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Background & Objective: Preoperative anxiety among children may at times be very cumbersome for the anesthesiologist, as an anxious child cannot be expected to be very cooperative. Anxiety may interfere into vascular excess and smooth induction of anesthesia. This study was conducted to assess the efficacy of ‘pediatric anesthesia comic information’ leaflet in reducing preoperative anxiety and to obtain parents feedback on its utility. Methodology: It was a prospective single blinded randomized controlled trial among 150 children, aged 6-12 y, undergoing elective surgery in a tertiary-care hospital. Test group (Group T) was given a comic leaflet along with oral information while control group (Group C) received only oral information. Preoperative anxiety was measured using Modified Yale Preoperative Anxiety Scale (m-YPAS) at three time intervals along with feedback from parents on the comic’s utility. Data was analyzed using SPSS version 21.0 with Chi-square, independent t and Mann Whitney tests applied to interpret the results. Results: Pre-operative anxiety on the day prior to surgery (T1) was 25.75 ± 5.52 and 26.61 ± 7.77 compared to baseline (T0) score of 25.8 ± 6.1 and 26.6 ± 8.0 in group T and C respectively. The mean scores in the holding area (T2) was 38.87 ± 14.20 and 41.35 ± 16.40 in Group T and C respectively. The p value of change in the preoperative anxiety scores T0-T1 was 0.2, and T0-T2 was 0.24 with no significant decrease in preoperative anxiety in intervention compared to the control group (p > 0.05). Conclusion: Our results show that comic leaflet, given pre-operatively in addition to standard oral information had no additional effect on reducing anxiety in children undergoing surgery. However, the parents of the study subjects found the comic leaflet to be informative and it needs to be explored further in future research. Key words: Anesthesia; Preoperative anxiety; Pediatrics; Surgery; Comic leaflet Citation: Kulkarni MM, Pradeep S, Rao M, Kulkarni MM. A randomized controlled trial to study the effect of a pediatric anesthesia comic information leaflet on preoperative anxiety in children. Anaesth. pain intensive care 2021;26(1):75-80. DOI: 10.35975/apic.v26i1.1771 Received: June 27, 2021, Reviewed: September 28, 2021, Accepted: November 17, 2021

IntroductionTobacco has been a complex global problem that has adversely affected almost all the sectors of society. However, the ill-effects are often most reflected in humanitarian settings, which inadvertently are surmounted by fragile systems. We aim to map tobacco prevention and control intervention in humanitarian settings.Methods and analysisThis scoping review will follow the guidelines of the Joanna Briggs Institute. A comprehensive search strategy was designed using Medical Subject Heading terms, subject experts and pertinent reviews. The search was conducted on Medline (through PubMed and Ovid), EMBASE (through OVID), ProQuest Health and Medical Complete, EBSCO (through CINAHL Complete), Scopus and Web of Science databases. Two reviewers will independently screen the identified studies on removing duplicates, which shall be followed by data extraction using a pretested data extraction form. A narrative synthesis approach will be employed to collate the findings from the studies and tabular formats would be used to aid the representation.Ethics and disseminationThis review will identify, map and synthesise the interventions for tobacco prevention and control in the humanitarian settings. An ethics committee approval was not sought for this body of work as it does not include human subjects. Results from the study will be disseminated through conference presentations and peer-reviewed publications.

Introduction Although most of the disease burden internationally is due to tobacco smoking, smokeless tobacco (SLT) use contributed to an estimated 76 000 deaths in 2017. We have studied the potential risk factors for SLT use among adolescents in South India. Methods A cross-sectional questionnaire survey of all students in grades 6–8 in schools in the Udupi district of Karnataka State ascertained SLT use status and potential determinants of SLT uptake. Ever SLT use was defined as any reported consumption of any SLT products, currently or at any time in the past. Independent effects on ever SLT use status were estimated using multiple logistic regression. Results Of 46 706 students from 914 participating schools, 39 282 (84.1%) provided questionnaire responses sufficiently complete for analysis. Ever SLT use was reported by 775 (2.0%) participants and in a mutually adjusted model was significantly related to age, male sex, family use, or friend’s use of SLT, low socioeconomic status, high rebelliousness, and low self-esteem. After controlling for these effects, the odds of ever-SLT use were significantly higher among students who had least awareness of the harmful effects of tobacco use (odds ratio 3.7, 95% confidence interval [2.9, 4.7]) and significantly lower among those not exposed to tobacco advertising (odds ratio 0.7, 95% confidence interval [0.5, 0.8]). Conclusions The prevalence of SLT use among children in Karnataka is relatively low when compared with other studies in India. The significant potential risk factors of SLT use include low awareness of the harmful effects of tobacco and tobacco control policies and exposure to tobacco advertising. Implications The prevalence of SLT use among school going adolescents in South India is relatively low. The potential risk factors for SLT use among adolescents in southern India are similar to those for smoked tobacco. It includes age, male gender, family or friend’s use of SLT, low socioeconomic status, high rebelliousness, low self-esteem, exposure to tobacco advertisement and least awareness about the harmful effects of tobacco and of tobacco control policies. The present study lays emphasis regarding creating awareness about tobacco harms and control policies for further reducing tobacco use among adolescents.

Background: Beedi rolling is one of the principal occupations of women residing in coastal Karnataka. The beedi worker's welfare fund consists of a combination of schemes to improve the living conditions of beedi workers and their families. On the other hand, the government is introducing several anti-tobacco policies, which could lead to insecurity among beedi rollers about their future. As a result, majority of the trade unions believe that alternate livelihood must be provided to the workers. In the midst of economic benefits and stringent tobacco control policies, this study explores the perception of beedi rollers to quit tobacco rolling and engage with an alternative livelihood. Objectives: The objectives of this study were as follows: (1) to explore the opinion of beedi workers toward alternate means of livelihood and (2) to identify the benefits availed by the beedi workers. Methodology: The study was conducted with a semi-structured questionnaire by interview method in all the seven blocks of the Udupi district of Karnataka with a total of 381 respondents through convenience sampling. The interviewer administered the survey with the help of a predesigned user application which was developed through Kobo Toolbox, and the analysis was carried out using IBM SPSS version 26. Results: Although 69% of the respondents believed that beedi rolling is not a secured job, three-fourth of the respondents were not ready to quit the beedi rolling job due to low education, higher age, and lack of financial support to invest in other occupations. Conclusion: Our study showed that most of the participants were full-time beedi rollers and most of them were not ready to shift to other jobs due to old age, lack of experience with other vocations, and benefits availed. There is a need to focus on strengthening skill development programs and introduce sustainable economic alternatives to the beedi rollers.

Background: Tobacco use not only increases mortality, but also causes enormous burden to the Nation’s health and economy. The WHO -Framework Convention on Tobacco Control implemented “MPOWER”, comprising of an important entity of ‘offering help to tobacco users’ to quit. Quitline provides evidence-based treatment services to tobacco users and advertising those services has the potential to increase their utilisation. Objectives: Our objective was to assess the awareness and utilisation of the newly introduced quitline on tobacco packs among tobacco users. Materials and Methods: After obtaining Ethics Committee approval, this cross-sectional study was conducted from March-June 2019 in a purposive sample of tobacco users aged 18 years and above at the point of sale with prior informed consent. The questionnaire included questions on the users’ knowledge and utilisation of the quitline. Results: Most of the tobacco users (84.6 %) had not observed the quitline on tobacco pack. Amongst those who observed the quitline, 65.5% were smokers, while the smokeless tobacco users who comprised half of the study population were unaware of the quitline. More than 97% of illiterates were unaware of the quitline. Only three tobacco users who were aware of quitline had tried using it. Conclusion: Most of the tobacco users had basic education but were not aware of the quitline on the tobacco packs and only a very few of them used the services, highlighting the need to increase its awareness for effective tobacco control.

IntroductionAccelerating progress on tobacco control will require Article 5.3 of the WHO Framework Convention on Tobacco Control to be systematically integrated into policies and practices of sectors beyond health at diverse government levels. However, no study has explored implementation challenges of Article 5.3 within multilevel systems such as India, where political decisions on tobacco control occur at diverse government levels, which may constrain action at local level.MethodsBased on 33 semi-structured interviews with diverse government and civil society stakeholders across four districts in Karnataka, India (Mysore, Mangalore, Bengaluru (rural) and Udupi), this study examines challenges to implement Article 5.3 arising from competing agendas and policies of different actors at multiple levels.ResultsOur analysis reveals generally low levels of awareness of Article 5.3 and its guideline recommendations, even among those directly involved in tobacco control at district level. Efforts to implement Article 5.3 were also challenged by competing views on the appropriate terms of engagement with industry actors. Scope to reconcile tensions across competing health, agriculture and commercial agendas was further constrained by the policies and practices of the national Tobacco Board, thereby undermining local implementation of Article 5.3. The most challenging aspect of Article 5.3 implementation was the difficulties in restricting engagement by government officials and departments with tobacco industry corporate social responsibility initiatives given national requirements for such activities among major corporations.ConclusionsPromoting effective implementation of Article 5.3 in Karnataka will require policymakers to work across policy silos and reconcile tensions across India’s national health and economic priorities.

Background: The Government of Karnataka banned loose cigarettes sale effect from September 2017 and is punishable under Cigarettes and Other Tobacco Products Act (COTPA) with fine and imprisonment in case of violation. Aim & Objective: Study aims to assess awareness, perceptions and practices about ban among tobacco vendors and smokers. Methods and Material: Cross sectional survey was carried using pre-tested questionnaire to collect information regarding awareness about ban among vendors and smokers. Data were analyzed using SPSS version 15.0. Results: Ninety-five percent of the tobacco vendors continued to sell loose cigarettes despite the ban. Among vendors, 49.7%, were aware of ban and of them 53.5% knew it is a punishable offense. Vendors opined that they would stop selling loose cigarettes if ban is strictly enforced with frequent checks on periodical basis. One-fourth smokers opined they will reduce cigarettes consumption with few making an attempt to quit. Conclusions: Awareness about ban on sale of loose cigarettes was unsatisfactory among vendors and smokers including lack of knowledge regarding legal actions in case of violation. However, vendors responded favorably towards obeying the law. Smokers are likely to reduce or even quit smoking if the law is strictly enforced which highlights the need for creating awareness drives and strong enforcement of the policy.

Introduction: Laryngoscopy forms an important part of general anaesthesia and endotracheal intubation. Laryngoscope blades of different shapes have been designed and studied. Objective: We compared Macintosh and Mac Doshi blades for laryngoscopic view, time for intubation and cardiovascular response during intubation. Materials and Methods: Following Institutional ethical committee approval, this prospective randomized study was undertaken in 160 patients scheduled for elective surgery requiring orotracheal intubation assigned into two groups: group M (Macintosh) and group D (Mac Doshi). After intravenous induction, laryngoscopy was performed, and trachea intubated. Ease of glottic visualization and ease of intubation were noted as per Cormack Lehane (CL) scale and Arino scale respectively. The haemodynamic variables were also noted at regular time intervals. Results: Ease of glottic visualization and intubation assessed through CL grade (P=0.65) and Arino scale (P=0.084) were comparable in both groups using Fisher’s exact test. Time to glottic visualization was 8.24±3.03 seconds for Macintosh group and 8.44±3.73 seconds for Mac Doshi group (p=0.7). Time to intubate was 30.29±11.47 seconds for Macintosh and 27.25±7.03 seconds for Mac Doshi group (P=0.046). All haemodynamic parameters were also comparable without clinical significance. Conclusion: Macintosh blade and Mac Doshi were found to be comparable in terms of ease of glottic visualization and intubation. There was no difference in time taken for glottic visualisation, time for intubation and haemodynamic parameters between the two groups. Keywords: Laryngoscopy, Macintosh blade, Mac Doshi blade, General anaesthesia, Ease of intubation.

A lyophilized bovine-human rotavirus reassortant pentavalent vaccine (BRV-PV, Rotasiil®) was licensed in 2016. A liquid formulation of this vaccine (LBRV-PV, Rotasiil - Liquid) was subsequently developed and was tested for non-inferiority to Rotasiil® and for lot-to-lot consistency.This Phase II/III, open label, randomized study was conducted at seven sites across India from November 2017 to June 2018. Participants were randomized into four arms; Lots A, B, and C of LBRV-PV and Rotasiil® in 1:1:1:1 ratio. Three doses of study vaccines were given at 6, 10, and 14 weeks of age. Blood samples were collected four weeks after the third dose to assess rotavirus IgA antibody levels. Non-inferiority of LBRV-PV to Rotasiil was proven if the lower limit two-sided 95% confidence interval (CI) of geometric mean concentration (GMC) ratio was at least 0.5. Lot-to-lot consistency was proven if 95% CI of the GMC ratios of three lots were between 0.5 and 2. Solicited reactions were collected by using diary cards.Of the 1500 randomized infants, 1436 infants completed the study. The IgA GMC ratio of LBRV-PV to Rotasiil® was 1.19 (95% CI 0.96, 1.48). The corresponding IgA seropositivity rates were 60.41% (57.41, 63.35) and 52.75% (47.48, 57.97). The IgA GMC ratios among the three LBRV-PV lots were: Lot A versus Lot B: 1.34 (1.03, 1.75); Lot A versus Lot C: 1.22 (0.93, 1.60); and Lot B versus Lot C: 0.91 (0.69, 1.19). The 95% CIs for the GMC ratios were between 0.69 and 1.75. The incidence of solicited reactions was comparable across the four arms. Only one serious adverse event of gastroenteritis event in the Rotasiil® group was causally related.The immunological non-inferiority of LBRV-PV against Rotasiil® as well as lot-to-lot consistency of LBRV-PV was demonstrated. LBRV-PV had safety profile similar to Rotasiil®.Clinical Trials.Gov [NCT03474055] and Clinical Trial Registry of India [CTRI/2017/10/010104].

ObjectivesThough exposure to alcohol imagery in films is a significant determinant of uptake and severity of alcohol consumption among young people, there is poor evidence regarding the content of alcohol imagery in films in low-income and middle-income countries. We have measured alcohol imagery content and branding in popular Indian films, in total and in relation to language and age rating.DesignIn this observational study we measured alcohol imagery semiquantitatively using 5-minute interval coding. We coded each interval according to whether it contained alcohol imagery or brand appearances.SettingIndia.ParticipantsNone. Content analysis of a total of 30 national box office hit films over a period of 3 years from 2015 to 2017.Primary and secondary outcome measuresTo assess alcohol imagery in Indian films and its distribution in relation to age and language rating has been determined.ResultsThe 30 films included 22 (73%) Hindi films and 8 (27%) in regional languages. Seven (23%) were rated suitable for viewing by all ages (U), and 23 (77%) rated as suitable for viewing by children subject to parental guidance for those aged under 12 (UA). Any alcohol imagery was seen in 97% of the films, with 195 of a total of 923 5-minute intervals, and actual alcohol use in 25 (83%) films, in 90 (10%) intervals. The occurrence of these and other categories of alcohol imagery was similar in U-rated and UA-rated films, and in Hindi and local language films. Episodes of alcohol branding occurred in 10 intervals in five films.ConclusionAlmost all films popular in India contain alcohol imagery, irrespective of age rating and language. Measures need to be undertaken to limit alcohol imagery in Indian films to protect the health of young people, and to monitor alcohol imagery in other social media platforms in future.

Background: Integrated Child Development Services (ICDS) scheme is the leading outreach program aimed at promoting maternal and child health care and help in strengthening the implementation of MCH activities like immunization, growth monitoring, supplementation of vitamin A and iron folic acid tablets. Hence, ICDS takes holistic approach in development of children and attempts to improve their prenatal and post-natal environment. Hence the present study was undertaken to study the awareness and utilization of ICDS scheme by expectant mothers and nursing mothers in coastal Karnataka. Objectives of current study were to study the awareness and utilization of services offered to mothers under ICDS 2 and to assess the perception about the services.Methods: A community based cross sectional study was done among 141 mothers registered in anganwadis.Results: Majority were aware of SN (96.5%) followed by TT immunization (89.4%) and NHED (22%). The most common service utilized by the study subjects was supplementary nutrition (94.3%) followed by NHED (24.1%) and home visit (23.4%). Larger proportion of the study subjects were of opinion that SN food of good quality (57.1%) and almost 96.2% mothers said food was of adequate quantity.Conclusions: Among the eligible expectant and nursing mothers, majority of them utilized supplementary nutrition. Nearly 40% of expectant and nursing mothers were not happy about the quality of food offered to them. Nutrition and health education sessions were attended by only 40% of the eligible mothers.

Background Exposure to tobacco imagery in films causes young people to start smoking. Popular Indian films contain high levels of tobacco imagery, but those that do are required by law to display onscreen health warnings when smoking imagery occurs and to include other health promotion messaging before and during the film. We report a prospective cohort study of incident smoking in relation to exposure to film tobacco imagery and anti-tobacco messaging in a cohort of children in southern India. Methods We carried out a one-year longitudinal follow up questionnaire survey in 2018 of a cohort of 39,282 students in grades 6, 7 and 8 (aged between 10 and 15 years) in schools in the Udupi district of Karnataka State in India who participated in a 2017 cross-sectional study of exposure to smoking in films and ever smoking status. Results We obtained usable linked data in 2018 from 33,725 of the 39,282 (86%) participants with data from 2017. Incident smoking was reported by 382 (1.1%) participants. After adjusting for age, sex and common confounders significantly associated with incident smoking there was no significant independent effect of exposure to film smoking, either as a binary (Odds Ratio 1.6, 95% Confidence Interval (CI) 0.5 to 4.9) or as a graded variable, on smoking uptake. An exploratory analysis indicated that the presence of on-screen health warnings that complied fully with Indian law was associated with a significantly lower odds of smoking uptake (Odds Ratio 0.8 (0.6 to 1.0, p = 0.031) relative to the same exposure sustained in absence of compliant warnings. Conclusion Exposure to tobacco imagery in Indian films was not associated with a significantly increased risk of incident smoking in South Indian children. While it is possible that this finding is a false negative, it is also possible that the effect of film exposure has been attenuated by the presence of on-screen health warnings or other Indian tobacco-free film rules. Our findings therefore support the wider implementation of similar tobacco-free film measures in other countries.

ObjectivesThere is growing recognition around the importance of multimorbidity in low-income and middle-income country (LMIC) settings, and specifically the need for pragmatic intervention studies to reduce the risk of developing multimorbidity, and of mitigating the complications and progression of multimorbidity in LMICs. One of many challenges in completing such research has been the selection of appropriate outcomes measures. A 2018 Delphi exercise to develop a core-outcome set for multimorbidity research did not specifically address the challenges of multimorbidity in LMICs where the global burden is greatest, patterns of disease often differ and health systems are frequently fragmented. We, therefore, aimed to summarise and critically review outcome measures suitable for studies investigating mitigation of multimorbidity in LMIC settings.SettingLMIC.ParticipantsPeople with multimorbidity.Outcome measuresIdentification of all outcome measures.ResultsWe present a critical review of outcome measures across eight domains: mortality, quality of life, function, health economics, healthcare access and utilisation, treatment burden, measures of ‘Healthy Living’ and self-efficacy and social functioning.ConclusionsStudies in multimorbidity are necessarily diverse and thus different outcome measures will be appropriate for different study designs. Presenting the diversity of outcome measures across domains should provide a useful summary for researchers, encourage the use of multiple domains in multimorbidity research, and provoke debate and progress in the field.

Background Diabetic foot is one of the most significant and devastating complication of diabetes. The objective of this study was to assess the prevalence of diabetic foot syndrome (DFS) and the associated risk factors among people with diabetes mellitus. Methods A community based cross-sectional study was carried out among 620 subjects with diabetes mellitus (DM) in rural areas of Udupi district. The Michigan Neuropathy Screening Instrument was used to identify peripheral neuropathy. Ankle brachial index was used to identify peripheral arterial disease (PAD). Subjects with diabetic foot syndrome were classified according to the International Working Group on Diabetic Foot (IWGDF) classification system. Results The overall prevalence of DFS was 51.8%. Among them 31.3, 11.9 and 8.5% belonged to category 1, 2 and 3 respectively. Multivariate logistic regression analysis showed advancing age, low socio-economic status, sedentary physical activity and longer duration of DM were significant independent correlates of DFS. Conclusion The overall prevalence of DFS was high among the study population; hence the screening for foot complications should start at the time of diagnosis of diabetes integrated with sustainable patient education at primary care level by training of health care providers at primary care level.

Introduction In September 2014, the Government of India introduced legislation requiring all tobacco packaging to display a health warning covering 85% (60% pictorial, 25% text) of the principal display area of the pack, of at least 4 cm in height and 3.5 cm width, with legible text in a white font on a black background and in English and/or the same Indian language as the language used on the pack. We evaluated compliance with this legislation in the Udupi district of Karnataka, India. Methods We procured one example of every tobacco pack of cigarettes, beedis, chewing tobacco, and snuff sold by a convenience sample of retailers in one urban and two rural areas in each of the five administrative blocks of the Udupi district between June and August 2018. For each pack we measured the size of the health warning, calculated the proportion of the pack covered, and assessed the legibility. Results A total of 365 packs were collected from retailers, with 357 of these branded and eight, all packs of snuff, unbranded. Warnings on 320 (87.3%) packs did not reach the legally required proportional magnitude, warnings on 140 (38.4%) packs were not legible, and warnings on 117 packs (32.1%) did not meet the language requirement. Only 45 packs (12.3%) were fully compliant. Conclusions Compliance with warning legislation in this district of India is low, highlighting the need for more effective enforcement. Implications Warnings on tobacco packaging are an important and inexpensive means of communicating the harms associated with tobacco use. However, relatively few studies have explored regulatory compliance with warnings. We collected all unique tobacco packs from 66 retailers in a district in Karnataka in India and assessed whether each met the legislative requirements in terms of warning size and proportion of the pack covered, legibility, and the language used. Of the 365 packs collected, only one in eight was compliant with the legislative requirements. This study highlights the importance of assessing warning compliance and the need for enforcement in India.

BackgroundExposure to smoking in films is a recognised cause of smoking uptake among children. In India, in an attempt to protect children, films containing smoking are required to include tobacco control messaging including audiovisual disclaimers, on-screen health warnings when tobacco imagery is displayed and antitobacco ‘health spots’ before and during the film. We report a study of the association between ever smoking and exposure to tobacco imagery in locally popular films among children in Udupi district of Karnataka state in southern India.MethodsA cross-sectional questionnaire survey of all students in grades 6–8 in schools in the Udupi district ascertained smoking status and potential confounders of smoking uptake, and whether children had seen any of 27 locally popular films we had coded and found to contain imagery of actual or implied tobacco use. Ever-smoking status was defined as any reported smoking of cigarettes, beedis or other tobacco products currently or at any time in the past. Independent effects on ever-smoking status were estimated using multiple logistic regression.ResultsOf 46 706 students enrolled in grades 6–8 in 914 participating schools, 39 282 (84.1%) provided questionnaire responses sufficiently complete for analysis. Ever smoking was reported by 914 (2.3%) participants and in a mutually adjusted model was significantly related to age, male sex, living in a home where smoking is allowed, having parents or siblings who smoke, low paternal education, low levels of family wealth, low self-esteem, rebelliousness and poor school performance. After allowing for these effects, the odds of ever smoking were not increased among students who had seen any of the listed films containing tobacco imagery when included in the analysis as a binary exposure (OR 0.9, 95% CI 0.4 to 2.0), and decreased in relation to level of exposure graded into tertiles of tobacco intervals seen.ConclusionsIn this cross-sectional study, children in southern India who had seen films containing tobacco imagery are no more likely to smoke than those who had not, indicating that the tobacco control messaging mandated by Indian law may be attenuating the effect of tobacco imagery in films on smoking uptake.

Introduction: The Government of India has taken several steps to reduce tobacco use, including legislation in the Cigarettes and Other Tobacco Products Act (COTPA) requiring health warnings on tobacco products. This study assessed compliance with the legislation on warnings, and awareness of these warnings and their perceived impact in preventing tobacco uptake among college students in a district of Karnataka, India. Material and Methods: This study consisted of two components, pack collection and a survey. For the first, tobacco packs were obtained from all tobacco selling shops in an urban and a rural locality in the Karkala block of Udupi district. Empty cigarette packs were collected from shops, and full packs were purchased if empty packs were not available . The packs were collected to measure their dimensions, as per the Tobacco Pack Surveillance System guidelines, and assessed for compliance, as per COTPA. For the second component of the study, a questionnaire was distributed to each college student to fill in; this was done to assess awareness of the new warnings at the time of the pilot survey, knowledge of harms, and perceptions of the warnings in reducing tobacco uptake. Results: We collected 26 tobacco packs. Two (8%) packs had warnings that were the correct size (85% of the main display areas), 15 (58%) packs had clear and legible warnings, and 18 (69%) packs had warning messages in the appropriate language. In the student survey, 60% of males and 52% of females indicated that they would not start using any tobacco products on seeing the new warnings. Conclusions: Only a few studies other than our pilot study have assessed compliance with legislation on health warnings in low- or middle-income countries. Although health warnings were perceived as a deterrent to tobacco use among students, compliance with national legislation in this pilot study was found to be low.

Introduction: Children are the foundation of a strong and healthy nation. Morbidity among school-going children adversely affects their normal growth and development and hence is a major public health concern. School health program was started as an important component of total health care delivery system in the country with a purpose of addressing the health needs of children. Aim: To assess the morbidity pattern and nutritional status among school children. Materials and Methods: Study design: A cross-sectional study. Study period: 1-year from 1 st July 2012 to 30 th June 2013. Study setting: 14 schools with a total strength of 909 children in a rural area of coastal Karnataka. Data collection: Health examination of the school children was carried out by a trained team. Data regarding anthropometric measurements, refractory error, medical problems and minor ailments were collected using a predesigned proforma. Results: A total of 797 children were examined. Dental caries was the most common ailment observed in 31.86% of children 43.32% of the children were underweight, 53.03% were normal, and 3.65% were overweight for age. Conclusion: The school health program provides a good opportunity to screen, identify and impart education regarding health related issues. The common morbidities found were dental caries, pallor, upper respiratory tract infection and refractory error. Overweight was also observed in the school children and needs to be addressed. There is a scope of providing comprehensive school health services by incorporating dental care.

Objective: A study was conducted to develop and validate a screening model using risk scores to identify individuals at high risk for developing oral cancer in an Indian population. Methods: Life-course data collected from a multicentre case-control study in India were used. Interview was conducted to collect information on predictors limited to the time before the onset of symptoms or cancer diagnosis. Predictors included statistically significant risk factors in the multivariable model. A risk score for each predictor was derived from respective odds ratios (OR). Discrimination of the final model, risk scores and various risk score cut-offs was examined using the c statistic. The optimal cut-off was determined as the one with good area under curve (AUC) and high sensitivity. Predictive ability of the regression model and cut-off risk score was determined by calculating sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Models were validated from a bootstrap sample. Results: Smoking, chewing quid and/or tobacco, alcohol, a family history of upper aero-digestive tract cancer, diet and oral hygiene behaviour were the predictors. Risk scores ranged from 0 to 28. Area under the receiver operating characteristic (ROC) curve for risk scores was good (0.866). The sensitivity (0.928) and negative predictive value (0.927) were high, while specificity (0.603) and positive predictive value (0.607) were low for a risk score cut-off of 6. Conclusion: A risk score model to screen for individuals with high risk of oral cancer with satisfactory predictive ability was developed in the Indian population. Validation of the model in other populations is necessary before it can be recommended to identify subgroups of the population to be directed towards more extensive clinical evaluation. Refereed/Peer-reviewed

Introduction: Tobacco use can affect human health adversely and can lead to loss of productivity due to tobacco-related illnesses. It is a major cause of premature death across the world and in India. Objectives: (1) To determine the prevalence of tobacco use among adults in rural field practice area. (2) To study the knowledge and attitude regarding tobacco use. (3) To study the willingness to quit tobacco among its users. Methods; Study design: Cross sectional study. Study area: Rural field practice area of Department of Community Medicine. Kasturba Medical College, Manipal University, Manipal. A pretested semi-structured questionnaire was used to collect data from consenting adults during field visits. Tobacco usage status was categorised as per the WHO guidelines and the data was entered and analysed using Statistical Package for Social Sciences (SPSS) version 15.0(SPSS South Asia, Bangalore). Results are presented in frequencies and percentages. Chisquare test was applied to study association of factors with tobacco usage. Results: A total of 223 individuals were included in the study which comprised 139 (62.3%) males and 84 (37.7%) females. Of the surveyed population, 77(34.5%) were ever users of tobacco with 63(81.8%) being current users and 14 (19.2%) ex-users. Majority (89.7%) of the people were aware that tobacco use has harmful effects on health. Among current consumers, 47 (74.6%) of them were willing to quit tobacco. Conclusion: The study shows that inspite of having adequate knowledge regarding the ill-effects of tobacco use; the prevalence of its use is considerably high. Hence, there is a need to convert the knowledge into practice by behaviour change communication and provide timely support services like tobacco cessation clinics in the community.

CONTEXT: The prevalence of Diabetes is on a rise throughout the world. The major task for the community physicians is identification of individuals at risk in order to delay or prevent the onset of Diabetes Mellitus. The present study was conducted to assess the utility of Indian Diabetic Risk score (IDRS) in a rural area. SETTINGS AND DESIGN: A cross-sectional study was conducted during screening camps held at the Rural Maternity and Child Welfare Homes, managed by Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal. MATERIAL AND METHODS: Data was collected with respect to Socio-demographic factors, occupation, physical activity and family history of Diabetes. Anthropometric measurements were done and random blood glucose was estimated using a glucometer. All subjects attending the camp above 25 years of age were eligible to be part of the study except known diabetics. RESULTS: A total of 251 adults reported for the health camps conducted at the rural centres, out of which the data for 209 participants was complete and eligible. Among 209 subjects, majority (78.5%) were females and 21.5% were males. The IDRS Score of ≥ 60 was obtained for 115(55%) subjects, moderate risk with score ranging 30 to 50 was seen in 90(43.1%) and 4(1.9%) had low risk. Of the 115 subjects who belonged to high risk group, 21 (18.3%) of them had RBS ≥140 mg/dl. CONCLUSION: IDRS is a simple useful and cost-effective screening tool for diabetes in resource limited settings.

Background: Early life socioeconomic disadvantage could affect adult health directly or indirectly. To the best of our knowledge, there are no studies of the direct effect of early life socioeconomic conditions on oral cancer occurrence in adult life. Methods: We conducted a multicenter, hospital-based, case-control study in India between 2011 and 2012 on 180 histopathologically confirmed incident oral and/or oropharyngeal cancer cases, aged 18 years or more, and 272 controls that included hospital visitors, who were not diagnosed with any cancer in the same hospitals. Life-course data were collected on socioeconomic conditions, risk factors, and parental behavior through interview employing a life grid. The early life socioeconomic conditions measure was determined by occupation of the head of household in childhood. Adult socioeconomic measures included participant's education and current occupation of the head of household. Marginal structural models with stabilized inverse probability weights were used to estimate the controlled direct effects of early life socioeconomic conditions on oral cancer. Results: The total effect model showed that those in the low socioeconomic conditions in the early years of childhood had 60% (risk ratio [RR] = 1.6 [95% confidence interval {CI} = 1.4, 1.9]) increased risk of oral cancer. From the marginal structural models, the estimated risk for developing oral cancer among those in low early life socioeconomic conditions was 50% (RR = 1.5 [95% CI = 1.4, 1.5]), 20% (RR = 1.2 [95% CI = 0.9, 1.7]), and 90% (RR = 1.9 [95% CI = 1.7, 2.2]) greater than those in the high socioeconomic conditions when controlled for smoking, chewing, and alcohol, respectively. When all the three mediators were controlled in a marginal structural model, the RR was 1.3 (95% CI = 1.0, 1.6). Conclusion: Early life low socioeconomic condition had a controlled direct effect on oral cancer when smoking, chewing tobacco, and alcohol were separately adjusted in marginal structural models. Refereed/Peer-reviewed

Background: The prevalence of stroke was reportedly higher in four coastal villages as compared to the neighbouring villages. Hence the study was conducted to identify the risk factors for stroke cases in the four villages of Mavinakurve Gram Panchayath, Bhatkal Taluk, Karnataka, India. Methods: 53 stroke patients were compared with 106 age and locality matched controls. Data was obtained using a predesigned, pretested questionnaire for socio-demographic variables, sources of water, palm oil and milk powder consumption, smoking and alcohol usage, stress score, history of hypertension, BMI and Waist Hip ratio. The data was entered in the SPSS version 15.0 and analysed. Results were expressed as proportions. Associations were analyzed using Chi-square test. A p-value less than 0.05 was considered significant. Results: Most of the cases (53%) and controls (45%) belonged to the age group of 60-69 years. 62.2% of the cases were males and 37.8% were females. 45.3% of the cases and 34.0% of the controls were involved in fishing. 15% of the cases and 2.8% of the controls had high stress. Statistically significant association was found between high stress and stroke. 86.8% of cases and 72.6% of controls were hypertensive (p value of 0.04). Conclusions: The prevalence of stroke in this area is higher than the state/national average. Hypertension and stress are important risk factors for stroke. Periodic screening for early detection of hypertension, health education, appropriate lifestyle modification and prompt treatment for hypertension are very important.

INTRODUCTION: According to Joint National Committee-7 (JNC-7) guidelines, a systolic blood pressure (SBP) of 120 to 139 mm Hg and/or diastolic blood pressure (DBP) of 80 to 89 mm Hg is considered as pre-hypertension. Existing evidence suggest that the cardiovascular morbidities are increasing among pre-hypertensive individuals compared to normal. OBJECTIVE: To assess the magnitude and factors associated with pre-hypertension among young adults (20-30 years) in coastal villages of Udupi Taluk (an area of land with a city or town that serves as its administrative centre and usually a number of villages), Udupi District, Karnataka state, India. DESIGN: Community based cross sectional study. SETTING: 6 (out of total 14) coastal villages of Udupi Taluk, Karnataka state, India. SAMPLE: 1,152 young adults (age group: 20-30 years) selected by stratified random sampling in 6 coastal villages of Udupi Taluk, Karnataka state, India. METHOD: A semi structured pre-tested questionnaire was used to elicit the details on socio-demographic variables, dietary habits, tobacco use, alcohol consumption, physical activity, family history of hypertension and stress levels. Anthropometric measurements and blood pressure were recorded according to standard protocols. Serum cholesterol was measured in a sub sample of the study population. Multivariate logistic regression was applied to identify the independent correlates of pre-hypertension among young adults (20-30 years). MAIN OUTCOME MEASURES: Prevalence, Odds ratio (OR) and adjusted (adj) OR for pre-hypertension among young adults (20-30 years). RESULTS: The prevalence of pre-hypertension in the study population was 45.2% (95%CI: 42.4-48). Multivariate logistic regression analysis revealed that age group of 25-30 years (adj OR: 4.25, 95% CI: 2.99-6.05), white collared (adj OR: 2.29, 95% CI: 1.08-4.85) and skilled occupation (adj OR: 3.24, 95% CI: 1.64-6.42), students (adj OR: 2.46, 95% CI: 1.22-4.95), using refined cooking oil (adj OR: 0.53, 95% CI: 0.29-0.95), extra salt in meals (adj OR: 2.46, 95% CI: 1.52-3.99), salty food items (adj OR: 6.99, 95% CI: 3.63-13.48), pre-obese (adj OR: 1.66, 95% CI: 1.03-2.67) and obese (adj OR: 9.16, 95% CI: 2.54, 36.4) were the significant correlates of pre-hypertension. CONCLUSION: In the study population, prevalence of pre-hypertension among young adults (20-30 years) was high (45.2%). Biological (age 25-30 years, pre-obesity and obesity) and behavioral (sedentary occupation, intake of extra salt in meals/salty food and not using refined cooking oil) factors were associated with pre-hypertension. Study emphasizes the need of community based screening of pre-hypertension under National Rural Health Mission. It also provides apt information for the evidence based designing of interventions for lifestyle modifications among high risk young adults in the study area.

Hypertension is a chronic condition of concern and a major public health problem posing a challenge to population in socioeconomic and demographic transition. Prehypertension in adolescents and young adults is an important risk for developing hypertension in later years of life. Therefore this study was taken up among medicos of this institute to study about prehypertension and its associated factors. The objective of the study was to see the prevalence of prehypertension and its associated factors among medicos of SSIMSRC, Devangere. The study duration was from 1st July 2009 to 31st August 2009. The sample size worked out to be 100 and this set of participants was selected by systematic random sampling. A predesigned and pretested proforma was used to collect the relevant data. Blood pressure (BP) was measured in sitting posture using a standard sphygmomanometer on two different occasions and the average was noted. BP was classified as per the Joint National Committee on prevention, detection, evaluation and treatment of blood pressure. Data was analysed by SPSS. Descriptive statistics was presented by, percentage, mean and SD. Groups are compared with the help of z-test, t-test and Chi-square test. All the participants were in the age group of 18 to 22 years and mean age was 20.29 +/- 0.86 years. Among 100 participants 56 were males and 44 were females. The mean systolic blood pressure was 117.68 +/- 7.16 mm Hg and that of diastolic blood pressure was 77.3 +/- 7.93 min Hg. The percentage of prehypertension and hypertension was 67%. Three participants were diagnosed to be hypertensive.

Context: Globally, there has been an increase in incidence of paratyphoid fever, including paratyphoid fever caused by antimicrobial-resistant strains. Studying the clinical profile and antimicrobial sensitivity of paratyphoid fever would help in early diagnosis, appropriate treatment, rational use of antibiotics and prevent drug resistance. Aim: The aim of the study was to evaluate the clinical profile and sensitivity patterns of antibiotics used in the treatment of paratyphoid fever. Settings and Design: A record-based study was done in tertiary care hospital, South India. Materials and Methods: A retrospective analysis of culture-proven cases of paratyphoid fever was done in a tertiary care hospital. The socio-demographic characteristics, mode of presentation and the sensitivity pattern of isolates from blood culture were recorded. One hundred and ten case files of Salmonella paratyphi were reviewed from the medical records section and the required data (data regarding the clinical profile and antibiotic sensitivity) was collected and analyzed using SPSS version 11.5. Results: Fever was present in all patients. All the cases were sensitive for third-generation cephalosporins, and only 31.8% of the cases were sensitive for quinolones. Sensitivity towards other antibiotics in descending order was as follows: ampicillin 93.6%, chloramphenicol 91.8%, aminoglycosides 90.4% and sulphonamides 76.4%. Conclusions: Research shows that there is increasing resistance to fluoroquinolones and sensitivity to chloramphenicol. Considering the changing trend in the sensitivity pattern, the recommendations of treatment for enteric fever need to be rationalized and re-considered.