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Background and aims Potential role of health literacy in determining adherence to COVID-19 preventive behavior, pharmacological, and lifestyle management among diagnosed patients of chronic diseases during nationwide lockdown is inadequately investigated. Methods A cross-sectional study was conducted from May–August 2020 among diagnosed patients of chronic diseases residing in a COVID-19 hotspot of urban Jodhpur, Rajasthan, and availing health services from primary care facility. Telephonic interviews of participants were conducted to determine their health literacy using HLS-EU-Q47 questionnaire, adherence to COVID-19 preventive behaviour as per World Health Organization recommendations, and compliance to prescribed pharmacological and physical activity recommendations for chronic disease. Results All the 605 diagnosed patients of chronic diseases availing services from primary care facility were contacted for the study, yielding response rate of 68% with 412 agreeing to participate. Insufficient health literacy was observed for 65.8% participants. Only about half of participants had scored above median for COVID-19 awareness (55.1%) and preventive behavior (45.1%). Health literacy was observed to be significant predictor of COVID-19 awareness [aOR: 3.53 (95% CI: 1.81–6.88)]; COVID-19 preventive behavior [aOR: 2.06, 95%CI; 1.14–3.69] and compliance to pharmacological management [aOR: 3.05; 95% CI: 1.47–6.35] but not for physical activity. Conclusion COVID-19 awareness, preventive behavior, and compliance to pharmacological management is associated with health literacy among patients of chronic disease availing services from primary health facility. Focusing on health literacy could thus be an essential strategic intervention yielding long term benefits., Highlights • Majority (65.8%) of chronic disease patients availing care from the primary level possess insufficient Health literacy. • Health literacy is an important predictor of COVID-19 preventive behaviour and adherence to pharmacological management. • Enhancing health literacy of chronic disease patients availing care from the primary level require attention in India.

The purpose of this study was to estimate the minimal clinically important difference (MCID) of mouth opening (MO) and patient satisfaction in surgically treated oral submucous fibrosis (OSMF) patients.The status of MO was collected preoperatively (T0), postoperatively at 3 months (T1), and at a minimum of 6 months postoperatively (T2). MCID was determined through the anchor-based approach with the change difference method, mean change method, and receiver operator characteristic curve (ROC) method.In this study, 35 patients enrolled and completed postoperative follow-up (T2) averaging a duration of 18.1 months. At T1, using the change difference method, MO was 14.89 mm and the ROC curve exhibited a 11.5 gain in MO (sensitivity 81.8% and specificity 100%, area under the curve [AUC] of 0.902) and was classified as MCID as reported by patients. At T2, MCID of MO was 9.75 mm using the change difference method and 11.75 mm by the mean change method. The ROC curve revealed that the MCID of MO at T2 was 10.5 mm with 73.9% sensitivity and 83.3% specificity (AUC of 0.873). The kappa value was 0.91, confirming reliability of the data.This study demonstrated MCID values that indicate the clinical relevance of surgical treatment of OSMF if the minimum possible gain in MO is approximately 10 mm.

The educational environment in a medical school is a crucial component in a student's learning and is also important in the development of personality, behavior, and work ethics. The objective of the study was to assess the perception of the educational environment among medical students. An observational cross-sectional study conducted on second, fourth, sixth, eighth semesters and interns. Dundee Ready Education Environment Measure (DREEM) inventory was used as study tool which contains 50 items and is subdivided into five domain subscales: students’ perceptions of learning (SPoL); students’ perceptions of teachers (SPoT); students’ academic self-perception (SASP); students’ perceptions of the atmosphere (SPoA); and students' social self-perception (SSSP). Data were presented as Mean+/-SD and analyzed using descriptive statistics. A total of 449 undergraduates of age group 18 to 25 years participated, the majority were males (72.6%) and studied from private (82%) and English medium schools (75%) without any additional qualifications (99.6%). The mean total DREEM score±SD was 130.85±19.24 and there was a significant difference between males and females (p=0.029). The mean total subscale scores (SD) were: SPoL=33.37(5.89), SPoT=27.95(3.98), SASP=21.41(4.47), SPoA=30.15(5.78) and SSSP=17.97(3.20). The mean total DREEM score ± SD of the fourth semester (134.45±19.02) was highest and the eighth semester (125.71±21.55) was the lowest and there was a significant difference between scores of various semesters(p=0.016). On analyzing the total DREEM score, 61 students had scores in 'excellent', 363 in 'more positive than negative', and 25 in the 'plenty of problems’ category. The educational environment perceived by the medical undergraduates more positive than negative. The study findings would help modify the learning environment and curriculum.

BackgroundDespite the success of adult vaccination against COVID-19, providing vaccines to children remains a challenge for policymakers globally. As parents are primary decision-makers for their children, we aimed to assess parents' perceptions and intentions regarding COVID-19 vaccination in India.MethodsA cross-sectional web-based study was designed, parents or caregivers (N = 770) were recruited through snowball sampling using Google form. Cross-tabulation was performed by parents' intention to vaccinate their children against COVID-19 virus with sociodemographic characteristics and their risk perception toward COVID-19, trust in the healthcare system, and their history of vaccine hesitancy behavior. Multivariable logistic regression analysis was performed to compute the predictors of child vaccination intention among Indian parents.ResultsSeven hundred and seventy parents across the country have completed the survey. Of the 770 participants, 258 (33.5%) have shown intent to vaccinate their children. The stated likelihood of child vaccination was greater among parents who had a bachelor's degree or higher education (aOR: 1.98, 95% CI: 1.15–3.51); as well as among parents who intended to vaccinate themselves (aOR: 2.35, 95% CI: 1.30–4.67). Parental concerns centered around vaccine safety and side effects.ConclusionIndian parents reported high knowledge of the COVID-19 virus and were aware of the development of a vaccine. However, about one-third of parents intended to vaccinate their children, and about half of them were not sure whether to vaccinate their children or not against the COVID-19 virus. The study highlighted the need for health promotion strategies that promote vaccine uptake among parents.

The coronavirus disease-19 (COVID-19) pandemic has led to unprecedented morbidity and mortality across the world. Chronic disease patients of urban poor neighbourhoods are one of the most vulnerable population subgroups as the number of cases and deaths increase exponentially in India. The study aims to explore the factors associated with desirable health behaviours among chronic disease patients availing care from a primary health facility and examine their association with the COVID-19 preventive behaviour.A cross-sectional study was conducted among chronic disease patients attending a health centre in an urban area of Jodhpur, Rajasthan. A interviewer administered semi-structured questionnaire was pilot tested and validated prior to initiation of data collection. A total of 520 patients were enrolled for the study.Poor adherence to health behaviour was observed among a majority of the respondents (infrequent physical activity: 72.0%, one or less fruit serving per day: 96.5%, one or less vegetable serving per day: 88.8%). A factor analysis revealed three domains of COVID-19 preventive behaviour: sanitisation, preventive hygiene and social distancing. Multiple regression revealed respondents opting for COVID-19 screening and those with lower salt intake followed the overall and individual COVID-19 preventive behaviour.The health behaviour assessment and inter-personal counselling by the health care providers at the primary health facilities may contribute to the increasing adherence for the COVID-19 preventive behaviour among chronic disease patients.

Background Nearly half of population with Diabetes and Hypertension is estimated to be undetected in India. The objectives of this study were to conduct opportunistic screening for Diabetes and Hypertension coming to OPD of health centres under Department of Community Medicine and Family Medicine, AIIMS Jodhpur, India and to develop the models for prediction of Diabetes and Hypertension. Methods Time bound study was conducted at three rural health centres between 2018-19. A total of 942 patients aged ≥30 years were screened. Data was recorded using Epicollect5. Risk assessment was done by using Indian Diabetes risk score (IDRS), Community based assessment checklist (CBAC), Waist Hip Ratio, & BMI. Random and fasting capillary blood sugar and BP was measured. Results The mean age of the participants was 52.4 ± 13.5 years. As much as 446 (47.4%) had IDRS score of ≥ 60 and 276 (29.3%) had CBAC score of ≥ 4. RBS level of ≥ 140mg/dl was found among 223 participants, of these, 42.5% were diagnosed to be diabetic on FBS. One-fourth (25.6%) were estimated to be hypertensive. Physical activity and hypertension were best predicting the diabetes (r2= 90.8), while hypertension was best predicted by age and BMI (r2= 74.3). Conclusions Prevalence of diabetes and hypertension was in accordance with the reported prevalence in the country. As compared to existing models, less number of prediction variables were identified for NCDs. Key messages The study highlights the need for implementation of hospital based opportunistic screening and point out the necessity to revise the existing prediction models for NCDs.

OBJECTIVES To assess the relation between total job stressor burden and physician burnout, identifying potentially contributory modifiable stressors, using a comprehensive, theory-based instrument created for physicians by physicians. METHODS From 2018 to 2019, we conducted a cross-sectional study in a public teaching hospital in India. Of 305 clinically active physicians, 293 were reached and 42.7% participated. Job stressors were assessed via the physician-specific Occupational Stressor Index (OSI) and burnout by the Copenhagen Burnout Index (CBI). RESULTS The 76 fully participating physicians were 68% male, 84% residents, and 70% age 30 or younger, from various specialties. Mean scores for total OSI: 87 ± 7.8; personal burnout: 46.6 ± 18.2; work-related burnout: 41.4 ± 20.7; and patient-related burnout: 31.7 ± 22.4. Total OSI scores were significantly associated with personal and work-related burnout, adjusting for working-years as physicians and sex. Total OSI scores >88 showed adjusted odds ratios (±95% confidence intervals): 3.99 (1.31, 12.1) and 6.50 (1.85, 22.8) for personal and work-related burnout, respectively. The high demands aspect of the OSI showed significant multivariate relations to personal, work-related, and patient-related burnout. Patient-related burnout was significantly more likely among male physicians in these multivariate analyses. Physicians outside preventive/diagnostic areas, with heavier burdens and more emergency cases were less likely to fully participate. CONCLUSIONS The total burden of job stressors is powerfully associated with personal and work-related burnout. The clinically defined total OSI cutpoint >88 warranting urgent intervention is corroborated by >3-fold odds of personal and work-related burnout. Lowering total OSI scores is an immediate priority, starting with potentially modifiable stressors that are already maximum/near-maximum (inadequate rest breaks, nightshifts, work hours, insufficient work-free vacation time, and infection hazards). These issues affect patient care.

ObjectiveTo generate national estimates of key non-communicable disease (NCD) risk factors for adolescents (15–17 years) identified in the National NCD Monitoring Framework and, study the knowledge, attitudes and practices towards NCD risk behaviours among school-going adolescents.Design and settingA community-based, national, cross-sectional survey conducted during 2017–2018. The survey was coordinated by the Indian Council of Medical Research—National Centre for Disease Informatics and Research with 10 reputed implementing research institutes/organisations across India in urban and rural areas.ParticipantsA multistage sampling design was adopted covering ages between 15 and 69 years—adolescents (15–17 years) and adults (18–69 years). The sample included 12 000 households drawn from 600 primary sampling units. All available adolescents (15–17 years) from the selected households were included in the survey.Main outcome measuresKey NCD risk factors for adolescents (15–17 years)—current tobacco and alcohol use, dietary behaviours, insufficient physical activity, overweight and obesity.ResultsOverall, 1402 households and 1531 adolescents completed the survey. Prevalence of current daily use of tobacco was 3.1% (95% CI: 2.0% to 4.7%), 25.2% (95% CI: 22.2% to 28.5%) adolescents showed insufficient levels of physical activity, 6.2% (95% CI: 4.9% to 7.9%) were overweight and 1.8% (95% CI: 1.0% to 2.9%) were obese. Two-thirds reported being imparted health education on NCD risk factors in their schools/colleges.ConclusionThe survey provides baseline data on NCD-related key risk factors among 15–17 years in India. These national-level data fill information gaps for this age group and help assess India’s progress towards NCD targets set for 2025 comprehensively. Though the prevalence of select risk factors is much lower than in many developed countries, this study offers national evidence for revisiting and framing appropriate policies, strategies for prevention and control of NCDs in younger age groups.

Bronchoscopic lung volume reduction (BLVR) methods have emerged as a new treatment option for patients with severe emphysema. Endobronchial valves and coils have been extensively studied. This review assesses efficacy, safety, and cost effectiveness of the BLVR procedures (stent, valves, vapor ablation, endobronchial coils, lung sealant) in patients with severe emphysema. Databases were searched until October 2016, and randomized controlled trials (RCTs) comparing available BLVR procedures to standard medical care or sham bronchoscopy were included. Random effect model and generic inverse variance approach were used for meta-analysis. Out of 381 identified records, 16 RCTs were included. As compared to recommended medical care or sham bronchoscopy, the BLVR procedures are more effective in improving quality of life [SGRQ score (WMD=−6.38; −9.12 to −3.65)] and 6MWT (WMD=24.21; 9.68–38.74) and percentage FEV1 (WMD=10.48; 7.07–13.89). Increased risk of serious adverse events (RR=2.18; 1.63–2.93), specifically for chronic pulmonary obstructive disease exacerbations and lower respiratory tract infection combined (RR=1.37; 1.07–1.75), were observed with bronchoscopic interventions, while there was no difference in number of deaths (RR=1.25; 0.79–1.99) and respiratory failure (RR=1.13; 0.57–2.21). The BLVR procedures, especially endobronchial coils, were found to be effective in the management of patients with severe emphysema irrespective of collateral ventilation. However, characterization of patients who would be most benefited from these procedures is required, and effectiveness of these procedures in long run needs to be established.

BackgroundDelay in receiving timely care after road traffic accidents (RTAs) result in higher morbidity and mortality, suggesting need of educational interventions for improving provision of first aid. Based on the theory of planned behaviour (TBP), the present study aims to develop and validate the scale to Measure of Intention to Help Road Accident Victim (MIHRAV) of young adults in a fast urbanizing Indian city.MethodsA cross sectional survey was conducted among the college students of Jodhpur, Rajasthan. The initial MIHRAV questionnaire developed for study comprised of 26 self-reported items encompassing four main constructs: intention to help; social norms; attitude and self-efficacy. The validation process included face validity, content validity, exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and reliability analysis. ResultsSix hundred ninety-five college students participated in this study. EFA extracted four factor structure containing 20 items. The CFA yielded good model fit with 19 items, and explained 79% of variance (chi square = 413.359, df = 140, χ2/df = 2.95, CFI = 0.93 and TLI = 0.92 and RMSEA = 0.05). The Cronbach’s alpha indicated satisfactory internal consistency for questionnaire (α = .88), and for subscales (social norms - α = .62, attitude - α = .65, perceived confidence- α = .74, and intention α = .86).Conclusions The final MIHRAV instrument is aligned with constructs of TPB. It included 19 items measuring intention to help (9 items); perceived confidence (4 items); attitude (3 items) and social norm (3 items). MIHRAV was found to be reliable and valid tool to assess young adult’s intention to help road accident victims. Assessing and building this aspect has the potential to positively impact young adult’s likelihood to intervene as first responders at RTAs.

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Hearing loss affects access to spoken language, which can affect cognition and development, and can negatively affect social wellbeing. We present updated estimates from the Global Burden of Disease (GBD) study on the prevalence of hearing loss in 2019, as well as the condition's associated disability. Methods: We did systematic reviews of population-representative surveys on hearing loss prevalence from 1990 to 2019. We fitted nested meta-regression models for severity-specific prevalence, accounting for hearing aid coverage, cause, and the presence of tinnitus. We also forecasted the prevalence of hearing loss until 2050. Findings: An estimated 1·57 billion (95% uncertainty interval 1·51–1·64) people globally had hearing loss in 2019, accounting for one in five people (20·3% [19·5–21·1]). Of these, 403·3 million (357·3–449·5) people had hearing loss that was moderate or higher in severity after adjusting for hearing aid use, and 430·4 million (381·7–479·6) without adjustment. The largest number of people with moderate-to-complete hearing loss resided in the Western Pacific region (127·1 million people [112·3–142·6]). Of all people with a hearing impairment, 62·1% (60·2–63·9) were older than 50 years. The Healthcare Access and Quality (HAQ) Index explained 65·8% of the variation in national age-standardised rates of years lived with disability, because countries with a low HAQ Index had higher rates of years lived with disability. By 2050, a projected 2·45 billion (2·35–2·56) people will have hearing loss, a 56·1% (47·3–65·2) increase from 2019, despite stable age-standardised prevalence. Interpretation: As populations age, the number of people with hearing loss will increase. Interventions such as childhood screening, hearing aids, effective management of otitis media and meningitis, and cochlear implants have the potential to ameliorate this burden. Because the burden of moderate-to-complete hearing loss is concentrated in countries with low health-care quality and access, stronger health-care provision mechanisms are needed to reduce the burden of unaddressed hearing loss in these settings. Funding: Bill & Melinda Gates Foundation and WHO.

Background High maternal mortality in the state like Rajasthan, which is at second rank in terms of high Maternal Mortality Ratio (MMR) in India, require concentrated efforts in this direction The objectives of this study were to assess the magnitude and trend of maternal death and underlying factors contributing to maternal deaths in Rajasthan and to identify barriers and challenges in reporting maternal deaths in Rajasthan. Methods Data related to maternal deaths, cause of deaths and live births were retrieved from official Government sources and MMR was calculated. To find out the underlying factors contributing to maternal deaths, Verbal Autopsies were conducted through household surveys. In-depth interviews of health care staff were conducted to carry out the 'SWOT' analysis in order to identify the barriers in reporting maternal deaths. Data was analysed using SPSS version 23. Results A total of 7185 maternal deaths were reported from Rajasthan in last five years. The mean age of mothers was 25.18±4.98 years. Haemorrhage were reported as most common cause of maternal death (17%) followed by Severe hypertension or fits (8%) and obstructed labour (2%). The median duration of hospital stay was 23 hours (IQR=7.5-70). Maximum deaths were reported during post-partum period (61%), while around one fourth of the deaths happened during delivery. Conclusions The discrepancies were observed in the reporting of number and causes of maternal deaths. The trend and forecasted figures were quite different from the published National and State level reports in this regard. Key messages need to streamline and strengthen the Maternal Deaths Surveillance and Response to track the number of deaths and get the exact information about the underlying factors contributing to them. Effective strategies can be developed to reduce the Maternal Deaths in the State.

Results from several randomized controlled trials have shown a beneficial effect of ozone in reducing postsurgical complications after impacted mandibular third-molar surgery, but the literature is lacking a systematic review and meta-analysis.The authors conducted this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines after exclusion and inclusion criteria were applied and the following outcome parameters were evaluated: pain, swelling, trismus, quality of life, number of analgesics consumed, and adverse events. RevMan Cochrane Collaboration software, Version 5.3, was used to perform meta-analysis and the Grading of Recommendation Assessment, Development and Evaluation approach was used to rate the certainty of evidence.Patients who underwent adjuvant ozone application reported lower pain scores than patients in the control group at 24 hours after surgery (95% CI, -3.94 to -1.56) and at 7 days (95% CI, -1.67 to -0.78). Pooled analysis of all 4 included trials revealed a standardized mean difference (SMD) in swelling of -0.44 at 24 hours, 0.63 at 72 hours, and -0.87 at 7 days after surgery in the experimental group. Higher mean estimates in mouth opening were experienced by patients who received ozone at 24 hours (SMD, 2.74; 95% CI, -1.93 to 7.41; 4 studies, 133 patients), 72 hours (SMD, 2.77; 95% CI, -0.63 to 6.17; 4 studies, 133 patients), and 7 days after surgery (SMD, 1.42 SMD; 95% CI, -1.34 to 4.18; 4 studies, 133 patients).Evidence suggests that adjuvant ozone application can offer some benefit for reducing pain, improving quality of life, and decreasing mean intake of analgesics after impacted mandibular third-molar surgery, but it is not effective in reducing facial swelling and trismus, which paves the way for future research.

Context It was hypothesized that knowledge of skilled birth attendants (SBAs) about partograph and its utilization can be improved by modifying their predictors through training workshops. Aim To upgrade the knowledge regarding partograph and its utilization by SBAs by modifying their predictors through training workshops. Settings and design This was an intervention study, which was conducted in a rural area of the Jodhpur district of Rajasthan state. Subjects and methods The SBAs were interviewed through pre and postintervention with the help of a prevalidated semi-structured interview schedule. As a part of an intervention, a series of half-day training workshops were conducted in the intervention block. Data were analyzed using SPSS version 23. Statistical analysis used Descriptive statistics, univariate (Chi-square, t-test), and multivariate (logistic regression) analysis. Results A total of 213 SBAs (105 from intervention and 108 from control block) were included in the study. SBAs who had received training related to the partograph were having significantly higher odds of knowing (AOR = 22.6[10.7-47.9]) as well as utilization (AOR = 22.5[7.05-72.1]) of partographs as compared to their counterparts. Knowledge was also a significant predictor of the utilization of partograph. Intervention could significantly improve the knowledge of SBAs about partograph as well as its utilization in the intervention block. Conclusion Significant impact of the intervention on knowledge about partograph and its utilization was evidenced in the present study. There is a need to conduct training and refresher courses for healthcare workers on partograph use.

Road traffic injuries are placing an increasing and disproportionate global health burden upon developing countries. An understanding of region specific epidemiological risk factors is imperative in order to plan appropriate prevention and control strategies. The objective of the study was to evaluate epidemiological risk factors of road traffic injury victims in Delhi, India with the help of Haddon injury analysis framework. The current study was conducted among crash victims admitted to the government hospital. Data obtained from the hospital, police records and crash victims was triangulated with geospatial analysis. Haddon matrix was utilized to understand the interplay of human, vehicle and environmental factors in pre-crash, crash and post-crash phases of an accident. A total of 544 victims were included as study participants with mean age of 30.8 years for males and 31.81 years for females and were from lower socio-economic groups. Pedestrians (36.2%) and two-wheeler riders, especially those on pillion vehicles (21.5%), were worst affected victims. The crude odds ratio for motorized road users for experiencing a crash was higher on slippery roads [p

Background: Ingestion of excess fluoride can cause fluorosis which adversely affects teeth and bones. Fluorosis is a major public health problem in the state of Rajasthan with all its 32 districts having variable fluoride contamination, and many initiatives are currently implemented in this region to mitigate the fluorosis burden. Objective: The objective of this study was to assess fluorosis, its risk factors, and the awareness among school students and teachers in endemic villages of Jodhpur district, Rajasthan. Materials and Methods: A representative sample of 300 students of age 12–15 years were enrolled for cross-sectional study in selected villages. Data were collected regarding awareness, behavioral and preventive practices about fluorosis and clinical assessment and fluoride estimation in water and urine samples was done. Results: Dental fluorosis through Dean's index was observed in 24.5% of students. The awareness and practices for fluorosis prevention and its risk factors were poor among both students and teachers. Intake of piped water supply was reported by majority of students (95.8%). High fluoride concentration was found in 35 (81.3%) out of 43 urine samples. Conclusion: Improvement in drinking water supply in the endemic village of Rajasthan has decreased the burden of fluorosis, but low level of awareness and prevailing dietary and behavioral practices still pose them at risk of high fluoride intake. This signifies the need to address nonconventional sources of fluoride intake (diet and toothpaste) and early screening of disease by involving teachers and family physicians in fluoride mitigation efforts.

Quality home-based care for patients with the end-stage disease is increasingly being preferred. Responding to disease associated symptoms and complications may pose an array of challenges in evolving palliative care systems, as no formal institutional mechanism exists to respond to patient and caregiver's wishes. Family and primary care physicians can play an instrumental role in such scenarios by bridging the gaps between cancer specialists and patient and caregivers expectations.

Background The primary objective of National NCD monitoring survey (NNMS) was to generate national-level estimates of key NCD indicators identified in the national NCD monitoring framework. This paper describes survey study protocol and prevalence of risk factors among adults (18–69 years). Materials and methods NNMS was a national level cross-sectional survey conducted during 2017–18. The estimated sample size was 12,000 households from 600 primary sampling units. One adult (18–69 years) per household was selected using the World Health Organization-KISH grid. The study tools were adapted from WHO-STEPwise approach to NCD risk factor surveillance, IDSP-NCD risk factor survey and WHO-Global adult tobacco survey. Total of 8/10 indicators of adult NCD risk factors according to national NCD disease monitoring framework was studied. This survey for the first time estimated dietary intake of salt intake of population at a national level from spot urine samples. Results Total of 11139 households and 10659 adults completed the survey. Prevalence of tobacco and alcohol use was 32.8% (95% CI: 30.8–35.0) and 15.9% (95% CI: 14.2–17.7) respectively. More than one-third adults were physically inactive [41.3% (95% CI: 39.4–43.3)], majority [98.4% (95% CI: 97.8–98.8)] consumed less than 5 servings of fruits and / or vegetables per day and mean salt intake was 8 g/day (95% CI: 7.8–8.2). Proportion with raised blood pressure and raised blood glucose were 28.5% (95% CI: 27.0–30.1) and 9.3% (95% CI: 8.3–10.5) respectively. 12.8% (95% CI: 11.2–14.5) of adults (40–69 years) had ten-year CVD risk of ≥30% or with existing CVD. Conclusion NNMS was the first comprehensive national survey providing relevant data to assess India’s progress towards targets in National NCD monitoring framework and NCD Action Plan. Established methodology and findings from survey would contribute to plan future state-based surveys and also frame policies for prevention and control of NCDs.

Background Trauma registry (TR) has been globally recognized as one of the vital tool in bridging the gap of information. The concept of TR has been extended to traumatic brain injuries (TBIs) in our study. Objectives Present study was conducted to identify core variables necessary to collect data on the sociodemographics, clinical courses, interventions, and outcomes of TBIs and to develop an electronic data entry interface (including web-based data record interface). Methods A predesigned pro forma with guidelines to complete the questionnaire was used to collect the data maintaining uniformity and reproducibility. The details of TBI pilot study questionnaire and data collection procedure (which included emergency assessment, patient characterization, preclinical data, emergency room intervention details, intensive care unit management details, diagnosis, and follow-up) were structured indigenously. Results A total of 402 patients were included in this study. The mean age was 37.34 ± 16.08 years (male 78.11% and female 21.89%) and fairly good amount of details were available for the majority of the variables. In addition to the previously described variables, many other variables are proposed to be added to the further study which include handedness (right/left/ambidexterity), primary caregiver—responsible for earning in family, management-related variables (hypothermia therapy, nutrition replacement, hyperventilation therapy, and seizure prophylaxis), and details of complications (hypotension episode, hypoxia episode, any infections, and deep vein thrombosis). Disability rating scale was being added to make data collection and follow-up more objective and comparable. Conclusion We hope and believe that this study will provide a cost effective, yet comprehensive data collection system on different parameters encompassing TBIs including configuration of existing care in our country.

Introduction In this article, we describe our experience of using Rotterdam computed tomography (CT) score at index admission to predict the outcome in traumatic brain injury (TBI) patients. Materials and Methods A total of 370 TBI patients admitted to the Neurosurgery Intensive Care Unit, Narayana Medical College and Hospital, Andhra Pradesh, between January 2014 and December 2014 were evaluated. Based on availability of emergency CT scan, these patients' charts were reviewed prospectively. CT scan findings were quantified using Rotterdam CT classification (basal cistern, midline shift, and intraventricular blood/subarachnoid blood). Patient characteristic, Glasgow Coma Scale (GCS) score, Rotterdam CT classification, and outcome were analyzed. Correlation between Rotterdam CT classification at index admission and outcome at discharge from the hospital, alive or dead, was assessed. Results The mean age of patients was 39.19 ± 15.18 years. Rotterdam CT score was significant ( p p = 0.618). The outcome and individual components of Rotterdam CT classification were statistically significant. Conclusion Increase in Rotterdam CT score was significantly associated with mortality at discharge. We suggest that it is possible to predict the outcome based on CT scan findings. However, the findings can have shortcomings, due to obvious reasons.

The trauma pandemic is one of the leading causes of death worldwide but especially in rapidly developing economies. Perhaps, a common cause of trauma-related mortality in these settings comes from the rapid expansion of motor vehicle ownership without the corresponding expansion of national prehospital training in developed countries. The resulting road traffic injuries often never make it to the hospital in time for effective treatment, resulting in preventable disability and death. The current article examines the development of a medical first responder training program that has the potential to reduce this unnecessary morbidity and mortality.An intensive training workshop has been differentiated into two progressive tiers: acute trauma training (ATT) and broad trauma training (BTT) protocols. These four-hour and two-day protocols, respectively, allow for the mass education of laypersons-such as police officials, fire brigade, and taxi and/or ambulance drivers-who are most likely to interact first with prehospital victims. Over 750 ATT participants and 168 BTT participants were trained across three Indian educational institutions at Jodhpur and Jaipur. Trainees were given didactic and hands-on education in a series of critical trauma topics, in addition to pretraining and post-training self-assessments to rate clinical confidence across curricular topics. Two-sample t-test statistical analyses were performed to compare pretraining and post-training confidence levels.Program development resulted in recruitment of a variety of career backgrounds for enrollment in both our ATT and BTT workshops. The workshops were run by local physicians from a wide spectrum of medical specialties and previously ATT-trained police officials. Statistically significant improvements in clinical confidence across all curricular topics for ATT and BTT protocols were identified (P 0.0001). In addition, improvement in confidence after BTT training was similar in Jodhpur compared with Jaipur.These results suggest a promising level of reliability and reproducibility across different geographic areas in rapidly developing settings. Program expansion can offer an exponential growth in the training rate of medical first responders, which can help curb the trauma-related mortality in rapidly developing economies. Future directions will include clinical competency assessments and further progressive differentiation into higher tiers of trauma expertise.

Introduction Non-communicable diseases (NCDs) are on the rise among vulnerable occupations like: Law enforcement. These NCDs share common behavioural risk factors, namely, tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity etc. Methods A cross-sectional study was conducted among policemen for 2 months (August–September 2016). A total 5 camps were conducted to cover 280 study participants from all 23 stations/posts. The standard WHO-STEP wise approach for NCD surveillance was incorporated as data collection strategy. Data collection included: An interview, physical and biochemical measurements and health promotion session. Multivariate logistic regression analysis done to test significant risk association. Result Participants had mean age of 39.09 years, most 266 (95.0%) were men and more than half 162 (57.8%) were college educated. Risk assessment revealed high burden of: Tobacco 83 (29.6%) and Alcohol 94 (33.6%) intake, inadequate fruit-vegetable intake 243 (86.8%) and high salt intake 29 (10.4%), inadequately physically activity 212 (75.8%) and obesity 116 (44.3%) and past history of disease i.e. CVDs 21 (7.5%), Hypertension 82 (14.64%), Hypercholesterolemia 16 (21.62%) and Diabetes 29 (10.59%). The mean BP reading was 115.8±11.5 mmHg (Systolic) and 80.4±4.9 mmHg (Diastolic).Screening suggested82 (29.28%) and 213 (76.1%) had Hypertension and Pre-Hypertension respectively. Hypertension was significantly associated with tobacco(OR: 3.7, p=0.045) and alcohol (5.2,0.023), obesity/overweight (5.2,0.022), lower education(3.9,0.041)and diabetes(5.9,0.014). Discussion Present study reflects a heavy burden of Hypertension and risk factors among the law enforcement personnel coupled with poor awareness and lifestyle and treatment seeking behaviour. Study participants had poor knowledge and health behaviour in respect to NCDs and risk factors. Poor awareness and practices hamper primary and secondary prevention strategies for averting NCDs.

Objective: The current study was aimed to assess the facilities and services being provided at the Anganwadi Centres (AWCs) by the Anganwadi workers with regards to the norms laid down by Integrated Child development Service (ICDS) scheme, with special emphasis on the children of 0–6 years of age. Design: Cross-sectional study. Setting: A resettlement colonyof North-West District of Delhi, having a population of hundred thousand. Participants: A total of 41 AWCs were present in the study area and were included in our study. The Anganwadi workers at these AWCs were interviewed. Main Outcome Measures: The outcome measures were the facilities present at the AWCs and knowledge of Anganwadi workers regarding the services to be provided and revised supplementary nutrition norms laid down by ICDS. Results: The AWCs in the area were covered under three projects namely Project A, B and C consisting of 18, 9 and 14 AWCs, respectively. The mean room size for all the AWCs was 108.97 ± 62.18 square feet. A weighing machine was present in 29 (70.7%) of the AWCs. Growth charts for growth monitoringof children were present in 28 (68.3%) ofAWCs. A drug kit wasnot present in 14(34.1%) of the 41 AWCs. The mean number of children of 0–3 years enrolled per AWC was 45.78 ± 14.07. However, the mean numberof children present at the time of the visit at the AWCs was 6.24 ± 5.39. Knowledge of Anganwadi workers regarding revised norms for calorie and protein for beneficiaries was found to be poor. Conclusion: This study showed a lack of facilities at the AWCs and poor knowledge of Anganwadi workers. Thus a regular training and supportive supervision of the Anganwadi workers is recommended along with the availability of adequate facilities and infrastructures.