Prevalence, Pattern, and Reasons for Self-Medication: A Community-Based Cross-Sectional Study From Central India.

Introduction Self-medication is an important public health problem, with varied prevalence across the world. The high prevalence of self-medication in India is one of the important factors contributing to the development of antimicrobial resistance. Self-medication without medical guidance can lead to inappropriate, incorrect, or undue therapy, missed diagnosis, delays in appropriate treatment, pathogen resistance, and increased morbidity. The growing trend of self-medication can be attributed to various factors like the urge for self-care, sympathy toward sick family members, inaccessible health services and nonavailability of drugs, time and financial constraints, ignorance, misbeliefs, extensive advertisement and availability of drugs in places other than drug shops. Methodology The present community-based descriptive cross-sectional study was conducted in an urban field practice area of a tertiary health care center (UHTC) in Central India. Individuals above 18 years of age and present at home at the time of the house-to-house survey comprised the study participants. A total of 400 participants were enrolled in the study. Data were collected using a predesigned and pretested questionnaire by the face-to-face interview technique. Results The prevalence of self-medication in the area was 60 % (240). The most widely used drugs for self-medication were analgesics (159; 66.25%) and antipyretics (142; 59.16%). Common ailments for which self-medication was used frequently were fever, body aches, common cold, and cough. It was observed that female participants were twice more likely to self-medicate as compared to male participants (Odds Ratio (OR): 2.04; Prevalence (p) = 0.014, Confidence Interval (CI) 95% = 1.15-3.62). Additionally, those having education above the high school level had more chances of self-medicating than those educated less than high school (OR: 1.25; p≤0.014, CI 95%=1.05-1.50). The commonest reasons for resorting to self-medication as per the findings of the present study are that it saves time and the condition was not serious enough to warrant a physician's consultation.

Association between tooth loss and risk of occurrence of oral cancer - A systematic review and meta-analysis.

Background: Periodontitis, the second most common reason for tooth loss in adults, is a chronic inflammatory condition that increases the prevalence of cancer by inhibiting apoptosis and promoting tumor cell growth. However, it is still debatable if tooth loss is an important risk factor in oral cancer (OC). The aim of this systematic review is to analyze the relationship between tooth loss and the probability of developing head-and-neck cancer and also to see if there is an association between tooth loss, periodontitis, and the risk of OC. Materials and Methods: Studies that depicted a link between tooth loss and OC (till 2017) were searched from online databases accompanied by a thorough manual search of relevant journals. Data were collected from eligible studies, and meta-analysis was carried out using the Meta-Analysis software. The effect of various inclusions was assessed by sensitivity and subgroup analysis. Publication bias was also evaluated. Results: The meta-analysis consisted of 15 publications. When the number of teeth lost was counted, there was significant variability (I2 = 98.7%, P = 0.0001). When more than 15 teeth were missing in a subgroup analysis, there was a 2.4 times greater risk of OC (odds ratio: 2.496, 95% confidence interval [CI] = 2.067-3.015, P = 0.001) with no heterogeneity (I2 = 0.00%, 95% CI for I2 = 0.00-68.98). Subgroup analysis revealed that there was no evidence of publication bias. Conclusion: It was concluded that tooth loss can increase the OC risk by nearly 2 folds. However, large-scale population-based studies are needed to substantiate the findings.

Effect of home-based childcare on childhood mortality in rural Maharashtra, India: a cluster randomised controlled trial.

BACKGROUND: Melghat, an impoverished rural area in Maharashtra state, India; has scarce hospital services and low health-seeking behaviour. At baseline (2004) the under-five mortality rate (U5MR) (number of deaths in children aged 0-5 years/1000 live births) was 147.21 and infant mortality rate (IMR) (number of deaths of infants aged under 1 year/1000 live births) was 106.6 per 1000 live births. We aimed at reducing mortality rates through home-based child care (HBCC) using village health workers (VHWs). METHODS: A cluster-randomised control trial was conducted in 34 randomly assigned clusters/villages of Melghat, Maharashtra state, between 2004 and 2009. Participants included all under-five children and their parents. Interventions delivered through VHWs were patient-public involvement, newborn care, disease management and behaviour change communications. Primary outcome indicators were U5MR and IMR. Secondary outcome indicators were neonatal mortality rate (NMR) (number of neonatal deaths aged 0-28 days/1000 live births) and perinatal mortality rate (PMR) (number of stillbirths and early neonatal deaths/1000 total births). Analysis was by intention-to-treat at the individual level. This trial was extended to a service phase (2010-2015) in both arms and a government replication phase (2016-2019) only for the intervention clusters/areas (IA). FINDINGS: There were 18 control areas/clusters (CA) allocated and analysed with 4426 individuals, and 16 of 18 allocated IA, analysed with 3230 individuals. The IMR and U5MR in IA were reduced from 106.60 and 147.21 to 32.75 and 50.38 (reduction by 69.28% and 65.78%, respectively) compared with increases in CA from 67.67 and 105.3 to 86.83 and 122.8, respectively, from baseline to end of intervention. NMR and PMR in IA showed reductions from 50.76 to 22.67 (by 55.34%) and from 75.06 to 24.94 (by 66.77%) respectively. These gains extended to villages in the service and replication phases. INTERPRETATION: This socio-culturally contextualised model for HBCC through VHWs backed up with institutional support is effective for significant reduction of U5MR, IMR and NMR in impoverished rural areas. This reduction was maintained in the study area during the service phase, indicating feasibility of implementation in large-scale public health programmes. Replicability of the model was demonstrated by a linear decline in all the mortality rates in 20 new villages during the government phase. TRIAL REGISTRATION NUMBER: NCT02473796.

The color stability of maxillofacial silicones: A systematic review and meta analysis.

Aim: This systematic review aims to identify and interpret results of studies that evaluated the changes in the color stability of maxillofacial prosthetic materials due to chemical instability of silicones and pigments and the effect of exposure to environmental conditions and aging factors on the same. Settings and Design: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA). Materials and Methods: Relevant articles written in English only, before November 15, 2019, were identified using an electronic search in the PubMed/Medline conducted to identify pertinent articles. The relevancy of the articles was verified by screening the title, abstract, and full text, if they met the inclusion criteria. A total of 42 articles satisfied the criteria, from which data were extracted for qualitative synthesis. This review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO registration number CRD42019124562). Statistical Analysis Used: Since considerable data heterogenicity was present in all studies except the ones on incorporation of TiO2 for which meta-analysis using random effects model was performed. Results: The database search resulted in 234 studies, of which 202 articles were excluded due to lack of relevance, duplication, and unavailability of data. The remaining 32 fulltext articles were assessed for eligibility, out of which 2 articles were excluded. Twelve articles were yielded by manual search. A total of 42 studies were included in the present systematic review. Due to heterogeneous data, meta-analysis could be only carried out with the effect of TiO2 nano particle on color stability. Conclusions: Although there has been extensive amount of research in this field, an ideal maxillofacial silicone exhibiting good color stability in various human and environmental aging conditions is yet to be identified. Human and environmental aging conditions have an adverse effect on the color stability and addition of TiO2 nano particle seems to improve the same.

COVID-19 and subsequent lockdown: Adverse effects on psychological health of Indian women.

CONTEXT: COVID-19 pandemic and subsequent lockdown have led to adverse psychological outcomes in general population. Stress is mounting at an unbelievable pace and one gender is taking the brunt more than the other. While it's easy to understand the predicaments of working women and how stressful they are during the lockdown, what escapes the notice is the condition of homemaker women who face a lot of challenges as their workload has increased due to lack of house help. Hence the study was conducted to assess anxiety and stress related to problems arising out of COVID-19 and the subsequent lockdown among Indian women. METHODS AND MATERIAL: Cross-sectional study was carried out among women across India using snowball sampling technique. Data was collected by a semi-structured online questionnaire based on GAD-7 and PSS scales. It was done using STATA 10.1 and Spearman's correlation coefficient, Kendall's Tau, etc., were applied. RESULTS: Majority of study participants mentioned either improvement or no change in their personal relations. Anxiety was present in 55.97% and moderate stress in 90.53% of the female participants. Mean GAD and PSS scores were 5.91 and 21.91 respectively. Anxiety and stress were found to be significantly related to getting help in the household work and occupational status. Watching movies and trying different recipes were the main destressors. CONCLUSIONS: More than half of the women are having anxiety and almost all have some form of stress due to COVID-19 pandemic and the subsequent lockdown.

Risk factors for acute myocardial infarction in central India: a case-control study.

BACKGROUND: Atherosclerosis is a multi-factorial disease involving the interplay of genetic and environmental factors. Studies highlighting the public health importance of risk factors like chronic infections causing acute myocardial infarction (AMI) in the Indian context are scarce. This study was undertaken to study the association of socio-demographic and life-style factors with acute myocardial infarction in central India. MATERIALS AND METHODS: The cases and controls were group-matched for age, gender, and socio-economic status. A blinded research associate administered the study questionnaire. We performed an unconditional multiple logistic regression analysis. RESULTS: The case-control study included 265 cases of AMI and 265 controls. The results of final model of logistic regression analysis for risk factors of AMI included 11 risk factors at α = 0.05. They were waist hip ratio, body mass index, stress at home in last 1 year, hypertension, family history of CHD, past history of gingival sepsis, tobacco smoking, raised total serum cholesterol, Chlamydia pneumoniae, Helicobacter pylori and raised C-reactive protein. CONCLUSION: The findings confirm the role of conventional risk factors for cardiac disease and highlight need for research into the association between chronic infections with AMI.

Risk factors for low birth weight in an Indian urban setting: a nested case control study.

This study explores the risk factors for low birth weight (LBW) in an urban Indian setting by using a nested case-control design. Information on potential risk factors was sought from 384 pregnant women attending an antenatal clinic, and they were followed until birth. Based on birth weight, the babies of these women were categorized as cases or controls. Bivariate analyses between each risk factor and birth weight showed an unadjusted significant association (P < .05) for maternal age ≤20 years, antenatal clinic registration after the first trimester, ≤5 antenatal visits, and <80% of the recommended dietary allowance (RDA) for calories and proteins. Multiple logistic regression analysis showed an adjusted significant association for calorie intake <80% RDA (P < .048), low zinc intake (P < .001), and ≤5 antenatal visits (P < .001). This study emphasizes the continuing importance of timely and regular antenatal visits and intake of appropriate amount of calories. The role of zinc as a risk factor for LBW warrants further research.

Results of single-staged rotational osteotomy in a child with congenital proximal radioulnar synostosis: subjective and objective evaluation.

BACKGROUND: For congenital proximal radioulnar synostosis, both conservative and operative treatments have been described. Most of the studies describing surgical interventions are based on subjective evaluation of the forearm function and have used severe degree of forearm pronation as an indication for surgery. This study describes a single-staged rotational osteotomy of the proximal third ulna and distal third radius. The aim of the study was to assess the utility of the described surgical procedure by subjective and objective evaluations of the forearm function. METHODS: Forty-eight children with congenital proximal radioulnar synostosis were evaluated by subjective and objective assessments and were followed up prospectively. Subjective evaluation consisted of a set of 12 questions regarding the basic activities of life. Objective evaluation was made using the Jebsen-Taylor hand-function test and a classification system used by Failla and colleagues for 15 tasks described by Morrey and colleagues. Eleven children were treated conservatively. Thirty-six children underwent a single-staged rotational osteotomy of the proximal third ulna and distal third radius. After surgery, the evaluations were repeated. The mean age at surgery was 8.6±3.7 years, and the mean postoperative follow-up period was 54±13 months. RESULTS: All operated forearms showed a statistically significant improvement in functioning after surgery as per the subjective and objective evaluations. The mean time taken to carry out all activities before surgery was 47.7+10.0 seconds, which significantly reduced to 33.3+6.6 seconds after surgery (P=0.0001) as per the results of the Jebsen-Taylor hand-function test. All good (n=19) and fair (n=11) results were converted to excellent (n=30) after surgery as per the modified Failla classification. There were no neurovascular injuries as compared with other published techniques. Only 1 child had delayed union, and 1 had persistent dorsal angulation at the radial osteotomy site. CONCLUSIONS: For patients with congenital radioulnar synostosis and pronation deformity interfering with function and quality of life, the single-staged rotational osteotomy of the radius and ulna is a good alternative procedure. LEVEL OF EVIDENCE: Level IV--therapeutic.

Effect of indoor air pollution during cooking on peak expiratory flow rate and its association with exposure index in rural women.

Routine exposure to domestic cooking fuels is an important source of indoor air pollution causing deterioration of lung function. We conducted a community based cross-sectional study in 760 non-smoking rural women involved in household cooking with four types of cooking fuels i.e. Biomass, Kerosene stove, Liquid Petroleum Gas (LPG) and Mixed (combination of two and more cooking fuels). Peak Expiratory Flow Rate (PEFR) less than 80% of the predicted was considered as abnormal PEFR. The overall prevalence of abnormal PEFR was found to be 29.1% with greater predominance among biomass fuel users (43.3%) with high risk ratio (1.86) as compared to kerosene (0.63), LPG (0.75) and mixed (0.66) fuel users. However the pair wise comparison of different groups of cooking fuels by Marascuilo procedure reported significant differences within different groups except kerosene--mixed group. The study also demonstrated a negative correlation between observed PEFR and exposure indices in different cooking fuels (r = -0.51). Our results indicate that prolonged exposure to cooking fuels particularly biomass fuels as a source of cooking adversely affects PEFR in nonsmoking rural women.

Urban-rural differences in menstrual problems and practices of girl students in Nagpur, India.

Menstruation in adolescent girls is often associated with menstruation related problems and poor practices. The study was planned to investigate the menstrual related problems and menstrual practices among school going adolescent girls. The study was a community based cross sectional study in a girls school in Nagpur. Majority of menstrual practices were significantly better in urban girls as compared to rural girls (P<0.05). Majority of the girls (71.83%) had at least one problem related to menstrual cycles. There was a significant difference in proportion of menstrual problems in rural and urban girls (P<0.01). Menstrual problems are a common source of morbidity in this population.

Landscaping biostatistics education in India.

Biostatistics plays an important role in measuring, understanding, and describing the overall health and well-being of a population. Biostatistics as a subject evolved from the application of statistics in various research aspects of biology, biomedical care, and public health. However, with a recent increase in number of health and pharmacy related research, the demand for trained biostatisticians is also increasing. The present paper is an attempt to undertake a situational analysis of biostatistics education in India. A systematic, predefined approach, with three parallel strategies was used to collect and assemble the data regarding training in biostatistics in India. Our study results show that there is paucity of programs providing specialized training in biostatistics in India. Only about 19 institutions in India are offering various courses in biostatistics/medical statistics/health statistics/biometry. It is important to look into the current capacity building initiatives in this domain. Some other means for giving importance to biostatistics could be by making it a separate branch/specialization in a majority of the institutions, particularly in medical colleges.

Can the Griess Nitrite Test and a Urinary Pus Cell Count of ≥5 Cells Per Micro Litre of Urine in Pregnant Women be Used for the Screening or the Early Detection of Urinary Tract Infections in Rural India?

OBJECTIVES: Urinary Tract Infection (UTI) is a common problem in pregnancy due to the morphological and the physiological changes that take place in the genitourinary tract during pregnancy. Screening methods may be useful, because a full bacteriological analysis could be reserved for those patients who are symptomatic or those who have positive screening test results. The exact prevalence of UTI in rural, pregnant women is unknown. The present study was undertaken to estimate the prevalence of UTI in pregnant women and for ascertaining the utility of the Griess Nitrite test and the Urinary Pus Cell Count of ≥5 cells per micro litre test for the screening or the early detection of UTI in them at primary health care clinics. Occurrence of urinary complaints was compared in UTI and non UTI women. METHOD: We conducted a study on 300 randomly selected, pregnant women from rural areas. Urine cultures, pus-cell counts and the Griess nitrite test were used for diagnosis of UTI. The screening tests for UTI were evaluated in terms of their sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and the percentage of correctly classified. RESULTS: In the present study, the prevalence of UTI was found to be 29/300 (9.6%, 95% confidence interval 9.57-9.63). The specificities of the two screening tests were comparable (97.05% and 94.47%). Also, the negative predictive values of the two tests were almost similar (97.77% and 96.96%). The percentage of correctly classified by the Griess nitrite test and the urine pus cell count were found to be 95.33% and 92.33% respectively. The proportion of the women with various urinary complaints was significantly higher (P<0.00) in the UTI subjects as compared to that in the non-UTI subjects. CONCLUSION: Urine culture remains the gold standard for the detection of asymptomatic bacteriuria. The Nitrite test of uncentrifuged urine was observed to be the best among the screening tests which were evaluated in terms of their efficiency and validity.

Neonatal morbidity and mortality in tribal and rural communities in central India.

BACKGROUND AND OBJECTIVES: Little is known about the natural history of neonates born in the rural and tribal areas in India. The Neonatal Disease Surveillance Study (NDSS) measures the incidence of high-priority neonatal diseases, neonatal health events and associated risk factors to plan appropriate and effective actions. MATERIALS AND METHODS: The NDSS is being conducted in Ramtek Revenue Block, Nagpur district, Maharashtra state, given its considerably high level of neonatal mortality. All households from five selected primary health centers were screened. Both active and passive surveillance systems were used for systematic collection of mother's health during pregnancy and of baby's health from birth to 4 months after birth. First-year results from November 2006 to October 2007 are presented. RESULTS: Pregnancy outcomes were available for 1,136 women, with an overall neonatal mortality of 73 per 1,000 live births. The pregnancy outcomes varied by gestational age of the baby; miscarriages and abortions were higher in tribal than in non-tribal women, and tribal women had higher rates of low-birth weight (LBW) neonates than non-tribal women. The main cause of neonatal mortality was LBW, followed by sepsis and respiratory illness. The mortality of non-tribal babies was most strongly associated with pre term. For tribal babies, mortality was also associated with maternal morbidity and delay in the initiation of breastfeeding. INTERPRETATION AND CONCLUSIONS: The NDSS provides valuable information on the potentially modifiable factors associated with increased likelihood of neonatal mortality and morbidity. The Neonatal Health Research Initiative is now developing community-based interventions to reduce the high rate of neonatal mortality and morbidity in the rural areas of India.

Prevalence, awareness, control, and associations of arterial hypertension in a rural central India population: the Central India Eye and Medical Study.

BACKGROUND: Because relatively little has been known about the actual prevalence of hypertension in India, particularly for its rural population, we investigated the prevalence of arterial hypertension in a rural Indian population. METHODS: The Central India Eye and Medical Study is a population-based study in a rural Central Indian region. It included 4,711 subjects (ages 30+ years) undergoing an ophthalmic and medical examination. Hypertension was defined as systolic blood pressure > or =140 mm Hg and/or diastolic blood pressure > or =90 mm Hg, and/or self-reported current treatment for hypertension. RESULTS: Arterial hypertension was found in 1,041 (22.1%) subjects. Its prevalence was associated with higher age (P < 0.001), higher body mass index (P < 0.001), body height (P = 0.001), higher blood hemoglobin levels (P < 0.001), and elevated blood urea concentration (P = 0.008). It was not significantly associated with gender, level of education, family income, kind of daily physical activities, type of diet, and serum concentrations of cholesterol and creatinine. Among the hypertensive study participants (n = 1,041), 208 (20.0%) subjects were aware of their disease. A current antihypertensive treatment was reported by 84 subjects of the 1,041 arterial hypertensive subjects (8.1 +/- 0.9%). Out of the treated subjects, 24 (29%) had abnormally high diastolic blood pressure measurements and 44 (52%) participants had abnormally high systolic blood pressure measurements. CONCLUSIONS: In a rural Central Indian population of ages 30+ years, the prevalence of arterial hypertension was 22.1 +/- 0.6% with an awareness rate of 20% and a treatment rate of 8%. The low awareness and treatment rate may demand increasing public health efforts.

Increasing access to safe abortion services in rural India: experiences with medical abortion in a primary health center.

INTRODUCTION: To increase access to safe abortion in rural India, the feasibility and acceptability of mifepristone-misoprostol abortion was assessed in a typical government run primary health center (PHC) in Nagpur district, Maharashtra State, that does not offer surgical abortion services and must refer off-site for emergency and backup services. MATERIALS AND METHODS: Consenting pregnant women (n=149) with