of a clinic-based behavioral intervention in promoting enrolment in a text-message tobacco cessation program at a rural primary health clinic in Delhi, India.

INTRODUCTION: The mCessation is a text-message service for quitting tobacco in India, associated with high quit rates but low rates of enrolment. We determined if a brief behavioral intervention package (BBPMC) can promote the enrolment of male tobacco users in the mCessation program (MCP). METHODS: We conducted a quasi-experimental study (single-arm) at a rural primary health clinic in Delhi, India, January-April 2019. We enrolled adult male current tobacco users after screening for eligibility. A trained medical physician administered the BBPMC explaining to patients the major health risks causally associated with tobacco use, along with information on the MCP and the way to register for the service. RESULTS: We recruited a total of 159 tobacco users, mean age 44.5 years (SD=14.3) with median tobacco use duration of 15 years. After administration of the BBPMC, 50 (31.2%) participants registered with the MCP program on-site. On an adjusted analysis, tobacco users with a preexisting intention to quit were three times more likely to enroll in the MCP. CONCLUSIONS: Physicians and other healthcare providers in Indian outpatient health settings should utilize BBPMC like interventions that are easily scalable, require no specialized training, and and allow them to fulfill their obligation to provide a readily accessible tobacco cessation service to their patients.

Perceived Stress and its Epidemiological and Behavioral Correlates in an Urban Area of Delhi, India: A Community-Based Cross-Sectional Study.

BACKGROUND: Increasing stress has been recognized as a major public health problem in the developing world accelerated by an ongoing demographic, economic, and sociocultural transition. Our study objectives were to validate a Hindi version of the 10-item Perceived Stress Scale (PSS-10) and to also assess the extent of perceived stress and its correlates among an adult population in an urban area of Delhi. METHODOLOGY: A community-based cross-sectional study was conducted in an urban resettlement colony of Delhi among 480 adult subjects aged 25--65 years, during the period from January to December 2015. The PSS-10 was translated into Hindi and validated in the study population. Data was analyzed using IBM SPSS Version 25. RESULTS: A total of 243 (50.6%) men and 237 (49.4%) women were enrolled. The scale had an acceptable level of internal consistency (Cronbach's alpha = 0.731). A principal component analysis was run on the PSS-10 data, based on which a three-component structure was accepted, which explained 61% of the total variance. The mean PSS score was 19.25 (SD = 4.50) years. Perceived stress was highest in the 35--50 age group. On multivariate analysis, low socioeconomic status and a white-collar occupation were found to be associated with increased perceived stress (P < 0.001). CONCLUSION: A high burden of perceived stress exists in residents of a low-income urban population in India.

A prescription audit using the World Health Organization-recommended core drug use indicators in a rural hospital of Delhi.

INTRODUCTION: The inappropriate use of drugs is a global health problem, especially in developing country like India. Irrational prescriptions have an ill effect on health as well as health-care expenditure. Prescription auditing is an important tool to improve the quality of prescriptions, which in turn improves the quality of health care provided. The present study was conducted to investigate the rational use of drugs for completeness, legibility, and against the World Health Organization (WHO)-recommended core drug use indicators. MATERIALS AND METHODS: A cross-sectional, outpatient department-based study was carried out in a rural hospital of Delhi wherein 120 prescriptions were randomly sampled, irrespective of patient characteristics and diagnosis over a period of 1 month. All the prescriptions were analyzed for general details, medical components, and WHO core drug use indicators. The data obtained were summed up and presented as descriptive statistics using the Microsoft Excel and were analyzed using SPSS version 16. RESULTS: All the prescriptions had general details mentioned in it. The diagnosis was mentioned in 64.2% of prescriptions, and 85.8% of drugs were prescribed by generic name. An average of 3.02 drugs per encounter was prescribed. The average consultation time and dispensing time were 2.8 min and 1.2 min, respectively. Only half of the patients had correct knowledge of dose. CONCLUSIONS: Our study highlights the need to train our prescribing doctors on writing rational prescriptions for quality improvement.

Knowledge regarding anesthesiologist and anesthesiology among patients and attendants attending a rural hospital of New Delhi.

INTRODUCTION: Anesthesia has become one of the most advanced specialties in modern medicine with tremendous growth in knowledge and substances available for use. However, public awareness toward anesthesiologist and anesthesiology is limited. It is important for us to make people aware about the role played by an anesthesiologist in medical setup. The present study was conducted among patients and attendants to assess the knowledge regarding the anesthesiologist and anesthesiology. MATERIALS AND METHODS: The study was carried out at a rural hospital of New Delhi, on 250 adult patients and attendants visiting outpatient departments to assess their knowledge regarding anesthesiologists and anesthesiology. An interview in their local language with the help of a prestructured questionnaire was carried out over a 3 month period. The participants on the basis of their answers were classified as aware or unaware. The data were analyzed using SPSS version 17. RESULTS: Most of the patients in our study were not aware of the role of anesthesiologists, their role in OT and postoperative period, and about anesthesiology as a separate discipline. They were aware of the general and regional anesthesia techniques. Only half of the participants had good knowledge (55.6%), and it was significantly associated with age, sex, and education (P < 0.001). CONCLUSION: There is ignorance among the general population regarding the role played by anesthesiologists. We need newer initiatives for educating public and professionals for future progress.

Effect of mHealth on modifying behavioural risk-factors of non-communicable diseases in an adult, rural population in Delhi, India.

BACKGROUND: The rising trend of non-communicable diseases (NCDs) has led to a "dual burden" in low and middle-income (LAMI) countries like India which are still battling with high prevalence of communicable diseases. The incorporation of a target specially dedicated to NCDs within the goal 3 of the newly adopted Sustainable Development Goals indicates the importance the world now accords to prevention and control of these diseases. Mobile phone technology is increasingly viewed as a promising communication channel that can be utilized for primary prevention of NCDs by promoting behaviour change and risk factor modification. METHODS: A "Before and After" Intervention study was conducted on 400 subjects, over a period of one year, in Barwala village, Delhi, India. An mHealth intervention package consisting of weekly text messages and monthly telephone calls addressing lifestyle modification for risk factors of NCDs was given to the intervention group, compared to no intervention package in control group. RESULTS: After Intervention Phase, significant reduction was seen in behavioural risk factors (unhealthy diet and insufficient physical activity) in the intervention group compared to control group. Body mass index (BMI), systolic blood pressure and fasting blood sugar level also showed significant difference in the intervention group as compared to controls. CONCLUSIONS: Our study has demonstrated the usefulness of mHealth for health promotion and lifestyle modification at community level in a LAMI country. With the growing burden of NCDs in the community, such cost effective and innovative measures will be needed that can easily reach the masses.

Social Security Measures for Elderly Population in Delhi, India: Awareness, Utilization and Barriers.

INTRODUCTION: World population of elderly is increasing at a fast pace. The number of elderly in India has increased by 54.77% in the last 15 years. A number of social security measures have been taken by Indian government. AIM: To assess awareness, utilization and barriers faced while utilizing social security schemes by elderly in a secondary care hospital situated in a rural area in Delhi, India. MATERIALS AND METHODS: A cross-sectional study was conducted among 360 individuals aged 60 years and above in a secondary care hospital situated in a rural area in Delhi. A pre-tested, semi-structured schedule prepared in local language was used. Data was analysed using SPSS software (version 17.0). Chi-square test was used to observe any statistical association between categorical variables. The results were considered statistically significant if p-value was less than 0.05. RESULTS: A majority of study subjects were females (54.2%), Hindu (89.7%), married (60.3%) and were not engaged in any occupation (82.8%). Awareness about Indira Gandhi National Old Age Pension Scheme (IGNOAPS) was present among 286 (79.4%) and Annapurna scheme in 193 (53.6%) subjects. Among 223 subjects who were below poverty line, 179 (80.3%) were aware of IGNOAPS; while, 112 (50.2%) were utilizing the scheme. There was no association of awareness with education status, occupation, religion, family type, marital status and caste (p>0.05). Corruption and tedious administrative formalities were major barriers reported. CONCLUSION: Awareness generation, provision of information on how to approach the concerned authority for utilizing the scheme and ease of administrative procedures should be an integral part of any social security scheme or measure. In the present study, about 79.4% of elderly were aware and 45% of the eligible subjects were utilizing pension scheme. Major barriers reported in utilization of schemes were corruption and tedious administrative procedures.

A Comparative Study of Prevalence of RTI/STI Symptoms and Treatment Seeking Behaviour among the Married Women in Urban and Rural Areas of Delhi.

Background. In developing countries, women are at high risk for several reproductive health problems especially RTI/STIs. Since all RTIs/ STIs are preventable and most of them are curable, it is pertinent to study the determinants of the health seeking behaviour. Objectives. To compare the prevalence and treatment seeking behaviour about RTI/STI symptoms among the married women of reproductive age group (18-45 years) living in urban and rural area of Delhi. Methods. A cross-sectional study was done among the married women of reproductive age group residing in Pooth Khurd, a village in North West district of Delhi, and Delhi Gate, an urban locality situated in central Delhi. Results. In this study, the prevalence of RTI/STI symptoms was found to be similar in both urban (42.3%) and rural area (42%). In urban area, 73% sought treatment, while in rural area only 45.6% sought treatment. Prevalence of the symptoms was found to be higher among the study subjects who were not using any contraceptive method, had history of abortion, and were with lower educational status, in both urban and rural areas. Treatment seeking behaviour was significantly higher among the educated women, contraceptive users, and older age group women in both rural and urban area.

Determinants of contraceptive practices among eligible couples of urban slum in bankura district, west bengal.

BACKGROUND: Primary care physicians should be aware of the alarming population growth in the developing countries including India. OBJECTIVES: To find couple protection rate (CPR) and risk variables that affect contraceptive practice among eligible couples in an urban slum of Bankura district. MATERIALS AND METHODS: A cross-sectional observational study of 3 months was undertaken on 200 eligible couples in Bakultala urban slum, Lokepur, Bankura district, West Bengal to get relation between various factors that could affect contraceptive practices. RESULTS: Majority of the study population (59%) was young adults (20-29 years age); 65% belonged to nuclear families; one-third were married in less than 18 years of their age. CPR was 67.50%; 49% used permanent methods. Among contraceptive users, significantly higher numbers of couples were married during 18-24 years of age (75%), belonged to nuclear family (70%), literate up to class 10 (73%), having three or more living children (77.50%), and from socioeconomic status of class II (80%). Female literacy rate was higher than national average; 92.50%wives of eligible couple were literate; and tubectomy was commonest contraceptive methods. CONCLUSION: CPR was high, though different factors like age at marriage, type of family, number of living children, literacy status of female partner, and socioeconomic status significantly affected contraceptive behavior of the study population.