Hypertension is the leading risk factor for global disease burden. Inequalities in health among urban poor and non-poor is a matter of concern. The current study was done to estimate the prevalence ...of hypertension and to describe the health seeking and risk factor profile of people with hypertension in the urban slums of Kochi, Kerala, India.
Blood pressure of 5980 adults from 20 randomly selected slums were measured by door to door survey by trained nurses as a part of baseline assessment for a cluster randomised controlled trial.
Prevalence of hypertension was found to be 34.8% (95% CI 33.5–34.9). Among those with hypertension, 66.9% were aware of their hypertensive status, of which 75.8% were initiated on treatment for hypertension. Proportion of hypertensive in the population who had their blood pressure under control was 24.5%. Among hypertensive, 53% were obese, 25.1% had diabetes mellitus, 14% had history of hospitalisation for high blood pressure. Of them, 60.3% had a per capita salt consumption above 8 g/day and 47.5% of them reported sitting for more than 8 h on a usual day. Mean monthly out of pocket expenditure for treatment of hypertension was $9(Median $8, IQR $16).
One in three adults in urban slums of Kochi had hypertension. High rates of obesity, salt intake, physical inactivity prevails among the people with hypertension. Awareness, treatment initiation and control rate of hypertension are lower in urban slums as compared to non-slum urban areas. Slums require additional attention to ensure equitable and universal access to hypertension control.
The reasons for skipping breakfast reported in order of frequency (n=38) were lack of time (20), conscious about body image (10), not hungry in the morning (4), don't like breakfast foods (2) and ...others (2). 6 Szajewska H, Ruszczynski M. Systematic review demonstrating that breakfast consumption influences body weight outcomes in children and adolescents in Europe. Association of breakfast intake with obesity, dietary and physical activity behavior among urban school-aged adolescents in Delhi, India: Results of a cross-sectional study.
Context: Urban population in India is growing exponentially. The public sector urban health delivery system has so far been limited in its reach and is far from adequate. Aims: This study aims to ...estimate routine immunization coverage and associated factors among children (12-23 months and 60-84 months) in the urban Kochi Metropolitan Area of Kerala. Settings and Design: A cross-sectional study was conducted in Kochi Metropolitan area. Materials and Methods: A cluster sampling technique was used to collect data on immunization status from 310 children aged between 12 and 23 months and 308 children aged between 60 and 84 months. Statistical Analysis: Crude coverage details for each vaccine were estimated using percentages and confidence intervals. Bivariate and multivariate analysis were conducted to identify factors associated with immunization coverage. Results: Among the children aged 12-23 months, 89% (95% CI 85.5%-92.5%) were fully immunized, 10% were partially immunized, and 1% unimmunized. Less than 10 years of schooling among mothers (OR 2.40, 95% CI 1.20-4.81) and living in a nuclear family (OR 1.72, 95% CI 1.06-3.14) were determinants associated with partial or unimmunization of children as per multivariate analysis. The coverage of individual vaccines was found to decrease after 18 months from 90% to 75% at 4-5 years for Diphtheria Pertussis Tetanus (DPT) booster. Bivariate analysis found lower birth order and belonging to the Muslim religion as significant factors for this decrease. Conclusion: Education of the mother and nuclear families emerged as areas of vulnerability in urban immunization coverage. Inadequate social support and competing priorities with regard to balancing work and home probably lead to delay or forgetfulness in vaccination. Therefore, a locally contextualized comprehensive strategy with strengthening of the primary health system is needed to improve the immunization coverage in urban areas.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Abstract Background Cardiovascular disease (CVD) is the leading cause of mortality worldwide, and at present, India has the highest burden of acute coronary syndrome and ST-elevation myocardial ...infarction (MI). A key reason for poor outcomes is non-adherence to medication. Methods The intervention is a 2 × 2 factorial design trial applying two interventions individually and in combination with 1:1 allocation ratio: (i) ASHA-led medication adherence initiative comprising of home visits and (ii) m-health intervention using reminders and self-reporting of medication use. This design will lead to four potential experimental conditions: (i) ASHA-led intervention, (ii) m-health intervention, (iii) ASHA and m-health intervention combination, (iv) standard of care. The cluster randomized trial has been chosen as it randomizes communities instead of individuals, avoiding contamination between participants. Subcenters are a natural subset of the health system, and they will be considered as the cluster/unit. The factorial cluster randomized controlled trial (cRCT) will also incorporate a nested health economic evaluation to assess the cost-effectiveness and return on investment (ROI) of the interventions on medication adherence among patients with CVDs. The sample size has been calculated to be 393 individuals per arm with 4–5 subcenters in each arm. A process evaluation to understand the effect of the intervention in terms of acceptability, adoption (uptake), appropriateness, costs, feasibility, fidelity, penetration (integration of a practice within a specific setting), and sustainability will be done. Discussion The effect of different types of intervention alone and in combination will be assessed using a cluster randomized design involving 18 subcenter areas. The trial will explore local knowledge and perceptions and empower people by shifting the onus onto themselves for their medication adherence. The proposal is aligned to the WHO-NCD aims of improving the availability of the affordable basic technologies and essential medicines, training the health workforce and strengthening the capacity of at the primary care level, to address the control of NCDs. The proposal also helps expand the use of digital technologies to increase health service access and efficacy for NCD treatment and may help reduce cost of treatment. Trial registration The trial has been registered with the Clinical Trial Registry of India (CTRI), reference number CTRI/2023/10/059095.
There are limited data available regarding the problem of anemia and malnutrition in the elderly care homes in India. The current study analyzed comprehensive health check-up data of 104 elderly ...inmates belonging to five old age homes in Kochi city. Hemoglobin was estimated using Hem°Cue® Hb 201 System. Anemia status was decided as per WHO guidelines; less than 12 g/dl for women and less than 13 g/dl for men. Among them, 28.3% (13/46) of males and 20.7% (12/58) had Body Mass Index less than 18.5. Mean hemoglobin was 11.28 (SD 1.88, 95% CI 10.95-11.60) ranging from 6.2g/dl to 16.40g/dl. Prevalence of anemia was 73.9% (34/46) among males and 77.6% (45/58) among females (p 0.417). Prevalence of malnutrition and anemia among elderly in old age home at Kochi were high and warrants urgent attention from the side of policy makers, primary health care providers, researchers and civil society.
The impact of corrosion and its inhibition is not new to the scientific world. The present work reports the Copper corrosion inhibition efficiency of Boron Nitride Nanosheets (BNNS) dispersed ...biopolymer blend of Gum Arabic and Sodium Alginate coded GASA3 in acidic medium. The uniform dispersion of BNNS prepared by liquid phase exfoliation using ultrasonication method with Dimethyl Formamide significantly enhanced the inhibition rate of GASA3 on Copper. UV–visible spectra of bulk BN, BNNS and BNNS dispersed in GASA3 were obtained to confirm the dispersion stability of prepared nanosheets. The inhibition efficiency (IE) on Copper by BNNS dispersed GASA3 blend solution has been investigated by mass loss method, potentiodynamic polarization method, and electrochemical impedance method. The anticorrosion nature of BNNS is attributed to its barrier property, impermeable nature, uniform dispersion and electrical insulating property. The examination of atomic force microscopy images and field emission scanning electron microscope images obtained helped in proving the adsorption of molecules which delayed the penetration of acid molecules onto the Copper surface. The IE% obtained for BNNS dispersed GASA3 solution are 97.2%, 98.7% and 95% from weight loss, potentiodynamic polarization, and electrochemical impedance methods, respectively.
Anaemia has significant negative impact on the health of school children including poor scholastic performance and cognitive impairment. The present study was done with the objective to estimate the ...prevalence of anemia among school going children in Ernakulam district, Kerala and to determine a few factors associated with anemia. Hemoglobin of 880 students of 6th to 9th standard in 11 randomly selected schools of Ernakulam district was estimated using HemoCue 201 photometer. Prevalence of anaemia was expressed using frequencies and percentages. Univariate analysis for factors associated with anemia was done. Selected variables were entered into a logistic regression model. The prevalence of anemia was estimated to be 44% (95% CI 40.67–47.33). Among them 0.8% had severe anemia, 3.5% had moderate anemia and 39.7% had mild anemia. Among them 21.3% and 52.6% reported not in the habit of consuming green leafy vegetables and citrus fruits respectively, at least three times on a usual week. Anemia among children was associated with female gender (adjusted OR 1.53, 95% CI 1.16–2.04), higher age group (adjusted OR 2.24, 95% CI 1.69–2.91) and regular intake of tea/coffee along with major meals (adjusted OR 1.62, 95% CI 1.20–2.04). Anemia among school going children in Ernakulam remains a public health problem and was more among females, higher age groups (12–15 years) and those reported regular intake of tea/coffee along with major meals. The consumption of iron rich foods among the students was poor. Behavior change communication for dietary modification and universal supplementation of iron is warranted.
Abstract
STUDY QUESTION
Do circadian genes exhibit an altered profile in peripheral blood mononuclear cells (PBMCs) of polycystic ovary syndrome (PCOS) patients and do they have a potential role in ...androgen excess?
SUMMARY ANSWER
Our findings revealed that an impaired circadian clock could hamper the regulation of peripheral steroid metabolism in PCOS women.
WHAT IS KNOWN ALREADY
PCOS patients exhibit features of metabolic syndrome. Circadian rhythm disruption is involved in the development of metabolic diseases and subfertility. An association between shift work and the incidence of PCOS in females was recently reported.
STUDY DESIGN, SIZE, DURATION
This is a retrospective case-referent study in which peripheral blood samples were obtained from 101 control and 101 PCOS subjects. PCOS diagnoses were based on Rotterdam Consensus criteria.
PARTICIPANTS/MATERIALS, SETTING, METHODS
This study comprised 101 women with PCOS and 101 control volunteers, as well as Swiss albino mice treated with dehydroepiandrosterone (DHEA) to induce PCOS development. Gene expression analyses of circadian and steroidogenesis genes in human PBMC and mice ovaries and blood were executed by quantitative real-time PCR.
MAIN RESULTS AND THE ROLE OF CHANCE
We observed aberrant expression of peripheral circadian clock genes in PCOS, with a significant reduction in the core clock genes, circadian locomotor output cycles kaput (CLOCK) (P ≤ 0.00001), brain and muscle ARNT-like 1 (BMAL1) (P ≤ 0.00001) and NPAS2 (P ≤ 0.001), and upregulation of their negative feedback loop genes, CRY1 (P ≤ 0.00003), CRY2 (P ≤ 0.00006), PER1 (P ≤ 0.003), PER2 (P ≤ 0.002), DEC1 (P ≤ 0.0001) and DEC2 (P ≤ 0.00005). Transcript levels of an additional feedback loop regulating BMAL1 showed varied expression, with reduced RORA (P ≤ 0.008) and increased NR1D1 (P ≤ 0.02) in PCOS patients in comparison with the control group. We also demonstrated the expression pattern of clock genes in PBMCs of PCOS women at three different time points. PCOS patients also exhibited increased mRNA levels of steroidogenic enzymes like StAR (P ≤ 0.0005), CYP17A1 (P ≤ 0.005), SRD5A1 (P ≤ 0.00006) and SRD5A2 (P ≤ 0.009). Knockdown of CLOCK/BMAL1 in PBMCs resulted in a significant reduction in estradiol production, by reducing CYP19A1 and a significant increase in dihydrotestosterone production, by upregulating SRD5A1 and SRD5A2 in PBMCs. Our data also showed that CYP17A1 as a direct CLOCK-BMAL1 target in PBMCs. Phenotypic classification of PCOS subgroups showed a higher variation in expression of clock genes and steroidogenesis genes with phenotype A of PCOS. In alignment with the above results, altered expression of ovarian core clock genes (Clock, Bmal1 and Per2) was found in DHEA-treated PCOS mice. The expression of peripheral blood core clock genes in DHEA-induced PCOS mice was less robust and showed a loss of periodicity in comparison with that of control mice.
LARGE SCALE DATA
N/A.
LIMITATIONS, REASONS FOR CAUTION
We could not evaluate the circadian oscillation of clock genes and clock-controlled genes over a 24-h period in the peripheral blood of control versus PCOS subjects. Additionally, circadian genes in the ovaries of PCOS women could not be evaluated due to limitations in sample availability, hence we employed the androgen excess mouse model of PCOS for ovarian circadian assessment. Clock genes were assessed in the whole ovary of the androgen excess mouse model of PCOS rather than in granulosa cells, which is another limitation of the present work.
WIDER IMPLICATIONS OF THE FINDINGS
Our observations suggest that the biological clock is one of the contributing factors in androgen excess in PCOS, owing to its potential role in modulating peripheral androgen metabolism. Considering the increasing prevalence of PCOS and the rising frequency of delayed circadian rhythms and insufficient sleep among women, our study emphasizes the potential in modulating circadian rhythm as an important strategy in PCOS management, and further research on this aspect is highly warranted.
STUDY FUNDING/COMPETING INTEREST(S)
This work was supported by the RGCB-DBT Core Funds and a grant (#BT/PR29996/MED/97/472/2020) from the Department of Biotechnology (DBT), India, to M.L. B.S.J. was supported by a DST/INSPIRE Fellowship/2015/IF150361 and M.B.K. was supported by the Research Fellowship from Council of Scientific & Industrial Research (CSIR) (10.2(5)/2007(ii).E.U.II). The authors declare no competing interests.
TRIAL REGISTRATION NUMBER
N/A.
A reduced graphene oxide (RGO) supported electropolymerised copper coordinated aminoacid (Cu-poly(Ala)) was deposited on a glassy carbon electrode (GCE) by a two-step process and its application as a ...sensor is demonstrated herein. The prepared nanocomposite presented a novel way for the design of an electrochemical sensor by incorporating the fascinating characteristics of amino acid alanine as the molecular host providing cavities and Cu2+ as the active centre generating a platform for electrochemical deposition of RGO. The sensor was able to detect both phenolic as well as tertiary amine group of morphine (MO). A lowering of potentials by 270 mV and 145 mV compared to bare GCE was monitored, which is much lower than available reports. An enhanced rate constant of the order of 3.5 × 105 mol−1 L s−1 was obtained. This novel sensing platform for MO produced a very low detection limit of 47 nM with a very good linear dynamic range 50 nm to 80 μM. The sensor displayed good anti interference ability, stability and was successfully applied to real sample analysis.
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•The RGO/Cu-poly(Ala)/GCE with excellent electrocatalytic activity towards morphine•Nanomolar level detection of morphine with a wide linear range at low potential•Rate constant of the order 3.5 × 105 mol−1 L s−1
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