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Papers by Ashok Bhardwaj
Journal of Comprehensive Health
Village level inclusion of Accredited Social Health Activist (ASHA) for early diagnosis and treat... more Village level inclusion of Accredited Social Health Activist (ASHA) for early diagnosis and treatment of Tuberculosis (TB) expects increase in case detection. Study was done to assess the feasibility and performance of ASHA led active case finding (ACF) strategy for TB. In a health block with a total population of about 0.18 million, 88 out of 210 ASHAs, were incentivized to screen 44,589 individuals of more than 18 years of age for presumptive TB. A project staff, as a support to ASHA, was recruited for collection of sputum specimens for testing and communicating the results back to ASHAs. ACF identified 489 (1.1%) presumptive cases and 19 confirmed cases of sputum positive pulmonary TB with case detection rate of 0.42/100,000 population additional to already registered cases under RNTCP. Timely and appropriate incentives along with supportive supervision are critical steps for effective execution of desired deliverables ASHA for TB control.
BMJ Open
ObjectivesWe verified subnational (state/union territory (UT)/district) claims of achievements in... more ObjectivesWe verified subnational (state/union territory (UT)/district) claims of achievements in reducing tuberculosis (TB) incidence in 2020 compared with 2015, in India.DesignA community-based survey, analysis of programme data and anti-TB drug sales and utilisation data.SettingNational TB Elimination Program and private TB treatment settings in 73 districts that had filed a claim to the Central TB Division of India for progress towards TB-free status.ParticipantsEach district was divided into survey units (SU) and one village/ward was randomly selected from each SU. All household members in the selected village were interviewed. Sputum from participants with a history of anti-TB therapy (ATT), those currently experiencing chest symptoms or on ATT were tested using Xpert/Rif/TrueNat. The survey continued until 30 Mycobacterium tuberculosis cases were identified in a district.Outcome measuresWe calculated a direct estimate of TB incidence based on incident cases identified in the ...
Indian Journal of Community Health, 2021
It was 30th January 2020 when India reported its first COVID 19 in Kerala. Soon, the pandemic of ... more It was 30th January 2020 when India reported its first COVID 19 in Kerala. Soon, the pandemic of SARS-CoV-2 was inevitably knocking at the doors of the small hilly state of Himachal Pradesh (HP). On 20th March 2020, HP reported its first two cases of SARS-CoV-2 in Kangra district. Since then, although the COVID-19 pandemic was ensuing in the state, the epidemic was well contained due to the extensive collective efforts of the health department and other stakeholders. COVID 19 pandemic has emerged as a significant barrier, hampering all the regular activities and impacting all spheres of life. Particularly in HP, health care services were predominantly delivered through government services across the state. As program managers, post-graduates of Community Medicine are the critical stakeholders of health care delivery at the peripheral level and integral implementers of Flu-Clinic, Contact Tracing, Surveillance and field survey teams. Ensuing pandemic enforces the need for the early ...
Indian Journal of Health Sciences and Biomedical Research (KLEU), 2022
BACKGROUND: Neurological disorders are being recognized as a part of epidemiological transition w... more BACKGROUND: Neurological disorders are being recognized as a part of epidemiological transition worldwide. The much-needed database on neurological diseases in India is lacking. OBJECTIVE: The objective of this study was to estimate the prevalence of major neurological disorders in tribal population of Himachal Pradesh. METHODOLOGY: A community-based survey was conducted in two tribal districts and two tribal blocks of one district of Himachal Pradesh, India. A cluster-randomized sampling technique was used to study a population of 10,000 between 2017 and 2018. Forty clusters were identified in three districts. The study was conducted in two phases in individuals above 7 years of age. The individuals screened positive in stage 1 (using the National Institute of Mental Health and Neurosciences protocol for assessing neurological disorders) were examined by clinical team in stage 2 and classified. RESULTS: A total of 8255 individuals reported for phase two of the study (response rate of 82.55%). The crude prevalence of neurological disorders in the tribal population was 3.04% after clinical assessment in stage 2. Migraine (1.9%) was the most common disorder followed by stroke (0.47%). CONCLUSION: The prevalence of neurological disorders in tribal populations is comparable to the general population. This is an indicator of lifestyle diseases entering into the indigenous population and demands neurological health care tailored in primary health care.
The Indian journal of medical research, 2013
There are no active surveillance studies reported from South East Asian Region to document the im... more There are no active surveillance studies reported from South East Asian Region to document the impact of change in socio-economic state on the prevalence of rheumatic fever/rheumatic heart disease (RF/RHD) in children. Therefore, we conducted a study to determine the epidemiological trends of RF/RHD in school children of Shimla city and adjoining suburbs in north India and its association with change in socio-economic status. Active surveillance studies were conducted in 2007-2008 in urban and rural areas of Shimla, and 15145 school children, aged 5-15 yr were included and identical screening methodology as used in earlier similar survey conducted in 1992-1993 was used. The study samples were selected from schools of Shimla city and adjoining rural areas by multistage stratified cluster sampling method in both survey studies. After a relevant history and clinical examination by trained doctor, echocardiographic evaluation of suspected cases was done. An updated Jones (1992) criterio...
Journal of Indian Speech Language & Hearing Association
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Climate change is expected to alter the geographic and seasonal distributions of exist... more BACKGROUND Climate change is expected to alter the geographic and seasonal distributions of existing vectors and vector-borne diseases. Febrile illness is the most common presentation of these diseases and a public health problem affecting most of the people in developing world along with the prevailing burden of other communicable diseases. Aims and Objectives-To study the seasonal trend analysis (2013-15) of fever cases admitted in a tertiary centre of Himachal Pradesh. MATERIALS AND METHODS A retrospective descriptive record-based analysis of fever cases admitted in medicine and paediatrics ward from 2013-15 of Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, H.P. RESULTS Among febrile illnesses, fever of unknown origin is the leading cause of illness in all the three years. There is a resurgence of scrub typhus infection with increasing trend of cases in monsoon and post-monsoon season. Fever with neurological involvement was also recorded among young and productive age group in winter season with an upward trend. CONCLUSION There are only a limited number of studies from India reporting on the aetiology of fever and reliable surveillance data are not available; hence, a better insight in the epidemiology of febrile diseases will be helpful in order to target clinical work-up and treatment.
BACKGROUND Human-centered dietary decision support systems are fundamental to diabetes management... more BACKGROUND Human-centered dietary decision support systems are fundamental to diabetes management, and they address limitations of existing diet management systems. OBJECTIVE The objective of the proposed study is to evaluate the use of an interactive telephone-linked Personalized Human Centered Decision Support System for facilitating the delivery of personalized nutrition care for diabetic patients METHODS A Quasi-experimental trial was conducted between the period of June and December, 2018. Study participants were recruited from: Community Health Center, Dharamshala, Kangra (urban population); and Model Rural Health Unit, Haroli Block, Una (rural population). Eligible participants included: adults aged 30 years and above; having both controlled and uncontrolled diabetes; agreeing to participate in the study; available for follow-up interview; and having telephone or computer at home. Diabetic status assessed by physician diagnosis. Individuals with mental or physical challenges ...
Indian Journal of Tuberculosis
Tuberculosis (TB) recurrence observed to be an important event in its treatment and has future im... more Tuberculosis (TB) recurrence observed to be an important event in its treatment and has future implications under national TB control efforts. The present study was carried out to assess the recurrence rate along with its risk factors among patients undergoing treatment for TB under Revised National TB Control Program (RNTCP). Total 204 patients in health block of district Una, Himachal Pradesh were studied using pretested structured interviewer-administered questionnaire. Along with univariate a non-hierarchal multi-way frequency analysis (MFA) was done to study the one and multi-way effects between the discrete variables included in a hypothesized model. The variables were under-nutrition, pulmonary TB, injecting drug use (IDU), multi-drug resistant (MDR) TB, and past TB (recurrent cases). Total 29 cases (14.2%) had recurrence (17.7/100,000 population) with significantly high fraction for alternate residence (Recurrent: 50.0%, Non-recurrent: 47.4%; p = 0.001), Multi-drug resistance (MDR) TB (Recurrent: 13.8%, Non-recurrent: 2.3%; p = 0.003), and sputum negative patients (Recurrent: 51.7%, Non-recurrent: 14.5%; p = 0.000). Non-recurrent cases had significantly high fraction for sputum positive cases (Recurrent: 48.3%, Non-recurrent: 72.1%; p = 0.011), and extra-pulmonary TB (Recurrent: 00.0%, Non-recurrent: 13.4%; p = 0.036). MFA observed all significant one-way effects. Significant two-way effects were IDU and pulmonary TB (p = 0.001), MDR and past TB (p = 0.004), IDU and past TB (p = 0.019), and IDU and MDR-TB (p = 0.039). Proportion of TB recurrence was expected with a significant difference between the history of change of residence, MDR-TB, pulmonary and extra-pulmonary nature of the disease. Hypothesized model observed with a significant association of IDU, pulmonary TB, MDR-TB and past TB.
Indian journal of public health
Limited availability of randomized control trial warranted the conduct of a present study to demo... more Limited availability of randomized control trial warranted the conduct of a present study to demonstrate the effectiveness of mobile phone-based short message services (SMSs) on reduction in mean fasting blood glucose (FBG) in patients with type-2 diabetes mellitus. A total of 955 patients were recruited from primary and secondary health-care facilities and randomized to intervention (479) and control (476) group. Messages were delivered to patients for 12 months tailoring to their recent FBG values. SMS included information to maintain the desired FBG levels and next due date for FBG assessment. Patients were statistically similar for their age, socioeconomic status, smoking, and alcohol use. After the intervention, an average FBG declined from 163.7 to 152.8 mg/dl (P = 0.019) in intervention and from 150.5 to 149.2 mg/dl (P = 0.859) in control group. Adjusted for the baseline FBG, the intervention was found to be significantly effective (odds ratio: 1.7; 95 confidence interval: 1....
Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine
Unprecedented low coverage (63%) of fully vaccinated (FV) children in the recent round of nationa... more Unprecedented low coverage (63%) of fully vaccinated (FV) children in the recent round of national survey district level household (HH) and facility survey 4 (DLHS-4) propelled health system of Himachal Pradesh for an independent rapid assessment of FV coverage. The aim of the study was to assess the FV coverage among 12-23-month old children in the state. A community-based survey with an interviewer-administered questionnaire was carried out in all 12 districts of Himachal Pradesh from September 2015 to January 2016. WHO 30 × 7 cluster technique was used. Chi-square and unpaired Student's t-test along with 95% confidence intervals. A total of 2492 children across 35,551 HHs (2.4% of state share) were surveyed with FV coverage of 98.1% (95% confidence interval [CI]: 97.5-98.6) and 86% (95% CI: 84.6-87.3) based on history and card, respectively. The reported FV coverage in the current study was observed too high in the state as reported in earlier round of the national surveys (e...
Journal of Evolution of Medical and Dental Sciences
BACKGROUND This interim analysis of an ongoing project aims to study the association of fluoride ... more BACKGROUND This interim analysis of an ongoing project aims to study the association of fluoride levels with dental fluorosis and intelligence among children of 10-14 years of age in study area. MATERIALS AND METHODS The study was conducted in randomly selected 15 government high schools of District Una, Himachal Pradesh. The analysis of seven schools is being discussed with a sample size of 270. Dean's Fluorosis index was used to study fluorosis level and Intelligence test was conducted on students by using Raven's standard progressive matrices questionnaire. Study Duration-Nine months. RESULTS Dental fluorosis was observed among 11.5% of students. It was higher among females (12.4%) as compared to males (10.6%). The intelligence level assessment of student showed that all of them were in the range of above average; about 83.3% of students were having grade III (Average) level of intelligence. CONCLUSION As the fluorosis level increased, the proportion of children with lower intelligence increased. Based on the findings, the chronic exposure to high levels of fluoride can be one of the factors that influence intellectual development.
International Journal Of Community Medicine And Public Health
Background: One of the major risk factor for tuberculosis (TB) includes working in close proximit... more Background: One of the major risk factor for tuberculosis (TB) includes working in close proximity to the patients. Recent evidence suggests that nursing professionals are vulnerable to tuberculosis not only because of elevated exposure, but also because of misinformation and lack of updated data regarding knowledge about the disease. Our study aimed to gather knowledge and health care practices related to TB amongst nurses in a medical college and that of a peripheral health care unit. The objectives of the study were to compare the level of knowledge regarding tuberculosis and practices related to it in nursing staff of a Medical College and nursing staff working at peripheral health care unit.Methods: This cross-sectional study was conducted in a rural medical college and a training centre for health professionals of Himachal Pradesh over a period of 3 months (w.e.f. October–December, 2014). A total of randomly selected staff nurses of medical college and nurses working at differ...
Indian Journal of Tuberculosis
Various factors affect plasma concentrations of antitubercular drugs in different populations so ... more Various factors affect plasma concentrations of antitubercular drugs in different populations so dosing schedule should be adjusted after therapeutic drug monitoring. To study variability in plasma concentrations of Rifampicin and Pyrazinamide with pre and post-meal administration of drugs in tuberculosis patients. 52 patients of pulmonary tuberculosis, divided in to two groups, pre and post-meal through systemic randomization. After taking pre-dose sample, drugs were administered according to the group. Samples were withdrawn at 2, 4, 6, and 10h after drug administration. Analysis of samples was done using HPLC. Mean±1SD of Cmax of Rifampicin was 7.75±2.82μg/ml, mean±1SD of AUC0-10 was 42.17±17.25μgh/ml, adjusted Tmax was 4.25h. In pre-meal samples, the corresponding values were 7.75±2.88μg/ml, 42.83±18.47μgh/ml, 3.76h and in post-meal samples 8.03±2.30μg/ml, 41.56±16.46μgh/ml and 4.75h. Mean±1SD of Cmax levels of Pyrazinamide was 54.49±21.86μg/ml, mean±1SD of AUC0-10 was 337.94±124.28μgh/ml and adjusted Tmax was 3.49h. In pre-meal samples the corresponding values were 52.00±19.13μg/ml, 329.96±112.11μgh/ml, 3.23h, and in post-meal samples 57.43±23.61μg/ml, 345.58±136.99μgh/ml, 3.54h. There is huge variability in the plasma levels of Rifampicin and Pyrazinamide in population of this sub-himalayan region.
Journal of neurosciences in rural practice
Studies on autism spectrum disorders (ASDs) have largely focused on children in specific settings... more Studies on autism spectrum disorders (ASDs) have largely focused on children in specific settings. The current scenario of research in ASDs is limited largely to clinic-based case reports, case series, and retrospective chart reviews. The present study is the first population-based prevalence study conducted across rural, urban, and tribal populations in India. A cross-sectional two-phase study was conducted covering children in the age group of 1-10 years of age across geographical regions representing rural, urban, and tribal populations. The first phase (screening phase) involved administration of the Hindi version of the Indian Scale for Assessment of Autism. Those identified as suspected of ASD and 10% of all classified as nonsuspects for autism were also evaluated by the clinical team in second phase (evaluation phase). Forty-three children out of a total of 28,070 children in rural, urban, and tribal area in the age group of 1-10 years were diagnosed as cases of ASD yielding ...
Indian journal of public health
The existence of an endemic goiter belt along the southern slopes of the Himalayas has been known... more The existence of an endemic goiter belt along the southern slopes of the Himalayas has been known for a long time. Prevalence of neonatal hypothyroidism is high and there has been little work on the prevalence of mental retardation in this part of India. The study was conducted with the aim to know the prevalence of mental retardation in the urban and rural populations of Himachal Pradesh, India and to generate a hypothesis on the differential distribution (geographical) of mental retardation. This cross-sectional study was conducted in the rural and urban areas of the district of Kangra, Himachal Pradesh, India among children of 1-10 years of age. In the first phase, the children in the age group of 1-10 years were screened for mental retardation using the Ten Questions Screen, whereas in the second phase the suspects were evaluated clinically. The prevalence of mental retardation was found to be 1.71% in the study population with higher prevalence (3.3%) in the 73-120 months age g...
Journal of neurosciences in rural practice
Mental retardation is one of the most common disabilities of childhood. The research on childhood... more Mental retardation is one of the most common disabilities of childhood. The research on childhood malnutrition and its relationship with cognitive functioning suggests that malnutrition alone does not cause mental retardation. To identify the relation between malnutrition and cognition among children from a Sub-Himalayan state in North India. A two-phase cross-sectional study was conducted in the rural, urban, and slum area of district Kangra. A 30-cluster sampling technique was used to screen a population of children 1-10 years of age from five randomly selected panchayats (village government units) of district Kangra. The screening was based on a modified version of the ten questions screen, adapted to the local population. In the first phase, a door-to-door survey was done to identify suspects of mental retardation. In the second phase, the children found positive in the first phase were called for clinical examination to confirm mental retardation. Anthropometric assessment of a...
Base de dados : WHOLIS. Pesquisa : 49177 [Identificador único]. Referências encontradas : 1 [refi... more Base de dados : WHOLIS. Pesquisa : 49177 [Identificador único]. Referências encontradas : 1 [refinar]. Mostrando: 1 .. 1 no formato [Detalhado]. página 1 de 1, 1 / 1, WHOLIS, seleciona. para imprimir. Fotocópia. Id: 49177. Autor: Bhardwaj ...
Base de dados : WHOLIS. Pesquisa : 43139 [Identificador único]. Referências encontradas : 1 [refi... more Base de dados : WHOLIS. Pesquisa : 43139 [Identificador único]. Referências encontradas : 1 [refinar]. Mostrando: 1 .. 1 no formato [Detalhado]. página 1 de 1, 1 / 1, WHOLIS, seleciona. para imprimir. Fotocópia. Id: 43139. Autor: Bhardwaj ...
Journal of Comprehensive Health
Village level inclusion of Accredited Social Health Activist (ASHA) for early diagnosis and treat... more Village level inclusion of Accredited Social Health Activist (ASHA) for early diagnosis and treatment of Tuberculosis (TB) expects increase in case detection. Study was done to assess the feasibility and performance of ASHA led active case finding (ACF) strategy for TB. In a health block with a total population of about 0.18 million, 88 out of 210 ASHAs, were incentivized to screen 44,589 individuals of more than 18 years of age for presumptive TB. A project staff, as a support to ASHA, was recruited for collection of sputum specimens for testing and communicating the results back to ASHAs. ACF identified 489 (1.1%) presumptive cases and 19 confirmed cases of sputum positive pulmonary TB with case detection rate of 0.42/100,000 population additional to already registered cases under RNTCP. Timely and appropriate incentives along with supportive supervision are critical steps for effective execution of desired deliverables ASHA for TB control.
BMJ Open
ObjectivesWe verified subnational (state/union territory (UT)/district) claims of achievements in... more ObjectivesWe verified subnational (state/union territory (UT)/district) claims of achievements in reducing tuberculosis (TB) incidence in 2020 compared with 2015, in India.DesignA community-based survey, analysis of programme data and anti-TB drug sales and utilisation data.SettingNational TB Elimination Program and private TB treatment settings in 73 districts that had filed a claim to the Central TB Division of India for progress towards TB-free status.ParticipantsEach district was divided into survey units (SU) and one village/ward was randomly selected from each SU. All household members in the selected village were interviewed. Sputum from participants with a history of anti-TB therapy (ATT), those currently experiencing chest symptoms or on ATT were tested using Xpert/Rif/TrueNat. The survey continued until 30 Mycobacterium tuberculosis cases were identified in a district.Outcome measuresWe calculated a direct estimate of TB incidence based on incident cases identified in the ...
Indian Journal of Community Health, 2021
It was 30th January 2020 when India reported its first COVID 19 in Kerala. Soon, the pandemic of ... more It was 30th January 2020 when India reported its first COVID 19 in Kerala. Soon, the pandemic of SARS-CoV-2 was inevitably knocking at the doors of the small hilly state of Himachal Pradesh (HP). On 20th March 2020, HP reported its first two cases of SARS-CoV-2 in Kangra district. Since then, although the COVID-19 pandemic was ensuing in the state, the epidemic was well contained due to the extensive collective efforts of the health department and other stakeholders. COVID 19 pandemic has emerged as a significant barrier, hampering all the regular activities and impacting all spheres of life. Particularly in HP, health care services were predominantly delivered through government services across the state. As program managers, post-graduates of Community Medicine are the critical stakeholders of health care delivery at the peripheral level and integral implementers of Flu-Clinic, Contact Tracing, Surveillance and field survey teams. Ensuing pandemic enforces the need for the early ...
Indian Journal of Health Sciences and Biomedical Research (KLEU), 2022
BACKGROUND: Neurological disorders are being recognized as a part of epidemiological transition w... more BACKGROUND: Neurological disorders are being recognized as a part of epidemiological transition worldwide. The much-needed database on neurological diseases in India is lacking. OBJECTIVE: The objective of this study was to estimate the prevalence of major neurological disorders in tribal population of Himachal Pradesh. METHODOLOGY: A community-based survey was conducted in two tribal districts and two tribal blocks of one district of Himachal Pradesh, India. A cluster-randomized sampling technique was used to study a population of 10,000 between 2017 and 2018. Forty clusters were identified in three districts. The study was conducted in two phases in individuals above 7 years of age. The individuals screened positive in stage 1 (using the National Institute of Mental Health and Neurosciences protocol for assessing neurological disorders) were examined by clinical team in stage 2 and classified. RESULTS: A total of 8255 individuals reported for phase two of the study (response rate of 82.55%). The crude prevalence of neurological disorders in the tribal population was 3.04% after clinical assessment in stage 2. Migraine (1.9%) was the most common disorder followed by stroke (0.47%). CONCLUSION: The prevalence of neurological disorders in tribal populations is comparable to the general population. This is an indicator of lifestyle diseases entering into the indigenous population and demands neurological health care tailored in primary health care.
The Indian journal of medical research, 2013
There are no active surveillance studies reported from South East Asian Region to document the im... more There are no active surveillance studies reported from South East Asian Region to document the impact of change in socio-economic state on the prevalence of rheumatic fever/rheumatic heart disease (RF/RHD) in children. Therefore, we conducted a study to determine the epidemiological trends of RF/RHD in school children of Shimla city and adjoining suburbs in north India and its association with change in socio-economic status. Active surveillance studies were conducted in 2007-2008 in urban and rural areas of Shimla, and 15145 school children, aged 5-15 yr were included and identical screening methodology as used in earlier similar survey conducted in 1992-1993 was used. The study samples were selected from schools of Shimla city and adjoining rural areas by multistage stratified cluster sampling method in both survey studies. After a relevant history and clinical examination by trained doctor, echocardiographic evaluation of suspected cases was done. An updated Jones (1992) criterio...
Journal of Indian Speech Language & Hearing Association
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Climate change is expected to alter the geographic and seasonal distributions of exist... more BACKGROUND Climate change is expected to alter the geographic and seasonal distributions of existing vectors and vector-borne diseases. Febrile illness is the most common presentation of these diseases and a public health problem affecting most of the people in developing world along with the prevailing burden of other communicable diseases. Aims and Objectives-To study the seasonal trend analysis (2013-15) of fever cases admitted in a tertiary centre of Himachal Pradesh. MATERIALS AND METHODS A retrospective descriptive record-based analysis of fever cases admitted in medicine and paediatrics ward from 2013-15 of Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, H.P. RESULTS Among febrile illnesses, fever of unknown origin is the leading cause of illness in all the three years. There is a resurgence of scrub typhus infection with increasing trend of cases in monsoon and post-monsoon season. Fever with neurological involvement was also recorded among young and productive age group in winter season with an upward trend. CONCLUSION There are only a limited number of studies from India reporting on the aetiology of fever and reliable surveillance data are not available; hence, a better insight in the epidemiology of febrile diseases will be helpful in order to target clinical work-up and treatment.
BACKGROUND Human-centered dietary decision support systems are fundamental to diabetes management... more BACKGROUND Human-centered dietary decision support systems are fundamental to diabetes management, and they address limitations of existing diet management systems. OBJECTIVE The objective of the proposed study is to evaluate the use of an interactive telephone-linked Personalized Human Centered Decision Support System for facilitating the delivery of personalized nutrition care for diabetic patients METHODS A Quasi-experimental trial was conducted between the period of June and December, 2018. Study participants were recruited from: Community Health Center, Dharamshala, Kangra (urban population); and Model Rural Health Unit, Haroli Block, Una (rural population). Eligible participants included: adults aged 30 years and above; having both controlled and uncontrolled diabetes; agreeing to participate in the study; available for follow-up interview; and having telephone or computer at home. Diabetic status assessed by physician diagnosis. Individuals with mental or physical challenges ...
Indian Journal of Tuberculosis
Tuberculosis (TB) recurrence observed to be an important event in its treatment and has future im... more Tuberculosis (TB) recurrence observed to be an important event in its treatment and has future implications under national TB control efforts. The present study was carried out to assess the recurrence rate along with its risk factors among patients undergoing treatment for TB under Revised National TB Control Program (RNTCP). Total 204 patients in health block of district Una, Himachal Pradesh were studied using pretested structured interviewer-administered questionnaire. Along with univariate a non-hierarchal multi-way frequency analysis (MFA) was done to study the one and multi-way effects between the discrete variables included in a hypothesized model. The variables were under-nutrition, pulmonary TB, injecting drug use (IDU), multi-drug resistant (MDR) TB, and past TB (recurrent cases). Total 29 cases (14.2%) had recurrence (17.7/100,000 population) with significantly high fraction for alternate residence (Recurrent: 50.0%, Non-recurrent: 47.4%; p = 0.001), Multi-drug resistance (MDR) TB (Recurrent: 13.8%, Non-recurrent: 2.3%; p = 0.003), and sputum negative patients (Recurrent: 51.7%, Non-recurrent: 14.5%; p = 0.000). Non-recurrent cases had significantly high fraction for sputum positive cases (Recurrent: 48.3%, Non-recurrent: 72.1%; p = 0.011), and extra-pulmonary TB (Recurrent: 00.0%, Non-recurrent: 13.4%; p = 0.036). MFA observed all significant one-way effects. Significant two-way effects were IDU and pulmonary TB (p = 0.001), MDR and past TB (p = 0.004), IDU and past TB (p = 0.019), and IDU and MDR-TB (p = 0.039). Proportion of TB recurrence was expected with a significant difference between the history of change of residence, MDR-TB, pulmonary and extra-pulmonary nature of the disease. Hypothesized model observed with a significant association of IDU, pulmonary TB, MDR-TB and past TB.
Indian journal of public health
Limited availability of randomized control trial warranted the conduct of a present study to demo... more Limited availability of randomized control trial warranted the conduct of a present study to demonstrate the effectiveness of mobile phone-based short message services (SMSs) on reduction in mean fasting blood glucose (FBG) in patients with type-2 diabetes mellitus. A total of 955 patients were recruited from primary and secondary health-care facilities and randomized to intervention (479) and control (476) group. Messages were delivered to patients for 12 months tailoring to their recent FBG values. SMS included information to maintain the desired FBG levels and next due date for FBG assessment. Patients were statistically similar for their age, socioeconomic status, smoking, and alcohol use. After the intervention, an average FBG declined from 163.7 to 152.8 mg/dl (P = 0.019) in intervention and from 150.5 to 149.2 mg/dl (P = 0.859) in control group. Adjusted for the baseline FBG, the intervention was found to be significantly effective (odds ratio: 1.7; 95 confidence interval: 1....
Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine
Unprecedented low coverage (63%) of fully vaccinated (FV) children in the recent round of nationa... more Unprecedented low coverage (63%) of fully vaccinated (FV) children in the recent round of national survey district level household (HH) and facility survey 4 (DLHS-4) propelled health system of Himachal Pradesh for an independent rapid assessment of FV coverage. The aim of the study was to assess the FV coverage among 12-23-month old children in the state. A community-based survey with an interviewer-administered questionnaire was carried out in all 12 districts of Himachal Pradesh from September 2015 to January 2016. WHO 30 × 7 cluster technique was used. Chi-square and unpaired Student's t-test along with 95% confidence intervals. A total of 2492 children across 35,551 HHs (2.4% of state share) were surveyed with FV coverage of 98.1% (95% confidence interval [CI]: 97.5-98.6) and 86% (95% CI: 84.6-87.3) based on history and card, respectively. The reported FV coverage in the current study was observed too high in the state as reported in earlier round of the national surveys (e...
Journal of Evolution of Medical and Dental Sciences
BACKGROUND This interim analysis of an ongoing project aims to study the association of fluoride ... more BACKGROUND This interim analysis of an ongoing project aims to study the association of fluoride levels with dental fluorosis and intelligence among children of 10-14 years of age in study area. MATERIALS AND METHODS The study was conducted in randomly selected 15 government high schools of District Una, Himachal Pradesh. The analysis of seven schools is being discussed with a sample size of 270. Dean's Fluorosis index was used to study fluorosis level and Intelligence test was conducted on students by using Raven's standard progressive matrices questionnaire. Study Duration-Nine months. RESULTS Dental fluorosis was observed among 11.5% of students. It was higher among females (12.4%) as compared to males (10.6%). The intelligence level assessment of student showed that all of them were in the range of above average; about 83.3% of students were having grade III (Average) level of intelligence. CONCLUSION As the fluorosis level increased, the proportion of children with lower intelligence increased. Based on the findings, the chronic exposure to high levels of fluoride can be one of the factors that influence intellectual development.
International Journal Of Community Medicine And Public Health
Background: One of the major risk factor for tuberculosis (TB) includes working in close proximit... more Background: One of the major risk factor for tuberculosis (TB) includes working in close proximity to the patients. Recent evidence suggests that nursing professionals are vulnerable to tuberculosis not only because of elevated exposure, but also because of misinformation and lack of updated data regarding knowledge about the disease. Our study aimed to gather knowledge and health care practices related to TB amongst nurses in a medical college and that of a peripheral health care unit. The objectives of the study were to compare the level of knowledge regarding tuberculosis and practices related to it in nursing staff of a Medical College and nursing staff working at peripheral health care unit.Methods: This cross-sectional study was conducted in a rural medical college and a training centre for health professionals of Himachal Pradesh over a period of 3 months (w.e.f. October–December, 2014). A total of randomly selected staff nurses of medical college and nurses working at differ...
Indian Journal of Tuberculosis
Various factors affect plasma concentrations of antitubercular drugs in different populations so ... more Various factors affect plasma concentrations of antitubercular drugs in different populations so dosing schedule should be adjusted after therapeutic drug monitoring. To study variability in plasma concentrations of Rifampicin and Pyrazinamide with pre and post-meal administration of drugs in tuberculosis patients. 52 patients of pulmonary tuberculosis, divided in to two groups, pre and post-meal through systemic randomization. After taking pre-dose sample, drugs were administered according to the group. Samples were withdrawn at 2, 4, 6, and 10h after drug administration. Analysis of samples was done using HPLC. Mean±1SD of Cmax of Rifampicin was 7.75±2.82μg/ml, mean±1SD of AUC0-10 was 42.17±17.25μgh/ml, adjusted Tmax was 4.25h. In pre-meal samples, the corresponding values were 7.75±2.88μg/ml, 42.83±18.47μgh/ml, 3.76h and in post-meal samples 8.03±2.30μg/ml, 41.56±16.46μgh/ml and 4.75h. Mean±1SD of Cmax levels of Pyrazinamide was 54.49±21.86μg/ml, mean±1SD of AUC0-10 was 337.94±124.28μgh/ml and adjusted Tmax was 3.49h. In pre-meal samples the corresponding values were 52.00±19.13μg/ml, 329.96±112.11μgh/ml, 3.23h, and in post-meal samples 57.43±23.61μg/ml, 345.58±136.99μgh/ml, 3.54h. There is huge variability in the plasma levels of Rifampicin and Pyrazinamide in population of this sub-himalayan region.
Journal of neurosciences in rural practice
Studies on autism spectrum disorders (ASDs) have largely focused on children in specific settings... more Studies on autism spectrum disorders (ASDs) have largely focused on children in specific settings. The current scenario of research in ASDs is limited largely to clinic-based case reports, case series, and retrospective chart reviews. The present study is the first population-based prevalence study conducted across rural, urban, and tribal populations in India. A cross-sectional two-phase study was conducted covering children in the age group of 1-10 years of age across geographical regions representing rural, urban, and tribal populations. The first phase (screening phase) involved administration of the Hindi version of the Indian Scale for Assessment of Autism. Those identified as suspected of ASD and 10% of all classified as nonsuspects for autism were also evaluated by the clinical team in second phase (evaluation phase). Forty-three children out of a total of 28,070 children in rural, urban, and tribal area in the age group of 1-10 years were diagnosed as cases of ASD yielding ...
Indian journal of public health
The existence of an endemic goiter belt along the southern slopes of the Himalayas has been known... more The existence of an endemic goiter belt along the southern slopes of the Himalayas has been known for a long time. Prevalence of neonatal hypothyroidism is high and there has been little work on the prevalence of mental retardation in this part of India. The study was conducted with the aim to know the prevalence of mental retardation in the urban and rural populations of Himachal Pradesh, India and to generate a hypothesis on the differential distribution (geographical) of mental retardation. This cross-sectional study was conducted in the rural and urban areas of the district of Kangra, Himachal Pradesh, India among children of 1-10 years of age. In the first phase, the children in the age group of 1-10 years were screened for mental retardation using the Ten Questions Screen, whereas in the second phase the suspects were evaluated clinically. The prevalence of mental retardation was found to be 1.71% in the study population with higher prevalence (3.3%) in the 73-120 months age g...
Journal of neurosciences in rural practice
Mental retardation is one of the most common disabilities of childhood. The research on childhood... more Mental retardation is one of the most common disabilities of childhood. The research on childhood malnutrition and its relationship with cognitive functioning suggests that malnutrition alone does not cause mental retardation. To identify the relation between malnutrition and cognition among children from a Sub-Himalayan state in North India. A two-phase cross-sectional study was conducted in the rural, urban, and slum area of district Kangra. A 30-cluster sampling technique was used to screen a population of children 1-10 years of age from five randomly selected panchayats (village government units) of district Kangra. The screening was based on a modified version of the ten questions screen, adapted to the local population. In the first phase, a door-to-door survey was done to identify suspects of mental retardation. In the second phase, the children found positive in the first phase were called for clinical examination to confirm mental retardation. Anthropometric assessment of a...
Base de dados : WHOLIS. Pesquisa : 49177 [Identificador único]. Referências encontradas : 1 [refi... more Base de dados : WHOLIS. Pesquisa : 49177 [Identificador único]. Referências encontradas : 1 [refinar]. Mostrando: 1 .. 1 no formato [Detalhado]. página 1 de 1, 1 / 1, WHOLIS, seleciona. para imprimir. Fotocópia. Id: 49177. Autor: Bhardwaj ...
Base de dados : WHOLIS. Pesquisa : 43139 [Identificador único]. Referências encontradas : 1 [refi... more Base de dados : WHOLIS. Pesquisa : 43139 [Identificador único]. Referências encontradas : 1 [refinar]. Mostrando: 1 .. 1 no formato [Detalhado]. página 1 de 1, 1 / 1, WHOLIS, seleciona. para imprimir. Fotocópia. Id: 43139. Autor: Bhardwaj ...