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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524193EnglishN2017February10HealthcareAchievements and Implications of HIV Prevention Programme among General Population: A Systematic Evaluation of HAF II Project in Plateau State, Nigeria
English0107Ademola L. Adelekan1English9*English Garos M. Bature2English Joyce Dakun3English Harrison Christian4English Nanmak Bali5English Hosea Onuche6English Rhoda Udanyi7English Temilade Adegoke8English Oladipupo S. Olaleye1English9English Sunday M. Koka2English Beben W. Wukatda2EnglishBackground: Nigeria has the second largest HIV burden in the world and Plateau State is one of the states with highest prevalence in Nigeria. It is therefore necessary to ameliorate this problem. This paper therefore presents achievements and implications of HIV prevention programme among general population in Plateau State, Nigeria.
Method: This intervention project was carried out among male and female between the ages of 15-49 years. A total of five civil society organizations were engaged by Plateau State Agency for the Control of AIDS and trained to provide HIV prevention programmes under the HIV/AIDS Fund (HAF) II project. A total of 54,401 individuals were the estimated sample size for this intervention and the minimum prevention package intervention was adopted in the implementation of this project activities. Data collected were analyzed using Microsoft Excel and presented using descriptive statistics such as percentage, simple proportion and frequency.
Result: A total of 115 community dialogues/advocacies were carried out during this intervention and 5,528 male and 4,813 female influencers participated. A total of 52,417 male and 7,081 female condoms were distributed. A total number of 32,396 males and 28,121 females were counseled, tested and received result. Among these, 147 males and 180 females tested positive. A total number of 1,959 males and 111 females were referred for STI with almost all the referrals (99.4% male and 91.0% female) taking place in 2015. During this project, 16 pregnant women were also referred for antenatal care.
Conclusion: This intervention successfully scaled-up demand creation for condoms use and HIV counseling and testing through a mix of structural, behavioral and biomedical interventions. More engagement at all levels to ensure community ownership of the HIV response with a view to ensuring sustainability through increased funding should therefore be encouraged.
EnglishHAF II project, General population, Minimum prevention package intervention, HIV/AIDSINTRODUCTION
High incidence of HIV and AIDS has a disproportionately greater impact on sub-Saharan Africa, which constitutes about 10 percent of the world’s population but has the highest number of HIV infections. Twenty five million of the global estimates of about 40 million infected people live in this region of the World [1]. Out of the current estimated population of about 182.2 million people in Nigeria, between 3.2 and 3.8 million are reported to be infected and this figure is projected to increase to between 3.7 and 4.3 million by the year 2020. Nigeria has the second largest HIV epidemic in the world [2]. Although HIV prevalence among adults is remarkably small (3.1%) compared to other sub-Saharan African countries such as South Africa (19.2%) and Zambia (12.9%), the size of Nigeria's population means 3.5 million people were living with HIV in 2015 [3]. An estimated 60% of new HIV infections in western and central Africa in 2015 occurred in Nigeria together with South Africa and Uganda, the country accounts for almost half of all new HIV infections in sub-Saharan Africa every year [3]. This is despite achieving a 35% reduction in new infections between 2005 and 2013 [4]. Unprotected heterosexual sex accounts for 80% of new HIV infections in Nigeria, with the majority of remaining HIV infections occurring in key affected populations such as sex workers [2]. HIV prevalence is highest in Nigeria’s southern states (known as the South South Zone), and stands at 5.5%. It is lowest in the southeast (the South East Zone) where there is a prevalence of 1.8%. There are higher rates of HIV in rural areas (4%) than in urban ones (3%) [2]. Approximately 180,000 people died from AIDS-related illnesses in Nigeria in 2015 [5]. Since 2005, the reduction in the number of annual AIDS-related deaths has been minimal, indicative of the fact that only half (51%) of those living with HIV in Nigeria are accessing antiretroviral treatment (ART) [6].
Plateau state has been classified among states in the “hot zone” of HIV infections. The state is one of the 12 + 1 states contributing the highest HIV prevalence in Nigeria. The state had a prevalence of 7.7% in 2010 placing her in the 6th position in the country and the 2nd position among the states in the North Central zone [7]. The prevalence is higher in the urban areas than in the rural areas (10.5% as compared with 2%). HIV prevention efforts to date have overwhelmingly focused on reducing individual risk, with fewer efforts made to address structural factors, social norm and cultural believes that increase vulnerability to HIV. The approach known as “combination prevention offers the best prospects for addressing documented weaknesses in HIV prevention programming and for generating significant, sustained reductions in HIV incidence in diverse settings as it relies on the evidence informed, strategic, simultaneous use of complementary behavioral, biomedical and structural prevention strategies. This paper therefore presents achievements and implications of HIV prevention programme among general population in Plateau State, Nigeria
MATERIALS AND METHODS
Study Design
This intervention project was carried out among general population in Plateau State, Nigeria between the year 2013 and 2016. A total of five civil society organizations (CSOs) were engaged by Plateau State Agency for the Control of AIDS and trained to provide HIV prevention programmes under the HIV/AIDS Fund (HAF) II project. The CSOs engaged for this intervention are Fahariya Adolescent Development Network (FAANET), Adolescent Health Empowerment and Development Initiative Nigeria (AHEAD-NG), Relief and Hope foundation, Youth’s Information and Leadership Training Centre and Scripture Union West Africa (SUWA).
Study Area
This study was carried out in two randomly selected local government areas (LGAs) in Plateau States namely Shendam and Jos-North LGAs. The LGAs with the highest prevalence were Jos North (16.7%) and Shendam (4.6%) according to the 2010 National sero-prevalence study [7]. Plateau State is one of the 36 states of Nigeria located within the north central geopolitical Zone. The 2006 National Population Census put the population of Plateau State at 3,178,712 (1,593,033 males and 1,585,679 females) [8]. Shendam is an LGA with its headquarters in the town of Shendam at 8°53′00″ N 9°32′00″ E. It has an area of 2,477 km² and a population of 208,017. Jos-North on the other hand is an LGA with its headquarters in the city center of Jos. It has an area of 291 km² and a population of 429,300 [8].
Study Population
The project was carried out among male and female between the ages of 15-49 years in two local government areas
Sample size
A total of 54,401 (male and female) were the estimated sample size for this intervention
Intervention
The minimum prevention package intervention (MPPI) was adopted in the implementation of this project. Project interventions are categorized under the three components of MPPI which are structural, behavioural and biomedical interventions. Activities carried out under each of the component are summarized below situs slot ;
Structural Intervention
This area of intervention involves mobilizing community and individuals to address structural barriers such as cultural believes and practices that hinder peoples access and utilization of appropriate HIV prevention, treatment and care services. The implementing organizations organized series of community dialogues, outreaches, sensitization and awareness creation across all the project communities with the aim of sensitizing community stakeholders on the HIV/AIDS situation around them and to recruit community volunteers to be trained as peer educators. The session attracted a number of influencers who also participated in various awareness programs. They were introduced to the basics of HIV and AIDS which includes the mode of transmission and prevention as well as the cycle of HIV (how untreated HIV becomes AIDS). The aim was to bring community stake holders together, properly intimate them about the project to be implemented, discuss possible success routes for the project, and start making efforts towards community ownership of the project.
Behavioral intervention
This aspect involves change in behavior aimed at influencing beneficiaries to adopt healthy behaviors so as to reduce their risk for HIV infection. Such behaviors include partner reduction, correct and consistent use of condom, good health seeking behavior for prompt treatment of STIs, treatment referral, follow-up and HCT. Behaviors of the general population in the course of this project were targeted to be modified through the use of Peer Education (PEs) and Condom distribution.
Identification, Selection and Capacity Building for Peer Educators (PE)
The implementing organizations identified and trained voluntary peer educators (1200 males and 1550 females) among the general population who also reached a number of their peers on HIV and AIDS related issues. Three days training was designed purposely to build the capacity of PEs and improve their proficiency in carrying out effective HIV prevention intervention activities among their peers in their various communities. Using Peer Education manuals, the participants were taken through series of topics on HIV/AIDS issues and peer education strategies for balance ABC prevention intervention. Each modules and topics were presented using discussion, group works, role plays and various exercises and energizers. Also, pre and post-test evaluation of participants at the point of entry and at the end of training was conducted to measure the impact of the training on the trained peer educators. Topic covered during the training as designed in the seven (7) modules PEs guides include the following and many other: life skills, general knowledge of HIV/AIDs, sexually transmitted infections and types, HIV prevention and access to help, gender and sexuality, peer education characteristics and qualities, gender and HIV/AIDs. The peer educators were involved in contact making referrals, distribution of IEC materials, demonstration and distribution of condoms, running education and training sessions, mobilizing community members and advocacy. The peer educators ensured 2 to 3 regular contacts with their peers in 10 to 15 day interval within a period of 2 or 3 months.
Selection Criteria for PEs
The PEs were selected from community based organizations (barbers, fashion designers, patent medicine vendor and hair dressing associations), religion organization (Christian Association of Nigeria and Muslim Associations). Those who were recruited as PEs met certain criteria such as: been resident within the project community, been able to read and write and availability within the project community for a period of 18 months.
Condom Distribution
Condom messages were given on the importance and need for consistent and correct condom use. Proper and correct use of condom was demonstrated and a number of both male and female condoms were distributed within the project communities. Some PEs also did condom forecasting for their peers and distributed the commodity which was made available by the project management team. All these were to facilitate a change in attitude and behavior among the general population within the project communities.
Biomedical Intervention
HIV Counseling and Testing (HCT)
HCT was conducted by trained counselor tester using the client intake form for data documentation. The HCT has three distinct components: risk assessment and counseling before the blood or oral sample is taken, testing of the sample, and counseling and referral with the test results. These three components were properly followed in this project. The implementing organizations trained ad-hoc counselor tester and peer educator volunteers who conducted mobile HIV counseling and testing among the general population. In addition, some project management staff also organized community HCT outreaches. During this period, awareness was also created on the use of condom and condoms were also distributed.
Referral
Client needs for care and supportive services are assessed and prioritized while the clients are provided with assistance such as setting up appointments, providing transportation among others in accessing treatment and care services. Follow-up were also provided to participants to facilitate initial contact with care and support service providers. During the period of this project through the Ad-hoc testers and trained volunteers, several referrals were made for care and treatment in various health care facilities. Clients diagnosed for STIs and HIV were tracked and escorted to the health facilities for care/treatment.
Start-Up Training
Preceding the commencement of the intervention phase was a start-up training and capacity building for project staff and project management team and reviews of such meetings continued as the project progressed. Start-up training was held by the Plateau state agency for the control of AIDS together with key members of implementing organizations management team, staff and board members where they were well informed of the project and its processes. The aim of the training was to strengthen their capacity for better understanding of MPPI for optimum project implementation. They were trained on thematic areas including but not limited to implementation of HPDP in Nigeria, drivers of HIV/AIDS epidemic in Nigeria, care and services for people living with HIV (PLHIV), implementation plan for CSOs on the HAF II project, importance of community dialogues and advocacy visits, monitoring and evaluation system for prevention.
Monitoring and Evaluation (MandE) Visit
Several MandE visits and activities were carried out by the implementing situs judi slot online deposit pulsa tanpa potongan and other project team actors to ensure that activities were implemented as planned and that the data recorded and reported were accurate and valid. It was also to incorporate a system of analysis, supervision and review which led to remedial actions to improve performance. For the monitoring and supervision to yield reasonable success in the project locations, key questions were incorporated in a short precise MandE tool to attain useful and specific data during supervision and monitoring visits to the implementation sites. The responses retrieved provided an overview of the impact of interventions; highlighting areas of success and the major areas that required improvement.
Data Management and Analysis
Capacity Building on Data Entry
In order to ensure quality data, key project staff attended the DHIS training conducted by PLACA for uniform state platform collation of data. During the 5 days training, CSOs were coached on how to enter the collected data on the platform.
Data Quality Assurance (DQA)
DQA was carried out and this provided a platform for evaluating the performance and impact of the project implemented. During project management meeting, it was discussed how to carry out the DQA, which sites to visit, which PE conductor should be involved, logistics, location/sites, thematic areas and number of days to carry out the activity. Profiling the data to discover inconsistencies and other anomalies in the data, as well as performing data cleansing activities (e.g. removing outliers, missing data interpolation) to improve the data quality was also done.
Data Analysis
Data were entered on DHIS2 platform and later exported and analyzed using Microsoft Excel. Data were presented using descriptive statistics such as percentage, simple proportion and frequency.
Ethical consideration
It was ensured that there was confidentiality during HIV counseling and testing and permission was adequately sought from various community leaders before approaching the community members. Client intake forms used during the HCT were also kept where unauthorized person could not gain access to it.
RESULT
Structural Intervention
Table 1 presents the result of the structural intervention. Out of the total number of 115 community dialogues/advocacies carried out during the project period, 27.0% were carried out in 2014, 73.0% in 2015 while none took place in 2016. A total number of 5,528 male and 4,813 female influencers participated in the community dialogue with 16.6% of male and 3.7% of female participants in 2014, 83.4% of male and 96.3% of female participants in 2015.
Behavioural Intervention
The result of behavioral intervention is presented in table 2. A total number of 52,417 male condoms and 7,081 female condoms were distributed out of which 4.3% of male condom and 3.6% of female condom were distributed in 2014, 95.3% of male condoms and 99.4% of female condoms were distributed in 2015 and 0.4% of male and 0.4% of female condoms were distributed in 2016. A total number of 26,442 male peers and 23,413 female peers were registered during the project period. Out of this number, almost all peer registration was done in 2015 with 92.7% of male and 91.7% of female peers registered during this period while 7.2% of male and 8.3% of female peers was registered in 2014 and just 0.1% of both male and female peer registration was done in 2016.
Biomedical Intervention
The result of the biomedical aspect of the intervention which involves various activities such as HCT, referrals for sexually transmitted infections (STI), antiretroviral therapy (ART) and antenatal care (ANC) is presented in table 3 and 4. A total number of 32,396 males and 28,121 females were counseled, tested and received result (CTR). Among these, 147 males and 180 females tested positive (Table 3). A total number of 1,959 males and 111 females were referred for STI with almost all the referrals (99.4% male and 91.0% female) taking place in 2015 and 0.6% of male and 9% of female referrals for STI took place in 2014. Also, 83 people were going for STI services while 172 people were referred for ART out of which 8.1% were referred in 2014, 91.3% in 2015 and 0.6% in 2016. During this period, 216 pregnant women were also referred for ANC with all these referrals taking place in 2016 (Table 4).
Coverage of MPPI, HCT and Prevalence of HIV
A total of 32127 (64.4%) of the registered peers were reached with all the three stages of MPPI and 60517 (111.1%) were reached with only HCT. Among these, 327 (0.5%) were tested positive to HIV (Fig. 1).
DISCUSSION
The structural intervention of this program which included community dialogue/ mobilization was able to attract greater number of influencers in the year 2015 as compared to 2014. This difference could be as a result of the fact that almost thrice the number of community mobilization that took place in 2014 occurred in 2015. It was observed that no community dialogue took place in 2016 and this could be attributed to rounding off of the program while most activities have taken place during the previous years. Community dialogue in this project was very useful as it helped identify and enlist key individuals for sustainable partnership, helped solicit community participation, support and commitment to problem solving for sustainable behavioral change and promoted sharing of information and ideas between individuals of different cadres and backgrounds. Through facilitated sessions during the course of various community mobilizations, the program sparked critical thinking and open dialogue among participants which promoted mutual understanding of the epidemic and how to control it. In a similar attempt to evaluate the effectiveness of community dialogue in changing gender norms for HIV prevention in Tchova, Mozambique, Maria et, al [9] observed that community participation contributed significantly to observed changes in three of the underlying structural factors of HIV namely gender attitudes, gender roles, and HIV stigma. It was noted that the program also contributed to changing HIV prevention knowledge and behaviors that are associated with HIV infection, including discussion of HIV between sex partners.
The behavioral intervention of the program aimed at changing the behaviors of the general population incorporated both male and female condom distribution together with peer education. Most of the peer registration took place in 2015 and this probably explained why higher condom distribution occurred in 2015 as compared to 2014. Higher registration rate of peers and larger quantity of condom distribution that took place in 2015 can also be attributed to better access to resources both in financial and resource terms. It could also be that the system was more stabilized and organized subject to a wealth of experience gathered over the previous year. In all, more male condoms were distributed as compared to that of female condoms and this could be as a result of usual female attitude of evading stigma associated with collection of such commodity. However, adequate and effective awareness and education on condom use as a sustainable option for prevention of STIs prior to distribution could have removed such limiting barriers. Usage of condoms and especially if they are to be used consistently as a means of HIV prevention requires that people have access to them and are able to afford them. A reliable supply and distribution system of condoms during this project period provided accessibility and availability through mass distribution thus promoting uptake of the commodity. The use of peer educators in this project facilitated interactions between condom use and HIV prevention by communicating information on the effectiveness of condoms and by ensuring a sufficient and regular supply of condoms to those who require them. Condom promotion and distribution has been credited with large-scale successful programs in the developing world to control HIV and AIDS as noted in Thailand nationwide condom program aiming for 100% condom use in sexual encounters with sex workers. The program according to Levine [10] which provided condoms free of charge, provided education and promotion of condoms, and carefully monitored incidences of sexually transmitted infections to identify locations that were not in compliance with the initiative noted that sexually transmitted infections fell significantly and reported rapid rise in condom use. Most aspect of biomedical interventions such as number of people accessing counseling and testing and referrals for STI recorded the highest number in 2015 and this could be attributed to better resource mobilization and impact of activities of previous year. There was a good reflection of male to female ratio participation in counseling and testing and this reflects a good degree of women involvement in the project. However, more females tested positive as compared to males in this project. This reflects a higher prevalence of HIV infection among women than their male counterparts and this could be traced to the fact that women are at a greater biological risk of contracting HIV than men through various routes such as their greater mucosal surface area which is exposed to pathogens and infectious fluid for longer periods during sexual intercourse, low economic status which is associated with earlier sexual experience, lower condom use, multiple sex partners, and gender norms which promote multiple concurrent sexual partners for men among others. The 0.5% prevalence of HIV in this project marks a significant reduction when compared with 7.7% recorded for the state in 2010 [7]. This could have been as a result of various prevention activities that have been ongoing in the state to curb the epidemics. However, the impact of the combination prevention program undertaken in this project can only be felt by conducting a post prevention program analysis.
Implications for Programming
Effective and efficient prevention strategy that can lead to reduced incidence of HIV and AIDS must incorporate critical components of MPPI which include structural, behavioral and biomedical intervention as undergone in this project in selected local governments, however, extension of such intervention package to other local governments of the state cannot be overemphasized. Generally, the program was a success as HCT reached above its target. However, the percentage reached with MPPI was low compared to the target expected to be achieved in this programme despite the fact that a good number of the population were registered as peers for the behavioural intervention. This low achievement may be attributed to low turn-out of peers for the cohort session and not HCT or attrition of the peers, hence failure to meet up with the minimum of 6 contacts for cohort sessions before being said to be reached with MPPI. Future similar programmes among general population in the state should ensure more people are reached with behavioral intervention and MPPI by planning ahead to prevent such challenge even if it may involve the use of incentives. Considering that the program recorded great number of people reached with counseling and testing, it is evident that outreach workers and peer counselors/educators can be an important and effective resource to help clients identify needs and plan successful referrals. When peer education programmes are well designed and well implemented as a component of an overall HIV prevention strategy, they can contribute towards improving knowledge, attitudes and skills related to HIV. Successful peer education can motivate people to adopt and maintain safer sexual behaviour or minimize risk practices associated with sex and drug use. It can also reinforce behavior change, as the participant identified with a peer group where safer behaviour becomes the group norm. However, to enhance successful completion of referral and follow up, it is important to incorporate post-test support and services that advice those who test HIV-positive on the meaning of their diagnosis, and on referral to the treatment, care and support and prevention programmes and services available to assist them. This may go a long way in changing the attitude of people referred for STI to do proper follow up and complete their referrals.
CONCLUSION
This project successfully scaled-up demand creation for condoms and HIV counseling and testing among general population through a mix of structural, behavioral and biomedical interventions. The HIV minimum package prevention intervention provided suitable strategy for scaling up of the uptake of HCT, HIV peer education and condom promotion services. More engagement at all levels to engender political commitment and ownership of the HIV response (including State and LGA levels) with a view of ensuring sustainability through increased funding should also be encouraged.
Acknowledgment
The evaluation team wishes to acknowledge the World Bank and the National Agency for the Control of AIDS (NACA) for making available the funding for the evaluation and dissemination of this project intervention. Special appreciation goes Mrs. Philomena Daduut, Mrs. Aishetu J. Garang, Seign. Ango G. Abdullahi, Mr. Albert Fube Bewaran, Mr. Melchizedek Toma, Apollos Enoch and Dachollom Pam for their support and cooperation during this project implementation. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=89http://ijcrr.com/article_html.php?did=89
Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization (WHO). AIDS epidemic update (2007)
National Agency for the Control of AIDS (NACA). Global AIDS Report Progress Report for Nigeria. 2015
Joint United Nations Programme on HIV/AIDS (UNAIDS). 'Prevention Gap Report. 2016
Joint United Nations Programme on HIV/AIDS (UNAIDS). 2014 The Gap Report
Joint United Nations Programme on HIV/AIDS (UNAIDS). 2015 HIV and AIDS estimates
National Agency for the Control of AIDS (NACA). ‘End of Term Desk Review Report of the 2010-2015 National HIV/AIDS Strategic Plan’
Federal Ministry of Health (FMOH) Abuja: 2010. Technical report on National HIV Sero-prevalence sentinel Survey Among Pregnant Women Attending Antenatal Clinics in Nigeria.
National Population Commission (NPC) [Nigeria] 2006 Population and Housing Census of the Federal Republic of Nigeria. Abuja, Nigeria: National Population Commission; 2006.
Maria Elena Figueroa, Patricia Poppe, Maria Carrasco, Maria Dirce Pinho, Felisberto Massingue, Maria Tanque and Amata Kwizera. Effectiveness of Community Dialogue in Changing Gender and Sexual Norms for HIV Prevention: Evaluation of the Tchova Tchova Program in Mozambique, Journal of Health Communication, 2016. 21:5, 554-563, DOI: 10.1080/10810730.2015.1114050
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524193EnglishN2017February10HealthcareAchievements and Implications of Positive Health Dignity and Prevention Model among People Living with HIV: A Systematic Evaluation of HAF II Project in Plateau State, Nigeria
English0813Ademola L. Adelekan1English9*English Garos M. Bature2English Hadiza Maina3English Tagurum Yetunde4English Nanmak Bali5English Ezekiel Jamaka6English Sunday M. Koka2English Beben W. Wukatda2English Michael A. Owojuyigbe7English Olusegun Adeoye8English Michael OlugbilEnglishBackground: Nigeria accounts for almost half of all new HIV infections in sub-Saharan Africa every year. The positive health dignity and prevention (PHDP) intervention was designed by Plateau State Agency for the control of AIDS by engaging civil society organizations (CSOs) to reduced incidence of new infections, improved community-based care and support for people living with HIV (PLHIV) and reduce discrimination and stigmatization against PLHIV in plateau state, Nigeria. This article therefore presents the results of the intervention including the achievements and implications for programming.
Methods: This was an intervention project carried out in 3 out of 17 LGAs in plateau state with an estimated sample size of 17,177. The intervention was carried out by four CSOs who were engaged and provided with financial support under the HIV/AIDS Fund (HAF) II project. The CSOs worked among the PLHIV in the state using the PHDP model which is the minimum package for PLHIV interventions under the continuum of care. Data were collected using various data collection and reporting tools and entered into DHIS2 platform. Data were subsequently exported into Microsoft excel where it was analyzed and results presented in charts and tables.
Results: The overall target population reached during this intervention was 38211 PLHIV given a target reached of 222.5%. Among these, 74 persons died while 21 persons voluntarily withdrawn from this project. A total of 87 community dialogues were held and 912 influencers participated. A total of 12 income generating activities were also held and 89 persons benefitted. A total of 29312 (76.7%) persons were reached with at least one care representing a 76.7%. Out of the total of 51143 condoms required for this intervention, only 51.1% condoms were distributed while 1271 pregnant women were referred for antenatal care services.
Conclusion: This intervention had beneficial effects on people living with HIV and their families. Social and economic support for people living with HIV within the context of positive health, dignity and prevention is perhaps the most difficult to address, as it depends in large measure on the broader national economic, social and social protection systems, which are underfinanced in this intervention.
EnglishHAF II project, Positive health dignity and prevention, People living with HIVINTRODUCTION
In 2010, it was estimated that worldwide, over 34 million people were HIV-positive and approximately 68% of them lived in sub-Saharan Africa [1]. In this geographical region of the world, the typical pattern of healthcare is a combination of overburdened healthcare services with insufficient financial resources, inadequate infrastructure, few hospital beds and fewer health workers to cope with the health burdens faced [2-3]. The HIV pandemic, which is greatest in sub-Saharan Africa, contributes immensely to the health burden, and this further overstretches the already overburdened health systems [2;4]. Nigeria has the second largest HIV epidemic in the world [1]. Although HIV prevalence among adults is remarkably small (3.1%) compared to other sub-Saharan African countries such as South Africa (19.2%) and Zambia (12.9%), the size of Nigeria's population means 3.5 million people were living with HIV in 2015 [5]. An estimated 60% of new HIV infections in western and central Africa in 2015 occurred in Nigeria [5], together with South Africa and Uganda, the country accounts for almost half of all new HIV infections in sub-Saharan Africa every year [6]. This is despite achieving a 35% reduction in new infections between 2005 and 2013 [6]. Unprotected heterosexual sex accounts for 80% of new HIV infections in Nigeria, with the majority of remaining HIV infections occurring in key affected populations such as sex workers [7].
HIV prevalence is highest in Nigeria’s southern states (known as the South South Zone), and stands at 5.5%. It is lowest in the southeast (the South East Zone) where there is a prevalence of 1.8%. There are higher rates of HIV in rural areas (4%) than in urban ones (3%) [7]. Approximately 180,000 people died from AIDS-related illnesses in Nigeria in 2015 [8]. Since 2005, the reduction in the number of annual AIDS-related deaths has been minimal, indicative of the fact that only half (51%) of those living with HIV in Nigeria are accessing antiretroviral treatment (ART) [9]. Positive health dignity and prevention (PHDP) intervention designed by Plateau State Agency for the control of AIDS (PLACA) by engaging civil society organizations to reduced incidence of new infections, improved community-based care and support for people living with HIV (PLHIV) and reduce discrimination and stigmatization against PLHIV in plateau state, Nigeria. This article therefore presents the results of the intervention including the achievements and implications for programming.
MATERIALS AND METHODS
Study Design and Scope
This was an intervention project carried out among PLHIV in Plateau State, Nigeria. The HIV Programme Development Project (HPDP) aimed to improve the evidence-based targeting of activities within the State, by focusing on factors that drive the spread of the epidemic, thus attempting to reduce the incidence of new infections, while ensuring adequate care and support is provided for PLHIV.
Study Area
Plateau State is one of the states in the North-Central geo-political Zone. The state covers an area of about 26,899 square kilometers bounded in the North East by Bauchi State, North West by Kaduna State, South East by Taraba State and to the South and South West by Nasarawa State. Plateau state has a total population of 3,206, 531 people. The population of state from 2006 census was 1,598,998 males and 1,607,533 females with an annual growth rate of about 2.7%. The State has three senatorial zones and 17 Local Government Areas with a land area of 30,913km [10].
Study Population
The study population consisted of PLHIV who are randomly selected from three out of seventeen LGAs namely Jos North, Shendam and Pankshin LGAs.
Sample Size
The estimated sample size for this intervention was 17,177 PLHIV
Description of Intervention
This intervention was carried out by four Civil Society Organizations (CSOs) who were engaged and provided with financial support under the HIV/AIDS Fund (HAF) II component of HPDP II project. The CSOs engaged are Halt AIDS, Relief and Hope Foundation (RAHF), Christian Health Association of Nigeria (CHAN) and Manna Resource Development Center. The CSOs worked among the PLHIV in the state using Positive health dignity and prevention (PHDP) model which is the minimum package for PLHIV interventions under the continuum of care were used for this intervention. Programmatic components of Positive Health, Dignity and Prevention fall under the following eight (8) thematic areas namely Empowerment of people living with HIV and networks of PLHIV, Health promotion and access and Gender equality. Others are Human rights, Prevention of new infections, sexual and reproductive health and rights, social and economic support including measuring impact. Positive Health, Dignity and Prevention model is not just a new name for the concept of HIV prevention for and by people living with HIV, formerly known as ‘positive prevention’. Rather, PHDP is built upon a broader foundation that includes improving and maintaining the dignity of the individual living with HIV; supports and enhances the individual’s physical, mental, emotional and sexual health; and, which, in turn, among other benefits, creates an enabling environment that will reduce the likelihood of new HIV infections [11]. Positive Health, Dignity and Prevention encompasses the full range of health and social justice issues for people living with HIV, and espouses the fundamental principles that responsibility for HIV prevention should be shared and that policies and programmes for people living with HIV should be designed and implemented with the meaningful involvement of people living with HIV [11]. By linking the social, health, and prevention needs of the person living with HIV within a human rights framework, PHDP results in a more efficient use of resources, with outcomes that are more responsive to the needs of people living with HIV and more beneficial for their partners, families, and communities [11]. The specific activities carried out under this intervention are described below.
Income Generation Activities
Income Generation Activities (IGAs) were provided through vocational empowerment for PLHIV to ensure that PLHIVs learned how to work independently, as well as earn income on their own.
Advocacy and Community Dialogue
Advocacy visits were made, and community dialogues were held with leaders of PLHIV groups and other stakeholders at the community level particularly among gate-keepers and people affected by AIDS. This was done to educate community members on stigmatization and discrimination against PLHIV within the communities.
Peer Education Session
A total of 538 peer educators were selected and trained to provide peer education sessions to their peers on partner reduction, correct and consistent use of condom, good health seeking behaviour, basic infection control practices at home, management of general ailments and identification of signs and symptoms of health issues requiring immediate medical care. They were also provided with sessions on Positive Health Dignity and Prevention (PHDP) in Nigeria, HIV prevention at the community setting, basic facts about HIV/AIDS, HIV related stigma and discrimination, management of sexually transmitted infections (STIs) including where and how to access antiretroviral therapy. Each training session was attended by a minimum of 15 and maximum of 30 participants and each participant were mandated to step down the knowledge to not less than 10 colleagues which are mostly PLHIV and/or their relatives.
Counseling Support
Counselling support was provided by trained volunteers on a wide-range of issues (disclosure of HIV status, treatment education and adherence support, psycho-social support, nutrition, positive living and positive prevention, sexual and reproductive health issues such as pregnancy and family planning, home based care) through one-to-one counselling or couple/family counselling. Children and adolescents living with HIV were also provided with counselling services on HIV status disclosure, ART adherence, personal hygiene, eating healthy and hygienic food, coping with emotions etc.
PLHIV Support Group
Support group was formed for PLHIV with the aimed of providing a platform for them to share their concerns and learn from each other. Regular support group meetings were organized by trained volunteers and information on various themes are provided to build capacity of PLHIV to live quality life. Monitoring and evaluation officers of the implementing CSOs monitored support group meeting by attending the meeting to encourage regular meeting attendance of support group members, share experience and encourage proper adherence alongside the normal health talk during support group meeting.
Condom Promotion
Several condom messaging, sensitization and demonstrations was carried out at individual volunteer cohort level and special sessions at least twice in a month. Project monitoring team re-enforcing the activities of volunteers by organizing special sessions with cohort group members to carry out comprehensive condom promotion
Data Collection
Data were collected during peer-to-peer sessions by the peer educators. Also collected were the number of PLHIV who received support services, and those who completed referrals.
Data Analysis
Data were collected using various but uniform data collection and reporting tools. The data were collected from various activities carried out under enrollment pattern, structural and socio-economic intervention and positive health dignity and prevention. The data were entered into DHIS2 platform and exported into Microsoft excel. The results were analyzed using Microsoft Excel by comparing frequencies and percentages while carefully presented in tables.
Ethical Consideration
Prior to the commencement of the intervention, the proposal was subjected to a two-stage review and ethical approval to conduct the research was obtained from the National and the State Ethical Review Committee and Federal Ministry of Health, Nigeria. Also, permission was obtained from the leaders of the identified groups where necessary.
RESULTS
The findings are presented based on the levels of intervention: Enrollment pattern, Structural and socio-economic intervention and positive health dignity and prevention. The overall target population reached during this intervention was 38211 given a target reached of 222.5%.
Enrollment pattern of participants
Out of the 38211 persons enrolled, 98.8% were enrolled in 2015. A total of 74 persons died and among these, 87.8% died in 2015. A total of 21 persons voluntarily withdrawn from this intervention without reason (Table 1)
Structural and Socio-economic Intervention
Out of the total of 87 community dialogues held, 82.8% were held in 2015 and a total of 912 influencers participated. A total of 12 income generating activities were held and the number of persons referred totaled 121 while only 89 persons benefitted (Table 2).
Positive Health Dignity and Prevention (PHDP)
Out of the 38211 reached with this intervention, a total of 29312 persons were reached with at least minimum of one care representing a 76.7%. A total of 16355 persons were support service and among these, 68.7% were reached in 2015. Out of the total of 51143 condoms required for this intervention, only 51.1% condoms were distributed. Among these, 20.7% and 79.3% were female and males condoms respectively. A total of 202 persons reported that they were currently receiving STI services and 80 persons were referred for STI. A total of 1271 pregnant women were referred for antenatal care services (Table 3).
DISCUSSION
This project was carried out among PLHIV in a bid to know the number of persons infected by the epidemic, as well as to ensure that they are catered for by the communities they belong to. This was brought to bear in the community dialogues, and advocacy meetings held with community members, and leaders, as well as with the leaders and members of existing PLHIV groups. Furthermore, support groups were worked with to enlighten them on the necessary issues of PLHIV care and support. Additionally, several care options were made available to those infected and who had enrolled, with clients being helped towards completion of referrals. Also, vocational empowerment was provided to ensure that PLHIV can cater for themselves financially when necessary. Many of the participants were provided with home based care. The World Health Organisation, the government of several countries as well as care givers of PLWHA have acknowledged home based care as a necessary component of HIV care and support [12-14]. Home based care programmes have been developed with a view to assisting families and care givers in providing HIV-related care to patients, and this has aided in reducing the burden on hospitals caring for PLWHA [15]. It has been estimated that up to 90% of illness care may be provided in the home by untrained family and associates [16]. In resource constrained settings burdened by HIV/AIDS such as found in sub-Saharan Africa, home based care plays a valuable and strategic role in complementing existing health care services by extending the continuum of care for PLWHA and their families into the home, thus bridging the gap between facility and home care [14;16;17]. However, in some instances, HBC is the only option available for many HIV/AIDS patients who do not have access to healthcare facilities for various reasons and it replaces hospital care [17]. Furthermore, such care is usually carried out by persons who have no training or contact with professional help. An effective HBC programme for PLWHA can yield major health and social benefits not only to the patients, but also to their families and therefore the community [18].
One of the most important phases of this intervention was the provision of PLHIV with adherence support. This was because PLHIV need to consider themselves as part of the solution rather than a part of the problem. Strict adherence to antiretroviral therapy (ART) is key to sustained HIV suppression, reduced risk of drug resistance, improved overall health, quality of life, and survival [19-20], as well as decreased risk of HIV transmission [21]. Conversely, poor adherence is the major cause of therapeutic failure. Achieving adherence to ART is a critical determinant of long-term outcome in HIV infected patients. It is unfortunate to note in this intervention that only a little more than half of the condoms required for this intervention were distributed when condoms are a critical component in a comprehensive and sustainable approach to the prevention of HIV and other sexually transmitted infections (STIs) [22]. Laboratory studies show that condoms provide an impermeable barrier to particles the size of sperm and STI pathogens, including HIV [23-24]. Condoms, when used consistently and correctly, are highly effective in preventing the sexual transmission of HIV. Research among sero-discordant couples (where one partner is living with HIV and the other is not) shows that consistent condom use significantly reduces the risk of HIV transmission both from men to women and women to men [25-27]. Consistent and correct use of condoms also reduces the risk of acquiring other STIs and associated conditions, including genital warts and cervical cancer. With a failure rate of about 2% when used consistently and correctly, condoms are very effective at preventing unintended pregnancy [28-29].
Implications for Programming
Preventing new HIV infections is the shared responsibility of everyone irrespective of HIV status. As such, this intervention includes people living with HIV in all aspects of project activities. It rejects the notion that people living with HIV are solely responsible for the health of those with whom they interact. It also acknowledges and addresses HIV-related stigma and other social determinants of health that influence the vulnerability of those affected. Furthermore, this intervention promotes programmes that help empower participants to take responsibility for their own health and well being. By doing so, this will have a positive impact on partners, families and communities. Sustainable finance and support is essential in order to ensure that the impacts of this intervention are not lost. In addition, it is further important for future interventions in like-mold to ensure that facilities, and care services are available to cater for more participants than previously estimated. This would help reduce incidences of disenfranchisement with such programmes, as well as ensure that all enrolled clients are adequately catered to, and the spread of HIV through PLHIV or the occurrence of deaths of PLHIV is well dealt with. It is important to further point out that more PLHIV than the estimated target population trooped out to avail themselves of the various services on offer during the intervention. This can be observed in the number of enrollees during the programme duration which as noted exceeded the target population, adding up to slightly more than two times the estimated expected target, leading to a situation of low coverage of clients who turned out for the intervention programme, with a variety of services. In other circumstances, this occurrence might have led to a chaotic situation wherein clients would return to their abodes hugely dissatisfied with the intervention programme, and this would in turn have spiral consequences on the health of many-a-client and the spread of HIV among the population.
CONCLUSION
This intervention had beneficial effects on people living with HIV, their partners, families, and communities, including reducing the likelihood of new infections. Social and economic support for people living with HIV within the context of positive health, dignity and prevention is perhaps the most difficult to address, as it depends in large measure on the broader national economic, social and social protection systems, which are underfinanced in this intervention. Employment and economic empowerment for people living with HIV- in particular, women and young people living with HIV requires ensuring that PLHIV have equitable access to education and employment.
Acknowledgment
The evaluation team wishes to acknowledge the World Bank and the National Agency for the Control of AIDS (NACA) for making available the funding for the evaluation and dissemination of this project intervention. Special appreciation goes Mrs. Philomena Daduut, Mrs. Aishetu J. Garang, Seign. Ango G. Abdullahi, Mr. Albert Fube Bewaran, Mr. Melchizedek Toma, Apollos Enoch and Dachollom Pam for their support and cooperation during this project implementation. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/ publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Conflict of interest: None
Englishhttp://ijcrr.com/abstract.php?article_id=90http://ijcrr.com/article_html.php?did=90
United Nations Programme on HIV/AIDS (UNAIDS) (2010). Global report: UNAIDS report on the global AIDS epidemic 2010. Geneva: UNAIDS
World Health Organization (WHO) (2008). Primary health care: now more than ever. Geneva, WHO. Available at: http://www.who.int/whr/2008/whr08_en.pdf
Tillekeratne LG, Thielman NM, Kiwera RA, Chu HY, Kaale L, Morpeth SC, Ostermann J, Mtweve SP, Shao JF, Bartlett JA, Crump JA (2009). Morbidity and mortality among a cohort of HIV-infected adults in a programme for community home-based care, in the Kilimanjaro Region of Tanzania (2003–2005). Ann. Trop. Med. Parasitol. 103(3):263-273.
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United Nations Programme on HIV/AIDS (UNAIDS). 2016 Prevention Gap Report
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Mupfurima IM (2013). Home based care for HIV and AIDS patients: A case of Rujeko C suburbs Masvingo urban Zimbabwe. Int. J. Acad. Res. Prog. Educ. Dev 2(2):99-112.
Chesney MA. The elusive gold standard. Future perspectives for HIV adherence assessment and intervention. J Acquir Immune Defic Syndr. 2006;43 Suppl 1:S149-155. Available at http://www.ncbi.nlm.nih.gov/pubmed/17133199.
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McPherson-Baker S, Malow RM, Penedo F, Jones DL, Schneiderman N, Klimas NG. Enhancing adherence to combination antiretroviral therapy in non-adherent HIV-positive men. AIDS Care. 2000;12(4):399-404. Available at http://www.ncbi.nlm.nih.gov/pubmed/11091772.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524193EnglishN2017February10HealthcareBlack to Pink: A Case Report of Treating Gingival Hyperpigmentation
English1417Renganath M. J.1English Ramakrishnan T.2English Vidya Sekhar3English Manisundar N.3English Ebenezer M.4English Anithadevi S.1EnglishAim: Gingival depigmentation is a periodontal plastic surgical procedure by which the gingival hyperpigmentation is removed or reduced by various techniques. The present case report aims at yielding aesthetically acceptable results by using scalpel for depigmentation that doesn’t require any elegant instruments or apparatus.
Case Report: A 23 years old female patient with the chief complaint of blackish discoloration of her gums. On intraoral examination, the gingiva presented with generalized pronounced blackish melanin pigmentation which was un-aesthetic while smiling. Depigmentation using Scalpel was performed by complete removal of hyper-pigmented gingiva.
Discussion: Even though numerous techniques have been employed for depigmentation, the selection of a technique should predominantly based on clinical expertise, individual preferences and patient’s affordability. Scalpel was chosen for the present case because of the superior properties like simplified procedure, cost-effective and also complete removal of hyper-pigmented gingiva could be achieved.
Conclusion: With the limitations of present study, it could be concluded that gingival depigmentation using scalpel was easy to perform, cost-effective and above all it causes minimum discomfort to the patients with excellent results and patient satisfaction.
EnglishGingival hyperpigmentation, Blackish gingiva, Melanin pigmentation, Scalpel depigmentationINTRODUCTION:
A charming smile can open doors and knock down barriers that stand between an individual and a situs slot, richer life.1 If the teeth is considered as the canvas of a painting, then the gum tissue will be the frame around the canvas. In other words, the gum tissue can make or break a smile.
The colour of the gingiva is determined by numerous factors that includes the size and number of blood vessels, thickness of the epithelium, the quantity of keratinization, and the pigments within the epithelium.
The colour of the attached and marginal gingiva is generally described as “coral pink” due to the thickness and degree of keratinization of the epithelium, the vascular supply and the presence of pigment-containing cells.2
Brown or dark pigmentation of the gingival can be caused by a array of local and systemic factors. Systemic conditions such as antimalarial therapy, malignant melanoma, Peutz-jeghers syndrome, Albright’s syndrome, trauma, endocrine disturbances hemachromatosis, chronic pulmonary disease and racial pigmentation are the identified causes of oral melanin pigmentation.3
Melanin is a non- hemoglobin-derived brown pigment, present in all normal individuals but high levels of oral melanin pigmentation are observed in individuals of African, East Asian.
The distribution of pigmentation in oral cavity in black individuals is as follows: gingiva, 60%; hard palate, 61%; mucous membrane, 22%; and tongue, 15%. Gingival pigmentation occurs as a diffuse, irregularly shaped brown and light-brown patch. It may appear in the gingiva as early as 3 hours after birth, and it is often the only evidence of pigmentation.4
During recent years, the need for aesthetics in dentistry has increased, with a growing demand for a pleasing smile. This has made many individuals more aware of their gingival pigmentation, which may be apparent during smiling and speech. Gingival depigmentation is a periodontal aesthetic surgical procedure by which the gingival hyperpigmentation is removed or reduced by a range of techniques. The first and foremost indication for depigmentation is the patient’s demand for improved aesthetics.
Traditionally, gingival depigmentation has been carried out with the use of nonsurgical and surgical procedures that includes electrosurgical, cryosurgical, and chemical techniques. However, those techniques were met with uncertainty because of their varying degrees of success. More recently, lasers have been used to ablate cells that produce the melanin pigment.5
The present case report reveals a simple and effective surgical depigmentation technique that doesn’t require any elegant instruments or apparatus, but yields aesthetically acceptable results.
CASE REPORT:
A 23 years old female patient reported to department of Periodontology, Adhiparasakthi Dental College and hospital, Melmaruvathur, with the chief complaint of brownish discoloration of her gums, by which she was feeling unpleasant while smiling. On intra oral examination, the gingiva presented with generalized pronounced blackish melanin pigmentation associated with a healthy periodontium [Fig:1]. The patient had acceptable oral hygiene levels, with good plaque control and no other systemic conditions.
Considering the patient’s concern, an arch based surgical gingival de-pigmentation procedure was planned. Under local anaesthesia, the hyper-pigmented gingiva in the maxillary arch was de-epithelised using no.15 BP blade by scrapping off the pigmented gingiva in-between distal aspects of tooth no.13 to 33 [Fig:2]. Following de-epithelisation, the site was irrigated thoroughly with saline and the surgical site was secured by placing periodontal dressing (COE Pack™) over it [Fig:3]. One week following the surgery, the patient was reviewed and the periodontal dressing was removed where, the gingiva exhibited excellent healing and improved color change from brownish to pink at 1 week [Fig:4] and 1 month [Fig:5] post-operatively.
Thereby, the depigmentation for mandibular arch was instituted 2 weeks following de-pigmentation of maxillary arch. The procedure for mandibular arch was performed same as that of maxillary arch in-between distal aspects of tooth no.33 to 43 [Fig:6] using scalpel. Periodontal dressing was placed over the surgical site following de-pigmentation [Fig:7]. The periodontal dressing was removed 1 week following the surgery. The gingiva in mandibular anterior region also exhibited enhanced colour change from brownish to pink 3 months following the surgery situs judi slot online deposit pulsa tanpa potongan].
DISCUSSION:
Numerous techniques have been employed so far for the treatment of gingival hyperpigmentation and to enhance the aesthetics of the patient. Various techniques for gingival depigmentation include:
1. De-epithelization:
a. Scalpel technique
b. Gingival abrasion technique using diamond bur
c. Combination of the scalpel and bur
2. Gingivectomy
3. Free gingival autografting, Acellular dermal matrix allograft.
4. Electrosurgery
5. Cryosurgery:
a. Using liquid nitrogren
b. Using a gas expansion system
6. Chemical agents:
a. 90% phenol and 95% alcohol
b. Ascorbic acid
7. Laser:
a. Diode laser
b. Nd:YAG
c. CO2 laser
d. Argon laser
Even though the above techniques may be employed for depigmentation, selection of a technique should predominantly based on clinical expertise, individual preferences and patient’s affordability. They should be performed cautiously in such a way to protect adjacent tissue. Because inappropriate technique may lead to gingival recession, damage to the underlying periosteum and may even cause pain, discomfort and uneven wound healing. Scalpel have been chosen for the present case because of the properties like, relatively simple and effective, and most economical of all the other techniques available. Also de-pigmentation using scalpel does not require any sophisticated armamentarium, easy to perform and, most importantly, requires minimum time and effort.6
The procedure essentially involves surgical removal of the gingival epithelium along with a layer of the underlying connective tissue under adequate local anaesthesia and allowing the denuded connective tissue to heal by secondary intention. The new epithelium that forms is devoid of pigmentation.7
All remnants of the pigment layer should be removed cautiously to avoid probabilities of recurrences and in such a way without exposing the underlying bone.
Also, the healing period for scalpel wound is faster than other techniques; it would result in spiteful haemorrhage during or after surgery. Hence, it is obligatory to cover the surgical site with periodontal dressing for 1 week.8
Lasers when used, have the combined advantages of rapid healing of the scalpel surgery and the minimal bleeding of electrosurgery. A single step laser treatment is usually sufficient to eliminate the pigmented gingiva and does not require a periodontal dressing. However, laser surgery does have some disadvantages. Delayed type of inflammatory reaction may occur with mild post-operative discomfort lasting up to 1–2 weeks. Re-epithelialisation is delayed as compared to conventional surgery due to lack of wound contraction. Moreover, expensive and sophisticated equipment makes the treatment very expensive with added disadvantage of loss of tactile feedback with the use of lasers.9
Scalpel was chosen for the present case because of the superior properties like simplified procedure, cheapest and also complete removal of hyper-pigmented gingiva could be achieved.
Studies have reported that after surgery, it was crucial to cover the exposed lamina propria with the periodontal dressing for 7-10 days following surgical removal of hyper-pigmented gingiva. They also stated that it took apparent 6 weeks to heal and the surgical site left a subtle scar.10 But, in the present case, there was no scar formation after healing time which was 2-3 weeks. The obtained results were admirable with 3 months follow-up.
Though the cryosurgery and laser therapy modalities achieved satisfactory results, they required refined equipment that is not commonly available in all the scenarios. Therefore, consideration the equipment constraints, is highly recommended that the scalpel surgical technique still exists as supreme technique of choice for gingival depigmentation at most circumstances.
It has been documented in the literature that, recurrence following depigmentation has occurred, within 24 days to as long as 8 years. The mechanism for recurrence suggested that the melanocytes gets proliferate and migrate into the depigmented areas.11
CONCLUSION:
Gingival melanin pigmentations is a more common finding in Indian population. Though, not all the cases requires treatment to correct the melanin pigmentation of gingiva, certain individuals requires intervention due to aesthetic issues. Numerous techniques are available with some benefits and some downsides. The case presented here, have been treated with scalpel because of its simple and effective procedure for gingival melanin hyperpigmentation, which resulted in enhanced aesthetics and cosmetic appearance. However, further studies with large population and with long-term follow-up should be done to evaluate the clinical benefits, to observe the treatment stability and re-pigmentation patterns and also to focus on preventing the source of recurrence.
Acknowledgement:
The authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=91http://ijcrr.com/article_html.php?did=91
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Kathariya R, Pradeep AR. Split mouth de-epithelization techniques for gingival depigmentation: A case series and review of literature. J Indian Soc Periodontol 2011;15:161-8.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524193EnglishN2017February10HealthcarePrediction of the Protein 3D Structure of Fimbrial Protein Fim a Type 1 of Porphyromonas Gingivalis - Strain ATCC 33277(A Keystone Periodontal Pathogen) using Homology Modeling and Structure Analysis
English1823Priyanka K. CholanEnglish Judith Grace JenefaEnglishIntroduction: Porphyromonasgingivalis, is a bacterium that has high degree of association with periodontitis, specially due to the expression of a wide array of virulence factors, of which the fimbriae is of particular interest owing to its adherence and colonization potential in the subgingival niche. This study deals with the determination of the protein 3D structure of major fimbriaefim A type-1of the pathogen Porphyromonasgingivalis–strain ATCC 33277.
Materials Used: FASTA (Fast Adaptive Shrinkage Thresholding Algorithm) protein sequence from NCBI Database, Homology modeling server Swiss-model workspace, CASTp (Computed Atlas of Surface Topography of protein) server, Pro-Q (proetein quality predictor) and PROSESS ((Protein Structure Evaluation Suite and Server).
Methodology: The FASTA protein sequence of fimA type-1 of P. gingivalis– strain ATCC 33277 was retrieved from NCBI database (NCBI- National Centre for Biotechnology Information). The 3D structures of the protein were determined by homology modeling server Swiss-Model workspace. Three models were predicted, and the most relevant structure is estimated by passing various quality assessments steps like ProQand validating test –PROSESS
Results: The protein 3D modeling of major fimbriae fimA type-1 of the pathogen Porphyromonasgingivalis–strain ATCC 33277were subjected to a series of quality check steps and the three most relevant models were prognosticated. In association with this, model 3 was considered to be the most valid and likely structure of fim A type 1.
Conclusion: This study paves way for future studies to be performed in this field including the identification of the protein structure and functions, its pathogenic role in periodontitis and thereby targeting the active sites and hence disease prevention.
EnglishFim A type-1,3D structure, FASTA, Swiss model, CASTp, ProsessINTRODUCTION
Porphyromonasgingivalis situs slot , a predominant black-pigmented anaerobic rod of the red complex group residing in subgingival biofilms, is widely recognized as a major contributor to the development of periodontal diseasesand other systemic infections, including coronary artery disease, stroke, diabetes mellitus, preterm delivery of low birth weight infants (1,2). P.gingivalis harbors many virulence factors including factors like fimbriae, haemagglutinin, capsule, lipopolysaccharide (LPS), outer membrane vesicles, organic metabolites such as butyric acid and various enzymes such Arg- and Lys-gigipains, collagenase, gelatinase, hyaluronidase and proteases(3). Among the various virulence factors -Fimbriae is a critical factor for colonization of P. gingivalis in the sub-gingival tissues and gingival crevices by the fimbriae-mediated adherence to the gingival epithelial cells (1).
Fimbriae are thin filamentous and proteinaceous surface appendages found in many bacterial species that plays an important pathogenic role in bacterial invasion. Fimbriae of P. gingivalis are composed of constituent (subunit) protein, fimbrillin, with a molecular weight of 40-42 kDa by sodium dodecyl sulfate-polyacrylamide gel electrophoresis.Ultra-structural examinations of these strains have shown that peritrichous fimbriae vary in length from 0.3 to 3 mm and are 5 nm wide (1,4) and have been classified as major or long fimbriae (FimA) based on their fimbrillin monomer configuration(5-7).
Lee et al.1991compared fimbriae diversities of size and amino terminal sequence of fimbrillins from various P. gingivalis strains; they differed in molecular weights rangingfrom 40.5 to 49 kDa and were classified into four types (types I to IV) based on the amino-terminal sequences of fimbrillins. Further molecular and epidemiological studies using PCRmethod to differentiate possibly varied bacterial pathogenicity revealed that P.gingivalis fimbriae are classified into six genotypes based on the diversity of the fim Agenes encoding each fimbrillin (types I to V, and type Ib (3,8).
The long fimbriae are primarily responsible for many of the adhesive properties of the organism, binding specifically to and activating various host cells, such as human epithelial, endothelial, and spleen cells, as well as peripheral blood monocytes, resulting in the release of inflammatory cytokines and several distinct adhesion molecules (9,10,11,12).
Currently, determining the three dimensional protein structures are of great significance in the field of medicine as many different types of biological experiments such as site-directed mutagenesis or structure-based discovery of specific inhibitors can be performed. Indeed, the number of structurally characterized proteins is small compared with the number of known protein sequences.
There are various methods of identifying the protein structures, including -a.genetic methods–site-directed mutagenesis, conceptual translation -b. Protein purification: chromatography, protein assay, gel electrophoresis, electro-focusing; -c. Advanced studies such as x-ray crystallography, protein NMR, cryo-electron microscopy, small angle scattering, etc. These methods seem to be extensive and very tedious. Thus computational methods for modeling 3D structures of protein have been developed to overcome these limitations.Some of them include: molecular dynamics, protein structural alignment, protein ontology. The number of possible folds in nature appears to be limited and the 3D structure of proteins are better conserved than their sequences, it is possible to identify a homologous protein with a known structure (template) for a given protein sequence (target). In these cases, homology modeling has proven to be the preferred method of choice to generate a dependable 3D model of a protein from its amino acid sequence as impressively shown in several meetings of the bi-annual situs judi slot online deposit pulsa tanpa potongan experiment. Hence this study was aimed at the identification of the protein3D structure of the major fimbriae fimA type-1 of Porphyromonasgingivalis strain ATCC 33277, by using homology modeling.
MATERIALS AND METHODOLOGY
(i) Homology modeling
Homology modeling is routinely used in many applications, such as virtual screening, or rationalizing the effects of sequence variations. To build a homology model, one must follow the following four fundamental steps:
(1) Identifying of the structural template(s),
(2) Aligning the target sequence and template structure(s),
(3) Building a model and
(4) Evaluating the quality of the model.
These steps can be repeated until a satisfying modeling result is achieved. Each of the four steps requires specialized software as well as access to up-to-date protein sequences and structure databases (13).
Further research in homology modeling brings out the use of seven detailed steps including,
1. Template recognition and initial alignment
2. Alignment correction
3. Backbone generation
4. Loop modeling
5. Side-chain modeling
6. Model optimization
7. Model validation (14)
(ii) FASTA- Sequence Alignment Program
For performing the first step in homology modeling, simple sequence alignment programs are used. In this case, modeling of P. gingivalis - fim-A protein is performed by the Fast Adaptive Shrinkage Thresholding Algorithm, FASTA which was first developed by Pearson and Lipman. This compares the test sequence and the query sequence and helps in formatting a template, which in turn provides us with a sequence.
(iii) SWISS-MODEL Workspace
With this sequence, further modeling is done using the SWISS-MODEL.There are various modeling modes in the SWISS-MODEL and the mode “My workspace” is used here. SWISS-MODEL workspace is an integrated Web-based modeling expert system. For a given target protein, a library of experimental protein structures is searched to identify relevant templates. On the basis of a sequence alignment between the target protein and the template structure, a three-dimensional model for the target protein is procured.The template structure database used by this workspace is derived from the Protein Data Bank (15). Thus homology modeling with SWISS-MODEL workspace has proved to be effective in determining the 3D protein structure of fim A of P. gingivalis and the following models were obtained- (refer figure - 1)
(iv)CASTp- Computed Atlas of Surface Topography of proteins
The active sites or pockets in the protein were identified by using CASTp and are highlighted with green in the models. (Refer figure -2). The proteins function through certain sites and hence recognition and identification of these active sites is essential to understand the function of the proteins. These active sites can be inhibited, which will in-turn reduce the action of the bacteria.
(v) ProQ – protein quality predictor
ProQ is a software to check the quality of the obtained model (refer figure 3). If the predicted structure satisfies the validation parameters of ProQ then the structure was taken for further analysis. The following results were obtained for the various models. (refer figure -3)
(vi) PROSESS- Protein Structure Evaluation Suite and Server
Model-3 is the one,which shows much higher scores when compared to the other models. Thus this model was further assessed by Protein Structure Evaluation Suite and Server, PROSESS, to validate the model obtained.
The covalent bonds/peptide bonds play an important role in determining the shape of the protein that is very important for its function. The bond links the adjacent amino acid residues inaproteinformed by condensation reaction between the amine group of one amino acid and the carboxyl group of another with the release of a water molecule. These bonds are highly specific, thus they are important in determining the structure of the protein. (16)
The non-covalent bonds also referred to as interactions are weak bonds and maintains the 3D structure of the large protein molecules. Their existence is transientand multiple bonds act together to produce highly stable and specific associations between different parts of a large molecule. (17)
These angles are important local structural parameters that control protein folding and provide the flexibility required for the polypeptide backbone to adopt a certain fold. Thus they provide insights into the function of the protein.
DISCUSSION
The function of the protein depends on its structure. The structure in-turn depends on the physical and chemical parameters. Although the information needed for life is encoded by the DNA molecule, the dynamic process of life in maintenance, replication, defense and reproduction are carried out by these proteins. Thus obtaining the three dimensionalproteinstructure provides us with information about the medicinally relevant receptors, small ligands, etc and targeting this protein in the pathogen for therapy is essential with many benefits, including, decreasing the dosage of the drug, reduced adverse effects, low rates of drug toxicity, faster rates of action and definitive outcomes. Drugs are ligands that not only fit onto the binding pocket of the target protein, but are also absorbed, transported, distributed to the right compartment. It is highly stable to metabolization, safe, free of side-effects and chemically stabile in the formulation. Finding a lead compound, optimizing its properties and obtaining a drug takes enormous time and money. This in turn is simplified by varied molecular modeling tools (18) (refer figure 4). The current study which is at its nascent level dealing with targeted drug delivery has promising results down the road.
Any protein structure has four levels including primary, secondary, tertiary and quaternary structures respectively. Primary structure is the linear sequence of amino acids. Secondary structure is the local con-formation of α-helixes, β-sheets and random coils. The angle between two adjacent amino acids is called torsion angle, which deter-mines the twists/turns of the sequences resulting in secondary structure. Tertiary structure (3D) results from the packing of secondary structural elements at a stable conformation. Quaternary structure is combination of one or more subunits or chains. (18). Obtaining an accurate model through the conventional techniques such as NMR (nuclear magnetic resonance spectroscopy) analysis or X-ray diffraction techniques is time consuming and elaborate. Thus homology modeling proves to be one of the most valid and efficient means of obtaining an accurate model of protein.
And so, inthis study, the protein 3D structure of fimA type 1 of P. gingivalis was found by using the afore mentioned technique of SWISS MODEL workspace. This included obtaining the FASTA sequence by using the amino-acid sequence, which was then used for homology modeling from which the three models were obtained (refer figure 1). Model quality assessment tools are used to evaluate the reliability of the resulting models. With the help of CASTp, the active sites were predicted for the three protein models (refer figure 2). These structures obtained were validated by ProQ and the LG scores were 0.783, 3.142 and 4.547 respectively and the Max Sub scores were 0.059, 0.207 and 0.298 respectively (refer figure 3).Subsequently, model 3 was considered the finest model and with this model further analysis was made. PROSESS was done to assess the quality of the structure obtained and the results were tabulated in the above mentioned manner (refer results). The values of the covalent bond quality showed a high score of 6.5. But certain values related to the non-covalent bond quality and the torsion angle qualityhowever, showedlower values of about 3.5. This becomes a limitation of the protein modeling of fim A type 1 of P.gingivalis and further laborious studies are required to validate the above results and predict the appropriate structure making use of our analysis.
This homology modeling technique is currently the most meticulous and time saving computational method to generate reliable structural models and is frequently used in many biological scenarios. Normally, the computational effort for a modeling project is fairly less and lasts only for a few hours. However, this does not include the time required for visualization and interpretation of the model, which may vary depending on the personal experience working with protein structures.
Thus this study has resulted in the identification of the three dimensional protein model of fimA type 1 of P.gingivalis –strain ATCC 33277, which is an extremely good model – a model verified and validated by many tests. This study is only the beginning of an elaborate and extensive research work that must be carried out to aid in the discovery of targeted drugs and other substancesthat can inactivate the periopathogen at the very germinal stage of adhesion to the host.
CONCLUSION
Thus, from the above modeling performed andafter being subjected through a series of analysis, MODEL-3 was found to be more accurate when compared to the other models obtained. Thus avalidated three dimensional model or a protein structure of the fim-A type-1 of P.gingivalis isobtained through homology modeling. Identifying this protein structure is only the initial step for manifoldrigorous time-consuming procedures including identifying and proving the functions of the protein and its pathogenic role in periodontitis and finally targeted drug delivery. Even though targeted drug delivery seems to be one of the leading ways in therapy for a myriad of diseases, its role in periodontitis is still questionable and continues to remain a myth whatsoever!!
ACKNOWLEDGEMENTS
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Conflicts of interest: None
Source of Funding: None
Englishhttp://ijcrr.com/abstract.php?article_id=92http://ijcrr.com/article_html.php?did=921. Morten Enersen1, Kazuhiko Nakano, Atsuo Amano. Porphyromonasgingivalis fimbriae . J Oral Microbiol 2013; 5: 20265.
2. Holt S, Ebersole J. Porphyromonasgingivalis, Treponemadenticola, and Tannerella forsythia: the ‘‘red complex’’, a prototype polybacterial pathogenic consortium in periodontitis. Periodontol 2000 2005; 38: 72-122.
3. Shigenobu Kimura, Yuko Ohara-Nemoto, Yu Shimoyama, Taichi Ishikawa and Minoru Sasaki.Pathogenic Factors of P. gingivalisand the Host Defense Mechanisms.Intechopen 2012; 1 : 1-17.
4. Lamont RJ, Jenkinson H. Life below the gum line: pathogenic mechanisms of Porphyromonasgingivalis. MicrobiolMolBiol Rev 1998; 62: 1244-63.
5. Dickinson DP, Kubiniec MA, Yoshimura F, GencoRJ.Molecular cloning and sequencing of the gene encoding the fimbrial subunit protein of Bacteroidesgingivalis. J Bacteriol 1988; 170: 1658-65.
6. Lee JY, Sojar HT, Bedi GS, Genco RJ. Porphyromonas (Bacteroides) gingivalisfimbrillin: size, amino-terminalsequence, and antigenic heterogeneity. Infect Immun 1991; 59: 383-9.
7. Wu H, Fives-Taylor P. Molecular strategies for fimbrial expression and assembly. Crit Rev Oral Biol Med 2001; 12: 101-15.
8. Slots J, Gibbons RJ. Attachment of Bacteriodes melaninogenicus subsp. asaccharolyticus to oral surfaces and its possible role in colonization of the mouth and periodontal pockets. Infect Immun 1978; 19: 254-64.
9. Holt S, Ebersole J. Porphyromonasgingivalis, Treponemadenticola, and Tannerella forsythia: the ‘‘red Complex’’, a prototype polybacterial pathogenic consortium in periodontitis. Periodontol 2000 2005; 38: 72-122.
10. Lamont RJ, Jenkinson HF. Subgingival colonization by Porphyromonasgingivalis. Oral Microbiol Immunol 2000; 15: 341-9.
11. Amano A, Nakagawa I, Okahashi N, Hamada N. Variations of Porphyromonasgingivalis fimbriae in relation to microbial pathogenesis. J Periodontal Res 2004; 39: 136-42.
12. Amano A. Molecular interaction of Porphyromonasgingivalis with host cells: implication for the microbial pathogenesis of periodontal disease. J Periodontol 2003; 74: 90-6.
13. Konstantin Arnold, Lorenza Bordoli, Ju¨ rgenKopp and TorstenSchwede. The SWISS-MODEL workspace: a web-based environmentfor protein structure homology modeling. Bioinformatics 2006; 22: 195–201
14. Elmar Krieger, Sander B. Nabuurs, and GertVriend. Homology modeling. 2003; pages 507-521.
15. Lorenza Bordoli, Florian Kiefer, Konstantin Arnold, Pascal Benkert, James Battey and TorstenSchwede. Protein structure homology modeling using SWISS-MODEL workspace. Nature Protocols 2008; 4: 1 – 13.
16. Ardala Breda, Napoleao Fonseca Valadares, Osmar Norberto de Souza, and Richard Charles Garratt. Protein structure, Modelling and Applications. Chapter A06, September 14, 2007; Pages1-185.
17. S. Brindha, Sangzuala Sailo, Liansangmawii Chhakchhuak, Pranjal Kalita, G. Gurusubramanian , N. Senthil Kumar.Protein 3D structure determination using homology modeling and structure analysisSci Vis 2011; 125-133.
18.Lodish H, Berk A, Zipursky SL, et al. Molecular Cell Biology- Purifying, Detecting and Characterizing. 5th edition; Section 3.6: Pages 86-99.
19.Socransky SS, Haffajee AD, Cugini MA, Smith C, KentRL. Jr. Microbial complexes in subgingivalplaque. J. Clin Periodontol 1998; 25: 134-44.
20. Socransky SS, Haffajee AD. Periodontal microbial ecology. Periodontol 2000 2005; 38: 135-87.
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24. Handley PS, Tipler LS. An electron microscopic survey of thesurface structures and hydrophobicity of oral and non-oral species of the bacterial genus Bacteroides. Arch Oral Biol 1986;31: 325-35.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524193EnglishN2017February10HealthcareHematological and Bone Marrow Biopsy Evaluation in Non Hodgkin Lymphoma
English2427Kanwalpreet Kaur1English Nidhi Sharma2English Karuna Gupta3English Sandhya Gulati4English Prerana Choudhary5EnglishAim: Bone marrow evaluationis an integral part of staging workup in patients with Non-Hodgkin’s lymphoma (NHL). Aim of this study is to analyze incidence and histological pattern of bone marrow involvement in diagnosed cases of NHL.
Methodology: This is a retrospective study on 85 patients diagnosed with NHL. Bone marrow biopsy was performed under local anesthesia as a part of staging workup in cases of NHL. Complete blood counts (CBC) were also noted in each case.
Results: In this study, NHL cases comprised of low grade NHL 68.2%, intermediate grade 28.2% and high grade 3.5%. The age ranged from 10 to 75 years and M: F ratio was 1.07:1. 38.8% (33/85) cases showed bone marrow involvement. Majority of bone marrow involvement was seen in indolent lymphomas (87.8%). Most common pattern of involvement was mixed (12/33) followed by diffuse (9/33), interstitial (8/33) and nodular (4/33). 87.9% cases showed increase in reticulin which included reticulin grade 1(9/33), grade 2(14/33) and grade 3(6/33). Only 48.5% cases of bone marrow involved cases had CBC abnormalities while 51.5% were completely normal. CBC abnormalities included anemia (5/16), leucopenia (3/16), leukocytosis (8/16) and thrombocytopenia (9/16).
Discussion: In the present study, bone marrow involvement by non-Hodgkin lymphoma was seen in 38.8% cases. Other studies also described the incidence of bone marrow involvement from 27.6% to 53%. Predominant involvement was observed in indolent cases which were similarly noted in other studies.
Conclusion: Bone marrow biopsy is an essential part of staging work up of NHL affecting the prognosis and treatment.
EnglishNon Hodgkin lymphoma, Bone marrow infiltration, HemogramIntroduction
Non Hodgkins lymphoma (NHL) includes heterogenous group of neoplasms each with distinct clinical, morphological, immunophenotypic, genetic features and different response to therapy. The incidence of NHL for India was estimated to be 2.2/100,000 with 23,801 new cases[1]. Bone marrow (BM) evaluation is an essential part of staging work up in NHL (modified Ann Arbor staging). The aim of this study was to analyze the incidence and histological pattern of bone marrow involvement in diagnosed cases of situs slot.
Material and methods
This was a retrospective study on 85 patients diagnosed with NHL. Bone marrow biopsy was performed as a part of routine staging workup. Informed consent was taken from each patient before the procedure and performa containing basic information of patient including age, sex and indication of procedure was filled. Bone marrow biopsy was performed under local anesthesia from posterior iliac spine using Jamshidi needle. It was fixed in Bouin’s solution, decalcified in 5% nitric acid for two hours followed by routine paraffin embedding and processing. Multiple serial sections stained with Hematoxylin and eosin and reticulin were examined for histological pattern of infiltration and fibrosis. Complete blood counts (CBC) were also noted in each case by a five part automated analyser.
Results
This study included 85 cases diagnosed with NHL who underwent BM evaluation as a part of staging work up over one year. International working formulation was followed to classify NHL as low, intermediate and high grade. In this study, NHL cases comprised of low grade NHL 68.2%, intermediate grade 28.2% and high grade 3.5%. The age ranged from 10 to 75 years and M: F ratio was 1.07:1.
Bone marrow involvement was seen in 38.8% (33/85) cases. Majority of bone marrow involvement was seen in indolent lymphomas (87.8%) while 12.1% of aggressive lymphomas showed BM involement. None of the highly aggressive lymphoma showed infiltration in BM. Most common pattern of involvement was mixed (12/33) [figure1] followed by diffuse (9/33) [figure2], interstitial (8/33) [figure1] and nodular (4/33) [figure 3]. Increase in reticulin was noted in 34.1% cases which included reticulin grade 1(9/33), grade 2(14/33) and grade 3(6/33). (table 1)
CBC abnormalities were seen in 30 patients. NHL cases without BM involvement showed abnormalities in CBC in 16.5% cases while only 18.8% cases of NHL with BM infiltration showed abnormalities in CBC. Only 48.5% cases of bone marrow involved cases had CBC abnormalities while 51.5% were completely normal(table 2). There was no significant association between abnormal hemogram and BM involvement by NHL on applying Fisher Exact test (P value = 0.062).
CBC abnormalities included anemia(5/16), leukocytosis (8/16), leukopenia (3/16) and thrombocytopenia (9/16) in NHL cases with BM involvement while in NHL cases without BM infiltration showed CBC abnormalities as anemia (10/30), leukocytosis (8/30), leukopenia (2/30) and thrombocytopenia(14/30). Unilineagecytopenia was seen in 5cases, bilineagecytopenia in 10 cases while pancytopenia in 4 cases.
Discussion
In the present study, bone marrow involvement by non-Hodgkin lymphoma was seen in 38.8% cases. Other studies also described the incidence of bone marrow involvement from 27.6% to 53%[2-9]. The reason of difference in incidence of BM involvement is due to differences in histological subtypes in different studies and time elapsed between initial diagnosis of NHL and BM evaluation.
In the present study, majority of bone marrow involvement was seen in indolent lymphomas (87.8%). It was similar to studies of Tarek et al.[8] and Mokhtar et al.[10] which also showed the predominance of marrow involvement in indolent lymphomas.
Small lymphocytic lymphoma (SLL) showed highest incidence of marrow involvement (70%). It was in concordance with results of study of Suneet et al. [7] and Prateek et al. [11]. Diffuse large B cell Lymphoma (DLBCL) had relatively lower frequency of spread of lymphomas to BM (18%). However other studies showed involvement upto 33%[8].This was because most of the tumours in our study were not typed at the time of BM evaluation. They were diagnosed as NHL on fine needle aspiration.
Most common pattern of involvement was mixed (12/33) followed by diffuse (9/33), interstitial (8/33) and nodular (4/33) in this study. It was similar to findings of Arber et al [6] and Suneet et al. [7] however, Foucar et al. [3] found focal involvement to be the predominant pattern. It was because of the large sample size of study with most common lymphoma being follicular lymphoma. Lim et al [9] reported diffuse pattern as the most pattern of involvement.
In this study, 87.9% cases showed increase in reticulin which included reticulin grade 1(9/33), grade 2(14/33) and grade 3(6/33). Increased reticulin deposition is restricted to the areas of infiltration. Reticulin stain is useful in detecting scanty interstitial infiltrates which are not so evident on H&E stains. However, reticulin fibrosis did not correlate with NHL grade. This was similar to findings of study of Prateek et al.[11]
Only 48.5% cases of bone marrow involved cases had CBC abnormalities while 51.5% were completely situs judi slot online deposit pulsa tanpa potongan. This was similar to results of Prateek et al [11]in which 46.8% of NHL showed BM involvement with CBC abnormalities. Abnormal hemogram findings were not useful to predict BM infiltration in NHL. The same was concluded by studies of Hiorns et al12 and Prateek et. al[11].
Conclusion
Bone marrow biopsy is an essential part of staging work up of NHL affecting the prognosis and treatment. Indolent lymphomas showed higher rate of bone marrow involvement than highly aggressive lymphomas. Abnormal hemogram findings did not reveal any correlation with bone marrow infiltration.
Englishhttp://ijcrr.com/abstract.php?article_id=93http://ijcrr.com/article_html.php?did=93
Nair R. Arora N. Mallath M.K. Epidemiology of Non-Hodgkin's Lymphoma in India. Oncology 2016;91:18-25.
Brunning RD, Bloomfield CD, McKenna RW, Peterson L. Bilateral trephine biopsies in lymphoma and other neoplastic conditions. Ann Intern Med 1975;82:365-6.
Foucar K, McKenna RW, Frizzera G, Brunning RD. Bone marrow and blood involvement by lymphoma in relationship to the Luke-Collins classification. Cancer 1982;49:888-97
Varma N, Dash S, Sarode R, Marwah N. Relative efficacy of bone marrow trephine biopsy sections as compared to trephine imprints and aspiration smears in routine hematological practice. Indian J Pathol Microbiol 1993;36:215-26
Schmid C, Isaacson PG. Bone marrow trephine biopsy in lymphoproliferative diseases. J Clin Pathol 1992;45:745-50.
Arber DA, George TI. Bone marrow biopsy involvement by non-?Hodgkin's lymphoma: frequency of lymphoma types, patterns, blood involvement, and discordance with other sites in 450 specimens. Am J Surg Pathol 2005;29:1549-57.
Kumar S, Rau AR, Naik R, Kini H, Mathai AM, Pai MR, Khadilkar UN. Bone marrow biopsy in non-Hodgkin lymphoma: a morphological study. Indian J PatholMicrobiol. 2009 Jul-Sep;52(3):332-8.
Tarek MN, Bolkainy E, Deif WSA, Gouda HM, Mokhtar NM. Evaluation of Bone marrow in 143 Lymphomas: the relative frequency and pattern of involvement, secondary myelopathies, pitfalls and diagnostic validity. Journal of the egyptian nat. cancer inst.2008;20:17-30
Lim EJ, PehSC.Bone marrow and peripheral blood changes in non-Hodgkin's lymphoma. Singapore Med J. 2000 Jun;41(6):279-85.
Mokhtar N, Khaled H (editors). Lymphoma, 1st edition, Cairo, Cairo University Press. 2002,23:0138-190.
Bhatia P, Das R, Ahluwalia J, Malhotra P, Varma N, Varma S, Trehan A, and Marwaha RK. Hematological Evaluation of Primary Extra Nodal Versus Nodal NHL: A Study from North India. Indian J Hematol Blood Transfus. 2011 Jun; 27(2): 88–92.
L. R. Hiorns, J. Nicholls, J. P. Sloane, A. Horwich, S. Ashley, and M. Brada. Peripheral blood involvement in non-Hodgkin's lymphoma detected by clonal gene rearrangement as a biological prognostic marker.Br J Cancer. 1994 Feb; 69(2): 347–351.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524193EnglishN2017February10Healthcare
Knowledge and Practices of Caretakers About Immunization Among Children Aged 12 - 23 Months of Rural block Gudamalani, District Barmer (Rajasthan)
English2833Choudhary Bhagraj1English Solanki S. L.2English S. M. Yadav3English
Background: Immunization done in childhood period almost guarantees protection from many vaccine preventable diseases. It prevents 2 million deaths per year worldwide and is rightly considered to be ‘overwhelmingly good ‘preventive tool by the scientific community. Uptake of vaccination as per national immunization schedule is dependent not only on provision of health services but also on other factors including knowledge and attitude of mothers.
Objectives:
1. To determine immunization coverage of infants according to EPI.
2. To access the knowledge of caretakers of infants aged 12 – 23 months regarding immunization.
Materials and Methods: It was a cross-sectional study conducted from October 2016 to December 2016, included 210 caretakers and 210 infants of 12-23 months old selected by applying the 30 × 7 cluster sampling method in block Gudamalani of district Barmer. Only one infant was included from each caretaker.
Results: Out of total 210 subjects, 111 (52.85%) were males and rest 99 (47.15%) females. BCG was administered to 106 (95.49%) of males and 85 (85.85%) of females, DPT III to 83 (74.77%) of males and 70 (70.70%) of females and Measles to 149 (70.96%) of the total subjects. The dropout rates in both the gender was observed maximum in BCG to Measles (23.58 in males and 20.00 in females) followed by DPT – I to DPT – III (16.16 in males to 9.75 in females). Knowledge about the correct age of vaccination for Measles, BCG, DPT, OPV were 26.67%, 21.43%, 18.57% and 12.85% of the study subjects respectively. Fever (54.28%), swelling (74.76%), redness (60.95%) on thigh after DPT emerged as main side effects of vaccination. Measles (86.19%) and Polio (65.24%) were the most commonly heard diseases, among the vaccine preventable diseases.
Conclusion: Though the coverage rate for vaccine preventable diseases was good in our study, but still there is a need to increase the immunization coverage among the infants, so that not a single child remains unimmunized. Since the infants are vulnerable to infections towards vaccine preventable diseases (VPDs), it necessitates for collection of the data on the knowledge, and practices of the caretakers with respect to different aspects of
EnglishFever, Measles, Vaccine preventable diseases, Side effects
Introduction
“The child is a God’s gift to the family. Each child is created in the special image and likeness of God for greater affection, to love and to be loved.”
In the last 50 years, it was observed that immunization has saved the lives of more children than any other medical intervention. Immunization is one of the best indicators to evaluate the health outcomes and services distributed across various socio - economic groups to prevent a series of major illnesses. According to the NFHS-3 in India, the percentage of immunization increased from 36.0% in (1992), to 42.0% in (1998) and further to 44.0% in (2005) of the children in age one to two years. But it is still, very less than to the desired goal of achieving 85.0% coverage (1). Immunization practices are particularly much valuable in environment where children are undernourished and die from vaccine preventable diseases. Vaccines are safe, simple and cost-effective ways to save and improve the lives of children. Knowing the extensive benefits of immunization, further any imbalances in knowledge, attitude and practices shall be a cause of serious policy concern. Uptake of vaccination services is dependent on provision of the services as well as on other factors including knowledge and attitude of mothers and density of health workers.
The most important factors influencing the attitudes of caretakers was considered to be the cultural receptivity perceived modernity and education, as well as the trust in health workers.
Immunization is a key strategy to achieve the Millennium Development Goals (MDGs) especially to reduce the under-5 mortality rate (U5MR), infant mortality rate (IMR) and proportion of child immunized against measles.
Ever since the launch of EPI in 1978 & UIP in 1985 with promotion through CSSM program & RCH in 1997, there has been considerable progress in control of vaccine preventable diseases, but in spite of the progress every year a large number of children continue to be affected with VPD's.
It is estimated that every year, at least 27 million children and 40 million pregnant women worldwide do not receive the basic package of immunization (as defined by the WHO and UNICEF), and 2 to 3 million people die from vaccine preventable diseases. Around 10 million children under the age of five years die every year and over 27 million infants in the world do not get the coverage of full routine immunization. In the developing world, it does not only prevent about 3 million child death per year but also has the potential to avert additional 2 million deaths if immunization programmes are expanded and fully implemented(2). The accurate measurement of vaccination coverage is an essential step in determining the expected reductions in morbidity and mortality from VPDs. Although the immunization coverage has increased substantially in the recent years but the children aged 12 - 23 months in urban India; only 60% were fully immunized which is less than the desired goal of achieving 85%coverage. Immunization status varies widely across regions, states, strata’s of the society due to socio – demographic factors and availability of health care.
Objectives of the study
To determine immunization coverage of infants according to EPI.
To access the knowledge of caretakers of the infants aged 12 – 23 months regarding immunization.
Methodology
This is a cross-sectional household based study included 210 caretakers and 210 infants of 12-23 months old selected by applying the 30 × 7 cluster sampling method in block Gudamalani of Barmer district with the desired precision of ± 10% and expected coverage of 85% as proposed by WHO(3). House-to-house visits and face-to face interviews were conducted on a pre-tested proforma after taking the consent from the caretakers. Only one caretaker was selected for each infant. Knowledge about vaccine with the site of injection was assessed.
Complete Immunization - Child who has received three doses of DPT, Hepatitis B and OPV each, and one dose of BCG and Measles each.
Partial Immunization - A child who had missed any one or more of the above doses
No Immunization - A child who had not received even a single dose of any vaccine
Drop Out Rate – DPT I coverage – DPT III coverage /DPT I coverage ×100
Results:
In total 210 subjects, males were 111 (52.85%) and 99 (47.15%) females. It was observed that 149 (70.96%) infants were completely immunized and 50 (23.80%) had partial immunization while 11 (5.24%) were not immunized with any vaccine. The percentage of males was higher, (72.97%) among fully immunized children whereas female subjects was higher in both partial (24.24%) and non-immunized (7.07%) subjects. (Table 1)
BCG was administered to 191 (90.95%) of the subjects of which 106 (95.49%) were males and 85 (85.85%) females, whereas OPV – 0 dose was administered to 196 (93.33%) subjects. DPT III was administered to 83 (74.77%) of males and 70 (70.70%) of females. Three doses of Hepatitis B were administered to 84 (75.67%) of males and 70 (70.71%) of females. Measles was administered to 81 (72.97%) of males and (68.68%) of females. (Table 2)
The dropout rates in both the gender was observed maximum in BCG to measles (23.58 in males and 20.00 in females) followed by DPT – I to DPT – III was (16.16 in males to 9.75 in females). Further for BCG to DPT it was (6.60 in males and 3.52 in females) , for Hepatitis B – III to Measles (3.57 in males and 2.94 in females), and lowest for DPT – III to Measles (2.40 in males to 2.85 in females). (Table 3)
When the knowledge of care-givers regarding the various aspects of routine immunization accessed, it was seen that only 30.95% of care-givers knew that children less than five years of age are the candidates for routine immunization under national immunization schedule (NIS). In this study, 57.61% of caretakers had heard for tuberculosis, 86.19% for polio, 24.28%for diphtheria, 18.57% for pertussis, 31.42% for tetanus, 6.67% for Hepatitis B and 65.24% for measles among the vaccine preventable diseases. Knowledge about the correct age for vaccination was 21.43% for BCG and 26.67% Measles, 18.57% DPT, 5.23% Hepatitis B, and 12.85% for OPV. Among the caretakers, 63.33% had the correct knowledge for three doses of DPT, to be given up to the age of one year. Contra-indications of any vaccines were stated as fever (46.67%), cough and cold (45.24%) and diarrhoea (33.33%). fever (54.28%) and the main side effects of vaccination emerged as swelling (74.76%) redness (60.95%) on thigh after DPT.(Table 4)
Discussion:
The main factors for children not being fully immunized and low coverage of immunization may be the lack of knowledge or awareness about the importance of prevention of VPDs and ‘not aware of the needs of vaccination’ as well as the inadequacy of community participation. Therefore keeping every factor in mind the present study was carried out with the objectives of assessing the knowledge of routine child immunization among care-givers of 12 to 23 months old children, finding out the coverage of all the vaccines among the recipients.
In the present study, the subjects were 52.85% males and 47.15% females. These results are similar to study by (4), (5), (6)(51.9%, 58.6%, 53.8% males, and 48.1%, 41.4%, 46.2% females) respectively.
In our study out of 210 infants, 70.96% were fully immunized while 23.80% partially and only 5.24% were non - immunized. Similar results of 72.23% completely immunized and 4.64% non - immunized, were observed in a study by (7)and in another study (8), 73.3% fully immunized and 2.8% non-immunized. In study by (9),(6), a very high 95.0% and 86.67% of complete immunization was observed, whereas (10), (11) observed 69.3% and 60.8%, and, while, the study (10) observed only 44.85% of complete immunization. (Table 1)
We observed 90.95% of infants immunized with the BCG which are comparable to 94.75% by(8)89.1% by (5) and 86.5% by (12) while higher results (98.75%)were observed by (6). In our study we observed DPT – I in 86.19% and DPT – II in 78.57% which is comparable with (12)(84.2% DPT – I and 82.2% DPT – II. Measles vaccine was administered in our study in 149 (70.96%) which is also comparable to 78.3% by (12) whereas study by (6) observed high results 87.62%. (Table 2)
The dropout rate for DPT I to DPT III was 16.02 which is quite comparable to a study 18.0 by (13),(14) and 15 by (8) while dropout rate for DPT I to Measles was 2.40 for males and 2.85 for females, which is much less than the study by (6) 4.72% and 8.79% respectively.(Table 3)
To achieve maximum benefit, it is necessary that immunization coverage should uniformly reach to all levels of society for all vaccine preventable diseases. This requires prompt effort on provision of immunization services and optimum utilization of these services by the target population. Mothers of under-five children are the main target as care givers for childhood immunization and so needed to be significantly aware of the services and benefits of immunization. It requires knowledge about the vaccination, the appropriate age of vaccination along with the impact of morbidity and mortality of vaccine preventable diseases with the benefits and utilization of health services.
In our study, 30.95% of the care-givers knew that under-five children were the candidates for routine immunization, similar to 36.0% by (5). Out of 210 study subjects, 78.57% referred two diseases out of all vaccine preventable diseases correctly, similar to (9) (83.0%) in (16), 85%. In the present study 57.61% of the subjects, named tuberculosis, 24.28% diphtheria, 18.57 % pertussis and 65.24% measles a VPD, similar to study by (11) i.e.52.4% tuberculosis, 23.2% diphtheria, 17.3% pertussis and 61.0% for measles. In our study contra-indication for vaccination indicated by caretakers was 46.67% fever, 45.24% cough and cold and 18.57% diarrhoea, while in a study by (5) it was 37.5% fever, 35.2% cough and cold, 24.8% diarrhoea. Study by (17) reported 24.0% fever, 41.0% for cold and 14.0% for diarrhoea for contra-indication.
In our study 63.33% care givers had the knowledge of three doses for DPT; similar to 60.0% by (17). (Table 4)
Conclusion:
Though the knowledge of the studied mothers about vaccination was not appropriate as reflected by the results of this study for achieving the Millennium Development Goals. It requires for strengthening of the efforts for aggressive campaigning, community involvement with dissemination of information for the success of the universal immunization programme. In this study we had gone through to know the existing levels of knowledge among the mothers and to assess the immunization practices in the areas needed for the improvement. Therefore it can be said that, IEC activities focused on immunization to be implemented sincerely with dense efforts for better coverage in areas with incomplete immunization.
Acknowledgement
Authors acknowledge the immense help received from the scholars, whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/ editors/ publishers of all those articles, and books from where the literature for this article has been reviewed and discussed.
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: Approved by the Institutional ethics committee
Englishhttp://ijcrr.com/abstract.php?article_id=94http://ijcrr.com/article_html.php?did=94
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524193EnglishN2017February10HealthcareDevelopment of an Interactive Website on Metabolic Syndrome and its impact on obese Adolescent Girls
English3438Kalpana C. A.EnglishAim: Metabolic Syndrome has become one of the most severe health problems of the 21st century. In India, the overall prevalence of metabolic syndrome among adolescents is 4.2 per cent. World Wide Web has become indispensable and the most effective distribution channel in this era of digital technology and is convenient to use and capable of reaching adolescents. With this in view, the present study aimed to develop an interactive website on metabolic syndrome, impart nutrition education with the developed website and evaluate its impact on the nutritional knowledge of obese adolescent girls (16-18 years).
Methodology: An informative, responsive website was developed with the domain name metabolicsyndrome-km.com. The website included information on metabolic syndrome, causes, symptoms, risk factors, criteria to diagnose metabolic syndrome, diet plan for adolescents with metabolic syndrome, basic food groups, recommended daily allowances, indicator of metabolic syndrome and body mass index calculations.
Result: The website was developed using Hypertext Markup Language (HTML), Cascading Style Sheets (CSS) and Adobe Photoshop. The calculations and the questionnaire were computed using PHP: Hypertext Preprocessor and JavaScript. The software applications used to create HTML for the nutrition website was Dreamweaver.
Discussion: Obese adolescent girls (198) were educated and instructed to visit the developed metabolic syndrome website and changes in their nutritional knowledge and was evaluated. The nutritional knowledge attained through the website was evaluated by using a control panel with username and password url in which the viewers posted their questionnaire. A significant increase in nutritional knowledge after imparting nutrition education among obese adolescent girls was observed (pEnglishObesity, Metabolic syndrome, Adolescent girls, Nutritional knowledge, WebsiteIntroduction
Adolescence is a prime time for health promotion and for establishment of healthy behavior that influence health in later years. They are at high risk for nutritional morbidity 1. Nutritional problems among adolescents are under nutrition, anemia, overweight or obesity, polycystic ovarian syndrome, eating disorder and metabolic syndrome it is common among adolescents throughout the world it not only affect their growth and development but also in future would their livelihood as adults2.India alone has 105 million adolescent girls and among them an overall prevalence of metabolic syndrome is 4.2 in 16-18 years age group3. Diet of today’s preadolescents and adolescents are low in fruits, vegetables, dairy products, whole grains, and high in total fats, saturated fats and added sugars 4. Changes in dietary habits are important in the treatment of metabolic syndrome. Nutrition health education is an effective method to improve the dietary behavior and provides great opportunity to learn about the essentials of nutrition for health and to take steps to improve the quality of their diets, thus their well5. Ninety three per cent of adolescents in the age groups of 16-18 years go online for nutrition information and the internet has become indispensable for various instrumental purposes6. With this in view, the objectives for the study were to develop an interactive website on metabolic syndrome, impart nutrition education using the developed Website and evaluate the impact of nutrition education on Obese adolescent girls.
Methodology
Assessment of Nutritional Knowledge, Attitude and Practices (KAP) of selected
obese adolescent girls.
A specially designed pre-tested questionnaire which comprised of 35 multiple choice questions was formulated to assess the nutritional knowledge, attitude and practices of selected obese adolescent girls.
Framing the content for the website
The topics considered for the content which aimed to inculcate nutritional knowledge on metabolic syndrome among the adolescents were Causes and symptoms of metabolic syndrome, Risk factors of metabolic syndrome, Treating and preventing of metabolic syndrome, Healthy food guide, Recommended Dietary Allowance, Basic Food groups, Dietary plan for metabolic syndrome and Body Mass Index Indicator for metabolic syndrome. A common logo was selected for all web pages in the website. The logo selected was “Small steps…..right Direction”
Website Development Process: The website was developed with the expertise and help of a web programmer and designer as follows
Site Architecture: The web architecture for navigation and select screens was determined by the web programmer; the screens and interactive tools were created by the web designer.
Content-only Site Framework: A navigation map which outlines the structure of the entire web project, showing all pages within the site and the connections from one page to others was outlined.
Website Production
Templates: Templates were created for typical pages at all levels for the website. Templates are skeleton files used to make finished pages by inserting texts, graphics, and other contents at marked places in templates 7.
Client-side Programming: The Scripts included in the nutrition website were style sheets and Java for the client- side programming. Client-side programs can make Web pages more interactive and responsive8.
Server-side Programming: Jquery and JavaScript programs were used for form processing in Questionnaire of the metabolic syndrome website The Web would be much less useful without the ability to request and process user input data 9.
Typography: Typography is a very important element of Web design. The fonts used in the nutrition website were Arial. The font size used was 14.
Images: Visual impact of shape, colour and contrast, web pages can be interesting graphically and will motivate the visitor to investigate their contents. Using images can enhance almost any web pages if used appropriately10.
Page Layout: Page layout is the part of graphic design that deals with the arrangement and style treatment of content on a page.
Colour: Green colour was used in the main background, white colour was used as a background for the contents and black colour was used with fonts in the contents.
Reviewing and Testing Website
The Website was checked for any spelling mistakes and/or grammatical errors. The page layout was checked for its consistency. The programming written was tested for correct values. After viewing the entire website before it was published, it was rated for its acceptance and satisfaction with the interface and navigation, tone, colour and content of the website and the spelling mistakes were corrected.
6. Publishing the Website: Publishing a website is the process of making it available to the users. It involves actual uploading of the website to a server.
Domain Name: Websites are accessed by an IP address or a domain name. A domain name should be easy to pronounce, spell and remember. It should also relate to the website content. The domain name that was registered for the metabolic syndrome website was metabolicsyndrome-km.com.
7. Uploading the Website: File Transfer Protocol (FTP) program was used to upload files containing each individual web page to the server.
8. Programs and Tools Used
HTML: HTML stands for Hypertext Markup Language. The software application used to create HTML for the metabolic syndrome website was Dreamweaver.
Responsive Website: It is a responsive website and can be viewed easily in any device like computer monitors, tablets, mobiles, etc.
PHP: PHP stands for PHP: Hypertext Preprocessor. Mathematical calculations for Body Mass Index and Metabolic syndrome Calculations in the metabolic syndrome website were done using core PHP.
JavaScipt: JavaScript is a programming language that enhances HTML with animation, interactivity and dynamic visual effects. JavaScript programs were used to the correctness of the data input in the Questionnaire and Metabolic syndrome indicator calculation and calculate Your BMI forms on the client side.
Cascading Style Sheets: The Cascading Style Sheets (CSS) provides the designer the power to control design of the website11. From precise margins to pixel-perfect spacing to fonts and typefaces, CSS was used for the layout method in the metabolic syndrome
Photoshop: Photoshop was used to make the background of the images transparent to merge in the webpage of the metabolic syndrome website. The website can be accessed at metabolicsyndrome-km.com.
9. Implementation of Nutrition Education through the Developed Website
Nutrition education using the developed website on metabolic syndrome was imparted by the following methods.
1. The selected obese adolescent girls were instructed to assemble in a specific classroom fitted with an LCD projector and the investigator made the adolescent girls to view the website with the help of a laptop having internet facility.
2. Since the adolescent girls were students, they were able to view the website in the computer laboratory available in their own campus with due permission from their faculty.
3. The adolescent girls also viewed the website at their homes or in browsing centers and from their own laptops.
10. Evaluation of the Impact of Nutrition Education
Nutrition education was imparted to the obese adolescent girls and they were instructed to answer the questions posted in the questionnaire in the website and was evaluated by using control panel which is sent to the investigators email id by the website developers with username and password http://metabolicsyndromekm.com/admin-cp/. The post test questionnaire was also given in printed form. The post test was carried after duration of three months of nutrition education programme. The difference in scores of nutritional knowledge, attitude and practices was computed and analysed for any impact. Apart from this, the opinion of the selected obese adolescent girls on the developed website was assessed by administrating a designed opinionnaire.
The research design and the protocols used in the study were submitted for scrutinisation and approval to the Institutional Ethical Committee and Ethical Clearance and an approval certificate No : AUW/IHEC-14-15/FHP/FSN-01 was obtained from Avinashilingam University for Women, Coimbatore, Tamilnadu, India
Result
Changes in mean scores for nutritional knowledge of obese adolescent girls
The mean scores for nutritional knowledge of obese adolescent girls before and after education are presented in Table I
Discussion
The scores for nutritional knowledge before education were 4.1 and it had increased to 14.4 after education among the obese adolescent girls in the age group of 16 years, while among the obese adolescent girls in the age group of 17 years, the nutritional knowledge scores before education was 4.3 and it had increased to 15.0 after education and among the obese adolescent girls in the age group of 18 years, the nutritional knowledge scores before education were 4.5 and it had increased to 15.1 after education. Statistical analysis revealed a significant difference (pEnglishhttp://ijcrr.com/abstract.php?article_id=95http://ijcrr.com/article_html.php?did=95
Gouri Kumari Padhy, Anasuya Pattanayak, Dhaneswari Jena (2013), Effectiveness of Planned Teaching Programme on Reproductive Health Among Adolescent Girls. Indian Medical Gazette, Pg. 287.
Gupta, N., and Kochar, G.K. (2009), Pervasiveness of anemia in adolescent girls of low socio-economic group of the district of Kurukshetra (Haryana). The Internet Journal of Nutrition and Wellness, Vol 7(1):pp.12.
Narinder Singh, Ravi Kumar Parihar, Ghanshyam Saini, Sandeep Kumar Mohan, Neeraj Sharma, Mohd Razaq (2013) Prevalence of metabolic syndrome in adolescents aged 10-18 years in Jammu, J and K .Journal of clinical endocrinology and metabolism.
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Qiaoling, Aiuna, LuFeng (2009), To Observe Effect of Nutrition Education in Non-Medical Speciality students. Modern Preventive Medicine, Vol.36 (8), pp.3492-4.
Amanda, L., Kristen, P., Aaron, S., Kathryn, Z. (2010), Teens and Internet Use, Annual Review of Public Health, Vol.30, pp. 273- 292.
Mathew, M. (2011), Creating a Website: The Missing Manual. O’ Reilly Media, Inc., US. Pg.151.
David Flanagan (2008), Javascript: The definitive guide. 5th edition. O’Reilly media, Inc., US. Pg.237.
Lopuck, L., (2011), Web design for dummies. 2nd edition. Wiley publishing, Inc.Pg.265.
Shelly, G.B., Joy L. Starks (2010), Adobe photoshop Cs5: Introductory. Nelson education Ltd., Pg.2.
West, R., Tom Muck, Tom Allen (2009), Dreamweaver Ultra Dev. 4: The Complete Reference. Tata Mc Graw-Hill Publishing Company Ltd. Pg.190.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524193EnglishN2017February10HealthcareIndian Diabetic Risk Score- A Tool For Predicting Risk Of Undiagnosed Type 2 Diabetes Mellitus
English3942Sheikh Mohd Saleem1English Adnan Firdous Raina2English S. Muhammad Salim Khan3English Shah Sumaya Jan4EnglishObjectives: The objective of the study was to assess the performance of the Indian Diabetic Risk Score (IDRS) questionnaire for detecting and predicting risk of Type 2 diabetes mellitus (T2DM) in patients attending a primary health centre.
Material and Methods: We conducted a cross-sectional study comprising 1530 adult participants, age (>20 yrs) attending Outpatient department of a primary health centre located at Harwan, district Srinagar without a diagnosis of Type 2 diabetes mellitus. The risk of developing Type 2 diabetes mellitus was assessed using the validated and widely used Indian diabetic risk score. Total Risk Score of each participant was analysed and compared.
Results: Data on 1530 participants with unknown diabetes mellitus were analysed with the mean age of 51.5 years, majority 54% females, 64.18% belonging to nuclear family and majority were from lower middle socio economic status. Around 99.73% were non vegetarian population with 19.15% having smoking habits. According to Indian diabetic risk score of Madras diabetic research federation the study population were classified to be low, medium and high risk for developing type 2 diabetes were 70.4%, 19.5% and 10.1% respectively.
Conclusion: The IDRS questionnaire designed by Madras Diabetic Research Foundation is a useful screening tool to identify unknown Type 2 diabetes mellitus. The questionnaire is a reliable, valuable and easy to use screening tool which can be used in a primary care setup and better convince people at high risk of Type 2 diabetes mellitus to take action towards healthier lifestyle habits.
EnglishIndian diabetic risk score; Type 2 diabetes mellitus; Prediabetes; Screening; Saleem IDRSINTRODUCTION
The prevalence of diabetes is on an increase due to over growth of population, urban life style, physical inactivity, aging and increasing prevalence of obesity. Diabetes mellitus (DM) affects around 8.3% of worlds adult population, and World health organisation has predicted the total number of cases of diabetes mellitus to rise from 371 million in 2012 to 552 million in 2030 [1]. Due to such a huge burden diabetes mellitus has become one of the most common non-communicable diseases affecting all age groups in urban and rural population without urban rural differences.[2,3] The burden has reached to such limits that we may find a diabetic patient in each house hold in India in coming future. According to WHO SEARO 3, the projected increase by year 2025 will be 70 million diabetic patients in India posing a huge burden to the economic and health care system of country. The patients with Type 2 diabetes Mellitus may often remain asymptomatic for a longer period of time with abnormal blood glucose, cholesterol and triglycerides. In fact, their diagnosis is often delayed until the development of complications or the disease is diagnosed incidentally by a health professional. Moreover, the management of diabetes with complications is more difficult and expensive. Studies have documented that patients with diabetes Mellitus or impaired glucose tolerance had already developed subclinical atherosclerosis even before diagnosis of diabetes mellitus is confirmed [4]. Therefore, early diagnosis of diabetes mellitus could favour the implementation of preventive measures aimed at preventing complications associated with diabetes mellitus. Furthermore, every year around 5%-10% of individuals with impaired fasting glycaemia and impaired glucose tolerance have a greater risk of being diagnosed with Type 2 diabetes mellitus [5]. It is well understood that Type 2 diabetes mellitus is a preventable disease, so earlier detection of population at risk and subsequent follow-up with interventional strategies can prevent Type 2 diabetes mellitus, improve glycemic control, and decrease its incidence in the population and complication associated with it. [6]. Diabetes mellitus risk scores [7] is an easy, less time consuming, non-invasive, and cost effective approach to assess an individual’s risk of Undiagnosed Type 2 diabetes mellitus and dysglycaemia. In our study we have used Indian Diabetes Risk Score (IDRS) developed by Madras Diabetes Research Foundation and Ramachandran A et al.[8,9] which is one of the most frequently used instruments for assessing the risk of diabetes mellitus for Indian population. It comprises of only four variables like Age, Waist circumference, Family history of diabetes and daily physical activity. Indian diabetes risk score assesses whether an individual has undiagnosed Type 2 Diabetes Mellitus or dysglycaemia or the probability of developing Type 2 diabetes mellitus during the following 10 years. Many studies have been done outside Kashmir, India to validate the ability of the Indian diabetes risk score for detection of undiagnosed Type 2 Diabetes Mellitus. However, to our knowledge; no studies have examined the validation of score for detection of undiagnosed Type 2 Diabetes Mellitus in Kashmiri population. We performed this study to evaluate the performance of Indian diabetic risk score for screening of undiagnosed Type 2 Diabetes Mellitus and any dysglycaemia in a representative sample of the kashmiri population living in Harwan Zone, District Srinagar.
MATERIAL AND METHODS
A cross-sectional study was undertaken to evaluate the performance of Indian Diabetes Risk Score among adult patients (age >20 years) attending outpatient department of a primary health centre located at Harwan, district Srinagar. Prior ethical clearance from the departmental head and ethical committee was sought out and only those patients who gave written informed consent were included in the study. A total of 1530 patients participated in the study from January 2016 to July 2016. Each participant was selected using systematic sampling where every third adult patient (age >20 years) attending the Outpatient department of primary health care centre was included in the study. Participants with known diabetes mellitus and pregnant women were excluded from the study. We used Indian Diabetes Risk Score designed by Madras diabetes Research association and Ramachandran et al which is one of the most frequently used instruments for assessing the risk of diabetes mellitus in India. An IDRS value > or = 60 had the optimum sensitivity (72.5 %) and specificity (60.1%) for determining undiagnosed diabetes with a positive predictive value of 17.0%, negative predictive value of 95.1%, and accuracy of 61.3%.[8] Sociodemographic, Anthropometric parameters, Lifestyle factors, Age, BMI, Waist circumference, Family history of diabetes, Use of blood pressure medication, History of elevated blood glucose, Daily physical activity, and daily consumption of vegetables, fruit, and berries were taken into account and recorded on a pre designed Proforma. Total Risk Score of each participant was analysed and compared. Subjects with IRDS score of Englishhttp://ijcrr.com/abstract.php?article_id=96http://ijcrr.com/article_html.php?did=96
Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract 2011; 94(3):311–2. doi:10.1016/j.diabres.2011.10.029 PMID:22079683
Gupta OP, Joshi MH, Dave SK. Prevalence of Diabetes in India. Adv Metab Disord.1978;9:147-65
Chow CK, Raju PK, Raju R, Reddy KS. The prevalence and management of Diabetes in rural India. Diabetes Care. 2006;29:1717-8
Gong W, Lu B, Yang Z, Ye W, Du Y, Wang M, et al. Early-stage atherosclerosis in newly diagnosed, untreated type 2 diabetes mellitus and impaired glucose tolerance. Diabetes Metab 2009; 35(6):458–62. doi:10.1016/j.diabet.2009.05.005PMID:19879790
Nathan DM, Davidson MB, DeFronzo RA, Heine RJ, Henry RR, Pratley R, et al; American Diabetes Association. Impaired fasting glucose and impaired glucose tolerance: implications for care. Diabetes Care 2007; 30(3):753–9. PMID:17327355
Lindström J, Peltonen M, Eriksson JG, Aunola S, Hämäläinen H, Ilanne-Parikka P, et al; Finnish Diabetes Prevention Study (DPS) Group. Determinants for the effectiveness of lifestyle intervention in the Finnish Diabetes Prevention Study. Diabetes Care 2008; 31(5):857–62. doi:10.2337/dc07-2162PMID: 18252900
Lee CM, Colagiuri S. Risk scores for diabetes prediction: the International Diabetes Federation PREDICT-2 project. Diabetes Res Clin Pract 2013; 100(2):285–6. doi:10.1016/j.diabres.2013.01.024 PMID:23415425
Mohan V, Deepa R, Deepa M, Somannavar S, Datta M.A simplified Indian Diabetes Risk Score for screening for undiagnosed diabetic subjects. J Assoc Physicians India. 2005;53:75 63
Ramachandran A, Snehalatha C, Vijay V, Wareham NJ, Colagiuri S. Derivation and validation of diabetes risk score for urban Asian Indians. Diabetes Res Clin Pract. 2005;70(1):63-70.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524193EnglishN2017February10HealthcareASSESSMENT OF QUALITY OF LIFE IN NORMAL INDIVIDUALS USING THE SF-36 QUESTIONNAIRE
English4347Ronika AgrawalEnglishCharleen D SilvaEnglishContext: Quality of life of individuals varies in different cities, countries and continents. It is influenced by lifestyle, infrastructure, emotional and social wellbeing. The Quality of Life (QOL) values of the Western population are available but it cannot be used in Indian setup due to various factors and diversities. It is of utmost importance to know about the quality of life in normal individuals so as to try to aspire to reach those values in the diseased population. Thus, we can try to improve the quality of life in the diseased population.
Aim: To assess the quality of life in normal individuals using the SF-36 Questionnaire
Settings and Design: Permission to carry out the study was taken from the college ethical committee. The study included a consent, assessment form and the SF-36 quality of life questionnaire. Permission for the usage of the questionnaire was procured from OptumInsight Life Sciences, Inc. 400 normal individuals of age group between 35 to 60 years, both males and females not suffering from any disease and educated middle class individuals above 8th grade were included. The exclusion criteria involved psychiatric complications, cerebrovascular disease, cardiovascular diseases, diabetes, neuropathy, chronic joint pain, recent trauma, pregnant females and respiratory diseases.
Methods and Material: A study was conducted using a convenient sampling method and included 400 individuals. The SF-36 questionnaire was used.
Statistical Analysis: Data analysis was done using the SPSS version 14.
Results: The physical component of QOL of individuals between 35-44 years is good in comparison to the other groups. The mental component of QOL is higher in individuals between 35-44 years than in group 54-60 years while group 45-54 years showed poor results. The QOL of males is much better than females both physically and mentally. Education has no effect on the QOL of normal individuals.
Conclusion: The quality of life of middle class Indian population as per SF-36 scoring is around 75 on 100. Mental Component Summary scores are better than Physical Component Summary scores. Quality of Life of males is better compared to females. As aging progresses, QOL reduces. Education has no effect on QOL.
EnglishSF- 36, Quality of Life Questionnaire, Indian Population, PCS, MCSINTRODUCTION:
The quality of life is concerned with the living standard of all the members of the family or society. This is the age of competition and everyone is busy with their personal and professional life. More attention is being given to the development of the quality of life. There has been an increased importance given to the patient’s point of view and is an important aspect in the evaluation of health care outcomes.[1] This has resulted in the use of several questionnaire to assess the health related quality of life. [1]
WHO defines health as “a state of complete physical, mental and social wellbeing and not merely the absence of any disease or infirmity”. Any compromise in the physical, mental and social dimensions of health adversely affects the quality of life of an individual.
To measure the quality of life different questionnaires can be used. The questionnaire has to be such that it can rightly judge the quality of life of individuals. Until recently, there were not many pragmatic measures of health related quality of life developed for use in the general community.[2]
The SF-36 instrument is sensitive to changes in the age, social and financial condition and health of the general population.[1]Measuring quality of life is one of several components for determining intervention effectiveness in primary care settings. The effectiveness of health care is comprehensively determined by measures of clinical changes in patient’s condition, indicators of knowledge and self-management, satisfaction with healthcare provision and quality of life.
Quality of life of individuals varies in different cities, countries and continents. It is influenced by lifestyle, infrastructure, emotional and social wellbeing. The values of the Western population are available but it cannot be used in Indian setup due to various factors and diversities.
It is of utmost importance to know about the quality of life in normal individuals so as to try to aspire to reach those values in the diseased population. Thus, we can try to improve the quality of life in the diseased population. We have chosen SF-36 questionnaire for our study as a comparison of a series of different health status questionnaires indicated that the SF-36 is also more reactive to clinical improvement than the other questionnaires tested.
Materials and methods:
Permission to carry out the study was taken from the college ethical committee. The study included a consent, assessment form and the SF-36 quality of life questionnaire. Permission for the usage of the questionnaire was procured from OptumInsight Life Sciences, Inc. 400 normal individuals were included from co-operative housing societies, hostels, colleges. The inclusion criteria comprised of age group between 35 to 60 years, both males and females who were normal and educated middle class individuals above 8th grade. The exclusion criteria involved psychiatric complications, cerebrovascular disease, cardiovascular diseases, diabetes, neuropathy, chronic joint pain, recent trauma, pregnant females and respiratory diseases. Individuals were explained and informed about the study. 396 individuals filled the questionnaire while 4 individuals did not complete due to lack of time. Only after their written consent they were included in the study. The data taken in the assessment form included name, age, gender, occupation, weight, height, BMI, educational qualification, marital status, economic status and whether the individuals were suffering from any disease or were on any medications.
Statistical Methods: With the help of the scoring software granted by OptumInsight Life Sciences, Inc. the scores were calculated. Data analysis was done with the help of SPSS version 14. Anova was used to find the significance. Level of significance was set at 0.05.
Results:
The physical quality of life of individuals between 35-44 years is good in comparison to the other groups. The mental quality of life is higher in individuals between 35-44 years than in group 54-60 years while group 45-54 years showed poor results. The quality of life of males is much better than females both physically and mentally. Education has no effect on the quality of life of normal individuals.
Discussion:
We have done the study to find out the quality of life in normal population using the SF-36 questionnaire. There are various factors that affect the quality of life in normal individuals. The highest score in the SF 36 questionnaire is 100 and the lowest is 0 indicating poor quality of life.
The mean calculated for Physical functioning(PF) is 75.29 and SD is ±22.81. With the advancement in the technology, many individuals live a sedentary life. They avoid participating in any sports and with the availabilities of elevators, they do not climb the stairs. With aging, there is a loss of muscle strength which in turn results in frailty and it affects the person from living an independent life.[3] The hormonal system also shows decreasing circulating hormone concentrations during normal aging process.[4] Physical activity influences the bone density and bone architecture via the load bearing effect on the skeleton( Lanyon 1987, 1993). Thus, regular exercise can help elderly population to be functionally self-reliant( Buchner 1997, LaCroix et al 1993, Nelson et al 1994). The mean of Physical functioning(PF) is 84.2 and SD is ±23.3 in the United States of America population. The scores are higher in comparison to those got by our study. In western countries, from childhood people are involved in many extra-curricular activities like skating, playing golf, skiing etc and are more physically active.
The mean calculated for role of Physical health (RP) is 78.59 and SD ±31.84 which indicates it as a good score. The mean of Physical health (RP) in United States of America population is 80.9 and SD ±34. There is hardly any difference between the two scores.
The mean calculated for bodily pain(BP) is 73.80 and SD ±21.28 The factors that affects the BP score may be pain due to overuse, poor posture, muscle strain, repetitive stress injury, injury to muscles, ligaments and also the intervertebral discs that supports the spine. As age progresses degenerative changes in the joints also leads to pain. The mean of bodily pain(BP) in United States of America population is 75.2 and SD is ±23.7 which is less than the Indian population.
General health (GH) reflects the individual’s perception of his/her health and his/her attitude towards life. The mean calculated for GH is 73.30 and SD is ±17.77 Health has fundamentals without which no drugs, surgeries will be effective. The fundamentals factors affecting health are good nutrition, exercise, adequate hydration, proper sleep, proper hygiene, sunlight, emotional and spiritual aspects.[5] Negative health consequences associated with retirement have not been demonstrated. Infact some benefits are seen primarily in the psychological domain and in health domain (Gall et al., 1997; Midanik et al., 1995; Osteberg and Samuelsson 1994; Salokangas and Jowkamaa, 1991). The mean of GH in United States of America population is 71.9 and SD is ±20.3 which is almost similar to the Indian population.
Vitality (VT) includes lively feeling, energy, tiredness etc. The mean calculated for Vitality (VT) is 70.53 and SD is ±17.06. Individuals feel more tired and worn out and have difficulty with work of other daily activities due to their physical health and emotional problems. The mean of Vitality (VT) in United States of America population is 60.9 and SD is ±20.9. There is quite a lot of difference in the scores in comparison to the Indian population. This shows that Indian population is more energetic.
Social functioning (SF) interferes with an individual’s social activities like visiting friends, relatives etc. The mean calculated for SF is 75.07 and SD is ±22.28. Factors affecting this score are alcoholism and lack of close ties or bondage with others[5] Alcoholism reduces the health related quality of life in normal individuals [7]The mean of Social functioning (SF) in United States of America population is 83.3 and SD is ±22.7. In foreign countries people live a more extrovert type of life and they are involved in more physical activity. Being out of home on weekend’s leads to social interaction and bonding.
Role of emotional wellbeing (RE) includes problems faced by an individual with work or any other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious). The mean calculated for RE is 78.28 and SD is ±31.38 The mean of Role of emotional wellbeing (RE) in United States of America population is 81.3 and SD is ±33 which is similar to the Indian population. A person’s emotional and social wellbeing can form from their friends, family, sense of belonging, self- image, education and childhood. These factors can shape how a person feels about self and how their friends and family see them. Peoples love and support can boost an individual’s self- confidence and help the individual become happier. If someone is lacking in these areas, this will lower their wellbeing and they will find it hard to have the potential to grow and have a good wellbeing.
Mental health (MH) includes nervousness, feeling of blue or sad, happy, peaceful etc. The mean calculated for Mental health (MH) is 78.11 and SD is ±17.34 This score seems to be good. As on the large scale people are highly educated thus are able to cope up with the daily stress and probably have a good mental health. The mean of Mental health (MH) in United States of America population is 74.7 and SD is ±18.1 which is less in comparison to the Indian population. Indian people are more mentally stable and happy. They have less mental issues in comparison to the western population.
Physical wellbeing depends upon age, mobility, sleep, diet, exercise routine and environment. These are the physical needs to keep the body healthy and happy with no limitations. These physical factors will help maintain an individual’s physical needs and wellbeing.
The Physical Component Summary(PCS) calculated mean is 47.87 and SD is ± 8.17 and Mental Component Summary(MCS) calculated mean is 51.63 and SD is ±8.55. While the United States of America population values for Physical Component Summary(PCS) mean is 50 and SD is ±10 and the Mental Component Summary(MCS) mean is 50 and SD is ±10. Studies published in the past decade demonstrate the health benefits of prayers. Studies show that mortality and quality of life among those frequently attending community services are partly because of improved health practices and partly because of increased social contacts due to meeting every day. [6-9]
The quality of life in males is higher in comparison to females. At workplace men hold higher posts and females are more likely to experience job insecurity, lack of autonomy and less supervisor support, including in relation to work-life balance [10].Women are highly prone to depression than men. The depression in women is high, because of environmental factors. The environmental factors include the gender bias and identity roles.[11] Various hormonal reduction like estrogen also causes harmful effects in women such reduction in the bone density, cardiovascular diseases etc. Non-communicable diseases like cardiovascular diseases, cancers and chronic respiratory diseases strike women at an earlier age in less developed countries. [12]
According to our study, as aging progresses there is a reduction in the quality of life. Age group of 35-44 years has a better quality of life in comparison to the age group of 45-54 years and 55-60 years. Physically unhealthy days increased with age. Mentally unhealthy days decreased with age in the older groups. Limitation of activity refers to a long-term reduction in a person’s ability to do his or her usual activities. The limitations are caused by physical, mental or emotional problems.
There is no statistical significance between the mean values and any of the parameters of the quality of life with respect to education. According to our study, education has no role or effect in the quality of life of an individual.
CONCLUSION
The quality of life of middle class Indian population as per SF-36 scoring is around 75 on 100. Mental Component Summary scores are better than Physical Component Summary scores. Quality of Life of males is better compared to females. As aging progresses, quality of life reduces. Education has no effect on quality of life.
ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles were cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. We would also like to thank all our participants for their valuable time and participation.
Financial Support: None
Conflict of Interest: None
Englishhttp://ijcrr.com/abstract.php?article_id=97http://ijcrr.com/article_html.php?did=97
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Idler and Kasl, 1997. Frequent religious attendance predicted better physical function 8–12 years later. U.S Department of Health and Human Services
Lippe, T. van der et al. (2009). Final Report Quality of Life in a Changing Europe. Deliverable of EU-project Quality, Utrecht: Utrecht University.
Zender R, et al. Women's mental health: Depression and anxiety. Nursing Clinics of North America. 2009;44:355.
Gretchen A Stevens et al., Global mortality trends and patterns in older women .Bulletin of the World Health Organization 2013;91:630-639.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524193EnglishN2017February10HealthcarePredictors of psychological distress and depression among patients with type 2 diabetes mellitus
English4852Siva Ilango T.1English Maithreyi P.2English Siddharth S.3English Anand N. N.4English Nambi S.5EnglishAim: Diabetes mellitus, being a chronic disorder has been found to be associated with psychological distress in the form of anxiety and depression. The present study aimed to ascertain the clinical predictors of psychological distress and depression among patients with diabetes mellitus.
Methodology: The present cross-sectional questionnaire-based study recruited 100 patients with type 2 diabetes mellitus from a tertiary care hospital in India. Presence of distress was assessed using cut-off scores on General Health Questionnaire (GHQ-12). Binary logistic regression analysis was used to find the independent predictors of having psychological distress as per GHQ-12. Depressive symptoms were assessed using Hamilton Depression Rating Scale (HAM-D) among patients who were found to be distressed as per GHQ-12.
Result: Psychological distress as per GHQ-12 cut-off was present in 51% of the sample. The patients with psychological distress were less likely to be married and belong to nuclear family, have a longer duration of diabetes mellitus, have higher fasting and post-prandial blood sugars, and were more likely to have dyslipidaemia, being prescribed insulin, have complications of diabetes mellitus and have a past history of depression. Logistic regression analysis revealed increased fasting glucose and use of insulin to be independent predictors of having psychological distress. Among those with significant distress, 18 (35.3%), 25 (49.0%) and 8 (15.7%) had mild, moderate and severe depressive symptoms according to HAM-D.
Discussion: The present study suggests that several diabetes-related clinical parameters predispose to the occurrence of psychological distress among patients with diabetes.
Conclusion: Clinicians need to be sensitive to the presence of psychological distress and depression in patients with diabetes who have such predisposing factors.
EnglishDiabetes Mellitus, NIDDM, GHQ, Psychological distress, DepressionIntroduction:
Diabetes mellitus is a multi-system disorder characterised by impaired glycaemic control and is associated with arange of medical complications. Adverse events may occur due to medication dosing and complications of the disorder may slowly progress. All these facets make the individuals with diabetes predisposed to have psychological distress in the form of depression and anxiety. [1, 2]
Several factors are likely to influence the occurrence of psychological distress among patients with diabetes mellitus.The relationship of glycaemic control with diabetes related distress has been conflicting with some studies supporting such an association, and others not being able to demonstrate such association. Insulin use, which is an invasive and painful treatment regimen, has been found to be associated with greater psychological distress. [3]
Addressing the psychological distress among patients with diabetes is associated with improved treatment outcomes. The better outcomes with interventions are not only in terms of relieving the distressing symptoms, but also improving the quality of life and general functioning. [4]
India probably houses the largest population of patients with diabetes mellitus. The health-care delivery and cultural characteristics in India are quite different in India, and differ in various regions of India.[5] Given such a high prevalence there is a need understand the prevalence and determinants of psychological distress among patients with diabetes in India. Hence this study aimed to assess the occurrence and predisposing clinical factors among patients with diabetes in Indian tertiary care setting.
Methods:
Setting and sample
The present cross-sectional questionnaire based study was conducted at a tertiary care hospital in south India. The present study was conducted in the outpatient of the department of medicine of the hospital. The present study was conducted among ambulant outpatients with type 2 diabetes mellitus. The inclusion criteria were having type 2 diabetes mellitus for a period of at least 1 year and willingness to participate in the study. The exclusion criteria were those with severe complications precluding an interview and those not willing to provide informed consent.
Procedure
After obtaining informed consent, the participants were recruited into the study. Information was gathered from the patients, their care-givers and medical records using a semi structured proforma. Clinical characteristics recorded included duration of the diabetes in years, recent-most fasting and post prandial blood sugars, recent HbA1c, presence of dyslipidaemia, smoking or alcohol use, medication treatment, h/o depression and complications. Presence of psychological distress was ascertained using General Health Questionnaire (GHQ-12)[7]. The 17-item Hamilton Depression Rating Scale (HAM-D) [8] was used to assess for depressive symptoms in patients scoring above the cut-off for GHQ-12.
Analysis
Statistical analysis was carried out using SPSS version 20. The sample was segregated into two groups: one with psychological distress as per GHQ-12 and one without psychological distress. The two groups were compared between each other using student t test for continuous variables and χ2 test for nominal variables. Multivariable analysis was conducted using binomial logistic regression analysis to find the independent predictors of having psychological distress. The clinical variables including age which showed at least a trend level association (p Englishhttp://ijcrr.com/abstract.php?article_id=98http://ijcrr.com/article_html.php?did=98
Ali S, Stone MA, Peters JL, Davies MJ, Khunti K. The prevalence of co-morbid depression in adults with Type 2 diabetes: a systematic review and meta-analysis. Diabet Med J Br Diabet Assoc 2006;23(11):1165–73.
Grigsby AB, Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. Prevalence of anxiety in adults with diabetes: a systematic review. J Psychosom Res 2002;53(6):1053–60.
De Sonnaville JJ, Snoek FJ, Colly LP, Devillé W, Wijkel D, Heine RJ. Well-being and symptoms in relation to insulin therapy in type 2 diabetes. Diabetes Care 1998;21(6):919–24.
Naseer Ali, Viveka P Jyotsna, Nand Kumar et al., Prevalence of Depression Among Type 2 Diabetes compared to Healthy Non Diabetic Controls. Journal of the association of physicians of India, September 2013, Vol. 61
Amit Raval, Ethiraj Dhanaraj, Anil Bhansali, et al., Prevalence and determinants of depression in type 2 diabetes patients in a tertiary care centre. Indian J Med Res 132, August 2010, pp 195-200.
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311(5):507–20.
Kuruvilla A, Pothen M, Philip K, Braganza D, Joseph A, Jacob KS. The validation of the Tamil version of the 12 item general health questionnaire. Indian J Psychiatry 1999;41(3):217–21.
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Ciechanowski PS, Katon WJ, Russo JE. Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. Arch Intern Med 2000;160(21):3278–85.
Egede LE, Zheng D, Simpson K. Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care 2002;25(3):464–70.
Katon WJ, Rutter C, Simon G, Lin EHB, Ludman E, Ciechanowski P, et al. The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care 2005;28(11):2668–72.
Van Dooren FEP, Nefs G, Schram MT, Verhey FRJ, Denollet J, Pouwer F. Depression and risk of mortality in people with diabetes mellitus: a systematic review and meta-analysis. PloS One 2013;8(3):e57058.
Anderson, R.J., Freeland, K. E., Clouse, R.E., and Lustman, P.J. (2001) The prevalence of co-morbid depression in adults with diabetes. A meta-analysis. Diabetes Care, 6, 1069-1078
Peyrot, M. and Rubin, R.R (1997) Levels and risks of depression and anxiety symptomatology among diabetic adults. Diabetes Care, 20, 585-590
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524193EnglishN2017February10General SciencesMicrobial Fingerprinting - A current vogue in Microbial Forensics
English5357Moumita Sinha1English I. Arjun Rao2EnglishClassification and Identification of the microorganisms are of utmost importance in the field of environmental, industrial, medical and agricultural microbiology, microbial ecology and microbial forensic studies. Conventional phenotype-based methods come across many challenges and shortcomings which limit their usability. Molecular techniques offer better arrangements in recognizing and portraying microorganisms. A few DNA fingerprinting strategies have been produced and are being used as of now. In principle, most of these methods are based on PCR and restriction site analysis. Some of these methods are still not cost-effective in use and require huge set-up cost. Continuous research is going on around the world to improve the methodology and applicability of these methods as well as to make them economic and in routine use in forensic investigations..
EnglishMicrobes, Fingerprinting, DNA, RFLP, MultilocusIntroduction
Microbiology is the investigation of tiny life forms, or any living life form that is either a solitary cell (unicellular), a cell group, or has no cells by any stretch of the imagination (acellular). Numerous microorganisms (organisms) are pathogenic and cause illness while different microorganisms are not a threat to human wellbeing. Microorganisms can aimlessly and unlawfully be utilized as operators of natural fighting, bio-violations and agro fear based oppression. Worried to this, Microbial Forensics rose as interdisciplinary field of microbiology dedicated to the improvement, assessment, approval, and utilization of strategies to distinguish and completely portray microbial specimens containing a natural specialist or its segments1. The principle objective of criminological microbiologist is to distinguish feasible pathogens and recognize their DNA marks to decide the root of likely source. In the late years, another logical train microbial fingerprinting has been set up under microbial legal sciences with a specific end goal to fortify the law implementation reaction particularly in a bioterrorism occasion 2. Microbial fingerprinting strategies are a class of methods that separate microorganisms or gatherings of microorganisms in light of novel attributes of a general part or area of a bio particle (e.g., phospholipids, DNA, or RNA). Microbial fingerprinting strategies give a general profile of the microbial group, and some can be utilized to distinguish subsets of the microorganisms exhibit. This survey article means to reveal some insight into this new train and the strategies utilized as a part of microbial fingerprinting.
Different Microbial Fingerprinting Methods (MPMs)
Microbial fingerprinting strategies can give a full examination of the microbial group. It doesn't require much learning about which microorganisms are of the premium. The hereditary techniques permit distinguishing proof of primary individuals from the microbial group to the family or even class level. It indicates distinctive microorganisms or gatherings of microorganisms in view of one of a kind attributes of a mutual thing or area of a bio atom, (for example, phospholipids, DNA, or RNA). Microbial Fingerprinting Methods are applicable to give a general perspective of the microbial group. It shows microbial differing qualities and tells about sorts of metabolic procedures happening on the site. It likewise distinguishes a subset of the microorganisms introduces in the specimen. Advance, it can recognize the microbial greenery of the specific topographical area which is particular to that area. This is relevant and important because every microorganism has its own signature flora that can determine the surrounding environment of an individual during the criminal investigation. Some of the methods used for microbial fingerprinting are as follows:
PLFA Analysis
Phospholipids are an essential auxiliary segment of the layers of every living cell and separate quickly upon cell demise. In this manner, the mass of PLFAs in an example is an immediate measure of the feasible biomass in the specimen. While all cell layers contain phospholipids, not all life forms or gatherings of creatures contain the same PLFA sorts in similar extents. A few classes of creatures deliver one of a kind or "mark" sorts of PLFA3. Measuring these PLFA assembles in this manner makes a profile or unique finger impression of the reasonable microbial group and gives knowledge into a few essential microbial utilitarian gatherings (e.g., iron-and sulfate-decreasing microscopic organisms).
PLFA examination is like an evaluation of other concoction mixes present as blends (e.g., unstable natural mixes) in ecological examples: (1) extraction, (2) detachment by gas chromatography with fire ionization discovery, and if important, (3) affirmation of recognizable proof by mass spectroscopy. PLFA investigation can likewise be joined with stable isotope testing (SIP) to show that biodegradation is happening by measuring consolidation of the steady isotope mark into biomass. PLFA examination is economically accessible.
DGGE Analysis
DGGE is a nucleic corrosive (DNA or RNA)–based strategy used to create a hereditary unique mark of the microbial group and possibly distinguish overwhelming microorganisms. DGGE profiles are frequently used to look at contrasts or changes in microbial group differing qualities and structure between tests, after some time or space or in light of treatment. DGGE typically includes a four-stage handle: (1) DNA or RNA extraction, (2) intensification, (3) detachment and representation, and (4) grouping recognizable proof. The enhancement step utilizes polymerase chain response (PCR) to produce a large number of duplicates of a variable locale inside an objective quality. The DNA course of action of this variable region is different for each kind of minute living being. Thus, the PCR step makes a mix of the quality bits every addressing a creature bunches appear in the primary example. The third step of DGGE uses an electric current (electrophoresis) and a denaturing system to separate this mix in light of the DNA gathering, making a profile, or exceptional check, of the microbial gathering. Figure 1 exhibits an ordinary acrylamide gel picture: a subset of the individual "gatherings" are isolated (physically cut) from the gel, the DNA progression is settled for each removed band, and the ensuing DNA plan is stand out from a database to perceive the microbial people identifying with each band 4. Promote understanding is construct to a great extent in light of connecting site conditions and exercises to general attributes of the microorganisms that were recognized in the specimen. DGGE is economically accessible.
T-RFLP Analysis
T-RFLP has also been employed to characterize microbial communities 5. Similar to DGGE, T-RFLP is a nucleic acid (DNA or RNA)–based technique that provides a fingerprint of the microbial community and can be used to identify specific microbial populations. T-RFLP is a four-step process: (1) DNA or RNA extraction, (2) PCR amplification, (3) enzyme digestion, and (4) fragment identification. After isolation of the aggregate group DNA or RNA, PCR amplification with a fluorescent labelled PCR primer is utilized to make different duplicates of an objective quality, and the PCR items are then processed with confinement proteins that cut the DNA particle at known arrangements. The span of each subsequent terminal confinement piece is characteristic of a particular microorganism. T-RFLP offers greater sensitivity than DGGE (i.e., it may detect microorganisms that are present at lower numbers in a sample). T-RFLP is commercially available 6.
Other DNA based Advanced Microbial Fingerprinting Methods
Restriction endonuclease analysis of chromosome (REAC)
REAC includes disconnection of chromosomal DNA, processing with at least one limitation compounds took after by their determination into detectable banding examples or "unique mark" after electrophoresis on agarose or polyacrylamide gel. Many pieces running from 0.5-5 kb long are created. The groups acquired are recolored in situ or denatured inside the gel, smeared onto a reasonable layer (nitrocellulose/nylon) and after that recolored. The subsequent example of groups, mirroring the cutting destinations of the specific catalysts in the chromosome, is exceedingly normal for the given strain and is alluded to as the strain's "unique mark". Strains are separated in light of their fingerprints. Separates indicating one band contrast in the unique mark are considered subtypes of each other. Designs having at least 2 band contrasts are for the most part described as various strains. The varieties in the fingerprints acquired by these techniques represent even the minor changes in the hereditary substance of an organism like point transformation, additions, erasures, site particular recombination and change. In this manner, REAC is an exceedingly delicate method and even a solitary occasion bringing about an adjustment in DNA can be followed, along these lines it is a critical apparatus for epidemiological examination for strain writing. REAC helped in following the flare-up of Pseudomonas aeruginosa mastitis among Irish Dairy groups 7. One noteworthy favorable position of this technique is that it includes the entire chromosome, so the strains are thought about on an expansive premise and no earlier learning of grouping information is required. Utilizing REAC all strains can be written. In any case, at times fingerprints are extremely mind boggling and hard to translate. Nearness of plasmid DNA in the response blend can at times meddle with the outcomes. As of late a few PC based examination strategies have been produced that make correlation of REAC examples simple and develop databases for identity searches and epidemiological typing 6.
Restriction endonuclease analysis of plasmid DNA (REAP)
This strategy can be utilized for those microorganisms which harbor plasmids. Plasmids can be recognized promptly by basic lysis system took after by the agarose gel electrophoresis of the lysate 8. The numbers and the sizes of the plasmids present are utilized as the premise of strain recognizable proof. This strain writing method has been utilized effectively for investigation of episodes of nosocomial diseases and group procured contaminations brought about by different types of gram-negative microbes 9-10. A few strains of microscopic organisms convey just a solitary huge plasmid, in the scope of 100-150kb. Due to the trouble to separate plasmids in this range, a limitation endonuclease processing step is added to expand the unfair force of agarose gel electrophoresis. At present, this technique is fundamentally utilized for staphylococcal secludes, which regularly convey different plasmids and for chose types of Enterobacteriacea, which frequently have extensive unmistakable plasmids 11.
Random amplified polymorphic DNA (RAPD)
This strategy depends on self-assertive intensification of polymorphic DNA groupings. Enhancement is completed utilizing single or different, non-particular preliminaries whose successions are arbitrary and not intended to be reciprocal to a specific site in the chromosome. These preliminaries tie at different 'best-fit' groupings on the denatured DNA under low stringency conditions and stretch out productively to give short amplicons. In consequent cycling, conditions are made more stringent so preparation keeps on binding to best-fit successions and create results of settled lengths. Their (items) electrophoresis and recoloring produces the unique mark. RAPD has the fundamental preferred standpoint that no earlier grouping data is required. Additionally, the whole genomic succession is investigated for correlation. Since the preparation are not coordinated against a specific hereditary locus, a few preparing occasions can come about because of varieties in trial conditions, making thorough institutionalization of the technique basic. The significant detriment of this strategy is absence of between research facility reproducibility. A little change in convention, preparation, polymerase or DNA extraction may give distinctive outcomes.
RAPD has been utilized for writing of various microscopic organisms utilizing 10-mer preparation (oligonucleotides comprising of 10 nucleotides). It was completed for Campylobacter coli and C. jejuni 12, Listeria monocytogenes 13, Staphylococcus haemolyticus 14, Vibrio vulnificus 15. In V. vulnificus writing, prejudicial force of RAPD was highlighted; a distinction in band examples was acquired amongst exemplified and non-embodied isogenic morphotypes. Another adaptation of RAPD is AP-PCR i.e. self-assertively prepared PCR in which PCR is completed with subjective preparation. Here, PCR is completed utilizing >20-mer preparation rather than 10-mer (RAPD). Different subtle elements of the technique stay comparative16-18. As of late, to advance unwavering quality and reproducibility of subjectively prepared PCR, different methods have been suggested by Tyler et al. (1997) 19.
Multilocus sequence typing (MLST)
MLST depends on the direct sequencing of ~500 nucleotides of various housekeeping qualities. The grouping of each of these quality sections is considered as a one of a kind allele, and dendrograms are built from the pair wise distinction in the multilocus allelic profiles by bunch examination. As this technique records the varieties that amass gradually, MLST is a reasonable strategy to concentrate long haul and worldwide the study of disease transmission or development of organisms. Likewise, MLST is appropriate for the development of worldwide databanks assessable to various research facilities for result examination and arrangement 20. As of late MLST has turned into a best quality level method for grouping of Neisseria meningitides 20. MLST has likewise been set up for Streptococcus pneumonia 21-22 and is in advance for Streptococcus pyogenes, Haemophilus influenzae and Campylobacter jejuni. As of late Cocolin et al. (2000) 23 have utilized a comparable method for recognizing 39 strains of Lactobacillus species confined from normally aged Italian frankfurters. A little section from 16S rRNA was increased through PCR. Tannock et al. (1999) 24 distinguished Lactobacillus secludes from gastrointestinal tract, silage and yogurt by opening up and sequencing spacer district in the vicinity of 23S rRNA qualities (The successions got were contrasted and the reference strains in databases, for example, Genbank and a likeness of at least 97.5% was considered to give ID). The 16S-23S intergenic spacer area sequencing has been utilized for recognizable proof of Clostridium difficile and Staphylococcus aureus 25. Albeit costly and work concentrated, none of the DNA fingerprinting procedure depicted above is as dependable or as reproducible as MLST. Once the cost and the trouble of the huge scale sequencing have been lessened by innovative improvements, MLST will turn into the technique for decision in numerous research centers far and wide.
Low-Molecular-Weight (LMW) RNA fingerprinting
A hereditary fingerprinting strategy that has been utilized for over 10 years is profiling of low-atomic weight (LMW) RNA (5S ribosomal RNA {rRNA}and exchange RNA {tRNA} 26. The method 26 is clear; add up to RNA is extricated from a natural specimen, and isolated by high-determination polyacrylamide gel electrophoresis. The division profiles of the 5S rRNA and tRNA (the 16S r RNA particles are too large to enter the gel) can be pictured by silver recoloring or via autoradiography if the RNA was radioactively named. Accordingly, the profiles are checked, and put away in an electronic database for correlation. LMW RNA profiling has been utilized to screen bacterial populace elements in an arrangement of freshwater mesocosms after expansion of non-indigenous microorganisms and culture medium 27. The approach was likewise used to explore the assorted qualities and movement of bacterial populaces in a stratified water segment of the focal Baltic Sea 28. (Höfle and Brettar, 1996). Bidle and Fletcher (1995) 29 utilized LMW RNA profiling to think about free-living and molecule related bacterial groups from various profundities and distinctive destinations in an estuary straight. Favorable position of the LMW RNA fingerprinting method is the nonappearance of an in vitro enhancement venture to deliver adequate material to be broke down, in light of the fact that such an intensification step may make mistakes 30. Another positive point is that individual groups can be sequenced 31 or profiles can be hybridized with particular tests to evaluate the personality of the group individuals. In any case, just constrained phylogenetic data can be acquired from the little 5S rRNA (max. 131 nucleotides) and tRNA (max. 96 nucleotides). Another frail point is the quick debasement of RNA, which may shape extra groups in the profiles making the translation of results troublesome.
Importance of Data Generated from Microbial Fingerprinting Methods
Information produced from MPMs is utilized to comprehend which microorganisms are available and how they are associated with their natural conditions. MPMs can likewise be utilized to track the general changes in the microbial group after some time or in light of remediation exercises. The subsequent fingerprints can be coupled to factual examination and different sorts of estimations. Tests after investigation are contrasted with reference groups, which are nearer to reference band are deciphered as being biologically comparable while that are far separated are translated as containing huge contrasts.
Conclusion
From the previous record, plainly in the most recent decade or something like that, few DNA-based fingerprinting strategies have been produced to help with the distinguishing proof and portrayal of the organisms. Despite the fact that the traditional phenotypic strategies like serotyping would keep on being utilized for quite a while to come, atomic procedures will be progressively utilized as a part without bounds. Additionally look into on the techniques of DNA fingerprinting strategies would uncover the pitfalls to which these are inclined and would absolutely be refined, making them more powerful and pertinent in the greater part of the world where research facilities are malpractice. A few of these techniques will then empower production of huge reference libraries or databases of the typed organisms for correlation, fast recognizable proof, portrayal and characterization of new disconnects over the world.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524193EnglishN2017February10HealthcareAttitude and Practices of early adults of Lucknow city about Heart diseases: A cross-sectional survey
English5863Dayal BhawanaEnglish Singh NeetuEnglishIntroduction: CVD is a leading cause of mortality in India of which majority of individuals are adults in the age group of 20-40 years. However because of less knowledge among people evident from various researches the attitude and practices associated with CVD is hampered.
Aim and objectives: A cross- sectional study was conducted to determine the level of attitude and practices on cardiovascular disease among early adults of age group 20-40 years.
Method/ study design: A total of 250 adults aged 20-40 years were included using purposive sampling excluding those who were illiterates and were CVD patients, personally questionnaires were filled for each individual.
Findings: Majority of respondents were female 143 (57.20%), the mean age of the participants was 27.42 ±6.7. Most of the people at present did not suffer from any morbidity condition with a percentage of 112 (44.80%), followed by those 87 (34.80%) who were seeking medical help for some or the other kind of illness. The mean score for attitude was 11.82±5.032, 37.6% score ranging from 0 to 19 and for practice, scores ranged from 3 to 15 (mean=8.93; SD=2.2; n=250), 87.60% (n=219) of the respondents scored in the poor practice range while 12.40% (n=31) followed fair practice. None of the respondents fell in the category of Good practice.
Conclusion: A continuous effort is needed to enhance the attitude by involving them into educational programmes and making them aware of the available CVD guidelines by the government. The primary focus lies on improving the attitude because adults are the most productive people and their energy might get wasted if their practices continue to hamper their health
EnglishCVD, Lifestyle, Risk factors, MorbidityIntroduction:
The world’s largest growing economy India is undergoing a rapid economic growth, coupled with demographic, cultural and lifestyle changes posing a serious concern of the health profile of India citizens. In India, CVD has been designated as the leading cause of mortality and morbidity, representing a total of 31% of all global deaths (WHO Fact sheet, 2015).
The majority of individuals lying in the age group of 20-69 years will encounter nearly half of the estimated deaths increasing to 24.8% which means losing more productive people too these diseases. Different studies on heart disease confirmed that most of the risk factors for heart disease starts to develop at young age (Berenson, 2009; Pencina et al., 2009;). Studies completed among university students showed that college students have enough risk factors for developing CVD (Hlaing et al., 2007; Spencer, 2002). Awareness towards the RFs as already mentioned stands of utmost importance and its management and continued practice have resulted in improved situation of individuals (Sarrafzadegan et al., 2009, Rani et al., 2012; Ramanath et al. (2012) Eastwood et al., 2013; Khosravi et al. 2010) such as bringing the SBP, DBP level to normal range, decreased cholesterol levels, smoking cessation, increased physical activity etc. The most important reason for the unawareness is the lack of knowledge which in return affects their attitude and practices, and pertaining to the fact that there is very little existing knowledge on CVD among both sexes and also that they identify CVD as a risk for their health in the coming future (Vanhecke at al., 2006) and also among those who have existing CVD (Celentano et al., 2004). So a person with a positive attitude will divert himself to change his behaviour to practice good things as the existing studies prove that there is significantly low proportion of people having good knowledge (Pandey and Khadka, (2012; Winham and johns (2011), Positive attitude (Bollu et al., 2015; Oguoma et al. 2014) and fair practice (Mittwali et al., 2013; Andsoy et al., 2015).
Methodology:
Design, sample and setting
Heart disease associated attitude and practices among early adults was conducted using a descriptive study. The criteria included in the study were 1) Selected individuals belonging to the age group of 20-40 years), 2) Literate individuals not diagnosed with CVD and a Lucknow citizen. The study was conducted in the city of Lucknow, participants were approached personally and permission was obtained from them by telling the gist of the study. Participants were recruited from university and houses. A purposive sample of 250 was recruited in the present study.
Data collection tools:
A set of questionnaire was developed with first part consisting of socio-demographic data. Part II consisted of 20 items tool each for attitude and practice. 3- point likert scale for attitude (agree, neutral and not agree) and (never. Seldom and always) for practice. The cronbach’s alpha for this questionnaire were .909 and .712 respectively. The scores were classified into 3 levels (Positive, Neutral and Negative Attitude) and (Good, Fair and poor practice) according to Bloom’s cut off point. Positive attitude and good practice: - Practice score that fell above 16 scores (above 80%), Neutral attitude and Fair practice: - Practice score that fell between 12-15 (60% - 79%) and Negative attitude and Poor practice: - Practice score that fell below 12 (0-59%). Reveres scoring was done was negative practice.
Data Analysis:
Data was analysed using SPSS (version 20), descriptive statistics was used to describe the study variables by reporting their frequencies and percentages. Data was analysed by reporting their means and SD and the level of attitude and practice score among early adults.
Results:
Socio- demographic characteristics:
The study results summarized in Table 1 reveals the socio- demographic characteristics of the respondents. The total numbers of respondents included in this study were two hundred and fifty (250) out of which 129 (51.60%) belonged to the age group of 20 to 25 years, 53 (21.20%) belonged to the age group of 25 to 30 years, 24 (9.60%) were from the age group of 30 to 35 years and 44 (17.60%) were found between the age group of 35 to 40 years. The mean age of the participants was 27.42 ±6.7.
The majority of the respondents were Hindu 219 (87.60%), Muslim being 30 (12%) and Christians being 1 (0.40%). Maximum number of respondents belonged to the general category 130 (52%) followed by SC being 79 (31.60%), OBC 32(12.80%) and ST 9 (3.60).
There were a total number of 143 (57.20%) female and 107 (42.80%) male respondents in which the majority of the participants were single 158 (63.20%), 90 (36.00%) were married and only 2 (0.80%) were divorced.
Most of the people at present did not suffer from any morbidity condition with a percentage of 112 (44.80%), followed by those 87 (34.80%) who were seeking medical help for some or the other kind of illness which includes certain severe conditions such as high cholesterol 12 (4.8%), arthritis 9(3.5%) , lower abdomen pain 7(2.8%), hypotension 8(3.2%) , dengue 3(1.2%), thyroid 3(1.2%), migraine 6(2.4%), hypothyroid 1(.4%), cervical 2(.8%), Tuberculosis 2(2.8%), paralysis 3(1.2%), gastric discomfort 4(1.6%), Urinary tract infection 4(1.6%), liver cancer 1(.4%), cyst 1(.4%), sinus 1(.4%), asthma 1(.4%), osteoporosis 2(.8%), kidney disorder 5(2%), liver failure 1(.4%), typhoid 1(.4%), hepatitis 1(.4%), fatty liver 1(.4%) and kidney stones 1(.4%) while conditions like weakness 9(3.5%), hand shake 2(.8%), fatigue 6(2.4%) , diarrhoea 1(.4%), heaviness1(.4%), anxiety 4(1.6%), fever 2(.8%), irregular periods 7(2.8%), obesity 5(2%), throat pain 4(1.6%), back pain 7(2.8%), depression 2(.8%), leg swelling 1(.4%) which involves less distress yet imperative care. Quite equal number of people was found from diabetes and hypertension with 9.20 % (23) and 10.00% (25) respectively. Only 2 (.80%) people were suffering from both diabetes and hypertension and 1 (.40%) from coronary heart disease. The percentage of professional and self-employed respondents was 16.40% and 18.40% with housewives and retired respondents being 3.20% and 9.60% only.
The CVD associated attitude score of the respondents was classified as positive, Neutral and negative with the highest negative mean score of 11.82±5.032, 37.6% score ranging from 0 to 19 as demonstrated in Figure 1 and figure 3.
Table 2 demonstrates the majority of attitude question were replied with a positive answer for personal attributes, however when asked about morbidity pattern associated CVD attitude such as keeping an holistic approach to treat CVD 47.20% showed a neutral attitude quite similar to the study conducted by (Oguoma et al.,2014).
Self Reported Practice on CVD:
The practice scores ranged from 3 to 15 (mean=8.93; SD=2.2; n=250)(Figure 2), 87.60% (n=219) of the respondents scored in the poor practice range while 12.40% (n=31) followed fair practice. None of the respondents fell in the category of Good practice.
Discussion:
The results summarise in table 2 illustrates that most of the respondents had a positive approach towards dietary pattern, 69.20% agreed that diet control can act as a central pillar for CVD management, while most of them had a neutral attitude in believing modified diets as a phenomena of change for “at risk” individuals. 72.40%individuals agreed of avoiding salt in their diet similar to the results found by (Bollu et al., 2015). Most respondents displayed quite a positive attitude for physical activity associated attitude such as 76.80% and 77.20% agreed that physical exercise and yoga along with meditation have a positive effect on CVD patients respectively more than the results obtained by (Bollu et al.,2015).
Study participants however had a less positive for smoking (50%), and excessive medication (34%) being the only reason for heart problems. But the intake of alcohol and tobacco being major a major risks for heart diseases was accepted by 65.60% and 59.60% respondents respectively
According to table no 3 for practice associated with CVD, In the “Never” component 208 (83.20%) respondents have never attended a single counselling related to CVD and almost half of the individuals have not adopted any strategy of wellness More than half of the respondents (62.40%) did not follow any primordial practices to delay the onset of heart diseases; while 41.20% always preferred to receive medicine treatment and very few (56.40%) reported getting their blood profile checked.
In the Dietary pattern section more than half (55.20%) of the subjects reported frequent consumption of fatty food more than 3times a week, and around 38.4% of them consuming more than 3 tsp spoon a day. Consumption of any modified diet in last one month was only reported by 8.00%.
Yoga or meditation was found to be practiced by only 14% respondents, and 37.20% experienced restlessness during walking or exercise. The practice of doing physical exercise or brisk walking regularly was found among 32.40% and 31.20% respectively mush less than the results reported by (Oguoma et al.,2014) of 64.9% indulging in any form of exercising.
The consumption of alcohol and smoking was seldom seeing among 40% and 45% respectively as compared to 86.3% people stated by (Mittwali et al., 2013). However 69% subjects did not accept of adopting any change after knowing the harmful effects of tobacco on health whilst only 3.20% people reported of consuming any anti- depressants or sleeping drugs.
Conclusion:
The percentage of Good score for attitude and practice among early adults were 27.2% and 21.2% respectively. The attitude among adults is negative because of which their practice suffers. A continuous effort is needed to enhance the attitude by involving them into educational programmes and making them aware of the available CVD guidelines by the government. The primary focus lies on improving the attitude because adults are the most productive people and their energy might get wasted if their practices continue to hamper their health.
Acknowledgement:
Special mention goes to the respondents who took time to complete this survey along Dr. Rakesh Pradhan Chief Medical Officer, BBAU Lucknow for providing all the needed help throughout the study. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Ethical clearance:
As the research is a descriptive one, no human blood or specimen was taken; only verbal communication was done for filing the questionnaire whilst keeping the names strictly private in the present study. Thus, the clearance was not needed for the present work and it went past the ethical committee approval.
Source of funding: N/A
Conflict of Interest: N/A
Englishhttp://ijcrr.com/abstract.php?article_id=100http://ijcrr.com/article_html.php?did=100
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