Analysis of a Targeted Intervention Programme on the Risk Behaviours of Injecting Drug Users in India: Evidence From the National Integrated Biological and Behavioural Surveillance Survey / 예방의학회지

Objectives@#This study provides insights on the impact of a targeted intervention (TI) programme on behaviour change among injecting drug users (IDUs) in India. @*Methods@#This paper examined the data from the Integrated Biological and Behavioural Surveillance 2014-2015 for IDUs in India. Logistic regression was performed to understand the factors (TI programme services) that affected injecting risk behaviours by adjusting for covariates. Propensity score matching was conducted to understand the impact of the TI programme on using new needles/syringes and sharing needles/syringes in the most recent injecting episode by accounting for the covariates that predicted receiving the intervention. @*Results@#Participants who received new needles and syringes from peer educators or outreach workers were 1.3 times (adjusted odds ratio, 1.29; 95% confidence interval [CI], 1.09 to 1.53) more likely to use new needles/syringes during most recent injecting episode than participants who did not receive needles/syringes. The matched-samples estimate (i.e., average treatment effect on treated) of using new needles in the most recent injecting episode showed a 2.8% (95% CI, 0.0 to 5.6) increase in the use of new needles and a 6.5% (95% CI, -9.7 to -3.3) decrease in needle sharing in the most recent injecting episode in participants who received new needles/syringes. There was a 2.2% (95% CI, -3.8 to -0.6) decrease in needle sharing in the most recent injecting episode among participants who were referred to other services (integrated counselling and testing centre, detox centres, etc.). @*Conclusions@#The TI programme proved to be effective for behaviour change among IDUs, as substantiated by the use of new needles/syringes and sharing of needles/syringes.

District-level HIV estimates using the spectrum model in five states of India, 2017.

ABSTRACT: Decentralized response has been the hallmark of the National AIDS Control Programme in India. District-level HIV burden estimates quantifying the distribution of the epidemics are needed to enhance this decentralized response further to monitor the progress on prevention, testing, and treatment interventions. In this paper, we describe the methodology and results of district-level estimates using the Spectrum model piloted in 5 states of India under National AIDS Control Programme.Using state spectrum model for HIV estimations 2017, we disaggregated state results by the district in pilot states. Each district was considered a subepidemic and HIV epidemic configuration was carried out in its general population as well as in key population. We used HIV surveillance data from antenatal clinics and routine pregnant women testing to model the general population's epidemic curve. We used HIV prevalence data available from HIV sentinel surveillance and integrated biological and behavioral surveys to inform the epidemic curve for key population. Estimation and projection packgage classic platform was used for the curve fitting. District-wide estimates extracted from subpopulation summary in Spectrum results section were used to calculate relative burden for each district and applied to approved State HIV Estimations 2017 estimates.No district in Tamil Nadu had an adult HIV prevalence of higher than 0.5% except for one, and the epidemic seems to be declining. In Maharashtra, the epidemic has shown a decline, with all except 5 districts showing an adult prevalence of less than 0.50%. In Gujarat and Uttar Pradesh, few districts showed rising HIV prevalence. However, none had an adult prevalence of higher than 0.50%. In Mizoram, 6 of 8 districts showed a rising HIV trend with an adult prevalence of 1% or more in 5 districts.Disaggregation of state-level estimates by districts provided insights on epidemic diversity within the analyzed states. It also provided baseline evidence to measure the progress toward the goal of end of AIDS by 2030.

Calorie counting smart phone apps: Effectiveness in nutritional awareness, lifestyle modification and weight management among young Indian adults.

Calorie counting mobile apps claim to assist in weight management by helping users monitor their diets and track activity. This study assessed quality and effectiveness of popular calorie counting apps in weight management and behaviour change. Top 20 apps were selected from Google Play store and their quality was assessed using a 55-point scoring scale on attributes like standards used, content accuracy, user interface and sources of database. The mean (±SD (standard deviation)) quality score was 36.95 (±5.65). The calorie and activity recommendations were compared with standards and over 65 per cent apps over/underestimated calorie intake. To assess effectiveness, 60 young volunteers were recruited and divided into two groups. The intervention group (n = 30) was asked to use one of the top 3 apps for 8 weeks. Pre- and post-comparisons were made with the control group (n = 28). No significant difference was noted in anthropometry or food consumption. There was increasing trend (13.33%) in physical activity in the intervention group.

Systematic review and meta-analysis approach on vitamin A fortified foods and its effect on retinol concentration in under 10 year children.

OBJECTIVE: To carry out a systematic review and meta-analysis of the trials to identify as well as quantify the effect of vitamin A fortified food on serum vitamin A concentration among children under 10 year. STUDY DESIGN: All the relevant studies has been retrieved by MEDLINE, PubMed, Embase, ProQuest and the Cochrane Library and secondary referencing. A random effects model was applied to compute the pooled effect size of effect of serum retinol. Meta regression was performed to detect the sources of heterogeneity and moderator variables on the study effect. We included all the relevant randomized control trials. These studies were assessed for inclusion and validity, with independent duplication. RESULTS: Out of 648 published studies, fourteen were included and evaluated. These studies were covering 6153 children and the duration of feeding for the fortified foods ranged between 3 and 12 months. A pooled effect size of vitamin A fortification on retinol in children was estimated (N 6153; Standard Mean Difference = 0.47; 95% CI 0.16, 0.78). However, there was evidence of substantial heterogeneity of estimate on effect (I2 = 97%, τ2(tau-squared) = 0.55, p < 0.01). CONCLUSION: This study suggests that consumption of Vitamin A fortified foods results in increased concentration of retinol and thereby results in reduction of Vitamin A deficiency among the children.

Accumulation of polychlorinated biphenyls in fish and assessment of dietary exposure: a study in Hyderabad City, India.

The objective of this study is to determine the concentrations of polychlorinated biphenyls (PCBs) in different fish species collected from fish outlets in the south Indian city of Hyderabad. The samples of fish extracted by using Quick, Easy, Cheap, Effective, Rugged, and Safe (QuEChERS) and concentrations of polychlorinated biphenyls (PCBs, 45 congeners) were determined by gas chromatography-microelectron capture detection (GC-µECD) method. The intake of individual PCB congeners through fish, toxicity equivalence factors (TEFs), hazardous quotient, quantitative assessment, and risk evaluations was estimated in the Indian population. Daily dietary intakes of PCBs at the 95th-percentile-measured concentrations were twice the values of the 50th-percentile-measured concentrations in all socio-economic groups. The dietary intakes of PCBs through fish consumption in middle-income group, low-income group, and industrial laborers (0.023 µg kg(-1) day(-1)), the high-income group (0.031 µg kg(-1) day(-1)), and slum dwellers (0.039 µg kg(-1) day(-1)) exceeded the reference dose. The observed estimated daily intakes (EDIs) of our study for all socio-economic sections (0.0087 µg/kg/day) crossed the cancer benchmark concentration of 0.0003 µg/kg/day. In slum dwellers, the ingestion of fish from freshwater and marine water results in the highest lifetime cancer risks of 4.7 in 100,000 and 7.8 in 100,000, respectively. Ultimately, the concentrations of PCBs were determined high in all of the fish species collected. Risk assessment showed that the fish were highly contaminated with PCBs and may pose health threats to consumers in the city of Hyderabad as well as a lifetime cancer risk.

A meta-analysis combining parallel and cross-over randomized controlled trials to assess impact of iodine fortified foods on urinary iodine concentration among children.

The purpose of this analysis was to combine evidence from parallel and cross-over randomized controlled trials to assess the impact of iodine fortified foods on urinary iodine concentration (UIC) in children. A structured search for studies on iodine intervention studies on MEDLINE, Pro Quest, and the Cochrane Library from Jan, 1990 to Dec, 2012 was carried out. Carry-over effect was estimated by general linear model. We explored two methods to pool continuous outcomes in a meta-analysis by combining parallel and cross-over trial designs. The standard mean difference was calculated for net change in UIC. Fixed or random-effects models were used to summaries fortified food response data. Meta-regression and covariate meta-analysis were performed to explore the influ-ence of confounders on the net pooled effect on UIC. The overall pooled estimate, which combined parallel with cross-over trials in the absence of carry-over effect of UIC from 9 studies, showed a significant increase in the fortified group compared with the control group (n=3448; standard mean difference=2.02 µg/L; 95% CI: 1.30, 2.73; I2=99%, τ2=1.81, p<0.01). Meta-regression analysis indicated that dose of the feeding was positively related to the effect size (regression coefficient=0.014; 95% CI: 0.003, 0.026; p<0.019). The net pooled effect size after removing the confounders was 1.59 (95% CI: 0.953, 2.23) µg/L. There was an association between intakes of io-dine fortified foods and UIC in children. These results suggest that we can combine parallel with cross-over trials for meta-analysis for nutrients such as iodine when absorption is high.

Evaluation of Bar, Barnase, and Barstar recombinant proteins expressed in genetically engineered Brassica juncea (Indian mustard) for potential risks of food allergy using bioinformatics and literature searches.

The potential allergenicity of Bar, Barnase, and Barstar recombinant proteins expressed in genetically engineered mustard for pollination control in plant breeding was evaluated for regulatory review. To evaluate the potential allergenicity of the Bar, Barnase and Barstar proteins amino acid sequence comparisons were made to those of known and putative allergens, and search for published evidence to the sources of the genes using the AllergenOnline.org database. Initial comparisons in 2012 were performed with version 12 by methods recommended by the Codex Alimentarius Commission and the Indian Council of Medical Research, Government of India. Searches were repeated with version 15 in 2015. A literature search was performed using PubMed to identify reports of allergy associated with the sources of the three transgenes. Potential open reading frames at the DNA insertion site were evaluated for matches to allergens. No significant sequence identity matches were identified with Bar, Barnase or Barstar proteins or potential fusion peptides at the genomic-insert junctions compared to known allergens. No references were identified that associated the sources of the genes with allergy. Based on these results we conclude that the Bar, Barnase and Barstar proteins are unlikely to present any significant risk of food allergy to consumers.

Assessment of dietary intakes of nineteen pesticide residues among five socioeconomic sections of Hyderabad--a total diet study approach.

Total diet study approach was used to assess the dietary intakes of pesticide residues among the select population in Hyderabad. When assessed by a food frequency questionnaire, it was found that the food intakes varied among five socioeconomic sections (SES). Therefore, we intended to compare the intakes of pesticide residues through these foods among the five SES. A total of 195 foods from different markets were collected and analyzed for 19 pesticides. The residues were analyzed with a gas chromatograph and were confirmed with mass spectrometry. About 51 % of the samples were detected with one or more residues. Thirteen out of the 19 residues were present in levels above detection limits in various concentrations. The median concentrations of the residues in all the samples tested, ranged from 0.00010 to 0.33 mg/kg. Highest median concentration was for ß-HCH in water samples. Exposures to all the residues were below the respective ADIs at both mean and 95th percentile levels of food intakes with highest estimated dietary intakes (EDIs) of ß-HCH in both the cases. The EDIs of ß-HCH were the highest among all the residues at both the intake levels among all the SES. The EDIs of ß-HCH were significantly higher in lower SES than higher SES possibly due to the consumption of rice cooked in water contaminated with ß-HCH. EDIs for other residues did not differ significantly among the five SES.

Use of food label information by urban consumers in India - a study among supermarket shoppers.

OBJECTIVE: To study consumer knowledge and use of food labels. DESIGN: A cross-sectional study employing both quantitative and qualitative methods. Intercept interviews were conducted with 1832 consumers at supermarket sites selected using a stratified random sampling procedure. This information was triangulated with twenty-one focus group discussions. SETTING: New Delhi and Hyderabad, two metro-cities from north and south India. SUBJECTS: Adolescent (10-19 years), adult (20-59 years) and elderly (≥60 years) consumers. RESULTS: While the national urban literacy rate is 84 %, about 99 % of the study participants were educated. About 45 % reported that they buy pre-packaged foods once weekly and about a fifth buy them every day. Taste, quality, convenience and ease of use are the main reasons for buying pre-packaged foods. Although 90 % of consumers across the age groups read food labels, the majority (81 %) looked only for the manufacturing date or expiry/best before date. Of those who read labels, only a third checked nutrition information and ingredients. Nutrient information on labels was not often read because most consumers either lacked nutrition knowledge or found the information too technical to understand. About 60 % read quality symbols. A positive association was found between education level and checking various aspects of food labels. Women and girls concerned about 'fat' and 'sugar' intake read the nutrition facts panel. CONCLUSIONS: The intention of promoting healthy food choices through use of food labels is not being completely met. Since a majority of people found it difficult to comprehend nutrition information, there is a need to take up educational activities and/or introduce new forms of labelling.

Knowledge and practices of using food label information among adolescents attending schools in Kolkata, India.

OBJECTIVE: To assess knowledge and use of label information among adolescents. METHODS: A cross-sectional study was conducted among adolescents (N = 316) from 6 schools selected randomly using cluster sampling. A pre-coded questionnaire was used to assess frequently consumed packaged foods, whether label information was read, knowledge of symbols, and usefulness of nutrition information display. The data were analyzed using descriptive statistics and chi-square tests. RESULTS: Although 88% of adolescents read food labels, many read only date of manufacture (79%), expiration (74%) or best used before dates (65%). Fewer adolescents read ingredients (50%) and nutrition information (20%). Their knowledge about quality symbols was low. Many of them (over 60%) recognized the symbols but had no knowledge of what they indicated. About 66% believed that nutrition information on labels was too complex to understand. CONCLUSIONS AND IMPLICATIONS: There is a need to provide education on different aspects of label information to promote label use. The effectiveness of alternative methods of nutrition information display should also be investigated.

Focus group studies on food safety knowledge, perceptions, and practices of school-going adolescent girls in South India.

OBJECTIVE: To understand food safety knowledge, perceptions, and practices of adolescent girls. DESIGN: Focus group discussions (FGDs) with 32 groups selected using stratified random sampling. SETTING: Four South Indian states. PARTICIPANTS: Adolescent girls (10-19 years). PHENOMENA OF INTEREST: Food safety knowledge, perceptions, and practices. ANALYSES: FGDs were audio recorded, transcribed, and manually coded by topic. At each stage of coding and analysis, reports were read independently by 3 researchers. Results were presented according to 4 food safety topics: concept of safe food; home-cooked food or outside food; packaged food products and food labels; and previous exposure to food safety education. RESULTS: Subjects confused the concept of nutrition with food safety. They were checking food labels, but they were not aware of quality symbols like ISI (Bureau of Indian Standards), FPO (Fruit Products Order), and AGMARK (Agriculture Marking and Grading Act); trusted more in brand names/expensive packaged food; were less careful about snack food safety. Receiving food safety information through school health education was preferred. CONCLUSIONS AND IMPLICATIONS: Adolescent girls are not aware of food quality standards. Awareness needs to be raised on permitted food additives concerning which foods can use them. Children should be familiarized with quality symbols on food labels.

Effect of integration of supplemental nutrition with public health programmes in pregnancy and early childhood on cardiovascular risk in rural Indian adolescents: long term follow-up of Hyderabad nutrition trial.

OBJECTIVE: To determine whether integration of nutritional supplementation with other public health programmes in early life reduces the risk of cardiovascular disease in undernourished populations. DESIGN: Approximately 15 years' follow-up of participants born within an earlier controlled, community trial of nutritional supplementation integrated with other public health programmes. SETTING: 29 villages (15 intervention, 14 control) near Hyderabad city, south India. PARTICIPANTS: 1165 adolescents aged 13-18 years. INTERVENTION: Balanced protein-calorie supplementation (2.51 MJ, 20 g protein) offered daily to pregnant women and preschool children aged under 6 years, coupled with integrated delivery of vertical public health programmes. MAIN OUTCOME MEASURES: Height, adiposity, blood pressures, lipids, insulin resistance (homoeostasis model assessment (HOMA) score), and arterial stiffness (augmentation index). RESULTS: The participants from the intervention villages were 14 mm (95% confidence interval 4 to 23; P=0.007) taller than controls but had similar body composition. The participants from the intervention villages had more favourable measures of insulin resistance and arterial stiffness: 20% (3% to 39%; P=0.02) lower HOMA score and 3.3% (1% to 5.7%; P=0.008) lower augmentation index. No strong evidence existed for differences in blood pressures and serum lipids. CONCLUSIONS: In this undernourished population, integrated delivery of supplemental nutrition with other public health programmes in pregnancy and early childhood was associated with a more favourable profile of cardiovascular disease risk factors in adolescence. This pragmatic study provides the most robust evidence to date on this important hypothesis for which classic trials are unlikely. Improved maternal and child nutrition may have a role in reducing the burden of cardiovascular disease in low income and middle income countries.