Sweet Memories or Not? A Comparative Study on Cognitive Impairment in Diabetes Mellitus.

INTRODUCTION: Type 2 Diabetes Mellitus is a modern-day epidemic and dementia has been declared as a global challenge. It is, therefore, worthwhile to investigate the effect that Diabetes has on cognition. Although effective screening is routinely carried out for various complications of Diabetes, its effect on Higher Mental Functions is often overlooked. METHODOLOGY: A cross-sectional analytical study to assess Cognitive Impairment was carried out on 800 participants, 400 diabetics and 400 non-diabetics attending a tertiary care center. The Addenbrooke's Cognitive Examination- III was used, which is a validated, highly sensitive tool having a maximum score of 100. Patients with a score < /= 82 were considered to have impaired Cognition. Statistical analysis was done using SPSSv.21. Suitable statistical tests like Mann-Whitney U, t-test, ROC curve and Logistic regression analysis were done. RESULTS: Cognitive Impairment was present in 63.8% of the diabetics when compared to only 10.8% in the non-diabetics, with an Odds Ratio-8.78 (CI-4.47-17.22). The total ACE score in diabetics [median-82 (IQR-4), mean rank-270.06] was less compared to the non-diabetic patients [median- 85 (IQR-3), mean rank-530.94] (U = 27822, p-0.001). Attention, Memory, Language, and Visuospatial domains were significantly lower in the diabetics compared to the non-diabetics. However, the fluency domain was not affected. Hypertension and the presence of macrovascular diseases were significantly associated with Cognitive Impairment (p < 0.005). Those with Cognitive dysfunction also had higher mean RBS values and longer duration of Diabetes (p-0.001). The cut-off value for RBS (to distinguish people with and without Cognitive Impairment) from ROC curve was 142.5 (AUC = 0.834, Youden's Index-0.586, p-0.001) and for duration of Diabetes was 7.5 years (AUC = 0.847, Youden's Index-0.529, p-0.001). CONCLUSION: This paper highlights that Cognitive Impairment exists in a very high proportion of diabetic patients in Kerala. So, it is important that we do an early assessment of cognitive function in diabetes patients and manage them prudently. Early interventions may prove to be beneficial in the long run, considering the burden of diabetes and cognitive dysfunction associated with the disease.

Effect of vitamin-D supplementation on self-perceived health-related quality of life in postmenopausal women in Ludhiana, Punjab.

Postmenopausal women are routinely prescribed calcium and Vitamin-D supplements in view of their increased risk of osteoporosis and fractures. A community-based interventional study was undertaken to determine the effect of Vitamin-D supplementation on self-perceived health-related quality of life in 290 postmenopausal women over 6 months in 2015. Vitamin D (60,000 IU) was supplemented for 8 weeks. The CDC-Health-Related Quality-of-Life Questionnaire -14 was administered to the subjects at baseline and post intervention. The pre and postintervention responses were compared using Chi-square test and paired t-test as appropriate. There was a significant improvement in their overall general health status. Mean systolic blood pressure (BP) was reduced by 3.0% (P = 0.0705) and the mean diastolic BP by 3.2% (P = 0.0419). Post supplementation, high serum Vitamin-D levels was observed in 6.5% of the 92 subjects tested. Prescribing Vitamin D to postmenopausal women without checking the serum levels prior to supplementation may occasionally lead to toxicity.

A Comparative Study Assessing Sleep Duration and Associated Factors among Adolescents Studying in Different Types of Schools in an Urban Area of Kerala, India.

BACKGROUND: Sleep is essential for optimizing physical, cognitive, and emotional functioning of adolescents. Adolescents are one of the most sleep-deprived age groups in the society. OBJECTIVES: To assess sleep duration and associated factors among adolescent children studying in different types of schools in an urban area of Kerala. METHODOLOGY: This cross-sectional study was conducted in Pathanamthitta district, Kerala, from January to December 2017. All adolescent children studying in high school and higher secondary classes were included using stratified random sampling. Study tool included a questionnaire which collected sociodemographic information, sleep duration, and schedule. RESULTS: In this study, 657 students were enrolled. The mean age of the participants was 15.09 ± 1.33 years. 201 students (30.6%) were from government school, 242 (36.8%) from aided, and 214 (32.6%) were from private school. The mean sleep duration among the students was 7.2 ± 1.26 h. Sleep duration was found to be inadequate in 60% of the children. The sleep duration was found to be longer during weekends compared to weekdays. Nearly 92% of students take a daytime nap of >1 h during weekends. Private school students had inadequate sleep duration, late bedtime, and early wake-up time compared to other students. Higher age, class, education of parents, family income, distance travelled to school, and female gender were the other factors associated with inadequate sleep among adolescents. CONCLUSION: Inadequate sleep duration and difference in sleep schedule during weekends were observed among adolescents, especially among private school students. Primary prevention approach aimed at spreading adequate awareness regarding the importance of sleep among students, parents, and teachers should be practiced.

Evaluation of a community-based intervention to improve routine childhood vaccination uptake among migrants in urban slums of Ludhiana, India.

Background: Evidence on the effectiveness of community-based interventions in improving vaccination uptake in migrant populations is limited. This study aims to evaluate the effectiveness of a community-based intervention to improve access to and uptake of childhood vaccinations among urban slum-dwelling migrant communities in Ludhiana, India. Methods: A mixed-methods evaluation was conducted involving a post-intervention comparison of vaccination uptake in six randomly selected intervention and control slum communities. Multilevel logistic regression to account for clustering of effects was used to investigate the impact of the intervention on vaccination uptake. Thematic analysis was used to analyse qualitative data. Results: Overall, vaccination uptake was significantly higher in the intervention clusters and the likelihood of full immunization by the age of 1 year was more than twice that in the control clusters [OR: 2.27 (95%CI: 1.12-4.60); P = 0.023]. Qualitative findings showed that stakeholders felt ownership of the intervention and that it was effective in increasing accessibility to and uptake of vaccinations. However, they emphasized the importance of continued government support for the intervention. Conclusions: Community-based interventions can significantly increase vaccination coverage in deprived populations with previously low uptake of childhood immunization but such initiatives need to be delivered in partnership with the government.

Prevalence and association of physical activity with obesity: an urban, community-based, cross-sectional study.

AIM: To study levels of physical activity and various measures of obesity and their association in an urban population. STUDY DESIGN: Cross sectional. MATERIALS AND METHODS: One thousand and forty-seven individuals between the ages 25-64 years systematically sampled from a community-based population database were contacted through a house-to-house survey. We adopted the WHO STEPS guidelines for conducting this study. Anthropological measures collected were height, weight, and waist and hip circumference. RESULTS: Physical Activity (PA) levels declined with age and the decline was greater among females. The Pearson's correlation coefficient for age against PA among males was found to be negative and weak (r = -0.104) and that among females was found to be similar (r = -0.206). The prevalence of obesity was higher among females (28.8 %) than among males (13.3 %) and the difference was statistically significant. There was a progressive increase in abdominal obesity with age in both genders. The prevalence of overweight and obesity was higher among individuals with low levels of PA as compared to those with high levels of PA. CONCLUSION: Sedentary behavior is prevalent in more than half of the current study sample. This was more so with increasing age, female gender and increasing obesity. PA is an important component on long-term weight control, and therefore adequate levels of activity should be prescribed to combat the obesity epidemic. Habitual moderate physical activity may be beneficial in preventing excess accumulation of fat.